Scott Benner 3/21/23 Scott Benner 3/21/23

#873 X, Y and Zed

Mellisa has type 1 diabetes.

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Scott Benner 0:00
Hello friends and welcome to episode 873 of the Juicebox Podcast.

Melissa is an adult living with type one diabetes who has had a shift in her thinking and her health. While you're listening today, 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. Hey, listen, if you'd like to help out with T one D research, you can do it right from your home at T one D exchange.org. Forward slash juice box just join the registry and complete their survey when you do your answers. We'll help people living with type one diabetes, they may help you and they're going to support the podcast T one D exchange.org. Forward slash juice box 130 5% off your entire order at cozy earth.com You can get it by using the offer code juice box at checkout. And speaking of saving money, I have a sponsor called Better help.com. And if you use the link better help.com forward slash juicebox you will save 10% off your first month of therapy links in the show notes links to juicebox podcast.com. Click on the links support the podcast. This episode of The Juicebox Podcast is sponsored by us med now us med is where Arden gets her Omni pods and her Dex comes from and they carry way more than that. So check them out at us med.com forward slash juice box or by calling 888-721-1514 That's how you get your free benefits check and get rolling with us med 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.

Melissa 2:11
My name is Melissa and I'm a type one diabetic. I have been diagnosed with type one since May of 2006.

Scott Benner 2:20
Wow. And obviously you're from Detroit.

Melissa 2:23
Of course. I'm from Australia. I'm in the state of Queensland, and live on a nice little spot called the Sunshine Coast. Well, that

Scott Benner 2:35
sounds lovely. Yes, at the moment, it

Melissa 2:37
is absolutely pissing down. So not really.

Scott Benner 2:43
That hot there? No,

Melissa 2:44
usually Yes. But we're in our winter at the moment. So it's I shouldn't complain. It's I think we had a high of 15. Today was our high. Wait. So that's about as cold as it gets

Scott Benner 2:58
Celsius, right? Yes, yes. There's like a massive heatwave everywhere else in the world. And you're just Yeah, yeah. It's not too bad. It's wintertime, it's about 60 degrees, everything's fine. I woke up yesterday and turned on the news. And it was a hay. It's 115 degrees in Texas. And I was like, Wow, are they alive? Like how does that work? You know, but no, of course, How hot does it get there in the summer.

Melissa 3:29
Um, we can get up to around about high 30s to sort of low 40s. But we usually like there'll be a like anywhere like a heatwave period, usually around the middle of January, and then it's gone. And then it just starts sort of tapering off from there. Well, that's

Scott Benner 3:51
not much cooler than what I was complaining about here. So I just I woke up today and I was like, uh, hopefully there's no word of like, blackouts and things like that. Do you guys do air conditioning there now?

Melissa 4:05
Yes, you do. Yes. That is a necessity because it's, it's only like, we say that by about mid August is we have like a we call it like a shows or like a carnival type sort of thing that happens in Brisbane, the city of Queensland basically and they once that's over and done with winters pretty much finished, and it just starts getting hotter from that point on basically like, yeah, so yeah, it doesn't really last very long. We've sort of got about a month and a half or two months worth of coolish that I'm still walking around and a T shirt and a pair of like, you know, shorts and just put a jumper over the top and it's usually okay, so

Scott Benner 4:53
every every person my wife works with from Europe right now. They're on their calls and they just love it. they're melting into their desks. You know, they're slumped forward and my wife said, are you okay? Like there's there's no air conditioner here. And a lovely woman from France. She said, there's no air conditioning here. She, she told my wife, she thinks her cat isn't doing well. And I was like, Oh my gosh, I was like, what do you what has like get an air conditioner? And then Yeah, apparently that's just not what they do. So

Melissa 5:20
no way you wouldn't be Yeah, no, I imagine. Oh, anyway,

Scott Benner 5:24
that's what you get for being right. Your electrical system just can't hang. I'm assuming, I wish I knew. Because my son asked me is like, Why the hell don't they have an air conditioner? I was like, I think if everyone started plugging in air conditioners, the grid would fall apart on them. So I don't know. I have to figure out why.

Melissa 5:45
I don't know. Probably be surprised.

Scott Benner 5:49
You're like, this is not why I came on this podcast, you moron. So let's get

Melissa 5:55
the things that you can think about at 11 o'clock at night.

Scott Benner 5:58
Yeah, right. And you're straight, I'm assuming?

Melissa 6:01
Yes. Love it. Keep my brain awake.

Scott Benner 6:08
When it's earlier, listen, it's not early here. It's nine in the morning, right? But I haven't done one in like, I don't know, I like strategically started setting up my times a little later in the day. So last night, last night. Everyone's around and I'm like, I gotta get the bed.

Melissa 6:27
And they're like, You were prepping for this. Like I've been I'm like, I need to stay awake.

Scott Benner 6:33
Why am I I have a nine o'clock tomorrow. And my wife goes, my first meeting is at seven. I was like, listen, that's your problem. I was like oh, no, you should have started a podcast. He's not taking like a Normie job. But I have to be going at nine. I was thinking I have to be thinking she goes Do you think I don't have to think in the morning. I was like, I don't know what you do. That's not my problem. Again, listen, decisions were made. You are where you

Melissa 6:58
are. That's right. You made your bed.

Scott Benner 7:02
Go down there and make us some money. Damn it. Yeah, exactly. Kids can't mooch off this box if

Melissa 7:12
this is true.

Scott Benner 7:13
I listen. I say all the time. Sometimes I say things in these podcasts because I'm, I hope my kids hear it one day. My son just graduated from college. And like I'm all about not like I'm not like right up his butt like Go work right now. You know, but yeah, it'd be interesting if he was a little more motivated.

Melissa 7:32
Yes.

Scott Benner 7:33
That's a very interesting separation. I'm saying

Melissa 7:39
Come on, little buddy fly.

Scott Benner 7:42
And it's, I don't know. He's doing fine. I just there's part of me that wishes that one morning I'd see him get up and just full of them and vigor and be like, You know what I'm doing today. Finishing that resume like great. Got your degree. Could you go see if someone's interested in hiring your police? Anyone? Yes. Yeah. Yes. That is fair. All right, Melissa. So you're how old? I am. 34.

And when were you diagnosed?

Melissa 8:11
I so I like many others I have listened to on your podcast was diagnosed will misdiagnosed as type two, just before my 18th birthday. So it was a couple of days before Christmas of 2005. Yes, I

Scott Benner 8:32
have when you're 18. I'm assuming you were finishing school or had just had just just okay. Were you did you go to what would you guys call it uni?

Melissa 8:46
Uni isn't it? Yeah, next step after high school, but I didn't. I had gone straight into a like a traineeship. I know what the equivalent would be. But like, yeah, basically just going straight into work and doing a course at the same time in the field that I was working in. You know,

Scott Benner 9:05
the little voice inside of me that wants the podcast to be just as much fun as possible. Like you were like, you're like what I did was I'm like gun running, say gun running. In my head, I was like, what would be more interesting hooking your gun running? I hope she says something good. You know, you're like yeah, with a training. First off, I was like, God damn it.

Melissa 9:26
Boring. Yeah, tell me about it.

Scott Benner 9:28
I learned how to count cards. Scott. I went to Las Vegas until I got arrested. It was amazing. Let me tell you about my cocaine habit. Nothing. You're like no, I got a job. Oh, I

Melissa 9:38
wish my life was more fun.

Scott Benner 9:41
Well, what I've just described I don't know if it would make it more fun but

Melissa 9:44
this is true. More complicated, at least. Anyway. Yes. Not

Scott Benner 9:48
denigrating your decisions. Good solid.

Melissa 9:53
Yeah, no and you know, I think I in red Respect, I'm definitely glad that I was diagnosed at the time that I was. My grandma. So my mom's mom was diagnosed with gestational diabetes after she had my mother and that was in 1960. And I think my grandmother was around, you know, mid 30s, I think. And she basically just, as my understanding of it, it just somewhat developed into sort of being insulin dependent after having my mother. So she passed away a couple of years ago, but bless, she was definitely my inspiration. She had lived her whole, you know, diabetic life. And pretty much had absolutely no complications, like, you know, like, other than just the normal general things that you get when you get older and older and older. But nothing, there was a there was nothing she she looked after herself, she, you know, did everything that she had to do. And I just remember looking at that and thinking, God, I hope I don't get that. Still, like, you know, until I did.

Scott Benner 11:20
You might have jinxed yourself. I don't believe in that. But it's

Melissa 11:26
the amount of times that I had things come up in my life prior to having diabetes and thinking, I remember when I was learning to drive, and the instructor got a horrible phone call from a son or daughter or whatever, and was, you know, went on to explain to me that they were a diabetic and had a really bad low and I had that general sort of understanding of it. From my grandmother and everything, and you know, then I remember her just like sort of telling me like, Oh, this is awful. And this is so horrible. And thinking, oh my gosh, like, you know, there are other people that, you know, obviously have this and have really, really bad times with this. And I only really knew my grandmother who was doing, you know, like, she just went about her day. And I remember thinking again, God, I hope I don't get this, like, I hate needles, and this would really suck. Like, no one really loves needles. I don't think but I always

Scott Benner 12:28
think that when people say like, I don't like needles, I thought I always think like, do you imagine there's a bunch of people running around?

Melissa 12:35
Like, I love it. I love a good needle.

Scott Benner 12:41
You know, when people started telling their stories, you know, and this was crazy, because I don't like needles. Like, really? Tell me more. It's fascinating. Could you just say you're a gun runner, please. I'm trying to get downloads here.

Melissa 12:57
Oh, I love this. I hopefully there's something exciting coming.

Scott Benner 13:01
Anyway, so. But I take your point. Yeah. So you just happened to be in this this like, random situation where you got to see somebody struggle with diabetes around how much? I mean, I don't know how old you have to be to drive in Australia. So how old were you then?

Melissa 13:16
Um, I would have been around 16. So it would have been, yeah, about a year to two years before diagnosis that I had had that and that was really the like, I'd never had any friends growing up that had it. So I didn't have anyone that was in my general circle of people that had it. And that was sort of the that was sort of the first time that I had sort of encountered someone else other than my grandma. And it was God awful. Like, it was you know, like the ATM like my grandmother was, you know, after having it for so long and being diagnosed when she was she was you know, she would never inject herself in front of anyone she would always go to the bathroom she would for all intents purposes you would have never have known that she was a diabetic except for the occasional low and you know, you could tell them but yeah,

Scott Benner 14:12
did the driver's ed person make you drive to the house for the kid where the person was like,

Melissa 14:17
No, like you're no but it was it was scary enough though that like that was almost what I was sort of expecting like, I did say to her like do Should we just like do you need to go like yeah, because she was like calling people to try and like sort this out. I don't know how old her her kid was but um I just remember thinking like this is like, like that there was that sense of life and death and really not.

Scott Benner 14:44
Again, it was just hoping that your first driving experience was you like mad driving in the movie, you know? And you don't know what you're doing and it says like student on board anyway make for a great movie. Yeah. aren't in so in New Jersey, you have to drive for six hours with uh, everything in New Jersey is about making money for somebody else. Like you're not allowed to pump your own gas and they can hire people to pump your gas, which I'm like, Okay, that seems reasonable. Right? But when you convenient Yeah, well, listen, it's convenience is it's lovely, but I like that they're making jobs like there's nothing wrong with that. But the drivers that thing is you have to drive with a driver's ed person for six hours before you can go. I don't know before you can drive on your permit after that. Yep, so Arden's out, like on her second time, and she's with this woman, she goes, that I don't even know how to describe this lady. And I was like, okay, she's like, she was rough. And I was like, okay, and I said, all she talked about, like, imagine this woman in her 40s were the men she had been with before. My daughter was like, 17 going like, Oh, that's amazing. Great, this is lovely. And so you know, this, this adult on making air quotes is, you know, got these kids trapped in a car telling her war stories of my daughter's like, I just needed six hours. If I listen to you, will you pass me? The first day is all very easy. On the second day. They're doing a little more. It's ramping up a little bit. The woman gets a phone call and says no, no, no. Now we can come. Yeah, no, this one can drive. I can tell him I will my daughter's like, wait, what? And then she suddenly took her off this little route that they have for the kids to get them going and just took her right out on the highway to somebody's house to drop off like a certificate or something like that. It's like I was her Uber driver. Oh my god. Oh my god. Yeah,

Melissa 16:36
that's awful. I thought you were gonna say that you will get she was gonna have to drop her off for a booty call.

Scott Benner 16:42
From from artists description. She's like, I don't think these stories were real.

Anyway, I people, right, I have to make a note for myself to see if she can remember a couple of those stories next time ever on the podcast? Seller drivers. It's hard. Yes. All right. So you grew up around your grandma, mom, it was there. But it didn't seem awful, because she was kind of keeping it to herself. Yeah, yeah, one story where this happens, then you then you're off to work after school, and how does it present?

Melissa 17:16
I remember, like I was that typical person who very rarely ate breakfast, and by about 1010 30 would start getting very shaky very and just sort of like, just generally feeling like that would have been definitely low symptoms. I imagine. And by that time, I like. Just remember sort of thinking there was obviously something wrong. I had self diagnosed myself with Ross River fever with absolutely no reason to think like there was absolutely no valid reason for me to think that that was what it was other than it was like, well, it's not anything else. And that's something that simple to you know, fix, hopefully. So I remember going to that sort of happened.

Scott Benner 18:03
Hold on. You said something that I've never heard of before. Is it Ross River fever? Yes.

Melissa 18:09
Yes. It's a mosquito borne like, virus thing that just makes you feel like so. Yeah.

Scott Benner 18:16
Everyone who ever thought I might go to Australia one day was just like, yeah, no, thanks.

Melissa 18:20
Yeah. There's plenty of nice things but you don't want to get don't get eaten by the mosquitoes.

Scott Benner 18:29
Remember that King Kong movie where they lived on that island Scott? fighters came? It's not like that here at all. Don't worry.

Melissa 18:38
They're not big, but there's just lots of them.

Scott Benner 18:40
So what just told me the symptoms that made you think you had Ross River Virus,

Melissa 18:46
I was just the fatigue. The just the all over aches that like the tiredness and I had sort of that was pretty much like, other than I didn't really sort of link the symptoms of the shakiness or anything of being anything other than geez, I probably should eat something. And just sort of I remember going in at around about October ish. And at that time, I didn't really have a GP, like a general doctor or anything. And just going into one that was close to work. And you know, she did the whole, you know, Yep. Cool. All right, we'll just run some Bloods and we'll see what's going on. Cool. And then of course, you know, I didn't bother following that up straight away. So time had passed. It eventually got them done going back, blah, blah, blah. And then she sort of by memory. I don't know whether that then she ran another lot of tests, potentially, I think. And then it was it was like it was a couple of visits. Before we got to the point of where I remember her, telling me that my HPA one C, I think was 12. My memory and my fasting blood sugar when she checked it, there was like 15. Lola wasn't fasting, but it was, yeah, at the time was 15. And she was like, yeah, no, you have type two diabetes you are like, and at the time, for context, I was probably I'm about five foot six. And at the time, probably weighed around about 80 kilos, I don't know what the conversion is. And she's done her little BMI calculation and pretty much said, you're about 20 to 25 kilos overweight. And that is the reason why you have type two diabetes, that was that was her first sort of go to she said, You need to go on a low GI diet. And I'm going to give you some Metformin. And I will see you back in a couple of weeks, and we'll go from there, test your sugars get a glucometer. And that was sort of the long and short of it. So I remember when I told my parents how angry like, my dad doesn't often, you know, he's the sort of person who doesn't get disappointed. He's, you know, man of few words, and he was so angry at me. He was like, not like, not directly at me, but I think obviously angry and upset that this was the situation. And that was the only emotion that he knew at the time. But it was it was, it was crap. Like, it was such a horrible feeling. And then, you know, mums, sort of, you know, thinking, Oh, it's all my fault. You know, it's, you know, it's, you know, her mom's got it, and all this sort of, and unlike that, you know, at the time, I was sort of like, well, you know, they're telling me that I've done this to myself. And so I had all of this awful. Yeah, so

Scott Benner 22:19
don't be sorry, did your dad expressed that he was mad at you? Or did you feel it from him?

Melissa 22:25
Um, I'm on a bit of both. I think he was very short with me and very snappy at me. And I think he had even by memory, I remember being at the place in my house, but I can't remember exactly the words that he said. But it was it was very aggressive. You know, it was, you know, like, very blaming and very aggressive. And that, that hurt me more than anything because it was, you know, like when the person that you don't expect to say something says something and, you know, you catch him more than Yeah, yes.

Scott Benner 23:07
That that none of that was true. And you're going on was that What's that process like for those couple of weeks you're doing Metformin? It's obviously not helping and, and you're waiting and waiting and waiting?

Melissa 23:21
Oh, I felt like I was just chasing my tail that literally so it was I remember I started taking the Metformin she increased my doses Well, I think I can't remember whether I'd gone back to her or whether she'd given me the instructions to sort of go well if they're not if your levels aren't x by this point. Then take two tablets or you know slowly increase your dosage and then I started getting all the lovely side effects from Metformin the upset stomach and the bitter nausea so you know was having to double dose up on every you know, other thing to counteract all of those my sugars were awful you know, there was there was absolutely no improvement based on the Metformin so I remember going back to her and she said to me, you're obviously not eating well enough because look at your levels. And I just like

Scott Benner 24:20
you are you are falling Oh, yeah,

Melissa 24:23
yeah, yeah, I remember for Christmas day. I had eggs for breakfast. And I had one piece of bread with cheese and chicken on it for lunch and also for dinner. Like I was you know, I like again bread. Exactly. Come on, like cut me some slack you know, like, no, no, no treats No, nothing like I I very much She took what she said is serious and thought, oh my gosh, like, I don't, I don't, I don't want this, like, if I've done this, then you know, I need to do something about this. And she, you know, made me feel like I was, you know, this was all my fault. And in my knowledge also was as you know, sound as it was, you know, when she said to me, you just need to eat low GI food. You know, look for the labels that say low GI. It didn't really give me anything. So I remember

Scott Benner 25:37
Dr. Not a witch doctor, right? Yes. Oh, yes. We're now in the middle of like, nowhere in a hut or something with this happen?

Melissa 25:46
Oh, no, no. And you know what, like, this is the this gets this gets that I have, I feel like I must be a magnet for really awful doctors because I feel like this is all I've encountered. We've got an abundance of dumb people over here.

Scott Benner 26:03
So that job you got after high school was with the travel council for Australia

and get some Ross River fever and treated by dumb people when you have to go to the doctor.

Melissa 26:20
Oh, yes. Don't move over here looking for a doctor if you think you've got diabetes, or Ross River fever for that matter. Because you're absolutely stuffed

Scott Benner 26:27
with a you have to keep talking because at the moment your episode is called Chicken bread with cheese. So don't think that's brilliant. Hey, Have I ever told the story about when I spoke in the Dominican Republic? No. So I I accepted an invitation to speak about diabetes in the Dominican. And they asked me to come to talk about management in in depressed areas where people didn't have money for stuff. So I wrote some stuff for myself, had never been to the Dominican Republic got there realized that my idea of poverty and their idea of poverty were not the same thing. But I figured why I have to, I have to rethink what I'm going to do. But they wanted to take me to dinner first. So I arrived at my hotel where a hotel employee is sitting out front on a lawn chair with a sawed off shotgun. He was the security and I went inside and I started walking upstairs thinking I've made a significant mistake. And so I and that was saying yes to the thing is what I was thinking. So I go upstairs, I get packed, they say they're gonna come pick me up, come pick me up in a van, I get in the van. We're driving along. And a mosquito flies through the van. And I'm with like two people who came in to speak and three locals and the driver and the locals just push themselves away from the center of the van to the edges of the van and they're like, don't let it get you. Oh my god. I'm like, what is happening? And so I'm like, it's just a mosquito. I'm thinking and then one of them very artfully kills it. I was. And I mean, I had to ask because I mean, I don't want to get bitten by a mosquito. But what just happened here? And my, my best recollection of one of them was like, you get chimichanga I forget what they said. And that wasn't that wasn't me being like, insensitive. I really don't if they said something similar to that. And and they said if you get that you will just have diarrhea for months. And I'm like, I'm like can I go back to the hotel and see if the shotgun guy and I can like become friends like I was this all happened to try my chances there? Yes. All became within like a half an hour of me being there. I was like, that's the security guy. And if I get bit by a bug that I can't see, I'm going to poo for a long time. I was Oh, goody. I'm so glad. Okay, anyway, great trip. It really was good. I just had to learn to dress like a local, which meant, like you wear pants when it's 1000 degrees outside. So I figured that in long sleeve. So I did all that. And the talk was really interesting. I've never since then or before spoken through a translator. But it was really amazing. Like I stood in front of a crowd of a few 100 people. And in the middle of the crowd, there was a person in a soundproof box. And she spoke English and then whatever local language was best for everybody to hear. And I spoke you could hear my voice over the speaker. And then everyone watching me sort of looked at me blankly for a second. And then she translated it and then they nodded along and then I found my rhythm and it was really cool actually going on the trip was amazing. Aside from the shotgun guys and the the mosquito

Melissa 29:52
mosquito Nice.

Scott Benner 29:54
Yeah, well, literally. Yeah, it wasn't just the mosquito with a bad attitude is gonna make me poor myself the death rate and other things like joint pain and like they just described it as like your life will just end for a few months and if it goes away, you'll be fine afterwards I'll say, Oh, awesome, great. Anyway, oh my god. Yeah, I'm so sorry.

Melissa 30:17
I don't know, mosquitoes suck.

Scott Benner 30:21
Is that where you took out of that? Because I took that hot water hot weather places are to be avoided. Well,

Melissa 30:29
it's so much nicer than cold weather.

Scott Benner 30:31
Oh, hold with it. Yeah, that's obvious. But the mosquitoes can't live in the cold. So who knows? Well, yes, I'm so sorry. Let's get back to where you are. Every doctor in Australia is terrible that you've met

Melissa 30:44
girl down? Yes. Yes. So yeah, no, she, I think the next words that came out of her mouth. Were if you don't start if you shouldn't be your blood sugar levels, don't start improving. I'm going to put you on insulin. And threatened to me with it.

Scott Benner 31:01
Oh, great. Yeah. I mean, you were there. I think if you knew better, you'd be like, yes. Can I please have the hand please?

