Podcast Episodes

The Juicebox Podcast is from the writer of the popular diabetes parenting blog Arden's Day and the award winning parenting memoir, 'Life Is Short, Laundry Is Eternal: Confessions of a Stay-At-Home Dad'. Hosted by Scott Benner, the show features intimate conversations of living and parenting with type I diabetes.

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#369 Ask Scott And Jenny: Chapter Fourteen

August 19, 2020Scott Benner

Answers to Your Diabetes Questions…

Ask Scott and Jenny, Answers to Your Diabetes Questions

Any helpful tips on sleepovers?

What to do and consider when relocating? Tips on finding a new doctor.
What other specialists do diabetics need to visit?

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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 0:02
Hello, everyone, welcome to Episode 369 of the Juicebox Podcast today on Ask Scott and Jenny. And these are questions that Jenny and I did our best to answer that came directly from you. Today we'll be talking about sleep overs, relocating, finding new doctors, blind management, which is the idea of being able to manage Type One Diabetes without being with the person that you're helping. And what are those other doctors that people with type one diabetes need to visit? Now you guys know Jenny, by now, Jenny has had Type One Diabetes for over 30 years. She's a certified diabetes educator and a lot of other cool things. But mostly, she's the first you know, from the pro tip series from ask Scott and Jenny, of course, and defining diabetes. Jenny really is just the cat's pajamas when it comes to type one and a couple of other things. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan for becoming bold with insulin. If you hold on for just one second, after the music, I have something for you.

So today's show doesn't have a sponsor in the classic sense, meaning that no one has you know, paid a fee to put an ad on the podcast today. What I do have, however, is an opportunity, one for you. And one for me. One for everybody living with Type One Diabetes, actually, but let me explain a little bit to you. If you remember back a number of weeks ago, maybe it's months now, the CEO of T one D exchange came on. It's a nonprofit that does data driven stuff to help people with type one diabetes. Anyway, after that episode, I maintained a relationship with T Wendy exchange, we're talking back and forth about a couple of things. And they asked me if I'd be interested in helping them gain participants for the T one D exchange registry. So see the T one D exchange registry is a research study conducted over time for individuals with Type One Diabetes and their supporters for like the parents of somebody with type one as well. The participants are volunteers that provide their data for research by just answering these questions in an annual survey. Once you're enrolled, registry, participants have the opportunity to sign up for other studies on various topics related to type one diabetes. The goal here is to improve knowledge of type one diabetes, help accelerate the discovery and development of new treatments, or to generate evidence that supports policy and insurance coverage changes that help people living with type one. So if you're not just paying for me to tell you this, how does this work? This is important for me to tell you, I want you to understand this.

Every one of you that goes to the link, T one d exchange.org. forward slash juicebox enters the registry, answers a couple of questions to see if you're eligible. And it's really just about having diabetes, couple other things. And then complete the questionnaire, which I've done already took me about seven minutes, I actually did it live. And I recorded it. So it's at the end of this episode. So you can hear took me about seven minutes. The questions are very basic and completely anonymous, your information will never be attached to the answers, they will never know that you. Let's say your name, for instance, is john. And john, your information, the answers to your questions will never be attached to your name. It's taken very, very, very seriously. HIPAA regulations are followed to, you know, the nth degree. Anyway, this information impacts all kinds of things. For instance, you know how Medicare started covering cgms. They used the data that the T one D exchange was able to pull together to show how important that was. And it helped move that legislation forward. It's helped coverage for test trips, it's helped to show that Dexcom can work without finger sticks, all of this different stuff. But but here ends up being the real problem. The more data that they have, the better. They can do their job. And the T one D exchange is having trouble getting enough people to do it. That's why they came to me they thought that this podcast could reach more people. It's not a situation where people don't want to do it. It's that they don't know it exists. So they don't know how to do it. So they don't just need 25 of you to do this. They don't just need 100 of you to do this. They need thousands of you to do this and it's super simple. Again, you'll see at the end, but you go online, the website is really clean. It's very intuitive. It's easy to get through a couple quick questions. Am I okay to do this? Yes, comes back immediately through your email, you keep going, right there on the web page, answer the questions, I go over every question. So you know them. And then that's it. And then annually, so yearly, you'll be asked to kind of update your answers to some things and maybe ask different questions. I put a lot more information at the end of the episode, so you can understand this. But that's it. It's super simple, and incredibly valuable for people living with type one. So if you've been looking for a way to support people with type one diabetes, and if you'd like to support the podcast, this is going to do that, you know, with one one effort two birds, one stone, think of it any way you want to, you're going to help people with type one, you're going to help yourself, you're going to help your child, you're going to help the future with type one diabetes, and you're going to help support the podcast. T one D exchange wants you to know that the purpose of the study is to collect the information from individuals with type one diabetes, and parents of children with T one D to learn more about the management of type one diabetes, how it may change over time, and how different management approaches relate to glycaemic outcomes, acute complications and the use of health services at this time, there is no end date in sight for the registry. T Wendy exchanged hopes to follow a large group of people with type one diabetes over many years, so they can get a very firm grasp of what all this data means. Anyway, I think the people listening to this podcast fit perfectly into this idea. And I know we can reach a lot of people. So if that sounds good to you, and you can spare a few minutes, T one d exchange.org. forward slash juicebox. Links near show notes and links at Juicebox podcast.com. us residents only. Oh my god. Hi.

Unknown Speaker 7:00
Hi.

Scott Benner 7:02
When you texted I was like leisurely. Just you know,

Jennifer Smith, CDE 7:05
like getting a cup of coffee or no tea. Don't drink coffee. Tea. Yeah, I was.

Scott Benner 7:10
I had a Arden's blood sugar got low on me at 4am Oh, no, just two seconds. I got up and I fixed it. But I I stayed awake to make sure. And then the dogs barked. And then before I knew it, it was 630 to get out. I hadn't been up yet. And Kelly let me sleep. So I just like 10 minutes ago, my eyes was like, Huh, it's morning. Funny, I don't sleep in ever. I never get to sleep in. So I was like,

Jennifer Smith, CDE 7:43
well, that's a long sleep. And it was.

Scott Benner 7:45
And so I was like, Okay, cool. Like, I'm gonna go set up and get ready. I'll take a shower. And then you're like, I'm ready. Lady, what's going on? All right, Jenny, let's actually get to the questions here, shall we? Get Megan Megan goes, I've heard Jenny talk about when she was little. This is about little tiny Jenny Oh, and did sleep overs. I've never let my daughter go to someone else's house overnight. She's nine years old. Any helpful hints? She doesn't wake up to her phone alarms. So it would have to be me calling in other parents when she needs something. Well, I know what I do. So you're in a different position. You're, you're not little Jenny anymore. But like, let's talk about that for a second back in the day. Like why was it easier when people knew less about diabetes? Like and I mean about the data and what was actually happening? Because

Jennifer Smith, CDE 8:37
Yeah, I mean, did you because nobody could follow anything. I mean, there was there was literally no continuous glucose monitor. And while there were pumps, they were they were nothing. So I didn't I didn't have one. I was only on daily injections. I mean, this lipo was first that I had, it wasn't like some random person down the block that was like, Hey, I met Jenny at the playground. Let's have her come sleep over. You know, I mean, these sleep overs were with good friends that knew that I had diabetes. I mean, they didn't know much about the management of it. But you know, what my parents essentially my mom really did. And she was like, the order keeper in our house. Was she just kind of hyped up a plan, right, she was, she called the parent ahead of time. She knew kind of like what kind of snacks and things what we were going to be doing, whether it be like playing outside or whatnot before or if it was just an evening kind of thing where we'd be watching movies and then talking all night or whatever it was, you know, and she essentially just gave a guideline for Jenny needs to check her blood sugar at these times. Again, we had no continuous monitor just so I had to do a finger stick right and you know, has to have a snack at this time because actually at the time of doing sleep overs, and even In through high school, the insulin that I was on required very regular meals and snacks, I didn't have the option of using a human log because it wasn't available or a nova log because it wasn't available. There was no rapid there was our right, which was longer acting. So I had very time two types of things. So I always had an evening snack plan. And it was just that my mom had to make a consideration for what that was going to be at the friend's house. Now compared to what I usually had at home,

Scott Benner 10:31
did you deal with the lows, the way people deal with lows now on that insulin.

Jennifer Smith, CDE 10:37
Um, only if you didn't eat only if you didn't eat correct, because on regular insulin, you usually mixed it in a syringe with an intermediate acting insulin, which was cloudy, right? And that had about a 12 to maybe 16 ish hour impacts, you took that kind of insulin with the our insulin every 12 hours morning, you didn't take any insulin at lunchtime, because the cloudy insulin was supposed to peak in action. And so the lunchtime met the peak of that insulin, so you didn't take insulin to cover lunch. But again, meals were also very structured, like I had a certain amount of fruit and vegetable and protein and fat. And, you know, everything at the meal was very sort of sketchy, you know, a schedule that was regimented. So I think that might have actually made it a little bit. A little simpler. I would say

Scott Benner 11:28
I'm honestly, I'm thinking your mom's real concern was eating at certain times, right testing to make sure we're not way crazy off one way or the other, and, and maybe having to adjust the insulin a little more aggressively for party foods that you didn't eat every day.

Jennifer Smith, CDE 11:47
Right? Right. And potentially knowing that, you know, the next morning, I mean, the call was always this Jenny's blood sugar. It wasn't that the parent of the house figured out what to do. It was that they called my mom and they were like, this is Jenny's blood sugar, and that we did the math, and we figured it out. You know, we knew how much to take them in. Because we did have a correction. Yeah, you know, to be able to add in. But as far as overnight, I believe I remember the parents at night, waking me up in some cases, but I can definitely say not all the time to test. I mean, that was a, that was a thing that my parents did do at home. But I'm quite sure that my mom didn't have them doing that all the time with,

Scott Benner 12:33
it'll be okay. It's usually Okay, that kind of thing.

Jennifer Smith, CDE 12:35
And she went with that, because she knew the kinds of things I was going to be snacking on at a party in the evening, were likely actually just going to drive my blood sugar higher than we would want them anyway. Yeah. And we just left him sit there. So you know, we didn't know really,

Scott Benner 12:48
so. So I think the two things here that make your experience different than Megan's question is the type of insulin right that we use now versus back then. Right? And that your mom had things pretty well structured, right? Yeah. She wasn't like, things weren't a mess at your house for your diabetes. Your mom was like, well, we'll just roll the dice and let her go. You're like, shoot, right? She had a plan? I think it sounds to me, How old is your mom?

Jennifer Smith, CDE 13:21
Um, my mom is

Scott Benner 13:22

How would she do on one of these interviews? Do you think I just thought it might be. might be interesting to talk to your mom one day. But, but you'll decide if that's a good idea or not. I don't I don't need to know. But But my thought was, is that she was she was more like us, the people listening to this podcast, probably. But back then. She really, like dug through it. It wasn't just as easy as you know, like, blah, blah. Like, I know, I had friends who had diabetes, you know, that long ago. And it was just sort of like, Hey, this is what they told me to do. And this is what I do. Right? They weren't looking at it any farther than that. Right? And so

Jennifer Smith, CDE 13:59
today's technology has brought in the ability to see so much more. I mean, I mean, even my mom says, today, gosh, I wish that I had had this type of visual information. When you were little right. The things that we could have done differently is kind of, and I'm like, you know what, Mom, I'm alive. I am complication free. You did a really good job with what you had. And that is what it is, you know. But in today's world with the technology we have, you kind of have to take it and say, What do you know about the people where you're sending your child's sleep over?

Scott Benner 14:34
Right really going to do this thing that you're asking to do? Or will they not see it as being important? But I also think that if Megan has a CGM, if she has a dexcom and she has shared I mean, which I think at this point, they all share like there's not one that I don't think anybody's using one that they can't see on a phone or, or something like that remotely. So is the idea for me. I mean, here's how I did it. I think I thought, okay, I can't not let Arden spend the night at someone's house, right. And I've had two different experiences. I've had parents who lets you know what, I've had three different experiences. That's interesting. I've had parents who just listened to what I said, and didn't over or under think it. And that always went well. I had a guy who had struck him so hard. The Father, not the mother. He just stayed up all night long. He couldn't bring himself and go to sleep. When I got there in the morning to pick him up. He hugged me, and we did not know each other. And it was a I'm sorry, Your daughter has this hug. Oh, like it was like that.

Jennifer Smith, CDE 15:39
Like, I'm sorry that you stay up all night? Yes.

Scott Benner 15:41
He just assumed I think that I probably know, he probably looked at me. Like, that's why that guy looks so bad. But, yeah, I mean, I wouldn't be I wouldn't be okay either if I never slept, but no, he just, he cared so much. And he and he took it so seriously, that he couldn't bring himself to have a moment he slept through. And he just sat up. Sure. And I've had people this one woman comes to mind. Who, if something would go wrong, it was fine if it went right. But if something went wrong, if Arden's blood sugar got out of toe a little bit, she'd call me and say you have to come get her. And she made me pick it up at three o'clock in the morning, once. So I've had all the different experiences. So the people you're sending them to, are a big part of this AR because you don't know how they're going to react to being able to see the data. Right?

Jennifer Smith, CDE 16:37
And I think you may want to in that, in that sense, you may want to even start with the people who really, you've come to know them, well, you don't only know their child, but you've come to know the parents of the child, right? You've gotten comfortable with them, they see your strategy of management because you've interacted socially, hopefully again, at some point.

Unknown Speaker 16:59
What right.

Jennifer Smith, CDE 17:02
video now. Right, right. So, you know, I think once you get to know people, they have a comfort level, because they can see how you strategize. And they can see your comfort level with it. It's throwing a child into a setting where again, it's like, the parent of a kid who's kind of newer, to the group of kids your child hangs out with, and you're like, they're trying to get to know people. So they're going to have a party and whatever. Well, you know, what, maybe call the parent talk, see what their comfort level really is with everything. Because people I've learned people get a sense of comfort from what you exude. Right? They, they, they feel eventually what you're feeling about it. So if you're like, oh my goodness, wow. I mean, they're gonna be all like, anxious and like, ramped up

Scott Benner 17:53
to, every time I talked about school, I tell people do not come off as crazy, because they're just gonna think you're crazy. And that's going to be the end of it. Now, the person who made me come get Arden at three o'clock in the morning, let me say this. I was not surprised that she was the one that that happened with. She was a me person. And when it got hard for me, being her she didn't want to have anything to do with anymore, but her kid was popular and art and was trying to, you know, get along. Yeah. Interestingly enough, now I think Arden's popularity has changed a better way. Yeah. So I don't see Arden trying to, you know, make friends anymore. It's she's just comfortable with the people she's comfortable with now, which is really nice. But But this bigger idea. And Megan, you're lucky you answer the SS question here. Do you know, years ago before all this fun technology, I actually sat in Manhattan for 12 hours in a television studio in a chair, and a light would come on. And someone would say you're live in Indianapolis on CBS three news in 54321. And then I would talk about sleep overs. And I did it for Lilly. And then you'd sit back and say this one's a radio, you don't have to be on camera and you sit back and then you do a radio interview. I forget what they call them. But I did one one time for Lilly diabetes, when they were putting out this little book, it was like kids books or something like yeah, like the CoCo bucks. Yeah. And it was interesting, because I got to talk about sleep overs over and over again, it was a little more like, Listen, you really need to let your kids do this, because it's a weird thing to restrict. Now, having said that, I know people who think that sleep overs are weird, and would never let their children sleep in someone else's house. And I don't know that I can argue with that. Like, I mean, if that's your feeling then right on, but what I think is, is that if this is something your kid wants to do, and something you want them to do, having to restrict them because of diabetes is gonna have some sort of psychological impact. It might be a little But it's not a good thing moving forward, I was never allowed to go anywhere, which will later build into I shouldn't go places I'm scared like it could, it could pet right it could build, some people might not care. So I think if you've got the technology, the way I ended up eventually being good at letting art and go anywhere, was I would practice managing when she wasn't with me through Texas Rangers, right, and then we got so good at it, I don't need to be with Arden to help her with their blood sugar, right, then it becomes the overnight spot, then you have to have a person who's willing to take a phone call, and knows it's possible the phone's gonna ring overnight and will wake up and can take direction from you over the phone. Correct me though.

Jennifer Smith, CDE 20:44
And all kids too hard, a very different level of their own ability to manage, right? Some kids from early on, can wake up to their alarms, and they may not know how to treat it, but they wake up to it, they go shake their parent, they're like I'm low, or their parent is already in the kitchen getting themselves think or whatever. Some kids sleep through everything. And it's a good majority of kids who actually sleep through everything, you know, because they just kids have a very deep sleep, which is a good thing. But from the standpoint of alarms, especially when you're trying to communicate with your child at three o'clock in the morning, and they're, you know, six miles away. That's it's hard. So again, you have to have that communication piece with the parent, not necessarily saying hey, if to sit up all night and watch my child's blood sugar, but if I call you, I would hope that you're going to answer you know,

Scott Benner 21:38
two other things with technology that helped with that. One Find My iPhone for people with iPhones, if you don't know what find iPhone is it sends a piercing signal through another phone. So you know, you could send that. The other thing is to I would you know, after dexcom share was was you know, a thing. I put the the follow app on the parents phone, right? But only give them alarms for low extreme

Jennifer Smith, CDE 22:08
high or really

Scott Benner 22:10
percent right, I would put an extreme high or at 55. I said, Alright, listen, if this thing beeps you know, kind of deep and twice. Her blood sugar's too high. And if it beeps, like faster, I can't I said dumb and you'll see like, it actually sounds more panic the low beat Yeah, it feels like it's killing you, oh my god, you're low do something. Or my brain is, you know, you know, attributed that to the sound at this point. But and I said, you know, it'll be beep, beep, beep beep for really fast that's low. Low means do something right now don't wait, hi means we really should be getting her blood sugar down. And those were simple, like directions that I think they were able to understand. Yeah, maybe my

Jennifer Smith, CDE 22:55
mom, my mom went as far as all the sleepovers that I went to I always had my glue gun kit with me. I did. I mean, the parents again, were knowledgeable, good friend, parents. And they, they knew how to use it. They knew the purpose of it. So I just I brought it along. But again, never had to use it in those circumstances. Thankfully, the parents never had to try to read the directions at two o'clock in the morning. And

Scott Benner 23:22
it's a tough thing to look at another human being in the face, pull the thing out and go, if she has a seizure, what I need you to do, like, wait, what a second now. Yeah, and you're like, Oh, don't worry, that's not gonna happen. I used to say aren't had diabetes for five years, six years, eight years, that's never happened. We've never used one of these, I buy these and throw these away all the time, blah, blah, blah. Right. Having said that, if she should have a seizure, it's not a not a reassuring thing to say to another person. But it's a good thing. And so my point is, maybe have that this is how the glucagon works conversation, not at the drop off. But prior to that, so that you don't put them into shock. You know,

Jennifer Smith, CDE 24:02
and I think you'd actually just said something very appropriate. It's the prior to, it's the planning. Yeah, right. Most people don't have any plan for dropping their child off at a sleep over. Other than just saying, yes, you can go get everything ready, and they drop them off. Yeah, as a parent with diabetes, you already know that you have to have a plan for a plan and plan B for Plan C and whatever else. Yeah. So it's the plan ahead, the talk ahead, don't expect to spit everything out at the parent as you're dropping your child off at the curb and then be like, bye, bye.

Scott Benner 24:40
This is not something you should be yelling out the car window. I'm actually thinking we should add a couple other things to this. So parties, picnics, things that you don't go to because you don't you know, you don't like the parents. So you just I can't spend the afternoon over there with those drunks, you know, like gigs or whatever. Whenever you know, something you Won't be at. I think a lot of these ideas fit right along. And they're actually simpler because people are always going to be awake during them. The one thing that I know causes a hiccup is a pool party when you go in the pool, now you're not, you don't have a signal for your CGM anymore, right. And so I think still, one of my, one of my most valuable diabetes skills, is being able to blind manage diabetes, like not to have to be with the person or see exactly what's happening, to infer, from what I know about the situation or what I can see in the data. I think that's why I'm good at looking at someone's graph and being like, hey, blah, blah, blah, you know, do this and this and the way I think of it, the way I thought of it originally, when I realized I need to be better at this when I'm not with it, is I was always impressed by customer service people for computers. Like they're not looking at your computer, but they're walking you through the computer, right? Like they're like, you know, see that thing over there. Click on that,

Jennifer Smith, CDE 26:06
you know, the parts, they know where they are, they know where to poke it, they know exactly on a list of a drop down which one to write,

Scott Benner 26:12
right, like, in my mind, make yourself a marine that can take apart and put his gun back together, blindfolded. Like, like that sort of a thing with diabetes. Like I feel like I'm there now, which will help you in your own life too. But it definitely helps you when you lose the signal. And you can calmly say to yourself, okay, the signals last Arden's in the pool now, yeah, she's not gonna swim that long, she doesn't usually swim this long. So in about a half an hour, you know, she was 105 and a half an hour, if I haven't heard from her, I'm gonna send her a text and ask her to get back near the transmitter for a minute. And be okay with that. And not be sitting around your house, you know, scrolling on the walls in your own excrement because you've lost your mind. Billy's a nice boy. Like, you know what I mean? Like, like, try to hold it together is what I'm saying. And if you can't hold it together a nice phone call to the host parent who's willing to take that phone call or text just say, hey, I need you to have Arden test your blood sugar. Right? That's all

Jennifer Smith, CDE 27:12
and tell her to get out of the pool for five

Scott Benner 27:15
minutes, text me afterwards. That's, it's all very reasonable. In the end, as we're talking to Megan and talking to each other, and I'm recollecting all these things I've done throughout time with diabetes. In my mind, I feel like I'm like, I almost feel like I'm getting away with something or having a podcast, because is anything we've just said not common sense. Like, right? It's just that what happens to us around diabetes, is the fear literally knocks that common sense right out to you. Correct? Yeah. And then and you cling to I need rules, give me rules to follow, if I have rules, then nothing will happen to my kids not gonna have something happened to him, I don't want to happen. I don't think that's it. Like I don't, I think those rules are just there to make people give them like a, almost a false sense of calm, where what you really need to do is understand it, and is different than anything else in the world really. You know, also making keep in mind is your kids nine, now she's going to get a little older skin and want to go to a dance at the school, this is going to be the same, the same muscle you're going to use there, you're going to start sending her to parties, I hate to say this in the 1314 range, some little malcontent and your town is going to start drinking and think it's really super cool to bring alcohol to a party. And hopefully your kid won't be the one at 14 years old and artist that wants to try it right. But you know, by then I'd like to see you have a firm grasp on this. Because, you know, right, everything gets a little harder when they hit that, that age in there.

