Scott Benner 8/29/25 Scott Benner 8/29/25

#1614 Somebody’s Always Peeing - Part 1

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Monica shares her son Timothy’s type 1 diabetes journey, from diagnosis to teenage independence, opening up about fear, resilience, and finding balance as a parent learning to let go. Part 1 of 2

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

Scott Benner 0:00
Friends, we're all back together for the next episode of The Juicebox podcast. Welcome.

Monica 0:16
Hi. I'm Monica. I am mom of Timothy, who is 17 years old, and he was diagnosed with type one in October of 2020

Scott Benner 0:27
I am here to tell you about juice cruise. 2026 we will be departing from Miami on June 21 2026 for a seven night trip going to the Caribbean. That's right. We're going to leave Miami and then stop at Coco k in the Bahamas. After that, it's on to St Kitts, St Thomas and a beautiful cruise through the Virgin Islands. The first juice Cruise was awesome. The second one's going to be bigger, better and bolder. This is your opportunity to relax while making lifelong friends who have type one diabetes, expand your community and your knowledge on juice cruise 2026 learn more right now at Juicebox podcast.com/juice. Cruise. At that link, you'll also find photographs from the first cruise. Nothing you hear on the Juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. This episode of The Juicebox podcast is brought to you by my favorite diabetes organization, touched by type one. Please take a moment to learn more about them at touched by type one.org on Facebook and Instagram. Touched by type one.org check out their many programs, their annual conference awareness campaign, their D box program, dancing for diabetes. They have a dance program for local kids, a golf night and so much more. Touched by type one.org. You're looking to help or you want to see people helping people with type one. You want touched by type one.org. I'm having an on body vibe alert. This episode of The Juicebox podcast is sponsored by ever since 365 the only one year where CGM that's one insertion and one CGM a year, one CGM one year, not every 10 or 14 days ever since cgm.com/juicebox this episode of The Juicebox podcast is sponsored by the Omnipod five and At my link, omnipod.com/juicebox you can get yourself a free, what I just say, a free Omnipod five starter kit, free. Get out of here. Go click on that link, omnipod.com/juicebox check it out. Terms and Conditions. Apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox links in the show notes. Links at Juicebox podcast.com.

Monica 3:05
Hi. I'm Monica. I am mom of Timothy, who is 17 years old, and he was diagnosed with type one in October of 2020, almost five years ago. Yes, almost five years ago. Okay. He was 12 at the time. He was 12 at the time.

Scott Benner 3:21
Okay, do you have any hype, any autoimmune stuff like hypothyroidism, or anything like that?

Monica 3:28
It's interesting because I was hypothyroid during my last couple years of high school, and then beginning of college, was on Synthroid, and then it went back that I didn't need to take thyroid. I've had it tested for the rest of my life since then, and right now, I have a very kind Doctor Who is saying, Hey, your t3 and t4 levels are a little bit low. I don't have antibodies showing that it definitely has Hashimotos or anything. But she said, let's, you know, let's try working with a little bit of the natural thyroid to see if we can improve some symptoms. And thanks. So it's interesting, because I do, I know your next question may relate to any auto immune in the family. My sister has mixed tissue mix connective tissue disorder, which has features of scleroderma and dermatomyositis, so they kind of can't categorize it, but I have a sister in law, not related, who has lupus, and she said, really, with a lot of the autoimmune you've got overlapping symptoms, and they doesn't really matter what they call them, they're using the same treatments for most of them. So it doesn't really matter, but you have characteristics of

Scott Benner 4:47
each different things, right? Yeah, so you have how many children

Monica 4:52
I have, three. I have Peter, who's 13, Timothy is 17, and Jacob is 19,

Scott Benner 4:56
and when he was diagnosed, to. You by surprise,

Monica 5:01
yes and no. So it was, it was October, and during that summer, it was covid, and we had decided to get a water cooler. We noticed that he was drinking a lot of water. Actually, my my husband noticed it, and he had been diagnosed pre diabetic, and then type two. And he, he first started saying to him himself, oh, I'm drinking so much water. I'm drinking so much water. So when Timothy started drinking on a lot of water, he had, you know, Dave was thinking, hey, you know what? You know what, if there's diabetes. And so he was thinking it from a type two perspective. I think, you know, there was no reason for us to believe that there was a type one issue. But he's he was drinking more and more. Your

Scott Benner 5:45
husband gone through that, and he saw it with you know, at first he probably just thought, See, I knew they were going to drink all this water is going to cost me an arm and a leg to have this water cooler here

Monica 5:55
Precisely, precisely what we thought, because it's a novelty. And it was the summertime, and it was hot, and we were home all the time. We weren't out and about as much, so the water consumption was high. And I Yeah, and I looked at and I thought, oh. I said, No, you know. And I I didn't want anything to be wrong, so I didn't in. And I am tend to, I do tend to worry about, you know, possible things. I overthink things. But I didn't jump on that. And I didn't, I didn't really think anything of it. Then as the summer went on, Timothy said, you know, I've lost some weight, and now he had gotten a little bit, I mean, thicker, I guess. And teenage boys tend to do that as if they'll go through phases where they grow out and then up and out and then up. So he was, he had a little bit of a punch, but nothing big. But he said, You know, I've lost weight, but then he had lost a bunch more weight. And I called the pediatrician. I said, you know, we need to come in and get checked out. We got in there and he had lost, I'm trying to think, 10 pounds or so, and I could see on the his face, the PA his face, that, you know, he was like, because he was reassuring me, you know, everything's probably fine. Then he looked and he said, he went, Okay, let's, let's

Scott Benner 7:12
test him. Did you bring up diabetes when you brought him in, or did they bring it up?

Monica 7:16
I honestly am blanking. I remember, I think I said we're wondering if he possibly has diabetes, and it was the weight loss, and the, I said he's got weight loss and he's he wasn't saying that he was going to the bathroom all the time. And I don't know Sure, my my boys, somebody's always going to the bathroom. I don't know. Um,

Scott Benner 7:35
three boys is a lot, isn't it? Plus your husband is four, right? Yeah, right,

Monica 7:39
exactly. So I don't know somebody is always peeing, so I hadn't noticed that, but I say he's been drinking a lot of water, and he's lost weight. And so I think they thought, okay, nervous, mom. But then when he got on the scale, then he said, Okay, so they had someone in to did blood work for the A, 1c, but then after that, they came in with the meter, which I don't know why it wasn't in the other order, it read high and they said, Wait a minute. And they got the doctor to come in and try it again. And they said, Okay, we're sending you over to Morristown hospital, to the children's hospital there. You want to go there instead of the hospital that's near me, because they'll be well equipped to deal with this.

Scott Benner 8:21
You said you can overreact to things, right? And so did you have that kind of reaction, or did you hold it together? Was your husband with you in the office? Did you go right to the hospital? I

Monica 8:31
came home, and I don't know where. I'm trying to think of where Dave was at the time, but I remember very clearly I went out in the in the driveway, and I called my dad, and I said, we're going to be, you know, Timothy has type one diabetes, we're going to be going over to the hospital. And I said, you know, it's all going to be okay, but I don't know how much more i i can take, because in March of 2020, my mom passed away from stage four cancer. It was the weekend that everything shut down for CO for covid, yeah, so we actually were driving back to New Jersey. Exits were shutting down, and everything hers was the last funeral they were able to have at that church. So I had been grieving, and, you know, at home and by myself with the kids over the course of that summer, but then to be hit with this and say, All right, I'm going to pick myself up, and now we're going to, we're going to work on this. But I thought I remember feeling this is this is overwhelming. And you know what was me? And you know, how come I gotta deal with one more thing.

Scott Benner 9:42
How old are you today? I am 5353 Oh, wow. Are you okay? Yeah, yeah. So you're, you're in, you're 48 when this is happening. Then, yep, yep, your mom, your mom's passed away. Cove, it's happening. Your son gets type one diabetes. So I hear you saying that I know this is going to be okay, but I. Don't know if I'm gonna make it to the point where it's okay or not. Was that the idea like, maybe I'll sputter out here before we even get to the part where this has worked out,

Monica 10:07
I see, and I've noticed this too, is, is that I I'll get really nervous ahead of time. Of a lot of things now, all kinds of things with parenting, things going on is, and I keep telling this to my kids too, is that most of the time, that anticipation and the worry of what if is way worse than when you're actually dealing with something? Yeah. So when I when I am in a situation where there is something that's wrong and I need to fix it, I am not freaking out until afterwards, and there's a letdown. So I, you know, I shed a little tear in the in the driveway, went in, finished packing up the bag with Timothy.

Scott Benner 10:50
How did your son handle it like it not just in the moment, but in the preceding days and weeks? Was it overwhelming for him, or did he seem like he was feeling

Monica 10:59
again, knock on everything, because I do still have two kids who, you know, have a lifetime ahead of them. But we say if one of them was the one, Timothy was the Timothy is the one, the chill just rolled with it. This is kind of funny that there was this magazine. I think it's run by like, the same place they made highlights. You, since we're the same age, you might know the highlights magazine that we all look looked at as kid. There's these different ones, and one of them is a science magazine, and they had had a cartoon thing about type one diabetes, like a two pager. We had gotten home from a pediatrician, he went over to that he's a big reader, and he flipped to it, and like re read the little cartoon of this girl on a playground explaining to her classmates in the cartoon format that she has type one and what that means. And so he read again over what those details were as we were getting ready to go to the hospital. My story about how he accepted it, though, is after our stay, and we stayed, I think, about three days, they asked him if he wanted a wheelchair out, and he kind of looked at them and he, you know, he was like, you know, he's like, I'm fine. He said, Really, not that much has changed. Now I'm going to be taking a little blood out and putting some insulin in. And

Scott Benner 12:22
that was just his attitude about it. Yeah, that's awesome, yeah. And you think just seeing that little cartoon gave him some, I guess, perspective that he that he needed,

Monica 12:32
you know, context and a little bit of information about what it was, yeah, that was his only sense of what I mean. Thankfully, he'd had that. Because I don't know how with 12 year olds, you say to them, what's type one diabetes? Yeah, I think it varies depending on the people's families, and you know who they've come in contact with that, they may have no understanding of that, but what he had, and he could kind of grasp at was, wait a minute, I just read about type one diabetes. Let me read through that. And I think that cartoon probably did calm him down.

Scott Benner 13:09
Yeah, as much about how he deals with it changed in the five years.

Monica 13:15
No. One of the things that I, that I did want, want to talk about was the transition that I'm dealing with now, with him at age 17, with me starting off in the beginning, I am a researcher. I immediately I read, think like a pancreas and pumping insulin. And I I have not been a Facebook person, and I had never listened to a podcast, so I reached out for books, and I knew of I knew someone who that knew someone who had been diagnosed with LADA and was put into contact with her, and those were my initial sources of information, along with the people at at the hospital. So I have always been, okay, I've got all this information. This is what we're going to do now. As the years go by, I'm explaining to him more and more what's going on, what to do, how I handle it, and this process of what I think a range should be. And what Timothy thinks an acceptable range is is a bit of a difference.

Scott Benner 14:27
Is what he thinks of as an acceptable range based on health, or is it based on his desire to touch diabetes? And how many times a day, today's episode is brought to you by Omnipod. Did you know that the majority of Omnipod five users pay less than $30 per month at the pharmacy? That's less than $1 a day for tube free automated insulin delivery, and a third of Omnipod five users pay $0 per month. You heard that right? Zero? That's less than your daily coffee. For all of the benefits of tubeless, waterproof, automated insulin delivery. My daughter has been wearing an Omnipod every day since she was four years old, and she's about to be 21 my family relies on Omnipod, and I think you'll love it, and you can try it for free right now by requesting your free Starter Kit today at my link, omnipod.com/juicebox, Omnipod has been an advertiser for a decade. But even if they weren't, I would tell you proudly, my daughter wears an Omnipod. Omnipod.com/juicebox Terms and Conditions apply. Eligibility may vary. Why don't you get yourself that free starter kit, full terms and conditions can be found at omnipod.com/juicebox when you think of a CGM and all the good that it brings in your life, is the first thing you think about. I love that I have to change it all the time. I love the warm up period every time I have to change it. I love that when I bump into a door frame, sometimes it gets ripped off. I love that the adhesive kind of gets mushy sometimes when I sweat and falls off. No, these are not the things that you love about a CGM. Today's episode of The Juicebox podcast is sponsored by the Eversense 365 the only CGM that you only have to put on once a year, and the only CGM that won't give you any of those problems. The Eversense 365 is the only one year CGM designed to minimize the vice frustration. It has exceptional accuracy for one year with almost no false alarms from compression lows while you're sleeping, you can manage your diabetes instead of your CGM with the ever since 365 learn more and get started today at ever since cgm.com/juicebox one year, one CGM.

Monica 16:44
I think it's it's that. But then also he and my husband, they, they were told from the beginning they don't die, advice, right? 70 to 180 7180 and so I don't want to scare Timothy, and I'm not doing it out of panic, either, but I know that every time you're going higher, you're introducing some more possibility of risk, or a possibility of things that are not good for your body. So I, you know, I really do want to keep it in a tighter range he doesn't understand the, you know, stickiness, and the, you know, the tiny little vessels, and all the stuff that we've talked about

Scott Benner 17:30
Monica, because you haven't shared that with him yet.

Monica 17:34
I have, you have, but I have, and I say, you know, every time your blood sugar gets high, it's sort of, it's kind of scraping. You've, you've described it as the scraping, you know, sort of scraping away in there. And that's not good. But he doesn't have, and I'm glad he's chill, and he doesn't have the sense of the sense of urgency, but I see something, and I think, crush it. Crush it. We gotta take care of this. And he's like, Yeah, I, you know, I took some insulin, it'll be fine again. It's the sense of urgency and how he reacts, and it's not that he ignores anything, yeah, but he isn't as aggressive, and he doesn't act as as quickly as I would. And I need to gradually accept that we're different people, and I've been managing this, but the goal as a parent is to have your child become independent and manage their own life, and you are equipping them with the skills to do that.

Scott Benner 18:32
It's probably one of the more difficult parts of the maturation of this relationship, the diabetes, part of the of the relationship between a parent and child. I think maybe one of the most difficult parts is when you make the realization that you've told them they understand, and now you're waiting to see if they care enough to implement Yes,

Monica 18:52
exactly, and that is what I really am struggling with as especially during this past year, because he's gotten his driver's license. His friends have driver's licenses. There's a lot more of hey, we're going out to eat, and then I'm texting him. I do have to say that I really, really wish that insulet would have given a View app for us, because when we were on the dash and I could see what boluses he had given, I felt like so, you know, so much less of a nag than I do now texting him saying, Did you correct already fat and protein, please. And he'll say already did. Or, you know, sometimes he doesn't. But I could see before I could look at the I could look at my app, as you know, in that follower sense, and say, Oh, I see what's on board. I see that he just gave so then I didn't have to nag him. So I feel a little bit more helicopter ish now, because I'm always having to ask.

Scott Benner 19:57
So the visualization that you can make. Often stops you from needing to actually contact him, which stops you from bugging him, and him feeling bugged, and vice versa, you feeling like you're bugging him, right?

Monica 20:09
If I had the data, which I don't anymore, because, because of Omnipod five,

Scott Benner 20:13
Omnipod five doesn't have an app where another person can kind of see what's going on, how much insulin is in that, right?

Monica 20:19
Because the dash had the View app. It was Omnipod view. And then so you would look, and you would see, you would see iob, and you would see the lat the time of the last dose. Now we've got the three hour delay in these glue row and different apps that I've because I've looked to see if there's anything, but no, you you can't get that information.

Scott Benner 20:40
Omnipod say they were going to make that and they haven't, or did they never mention it? Never

Monica 20:45
mentioned it. And I've looked and I haven't seen anything. I've, you know, I, you know, I'm sure I was on the customer satisfaction review survey things. I'm filled it out a dozen times because we went to Omnipod five in June of 2022 as soon as it came out, we had been on dash for four months, and I switched right away went, you know, went with it, and just was figuring this out, and then realized over time how much I missed, even just the four months of having that the view, yeah, before that was we had in pen, and So I had visibility with that. And I really do think that that was, that was an awesome thing for us, the in pen, because you could see the doses. And so I again, we had a history of what's going on, and with two people doing don't and with the doses, and with having a teenager, that's an, I think it's a really an excellent thing to be able to see that without the nagging

Scott Benner 21:42
part, yeah, of course. Well, I mean, you're making your plea here, they'll definitely hear it here. So, oh,

Monica 21:49
hopefully. So trust me, it would be great. Yeah,

Scott Benner 21:53
that's awesome. Well, there you go. I think it's a great idea. I see the value in it, like, beyond just management stuff. But like you said, like helping to, you know, not put extra stressors on people's relationships. It's a big I think it could be a big deal, you know, right?