Melissa 31:08
Please give it to me. I think the thoughts that come into my head was good. No. You're not giving me that. That's, that's a that's a no from me. And I that was the last time I saw her. And I think within it wasn't, it was probably a week or two, I had gone to my original sort of family doctor and explained everything. You know, this is this is what's happened. This is how it's come about. And she basically just said, Look, you know, you you don't fit the profile. You know, yes, you could lose a couple of kilos. But that's that. That's neither here nor there. Like that's, that's irrelevant. I think I'm just gonna send you straight to an endocrinologist. This is this particular person I'm referring you now. And basically went to him and that's when he diagnosed me in the May and yeah, had said that it was just like an onset. And yeah, he put me on Nova mix.

Scott Benner 32:20
How long did that whole process take from the first doctor getting it wrong to the next one getting it right.

Melissa 32:27
Um, December through, so through to the maze. So five, six months. Wow, that sounds of being on the metaphor. I remember I was. I can't remember whether I was on Metformin first or diabetics first. But I remember being on both of them. It was I think it was a matter of well, that's not working. Let's try this one sort of thing.

Scott Benner 32:50
I want to I want to find out what happened next. But first, I need to tell you, my chimichanga thing was not far off. Is it chick? UNGUJA?

Melissa 33:00
Oh, no. Are you what you were pretty spot on?

Scott Benner 33:04
I'll tell you right now. Sounds awful. Those c h i k UNGUNY. This is many years ago so that I even came close to the sounds I'm pretty impressed by because, yeah, no, no, I'm so happy with myself. I love it. Yeah. Did I didn't just randomly say malaria or like a, like a more common word that would pop into my head that I was like, No, I remember it started with me. Chunga sort of was like CH and then there were a lot of letters afterwards. That's how I there's a look into my brain. Love it frightening, frightening place that it might be. Okay, so were you receptive to getting insulin?

Melissa 33:49
When, when he went when he sort of was able to just sort of say, okay, everything that that previous doctor had said was a load of rubbish. Listen to me. And

Scott Benner 34:04
sure about it. Okay. Yeah. Oh, yes. Your situation that you're willing to do that though, right?

Melissa 34:11
Yes, I was in at the same time, I think going back to my original sort of like family doctor, and her sort of saying to me, you know, I'm going to send you straight to this guy. I really trust him. He's brilliant. Yeah, hasn't got the best bedside manner. Like Well, I'm not used to that. As long as he's not done

Scott Benner 34:43
that seems reasonable. Yeah,

Melissa 34:45
yeah. Yeah, lower my expectations. And he was he was good, you know, definitely didn't have a bedside manner at all, but was to the point and explain things in a way that made sense to me. which bought the trust? He? Yes started me on the Nova mix. And I sort of you know, went on to, to do that I think I think by memory. My next HBA when C was around nine ish was, I think by memory the next one that I'd gotten when I was with him. So seeing is that I'd had really no management for that six month period other than being on tablets that just make you want to spew. It wasn't too terrible, not great, but it was what it was. And, yeah, you know, just getting the dosage right. And got to a point where that wasn't too bad. You know, went to the dietician went through all of those things. And I think pretty much I got to a point where I was at that seven ish. level, and then it was

Scott Benner 36:12
like, start feeling better.

Melissa 36:14
Oh, 100%. Yeah, yeah. And, yeah, have

Scott Benner 36:18
the wherewithal to go to your father and talk to him about what happened in the beginning.

Melissa 36:23
I spoke to him, I think it was that next day, and just said to him, by memory, I think, you know, I, you know, I can't help this, like, I can't, like I can't do anything about what it is. I'm just going to try my best, you know, to try and make this as good as I can. And, you know, they I think once the shock of everything had sort of settled. They were both on board with trying to do as much as they could to try and help from a supportive sort of standpoint. And again, you know, it was nice having my grandma my grandmother around because she was, I think I didn't find this out until after she had passed away but from other family members that she she held quite a bit of guilt from from what they had sort of said in regards to me also having diabetes.

Scott Benner 37:36
That's terrible. Yeah, huh. I shouldn't have done that. Do you have chi?

Melissa 37:41
I do. I've got a five year old little daughter, Sophie.

Scott Benner 37:44
Congratulations. That's lovely. Yeah, I'm sad to hear she felt that way. Yeah, you know, what, um, I had a question. I think you said something sad and zapped it right out of my head. Dammit. Does your blade do what your dad did? I'm gonna blame you. How's your phone

Melissa 38:10
my brain

Scott Benner 38:11
No, no, I Dad Hold on, Dad. Come on, Scott. What the heck? I don't know. That's gone.

Melissa 38:23
I'm trying to think of where my brain was was sitting at that too.

Scott Benner 38:26
You know, we'll do more of that. We'll just put the ads right here.

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It Okay, and then it's I wish I knew which ads were going on this one I do. Um, off the top my head for you right now, because I'm feeling a little late. I think. I think the people paying for them would be just thrilled. Every once in a while I do want to I think I don't I don't think they're gonna like that. Oh, I like it. That's all that matters good with me. I think it's fun. So I didn't mention Dexcom very much live is still in the Dexcom. Man, I still enjoyed the conversation. And I did. I said the link. It's good.

Melissa 42:00
Oh, I'll I'll say enough about Dexcom and all the right ways. Very much.

Scott Benner 42:07
Kidding. I guess let's pick up there then. So you're you're at that, you know, a young age still? Are you? Oh, I have my question. Sure. Sorry. I walked in circles to get to it. No, no. What's it like? It's just kind of a deep question. It's not, it's not on track with our conversation. So I apologize if it feels like it's out of left field? No, what is it like to, to have that realization that the kind of so called promise of being alive isn't being fulfilled to you, meaning, meaning you 10 fingers 10 toes, you can walk you can run, you can think you can go out in the heat, you can go out in the cold, you need something like what happens when you realize like, wow, most people get this I didn't get it.

Melissa 42:55
I remember there was definitely a sense of a feeling quite broken. And but at the same time, I think I used a bit of denial to sort of get me through and just sort of a bit of fake it till you make it sort of thing like I've always sort of tried to frame even from the from the beginning frame it as you know, surely this is a good thing, like I'm not the best eight or I'm not the best person with X, Y and Zed and you know if this is something that's going to kick me out the Assabet and make me a bit more accountable to hopefully, you know, having a longer life. That's a good thing. Like I'd sort of Yeah, I don't feel like they I know that there was that sense of feeling broken, but majority of most of it was sort of me trying to convince myself that No, no, no, this is okay. This is a good thing. This is making you be better. So that's Yeah,

Scott Benner 44:13
okay. I appreciate that. I wonder sometimes if people realize I'm just asking questions of people I want to know from about Arden No, I think that's fair. Yeah, I I'm just using the podcast for myself. I'm as amazed as anyone else that anybody's listening to it. So you may have moved chicken bread with cheese to X, Y and Zed Oh,

Melissa 44:35
oh, I do love x y and Zed I use it every day.

Scott Benner 44:40
So Good on you because the chicken bread with cheese was in my opinion. It happened too early in the podcast episode I like people to have to wait longer to find out why the podcast isn't named. Gets my brings my listen through rate up Melissa which believe it or not helps with the advertisers they they like to know you're making it past the ads. You know they mean

Melissa 44:59
you 100% I remember when when I, which we'll get to towards the end of my story. But I remember when I first started listening and not having any context around why you named each episode why and what you did. So I was looking at all of these titles and going oh, yeah. I don't know why I was so confused. But yes, now you don't judge a book by its cover, and you just listen to them all, because they're all great.

Scott Benner 45:38
I've gotten so much advice from people along the way. And none of it's been right. It's fascinating. You have to put what the episodes about in the title. I'm like, I don't know, I'm not going to. And and you have to do this. And you have to do that. And, you know, one person told me that I need like, a recipe once in a while, because people would diabetes like to get recipes. And I was like, Oh, I'm not doing that either. You know, you have to let people talk. And I'm like, Yeah, I mean, I do. But I want to talk to like, you know, it's, it's not just a it's not a repository for people to just blather on. I have to tell you. Most of this is interesting. I recorded one the other day that for the first time I thought I might not use this. Oh, I've never had that thought before. Eight years. Like not like seriously, it's what is it? 2022 I can't keep track the COVID really messed me up. I don't know where I'm at. I thought it was gonna come back. But I don't know what day it is. I don't know what year it I don't care anymore. But yeah, it doesn't matter. But uh, yeah, I the person just I don't know that they answered one of my questions. Yeah, right. And what they said just rambled and went in circles. And I don't think it was purposeful. I think they just they weren't good at having the conversation. I think they thought they weren't. I'll have to listen back to it. Oh, and I will. But if it makes my brain is numb as it did the first time. It's gonna be the first time I just go. Hey, so no, yeah, the microphone didn't work. I'm sorry. I don't know what I'll say exactly, because I feel bad about it. But I got to the end of it, and I thought my might be the only one that ever hears that. But anyway, like I've gotten like a ton of bad advice. One of them. One of the people told me that I can't tell anybody how I manage Arden's blood sugar's Yeah, right. Yeah. Can you imagine this podcast if we didn't talk about that? Oh, God, would that be again? dumb people? Yeah. Not just doctors. Melissa, nice dumb people are not just doctors. Oh, this was just an Australia that can be your title. But I for so many people, I for some reason picture Australian people as less. Woke i guess i Maybe I'm wrong. I don't know. Although not and I they locked you guys up pretty good during COVID You took it? So I don't know what to say about that. You know what that like?

Melissa 48:06
I think there's an element of like, even still, like, we're so chill, like, so relaxed about things like there was different states in Australia that got locked up harder for a lot longer than what Queensland in particular did. And yeah, like we've we've, we've, we've been very, like, you know, like, I know a lot of people who have gotten or gotten sick and you know, and it is what it is sort of thing but you know, we've all remained very, very relaxed about it sort of thing, which is Queensland, Queensland mentality.

Scott Benner 48:46
Just chill out is everybody Hi, Kate. Melissa, what are you trying to tell me right now? Yes, yeah, a little bit but he's just a little stone sitting on the beach

Melissa 48:59
almost. Yeah, there is probably a higher I'm not painting a very good picture for you, but it's probably Yeah, we've got great beaches. And when it is sunny, it's lovely. But there is probably a higher percentage I reckon now sort of between where I'm at and sort of the border for the next state that are just very much that that you know, they're all very much

Scott Benner 49:32
don't worry you're not the

Melissa 49:35
boss and all that sort of stuff. Not that the you know,

Scott Benner 49:38
how could you say the beaches are great Don't you have great white sharks all around that island of yours?

Melissa 49:44
Gathering That

Scott Benner 49:47
is ridiculous.

Melissa 49:49
Well, I consider out like where where I'm at we like shoulder shocks and stuff, but we don't Get like if you go any further north than where I'm at you start getting killer jellyfish like these jellyfish and no doubt the site like I've you know they're they're tiny they're tiny like the size of your thumb called era Ganges and they can they can kill you and so can normal box jellyfish too I suppose but you know they we don't get crocodiles for the most part here in our in our waterways as such we don't so yeah we're a little bit more sheltered which is nice I like

Scott Benner 50:38
that you think the statement we don't get crocodiles for the most part is comfy and

Melissa 50:45
I had to think about that because I remember there was you know there's that one time that you know one just happened to slip down the street so to speak

Scott Benner 50:57
that's the first one that's the first thing you said that felt like double entendre to me remember the time the crocodile slipped downstream? We drank so much think I just made up the same for those sacks? I'm writing that. I want credit in the lexicon when it happens.

Melissa 51:27
Oh, that's hilarious. Okay.

Scott Benner 51:30
I'm awake now. Melissa? Okay, we're good. Love it. How do you get how do you manage it? Like you mentioned Dexcom like you have it now but you didn't have it? Obviously back then. It didn't exist. So how was management I just see mostly went from crocodiles slips downstream to how did you manage your diabetes? People really have to appreciate my my prowess at some point.

Melissa 51:53
Oh, I love it. I love it. You you've got a way of just getting right back on track again. It's like okay, and

Scott Benner 52:00
right back off track again to give myself credit for Okay,

Melissa 52:07
nothing wrong with that.

Scott Benner 52:09
Yeah, what did you start with? I, eventually this podcast is gonna have nothing to do with diabetes. At the end, we're gonna be doing movie reviews, I don't know what's happening.

Melissa 52:19
That's okay. Um, so I had Yeah, the Nova, the Nova mix. And I had an Accu check, go meet up. And pretty much just used that right through by memory until around about might have been maybe 2012 2013 ish, I reckon. And pretty much between that point that sort of six to seven years, to be honest, just seems like an absolute blur. Like, thinking back, I can't really recall. Anything that really affected me positive or negatively when it comes to diabetes, like I was, so I just did the bare minimum. And just, you know, I would, I would check my, my, you know, my blood sugar was a couple of times a day, I would, you know, the Nova mix would do just what it had to do. If it was high, it was high. Like, there wasn't anything else I could do about it sort of thing. And there was never any, you know, worried about changing anything. And again, I was none the wiser and didn't really know. Anything else. So it just kept doing what I had to do just kept, you know, living the way that I knew how and didn't know anything else other than that way. And then I

Scott Benner 53:57
did that lead to outcomes that were less than, than valuable, or did you not even? I mean, how are you even checking on your health in the beginning?

Melissa 54:07
I reckon I probably like, for the most part, I don't think like I never, I've never, never been into debt or DKA. I've never had a really bad low, not to the point of where like I've had to give myself glucagon a couple of times, but I've never had a really bad instance at either end. I would I was not getting my A onesies checked regularly. I would sort of do it if I had to, or if the doctor was like, Okay, we'll check it while we're in the clinic now. And yeah, very rarely, very rarely was, you know, I'd get my bloods done maybe once every, you know, six to 12 months again, when I was sort of like frowned upon and forced to you know, there was times I remember, you know, I went on a on a holiday up to the top of Queensland. And Mike, I don't actually have any strips and was just completely unfair, like I'm fazed by it. Yeah, I should probably buy some. And that was sort of that was that was all that sort of entered into my mind. godson never used them was just like, oh, well, I'm on a holiday. And I think because, you know, I would go and get my onesies and they were coming back, you know, sevens and eights. You know, no one was, it was it was never enough to be a red flag. And again, knowing none of the wiser in terms of like, the equal parts lows that I was having to equal parts highs, that was, that was why I was getting those numbers, like understanding that now. But yeah, like I was just doing the bare minimum, like I was, you know, eating as I wanted to, I've always been quite into exercise, like gym stuff, and everything. So I was still maintaining a relative amount of exercise. But that was sort of about it. And then I met or not met have known my husband since we were 14. So long time. And we got married last year, we've been together for 12 years. So probably around the time that just after him and I had sort of gotten together was probably the time where I was like, I really need to get my into gear, I need to sort my life out, I need to get my health on track. Like, I have something serious, you know, that I have to be accountable for and to rather than just myself.

Scott Benner 57:01
We're obviously for those eight years in between. I think I did the math, right. You knew each other for a long time. But you've only been together for 12 years. What happened there?

Melissa 57:11
Ah, with my previous partner before, we were all friends. And I think because everyone knew that I had diabetes, but it was very much. She's not worried about it. We don't have to be worried about it. Like they were none the wiser, because I was so okay with everything. If anyone ever asked, yeah, it's fine. It's good. And yeah, like I just, I would never go into detail with anything. Like, we'd never, you know, anytime my parents would ever say how was it? I would just give them the bare minimum. And it was always positive. And never really wanted to burden anyone with any of that. Even though I was feeling like, you know, I could like No, I didn't know that I could be doing better at the same time because they were like, I think while there was never this sense of okay, well, you know, let's try for a six A whimsy, or let's try and improve that seven or eight. It was just like, yep, everything's fine. Cool. Yep. Cool.

Scott Benner 58:26
The number comes in a place where the doctors like, that's good. And it doesn't matter how poorly you got to the number. Yeah, kind of rest on that as your Yes, sir. Yeah.

Melissa 58:35
Oh, 100%. And again, like, you know, having diabetes for 16 years and only knowing and really understanding all of this. Since listening to the podcast in the last 12 months. It's like, like, seriously is dumb people there was there was too many dumb people around here that are giving enough good quality information. The whole like a person you know, shouldn't have to have diabetes for this amount of time without getting that general understanding.

Scott Benner 59:07
How much of of your comfort with it being where it was, do you think was your age and how much do you think it has to do with your initial experience and not end? I'm gonna say to seeing your dad's reaction. There's no way you wanted him to know anything was wrong after that, I would imagine.

Melissa 59:27
I think every part of that affected the way I looked at it. My mum has never been in good health. She's an alcoholic. She has had thyroid cancer and had her thyroid removed. She had epilepsy, which was somewhat induced by we the doctors could never pinpoint whether it was due Due to anything in particular, like they'd sort of thrown around the thought that it could have been induced by low blood sugars, but she was never diagnosed as a diabetic. So all of these other health factors that I've sort of grown up with and lived with prior to my diagnosis really sort of shaped my, my outlook and what I chose to tell them. Because it just it was just it was just easier it not existing to them.

Scott Benner 1:00:36
I mean, I understand it's, yeah, I think really, we all kind of want things to go perfectly, you know, like, Oh, I got sick and my family jumped right in, they were just, you know, they were just right there the whole time. But I don't think that that is what happens for most people. I think that idea of the hope that everything's okay. Or it's just a new level of okay. Is, um, I mean, I think it's on everybody's mind, I don't think they think about it consciously, but nobody wants to walk around thinking, Everything's bad, everything needs effort. Here's a list of things we don't do anymore, because we do this instead. You know, like, there's an idea of like, staying normal, stay positive, keep going ignore the stuff that's too hard to deal with. I never felt that way. I was, I was always I don't when doctors would say like, oh, this is great. Hey, once he seven and a half, that's great. You're doing great. I was like, No, I don't think I am. Like it's weighed close to the red part on the chart here on the wall. You know, and, and, you know, don't the one that I think the one that pushed me towards this was that I didn't have to worry about high blood sugars, because she was too young for it to hurt her. And I thought nothing about that sound scientific at all. You know, like, like, What do you mean? Like, there's a certain age where we're a detriment to your body is, it's a gimme, like, it was just that it's a mulligan, or I just I was just, I've never been golfing in my life. It's weird that I reached for that. But, but you don't mean like, it just doesn't count doesn't count? Because? Cuz she's four? I think I don't, I don't think that's right. You know, like, so. I don't know. And it was wasn't for me, it was for somebody I cared about which, interestingly enough, you just described the same thing that everybody else describes as an adult that comes on here, which is you really didn't take care of yourself until there was someone in your life that you wanted to be okay for? Yeah. 100%. And I'm not a psychiatrist, but I guess watching your dad grow up with a spouse who was sick, you didn't want to be that person to this person you're with now?

Melissa 1:02:45
Oh, 100% 100%. And it was, you know, I think it was definitely that it's time to, you know, be an adult now. You know, it's time to batten down the hatches and start looking at what a future actually looks like, you know, are we going to have kids all these sorts of things, and I remember going to that first appointment, and I had, like a student doctor at the endocrinologist office, sit me down and ran through everything. And I think at that stage, my one C was low eights. And I remember him saying to me, at the ripe old age of probably around about 2024 2025 or so, if you keep going this way, you're not going to make 40

Scott Benner 1:03:47
No, that's not Oh, Mike. Yeah, right. Okay. Well, I gotta go

Melissa 1:03:52
far out. Like, yeah, like it was, it was it was it was equal parts, like urine oil. And you know, are you actually serious though? And it absolutely scared the shit out of me. Like I thought, you know, I That's That's not okay. That's not fair. Like, you know, I'm here on I'm I'm ready to go now sort of thing and

Scott Benner 1:04:18
I'm not letting diabetes slow me down.

Melissa 1:04:24
I'm, I'm ready. I'm ready to go. Like I'm you know, and he sort of, I don't know, it was just it was such a he, what like I had sort of gone in there in that state of you know, I'm ready. You know, I'm ready to be compliant. You know, I'm not I don't want to be the person that you're putting, you know, the strike marks against and stuff like I'm ready to listen now sort of thing and he just thought I was full of it like, and really just made me feel like you know, no, no, no, you're you know, you You're gonna die if you keep going this way, and I'm going to scare you into thinking that you really, you know, make sure that you really get it. And when I said to him that I was, you know, hopefully wanting to start a family and this is this is my motivation and he then passed me on to my now, endocrinologist and she has been amazing. She she is she is equal parts amazing and stunning and lovely and kind and supportive, and, and everything that you can sort of hope for, which has just made things so much easier.

Scott Benner 1:05:39
And I asked you to be introspective for a second, because it feels like you're describing a scenario where a doctor heard you say something that made them think, Oh, this one's ready, and slid you over to the other side of the ledger. Like, oh, we can start helping her now. It is there anything about you? That would indicate that you weren't? Like, like, was that doctor assessing you correctly? I guess? That's my question.

Melissa 1:06:05
I think, I think because there was such a massive time between me saying and then do my endo and not seeing them. I had had my when I first got diagnosed, I was seeing an endo and a private practice, and then didn't like he then I don't know where he went and then ended up having to try and find another one. And it was that awkward stage of sort of a not really wanting one and also sort of needing one at the same time. And when I finally got to that stage of where I got referred to them, I think he was just sort of looking at me like, Well, you haven't seen one in at least the last two years.

Scott Benner 1:06:51
Okay, you know, it wasn't because he heard I want to have a baby and I want to do all this it was because he's like, you haven't taken any he was, so he kind of he kind of became your parent there and put you on the road? I think so. Yeah. It's interesting, because you hear people say, the doctor didn't do enough. Or, you know, they could have tried to help me with this, or blah, blah, blah. And then you hear doctors say, Well, don't listen, people aren't ready to take help, and yet forced them. And to me, it seems like it's I don't know, I don't know if if it's a little bit of each side blaming each other? Or if Yeah, or if each side's right. In some scenarios, I can never tell completely, or if it's just not something I'm ever going to quite figure out. But, you know, it's,

Melissa 1:07:40
I think you're definitely right in that in like, in this case, most definitely. Because he had all like, uh, he had all the right reasons to think that I was, you know, and I know that I wasn't compliant. But it was it was that sense of frustration of being like, come on, like, I'm here. I'm, I'm, you know, I'm raising my white flag. I'm asking for help. Don't make me feel even worse than what I already do, in a sense, like, yeah, that was that was probably the thing that sort of put me like, while I felt like I was taking a step forward, it sort of also made me feel like I got kicked back a couple of steps. How so? I think it's sort of it was I remember feeling quite I wouldn't say traumatized as the word but to an extent like it sort of put me in a place of where I was like, Okay, I better be good I better be good I better be good and and really over focusing like you know, really micromanaging things as much as I could for periods after seeing him thinking you know, if I don't do this I'm gonna die like it was everything like was so catastrophic. And there was no happy medium for a period of time.