Jennifer Smith, CDE 28:50
And I think you brought up a point to before about, you know, it's your decision that you just don't agree with sleepovers at all has nothing to do with diabetes, then for the child who has siblings, those siblings also follow the same rules. So it's a little easier for that child to feel like has nothing to do with diabetes, it's just because mom and dad don't really agree with going to sleepovers. Whereas if your siblings are going to parties, and they're eight years old, and you're 12 years old, that's really that's not fair. It's not your call, and you're causing a problem that could be a problem later on for how that child continues to grow and feel about sharing about diabetes and being open about it and even managing it a little bit more on their own in an open way.

Scott Benner 29:36
Diabetes is already an already has the possibility of being an issue in your kid's life. You don't want to turn it into that cousin that you talk about behind their back. Where you know, I mean, where you're like, oh, yo, Patty's great. And then at home, everybody's like, Patti. So where am I? Right? You know, maybe like you, you know how it goes with family, right? Like because that's, you don't want your kid you don't want to be telling your kid. It's fun. This is manageable, you can have a normal life. And then, you know, three times a year be like, but you can't go because of this diabetes. It's not my fault. I'm not the one keeping you out of it. Because now you now know Nobody. Nobody likes Patti, and not therapy, and right, not gonna help you throughout your life.

Jennifer Smith, CDE 30:18
No, no, I mean, I can, I can remember only one. And as an adult now, well beyond my teen years, I still remember this one time that I was not allowed to go to do something. And it was in high school. And I know it had to do with diabetes. I do. Yeah. And I know, because my brother who's four years younger, so we were never in high school together, right. I finished I went to college, he started his freshman year, so we were never together. My senior year, our basketball team went to stay. And that meant that we wanted to travel with our team. And we wanted to go to state and watch them play a weekend tournament. Right? My mom wouldn't let me go. All my friends were going my known friends, good parents that my parents knew were going to be there. My mom wouldn't let me go. Yeah. And I knew the reason, despite her letting me go to a million other things, sleep away Girl Scout camp, sleep overs, all those things. But I was in high school. And she didn't want me to go out of town to sleep in a hotel, along with this like, and again, I think from a visual had she had some information technology wise, she would have been okay with it. But yeah, that was the one instance and I know it was diabetes, because my brother when he was in high school, they also at some point went to state, the varsity team, and my brother got to go

Scott Benner 31:46
could this has been a gender thing, as I'm asking was, was was your mom trying to keep Jenny pure another week? I don't know. Why, why did you really want to go to the basketball tournament?

Jennifer Smith, CDE 31:58
And that's the funny thing that was a really like, I was I still am pretty much like a follow the rules. There are many things that I don't, you know, follow strictly everything kind of go my, but I'm pretty much like the rule follower. And I was I growing up my brother was the one that pushed the buttons. He pushed the limits. He did not me. I was the firstborn and I did it. Like I was told I'd be home by 1130. I am home at 1120. I was told to be home at 1130. I I don't know if it was the gender component. Perhaps it was. I maybe don't

Scott Benner 32:33
I don't know, either. I'm just wondering. That's all

Jennifer Smith, CDE 32:35
anyway, that's the only one situation that I

Scott Benner 32:37
can remember if your mom was like, I'm just gonna pull this diabetes card out one time here to keep Jenny a virgin.

Jennifer Smith, CDE 32:47
Boyfriend at the point.

Scott Benner 32:49
Don't need one of those at a basketball tournament. Anyway, that's nice. Do we want to talk about relocating when you have type one, like literally moving somewhere else? Or do we want to talk about it or

Unknown Speaker 33:05
have you? Oh, I've done.

Scott Benner 33:07
Alright, here we go. MC pres what to do or what to consider when relocating, especially if you're the caregiver of a younger kid with type one, what should I do before leaving? And when I get to my new location? All right, Jenny, you married somebody in the military. All right.

Jennifer Smith, CDE 33:26
I did. My husband is a retired Marines.

Scott Benner 33:29
So he actually probably does know how to take a gun apart with his eyes closed. And what else can your husband do in the dark? And? And

Unknown Speaker 33:42
we'll go with guns.

Unknown Speaker 33:42
Yeah.

Scott Benner 33:45
We're just gonna talk about Jenny's husband's pistol for a couple more seconds. And then we're going to talk about reload. I'm just kidding. Go ahead. What do you do to read now that I've got her?

Jennifer Smith, CDE 33:52
Yeah, we've, we've relocated a lot. I mean, since we got married. We have moved many numerous times, within cities as well as out I mean, we grew, we moved. When I did my internship out to Colorado, that I took my first job and we moved down to Florida. Now we, that husband took a different job. So we moved up to Washington, DC. And then the area was very busy, and we wanted to be closer to family. So we moved back to Madison, Wisconsin to be closer to family when we wanted to have kids. So we've moved a lot. And in each instance I can say that prep ahead of time and so that this is a great question. I somebody is thinking ahead here, they're thinking I know I should be planning something, but what should it be right? I mean, as as the person myself with diabetes, I always very quickly established, who to go to write with whoever my insurance was. Once we got there who I could see I called a bunch Have people I called around to see, you know, as an endocrine practice for adults? Do you see a lot of type ones? Or are you mostly type twos and you just dabble in type ones, or, you know, you're only like, this friendly to this particular pump, and you don't want to help anybody with anybody, anything else? I. So I guess, in that it's asking questions, right? In within, again, kind of your network of provider availability, yeah. As the caregiver, those are some things that you can do ahead of time, that, you know, if you're, if you know that you're moving someplace, obviously, you've got a location that you're moving to, you're not just going to like live in your car on the street corner until you find a place. So you've either got an apartment, or a home that you're renting or a home that you're buying and your new location. You know, consider distance in a city, if the best provider is 20 miles across the city, but they're the best. And you've heard the, the greatest things and they've got openings, you have to kind of fit that into your I can do that. And in the moment to see the person every three months or every six months. So I can do that? Or do you want to be closer? Do you have a lot more issues that you need to discuss, but calling around as well, like I said, if you know, especially because insurance dictates a lot of what you can do. So if you know what your provider is going to allow in the new location, look at the network of providers on that plan. Yeah, start to pick out some even even you know, with so much social networking online and the diabetes online community, there's so many Facebook groups, especially available that can give you you know, parents of kids with type one, ask a guarantee, at least in some of the big major cities, and in most of the states, you're gonna find somebody who answers you back and says, Hey, I live in this city, and I see this person and they're really, really awesome.

Scott Benner 36:59
You know, mine when you do that, though, everybody, everybody grades differently, like they do. What is awesome mean? Like, you know, in the back of someone's head, awesome could mean you know, I come in there with an 8.1. And they don't give me a hassle. I like that. It's awesome, which probably isn't is a good thing. I'm just saying that people's expectations are varying. But I do think it's a valuable way I just used my breach to try to find a an endo, for a girl in New York City. Yeah, you know, and I'm wondering as we're talking, if you don't, I wonder if you couldn't set up a short conversation, not an interview, you wouldn't call it an interview to the doctor, because they wouldn't like that. Right there. God complex would definitely not like that. But um, but you know, I conversation where you say, look, this is how I manage? Would that be okay with you? You know, like, would you be open to helping me on this path, because I don't want to take all the effort of coming to the PAC practice sitting down explaining to you what I do, and having you say, you can't do it like this, or, you know, I just don't waste your time or my time. I wonder if that's not valuable?

Jennifer Smith, CDE 38:04
I think that's kind of the it's sort of a more in depth. thing to do, I think more the tip of the iceberg for for filtering. Yeah, which is kind of what you're doing is calling the providers that you can see, you know, on your plan or whatever, and assessing, most likely you're going to get in contact with their nurse that helps them rather than the actual practitioner and ask ask them Yeah, right, you know, have a line of questions that are essentially, I use this kind of product, I use this kind of continuous monitor this kind of, you know, I use this software. Does your offer, is your office, you know, kind of allowable for these types of things. Do you use these? Would you allow me to bring in reports, if you can't physically see them? How much time will you spend with me? I've got a lot of questions. I've got other things besides diabetes, maybe they've got celiac as well. Or maybe they've right can you work with them?

Scott Benner 39:03
how flexible would you be if I said, you look, I you know, I don't wait three hours to correct the high. You know, because there's a there's some places who'd know, I'm starting to believe they know so little about it. In regard in terms of like, looking at the data and making a decision, they need to know when things happen, because that's how they think about it. I'm starting to think now that's what it's about. It's not about I don't want you correcting a high probably in the back of their mind. They're like, geez, get this blood sugar down. But if you did, then they don't know how to look at your graphs and make sense of them anymore. Right. And and so, you know, if I did that, yeah, right. I need these notes to say what I need them to say so that I can help you. Otherwise, if you bring me different data, I'm, I'm useless to you. You know, I'm starting to think it's a little less about them wanting you to do something a specific way just to control you or because they think you're wrong. And it's more about them, about you getting them out of their element. By doing things differently than they're accustomed to, right, right. But But and

Jennifer Smith, CDE 40:04
that's, that's the notes component that I always talk to the people that I work with about. Your doctor isn't necessarily like a bad doctor. Yeah, it's just that one, they have a time constraint. First. Secondly, if you only give them your pump to download, there are no notes. There's no history, and there's no information about it. They can only take the information there and make suggestions based on data, right, but they don't know the variables of your day. If you come into the office, and you've been in Aruba for the last three weeks drinking my ties on the beach. They didn't know that when they looked at your data and said, well,

Unknown Speaker 40:43
gosh, right,

Jennifer Smith, CDE 40:44
what was going on here?

Scott Benner 40:46
Sometimes people don't know, I have to say, That's weird. What's happening right there. You know, I, you know, what made me think of this. And I've never considered this before. But I think it's a good idea. Like you're saying call head talk to a nurse or practitioner or something, get a feel before you lock yourself in, and then then have to go through that trauma. It made me think of, when my son was recruiting for baseball, we went to a meeting. And I think he wanted to go to this place. And the guy started saying weird stuff. And it was like any any we walked out, he goes not here, not this guy. And I went, Okay, why he goes, I don't know, man, not here. And I'm like, all right, you know. So he just, he got some feedback back from this man that made him feel like this is not where I want to spend four years playing bass. Right?

Jennifer Smith, CDE 41:31
Well, and you bring in a good point there too, from you know, this, this person is asking specifically for their child, they don't know how old this child might be a young or might be a teen or whatnot. But I think especially for all ages, finding this would be a pediatric and no practice, right? But finding one that the doctor really has interaction with the child and expects the child to be a part of the conversation too. Even if it's you, right? It's it's not just I'm talking to your parent, and you're off in the corner playing on your iPad, because I don't give two hoots about talking to you. I'm just going to look at your data. In my opinion, if it was my child, that's not the kind of practitioner I want. My child needs to be engaged in that visit, even if they're three years old. And the doctor just asks, Where do you like to put your pump? Or which finger Do you like to stick or write? I mean, there needs to be and that those are questions again, that you can ask ahead of time. How do you work with kids? Yeah,

Scott Benner 42:35
and that's good, because it might not be so important in the moment, but it's important for when your kids 25 and feels comfortable talking to their doctor about their diabetes, right? Yeah, I our endo is very good about that with Arden. Because, you know, in honesty, Jenny's right, they're just they're honestly those kids are really there. So they can check their sites to make sure their sites aren't going bad. And like, you know, right, ask them, you know, the rest of the questions or to make them comfortable. And now you're making a point, though, about being an adult. I think about this all the time for Arden. I wouldn't know this if I wasn't so involved in community. But adult endos are a bit of a grab bag. Right? It there's not a ton of really good ones. And so, unfortunately, I want Yeah, I wonder how long I have to start prior to art and getting booted from a children's hospital. How old? Do they let you be at a children's hospital? You're done college 18. Is it not? If you go to college, you can keep going there because PD pediatric? That's a good question. Yeah. also find out about that.

Jennifer Smith, CDE 43:40
Yeah, I would definitely ask about that. Because I know it used to be like, when I was kicked out of my pedes it I was 18 Yeah, it didn't matter. That was in college. I was 18. And I had to switch over to a an adult and oh,

Scott Benner 43:53
yeah, I'll tell you, I might very well lead with Listen, here's Arden's records for all these years. I just need you to write some prescriptions. Can you do that for me? You got an A one c machine back there somewhere, you know what I mean? Like, like, that sort of thing. Without being cocky in a way that will make them be like not like you to like there's that's the other part of it is like you have to realize you're building a real personal relationship even though it only happens 20 minutes at a time every three months. You don't want the doctor to walk in and look you in the face again. This one? Yeah. I remember him. He didn't need me, like didn't mean like you're you need to avoid that kind of stuff. So. Alright. That makes sense to be cover that,

Unknown Speaker 44:40
I think All right, cool.

Scott Benner 44:46
So here's a pretty simple one. And now you got you go.

Jennifer Smith, CDE 44:48
Oh, I was gonna say the one. The only other thing that I would add to the end of that would also be from a prep standpoint, which is the quote, you know the question make sure that priority tubing, you have enough supplies that you're not in a rat race of establishing with a practitioner to actually get new prescriptions for things. Yeah. Because that a new new provider will usually not do, right. If they don't know you from the corner, man. They are not going to write a prescription for you just because you're in urgent need of one, but

Scott Benner 45:22
the person you're currently with would probably be happy to load you up before you moved. Yeah, right. I know. Um, one time, Kelly switched jobs, unexpectedly. Nice way of saying that, isn't it? One time? Oh, and don't worry, we're fine. But but but you know, she switched jobs unexpectedly one time. And I was right on the phone, nurse practitioner, I was like, Hey, we might have a gap in medical insurance. And she's she, I didn't even have to like, finish my sentence. She's like, Oh, okay. I'll just send all the scripts here because we bought online pharmacies. Like I'll send everything in right now. for it. I was like, thank you. There was it. So what I'm saying is that while my wife was transitioning, there was a stack of insulin in my refrigerator big enough that like, we couldn't buy hotdogs get on me. Yeah, so we're a little low on space. And, and, and that's because we had a great relationship with her. But you know, she's the one we know. So if you're going to relocate, stopped up with the person who knows you beforehand. All right. We I think we can do this one before you go. Brittany said, all of the other. By the way, there's a before I start, there's there's a question here that I don't know if we can ever, I'm going to read your question, and we're not going to do it. But it says I feel like so many of us struggle with finding the right balance of explaining diabetes, like fitting in the right amount of details. So they understand it's more than a couple of shots, but not too many details where you give, but they give you the glazed over last

Jennifer Smith, CDE 46:54
is like explaining to somebody else about

Scott Benner 46:58
just like not necessarily the how or the why or the scientific medical part. But like a, hey, if you're listening to this, someone you know, love has type one diabetes feel they need insulin for food they eat but not all carbs are equal, you know, and she goes, this is really interesting. She goes, basically, you know, could you roll all of the episodes of the podcast into a quick 30 minutes that I can hand off to another person? I don't know. I don't know if we could and at the same time, I'm I'm invigorated by the idea of trying.

Jennifer Smith, CDE 47:31
Well, actually, that strikes of funny because I had a thought the other day, like as I was, I usually try to like read or like do a little bit of journaling before bed. Just like my down mental shift. And I was thinking, we've done a lot of like informative, I was like, I wonder if somebody would take all of these and like write them into a book. I make a book for

Scott Benner 47:56
waiting for somebody to ask me to make the podcast the book. And to be perfectly honest with you. I started having that conversation with someone last year, and then it died somewhere along the way. But interestingly enough, for you know, I've written a book, I have this podcast, there's a couple of things I've done throughout my life. If you knew how many things how many irons went into the fire and never came back out of the fire again, you gotta throw a lot against the wall to make something work, you know? Yeah. Yes, you do. I'll tell you what I you know, hold on. Let's do one more quick question about that. Okay. So Brittany says all of the other type one diabetes related appointments we need to make diagnosed for nine months and just heard last week, we need to make eye appointments for my four year old what else Don't I know about? So I appointments are the, you know, the big one, right? They dilate your eyes, and they look all the way back there and they get a baseline for the health of your eye? And then you go back every year and do it again and again. Yep. Right? And what do they just tell people what they're looking forward to that.

Jennifer Smith, CDE 48:56
They're really looking at the vessels in the back of the eye? Anytime you go to an ophthalmologist, not just an optoma optometry, you know, Dr. omala, just actually has studied enough and knows, like, kind of the diseases of the eyes. And also can really focus in and do that where they dilate the eye. They look at the back of the eye. They're essentially looking at the vessels and they're looking for what are called micro like hemorrhages, or big hemorrhages, potentially, but they're looking for those vessels to have kind of opened, right. And when that happens, the eye tries to heal itself and it makes these tinier little vessels. But unfortunately, in that healing and making of little vessels, those little vessels are not as stable so they have more potential to break and or hemorrhage yet again, creating more problem in the eye so that you just we really want to establish and when I was first diagnosed, my doctor told my parents Not to have me visit the eye doctor until my blood sugar's had actually stabilized after diagnosis. Because those high blood sugars can affect so much early on, it makes

Scott Benner 50:09
it look wonky right there,

Jennifer Smith, CDE 50:11
it makes it looks wonky. So you, you really want some stability after initial diagnosis to go in and get an eye exam, right. So, you know, nine months post diagnosis certainly get been established, where is the eye health right now, whether the child has to or 80, or 96, you want to have kind of an established, this is where your eyes are, because then every year at least, you should be having new checks. And if there are problems that do end up coming up, they'll have you come in more frequently then, and there are therapies and things that they can do if there is a problem down the road. But that early on, gives you baseline, right. And for little kids, it's it's really mostly the eye doctor, really, I think of one two that many people don't really consider relevant to diabetes, but it's the dentist. Yeah, if you don't have a regular dental routine for your children with diabetes, get on board with that right now. They should be having a cleaning evaluation checkup every six months at least. Right?

Scott Benner 51:16
Yeah, it's a for a couple of reasons a diabetes, but by your kid is, you know, we always talk about it, like, you don't think of juice is a bad thing. Cuz it's medicine. You know? Oh, my kid takes Smarties by do. You know, like, there's a lot of simple sugars, especially in the beginning, when you're really learning how to keep things, they are a lot of sugar that is not followed up by much teeth brushing. So you really have to be ahead of it. And I've talked about it on here before we just one time switch juice boxes, because Arden just was sick of hers. But I had the right one meaning I could track it, it did what I wanted, it didn't have too much sugar in it. In the six months, she used the other box. And thank God she had baby teeth, teeth still, she developed 10 cavities from this different juice box. So you know, yeah. T says, Is there anything else you should be doing that she can't think of right now.

Unknown Speaker 52:13
I mean,

Jennifer Smith, CDE 52:15
you know, we always talk about like, foot health as well with diabetes, right, just from the standpoint of like nerve health and everything. podiatry. I mean,

Scott Benner 52:25
you know, taking your No, no, your four year old to the house. Yeah, this

Jennifer Smith, CDE 52:29
unless for some reason they already have been established with flat feet, or something else, or they've got shoe inserts or whatnot, obviously, you want to talk to your podiatrist and inform them. Well, now we have a diagnosis of diabetes in the picture here, as well, just to you know, I obviously chart should show them that, but you just want to bring it up.

Scott Benner 52:48
Yeah, if you don't understand the reason, foot health is so important for diabetics, if you should develop neuropathy, and you can't feel your feet now suddenly a small wound that you'd be aware of you might not be aware of any more wrapping that could be your fat goes on long enough, that can be a really terrible problem.

Jennifer Smith, CDE 53:06
Correct. And in the same vein, you know, kids are kids. I mean, sometimes my kids run around in the backyard in the nice grass without shoes on. Yeah, I mean, technically, as somebody with diabetes, and technically, you know, we're told Don't, don't not wear shoes, you know, walk in the backyard without shoes, and walk out to get the mail in the morning or whatever, you know, without my flip flops on, and, but I have feeling in my feet, no

Unknown Speaker 53:33
buttons, nobody dresses.

Jennifer Smith, CDE 53:35
But even for kids, you know, kids, sometimes they're not very like a tune to their body, right? So check your kid's feed every time you give them a bath or at night when you're taking their socks off to put them in bed. Just check their feet. And that's better than anything but don't have

Scott Benner 53:51
a paranoia around it puts don't happen. Right, right. I mean, the only thing, the only other thing I would say to Brittany is that through the years, you know, I pay a little closer attention to blood tests. I think I don't just take it's in range as an answer. So, you know, what does that mean? Am I at the low end of the range of she thought, like were in that range? Is she and you know, I'll go into it in another episode. But, you know, Arden has hypothyroidism but her labs were quote unquote, in range, but we were watching her like, shut off like a, you know, like a light. That battery was dying. Yeah. And and the doctor is like, no, she's fine. We don't treat in this range. And I was like, ooh, you treat my kid in this range. So make make with the Synthroid, you know, right, but right. I'll talk about that at some point.

