#852 That Blows

Tim has type 1 diabetes.

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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 852 of the Juicebox Podcast

Tim is a type one he's been living with type one diabetes for quite some time. He's an adult. This is his story. I enjoyed it. I think you will too. I'm almost down to just not doing these opens for you. I don't know what to say about this episode. It's great, really great conversation with him. You know what I mean? He has type one diabetes is an adult, I don't know what else to tell you. I will tell you that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please Always consult a physician before you make any changes to your health care plan or become bold with insulin. Are you a type one like Tim? Or are you the caregiver of someone with type one? If you are and you're a US resident, you are eligible to fill out the T one D exchange survey. This takes about 10 minutes and helps people with type one diabetes. And how does it help? It helps because you're supporting type one research. T one D exchange.org. Forward slash juicebox never has it been so easy to be so helpful. You know, don't let my open make you feel weirdly about this episode. It's so good. I just don't know how to explain an hour and 20 minutes of talking in two seconds. You know. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter contour next one.com forward slash juice box. Today I saw someone online they were so confused about why their meter was so far off from their CGM. And I looked at the meter and the photo I had never heard of it before in my life. And so I said how do you even know that meters accurate? Got to get an accurate meter contour next.com forward slash juicebox. You want to know something else? This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox.

Tim 2:14
My name is Tim. I am a type one diabetic. And I have been for about 22 years. How old does that make you? So I'm 39. I was diagnosed April 18 2000. And I was 17 years old and I was diagnosed it's

Scott Benner 2:35
gonna say you're getting ready to graduate from high school.

Tim 2:38
I was a spring of my junior year. So like a little bit of a diagnosis story it was I was I still am a classical musician. I play the French horn. And I was preparing for college auditions because I was going to major in music I had. I grew up in Seattle. And my mom and I were going to Florida to take lessons with a couple of different for insurance teachers at Florida State and I believe University of South Florida both had really good teachers there at the time. And so we flew to Florida to kind of get lessons with those teachers and tour the schools and stuff like that. And she that's when she noticed because we were at close quarters that I was really skinny and drinking water all the time and waking up middle of the night. cotton mouth drinking like, you know, five glasses of water and going back to sleep. Peeing constantly all that stuff. It's kind of funny, because I still kind of joke that I blame Florida for my diabetes. So

Scott Benner 3:52
I blame them for some things as well. Yeah, yeah.

Tim 3:55
And this was before was it? Yeah. 2000. It was before the bush Gore election, but you know,

Scott Benner 4:04
it's him getting my reference. Okay, so french horn, you do that for a living.

Tim 4:12
So, I'm a music teacher, but I freelance as much as I can. My undergrad degree was in music performance. And a lot of my friends from my undergrad degree are like, making it big time like playing on Hollywood films and stuff. And I just play in local orchestras, Brass Quintet, woodwind quintets, on Cortez. Kind of wherever and I don't need since I'm a full time music teacher at a public school. I don't need to freelance to make a living. I just enjoy it.

Scott Benner 4:48
Okay, that's excellent. And you probably named your episode. This blows depending on what else happens for the next hour. So we'll see. The French horn makes me think of trying to force A tiny bit of air or a lot of air through a tiny passage. But that's a lot like that is it's

Tim 5:06
Yeah. And it's all about the air. Yeah.

Scott Benner 5:09
Kidding. How do you become interested in that?

Tim 5:13
Well, I, I was in band, well start off my older sister was in band, and my older brother was an orchestra. And so I always knew I wanted to play an instrument. I just wanted to take piano lessons at a young age for a couple years, then started playing the trumpet. And then my my brother's best friend had been a French horn player, I remember when their band toured our elementary school. And I saw him in the horn section holding up his horn when they were going through teaching the instruments. And I was like, Oh, he's cool. And I, when the band director said, Hey, we need to switch some people to Horn you won't have to rent a trumpet anymore. We'll provide a horn for you. That was enough to convince my mom. And little did she know how much she'd be paying for music lessons. Once I started taking private lessons and practicing a lot, so I remember

Scott Benner 6:08
that moment in, in school when they introduced you to all the the instruments, and I wanted to play the cello so badly. And by the time like, I just got up in line. The cellos were gone. And the guys like you should try a saxophone. And I did not like not the same. Yeah, I did not like that did not do it very long. I think honestly, carrying it back and forth in my house a couple of times is what did me and but I'm sure I wouldn't have enjoyed, maybe I would have liked the cello. Enough. I would have tried it. I'm not certain. But yeah, I gotta eliminate it from my choice. Just because there weren't enough interest. And it sounds to like, your school did something similar. They're like, hey, we need a French horn. It's free. Come on, take

Tim 6:49
it. Yeah. very motivating.

Scott Benner 6:52
That's wonderful. Well, that's, that's really interesting. So you do it now as a as a as a profession. You teach other children, you teach children how to how to play music?

Tim 7:02
Yeah. So I I went to let's see, I went to school for music performance at in Southern California. I grew up in Seattle, and ended up going to USC. And speaking of Hollywood, like, all my teachers were like Hollywood guys, just cool. And the one when I finished my undergrad, I wasn't sure if I wanted to be a music teacher. I thought I might be good at it. And it might be something I'd want to do, but I wasn't quite sure. And I ended up taking a year off. I actually played in Mexico for a little while. And that's also kind of interesting as a type one diabetic, taking all taking all your Medtronic pump gear down to Mexico and spend like four or five months down in Mexico. And then after I finished kind of playing down there, I end up starting a master's in education, and got hired in. I'm in Orange County. And I got hired down here in the middle of my student teaching.

Scott Benner 8:09
Did you play classical music in Mexico? Or did you play more cultural stuff?

Tim 8:14
Yeah, no, it was a classical music and the occasional Mexican pop concert. Yeah. Sounds like fun. And so it was a really fun experience. I was a professional orchestra experience. So we do. You'd rehearse Monday through Thursday, nine to noon, you'd have a concert Thursday night, you have two days off another concert Sunday afternoon, new music the next Monday, and did that September through December and then came back for like a month and a half in January, February?

Scott Benner 8:44
I bet you that that makes you nimble, huh? Like it really teaches you how to how to learn and relearn.

Tim 8:51
Yeah, it's it also is you spend your entire undergrad as a music as a musician, kind of putting the orchestra life on a pedestal. And then you got to taste it. And granted, it's not the same experience as someone who plays in the Los Angeles Philharmonic, but it still I was like, You know what, this was great. But I don't feel like I have to do this to be happy. Like I thought I maybe did. And it kind of gave me permission to pursue life as being a music teacher and feel feel content with that and not like I was like, giving up on my dreams, you know, excellent.

Scott Benner 9:25
Yeah. Did you ever get to play in the marching band at USC?

Tim 9:29
I, I was very non marching band oriented all through high school. And and I actually did not play in the marching band at SC and I always get asked that question.

Scott Benner 9:42
Well, it's just an iconic image in my mind, right?

Tim 9:45
Oh, yeah. They're a great band. Yeah. Yeah, they are a fantastic band. And I my roommate played in the band and had a great experience. I a lot of friends that played in the band. I was I've always been an orchestra. And maybe when ensemble that even that's like, I prefer orchestras.

Scott Benner 10:04
Alright, let's ask the real question here. Tim, before we move on, can you get girls playing the French horn?

Tim 10:09
No, no, I shouldn't say that. It's not true. I did not meet my wife playing the French horn. So, okay, fine. I'll just say, Oh, no. You said no, no. Yeah, well, actually going back. So when I was in middle school, I started playing the horn in sixth grade. And I started playing the guitar in seventh grade. Largely because, number one, they wouldn't let French ones play in the jazz band. And number two, I knew that French horn wasn't gonna get any girls

Scott Benner 10:39
did the guitar work?

Tim 10:42
Vaguely. It's a lot more about confidence than it is about what instrument you play. And that's, you know, I was never confident. I think

Scott Benner 10:51
that's something I think even visually confident people, it doesn't seem to mean as much about how they look even confidence. Confidence plays a big part. Anyway, so are you forcing any of your children to play an instrument or do they seem interested?

Tim 11:10
Well, I am, I'm always a fan of exposing them to lots of stuff and seeing where their passion lies. And if it's playing an instrument, that's fine. And if it's something else in the arts, that's fine, too. But you better believe there'll be lots of arts right, so my daughter is at a incanto summer camp right now.

Scott Benner 11:31
Oh, wow. That's really cool.

Tim 11:32
I still she's six. She's the right age for that.

Scott Benner 11:35
Without any hesitation. If you asked me the best concert I've ever been to. Yo Yo Ma playing Bach Cello suites. That was it. It's the best

Tim 11:42
thing. Oh, yeah. I played with, with Yo Yo Ma in college. And it was a fantastic experience.

Scott Benner 11:47
No kidding. Here we went. Go ahead.

Tim 11:50
I'm sorry. He's every bit as great as his reputation precedes and he's also every bit as humble and kind.

Scott Benner 11:58
It seemed obvious. He just he, we were at the Washington cathedral. And it's a very small stage. We drove all the way to Washington from New Jersey to say it and I think we're about eight rows from the side of the stage and he just came out, sat down, spoke for 30 seconds. Played. Got to the end of the suite, stopped, stood up spoke for 30 seconds sat back down played again. Just rolled right through them. It was did you roll through all six? Yeah. Was something else? Oh, gosh. That's

Tim 12:26
amazing. Yeah, it was.

Scott Benner 12:28
It was one of the most amazing things I've ever seen live. So and it sounded it sounded better than I imagined it was going to.

Tim 12:38
It was we played it was right after his Ennio Morricone album came out. And we did a bunch of music from it was like, like, like the mission and good, the bad and the ugly and stuff like that, that we played with him.

Scott Benner 12:52
Wow. Sounds fun. Okay, so you get diabetes when you're 70. Do you have any brothers or sisters? Does anybody else in your family have type one?

Tim 13:00
No one has type one. Grandmother had type two. But autoimmune stuff was pretty rampant in my family. So my grandmother died of scleroderma. And she had been a smoker her whole life and so slow drummer, like turns her tissue hard, weird autoimmune thing where it turns her tissue like really hard. And it has affected her lungs. Oh, and so that's what took my grandmother. on my mom's side. My mom has it's actually gone into remission, but her motto myositis. When she was in, like, when she was young, like probably about younger than were how old I am now. So I think she was in her 20s or early 30s when she had her moto myositis. And that ended up going into remission. That's also autoimmune. Everyone seems that well, no, not my oldest brother. My mom and my sister all have thyroid problems. I have Hashem overdose also, I was diagnosed with that, I think like 2010 or so. So it was about 10 years after my type one diagnosis. And then my daughter just diagnosed this month with celiac.

Scott Benner 14:22
Okay. And you have two kids.

Tim 14:26
Yeah, my son is 19 months. And so far, everything's a okay, we're planning on we did. Right when we were going through all this bloodwork for my daughter, we did trial net. And she was negative for type one auto antibodies. And so hurray, it was fighting one small bit of one small bit of positivity in the midst of other difficult medical diagnoses. But when my son turns to I'm planning on doing trial net with him as well just to see,

Scott Benner 14:56
okay, that's funny because I'm looking up thick You know, when, when people talk I google and a lot of the word rare, fewer than 2000 or 200,000 cases a year pop up when you're talking the sclera, DOMA or Derma, could it could impact anywhere but it it specifically impacted your grandmother's lungs? Yeah, yeah. She

Tim 15:19
had been a lifelong smoker. Okay,

Scott Benner 15:21
so maybe the weakening of from the smoking might have a draw to that area. Is that what I'm thinking? Or maybe yeah, you're susceptible perhaps.

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Tim 18:39
Yeah, I think so.

Scott Benner 18:42
And then Ooh. DERMA town. What is it Derma termies. microsite

Tim 18:49
moto myositis your Moto myositis

Scott Benner 18:53
and in full inflammatory diseases mark my muscle weakness and a skin rash. How long did it impact your mom?

Tim 19:00
Um, gosh, just a few years, I think. And it was it was the point she said that her muscles were affected where she couldn't even raise her arms above her head. And yeah, I know, it was really difficult. And then it went into remission. Just so. Yeah, like she's not affected by right now. So

Scott Benner 19:20
and she's in her 60s now. I'm guessing by your age.