Monica 22:08
I would love to loop, but I know that both my husband and my son would be hesitant to do that. They would be concerned not FDA approved. What is this? You're just dealing with some guy on the internet who's creating something they they would be opposed to that. I would love to have the ability to loop for several reasons, but one of them is being able to have that real time information without constantly being, you know, the diet and the diabetes. Why do

Scott Benner 22:38
you think you're comfortable with it, and they wouldn't be, is it because you're involved online? You see people using it?

Monica 22:43
Yeah, I know so much more about it. My husband is not past a lot of the information that we got at the hospital. He didn't read books, he didn't dive into that. That's always been how I was, how I have been. I thought I wanted to be a reference librarian when I was in elementary school, I just dive into a topic, learn all that I can about it. I just love information. So I when I had something to direct this information, the information gathering, you know, I went into and I read all of that. So I have a more of a comfort level, because I hear of so many people and listen to the loop and learn videos, stuff like that, that I am comfortable with it, but they think, Wait a minute, you know? What if something goes wrong with with the computer program? You know? What if,

Scott Benner 23:32
well, when you share that with them, I mean, have you shared that with your husband? Like, Hey, I've really researched this, and I think this is a great idea, yeah. And you don't get a lot of response back on that, not

Monica 23:43
enthusiasm. No, we started out in the beginning with that, with the MDI, Dave, you know, I have always had a big problem with needles, so, and then now, all of a sudden, I got to inject my kid all the time, and our hospital and malar endo had said, No, it's a year until you can have a pump. So that's, you know, as you know, a lot of needles. He gave a lot of the shots in the beginning, and then I got more comfortable with it. So in the beginning, we were real good with the you count the number of carbs we had our little log. We had to write every single thing down how much we'd given. He was involved in a lot of that. And then we were waking up, Timothy up for blood sugar checks every three hours overnight for the first couple weeks. Couple months in, we got the Dexcom. So Dave was involved more in the beginning, but again, as I'm saying, he still believes that it's you do this, you do this, and you and then you've got to you've got a good outcome, because you did what you were

Scott Benner 24:39
told. He bought the sales pitch that he got the first time, exactly,

Monica 24:43
yeah. And he missed the part where someone in the hospital did say, this is more of an art than a science. But he sort of missed that part. It truly is with all the variables. And he'll look and say, Well, what you know, didn't he dose? Yes, he dosed. How? However, there's the fact that another thing, Timothy likes to run the pods right up into the end. And I know that at two and a half days, or less than 50 units, if we get that,

Scott Benner 25:12
that's not the best time to have a loaf of bread. No,

Monica 25:15
no, because we know that the absorption something's going on and it requires X percentage increase in the doses. But I don't really know how to figure out how much. I just know it definitely takes more insulin on the last 12 hours or so. I say, Timothy, can you change the pod?

Scott Benner 25:35
So, yeah, well, no, I hear what you're saying. That's the human part of it, like if people with type one who don't have kids with type one are listening to you. Probably think when I say it too, they're probably like, oh, yeah, get out of their business. It's up to them. There's more to it than all that, right? And that's part of it, like, but then the the rest of it for you is to realize that they're right to some degree as well. Yes, like, it is just, it is his thing, and it's just, it's hard I imagine, if you're anywhere in your mind, like I am, it's hard to imagine that 10 years from now, you'll have absolutely no sway over your son whatsoever. And what if he's a person who just doesn't take care of his health, right? Like, that's what scares you. And it's funny, because you have two other kids, I bet you don't think about it once, about them. I

Monica 26:20
mean concerns about what, about what they might do 10 years from now.

Scott Benner 26:25
It's tough, because it puts you into that like, into that mindset cost. I think about stuff like that all the time, and when I talk to my brother in law or my sister in laws or whatever, like people, I know that I can sit down and speak like very candidly with about their parenting styles. They don't think about their kids at all, all, not at all. Like, you know, like, I one point, somebody close to me is kid, you know, kid in their 20s is having trouble. And I was like, Well, are they going to the bathroom regularly? And she goes, How would I know that? And I was like, Oh, all right, you know, I said, What about, like, vitamins and this and, like, I'm asking questions. I have no idea, right? Like, no idea. And I was like, oh, okay, right. By the way, there's part of me, Monica, that yearns for that, but then there's also part of me that looks up and sees 60 and 70 year old people with their 30 and 40 year old kids, and their kids are in horrible health situations, and I think they didn't get the information they needed. And now it really, I mean, it's not too late. You could certainly do something for yourself, but it's a lot of wasted time, right? Yeah, right. So you have that feeling too, yeah,

Monica 27:29
it's, it's that balance, because, again, like I said, always into into research, diving into stuff. So I've, before all of this, I've been super interested in nutrition and the effect, you know, the effects on, you know, what, you know, what we eat, and the, you know, supplements and all of that. So when I look at this and think, all right, pre, you know, for long term health, the, you know, these are things that are good for you. And you know, with all three kids and my husband, too, with, you know, I really like the it won't be new now, but it's new as of right now. The series with Jenny about nutrition and looking at these, these building blocks that we're putting in, and how our bodies are processing all of that. So I have to say that in the beginning, I felt a little carb phobic, because we had to count everything. And I thought, okay, so we should be reasonable, not restricting, but kind of restricting the carbs, because that's going to cause more variability. And so we looked for lower carb options, and I realized some of that was fear, so I started working towards being able to dose for what he wanted to eat. However, as Jenny points out, and you were pointing out yesterday with a story about Velveeta, what we want to eat is not necessarily what's best for us to eat. So like you've said just before, you can't you can figure out how to dose for a pop tart. Is that the goal to try to support your child eating Pop Tarts. If you know that that is not the way that long term health is is going to be secured. Yeah,

Scott Benner 29:08
it's a balancing act, that's for sure. If it makes anybody feel any better, this wasn't about diabetes, but it was something health related. Still, I suggested something to Arden recently, and she goes, You don't know what you're talking about. Like, she just hit, and I was like, I've had 17 different conversations with 14 different doctors about this. I might have a grasp of this stronger than a lot of people, you know, like, and what I realized was, is that it was one of those things where she was like, I think this happens to a lot of people. Like, I was trying to talk to her about a supplement, like, nothing crazy, just, you know, keeping her vitamin D level up. That's not a thing she sees impact from Do you understand, like, what I mean? Like, she doesn't wake up one day go I took a vitamin D tablet yesterday, and the next day I felt better. Nobody feels that, but I know it's important to keep her vitamin D level up for a number of reasons. And when she turned to me and she's and I realized for a moment, she just saw me as like, Oh, that's my dad. He thinks he knows something. Thing. And, like, then there was part of me that was, like, on this, like, I'm wrong about a lot of stuff, but on this, I'm right. I absolutely do okay. And then I realized, like, That's it, like, this is a is this a thing you're gonna argue about? Like, it's not, like, I don't wanna create a divide with her over vitamin D, but at the same time, I can think off top my head of four really good reasons why she should be taking it, and I think they're all backed up by a lot of science and a lot of experience with people. And then I just sit there, and I think there's going to be a time she'll be in her mid 20s, like I just have to wait till then, because then you say it again, and she'll take it more seriously, like she's still growing as a pre I know she wouldn't think this. If you brought her in here right now, she'd be like, I'm a fully formed person. I'm as smart as I've ever been. I'm smarter than you, old man. I've heard you say stupid stuff, like she's still stuck in that. But I know, because my son's a little older, that once you get through that last push of defiance, like you start turning into an adult. I really am beginning to believe, like, that's going to be my last stand with Arden. Like that's the spot where I'll have the most success now that she's older, it's going to be like after she's in her mid 20s. I think,

Monica 31:17
anyway, I'm I am hoping for that. But then when I look at talking to people about nutrition and health and wellness in general, I think you have people that are in the realm of they can see why they might want to try something, and some that are not that's just not a higher priority thing for them. Yeah,

Scott Benner 31:39
and they, they might not connect the dots to ever that can happen as well. I mean, nutrition is an example of, like, it's such a good one. Like, I know I'm probably losing listeners by putting up content about nutrition, because some people are probably like, don't tell me how to eat. And I'm I certainly don't think we're doing that. But no, no, no, definitely not. But at the same time, like, I watched a conversation online the other day about soda and there, I mean, people do not understand how bad soda is for them. Like, generally, spam me people, there are people who do understand, but like, the of those who don't, they're just like, it's a drink. They don't see it, you know, like, and you could, you could try to sit down and make that argument anything like, I would tell you right now not to drink orange juice that is, generally speaking, not healthy. Like, have I had a small glass of orange juice with breakfast? Sometimes, because it's, like, very tasty, like I have, but there's 3000 better ways to get the nutrients in orange juice without all the sugar that comes with it.

Monica 32:31
Absolutely, absolutely. I just heard someone, a medical doctor, on a podcast, talking about metal you know, metabolic issues, and you know how? You know how we're looking at glucose spikes in every day, you know in everyday people, and why, and the effects over time of what happens and metabolically what happens as we get older. And he said, I love the taste of oranges. I love to eat an orange, and I do love to drink a glass of orange juice, but within a couple of seconds I have consumed eight oranges, yeah? And so our body wasn't meant to process that delicious orange in that quantity that quickly, yeah, 100%

Scott Benner 33:12
and anyway, my point is, you say that to somebody and they really don't know or something so, like, prevalent in their life, they don't even, like, they're like, Wow, how could that be bad? Like, there's a whole aisle of that at the grocery store. Like, how could that be bad for people? I see all kinds of people buying it. They're not dropping dead in the driveway Exactly, exactly. And I tried to be open about it. Like, when I was talking to the person online, I was like, Look, you should do you I don't care. Like, don't do whatever you want. I was like, but I don't think you should drink sugar. And I said, I think that a lot of what's in soda is bad for you. And I want to be clear. I'm saying that as a person who's literally drinking a diet soda while I'm having this conversation, I'm not like, perfect. I'm just and I know that I'm having all the bad things that you're having, but at least my bad thing doesn't have all the sugar in it, and it takes five seconds for someone to come in and go, you're using an artificial sweetener that's more dangerous than sugar. And I'm like, I just said, I know this is bad too. Exactly, both not good for you. I'm just trying to limit the sugar. And my point isn't that you should be drinking diets so deep. And my point is that that's not good for you at all. Now I know you're going to have some of it like and a lot of people are, but that point that Jenny and I are gonna, you know, either have made in an episode that you've heard, or you're gonna hear us make at some point we both, I think it is the one that just went out. You probably just didn't hear it like we both related a story of watching someone walk out of a grocery store with what appeared to be months worth of soda, hundreds and hundreds of dollars of it stacked up in carts, and I'm like, God, like, have a glass of water that's gonna kill you. And in my experience, the person I saw doing it did not look like they were having great health outcomes. And so anyway, like, it's neither here nor there. I'm not even sure how we got farther down.

Monica 34:57
Yeah, no, I Well, I do. Yeah. It's because I'm here. But the the episode was yesterday, while I was mowing the lawn, I was listening to you and Jenny talk about this and how you had similar people. And she said, I think I saw her in my grocery store too. What I liked about that is, in that afterwards you were talking talking about, and I do sounds dramatic when we say it and we talk about, well, there becomes somewhat of a an addiction, that you get hooked on the taste, and you get hooked on these, the the formulas that they've they've got, and then that becomes a habit that what you do is you drink several, several sodas. Or we're in the day, you know, we're in the days now of you know, oh, you know what that that restaurant doesn't have free refills,

Scott Benner 35:42
yeah? And then it turns into a quantity issue. Yeah, you're just taking in so much like, yeah, like, Listen, I'm not a perfect person. I have a diet soda with me while I'm recording the podcast constantly, because it keeps my mouth wet without I don't know how to put this, but if you talk a lot, and you're being recorded, water's not the way to go, because it somehow dries your mouth at the same time you get, like, Smacky. And so there's something in this poison that's in this cup that stops that from happening. So I use it while I'm recording. Also the not for nothing, I take in no caffeine except for this. So it does also help me. While I'm recording, it gives me a little, a little bump. You know what? I mean? I

Monica 36:24
kind of wanted to ask about that. You net coffee tea. You never did you try it and not like it. Or

Scott Benner 36:30
as an adult, I have never drank coffee. Okay? As a teenager, I've never drank it. I probably had a few sips of it when I was a kid, because my parents drank it all the time. It just never occurred to me to try to coffee. I will have a cup of tea a few times a year. But I have to admit, that's even a thing that bothers me. I like hot tea. This is going to sound ridiculous to people, but like, I'm so busy and running around so much that warming up the kettle and putting in the it's almost more time than I can, I can give away, and I know that once my life gets calmer, I will drink more tea. But no, I've never had coffee, and I don't think I'm missing anything, and I don't care,

Monica 37:11
see, I do like the smell of it, and that, you know, like it's, it's something that I smell it, and it's, you know, it's part of my morning, all of that. And I think for a lot of people, it does feel that way, but, and then no one in the house drinks, drinks coffee.

Scott Benner 37:24
No, my wife doesn't drink coffee. My kids don't drink it. Yeah, my kids don't drink alcohol generally. I mean, I'm certain that they've, you know, I'm certain Arden's been in a party and had a shot of something or something like that, but she doesn't drink at all. My son went to college and, like, he's, like, I don't drink. Like, it's just not a thing I do. It's, I don't know, we're not that's not the stuff we do, I guess, and for no reason, like, it's not a I'm not making a judgment about anything or anything like that. And I think coffee smells good. I think it smells awesome. Actually, it just never occurred to me to try it. And now the truth is, is that, like, even if I wanted to, I'm so cheap, like, I don't know what a coffee cost at Starbucks, for an example, or dollars? Yeah, no, no, you wouldn't get that money out of me if I was bleeding to death. Nope. Yeah. So

Monica 38:10
me, no, me either maybe is a little bit of a segue, as it's something that I did when I saw there was an email that went out earlier today saying, you know, say, you know, sign up to be on the podcast. And I looked and I thought, hmm, if I did what I need to tell Scott is that he needs to stop saying how old he is, because this I'm so old. I'm so old when you are about a week older than me, you know, I'm yelling back at you. You upset? Yeah, I'm guess, because we are not that old, sir,

Scott Benner 38:43
yeah. Well, I'll tell you, Monica, I just, I brought this up the other day, so I don't, I won't belabor it, but there's a tick tock trend right now, of like, this is 50 or something like that. And every one I've seen I'm like, Man, those people look way older than I do, right? I have to tell you, I don't feel old. Like, the only time I feel old is now when I get tired, I'll tell you that I think the thing that saved my life is the woman who came on and told me to try looping back before tandem had control IQ, before Omnipod had Omnipod five, before Medtronic had so before all those automations were available, this person was like, you should try this. Do it yourself. System and it let me sleep, sleep, and when I got rested, I had the opportunity to look back to see how exhausted I was, right? I think it would have killed me eventually, especially now this many years later. Of all the things that I used to be able to just put my head down and run through a wall like if I don't get sick often at all, but if I did, I'd get up the next day. I'd be fine. If I didn't get a good night's sleep, it didn't matter. I'd get it the following night. But now, if I just had this happen to me a week ago, Arden like got high overnight. It woke me up. I got up. I realized she was asleep already. I made a Bolus. I adjusted some basal. This whole like, I pushed her like, I pushed her blood sugar back in the other direction. And I found myself thinking, I want to wait 20 minutes to make sure this does what I think it's going to do. If it does what I think is going to do, 20 minutes from now, it's going to be okay, and if it doesn't, I probably have to put in another half a unit. This was my thought, right? Well, in that 20 minutes, I woke up, and then it was two o'clock in the morning, and Scotty wasn't sleepy anymore, and then I didn't go back to sleep till four, and I just missed two hours of sleep in the middle of the night and the entire next day. I wasn't worth Yep, and that, I think, is my age, honestly, Yep,

Monica 40:35
yeah, I see that with the with the sleep and the effects of sleep, yet I still do the stand up a little bit too late get, you know, reading something, whatever. I really should be in bed, because I know I'll, you know, I'm going to pay for it in the morning there. I still kind of believe that I'm able to do that, and I'm not. The other thing is, driving at night. That's some, that's where I do see that I feel

Scott Benner 41:00
older part on your eyes you can't see. Well, yeah,

Monica 41:03
I have contact lenses, and I've had glasses since I was six years old, and so because of that, and then the slightest stigmatism, but just with getting older, the eye doctor says, yeah, the you know, the nighttime driving vision is,

Scott Benner 41:16
yeah. Every day I come in this office and I sit down, and for the first five minutes, my eyes have to adjust the distance I am from the keyboard and the monitors. And I sit here. I don't want to lie to you. I sit here angry, waiting for that to happen. My eyes were so perfect my whole life. When I first sit down and fire up my monitors, they're not clear. And then after I'm here and I adjust to the distance they are, and even, like, I'll look down at the keyboard in the beginning, I can't even start working because the keyboard is blowing like, if I didn't know how to type, I'd be stuck sitting there waiting for everything to come into

Monica 41:49
focus. I wonder what that is, though, because that's not like a reading glasses sort of issue.