Unknown Speaker 54:39
Yeah,

Jennifer Smith, CDE 54:40
I think the the only other thing I was gonna say would be um, this is a, I feel like this is a missed point entirely. And I know I've talked about it, we talked about nutrition, and kind of impact of foods and whatnot. But for kids who have diabetes, working with A good dietitian, who's a diabetes educator. Yeah. It's a great way to establish what are your child's needs? Not because they have diabetes, but as a child, what should your child be eating? How much and it's not, you know, work with somebody who really understands that it's not all about, I'm not here to talk about carbohydrates, I get it, I know how to count my carbs don't teach me how to read a label. I want to know what my kid needs, how much extra protein do they need, they're in gymnastics for hours, three times a week, or they're playing soccer, you know, two hours, four times, whatever it is, those are really important, because then the diabetes management works in to what you're

Scott Benner 55:43
feeding them. We really don't talk about, like, food as fuel. No, in America at all the way we should. And sometimes you're pushing through activities. And your body is, you know, it's it's lacking. It's eating itself to get through what it wants to do. And you're like, Look, they're fine. They're kids, kids are resilient, you know? Right, whatever stupid thing people say.

Hey, huge thanks to everybody out there for sending in their questions. And of course, the Jenny from integrated diabetes.com for coming on and checking it out. If you want to hire Jenny, you can do that at integrated diabetes.com. Okay, if you want to join the T one D exchange registry, just go to T one d exchange.org. forward slash juicebox. And you can do everything that I explained at the beginning of the podcast episode. But if you'd like to actually hear me go through the questions first, that's going to happen right now. So settle in and keep listening or jump over there to T one d exchange.org. forward slash juice box right now. And get started. Okay, guys, I'm gonna sign up for the T one D registry right here. My name is Scott, enter. My email address is Scott Juicebox podcast.com. password, phone number for added security for a one time identification code to your mobile phone. All right, do that. Who am I completing these questions for my child who is under 18. The other option is myself over 18 because I picked my child I put in hardens name. Sign up. Well, that was easy. confirmation code. That quick submit success. Your account has been created. Let's get started. Okay, now I'm going to answer the questions. Start the study. Are you and your child able to read understand English? Yes. What's your child's date of birth? was easy. I knew that. What is your child currently live which state? Okay, was easy. And the code you can also answer my child does not live in the US or US territory. Let's say. Has your child been diagnosed with Type One Diabetes? Why she has been easier child currently using insulin? Yes, I'm finished. You are all finished the screen questions? That was easy. Once you're ready, you can submit your answers. I have submitted my answers. But this is going to tell me if I'm if Arden's eligible for success your child is eligible to take part in the registry, you will now move on to the informed consent and decide to go to consent. There's some legal stuff here I say continue what is good for my son? Can I stop being the study? You or your child can stop participating at any time you will be told about new information or is there a cost related to being the study no cost? Is there a payment for taking part in the study? There is no payment for taking part in the study at this time. How will my child's or my information be kept confidential? Very, very, very. There's a lot of stuff here confidential. Okay. Now consent, I agree to take part and then type your name like a signature and agree received an email says, Oh, it's a copy of the consent form. That's lovely. That was easy. And you do a cent you're being asked to be in a research study. The purpose of this asset form is to help you decide if you want to be in the research study then you should not join this study until you've answered all the questions are answered. Okay. Who's doing the study done by the T one D Exchange and is being funded by the Helmsley charitable trust. He went to exchange we use the funding to organize the study. purpose of the study is to collect information from individuals with one D and parents of children went to India to learn more about the management of T one D, how it may change over time and how different management approaches relate to glycaemic outcomes, acute complications and use of health services So at this time, we do not have an end date for the registry, but we hope to enroll and follow a large group of people with T one D for multiple years. That's cool. And I hope that a large amount of those people come from this podcast. Alright, so we say yes to assent we have your consent you have completed the informed consent process, you are signed and dated consent form has been sent to your email. Oh, there it is. Okay, now there's a questionnaire. Before you start, you will be reading and answering the following questions on behalf of a minor. Okay. What's your child's biological sex at birth? They identify race and ethnicity. What percentage of the time does your child reside in your home? When was your child diagnosed with Type One Diabetes? You know, I don't remember the exact day. What's interesting, just put month in year how was your child diagnosed? Or it was in DK? What was your child's last day one see this one? I know

5.8 How did you or your child find out about the registry I found out from the Juicebox Podcast that's other juice box make sure you put that in their podcast Cool. Thanks. What's the highest level of education that you the parent of the parent or caregiver completed Please select only one answer. What is your the parent or caregivers current household income from all sources? How would you best describe your the parent caregivers current employment status? I think I'm employed right here on the podcast. Call that part time. What kind of health coverage does your child currently have? Who does your child see for diabetes care? And you can choose more than one like she has an endocrinologist but also a nurse practitioner he which of course we go by Be specific match practitioner got it in a certified diabetes educator. How tall is your job? I know this to Arden is five seven feet seven inches.

Unknown Speaker 1:02:21
wants to see why. I know that as well.

Scott Benner 1:02:26
Just any of her immediate biological family members have diabetes. Does your child have any other immune diseases? Seems so hypothyroidism? I look at this psoriasis is listed there. It's interesting.

Unknown Speaker 1:02:44
Is your child currently pregnant?

Scott Benner 1:02:46
No. How many biological children does your child have? Zero? Has your child ever been treated for and or diagnosed with any of the following frozen shoulder? anxiety Alzheimer's substance abuse I'm not gonna read all these let me just roll through here real quick cardiovascular disease

Unknown Speaker 1:03:07
No, no, no, no.

Scott Benner 1:03:11
It feels pretty good to be able to say no to these things. That's cool. No I should child had an ice slit transplant. No. pancreas transplant No. Types of insulin does your child take a pee next How does your child usually take insulin? insulin pump tubeless Omni pod it's very specific was also on here for if you loop you can put on here open APS Android. Oh, there's very uh, insulin, pens, oranges and helbling. Everything's here. addition to insulin. Is your child currently using medications to lower blood sugar? No. Child ever used a real time continuous glucose monitor? Yes. The dexcom g six. How many times per day? Does your child check their blood sugar with a glucose meter? Doing a little averaging here? Which glucose monitors your child use? Oh, that's easy. Contour. Next One blood glucose meter. Where's that? From a sensia Contour. Next One. Got it. Next, describe your child's experience starting in January of 2020 with Coronavirus.

No, my child has not had symptoms. And then okay. And my child did not get tested. Okay. I finished it was it I submit my answers. I've done it. I have successfully joined the T one D exchange and completed the questions. Now what's gonna happen is once a year they're going to reach out to me and ask me to update some questions. And that's it. That's all this is completely complete. pletely blinded meaning no one knows who you are. Nobody knows who your kid is. These are just questions that you're answering to help other people with type one diabetes. The T one D exchange registry is a research study conducted over time for individuals with Type One Diabetes and their supporters. Participants volunteer to provide their data for research, for example, by answering questions in an annual survey. Once enrolled, registry participants have the opportunity to sign up for other studies on various topics related to type one diabetes. The goal here is to improve knowledge of type one, help accelerate the discovery and development of new treatments, and to generate evidence to support policy or insurance coverage changes that help people with type one diabetes, all participant information is kept confidential participation is completely voluntary, your information will be kept in an encrypted database in an anonymous way, this means in place of your name, you will be issued a randomly generated identification number, opting out at any point will not affect your care. By sharing your opinions, experiences and data, you will help create the most comprehensive data set of those diagnosed with Type One Diabetes in the United States. This will advance meaningful treatment care and policy, all participation information is kept confidential. And participation is completely voluntary. This questionnaire can be done from your mobile device on the go or in the comfort of your own home. It is fast as you just heard, easy as you just heard, and confidential. As I've promised you now three times, and the T one t exchange has promised me over and over again, I asked them a million times before I did this, the online platform is very easy to use. I just did it in front of you. But I'm telling you super simple and clear. The screens are clear what to do next is clear, there's no you know what I mean? Like it's not a messy setup online, you can really see what it is you're supposed to be doing. It is not difficult to get through this. The T one D exchange, of course takes your data very seriously. That's why they are HIPAA compliant. When you register, you're assigned a unique identifier. So none of your personal identifiable information will ever be linked to the data, you provide your what I'm saying, you and the data, even though I mean, you heard what they just asked me it's not like it's a big deal or anything but you and the data are never associated to each other within the database. Nobody could. I'm so nervous talking about this, because I'm going to keep saying data and data because I jump between data and data just like it's super easy. Oh, by the way, everything you do with T when the exchange is online, you'll never be asked to go to a doctor or an in person study or anything like that. But if they have something like that in the future, that's going to be completely optional. So if you've ever wanted to support the Type One Diabetes community, and didn't know how this is a really super simple way for you to do it. And full disclosure, it supports the podcast. But I want to be absolutely clear. This is an ad. Now it doesn't mean that the T one D exchange just said Look, I'll pay you some money to be on this episode, you'll tell people about the exchange. It's not an ad like that you just hearing this is not is not making money to understand I'm saying I'm going to get some money every time one of you completes the survey. So if you're looking for a super simple way to support the T one D community research development, things like that, and the podcast without having to buy anything, right. So here's a way for you to support the podcast without $1 leave in your pocket. You don't have to get yourself an omni pod tubeless insulin pump, you don't have to get yourself a dexcom g six continuous glucose monitor. You don't have to get yourself a Contour. Next One blood glucose meter. You don't have to buy Lily's chocolates. You don't have to get some GMO glucagon through a link. Like none of that just do this thing. You'll support the podcast. Obviously, supporting goals of people with type one diabetes comes first. But if you can help the podcast at the same time, I mean, double bonus. Right? Like Bingo.

I just want to add that as you know you hear me say all the time I'm very careful about the advertisers that come on the podcast. I think you know that I believe on the pod Dexcom Contour Next One to be gold standard in their spaces and the T one D exchange gives me that same feeling. I don't know if you remember back a little while ago but the CEO of the T one D exchange, Dave Walton came on the show and I had a really interesting conversation with him. That led to more conversations that led to this opportunity. So being superduper honest, the T one D exchange has thousands of spots open and they need this data from the from thousands of people and they're not getting it. So they came to me and said we were hoping you could reach a broader audience with more people and fill these slots. So Everybody, please go. They don't just need 50 people, they don't just need 500 people, they need thousands. And I know you're all out there, I can see, I can see who's listening. So if you guys could just jump in and do this, you'd be helping them, helping me helping the podcast, helping yourself helping other people with type one diabetes, it is a win, win, win, win, win, win, win. Okay, guys, T one d exchange.org, forward slash juicebox. I put that link right there in the show notes to the podcast app. And there'll be a page at Juicebox podcast.com. But all you need to do is go to T one d exchange.org. Ford slash juice box and do the things you just heard me do. It's that simple. Thanks so much for listening to this episode of the Juicebox Podcast. We'll be back very soon. With more interviews, information, and fun. Oh, hey, I'm glad you're still here. Listen, I bought any new microphone and we had a time set up this to get it all set up for and it happened to be as I was finishing up this episode, the editing of this episode, so I recorded it. I don't know if you want to hear Jenny and I set up a microphone. But if you do keep listening,

Jennifer Smith, CDE 1:11:17
stay in place. And then I hooked on the microphone and just see where it was supposed to be. So I was

Scott Benner 1:11:22
like, clearly that's all I had to do. By the way a second ago. I decided I'm recording this because I'm going to put it at the end of the episode. I was trying to hook your microphone and microphone. So if you want to curse I'll BPL Okay, so you already hooked up your one mic, it shouldn't be that hard. This is just a USB cable just like the other one, right?

Jennifer Smith, CDE 1:11:41
Um, yes, it's got a USB cable. Again, I didn't like connected or plug it in yet. And it looks like it's got a place for like, it just got a headphone jack to

Scott Benner 1:11:51
Yes, that is not something you'll need.

Jennifer Smith, CDE 1:11:54
So just keep doing my headphones through the computer like I do. 100%

Scott Benner 1:11:57
that's for if you were doing recording and you wanted to do something where you could hear yourself before you got processed through the computer, you'd listen to that. And that's actually those dials are for that as well. So you won't need those dials either. Okay.

Jennifer Smith, CDE 1:12:13
So I don't really have to play with either of these, which I don't really know what they mean nothing

Scott Benner 1:12:17
for you to do there.

Jennifer Smith, CDE 1:12:19
Okay, so just plug this into the computer and then hopefully the microphone goes through this. I

Scott Benner 1:12:25
think it's gonna magically begin to work. Let's see. I'm just finishing an episode that's gonna go up now, but with you and I, oh, yeah, I can ask Scott and Jenny episode.

Jennifer Smith, CDE 1:12:38
Oh, nice. Yay. Okay, I've got like a little blue light on this thing in the jigger. Okay. It's all fancy. Like I walked into my office, I set it up, like, at night, it was like 10 o'clock, because then everybody's asleep, right? And nobody bugs me. And little boys aren't like, Can I play with the buttons and like, dial everything and like, see how the arm works and whatever. Yeah. And so then I walked into my office the other day, and I was like, outside my office being completely deranged right now because we'll be doing the floor and everything in it. So everything works for it. This is art and stuff from

Scott Benner 1:13:11
her room or painting her room. Everything of hers is behind me right now. So I hear you.

Jennifer Smith, CDE 1:13:16
Yes, if you could see the floor, it looks it's like a disaster. for it. They walked in and I was like, outside of the horrid stuff. I was like, my desk actually looks like it looks like like a studio.

Scott Benner 1:13:30
Kind of is. So um, alright, so I think what you need to do is go you're Are you in zoom the application? Are you on zoom online, you have the application zoom on your, on your computer, right?

Jennifer Smith, CDE 1:13:43
I do have the zoom app on my computer, and that I clicked the link that you sent me in the the message and I just pulled up my messenger messages on my computer. And I just clicked the link through the messages. So I'm assuming it's coming through the app on my computer.

Scott Benner 1:13:59
So top left of your so when you click on the zoom window and activate it, you should see on the top left of your screen and your Apple it should say zoom.us next Yeah. Okay, good. So go up to that and then go down to preferences. Yep. And microphone. What's the show?

Jennifer Smith, CDE 1:14:18
I have? Oh, yeah. So it's on audio already. And then

Scott Benner 1:14:22
this is a microphone microphone on turn. All right now,

Jennifer Smith, CDE 1:14:26
it looks like it says built in microphone. internal microphone. Yes.

Scott Benner 1:14:31
Click on that. And then the new microphone should be there as well.

Jennifer Smith, CDE 1:14:34
Yes. And click on there.

Scott Benner 1:14:36
Yeah. Okay. Oh is the volume all the way up the volume slider underneath of it.

Jennifer Smith, CDE 1:14:41
The volume slide is like a little bit down lower than half. We should

Scott Benner 1:14:46
all the way to the top. Let's see what happens at the top.

Jennifer Smith, CDE 1:14:51
Hello, move, move, move, move, move. almost to the top. Wow.

Scott Benner 1:14:58
Okay, let's try halfway.

Jennifer Smith, CDE 1:15:02
Alright, let's see here. Oh, I don't know what it's, it's not sliding down. Now, let's just

Scott Benner 1:15:11
click on it. You can click on the dot and then drag it.

Jennifer Smith, CDE 1:15:16
It's not dragging for me. It's not doing anything. It's kind of weird. Did you click on automatically adjust microphone volume by mistake? Oh, let's take that off. There. So now it's in the now it's in the middle.

Scott Benner 1:15:28
Okay. So, now you can see, I my microphone is different than yours, but I'm up on my mic, right? Yes, I'm like, about next to it like next to him. I don't want you to have to be that much. So let's try bringing it How far are we from your face right now, I guess. Jenny's measuring with their fingers, probably about 434 inches. Okay, three inches, so try bringing it a little closer. But there are that,

Unknown Speaker 1:16:00
hey, that's like, two inches right

Scott Benner 1:16:03
there. Whoo. It sounds really good.

Jennifer Smith, CDE 1:16:05
Okay, I'll have to just mark this little like, space. Well, like, I feel like I like cfcu. Because the microphones like covering. I know,

Scott Benner 1:16:14
I feel the same way. Sometimes. Actually, there are times when people say you go away from the mic. It's because I'm looking at a person and I kind of turn my face to try to feel more like something which is not the there's not good, better, better, they can hear us. Cool. So I'm with you at that desk. Here's why I like you at that distance. Because when that slider was higher, we were getting a little noise but but slide that slider up just a little bit more. And let me see where the noise comes in.

Unknown Speaker 1:16:43
See.

Jennifer Smith, CDE 1:16:47
So now it's at like three quarters.

Scott Benner 1:16:50
And there's a little bit of noise. So slide it down. Go back a little bit. I'm trying to get it so that's louder, and you can take the mic a little farther away from your mouth, if that makes sense.

Jennifer Smith, CDE 1:16:59
So now it's probably at like 60% of the way towards full volume. I love this.

Scott Benner 1:17:04
This sounds terrific. It really really does sound good. Yay. Oh, I'm so excited. I'm glad it's because this good.

Jennifer Smith, CDE 1:17:13
I don't I don't hear anything like different but I also don't do this, like, you know, I don't record and do all of the listening and the editing. So I don't hear the differences. Yeah,

Scott Benner 1:17:23
it is literally not going to sound any different here, but it's just gonna be way better for the people listening. So this actually ended up being Oh, I lost my ears for a second. But I know why give me a second. Um, hold on one second.

Jennifer Smith, CDE 1:17:38
Yeah, thank my my tea and like slosh around the ice cubes anymore. While we're actually

Scott Benner 1:17:44
because the irony here everything The irony is, is that microphone is going to hear less of the background in your room than they did. So that one is more just right here around your mouth. Because interest. It's so odd the way this worked out. Because you and I set up this microphone test randomly. And I spent the morning editing an episode, the episode that made me think I am buying Jenny a new microphone. Because there was something I don't know if you remember we must have recorded How would you remember this was like April right? As Corona was starting. We did an ask Scott and Jenny, which is this episode right here. Okay, um, because I'm just going to leave this conversation at the end of it so people can hear it. And there was a noise behind you. And we couldn't get rid of it. And we were like, Is it the fan from your computer? You remember? So there's some small noise in the background? That that microphone was just picking it up? Right?

Jennifer Smith, CDE 1:18:38
Yeah, I remember picking up the mic that I had, which is a much better mic than I had ever had before. And I was like moving it around. You're like Yep, nope, I can still hear it. I can still hear I don't know what else

Scott Benner 1:18:50
was picking something up in the room, right like a background noise in the room. And so I'm getting a text that Arden is hungry. One second. Apparently I'm the short order cook. today. I would never say this in front of my wife. But when we're both working for home, I think to her Her work is more important than mine. So when something like this comes up, I tend to be the verse that takes a break and goes and handles it. But I'm not complaining. It's fine. No. But anyway, yeah, like so we're recording and there's this background noise and you're talking I'm really interested. And then I'm just annoyed by the noise and I thought yeah, I have to get any better microphones so you have a much better microphone now. And you sound super clear. As a matter of fact, in an hour or two when this is on the internet, you should go listen to some of it from the beginning and then and then listen to this you'll be totally different in the difference in it. I am jacked up excited about this. This is a really great thank you and you don't have anything else to do so. Is it okay like you'll be able to keep it out of your way when you don't need it like or Yeah,

Jennifer Smith, CDE 1:19:52
absolutely the arm is really actually quite nice because I it did come the microphone itself came with like a stand to pop it up.

Scott Benner 1:19:59
I saw that. I didn't like that though, for you

Jennifer Smith, CDE 1:20:02
that Yeah, the nice thing is that this I can just slide off to the side and pot often over. Um, so yeah,

Scott Benner 1:20:10
plus Thank you very much. No, please, thank you. Here's some stuff you don't know about yourself when you're being when you're making a point. You bang the table. Do I really you get excited? You're like, you bang the table. So I couldn't give you the mic stand on the table because it would like go think when you were doing that that was and so I'm like, I she can't have that. That's why when I didn't by the way for anyone listening I did not force Jenny. I said Do you want a boom arm? Or do you want a table? She got the pic. And but when you said you under the boom arm? I was quietly like, yes. Okay, that's gonna be better. But you're gonna use this now for your calls. Now? I would imagine, right?

Jennifer Smith, CDE 1:20:45
I guess I certainly could try it and see if the call like, if the noise and everything is certainly better, especially since you said that it deletes much of the noise in the background. I mean, I do work from home. So especially with everything the way that it is now and the fact that my upcoming second grader will be virtually school from home.

Unknown Speaker 1:21:06
I'm ever feeling it was gonna be on the podcast sometime this year.

Unknown Speaker 1:21:10
Or noise? background.

Jennifer Smith, CDE 1:21:12
But that'll be kind of nice. Because if I do use this, I would expect that then maybe some of that background noise will be less Yeah, I'm can't guarantee that my 85 pound chocolate lab barking will be completely gone. But

Scott Benner 1:21:26
no, no, this is a way to you just hear those a clarity in your voice now. And like a like a, I think you would call it a timber. Like there's a depth to it that didn't exist before. So isn't there's perfect? Listen, we never do this. But when we're going to record on Friday, let's see. Can we do an episode of you and I talking to significant others in people's lives, teachers, co workers, family members and explain diabetes to them. Like this is the first time they're hearing about it.

