Scott Benner 1/20/25 Scott Benner 1/20/25

#1410 iLet User Experience

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

I'm very excited to share this episode with you. I'm talking today with Dr Hamdy. He is a senior staff physician at Joslin Diabetes Center, the Director of International Medical Affairs, the Medical Director of the obesity clinic program and inpatient Diabetes Program, and an associate professor at Harvard Medical School. And he's here today to share his very important message for those of us using GLP meds, please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin when you place your first order for AG, one, with my link, you'll get five free travel packs and a Free year supply of vitamin D drink. AG, one.com/juice, box. Don't forget, if you're a US resident who has type one or is the caregiver of someone with type one, visit T 1d exchange.org/juice box right now and complete that survey. It will take you 10 minutes to complete the survey, and that effort alone will help to move type one diabetes research forward. It will cost you nothing to help.

The episode you're about to listen to is sponsored by Omnipod and the Omnipod five. Learn more at omnipod.com/juicebox use my links to support the show. We're also sponsored today by touched by type one, and they have something great coming up on March 8. Touched by type one is hosting their very first steps to a cure walk. And you can register right now to participate. Touched by type one.org Go to the Programs tab, click on Steps to a cure and sign up today. You can sponsor walk or volunteer. Check it out.

Osama Hamdy, MD, PhD 2:06
I'm Osama Hamd,. I'm the Medical Director of the obesity clinical program at Joslin Diabetes Center and associate professor of medicine at Harvard Medical

Scott Benner 2:16
School. How did we meet each other? Who put us in touch? Do you remember one of

Speaker 1 2:21
our nurse practitioner, Daniel rock,

Scott Benner 2:25
what did she tell you? I'm interested. What made you be willing to do this? Yeah,

Speaker 1 2:30
he told me it is a very popular broadcast, very efficient broadcast. He follow a lot, and he thought that it would be a good idea that we comment on muscle mass and some of the work that we frequently do in that space on obesity. I had been in obesity field for 40 years now, wow, and I created the obesity clinical program at Joslin Diabetes Center as one of the biggest programs. We had been doing several weight management. You know, we did research that cost us almost $16 million to come with the the best weight management, multi disciplinary weight management program for our patients. It's called, why weight, weight achievement, intensive treatment. And then we have another program called diabetes remission outcome program, drop program, which aimed for diabetes remission in early inpatient, was early diabetes.

Scott Benner 3:27
Can I go to the beginning and ask you about how we got to that? Yeah, yeah, we can. You can ask whatever you would like. You know, you've been in it for 40 years. Let me ask you what got you into it, and what was it like back then, versus what is it now, and how did it change throughout the time? Oh,

Speaker 1 3:44
there is major, major change. You know, the whole concept that link obesity to diabetes was not clear in the old days. You know why people with obesity develop diabetes? Who will develop diabetes? Why Some develop diabetes and others are not until we discover the whole idea of insulin resistance, that once you are obese, and especially if you have more fat in the abdominal area and visceral area, you'll become insulin resistant. And this could be the reason why people, when they gain weight, the start to develop diabetes. So my early research back almost 25 years ago, we found that 7% weight loss improves insulin sensitivity by 57% Wow. So I remember I was whispering to my colleagues at that time, telling them that means diabetes is not a chronic disease. Actually, in reality, we can reverse diabetes. But that concept was not there at that time. Concept that this is a chronic disease, whatever you will do, there is nothing that can reverse it. But people who repeated those studies found 7080, even 90% after. Bariatric surgery significant improvement in insulin sensitivity, which means that if you catch it early enough, especially within the first five to seven years, you can actually reverse diabetes. So

Scott Benner 5:12
for type two, how does the bariatric help? Does it help with the weight loss, or does it help with the with something else, too many?

Speaker 1 5:19
The best to answer is that patients with after bioethic surgery, they stop their diabetes medication in frequently. Why they are in the hospital even before weight loss?

Scott Benner 5:32
Why do you think that is the what's the cause and effect? It is a

Speaker 1 5:36
reduction, significant reduction, in the anti hepatic fat, so when they are in the hospital. After surgery, they are not on oral feeding that much. It is all IV fluids or IV glucose. There is significant deficiency in nutrients in the beginning. So the easiest for the body to do is to take the fat inside the liver and use it as as a source of energy. And immediately, with the reduction in the intra hepatic fat, you will, you will start to see improvement. And then later on, when they start to lose weight, that's when you get the maximum improvement.