Scott Benner 41:53
No, if I put my reading glasses on, it would be fine right away. I don't want to do that, so I sit there and I just wait for my eyes to adjust, and I'm irritated the entire time. Like irritated is the wrong word. I'm angry the entire time, and I do, and I think that's age as well. Now, having said that, I don't look like I'm 25 but I think if you line me up against a bunch of people in their mid 50s, no, you could easily believe I was 10 years younger than they

Monica 42:17
are. You've told several of these anecdotes on the podcast. I'm very young looking. So there are, there are young women. And who are, you know, who are baristas and sort of things. And they comment about, about how useful you are.

Scott Benner 42:29
It's lovely, you know, it's, it's, it's lovely. This is the secret, Monica, it's there. It really is like, if my hair is dark, so I pull it off. Well, I haven't gotten to that spot yet where my hair looks like it's markered onto my face because my skin is too light, you know what I mean? Like, when white? Yeah, that hasn't happened to me yet. So that's it. The day that happens, I just give up. It's

Monica 42:49
over. Yeah, I have friends that hate me, but I haven't had to color my hair yet. Yeah, either. And so it's, it's a big deal.

Scott Benner 42:57
I'm not going to color my hair. I'm just going to give up.

Monica 43:01
I don't know if I'll just give up, but, but, yeah, I, you know, I get it. I think it's part of it, though, because you you can tell when somebody's got a natural hair, hair color, male or female, yeah. And I think that that might be part of it. I don't know. Inside, I definitely don't feel as old as as we are. There are things that I think, wow, I used to be able to do X or Y, but, you know, I think it's true. It's the stuff with the sleep and then, yeah, the vision, the vision stuff. It's, yeah, it's, I mean, there's nothing we could have done about it.

Scott Benner 43:31
No, not at all. It just is what it is. But I'll tell you that one of the things that I'm very aware of is that I know my personality, my language, and how I think about things, probably comes off decades younger than I am, right? So when you're in public and you start talking, I can see sometimes that either, like, younger people are, like, confused. I mean, I'm not gonna use the word creepy, but it comes off. I probably comes off oddly to them that apart like I look, I look younger than most 53 year old people, but I don't look like I'm 25 you know, I'm an older person right here I am talking about, like, stuff that they just don't see people their parents age talking about. And I know at some point I'm just gonna have to bite my tongue, because it's gonna come off so weird. And then when I get around people my own age, I have no interest talking about any of the crap that they want to talk about, I know. Like, so that becomes a problem, too. So you're around a bunch of people your own age, and you're like, Have you heard this song from this like button? They're like, What are you talking about? I'm like, oh, it's really great. Like, you start talking about it. You're like, you bring up something, and you know that's happening, you know? And you're and they're, I'm like, Have you heard about this? And they go, No. And I'm like, What do you think about Kanye? And they're like, who? And I'm like, Oh, okay. Now people don't know this, yeah, but Monica has wanted to come on the podcast. Was too nervous to do it. She's been listening for a long time. She's very active in the Facebook group. She's a great supporter of the things I do. And she and I were messaging about something today. She was literally trying to help me with. Something. And I said, Have you ever thought of coming on the podcast because I suddenly have a slot available today? And she's like, Oh, I'd be too nervous to do that. But then two and a half hours later, here we are recording, so she didn't get the time to, like, write a note and tell me what she wanted to talk about. So is there anything you really want to make sure we get

Monica 45:16
into I when I thought about that in the couple of hours of thinking that I had Timothy and his development there. And, I mean, we've talked, we've talked about that a little bit. I'm trying to think about anything

Scott Benner 45:27
else, because I have stuff to ask you, but I want to make sure you get what you want to

Monica 45:31
say. I'm looking over here because I did have a note, a little page, in case I ever did have the nerve to go on the podcast, the details of when he was diagnosed, what we're doing it now I think that, like, it's a recap what we were talking talking about, just I think that it really is hard for us as parents when we take a look at what we always want better for our children, and that combined with the overthinking, and I'm saying, All right, so I, you know I want, you know, I want between 70 And 140 I want 70% or more in that. And with all the data and information that we have, we can keep looking at that, and we can get into the area where we are bugging our children, or, you know, stepping in too much. That's something that I that, I definitely think that that, you know, balance is important, but really difficult to do because you want the best for your kid, but you also don't want things to be all about. Come on, you should have given more. Yeah, come on. You've got to correct this. This now

Scott Benner 46:30
it's definitely the fast track to you not having a good relationship as the as adults, or them pushing back and willfully not doing what you're asking, because it's the thing you're asking for them to do. I mean, like, listen, the easy example is, is that nobody makes more Democrats than Republican parents, and nobody makes more Republicans than democratic you know what I mean? Because you're because your kids are going to just hear what you're saying and then look to the other direction. That's all.

Monica 46:56
I don't think my husband has ever heard that one that that's very interesting.

Scott Benner 47:01
Monica, like you hear your mom and dad say something one too many times, like, I don't want to be connected to this anymore, and you don't want that to be diabetes, right? Exactly. It's funny because you listen to adults come on here in their late 20s, who have who grew up through high school with type one and went off to college, and they tell you, I wish my parents were more involved. I wish when I pushed back, that my parents wouldn't have given up. But that's hindsight. You can if you could go back and ask the 17 year old them, they'd say, my mom's an idiot, my dad's an Assal. They don't know what they're talking about. They're bugging me like but like, everything's hindsight. When you hear somebody say something thoughtful, it's almost always in hindsight. So you know, the problem is you have to deal now and in now with with the person you're speaking to. And that's why I think it's always important to keep a really long view of what you're doing, like you're not trying to win the day. You're trying to make sure that in the future, you've raised a person who wants willingly to take care of themselves.

This episode was too good to cut anything out of but too long to make just one episode. So this is part one. Make sure you go find part two. Right now it's going to be the next episode in your feet. I'd like to thank the ever since 365 for sponsoring this episode of The Juicebox podcast, and remind you that if you want the only sensor that gets inserted once a year and not every 14 days, you want the ever since CGM, ever since cgm.com/juicebox cgm.com/juicebox one year one CGM, touched by type one sponsored this episode of The Juicebox podcast. Check them out at touched by type one.org. On Instagram and Facebook. Give them a follow. Go check out what they're doing. They are helping people with type one diabetes in ways you just can't imagine. This episode of The Juicebox podcast is sponsored by the Omnipod five. And at my link, omnipod.com/juicebox you can get yourself a free, what I just say, a free Omnipod five starter kit, free. Get out of here. Go click on that link, omnipod.com/juicebox check it out. Terms and Conditions. Apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox links in the show notes, links at Juicebox podcast.com. I can't thank you enough for listening. Please make sure you're subscribed, you're following in your audio app. I'll be back tomorrow with another episode of The Juicebox podcast. My diabetes Pro Tip series is about cutting through the clutter of diabetes management to give you the straightforward, practical insights that truly make a difference. Ins, this series is all about mastering the fundamentals, whether it's the basics of insulin dosing adjustments or everyday management strategies that will empower you to take control. I'm joined by Jenny Smith, who is a diabetes educator with over 35 years of personal experience, and we break down complex concepts into simple, actionable tips. The Diabetes Pro Tip series runs between Episode 1001 1025, in your podcast player, where you can listen to it at Juicebox podcast.com by going up into the menu if you're looking for community around type one diabetes, check out the Juicebox podcast. Private Facebook group Juicebox podcast type one diabetes. But everybody is welcome type one type two, gestational loved ones. It doesn't matter to me, if you're impacted by diabetes and you're looking for support, comfort or community, check out Juicebox podcast, type one diabetes on Facebook. The episode you just heard was professionally edited by wrong way recording, wrongway recording.com,

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Scott Benner 8/28/25 Scott Benner 8/28/25

#1613 Bolus 4 - Intro and Doritos

Jenny and Scott talk about bolusing for Doritos

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Welcome back, friends to another episode of The Juicebox podcast.

In every episode of Bolus four, Jenny Smith and I are going to take a few minutes to talk through how to Bolus for a single item of food. Jenny and I are going to follow a little bit of a road map called meal bolt. Measure the meal, evaluate yourself. Add the base units, layer a correction. Build the Bolus shape, offset the timing. Look at the CGM tweak for next time. Having said that these episodes are going to be very conversational and not incredibly technical. We want you to hear how we think about it, but we also would like you to know that this is kind of the pathway we're considering while we're talking about it. So while you might not hear us say every letter of meal bolt in every episode, we will be thinking about it while we're talking. If you want to learn more, go to Juicebox podcast.com. Forward slash meal, dash, bolt. But for now, we'll find out how to Bolus for today's subject, please don't forget that nothing you hear on the Juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin.

This episode is sponsored by the tandem mobi system, which is powered by tandems, newest algorithm control iq plus technology. Tandem Moby has a predictive algorithm that helps prevent highs and lows, and is now available for ages two and up. Learn more and get started today at tandem diabetes.com/juicebox All right. Jennifer, I have an idea, okay, and I've been workshopping it in my mind now for a few weeks, and I want to work through the rest of it with you now. Awesome. I'm very worried that I'm going to say something to you and you're going to go, oh, Scott, I already have that. And I don't want to steal your thing if that's the case, or maybe you don't, but I want to make a series of short episodes that's just about each episode is about bolusing for one food item. So imagine, right? So imagine that I might already have a list of hundreds of food items from listeners, and they're like, please tell me how to Bolus for this. Or, you know, this specifically, not just pizza. I want to know how to Bolus for Domino's Pizza, very specific stuff, not just cereal. I want to understand how to Bolus for Lucky Charms. Okay, that kind of stuff. And actually, good foods on the list too, Jenny, don't worry. Great. But when I started thinking about you, and I doing that, the first way I imagined it was me just saying to you, okay, Jenny, let's figure out how to Bolus for and then say the food item, and then us just talk it through, which I think is valuable, but I also think that there's got to be steps, like, whether we know it or not, there are steps in Our head about what we think about when we're bolusing, even if we're not actually thinking about it.

Jennifer Smith, CDE 3:05
Yeah, they're unconscious. They're sort of in a file cabinet. I've done this. I know how to it's almost like a behind the scene. Absolutely, there's their steps.

Scott Benner 3:14
Yes, do you have these steps written down? Ah, you don't. Excellent. Do

Speaker 1 3:19
I have steps written down for how I Bolus through things. No, that's 37 years.

Scott Benner 3:25
But like, what I'm thinking is, is that if there was a framework, then while we talk about it in each episode, we can use the framework, and then it'll become just a thing that happens without you having to know the framework. Can I give you the

Jennifer Smith, CDE 3:39
frame you can and I think it's probably while I don't have it written down, this is probably exactly how I teach bolusing for food, despite not having it written down, as I think about it, I know that I teach bolusing for food the same way, person to person and variable to variable. And then the one other thing that I was thinking about to, you know, you always talk about these ideas a little bit ahead of, you know, whatever. But my consideration too was, how do we bring into this Bolus thing for, let's say, an apple, and considering, then, is there something to adjust because of the aid system you might be using? Yep, right? So which I, I consider kind of, and I think you probably coined it. I don't think I've heard it anywhere other community in diabetes, but like the ninja level is now, you know, bolusing, you know the steps, but what's the system you're using? How does your algorithm work? Because that's going to make a difference in how you choose to Bolus for this particular

Scott Benner 4:52
food. Okay, I think this is going to be exciting. I'm pretty excited. So

Jennifer Smith, CDE 4:56
that was on, that was the only thing on this topic that I was like, You. This changes things, because people aren't just MDI and conventional pumps anymore, and

Scott Benner 5:06
I want them to, because CGM exists too, like all right. So here's how I have it laid out. I almost had it in an acronym, so close. Oh, so it's meal bolt, M, E, A, l, B, O, L, T, all right, meal measure the meal. So that step is list your carbs, fat, protein, glycemic impact, yep. E, evaluate yourself. Check your CGM, your blood sugar, insulin on board planned activity and stress level, okay. A, add the base units, calculate the food Bolus, the carbs divided by insulin to carb ratio. What is A? A is what add the base units? So the base units tough here. Okay, I'm trying to get an acronym in here. I don't know that we're going to end up with meal bowl, but I think the steps are here. So like, think about it right. List the carbs, the fat, the protein. Get that information. Check your blood sugar and your insulin on board. Am I about to go sit down on the sofa? Am I about to go for a run? Yep, now like calculate our food boluses using our insulin to carb ratio, yep. L, layer a correction look at the current blood sugar and the target. Use your correction factor right. Check on your insulin on board again. B, build the Bolus shape. Decide upfront percentage versus extended and duration. Yep. Offset the timing. Choose Pre-Bolus lead time or maybe a split dose. Okay. L, look at your CGM right to see to look for your curve. Are you on the way down? Are you on the way up? Maybe you need a little more. Maybe you need a little less. And then tweak for next time, log the outcome, adjust ratios split, so be flexible at the end. Yeah. All right, so I put it online, and people are like, that's a lot to remember. And I thought that's exactly what I think about every time I think about bolusing for food, but I don't consciously think about it that way.

Jennifer Smith, CDE 7:01
Well, that's why I said when you asked if I had steps 100% I have steps. They're just I've done them so much that I don't would have never come up with an acronym for them.

Scott Benner 7:13
Do you have any idea how hard it was to, like, sit down and go through it? I'm doing things so automatically, I couldn't find them when I was looking for them right away. It took me a while. Actually, I've been working on this for

Jennifer Smith, CDE 7:24
a while. Can I tell you what my favorite one of this is being the more type A versus that I tend to be. I really like tea tweak for next time. This encourages as much as people hate doing. It encourages some records. It encourages paying attention to the data that is all systems, even if you're just using injections, there is some place that's gathering that data for you that you can look back and say, Okay, I really want to figure out my apple, or I really want to figure out this great mark it down. Do these steps what didn't work. Tweak it for next time. That's my favorite step.

Scott Benner 8:08
Yay. So I think that everything's that's in these kind of like eight ideas. If you went right now and listened to the Pro Tip series, you'd hear they're there some version of that in the conversation, but it's very conversational. And I want these episodes to be small. I actually think I'm just gonna make them part of the small sip series, right? Like little tiny, like pieces of information. So what I was afraid was gonna happen was that I'd bring up a food, like choice, and then you and I would talk for a half an hour about bolusing for the food, because I think we could get lost talking about it. So I thought, like, we need a structure. Yes, yes, right? That's all so now, but, but what we really have to figure out is, is this actually, can there be fewer steps? Is this the step? Like, you know, like, that's the thing I want to figure out with you. So I'm gonna, like, I'm gonna actually make a thing and send it over to you. Okay, hold on one second.