Jennifer Smith, CDE 1:21:57
Like layman's term? Well,

Scott Benner 1:21:59
well, so like imagine you get diagnosed or you have type one and you have people around you who want to know more, but it's overwhelming to explain it to them. I want them to be able to say here's an episode of this podcast. It will explain diabetes too. Can we do though? That sounds fun. I think we can. Okay, absolutely. All right. You go back to your life. This is super exciting. I will send you a text when this is available so you can hear it. Thanks Scott. CJ, you want to say goodbye to the people are gonna hear

Jennifer Smith, CDE 1:22:23
Bye bye. Bye

Scott Benner 1:22:27
bye. See you

About Jenny Smith

Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com

As Scott & Jenny

#369 Ask Scott And Jenny: Chapter Fourteen

#355 Ask Scott And Jenny: Chapter Thirteen

#328 Ask Scott and Jenny: Facebook LIVE Edition

#321 Ask Scott and Jenny: Chapter Twelve

#317 Ask Scott and Jenny: Chapter Eleven

#299 Ask Scott and Jenny: Chapter Ten

#297 Ask Scott and Jenny: Chapter Nine

#291 Ask Scott and Jenny: Chapter Eight

#282 Ask Scott and Jenny: Chapter Seven

#277 Ask Scott and Jenny: Chapter Six

#273 Ask Scott and Jenny: Chapter Five

#271 Ask Scott and Jenny: Chapter Four

#267 Ask Scott and Jenny: Chapter Three

#265 Ask Scott and Jenny: Chapter Two

#262 Ask Scott and Jenny: Chapter One

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

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categories Omnipod, Juicebox Podcast, Dexcom, Interview, Type 1 Diabetes, Pre Bolus, Ask Scott & Jenny
tags Juicebox Podcast, Omnipod

#355 Ask Scott And Jenny: Chapter Thirteen

July 11, 2020Scott Benner

Answers to Your Diabetes Questions…

Ask Scott and Jenny, Answers to Your Diabetes Questions

How do you estimate how long an increased temp basal will be necessary based on the amount of fat, carbs or protein in a meal?

Is there a strategy for eating food in a certain order?
Let’s talk about artificial sweeteners, sugar alcohols and the impact on blood sugar.
What happens when you fly with an insulin pump?
Let’s talk about the first years of diagnosis and the impact on long-term health.
Is it true that younger children are harder to control? Tips on pre bolusing kids, not comparing your graphs and asking the right questions.
How do you calculate your bump and nudge ratio?

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, welcome to Episode 355 of the Juicebox Podcast. Today's show is an hour of ask Scott and Jenny. I'll tell you about Jenny in a second. But let's look at my notes here about what's involved in this. Out.

Unknown Speaker 0:18
Increase babies.

Scott Benner 0:21
I can't read my own writing, but this is a thing. Well, alright, hold on. Let me count the scribbles. 1234567. Jenny and I are going to talk apparently about seven different things about type one diabetes today. And all those questions were sent in by listeners just like you. I'm sorry, I cannot be more direct than that. I tried to make a list. I wrote them down. I just hold on. Air travel with a pump. Alright, that one I got figured out our kids easier when they get older. Maybe that's what that means. My writing is terrible. Is there a method to bazel increases Temp Basal increases? That might be what that is. Order. ordered. Cathy, that can't be right. Um, figure out bumps. I guess that's about how do you know how to bump and nudge. Bad. Turn COVID. Court Li issues Wait, what? Between Okay, not bad turn between old something issues. Health beegees that health? halt all halls.

Unknown Speaker 1:52
Okay.

Scott Benner 1:55
Um, anyway, it's gonna be a surprise. It's a great episode. I just edited it. I really loved it. I just edited it. The other day is edited a word or do I say it wrong? It's hard to know, I guess. All right, hold on a second. Let me tell you a little bit about Jenny Smith. You know, Jenny, of course, from the diabetes pro tip episodes from ask Scott and Jenny, and defining diabetes. Jenny has type one diabetes now for over 30 years. I wonder if I could do this off the top of my head. I'm gonna go to where I have the information. Give me a second. I'm gonna go to where I have the information about Jenny. But I'm going to try to say it off of the top of my head first. So I'm near Jenny's thing, but I'm not looking at it. Alright, ready? Off the top of my head. Jenny Smith has had Type One Diabetes for over 30 years. She's a certified diabetes educator. Something nutritionist, a certified trainer on most makes and models of pumps and continuous glucose monitors. She's a terrific person. Alright, hold on. Ready? Now let me go to the thing. Jenny Smith has lived with Type One Diabetes for 30 years. She holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator, and a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. But of course, most importantly, she is the best Juicebox Podcast Guest ever unless you've been on the show. And then in that case, you're the best one and Jenny's the second best one. I wonder how well I got that from the first thing. We are four minutes into this now are you guys listening to this? I'm so sorry. This episode of The Juicebox Podcast is sponsored today by Dexcom. On the pod the Contour Next One blood glucose meter and touched by type one, there are no ads in the show today. I'm just here to remind you that these are the advertisers and that they're lovely. And if you're interested in them, using my links helps the podcast and I appreciate it. Usually I tell you dexcom.com forward slash juice box, my omnipod.com forward slash juice box touched by type one.org. And I usually say something about Contour Next One but I've got my own link now. So you got to remember this one now. Contour Next one.com forward slash juice box. And now I'm just gonna make sure that that's actually correct because that feels wrong. Nope, it's right. Contour Next one.com forward slash juice box. Check out the Contour Next One blood glucose meter and all of the meters that contour cells. Also do you know it's possible that you're paying more to your insurance than it would cost to buy test strips in cash. You should check that out at the link as well. Do you want a free no obligation demo of the Omni pod sent directly to your home? do that at my link to my omnipod.com forward slash juice box. Dexcom is Guess where all the great information about the G sexist, but that's a lot. So go check that out too. And when you're done, you're gonna need some energy because you've been on the internet now and you're getting sleepy. Touched by type one.org. It'll lift you're right back up again. Let's get to Jenny and the Ask Scott and Jenny questions. Thank you everyone for sending in the questions that you sent. I am sorry that at the moment, I don't remember what any of them were. But I do remember that they were wonderful. Jenny was fantastic. I of course, was delightful. Hey, now please remember, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. One last thing juice box. docs.com is an ever growing list of doctors and other helpful people in the medical industry that you found you the listeners have found and shared with me. We're making a beautiful list. You can add to it if you want or go take from it. It's like that Penny thing at the convenience store. Give a penny take a penny. Give a good doctor. Take a good doctor. When Jenny and I record we usually catch up for a few minutes first, and I don't record it normally. But this time I did. It's just us talking about weird stuff going on around Coronavirus in our lives and I left it in for you. You can eavesdrop on the silly things we say to each other when no one's listening.

Jennifer Smith, CDE 6:31
Because their haircut had been delayed twice. We had had haircuts set up right including my own. You got a friend who has her own shop. And so she was going to do the boys it's in with the boys watching a movie with their little girl who is just a little older than Oscar is. And she was going to do my hair all set up. Now we rescheduled it because things had been like postponed. Now we've rescheduled it again for like mid May. Who knows whether that my boys look like shaggy dogs. Like I was like, even my husband was like their hair needs to be cut like it was getting to the point of like they'd sleep. And that bed head was like just not culpable. How did you no matter how much I just I caught it. Have you ever cut anyone's hair before? Um, I've trimmed their hair before in a pinch like this, okay, but like this was really like it was a haircut. And I it's fine.

Scott Benner 7:27
Kelly, Kelly sent me the other day, time to go to the heavier hair product. And I was like, Yes, I'm gonna need something with a little more control. I had my hair kind of short recently. And so I was just using like a little paste or rod or whatever, just like just a little bit. And now I use it, my hair is just like weak back, we can overpower that. And you know that I'm gonna have to go to a baseball hat pretty soon. And I don't think I have the head to shave my head just to start over again. So I'm not doing that.

Jennifer Smith, CDE 7:57
It's kind of funny. I actually I refer to like those days with diabetes, where you're just like, I don't know what's going on today. And it's just weird and bizarre. I called them I call them bad diabetes hair days where there's no amount of like mousse or gel or whatever that you can throw at it. That makes it like flap down the right way. That's how I count for that.

Unknown Speaker 8:20
How long have you been in your house by now?

Scott Benner 8:23
This is in three days. I'm on to three solid weeks.

Jennifer Smith, CDE 8:29
Yeah, by the end of this week, it'll be three solid weeks. Yeah.

Scott Benner 8:32
Can I make them? admission? Yeah. I know a lot of people say this. But I haven't really noticed that much of a difference in my life, which I'm assuming is bad for me. But, but also, I find it incredibly relaxing

Jennifer Smith, CDE 8:50
that you don't actually have to physically go anywhere.

Scott Benner 8:53
what the expectations are gone now

Jennifer Smith, CDE 8:55
are gone. Right? Yeah. Like, you're not expected to attend the ball down the street or go to some fees like hoopla right?

Scott Benner 9:03
My kids keep my house clean. Talk to my wife the way we always do. There's nothing there that would change and put this podcast out in the schedule. Nothing else in the world matters right now.

Jennifer Smith, CDE 9:16
Yeah, that's the only the biggest things I mean, that are changes for us. Like I love. I love grocery shopping. I love grocery shopping. And at this point, my husband is the one that's actually going now to the grocery store, pick

Scott Benner 9:31
the person

Jennifer Smith, CDE 9:32
because we pick the person and I'm the person that doesn't have you know, so. So yeah, so he's the one going to the grocery store and doing all that I like, I feel kind of a sense of loss.

Scott Benner 9:45
Oh, wow. Now I hear you. I'm the one having to go to the store. So yeah, and I've been twice now. And I'm like a ninja. I just have a little schmutz in my pocket. You know, I'm sure there's a real word for it but the stuff that kills the germs. And I hadn't, you know, I don't touch anything, bang, bang, bang and grab my stuff. Get out of there gela hands, move to the car, get the stuff into the car gel the hands again, get back in the car. You know, get it home, I strip away the packaging and do all the things you're supposed to do then clean the place where I stripped away the packaging, clean my hands again, and I'm done. I'm just like, hmm, probably should be doing this all the time. Not this intensely. But.

Jennifer Smith, CDE 10:28
But something similar. Yeah, actually sounds very much like ginger. You know, she actually posted something the other day about this is, this is what I do my one trip out of the house like and we also in, we've been really trying to like, we get the load of what we need. And then we really like our refrigerator right now is on the minimum. I think the only fresh vegetable we have left in our fridge right now is celery. Like we got to get to the refrigerator or the grocery because I need more than celery and hummus.

Scott Benner 11:03
That's a Facebook post for us. Anyway, we're down to celery, it's time for the celery. It's time,

Jennifer Smith, CDE 11:07
right? But so ginger actually takes she has gloves. She wears them, she actually takes in paper bags to the grocery store so she can get her groceries into the paper bags. Rather than having to push a cart that somebody else pushed, she takes them to the self checkout. So nobody else has to touch her groceries. She puts them into her bags. And then she actually doesn't even take those bags into the house. She like, takes the stuff out, puts them in a new bag to go into the house. And she's like, and I wash and scrub and I sanitize and I she's like, that's what I do.

Scott Benner 11:40
So my friend washing a brand new bag of potatoes in their sink yesterday. And I had two simultaneous thoughts. I thought that's a great idea. And I laughed a little bit. So but I when I put the hand sanitizer on I hand sanitize me and the cart. But But again, I got lucky because when we moved my son out of college, he had a 40 ounce jug of hand sanitizer that he hadn't touched. Oh, it was like finding a gold brick and the top of his like I was up in the top of the shelf. I was like, Oh my god, I'm so glad you're coming home. You're saving all of our lives Look at this. And and and then it made me think like, why does he buy stuff like this and then not touch it and use it for anything? Because he we didn't give it to him. He needed it for something. He got into his head at some point, you know,

Jennifer Smith, CDE 12:28
yeah, he put it in the back of his closet.

Scott Benner 12:29
Yes. There's a 20 year old boy for you. He heard about what was going on. I do remember sending him a text. And I said, Look, I know I bug you sometimes at school about sanitizing your hands, please be a little more mindful about it. Like I was trying to get him moving before this all exploded without worrying him. And so I guess he went to the trouble of buying it, which was not using it away rather.

Jennifer Smith, CDE 12:51
I'll use it when it really gets. Alright.

Scott Benner 12:53
Now he did say he had a little one he been using. So I'm like, maybe he was using I mean,

Jennifer Smith, CDE 12:58
or maybe he was using the big one to refill his little one who wasn't open to me. So

Scott Benner 13:03
let's try not to be too full for

Jennifer Smith, CDE 13:05
giving him a little credit.

Scott Benner 13:06
He's two years into college. He just committed to his major he the other day. He's not exactly out in front kind of kid. Yeah. So anyway. Oh, I want to tell you something real quick. And then we'll start this recording. And All right. Let's get back to our Ask Scott and Jenny list. I say what's

Jennifer Smith, CDE 13:30
on the plan today? Well, I gotta tell you, oh, no, I never know. I appreciate

Scott Benner 13:34
that about you, by the way that you've never once been like, exactly what we're gonna talk about before we talk about, which is why it is a surprise. This time, I actually marked the ones we did with a little word done next to it, which trust me is a major, major consideration for me because I'm not normally even that smart.

Jennifer Smith, CDE 13:54
You're smart. You're just not that organized, right?

Scott Benner 13:56
Well, sure. I keep a lot of stuff in my head. I don't write stuff down. I'm not I don't check boxes and stuff like that. But sometimes like this is a necessary thing to me. All right, I'm gonna start with

Jennifer Smith, CDE 14:09
Well, our list here is also very long. So putting done next to them was Oh, yeah,

Scott Benner 14:14
it's a long list. I'm just telling you. I'm not normally that smart. Bethany asks, Is there a way to estimate how long an increased bazel will be necessary based on the amount of fat carbs or protein in a meal? So she's looking for if there's this many carbs then do it for that long, but I don't know if there is or not,

Jennifer Smith, CDE 14:35
not typically I and that's why we have the we have a standard of what we say start with right for fat end of the meal increase the bazel by 50% over the next six to eight hours. experience will show you whether or not that works well. I for one have found that an increase in bazel for a while That meal in the daytime, I don't need as much of an increase, and I don't need it for as long at night. So for example,

Scott Benner 15:09
if I think,

Jennifer Smith, CDE 15:10
I think it's because during the day I'm, I'm up, I'm moving after the meal time, like if I go and I have a higher fat type of lunch, let's call it pizza or whatever, right? That's the typical example. Usually in the evening, I would need that 50% increase, and I typically need it for about six hours, during the daytime lunch, I usually need maybe a 30% increase, and I only need it for about three or four hours. Okay. And I I have to save from just experimentation. I think it's truly because after lunch, I'm not going to lay down for a four hour nap. I'm up, I'm moving, I'm doing things. I've got things to do around the house or with my kids or whatever. I'm just busier were in the evening time after a dinner like that. Well, I might be doing some things like putting my kids to bed or doing the dishes or maybe in the laundry or something. But for the most part, a lot more like sedentary. I went to the evening.

Scott Benner 16:09
Yeah, that makes sense. I listen, obviously, I think about it in pictures. But in my mind the basals a, it's a heavy jacket. And you mean you put it on while you need it. And when you get too warm, you take it off. So it's easy to say if you have a CGM. But if you don't then just test at more at intervals, I also believe that after experience, you know, the answer will come to you. Let's say it ends up being four hours that you need this basal rate for, you know, the second and third time it ends up being four hours. Well, I mean, then I stopped testing and I assume it's four hours. Right? You know, but you have to try it to know,

Jennifer Smith, CDE 16:45
to know, and the same thing kind of goes for protein, you know, the, the bolusing strategy for the most part, not bazel increased. But the bolusing strategy for protein says try to start it at the end of the meal extend the whole bolus out over the course of a three hour time period. Well, on average, people probably needed somewhere between two and four hours, depending on the portion of the meat, you know, if you're only bolusing for 12 extra grams of protein versus the night that you go for your 16 ounce pound of steak and your bolusing for 40 grams of protein. Very likely, that's going to also define a time to extend it out over Hmm. Because of the portion, right, it's kind of like the load impact versus just, you know, yeah. So that that can help with that too. The other thing for protein is kind of the kind of protein, you may find that leaner proteins such as, like a lean chicken, or even most fish tend to have a lower impact on blood sugar over the hours after even if the quantity is large, you might still have to cover it but maybe not quite as much as something like red meat. Okay. Red meat has not only does it take longer to digest, but it also has a lingering impact. Yeah, so those are some things to consider. I wish people

Scott Benner 18:15
could see that out last night Arden had a an avocado salad and edamame a for dinner. Yeah. And I want to say that i bolused 40 or 50 carbs for that. Like, and that I think is stuff people look at and go there's, that's free, almost that's a vegetable. And then I looked at the fat and the avocado was a big part of it. Like I think the true carb count, if I was really paying attention was probably more like 30 carbs when she put the dressing on and stuff like that, which she didn't use a ton of. But I looked at the fat and I was like, all right, like we're gonna need more power here. This there's going to be more glycemic load here from the fat and not in the way you think of it normally not, not from carbs, but just from its ability to hold it up which I think yeah, I think that might lead us into Jamie's question here. Now Jamie bemused, Jamie says maybe this is a pro tip and you tell me if you think it needs its own miniature discussion? Because this is something I've I don't think we I don't think I put a ton of effort into understanding but I know that some people do. She's asking about eating food in a certain order. Her examples last saving fruit for last, when you aren't as low as you would be when you started the meal or like the other way around, like what do you do? You know? So the

Jennifer Smith, CDE 19:36
timing or the placement of the food intake?

Scott Benner 19:39
Yes.

Jennifer Smith, CDE 19:41
Is to a degree, there is some there is some strategy for what she's kind of talking about. You know, if you are starting on the higher end, blood sugar wise, and let's say you didn't have as much time to Pre-Bolus as you would have really liked to Sure. If you Start the meal with, like, Iceberg lettuce and the protein part of it right, you're gonna have that sitting in your stomach first getting worked on first before you maybe get to your baked potato or your rice peel off, or your fruit on the end or whatever it might be, starting with the lower glycemic or almost no carb kinds of foods first, yeah, puts that into the stomach to get going. We know that proteins and fats take longer time to process and digest to begin with. And well, I mean, I kind of always think of my stomach kind of like a cement mixer. Right? It's not just taking your chicken and digesting it, and then moving on to your berries and then digesting those. I mean, it does all get churned together and processed, you know, with stomach acids and whatnot. But for the most part, yes, if you can start the meal with the things that you know, are going to be slower, letting the insulin kind of get working and going, and then add in the carbs at the end. Absolutely. That's a strategy strategy to use. Yeah.

Scott Benner 21:01
And I mean, I've had I've sent Arden into a meal more times than, you know, I can count where she's, you know, 70, or 65. And the last thing in my text was like, start with, you know, whenever the simplest sugar is, right, is that

Jennifer Smith, CDE 21:15
what the right the apple or apple sauce or whatever,

Scott Benner 21:18
right? I've said before eat the banana first. And I know that's not exactly. I don't think she looks at it and thinks I should eat the banana first, although I don't know. Because yesterday, what did she say to me yesterday? That was she said, Can I have a snack? And I was like, yeah, sure she goes, so what do you want? And she said, Oh, no, wait, it was at the end of breakfast. And she's like, Can I have a little more food? And I said, Sure. What do you want? She said, can I send bacon and an orange? And I was like, yeah, you want a bacon with orange. And we had a little bacon left on a plate. And I had oranges. And I thought, all right, and she looks so happy. She's like, the orange and picking it the bake? And I was like, well, that's a weird mix. Definitely what she wanted. So, you know, I mean, I think that's, I think it's reasonable to be thoughtful about it. Now, I do know, there are some people who steadfastly eat their meals and orders to keep these incredibly stable blood sugars. I don't know, I can't speak to it. And I don't know that I would want to live my whole life that way, either.

Jennifer Smith, CDE 22:22
Right, you know, strategy wise that what you found works, and that makes you happiest, because then you're not dealing with the flux in blood sugar. Great, if that's your strategy, have at it, keep up with it, you know, everybody finds what works, or hopefully, they're learning to find what works, right. But I mean, even even in consideration it if you're looking at a dessert, like at the end of a really big meal, a good example is something like a Thanksgiving dinner, or a holiday meal, or you've had all of these like, heavier, more dense types of foods. And then at the end of the meal, you add like grandma's apple pie with like marshmallows baked on the top of it, or whatever it is, you know, you're thinking, Oh, my gosh, this is all sugar. Well, what else do you have to consider, you have to consider all that other food that's sitting in your stomach. So, so heavy, that might actually be a time that while normally you'd take Bolus and Pre-Bolus everything, not even choosing an extended Bolus. Yeah, at this point, you've got all this extra food sitting in your stomach. And while this is simpler sugar, its impact is going to be drawn out. So you may actually want to do an extended bolus for this dessert. Because otherwise you're going to go low,

Scott Benner 23:43
because it's flopping into your stomach and laying on top. It's not part of what's happening. Right? Correct. Yeah. See, that's the stuff that is it's smart to understand. And I just think I think of it is experiential, like I just might go I know from experience this doesn't need a Pre-Bolus the way it would normally we already and I think of it as like, we already have so much insulin in the processes or I guess what we're saying the same thing. The process is already happening. Now we're just throwing in, you know, like another teaspoon into a gallon of water. And yeah, okay. By the way, all of Jamie's questions are like I think this would be a good pro tip. I think she's trying to produce the podcast here which by the way, there's some really good questions here. I don't think this one needs its own episode. So I'm gonna ask one more of Jamie's questions because she asked specifically. I want to know Jenny's take on artificial sugar. So artificial sweeteners. I know they affect people differently. But in she said In your opinion, which ones seem to have the least impact. She said, I also feel like a lot of people don't realize you can see rise from zero carb drinks. I will tell you that Arden doesn't drink a lot of soda. But if I start seeing her blood sugar gets sticky. I look to see if she's gonna Diet Coke. And that sometimes that holds her up a little higher. It's not like don't get me wrong doesn't make her 300. But it could make an incredibly difficult 140. Right? It doesn't want to give up.