Scott Benner 6:17
Wow, that's insane. So, so you saw that you saw, give these people bariatric surgery, they what can reverse type two or stop pre diabetes, either or,

Speaker 1 6:29
you know, it depends in at what stage you are doing. If you are in the pre diabetes phase, definitely okay, you will prevent the type two diabetes. But if you're already on type two diabetes, when it is shorter duration, less than five years, definitely remission can occur for how long that remission will maintain. It is not studied significantly right now.

Scott Benner 6:53
So is the biggest hurdle, then, is losing the weight, not

Speaker 1 6:58
losing the weight in precisely it is when you lose weight, when you say lose weight, you lose muscles, you lose fat, but when you are when we are talking here, we are talking about the critical fat in the body. This is the intra abdominal fat and intra hepatic fat, visceral fat, intramuscular and sufficient fat, all this ectopic fat is dangerous. Okay, this is a problem.

Scott Benner 7:25
I hear people talk about all the time how extra fat impacts hormones and causes hormonal issues. Is that, is that something that you're aware of, today's episode of The Juicebox Podcast is sponsored by Omnipod. Before I tell you about Omnipod, the device. I'd like to tell you about Omnipod, the company. I approached Omnipod in 2015 and asked them to buy an ad on a podcast that I hadn't even begun to make yet because the podcast didn't have any listeners. All I could promise them was that I was going to try to help people living with type one diabetes, and that was enough for Omnipod. They bought their first ad, and I used that money to support myself while I was growing the Juicebox Podcast. You might even say that Omnipod is the firm foundation of the Juicebox Podcast, and it's actually the firm foundation of how my daughter manages her type one diabetes every day, omnipod.com/juicebox whether you want the Omnipod five or the Omnipod dash, using my link, let's Omnipod know what a good decision they made in 2015 and continue to make to this day. Omnipod is easy to use, easy to fill, easy to wear, and I know that because my daughter has been wearing one every day since she was four years old, and she will be 20 this year, there is not enough time in an ad for me to tell you everything that I know about Omnipod, but please take a look omnipod.com/juicebox I think Omnipod could be a good friend to you, just like it has been to my daughter and my family. That's

Speaker 1 9:05
absolutely right, and I wrote about it before. You know adipose tissue is not an inner tissue. This is an endocrine gland. It secrets hormones like, for example, Leptin hormone, the satiety hormone, the major satellite hormone is coming from adipose tissue, from fat tissue. There is another hormone called the bone actin, which actually increase insulin sensitivity. Unfortunately, when people are obese, adiponing is low, and that's why they are insulin resistant. Interestingly, when you lose weight, adiponing start to go up. And to make it even more complicated, visceral fat is different than subcutaneous fat. Okay, those are two different organs in their genetic expression, in their hormonal secretion, in their even relationship to each other. And so the distribution of fat is. More important when it comes to the endocrine function of the devastation.

Scott Benner 10:03
How does it impact satiation? Yeah, there is a hormone

Speaker 1 10:07
comes from subcutaneous fat. Subcutaneous fat, okay, there's external fat, not the internal fat. It's called leptin. So Leptin is a hormone, one of the major hormone that induced satiety. Just to consider leptin as a defense lawyer for your fat. You know, anytime you start to lose fat, leptin goes up Shut your appetite. Try to preserve fat as much as you can. And interestingly, leptin has a circadian pattern, so it is mostly secreted between 8pm till 8am that's why we will are eating during the day, and they don't eat during during those hours, right? Exactly, right. So let me give an example. If we will get leptin abnormality or Lipton deficiency, they start to eat significant amount of food in the evening. We call them night eating syndrome. So night eating syndrome affect around 2% of the US population. And the eating average studies showed, in average is three big meals after their supper, three big meals. Each meal is 1250 calories. So you can imagine if that hormone is just deficient. Yeah, wow. Some people are, they are born, but this very rare born nose lipicsy And they are very obese from their