Tim 19:24
She's in her 70s 70s.

Scott Benner 19:26
Okay, yeah,

Tim 19:27
I my my. I'm the youngest of four and my oldest is 11 years old and meet my oldest brother. So it's a bit bit of a spread between us.

Scott Benner 19:35
Well, there might have been a gap in there where your mom wasn't up for making a baby, too if she wasn't feeling well, right.

Tim 19:42
It was. She had the oldest two and then there was a big gap and then she had my brother and me.

Scott Benner 19:48
How did your Hashimotos present?

Tim 19:52
Um, I didn't recall necessarily having all kinds of weird symptoms, but I went into my endocrinologist and my endocrinologist always kind of as a matter of course would feel my thyroid. And so I went in this time and he felt my thyroid and says, Oh yep, you have a goiter, you are passionate motos. I'm going to send you in for an ultrasound to confirm. And then so they did an ultrasound on my neck and and then started me on label thyroxin. Yeah.

Scott Benner 20:29
Just take batteries take a T three supplement as well. Oh, so

Tim 20:32
that's I actually do take it through T three supplement as well now, which kind of goes back to just kind of recently, it was about probably a year and a half ago was right after my son was born. I started having these really weird symptoms. And it was it was like gastroparesis symptoms and at the time, I didn't know what gastroparesis was. But I had just, I had what was the book that I looked at? It was it was the Bernstein book, which I'm not a big proponent of but I was looking through and I remember reading something about gastroparesis. So I went back and looked at the Bernstein book, and he had this whole thing talking about the symptoms of gastroparesis, and I was like, that is what I'm experiencing, it was like, I would eat I would only be able to eat a little bit and I'd feel full and nauseated for like, four or five hours, okay. And then I was so I, I was like, This sounds like gastric creases. I went to my primary care doctor, I said, I feel like I'm showing these symptoms. I said, Okay, we'll refer you to a GI the GI doctor ordered like the it's like the barium drink test where you like drink a barium milkshake, and then they like take pictures of your stomach. But it wasn't really conclusive for gastroparesis. Meanwhile, I saw my endocrinologist we did bloodwork, my thyroid was at like 12 and this was like a year and a half ago, my thyroid has always been well controlled. But my thyroid went way out of whack. Like and I don't know why it went way out of whack, but we increased my thyroid medication like by like, two increments right up to like 150 I was I think I was at like maybe 112 He moved me up to like 150 And then that was too far and then we ended up pulling it back to like 137 And then I still was having weird symptoms. And I believe that like the last time that you and I like messaged each other it was like over up iron supplements. Because I messaged you about like iron supplements and I you talked about your low iron issues. My iron was at like 11 though.

Scott Benner 22:49
Yeah, that's low that make you feel like you're gonna fall right over on top and then you can misconstrue that with thyroid symptoms too. Huh?

Tim 22:57
Yeah, yeah. But my my after the doctor fixed my thyroid dose that gastroparesis. symptoms resolved within a month. Yeah, because it wasn't gastroparesis. It's the it was Yeah. Thyroid induced dysmotility.

Scott Benner 23:18
Yeah. Hey, I'm gonna say about that. Were you very stressed about the baby at that time or anything like that?

Tim 23:26
I don't know, I was particularly stressed about the baby

Scott Benner 23:30
or anything like, you know, something that could have you had a virus and illness, something that could kind of throw you into flux for a while? Yeah, I

Tim 23:38
don't, I don't think so. I mean, this isn't the heart of the COVID stuff. But I, we never got COVID. So we were always pretty careful. There's they're actually, I'm sorry. I changed when my my school like, when everything closed down. Like in spring of 2020. My district opened up a virtual school. And I actually transferred to it, just because I it was still so early, and I just didn't want to be back in person. Like, just, you know, they all they're saying, you know, if you have type one, and you're well controlled, it's not going to give you necessarily a worse outcome. But I was like, I don't want to mess with this. So. So I went to a virtual school and I've actually stayed there. So now I teach. I don't teach band choir anymore. I teach like guitar over zoom and music appreciation and songwriting and things like that.

Scott Benner 24:35
So you're teaching strictly over zoom. So yeah, you can teach the guitar I guess you can, right? You can. I mean, I saw Metallica teaching people how to play riffs the other day in some paid service. So I assume it's this idea right?

Tim 24:49
You know, a works pretty well. You use a lot a lot of other things like you have to use other like, that's a quick take quick little snapshots of their own playing like after every lesson. So He asked them to make like a flip grade, which is like a short little video or something like that to show that they're practicing the skill you're working on, because they're all muted. So there's no way that you can like really know how they're doing unless you're doing those other things. But yeah, we can, we can do it.

Scott Benner 25:15
Also with large class, like,

Tim 25:19
under 15. Kids, but yeah, well, I

Scott Benner 25:21
mean, if you're, if it's music, any, anyone over one is large, because you can't so there's no audio. So are you? Are you studying their their finger work and things like that, I'll look

Tim 25:29
at their finger work. And then I will have them I'll show them a technique. I'll give them time to practice it. Maybe like have them work on an A chord. It's like a beginning guitar class. So it's like, like, basic chords and basic note reading stuff. And then, yeah, they'll make a little video of whatever the scale is, like of them playing a C chord or a G chord, or where

Scott Benner 25:56
How long do you let somebody go before you tell them? They're not good at it? Oh, I

Tim 26:00
don't I don't tell people. They're not good. Never kidding.

Scott Benner 26:02
Just keep going. Okay. Like, I

Tim 26:04
mean, people know if they're not good. But I will tell them if they've been playing tests, I'll, I'll give them accurate score.

Scott Benner 26:13
But you never pull someone aside and go, Listen, you're wasting your time. This is never gonna come together for you. It's no

Tim 26:18
not not with the phase that I would be. I mean, if I was like a college professor, and like someone was trying to make it for a living like that, sorry, buddy. You don't have what it takes. But not but no, not like, not for, you know, I, I've only had I've been teaching music for 15 or 16 years, and I've only had one or two kids go professional. And that's fine.

Scott Benner 26:41
So that would be the expectation, right?

Tim 26:44
Yeah. Well, the expectation is for teaching music for kids is that they're going to hopefully learn to enjoy music,

Scott Benner 26:49
right? Yeah, no, I imagine. Does that work? Or do you not? I mean, like, do you see it translate into their lives? Do they? Are they listening to music that you're surprised by? Or do they appreciate things that you wouldn't expect for their age when they're when they're playing?

Tim 27:04
I think so. Not all the time. But I think so. Yeah. Yeah, I think. And then you can see kids, I remember having kids were like, I had a kid who didn't really even want to be in band. He wanted to be an ASP, but ASP was full. And then I got him started and on. He was on trumpet, and I switched him to French horn. And then he like went on to major in music. Like he really took off like, so. Like, you have kids that don't know they love it. And then you teach them some stuff, and then they take off. Wow, that's really rewarding. What is ASP? I'm sorry. Oh, it's like, student leadership. Okay. I

Scott Benner 27:39
thought it was like a porn genre or something was I don't know what. Like, Jesus, I know. Kids are doing stuff I don't even know about anymore. Yeah. Okay. So alright, so Okay, wait a minute, I want to go back to the Hashima. So Hashimotos presented the way it did. And you took care of it. And but you added T three. What?

Tim 28:01
Yeah, so I was still having weird energy things. And I just my thing I really liked about my inner my current endocrinologist, not the same one that diagnosed me with Hashimotos. But he, I didn't have a Dexcom before I saw him. I didn't get on the pod before I saw him. He has been always very upfront about current tech, and advocating for it. So I currently I currently loop and I, I use Omnipod and Dexcom. And he has been supportive all along. He hasn't been like, Hey, you should look i That's all been me. But I said, you know, I want to do this. And he's like, do you understand how the settings work? And like, yes. And he goes, okay. Let me know if you have questions, you know, so. And then he's always if I'm like, hey, I want to try. You and Jeff, because the ASP isn't covered right on my plan. We tried it I actually had the same experience as your daughter burns, burns, burns, burns and pods all fail but like a day and a half in Okay, so I went back to novel Novolog

Scott Benner 29:17
her parla last and she just so fast she could she could take the fiasco but it made her very sore at her so yeah,

Tim 29:26
I I can take it via syringe I keep a vial of it around for if I'm like stuck high. But because it works and it works fast by syringe and it doesn't burn by syringe, but in the pump, it burned and then I would get inflamed. My site would get inflamed and it would fail by the end of the second day. Yeah, always that's interesting sometimes earlier

Scott Benner 29:49
we kept it around to we use it with a syringe once in awhile to I'm sort of like, you know, let's stop messing with this and just go crush this real quickly. The loom JEV she came to me within hours and said, I'm taking this pump off right now.

Tim 30:03
Yeah, it burns.

Scott Benner 30:04
Yeah, that that she didn't she didn't jive with very well,

Tim 30:08
I wish I hadn't but because I liked how fast it worked Oh,

Scott Benner 30:10
I really enjoyed fast it made it made an actual difference in her in her blood sugar's and that's saying something and it created a lot more. A lot fewer choppy lines kept things more smooth. Just and you know and kept you from having to Pre-Bolus as far out it was it was very nice. Had it not stung or she would be definitely using it right now. I'm sure it's working for plenty of people. It just sadly didn't work out for her. Actually, I wanted to tell you that before T three for Arden. So Arden takes cider mill as her T three.

Tim 30:50
My son takes mine's like a cider mill generic. Okay,

Scott Benner 30:53
my son takes Armour Thyroid, SS T three. And for him, it's just it's a good balance for him. His energy is good. His muscle tone like everything just works for him. And add he's a terrific endocrinologist though, especially for thyroid and but aren't and so Arjun tried to armor because coal was using armor didn't work for. So Addy moved her to cider mill and boom, she's good again, without cider mill. Here's the example. You know, you know, in the yearbook since you're a teacher, you can buy like an ad for your kid. Based on it basically just says like, congratulations, you graduated in the school, make some money off it, you throw a picture and you write something. That's it. We took one lovely photo of Arden and surrounded it by I think eight or nine photos of her just slumped over sleeping in our house in the strangest places, like facedown on a countertop or in the fetal position. But up on her knees and her head on the floor or under a blanket or under a jacket. We had so many photos of her just asleep in the string sad and funny. Yes, exactly. So I forget exactly what it says. But it says something like you know art and we're very proud, whatever you would say. And at the end it says if you see our daughter sleeping at college, please put a blanket over her. And but, you know, she just I mean she'd come home from school and we had like a barstool, you know, a cold piece of stone. And she just lay down face down on it and go to sleep. And it's and then you give her that T three and I'm telling you in mere days, it's over. It's just

Tim 32:29
gone. Well kind of a percentage of because the way my endo explained it is the the T three is five times stronger than T four. So like, I was taking like 137 of t four and he reduced it to 112. But they gave you five micrograms of T three?

Scott Benner 32:46
I think so. I think that's five mils. five micrograms. Yeah, yeah.

Tim 32:51
It's interesting. Yeah, that same amount. Yeah. He reduced He reduced my, yeah, he reduced my T four, which is levoxyl, which is the one that actually shaped like a thyroid. And he's like, Yeah, you we've talked about how you talked about how generics thyroid pills like to be careful about. And so by doctors like that levoxyl is the generic I prescribe because I like it. It's consistent. And we're

Scott Benner 33:18
good. Might both of my kids take tiersen as their T four. Which is a just a pure form of it. It's an a cap capital, what would you call it? It's not a tablet. It's not a capsule. It's a gel cap. Thank you. I don't know why that word escapes me. One of them is at point seven. And one of them's at point eight, five. I'm not sure which is which at this point, to be perfectly honest with you. But anyway, that's so there's a ton of this and your family, you know, your your do you say your daughter has celiac?

Tim 33:48
Yeah, just diagnosed we're really fresh. Okay.

Scott Benner 33:52
Anybody else in the family? How did you figured out her celiac.