Jennifer Smith, CDE 9:02
And for clarification, we're also talking about some of these foods will be simple, one item, foods like Apple, for example, and some things will be mixed meals. In fact, many of these are likely to be mixed meals

Scott Benner 9:17
as we go, yes, but in the beginning, you

Jennifer Smith, CDE 9:21
have them in order, from easy to hard. I'm still working on that. Okay,

Scott Benner 9:25
yeah, in the beginning, what I want is an encyclopedia of there must be like, I know I'm gonna say something crazy, like 50, but there must be like, 50 food items that most people eat, right? And

Jennifer Smith, CDE 9:40
most people have 20 to 25 themselves that are consistent over and over. Yeah,

Scott Benner 9:45
okay, I just sent you a link in your text. Okay, all right. So, so we'll, we'll look at these items, and I think we should practice a little bit, and then we'll like you and I will practice together, and then that's how we'll you. Start get these steps in order so that they're ready for when the next time we get on and we just start, like, because you guys don't know how Jenny, I make these, but we'll basically sit down for an hour and just hammer out as many as we possibly can, and you'll hear them five six minutes at a time. Like, so looking at it, tell me when you have it in front of you. I've got it in front of me. Is there anything glaringly missing, right? Like, really think about it like you're looking at food. How many carbs are in it? That's obvious. Is there fat or protein in it? Am I gonna have to Bolus for that? Yes. Is this a high glycemic or a low glycemic? Like, is it gonna hit me hard and fast, or is it gonna hit me, you know? Like, is

Jennifer Smith, CDE 10:36
it along with this? I think in measuring the meal, I think that's an

Scott Benner 10:40
appropriate I guess it's complete. We don't need anything else in that thought. I

Jennifer Smith, CDE 10:44
don't think so. But it also, when you're measuring, what are your look you're looking at measuring includes portion, how much are you eating, right? So beyond glycemic impact, there's also glycemic load, okay? And I think that that's valuable, because if we don't address portion size in the measure and talk about the impact or the difference that that can make, I think it may we may miss something right. We don't

Scott Benner 11:13
want to tell somebody how to Bolus for a bagel, but not talk about what would happen if you were going to eat three of those bagels, correct? Yeah, yeah.

Jennifer Smith, CDE 11:24
And my favorite one in that is watermelon, right? Watermelons got a really high glycemic index, but a portion, a single serving of it, doesn't have the load impact of eating four cups of it at a time, same glycemic index, but the load is what makes the difference, and then Bolus timing and all that kind of stuff goes along with it.

Scott Benner 11:45
Quite a handful or a cup of of watermelon, that's one thing. If I'm at a picnic and someone takes out a giant knife and slices off a two inch slab of it, and I sit down and shove it into my head, that's going to be different. Okay, so I added load to that. So list, carbs, fat, protein, glycemic impact and load, all right? The next step, evaluate yourself, check your CGM, your BGM, insulin, on board planned activity and stress. Is there anything else that the people could quickly assess about themselves?

Jennifer Smith, CDE 12:15
No, I think evaluate is. I think you've got everything here that would make sense. Okay. I mean, all evaluate yourself is not only where are you sitting in terms of hard numbers, but also what do you have going on? And those are the outside things, like variables that stress, illness, activity level, etc,

Scott Benner 12:38
right? Okay, the next one. I don't even know if I love the way I have this, like, add the base units, but calculate food Bolus, carbs divided by insulin to carb ratio. So calculate your food Bolus, so it doesn't have to be meal bulk, by the way. Like, I don't care what the acronym is. By the time it's over, this episode is sponsored by tandem Diabetes Care, and today I'm going to tell you about tandems, newest pump and algorithm, the tandem mobi system with control iq plus technology features auto Bolus, which can cover missed meal boluses and help prevent hyperglycemia. It has a dedicated sleep activity setting and is controlled from your personal iPhone. Tandem will help you to check your benefits today through my link, tandem diabetes.com/juicebox, this is going to help you to get started with tandem, smallest pump yet that's powered by its best algorithm ever control iq plus technology helps to keep blood sugars in range by predicting glucose levels 30 minutes ahead, and it adjusts insulin accordingly. You can wear the tandem Moby in a number of ways. Wear it on body with a patch like adhesive sleeve that is sold separately. Clip it discreetly to your clothing or slip it into your pocket head. Now to my link, tandem diabetes.com/juicebox to check out your benefits and get started today.

Jennifer Smith, CDE 14:00
No, the way you have this is correct, though, because the beginning steps of first you've measured, you know exactly, not exactly as precise as possible, what you're doing, right, and what the content kind of looks like. And then you're saying, Okay, well, my blood sugar's starting here, it's going up here, it's dropping here, I'm already low, blah, blah, blah. And then you're getting a calculation of knowing BG and knowing carbs, you're calculating what the dose would be just for the food to begin with. And then the next step is adding kind of a coating to that if needed a correction, or even taking insulin away, it could be correction in one way or another, more or a little bit less, yeah. And then the deciding pieces come in with the second word, which you know, the B, O, L, T, right when you're building in how you're gonna Bolus,

Scott Benner 14:52
Yep, yeah. So now we have, like, what the situation is, what situation I'm in, what are the details? Cells of how this insulin is going to get measured. Am I correcting for a blood sugar that exists already one way or the other? Like, you know, I know people hear that and think, Oh, if I'm 150 I need the meal, plus the, you know, the correction for the 150 but also you might get hungry and be 65 so we can still Bolus for that too. If we then look at the rest of it right, like, the side upfront percentage versus, am I going to extend this and how long am I going to extend it for? So build the Bolus like, shape like, think about how I'm going to apply this insulin to the situation. The B and the O kind of go together honestly, right? Because, you know, am I going to put it all up front? Am I going to spread it out? Am I going to spread it out for three hours? And how much of it is needs to be pre bolused? Right? Is kind of another way of thinking about it, because I don't know that like putting pre bolusing and split dosing together is really much I mean, is a split dose really much different than an extended I think that's kind of the same

Jennifer Smith, CDE 15:59
thing it is. But again, the way that, as you said, the build and the offset and they kind of go together. Sure they do, but for somebody who is newer, maybe to considering how to approach a meal, let's say they've used kind of pro tips, right, and now they need something like this as a stepping piece of in their decision making, because this brings it together. It kind of condenses all the pro tips in a way, which is, is nice somebody like me, all of these, they just float together like it's a quick, quick, quick, quick, quick decision. And if I had to, I guess I would have listed them like I had to think about a plan, but my brain just goes through these automatically.

Scott Benner 16:45
Yeah, you know. And I think that it does for most people, but there are still so many people online that are just like, I don't know how to Bolus for this item. And what that makes me think is they don't really know how to use their insulin well yet. But instead of continuing to tell them, like, Don't worry, you'll get it. You'll figure it out, which I do think is true. You know what? If there was a, like, a short Encyclopedia of 2040, 50 items that you just heard somebody say, because we're going to take a label and actually walk through this like, that's how you and I are going to handle this, right? If I figured that out for my basic stuff, and I did it over and over again, wouldn't there, like, that magic part you're talking about, where you just kind of know when it all comes out of your head, right? Like, maybe that would get them to it more quickly, is, like, kind of my hope also, you know, Jenny, there's stuff that I've thought I wanted to put into the podcast, and there's stuff that people have told me I should put in the podcast. And oftentimes those things are not things that occur to me. This is one of them. People have been asking for this for years, and I'll tell you the other thing they want us to do. They want us to break graphs down. Oh, and I always talk about, like, by the way, this might be the next series, but like, I always say, well, like, how am I going to do that without visuals. Like, the people listening can't see the graphs. And somebody said to me the other day, I was like, spitballing with a few people, and they said, why don't you just name the shapes? Because we all know them, right, right? Like, there's, like, you call them excursions at meals, but, like, a meal spike, right? There's a slow drift, there's a drop, a drop. Like, there's probably not that many different shapes on the graph. Most of us already probably think about them a certain way. Name them and then talk about the graph. And I was like, All right, I'll talk to Jenny about that and see Sure, let's, let's focus on this first Yes, yes. Okay, so you know, how long is the pre e Bolus gonna be? Then this is a step that I think can get lost. Like, look at your CGM, right? You know, Spot check your CGM. Are you one hour, three hour, five hours. Take a look at the curve. Are you on your way up? Are you on your way down? The way I talk about that in the Pro Tip series is I always tell people like, go to the three hour CGM line, go to the last three dots and see which way they're curving and like that gives you an idea of what what direction your blood sugar is going into. But I like the idea of thinking that part through for a half a second, because that's the one thing I still think I don't really get Arden to pay attention to all the time, is the trend. It's nice that you're eating. It's nice that you're Bolus sing for it. It's great that you're pre bolusing for it. But if you are pre bolusing 10 minutes before you were about to go from 150 to 220 I mean, you were screwed already. Anyway, yeah, right, right. And then your favorite one.

Jennifer Smith, CDE 19:33
The other thing is, in the look at the CGM, it is a slippery slope, so I think that it's valuable to point out when we're encouraging look at the CGM, the idea of spot checking at specific points along the post meal time period. And in the case of what we're trying to do is bring up specific foods or. Types of meals. If this is your meal that you really want to figure out, looking at the CGM doesn't mean every single day for every minute you're looking at your CGM, yeah? This

Scott Benner 20:09
is why you're learning how to do it right, like, right? Yeah. This is a

Jennifer Smith, CDE 20:13
spot check the Domino's Pizza at an hour. How are we looking you had a strategy in mind. The other piece to looking at the CGM is not being reactive, because you're trying to learn

Scott Benner 20:28
Yes. So like, just don't, like, freak out every time you see some like, let it play out so that you can, yes, you can figure it out. Like, so it's funny because you you kind of key down on one side to look at the CGM, and I keyed in on the other side for me, like, which is like, pay attention to where you are before you make this Bolus, but after you make the Bolus, the spot checking, like, go back an hour, three hours, five hours. Like, what's happening now, did this work the way I expected it to? If not, what am I seeing before CGM? So can you imagine the first person who figured out, like a fat rise, like, you know what I mean, like, without that, like, how many times they must have checked their blood sugar to be like, I'm telling you, if I eat a french fry, my blood sugar goes up faster than if this happens. You know, you've made these good decisions. You've you know, you've taken these steps. You put the Bolus in. An hour later you're still stable. Awesome. You know what I mean? Like, three hours later you're getting low, that'll help you with the Tweak for next time. Right, right. Maybe I didn't Pre-Bolus correctly, or, you know, whatever. And the

Jennifer Smith, CDE 21:27
only way that you can get, and I think that's why it is my favorite, the only way that you can really, truly get to tweaking what was an initial attempt is to really only do those spot checks. It's not a minute by minute, watch and react and hyperventilate because something's going on. It's a I am testing something out in order to adjust it for next time I have to let the scenario play out. Yes, I made a decision. It looks like my decision was not correct, but I'm gonna let it work itself out, because next time now I can spot what to

Scott Benner 22:05
change. This is a granular breakdown of the Eminem story that I tell in the Pro Tip series of somebody who just one day was like, Oh, I have a CGM now I can figure this out, and I'll put the insulin and see what happens. You can't, like, Jenny said, you can't, like, 10 minutes into it, freak out, like if you asked me, you know, at what point after a meal, Bolus, do you think, Oh, we missed. I need more insulin. I have an answer, but that answer is also based on me really understanding all these other steps that we just talked about. So while you're learning you can't just because you're just guessing the wrong direction, you'll cause, you'll probably over Bolus, cause a low or you'll eat at 120 because it's starting to go down and freak yourself out. And sometimes you just gotta wait. Okay? And

Jennifer Smith, CDE 22:47
the reason for these steps again, well, put together the very first step is what measure. So at the end of all of these steps, where you are watching the CGM trend, you know that your beginning pieces were well considered. It wasn't the random, I don't know it looks like 98 grams of carb, and this is what I put in, and this is the meal I'm no, no, no. Like, if you really want to figure out again your pizza or whatever it is, then take the

Scott Benner 23:21
steps, yeah, and you'll get there more quickly, because, yeah, this should work if you're swagging too, yeah, like, right, but you just might have to eat more pizza to get to the answer.

Jennifer Smith, CDE 23:30
And eventually, when you when you swag There's historical perspective to swagging. Yeah, you know when I go someplace and I'm on vacation and I am eating out 100% that's a swag. I mean, majority of the places that you go when you're on a vacation are not national chains.

Scott Benner 23:51
Yeah, right, yeah. You have no idea what you're eating. But I

Jennifer Smith, CDE 23:54
also know that I'm not going to choose the octopus plate, because I don't eat octopus so I usually on a menu. People are still more creatures of habit, right? They're more I know what I like. I'm going to choose something within the realm of my preferences, and because of that, I have some history around a food like this, yeah, so swaging becomes easier,

Scott Benner 24:19
sure. And I think that this process gets you to a place where you you talk about the way Jenny did earlier, like, I don't know, I know I do these things, but I don't think about them, right? But in the in the beginning, I just, I think this will be interesting, and there's a entire section of people listening who genuinely want this. So yeah, and they'll be sure that's awesome. Yeah. So now, do you have time to pick one thing and or do we do it next time we have

Jennifer Smith, CDE 24:44
let's see what do I'm full of my schedule. Look at your schedule. It's very

Scott Benner 24:47
busy schedule. People, people clamoring to speak with Jenny.

Jennifer Smith, CDE 24:52
Line out the door. I have about 15 minutes. Okay, so

Scott Benner 24:57
let's do this, since we have so maligned to read. Do's in the nutrition episodes, all right, let's use Doritos. Yeah, let's use Doritos nutrition

Jennifer Smith, CDE 25:08
label. Hold on, fabulous. Oh, poor Dorito Doritos took it hard, actually, everybody, right? They took it hard. But I guarantee that every time we said Doritos, people are like, Oh, Doritos. I haven't had Doritos in a really long time. I don't

Scott Benner 25:23
care about being healthy. They are so good. Okay, I've got a picture of a of a nutrition label from a Doritos bag. This is going to be clunky the first time because we don't have this worked out. Give a pen. Can you jot down something?

Jennifer Smith, CDE 25:37
I have a pen and I have a piece of paper?

Scott Benner 25:41
Yes. So let's start with the just so you know the serving size of this Doritos thing is, it's, oh, wait,

Jennifer Smith, CDE 25:47
wait, can I, can I guess what the serving size? Does it give it per chip? It's

Scott Benner 25:51
a grab bag. Oh, let me get it. Maybe I should get it off of a large bag so that I have how many chips it is. Hold on a second,

Jennifer Smith, CDE 26:00
because I want to try to guess how many chips is a serving?

Scott Benner 26:03
I think it's gonna be one. That's fun, yeah, they're like, oh, there's only 1000 grams in this. How many is it? Oh, don't, don't worry about how many for the serving.

Jennifer Smith, CDE 26:12
Well, I think it also begs a description of the difference between serving and portion. Yeah, right. Oh. Serving is what the label tells you is a single side or a single, you know, portion, and that's what everything on that label, then, is associated with that particular serving. Your portion might be for servings according to what the bag lists as a serving. I think it's a very valuable difference to make. What you put on your plate may be your portion, but I guarantee it's probably not one serving per the bag.

Scott Benner 26:47
So a nine and 9.25 ounce bag of Doritos, nacho cheese flavor tortilla chips contains approximately nine servings. So we're calling what a serving? An ounce? Yes. Wait. Is that gonna be like? That's just a few chips.

Jennifer Smith, CDE 27:01
It is usually from tortilla chip. Historically, is somewhere between nine to 12

Scott Benner 27:11
chips. This has it as 12. Oh, it has it as well. I

Jennifer Smith, CDE 27:14
just want to hear you guess first. Yes, nine to 12 is typical for tortilla

Scott Benner 27:18
chips. Okay, so 12 Doritos is a serving, okay? That's 150 calories, okay, it's eight grams of fat, okay, a gram of saturated fat, okay, fair amount of sodium in here. But that's what do we care about, sodium? Well,

Jennifer Smith, CDE 27:34
we care about sodium, but not from a store from, not from a standpoint or a Bolus thing, all

Scott Benner 27:39
right? It's 210 milligrams, just for that. Carbs. You wanna guess carbs

Unknown Speaker 27:45
for 1219,

Scott Benner 27:46
18. See, that's pretty close. Dietary Fiber, one sugar, one protein, two, calcium, calcium. How they get calcium into it? I

Jennifer Smith, CDE 27:57
would guess calcium is probably pretty minor. It's probably like one or 2% but it's because

Scott Benner 28:03
their daily value.

Jennifer Smith, CDE 28:05
If there's milk, there's some type of and I would expect it's also an enriched or a fortified product. So I would expect some of these are also added back pieces.