Scott Benner 1:09:07
Well, what what did you do that what were the steps that you took to bring yourself from where you were to where you are now and where are you now? Like, what do you have better variability? Yes, up and down. What's your aliens? Yes.

Melissa 1:09:18
All of the good things. So my endo at the time put me then on to Lantis and over rapid that was our first step taught me how to do all of that. Prior to my pregnancy in 2016, I'd gotten my a one C down to 6.8. I got a pump, the April of that year of 2016. So I got the Animus pump that made a massive difference again, so having, I think having you know going from When she new found out that I was on the Nova mix and then sort of suggested going on to, you know, the Nova rapid and the Lantus and on my arm more injections like this is, you know, God, God awful. And she's like, No, no, no, this is going to make a massive difference, like you're going to have freedom. Like it doesn't it doesn't get to, it's not going to seem like it. But it is, like, okay, and then I got the gist of what she meant, and, you know, really started to, you know, micromanage things, and, you know, doing so much better, and then the pump, you know, coming up and knowing how much more freedom again, having something attached to me all the time. So, yeah, sort of, you know, flash forward to now, and I have a 5.8 a one C, I am on the tandem with Basal IQ, and have a Dexcom G six, and have had so for the last three years, I've had the Dexcom Yeah, for the last three years had the G five and then transition when it got approved in Australia to the G six.

Scott Benner 1:11:07
Yeah, that's amazing. Good for you. Yeah, that must feel it. Yeah. Right. Oh, yeah.

Melissa 1:11:12
Honestly, like, I think the turning point really was, basically everything sort of continued to happen in a very, very much the same sort of way between, you know, I, all throughout my pregnancy, I tried to manage as best as I could, had my daughter, my one C went back up a bit, you know, trying to balance being a mother and looking after myself and looking after another person. And then getting basically to 12 months ago, and got married in June of last year. And went to my Endo, and again, I've managed seven eight onesies up and down, you know, for the last few years, and I think my one C was 7.7, point six or 7.8 or something after the wedding. And like, okay, something's got to give Like the old like, I've, you know, I don't feel okay about this, like, you know, I'd been fighting pretty much with my diabetes educator for the previous six months, you know, her trying to just ask butting heads trying to manage. manage things. She was always like, you know, why is this happening? And I'm like, I don't know. I really don't understand why I like and it was frustrating for me because she was questioning, you know, my, my daughter, and but I didn't understand it either. And, you know, she was thinking, you know, what did you eat here? And I'm like, No, I told you I didn't like, I don't know why it's just shut up like that. I don't understand. No one sort of, like, I'll go given a Dexcom boot with absolutely no context on what to do with it, other than this is gonna save you from testing. You know,

Scott Benner 1:13:07
I didn't know that you and I were gonna learn this at the same time. Is that what's happening right now? Yeah, yeah.

Melissa 1:13:13
Oh, I know. I'm like, seriously, like, it just, it felt like it was all very much like, like, since I don't know, like, since listening to so many other people's experiences. And you know, I'm sure they've, they've all probably had similar ish times as well, where there is that sense of, okay, well, I've been given a piece of technology or equipment, and not really any instructions on how to use it, but it just sort of was like, Oh, here's a pump. They go Go for it. And it's like, oh, okay, cool. Oh, I've got maybe I'll wait. And you know, like, everyone does for a period of time, I'll wait until they tell me to, you know, bumpity here and whatnot, and didn't have I think it's that I didn't feel confident or comfortable having ownership of my own health.

Scott Benner 1:14:05
Okay. And you're waiting for somebody to tell you what to do.

Melissa 1:14:09
100% 100% That's exactly what it was. And I remember I went through it like the beginning of last year and was like, you know, I was never a podcast person. Never listen to anything. I was like, No, thanks. I don't do that. And my drive to work is about 30 minutes there and 30 minutes back, so I started listening to some self helpy sort of stuff and whatnot. And then remember having this thought of, you know, maybe I could listen to something that might actually help me. You know, these are great, but like, I could be doing something more practical. With this time if I'm gonna, you know, whilst I was in the, in the realm of listening to podcasts, and that's what made me stumble. You know,

Scott Benner 1:14:54
getting your chakra in line wasn't helping you. Yeah, no, not at

Melissa 1:14:58
all. Not at all. Yes. No, no, no all the journaling in the world is not going to do anything for my blood sugar's.

Scott Benner 1:15:04
I kept writing down how I felt, am I a Wednesday didn't

Melissa 1:15:09
surprise, surprise.

Scott Benner 1:15:11
We used to do an episode about Pre-Bolus thing and see what happens.

Melissa 1:15:14
Exactly right. Yeah, yes. And that's exactly what I did. That was it was that was the thing that I was butting heads with my doctor about so much because I remember when they started looking at my time and range and sort of going, Oh, well, you're only like 30% time and range. And I'm like, where am I meant to be? Like, oh, well, you meant to be at 70%. And I'm like, oh, okay, well,

Scott Benner 1:15:42
okay, would have been cool if someone told me that. And by the way, how do I do that?

Melissa 1:15:46
How exactly, exactly. And I was still stuck in that, that realm of take eight jelly beans, wait a bit, have a sandwich, wait a bit, and just keep loading it all up, and then you'll be okay, you're not going to die. And it like saying it now makes me makes me feel really dumb? Because it took another educator at my clinic who was also a diabetic to say to me, have you ever considered just eating less? And you wouldn't have that be suck? And I'm like, Well, you know, I didn't

Scott Benner 1:16:26
hold on a second. You're saying carbs are making my blood sugar go up? Hold on. Wait a second. Hold on. I feel like I feel like your crocodile was just going up the waterway. I don't know what the straight stream exactly. I don't know. I forgot my own saying. That's embarrassing. And

Melissa 1:16:54
that's exactly what it felt like. It was like, What is this that you're telling me? And she's like, all just like, try having four jelly beans. Don't have you know, if you're, you know, 3.6 just have a few jellybeans you only want it to go up to five. And I'm like, watch this whole time I've been eating eight, and then having a sandwich or a glass of milk. And then I'll go up to 13. And then you know, and I'm playing that roller coaster ride. And yeah.

Scott Benner 1:17:21
How about instead of listening to a podcast about quilting? You find something? I know it's relaxing at all. But well, I'm very happy that you that you landed where you did it sounds? I mean, exceptional the change? Oh,

Melissa 1:17:38
100%. Like it's, I remember, I think, ah, one I think the first episode I listened to was Chris rude in 200. And something. And I just recently it was yesterday, listen to the second one that you did with him. And I tell

Scott Benner 1:17:58
you before you finish your story, I just booked him for next year yesterday.

Melissa 1:18:02
Oh, that's exciting. How funny. Oh, my God call him

Scott Benner 1:18:05
doing something on Instagram. And I was so touched by it that I just commented. And then he reached out and said, Can I get back on the podcast? I want to talk about mental health and diabetes and stuff. And I was like, Yeah, I was like, I can't have you on for like, a while because my schedule is so full. I was like, but go grab a date. So he did yesterday. So that's cool. That's awesome. Oh, all the planets are in a line. That's awesome. I'm sorry. Go ahead. Listen to Chris.

Melissa 1:18:28
Yeah. Yeah. And again, I think, you know, it was just that time and place like I had been following Chris, for a period of time prior to seeing him on like with the podcast, because he was, you know, the diabetes community. I did I do CrossFit and have done powerlifting. And then, you know, found him through all of that and was just in awe of all of the things that he does and everything like that. So seeing him his name attached to the episode and like, oh, cool, someone that I sort of not know, obviously, but know of oh, what I'll listen to this, because I know what you know, we're not talking about you know, anything else so I get Yeah, so listen to that. And I thought that you know, yep. Okay, like, like everyone else that's, you know, come and spoken to you and it's like, wow, this guy doesn't like it took me a while again, having absolutely no context about you at all. And realizing I think might have been might have even been in that episode. It might have been probably until I listened to maybe two or three that I'm like, you don't actually have diabetes. It's your daughter. That's incredible. You are incredible. You are in you know, and just sort of and just being in awe of the fact of again, you know, as everyone has said that you know that you're able to do what you do because it really has is made such a difference.

Scott Benner 1:20:02
I'm glad. That's wonderful. I appreciate you saying that too. Thank you. I was really proud of myself for not saying something stupid while you were doing that, because when I hear you ramping up to say something nice to me, I'm like, just deflect with humor. Just don't just say something. Oh, this is the part where you say something nice about me. Let me be quiet and listen, which is me. Me going, Oh, I'm so uncomfortable. Please stop. But at the same time, I need you to talk because it's a podcast. Like, if we were in public, and you started talking, I'd be like that, I get it. Unless I helped you. Thank you stop. Thank you. Yeah. It's gonna help it really just stop. Okay. So, but I don't know what's wrong with me. I bet but I'm doing much better. You have to admit over the years. Like of like listening to somebody say something nice about the podcast. I am, I think, eight more years, I'm gonna be a couple more. Guys, I'll just keep hanging out listening for the time when I just accept a compliment, like an adult. So

Melissa 1:21:06
oh, it's, it's, I think, again, it just reiterates even more. So when, you know, in in reflection, when, you know, pretty much every time I speak to my educator or even to my Endo, and I'm like, Yep, this is what I've been doing. And, and I'm telling them what I'm doing with my health. And you know, I'm in control of what I'm doing. And they're just like, Yep, cool. Oh, that's a great idea. Yeah. Cool. All right. Well, these aren't these aren't my ideas like, this is this is from a great this is from this is from high above, like, you

Scott Benner 1:21:39
know, I've got to say something. I'm still stuck. I got hung with the art of being sarcastic on her episode. She goes, I know, everyone thinks you're a diabetes God or something. I forget exactly what. But somebody called me that online the other day, and I'm like, please, don't please stop doing that. Like, it's very uncomfortable for me. No one cares about me malice. And like, I see someone right that I'm like, don't say that. Like, please. I don't want anyone to hear you saying that. Because now I have to come in and be like, Oh, no. And that it looks like false modesty. You know what I mean? Like, where I'm like, oh, like, you know, like, like, if a guy scored a touchdown, well, you don't have any real sports, so you don't understand what I'm saying. But if somebody did something, if somebody did something exceptional at a sporting event, and then at the end, they were like, Nah, it's it was nothing. You're like, bullshit. It's nothing. You're so much faster than everybody else. And so I can't win as my point. Like, there's no way for me to jump in and say, oh, you know, that's so I just end up saying things like, that's very kind or because I don't know what to say. Like, what am I supposed to say? I am really good at this. I mean,

Melissa 1:22:50
100% Thank you. Yes, I am. I am God know

Scott Benner 1:22:56
how uncomfortable that is. I don't feel that way. I want everyone to know that's listening. Those were Melissa's words. And I don't like

Melissa 1:23:04
that lol agree with me though.

Scott Benner 1:23:06
All I did was just I stepped back and I was like, I have to figure out how this insulin works. I'm using it wrong. And then, and then I figured it out. And then I found ways to talk about it that are relatable and easy to remember. That's all

Melissa 1:23:20
Oh, 100 it's, it's still surprises me. Like now that I'm in a place where I feel comfortable being able to explain things to my you know, healthcare people that there is the they don't see that they don't see the sense of like, adapting the way that they're trying to teach people so that it lands like It's like they have one teaching style, and they assume that everyone's got one learning style. And if the two don't meet in the middle, then you're stuffed.

Scott Benner 1:23:57
Unless the listen it's unfair, because there's only one God. So what are you expecting from these people? Exactly? Exactly. Exactly. What they lack in my opinion, and from my experience, it's the ability to tell a story. It just Yeah, that's what this is really

Melissa 1:24:15
creativity and just this Yeah, they will. As I said, they're all dumb. They just

Scott Benner 1:24:23
this is a good place to stop before you alienate the rest of that island. And it's an island right? I'm not wrong about that.

Melissa 1:24:30
Technically, yes. No. Yes. Yes. It's an Ireland big one. Yes.

Scott Benner 1:24:34
When are you guys going to invade New Zealand and just turn that into like a like a Health Report for yourself or something like that? Is that No,

Melissa 1:24:42
there's a way little while away from us, like we have we have Tasmania which is like the equivalent of Sicily at the bottom of Italy sort of thing like it's tiny little tiny little place but yeah, New Zealand is I think it's like a was six hour flight from it's not

Scott Benner 1:25:02
as close as I think it looks very close on that map thing. I don't know what to do. And I've had a number of people on from New Zealand were lovely, by the way, so

Melissa 1:25:09
100% I've got heaps of friends in New Zealand. Yeah, lovely.

Scott Benner 1:25:12
Alright, let's have a listen. I appreciate you doing this very much. I thought this was wonderful. I appreciate you being kind and let me be a few minutes late. That was that was very nice to the part. Yeah, the part where you refer to me lovingly, I enjoyed on I don't want to say otherwise. I'm just thrilled that neither of us was bit by anything deadly during this you probably more than me. I'm never coming where you are. Because I'm scared to death of the wildlife. I just want to be clear about that. And I don't want to be on a plane that long. Those are my pretty much my two reasons. But it sounds like I mean, let's I was gonna lie and say it sounds lovely. But it sounds like California has what you just described to me. So I don't know what

Melissa 1:25:52
pretty much. Not that I've been to California. But that's how I would imagine it also being Oh, what are we

Scott Benner 1:25:59
gonna do? Well, for all my killed by Heatwave, I look forward to this coming out and so people could hear

Melissa 1:26:03
it. Very much. So I'm very excited to cool. Now you

Scott Benner 1:26:07
were terrific. Really. I appreciate you doing this very much. I know you stayed up late and and that is do you know there's a picture of a platypus in front of me the entire time you were talking those are from right. Yes. I never once mentioned that because I'm I'm really I'm maturing as I get older. Pardon drew a picture of a platypus on my whiteboard in front of me. And then she wrote something next to it that I can't tell you because

Melissa 1:26:36
it's super appropriate.

Scott Benner 1:26:38
Anyway, all right. Well, thank you very much. Love it. Hold on one second. Thank you. Oh, of course.

Melissa 1:26:43
No dramas doe.

Scott Benner 1:26:52
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 GVOK E. G L you see? Ag o n.com. Forward slash juice box. And thank you us med head over now. To get your free benefits check out us med.com forward slash juice box or if you want to use the phone 888-721-1514 Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#872 Go With the Flow

Jim has had type 1 diabetes for 55 years.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 872 of the Juicebox Podcast.

Today, I'll be speaking with Jim. He's had type one diabetes for 55 years. And I think what I want to tell you about this episode is that a number of times, Jim really surprised me. You're never gonna go wrong with that. While you're listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you would like to save 35% on your entire order at cosy earth.com, all you need to do is use the offer code juice box at checkout It is that simple. Don't forget to go to T one D exchange.org. Forward slash juice box and take the survey completing the survey helps type one diabetes research it helps you and it supports the podcast T one D exchange.org. Forward slash juicebox. Go complete the survey. And if you're looking for community around type one diabetes, look no further than the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes

What did you do first thing this morning. The first thing I did was drink my ag one from athletic greens. Ag one is available at athletic greens.com forward slash juicebox. And when you use my offer code, you're also gonna get five free travel packs and a year supply of vitamin D. Thank you ag one for sponsoring this episode. Today's podcast is sponsored by touched by type one, now touched by type one is out there doing the good work touched by type one.org helping people with type one diabetes through their organization of just lovely people. It's wonderful. You have to go look at it touched by type one.org. And of course find them on Facebook and Instagram. I'll be speaking at their next event. So I hope I see you there.

Jim 2:24
My name is Jim. I live in northern Georgia. I'm a retired rubber chemist. I'm a musician and a car guy. I have three children and seven grandchildren. I'm 69 years old, and I've had type one diabetes for 55 years. But it does not slow me down.

Scott Benner 2:47
Jim, you are right, you have a longer intro because I think you have a longer richer life and some of the people who come on come on at a younger age and you make condoms. Well, back when you were working. Is that right?

Jim 2:57
Well, not that kind of rubber factory. It was mostly automotive parts.

Scott Benner 3:05
Okay. All right. Well, then there's a ton to pick through here. Isn't there? Sure. 55 your 14 when you were diagnosed?

Jim 3:13
I was actually 13 Or I was diagnosed in January to 67 and I turned 14 that March.

Scott Benner 3:22
Okay. 67 Yeah. All right. We're gonna get to that for certain of your children. Anybody have autoimmune?

Jim 3:32
No, no one. Of course my I have 344 of my grandchildren are under four years old. So it may be kind of early to tell. But so far, nothing.

Scott Benner 3:49
Nobody's being tested for markers or anything like that.

Jim 3:52
No, I haven't. I think I'm gonna just let them know they can do that if they want to. But no one else in my family either my you know, none of my parents, grandparents, uncles, aunts, cousins. Nobody.

Scott Benner 4:07
How about in your back in your family line? Other stuff like celiac or? I don't know. Hashimotos? Anything like that?

Jim 4:15
No. My mother died of leukemia in 1959. And my parents died 10 to 15 years ago but no, no auto immune stuff that I was aware of.

Scott Benner 4:33
Jimmy lost your mom when you were four.

Jim 4:35
I was six it was 1959

Scott Benner 4:41
Oh, that's that's something else.

Jim 4:43
Yeah, it was. You know, and it never really. I've never really had huge effects from anyone close to me dying except for my brother. He died maybe four years ago. And he, he was. I'm not sure what his actual diagnosis was. He was from what anyone could tell he was severely autistic. He was non communicative. He never spoke. And he got sick and ended up in the hospital on life support. And my parents being dead, I was left with the decision to basically unplugged machines. That was That was rough. Yeah, younger brother,

Scott Benner 5:40
older brother.

Jim 5:42
He was two years older than me. Okay. And

Scott Benner 5:45
it's interesting, because I guess if when he was born, like, do you think he ever had like an autism diagnosis? Or was that not something they did then?

Jim 5:54
Yeah, I don't know that they really knew much about it. until many years later. I think they just the first diagnosis was probably something like brain damage. So did but as far as I know, he was like that from birth. So

Scott Benner 6:12
did he live with your parents or in a facility?

Jim 6:16
He often on he lived with, with us at times? Probably until I was oh, 10 Because my dad remarried. And my stepmom just wasn't, she was kind of high strung, loved her dearly. And we had a great relationship, but she just wasn't equipped to deal with my brother. So. So he was in a facility after that. Gotcha.

Scott Benner 6:47
There are days 30 days, Jim, when I'm high strung. I just wish people use the term still.

Jim 6:54
Yeah, I'm typically not I'm pretty laid back.

Scott Benner 6:57
I can tell from your speech pattern that you're fairly laid back. Yeah. So. Alright, so I'm gonna pick through the rest of it a little bit. You play music?

Jim 7:07
Yeah. I started playing piano when I was probably five years old. We had an old piano down in the basement. And I would go down and play songs. I mean, not just plinking around, but actually with chords. And when I was eight, my dad said, if you take piano lessons for a year, I'll buy you a new piano. So he went out and bought the piano and I took lessons for I took private lessons for probably 10 years. And then I went to Michigan State University as a piano major. And unfortunately, that was the year that Michigan lowered the drinking age to 18. My my music major, and my college career didn't didn't pan out too. Well.

Scott Benner 8:06
I was gonna say, Jim did Meister Brau waylay your music career?

Jim 8:11
No, I think it was Old Milwaukee.

Scott Benner 8:15
Because, you know, it's funny as you're telling the story. I'm like, he goes, he's off to college for his music major, but he's a chemist, I think and that. None of that makes sense. So what did you wake up and reorient yourself?

Jim 8:29
Well, I took a I think I still planned on going back. Probably not to Michigan State because they weren't too happy with me. But But I took a summer job in a rubber factory. We were molding, like I said automotive parts. Started off on the press line actually doing manual labor, which was great for my diabetes, because I was getting, you know, strenuous exercise all day long. And I ended up staying there for eight years. And then I went back to college and got a chemistry degree.

Scott Benner 9:05
Wow. So something about the job made you want to do that.

Jim 9:11
It was a it was it paid better and was a lot easier than being a music teacher.

Scott Benner 9:20
Am I like the way you make all your decisions?

Jim 9:23
Yeah. All right. It gets even better than that. I was at a company in Indiana. I grew up in Michigan, but we lived in Indiana for 20 years. And I was at another company and I was always getting calls from headhunters. And this guy calls up and says I've got a job for you in this town in Indiana. Well in and this was in. This isn't the late 80s When I got this call. Well in 1978 I had gone to this as Auburn Indiana and every day Labor Day they do the Auburn cord Duesenberg Festival, which is a cars that they made and sold back in the 30s. And so I get this call about this job and the guy says it's in Auburn, Indiana. I said, that's the place with the cars had the a great job. And we went,

Scott Benner 10:19
sir Jim, your episode is gonna be called path of least resistance. I think

Jim 10:24
I know. Yeah. So I did. I did mention I'm a car guy. So

Scott Benner 10:28
what kind of cars do you enjoy?

Jim 10:32
Right now I'm in the muscle cars. I have a I have a 93 Mustang convertible. And then I also am working on my second 67 Pontiac GTO.

Scott Benner 10:46
Do you renovate them yourself? Or do you like to buy them ready to go?

Jim 10:50
No, I buy them as projects, and then I restore them. Okay. Are you and I told my wife, this is the last one I'm doing. For this, yeah.

Scott Benner 11:05
It's the work. That's that's the work. Yeah. Plus, as we know, you're not looking for a challenge.

Jim 11:10
No, not anymore.

Scott Benner 11:14
It's funny, you you said you started to say I told my wife as I was getting ready to say, are you married?

Jim 11:19
Yeah, I've been been married 41 years. We met at the first rubber factory I worked at. And there were people there who told her not to marry me. Because at the time I was, you know, the the quintessential hippie slash Bad Boy, you know, long hair and a beard. Little little bit into drugs and alcohol. They just told her to stay away from me. And we've been married 41 years now.

Scott Benner 11:51
Wow. What do you think? Did it Why do you think she ignored them?