Tim 33:55
So she's very small. She was like, probably like 10th percentile when she was little, like very little. And then she's kind of slowly creeping down. She was at fifth percentile when she turned five. And the doctors like they were watching this closely. Now. fifth percentile is a big deal. If she gets any lower than that we need to really look at what's going on. Yeah. And then when she was five, we did a full panel of bloodwork and a bone X ray on her wrist to see her bone age. And the her her celiac indicator level is that it's the level of auto antibodies against against gluten in the bloodstream was like, right at the borderline, like, borders. It's like 20 and she was at like 21 And so they'll be like, Okay, well, that's a little concerning. Let's watch it for a year and see what happens. age six, we did the same test she was over at like 86 So um they're like, Okay, that's conclusive for celiac. So we'll refer you to the GI. She just did the endoscopy, like the beginning of this month. And then that came back conclusive. But she's not symptomatic, other than being small, and occasionally complaining about tummy aches, but not chronically,

Scott Benner 35:18
but they're going to set her diet. Yeah,

Tim 35:21
we've already switched her diet. Okay. So as soon as she came back with the positive endoscopy, then we switched her diet. Okay, so we've already kind of transitioned our kitchen off of gluten. How long has it been? It's beginning of this month.

Scott Benner 35:37
Oh, very recent. So you shouldn't even ask if you've seen any difference.

Tim 35:42
Yeah, it's too soon. But right now we're just getting used to it and learning how to eat at restaurants and things like that,

Scott Benner 35:48
right? Did the whole family switch

Tim 35:52
our household, but like our kitchen, just because we don't want her to get cross contaminated. But it's important that my son continue to eat gluten. That's what our GI doctor said. Because if we take it out of his diet, he could develop an actual allergy to it to it. So he said that it's actually important that he continues to get it. So we're trying to figure out how to do that. But we'll figure it out. Like, you know, if we go to a restaurant or something like that, like you can have the bread and she can't, you know, so. And so we're trying to keep it in that way.

Scott Benner 36:30
Gotcha. Have you noticed any improvement for yourself stopping gluten? Sometimes people stop and they're like nothing changed. Even if they don't have a problem with it. And sometimes people feel like it was a good thing to do.

Tim 36:41
haven't noticed yet. Yeah.

Scott Benner 36:43
Thank you would if you were going to interesting, your wife, I'm assuming is just waiting for a moment when the three of you turn your back so she can run away. I'll be like, Oh my God, what's happening? Does she have any issues on her side? No, not really didn't attract a girl.

Tim 37:02
One now What? What? With with our son actually blinking if it was my Son or Son or daughter. It was our son. She had gestational diabetes. Okay. Wait, no, it was what

Scott Benner 37:22
is not funny. You don't know.

Tim 37:24
I Yeah. Why? Why am I blinking on whether it was which kid it was?

Scott Benner 37:28
Didn't see my daughter or did it not seem like a big deal?

Tim 37:33
It wasn't a huge deal. It's probably just eating more low carb and managed it that way.

Scott Benner 37:40
That's a great look into what life does to you right there. How old are you? How old your oldest? Six Six. So in the last six years your wife's had gestational diabetes and you're not sure with which pregnancy

Tim 37:51
sounds terrible? No, no, it's gonna listen to this and laugh and

Scott Benner 37:55
laugh at you we're not talking to you for three days one or the other.

Tim 38:01
Well, the thing is with with my daughter she had she ended up having sorry, my brain just went foggy house

Scott Benner 38:12
your blood sugar. Okay, you want to take a look at your CGM?

Tim 38:15
No, I actually I really high why don't I go high? I think I'm I think I'm stressed out talking to

Scott Benner 38:19
you. Stein excited. That's all demo. Basically celebrity. I got like

Tim 38:23
6.6 units of insulin onboard and I'm rising.

Scott Benner 38:26
No kidding. Yeah. Just at the beginning. You said I'm not nervous. This is fine. Yeah, yeah. Let's not try to figure Yeah, listen, it's a it can be can be scary. Talking to a person with as big of a public profile is

Tim 38:41
kind of a big deal. So you have all leather bound books. Your apartment smells like rich mahogany.

Scott Benner 38:50
That's not what's happening at all. But I mean, you and I have texted about like iron supplements. I don't imagine you would have been nervous to talk to me, but that's really interesting. Do you want to get a drink of water or anything? You okay? No,

Tim 39:03
I'm good. Okay.

Scott Benner 39:06
Okay, so your wife may or may not have had gestational diabetes and other things happening, but God knows what they were. That's a long time ago. Who cares? Really?

Tim 39:15
My daughter was born preemie and my wife had, like 21 days in the hospital. No, sorry. Two weeks on the hospital. My daughter had three weeks in the hospital. So Wow. It was my daughter was in the NICU for three weeks. So there is enough trauma there.

Scott Benner 39:34
Right now it's a lot to I'm telling you. It's a lot having kids is stressful. Forget the rest of it. Forget if it goes. If it goes right or wrong. It's it's still very stressful. How do you enjoy? Well, that's not my question. How did you manage prior to looping?

Tim 39:51
Okay, so diagnose. I did MDI for a few months and then with it by July, and I was diagnosed April Oh by July I was on a Medtronic pump. Okay, so I was doing Medtronic pumping for my senior year and then all the way through college and then till about um I went to an omni pod probably maybe eight years ago maybe less. And then I right about the time that we got married. That was 2009. I was trying the Medtronic CGM. You know, the old harpoon. It was terrible. It was. It was such a deep insertion and it like almost always bled. I remember. We were at our rehearsal dinner, and I had an in infected CGM sight from the Masonic harpoon. And I had to like pull it out in the bathroom of this big the Spaghetti Factory that we are eating our rehearsal dinner at and like gush blood all over the bathroom. Like it was, it was gnarly. And I was like, I couldn't wait to be done with that. And I was not wanting to try CGM again after that. Until so stated my Medtronic pump for a while. And then my, my endocrinologist, the one that had diagnosed me with with passionate motos. He didn't retire. But he closed his practice, because he came to medical became the metal direct medical director of the hospital, or like the diabetes director of the hospital, they have a diabetes Center. So he was closing his practice to like, focus on that administrative role. And then I was like, Well, you know, it's fine. I'll just control my, I'll just see my local my PCP for diabetes related stuff. And, and this is still doing, you know, poking my finger, hopefully four times a day, and managing with my pomp and Mike, my control was just not good. It was like, mid sevens, if I was doing well. I think it went as high as the mid eights. I think one point I got up to the low nines, just wasn't good. And then finally, I was like, it was just wasn't really getting better with my doctor. And I was like, I'd like to see an endocrinologist again, that endocrinologist was my current new one. And he was the first thing he's like, I want to get you on a Dexcom. And I was like, Well, I tried this other Medtronic. One. It was terrible. And he's like, Dexcom is way better. Try it. Okay. And it was amazing.

Scott Benner 42:45
I have questions. Hello, sir. Thank you. Oh, just out there. Because I have a few questions. First of all, I just want to let people know, the Old Spaghetti Factory does have open positions if you're looking for a job.

Tim 42:56
And if you want to clean up blood out of the bathroom front, it might still be some they're in one of them. Yeah, the one in Fullerton, California.

Scott Benner 43:06
Can you imagine people are like, Oh God, I go to that one. Trust me,

Tim 43:10
there's bound to be listeners to go to that. Well, I'm

Scott Benner 43:12
gonna say whatever happened to him in that bathroom is not nearly the worst thing that's ever happened in the Spaghetti Factory bathroom. Which, by the way, a way to splurge on that on that meal. It's really nice.

Tim 43:22
We kept our we kept our wedding under budget. Like we were

Scott Benner 43:25
like Intel when you said the Old Spaghetti Factory. Yeah,

Tim 43:29
I mean, I think we kept our wedding under 10 grand, which is really hard to do.

Scott Benner 43:33
This meal might have been at least $75. I've never been to a Spaghetti Factory. I don't mean though. All I know is that if I try to eat at a place called the Cheesecake Factory, I don't know if it's any relation. I will become physically ill for many hours afterwards.

Tim 43:50
Oh, yeah. Yeah. But yeah.

Scott Benner 43:52
So So tell me first talks about your management you said, you know, if I'm lucky, I'm in the sevens. What did that mean? Because we're not talking about such a long time ago. Right now you're painting a picture on 2009 Is that right? Right around them? What Weren't you doing that you could have been?

Tim 44:09
I mean, I wasn't poking my finger like before and after every meal. So I'd usually do before but usually not two hours after so never have a real representation of like, whether the insulin you gave yourself was working Pre-Bolus thing wasn't a thing. So sorry, my microphone is like drifting down it's on a little boom. Justice hopefully doesn't Creek

Scott Benner 44:33
figured it was in your vision. You could just see it dropping. Yeah. So

Tim 44:41
I bought I invested when I started teaching from home I invested in a really nice.

Scott Benner 44:45
No, you You sound to our microphone. Which one is it? It's a blue spark. Oh, it sounds great.

Tim 44:52
It's like a yeti but it's actually an XLR cable microphone, not like a USB microphone.

Scott Benner 44:57
Oh, yeah. I can't expect everybody to do that. Um, But good mics makes God happy. Okay, so were these things were these besides the Pre-Bolus? Well, you said Pre-Bolus thing wasn't a thing because you didn't do whatever because nobody told you about it.

Tim 45:10
No one ever told me I was always told to give myself my insulin when I eat. And there was never emphasized that I should do it before. Okay. And then, you know, at that point in my life, I was lucky to give it when I eat, oftentimes I would eat and then be like, oh, shoot, I forgot. And then I'd give myself insulin.

Scott Benner 45:29
So you get insulin when your blood sugar was 200. Maybe sometimes. Oh, easily. Yeah, but I mean, no CGM. So

Tim 45:34
how would I know? But yeah,

Scott Benner 45:35
and you weren't testing later. So you would just so you'd eat. Okay, so maybe you would test and say, Alright, my blood sugar is 150. And I'm about to have lunch. But then you eat take in. I mean, the Spaghetti Factory, we're going to call 170 carbs for your meal. That salad looks like it has 40 carbs in it. And I love that in a restaurant. You're like, it's a salad. I'm like, is it and anyway, so you're, you're you know, whatever your meal is. You eat your blood sugars going up from there you Bolus but you never check in again to see what happens. Yeah. And it's still it's still you're in the sevens. Yeah, oddly, oddly started creeping

Tim 46:14
up a little bit. But yeah. Okay. And then at this time, too, it was if I was making changes to my insulin it was with when I was in the endocrinologist office, looking through my inadequate charts. So, you know, we're still at this point, you still have the logbook? Yeah. I was passed that I think when I was diagnosed in high school, I was listening to someone. Recently, on the podcast, he was talking about fudging numbers in your logbook, when you're a kid so that you don't get yelled at by your doctor. Yeah. And I was like, I remember doing that number. Yeah, like, so. Like, I just look at all these blank spots. I'll just write a you know, 200 there and a 150. There, whatever, make them feel good. But you know, I was past that point. So I was willing to own up to not checking my blood sugar enough. But yeah, once I got the CGM, that was helpful. But it still was, like the the indicator of a bad job that I was doing. So you'd start to see like, oh, yeah, I'm spending a lot of time spiking, or I'm on a roller coaster or things like that.

Scott Benner 47:20
Yeah. To generate. Oh, it's generational for people who came up like you. Getting a CGM did exactly that. It was like, Oh, look how bad I am at this is how it's how it felt. Right. Yeah, absolutely. Which is, if you've been able to get past that.