Scott Benner 28:15
Okay, yeah, there's potassium in it too. It's interesting, not an amount that you need. Okay, so, but that's not the point. So now we are, let's be a person who's, I mean, we got to keep this easy, right? Like, my insulin to carb ratio is one unit for 10 carbs,

Jennifer Smith, CDE 28:30
and we're following our steps. Measure,

Scott Benner 28:33
yeah, and, and, let's, let's, let's set up this person. Let's do, one unit is 10 carbs. That's our insulin to carb ratio. One unit moves us 100 points that

Jennifer Smith, CDE 28:45
way. So we've got a correction factor of 100

Scott Benner 28:48
Yeah, just to keep everything simple, okay, and and then we have to give the person a blood sugar, all right, so let's start, because this is us just practicing. Let's start with like, a blood sugar. We're not looking to correct 100 Okay, let's just

Jennifer Smith, CDE 29:04
do that. That's the unicorn number, right? Everybody takes pictures of 100 right? Yeah, I

Scott Benner 29:08
take pictures of 70 sixes. But okay, so, okay, so person has the blood sugar of 100 their one unit moves them 10 carbs. One unit moves them 100 points. They're going to eat Doritos. Now, let's go back to our list. All right, we've evaluated the carbs. There is fat in it. Yes, is it fat that we're going to need to Bolus for it in an extended way?

Jennifer Smith, CDE 29:31
No, in one single serving. No 12 chips. No, what if I eat the whole bag? Jenny ate the whole how many servings? Do you say? Five servings in a bag? Oh, nine, yeah. Oh, my God. Well, what's Scott, what's your math? Nine times eight is what

Scott Benner 29:45
70? That would be 72 grams of fat.

Unknown Speaker 29:47
Wow, that's a lot of fat. Oh, my goodness, it's

Scott Benner 29:50
only nine ounces of Doritos. Jenny, this easily could happen during I'm watching mob land on Paramount plus, right? Now, easily, right, right? You don't know mob land. You. I don't know Rob land, I don't, yeah, it's neither here nor there. So, so, okay, that's a good point. Like, so is it one? Let's say they're eating one serving. The hell is eating 12 chips? All right, okay. He's like, I haven't had 12 chips in a year. That Dorito is insulin to carb ratio is one to 10. We're going to be having 18. So, you know, I'd go two units, just for fun, but it's one. What is it? 1.8 units,

Jennifer Smith, CDE 30:28
right? One to 10 at 18, yep,

Scott Benner 30:31
and it's going to be, I don't think the impact is going to be crazy, like, I think any kind of a reasonable I mean, if, if my blood sugar is nice and stable. There's no insulin on board, and I'm having 12 chips. I mean, I think a Pre-Bolus of five to 10 minutes probably get you there. Do you think more? Do you think more?

Jennifer Smith, CDE 30:52
What I know about the processed nature of chips and the fact that these have fat, but it's not a considerable amount of I mean, eight grams is eight grams, but it's not like 50 at once, right? The fact of the matter being that these chips are, they're processed. What are Doritos? Are they corn? I don't

Scott Benner 31:12
even know. I'm sure there's corn in them somewhere,

Jennifer Smith, CDE 31:15
whatever the ingredients are. I don't even know. I can find out. Feel like I should

Scott Benner 31:18
know that. How would you know that,

Jennifer Smith, CDE 31:22
I feel like I should know. I would guess corn. Corn is there wheat.

Scott Benner 31:26
I'm looking for an image I can blow up and see corn, vegetable oil from sunflower, canola and or corn oil, something called malted dextrin, made from corn less than 2% of the following salt, cheddar cheese, milk cheese, culture salt, enzymes, whey, mono sodium,

Jennifer Smith, CDE 31:48
glutamate, glutamate, butter, MSG, buttermilk,

Scott Benner 31:52
romano cheese, part skim, cow's milk cheese, cultures salt, enzymes, Romano cheese, cow's milk cheese, culture, salt enzymes, whey protein concentrate, onion powder, corn flour, natural and artificial flavor, dextrose, tomato powder, lactose spices, artificial colors, yellow, six, yellow, five, red, 40. Lactic acid, citric acid, sugar, garlic powder, skim milk, red and green bell pepper powder, the sodium inosit Nate, the sodium guilate, potassium chloride and sodium calcium. Eight contains milk ingredients,

Jennifer Smith, CDE 32:36
so mostly corn, right? I think so corn. And then what struck me there was kind of funny. It's not really anything here and there, what we're doing, but is the fact that they have naturally an artificially flavored dextrose. Like dextrose is just sugar, right? We have to artificially flavor it in Benner Rita,

Scott Benner 32:54
I might not have had a comma, natural and artificial flavor. Comma, dextrose.

Unknown Speaker 32:59
Sorry. Anyway, that

Scott Benner 33:02
was just sorry about that.

Jennifer Smith, CDE 33:04
No, no, it's all good. But corn, that was my purpose in, yeah, going back now in the Bolus strategy, right? Because we're on the step of building the Bolus shape, and that includes the timing the Pre-Bolus, right? So we're really looking at, you're at a stable looking blood sugar. No, iob, you haven't treated anything in the past. This brings in and builds in the variables you might be considering, right? And my expectation is that you'd need at least a 10 to 15 minute Pre-Bolus. Okay, for

Scott Benner 33:34
Doritos, 10 to 15 minute Pre-Bolus, by then, you're not even gonna want the Doritos anymore, so you might as well give up. Seriously, right. Do I have to split the dose? No, not for Doritos, okay. And when do you think I checked to see if I missed on this?

Jennifer Smith, CDE 33:49
Yeah, great, because these are more processed, again, like most packaged snacky kinds of foods like this, I would be checking at the one hour mark, because, again, these are more true carbies, and they're going to have an impact that tends to be a bit quicker. And also, because you're not eating in this environment, we're talking about single food digestion, kind of like glycemic index was sort of, you know, established. It's an in and out. Okay, so you're usually going to have potentially a quicker rise followed by a quicker plateau point, based on your timing of insulin and what you know about how your insulin works for you, with a finish out and aiming to be back at baseline again, if you've tested all of your other settings, etc, does

Scott Benner 34:39
any of this change for you if it's three servings,

Jennifer Smith, CDE 34:42
I would expect it would change

Scott Benner 34:43
if it were three servings, yes, how so do you think

Jennifer Smith, CDE 34:47
that first step measure the meal? Now we're looking at what, 36 grams of 1812, chips, 18. So that's a heck of a lot more carbohydrate. So we are not changing like. Glycemic index, but we're changing the glycemic load. We're changing how much of this is actually going in. I would expect that Pre-Bolus timing probably about the same, because the more of a food that you have, it's still going to take you longer to eat that many chips compared to just eating 12 chips. Now you're eating a lot more chip, 36

Scott Benner 35:22
chips. It's 54 carbs. Yeah, all of a sudden I just hit me, like, these conversations gonna be great for people, because I don't think anybody thinks about it that way. You know what? I mean, a handful potato chips, 15 carbs. I go, like, right? You're at the next handful. I don't even know if you're like, you've got it in your head the same way after that.

Jennifer Smith, CDE 35:40
And what a great time of the year. I mean, I don't know when these episodes will come out, but what a great time of the year to be discussing this. Because where are we? We're heading into most kids getting done with school, heading into summer, heading into a lot of vacation time, heading into a lot of family or gathering type of spaces, cookouts, et cetera. And what do we have at most of those things, it's not your usual, prepared, great stuff that you focus on eating at home. It's everybody brings something along, and most often, what's on the table, chips and potato salad. Exactly. We're

Scott Benner 36:17
gonna have burgers later. Kids, fruit salad is everyone's grandmother not put three baskets out with three paper towels in it and run around and dump three different kinds of potato chips in them and go, Hey everybody, like, you know, like, I just want everybody to be happy and dead. So okay, now, you know, this person's blood sugar is 150 before they start. And now my heart that changes the Pre-Bolus time, because I like to see a falling blood sugar before, like, you know what I mean? Like, if you, if you're 150 and you throw in a Pre-Bolus for, you know, 56 carbs of Doritos, and 10 minutes later, you're like, Oh, I'm eating now, but your blood sugar hasn't moved. I mean, I think you're 185 in 10 minutes,

Jennifer Smith, CDE 37:00
you're going to be rising and again, that also begs, you know, evaluate, which is your second step. Evaluate, where are you? Is that 150 stable, and you've been stable and just hovering there? The correction for adding into the food Bolus, maybe it takes hold a little bit faster and starts that drift down that you're looking for before you start to eat. And this then begs the consideration of evaluating your CGM along the way, even because don't get hard tied, I guess is my point to an actual I always Pre-Bolus 10 minutes. My Pre-Bolus is always 15 minutes? Well, maybe that has to be a floating a variable, depending on where are you and where are you headed. If the 150 is stable, flat, no insulin on board, great, right? You could probably turn that around pretty quick, and your Pre-Bolus maybe isn't very much longer. But are you 150 and still rising? You are that rise indicates a deficit of insulin. It means a longer Pre-Bolus. Okay?

Scott Benner 38:04
Kid comes downstairs, Mom, I'm gonna take a handful of Doritos that I'm going outside to kick a soccer ball. You do it differently? Yeah,

Jennifer Smith, CDE 38:10
absolutely. There's a variable in the picture, a handful of the Doritos again. What are we looking at? We're evaluating, is there insulin on board already? Blood Sugar might be 150 going to hit the soccer ball around, or throw a football with a friend, or whatever it is at that point, do even Bolus, right? And that begs the consideration. Then, as I said about what kind of system are they on? Yeah, has the system already kicked in some help that handful of Doritos might be totally fine,

Scott Benner 38:39
right? Right? Yeah, you're gonna have to look to see. It's not as easy as that evaluate part becomes a big deal like it does. Yeah, you're 150 and the algorithm just bolused for it, and you're about to go outside and run around, and maybe you can have a few Doritos and go, and we're not gonna see a difference here, right?

Jennifer Smith, CDE 38:56
You may not even need to Bolus at all for it, and it's totally fine,

Scott Benner 39:00
yep. Okay, all right, so this is how we're gonna do this. Is this gonna work for you? I love this is awesome. Having way too good of a time. I looked up and I thought, we're a couple of dorks.

Jennifer Smith, CDE 39:13
I'll be in the dorky nerve.

Scott Benner 39:15
I was like, we're gonna talk. I'm gonna love this. Okay, so hopefully people love it too. Thank you. Yeah, I really appreciate this. Thank you, of course, yeah.

The podcast you just enjoyed was sponsored by tandem diabetes care. Learn more about tandems, newest automated insulin delivery system, tandem Moby with control iq plus technology at tandem diabetes.com/juicebox. There are links in the show notes and links at Juicebox podcast.com. You.

In each episode of The Bolus four series, Jenny Smith and I are going to pick one food and talk through the bolusing for that food. We hope you find it valuable. Generally speaking, we're going to follow a bit of a formula, the meal bolt formula, M, E, A, l, B, O, L, T. You can learn more about it at Juicebox podcast.com, forward, slash, meal, dash, bolt. But here's what it is. Step 1m, measure the meal. E, evaluate yourself. A, add the base units, l, layer, a, correction B, build the Bolus shape, O, offset the timing, l, look at the CGM and T, tweak for next time. In a nutshell, we measure our meal, total carbohydrates, protein, fat, consider the glycemic index and the glycemic load, and then we evaluate yourself. What's your current blood sugar? How much insulin is on board, and what kind of activity are you going to be involved in or not involved in? You have any stress hormones, illness, what's going on with you? Then a we add the base units your carbs divided by insulin to carb ratio, just a simple Bolus l layer a correction, right? Do you have to add or subtract insulin based on your current blood sugar? Build the Bolus shape? Are we going to give it all up front, 100% for a fast digesting meal, or is there going to be like a combo or a square wave Bolus? Does it have to be extended? I'll set the timing. This is about pre bolusing. Does it take a couple of minutes this meal, or maybe 20 minutes are we going to have to again, consider combo square wave boluses and meals, figure out the timing of that meal and then l look at the CGM an hour later, was there a fast spike? Three hours later? Was there a delayed rise five hours later? Is there any lingering effect from fat and protein? Tweak, tweak for next time. T What did you eat? How much insulin and when? What did your blood sugar curve look like? What would you do next time? This is what we're going to talk about in every episode of Bolus for measure the meal, evaluate yourself. Add the base units, layer, a correction, build the Bolus shape, offset, the timing, look at the CGM tweak for next time. But it's not going to be that confusing, and we're not going to ask you to remember all of that stuff, but that's the pathway that Jenny and I are going to use to speak about each Bolus. The episode you just heard was professionally edited by wrong way recording. Wrong wayrecording.com.

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Scott Benner 8/27/25 Scott Benner 8/27/25

#1612 Chemo Caused Type One

Nicole shares her journey through breast cancer, thyroid failure, and type 1 diabetes, balancing resilience, humor, and family support while finding strength in community and technology.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Welcome back, friends. You are listening to the Juicebox podcast.

Nicole 0:14
Well, hi there. My name is Nicole. I live in a suburb of Chicago, and I'm pleased to be here on the Juicebox podcast. If

Scott Benner 0:24
this is your first time listening to the Juicebox podcast and you'd like to hear more, download Apple podcasts or Spotify, really, any audio app at all, look for the Juicebox podcast and follow or subscribe. We put out new content every day that you'll enjoy. Want to learn more about your diabetes management. Go to Juicebox podcast.com. Up in the menu and look for bold Beginnings The Diabetes Pro Tip series and much more. This podcast is full of collections and series of information that will help you to live better with insulin. Please don't forget that nothing you hear on the Juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Today's podcast is sponsored by us med. US med.com/juicebox you can get your diabetes supplies from the same place that we do. And I'm talking about Dexcom, libre, Omnipod, tandem, and so much more us, med.com/juicebox, or call 888-721-1514, today's episode is sponsored by the tandem mobi system with control iq plus technology. If you are looking for the only system with auto Bolus, multiple wear options and full control from your personal iPhone, you're looking for tandems, newest pump and algorithm, use my link to support the podcast, tandem diabetes.com/juicebox, check it out. The episode you're about to enjoy was brought to you by Dexcom, the Dexcom g7 the same CGM that my daughter wears. You can learn more and get started today at my link, dexcom.com/juicebox,

Nicole 2:13
Well, hi there. My name is Nicole. I live in a suburb of Chicago, and I'm pleased to be here on the Juicebox podcast. Nicole,

Scott Benner 2:24
I'm pleased for you to be here as well. Thank you. Yeah, you have a very a Michelle Obama quality about your voice. Does anybody ever told you that before? No, never. I think it's the Chicago thing. It's possible, yeah, but it's coming right through like so have you always been in Chicago or not always?

Nicole 2:42
Yes, born and raised, I had a short stint in college, where I moved to South Carolina for a summer for an internship, but always have been here. No

Scott Benner 2:53
kidding, awesome. You like the area. No reason to leave. I do.

Nicole 2:58
My family is here, so I plan to

Scott Benner 3:01
stay Ah, I see it's too cold for you, but your family's there. Is that? What you're telling

Nicole 3:05
me I'm saying that, yes, because I just went to Clearwater Florida a couple weeks ago, and it was amazing.

Scott Benner 3:11
Yeah, the warm is nice. Sometimes clear water. What were you there for?

Nicole 3:15
Nothing, relaxation, eat, sleep, repeat.

Scott Benner 3:19
Very nice. I've only been there once, twice, maybe. And I went down for spring training for the Phillies, actually. Oh, wow. And we spent it for yourself. My son and I and my brother went down and we went to we basically went to spring training games all week, and then hung out on the beach and did other stuff. That's nice. Yeah, it was very nice. So what brings you on the podcast

Nicole 3:38
today? So I remember that about a month or a couple months ago, you got on the Facebook, private Facebook group, and you threw out a post that said, hey, my one o'clock isn't working out, or whatever time it was. Is there anybody who could record for an hour click this link? And so there were a number of us that click that link, and there were three of us with you at the time, and then you took the post down, and we had a chat.

Scott Benner 4:08
Yes, that one's gonna come out soon, actually, that one's almost done. Oh yeah, that was great. You know, what ended up happening for people listening is that, first of all, I underestimated myself. I thought like, Oh, I'll be lucky, like someone will be able to do it. And a lot of people were able to do it, and I was like, Oh no, no. There's already three people in here. So I just put a stop to it, basically. And then I wanted it to just be like, and I thought the conversation was nice the way it went back and forth between a number of people. But yes, as you guys were going online, it just became obvious that each of you would have made a great episode. So here we are. That's awesome. I appreciate that. Yeah, no, absolutely it was. It was a good time, but we're gonna have a better time right now. Okay, so tell me a little bit about your health background.