Jim 11:57
I think it was probably, I'm sure it is, as it is, in most cases. It's a physical attraction to begin with. And that was incredibly strong with us. But she was also a Christian. And I saw something in her that made her different from all the other girls. And once I found out what it was I adopted that philosophy as well. And I think that's probably why we've been together for so long.

Scott Benner 12:33
What was that thing? Finding Jesus. Yeah, that that really appealed to?

Jim 12:41
Well, it didn't it first. And it didn't. It wasn't like an overnight change. It's it's a long process. And it's I think it's a lifelong process. And we went through some difficult times. And it was I think it was the only thing that saved us. And I'm not a you know, I'm not a holy roller. I'm not really outspoken about it. But, you know, I'll if someone you know, brings up the topic, I'm not afraid to discuss it.

Scott Benner 13:13
No, I mean, it's not why you're on but I'm, I'm just following the thread of the conversation. So were you looking for some constant in your life that you didn't have or what do you think it gave you

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Jim 16:25
it gave me peace and purpose. Which I didn't have before. And I don't know. I guess the piece that that you know, that was a pretty that time in my life. Let's see, we're going back to like 7879. I had been married before, got divorced. Well, we had a child and then we got divorced. And I was kind of floating around wasn't quite sure where I was going to go. played in a couple of bands. And we just we hit it off. And I think it was probably more than anything I may not have realized at the time, but I think it was just my my body or something was telling me. Dude, it's time to settle down.

Scott Benner 17:29
Jim in that in that time period when you talk about drugs, you talking about acid?

Jim 17:35
No, I never did acid It was mostly just marijuana. I did some cocaine, which I never really. It never really did anything for me. It was not a huge, you know, I only did it like two or three times. Mostly just marijuana.

Scott Benner 17:52
Okay. All right. So okay, so you have a previous marriage, but when you were very young, you weren't married very long.

Jim 18:01
Yeah, we got married when I was 22. And we were only married. Let's say we were married from 73 to I guess our divorce was final and 79.

Scott Benner 18:15
And one child, are you in touch with that job? Oh,

Jim 18:19
yeah. Yeah. We're still very close. He has three. I had three sons. He has three sons. And there's a huge story behind that because my, my dad had two sons. And like I said, I had three sons, my oldest son has three sons. My middle son had a son. So in our family, for 93 years, we had not had a girl born. And my youngest son in 19, or in 2018. Had the first girl in our family in 93 years. It's crazy. And then the next two kids were girls.

Scott Benner 19:08
Maybe maybe for the next 90 some years. It'll it'll just go that way.

Jim 19:12
Yeah, could be. But I tell people we didn't have any girls in our family for 100 years. Yeah, my wife says yeah, but you hardly had any people at all.

Scott Benner 19:21
You know, we realized recently that that my my parents bloodline and now pretty much because I'm adopted, so even though I have a son that name moves forward, but not not any connection to the to the family. And then my my brother has a daughter, and my other brother's children are his wife, his wife's their stepkids. So and I don't think they're gonna have more. And I was like, well, it's just sort of it and then it's funny. It felt like a big deal for a second and then I was like, yeah, it doesn't matter.

Jim 19:59
Yeah, Uh, well, I've got there's so many boys. I don't have to worry about our family.

Scott Benner 20:03
No kidding you people are gonna take well listen to you. Hopefully not, but it's possible in the coming decades, you're gonna be respond to this family is going to be responsible for an army of type one kids at some point. Oh, yeah,

Jim 20:18
I hope not. But you never know. Yeah,

Scott Benner 20:20
I mean, and if you're saying you go back that far and you can't find any auto immune, you really become an outlier in that situation.

Jim 20:26
Yeah, I definitely am. How do you figure out

Scott Benner 20:29
in the 1960s and the 1970s in the middle of you know, free love and everything else? And no real diabetes technology? How do you figure out how to take care of yourself? Like you are? You're healthy now? Is that correct?

Jim 20:44
Oh, yeah, yeah, no complications of any kind. I think it was just getting into a routine and doing what you need to do. Unfortunately, there was probably, I'm guessing it was probably not until sometime in the mid 80s. That I had kind of settled down and gotten into, you know, not eating as many things as I shouldn't have. And I'm just, I'm thankful that after having this disease for 55 years, I've got no retinopathy, no neuropathy. The only and the only other autoimmune I have is hypothyroid. So,

Scott Benner 21:41
Jim, it's almost ridiculous. I mean, I know. Now, you know, I'm thrilled for you. But it's almost just silly. What you're saying. So you managed for, like, around 20 years, not really paying very close attention to things. So what insulin are you using? In the beginning?

Jim 21:58
In the beginning, it was 45 units of lenti. Every day, one shot in the morning. That was it.

Scott Benner 22:03
That's all you did? Did you get low ever?

Jim 22:07
Very rarely. I only actually remember. I remember one day at work. This was probably in the late 70s, early 80s. I was at work, and I was trying to I was filing some papers. And I was putting them in folders in alphabetical order. And I couldn't do it. It was just, it's like I couldn't tell, you know, I had this thing with an AE on it. And I just couldn't figure out that it went in a folder. And this thing with a C on it went in the C folder. And my boss comes in. And he knew something was up. So he calls my wife. And he says add just get him a coke. He'll be fine. So

Scott Benner 23:02
and but that's but nothing. Wow. I mean, how do you? What's my question? Even? Do you think you just got lucky?

Jim 23:12
Well, you know, I don't believe in fate and luck and stuff like that. But yeah, I can't explain it. Now. I know that my my stepmom who I never called My stepmom she was my mom. She was great. We had a great relationship. She listened to what the doctor was saying about mostly about the diet. And back then it was the exchange diet. I think I was on 2700 calories a day. So it was like, you know, this many starches and this many fruits and this many vegetables and stuff like that. And she was she was good at sticking to that. And I think that would have had a better effect had I not been going off the deep end with you know, fruit pies and milkshakes and stuff like that.

Scott Benner 24:11
So the diet, the diet really only existed in the home.

Jim 24:15
Yeah, pretty much. Yeah. I mean, it was to the point where at night, I'd be practicing my clarinet in my bedroom. And I thought I could smell ammonia. And I finally realized years later that I was probably smelling the ketones oozing out of my pores.

Scott Benner 24:32
Jim, that's not a euphemism. You play the clarinet.

Jim 24:35
Yeah, I played in addition to piano. I started playing clarinet in sixth grade. But soon in, I don't know, eighth grade saxophone in ninth grade. And I think I think that's about it. I mean, I dabbled around on guitar and stuff like that, but never you It was mostly piano and wind instruments. And I've I currently play in the church, church orchestra. And I also belong to a local community band.

Scott Benner 25:10
Is it just come naturally to the music?

Jim 25:13
Yeah, yeah. It's I know that it's in, in anyone who's a successful musician. It's just a characteristic they've probably had from birth. And oddly enough, I think it's also accompanied by a very strong very strong math skills. Really, believe it or not, because music is very precise and rhythmic, and you have long notes and short notes, and they're all mathematically related. So you'll find I think you'll find that a lot of mathematicians and scientists are also musicians.

Scott Benner 26:02
And so that's, I guess, when you went back to college that that made all that easy as well.

Jim 26:08
Yeah, yeah. It would have except for the drinking age.

Scott Benner 26:13
I meant. I meant the second time, Jim.

Jim 26:16
Oh, the second time Yeah, yeah. No, no, the first

Scott Benner 26:19
time nothing helped you you write sounds like you almost got tossed out of there on your ass actually.

Jim 26:24
Yeah, pretty much. Yeah.

Scott Benner 26:27
So what did you tell me again, what your degree ended up being?

Jim 26:30
I got an associate's degree in chemistry, okay.

Scott Benner 26:34
And that propels you through a whole an entire career.

Jim 26:38
It actually, let's see, I took the first job in 72. I got my degree in. I didn't get my degree until 96. And then, I retired three years ago and 2019. So I was in the industry for 46 years.

Scott Benner 26:59
It is that a I'm going from how you were growing up until this, you started this career, do you? I mean, you met your wife there. So she didn't draw you to the place. You just just, I mean, you don't seem like the kind of the story doesn't propel itself towards I'm gonna get like a regular job and work in a rubber plant and, you know, make dashboards.

Jim 27:23
Yeah. Well, a friend of mine told me about this place, and I was looking for a summer job. So I went there and got in and it just took off from there. I started, like I said, I started off on the production line. They apparently the Forman noticed that I had more skills than just manual labor. So I ended up in the laboratory as the lab technician, and then ended up kind of just growing into a even though I had no degree, I was basically the chemist for the organization. So

Scott Benner 28:02
we're that's a story that won't exist anymore, huh? Yeah, yeah. You kind of bounced around as a younger person. And then get a job and based off of hard work and, and your intuition for the job, you moved up and raised a family and three kids off of an associate's degree. Yeah. And in your retirement, you have cars and free time and leisure and music and even playing musics not a cheap endeavor. So you through the years, we're buying instruments, and I'm imagining everything else. Yeah, that's, that might be a might be a time we all find ourselves missing at some point.

Jim 28:42
Yeah, I don't think it's like that anymore. So

Scott Benner 28:45
nine, my son left college and the pressure to like, find a job that paid well started, it felt like it started as they handed in the diploma, you know?

Jim 28:54
Yeah. And I've I've told young people over the years that going to college, and picking a degree without knowing whether it's something you really like to do dangerous is a huge mistake. I've often told people go out and work a bunch of places and figure out what it is you like, and then then decide what kind of degree you want.

Scott Benner 29:20
Jim a coffee is $8 How are they supposed to do that? They kind of get a job. I agree with you though. I thought. I felt like in the first 18 years of my first child's life. One of the strangest things I saw happen was him go to college and be like, This is what I'm gonna get a degree in, when he didn't know which way was up or what he cared about or anything like that. He just knew he knew what he was good at. But he didn't. He doesn't know what he likes or if he likes anything to be honest with you.

Jim 29:50
Yeah. And my youngest son did it right. He he was always interested in mechanical stuff. He and I worked on the cars together and He said I'm not going to college. And he picked out a trade school in Chicago. And now he is an ASE certified master mechanic with Land Rover.

Scott Benner 30:10
Okay, that's a that's a nice clean job nowadays being a mechanic.

Jim 30:15
Yeah, sorta

Scott Benner 30:17
little rolling computers that uh,

Jim 30:20
yeah. So he is he is currently re restoring my first 67 GTO. Oh, he can do it for you. Yeah. Well, he's doing that one and I'm working on the second one. Okay. And it's funny because my granddaughter. She calls me pop pop. And every time we talk about my son's GTO, she says, It's pop ups GTO.

Scott Benner 30:50
Jim all was left in the next however long we talked for his for you to say bang. So I can call this episode Pop Pop bang. Because right now, right now I'm stuck on Jim makes rubbers and stuff like that, which I don't think is appropriate. For.

Jim 31:07
Yeah. Jim met his wife in a rubber factory.

Scott Benner 31:10
Yeah, exactly. With all that rubber around on it, all those kids. Yeah.

Jim 31:16
Well, I guess the one related to diabetes. The one bang I've had in my life CGM. I mean, I'm sure other people have told you their stories. You know, I was drinking all the time peeing all the time losing weight, blah, blah, blah. You know, I had to do the urine tests, blah, blah, blah. There is kind of a funny story on how I got the pump therapy. I've been on pumps for 16 years now.

Scott Benner 31:48
16 years. Okay.

Jim 31:50
I was back in 2007. I don't know if they still even have these but you had health savings accounts or health care spending account?

Scott Benner 32:04
is what I used mine yesterday. They definitely have them. So well,

Jim 32:07
there were there was a different one that we had. Because because there's two choices. Now. Back in that day, if you didn't, if you had any money left in it at the end of the year, it was gone. Right? You didn't. You didn't get it. So I'm looking at my I kept pretty good track of it and in a spreadsheet. And I'm looking at it going, Oh, geez, I've got $1,000 left. If I don't use that I'm going to lose it. I think I'll go on an insulin pump. So I went to talk to my Endo. And he says, Yeah, I think you know, because I had a previous endo had told me that my control was so good. He says if you want to go on a pump, fine, but you're on MDI, you really don't. It's not going to make any difference. And it hasn't, as far as my, you know, agencies or anything like that. But I think it has, I think it has helped. And then when CGA CGM came out, that was like I said, that was a game changer.

Scott Benner 33:09
So tell me a little bit about you were on MDI for how long?

Jim 33:14
Um, let's see, I was on the single injection, probably until the late 80s. So 20 years. Wow. Right? And then in that, that 8990 range was when the human insulins were coming out. And he switched my endo switched me from the single shot to I think it was NPH in the morning and evening. And then at that time, it was human log, or humulus and humulus are right, at meal meals. Yeah. And then when human log came out, it was pretty much the same routine NPH in the morning, and evening and human log with meals.

Scott Benner 34:04
When do you slip into a Basal insulin?

Jim 34:07
I went, my first pump was in 2007. And it was the Medtronic 513 G. And that was, you know, that was a good, a good run, I thought. I mean, my agencies were always in the high fives, low sixes. But a couple of months ago, I pulled up some glucometer data, and in 2000 and this is on MDI. My average blood glucose was 150. But I was running 32% under 70 and 32% over 180 and only 30% in range. Yeah, well, there's even not. Um, so So as as you know, There's a fallacy to just looking at the A one C, right?

Scott Benner 35:03
Yeah, the you didn't have any kind of stability. So you were you were low for a long periods of time high for a long period of time. 150. And the average gave you an A one C, that seemed amazing, but probably was as good as Yeah, yeah.

Jim 35:16
And I think due to running low, so much, it didn't take that long to develop hypo unawareness, which I still have to this day.

Scott Benner 35:27
How low do you get before you know you are?

Jim 35:33
I'll get down to 37 and all fall down. That's the only way I know. I don't feel a thing. Wow. So then in 2017, I pulled up some more numbers. And things were better. Averages 121. I was only running 19%, low and 68% in range. So that was you know, halfway decent without having to CGM. Oh, the other the other stat on my first ones. My standard deviation was 87. And then in 2017, it dropped to 50. And then the last 90 days. Average is a little higher 136. But my standard deviation was 43. Only 3%, low 10%. High, and 84%. And range. And this is with this last 90 days, we've been traveling a lot. I would typically run 85 to 90%. Time and range. But like I said, we've been traveling, and that just kind of you know, I'm able to manage fairly well with it. But you still still get highs more than I like restaurant

Scott Benner 36:45
after restaurant sitting in a huge drop. Are you driving around right now or flying?

Jim 36:52
It? Well. It's a combination depending on we've got kids, my middle son and his wife and two, two kids are in California. My youngest son's in Illinois, and my oldest son's in Michigan. So we just we actually we just flew back yesterday from Michigan so

Scott Benner 37:12
well, well thank you. Actually Today's my birthday.

Jim 37:16
Is it happy birthday. Thank

Scott Benner 37:17
you very much. I only bring that up because people end up on the show all the time on their birthday and they bring it up and I was like I have to take I have to say when it's mine right. So when you when you went to a CGM was when

Jim 37:35
um let's see, I went on the G five and a tandem T slim and 2019 year I retired. Because I I guess my

I have I have recall issues. My other pump.

Scott Benner 37:57
The Medtronic

Jim 37:59
thanks. Expired expect the warranty expired in 2019, which was perfect timing. I did a lot of research looking at pumps and decided I want the teat one at the T slim even though I could only get the G five on Medicare at that time. The advantage to that was I had it all dialed in before I went on to G six and control IQ in 2020. So I had basically done all my Basal testing and everything at that time. And I frequently recommend to people on the web on the Facebook pages there to go on on control IQ. Do you have any advice for me and my advice is always get it dialed in before you turn control IQ on.

Scott Benner 38:44
Yeah, run it like a regular pump? Yeah. Yeah, it's tough because some people are, are hoping that that algorithm is going to save them from something they haven't been able to figure out so far. I wondered. Good, but I have a question. But the problem

Jim 38:59
I see with that is it's kind of like driving a car that you have an erotic that erratic speedometer. Yeah. You know, it reads high. So you're compensating for that. Well, then the next day, it reads a low so you're compensating for that? Well, your pup is compensating for things that are happening because your settings aren't right.

Scott Benner 39:27
Yeah, no, it's everything is settings. Jim, like, you know, I'm gonna say that forever. So what was what was my question? Oh, was it a huge shift? Going to a CGM and a pump versus just a pump versus just MDI? Like, was there ever a spot where you thought, I can't? I can't adapt to this or have you always been interested in moving forward with things?

Jim 39:56
No, I've always been Technology addict, so, okay. And I, I guess that's one thing that I'm typically not a compassionate person. But I do feel for the people who just don't have strong math and scientific skills. I mean, let's face it not everyone's a mathematician. And I can't imagine being diagnosed today. And the doctor saying, Here's a pump, and here's CGM. Go for it. It would have to be so overwhelming.

Scott Benner 40:39
Yeah. Don't you think that that's part of what we're seeing with? Like Omnipod? Five control IQ, that kind of thing? Doesn't it seem like they're trying to develop something that if you don't know much about it, you can still have more stability at a lower number than you're going to achieve on your own?

Jim 41:01
Oh, yeah, I'm sure of it. Yeah.

Scott Benner 41:04
Yeah, it does seem to me like what they're trying for me, because I get lost sometimes in the podcast, to where I'm very accustomed to being around people who are super motivated and either get it right away, or if they don't get it really nose to the grindstone, find a way to figure it out. Whereas I believe that it's possible that the, you know, the great majority of the rest of the people don't fall into those categories. And they might they might just be bouncing around their whole life and, and not knowing.

Jim 41:34
Right, yeah. And, and I think you see it in the Facebook posts. You know, people just I've had this disease for so many years, and I just can't control it. And I do feel for those people.

Scott Benner 41:49
You know, for the first time in forever, I mean, honestly, I've been doing this a really long time. No one's ever yelled at me. I got yelled at the other night, it really Yeah. And a Facebook post by but and I saw what was happening. So I didn't find it to be off putting. But here's what this person probably meant, not what they said. I think what they meant was, I can't figure this out. I need you to tell me. And I, of course, was trying to help them figure it out. And they just kind of, I don't even know how to put what happened. They just sort of we were in the middle of talking about something and they just turned on me. And you know, you're not helpful. This isn't helpful. Like I was trying to ask leading questions. I thought we were having a dialogue. I didn't realize I didn't realize that I was speaking with a person who probably was at wit's end. Yeah, you know, and feeling a ton of pressure. He was about a child about a younger child, like I understood. I mean, I completely understood and I tried really hard to like say, Hey, listen, I think we're just having a communication problem here. But the truth is, I, from my perspective, what was happening was, they were just, they couldn't take it anymore. They were up to like, somebody needs to tell me what to do. Because I don't know what to do. And that I think is your point is that those people are, you know, they're plentiful, and it's, um, it's a shame, you know, he said something strange. You threw me off, you're not normally compassionate.

Jim 43:21
Well, yeah, like I mentioned earlier, you know, when my mother died, and my dad died, and my stepmother died, I, you know, I wasn't hugely affected now, my mom. I think I was more affected by her than my actual biological mother. Because, I mean, let's face it, I was only six years old. That's pretty young. But when my when my mom died, she had she had been an executive secretary Ford, both her and my dad worked at Ford. And they met after my mother died. And she contracted Alzheimer's. And having known that she was an executive secretary at Ford Motor Company. She was a gourmet cook. She worked in offices. She was I mean, she was smart. And to see her reduced to what she was, you know, before she died. Was was hard. It was actually seeing her deteriorate. It was harder on me than her death was. Because I think by the time she died, she was I mean, she was done with it. Finally,

Scott Benner 44:48
do you feel like you've like, walled yourself off from those feelings?

Jim 44:54
Yeah, I don't know. I I've never I've never Put any I've never tried to do any, you know, soul searching about it or never seen a psychiatrist or anything like that you're

Scott Benner 45:07
from the wrong generation for that question. I just thought I would ask it. I got I got up the next day and I paid my bills. Yeah. Well, well, but it's interesting. Hey, listen, you don't, you don't lean in that direction. But I'm still gonna ask the question because of your older brother. Do you have any, like, tendencies towards spectrum stuff? I'm not sure what you mean, Autism Spectrum stuff? Or like, Do you have any leanings that way?

Jim 45:39
I suppose in a minor sense, because as a child, I was perfectly content playing by myself. I mean, I had, I had a lot of friends. And I was popular in school. But when I was younger, you know, I could sit in the basement hours for hours by myself playing with my Legos, and stuff like that. I didn't need anyone. But I wasn't. You know, I like I said, I had friends. We played, you know, we did stuff. So I suppose you know, there is I've always been kind of a loner. But but at the same time, you get a party going and I can be the life of the party.

Scott Benner 46:27
I took it. I took that from the beginning of your story. Yeah.

Jim 46:31
I guess I guess I'm kind of schizophrenic.

Scott Benner 46:34
Jim, I think you're one joint away from just going crazy right now.

Jim 46:37
Yeah. Hey, it's not legal down here. So

Scott Benner 46:42
Oh, okay. I was gonna ask you, if you still partake once in a while.

Jim 46:46
I did one of my kids, bachelor parties. And it slipped out. My wife heard about it. And she was not too happy with me.

Scott Benner 46:56
I didn't think she did. I was just checking on you

Jim 47:00
know, she doesn't know. Didn't?

Scott Benner 47:03
That's, uh, that's pretty interesting. What else do I have here for you? I did want to ask you about your wife wanted to ask if if she has any involvement with your diabetes at all.

Jim 47:11
I'm very little actually. I mean, I've been self managed for so long. She knows that I know how to take care of it. She can tell when I'm alone. Well, she used to be able to tell when I'm low. But I have my low limit on my Dexcom set or not on the Dexcom. But on my pump. I've got my low limits set at 100. So I get advanced warning when I start to go low. And she's I mean, she's she's pretty hands off, but she's aware of it. So

Scott Benner 47:46
is that a number that has increased as you've gotten older? Is that always been where you like to treat?

Jim 47:53
Well, yeah, that's a tough one because I don't think it was until till I got the CGM and 2019. That I really knew where I was because like I said, I had developed hypo unawareness so long ago, that you know, I like I said, I was out mowing the yard one day. And I really literally my legs went out from under me. So I was able to make my way into the house and checked on my glucometer. I was 37. And that happened at work wants to my legs went out from under me and it was exactly 37. So I know that if I fall down, I'm at 37.