Tim 47:36
Yes. Yeah. So go back to I guess it was my daughter was a was a, maybe three. Before my son was born. I was I think I was on Omnipod at the time, but I still wasn't like, like, wasn't looping and wasn't taking it all that seriously yet. Okay. So when I was diagnosed back in high school, there was one two other kids in my high school that had diabetes, one of which really went out of his way to become close friends with me regarding diabetes and be diabetic buddies, right. And here's a guy named Paul was awesome guy, he was diagnosed at like age four, we both had Medtronic pumps, we would always get together in the morning and be like, Oh, I was changing my pump site this morning. And, you know, exploded blood all over the place. Like, it was like, we would share stories with each other and group. We're good friends. And fast forward. Like, you know, I'm in California, he's up in Washington, but then I heard that he died. And I don't really know the reason, but I I guessing that it had something to do with diabetes. And also, I had had an eye test recently, where they said that there was a lesion on my eye. And so those two things together, were the, the holy crap, let's get this gets get my act together, right. My daughter was maybe three and it was I was like, I just know, we gotta get this together. So at that point, I was like, I'm going to do whatever I need to do to get my diabetes under control. There was a friend of mine at church, who his sister was type one and a nurse. And she was a big proponent of low carb, so of ketogenic and so that was my first thing was like, Okay, well, I'm gonna change the way that I'm eating so that I can make this easier and have better control. So I committed to eat that way for a year and I started eating low carb, and my agency dropped below sevens. So it was like six line one 6.4 At the highest, pretty straight lines. And but what I noticed eating that way was this is probably the 2018 that I was doing this insulin resistance became a real issue. So if I was going up either from you know, your body, you know, releasing hormones or whatever, or a small amount of carbs that you take in, it seemed like no normal amount of insulin would bring it down. And no, even no increased amount of insulin would bring it down, it would just be stuck. And until you'd stacked all of his insulin on it and came crashing down, right, so that insulin resistance part of it was, like, really a big deal. Also, like, at that point in my life, I was starting to like gain a lot of weight. Partially because I was kind of eating. I was eating like, I was a 20 year old when I wasn't anymore, right? And partially because I think I was having this insulin resistance issue. My doctor actually put me on Metformin. saying like, like, you know, you're having insulin resistance, which give you Metformin, see how it helps, it helped me lose a little bit of weight, it lowered my insulin needs by about a third. And then then I went low carb, I ended up not needing the Metformin anymore, and I lost a whole bunch of weight, like I went down to a much healthier weight. I'm like five, nine, and I weighed I think, at the most I was like 215. And then at this point, I went down to like the 180s then then so the insulin after a year of eating that way, I was just finding as like, Okay, this insulin resistance thing is really like discouraging. And so I started looking at other things like other ways of eating or what you know if there's other issues and or what might be helpful. And I came across the mastering diabetes guys. Yeah. And they proposed purport a plant based whole food, very low fat vegan diet, and their whole thing is we make this diet will make you super insulin sensitive. And I was like, Okay, that sounds like the solution to my problem. So I was like, I'll try that for a year or so. And I tried that. And then I lost even more weight and went down to like 175 which is like the lowest I weighed since high school or college. did find when I was eating really consistently that way that I became really resistant to insulin. I was also exercising more which helps

Scott Benner 52:49
you I think you misspoke you were you said resistance.

Tim 52:53
Oh, I'm sorry. Sensitive, right. Thank you. Thank you. Yeah, I was becoming more sensitive to my insulin less insulin resistant, and I I was finding really helpful but my family wasn't eating that way in that made it kind of difficult and I and then the pandemic hit, and it was just a lot harder to stay as clean on it as I was I was still eating that way but I wasn't eating as clean like as allowing more oils and eating bread because I started doing the home sourdough baking thing. And before my daughter had celiac, right, so I was finding that it was being it was less beneficial. And then then I was like, I'm not sure if I want to keep up with this and then that's about the same time that I really discovered your podcast. Okay. So here I was like, like, oh the answer to diabetes controls and eating a certain way and then and that also, I started looping about that time too. And just set it up all on my own like without much guidance as to what my numbers needed to be and you know, looking at the loop and learn stuff online is helpful too but so discovered your podcast was looking at all this different stuff about loop about looping, which is really really helpful. I still don't feel like my numbers are completely as dialed in as they should be. But I working on that. I might pick your brain on that a little bit. Okay. And, but really what I was like realizing is that I don't have to eat one of these ways. If I start doing other things like if I start making sure my basil is really dialed in and Pre-Bolus saying and revising the way that I Bolus for fat and protein, I think And I will have the results I'm looking for

Scott Benner 55:02
and be able to stop pretending that you like brussel sprouts. Yeah, yeah. Because nobody

Tim 55:07
actually stopped. I don't mind brussel sprouts but but that's that's, that's only if they're cooked in olive oil with the sonic vinegar, Tim. So

Scott Benner 55:14
Tim, have you ever heard anybody say I don't mind a chocolate chip cookie? No one's ever said it that way. You don't I mean,

Tim 55:20
you're not wrong. Yeah, no one

Scott Benner 55:23
goes, Oh, Doritos. I don't mind them.

Tim 55:28
Those things are genetically engineered in the lab.

Scott Benner 55:30
I be delicious. I wish people understood that a Dorito. In 2022 Doesn't taste like a burrito from 2019 Doesn't taste like one from 2010. Like, it's fascinating how they've, I'm assuming there's like less and less actual, like food in them as they go along? I don't know. But whatever. The some, some mad genius works in those those labs making those chemicals. So things taste the way they do. It's It's really It's fascinating. But I listen, I just don't like brussel sprouts. But that's but but but I'm taking your point, which I think is that you found a number of different ways to help yourself. And now it sounds like you use a blend of all of them.

Tim 56:13
I would say so. Yeah. And I think that the the most significant thing is a lot of your advice on Pre-Bolus thing, which again, like I told you was like, wasn't something that I was told to do. But it makes so much sense. And when I actually implement it correctly, it works really well. And when I don't implemented correctly, I really noticed a difference all

Scott Benner 56:33
time on a mountain. That's it. Yeah. Yeah. Absolutely. i This is my favorite part of the podcast where people say nice stuff about me. So I didn't mean to talk over you just now. I'm sorry. Yeah, well, no, I'm happy that it meant something. I hear people talking about those. Those vegetable boys sometimes, and I don't know their names. Are I forgotten what your what you said already? What the name of it is. But tell me again, the

Tim 56:59
Yeah, so it's mastering diabetes mastering. I think that what they say is, it can be beneficial. A lot of what they do is pointed toward type twos, but those two guys are type ones themselves. And but it, it uses that coaching model, which I feel like is unethical.

Scott Benner 57:22
Okay, hold on a second. So you can talk about that, if you want what I was gonna say first was, you can't argue with it, like Pre-Bolus thing is terrific. Understanding how it works is amazing. But the truth of it is, if you eat a Brussel sprout instead of burrito, it's going to be easier on your body, and easier on your body is going to mean less insulin, etc, etc. I'm never, you'll never hear me argue about that.

Tim 57:43
Well, and here's the thing too about about their style of eating is that they, they would they completely ignore the whole aspect of fat and protein is going to have a different impact on your blood sugar that needs insulin in a different way. Okay? They just ignore that completely because it's irrelevant to their work their style of eating. Because yeah, so involved in what they're eating right? Yeah. Because you completely take out the fat and protein only get protein from beans and the vegetables that you eat, and, and whole grains and stuff. And yes, that's very healthy. I was my blood work was the healthiest it's ever been when I was eating that way. It's really

Scott Benner 58:22
astonishing. Imagine Sure. No, I would, I would imagine that taking out extra things for your body to do makes it easier for your body to exist. But in the end, Tim, tell you Look, right. I'm just kidding. But I'm just gonna say you got to choose between. I just used to know this woman who used to say you have to choose between your ass and your face. That was how she put eating she said she goes she goes a few is about I guess she was talking about fat. Basically, you know, you want your ads to look nice. Your face to look nice is how she used to say, I don't know how accurate that is. But I could just I just picture this older woman wandering through my life going you got to choose between your ass and your face.

Tim 58:59
Okay, that expression a moment on the lips a lifetime on the hips.

Scott Benner 59:05
I think that's exactly what we're talking about. But apparently you get a nice youthful look in your face. Little job like I listen, I carry extra weight and I look 10 years younger than I am. If I was super thin, I'd look Oh, I saw Kevin Bacon the other day. He's probably 1000 times healthier than I am. And he looked 30 years older than me. So I don't know. He'll probably live until he's 120 But he looks like Methuselah. So what are we going to do? Because a lot that doesn't hit for you, right? You're not sure? No, I

Tim 59:33
get it. He's an old dude in the Bible. Yeah.

Scott Benner 59:38
Exactly. Still, by the way, I'm gonna call this episode this blows. You haven't said anything else that got me off it. So I don't want to talk about anybody specifically, but I do want to hear what you were gonna say about coaching models and how that strikes you as a person with diabetes?

Tim 59:56
Yeah. So like they're there. coaching model thing is like, you sign up, you pay way too much money a month, and they have a coach that goes through your food journals and your blood sugar numbers and helps you make the right decisions and stay motivated and on their way of eating and stuff like that. And they do put a lot of their information online not needing that. And then they also have a book and their book is good. So if anyone wants to eat, eat that way and get help, I think reading the book is fine. I don't think that's unethical. But, but I think that kind of like gatekeeping diabetes management, from a coaching model, something that can't be covered by insurance, you know, like, is kind of bizarre. Yeah. And I was, I was never interested in that. I was like, I can figure this out myself, like, and I was having success with it without needing to coach them. But it's funny,

Scott Benner 1:00:55
because to me, so I take your point, but I don't have diabetes, right. And so, but I am, I'm listening, I've existed in this space for a very long time, I've been very connected with people with type one and type two diabetes for a large portion of my adult life. I can't make right in my own heart, safeguarding information like that. But I understand it from a business perspective, you have this thing, you need to sell it, if you don't sell it, you're gonna be out of the business, we'll charge everybody an amount of money, this will keep us going will make money will exist, they'll get good information. But it still keeps some people from hear from hearing it. And I, to me, I just listen, I just figured out a way to do it where somebody else pays so you can hear. That's, that's pretty much it. And, you know, would I have had I chosen I guess if I wasn't who I am, and had I chosen to, to put everything behind you no offense that you had to pay to get over. If I did that. Not as many people would know, the podcast. And to me, it's about reaching the most people giving the most people an opportunity to have a healthy happy existence. And I found a way to do that, where I pay my bills, and I reach a bunch of people and some people do it differently. I mean, I could I know what my numbers are. If 10% of you had to pay me $100 a month to listen to this podcast, I'd be okay. You know what I mean? I might actually be Tim Hold on a second. We just do a little business here with your real quick. Yeah, truth is, I'd be making a lot more money, like a significant amount more. But I just I can't I can't bring myself to do it. I don't even know if I see it as a moral thing. It's just I'm not wired that way. But I could I could clear a couple million dollars a year if I did that. So

Tim 1:02:58
I when I was like, first deciding to go on to their style, their way of eating. I was like trying to crunch the numbers. I wasn't I wanted to do the coaching thing. And I was like, I even if I wanted to like I, it would be too hard of a financial hit for my family to do that. So yeah, it's like, and I'm, you know, firmly middle class as I'm a teacher, my wife's a preschool teacher. So

Scott Benner 1:03:27
I want to be clear that I don't make anywhere near a million dollars here. I just want to say that quickly. So, I mean, what I'm trying to say is by by, by a magnitude of order, I would make more money if I if I go over 90% of you and charge the other 10% that could

Tim 1:03:44
afford it. Make a note 59 We

Scott Benner 1:03:48
just you know, I'm 30 I got it, don't worry. I just and I didn't have to say it that way. But it is what would end up happening. I would I would just have to cut most of you away and say sorry, you don't get to hear the podcast and for the people who could remain and pay. You'd make me rich. So, you know, I'm not struggling Tim, I don't want you to feel that way. You know, but it's a it's a decision. And I mean, it's hard to argue with. You'll you'll know I gave up at the end if I do it. I'm just gonna be like Scott's gonna cash in at the end. The whole podcast just went behind behind a paywall. He's given up. But you know, I've been doing this for this is the eighth season of the show. Is it 1516 1718 1920 20 This is the eighth season of the show. Like the app, you know, not the eighth, like, you know, some crap podcasts that has 10 episodes a year and they're like, it's a season I'm like, yeah, it's two weeks your life. Like I make four episodes a week and for years. And before that I was one episode a week, two episodes a week this podcast has over 700 episodes is where as we're doing this. Yeah, and I even see that as part of how I keep you all interested. So more People can come in and learn about how to Pre-Bolus and do the basic things that I don't think should be kept from you. So, you know, to me this conversation with you today is as much about telling your story so that people who need community can feel community, as it is about hopefully entertaining someone into thinking, why don't I go find out what those pro tip episodes are about? You know, like I am, I am thoughtfully trying to help the people who are listening to the show. Yeah, you know, it works or, you know, as well as it does, I'm about to hit. I would say in the next handful of days, the show's going to hit. I want to make sure I get the number right. In the next couple of days, the show's going to hit 7 million total downloads, keeping in mind that the first four or so years of it probably only had 2 million. So I've stacked on like 5 million over the last handful of years. Today, the podcast became this this month, I think it's June. So it's June 29. Right now, today, the this this day made this month, the most popular month of the podcast ever. And if the next 30 hours go the way I think I'm going to crest, a significant download number for this month. And I see that and I just think cool. Let's do more, let's find more people teach them how to get their basil set up. Let's get more people who can decide I want to control like, you know, I want on the pod file, I'm going to I'm going to wear a Medtronic, I'm going to use an insulin pen, I'm going to use a pump, I'm going to use the pen, I'm going to figure out what works for me low carb, I'm going to have I'm going to eat vegetables, I'm going to Pre-Bolus real consistently, whatever you take out of this, that helps you is what I want for you

Tim 1:06:48
that and I just you know, I went through all these different ways of eating. And I feel like if I had discovered your podcast first I might have saved although no, honestly, it was a good experience to have eaten that I don't regret it at all. I, I mean, I'm better at cooking vegetables now than I ever was before. And so I can incorporate that into when I don't eat vegetables. But I also try to eat more vegetables than I did before this whole thing. So yeah, it's. But if I'd had your podcast, I think back then it would have saved me a bit of grief as far as some of the diabetes education stuff that maybe I and maybe if I had seen a diabetes educator, I might have gotten that information. Some of it too is like, when you have had diabetes for a certain number of years, you're like, you'll see an endocrinologist and they won't necessarily think you need to see a diabetes diabetes educator, even though they might have stuff that's helpful. So I don't think I saw a dietitian or a diabetes educator since I was first diagnosed. Yeah.