Jennifer Smith, CDE 25:12
So there are I mean, if you wanted, gosh, I'm trying to remember what the university was that did a study on. Like, how much of the on the market artificial sweeteners is considered safe, according to the type of artificial sweetener in the product. Right? So if you've got something like equal, you're talking about the artificial sweetener, aspartame, okay, right? If you're talking about Splenda, you're talking about sucralose. So and then, of course, there is sweet and low, which is this the saccharin kind of component right? Now, there are also what I call alternative sweeteners that I think sometimes get falsely right, that get falsely kind of categorized with artificial stevia, being one of those alternative sweeteners. It comes from a plant Yes, it is processed the the sweetening pieces that come out of the stevia plant get processed in order to make a product that you can like, you know, put into your, your drink tea, coffee, whatever sweetened beverage, you know, sweetened a baked product, with what with whatnot, but the studies around impact from stevia, comparative to those that are truly artificial, by artificial, I mean chemical in nature, they don't come from natural, outdoor plant life. Right, they are created in a lab. So those, there are acceptable limits to like how many packets a day technically you should have, or how many soft drinks you should have with how much or, you know, beverage or how much how much per packet or whatnot, and each of the different sweeteners does have a limit to it. I mean, it's, it's a lot. I mean, most of them, it's like 15 packets a day, you're 25 packets a day. I mean, maybe some people are having that much I,

Scott Benner 27:29
I hope to you,

Jennifer Smith, CDE 27:31
it seems like an awful lot to me. And I

Scott Benner 27:33
know, can I say something now that we've met in person? Yeah, not that this doesn't come across the video, you're in really good shape. Like you take really good care of yourself. And so like Jenny's fit, you know, she she's trying to embarrass us right now, only only I can see her and she's still embarrassed. But I mean, I thought you'd have a take on this, like, you know, I guess some people might be like, here's a glass of unsweetened tea, I'll put five packets of Splenda in it or something? I don't know,

Jennifer Smith, CDE 28:00
you know, right. And I mean, that it's a it's a question that she asks a good question, because it's something that whenever I'm talking nutrition with people in a visit, it often does come up, you know, what do you think about the artificial sweeteners, especially in the women that I work with through pregnancy? Right? It's a very common question, should I be you know, should I stop drinking my diet coke, blah, blah, blah, or whatever it is, you know, I, you know, we there are studies, I think that they're kind of like a 5050. There are studies that kind of err on the side of these are chemical in nature. They're, they're not natural. They're not like going out and pulling the broccoli off of your garden stock, right? It's something that some very smart lab chemistry person put together and hey, it's got a sweet taste. And hey, it doesn't. For many people, it doesn't raise blood sugar. I can't say that's 100% true for everybody. Like you said, Yes. Sometimes you'll see a rise and sometimes no sweetener sweetener.

Scott Benner 29:07
Yeah, I don't know if it's the I don't know if it's the artificial sweetener specifically, or if it's impacting or in a different way or I don't know what it's doing to her but her if she drinks too much Diet Coke, her blood sugar gets more difficult.

Jennifer Smith, CDE 29:20
Right? Right. Yeah. Right. And, and I've actually had some people I used to tea but teach a an in hospital type to class for people with type two diabetes. And even they, it was a very common question, and I can very much remember one older woman. She was like, in her upper 60s, the cutest little lady. And she was like, I can't drink those diet beverages. I just can't drink them. I'm like, Okay, well, why you know, the class is always like a discussion about you know, what works for you, blah, blah, blah. Just like every time I have them, my blood sugar goes right up and So and then obviously didn't have a continuous monitor or anything, she was really only doing it by finger stick analysis, you know, and whatnot. But I mean, she, her records actually showed I mean, she'd have nothing in the afternoon except her diet soda. And by dinnertime, her blood sugar was going up. If she didn't have it, it wasn't going up. It didn't happen. So, yeah.

Scott Benner 30:25
So aside from what you just said, which makes total sense that, you know, limiting the chemicals going into your body, probably a smart move. I don't eat that much sugar to begin with. So when I have a cup of tea, if I use two teaspoons of sugar, I mean, whatever, right? Like it, if Listen, if two teaspoons of sugar in a cup of tea is going to take me down Jenny, then I guess that's gonna take me down. You know, I mean, I, I just feel like that it wins. But

Jennifer Smith, CDE 30:50
I think eight grams of carb there.

Scott Benner 30:52
Yeah, I don't love I don't I don't need a lot of sugar at all. But, you know, at least it feels natural, to some degree, you know, so I didn't make it in a lab.

Jennifer Smith, CDE 31:05
You know, that's kind of what I say even about like the sugar free like the sugar free candies and whatnot that are out there. I mean, it kind of brings in along with artificial sweeteners. Of course, there's also then the alternative, like I said, the stevia. But then there's also another sort of bank of sweeteners, which are those sugar alcohols, right. And sugar alcohols, again, they come from, from plant based foods, most of them come from fermenting fruits and vegetable, carbs or sugars, so that what ends up happening in the body is the fermenting process allows a much slower impact on blood sugar than you would get from all out sugar. So most, you know of those sugar alcohols they provide only about half the amount of impact that true sugar does. And it's kervin action is very very slow. They also if you eat too many of them are not very nice digestive Lee on you. But I always feel like you know if you're going to eat three sugar free Hershey candy kisses, I would rather have the real thing. Yeah. And that's purchase personal at like you said you'd rather have the real sugar in your cup of tea than something that's artificial. And if you account for it in your day, total, you're keeping track of things. calorie wise, most of those sugar free products aren't lower calorie overall than the counterpart of regular things. Oftentimes, when they take sugar away, they have to add back something else that tastes a little bit better. And it's often fat. Yeah.

Scott Benner 32:46
Well, I listen, I will have chocolate once in a while. And there's a company that makes a chocolate chip that I find to be like a really quality chocolate chip. And instead of having like a Hershey Kiss, or something like that, not there's anything wrong with a Hershey Kiss, but there's a, you know, there's a quality issue there, like market chocolate versus, so I'll buy like a bag of chips. And if I want chocolate, I'll take like, I don't know, four or five chocolate chips. Yeah, by the way, the bag of chips is like $3 and it lasts forever. You know? So there's ways to, you know, substitute things and and correct and get more. I don't know, this isn't English, but more real food into your snacking. Even snacking like this, you know?

Jennifer Smith, CDE 33:32
Right, right. Okay. And I do know, I remember, if somebody wanted the actual information about how much artificial sweetener they can take in. It was a study done by the University of Alabama at Birmingham. You can actually go to their website and they give you information on how much saccharin aspartame and sucralose is appropriate. It's based on 150 pound person.

Scott Benner 34:00
So yeah, so be 150 pounds. You're taking this that into effect,

Unknown Speaker 34:03
FYI,

Scott Benner 34:04
restructuring your multiplications and your divisions in your business. Well, all right. Well, this question from Libby may not apply in our new world. But flying in an airplane and pumping with an insulin pump. So does air pressure deliver insulin? Is that why some people find themselves lower after a flight if they're wearing a pump? Jenny Jenny has read she just readjust her jaw six different times and a word. Yeah.

Jennifer Smith, CDE 34:36
Well, I want to I want to address it in terms of being true in also that there are no

Scott Benner 34:45
studies. There

Jennifer Smith, CDE 34:46
are no true studies that are approved by some fancy university or research laboratory that has actually done this. However, there is anecdotal let's call them evidence from people have diabetes where insulin pumps, and they've actually documented what happens when you fly with especially a tube insulin pump, okay? It's more, it's more of a known issue with a tube insulin pump, that in the ascent and descent with a tube pump pressurization can actually either withdraw insulin back into the reservoir, thus creating an air bubble in the tubing, and potentially then causing a lack in pumped insulin. Some people experience not only a high at some point, or a rise that they can't explain because they haven't had any food or anything else happening on a long flight. Or, in this example, a drop down often, and a lot of people refer to them as like the baggage claim lows, where they finally get to the baggage claim. And as long as their hike through the airport hasn't been like six miles, you know, they're huffing it. For the most part, people end up waiting for the bags and have a low blood sugar. And why it's because potentially on descent, there is a pump out of insulin from that piston from the pressure that pushes the insulin through the tubing and delivers almost a bolus of insulin, then that's it's not registered by the pump, you can't go into your insulin dose history and see oh two units was accidentally delivered. The pump doesn't give you that because it wasn't there were no button pushes get it.

Scott Benner 36:33
So it's like having a like a like a flatbed hose full of water and the water is just sitting in it, but you grab one side and give it a squeeze and it runs out the other side. So the air pressure increases and forces the insulin through an air to come out of your set. So that's where it goes

Jennifer Smith, CDE 36:48
correct. And our recommendation to kind of counter it is on ascent and descent, essentially, you disconnect. So for those with tube pumps, you would disconnect disconnect from your sight as soon as your rising or taking off. Once you get to cruising altitude, you go ahead, look at the tubing, if there are any air bubbles, prime the tubing, flush the air bubble out, reconnect cruise through, you know your three hour flight or whatever it is, as soon as you start your descent, go ahead and disconnect when you land. Go ahead again, take a peek at the tubing. If there are any air bubbles or anything, you essentially flush them out and reconnect. Yeah, that way you get rid of both potential problems makes sense.

Scott Benner 37:33
I happen to I'm googling while you're talking. And Medtronic has a little update on their site about just being more like attentive, which I think is any company's way of being like, you know, we don't really know what's gonna happen. So you pay better attention. And I'm not picking on Medtronic, I'm sure there's a version of this language is probably on everyone's site. But you're saying with Omni pod it might not exist?

Jennifer Smith, CDE 37:57
Yeah, there's I've only had, I've only had one person that I work with. Who has definitely she's noticed something happens. She always she never has highs. She has lows.

Scott Benner 38:12
But that's right. So

Jennifer Smith, CDE 38:13
but again, that's an N of one with one pump. And I you know, I've I've flown often enough I've worn Omni pod since 2006. I've flown a lot in that what? Almost 14 years ish, right? And I can't say that I've noticed anything. That's a trend when I fly. That would indicate Yeah, this is definitely happening three quarters of the time. We

Scott Benner 38:39
don't treat them differently during air travel at all. I mean, you know, maybe when you get out of the car at the airport, we're not I wouldn't bolus a 120 you know what I mean? Like I want to get through security and all that stuff with nothing going on. But as soon as we're back through, everything goes back to normal. We bolus normally on the plane and every other Yep. So yeah. Okay.

Jennifer Smith, CDE 39:01
The only thing that I guess it's not really in answer to this, like pressurization. But the one thing I do Do for travel and a lot of people notice is that many times when you're sedentary for more than about a two hour time period, you might actually need a temporary increase in your bazel just from the sedentary nature. You know, when I fly long distance, and I'm going to be sedentary for more than that two hours, I find that I need about a 15 to 20% bazel increase just

Scott Benner 39:28
to cover the fact that you're

Jennifer Smith, CDE 39:29
just not active anymore, just to do right.

Unknown Speaker 39:32
Okay. So, all right. What else?

Scott Benner 39:36
Well, Shannon has one here. Okay, that I don't know if we're gonna have the answer to or not. But let's take a look. It's a long one. So I'm going to synopsize she's curious about the health of older people with type one who have had what she's calling wild blood sugars in the first part of their life, but then learn tighter control later. Will they have you know, issues like that? or other health complications. And the last part is people who had to survive without CGM. Okay, so people who lived before all this technology, you know, like me? Yeah. Like

Jennifer Smith, CDE 40:15
I lived before all this

Scott Benner 40:16
fallacy. Oh, you know, I mean, I would I would say what we've said in the past is you can't bank health. Right. So you, but

Jennifer Smith, CDE 40:29
I don't know it also is not a like it, you know, the question really did really poor control leave lead into issues now that even with good control won't negate them all? we don't we don't know. Right, right. I mean, for the most part that earlier, less than optimal management wasn't good. I mean, it wasn't helpful, right. But does it mean that down the road with more optimized control, especially with the technology that we have, likely the control now is a huge benefit. And the fact that you were likely younger, and had the benefit of youth at that point, versus being older and now having really tight management, that's the benefit now that you're older. And as body systems age, things can break down faster? It is. It's just the life cycle. Right? It would

Scott Benner 41:34
make sense that while your body is older, and you know, by definition, more frail, that the better control, the better off it would be. I also do you remember back when they used to tell you like, Oh, you know, don't worry about blood sugar control in the first couple years when outlawed little kids even when Artem was first diagnosed. I was like, that doesn't make any sense to me, like a little bit it does. Now when I look back on it, like the idea of like, okay, she's young, and hopefully she's vital and healthy. And if you know, we scratch her arm, it's going to heal back over. And so if we scratch some veins on the inside of our body, they should heal. Okay. I don't know that that would be true for everybody. But I get the overall idea. But I think the danger of that idea back then, at least the way I saw it was that you were giving people the idea that blood sugar management didn't make a damn bit of difference. If you were young enough. You know, you've got five years to figure it out. Like I remember being told that when she was two, like, Don't worry, she's little. This won't hurt her right now. Like that does not make any rational sense to me.

Jennifer Smith, CDE 42:36
Yeah, my nephew was actually kind of the same thing. He was diagnosed when he was seven. And that was actually something that their pedes endo actually told them where I heard it. 100% it was, you know, don't worry right now he's not, he's not in his teen years. And you don't have to worry about anything? Well, from a, from a true standpoint, what I know is that we want to aim for more optimal, regardless of what age you are. Yeah, there are, there are some, like factual studies that have actually shown that once kids get to the teen years, with the hormones of growth within the teen years, that starts to make more impact on potential future complications. If glucose levels are poorly controlled, in that timeframe of life, comparative to earlier on, when the hormones are different, there's still growth going on. Obviously, you can see it in your kids as they grow when even when they're little, and they're not a teenager. But the difference being more of those like sex hormones really into the teen years have more of an impact. For whatever reason, I'm in the standpoint of glucose control being better or worse, and then what happens down the road? So

Scott Benner 44:02
trying to imagine like, you know, changing the sentence slightly, like, how about this one? Your four year old can smoke cigarettes, they're young enough, their body will fight it off. Would you say that? No.

Jennifer Smith, CDE 44:13
How about No,

Unknown Speaker 44:14
no, no, just a little crack cocaine. She's only six. Yeah, like, she'll bounce back from that

Jennifer Smith, CDE 44:18
wants to have the beer for dinner every night. Let her have

Scott Benner 44:22
a little she's only eight. It's never gonna impact her long term. Like, none of those things make sense to me. Don't right. And so when I was told that I was like, Listen, I am not buying into this mess. You know, uh, but at the same time, it didn't go well for you in the beginning. I think it is a lot akin to smoking cigarettes. The sooner you quit, the better off the rest of your time is gonna be.

Jennifer Smith, CDE 44:47
That's right. That's I mean, that's the reason that you know, parents are told not to smoke at home with their kids.

Unknown Speaker 44:54
Right, everybody.

Jennifer Smith, CDE 44:57
I mean, it's actually something for my nephew. I told him parents when they said, well, the doctor says it's okay, if you sit at you know, 200 all night, it's pretty safe. And as long as you staying under 250 That's okay. And I'm like that that's not okay. I mean, I really had to, like, emphasize to them that that that's not okay. He might only be seven, eight years old. But these numbers are not where you want him to be.

Scott Benner 45:21
Right? Well, um, here's what it reminds me of. And I probably said this once before, but it fits right here very well. I once helped a person in their late 30s make a pretty drastic transformation to their management pretty quickly. And when it when it kind of, you know, our time together came to an end, this person was really grateful that their blood sugar's were now, like in range and controllable, and, you know, not so variable, but angry and sad that someone hadn't told them about this sooner because they had had diabetes for you know, the better part of 25 years. Right. And and we're really concerned about exactly this question, like, What's going to happen to me in the future? Based on what happened to me, you know, in the beginning, and why would nobody have explained to me that, you know, Pre-Bolus things important, or any of the other little things that we talked about together? And the best I could say, in that moment, because I was out of my depth, you know, what I mean? Like, I don't have diabetes, no one's ever lied to me about my health care for dozens of years. And so I just said, Listen, you know, now, just do a good job, move forward. You can't change the past, you know, any other birthday card euphemisms you can think of, there's no sense in hanging on to anger about this, like you have a real chance. Like, let's see what happens. You know, I keep doing it. And and let's hope for the best and right. I mean, do you really have any other options than hoping for the best?

Jennifer Smith, CDE 46:53
No, there's not. And even, you know, if you knew what wasn't working in the past, it was likely because technology wasn't where it was today, right? I mean, my my mom definitely says, as I've said before, if she had the technology, now, she would have felt a lot more comfortable sending me off to a sleep over that the parents weren't given like a two page sheet of instructions of what to do, you know, she would have been able to follow things from home and felt a lot safer when she sent me to sleepaway camp. And, you know, all of those pieces of management that were there, we did the best that we could, but I'm quite sure that in between the finger sticks, I had a date, I'm sure it looked like a roller coaster, because we didn't know what was going on.

Scott Benner 47:40
I think that at some point in the very beginning, the statement 200 safe overnight, don't let it go over 250 I think that was probably reasonable at some point, you know what I mean, because of the lack of technology. And when they say safe, they didn't mean safe to your health, they meant safe, that you won't drop too far and get really low. Like that was the that was just try to understand that at some point, because of where the technology was, in the past, the entire focus of type one diabetes management was don't have a seizure, right? And don't go into DK, it was literally these two opposites. They didn't care about anything else, because they didn't know to care about anything else, because they didn't have the ability to care about anything else.

Jennifer Smith, CDE 48:25
And for little kids who don't often have symptom awareness.

Scott Benner 48:29
Even more important, even more important back then. Right? They can't tell you the problem ends up being is that as we leapt forward and leaped forward and leapt forward with technology,

Jennifer Smith, CDE 48:39
the education didn't

Scott Benner 48:41
Yeah, and and, and these, you know, tried and true methods of well, 200 safe and don't go over 250 they got passed down generation to generation. So what you're really seeing is that there's one group of people, health care providers, right, who have an origin story. And that origin story builds on how they talk. But a different group of people over here, device manufacturers, right? They're trying for something different. These two people do not intersect in their day to day business and the way they talk with other people. So while this guy's telling you to hundred safe, this company is over here telling you Hey, I think our gear can keep your blood sugar at 85. Which one sounds scarier? When the doctors telling you just to hundreds, okay, you don't want to get low and then the next person is like, Hey, 85 is possible. That sounds scary. Right? And so you're never going to reach the masses. Until healthcare professionals have the ability to believe that the technology does what it does, and are willing to say it out loud. And you know, I don't know. Good luck with that. Good luck getting a bunch of people to say what they think you know, instead of what they think is safe to say. Luck. That's gonna be very interesting. You know, if the FDA would let not let but I guess if if device manufacturers could get into the business of teaching their devices beyond, this is how it turns on and the sound turns off, then they might have the, the onus might be on them to show you how to use it correctly. Right? And because then they could really market their their devices as living healthier, not just easier, because that's how that's how they're stuck. That's how they're stuck marketing right now. It'll make your life easier. It'll be a smaller part of your life flexibility. Yeah, yeah. You don't want to have to disconnect to do this right on the pod. And like, like, and that's the stuff there. I don't want to say stock saying cuz that's a lot of valuable information in there. Yeah. But they don't get to say the rest of it. Like, why don't you try the Basal increase when you have pizza? Like, they can't say it, they can say the pump does a Temp Basal increase? They can't tell you why in the heck you might want to try. Try it. And therefore it's a tool you don't really it's a screwdriver, and you don't know how to use it. You don't know what it's for, you know, just know you have it. Anyway. Alright, that went down a weird road. Um, let's see. Sarah says, Sarah has three names. And her middle name is fun. Sarah says, I'm not sure if this is big enough. There's nothing too small to Jenny and I won't talk about. But is it true that younger children are harder control to control compared with older ones in terms of their blood sugar? Does body size make a difference? I always look at people stable graphs with such envy, as we seem to go up and down so much. That sounds like their daughter's two years old. Is that more normal in younger children? Or is that more proof of my inexperience? Because we're only about a year and a half into this? Well, I think it's probably both an indication of your inexperience and normal. I always tell people, you know, figure out how to use the insulin so you can feed them so you can fatten them up because this is easier when they get bigger. But I don't know if that's just me, or if that's true.

Jennifer Smith, CDE 52:07
Ya know? And they're they're kind of a number of questions within the question, right? There's, there are a number of things to kind of bring about our younger kids harder to manage than older kids. I think it's, it's a different strategy of management. Because variables through the life cycles change whether you're two or 82, there's always going to be something that's a little different in young children, you know how fast growth happens. So growth, impact is always going to be more profound than when you get to, let's say, the teen years, especially for like a teen girl, let's say, who's not growing anymore. But now she's got hormones and a monthly cycle and things like that. So that's in the picture, despite growth not being in the picture, right? You know,

Scott Benner 53:00
we talked about it wrong, though. We always say diabetes is always changing. Diabetes is the same, their bodies are changing. That's right. Right, right. So you know, when your kids littler, and like Jenny's saying they're putting on a pound or two every couple of weeks, that's making your bazel not correct, as they get bigger and bigger, right? Or at the same time, they become more active, they start to walk or they start to do more things. That changes the impact. And, and so is it harder, it's the same, it just changes more frequently, or growing, right? And then right, when they get to that point, you're talking about where they're like a, you know, an adult woman who's getting their period. It's still happening, but it's happening cyclically by week, this week is different than that week, and that week is different than this week, and you have to know what week you're in.

Jennifer Smith, CDE 53:49
Correct? Yeah. And then, you know, with little kids too, you know, the other the other part of little kids that can increase the amount of variability which she brings in, you know, I feel like we're all over the place versus some of these graphs that I see it that are just nice and flat. Well, the variability with a small child, 235 years old or whatnot, you know, and I mean, I know myself with even the way that my three year old eat, he could love the same exact breakfast and eat it 100% for five days in a row, and I give it to him On the sixth day, and he eats three nibbles, and he's like, I'm all done, mom. Okay, well, great. Now, if I had to, like Bolus for that, and I work with so many kids that I see this as a consistent problem, right? I mean, that as variability. Now you've bolus for this amount of insulin, and there's not this amount of food there. So you have to offset it in some way. Well, that brings in a potential roller coaster. If you haven't quite yet figured out how to offset what you sort of front loaded with.