Nicole 4:49
I've been pretty healthy. I work out a lot, cardio, weight, lifting. I had not had any issues with my health. Probably. Me Up until late 2022, July or August, I found a lump under my arm and then one in my breast, and so I scheduled an appointment for a mammogram, and then several tests later, appointment with an oncologist, and I was diagnosed with triple negative breast cancer in October of 2022 and then I started chemo in November

Scott Benner 5:31
of 2022 what's distinction triple negative? What does that mean? So

Nicole 5:36
it's negative for all of the hormone receptors, like estrogen, progesterone, whatever. The third one

Scott Benner 5:43
is, is that news we want to hear or don't want to hear? In that

Nicole 5:46
situation, you never want to hear any of it. I

Scott Benner 5:49
was gonna say, yeah, not that, not that you want it. But like, is there once you're there? Is there a you know, I don't know better. Is the right word. But like, more favorable for outcomes.

Nicole 6:00
I think that the hormone positive is better for outcomes, however, because once you're finished with chemo and radiation, if you go through it, then they put you on like five years of some type of aftercare pill to keep keep everything at bay. And with triple negative, there is no aftercare. You go through your chemo and radiation, if you choose it, like I said, and then they just kind of watch you. Every six months, I get a CT scan, okay, and then I follow up with my oncologist, and that's

Scott Benner 6:38
been going on for three years, almost. Yes, yeah. So I want to kind of go backwards so you get that news. I mean, I assume the lumps themselves are pretty worrisome, but, you know, I imagine you do your best to regulate yourself till you get back the diagnosis. But once the diagnosis comes, we know what mind frame does that put you into?

Nicole 6:59
I'm going to kill it. I I'm just gonna beat it. I'm gonna be successful. And that's that,

Scott Benner 7:04
yeah, you just felt right away like, Okay, I'll fight the fight. Absolutely Okay. So then what's the next step? What did you have done after you decided how you were going to handle it?

Nicole 7:13
They scheduled me to get a port, which is like a catheter in your chest, so that you so that they can get the drug infusion through that port instead of a different IV in your arm every time you come. Yeah. So they set up my treatment plan, which was 12 weeks weekly. And then once I finished with that, then it was four treatments, three weeks apart. So in total, that is eight rounds chemo.

Scott Benner 7:45
Okay, and are the lumps removed? Is the breast removed? Like? How do they handle all that?

Nicole 7:50
So then, once you finish, and I had a couple of hiccups here and there, my white blood count, I want to say, was too low. So they give you a I had to miss a week of chemo for that, and then they give you something to get it together, and then you can resume. So that pushed my treatment plan back a week or so, okay, and then we're at the end. My thyroid decided to give up the ghost. So the range for normal is like zero to four, okay, and mine was like 84

Scott Benner 8:26
your TSH, jump to 84 Yes, wow, it definitely

Nicole 8:29
stopped working, huh? Yeah, that was, like a first sign. So hadn't had, you know, many other fall off the cliff moments, but that one, so was

Scott Benner 8:40
the thyroid a thing they were tracking? Or did you just get so ill that you've they started looking for it?

Nicole 8:46
Yes, I had labs, I want to say weekly, because they wanted to make sure you're okay for the next treatment, right? So they were monitoring everything, and then the previous time, it was normal, but maybe trending a little higher, and then the next time it was way high. Is

Scott Benner 9:06
the common wisdom that the treatment causes the thyroid problem, or is it

Nicole 9:11
bad luck? The treatments are known to have several side effects. There is one particular drug. I hear the commercials for it now, and I, you know how they rattle off the side effects? And I was like, yeah, that happened to me.

Scott Benner 9:28
I got that one. Thank you. And so thyroid issues are. One of them is type one diabetes. One of them, or no, it is, is type two. Do you know, I don't know if they differentiate, oh, or if they just say, diabetes, okay, sorry. So you get the thyroid labs back. How do they manage that?

Nicole 9:46
I'm on levothyroxine. I don't remember what the doses was at the beginning, and it's gone up and down since that time. So that was probably in April of 2023, Three. Did that happen? Okay,

Scott Benner 10:02
that about a year after your treatments, or not quite

Nicole 10:05
six months. So we go from starting treatment in November of 22 to finishing in April of 23 okay,

Scott Benner 10:13
is that news? I don't know. Like, I guess a lot goes to your personality and your how you deal with things. But does that news of the thyroid feel like, oh gosh, another thing, or did it just feel like, okay, fine, I'll take the pill. Like, you know what I mean? Like, how did it strike you when you

Nicole 10:28
heard like, I didn't want to be on a medication for the rest of my life, so this isn't what I want. And they said, some people's resolve once they finish chemo, but mine has not yet.

Scott Benner 10:40
Okay, is it late enough now to think that it won't or is there hope there for that still,

Nicole 10:45
I always have hope.

Scott Benner 10:47
Nice, nice. That's awesome. Okay, so your levothyroxine, you must take a fair amount of it. If is, do you know what your dose is right now,

Nicole 10:58
100 microgram. Okay, all right, that makes sense. And I take that once a day, every day, except on Sundays. Now I take two pills.

Scott Benner 11:08
Oh, you got a good Endo. Well, oh yeah, you figured this out on your own. How did this go?

Nicole 11:15
I love my Endo, but I was really, really feeling fatigue recently, within the last three to four months, and I have been listening to the podcast, of course, and listening to you talk about your wife and your daughter, and how the range acceptable is, you know, from here to there, but sometimes you need to be north of the middle, etc. So I was like, I'm doing all the things I'm working out almost every day. I'm having a calorie deficit. Yes, by this time, I am using insulin full time. But something else is wrong. It can't be anything else but my thyroid. So we had a little exchange, and she wasn't willing, but then she upped my they had a cancelation in the office. She was able to bring me in. So I went and I met with her, and she said, Well, you know what? If you think it would help, I don't think it's going to you can take an extra half a pill. So that's how I got to having two pills on one day,

Scott Benner 12:17
once a week. Yeah, there's a lot of different ways to if you're a person, for example, who has trouble remembering your men. Remembering your medication. There are some doctors who will tell you to take seven days worth of it on one day, oh, and then just do it once a week. I mean, I definitely talk to your doctor about that first, but I've heard, I've heard people adjust or mess with how that medication goes in a number of different ways. So, but that's awesome, because, you know, I think my wife is on a schedule where she doesn't take it, like, literally, like one day a month or something. I've seen other schedules for Arden where she takes a second pill twice a month, like every two weeks. The doctors who know how to to dose that medication, the ones who really know her are impressive with it. So that's awesome. Yeah, so that helped, that little extra half a pill changed your the way you were feeling. It did awesome. Think how easy everybody it did, just timing an amount, right? Everything to some degree or not. Okay, so you have your thyroid. You're working that out. At what point do they tell you you have type two diabetes. In this process, I

Nicole 13:22
finished chemo in April. I went for my last scan. So about a month out from your last chemo, they wait for everything to settle. So in May, which is right after my last I went for my pet scan. I think I had a PET scan. They took my blood, they ran my labs, and my blood sugar was 424

Scott Benner 13:47
Ah, that's too high.

Nicole 13:51
And I'm like, what? Yeah, how's

Scott Benner 13:52
that happening? You said you're active, right? You're exercising. You stay in a calorie deficit at times, like you're doing all the things, yes, yeah, and did they just say type two right away? Or how does that process go? You can manage diabetes confidently with the powerfully simple Dexcom g7 dexcom.com/juicebox the Dexcom g7 is the CGM that my daughter is wearing. The g7 is a simple CGM system that delivers real time glucose numbers to your smartphone or smart watch. The g7 is made for all types of diabetes, type one and type two, but also people experiencing gestational diabetes. The Dexcom g7 can help you spend more time in range, which is proven to lower a 1c The more time you spend in range, the better and healthier you feel. And with the Dexcom clarity app, you can track your glucose trends, and the app will also provide you with a projected a 1c in as little as two weeks. If you're looking for clarity around your diabetes, you're looking for Dexcom, dexcom.com/ Juicebox. When you use my link, you're supporting the podcast dexcom.com/juicebox, head over there. Now let's talk about the tandem Moby insulin pump from today's sponsor tandem diabetes care, their newest algorithm control iq plus technology and the new tandem Moby pump offer you unique opportunities to have better control. It's the only system with auto Bolus that helps with missed meals and preventing hyperglycemia, the only system with a dedicated sleep setting, and the only system with off or on body wear options. Tandemobi gives you more discretion, freedom and options for how to manage your diabetes. This is their best algorithm ever, and they'd like you to check it out at tandem diabetes.com/juicebox when you get to my link, you're going to see integrations with Dexcom sensors and a ton of other information that's going to help you learn about tandems. Tiny pump that's big on control tandem diabetes.com/juicebox the tandem Moby system is available for people ages two and up who want an automated delivery system to help them sleep better wake up in range and address high blood sugars with auto Bolus.

Nicole 16:14
Unfortunately, yeah. Okay, so my primary care physician, yeah. Well, you know, looked at my history. I hadn't had any problem. My a 1c was in the normal range for the last few years. It's possibly, you know, type two. She gave me a prescription for Metformin. Off I went. Hopefully it'll resolve itself once you once the chemo gets out of your system, and by June, so like a month later, in that month, I was noticing my blood sugars really were not going down. I do believe I had a no I was doing finger stick at that time, I would check my blood sugars. I believe three times a day when I would get up, and then maybe before each meal. So I remember going to Aruba, and it just was not working. So I went in on the portal to the doctor's office, and I don't remember she might have been out of the office, but they connected me with a different position in the practice, and he put me, he gave me extra. So this must have been right before I went to Aruba. So he put me on glamempod. And I don't remember what the dosage was or if I was supposed to take it once or twice, but along the way, they were increasing the Metformin. It wasn't helping. So when I got back from Aruba, I went into the office. I don't remember a lot of anything coming out of that. But by July 16, I told my mother. I said, Mom, if my blood sugar does not come down, I'm going to the emergency

Scott Benner 17:51
room because you needed a different doctor, or because you thought you were medically in trouble.

Nicole 17:56
I just felt like something else needed to be done because the Metformin wasn't working and the other medication wasn't working, something was wrong, and it needed to be addressed. Nicole,

Scott Benner 18:08
our AI overlords say that a 400 blood sugar, even with chemotherapy, is likely diabetes, not a result of chemotherapy. Apparently, the the the level of your blood sugar. Should have told them that maybe it's not as easy as like this is going to go away, maybe when, when your chemo is done. Yeah, it's interesting. And And how long were you on the the oral Med and not seeing any relief from it? When? What were they telling you during it?

Nicole 18:37
Probably a month. Okay, at one point it increased, and I want to say I didn't like the increase because it was taking my appetite.

Scott Benner 18:47
Oh, okay, and that's, is that already an issue with chemo?

Nicole 18:51
I think that's an issue with metformin, because I was finished with chemo by then

Scott Benner 18:56
I got you Okay, did you experience it with chemo, the not being

Nicole 19:00
able to eat. Oh yes, yeah, yes.

Scott Benner 19:03
Is that because of nausea or just because of lack of hunger or a combination, a combination combination? Okay, so you're on this for a month. They up it. It takes away your desire to eat, which is terrible. But those blood sugars are not moving,

Nicole 19:18
not very much, they would, you know, go down to something, go up to three, something, you know, back and forth.

Scott Benner 19:26
I gotcha, okay, so you told your mom that. Then what ended up happening,

Nicole 19:30
I checked myself in, and they did like an EKG. They took my vitals after a while, they took me back, they put me on like a hydration. What does that cost? IV and an IV with the bag. So then they kept doing finger sticks, and think they took blood. So hourly, they would come in and check on me, and it was late. And then I believe I had the on call endocrinologist to come in and say, well. We check, then you have one of the well, basically that you have type one because you have one of the

Scott Benner 20:07
antibodies they said you had. We checked and you had an antibody and positive that looks like type

Nicole 20:12
one. Okay, yes, well, that means you're going to have to take insulin.

Scott Benner 20:17
Okay, so I'm going to keep asking this question along the way. How does that hit you? You didn't want to take a pill, and you're doing that under protest. So what happens when somebody tells you insulin? You've probably heard me talk about us Med and how simple it is to reorder with us med using their email system. But did you know that if you don't see the email and you're set up for this, you have to set it up. They don't just randomly call you, but I'm set up to be called if I don't respond to the email, because I don't trust myself 100% so one time I didn't respond to the email, and the phone rings the house. It's like, ring. You know how it works? And I picked it up. I was like, hello, and it was just the recording was like, US med doesn't actually sound like that, but you know what I'm saying. It said, Hey, you're I don't remember exactly what it says, but it's basically like, Hey, your orders ready? You want us to send it? Push this button if you want us to send it, or if you'd like to wait. I think it lets you put it off, like, a couple of weeks, or push this button for that. That's pretty much it. I push the button to send it, and a few days later, box right at my door. That's it. Us. Med, Comm, slash, Juicebox, or call 888-721-1514, get your free benefits. Check now and get started with us. Med, Dexcom, Omnipod, tandem freestyle, they've got all your favorites, even that new islet pump, check them out now at us, med.com/juicebox, or by calling 88872115, 888-721-1514, there are links in the show notes of your podcast player and links at Juicebox podcast.com to us, med and all the sponsors.

Nicole 21:50
I don't know what that meant to me in the time and space me being in the hospital. I'm not sure that it really registered, but I do remember him, you know, like, I can't remember if I was in my room by then, they fully got me a room, or if I was still down in the ER in the cubicles. But he explained about the insulin pens and the long acting and the short acting, and that I would have to get an appointment with an endocrinologist in a couple weeks, and I think he helped to get me in quicker with one of the endos. But, yeah, no, I was resistant.

Scott Benner 22:30
Did you have that feeling of like, no, it's, I could probably manage it with this Metformin. You just didn't give me enough of it yet. Were you resolved and understood it wasn't type two? Yes, okay, but resistant in the idea that, like that this is going to be your process. So then, like, explain to me, then what the next couple of days and weeks look like when that's your feeling you're leaving the I mean, you're a grown person, you know what? I mean, like you're You're not going home. I mean, maybe you'll call your mom to check in, but like, You're not going home to a to an adult who oversees you, who's going to help, right? It's on you. Are you married? I'm sorry. I don't even

Nicole 23:05
know. I am not. I have a 17 year old son, and my mom have, you know, small family, but a host of friends took really good care of me, all of them very nice while I was ill and going through so I was kept in the hospital for two nights because I was in, I'd say a mild DKA, but they hydrated me, test, test, test, something came back odd with my heart, and the cardiologist wanted put me on something I'm like, I'm not taking that. There's nothing wrong with my heart. They then did a stress test, and all that came back fine. This is

Scott Benner 23:47
all in the course of how much time, a year and a half, maybe, like from the beginning of the lump to this moment,

Nicole 23:53
almost a year, maybe nine months. A lot happening in your life. I did chemo, was six months, and then right after that, the thyroid, right after that, the

Scott Benner 24:05
diabetes, right? And you're raising a 17 year old at the same time.

Nicole 24:09
Yeah, he's 17. Now, he was 15. Then, oh, gosh,

Scott Benner 24:12
that's a that's an age, right? There, he's looking for you, right? So, yes, so you have that pressure as well. Your mom, yes, live with you. Helps you with that?

Nicole 24:21
No, she lives nearby, but she did move in for a few weeks.

Scott Benner 24:24
Yeah, I bet I would have moved How old are you now? I am 55 Yeah, I still would have moved in. I would have been like, guess what? I'm going to hobble my over there and sit that house for a while with you. Oh my gosh. Did you guys ever talk about it you and your mom quietly about which part, just that your health was, you know, going to be the main focus for a while, and that you were going to need assistance with raising your son and and probably, you know, taking care of the, you know, life in general. Did she like? Did you ask her to come or did she offer herself? I guess I

Nicole 24:59
would say she. She did both. At first, she was like, Well, how can I help? What do you want me to do? You know, I can get all my things. I can come over. We can stay, you know, and it just That's my best friend, you know?

Scott Benner 25:11
Yeah, that's awesome. That's really great. Any point during this first year, are you thinking about your own mortality, or you are locked pretty much in on I'm fighting. I'm winning.