Scott Benner 1:07:55
Well, I mean, the truth is, it sounds like your friend's death is what helped you the most right?

Tim 1:08:01
Yeah, I think so.

Scott Benner 1:08:02
It's ironic do you think about that often?

Tim 1:08:07
Yeah, I think about it from time to time.

Scott Benner 1:08:11
It's terrible as you were explaining your story with him. And you're talking about meeting him before school and commiserating in my in the back of my head and the bottom my heart I'm like, Oh, God, Paul's dead. Like that's exactly what I was thinking when you were telling the story. Because you hadn't up until then mentioned the birth of your children is the reason why you fixed it, which is what a lot of people say. Yeah. Don't let your wife hear that part. That the birth of your children didn't. Didn't move. enough to take care of

Tim 1:08:40
your doctor. I definitely wanted to fix it so that I can be around for my child.

Scott Benner 1:08:45
Was she that great? The kid is that what you're telling me? You should just okay.

Tim 1:08:49
She's fantastic. She's She's wonderful.

Scott Benner 1:08:56
Sure, she's wonderful. She's a great can you imagine if we got that recording in you're like, really? The kids? She's an albatross. I have to tell you this guy. complains constantly whines can't read. It's terrible.

Tim 1:09:12
Just fixing the reading thing right now.

Scott Benner 1:09:16
No, I'm yeah, I'm obviously I'm teasing. Because this point your wife's like, why did we do this? She's listening back. But no, I mean, my point is that I mean, I've interviewed interviewed enough people apparently not to be able to say interviewed but I've interviewed enough people to know that it takes some sort of a life moment where you suddenly don't feel like you're the focus of the world. And and you start thinking about other people more than you think about yourself, and then you realize I can't die. That's exactly what it ends up being. I have to be here or I love this person so much. I can't I don't want to shorten this time. And and that's usually what gets people and hope Fully, it's before something happens to them. That's irreversible. And, and speaking of that, how are your eyes doing? Since you're managing differently?

Tim 1:10:09
Yeah, so I'll first of all, since really looping, trying to Pre-Bolus as much as I can, and I'm not always great at it, but I'm, you know, working on getting better. My a one seat my last day once he was 5.5. That's amazing. And my last time I went to the eye doctor, they said that there's no sign of diabetic neuropathy in the eyes anymore. So that all resolved itself. So Ganderbal

Scott Benner 1:10:38
good for you. Congratulations. Thank you. Yeah, that's excellent. That's excellent news.

Tim 1:10:43
One of the things I wanted to ask about Yeah, go ahead. What's

Scott Benner 1:10:46
your turn is

Tim 1:10:48
loop loop related. So I feel like my, my basil is borderline too aggressive. But it's hard to say. And perhaps I just need to turn an open loop off so I can really see. But I don't like doing that. Because I like open loop. I mean, a like a closed loop. I mean, right. But, like, overnight, I'll have some nights where I'm sitting at 65, like, which is too low. I know. I want it to be higher. But then, other nights, I climb into 150, maybe even 200, and then come crashing down. And I guess it's I can usually look back and be like, okay, my dinner was like a little bit either car beer or high fat or whatever. But not necessarily always, how about might be

Scott Benner 1:11:50
pardon age of the pod you ever notice on

Tim 1:11:53
my pods. And as I'm getting, I'm seeing my pods fail more consistently into the second day, which is frustrating, but it is what it is. And I have enough of them. My doctor writes a prescription so that I could change from me to if I wanted. But yeah, I think it is oftentimes either pods or like a copier or fattier dinner I know which I ended up. Good. I'm sorry. I'll end up like what I was also kind of making adjustments to my ISF in loop. And I was it was something that Mr. Fox was saying that I haven't met him. We live in the same county, but I haven't met him. Yeah. I think we're Facebook friends. But the he was saying something about leaving your Basal the same. And I used to have a bajillion Basal rates like back when I had, you know, other ways of doing things. But I said it's a one Basal rate, and then I set my ISF aggressively. Yeah, my sensitivity factor to be like more aggressive at like, bedtime and less aggressive as the night went on. So that hopefully it wouldn't overpower me. And but I'm still getting overpowered and waking up having bad lows at night.

Scott Benner 1:13:16
Yeah, how low?

Tim 1:13:19
I'm in the 40s. Yeah,

Scott Benner 1:13:22
I just stopped the 60s. So. So Arden used on the pod five for a while, Tim, this is going to be something now that just you and I know. So when you get off of here, you're gonna keep it to yourself, because you're not going to come out for a while and you'll ruin the timeline of my podcast. Okay, thank you, but aren't used on the pod five for a number of months. Got the real gist of it. I understand how it works and everything. And it's just, it's really listened to all these algorithms are amazing. And but we went back to loop. So Arden went back to loop but she also stopped birth control at the same time. So I'm watching her insulin needs, they're starting to go down as the birth control pill leaves her and leaves her. So I'm having to I don't want to over adjust yet. I'm trying to watch but she had like a 55 Last night at like three in the morning. And I was thinking of doing the same thing that you were thinking of which is to take away some insulin sensitivity to make it weaker in the 130 to three, four or five o'clock range overnight. I think that might help a little bit. But for you specifically what you're talking about, do you have Nightscout? Yeah, yeah. So are you noticing? You said you think the basil might be too heavy? Are you noticing the algorithm taking away the basil all the time?

Tim 1:14:44
I'm gonna look and see. I haven't looked at my Nightscout recently.

Scott Benner 1:14:47
Because I mean, there's a lot to think about, right? Like, you know, is this happening on the third day of a pod? Because if it is, then maybe that's got something to do with it. The higher blood sugars but if you're getting low is a wall of things constantly taking away basil overnight there, maybe your basil is a little stronger, or maybe your insulin sensitivity is a little strong. Yeah, or maybe they're both a little stronger, I don't know. And the

Tim 1:15:10
other thing too is a little bit hard to tell because I'll I have a, you know all the when a Ginny's tips like a one point 150% Basal increase for eight hours started after you finish your meal, your high fat meal. So I have that as a as an override. And usually when I hit that, I don't have a big rise. So that's helpful. That's excellent. So or if I have a rise, it won't be it won't be like over 150. So that's that's good, too. But

yeah, it's let's see, I'm looking at my Nightscout right now to see.

Scott Benner 1:15:53
And there's nothing wrong with you know, opening the loop up and running it like a regular system for a little while and just seeing if you're getting what you want. Because sometimes your settings do get out of whack. You know, I was talking to somebody earlier today. And I said, I said the same thing. I'm like, I'd open the loop up and let it run for a little while see how your meals go. See how your stability is away from boluses and food and see if your Basal is really working or if you're being drugged down or drifting up. Because I think the person I was talking to earlier has probably found a way to compensate their Basal being too high with their carb ratio being lower than it should almost like old school MDI care, where they kind of load loaded up on basil and then assumed you work at a Bolus for your meal as well.

Tim 1:16:39
And that's where my might be like my Basal rate right now is I think I just marked it. I just brought it down on the tiny bit, but it was like 1.75 I think it's 1.65 right now,

Scott Benner 1:16:49
and you weigh are you 170 right now?

Tim 1:16:52
No, I'm a little bit more than that. Okay, 9190,

Scott Benner 1:16:55
let's not correct. Let me see there. But and are you still taking the Metformin? No. And you're not eating the the, the fruits of vegetables anymore like that? Not as much as much I'll try to eat well, maybe maybe there's that a little bit there, too. Maybe you gave up that diet and you gave up the Metformin, those were two things that were making your sensitivity greater. So now your Basal is higher. And then maybe there's times when it just maybe your sensitivity is there for reasons we don't make maybe it's exercise or something like that. And then and now you're getting low. I mean, you've been married for a while. Would you have sex? Like once a month? Is it happening once a month? Are you getting low? Once a month? Yeah, sorry, I didn't mean to just pick out a good month. But you know what I mean, like, maybe there's another impact coming in, and increasing your sensitivity a little bit and making those lows for you, or maybe have you know, big meals and crush them.

Tim 1:17:56
We're trying to we're trying to teach my daughter to swim, and we're trying to get to the pool every day. So we can let's uh, we're like, swimming a lot. Trying to exercise. But I'm not like doing like weightlifting, which really helps. And I need to do it like,

Scott Benner 1:18:10
exercise is going to help for sure. Any kind of exercise. I'll tell you right now, if you want to know, what's great about loop over retail systems, any of them. It's a lower target, and a more aggressive attack of a rising blood sugar. Yeah, that to me is what makes it special. And for all of these systems, what makes them special is that all the stuff we just talked about those variables, some of those knowable, and then sometimes unknowable things. You can have this algorithm out ahead of you going, Oh, God, Here's more. Here's less, here's more, here's less. Because without that, you turn into everybody else who's using insulin who is feeding three loaves a day, or existing with a 250 blood sugar for five hours because they don't want to get low later. Or where are the other problems? The problem is, is that this is a constantly fluctuating situation. And you are not a computer, Tim. So yeah, you know, you get your settings as good as you can get them. And you I just expect that some days, you're going to be 55 at three o'clock in the morning. But let's try to limit it as much as we can. And for people and then

Tim 1:19:21
of course, the good news is loop will then pull me back up again. So like I'll be you know, at by wakeup time, if

Scott Benner 1:19:27
you don't make if you don't make a significant mistake with insulin. The loop is very, very good at stopping you from at least having a really bad low blood sugar incident. Yeah, yeah. I mean, you can still do it. You could Bolus the wrong time or have variables that you don't, you don't factor in. And it makes some big Bolus for something when you didn't need it. I mean, you can overpower that algorithm, but in a normal situation, I mean, nobody wants to be 50 But you know, when you go back later and see how the you know, the algorithm was taken away basil for two and a half hours and it caught you at 50. You got to think in that exact same sleeping situation, your blood sugar would be zero if it wasn't for that algorithm. Yeah, that's amazing.

Tim 1:20:13
I know. I never want to I love I love loop. Man. I love it so much. Yeah. Hi. Are you you guys are still using an orange link? We are using the orange link? Yes, yeah. So as I know that they're they're not far off from 3.0 coming out and being able to use dash pods, but like, that's all the fancy computer people are working on that one right now,

Scott Benner 1:20:37
when we switched from when we called, I called us mad. And I said, I'm going to start getting the Omnipod five. Now I want to get go back to a different pod. They said we'll put you back to where you were. And I said, Can you give me a dash? So I've got Omni pod dash is coming to the house. Now we have a small stockpile of arrows pods that we're using up. And then we'll hopefully we can coincide when the loop algorithm is ready for for dash, and then just moved to that.

Tim 1:21:08
Yeah, I was actually thinking because I have a big stockpile of arrows as to I'd like practically 12 boxes saved up,

Scott Benner 1:21:14
use them out. So pardon? Do you use them up? Keep going?