Scott Benner 54:54
Right. I I always say that I think the key to Pre-Bolus in kids is to choose what ever amount, you know, they're gonna eat. Like it might just be five carbs, but nope. But have you ever sat your kid down, they've just been like, I'm not eating this at all that they put something in their mouth, right or they switch to something. So if it's a 20 carb meal, and you have that feeling of like, I don't know is this the day the kid just doesn't eat their breakfast Pre-Bolus five, you know, carbs have it right and get some insulin on your side. And then when you see Oh, this foods going in, then put the rest of it in right away, or they throw up their hands or like not today, lady, then you've got some time to decide what else they could eat, you haven't personally insulin for the entire 20 carbs. Now you're sitting there, just staring through the wall going, Oh, my God eat food. Because there's, because there's reasons you don't want to do that. You know, because you don't want to cause a weird relationship with your type one diabetic and food, you don't want them to feel like food is the thing they have to do even when they don't want to. There's some really good psychological reasons not to do that. Ah, you also don't want to get into the roller coaster situation where their blood sugar goes to 300 and then comes crashing down and then they have to feed them and that becomes your day. So you have to Pre-Bolus something. You know, it's so funny that I was corresponding with a person who was gastroparesis one time. And they were saying I really want to Pre-Bolus but I don't know how because some days my body starts to digest my food. And some days it doesn't. Right. And after a long phone conversation, I said, you should do what people do with little kids, and just get a little bit started. And then as you see your blood sugar, wanting to go up getting the indication that your food is being digested, then throw the rest of it in, right, that ended up working for that person,

Jennifer Smith, CDE 56:42
or throw some in and extend the rest of it, or keep

Scott Benner 56:45
eating it out into the future. But get it

Jennifer Smith, CDE 56:46
moving. Get it moving.

Scott Benner 56:48
And when I said that she's like, That's brilliant. I was like, that's not brilliant. That's desperate. I did not know what else to say. Like, well, but you've

Jennifer Smith, CDE 56:56
had enough experience with other situations in which that that sounded like a good alternative.

Scott Benner 57:03
parallels to try it. Yeah, yeah,

Unknown Speaker 57:05
absolutely.

Scott Benner 57:06
Absolutely. I was gonna say that I think that a pit that we all fall in it's one point or another with diabetes. Or maybe life in general, is feeling like there are rules that we don't know. And that we have to find those rules so that we can follow them when obviously, that's not how life really works.

Jennifer Smith, CDE 57:28
There are guidelines, I always feel like it's like this is your guideline to like, the exploration of the woods behind your house, right? There's no rules to follow. It's just don't go near the growling bear in the bush over there best practices, maybe some best practices, you know, that kind of a thing. The other thing that I did want to say is, you know, it's really hard with today's online community with diabetes, which is phenomenal. It is great. I wish I had had it as a teenager and even an adult into college. It would have been fantastic. But I also think that we unfortunately, start to compare to what other postings show. Right? And I I don't think that's fair to do. So in this case, you know, this mom was like, why see these straight graphs all the time? You don't know what went into that straight graph. Yeah. You don't know the food intake, you don't at the activity level, you don't know where they are in diagnosis, or whatnot, there's, there's a lot more that goes into that flat or that curvy or that, you know, up down roller coaster or whatever kind of graph. And so it's easy to stay, it's hard to like, accept, but don't judge your own management off of what somebody else has posted.

Scott Benner 58:56
Yeah, the things that they say are the important parts of getting that so I'm going to show Jenny something that she doesn't see they're gonna see versus that where's my camera? Can you see that? Mm hmm. Okay, so that's three different people I'm tracking on Dexcom. Wait, what are their blood sugars?

Jennifer Smith, CDE 59:12
Ah, one is 98 with a horizontal, straight, steady, and other one is 93 with an angled arrow up, and another one is 130 with a steady straight horizontal arrow,

Scott Benner 59:25
okay. Do you know what those three people have in common? They all have diabetes. They're managing their diabetes. This is gonna sound horrible to somebody. But trust me, I'm not trying to be like that. I'm not being pompous. They're using my style. Sure, that's what they have in common. They're reacting to certain things, doing certain things, not letting some things happen. Like that kind of stuff. There's a it's a system, they have a system on their head. They're following that system. And so at the same time of day, those are three people blood sugars that are pretty much the same, you know, they're there. They're stable in a great spot. Yep. It's because it's, it's the style. It's your style of management. So when when Sarah asks, Is this my inexperience? Not my circle, it might be an experience, it also might be that you're very experienced that something that doesn't work, right, you know, and now you're just beating your head against that wall going out, understand, this is what I was told to do. Why isn't it working? So there's one of those kids on there, I was texting with their mother last night. And I was like, you know, you need to give her some insulin right here. And she's like, I don't want to her blood sugar is only 140. And I was like, I don't care. Like, if you don't stop this 140 and make it 90, then two hours from now, when she goes to bed, she's going to be 200. And then you're going to get into a different space. And so my concept is, if you don't get high, you won't be high, you will be high. Right? And and it turns out if you put those concepts into practice, I mean, the pro tip series you and I did is just it's that's it. Like that's the whole thing right there. If you do those things, that's it. If you if you gave me three more kids, their blood sugar's would be right around there right now, then there's anomalies that happen, like, you know, I don't sometimes, you know, people eat things. They don't say what they eat, or they miss count carbs or don't don't aren't intuitive enough about glycemic load and index and stuff like that. But for the most part, you take the steps. It usually works,

Unknown Speaker 1:01:31
right? I mean, I don't

Scott Benner 1:01:32
know another way to say it. Like, I'm not trying to say it's easy. It's not easy. But there there is a formula in there to leads to that. Mm hmm. So that's two kids in there that are, you know, one of them's probably still asleep, one of them they're in, they're in different time zones, but they all have the same experience

Jennifer Smith, CDE 1:01:49
strategy.

Scott Benner 1:01:50
Yeah. So Sarah, I think you figure out what works. And then stay flexible while your kid is growing. And keep applying the tools. Understanding that the game is changing, right? A little bit. So yeah, if that makes any sense or not.

Jennifer Smith, CDE 1:02:08
And certainly reach out, you know, for help. Remember to ask more. Remember to ask more questions, even at your doctor or endo visit or CDE visit or whatever it is. Remember to ask more in depth questions in order to get more in depth help. Oftentimes, I think people end up going in not really knowing what to ask because they haven't gotten help before. So they just leave it up to the doctor to kind of give information, and then they get nothing back. And they think Well, my bad, dark, dark doctor is not very helpful. But if you don't bring in more I see this happening around gymnastics every day. I see this happening every Tuesday, Wednesday, Friday. Can you help me? Great. Now the doctor has more to go into the data and pull and get a trend. Yeah. And offer better suggests you have to

Scott Benner 1:02:59
you have to step back and have a macro view of diabetes. But you have to have micro questions. Right? Like, right, so like, you can't just yell. I don't understand every night at midnight, her blood sugar's high. But that's your macro view of it. That's not helpful to the person trying to help you. What's your micro view of it? What's happening in the hours just prior to that? Those are the things you need to know. You know, it's this one kid's blood sugar's were not great. Three days ago. And if you looked at the tech, I did it through texting. If you look at the questions, I asked them, most doctors would not look and go, Oh, well, those are the questions that need to be answered to fix this kid's blood sugar. I ask really odd things that answer the questions I need answered. And so my point is, is that those are the questions to me, you ask? Those are the like the micro specific questions. Yep. And I don't know how you Sarah, I don't know how you figure that out other than experience time and don't give up. But I can tell Sarah and anyone listening this? My experience has been that people who are thoughtful and concerned and care and ask questions like the one Sarah's asking, those are the people who make out well, because they're there, they're interested.

Jennifer Smith, CDE 1:04:14
Right? And they're trying and they keep looking until they get an actual answer that helps.

Scott Benner 1:04:19
That's it. They're interested in, they're trying and they care. And to be honest, that's pretty much what you need. Right? As long as you don't give up. You'll find it at some point. You might not find it for me, you might find it somewhere else. But right you'll find something that somebody says that clicks with you and makes it all feel kind of easy at that. Right. Jenny are we at a time?

Jennifer Smith, CDE 1:04:37
You have about nine minutes left nine minutes, or something easy for nine minutes?

Scott Benner 1:04:45
Um Oh, there's no answer to that one at all was like, oh, half an hour conversation and a lot of people asked it to, uh,

Jennifer Smith, CDE 1:04:57
maybe it's a maybe it's a

Scott Benner 1:05:00
Well, let's find out what you think. How do you calculate your bump and nudge ratios? So when I say to somebody, hey, that blood sugar's 140, I'd like it to get back to 90, bump it back down. That's not a, it's not a measurable idea to people, I guess. Okay, so I usually say how much insulin Do you think moves it from there to there and just go with your gut.

Jennifer Smith, CDE 1:05:30
Right. And it kind of starts then with kind of brings you back to the pro tip series of figuring out things like bazel and sensitivity factor. And even, you know, that kind of stuff. Because really, anytime you're playing with the bump the nudge, you're playing with the assumption that you know, a certain amount of insulin, let's say one unit will move your blood sugar, a certain number of points, right. So if you know one unit changes your blood sugar by 60 points. And you know that your cup of coffee in the morning without bolusing. for it, you've noticed that it kind of raises your blood sugar by 65 points on average, well, you know what, then you need to start taking a unit of insulin to stop the 65 point rise, because one unit offsets you by 60 points to drop you from too high, right back to where you want to be. Right. So the bump and nudge is kind of if they're looking for a math, it goes along mostly with sensitivity factor or correction factor. It goes along with how much do I want to knock this down, and how sensitive I am I to insulin at this point in the day, because many people also have sensitivity factors that differ based on nighttime daytime, afternoon or whatnot. I myself have two sensitivity factors, one that lasts through the day time, one that's overnight for me. So you know, I'm more sensitive to insulin overnight. So I don't need a load of correction. If I choose to Bolus for a higher number that gets up there overnight. I don't need as much overnight as I do during the daytime. Yeah,

Scott Benner 1:07:11
I have to say I don't think I take it for granted because of the podcast. And but if I wasn't talking about diabetes as much, I probably would, that idea that I can look at Arden's blood sugar to 11 o'clock and say, that needs a half unit and look at that same blood sugar at 7pm and say, hey, that's a unit or at four o'clock in the morning. It's point two, it just, I don't know how to explain, other than to say, I look at the blood sugar, I look at the situation. And then I know how much to give her. But I don't know how to tell you what I saw. And how it led me to that answer decision. Yeah, other than to say have diabetes for a while. And all of a sudden, you'll just sort of know.

Jennifer Smith, CDE 1:07:54
Some of it is some of its experienced definitely like I you know, I can say that. Gosh, if I know that one unit again, changes my blood sugar by 60 points. But I've also got like a load of fat in the picture. Well, gosh, yeah, need a lot more of a nudge than you would if it was just because of miscounted carbs.

Scott Benner 1:08:12
And I'm not saying that I haven't adjusted a blood sugar at 1am at an hour and a half later been woken up by the same high blood sugar and then thought, oh my god, what we ate for dinner. Now I remember like that's gonna happen, you know. But the good news about that is, is that I was trying to stop at 140. And it's still 140 I didn't stare at the 140 hope for the best watch it turned into a 220 Bolus for it, forget about the pizza, get up again at three o'clock when it's 250. Like didn't even like eat right, don't let it get out of hand so that it's manageable, and then the bumping in the nudging becomes less, in my mind dangerous because you're using less a less a smaller amount of insulin to accomplish something. So I say if you ever seen me speak, which might never see again. But that jokes funny for a couple of reasons. And everyone listening is only gonna get one of them. But that's okay. Yeah, thank you, Jay. which you may never see again, if you know, I'll say look, I'd like to see a stop a 110 or 120 diagonal up because you might stop it with point two or point three or if you're an adult with a unit like a tiny bit of insulin, you come back to 90, and you sit stable again, the likelihood of you getting low after that is small because you've used such a small amount of insulin to begin with. So that's how you keep from overcorrecting. And that's how I think of bumping and nudging. But and

Jennifer Smith, CDE 1:09:34
that is that is really where our where our hybrid closed looping systems, like control IQ, you know, with tandem, that's really where those systems are going. The idea that the bump and nudge becomes less of your play and more of the pumps interaction because it's got CGM data to interact with and it can see a rise happening. It knows Okay, I've got this value, I don't want this person to get above. So it starts nudging it either with a temporary bazel change, or with these little micro, you know, boluses, the control IQ system is in a system so far in what it can do, but I think that's where, you know, further progress into the pump company. Is that where they're going with the technology? Yeah, because they don't want Well, they don't people with diabetes don't want, while you know how to pump and nudge now, you don't want to have to pay attention so much to have to do it all the time.

Scott Benner 1:10:33
I always tell people to bumping and nudging is a teaching towards some point, you should learn from the bumping that you should have done something different meal, you know, like it's not a it's not a long term idea. It's part of a bigger teaching idea. And having said that, when I watch an algorithm change basal rates and you know, put insulin in, I'm like, that's what I do. Wow, I'm not gonna have to do that. And exciting. And by the way, bumping in nudging is, you know, it's my idea, the words, and they're for sale. Like if a pump company wants to buy them for marketing materials, I'm open to having a conversation, you know, just let me know. Anyway, Jenny, I'm gonna say thank you. Hold on one second. Thank you. You can actually hire Jenny Smith, did you know that she works at integrated diabetes. And they have a website aptly named, integrated diabetes calm. So that's where you can find more about what Jenny does in the professional life. I don't know how often I mentioned this, but I like to bring it up once in a while Jenny is not a paid contributor to the podcast. She just really likes being here. So this is not an ad. She's just a friend who likes being on the show. But that doesn't mean you can't you know, there are a couple of bucks. Get some help with your blood sugars. That's what you need. Thank you so much for listening to the Juicebox Podcast. Thank you for supporting the sponsors sponsors like Dexcom that you can find out more about@dexcom.com Ford slash juice box. And how about tubeless insulin pumps? Well, there's only really one, but it's called Omni pod. And you can find out more about that. And get yourself a free no obligation demo sent right to your home by going to my Omni pod.com forward slash juice box. And to find out more about Arden's blood sugar meter, the Contour Next One, you go to Contour Next one.com forward slash juice box, you're seeing a theme here you get it. And of course touched by type one is that touched by type one.org great organization doing wonderful things for people living with type one diabetes, and all they want is for you to know they exist. So go check them out. Touched by type one.org you think we'd get a juice box slash in there, but it's not happening? Okay. I'm not hurt. Oh my god, that was exhausting. I'll see you guys later. Bye. It's hard to talk like that for a long time. Everything's real deep and you're trying to enunciate and to not over speak or understand like, Hello, this is the word of God. You know, all fields like that a little bit. It's been a long week, too. It's Friday. I need to get to the weekend. Actually. I'm turning 49 on Sunday. And I'm feeling every moment of it. I'm not I'm okay. Am I it's hard to tell. Who am I arguing with

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#262 Ask Scott and Jenny: Chapter One

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categories Omnipod, Juicebox Podcast, Dexcom, Interview, Type 1 Diabetes, Pre Bolus, Ask Scott & Jenny
tags Juicebox Podcast, Omnipod

#342 Everything the Light Touches

June 05, 2020Scott Benner

Kyle Banks is a broadway performer living with type 1 diabetes

Check out what he’s doing at Kylercares.org

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Scott Benner 0:00
Hello and welcome to Episode 342 of the Juicebox Podcast. Today's show is sponsored by Omni pod and Dexcom. You can find out more about the Dexcom g six continuous glucose monitor by going to dexcom.com forward slash juice box. And to find out more and even get a free no obligation demo of the Omni pod tubeless insulin pump sent directly to you go to my Omni pod.com forward slash juice box.

Today on the show I'm gonna be speaking with Kyle banks. Kyle is a Broadway actor. And I'm sure you've probably seen him as I think we've all seen the Lion King on Broadway, right? Like everybody. Anyway, Kyle has type one diabetes. He's here today to talk about his journey, as well as what's going on currently in the world. And also tell me a little bit about his organization called Kyler cares, which you should check out at Kyler cares.org.

Don't be shocked. Kyle has an incredibly deep voice. He's going to make me sound like a five year old girl singing in the choir. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making changes to your healthcare plan. or becoming bold with insulin. Do you hear me trying to get deeper so that in a second it sounds

Kyle Banks 1:42
like I'm not.

Scott Benner 1:43
Thank you. Why do you say how's got a nice voice?

Kyle Banks 1:57
Kyle Banks here. Actor and it's diagnosed with Type One Diabetes about five years ago this coming November?

Scott Benner 2:07
How old are you now?

I am 4343. So you Wow. 38.

Kyle Banks 2:13
Yeah. diagnosed later in life.

Scott Benner 2:16
Anyone in the family that made you feel like this was a possibility? Or no, I'm the only lucky one. I assume that means you get the bigger piece of meat at Thanksgiving and things like Oh, oh, yes.

Unknown Speaker 2:30
Sure.

Scott Benner 2:32
If it's not the diabetes?

Kyle Banks 2:34
Yeah, I'll definitely I definitely use it to my advantage. No kidding.

Scott Benner 2:38
Well, that's, I mean, that's, you know, I guess to say, that I'm shocked by the age is a little bit of a fallacy because I've interviewed enough people now at every age to know what happens, but it really just isn't in what you would consider the sweet spot of getting typos. Maybe?

Kyle Banks 2:52
Yeah, most definitely. How did it present? I mean, people used to tell me this all the time, and it would kiss me off in the beginning. But now I totally get what they mean by if they would say you're lucky that you were diagnosed later in life? Like, what do you mean, this is horrible? Why would anybody want to be diagnosed with this at all, but I totally get what they mean, because they'd be diagnosed with it earlier. And just knowing that goes into it. And all that it requires of you. I do share that sentiment now.

Scott Benner 3:25
I wouldn't have to think and I'll be, you know, obviously, I don't know. But a couple of things come into my mind. First of all, the idea of complications, the earlier you start the more time diabetes has to work on Yes, but also as an adult, it's got to be a little easier to see a shift in your life and adjust to it then

Kyle Banks 3:47
most definitely things

Scott Benner 3:48
like that has happened before, right? I mean, not on this scale, but still you've had a place to live and then suddenly not had a place to live had a had a you know had a you know, I don't know you were dating somebody and then all of a sudden they were gone. Like that kind of stuff is an adjustment when you're 18 or that's that's tough. So

Kyle Banks 4:04
yeah, well yeah, I've also made decisions like for my life as far as like nutrition and just certain things that I've I've removed from like my diet and the way in which I've developed like exercise and in have incorporated that in my life. Now, definitely much better suited to deal with it now than I would have been years ago. So where were you?

Scott Benner 4:31
I guess professionally, what were you doing at 38?

Kyle Banks 4:35
Well, I've been performing on Broadway for since I was 25. So is on on tour at the time of my diagnosis and traveling. It just been wrapped up three months in Canada, and had just gotten to California. We were touring California for about two months. It's

Scott Benner 4:59
helped me expand Understand that and explain it to people because I live close enough to New York that when you say Broadway, there is a picture I get my mind. But people who live across the country, when when shows are incredibly popular. Eventually they they hit the road, right?

Kyle Banks 5:14
Right, the road, touring with Lion King at the time. And Lion King is based in New York, where it sits. But there's also a touring production that tours the country. So I bounce back and forth between the Broadway production and the touring show. That's interesting. So

Scott Benner 5:33
Wow, is that based on your desire to move around? I mean, I'm assuming there's some people who don't want to tour or is that not within your purview to make that decision to they just tell you, this is where you're going. Now, this is where you're

Kyle Banks 5:47
at? It's totally up to me, like, no one's putting a gun to my head, say you have to tour? No, initially, I was on Broadway for like, maybe five years. And I was asked if I would be interested in going up to the tour to fill in sometimes. And initially, I was like, No, I'm working in New York. Like, why would I go out to the tour and perform in Kennebunkport, Maine, right like that. But I had no idea that the tour actually pays more money, a lot more money.

Scott Benner 6:18
And you don't have to pay to live in New York anymore. It's probably

Kyle Banks 6:21
Oh, yes, yes. Yes. So I was like, why? After I learned that, I was like, why did you come to me sooner with this offer?

Scott Benner 6:28
When we were really young, my wife worked for a company that was in Manhattan, and she commuted in and out every day. And then one day, she didn't anymore. And she was in New Jersey, and her first paycheck came after New Jersey, and I called her on the phone. I was like, yo, they made a big mistake. Don't tell anybody. But it was just not paying the taxes in New York. Exactly. Yeah, very well. That's cool. So how long did you do the boat? I guess, how long did you perform in Manhattan? And how long were you doing the toy?

Kyle Banks 6:54
Well, I am, I'm a swing, I'm calling for this call the universal swing. So I have in and out of the show as needed. People will take a real job. So we have like vacations, people to take time off the six Luke sick leave. Because Lion King is such a high intense show with physical, physical activity. There are a lot of injuries. So I hop in as needed. So I part of the time I'm in New York, part of the time I'm on tour just just depends on where the need is.

Scott Benner 7:29
That's interesting. It's not something that would ever I mean, it makes perfect sense. But it's not something that would occur to me.

Kyle Banks 7:35
That's really that the show has to go on regardless, like what's going on with the actors. So there's always someone there to fill in.

Scott Benner 7:43
Can you do multiple roles? Mm hmm. Okay.

Kyle Banks 7:47
Yes, yes. Yes. You

Scott Benner 7:48
have like a sweet spot, like where you are where you did one more than another? Or does it not even work like that?

Kyle Banks 7:54
It doesn't work like that. It's just basically where the need is. The principal characters, they, they're really good about coming to work, and just being there and being present. But you know, sometimes no injuries happen. It said, people just need a break for family time, or personal refunds, or whatever the case may be.

Scott Benner 8:16
So you're in Canada headed to California, and how do you win? What's the first time you don't feel? Well?