Scott Benner 48:40
Has that happened since you've had a CGM?

Jim 48:43
No, it has not. No, that's a big change. I mean, I've had I've had lows, but because what a lot of times when I'm working on the car, it's physical, labor, turning wrenches. And I'll frequently turn my basil completely off when I go downstairs to work on the car, and then I have to set an alarm to make sure I turn it back on later in the day.

Scott Benner 49:06
Yeah, they say Jim Temp Basal off is the way to go. So you can't forget to put it back on. Avoid your DKA that way.

Jim 49:13
Yeah, well, I haven't been in DKA. Since I think the last one I had was in 19. I'm assuming it's going to be 1981 Based on the house I was living in. And I didn't even go to the hospital for that. I knew what was going on. I went to the pharmacy got a bottle a regular insulin, just you know, gave myself probably like 10 units or something like that. But I had been hospitalized for DKA three times. From probably in the early 70s I would say yeah, I buy nonsense then

Scott Benner 49:58
go As you're harkening back to earlier management ways that you know, and obviously you were doing what you were told. And I asked you earlier, you're healthy, right? You don't have anything you said, No, I'm good. But then you said later, you have brain fog you have you have trouble recalling things sometimes.

Jim 50:14
Yeah, I just had my, the when you're on Medicare, they give you an annual. It's not a physical Well, yeah, I guess it's a physical, but they also do a memory test. And I aced the memory test every time. But I told the doc I said this, and this is my PCP, not my Endo. He says, Well, you don't have any memory issues, you have recall issues. He said, the data is there, you just can't find it. So I'm not sure what that means. But it's it's particularly it's the worst with people's names. People I've known for 20 years, you know, it'll take and then their name will just come to me later on.

Scott Benner 50:57
looking them in the face or, or, or thinking of them, whatever. You just can't find the name sometimes.

Jim 51:02
Right? Yeah. Was that he didn't seem concerned about it. So I'm not sure it's not happened

Scott Benner 51:07
to him. Yeah. Good. Well, I, there's a, it's, I've said it here before. So it's not that much of a secret. But I'm just good at, at, at moving. So whenever I can't find a word, I just find a different one. But it happens to be on the podcast constantly. I'm just I talk so quickly, you can't see it happening usually, where I find a way to like artfully pause while I collect myself. And if I if I really get caught, then you know, I'll just admit to it while I'm talking about I cannot think of what I was thinking of just now. Part of I you know, I'm I'm 51 today. So I mean, that's not young, it's not old. And I've had problems with my iron being low in the past. So I'm not certain because the iron thing just like, it knocks you out. Like it's like, it's like being on a dimmer switch and somebody just shutting you off. Right. So, but but I know what you're talking about. I've had that experience we all have. I've watched it happen to my wife recently. She you know, she's getting older and the kids are like, she can't think of her word. And I'm like, you know, you only have like, 25 years before this happens to you. So just be a little. Yeah, that's interesting. It really, Jim. Yeah.

Jim 52:21
Like I said, it's worst with names. That's the big the big thing. And I actually read somewhere. I saw it on the internet. So it has to be true, that it's a there's actually a condition for this thing about not being able to remember people's names. Or recall, I'm sorry, recall their names. Yeah.

Scott Benner 52:42
I'm terrible with names, but I always have been. And, you know, it's not because I don't care about people. I just, I don't know, like, I can't remember people's names like in Titan my life I can. But you know, you get slightly outside of my bubble. And I'm like, I remember, you start telling stories around them. Like you even said, like, I remember what house I was in, like, like you can remember all that stuff. And not the one piece, I have to tell you, I find talking to you incredibly interesting because your life goes against conventional a little bit. And, you know, in a number of different ways. And it's interesting to look back at it as a whole. I find it super interesting to hear somebody talking about like, you know, I was married in my early 20s for a number of years, and I have a child. But then, you know, and I went to college once but then I went back to get an associate's degree, I had this job here, I met a person at the job. It's very interesting to hear it to hear it all in one place. I don't I don't know why exactly. Other than I think most people expect, you know, nowadays, it's, I'm gonna grow up, I'm gonna go to school, I'll meet a person, I'll marry that person. Everybody thinks that's gonna last forever, we'll have a bunch of kids as kids will become astronauts and quarterbacks and the President? Well, well, you know, I don't know how awesome that is anymore. But but you know, like, like, in these big things. And it's just, they realized the other night, I was taking out the trash where I do a lot of my best thinking, walking to the end of the street. And it's the only time I'm alone, like, during the week, and I just thought, you know, my expectations for things versus how they went. You really get a different perspective as you get older. Sure, yeah. All the things you think, in your 20s and 30s, while you have a young family is it's all hope it's not. It's not it's not based in much reality. And for the people who you know, for the people who get to the end, and it went exactly the way they thought it was going to go. I think that's a fluke. Maybe more than, than anything else.

Jim 54:49
Yeah. And I mean, I think this is one of those things that kind of goes back to another era. You know, my dad was a He was born in 1923. He spent he was a volunteer on B seven teams in World War Two, got shot down on his second mission and spent two years in a German prisoner of war camp, came back to the US, went to college on the GI Bill, and became an engineer and finished out his career at Ford Motor Company. I mean, he had a plan and he stuck to it. People don't do that anymore. I didn't even do it. Now, Jim,

Scott Benner 55:31
you're you blow in the wind like that thing. Our dealership? Yeah, pretty much you're like, you're like, weed? Beer? Yeah, no, Jesus, I don't care. Put it in front of me. I'll follow it.

Jim 55:48
I just go with the flow. You know, you really do. But so

Scott Benner 55:53
even with the diabetes, if you didn't fight against the changes, you took the time to relearn. I'm a big fan of that. And yeah, you know, you could have got stuck somewhere and been like, Screw it. I'm just gonna do it like this.

Jim 56:07
Yeah, well talk about memory. I'm the odd one of the odd things, I think. Because when I was diagnosed, it it didn't, you know, I was like, Okay, I got to do this. Let's move on with life. I can still clearly remember the doctor coming into the examination room and telling me I had diabetes. I can picture it plain as day almost like a motion picture. And what I find so odd about that is why do I remember that? Because I don't remember it having much of an effect on me at all. You know, a couple days later, I was in the hospital for a week while they got things straightened out. And

Scott Benner 56:55
that was it. That was it just went do what you're supposed to do.

Jim 56:58
Yeah, you know, for all the changes. All the weird tracks I've taken in my life. I've always been kind of a compliant. Person, except my wife accuses me of being passive aggressive.

Scott Benner 57:15
Yes, I'm sure you're terrible. Horrible, horrible person. Yes. The way you've stayed there and raised three children for 41 years. Yeah, stop smoking your weed when you were told. So? Yeah, you just don't

Jim 57:31
know, a poor listener. But yeah, I've had I've done a few other things in my life, too. Let's see in 1984. I hiked by myself into and out of the Grand Canyon, spent a week down in there. And that was when I was on the one shot a day prep, which I probably cut in half because of the, you know, the hiking exertion. But that was a fantastic trip. And in 2014, I had open heart surgery to fix my mitral valve, which I'd had, I'd had a heart murmur since I was a kid. And the doctors always told me, you'll probably have to get that fixed someday. And when I went in for I went in for an echocardiogram every year. And I'd always positioned myself so I could watch it on the screen. And I could see that, okay, this thing is not looking good now. And then about a month after that, I started getting short of breath and told my wife, Okay, it's time I told him at work. I said, I've got to go in for open heart surgery. So I'll be I'll be off for about a month and survived that. It really, I mean, looking back on it yet. It was pretty painful for a few days. But all in all, you know, it's it's still holding in there. So that was what, eight years ago.

Scott Benner 59:07
difficult recovery?

Jim 59:11
No, actually, the only thing that bothered me. And I don't recall what my blood sugar's were doing at the time, so they probably weren't too bad. I was on the Medtronic pump at that time. So I mean, they probably ran high for a while. I know they had me on an insulin drip in the hospital. And I'm not sure how many units per hour I was getting, but it was probably a pretty hefty dose. The worst thing about it was I had to cough to make sure I was getting any junk out of my lungs. And that hurt and that hurt. And I remember the first time I sneezed I was convinced my heart my chest was going to explode. load, you know, I was gonna break open and you know, my lungs were gonna spray over here and there was gonna be blood all over the plant bathroom but didn't happen. I didn't know that I was wired shut, so I couldn't explode. So

Scott Benner 1:00:13
well, that's really crazy. I'm feeling like there's a lot more that's happened to you that we're never gonna get.

Jim 1:00:19
I guess. That's all the major stuff. But I mean, the things. I've got a list here of everything. I wanted to talk about how we got one. We're almost done. Cool.

Scott Benner 1:00:33
I'm doing all right.

Jim 1:00:34
And I think we've mostly talked about the one the one section I have labeled what I don't have. And we already talked about most of that, you know, complications. I don't have any complications. I don't feel highs or lows. I don't have as many highs or lows. But, you know, I still hit that occasional 300 Because I didn't call us right for meal, eating out or something like that. But I, you know, I 303 50 I don't feel the same.

Scott Benner 1:01:04
You just don't know. There's no, this is real.

Jim 1:01:07
Yeah, I feel perfectly fine. I have never felt other than the initial lows that I felt very early on. I don't feel a thing. I don't feel so. You know, I mean, obviously, when you're in DKA, or, you know, puking your guts out, but and then the the whole other thing about no one in my family with tea, Wendy is is kind of weird.

Unknown Speaker 1:01:33
No, it is.

Jim 1:01:35
The other thing I have listed here is horror stories. And that's not not for me. But for things I've heard and seen over the years. I remember being in my, the endos office, the one that got me started on the pump. And I gotta say he was the best endo I ever had. Because he was a type one on pump therapy. He understood he knew what was going on. You know, he's the only one I've ever had, that really had an intimate knowledge of diabetes. But I was in his in his examination room one day. And the walls weren't very soundproof. And he was in the room next to me. And there was an older fellow who I assume was a type two. He walks in and says, Well, you're a one C was 11. And the guy says, Oh, is that bad? And I'm like, Oh, dude, you're killing yourself. And I mean, I laughed at it at the I don't know that I laughed at it at the time, because obviously, it's not funny. But I had another endo Tell me about a patient of his, who was a young college educated woman who simply refused to take care of her diabetes. She was in a wheelchair by the time she was in her mid 20s. And I'm just cash. It's so sad, you know, and me being a totally uncompassionate person, you know, to feel for someone you know. But and then, this was I think, in the early, probably the mid 80s. My wife and I were canoeing on a small river near where we lived. And fellow she worked with and her husband or his wife. We ran into them on the river, not literally ran into him, but he was type one, and he was having a low. And turns out that when he was diagnosed, his parents refused to admit that there was anything wrong, because he looked fine. There's nothing wrong with him. He was already in his mid 20s Suffering from retinopathy. But the worst, the worst, one of all was a good, a good friend of my wife, her. They were never married, but her boyfriend for years, was a type one. He had had both legs amputated. He was pretty much blind. He went into kidney failure, and he died and all as a result of type one. So, you know, like I said, I don't consider I don't particularly particularly believe in luck or fate. But I guess I have to say I've been pretty lucky. Ya

Scott Benner 1:04:39
know, I don't know another way to think about it. When the when the technology the understanding is where it was in the 60s and the 70s, the 80s and part of the 90s. You know, to make it as far as you have as well as you have is there's a little bit of it doesn't matter what you call it, right but but whatever it is, Is it's there? Because like you said, look at all the other stories you have, you know, just from being in the in the office or meeting people, you know, along along the way. Was there any kind of community aspect to diabetes like like the way you describe yourself? Like, it's interesting to me that you know, this podcast or that you're involved in the Facebook group, because it doesn't seem like you would be but you are?

Jim 1:05:27
Well, I think it was probably after I got on the CGM and the tandem T slim, and control IQ. And probably it may have started when I was researching what pump I want it to go on. I started looking up Facebook pages and found found the the tandem T slim page on there was a group 30 years with type one diabetes. Adults with T one D. And then I didn't see that the Juicebox Podcast until just probably within the last year. Someone on one of the pages mentioned, I listened to this podcast and it was really good. And I'm juicebox What the heck is that? So I looked it up and listened to a couple episodes and then I saw the pro tips. So I listened to all of those and then I've gone through the list. I haven't listened to all of them. I probably listened to maybe a third of them. I usually go by the titles. Oh, this one looks interesting. But I have to admit I've gotten some good tips. I think the best one was it might have been one of the pro tips was bumping nudge. Yeah. That that was good. And then the the other one about the the CIQ ninja, the guy whose son? Yeah, was that great? Yeah, that was a good one. And this morning this morning, I just listened to the the older lady who was diagnosed at like 49 I think it was number 714. They see Scott Scott made a Scott messed up. Yeah, it's got messed up. I enjoyed that one. I do like listening to other people and just hearing their experiences. But the weird. Another weird thing about my experience with T one D is I have met in 55 years I have met so few people with type one. I have never actually seen another person. I've never run into another person with an insulin pump. Really in person. Yeah, ever. But you

Scott Benner 1:07:57
met in five years. But you did see a type one on a river once that's gotta count for like fit. Yeah, different.

Jim 1:08:04
Yeah, but my wife knew him. And she told me he was diabetic so and the odd. There were two guys that I worked with. At the last company I retired from there were two guys who were T Wendy's. And they never talked about it. I never would have known it except for one of the guys saw my pump. Because he thought it was a pager. I said no, it's an insulin pump. And it turns so he and I hit it off pretty well. And I haven't heard from him for a while I need to contact him. But he was he was on the one of the later Medtronic pumps with The Guardian sensor, I think the 617 or something like that.

Scott Benner 1:08:47
Yeah, I don't know all those Medtronic pumps for sure. Of which there are many. So there's you like this, you like being around other people who have diabetes?

Jim 1:09:00
Yeah, um, I, in the I guess I've been on the Facebook pages for a few years. And I was giving a lot of advice to people who are newly diagnosed there having this issue with the pump. And I think I probably gave more advice than I got. But there were still some valuable things I picked up. And I Yeah, so I started my own Facebook page. Because there was one out there with 30 years with type one diabetes, and I said, well 30 I got that skill. 50. Let's go 50. So I started a Facebook page called 50 years with type one diabetes. And it's interesting because I've got like 60 I haven't looked at recently but about at least 62 members last time I looked and I'm the only one that posts anything. I might not always get a lot of comments when I do post something But no one volunteers anything. I think they're just like, Yeah, you know, I've had this for so long. It's just a way of life. I got nothing to post. So

Scott Benner 1:10:08
I also think that's a generational thing. I don't think people in their 60s are, are looking to, generally speaking be part of the social media movement. Yeah. It's hard to get people to share things. I have an incredibly tough time getting type twos to share. So I try, I try and I try and every once in a while you get one who's terrific, but it's not as many people as I hoped for. Yeah, your group has 75 members in it right now, Jim? Okay. All right. Well, that's excellent. 50 years with type one diabetes in the 50s. Five hours that correct? Yeah, yeah. Very nice. My group gets 300 new members a week. Yeah. And it's not something I expected. To be perfectly honest. Most of this is not something I expected that someone would tell you that, you know, I listened to a podcast, it still freaks me out. Or when someone you know, when people come in, they answer a question about how did you find out, and I read through every one of them that pops up in front of me. And I'm, I'm just stunned, you know, how and how it's sort of permeated and spread? I just never. I mean, I hoped but I didn't. I didn't really expect it to. Sure.

Jim 1:11:21
Yeah. Well, there are so many parents out there with children with t 1d. And that that's another group that I really feel for because it's, you know, it's hard enough to manage this thing by yourself, but managing it for someone else. Well, you know, it's hard because Arden you know, it's gotta be, it's gotta take a toll on you.

Scott Benner 1:11:47
Yeah, my wife, who doesn't she's pretty stoic, most of the time about stuff like this. But the other day, she said to me, we're, you know, we're getting older, we're not like, you know, we're not, we're not drifting, it's not over or anything like that. But she said, I just didn't think there'd be so many roadblocks. And I said, No, I didn't either. And it's tiring. And if you don't have the support you need from people and you don't have the support you need financially and, you know, health insurance wise, and your earlier point, you just kind of don't have the wherewithal to think it through, you know, and, and be ready to get it wrong and try again. And, you know, sometimes, you know, talk like you're talking about go with the flow, and sometimes, you know, have to stand up and push back. It's, it's more than you expect, you know, you're you're in your 20s and your 30s. And you're having kids and you think like, Oh, this one's my astronaut, and this one's gonna be a prince, and this one's gonna be this and you don't think that you know, 25 years later, you're still going to be on the internet trying to figure out why somebody's leg hurts, or Yeah, you know, what? That kind of stuff. It's just this autoimmune stuff is that sucks.

Jim 1:13:04
Yeah, yeah. Well, like I said, it's been a part of my life for so long that it's just, it's just, it's just there. You know?

Scott Benner 1:13:12
What's your, um, your early grooming was, I got captured by the, by the Nazis. And here I am. I'm back. So I don't imagine there's like given up in you.

Jim 1:13:24
Well, I guess that I probably inherited that from my dad, you know, he's, for him. You know, spending two years in prison camp and World War Two was, you know, he's, he said at one. From one standpoint, it was the scariest time of his life. But it was also the most glamorous time of his life because he was a hero back home and he's still like, he is a hero to me. You know,

Scott Benner 1:13:48
he knew that even when he was in, in the prisoner camp. He knew that that it like the knowledge that he was there and not giving up was, was uplifting to other people. Yeah, yeah,

Jim 1:14:00
I think so. Plus, how

Scott Benner 1:14:02
the hell do you complain, Jim? Like, right, like once, like, you know, my tires flat and he's like, Nazis, leave me alone. Let me know when you let me know when they lock you up in a prisoner of war camp and tell them go clean your room. You're like, all right. I guess he's got Well,

Jim 1:14:18
yeah. Well, all that plus having grown up during the Depression, sure, sure. So he'd been through it.

Scott Benner 1:14:26
No kidding. How old was he when he passed?

Jim 1:14:28
He was 87. That's a full life. Yeah. Yeah, he got a full full honors military. funeral. It was. It was very moving. I almost I almost teared up just thinking about it because it was it's like wow, 21 gun salute and everything.

Scott Benner 1:14:52
making you cry sounds difficult. So it

Jim 1:14:55
well, you know, not as difficult as it seems because I cry more to tears of joy than anything else.

Scott Benner 1:15:02
I had 20 minutes while I was by myself last night where I was doing laundry. And I found myself thinking of a memory of one of my kids and I made myself cry by myself. Yeah, yeah, it's,

Jim 1:15:12
well, I mean, we were my, let's see this, it'd be my wife's. No, my daughter in law's father does a church in his house. And we, usually when we're up there, if we're up there on a Sunday, we'll, we'll go, and it's very informal. And we were, we were singing a couple of hymns. And one of them was talking about something about a newborn baby. And we had two that were due within weeks. And I just, I just busted out in tears. It was, it was crazy.

Scott Benner 1:15:52
I think it's good for you, Jim. I really do. It's, it's a, I found myself just thinking about. I mean, my son's 22. He's still here. He just finished college. And I kept I keep thinking he's gonna leave. You know, I don't know when it's going to be. And what am I going to say to him before he goes, and I realized that the thing I always really want to say to him in tough situations, I never say because it's, it's not it's not valuable for him to hear when he's trying to make his way or be confident or things like that. You know what I mean? Like, there's the part you see the part you say, and there's the part you don't say? And I thought boy, before he leaves, like, how am I going to stop myself from saying, you know, please don't go. Yeah, I can't. I think I'm gonna have to say it. Because I don't know how I'm gonna hold it in. And yeah, because all the other times you know, you're, you know, something tough happens to them and, and you want to, you want to be like, Look, I know this sucks and everything and you should give up. But you don't you know, you don't say that. You say, Keep fighting in your mind. You think I don't think this is going to work out. But I think there's more value in him trying and failing than there is in him. Just walking away from it. He doesn't need to hear from me. This isn't gonna work. Yeah. I don't know how I'm going to tell him. You know, just I'm gonna miss you. It doesn't seem like enough. Yeah, well, anyway,

Jim 1:17:22
when my dad dropped me off at college, I basically got out of the car with my suitcases. And he said, by

Scott Benner 1:17:30
dollar Jerry, get your gym.

Jim 1:17:34
Watch out for the Nazis.

Scott Benner 1:17:36
Listen, if they throw those big grenades at you, you've got time to throw them back. Don't worry. Gotta go?

Jim 1:17:44
Yeah, pretty much.

Scott Benner 1:17:46
Well, that's interesting. Jim, you've had a hell of a life out. I appreciate you sharing it with me very much. Well, I

Jim 1:17:52
appreciate talking to you about it. It was good.

Scott Benner 1:17:54
No, it was the eight. Did you have a good time? Yeah, yeah. Fun. Good. Good. I'm glad I really am. I mean, I don't want to wish you luck, because I don't think you I think you believe in it.

Jim 1:18:07
Well, you know, whatever it is. I'll, I'll keep it.

Scott Benner 1:18:10
Ya know, I hope you stay on the path you're on. I hope. I hope you continue on like this. It's a it's really an uplifting story. Congratulate.

Jim 1:18:19
Yeah, I have to continue because my kids want to kidnap me and 2040 to take me to the 1,000th anniversary of a brewery in Germany. So 2040 Yeah, I'll be 87

Scott Benner 1:18:31
I don't have a ton of confidence. I'm going to be alive in 20.

Jim 1:18:35
Well, I told him, I told him You do realize that's beyond my life expectancy.