Tim 1:21:18
Yeah, so I'm gonna, I'm gonna try to use them up, I haven't ordered new ones. And then I'm going to try to start ordering dashboards after that. So I can?

Scott Benner 1:21:24
Well, the big concern of the day is is that the FDA is talking about, I'm actually going to spend some time tomorrow getting behind this online, try to move some people, this will be long gone by them. But there's something going on at the FDA where they might there. It's an X, they're trying to say what are they trying to say? Is that it was cyber cyber security and medical devices, quality systems considerations and content of pre market submissions. Except, I mean, I don't know what I got my wife reading it, they explained it to me right now.

Tim 1:21:58
I did the same thing last night. I just saw them posted that it on either loop and learn or on your Facebook group and I went online and and did the form. So right, yeah,

Scott Benner 1:22:10
yeah. So I'm gonna, I'm gonna try to put the power of the podcast behind this little bit, get people to send some notes, so that they don't protect that I'm making quotes are CGM data in a way where you can't use it? Because I mean, listen, I guarantee you that at some point in the future, retail systems will have a lower target, and there'll be more aggressive, and it'll be great. But in the meantime, and by the way, too, I want I do really mean this, and I'm gonna say it over and over again, because I don't want to dissuade people. For most people, you were on the pod five control like you something like that, you are going to have a significant increase in your health and happiness, like significant for people who know how to put their agency in the fives, and who don't see a spike over 140 Very often, those aren't going to do that for you. They're not meant to. And it's unfair to hold them up next to each other to be perfectly honest. But we need as people who I said, Wait, I don't have diabetes, people who have diabetes need for industry to be pressured into moving forward. Like we don't want any listener on the pod buys ads from me forever. You guys get the podcast because of them. They're beautiful to me. And aren't we using only positive shoes for it's amazing. I'm thrilled that company exists, but I don't want anybody resting on their laurels. Like Omnipod fives terrific make it better. And to me that's target and stopping spikes.

Tim 1:23:43
I mean, I'd be more interested in using one of those products as I've well the other thing too, is I thought maybe I'll try Omnipod five too. But then I also like so wedded to my Apple products from looping and just from doing music stuff where Apple's superior. So like. I don't want to use Omnipod five until it is talking to

Scott Benner 1:24:03
Oh, yeah, i are i handed on that. PDM and she goes Oh, what's this?

Tim 1:24:09
Yeah, I could totally see that conversation happening. Yeah,

Scott Benner 1:24:13
actually, the first time I gave it to her, she went no, and put it down on the table and walked away. Just from looking at just from realizing it wasn't on her phone. Yeah, not that the products not good or anything like that. You just it wasn't on her phone. And she went no, I don't even though she said she just went no and put it down. And then I started we're gonna do this. We're gonna do it for a while we want to understand how it works. And it might be great for you and we're gonna find out you know, so is

Tim 1:24:38
she comfortable? I know she's going to school in the fall right? Yeah, far away from you. Right so is are you going to have a little lesson on how to rebuild a loop?

Scott Benner 1:24:49
Like I'm gonna get her a used laptop, put Xcode on it and have it for nothing else and ship it down to her so that if it and when it happens, she knows how to rebuild rebuild the app and the P long line have made it so now you basically click a link to rebuild the app. It's

Tim 1:25:03
Oh, I know last time I rebuilt, I use that link. And it was the easiest thing ever. People if you don't know how to

Scott Benner 1:25:08
loop, it's so easy. The internet's amazing. Listen, and

Tim 1:25:12
I'm a music teacher, and I figured it out. We're going to

Scott Benner 1:25:15
forever be grateful for the people who, who put these efforts in. And I know that doesn't always coincide with what industry would wish was happening or what the FDA would wish was happening. But you have to take a big long look at this. It's it's magical, it's helping people. It's driving innovation. And it's very necessary and if you squelch it or hide it behind some cybersecurity both you're gonna be doing people a disservice with their health.

Tim 1:25:43
Yeah, I agree with you. And sorry, I was just thinking, I love explaining to people like, Oh, I I hacked my insulin pump, like, you know, like, it makes me feel like I'm much I'm much more

Scott Benner 1:25:59
more savvy, and I really I just give it I just, I just say there's a guy in Russia named Ivan, he did it. And we download it off the internet. And people do look at you a little sideways. But listen, I'll tell you right now, as far as tight tolerances are concerned, it's I don't know who the hell Ivan is, man. But God bless you know, thanks, Ivan. Yeah, thank you very much. And everybody, man Brown, Bob da, way more other people than Ivan. He's just the name I that sticks in my head. You know, but I mean, so many names run through my head about about people who've been putting incredible amounts of effort into this for years and years and years for, you know, largely No, no thanks. And no money. Yeah. And it's sometimes

Tim 1:26:43
less than thanks. I think I'm thinking about like, you know, like, what a taxing thing as must have been for people like Katie, of putting it together, and then having people complain, and she's done such an amazing job, getting it readable and all that,

Scott Benner 1:26:58
you know, when people are complaining to you and you're like, all I can think is, you could have just said thank you, that would have been enough for me to tell me what I've done wrong here. As I'm spending massive amounts of my life for free explaining things to you. Yeah, I would imagine people in her situation have probably felt, I mean, buoyed by it. And at times, I would imagine it was frustrating. So but it's incredibly. I'm incredibly grateful for it, as I'm sure everyone else is that uses it. And everyone else should be too if you use an Omnipod five or control IQ or maytronics thing, like whatever you using, like there are people out in the world driving innovation for you don't you don't even know there's even the there used to be this little group, I don't even know if they exist anymore. They used to hammer the FDA over stuff. And even now that we're seeing exponential growth and diabetes products is because of like a small group, like this little small nonprofit that just wouldn't let the FDA up off the mat. You know, they just kept pushing them about stuff. And that's something you get diagnosed today. You're never gonna know that happen. So yeah. Anyway, alright, Tim, I kept you longer than I said, I'm assuming one of your kids is at a bus stop right now crying because they think you don't love them.

Tim 1:28:15
And no, I I'm teaching at a summer camp that I like, have had this on my books for so I told the the director like, oh, I need to tie this morning off. So I can do this thing. And, and so like, but I told him, I'd be there at a certain time. So I should get over there.

Scott Benner 1:28:32
I'm starting to think you gotta go. Yeah, unless you want to say anything nice about me. But then otherwise, we can just say

Tim 1:28:37
something nice about Scott. I'll just say this. As much as I get a lot out of this podcast for management things, I get just as much therapy and camaraderie. And I just love hearing everyone's stories. And I learned so much from everybody. So I wanted to come on and kind of talk a little bit about my story. Not that it's particularly unique, but I feel like I have kind of a a mix of a lot of the different things that people have talked about. Yeah, no, I

Scott Benner 1:29:07
appreciate it. I thought you were terrific. And you could tell that you listen, you rolled with it so well, so I appreciate it very much.

Tim 1:29:13
Yeah. Listen. I listen a lot. My daughter's like, do we have to listen to this in the car? I'm like, Fine. We'll put on in content.

Scott Benner 1:29:19
What's? What's her name?

Tim 1:29:22
Her know her name is Ruby. Oh, Ruby.

Scott Benner 1:29:25
Ruby. Ruby. Don't tell your dad to shut my podcast off. I need these downloads kit. I know you don't understand your little but this is what keeps the lights on kid. Okay. And listen to the end to all the way to the end. Yeah, there's ads at the end.

Tim 1:29:39
And there's good stuff at the end. Sometimes you have the best jokes at the end. Well,

Scott Benner 1:29:42
the secret there, Tim is that I sometimes record those very late at night. And I am very, very unaware of myself and don't care and too lazy to go back and edit and I'll start rambling and saying stupid crap. And there's times my wife's like, What did you say at the end of that episode the other night? I'm like, I don't know what you're talking about. And it's should go back and play it for me. And I think he I probably shouldn't let that in there. But what you always do, I was making an ad last night. And I got five or six words into a sentence. And I thought there's not one valuable word in that sentence. And I just said, I don't care. And I just kept, just kept rolling. It's like, I'm not stopping. Anyway, I appreciate that you like it? I'll tell you one of the greatest things for me is that somehow my diabetes podcast is entertaining to people. Like I really Yeah, who knew? What Not me, I thought I was going to pump a booze, not

Tim 1:30:34
even a diabetic.

Scott Benner 1:30:37
Not remind people all the time. And probably it's hard to listen to, if you realize that, but there was a time where I just thought, like, I'm going to do a information dump out of my head. And this won't last that long. And it'll just sit around like a repository.

Tim 1:30:49
And when I, when I first started listening, I I was like, Wait, I didn't know the full story. And I was like, wait, is he a diabetic? Or oh, he's got a kid is diabetic. Oh, this guy knows a lot.

Scott Benner 1:31:02
What's the chance? Thank you?

Tim 1:31:05
Yeah, I, I have other type one friends that I'm like, dude, check this out. Because I know I have other type one friends that don't even use a Dexcom. And I'm like, come on. I hear

Scott Benner 1:31:14
sometimes from type ones that are like trying to get adult friends to listen. And their friends will be like, I'm not gonna listen to somebody who doesn't have diabetes, about diabetes. And like, some people will write me notes and explain like, you know, my buddies got like, a nine and a half a one C and I was like, geez, forget diabetes, like, most people apparently know more about diabetes than you do. Like, just listen to anybody who would tell you like, you know, maybe just, you know, I don't know, eat a certain way or do this, or Pre-Bolus, whatever, like this little adjustments can make a big deal. I don't understand it. And I do understand it. Like, I don't understand, like, Why do you care where good information comes from. But I do understand. I've been, you know, burdened by this my whole life. And now you're telling me some guy who doesn't even have it is going to show up in my ears and explain this to me, and he's going to understand it better than me. Like I can get where that would piss you off. You know? So yeah, it does make sense in certain situations. But I'm so delightful. You would think you would just listen for the fun of it. Yeah. Put up an episode yesterday with a girl who drank out of her Christmas tree. Were you getting that? You think the ADA is telling you that story? No way, baby,

Tim 1:32:24
that that one. And the young, the young woman who's bad exploded? Those are the

Scott Benner 1:32:29
I'll tell you what, if the JDRF ever puts out any content where some girls but explodes? I give up. But for now, this is the only place you're gonna get it. And by the way, I had somebody tell me recently like that had nothing to do with diabetes. I was like, huh, you're wrong, because it has to do with wound care and high blood sugars. And it will, someone will hear that story and think, Oh, I had a sore here or I cut myself and it didn't heal or something like that. And it will connect the it'll, it'll wire a circuit in their head for them. You know what I mean? And you can only do that with interesting content. Like you can't just like, you know, listen, if I was the ADA, I think they have a podcast, but God knows doesn't show up on the charts. So anyway, um, that's for sure. Let me just I've never listened to let me just be about people try to help people. But, you know, like, if they come along and they start talking, they want to do 15 minutes on wound care. You're not going to listen to that. Because boring. And you know what I mean? Like too much content in the world. I'm going to go watch a YouTube video before I listen that I'm going to go watch. You know, some of my favorite television show for the 17th time before I do that. I give you a podcast episode with the title butthole adjacent. Anybody who sees that and doesn't think what is this about? I don't understand you. You don't I mean, so the jump on you start listing this girl tells an intriguing story about her diagnosis that ends with her taint exploding, and just like, come on. You're welcome. Just

Tim 1:33:58
better than getting it from Florida.

Scott Benner 1:34:01
Just say thank you when I do that for you don't complain. Oh, my God. Anyway. All right. You're delightful. I appreciate this very much.

Tim 1:34:10
I appreciate you too. Thank you, Scott.

Scott Benner 1:34:16
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 g VOKEGLUC. Ag o n.com. Forward slash juicebox. Thank you also to the Contour Next One blood glucose meter. I'm not kidding. It's a fantastic meter. Contour next one.com forward slash juice box links in the show notes of the podcast player you're listening in now. And links at juicebox podcast.com. To G voc contour and all the sponsors. When you click on my links, you're supporting the Juicebox Podcast. And speaking of the juice box podcast we have a private Facebook group. I think it has like 34,000 members in it right now. And it is worth your time. Absolutely free Juicebox Podcast, type one diabetes on Facebook. That's about all I got for you today. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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#851 Best of Juicebox: Too Much Insulin?