Nicole 25:22
I think that I never, you know, you think about it, sure, but it wasn't like I'm going, I'm fighting this. I'm riding continuously and still to the wheels follow. So I do what I think I need to do. I'm prayerful. I'm, you know, I try still to be healthy. And what I fought Scott was the pump.

Scott Benner 25:45
Really, yes, okay. So somebody said, Hey, an insulin pump might be the way to go. And you were like, This is my line. I'm not going farther than this.

Nicole 25:55
It was kind of that. So, June 16, 17th or so, I was in a hospital. I probably got my indoor appointment at the beginning of August. They also set me up with a really great diabetes educator. They had a Diabetes Center at the hospital close to me, so I had support. But you probably know how it is I'm drinking from the fire hose, and all I want is information. So I get on the internet, I'm like, I'm on Facebook. You know, there's got to be some groups. I need some education. I'm googling everything. They're telling me these things, and I just information comforts me. So that's how I found the podcast, and it's been immensely helpful, but I did not want to pump. I got the CGM. I was on the g7 to begin with, and diabetes office, my endocrinologist office, she had a pharmacist who could work with people longer than she could, so she and I would talk periodically, like when I would have my appointments, they could be for 30 minutes. 45 minutes, they could be an hour. And she was just educating me and listening to how I eat, and, you know, how I was processing, and how I was doing with the MDI and all of that. And a couple of times she would say, I think you should get on a pump and you have to carry this little controller, and I'm like, I'm not carrying two phones, and I don't want to wear two devices. And I cried and cried, and I said, You know what? I got to do it because I'm not managing well on my own.

Scott Benner 27:32
What do you think the resistance is? Is it looking for control, or is it not wanting to be controlled by something? Or do you have any hindsight on the not wanting the pump, feeling,

Nicole 27:44
probably thinking I could do it myself, the pump made it so much easier. So you know how you're kind of kicking yourself for not doing it sooner. But the process, your process is yours. Yeah,

Scott Benner 27:57
no, for sure, it takes a little while to get through it. What got you through it was it time? Was it seeing other people the counsel of the person that was helping you, like, what got you over the hump?

Nicole 28:07
I think it was that I couldn't manage it myself and be within range. I was always high and, you know, I was documenting everything. All my meals go in an app, and I would look at the carb ratio, and I would give my lighting scale, whatever that was at the time, and it would do what it did, and then I would report back. So they just found me to be very meticulous with my health and my eating. And just thought I would be a good candidate for the the omnipot Five, because also I'm still active, so tubeless was the way for me. But I think the education and just realizing I need some additional help,

Scott Benner 28:49
yeah, I remember you popping up in the group in the beginning, and I think it's something to do with, like, you have, like a hyphenated or, like a three name, name. I don't know if something stick to my head differently. I don't know why. I don't know why. Anyway, I remember you were, you were just voracious for information, like always, like if I was there, like if I popped up, you were there absolutely and you had a question, and I saw you interacting with people and asking questions and talking back, and you used that space, I think exactly the way people should use it would. Is it fair to say that it propelled you through fast forwarded you through the process. I

Nicole 29:24
think it did. It was exactly what I needed in perfect time.

Scott Benner 29:28
Good, good. I'm glad, and I'm glad that you found a way to the pump so but talk for a minute about what struggling looked like. Were you honeymooning at that time when you were struggling an MDI, or was it just your lack of understanding? Like, what do you attribute that time of struggle to?

Nicole 29:44
I doubt that I was hunting Mooney, like I said. I think the pancreas just gave up the ghost, yeah, and then so they were running around. You're such a brittle diabetic. No, you don't understand, and I don't understand, but we're gonna get to

Scott Benner 29:58
it. The endo called you that. Yeah. Yeah, okay,

Nicole 30:01
yeah. You know, listening to a lot of what you were saying on your podcast and whatnot, it's not that you're brittle, it's just that you don't have the knowledge, you don't understand, perhaps the timing and the ratios, and we were getting all of that under control. So one time, I was like, Hey, I'm not brittle. She stopped saying that. You got her to stop, yes, yeah, on her own. Like, hey, stop saying that. Yeah.

Scott Benner 30:30
It's such a shame, because, I mean, obviously I think what you just said, but timing and amount is so much of insulin use, and just thoughtfully putting insulin in the right place is understanding the different impacts of different foods. And you know, if you have those levers pulled, you know, slightly wrong, you're not your knobs dialed a little incorrectly. Everything seems like it's happening for reasons you can't wrap your head around like so much so that it's a joke throughout the diabetes community, right? I can do the same thing today that I did yesterday, and I get a different outcome, except the same thing didn't happen. You're just not seeing what's different. And once you can step back far enough to see the differences, whether just be I injected my slow acting insulin in my thigh yesterday and today I put it in my stomach, or I'm on the third day of a insulin pump infusion set versus a fifth day, or a second day or the first day. Like something there is something different. Are my hormones different, right? Is my sleep different last night? Do I have more adrenaline happening? Like, there are a ton of variables. And yet, the way people will kind of colloquially talk about it. It's like, Oh, I did the same thing and, you know, blah blah, I ate the same foods and the same thing. I'm like, No, it's not the same. You just, you're not seeing it. But to leap over all of that, as a physician, to leap over all of that, and then just look at somebody go, you're brittle. I mean, it's a give up on their part. I think they're saying, like, I don't know how to help you. You're just, you're brittle. The word is incredibly insulting, just in general, I would think, takes away a lot of your confidence. I mean, imagine if someone called you brittle. Forget diabetes for any reason. You're at work, and you say something and someone goes, Oh, you're brittle. You know, like, how you supposed to rebound from that exactly? Yeah, but you knew not to take that seriously, because of the conversations and listening to the podcast, yes, that's awesome. That's really great. Makes me happy. Awesome. So okay, so she stopped saying brittle, and what happened next?

Nicole 32:32
So, you know, I have to be honest, it's been two years that I've been type one and had to use insulin. I'm still getting an understanding, but it comes in waves. I got the pump in October of 23 Yeah, it's wearing two devices. But, like, I'm so grateful that the technology is here and different than what it was 10 years ago, 20 years ago. Not that I have it so easy, but technology is my friend, and I'm I'm grateful for all the of the all of the advances that they have made to help us to live a normal and healthy and productive

Scott Benner 33:14
life. Yeah, no kidding. I mean it this industry. You know, you hear people complain sometimes like, oh, you know, they're making money off of my off of my illness, and I take your point, but at least they're making the stuff. I mean, the alternative. You don't want to think about the alternative if there, if there wasn't money in this, no, these companies wouldn't exist. And everybody be running around still, you know, with a meter and, you know, some needles and hoping for the best. And you do those interviews with those older folks that have lived through that and that didn't end well for people most of the time. So yeah, this is, this is an awesome time. Also, I want to ask you, maybe I'm, of course, I'm inferring from having spoken to you for a very short amount of time and just watching you online, but you strike me as a bright, thoughtful person who is never going to feel like enough information is enough. And at the same time, I imagine you as a person who is, I don't want to say hard on themselves about outcomes, but I think you have high expectation, I guess, for yourself. Is that fair?

Nicole 34:14
Okay, it's true. You are psychic. I do have high expectations for myself, because between the diabetes educator and my endo and the pharmacist, you're doing a really good job. Well, no, I'm not, and I could be doing better. And I want a better a, 1c and I want a better time and range now, my time and range now is pretty good. It's maybe 85% I'm trying to dial all of it in. And so, you know, with the variables with driving to work in Chicago, rush hour traffic like I just heard you say, or I just saw you say to someone in your post Pre-Bolus, for the adrenaline, what can. Thank you, Scott.

Scott Benner 35:02
Oh, that was today. Somebody asked about, yeah, hour ago, how do I handle my kid going off to school? I'm seeing, like, adrenaline spikes. And I was, I was like, I would first make sure, you know what's gonna happen, and then I'd Pre-Bolus for the adrenaline. And that's how I did it with Arden, when she, you know, was in high school, and she would get, I think, I don't know, nervous or whatever. On our way to school, we were bolusing. I used to drive hard in the morning. Like, the last thing I would say to her, probably, when we left the house, is like, okay, like, it's time to like Bolus for the day, and she'd have to give herself insulin for whatever that rise was coming. So

Nicole 35:35
sometimes I creep when I'm getting dressed. I'm like, What is this? Yes, you're

Scott Benner 35:39
not wanting to go to work. Probably Wow, or thinking about life or whatever in the back of your head. But I do want to go back just briefly. I don't do this enough anymore, where I get smug for a second, but I only know Nicole from like her posts on Facebook and maybe 20 minutes that I spoke to her in another recording that you guys probably have heard already by now. If I tell you online, You're crazy. You're crazy. If I tell you you're something. Just trust me, I'm good at this. I'm very good at seeing people. I don't know if I see myself well, but I see other people really well. You strike me as a go getter. You strike me as a person who wins usually at things they try to do, does not give up easily, and someone who's gonna take an 85% time and range and wonder how this could be a little better, but without and again, you stop me if I'm wrong, but I don't see you as a person who beats yourself up about it. I just see you as a information in, information out, person.

Nicole 36:33
I would agree. I would agree. And I think you're a good judge of character. I see it. You know, periodically, when I see something for your post. I'm like, Okay, so who went bananas in the group? It doesn't matter, but listen to what's guys saying here, and stop it.

Scott Benner 36:48
I'm not, nowhere near perfect, but I am a good parental figure. Like, I don't know, like, how that worked out for me Exactly. Like, again, I'm, I'm, I've 1000 things I could do differently or better, but when I'm assessing other people, I'm incredibly accurate. Usually, I don't know where that comes from. I don't even know if I want to call it a gift. It just it comes in very handy with the job I have. I guess it

Nicole 37:13
does. And I just want to say thank you for just saying that. I appreciate that.

Scott Benner 37:17
Oh, of course, Nicole, as well as the person could who has never met you and only sees you through internet writings, I feel like I see you. You give me a lot of hope when I'm doing what I'm doing, because you are a person who I see show up and say, I can figure this out like I know the answers are here. I will mine them out myself and put them into practice, because that's the last step of this that I can't do for people. Yes, you know this is true. I had a conversation, a business conversation, this morning. I don't know if it's gonna work out. I feel like it might. I don't wanna use any names yet, but there's this company that is, they're basically offering like direction for children, for a lot of different things, but diabetes is one of the things they're doing, and they've kind of gamified it a little bit, right? Like the information that they want people to have. You know, what would your endo want you to know? But they don't have time to tell you, like, that kind of stuff. But how do you actually get people interested in it? And how do you get the kids to listen to it? How do you get the parents to listen to it? So this company has set up this situation where you get a like, you should get a backpack and a Chromebook, and the Chromebook is locked down, and it has this, this gaming system on it, and the kids need tokens to play the game. And they get the tokens when their parents complete training stuff. So it's set up so the kids will bug the parents to go do the thing they're supposed to do, so they can get the tokens to play the game. And when you stop and really look at it, it's a it's somebody saying, we know that there's information people need, but it's hard to get them to go get it. And how do we get them interested in it. And, you know, parents are busy and they're tired and they don't have time, and that's probably how a lot of these balls get dropped. But what if the kid was coming to them constantly and saying, like, Look, you just have to watch this 15 minute thing, or listen to this 10 minute thing, and I'll get another 1000 tokens that I can keep playing with. And then the playing is also informative for the kid, and if it works, it'll, you know, I mean, they already, they've tested with it. They see it works. When I say works, it's, how do you get it into a lot of people's hands, right? Like, that's always the problem with everything. They wanted to know if they could start off by putting, like, the small sips, episodes of the podcast in there. And I was like, awesome, because this is my biggest problem too, right? Like, you know, how do you get people to do what's best for them? Yeah, that's really hard, and not just around diabetes, around everything. And anyway, you're a person who I feel like is out there trying to do that for yourself. And. In a world where I can only take everybody's I can only lead the horse so far towards the water, right? It can get frustrating for me at times, just like I imagine for the people who made that game. They must have been frustrated at some point and thought, how do we get these people to take these last two steps anyway? When I see people doing that, it makes my efforts feel valuable. You taking care of yourself helps me to continue to do this thing. I don't know if that's obvious or not, but, like, it's very valuable for me too, and I really

Nicole 40:28
appreciate it. That is awesome. Yeah. Well, good luck with that.

Scott Benner 40:32
Thank you. Well, just in general, too, a side of the game, like just making the content for the podcast, keeping up with the Facebook group, coming up with different ways to say things, trying to keep up with how people want their content, having to go out in the world and do trips and business things like I just got done, you know, doing like, three different trips in like six weeks. And, you know, I got home yesterday and I was just telling, like, we just put our bags away, you know. And I got a call yesterday, and the person says, Hey, I'd like to team up with you for ADA, friends for life. And what is it? Ad CES, the Diabetes Educators Conference all next year, and I found myself putting it on my calendar. I was like, oh, no, I just got my bag put away. Like, you know, you're making me think about this again. I think that's what needs to be done if you're going to reach people. And anyway, so that's what I do, and I need that energy from somewhere, because I am trapped in this room. You know, most of the time so well I don't sometimes get the feedback I need to motivates the wrong word, but like, power myself, I guess. And anyway, thank you. It means a lot to me.

Nicole 41:40
You're welcome. I know you can't hear me nodding my head, but hopefully you can hear me smiling, and I'm very encouraged by the things that you've got going on for you. Thank you.

Scott Benner 41:50
Thank you. I really welcome. I feel good about the thing I decided to do with my life, you know, as an adult, and I would like very much, I want to finish up with this. I don't want to look back and say, Oh, I used to do a podcast. I'd like to, like to do this for as long as is, it's valuable for people. So it is, yeah, it is. It's really awesome. Thank you. Well, okay, so where are you at? And we, I think we understand where you're at with your diabetes. Sounds like you're doing well and you're still learning, but how does the cancer thing go? I asked a question earlier. I don't know that you answered me like, did you have to have your breast removed? Or is it? How did that work?

Nicole 42:24
So yes, I finished chemo, and then I had some things happen, and I decided to do a double mastectomy. So after that PET scan that I had, I think they said it everything looked like it resolved, but then there was something in the other breast, and I was like, nope, not doing it. Take them both. Yeah, we're not doing this again. There's no more. Yeah, I don't have anything else to give. So you

Scott Benner 42:51
don't regret, you don't regret that decision. I imagine, not at all. Okay, how long ago was that?

Nicole 42:56
At least, that was August 16 of 2023 that is my anniversary of being cancer free, so I'm a few days away from that today. Oh,

Scott Benner 43:06
congratulations. That's lovely. Thank you. Yeah, I was worried a little when we started talking today, when I heard your Chicago accent, actually, more than anything, because I just had my experience with cancer is limited to my mom, my family and I were on vacation last week, and we're returning home on a late night flight. We were out on the West Coast, and this older woman, I'm gonna guess, in her late 70s, is with her adult daughter, and the daughter's taking the mom to the restroom on the plane. And the mom's like, you know, she's struggling down the aisle. The daughter's behind her, like, half apologizing to everybody, half hoping her mom doesn't fall and it just strikes me that when my mom got her okay to move after her chemo and she wanted to move out with my brother in Wisconsin, we couldn't figure out how to get her there. She couldn't do the car ride. It was too long. We were very afraid of a plane because of this situation. And my mom and I ended up taking a train, an overnight train, from New Jersey to Chicago, where my brother then picked her up and took her the last bit of the way. That's awesome, you know, we're on the train that night, and we and she got hungry, and we had to make it two train cars to the car where the food was. And that walk was so difficult and reminded me so much of the woman going down the aisle. And it took me to that place in my mind, but I did a good job with it. I was like, I was okay. And then I could hear the woman behind me talking through the door of the bathroom, Mom, are you okay? Yeah. And then I started getting really upset. Oh, my wife is across the aisle from me, and she and we're a very light hearted group of people. And my wife looks over and goes, Are you crying? Oh, and I was like, Yes. And I was like, just give me a minute. Cut me a break, but something had happened just before that, and she thought, she's like, is this dumb? Crying about that? Like, you know what I mean, and, and so I'm like, give me a second. I was like, trying to collect myself, and I told her, you know, I kind of told her, I said, that lady, she just reminded me of being on the train with my mom, walking to dinner, and she's like, and that made you cry? And I said, No. I said, What made me cry is I realized that sitting on that stupid train is the last time I ever sat and had a meal with my mom that and it just like it snowballed like that. And the amount of times that that my mom's cancer experience has made me remember something emotional. Made me want to ask you, how is it getting back to life, or does it pop into your head? A lot? That was actually my question. I told you all that to ask you that question, I

Nicole 45:51
don't think about it a whole lot, except for when it's time to be with my oncologist or have a scan, a CT scan, and the other thing that I want to say is I mentioned that I went into DKA in July of 2023 Yeah. And so I was finished with my treatments, and so surgery was scheduled for August of 2023 since I was diabetic, most people have their mastectomy, and then they go either direct to implants or they start the reconstructive process then. But because I was recently in DKA and they didn't know how I and my body would handle the diabetes and healing, I was not able to have immediate reconstruction. Oh, okay, I felt horrible, because the plastic surgeon is the one who had to tell me, and I just Boo hooed in the office. And I was like, Are you kidding me? So I had a six month delay, and there are a lot of people who choose to not have reconstruction, so they have their mastectomy, and they stay flat. They may or may not wear prosthetics. Have the form of having breasts, but

Scott Benner 47:15
I'm so old that the word falsies popped into my head. That was ridiculous,

Nicole 47:19
but Scott, I'm older than you.