Scott Benner 11:34
younger childhood. For people who would say, just do a setup, go for a walk, like, can you tell them why that doesn't work all the time for people who are or in this situation,

Speaker 1 11:46
you know, your your body, need different types of exercise, and each exercise had its own benefit. It is, you know, walking is aerobic exercise. This is very valuable for your heart, for your cardiac effect. But other types of exercise has measured, measure different, different angle. For example, you you need, you need to stretch your body. And stretching your body, which people can do it just for 10 minutes in the morning, increase blood flow to to the body, reduce energy injury, improve movement across the joints. There is a lot of benefit from stretching, but the most important component of exercise is actually strength exercise. Okay, and you cannot do exercise without doing muscle strength exercise. And the reason, the reason is that as you age, you lose muscle mass over time. So normal people without diabetes lose around 5% of their muscle mass every 10 years from age 30 up, people lose diabetes lose around seven to 8% of their muscle mass every 10 years from age 40 up,

Scott Benner 13:02
do we know why people with diabetes lose more than people without?

Speaker 1 13:06
Oh, yeah, there are that is a very complex metabolic issue. But the bottom line is that from age 40 to age 70, you lose around 24% of your muscle mass. I see by ages 70 up, you lose 15% of your muscle mass during your lifetime. If you live till 40, from 40 till 80, you lose 40% of your muscle mass.

Scott Benner 13:32
Is that something that I can I can't stop it completely, but I can get in the way of it, right, try to to slow it down. Is that the idea?

Speaker 1 13:39
Yeah, yeah, no, you do all the effort to prevent it, right? Because loss of muscle mass is, in my personal opinion, is a crime. You know, if you lose your muscle, or anything that makes you lose muscle, you will be in terrible scenario. This is how frailty occurs. This is how we will get poor quality of life. You can even stand from your chair. It is a problem, but there are three major problems. Just to be clear, there are three major problems when you lose muscle mass. Number one, you will not regain muscle mass. You can't get it back, bye, bye, muscle mass. It is very difficult, because you build the muscle mass over years by three hormones, growth hormone, insulin, sex hormones, okay, when you get older, all those hormones are noose down, so you don't have them, so you cannot build muscle mass that much in your older age, or I will say, from even middle age, there's a first problem. Second problem is, once you lose muscle mass, your energy expenditure start to go significantly down, to a degree that if you return back to eat whatever you used to eat, you gain weight, and that weight is not my. Muscle and fat. It is mostly fat. So every time that you lose weight, you lose muscle, and then you gain fat. If you return the back and then recycling, go care. And this leads to what's called sarcopenic obesity. Sarcopenic Obesity means you lose muscle and then you have more fat, okay, but if you age normally, you lose muscle all the time, until you reach a sarcopenia. In this scenario, I say, Okay, the third drawback, just to complete the drawbacks of losing muscle mass, that quality of life start to go significantly down and by percentage loss in the muscle mass. So if you lose 10% your performance of the muscles start to go down. 20% you start to have reduction in your immunity, and you get infections and and problems. 30% you can get pneumonia with zords. 40% of muscle mass loss means mortality will be significantly higher. So

Scott Benner 16:00
how do we balance in I guess, starting with obese or type two community, people are getting GLP medications. They're having some of them significant benefits as far as weight loss goes, but so I don't imagine you would trade their weight loss. But how do you mitigate the muscle loss in the same situation, like, what else should they be doing that we're probably not telling them about Yeah,

Speaker 1 16:21
this is a very, very important issue, because we have to differentiate, Scott from the beginning, between quality weight loss and quantity weight loss. Okay, the weight loss was in keratin mimetic drugs. This is a group of GLP one and GIP and GIP and all this group is volume weight loss, quantity weight loss, not quality weight loss. Quality weight loss is entirely different. Quality weight loss means you lose adipose tissue. You maintain muscle mass, you maintain muscle performance. And quality of life is much better. But if you lose the adipose tissue and lose muscle mass in the same time and have poor performance, weakness in the muscles and so on, you will you will be in in trouble. And that's exactly what happens with those medication. You know, people are happy with the volume of weight loss, but it is not a quality weight loss. So is it

Scott Benner 17:23
possible? Do you think to use the GLP and be exercising and supplementing at the same time to keep a balance? Yeah,