Episode 482 Too Much Insulin? was first published on May 21, 2021 and features a conversation about how much insulin is the right amount.

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

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello friends, and welcome to episode 851 of the Juicebox Podcast.

You may have heard this best of episode back on May 21 2021. It's with myself and Jenny Smith. Jenny, of course, is a CD who has had type one diabetes for, like 30 some years. And in this episode Jenny and I talk about a misnomer in the diabetes space. The idea that you can be using too much insulin, we're gonna have a whole conversation about it. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please Always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Don't forget to take the T one D exchange survey, please complete that survey AT T one D exchange.org. Forward slash juicebox. And these episodes don't have ads on them right now. So I'm doing something special. I'm going to tell you about it as soon as the music's over. But don't forget that generally speaking, the podcast is supported by a ton of great advertisers, all of whom have links in the show notes of your podcast player, and at juicebox podcast.com. Before we get started, I just want to reiterate you need the amount of insulin that you need. There is no wrong amount. I have this idea, since these episodes don't yet have advertising on them, although I'm open to selling it to someone who intend. But since they don't at the moment, I thought I would give some ads to people who live with diabetes and their life. So with that in mind, this episode of The Juicebox Podcast is brought to you by Tci. answering service reliable answering services 24/7 365 Let TC eyes reliable staff handle all of your phone calls in a professional manner. TCI answering service.com Head over there and check them out. And the owner of TCI is the mother of a 12 year old child with type one diabetes. So check them out. The podcast is also sponsored today by lower left side photography. Lower Left Side photography is located in central Iowa. But Jason bold travel around. He does wedding photography, and his work is just amazing. Lower left side.com Jason's son has type one diabetes. Alright, I'm gonna do two more but I don't know how I'm going to do this one. Looks like Shannon and her husband. Fun on the columbia.com it's in rural Washington, a small resort, kayaking tours, things like that. It looks lovely, but I don't I can't say the name of the town. scammer Oh, come on scam Okowa You gotta be kidding me. Skam Okay, Awa I'm assuming if you recognize that name, then you'll know where this is in Washington. And it's fun on the columbia.com beautiful photos. You go over to the website. You can take a tour of the place. Oh, it's really great. All right. I don't know how to say skim a coat. Alright, honestly. scam. Oh, co ah. Are you kidding me? Go check it out. Last one. Let's stick with this theme. Here. Oh, barn venue weddings in the Topeka is at Indiana. Yeah, to peaky Indiana called Lakeside occasions. at Lakeside. occasions.com. They have a website which I've just said. My husband and mother in law grew up on this farm. Our eight year old son was diagnosed in 2018. With no family history of T one D so check it out. Its lake side. Oh, this is pretty good. People have lovely. Look at this. Lakeside occasions.com I'm gonna give you the address. Is there a phone number? There's virtual tours here on the properties beautiful 260-585-3211 Topeka, Indiana, right i n is Indiana, isn't it? You'll figure it out. Let me get going on the episode. Hello friends, and welcome to episode 482 of the Juicebox Podcast guest who's on the show today.

Today on the podcast, I'm joined by Jenny Smith. Jenny of course, is from all the defining diabetes episodes and the pro Tip series. And she's here today to answer a question that I have based on watching people. I have a watching people question. I listened to a lot of people who use insulin. Some of them say this thing that doesn't make sense to me. And I want to ask Jenny her opinion. And while you're getting her opinion, 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. Were becoming bold with insulin. You know, I'm wearing headphones and I can hear myself and my voice sounds amazing right now. Jennie holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitors. And she just celebrated her 33rd anniversary.

The T one D exchange needs 6000 people to join the registry. And I have to keep saying this to you until you do it. So that he 1d Exchange is looking for T one D adults and T one D caregivers who are US residents. They want you to participate in a quick survey that can be completed in just a few minutes from your phone or computer after you finish the questions. And they are very simple. I completed the survey in about seven minutes. You may be contacted annually to update your information. And they may even ask you a couple more questions. But this is 100% Anonymous, it is completely HIPAA compliant. And it does not require you to ever visit a doctor or go to a remote site. See, this is interesting. This is a way for you in just a few minutes to help other people living with type one diabetes. past participants have helped bring increased coverage for test trips, Medicare coverage for CGM, and changes in the ADA guideline for pediatric a one sequels. These are important behind the scenes things that people with type one diabetes need, and you have a unique opportunity to help them. These are not deep probing personal questions. They're pretty simple, basic surface diabetes stuff, but they just need the data. Help them at T one D exchange.org. Forward slash juicebox. And at the very least, if 6000 of you go right now, by not to say this again. Do it for me. I'm kidding. Do it for the other people living with type one diabetes. But I mean, if you want to think of me while you're doing it, it's fine. This topic, absolutely mesmerizes me I because I can't make sense of it. And I know I can't make sense of it. Because I don't have diabetes. I know this is one of those things that I can't wrap my head around because of it. And it comes mostly from adults. Although I've seen parents lean into it a little bit too. And I'm I really want to kind of dig into this with you. Why do some people think that there's an amount of insulin that's too much insulin to use? And that they're actually embarrassed if they use that amount? Or feel like they're failing? Where does that thought come from?

Jennifer Smith, CDE 8:24
It's a good question. First off, I would think that it probably starts with some like, sort of off the cuff kind of comment from a doctor. Not that the doctor is really implying what the person takes out of it. Like doses of insulin usually go along with each other, you're not going to have a Basal rate of point two, and have an insulin sensitivity factor of 20, which is unbelievably aggressive, right? I mean, that's not going to typically happened. So in terms of like evenness of insulin distribution, they may have heard the doctor say, well, you're on a lot of insulin. So your ratios should be such and such, right? So it may initially come from something like that. But, you know, they even might compare them selves to another person with diabetes, who they maybe they work out together, or maybe they are close enough friends that they're just comparing things. And they say, Well, gosh, you know, I eat really well or I follow this type of exercise pattern. And gosh, it looks like I use like twice as much insulin as you and you're like a couch potato, whatever, you know,

Scott Benner 9:39
the closest I can come up with listening to people and I really mean that this isn't from one or two people. This is over the years. I hear this constantly. Like I'm a bad diabetic. I use too much insulin. I've heard those words come out of like grown people's mouths and it's Sometimes it feels like, it's I don't know if this is gonna sound crazy, but sometimes it feels like it's impacting them almost like an eating disorder, but it's like it's like disordered insulin use it feels like, and no matter how many times I talk to them, and I'm like, Hey, you just need what you need, or your body has a need meet the need, whatever I ended up saying to them. It doesn't feel like it's enough. Like, it feels like it's psychological. And you know what I mean? Like it really, and it's sad, too.

Jennifer Smith, CDE 10:28
I think some of it too, probably comes from those who are trying to manage weight. Because if you know really, what insulin is, it's a storage hormone, right? Its job is to move food from one place your bloodstream into a place to either get used or it gets stored. So, you know, if, if that's the fact then a lot of people also don't see what does insulin do, if you don't have diabetes, if it's really still being made from my pancreas, its job is still the same thing. So in terms of weight management, you may find that, well, gosh, I use an awful lot of insulin, if I was just using less insulin, maybe my body wouldn't pack away as many calories. And thus, you know, my insulin use would go down. And I also wouldn't be, you know, heavier than I maybe want to be. And it certainly brings into the discussion, kind of the whole, the whole things like eating disorders within the realm of diabetes, specifically, yeah.

Scott Benner 11:28
So I get the idea. But I've seen it a side of people who are concerned about their eating, like like this, you know, like, if somebody comes to me recently, and wouldn't use their name, but I don't think they'd mind being an example here. So they come in, and they're like, hey, you know, lately, my, you know, my blood sugars have been going up, right? Like my, my resting blood sugars are more like 170 that used to be more like 100. And showed me the graph, and I look at it pretty hard. And I'm like, it just feels like you need more basil here. And you know, like, then we could look at the meals. And, well, that's a lot of insulin, the person said, I don't usually use that much insulin. And I was like, Is there a problem with that? And the person said, it's embarrassing, but couldn't tell me why it's embarrassing that I'm using more insulin. And I,

Jennifer Smith, CDE 12:23
I guess, I would feel like maybe it's the thought that they're not managing well enough. So they need more insulin to compensate for their lack of management, which shouldn't be, right. Be the piece of like thought,

Scott Benner 12:38
that's how it feels to me too, that somehow, if I'm using more insulin, I'm doing something wrong. I didn't even see it connected to eating in this person's example. Although it's funny, because when it is connected to eating, it's the last thing people see, when you know, like, I'm using more insulin because I'm taking in more carbs. Insulin makes me gain weight. Although insulin didn't make you gain weight, the calories made you gain weight, the insulin was helping you keep your blood sugar down, they conflate the two somehow, right? You know, they mean, and then it gets but they're tortured by it. Yeah, like really, really. And I didn't know if you would talk to anybody that this would come up for or if you felt personally,

Jennifer Smith, CDE 13:18
I would say that more. I mean, at least once a week, I have somebody both young and old, meaning both parents of kids with diabetes, as well as adults managing their own diabetes. I I'd say you know, their, their typical question is, well, what does somebody else this age use? Is this the right amount of insulin? For me? Am I supposed to be on I guess, this much insulin? Or, you know, is this too little insulin? I mean, that's kind of the opposite with some kids or whatever. But it's always a question of, shouldn't it be specific to like, my age, or where I am in life or whatnot. And really, there's a physiologic personal physiologic need for insulin for everybody. And good, good point is that I've got a really good friend who is, she's tiny, she's like three inches, and I'm not tall, I'm only five, three, and she's like three inches shorter than me and probably weighs 10 or 15 pounds less than me and she uses more insulin than me. And she's single and more active than I am. So, you know, from that standpoint, it kind of gives you a visual that the right amount of insulin for you is the right amount of insulin for you, as long as it's keeping your glucose where you want it to be. Is it in the target that you're aiming for? And in the case of the person that you talk to, you know, their needs had gone up? Why? I don't know some variable in the picture that was new and causing something to happen but they just need more. And sometimes it's figuring out well is the more going to stick like, Is there is there or body reason like is thyroid? Is there something going on that's causing the need for more? And will it be short lived? While this other thing is going to be taken care of and managed and gotten into control as well. But overall, you know, it is? It's a good question. I know the other piece of that too much insulin, sometimes also comes from people who have sort of been scarred by really like, low blood sugars, in the aftermath of what they deemed was a big amount of insulin for a meal. Yeah. Right. They're very weary of gosh, I mean, I've worked with a number of adults who won't take more than like two or three units of insulin at a given time, no matter what, no matter what. And so, you know, then it becomes well, okay, well, what's your ratio covering then? Because you can only eat this much at a time. The way that it works.

Scott Benner 15:59
So you see people who spread like little meals out throughout the day. No kidding. Jenny is nodding at me knowingly Okay, so so that they won't have to take too much. That's what? So you said, I haven't ever thought but I want to go back to something you said. The comparison to others, is huge. And I always thought of it as looking for the answer through somebody else. But when you brought it up, I thought maybe there is just a comparison in their head, like, I don't want to do more or less than other people do. Like maybe there's a real human failing in this, it has nothing to do with diabetes, that like comparison thing.