Kyle Banks 8:22
Well, I began having vocal issues of cannabis. So I was traveling back and forth to the states to visit in T specialists to pay to go to visit EMT specialists to sort of help me figure out what was going on with me vocally. And once we got once we got to California, I was still having issues. So I continued to visit specialists in whatever area we were in just so that I could get through work and eat specialists prescribed for me prednisone, steroids. To help deal with some of the inflammation I was experiencing on my vocal cords. I was on prednisone for about two and a half months at a very high dose. And so maybe about two towards the end of like the two and a half months, I'll begin experiencing like these other symptoms that just started out of nowhere. Like the extreme hunger and extreme thirst and the constant urination and exhaustion, which is just awful when you're doing a show like The Lion King because what you need most is energy. And I I didn't pay much attention to it. I just noticed that I was feeling off. But what really got me to to visit a Urgent Care Physician in California was I just looked in the mirror one day and I was like, wow, I look really gone. I didn't even I hadn't even noticed that over the course of three weeks, I'd lost like 30 pounds, okay. And that's scared the hell out of me. So I ran to the urgent care doctor that day. And he tested my glucose. And he suspected that I had steroid induced type two diabetes. Interesting and suggested I go to the emergency room, I was like, well, I can't do that. I have a show in like two hours. But we'll just, he gave me prescribed Metformin for me. So I began taking the Metformin. And two weeks later, I still wasn't feeling I wasn't feeling any better. So I spoke with my mom, and she suggested that I come to New Orleans and visit her doctor and get a formal checkup. Right. And at that point, she took instruct that physician instructed me to go to the emergency room.

Scott Benner 10:52
I can't so I'm looking at you, but I'm only looking at you from like, chest up, but you look like a bigger person. 30 pounds. Where were you when you lost? 30 pounds? How much do you weigh?

Kyle Banks 11:00
I was typically like, between 175 180 Wow,

Scott Benner 11:04
you went down to like a a teenager's weight? Yeah. How tall? Are you? 620. My goodness, you must have been there for most.

Kyle Banks 11:14
I was looking like Skeletor. And out there.

It happened. It happened so fast. I noticed a drastic amount of weight. But I mean, when it when it falls off so quickly. You don't say anything? You don't see it.

Scott Benner 11:26
Yeah, I can only see Arden in a couple of photos. And then think how was it possible that we didn't notice that? Yes. Wait, you know?

Kyle Banks 11:35
Yeah, when I look back at photos of me, like you take a lot of photos, we clown a lot backstage. So I definitely looked ill did not look well, at all, at some

Scott Benner 11:46
point someone had to make the joke that you look like the week is Ellen, the line was definitely gonna get you.

Kyle Banks 11:52
The dancers can be a little sick, and that they you know, the ballerina body and everyone wants to be slim. And so they like work. You look.

Like, I look amazing, but I feel like I'm gonna pass out. Right?

Scott Benner 12:08
That's terrible, man. It really is. Especially true, because I can see a bunch of things coming here at 38. I mean, you're in amazing shape. Obviously, you're the only thing on me that is built like he was like one of my fingers. They're pretty thin. And so like, You're, you're in great shape. But But I think my bigger point is that at 38 do start thinking, am I getting older? Like, is this just time coming after me? Or, you know, yeah,

Kyle Banks 12:33
that that was definitely a thought, like, you know, maybe, maybe my metabolism is slowing down? Maybe my endurance is slowing down like I could I couldn't figure out what was going on. I just started taking more vitamins in that moment, hoping that it would help

Scott Benner 12:51
just using I realized you've been in other things, but just using Lion King, what's the what's the timeframe, you arrive when how long as the show run? How long you actually onstage,

Kyle Banks 13:03
we arrive at the show a half hour before the curtain goes up and gives us enough time like warm up, stretch, vocalize put on makeup wardrobe for the show. And the show runs for two hours and 40 minutes. Okay. So it's a long show.

Scott Benner 13:25
And I'm assuming you're walking and probably to the to the theater, and then there's just a lot of activity. And then there's

Kyle Banks 13:31
a lot of Yeah,

Scott Benner 13:32
and they are out there doing what you're doing. And everything's I said Is it is it a hype song I tried to figure this out. Because I obviously, we've been to a number of shows in my life, not just a couple, but a lot. It's interesting. If you hang around a little bit, or you're having lunch across the street afterwards or something, you'll see the performers just roll out the back door. And it's no different than if you hang out at a baseball game long enough in the parking lot. Eventually you will see 40 guys walking to their cars, you know leaving the Yes. And and I use my son as an example. Like when he's like they're so loose in the dugout when it's not their turn to do something. And then all of a sudden, it's like work time and you just something comes over them. So now I'm imagining that behind the curtain, very just a bunch of foolish people making nonsense, that all of a sudden it's time to roll out on stage and do your thing is that sort of like that.

Kyle Banks 14:22
That is the most accurate.

Scott Benner 14:29
That is very fun. Now it makes me wonder what those rockets are doing during the Christmas show.

Kyle Banks 14:33
Madness backstage. I mean, the real show happens behind the curtain. Sure.

Unknown Speaker 14:38
That sounds really interesting.

Scott Benner 14:44
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Kyle Banks 19:36
As hospitalized for two days and give them instruction about like you know how to inject insulin and and released sent out to the world to that's it Yeah,

my new life with Type One Diabetes.

Scott Benner 19:54
Yeah. Did you put on any weight in the hospital.

Kyle Banks 19:57
Again, my weight came back immediately.

I probably gained back all the weight I lost in it just as fast as I dropped it. Yeah,

Scott Benner 20:07
it's really interesting.

Kyle Banks 20:08
Mm hmm. It was just starting for those nutrients. And once the insulin got in, it was able to process it. Do what it was supposed to do again didn't Yeah.

Scott Benner 20:17
Have you looked back yet? and thought, wow, I was almost dead. Did you have you had that thought?

Kyle Banks 20:25
Yes. Yeah, yes, I could remember like, after the show would be so exhausted like I would have to sit in my dressing room for in the last thing we want to do is hang out in the theater after the show. We just want to get out and just whatever we do after the show, but I would literally sit in my dresser for sometimes two hours, just gain enough strength to like put on my pants and wash my wash the makeup off my face and walk to the hotel room across the street. It was definitely the close. I know I was really close to die. Yeah.

Scott Benner 21:00
Especially when your body starts giving away like that. The weight loss waste

Kyle Banks 21:04
such a wasting away. Yeah,

Scott Benner 21:07
cuz it starts getting into your muscles. And before you know it. I don't know. It's just It's terrible. I look back at Arden sometimes. And I think how close were we? You know, the doctors put a number on it. But you know, they're guessing But still, they thought they thought she'd be in a coma in another 24 hours. Yeah. And we brought her in and I was like, how did you get to Louisiana? You didn't drive in that condition? Did you

Kyle Banks 21:26
know we flying was a thing? You know, before the pandemic. I was like on a plane? At least three, maybe four times? Yeah,

Scott Benner 21:34
yeah, I get these notes. Now. They're like, hey, you'll come speak at this thing. And I'm like,

Unknown Speaker 21:40
maybe I will. Could I do it through like zoom or something?

Kyle Banks 21:43
Right. Now I'm driving everywhere.

Unknown Speaker 21:46
Can you wrap me in plastic and put me on the

Unknown Speaker 21:48
plane? To get sick?

Scott Benner 21:52
Meanwhile, it's probably gonna be fine. But you know, I don't know. The whole world seems like it's going crazy. Right? I guess for context for time. You and I are talking towards the end of COVID-19 while people are starting to go back and in the middle of the video church flirt riots. So right.

Kyle Banks 22:09
Yeah, every that's fascinating times in which we live. Yeah,

Scott Benner 22:13
no kidding. I, I'm just encapsulated by it for the last couple of days. Just you know, trying to wrap your head around. Everyone's perspective. Yeah, it's so clear how where everyone lands. Just think like, how are these things gonna find common? You know? Yeah, it's really, it's really ridiculous.

Kyle Banks 22:35
Anyway, at least

Scott Benner 22:37
Yeah. We it is ridiculous, right? Because you see somebody, you know, you see, see protests that seem well organized and intended. And you think, okay, that's right. And then four hours later, some guys like, you know, I could probably just piggyback off this to get myself a pair of sneakers. And, and then it becomes crazy. And someone thinks to light something on fire. And you're like, What is? What are you thinking?

Kyle Banks 23:03
Yeah, you know? Yeah, really? Yeah. Yeah. They really, they really went off in New York City and hit all of the high end shops.

Scott Benner 23:13
My daughter comes running down last night she goes, you should see what they're ripping off. And in Hollywood. She's like, She's like, a lot of people are gonna have great Pam bags. And it's so sad. Like, it really is. Yeah, I was listening to a family member of Mr. fluids. And he said he would not want people doing this. And yeah, you know, you just it the whole thing's heartbreaking. I don't even know how to,

Kyle Banks 23:37
you know, it really is. But yeah, to have people, like you said, piggybacking off of this moment, off of the protest, and using it as an opportunity to cause chaos.

Unknown Speaker 23:52
Or to put is pretty

Scott Benner 23:54
good, or to put any other thing in motion that I'll tell you. And I know, this isn't why you're on but it's just so timely at the moment. I saw a person make the point last night, that the rioting is a far left conspiracy to keep small businesses closed. And I was like, What? Wow. So wait, you're telling me that somebody went to Minneapolis, found a guy willing to murder someone with his knee and said, yo, we really need to keep the small businesses closed the next time you pull over a black guy could you kill him for me? Like, like,

Kyle Banks 24:27
Who thinks that way? That's deep.

Unknown Speaker 24:32
Crazy, is what it is. And I was like, I'm like, that's that's

Scott Benner 24:37
I mean, I guess the next question is, how much of this did the Illuminati have to do with and I was I just I backed away slowly. And I was like, that's enough internet for today. It really was fascinating. What's the impact on your day to day life right now is Is there any Are you just hiding inside waiting to go back to work like everybody else?

Kyle Banks 24:58
Oh, just hiding inside. waiting to go back to work like everyone else. And I'm here in New Orleans at the moment with my mom has a lot of like underlying condition. So I couldn't make it a point to like, continue quarantining, not seeing any of my friends that lived here. And if we do, like an outside spaces where the social properly social, or social distancing properly, and it's making sure I don't bring anything home to my mom, but um, I think, of course, I'm affected by all of the protests, just watching what's happening. On the news, it's troubling to see. Yeah. But, you know, it's definitely something that the protests was definitely something that's needed. There's so much pain and suffering happening right now. And it's just like the perfect storm with with George with George Floyd and Ahmad arbury. And then there's the situation in Central Park, you know, in couple of that with like, all of the suffering from the pandemic and people losing their jobs and not having ways to like provide food for their families. I guess nervous, which is really frayed. It's a powder keg.

Scott Benner 26:22
It really is. Yeah, I think my mom was that he was the guy that was jogging, right?

Kyle Banks 26:26
Yes. jogging. And yeah, I just

Scott Benner 26:28
kept thinking is this was going on? I was like, at some point, there's a tipping point in here, and we're gonna find it, you know. And it's just horrible. It's horrible. And I have to say, I hundred percent agree with you. At some point. You have to protest. Like, you have to go out in the street. You have to yell and scream. Yeah, I mean, you shouldn't be. I mean, first of all, if you're going to steal don't steal from $1. General, because what are you risking getting locked up for? For like a squishy ball in a cup? This like holds a lot? Yeah, I try to try a little harder than that, I guess. But seriously, they're coming out. I'm like, what could you need out of there? But anyway,

Kyle Banks 27:07
they were definitely successful it with that New York and LA on Melrose Place. But yeah, it is just awful, though. You can't just keep

Scott Benner 27:15
it things like this cannot continue to happen. And we just act like Oh, yeah. This is the thing that happens every six months. Yeah, you know,

Kyle Banks 27:23
this happened. I do you think it's good that the news is hasn't really been distracted with their messaging about what the protests are about as a result of like, all the fires that have been said, in the stores that are being looted? You know, they're still that they're reporting that, you know, especially NYPD is, it's reported that, you know, they know for sure that their outside influences, you know, sort of antagonizing the situation. And, you know, but it was was George Floyd is still like the center of

Unknown Speaker 28:00
the protest. I, I heard that. I think that's

Kyle Banks 28:02
a beautiful thing. Me too.

Scott Benner 28:04
I had heard that too. I'm sorry, I stepped on you there. But. So this When this happens, when people see protesting, then other groups can say, Hey, listen, if we send some people in there to cause trouble, they're gonna blame those minorities for that. And, you know, and it really is. Some people's minds work very deviously in a way that, uh, I don't, I can't appreciate, you know, so I just, I'm one of those like, I guess I'm crazy. I think just go do what you're doing, do a good job at it. That'll work out and you don't if it doesn't, doesn't work out for everybody. Keep going. You don't even like it just seems like life to me. But anyway, it was interesting what you said before about wanting to be out a little bit, but not wanting to be bringing something back to your mom, because she's got underlying issues. But also, if you looked at a lot of the deaths, being black was not a great thing for having COVID-19 Oh, yeah. And is that something community wide that people are aware of? And is it discussed?

Kyle Banks 29:06
Oh, yes. Yeah, no, here in New Orleans. I have a family distant family members that contracted to the COVID-19 and many households that lost their lives like a mother and two siblings. My mom's first cousins so distant relatives to me, but yeah, personally we know and friends of my mom's had lost their lives. So it's definitely in the effects of it have definitely been felt.

Scott Benner 29:41
Right. There's a when when Broadway opens back up, which there's no timeline for that yet as they're shooting for December But no, it's a it's a it's a touchy situation. Would you be able to go back if it was December, like for you in your heart personally.

Kyle Banks 30:00
I want to, you know, I'm hoping that things, I mean, I definitely would not do it if, as the as the way things are now, but you know if if there's a vaccine or if the if the virus seems to take a break in the coming months, and I'll definitely consider it. I mean, I love my job. I love what I do, and to not be able to do it is a it's a bit nerve wracking, but

Scott Benner 30:29
I'm picturing a lot of like paunchy gazelles jumping behind. So people have been on the sofa long too long, those first couple shows. Mommy does that. Does that look tired to you?

Kyle Banks 30:44
He does, sweetie. At his mom's house.

Scott Benner 30:50
Oh, my gosh, what? How much effort would it take to put you back into physical shape to perform?

Kyle Banks 30:57
Oh, well, I just I recently, about a month ago, I started working out again, because sitting on the couch is definitely taking effect.

Scott Benner 31:07
Your mom's probably cooking better than they do wherever you

Kyle Banks 31:11
most definitely. So spin stretching and working out at home. And so I'm getting, I'm getting getting in pretty good shape.

Scott Benner 31:19
I was talking to my son the other day because he should be. He should have been playing baseball through the spring. And then he gets a little break. And then he goes and plays in the summer. And I said to him, I was like, you gotta and he's working out sporadically. But he's like, it's hard to just without a goal. You can do maintenance stuff, but when you know, I have tasks I perform, and I know how to work out to support those tasks. And he's like, Can I do the workout and then I don't have the the other side of it is it gets it's kind of it feels useless a little bit in its interest. It really is interesting. basketball games are gonna be much more lower scoring by the time this is

Kyle Banks 32:00
bronze, like whoa, slow down.

I mean, the wake up call for me was I tried to put on a pair of jeans a few weeks ago. And I was like,

Scott Benner 32:11
well, in the beginning, I'm sorry.

Kyle Banks 32:15
All of my clothes are like basically the same size. So shopping. I need to do something about this

Scott Benner 32:23
to be hanging out in Louisiana in your underwear. Well, I tried to when this all happened. In the beginning, I looked at myself and I was like Scott, you cannot afford to gain any weight. So I just sort of went the other way. I've lost 11 pounds since COVID-19 started, because I like nice. I'm like I'm gonna have to like willfully go backwards. Or I'm gonna, you know, I don't know what will happen because trust me, I can't dance. And I can't hit a baseball either. So I'd be in a bit of trouble. When you left the hospital was it injections a pen? They give you a glucose monitor. How did all that kind

Kyle Banks 33:01
of pin hemlock pin and

lace?

moving a hammock pin and

Scott Benner 33:13
lattice for your slow Atlantis?

Yeah. Are you on the block? Now? Where do you still inject?

Kyle Banks 33:18
I'm on him on a pump and glucose monitor.

Scott Benner 33:22
Okay, what are you use? Dexcom? What? What pump? do you have? Omni pod? Could you write for the show?

Kyle Banks 33:29
All right. twinsies

Scott Benner 33:32
You certainly. Except trust me she she can't sing. So

Unknown Speaker 33:39
you know my pump?

Unknown Speaker 33:41
I lost your car.

Scott Benner 33:44
Good. I'm going yeah, all of a sudden you were like my pump and you were just going. So

Kyle Banks 33:49
yeah, my pump actually a malfunction. About two weeks ago, the PDM

Scott Benner 33:54
or the word PDF. Okay.

Kyle Banks 33:57
So I had to go back to the pins to add so luckily, I had the pins kenalog pins and Atlantis pins on me. And I'm surprised you I have to thank you so much. Because you have just given me I feel like it might be like two years ago I was introduced podcast is just researching, just looking for like more information on how to better take care of myself. And it was a

so sorry. Oh, who is that? That is a lovely Daesil What's the name? bazel bazel

like ardens bazel. Exactly. It's lazy bait. Exactly. Uh huh. Like if I if I have to think about bolusing and bazeley at least it's gonna bring a smile to my just

Scott Benner 34:55
Bell be an adorable dog. That's 100% true. I know. But thanks happier when I see him running around, I have this word attached to something else. But I can't believe that bazel would bark in the middle of you saying something amazing about me. So let's not overlook there.

Kyle Banks 35:13
But yeah, you know, you really just gave me like, the, the push, I needed to begin making decisions for with regard to my health and insulin therapy and, and just all of it. It's been great because it was at that point when I heard you know, being bold with insulin. Does that mean? And you know, just listening to you talk about like your experience with helping Ireland? Um, yeah, it just gave me the push, I need to just make some necessary changes.

Scott Benner 35:50
I appreciate knowing that. Thank you for sharing that with me. What was what was your life like? outcomes wise, prior to that those first three years, I guess, oh, just

Kyle Banks 36:01
a constant Yo, yo, okay. Like I would go, I would go to work and make sure that my glucose was really high. Because I knew that by the end of work, I would be crashing. So it was no real control. I didn't know what I was doing. I was just trying to get through, get through the show. And the only way I knew to do that was to just let myself go high. Otherwise, I would be crashing by intermission.

Scott Benner 36:26
I say I say how high did you have to come in at to make it through?

Kyle Banks 36:30
Not to 10? Okay.

Scott Benner 36:34
And then the effort and so was that? That was with pens too, right? That was pins for the for six months into my diagnosis, and then I moved over to the pot. Okay, so you still had your settings are off far enough with the pumps, though, that you've? So what do you do now to get ready? Is it do temp back, your basal rates,

Kyle Banks 36:54
sent back my bazel rates if I'm I'm, I'm from around 100 I'll cut my pot off completely for like an hour. Because activity will usually and I'm not not eating so the activity will usually sustain me. Yeah. And I'll still need a snack by intermission to keep from crashing. Okay. Um, but yeah, I definitely have a better system in play a healthier system, because I would not have a blast doing that, Oh,

Scott Benner 37:27
just a small portion of your check. When you go back in December, you just send it to the house, I'll say, for some time, just pick it's maybe it would be more reasonable. Now. That seriously, that's, that's really amazing. Do you can you I guess was my question. Can you describe to me Why have you ever been performing and felt yourself going low? What do you do in that situation?

Kyle Banks 37:51
That's another thing like the stress of like going low and having to drop out of scenes and having stage management so that when something happens in that show, it's like it's, it's it's just starts like a whole wrecking ball of like different departments needing to, if I drop out of the scene and stage management has to be contacted may have to notify the sound department which has to notify the wardrobe department in order to get another actor ready. And just at times, I was going low a lot, I have to drop out of scenes a lot. And I just really felt like I was affecting the show in a horrible way. Although Disney was they were very, really wonderful about it all making me feel they were more concerned about my safety. But me personally, I just felt like I was destroying the integrity of the show. At

Scott Benner 38:46
some point, it's got to be in the back of your head. Like they're not gonna put up with this forever. Right? Yeah, it gets some point. They're gonna say, look, we need, we need some consistency here from you. And we're sorry about your health problems. But, you know, this specific job Well, I'm glad that that didn't end up being the case.

Kyle Banks 39:00
And I'm really grateful to do and they were I mean, it's a it took me a while to figure it out. So they dealt with this for a few, maybe a year. Wow. So they were really they were really patient and understanding about me learning how to use this new technology that I'm using now. It's lovely.

Scott Benner 39:22
You said that you made some adjustments to your diet. Can you walk me through what you did?

Kyle Banks 39:28
Well, I'm not adjustments as far as being diagnosed was concerned. A few years before I was diagnosed, I began eating plant based diet. And And so yeah, that's, that's the I consume a totally plant based diet and I do believe that that has aided me a lot with regard to being able to to gain control.

Scott Benner 39:57
Okay, but the stuff you learned on the podcast applies Just as well to plant base as it does to prime Yeah, right.

Kyle Banks 40:03
Yeah. I mean, cuz boots do I mean it affects your glucose. So it even greens. So I mean it'd be minimal but they still have effect.

Scott Benner 40:13
It's funny there are some there are some vegetables that have more carbs in them, then you would venture to guess you know? Yeah, I'm always interested when people you know, in the beginning we start talking to them, they're so bad. I'm sorry for everybody listening, but you guys are so bad at like guessing carbs for for foods. And it's always I don't understand I did the right thing is such a confirmation bias like I counted, right? So I'll stop thinking about that portion of it. It's something else is the diabetes very common to get me you know what I mean? And, and I'm like, No, it's just you, you know, did you not count all this here? Or the fat or the protein like that stuff that no one tells you to think about it really? And

Kyle Banks 40:55
isn't it beginning, maybe, maybe for that entire year, I was probably given myself. I was dosing for 15 grams, regardless what was on my plate,

Scott Benner 41:07
that was just your go to.

Kyle Banks 41:09
That was my goal to Yeah.