Speaker 1 17:30
we need a lot of research in that area. But theoretically, that's absolutely right. If you take enough amount of quality protein, if you do a Strengths exercise. Very good quality of strength exercise, especially in the muscle, in the bearing muscle the body, bearing muscles around the size and back and and all this area, I think maybe you will mitigate some of the problem with loss and muscle mass. Yeah,

Scott Benner 17:59
so you don't know this, but I am 57 pounds lighter than I was two years ago, and from a GLP medication. Now I try to balance that with a significant amount of animal protein, and I do a protein drink every day to make sure my protein is high enough during that what I try to do is light to medium weight training in the beginning, arms, legs, poor, but it was harder in the beginning, because I was so I was so out of shape. Now, the irony here, I guess, is that as far as the amount of calories I take in, obviously I take in less now, because the GLP, it does, obviously, you know, kind of shut down your hunger. But at the same time, I'm not eating that much less, and so I noticed a difference immediately. I don't have diabetes, I didn't have diabetes, but I would have described to you that throughout my entire life, my body never responded to food in a way that made sense. My digestion didn't work well, and I had to, as an adult for years, get iron infusions, because my ferritin would drop through the floor, like every six months. But since the GLP, I don't need the iron infusions anymore. I now defecate like a normal person would, like, I eat, I don't get sick right away. And like, it has changed so many things for me, and I don't know how to put it all into words, like it feels like it's having impacts that weren't intended by the label, and I'm done now, like I don't really need to lose any more weight. I have some mid section fat that I'm still working through, but everything else I've been able to to get rid of. But I'm 53 I have very dark hair, so it might be hard for you to see that right now. I got to the point in my life where I thought everything I've tried supplementing, exercising, eating, right, all the things that people talk about, none of it was happening like, it just it wasn't doing anything for me. And I thought, I'm gonna die if I don't do something like I genuinely thought I'd have a heart attack in the next 10 years. So I thought, well, let me get rid of this weight the best I can. I'll try to mitigate. The the muscle loss, as best I can, and now that the weights gone, I'm upping my activity and being more strenuous and looking towards more building. Because the exact same thing that you're talking about, like, I I just watched my mother, you know, at the end of her life, in her early 80s, like, not be able to get up and sit down and get out of a chair and, like, I don't want that to be how I go out, so I'm trying, you know, but I don't know if I'm doing the right thing. Because, to your point, they came up with the meds, and they were like, here, and people got so excited that everybody started taking them, and nobody really knows what they're doing. So I'm, you know, lucky enough to have a nutritionist that I talked to on the podcast who warned me early on about the protein and the muscle building. Nobody told me about that, you know, so I don't know, like we're in a weird spot right now, I'm wondering what you feel about all that.

Speaker 1 20:50
What you did is, right? You know, you try to lose weight, because, you know, initially, you are talking about the complications of obesity. You know, Obesity is a disease. You know it is not symptom or a sign. Obesity is a disease. And you have obesity, you have many metabolic and you have many mechanical problem and you are at very high risk for cardiovascular disease and diabetes and many other problems. That's why people are basically awful in that scenario. But reality is that many obese people are malnourished. In reality, you know, study among the US population found the US population in general, obese or non obese, 40% of them have micronutrient deficiency. So when you are talking about iron or any other test elements or any of minerals, 40% have macronutrient deficiency. What do

Scott Benner 21:44
you think that is because I don't eat I'm gonna try to hold this up to the camera. I don't eat much differently now than I did then. I was eating protein, I was eating healthy, I was taking supplements. But look, can you

Speaker 1 21:56
see that? Oh yeah, yeah, I can see it different. It's a significant

Scott Benner 21:59
difference in who I am now, and so that person in that picture doesn't eat much differently than I do. I can tell you that if I inject on a Wednesday and eat normally, everything's fine, but if, even if I get to the end of the half life on the medication, I can see myself starting to gain weight having not changed one thing about what I'm doing in day six and seven. Do you think that there's an inflammation component to this for some people? Because we're also seeing people use it for PCOS. We're seeing people use it for a number of different things that it's not on label for, that all seems inflammation related, but I don't know anything. I only know what's happening to me. I don't really know what's happening.