Jennifer Smith, CDE 16:36
Right? And I would, I would say that that's, especially with the teens that I talked to the teens themselves are not really so concerned, it's more the parents that are concerned. He's using so much insulin, I remember when he was diagnosed, he was six, and he was on this tiny, tiny amount of insulin. Now he's got like, you know, Basal rates that are like 1.9 units an hour. And I'm like, well, he's a TI and he's growing. And he needs a lot more insulin. I mean, so comparison wise, you do have to look at time of life. But even with, you know, this tea, and let's say, compared to his friend, his needs may be very different. His friend might be getting along just fine on point nine units of basil an hour versus his 1.9. So

Scott Benner 17:23
yeah, yeah, I get that. It's interesting, too, because I think my brain I know yours does my brain kind of slips into that like slicked back, go macro, look at the whole picture. See, like, you were like maybe your thyroids out of whack or like, I don't think mostly people think about stuff like that. Right, and the impacts of other things on your blood sugar, the one that you just brought up now, which I'm always fascinated by is you'll get a note from somebody who says, I don't understand my kids had diabetes for two years. You know, all of a sudden, his blood sugars are high all the time. And my first question is, have they gained weight in the last like, three months? Oh, yeah, he's put on like, 10 pounds, it's like, well, you know, a gallon of gas moves a car that weighs 1000 pounds this far, it moves, it moves a car that weighs 1010 pounds, a little less, you know, like that. And, but they don't see that a lot. Everyone's so locked in on making a number. Be right, and, and holding on to some hope that it's just going to be like that forever. maybe that has something to do with this as well, I have no idea. I know, all I can tell you is that when I hear adults say it, there is sadness in their voice. And they feel like they failed somehow. And the other thing that, that I hear, too, that I want to know if you've heard and wondered where it comes from, if you know, is the idea that you can use too much insulin, and it's not healthy for you. Not that it will make your blood sugar low. But using too much. It's almost like giving me the person who's like, has pain and you say, take an Advil and I go, I don't want to put medication in me. Like and you go all right, right on, you know, I it feels like that a little bit like they're almost I don't want to say irritated but they're disappointed that they have to take insulin law. And somehow by using less of it, it's going to be healthier for them. When that's of course, the opposite. But do you know what I mean by that?

Jennifer Smith, CDE 19:21
I do and, you know, in terms of too much insulin, if you need a certain amount of insulin, you need it. I mean, that's the base fact. Right? But getting into the fact of where I remember years ago, even before I was I was working clinically. And I started a young girl teens on a pump. And prior to the training, we always go through like what's your insulin dosing, so I could figure out like the strategy for the pump settings, right? When she was telling me her doses and I was like, you're gonna be going through a reservoir a day. Like I'm serious that How much insulin this this team girl was using. And I was like, We need better insulin. Use you 100. At that point, I mean, you 500 was on the market. But it was not at all something that was typically used an insulin pump, we had to actually go about like getting a doctor's order to use it off label in her pump, in order for her to actually get enough insulin. But at that point, there, there are other reasons. And in that significant insulin resistance, then, if you're not a growing teen, or a growing child, or maybe you know, woman going through pregnancy, or some other type of like body, like health issue that might be impacting, yes, there are certain doses of insulin that typically you will need for your own body. But if you have all of a sudden, like climbed in need, for some reason, that's a reason to get a check in with your doctor to see if something else is going on. But then thankfully, there are, there are other meds on the market now that, you know, they're starting to be used. Thankfully, in type one, they started out mainly as type two because insulin resistance is a hallmark of type two specifically. But it's kind of becoming more visible now in the type one community. And so some of those meds that help with resistance, can actually help you get back to a more normal need for your own body of insulin. Because yes, exorbitant doses of insulin. At some point, you know, as I think we've talked before, like large depot's of insulin under the skin take a longer time to disperse and get absorbed. So while that active insulin time of let's call it three to five hours, or whatever, from a single one shot dose of insulin, if you've got two units, probably over the course of that time, you're going to see its action, the way that it was meant to be, if you've got a dose, that's like 30 units in a shot. That's a huge amount of insulin to get dispersed. So in terms of decreasing resistance, especially if it's climbed for you, you may want to explore the other medications that are on the market that are very helpful for that.

Scott Benner 22:27
Well, as as we're sitting here talking, I do think that there's this one aspect that's, that's kind of creeping into my mind and making sense to me that I've just never thought of, which is, if my insulin needs are going up, I know I'm eating more food or eating less healthy foods maybe? And possibly it could it could, that could be I shouldn't said I should I know that could be one of the reasons like say, say for a person, that is the reason instead of wanting to face head on the idea that I'm eating in a way that I'm not thrilled about. I focus on Oh, I don't want to take so much insulin. And then like you said, you have a higher blood sugar, which then keeps your body weight down. hurting you in other ways, right? Correct. I'm trying to like put myself in someone's shoes there. You don't I mean, that whole like,

Jennifer Smith, CDE 23:26
it's a difficult it's, it's it is it's very difficult. And I think even in this past year, was so much change to people's schedules. And I mean, even the people have worked within like cities where they were used to doing their their commute and getting on a train and walking and walking to the office and like that disappeared. And that might have been like 5000 of their 10,000 necessary steps in a day out of the picture. And now you're just getting up in the morning sitting at your desk and look at that you gain some weight and hey, you're going to probably need more insulin. In that time period,

Scott Benner 24:02
I would imagine plus the activity itself. Put your insulin requirement down. Yes. So now there's maybe you're going to gain weight because you're not moving as much and you're off as much. Yeah, blood sugar. Yeah. Well, that all makes a lot of sense. Like I it didn't not make sense to me. It's just that uh, it's happened so many times and people seem so sad when they say it. And I just wanted to really, like have a conversation and try to understand it because I really, I'm at a loss because I just come at it from like a clinical way but when they said I'm like wait, just put more in, you know, or exercise more, eat a little less or like these your options. It's that one specific sentence that I need more insulin, I don't want to use that much insulin or insulin is not good. Too much. Insulin is not good for you. I always expect they're gonna say because I don't want to get low. I don't want to have a ton of insulin in me. But that's not always the concern.

Jennifer Smith, CDE 24:58
It's just the actual Oh, that's the concern. Yes, the number,

Scott Benner 25:02
it's the number that messes them up. It's got nothing to do with anything out like if you, if you, I don't know, let's say I put you in charge of the world, and you decided that a unit of insulin was actually equivalent to two units of insulin. So we started calling to units one unit, then they'd be okay with it, then they'd be like, Oh, I'm only using three. Right? Right. But do you tell them it's six? And they're like, oh, it's still it's still like in I'm putting my fingers on. But it's still this much insulin in the syringes this much in a little tube. But if the number was different, they'd be okay with it. And that's got to be psychological. Right? Yeah,

Jennifer Smith, CDE 25:43
a lot. And I think it kind of goes back to what you brought up initially, is just that, that feeling of I need so much, I must be doing something wrong. Like the feeling of just you're like beating yourself up. Because why else would I need this much insulin? And that that's not normal? Why should I have to take 50 units every single day? Should I be more on like 20 units a day. I mean, from a standpoint of like, overall weight management, sure, doses of insulin can make a difference. But there are other lifestyle pieces that go into that. It's not just the management of the dose of the insulin.

Scott Benner 26:26
So the way we do it here is is interesting, like are no go through swings of you know, there'll be a day or two where suddenly there's just like, way more carbs than usual. And you don't notice it when it's happening. But then you do notice that if you're especially if you're on an on the pot or something with a cartridge in it when you're like, oh, I have to change my pump sooner than I thought I was going to. And yes, and so she used to be like, Why are we changing it now? And I was like, it's empty. And then you know, and she goes, Oh, why? And I was like, Why do you think she goes, Oh, I got nachos at Moe's yesterday. And I and I had a milkshake today. And I was like, That is why so you know, in a very, like, simple way. It helps her go. Alright, maybe I'm, maybe I'm carb crazy right now I don't realize that I'll pay a little more attention to it. I see it as a kind of a, it doesn't well, because it doesn't impact her adversely. In her mind. I see it as a positive thing. Because she she can kind of see like, oh, you know, pay attention to look what's happening to me. But anyway, okay. I appreciate you talking about this with me. Yes, I really did not meaningfully understand. And I think this helped a little bit. And I want people like, let me ask you this, though. If there aren't outside influences. In general, you're comfortable saying more insulin is not unhealthy for people.

Jennifer Smith, CDE 27:48
As long as it's managing their blood sugar, and everything is in target and they have no other health concerns, then the dose that they're taking, is obviously working to help them maintain control. Yes.

Scott Benner 28:02
So when I say meet the need on the podcast, that's what I mean. I just mean there's an amount of insulin you need. Use it. Use it. Yeah. Okay. Thank you.

How about Jenny? I love Jenny. You love Jenny, who doesn't love Jenny? There's no one. No one law. I mean, maybe once in her life, she cut a guy off in traffic. And that guy is still like, a person that cut me off in traffic, but they don't really know it's Jenny. They knew this Jenny. They want them. They'd be like, God cut me off, you're fine. Anyway, Jenny does this for a living it integrated diabetes.com. And you can check her out there. There's a link in the show notes. Alright, look, one last time in this 25 minutes that you've been with me, the T one D exchange needs your help. And the help they need is super simple to give. You just go to T one D exchange.org. Forward slash juicebox. That's my link, use that link. And then when you get there, click on Join our registering now. And after that, you complete this simple, quick survey. It's for US residents only. But it's so easy. Like right now, if you did it right now look at your watch. Or you probably want to watch to pick up your phone touch the face of it. If you did it right now, you'd be done in less than 10 minutes. It took me three hours to bring you this episode. And this is all I'm asking in return. T one D exchange.org. Forward slash juicebox. I mean, seriously, I booked Jenny. Record the thing. Edit it. I mean you notice how there's no like pops and clicks and noises and nothing distracting while you're listening. You're welcome. That was me. Scott. click click click with the mouse. They fixed the whole thing for you. hours it took like you're just like, oh, it was a quick 25 minute episode. It was nice. God said insulins important. And, Bob? No, no, there's more than that. It's deep. It's deep. It's building a narrative in your life about type one diabetes, giving you the tools and the access to information for the free. And all I ask is that you go to T one D exchange.org, forward slash juicebox. I only need 6000 of you to do it. I mean, there were hundreds of 1000s of downloads last month, I just need six of you. And I'm saying of the hundreds of 1000s of downloads, I need 6000. I'm tired of saying it, too. I know you're tired of hearing it. I'm tired of saying it. But I mean, at some point, one of us has got to pick up the mantle and do their part. I can only do this I filled out the survey is easy. Alright, I'm going to stop. I apologize. That was I, that was too much, too much. I should just say T one D exchange.org. Forward slash juicebox. You need to be a US resident who has type one, or is the caregiver of someone with type one. Please go fill it out if you have the chance. I mean, that's that's how I should say it. But I mean, come on this podcast is amazing. And it's free. Free. And what do I say to you? If you want to try out an on the pod, go to omnipod.com forward slash juice box I say if you want to check out at Dexcom go to dexcom.com forward slash use box I say you want to get a great meter contour next.com forward slash juice box. I say hey, my daughter's got this G voc hypo pen, you should check it out. That's it. I mean, you don't have to check it out. I'm not telling you to buy an AMI. But it's not like if you don't buy an omni pod, you're not allowed to listen anymore. I'm just saying if you're going to go check it out. But this T one D exchange thing. I mean, you're on the internet constantly. I see the people in my life. I know you don't put the phone down. And I'm not judging you. I'm just saying while you're doing it. You don't I mean, P one D exchange.org. Forward slash juicebox. Help a guy out a little bit. Don't make me beg you. It's embarrassing. I'll tell you what, if the T one D exchange contacts me at the end of the month, next month at the end of June and says we've added 1000 new people to the registry. Thanks to you. If they say that, what will I do? I will do an online talk about using insulin. Once a week, in July, once a week. Okay, I'll come on. I'll do it on Zoom. It'll be free, obviously, because you helped me out with the D one D exchange thing. And I will answer everyone's questions as long as I can. If we reach 1000. Now if we reach 1500, I'll get Jenny on one of those calls. If you do 2000, I'll do the call. Right? Every day every what I say every week in July. Jenny wants and what else will I do? I'll do something else. That's cool. I don't know what yet, but trust me, I'll come through T one D exchange.org. Forward slash juicebox. Use the link, complete the survey. That's it.

Thanks so much for listening to this episode of the Best of the Juicebox Podcast. If you're interested in hiring Jenny, she works at integrated diabetes.com. And don't forget all the great businesses owned by people who live with the type one diabetes, either parents or adults that I mentioned at the beginning, I closed all the tabs already where I would tell you about them again. So just rewind back to the beginning if you want to hear about them. Sorry about that. Thank you so much for listening. I'll be back again very soon with another episode of The Juicebox Podcast. And by the way, in the shownotes of your podcast player or at juicebox podcast.com are links to all of the regular sponsors of the show. So if you need an omni pod or Dexcom or G voc or something like that, use my link please

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850 Guilt and Shame

Erika Forsyth is an LMFT who has type 1 diabetes.

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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.

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