Scott Benner 1:18:40
Why don't we go earlier? And you just tell me it's the anniversary? Yeah. Well, I hope I hope to see pictures of your brewery trip. Okay. Put them on, put them on whatever magical thing exists in the future where we, you know, right. It's really something it's so cool. It's so cool to talk to somebody who's kept up with things the way you have and, and I am definitely calling your episode go with the flow. Okay. That's what I figured out while we were talking. Yeah. All right. Cool. Right, man. Have a great day. Hold on for me for one second. Okay. Of course, I want to thank Jim for coming on the show and sharing his story. And then I'd like to thank touched by type one and remind you to go to touched by type one.org. And thank ag one and remind you to go to athletic greens.com forward slash juice box. Of course you can get 35% off your entire order at cozy earth.com With offer code juice box, and 10% off your first month of therapy@betterhelp.com When you go to betterhelp.com forward slash juicebox. I hope you enjoyed this episode of the podcast. I'll be back very soon with another

#871 Best of Juicebox: Standard Deviation and her Friends

First published on Jun 8, 2020. Dexcom's John Welsh M.D. does a deep dive on Standard Deviation, Coefficient of Variation, A1c, Time in Range and more.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 871 of the Juicebox Podcast

Welcome back to the best of the Juicebox Podcast today we're revisiting episode 343. It originally aired on June 8 2020. And it's with John Welsh, a doctor who goes into a deep dive on standard deviation, coefficient of variation, a one C, and time and range. While you're listening today, 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, or becoming bold with insulin. Are you a US resident who has type one or the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. Join the registry complete the survey. When you complete that survey. You are helping type one diabetes research to move forward right from your sofa. You also might be helping out yourself and you're supporting the podcast T one D exchange.org. Forward slash juicebox.

This episode of the podcast is sponsored by cozy earth. Now you can get 35% off your entire order at cozy earth.com Just by using the offer code juicebox at checkout, I'm wearing cozy Earth joggers and a sweatshirt right now these joggers are like the best and our sheets are super duper super, super cool. And silky and soft. Also from cozy Earth. Cozy earth.com use the offer code juice box to save 35% The podcast is sponsored today by better help better help is the world's largest therapy service and is 100% online. With better help, you can tap into a network of over 25,000 licensed and experienced therapists who can help you with a wide range of issues. Better help.com forward slash juicebox. To get started, you just answer a few questions about your needs and preferences in therapy. That way BetterHelp can match you with the right therapist from their network. And when you use my link, you'll save 10% On your first month of therapy. You can message your therapist at any time and schedule live sessions when it's convenient for you. Talk to them however you feel comfortable text chat phone or video call. If your therapist isn't the right fit, for any reason at all, you can switch to a new therapist at no additional charge. And the best part for me is that with better help you get the same professionalism and quality you expect from in office therapy. But with a therapist who is custom picked for you, and you're gonna get more scheduling flexibility, and a more affordable price. I myself have just begun using better help. Better help.com forward slash juicebox that's better help h e l p.com. Forward slash juicebox. Save 10% On your first month of therapy. All right, let's talk about John Welsh for a second. John has type one diabetes. He's a physician. And he works at Dexcom. And he's on the show today because I reached out to Dexcom and said, I want to drill down deep. I want to understand granularly the way smart people understand what is standard deviation. And I know that might be like You're like Oh my God. That's what this episode is about. But no, no, listen to me, what we're going to talk about today, standard deviation, we're really going to understand what it is and how they come to those numbers. We're also going to talk about coefficient of variation. Now there's a lot of words you don't know. But by the end of this, you're going to understand. And you're going to understand why it's so important for you living with type one diabetes. After we get all this information into our heads, I started talking to John a little bit about how does he manage what does he call success at the end of the day. And it wasn't as much about the numbers, as you might think. But he really helped me to understand what these words that you know, maybe don't make sense to us right away. Just lay people what they mean, and how they're helping. You know, it used to be all about a one C right? You just tell you tell people like keep your eye one say here, this is what you have to do. But then all of a sudden you start hearing people talk about standard deviation and variability and this is going to help you to understand that even more. I had such a good time talking to John, that it got away from me. I was supposed to talk to him for an hour and like an hour and 20 minutes into it. I was like oh my god, I gotta let you go. He was like four We're minutes away from having to go to another meeting. And I just like, I'm sorry, go, go go. I found this incredibly interesting. I hope you do too. Because I really believe that the concepts that John and I spoke about today are at the core, they're the basis the bedrock of how you should be considering your health with type one diabetes, if you're looking for data to tell you how you're doing. These three things are a huge piece, you'll see. Please remember, while you're listening, 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. Becoming bold with insulin. I wanted to call this episode, sugar Adam. But anyway, you'll find out why. Here's my finding. And I've been at this for quite some time, being around the diabetes space, I guess. And when the powers that be whoever they be, decide that we should all be aiming for a lower agency, there's a way to disseminate that information they pull together, you know, industry people, and they give them the toxic here's why no one c should be here and not here. And here's what we've learned. And you know, you get that talk. And then those people find different stakeholders and influencers and they spread the word. And before you know it, when it's distilled out to the public, the message is simply, you know, the ADA decided that your agency should be this now. And that's what you're now going to hear your doctors, your doctors talking about. Like it's, you know, like, it's a rule handed down from my PI, though, suddenly, they have a different opinion. And if you don't pay attention, you don't realize that that's just how we get information out to people, right, there's no good way you can't call everybody in the world and say, Hey, by the way, your agency should be a little lower. Now, you do this. But often, while we're spreading that information, it lacks real context. And when this happened recently, I'm gonna guess in the last two years, when all of a sudden, you started hearing your endocrinologist tell you? Listen, it's really much more about variability, your standard deviation, and they started talking like that. There was no context with it again. And then suddenly, everyone's just, you know, they're walking around, like they learned something. And they say, you know, a one sees not as important a standard deviation, and then all the sudden the message becomes a one sees not important, and then it gets, it gets, you know what I mean? Like it gets ruined as people oversimplify things. And so I really want to leave this talk, just backwards and forwards understanding standard deviation. And when I reached out to Dexcom, I said, I need someone who can really do that, and no pressure, but they said it was you. So

John Welsh M.D. 7:50
I guess you know, if you looked around Dexcom, you would say, All right, we need somebody who can tell stories, who can talk in a straight line more or less. And my, just by way of introduction, I My job title is medical and scientific writer. So I love a good story. And I love especially those stories that have to do with numbers and stories that try to convince people that the truth is actually true. And numbers can really buttress a story, you say, hey, look, look what happens if you don't save for retirement. Here's, here's one way you could go if you spend your money in Las Vegas on that gambling table versus spending your money in an IRA or whatever. So the the idea that you can make convincing arguments with numerical data has always been attractive to me and, and that's why I did some residency training, I went to went to medical school, went to graduate school. And after medical school, I did residency training in laboratory medicine. And laboratory medicine is all about measuring things, and saying, Oh, you've got an abnormal value on one of your lab results. And here's why it matters. And here's what you should do to mitigate the risk of, for example, having a really high potassium level. So if you have good data, then you can make persuasive arguments and you can change people's behavior, hopefully, keep them out of trouble. In the case of a higher low potassium, you could save their life, if you get the doctors to intervene. In the case of some really abnormal lab value that might come up in the hospital context. The bigger question about about glucose values and standard deviation. We can get to that but you made the broader point about public health recommendations and man we are just right in the middle of public health recommendations with with the pandemic because there's there's a lot of uncertainty, which is gosh, you know, how can I go to the concert? Can I go to the restaurant? Can I go outside without wearing a mask and that the recommendations that we've been getting from public health authorities have been A little bit discombobulated maybe internally inconsistent and kind of frustrating at times. But I am with you though the idea that we can provide good evidence based recommendations with respect to goals in managing diabetes is, is a big interest of mine. I'm all about all about the numbers.

Scott Benner 10:20
Well, many, many years ago, I came to the conclusion for my daughter, that if I get what I expect is what I started thinking of it as I realized I had Arden's high line set at 200. And I always kept her under 200. So one day, I moved her to 180. And I was like, Oh, I always keep her under one ad. This is really interesting. So I kept pushing it down and pushing it down. And now my daughter's, you know, ranges 65 to 120. And mostly, we keep it in there. And when we don't, it doesn't go that far out. Right, I'm gonna go to 150. That's usually, you know, like, just now, I will use this morning as an example, two slices of toast, an avocado, butter, and an orange. And her blood sugar went to 148. And it's coming back now. And it's not over a longer yet. Beautiful. Right? And so, but her standard deviation will look bigger than someone else's. And I don't know if I'm making up things in my head, or, like, how is it possible that Arden can have a life like that, but her standard deviation could be higher than someone who's a one sees a point or two bigger than hers, and who have swings that are far higher and lasts longer. And so that's the one idea that keeps me focused on I don't understand standard deviation or not. And then when I start talking about it with the people that I that listen to the show, I come to realize that everyone's sort of got that, that confusion. So can we start very over simply. and standard deviation as an idea? Is a mathematical issue. Is that right?

John Welsh M.D. 12:01
Oh, it is it's it's a number that is used to describe a set of numbers. So for the case of folks who are using CGM, you might expect up to 288 numbers every day. And each number represents a glucose concentration. And you can use words to describe that set of numbers or you can use numbers to describe that set of numbers. The the average is a pretty simple number that it's easy to calculate, you would add up those 288 values and then divide by 288. And then you get the mean, in this case, it's the arithmetic mean. There's other flavors, there's the geometric and the harmonic mean. But we'll we'll leave those aside for now. But the arithmetic mean, tells you it's a measure of central tendency, where you might expect the average, if there is such a thing, an average value to fall. The standard deviation is is another number that's used to describe that set of numbers. And it describes the width of that distribution. So it gives you an idea of how surprised should you be when a number shows up, which is pretty far away from the main. So here's I've got a kind of wonderful document came out a couple years ago that looked at glucose concentrations in people without diabetes. And they they came out with normal values. And the normal value here for glucose was pretty close to where is it 99. And express this number 99 is the average and then they give you a plus and minus seven. That plus or minus seven refers to the standard deviation. And the standard deviation. If you imagine a bell curve that you might have seen in school, where the most popular value is right there in the middle, that's the mean value, in this case, 99. The plus or minus seven tells you how steep is the drop off on either side of that mean value. So in this case, the 99 plus or minus seven, if you were to go up to 106. In other words to the mean plus one standard deviation, you would expect to have about I'm sorry, let's go back and say 99 plus or minus 799 minus seven is 9299 plus seven is 106. So anywhere from 92 to 106. The expectation is that you would have two thirds of the values in that pretty narrow range. So if your goal is to have if your goal is to have quite a lot of stability, which in general is a good thing. You want that standard deviation to be low and normal people without diabetes, it is in fact quite low. 99 plus or minus seven is a very tight distribution. Two thirds of the values fall between 92 and 106. Okay, so Whether there's a calculation, we could walk through it if you want,

Scott Benner 15:02
please. Yeah, I was just going to tell you that when we're done. And I can say this because this won't go out until after I'm allowed to, but I'm wearing a Dexcom. Pro. I have been for a couple of days. Ah, so I can see, I'll be able to look while you're talking and figure out what mine is.

John Welsh M.D. 15:20
Oh, good. So are you able to see the real time data or not yet? No, I

Scott Benner 15:25
see it. It's not blinded. I'm looking at it on my phone.

John Welsh M.D. 15:28
Oh, okay. Well, I hope you're, I hope you're within seven points of 99. I hope you're well in the normal range.

Scott Benner 15:34
I certainly hope so too. But I am I, I was really, I have to be honest. As I put it on, I thought, I'm doing this so that I can see how a working pancreas attacks things brings them back what curves look like, I wanted to see all that because I thought it would make it easier for me to speak to people about about using insulin. But at the last second as I was about to do it, I thought am I about to find out I have like type two diabetes or pre diabetic or something like that as like maybe you know, and I just kind of was like, alright, well, if that's if that's the case, it's the case, I'm going to find out. But so far, so?

John Welsh M.D. 16:15
Well, I hope so. And when we do onboarding, we have people come work for Dexcom. And part of the onboarding process is, hey, look at, look at our product and look at what it does. And of course, it's voluntary, but we say all right, if you'd like to wear one of these, just to know what the experience is, like, we can get you set up with one of these. And our expectation is always your glucose values are going to be are going to be let me check boring. And you're going to have a really smooth ride throughout the day. You know, 99 plus or minus seven. But once once in a while we have we have people that come back and they say, you know, John, I learned something really interesting. And what's that? If I have if I have an entire pizza, I can get my sugar up to 180. And I say wow, that's, that's abnormal. And so people learn something, even if they don't have a known diabetes, they can learn something about diet and exercise that you know, I went for a long bike ride yesterday and I crashed I went pretty low. And then I had the the Coca Cola or the sugary drink. And then I saw my sugar zoom back up so you can learn a lot. And that's a general truism that you can learn a lot just by looking. But Scott, I'm pleased that you're wearing one of the CGM sensors and I hope you learned something I really

Scott Benner 17:39
am. I'll tell you already, I had two pieces, smaller pieces of homemade pizza on Sunday. And three and a half hours later, I got a push up from the protein and the fat probably holding the the crust of the pizza in my in my system longer. That was fascinating. And this morning, I had a breakfast that was just a piece of Turkey and toast. People are like oh my god so boring. But, but I smoked a turkey yesterday, it was so good. John, I want to have some sort of breakfast. So I took some turkey and I had a piece of toast this morning. And when I was done, I grabbed a navel orange. And when I ate the orange It tried really hard to push my blood sugar up. You know, not immediately but it was it was drastic, and my body attacked the drastic rise so much so that I was 74 straight down for a second before I leveled right back out at 80 It was amazing. I went from 74 straight down to 80 and stable in a fight in all my shin one five SEC five minute things. So I saw my body go oh, that's a lot of sugar from that orange. And you know, he's already put this bread in here, I guess you know, I don't obviously don't know exactly how my body's thinking but but the idea was I was I was starting to push up a little from the bread not greatly. But then I think when I added the the simple sugar, I just I got a really quick response. So I'm noticing that that every time I press with simple sugar, my body comes back more aggressively than it does with more complex carbs.

John Welsh M.D. 19:03
You know, boy, that's interesting and, and other people have described it to me where they'll, they might have some indiscretion, they'll say I'm gonna have a 24 ounce Mountain Dew and you slam the sugary beverage and you get this wonderful increase in sugar which you can feel in life is wonderful. And then what you described with the orange happens happens in a very dramatic way where they're the insulin kicks in and then the sugar plummets and then all of a sudden you have the the big crash after the sugar high comes the crash and that I think that's a manifestation of instability. And same thing. I'm going to make a quick little analogy to the cruise control on your on your car. What I hoped for when I engage the cruise control on my car is just a smooth ride. And and I don't want the car to be slamming on the throttle and slamming on the brake all the time. You I just want to be going at 65. All the way home. So I am very sympathetic to your experience with with high amplitude glycemic swings. It's it's a common thing, especially in the world of type one diabetes where we're all taking insulin.

Scott Benner 20:17
Yeah, it's it's very interesting. I'll tell you and I'll then I'm gonna let you get back to it. But the other thing that happened that I really didn't expect, but makes total sense, is that for about the first 36 hours, I wore it, every time I looked and saw my blood sugar stable, I had a horrible feeling of guilt. It was, it was really interesting, because my daughter has had type one since she was two, she's 15. Now I have interactions with 10s of 1000s of people who have diabetes, and they all would just, I don't, they would do anything to have that, you know. And it really, it really impacted me for in the beginning, I just was I felt very guilty for my pancreas working. It was a weird feeling. So, but I'm sorry, I shouldn't derail you, because we're talking about something that's, you know, you don't think it's complicated, but trust me, I do. So I shouldn't I shouldn't distract myself. But we were talking again, about about people, you know, who have a functioning pancreas. And you said, you know, let's pick 99 Is that is that that kind of center target? And you can go to 92 or up to 106? And then explain again, what I'm sorry, where were you headed with that?

John Welsh M.D. 21:23
Oh, sure. The value, I'm looking at a big article that came out a couple years ago, they looked at 153 People without without diabetes. And they put glucose monitors on him. And they they collected a bunch of data. And so the question, I guess the first question is, why would you care? Why would anybody bother? The answer is, well, we want to know what normal looks like. So we can decide if if a particular glucose profile is reassuringly normal, or if there's something going sideways on it. The 99 value from earlier is the mean, the standard deviation I gave you earlier is seven. And that tells you something about how wide the distribution is. So one standard deviation on either side of 99 would go from 92 on the low side up to one 106. on the high side, that mean plus or minus one standard deviation, the expectation is that two thirds of the values would fall in that relatively narrow range, two standard deviations 99 plus 14 is 114 113. on the high side, and then 99 minus 14, I guess is 85. Is that right? On the low side, so 85 to 113, the expectation is that you would cover an even higher percentage, I think 96% of the values would would fall in that range. And if you go out even further to plus or minus three standard deviations, the expectation is that almost all the values more than 99% of the values would fall within three standard deviations of that central value the mean. So that's, that's it in a nutshell, the calculation. It's not difficult, it's not trivial, but it's not difficult. I'm not sure if your audience would be interested in walking through it or just looking it up.

Scott Benner 23:19
Right now, John, this is very much meant to be for people who are interested in that. So I have a group of episodes, there's about 20 of them. They're called protests and they are deep dives into specific things about type one. And this is this is one so don't think of this as an interview as much as think of it is, we are really trying to pick this apart so that when someone listens through like, I'll be honest with you. In sixth grade, my guidance counselor told me I could take algebra halfway through algebra, I didn't understand algebra at all. And I thought, oh, my gosh, I'm terrible at math, I dropped out of it. A was a bad decision, because I followed a much simpler math track the rest of my time, which probably wasn't necessary. And just now, as you were talking, I, you know, you set up this scenario, and the standard deviation was plus or minus seven, and you started talking about out one, standard deviation two and three, and it just started to make sense to me. So you're doing a good job. Trust me if I understood what you just said, everyone listening has a chance to understand it as well.

John Welsh M.D. 24:20
Well, you're you're very kind and that's I'm very pleased to think that we're making progress toward the goal, then we can I can introduce the topic again and say the standard deviation is just a number that's used to describe a set of other numbers. The standard deviation, there's a calculation for it, it's a little bit involved, but involves, first of all calculating the mean for a population. The example that we used was the the mean value for people without diabetes, it's 99. You have quite a lot of values. You might have 1000s or 10s of 1000s of values. And this is where it gets a little bit tedious. For every one of those individual values in the set that you want to describe, you have to calculate the difference from the mean. And the difference from the mean is either going to be a negative number, or it's going to be a positive number, depending on whether the the individual value is higher or lower than the mean. You square that. So squaring a negative number, it gives you a positive number, squaring a positive number gives you a positive number. So you're going to get another set of numbers, which is the squared difference from the mean. And if you had 10,000 values in the set, you're going to have 10,000 squared differences from the mean, you have to add them all up, you get a sum of squared differences. And then you divide it by divided by the number of observations in the set minus one. So it's, it's a pretty complicated when you try to describe it verbally. But if you were to look at it on a sheet of paper, you would say, oh, it's, it's a series of steps. Add up all the squared differences from the mean, divided by a large number one less than the number of observations in your sample, and then take the square root. And then once you've taken the square root, bingo, there's your standard deviation. So it's, it's a few steps, but it's something that kids probably learned and then probably forget just as quickly as they learned it in, in middle school or high school algebra class.

Scott Benner 26:26
So how does clarity app like to simplify that all down? What is the clarity app looking at? When it tells me, you know, the, the standard deviation is 35? Can you like, distill it? What is it looking at to make that decision without the without the detail?

John Welsh M.D. 26:44
Oh, absolutely. So the statistics page, for the clarity app gives you some summary statistics. And just a quick little operational note, I wonder if you're able to see my page that I'm trying to share with you on the Zoom meeting? Yep. Oh, good. Okay. So maybe you should ask your question again. So we could rejoin the the post editing narrative?

Scott Benner 27:11
Oh, I just know, I was. What I'm worried. What I'm interested in is, is there's a clarity app, obviously. And it tells me, Oh, your standard deviation, or your daughter standard, if she is 35. Or some people are like, Oh, I'm struggling. And you know, my mind is 65. And I heard from a woman the other day that told me her doctor told her that anything under 100 was okay, which she very smartly was like, I don't think that sounds right. But I want to know, like, what does it look at? To tell me? My standard deviation is 34. Like, taking into account?

John Welsh M.D. 27:47
Oh, sure. Well, that's, I think I can get that one answered pretty quickly. We've got our statistics page. And if your audience wants to look at the Dexcom, clarity, web interface, there's a page all devoted to statistics. Looking right now, at my statistics for Monday, and this is every Monday for the past 30 days. So there's several Monday's in that sample, I've got a total of 1253 readings. And each one of those is estimated glucose value. And then the summary statistics, the minimum 40 Oh, that was scary, the maximum 244. So those are, those are not normal, the mean value 128. That's reassuring, and then the standard deviation 34. So to get that 34, the calculation that I just walked you through, which is look at every one of those 12 153 values, get the difference from the mean. So do the subtraction 128 Minus a particular value. You square each of those differences from the mean, add them all up, and then divide the total by 1252. And once you've done that, you take the square root of it, and it's it's 34. So there's, as I said, it's a little bit of algebra. But it's, again, the usefulness of it. 128 plus or minus 34, tells you that you would expect two thirds of those glucose readings to be within one standard deviation of the mean. So 128 minus 34 is just 90 something and then 128 plus 34 is 162. So you would you would expect most of my sugars to be in that in that range.

Scott Benner 29:41
Take for second example, I know we're going to oversimplify but describe what mean Yes.

John Welsh M.D. 29:51
Oh, sure. I mean, it's also known as the average value. So if you were to look at the NBA players As you say, Wow, NBA players are really tall. You might express that in numbers by saying the average or the mean, height of an NBA player is six feet six inches tall. So it's another word for average, it's a particular kind of average. But we don't need to talk about the other kinds of averages. Mean is usually just the arithmetic mean, you calculate it by adding up all the values, and then dividing that total by the number of values.

Scott Benner 30:31
So what I have here, what I'm looking at in front of me is 12 153 readings. There were 40 that were or is that under a certain number, those 40?

John Welsh M.D. 30:45
Oh, yeah, we're looking at these rows in the in the statistics, the number of readings, 1253 is a bottom, the minimum was 40. The maximum 244. And the mean value 128.

Scott Benner 30:59
Within within those 12 153 readings, there, the high was 244. The low was 40. But on average, this person's blood sugar was 128.

John Welsh M.D. 31:12
That's a that's a nice way to do it. And yeah, we're looking at, we're looking at my readings from the past month or so

Scott Benner 31:17
these are you Oh, my gosh, are you? Do you have type one?

John Welsh M.D. 31:21
I do. I've been living with type one for most of my life for past 45 years. And so far, so good.

Scott Benner 31:28
Show me like an example page. I didn't realize we were looking at your blood sugar. Well,

John Welsh M.D. 31:33
I yeah, you can spy on me. You can you can look at my summary statistics. Here we can we can continue with the summary statistics page. Yeah.