Scott Benner 47:23
Were you fighting around that word too when you were looking No,

Nicole 47:29
but I did that too, so you never know how you're going to deal with something until it presents itself. Yeah, and then you have a choice to make. The choice is, are you gonna sink or are you going to swim? And how you swim depends on you?

Scott Benner 47:50
Yeah, no, I agree with you. I really do. I think some people have sometimes, you know, implications that that stop them from being positive. But for the rest of us, like I do think you go where you point yourself, usually, there's a lot of value in not giving up and waking up every day fresh, making a good decision, following through, doing it again. What did you end up doing? Did you get reconstruction or implants?

Nicole 48:16
I did six months later. So I was flat for six months, and then in February, I got started the reconstruction process. So they put these expanders, they're like flat implants, and then they put saline in to them every every week or every other week to expand the tissues again, because they take all the tissue and the breast tissue right, and the skin is what I'm trying to say. They take all of that

Scott Benner 48:47
that skin's right on your breast bone when that starts right, and then it has to just expand to make space Correct. Okay, my question here is, it might seem like a tiny bit of a pivot, but you have such unique knowledge from like, taking the health out of it aside, but just from a, like, a feminine perspective, sexuality, etc, like, what was your findings living one way, and then, you know, having lived naturally, having lived before, the reconstruction, having lived afterwards. Is there lessons in there that that are worth sharing.

Nicole 49:20
I'm not certain. In some regards, I'm very matter of fact, kind of it is what it is. Did I like being flat? No, but it was a means to an end, and I got through it. So I felt like I wanted to have the prosthetics so that I could have that femininity. And I'm not, you know, if people ask, I tell them my story, because it can help someone else. There are people around me, family members of friends, who are going through it, have been through it, so we all try to share and encourage one another. Yeah, and I think that's important, because if you're scared, you're looking for resources to be re. Structured, and if I can provide that to someone I want to. But

Scott Benner 50:04
you were aware? You keep saying flat it strikes me oddly, but it's your word, so I'm gonna go with it. So with that flat time, were you aware, dressed, going out in the morning, like, did it strike you like, I wish this isn't how I looked? Or did it make you feel any sort of a way? Did you feel like people noticed or that somebody wouldn't be I don't even know if this matters, but somebody wouldn't feel the same way about you when they saw you. I'm really interested in how that, how that made you feel.

Nicole 50:31
I didn't want to go out without anything. I didn't go outside flat. Okay? My insurance, I have some pretty decent insurance, and they had a contract with Nordstrom. And so you go to Nordstrom and you get it fitted for your prosthetic, okay? And so they get you bras and try on a couple of sizes, and you like what you like, and then they send that home, and then they make a pocket with the bras, for the prosthesis to go in there. So, you know, it's a few weeks deal. I took the time to do that. Some people are okay without. I think that's part of who I am as a woman. So, yeah, I was, it was important for me to have that in the gap. My

Scott Benner 51:17
last question is, did you do the tattoo for the nipple, or was that not necessary? Or did you opt out of it? I

Nicole 51:23
have not done anything yet. It's been a full year since I got my implants, and so I'm, I guess, waiting for the scars to fade a little bit more. But I want to do the tattoo. I don't want to do the reconstructed

Scott Benner 51:38
nipples. Okay? And will that be covered by insurance?

Nicole 51:41
Technically, no, yes, and no, it has to be a certain amount, and it by the time you pay for it, they're gonna pay so little, but everything else was covered,

Scott Benner 51:52
right? Well, that's something. How long do you think until you do that?

Nicole 51:56
I don't know. I'm not in a rush. It's not a big deal.

Scott Benner 51:59
Gotcha. Okay, that's actually next year though. I got you so you're not in a rush, but you're doing it. Yeah? I'm gonna do it absolutely. Yeah. Well, I appreciate you sharing that. That's just not information a lot of people have to share. So I appreciate that. Is there anything that we haven't talked about that we should have?

Nicole 52:15
I don't think so. I just it was a wacky way to get to where I am. There has been I asked you, early on, had you heard of anyone else who had a similar situation to mine, and you didn't remember someone else, one of the group experts might have been Nico or Sylvia, came in and said, Well, yeah, and I listened to an episode that you recorded with another woman with a similar story, and while it is not prevalent, we are out there. Yeah, you know, I'm fortunate. I guess the medications help so many things. So what's the what's the takeaway your life, or diabetes?

Scott Benner 52:58
In retrospect, now, if somebody would have said, You look, here's the medication, you're gonna have. Medication you're gonna have to take for the cancer. It's gonna give you type one diabetes, but you're gonna be alive, you would immediately say, Oh, okay. Like, yeah, let's do that. But as it's happening to you, slowly, it feels like it's happening to you right, like this went wrong, and then this went wrong, and this went wrong, and then this one, I mean, you had four things go wrong in pretty short order, as far as I can tell, like you got cancer, you you know, chemo that probably destroyed your thyroid function, then somebody tells you have type two diabetes? No, no, it's not type two diabetes. It's type one diabetes. That's four things, pretty, pretty rapid fire happening to you, absolutely. Yeah, yeah, aside of all the other stuff that we're not talking about, which is you have a job and a child and things you enjoy doing that probably got ignored for a long time while you were were making your way through this and just generally feeling terrible. You know, people don't talk about it very much, but like chemo did. Did you get the bone pain from the chemo?

Nicole 53:56
No, no, I did not. They give you a couple of things like this 24 hour patch or something. I think it's called New last. And there's things that they give you to take so that you won't perhaps be plagued by it. But I didn't have a whole lot of

Scott Benner 54:15
that. Did you get that, that follow up medication after chemo that comes in an Omnipod?

Nicole 54:19
Yes, I think that's what the new last Yeah, right. I remember my

Scott Benner 54:24
mom called me. She's like, I'm wearing a pod, just like, Arden. I was like,

Nicole 54:28
All right, I don't remember it being as big, but it might have been, yeah,

Scott Benner 54:32
it's made by insulin. I don't know that it's the exact Yeah, that's an insult. That's the other thing they make, actually, is, is for that medication, that's a delivery system. Did you get restless leg syndrome? No, no, that's great. It's great that it worked well for you. Like that. My mom probably had restless leg before, but it got significantly worse

Nicole 54:52
afterwards. And I didn't have much. I didn't really have any neuropathy. Sometimes I have in my right arm, like. My index finger and my thumb, I have a little tingling, but I haven't like determined what that is. I don't have any other after effects other than creaky joints, but I say some of that is age, and my chiropractor and my acupuncture doctor have helped tremendously, and I'm feeling a whole lot better lately.

Scott Benner 55:23
It's awesome. Hey, listen, we didn't I didn't ask you, we? I almost said we, like, there's a group of people over here that failed to ask this question, but the chameleons, I didn't ask you. Is there any autoimmune in your family? Or do you think this is all generated by the chemotherapy?

Nicole 55:37
I personally think it's generated by the chemo. My great grandmother, my mother, remembers a little something with her blood sugar dropping when she was older. They had moved her here to Chicago, so it was maybe, you know, maybe the end of her life. I'm not sure how old she was, but they remember that her shaking and having to have something sweet, but they don't recall, like, being a full on diabetic, and she was elderly, so hard to know. I don't know if it was really

Scott Benner 56:08
diabetes, other thyroid with people in your family, no. So just uh, some bad luck. Then, okay, yay, yay. Bad luck. Your story is makes me feel good, because the way you're talking about it, the attitude that you bring to it, the effort that you put into it, it makes me feel like other people could do that as well. And that's what I need here on my end, is I need the hope that people are out there fighting for themselves the way you are.

Nicole 56:35
I think that they are. I think fear is a is a motivator, good and bad. Some people let fear stop them from moving forward, and some people take it as motivation to move forward.

Scott Benner 56:48
Yeah, I think it's an interesting position to be in the one I'm in, where I don't know who I'm talking to when I'm speaking. I feel like it's very important to say I know that everybody doesn't respond the same way to something at the same time, I don't think that it helps anybody not to say what you just said, which is, you know, sometimes people are faced with something and they rise up, and sometimes they don't, but if there's a pathway to rising up, I think we should share it with everybody so that as many people as possible can take advantage of the idea that you don't have to give up and give in. You don't have to take the first thing it said to you, you're not brittle because somebody told you you were, and everything else in between. It's important to keep educating yourself and keep demanding help, not letting people just draw a line on a piece of paper and go, Okay, we will. We give up on this one because they're, I mean, brittle is the one that's sticking out from my, you know, from your conversation. I mean, you could have heard that and crumbled and just stayed there. Can you imagine you'd be living right now with your blood sugar bouncing all over the place like it was, like, still, yeah, that could have happened. It, because it does happen to people. It could have happened to you. So anyway, I want everybody to take, take Nicole's energy and go throw it at whatever is trying to get you today. Absolutely. Yeah. Where do you think you got that from? Is it? Do you think it's upbringing, just how you're wired? Do you have any idea? Did you go through something hard that taught you how to be hard back?

Nicole 58:12
No, my mom, my dad, and some religious upbringing, but yeah, it's been

Scott Benner 58:19
good. Just kind of how you react. So you react to other things the same way I do. You do. Okay,

Nicole 58:25
all right, this is awesome. I've heard that one thing that you said, it was something about you. You come out a winner most times,

Scott Benner 58:34
yes, yes, I have said that. But it's different when you hear somebody say it back to you, though

Nicole 58:41
you might say it in a slightly different way, but first time I heard somebody say that, I was like, that's not true. You don't know what you're talking about. You do too, and so it's not a bad thing, but I'm very grateful for it. Yeah,

Scott Benner 58:53
I really do believe that when I try, most times, things go pretty well. You can philosophize about it and go deeper and say, I think I'm making reasonably good decisions along the way, and that's why things are going well. But I also think that just doing things, you know, moving forward is success, and it can be easy to look at the things that went wrong along the way and say, everything's out to get me. I can't win like, you know, whatever would come with that. And I have plenty of those things, if I chose to focus on them right now, and listed a ton of my failures for you, you could easily make the case that, like, look, this guy just fails at everything, but, like, it's not the case. And I think it's as simple as that. When I was growing up, I know we don't think of people making money as successful anymore. Everybody's mad at everybody who has, you know, made a million dollars. But when I was growing up, like, that was the that's the line, that was the Mendoza line, like, if I'm gonna win in life, I have to make a million dollars. Like, that's I was poor, and that's how it occurred to me. And I heard somebody say one time that they, I think they started three businesses and bankrupted each. One of them before they made a success, and now they made a million dollars. This is back in the 80s. And I was like, oh, like, so the person tried something and failed, and didn't just go, Okay, I'm a failure. They tried it again. It went bad again and again. It went bad a third time, and they still kept fighting and and that struck me back then, even as, like an early person in my early 20s, like the failures, just data in right and even the trying is moving forward. Even if you try and fail and try and fail, you still learn something along the way. Absolutely, yeah, 20 years later, I watched one of my kids, you know, working out for all star baseball or softball. I forget which team it was. And every year the kids would get these practice shirts because they practiced every day. So they get, they give them all these T shirts to practice in, so that you can keep them laundered, and they get a saying on the back of them. And I think one year it was, we never lose, we either try and we win or we fail and we learn, or something like that. It was, like, this long saying on the everyone else's sayings were so nice and, like, short, but that they had the, like, a book on the back of their shirt one year. And I thought, that's what those that's what that rich guy was telling me on the, you know, 20 years ago. He was like, Hey, listen, it's you're alive anyway, you might as well try. You know, I mean, like you're gonna get up anyway, you're gonna live a whole day. You might as well put some effort into it and see where it gets you. That's kind of how I think about it.

Nicole 1:01:29
So, yep, yeah, Andy, I was taught nothing beats a failure, but a try,

Scott Benner 1:01:33
really, that's simple. Gotta try. That would have been nicer on the back of that shirt. I don't know where you were that day, but, uh, that shirt was wordy,

Nicole 1:01:48
but it had impact. So that's all that matters. I

Scott Benner 1:01:50
think the next year just said down and dirty. So somebody gave up. They were like, Oh, we wrote a book last year. Let's keep it simple this year. Oh my gosh. Also, while, while we're talking about this at the very end, I'm gonna throw out there that Erica's daughter made all star softball this year, and I hope it went well. So if anybody knows Erica from some of the mental health stuff, her daughter's out there playing softball this summer, and I haven't checked in with her, but I'm going to All right, I'm not going to ask you why you think deep dish pizza is pizza, because that's reductive. We all know it isn't.

Nicole 1:02:23
I don't eat deep dish pizza. I have diabetes. I don't have the hang of that

Scott Benner 1:02:29
yet. You haven't figured that one out. No, no, all right. Well, come to come to New York or Philly or something, you can have a nice, you know, thin slice of pizza. It's pretty easy to Bolus for all right, Nicole, thank you so much for doing this with me. Will you hold Will you hold on one second? Please? I will thank you.

Head now to tandem diabetes.com/juicebox and check out today's sponsor tandem diabetes care. I think you're going to find exactly what you're looking for at that link, including a way to sign up and get started with the tandem Moby system. A huge thanks to us, med for sponsoring this episode of The Juicebox podcast. Don't forget us, med.com/juicebox, this is where we get our diabetes supplies from. You can as well, use the link or call 888-721-1514, use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us. Med. Dexcom sponsored this episode of The Juicebox podcast. Learn more about the Dexcom g7 at my link, dexcom.com/juicebox, I can't thank you enough for listening. Please make sure you're subscribed or following in your audio app. I'll be back tomorrow with another episode of The Juicebox podcast. Hey kids, listen up. You've made it to the end of the podcast. You must have enjoyed it. You know what else you might enjoy? The private Facebook group for the Juicebox podcast. I know you're thinking, uh, Facebook, Scott, please, but no, beautiful group, wonderful people, a fantastic community. Juicebox podcast. Type one diabetes on Facebook, of course, if you have type two, are you touched by diabetes in any way? You're absolutely welcome. It's a private group, so you'll have to answer a couple of questions before you come in. We make sure you're not a bot or an evildoer. Then you're on your way. You'll be part of the family. If you're looking to meet other people living with type one diabetes, head over to Juicebox podcast.com/juice, cruise, because next June, that's right. 2026 June, 21 the second juice Cruise is happening on the celebrity beyond cruise ship. It's a seven night trip going to the Caribbean. We're going to be visiting Miami, Coco, K, st, Thomas and St Kitts, the Virgin Islands. You're gonna love the Virgin Islands. Sail with Scott the Juicebox community on a week long voyage. Building. For people and families living with type one diabetes, enjoy tropical luxury, practical education and judgment free atmosphere. Perfect day at Coco Bay St, Kitts st, Thomas five interactive workshops with me and surprise guests on type one hacks and tech, mental health, mindfulness, nutrition exercise, personal growth and professional development, support groups and wellness discussions tailored for life with type one and celebrities, world class amenities, dining and entertainment. This is open from every age you know, newborn to 99 I don't care how old you are. Come out. Check us out. You can view state rooms and prices at Juicebox podcast.com/juice cruise. The last juice cruise just happened a couple weeks ago. 100 of you came. It was awesome. We're looking to make it even bigger this year. I hope you can check it out. The episode you just heard was professionally edited by wrong way recording, wrong wayrecording.com.

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