Scott Benner 41:10
Now I've seen people that I might go to for artists 50. Just always like, it's too much. We'll figure it out later. But we're not going to have it be too little. That's for sure. Because too little just starts to little happen today. So you know, you and I were supposed to record a little earlier. And I had a hiccup in my day, which left me out of the house when Arden had breakfast. And Kelly did a pretty good job with her helping her with, you know, the overall amount of insulin. But their Pre-Bolus wasn't good enough. And so it started shooting up, I got home I fixed you know, I worked on fixing it. But it's now I'm looking at a graph, I can see. We're like three hours into this. Now, we stopped it at 200. And now she's more like 150. And she'll be back again. So our, you know, our meal disasters aren't maybe the same as other people sometimes. But still, it was all still the same problem. It was she used the right amount of insulin at the wrong time. The food got ahead of her. And now suddenly, we're scampering to put more in that isn't too much and and then it ruins a ruins a gap of her day. It now makes you think about diabetes for three hours. Yeah, you know, instead of just getting it in at the right time and being done with it.

Kyle Banks 42:25
So Well, that was another thing that I got from you just Pre-Bolus thing. I mean, what a game changer that was. Was that it should say,

Scott Benner 42:35
yeah, just putting the putting the insulin in a position to to have a chance. I mean, really is all you're doing right. That's very cool. That's excellent. I'm

Kyle Banks 42:45
hoping a lot of people Scott, I really hope you, you get that. realized how important informative the work you're doing is That's very kind of you. Thank you.

Scott Benner 42:56
I was gonna say that Kyle met. So Kyle was introduced to me by Sam and as you will remember, I think, what is her episode called Sam is the Robin Hood of type. I don't know, there's something about I really, I know, I'm sorry about how I named the episodes. But anyway, so Sam is Sam is a is a person who's just amazing at handling, like kind of stuff you would never think about, like with insurance companies and, and hammering on them for to help people and stuff like that. So Sam reached out and said, you know, Kyle wants to be on the show. And I just thought she knew you. And that was like, I was like, great. But she does. He loves the show. And I was like that's not true. Because then I got like, I felt a little giddy. You know, I was like, you know, and and I was like that's that's really cool. I thought she was just being polite at first.

Kyle Banks 43:44
When when you texted me I told you is so weird. I'm like listening to you right now. And now you're texting.

Scott Benner 43:51
I have to admit that when you said that I felt weird to so we were both on uncomfortable. The difference. Like, I was like I I see the downloads. But you know, I had a conversation with a woman last night for five minutes, that who's thinking about coming on the show to talk about something touchy and difficult. And she wanted to talk a little first. And she started telling me about how the podcast helped there. And it's hard to know how to respond. Honestly, like, I appreciate it. And I feel it I really do. But it's don't it's strange to have so many people saying something similar to you and and you feel it every time. But if I really let myself I'd start crying. You could have made me cry if you would have went a little longer just now I would have been like, Kyle's doing better. And he gets the dance now, you know, like and Scott, you did that and you know, like I could easily fall apart. I'm a very emotional person. So I have to kind of hold it back a little bit, right. I literally I can't cry every time somebody sends a note. But it almost happens to me a lot. And my family makes fun of me when it happens. Just so you know. They're like There he is. He looks weepy and

Kyle Banks 45:00
Some pleasant for me is when I'm saying I have a positive impact on people's lives can be an emotional thing for sure. No,

Scott Benner 45:07
I appreciate that. I really don't. But in your you have a an organization that you started?

Kyle Banks 45:14
Yes, yes. It's called Kyler cares. We found it a year ago. And then our goal is to raise funds for insulin pumps and continuous glucose monitors for kids living with Type One Diabetes, especially kids coming from marginalized communities.

Scott Benner 45:35
Okay. You're so you're hoping to you have an organization you'd like to bring money in, and then turn that money back around to people to get them devices that they can afford? You know, it's incredibly odd that you say that. And if you'll, if you'll allow me one second to look here. I just had a really lovely phone call with a woman named Rebecca, the other day, and I went out on a limb there saying her name out loud before I checked the email, because you know, you listen to this podcast, and I've I really, I'm not good with names. But yes, Rebecca, I got it right, from something called the Fincher foundation. And she has a foundation that's doing the exact same thing. Wow. And it sounds like and you know, and it sounds like she's pretty successful at it. So I can I can maybe make an introduction for you. If you'd want to pick brains or anything like that ever. Let me know. Because it's, it's something that most of you don't know. And I don't really know how you would but well, prior to the podcast, when I realized that the blog was really popular, and I wanted to do something good with it, I hadn't considered the podcast yet. And I had forms in my hand to start, like a 501. c three, because I would the same ID issue, I thought, I wonder if I could help people pay for pumps and glucose monitors. And then I got overwhelmed by the process. So kudos to you for sticking to it because it about halfway through looking at those forums, I was like, Oh, boy, maybe I'm not the right person for this.

Kyle Banks 47:10
It's overwhelming. The funny thing about starting a new venture is you know, you have all these grandiose ideas until you realize the process is what it takes to actually see it through. So unluckily for me, I announced this idea at a convention with like, 3000 people there before I even like looked into what it would take to start it. So you know

Unknown Speaker 47:34
what Kyle's gonna do?

Scott Benner 47:38
Now you have to where you got to go find all 3000 of those people and be like, Listen, don't tell anybody about what else. Do you have space online that I can look at?

Kyle Banks 47:49
I do Kyler cares.org.

Scott Benner 47:55
Ky le our car yes.org? Mm, right. Okay, take a look.

Kyle Banks 48:01
Yeah, we were, um, we were having we're, we're planning on having our first fundraiser concert, here in New Orleans, in August. Mm hmm. It's tapping into Broadway community just connecting with a bunch of friends of mine that perform in shows like Book of Mormon and Kinky Boots, and Lion King, of course, Hamilton, and they're all coming down to perform in New Orleans for the concert, call it from Broadway with love, had the theater space donated as a 2800 seat theater of the Sanger theatre. It's where all the Broadway shows perform when they travel here, donated the space. And we're just all ready to go. Let's begin with Vanessa Williams about headlining, and then COVID happened. So now we're

Scott Benner 48:55
at that split on a pangolin. And now whatever happened, and now you're done.

Kyle Banks 49:01
Well, we were transitioning that to like an online concert. Okay.

Scott Benner 49:07
I hope you get to do it in person one day too, because that that sounds really lovely. What was the idea? Were you going to put on small portions of productions, or

Kyle Banks 49:17
were performing love songs from some of the most loved musicals around now?

Scott Benner 49:23
That's really nice to see. I want to see that alright, that should happen lifestyle. We're gonna get to a point I would love to see you do that live. But I'll I'll definitely share the link here for people to check it out and donate if they can. Kyler cares.org and the teddy bears really adorable. That's the first thing that caught my eyes like I like how it feels like it's hanging a little bit worse up straight. I can't decide what I feel like it's doing. But one way or the other. It's a T shirt. There should be if it's not,

Kyle Banks 49:53
it is a T

Scott Benner 49:57
is very nice. So how do you plan on on finding people who need the help?

Kyle Banks 50:03
Well, I've been

with Lion King, we do a lot of research outreach throughout the years, so I was already connected to Children's Hospital. So I just reached out to them. And that's when I really began to understand like how grave The situation is, especially among communities of color. Um, this, people with T, one D, from communities of colors, they're frequently using pumps and CG is they lack access to the technology because of finances or they're underinsured. They infrequently perform glucose testing, they, they have less contact with management staff is a difficulty relating to staff because of socio economical and cultural differences. So there's just a whole slew of problems that that antagonize a really bad situation. Did you ever by any chance hear me when I spoke to Anthony Anderson? And I asked him, if culturally, it's just one of those things like, Oh, I got it. And now whatever is going to happen is going to happen. Like this is my lot in life, I have diabetes, is that is that a function of everything you just said, if not having good information, or someone who can talk to you, you know, where you can, where you can listen? Totally. And I don't even think that it's a conscious choice that people are making just to disregard their situation. It's just the cards they've been dealt, and they don't have the resources and or the information to, you know, tackle it. Probably.

Scott Benner 51:49
Yeah, it's it's so interesting that it's no different than any other thing. And so yesterday, my son, who I have to admit, is a really good kid, and it's not getting a lot of trouble. He went to visit some friends. And park somewhere, got his car towed. And he called me, and nothing like that never happened to him. And he said, He's like, my car got towed. And I said, well, get it back. You know, like, I just figured it out, man, you're 20, you're pretty bright kid can get them car back, you know. And it was interesting to watch him work his way through it. Because there were just simple ideas or concepts, tools that he didn't have. And when he, when he reached into his mind, he just there was no, there was no function for this problem. And it's, it stopped him. And so I said, Okay, here's what you're gonna do. You know, first thing I want you to do is go back to where you parked the car, see if there's any signs there to indicate who might have towed your heart. If not, we're gonna call the police department, don't call 911 call the the non emergency line, ask them. And then I gave him tools, then he went off, did it no problem came right back and said, and as you're talking about it, I don't see any difference between that in a health thing. Someone's put you into a situation that you just don't have, you don't have a tool for and your imagination can't find it. Because it just doesn't it doesn't know from it, you know? And then that's it.

Kyle Banks 53:13
In the healthcare system is it's impossible to navigate. So yeah, that just makes that makes I mean, I, even when I have to reach out to my insurance and figure out, like, you know, who's paying for what, and you know, who do I have to contact for certain things that I need? It's, it can be really challenging, and it also consumes a lot of time. Yeah,

Scott Benner 53:40
I can see very simply people going from all those questions that they don't have answers to, to, you know, what they gave me the insulin, I've got the needle, let me just do this. And that's it. And then and then whatever is going to be is going to be and I mean, it's very unlikely. Like you think about the things that you've learned listening to the podcast, and you think about how long it took me like, what a What a weird situation I was in to even be able to do what I did. I was a stay at home parent, I got put in charge of a small child. I had time I had no resources, the resources kind of fell apart. And for people who are wondering, what we're describing happens to other people. It happened to me too, I didn't walk into some magical doctor's office who was like, here's the things you're going to do you know it and we live in a in a place with a good with a good health care system, and we were at a good institution. And still, it wasn't like they laid it all out. For me. We struggled for years. And had I not started the blog and felt some function to make the blog more than just Hey, diabetes sucks, right? You know, like, I don't know if I even would have ever helped Arden and so every we all can't have that. Those, I don't know, circumstances that allow us that kind of time together. get to something, you know, it's it's somebody needs to step in and say, Hey, listen, I want you to get your bazel. Right, then I want you to Pre-Bolus. And I want you to do this. And when this happens, do that, and then you learn as you go. I just it makes sense to me,

Kyle Banks 55:13
honestly, like you said, having the time to do it. I know I worked for a, the only time I took off from work after my diagnosis was made the three days I was hospitalized. And I worked for a year, just going through the motions, you know, just trying to survive with this new pump, and you know, insulin injections and figuring out, you know, living walking around most of the day with exorbitantly high glucose numbers, right. Um, but I, after a year that I took a year off, just because I just needed to reset, figure out what was going on with me. That's when I was introduced to podcast. And that's really when I had the time to just study and figure out, you know, how to better take care of myself.

Scott Benner 56:03
Yeah, I understand when I get notes sometimes from people, and they're like, Can you just point me to the couple of episodes I need on my head, it's not that easy. You know, I'm like, and I think just take some, you know, take 20 hours and listen to these, and that should get you going. I don't have time for that. And I think I understand, like, I understand that you don't feel like you have time. But if you listen, it's gonna create so much extra time for you like, but not everyone's even, like, I'm assuming you would you do to go home for that year?

Kyle Banks 56:32
I did. came to New Orleans.

Scott Benner 56:34
Yeah, some support somebody was there to like, to help you out? Yeah.

Kyle Banks 56:39
To your fact, at the top of the podcast, where I received care at aashna Hospital, and they actually making since COVID. In New Orleans, as hard as it has, it's actually been in the press a lot. But I was surprised as well that my caregivers here and my independent chronology team and National Hospital was was. So that's the word I'm looking for. They have been so helpful and so good. And I'm surprised that they are as forward thinking as they are with regard to treating diabetes. That's excellent.

Scott Benner 57:19
I'm always excited when I hear that there are institutions that are out on the edge and, and leaning into good ideas, because that's the only

Kyle Banks 57:27
way that you know, I also have, because I've been has been part of my time here in New Orleans. And part of my time in New York. I also have doctors in New York, that I endocrinology team in New York that I work with as well. And I find that the doctors in New Orleans, surprisingly, are a bit more knowledgeable. Yeah.

Scott Benner 57:48
But it you know, everybody likes to say, yeah, if something done like that, go to the city go to Manhattan. That's right, I get it. Right. You know, but a good doctor can live anywhere. That's the first thing but and having the having the the nerve to not be so institutional that you're more worried about not being wrong than about helping somebody is is a big deal. You know, it really is. Well, that's an interesting story, man. It really is. I'm glad I did this actually, by mentioning current events, you got your podcast moved up six months on the schedule. It's good to go out this week instead of like, you know, at Christmas. Because I don't want six months from now people going

Unknown Speaker 58:33
Wait, what's COVID-19?

Kyle Banks 58:37
That would be beautiful. If that's where we are in six. I hope so.

Scott Benner 58:41
Yeah. I don't know how to wonder what's going to happen. But I do know that I I completely beside with what you're saying about being frightened to just go get sick. And then there's the other side of me that thinks of it on a macro level. And I'm like, we got to get going, like, you know, Okay, sit around like this. You're seeing what's happening. You let people sit around, not make money for a few more months. And, you know, and see, it'll take a lot less to set, set them off, you know, and I don't know where it goes from there. It's it's, I always wonder to how it feels for people who live in more remote places to flip on the news and see something happening in Boston and Philly in New York. Like does it feel like another world to them? Or, to me it feels like it could be at my house at any second because that's how close I am. Yeah, you know,

Kyle Banks 59:30
it Yeah, imagine something you know, it's been pretty quiet here in New Orleans. So we haven't been affected by like the riots and the looting isn't some protests, but it's been all relatively peaceful and calm and not really a lot of numbers. But I guess that's how people felt when when the quarantine first began, like certain areas wasn't really being affected. So they were wondering, oh, why why should I shut down in Idaho? Right and we don't have during any deaths here, okay, we're not experiencing what New York City is in California are experiencing. So

Scott Benner 1:00:07
I had a talk set up in Wisconsin, as this was all going down in the second week of March. And they were still like, no, you're coming. And it was like the 26th of March. I'm like, No, there won't be airplanes on the 26th of March. And they did not know what I was talking about. And then all of a sudden, one day, somebody got sick in Wisconsin, and then they figured it out real quick, you know, and I was like, that's, it's really interesting how that happens. I always go back to in my mind. My brother grew up here on the East Coast with us, but he moved to Wisconsin. And I took that Wisconsin gig, partly because I could see my brother when I went. But, but so he's got an East Coast sensibility about the world. And on 911 he called me He's like, is this really a big deal? What's going on? I can't tell here. And I was like, Yeah, man, this is his terrorism. And this is a problem. Yeah, you know, and he's like, Alright, he's like, that's what I thought he was, but the way they talked about it here, you know, a plane hit a building, but like, it was very, I don't know, laissez faire in the in the first number of hours, you know, right. Obviously, they figured it out after that. But in the very beginning, New York's one of those places, like if you've never been there, I suggest coming in underground, which you'll end up doing unless you drive. Because the first time you walk up in the sun hit your face, and you look up you'll think I have never seen anything like this in my entire life. You

Kyle Banks 1:01:27
know, it's crazy. It's intense. You got to be ready. Working at a Time Square every day is is definitely a treat.

Scott Benner 1:01:36
Yeah, I we, you know, obviously I haven't been up in a little while because of all this, but it is a real, you just you've never, most people have never seen a building that tall next to a building. That's all that goes on seemingly forever. So many people moving. in unison, but separately, it's hard to put into words really generally mean but there's a flow of people it works. And I don't know I love it there. I love it out here in general on these coasts. I like I like, I like that feeling that the same guy that may flip you off or bumping into him a block later if you tripped and fell would stop and be like, yo, you are right. Yeah. It's just it's a it's a, I don't know, it's a weird thing. That's hard to put into words. Unless you've been there. Is there anything that we didn't talk about that you were hoping to?

Unknown Speaker 1:02:30
Um,

Unknown Speaker 1:02:31
no, we would cover

Kyle Banks 1:02:32
we covered a lot, you know, just basically, definitely the the organization kind of cares. We're figuring out now what our first fundraiser is going to look like later in this summer. So just be on the lookout for that. And we were also going to be producing some pieces of in collaboration with the partners that partnerships that we have with like the New Orleans Saints, the NFL, mobile snack cakes, intellect index calm, which sort of like help with like, marketing the message about centered around self care, okay? Because it's, it's a, it's, it's a really big issue. People just not having the information not realizing that the big with just minor tweaks that can really just make life with this disease a lot less stressful and just make life better.

Scott Benner 1:03:40
Yeah, I used to joke that if people figure out what I'm saying, isn't that complicated? They won't need the podcast anymore. But I don't joke like that anymore. Because then other people have been ripping me off. So I'm like, it is complicated. I'm the only one that can tell you.

Kyle Banks 1:03:54
But no, no, this is like one of the areas where, you know, copying is sort of like, it's gotta be flattering. You know, when you when you hear somebody

Scott Benner 1:04:07
do it. My wife is such a pain. She's like, she wants me to take the dogs out. And I'm like, she doesn't realize I'm still going. I listen, I'm not gonna joke with you about it. I'll be I'll be seriously. It is flattering to start doing something that people see and think, Wow, that's great. where it hurts a little bit is how much time and effort I put into the podcast. Then I see somebody else like trying to be like, oh, look what I thought to do. And I'm like, Yeah, like not that Pre-Bolus thing is patented. I'm not saying that. But there are ways that I explained things that I know for certain. I figured out and then I hear some and I hear someone used those exact words. And then there's two feelings. There's the This is great. It's getting around. But then there's the part of me who makes the podcast who wants everyone to listen to the podcast. You know, I mean, so it's a very interesting it's a it's a weird thing. It's a weird thing to have happen, because you definitely just want people to be healthy. Yeah, I suppose definitely. Yeah. But at the same time I want my downloads

Kyle Banks 1:05:14
you should get, those are

Scott Benner 1:05:15
my downloads, don't take my downloads.

Kyle Banks 1:05:18
You know, the thing I really would like to stress, especially with people of color that may be listening to your podcast is not I mean, you glucose now in how it affects you today is one thing, but the thing we really need to look out for is its effect on your life in 510 15 years from now, because I have been in communication, people who were just having the most heinous complications, and it's awful to see someone at the age of 35, you know, dealing with neuropathy and high damage in or females having pregnancy complications, or young males who who have to deal with erectile dysfunction in their early 30s. And like, it doesn't have to be that way. Yeah,

Scott Benner 1:06:01
no kidding. There's, there's just like everybody, there's always going to be somebody who no matter what happens, their body's just not going to do well with the diabetes. But for the most part, for most of you, for most everybody, there are certain easy things you can do to stop that stuff from happening. And it's like you said, it's, it's easy now to think oh, that's later it probably won't happen to me. But man, when it when it happens to you, there's no going back, you know, you it's not pretty, it isn't going to be something you want to deal with. So I appreciate that. But I'm going to put the link in for sure. And I'll mention it against the people here. That link of course is Kyler cares.org ky le r ca r s dot o RG or if you can imagine how Kyle would say it. Okay, why no, I can't do it. His voice is beautiful. Isn't it? Makes me feel like I'm feel like I'm squeaky over here. Thank you so much to dex comment on the pod for sponsoring this episode of the Juicebox Podcast. Please go to my on the pod.com forward slash juice box or dexcom.com forward slash juice box. Why did I say or it's and go to both of them? Find out more about the sponsors. A couple of housekeeping things first, and not that Disney needs to help. But if you've never seen the Lion King on Broadway, it is a beautiful spectacle. It is an absolute charm fest Did you hear that Thunder? It's coming. Whoo, geez. This could be a people, Episode 343 with a podcast and I get another one going up in a cyclone apparently. But before I do, let me ask you, if you Hi, just in case I get pulled up into a tornado, you might want to go to Apple podcasts and leave a wonderful review of the podcast. You know, so that other people who are finding it for the first time can trust what they're going to hear. They need to take a leap. And it might just be your review that lets them feel comfortable trying the podcast. So if you can do that, I would really appreciate it. What else if you're looking for, you know, some deep conversation with other listeners, check out the Facebook page for the Juicebox Podcast. There's of course the public page. It's called bold with insulin. And there's the private page, the juice box discussion group where people get together and talk about management ideas. It's a really great tight group. I'm proud of it. Honestly, there's over 3000 people in there now. I'm juice box. If you have a great physician that you'd like to suggest to somebody else, go to juice box docs.com and send me your addition and I'll add it to the list. It's JUICBOXD OCS calm and anything else. Hmm. I'm gonna be doing something cool next week, but I can't tell you about yet but I will tell you about it as soon as I can think it's gonna add to my understanding of how insulin works a lot actually. So I'm excited about that. It's embargoed for a while. I think I can tell you it a few more days. Oh, you know, dex company will be back on the show soon. I think the CEO is going to be back probably on June 16 ish around there. A lot of stuff going on at FX calm. Kevin Sayer is going to come back and fill us in on that. And I don't think oh, and I just recorded a really great afterdark today that I think you're going to enjoy. And next week I'm doing a bunch of recordings with Jenny so Jenny Lee backson. Speaking of Jenny, all of the diabetes pro tip episodes are collected at diabetes pro tip calm if you'd like to share them with a friend. There's no assets diabetes pro tip.com takes you to the collection of the episodes from the podcast. You of course can listen through your podcast player but easy way to share or to revisit anything else. Hmm No, I think that's it. I think I've covered everything.

Unknown Speaker 1:10:11
If I yeah,

Unknown Speaker 1:10:21
no, I was up say