Scott Benner 31:43
And I'm gonna have some questions about it when you're done. But please keep keep going.

John Welsh M.D. 31:47
Oh, sure. And this is an incredibly number, it's a very useful way to get a numerical description of other numbers. And so far, so good. You know, here's, here's a guy, John Walsh, who is this clown anyway, and what is he doing talking about his glucose numbers. So John's, had a, at least one time where he went all the way down to 40. But the main value 128 is reassuring. And then we get down to some other statistics that talk about the median value, the median value is the value above, above which and below which half of the values occurred. So in my case, the median is 122. And that tells you that half of my readings were above 122, and half of my readings were below 122. So that's another measure of central tendency. The end, it's usually expressed alongside the interquartile range. And so you look at the, the value that is 75% of the way to the top, so 75% of the values are below at 25% or above it. And in my case, the the 75th percentile is 153. The 25th percentile is 103. So you can say with, with some confidence that half of my values were between 103 and 153. And those are the 25th and 75th percentiles, and the the interquartile range here has given us 50. And that's just the difference between 153 and 103.

Scott Benner 33:33
So the question here, if if Yeah, if if half of those range between 103 and 153. I'm assuming that the other half are how we arrive at the standard deviation of 34? Like, I'm assuming you need that information to to come back to the standard deviation?

John Welsh M.D. 33:49
Oh, no, no, the standard deviation, the standard deviation relies on all values. And it doesn't, it doesn't care so much about the distribution, it just cares about how far from the mean value the values are. So there's, there's there's another point that I want to make, which is the median value, in my case, 122. The mean value is 128. A lot of times those are very close together. But sometimes they're very far apart. And there's some special circumstances where the mean value is much, much different than the median value. And we can talk about those if you think it's interesting.

Scott Benner 34:32
I wonder what I do want to know is, is how much of sensor like so you know, I've my daughter has been wearing a Dexcom since seven, maybe Dexcom, seven or seven plus back then. And so, obviously, we see things at every generation, improve and improve and improve but I could still say that for Arden in the first number of hours. You know that you put on a new sensor it's not as I don't know, it's not as tight with its understanding of your blood sugars that maybe is on, you know, day two or like, you know, or there's a sweet spot through the middle where it's crazy. Arden uses a Contour Next One blood glucose meter, which is incredibly accurate. And for a large part of our sensor where the meter and the CGM are spot on with each other there within a couple of points. And when you're managing type one, there's a ton of like, good feeling about that, knowing that, you know, she wakes up in the morning, and it says her blood sugar is 96. Now whether or not her blood sugar is really 85, or it's really, you know, I don't know, 104 to me is of no real consequence. It's in that space. And I'm thrilled with that. Then I put it on, and I don't have diabetes. And I wake up and it says my blood sugar's 94. And I think, Oh, my God, I've been fasting all night. And I'm 94 and I do a finger stick. And I'm 85 It's amazing that those seven points to a person without diabetes is, it's a different impact than it is to a person. Right? And so it is seriously like, I wake up in the morning, 94 I'm like, Oh, I guess that's it, I'll just eat lettuce till I die. But you know, like, like, it's just, it feels like that immediately. And, but I take that same information coming from my daughter, I am completely comforted by it, not just comforted by it. But it leads me in my understanding of how to manage her insulin and her health and everything. My question is, is that knowing that the sensor is a little, you know, on the on the edges, it struggles a tiny bit more than it does in the middle? Is there something about my data that I can't look at to micro? Like, do I have like, how much time do I really need before? The inconsistencies in the data? And the consistencies in the data bounce out to where it doesn't matter that it's not all? Perfect? Does that make sense?

John Welsh M.D. 36:53
Oh, that's, yeah, that is a very common question. And I don't have I don't have a good answer, I can tell you how I deal with imprecise measurements in my own life. And, and I've got, I had a wonderful bike ride yesterday, here in San Diego, and I've got a fancy bike that has a built in speedometer, it's based on how many how many times the will completes a revolution. So there's a speed sensor built into the into the wheel. And based on that, you can calculate your speed. And I've got another fancy thing in my phone where you can get your speed based on satellite data from your global positioning satellite system. And and I looked at it and I found myself chugging along the road and and the the speeds, you want to guess if they were exactly the same. No, they weren't. I was going 20 miles an hour. If you look at the wheel sensor, I was going 21 miles an hour, if you look at the GPS coordinate, so measuring your blood sugar and seeing one number and then looking at your CGM and seeing another number. And and it's frustrating, because there's no good way to to know how excited or how concerned to be about discrepancies. There's always going to be discrepancies. It's a rare thing when when the blood sugar tells you you're 105. And then you get that 105 From the CGM. And I don't want to give medical advice over the phone like this. But there is the possibility that you could calibrate your your G six and based on the your confidence in a blood glucose meeting reading, you could say, oh, my GSX is reading a little bit low. I'm going to calibrate it, and then bring it back into better alignment with the with the blood glucose meter. So I know it's frustrating. I wish I had a better. I wish we had better devices for measuring glucose with even more precision.

Scott Benner 38:59
They're amazing. You've had diabetes forever. You know how amazing this stuff is. Just because you work there doesn't mean you can't say that. And it's actually been very interesting for me because of the pro doesn't allow you to calibrate or at least I just had to go with it. And it really sure it was it was it was interesting to live in the space because for my first maybe 18 hours, the glucose monitor was reading about 10 to 12 points higher than what the finger stick was was pretty consistent for those few hours. And I found myself thinking if this was my daughter, and I put a brand new CGM on her that thought she was 110 when she was 91. I'd be like, Oh my god, this is the most amazing thing ever. I love this thing. It's so amazing. Except you know, and I didn't have diabetes and I was like, Is my pancreas not working? You know, like it's very like it's a it was just such a very different thing. But beyond that initial feeling. It really did just cement my idea of how much I love this technology. And and because I can remember managing my daughter's blood sugar without a glucose monitor. And to think that she'd be stable at 110 or 91, ever for hours and hours at a time is insane, but it just never happened. But over these last few days, we've been eating the same meals. And her care is so dialed in, due to a large due in large part to the information that comes back from the Dexcom that her blood sugars and mine are largely matching before and after meals.

John Welsh M.D. 40:35
Congratulations. And that's just That's wonderful news. And, you know, it's, and I'm totally with you, we we can talk about the battle days when when you had to make a make a guest and a lot of times it was not a very good guess based on just a urine dipstick and you could say, oh, I'm spilling sugar into my urine and I need more insulin, and you would have to make a guess. And some of the highs and lows were pretty scary. And, and people you know, sad, sad to say that people are still dying from insulin overdoses, insulin, let me check, it's a poison, and it can kill you. And there's, there's a lot of downside risk to insulin, even though it's a huge blessing, we're coming up on the 100 year anniversary of the commercialization of insulin. So we're all going to celebrate and be thankful for the commercialization of insulin and the fact that we're not dead. But it's, it's a tough disease. And you wouldn't, you wouldn't wish it on anybody because it's really a lifetime burden. But I'm really pleased.

Scott Benner 41:43
I just had a conversation briefly online with a woman this morning, who even with all the technology gets incredibly low every day. So I was turning her on to the podcast as like, this doesn't need to be you're just you're not using your insulin correctly. And it's not that it's not that difficult to figure out how you know, so I turned around, I was like, Listen, I have an idea. Can I hit you with some questions and see if you have answers to them. These are questions that came from listeners. And sure, I'm not asking you now I understand you're a doctor. But I'm not asking you that way. I'm asking you based on this information, this data and how much you've seen it? Do you see? Do you see information in the data that would help people with the things that they're concerned about? So the first one simple? Do you know what a non type one standard deviation usually is? Is there a range where it usually falls?

John Welsh M.D. 42:34
For example, somebody with type two?

Scott Benner 42:36
No, no, no, just someone who doesn't have diabetes at all. Do you know where like, like, where? Oh, yeah.

John Welsh M.D. 42:42
Yeah, so we've got a we've got some data from a big study of 153 people without diabetes. Their standard deviation was was seven,

Scott Benner 42:55
seven. Okay. Okay, is there? Let's see how I want to say this here. So this is a type one question somebody is somebody's asking. If there's a lot of variability within the good range, say like, like 70 to 120, this person's kind of bouncing between 70 and 120. There what they want to know, for their health? And maybe you don't know, but would they be better off sitting at 120 than they would be from going up and down between 70 and 120?

John Welsh M.D. 43:27
Oh, I think so. And there's, this kind of leads into another number that you can get with the, the summary sheet, it's the ambulatory glucose profile is something that Dexcom has. It's, it's not exclusive to Dexcom, but it's called the AGP. The ambulatory glucose profile, what

Scott Benner 43:46
my things John, don't know, you really got to get creative in charge of in medical in general in charge of the stuff that that goes back and touches people. If you look at glucose for I'm sorry.

John Welsh M.D. 44:01
There's, there's a lot of syllables there. And there's a whole industry for you know, if you come up with a new drug, you have to hire a marketing firm to come up with a name for your for your new drug. But there's a digression for you. Anyways, is the numbers. The numbers that are on the top line of the ambulatory glucose profile, the average is there, the time and ranges there. There's another number here, which is the standard deviation, and then the coefficient of variation. And that's a number that I think has has a lot of usefulness because it tells you how big is your standard deviation compared to the mean value. And there's some clinical implications for that as high, high coefficient of variation is dangerous because it puts you at very much increased risk for dangerously low events for for hypoglycemic misadventures. So the the coefficient of very Question again looking at my own data for the past 30 days, my coefficient of variation 31.3. And is that good or bad or indifferent? It's, it's higher than I'd like it. But is it dangerous? And there was a fun article. Fun, I don't know, but useful anyways, the useful article came out a couple years ago, and some folks in France in the UK came out with an article in diabetes care. And they they said, CV coefficient of variation of 36% is the threshold to distinguish between stable and unstable sugars. Because beyond this limit, the frequency of hypoglycemia is significantly increased. And, and if this, my own CV here 31.3%, that's reassuring, it's low, which is good. And it's less than 36%, which tells you that I'm, I could still go low. But the fact that this CV is less than 36% is reassuring. I went to see my endocrinologist and he said, Hey, John, keep up the good work. You're probably not going to die of hypoglycemia before the next time I see you. And I was so alright. Yeah.

Scott Benner 46:15
John, you know, it's interesting that I see with my daughter who is, you know, a woman, a burgeoning woman, is that with our care, the same exact care we use on weeks and days where she's not impacted by hormones? Arden's standard deviation is 24 ish. But oh, my gosh, that's terrific, thank you. But that's not why I'm telling you that what I'm telling you that is because although I appreciate it, why I'm telling you is because that when she is impacted with hormones, the run up to her period, for example, her deviation jumps up to 45. and N are no holes aren't different, her meals don't vary. It just, she needs more insulin. And it sometimes takes a couple of days for you to realize that that's happening. And then once it's happening to remember, it's happening to remember, like, you know, oh, you know, my ratios are telling me this much insulin, but it's four days before I'm gonna get my period. So it needs to be more, it's difficult to recall all that, you know, constantly. But it's fantastic. It's interestingly fantastic to see because if Artem was a boy, I think I would have a son with a with a standard deviation, pretty consistently within 24. Until they hit I'm assuming puberty as well. But you as a, it's just very interesting to look at your 30 day chart here. You're I know we're talking about so you don't mind, but your standard deviations 42. And you're saying it's not where you want it, but it's also not terrible, like people are trying to understand on the outside, what's the number that keeps them healthy? And what's the number where they think, you know, something else is going to happen? It is very simple in people's minds when they think about these numbers, like what am I gonna hit? How do I get to it?

John Welsh M.D. 48:03
Oh, yeah, yeah, and I think if the the more useful number and I think the one that is very convenient to have as a as a goal, and is is the coefficient of variation. And that's just a ratio, it's the standard deviation divided by the mean. And aiming for something less than 36% would be would be a reasonable would be a terrific goal. And if I were still seeing patients, I would say, Here's your, your coefficient of variation is 40%. Let's look more carefully at the trajectories or the, this is called a modal day plot. And I'm sure your audiences has seen this, it lays out the clock time here on the bottom axis, and then the glucose values on the vertical axis. And you can see the median value here and the bold line right in the middle. And then you can see the shading here, the blue shaded area covers 50% of the values and then the area in between the dotted lines covers 90%, or I'm sorry, 80% of the values. So what what I'm looking for what I wouldn't be looking for if I were looking at somebody else's plot is a smooth ride. And sometimes you can identify parts of the day where the ride is pretty bumpy. For example, after lunch, if you're having lunch at your desk and you're not going for a walk and you're having the third slice of pizza, you might see spikes after lunch or dinner. Or you might see plummeting lows after breakfast if you gave yourself too much insulin for breakfast, and fun to go with breakfast. So I'm not the standard deviation. If you're always cruising around a relatively high number like 170 The standard deviation is going to be bigger than if you're always cruising around at a much lower number like 100 And so, um, the number that I think is more reasonable to target as a therapeutic goal is the coefficient of variation.

Scott Benner 50:09
Okay? Under 36.

John Welsh M.D. 50:13
Yeah, that's, that seems to be the magic number. And that's the consensus and, and it's, it should be achievable if you if just pay attention to parts of the day where you might be having a bumpy ride, you can look at your behaviors, look at your response to your behaviors and say, You know what, I think I will, instead of having three slices of pizza, maybe I'll just have one. So CGM can be a wonderful motivator. It can inform people it can motivate and reward good choices. So I'm you can tell I'm a huge fan. I love evangelizing this stuff, but you can learn from, you can really learn a lot from the numbers. And the numbers can tell you, if you pay attention to him, to the numbers themselves, and also to the summary statistics, like the standard deviation, you can learn quite a lot from him.

Scott Benner 51:03
I'm a huge fan, I don't understand that, obviously, nearly as well as you do, but I know what it tells me. So for instance, after Ardennes, my, my poor daughter, one day is going to listen back to this and be like how much did they talk about my period on that podcast, but after so the lead up to her period, there's like three or four days prior to it, she gets, you know, all of a sudden, she needs way more insulin. And then in the first day or two of it, it happens still, but then there's a moment where it levels like whatever happens is done. She's still the periods still happening, but the hormonal impact seems to be going out of her body. So let me give you an example. Because it just happened yesterday for the last 24 hours. Arden's estimated a one, C is five, and our standard deviation is 24. Per average, blood sugar's 98. But if I just go back seven days, through her, you know, through this lead up to this period, estimated a one C 5.8, standard deviation 43, average blood sugar 119. It's an it's just the hormones, it's the lead up to her period. And so it's fascinating and not that you don't know but and then there's another time of the month where it happens again to her for four or five days. But just those just that week, and then that other chunk. So basically what I think is about 789, probably 12 or 13 days of the month, takes what would normally be I think, an SD and like I said in the mid 20s and an A one seat closer to five than six, and it moves her agency more towards like Hurray, once he pretty much sticks at like 5.6 it doesn't move very much. Okay, it's just very, I don't know, like I don't know what I would do before this information like no lie prior to it. I wasn't a different person. And we were not good at this at all. You just diabetes in general her hurry once these were in the eights and I finally got them into the sevens just by having, you know, better tools and insulin pump and a glucose monitor. But I still didn't understand that enough to turn it into real, like success, you know, like, like the idea of knowing when to Bolus and that sort of thing. But I know all that from this data now. And it's sure incredibly beneficial.

John Welsh M.D. 53:27
Absolutely. Well, I'm, I'm with you 100% on that. And I think for my own my own experience was in the bad old days before CGM, I was poking my finger and making a lot of guesses. And it really got me interested in how the body works. And it was a great, great motivator all through college. And that was part of my story when I was applying to medical school and I'm not alone. There's a lot of a lot of physicians who specialize in in Endocrinology and Metabolism who also have type one diabetes. So my own story is, is hey, this is really interesting. I want to learn about it. And I want to go to medical school and what do you know, the medical school here in town said all right. All right. Coming to medical school, and you can learn you can learn quite a lot in medical school about about the disease itself and about how you measure how you measure sugar and measure all the other important things that we care about in metabolism. So it's for me anyway, it was not just a life changing event when I got that diagnosis but it also sort of defined my career path toward a toward becoming a physician and also to to working here at Dexcom

Scott Benner 54:40
Yeah, so that's fascinating and I'm afraid I'm gonna start talking to you and then lose track of what we're supposed to be doing because questions I almost answered ask them and I was like, No, don't do that. What cut when you when you when this data is pulled together, given that there are you know, Blood Sugar legs and meters aren't perfect and nothing's perfect. What? What's built in to deal with the error? Like, how does it come to the number and? And take the the imprecise pneus out of it? Is it like, like looking at yours? For example, your standard deviations? 42? What if if if a Dexcom was absolutely perfect if there was a you know, if it wasn't technology, but it was it was your, you know, I don't know, something organic that could know 100% For sure. What all these measurements are on your glucose all the time? How far off? Do you think that number would be? If you had perfection? Does that make sense?

John Welsh M.D. 55:41
Oh, yeah. Yeah. You're You're hypothesizing that there is some there's no real answer. Yeah, there is. There does exist some true number. And we're always trying to become more more accurate and getting closer to that true number. We are, we're never going to get there. You have to stipulate that we're always going to have some, some wiggle and some imprecision. And that's, I think true. Because nothing on this planet is perfect. And we have to, if we get to heaven, and then everything is perfect in heaven, if we ever make it there.

Scott Benner 56:17
That'd be my first question. When I get there, I'll be like, what was my kids? Really?

John Welsh M.D. 56:24
Yeah, so that's a whole nother line of inquiry. But we're probably certainly within 10%, I think I'm confident that we're within 10%, I'm less confident that we're within 5%, I wouldn't be surprised if we were within 3%. And I would be really astonished. If you told me it was within 1%, I would be astonished. So I've got some confidence, the for the 10% precision. And I've got some optimism that we can usually get within 5% of the true value. Those are just speculative numbers. Because there's no such thing as a perfect value, even if even if you use the gold standard. We could quibble about any reference instrument. And this is one of the things they drilled into us during my residency training in laboratory medicine, which is, is there such a thing as a perfect measurement? No, not until we all die and go to heaven. While we're living on this earth, you have to deal with imprecision and uncertainty. But I think we're pretty good. And just for purposes that we care about managing managing diabetes and living a long happy life, I think we're we're well within the realm of of good enough.

Scott Benner 57:40
And outcomes are good based on what we noticed. Does that mean, from what you just said, if at a 42 standard deviation? Is it possible that your standard deviation is somewhere like 36? Or possibly like, I don't know, 48 or 47? Or is it more likely it's lower? Or more likely, it's higher? If it's Is there a likelihood that it's more one way than the other?

John Welsh M.D. 58:05
Oh, yeah, the standard deviation just tells you how, how spread out the distribution is. And the the true standard deviation could be higher or lower? Because all the numbers that the standard deviation depends on could actually be incorrect. So I think, yeah, that's a tough one. Let me let me think about that. Yeah. I'm looking now at this. Looking now at the standard deviation and this famous bell curve, the you know, what the, if I'm understanding your, your question correctly, could the standard deviation be something different?

Scott Benner 58:51
You use me as an example, in my situation, right. Now, if I put on a new CGM, every 10 days, I wear three sensors a month, nine sensors over a three month period, if I look back at my 90 days, my standard deviation, if my if my sensors reading just 10 points higher for the first, I don't know, just say 36 hours of every one of those things. Am I more likely to look higher than I am? Or lower than I am? Because of that? Higher right?

John Welsh M.D. 59:19
Oh, yeah, I think I think you would have a high. It's called a high bias. But your earlier question, could the standard deviation be something other than the calculated result? I? I think the answer is no. If if you give me the numbers from one to five, could the total be something other than 15? And I would say no, the total of the integers from one to five is 15. And if you give me a set of numbers, I can calculate the mean and the standard deviation. So I think the calculation that we've done here, resulting in this standard deviation of four 32 If we did the math correctly, then the standard deviation is 42

Scott Benner 1:00:04
is the I'm sorry, there's the algorithm that's making this decision. Does it scrub anything? Like, you know, like a compression load? Does it see that and go, we're not going to take this into account, does it do any of that kind of stuff?

John Welsh M.D. 1:00:18
Oh, yeah. And that's, I think that's true. That's got to be true for Medtronic, it's got to be true for Abbott, it's got to be true for sensing Onyx. And also for Dexcom, we've got, we've got algorithms, the signal that we are measuring is actually a voltage. It's a, it's so I'm sorry, it's current. So the current is very low. Current, usually measured in amperes. And we're dealing with billions of an ampere, I think, nano ampere, or Pico amperes. So incredibly small currents. And the challenge for the engineers is to take that very small electrical current, and translate that into a number that makes sense and number of milligrams per DL. So that requires some, some engineering talent. And it requires an algorithm. And I think that's part of the secret sauce that we have here at Dexcom. Medtronic, I'm sure they have a algorithm, which is similar, but slightly different. And the same for Abbott. And the same for sensing Onyx. And that's true. Whenever you're measuring something and saying what you're measuring, you know, for the example of your oven, if you're cooking, you're making your cookies, you're measuring temperature, what you're really measuring is the height of the mercury in the thermometer. And the trust is that that's a good representation of your temperature. And then going back to the bicycle speedometer example, what it's really measuring is how fast the wheel is turning in, you're translating that revolutions per minute into a speed. So it's a challenge to take a very small electrical current and turn it into a glucose value. And but that's, that's what we do. And I think that's what all the manufacturers have to do.

Scott Benner 1:02:07
It's amazing. And listen, we're one rabbit hole away from wondering if we live in a simulation. So let me ask a more concrete question. Ready, John? John, in 30 more minutes, we're going to be like, we're probably in the matrix. So just a real quick when Canadians or people who are using other scales, did they multiply their standard deviation by 18? To get their answer? Like, this person gave me an example so that their last standard deviation in Canada was 1.62. They multiply that by 18. To get the number that the way we're talking about it right now.

John Welsh M.D. 1:02:46
They sure would, yeah, so the the units for standard deviation, the standard deviation here in the US as milligrams per deal. outside the US, the standard deviation is millimoles per liter. And the conversion factor is is 18. So the standard deviations would be less by a factor of 18. In places where they use millimoles per liter, the end and that's a good point, thank you for bringing it up. And the point is that what would not change is the coefficient of variation. So if you were to take all my numbers, or if I were lucky enough to be a Canadian, and measuring my sugars and millimoles per liter, I would still have this coefficient of variation of 31.3%. That would not change, because you're dividing milligrams per DL in the numerator, milligrams per DL in the denominator, and those units would would cancel them out coefficient of variation. There's no units for that. It's just a percentage. I'm

Scott Benner 1:03:50
glad you said that, or some person, Saskatchewan was gonna take their coefficient and multiply it by 18. And that's great to know. And thank you for knowing it. By the way, when I asked the question, I appreciate that.

John Welsh M.D. 1:04:04
That's a good one. You know, if you got to, if you were to travel to Japan, you would trade your dollars for yen and you would find yourself 100 times more wealthy. Because you can buy you can buy about 100 yen with $1. But wait, everything's 100 times more expensive so

Scott Benner 1:04:21
well, so let me make sure I'm understanding exactly. So coefficient of variance, or variation we're talking about under 36 Really lessens your possibility of low blood sugar's standard deviation shows us how much stability we have, right like by keeping our variability lower. What is the measuring?

John Welsh M.D. 1:04:45
Oh, in terms of our health Oh, yeah, a one C there's I love a one C I want to strangle it and drown it in a bathtub. i A one C has been with me for a long time. It's about biomarker, it's hemoglobin obviously is the protein that fills up your red cells, it's got the red color, because it's got iron in the middle of it, it's got an iron atom. And it's the same color as rust. The hemoglobin a one C, the a part of it refers to the a chain. There's an a chain and a B chain. The hemoglobin a one refers to the first amino acid in the a chain of hemoglobin. And the C refers to the isoform, if you want to know refers to the isoform, of altered hemoglobin that travels on chromatography. Anyway, that's that's the long answer. The short answer is that hemoglobin a one C is a abnormal form of hemoglobin that has a sugar atom stuck onto it. And having that sugar, I'm sorry, sugar atom, it's a sugar molecule stuck onto it. And it's a nice indicator of how your ambient glucose concentrations have been going over the past two or three months. The downside of having a high a one C is that hemoglobin a one C molecules behave a little bit differently. And they're also markers that things are going haywire in other parts of your body, other proteins in your vasculature in your kidneys, and your liver might be getting decorated with sugar molecules when they really shouldn't be. So having having a very high hemoglobin a one C number tells you that quite a lot of your hemoglobin molecules are traveling around with this kind of gooey sticky sugar molecules stuck onto them. As I mentioned earlier, I it's it's not my favorite biomarker. What's your favorite biomarker, John, there's there's ways that you can fool the hemoglobin a one C test, and we can talk about those. There's some some people have problems with red cell production or red cell destruction that would throw it off. So you can really be misled by an A one C number, it can be too low. And you can say, Ah, you're doing just fine. Your a one C is in the normal range, when it should be much higher. And then on the flip side, you can see in a one C, some people have a one c values that are unexpectedly high compared to what their average glucose values are. So it can it can mislead you in a couple of different ways. I'm a much, much more enthusiastic about just using the average glucose value that you get from a CGM system to assess the adequacy of your glycemic control.

Scott Benner 1:07:50
Is that okay? You know, it's interesting, you made me think of last year I suffered, I had my ferritin was very low. And it's it. You know, at first everyone, the doctors thought I had cancer and we did all these things. And it turns out, I just had low ferritin. And so I got an infusion of of whatever they call it, it's I can't think of it now sit iron and it's a it's a mix, it looks like a rusty bag of water and back up, but during that time, what I was told was we can't trust your Awan see right now, because of your low ferritin. And I was like, huh, dig too deeply into it. But it's something you just said now made me think of it again. And then it made me think about how, you know, measurements, right? And you always get, you could use anything. Here's an example. My daughter has hypothyroidism. But when we first figured it out by her symptoms, the doctor's office looked and said, well, she's low, but she's in range. We don't want to do anything. And we made them give her the hormone, then because we had an experience with my wife who was low in in range, and they would never help her and it really hurt her over time. And so it made me wonder, especially for, you know, women in the menstruation age, is it possible that they have an A one see that looks better than it is if they have lower ferritin just like,

John Welsh M.D. 1:09:14
there you go. There you go. There's that's another of all the ways that a one C could be misleading. That's, that's, that's one of them. And I'm thinking, my own experience, I used to be a really avid blood donor. And I thought, oh, you know, what if I if I were to donate two units of blood, and then wait around for a couple of weeks and then get my a one C measured, that would falsely lower the a one C because as soon as I donate two units of blood, my my bone marrow is going to wake up and say, oh my gosh, John, you did something either stupid or crazy or really altruistic. By donating those two units of blood. We have to ramp up production, and we're going to flood your system with brand new red cells. So after two weeks after donating the blood, I would have a population of red cells, which were relatively young and had not had a chance to get glommed on to by the sugar molecules. And my agency would be falsely low. And I say, Yep, I can sure game the system that way. And that's the same for people who undergo acute blood loss, the A one C would be falsely decreased within a couple of weeks, once the red cell production line kicks into gear. And then people who have shortened red cell lifespans, there's there's some conditions, a lot of syllables, but hemoglobinopathies, if your hemoglobin, if your red cells are, are not up to the task, and if they're prematurely destroyed, you would have a very low a one C, and it would be misleading if you were trying to manage diabetes based on that.

Scott Benner 1:10:55
Okay, so Okay, so you as a person who's had type one for a long time, and is a physician, and I think we didn't really dig into it. But it sounds like you used to help people with type one as well, when you were practicing, is that right?

John Welsh M.D. 1:11:09
Oh, you know, indirectly I specialized in laboratory medicine and also anatomic pathology. So I would, I would look at disease, and I would measure disease and then I and then I went to anyway, so I never directly took care of people who were who needed insulin management.

Scott Benner 1:11:27
But for yourself, then let me just ask yourself that I guess it makes more sense. With your background, and how much time you spent digging around in this data? How do you measure your success? Like which one of these? I know there's going to be a grouping of them here. But but can you tell me what you look at every time you look at your data, just when you want to look and go, oh, I need to do a little more a little less? Like, what what is it your? Where do you focus? And is there any way to put them in descending order?

John Welsh M.D. 1:11:57
Oh, um, well, I am I'm getting old, every if you wait long enough, everybody's gonna get old. I used to worry quite a lot about my agency. And now I I really don't care I what I focus on mostly is the average glucose. And the the example that we're looking at now is 133, which, which is wonderful. And beyond that, I try not to rank myself, I try not to compare myself to my peers. Here at Dexcom. We've got some, some very talented folks with type one who are even more dialed in than I am. If it if it seems like I know what I'm doing, there's people down the hall who are even better. And then there's people in the community who who are need some advice. And that's the mandate, I say, You know what I'm I'm doing fine. But let's, let's see if there's problems that I can address. So I look at my average sugar, I look at the time high and low time and range. And the example that we're looking at 85.9% is pretty good. And then I also look at the the amount of trouble and strife that it causes me and I try to minimize that. I try to settle in on a good routine. That doesn't cause me too much trouble and strife. And finally, after 45 years of I think I've found a good routine for managing my own diabetes. That's

Scott Benner 1:13:23
amazing. That's I think what people need to hear too, it's funny, as you were saying all that I was looking at, at my daughter's nine, like I went to 90 days on her information, because you said average blood sugar. And her average blood sugar has been 115 over the last 90 days within an estimated a once a 5.6. But her standard deviation over that time is like I said, it's it's 45. And is that should I be more concerned about that?

John Welsh M.D. 1:13:54
Well, here's, here's an important question. And it relates to the time that she spends really low and I wonder if there's numbers for either time less than 70 or time less than 54 because because those are those are things that can cause trouble in a hurry. Being being less than 54 is kind of dangerous.

Scott Benner 1:14:14
I have I have her range set as 65 to 120 She's 9% low 54% in range and 37% high but she does not get for the most point we don't go over about 180 ever and under 55 I don't think happens twice a month maybe for long periods of time not like under 55 and falling where people are running around the house you know looking for the will and stuff like that just you know like a dip down that you caught a little too late and and it'll go to 55 and hang and come back up but we don't let her sit under that number. But I look at her standard deviation all the time and I I'm always just like, ah, that's where I need to do better. But like I said, you know, for half of the month, that standard deviation is 24. And then during her, you know, her hormonal times throws throws that number off, like, is that number less scary? Because she's a girl than it would be if she was a boy. I know. That's a weird question. But you don't I mean,

John Welsh M.D. 1:15:25
well, I, I don't know if I'm, I'm gonna take issue with your premise. I, what you told me was, is that number scary? And I? I don't think so. I don't think that's a scary number at all. Just based on the fact that she is so dialed in, and that she has almost continuous awareness of where she is. And she's got good access to to her family and to you and good access to to Kandi if she needs it. So it doesn't sound like she's in harm's way at all. The thing that you know, there's there's some things that are absolutely dangerous. One is one is going low, and finding yourself waking up with a crowd of people trying to resuscitate you is a terrible misadventure. Because you, you went low and you ignore the symptoms. And guess what, you had a seizure, you lost consciousness, you bumped your head. And now the EMTs are out. That's a scary misadventure. So I think if you told me earlier, she's, she's had it for quite a long time,

Scott Benner 1:16:34
she was diagnosed, too, and she's going to be 16 next month. Okay.

John Welsh M.D. 1:16:39
So 14 years, 14 years into it. Hopefully all the autonomic counterregulatory hormones are intact, and I hope they stay that way. So the hypoglycemia awareness, I hope is fully intact, and the counterregulatory hormones that that would kick in to bring her sugar back toward the normal range, I hope are intact. The, the coefficient of variation, you mentioned earlier, the standard deviation for your daughter and remind me of the coefficient of variation.

Scott Benner 1:17:11
Oh, let me get it for you. It does similarly, change with, with what's happening in her I have it at 90 days as 39% in the last 139, in the last week, 36%. But if I go into just the last three days, where like I said, the impact from the hormones is gone. It's 30%.

John Welsh M.D. 1:17:35
Okay, wow. So sometimes, sometimes it gets above that arbitrary number of 36%. So there's some stretches of time where the variability is, is in excess.

Scott Benner 1:17:48
And it's, it's important to note that so my daughter now for over six years has had an A one C between five two and six, two, and we don't restrict her diet in any way. So she'll have pancakes, you know, for breakfast on a Sunday morning. Just as easily as this morning I said she had, you know, an avocado, avocado toast. And so you know, she she's all over the place with what she eats. So we'll have nights where she just has a big salad for dinner, and nothing else. Last night, she had some turkey and small amount of potatoes. But when dessert came out, she wasn't interested. And so she's I call I would call her eating healthy and varied and not excessive. She's not a sweets person, like she's, she'll Trick or treat, but that's the hangout with our friends. And she comes home and doesn't know what to do with the candy. But you don't like that. That's sort of an idea. But, you know, I'm trying to talk through her to everybody so that everybody can kind of get a feeling for how they should feel about this information for themselves personally. Sure, yeah.

John Welsh M.D. 1:18:53
Well, there's, there are some things and we've we spend a lot of time looking at data here we've got some data science, people who built our career on looking at data, there's a couple of comments that might that might be helpful and one is to to look for opportunities to lower the standard deviation lower the coefficient of variation. One is to see if there's any evidence of overtreating highs or lows. And sometimes those really jump out if you look at the, the hourly plot, we call it the modal day plot. Sometimes you'll say, Oh, here's here's something where I know I know where I went sideways on this. I know I had the the big snack after lunch. I shouldn't have oh, there were free doughnuts in the conference room. I should have said no to those doughnuts. So sometimes there's opportunities for looking at your data, not the numbers but just looking at the the image of the 24 hour stretch of daytime you say wow, there's a big spike there. In the early morning hours, maybe I had too much snack before I went to bed. Maybe I have too much my own case, I had a habit of taking too much fast acting insulin to cover breakfast, and I would always go low around nine o'clock in the morning. So being looking at the data, not just as numbers, but as a graph can be very helpful. And it can reveal opportunities for making adjustments. And if if the standard deviation is in, in the high range, if the coefficient of variability is in the high range, then it deserves some some careful consideration about Wow, this is a bumpy ride, are there any particular times of the day that you would like to address with your end might be really amenable to making thoughtful changes?

Scott Benner 1:20:51
Can I ask, given how the numbers are calculated? If? How much is that? What's my question? Are any of the numbers based off of the the range that I've set up? So keeping in mind that my daughter's range is on my phone, it's 65 to 120. On her phone, I think it's 70 to 130. And so on her phone, which is the one that you know, her clarity accounts connected to and everything, if my daughter's blood sugar is quite literally, between 75 and 110 for two thirds of the day, but she has two big meals that spike her to one ad. But she's not more she's not at that one ad for more than an hour and comes back down without getting low. Do those numbers look artificially inflated? If that's how it works for her sometimes?

John Welsh M.D. 1:21:48
The I think your question is, what are the numbers that you see in the clarity report or the clarity, summary. And the time in different ranges? You can, you can set those you can customize the ranges that you want to see for and you can do that in the daytime in the nighttime ranges.

Scott Benner 1:22:08
If I changed her range, this might be a stupid question. But if I pushed my daughter's high number up to 180, would her standard deviation fall?

John Welsh M.D. 1:22:18
Oh, no, it would not know the standard deviation doesn't care whether a number is in the range, the range that you set is pretty arbitrary. You can you can turn that dial up or down. The the range that you set within clarity just tells you when are you going to get beeped. And what are the summary statistics for time and range?

Scott Benner 1:22:40
The data is based off of those ranges. Got it?

John Welsh M.D. 1:22:44
That's right. That's right, the standard deviation coefficient of variation, those numbers are those are not subject to change by just changing the the alerts or the target ranges.

Scott Benner 1:22:57
Okay. And they're based off of what quote unquote normal would be. Is that right?

John Welsh M.D. 1:23:03
Oh, actually, not the the normal range I mentioned earlier than the normal range is no more than 120. And at the moment, I'm just leaning over and checking my sugar right now is it's 109. But for the most part, having having a sugar of 150 would not be concerning. I don't think for any endocrinologist, if you were to cruise around at 150, all day, every day. The endocrinology community would say you're doing a good job, you're a one C is likely close to 7%. And your risk of long term complications is close to baseline is close to what the non diabetic population would have. So that'd be very reassuring. Even if you're having a abnormally high glucose numbers. I got a I got a call once I did some lab tests and for a different occasion, and the nurse called me up and said, John, I've got some very concerning news. Your your glucose is 123. And I thought, well, what's concerning about that? And she said, Well, it's higher than normal. And I said, Well, I have type one diabetes. And and as soon as she heard the fact that I had type one diabetes, she said, Oh, well, you're boring. Have a nice day. Goodbye.

Scott Benner 1:24:24
You mean, my daughter had to give urine one time and I left the room or I dropped off and didn't tell the nurse she had diabetes. And I walked halfway down the hall and ran back because I was worried for the nurse and she was running out of the room at the same time. And I looked at and I went she has type one and she goes Oh, okay. And then she she goes back in the room. Let me re ask my question because I have it in my mind and maybe I might ask another dumb question here. Trust me. It's very boss. I'm ready. So So Arden's blood sugar does sit in the 80s for most of the time, but sure, and and like I said, Sometimes she'll hit one ad on a call couple of meals. What if her blood sugar always sat at 120? And sometimes hit those 180s? Would that make her standard deviation lower?

John Welsh M.D. 1:25:14
I don't think I don't know, I don't think you've given me enough information. To ask that question we could we could do some numerical simulations, which would be interesting, but maybe a quite a digression. I don't think we can tell for sure, just based on what you told me. So it's, it's a big question mark, right now, I'd have to punt and say, I don't know,

Scott Benner 1:25:39
that's fine. I'm trying to I can't wrap my head around my own question, which is frustrating, as you may imagine, and a limitation of my intelligence, but I'm trying to, I'm trying to decide how, you know, so. So you don't, I know, you've heard a couple episodes of the show, John, but you don't listen to the show. And I actually would like to send you a short list of episodes, and let you listen to them and hear what you think of them. But most of the people who listen to this podcast, I would assume having a one C in the fives, or I would think over six and a half, for somebody who's been listening more than three months would be uncommon. And the basic tenant of the podcast is that you don't, you don't stare at a high blood sugar, you get it back down, without causing a low and there's ways to use insulin, you know, with the data that that makes that work. So we, you know, we're pretty heavily talking here about make sure your Basal insulin is right Pre-Bolus Your meals, don't stare at a high blood sugar, you know, don't cause a low bumping nudge with insulin, you know, if you after a meal at a meal time, you know, 45 minutes after you eat. If you're 136, diagonal up, we bump it back down. Again, if you're 85, diagonal down, that turns into 80 that you think this is going to keep going, you don't wait to see a 60 you take in a few carbs, and nudge that that blood sugar back up again, it's like driving between two lines, you know what I mean? Like you don't want to swerve, you just want to kind of try to stay as steady as possible. And we talked about a lot about how to use insulin, temporary Basal rates, both positive and negative, and food in ways that keep those swings from being crazy. And yet, there are people who come back with amazing a onesies who don't get low very often, but have a couple of spikes with larger meals. And these numbers that everyone's telling them, they're super important, you know, standard deviation, they can't seem to get into the space that they want. And then they start thinking about limiting food to make that happen. And I, I think that I think this podcast has a lot of different goals. But one of them is for you to understand insulin enough that you can eat what you want to eat. And I'm not saying that everyone should run out and eat those doughnuts at the conference table. Like, that's not my point. My point isn't, I'm not a person who says, Oh, you have diabetes, you know, don't ever think of you know, don't ever think about your your health, just eat whatever you want, because insulin can take care of it. My point is that if you understand how to use insulin, then you can go off into the world. And with a diet of your choosing, keep your blood sugar's in a more normal range and extend your health. But I'm baffled a little by my daughter's standard deviation. All the other numbers make sense to me. But that one number, I can't wrap my head around.

John Welsh M.D. 1:28:28
Yeah, and and you mentioned, you mentioned the hormonal changes that come by every month and and sometimes the good control becomes more of a challenge, obviously. And the coefficient of variability goes up. And and then unfortunately, the having a high coefficient of variation gives you a higher risk of symptomatic or potentially dangerous lows. But but so it's it's especially important to have that awareness of misadventures on the low side, especially during that time of the month where the swings are, especially high amplitude. The but the goal is, as you said, I think the goal is to spend most of your time out of harm's way. And to live a long happy life where your retinas your retinas last your whole life and your kidneys are going to last your whole life and you're going to die with all 10 of your toes where they belong at the end of your feet. So it sounds like she's well on the way and especially the education that you've been giving her and the insights that she's been getting from from CGM. Sounds like they've been tremendously helpful.

Scott Benner 1:29:40
I appreciate John I just did something that I'm so I feel badly about that because you're sharing sharing your screen. I can't see my screen. And I just realized that I've had you on for an hour and 20 minutes I'm so sorry. I didn't even I didn't really enjoying this and I didn't I didn't recognize about the passage of time. I hope I haven't kept you from something here. not just being polite to me.

John Welsh M.D. 1:30:01
Oh, well, let me You know, I think I had something that I did have something else on the calendar and I hope I'm not. I mean, check my little outlook here. You can see my calendar, there's something coming up at noon, so maybe we ought to

Scott Benner 1:30:15
go is what I was gonna say, yeah, 100% I, I just looked at my phone to look at something about art and to save you. And I was like, Oh my gosh, they're gonna crucify me. I've been I've had you wait too long. Listen, this was incredibly interesting. And I can't really thank you enough for doing it. Because, you know, it's not something everyone jumped up to do when I say can I get somebody who really understand standard deviation talk was a long line of people with their hand up, you know, so I really, I genuinely appreciate this. And I have to tell you, it's gonna go right out tomorrow. I don't usually put stuff out this quickly. But if this fits right into my schedule, so you'll be able to hear yourself and be horrified by your own voice in probably 12 hours or so.

John Welsh M.D. 1:30:57
Well, that's great. So you can I hope you cut out the obscenities and the screaming and and the lawnmowers. And

Scott Benner 1:31:03
all that horrible stuff you did will be cut out now people will just hear you say that and wonder what it is that we

John Welsh M.D. 1:31:10
Scott, what a pleasure, I enjoyed speaking with you, thank you for thanks for reaching out, and I'm a dew point. Dexcom is great. I'm just surrounded by really smart people who love who are really bought into the mission. It's a good company, it's a good product, it's a good mission. And I it's nice hearing about your own experience and your daughter as well. I hope you have a long happy life with with this thing that nobody wants. But we're doing the best we can with type one diabetes, you're very

Scott Benner 1:31:39
nice, John, but to think that you're not going to get drunk back on this podcast at some point is, is not reasonable. I'm gonna get you back here at some point, we'll find out more about you and your diabetes one day. I really appreciate this. I'm going to be incredibly humble all day long after talking to you just so you know.

John Welsh M.D. 1:31:56
I realized you've got to You're the God of podcasts, though. You can go have some podcast swagger, and brag about having a wonderful podcast.

Scott Benner 1:32:03
I'll have to lean on that since I couldn't get out of algebra in sixth grade. So thank you very much.

John Welsh M.D. 1:32:08
Okay, cheers Have a good rest of the afternoon. You too.

Scott Benner 1:32:13
I know that was a denser episode than you're accustomed to on this podcast. But I just thought that having someone like John walk through these ideas was important. I took a ton from it. I'm going to listen back to this a couple of times, because I am I'm not as smart as I need to be sometimes about some of this stuff. But John made it understandable and complete. I was really thrilled to have him on I'm going to have him back someday and just talk about him and his diabetes and try to learn his story. I wish you could have heard the conversation I had with my Booker when I was like, hey, I need somebody from DAX calm to talk about standard deviation, like, really deep dive. Is there somebody over there that can do that? And she was like, I'll find out. And boom, John Walsh comes out of nowhere. Really lovely. Man. I want to thank you for listening. I mean, especially if you're still here, an hour and a half into this, you are a major geek about diabetes data. And I love you for it. Thanks so much to on the pod touched by type one, the Contour Next One blood glucose meter, and Dexcom for sponsoring this episode of The Juicebox Podcast. Please again, go to juicebox podcast.com. For those links, or look right into the show notes of your podcast player. You can clicky clicky on him right there. One way or the other. If you use my links, you'll let the sponsors know that you came from the Juicebox Podcast and I will of course really appreciate that. Hope you're all well, especially in these times. I'm thinking of all of you, and I'll see you soon.

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