Speaker 1 22:42
You know, the medication does two jobs, okay? And this is a reason for weight loss. The first is chat appetite. It works on appetite center in the brain, chat appetite. And you know, most of the obviously, problem is related to larger abortion, frequent eating, stress eating, night eating, binge eating, all kind of stuff. So when you shut up, per se, you lose weight the second that is slow gastric evacuation. So basically, what you eat is slowly digested over time, because it takes longer duration in the Git to to move,

Scott Benner 23:22
and that's how I'm getting my iron from it now, because it's staying in there long enough for it to be extracted. Is that right,

Speaker 1 23:28
you know, but, yeah, when, when the food is slowly processed, definitely more digestion, more absorption, more rather than it, if there's, you know, a quick evacuation for, for, for that. But you know, once you lose weight, your body adjusts itself in many aspects. But the most important is that once you start to lose weight, the critical and the bad fat is a thirsty fat to go down, okay, the intra abdominal fat, the intra muscular fat, the intra hepatic fat, the intramyocardial all those ectopic fat start to go down. Once that visceral fat and intramuscular fat goes down, inflammation in your body will go way, way down. Okay, because that fat in your ectopic area is a source of the inflammation in your in your body. This was called sub clinical Corona inflammation. Why this happens? You know, when the fat cell gets larger. Let me explain it in a much better way. When the fat cell gets larger and larger and larger, it can, you know, can be a very big volume, the fat cell rupture. Actually, it is, I will not say rupture. It will be what's called fat cell necrosis. You know, the cell membrane of the fat cell get necrotized and so on. This death of the fat cell attract cells in your blood called the macrophages. Macrophages is like janitors. They come and to clean the debris of the fat cell. But. When they come in, there is it inside adipose tissue. We call them adipose tissue resident macrophage. They live in the adipose tissue. And this macrophages start to produce significant amount of what's called cytokines, inflammatory Cyto This is the reason why people get cardiovascular disease, heart attack, stroke, insulin resistance on type two diabetes is basically inflammation originated from macrophages raised in the adipose tissue in the ectopic area in your body. That's

Scott Benner 25:32
crazy. I never would have understood the pathway to that. That's really something. Yeah.

Speaker 1 25:36
So people who studied all this area, myself and many others found that the core problem of all this cardio metabolic issue is poor nutrition, because when you eat poor nutrition, you start to accumulate more visceral fat. Visceral fat attract the macrophages. Macrophages secrete inflammatory cytokines. You get inflammation, and then the three branch, dyslipidemia, hypertension, Corona, kidney disease, cardiovascular disease, until we will end up in ICU, heart attack or stroke.

Scott Benner 26:11
Is it possible that the increase in autoimmune issues like hypothyroidism, Hashimotos, type one diabetes? Could this all just be nutrient fat over generations?

Speaker 1 26:24
No, no, no. This entirely different scenario, type one diabetes and autoimmune disease, Hashimotos and autoimmune disease, those are entirely different. We are talking about the process of people who are gaining weight, and especially if they are gaining weight in this wrong area and the wrong area, the divorce tissue, in the visceral area, it can be just one to two kilograms of fat, but is extremely dangerous fat, okay, so you can, you can be lean and happy and so on, but you, if you have that visceral fat, you are at that major risk, like, For example, go, go to people living in South Asia and in India, the average body mass index, 2223 but if you do acidity scan for them, you'll find significant amount of edible station, okay, in visceral area, in the visceral area, that's why they get Diabetes at younger age you get cardiovascular disease at younger age, by age 4050, the may have heart attack. Yes, it doesn't matter how your body mass index looks like it is where that fat is located.

Scott Benner 27:33
So for people in India as an example, is that genetic, or is it food related? Is it more cultural?

Speaker 1 27:40
You know, the accumulation of fat and fat distribution in your body is based on ethnic background and some genetic components, like, for example, in the US, African American women accumulate more visceral fat than white women. In the in the in the same time, white men accumulate more visceral fat than African American. Men in Latin America, men and women accumulate more visceral fat. In South Asia, men and women accumulate more visceral fat. Middle Eastern is the same. Just to give you a very simple example of how this can be a problem. If you look to the women Indians and the Bema Indians, Native American they have the highest tendency to accommodate visceral fat. Do you know among the Bema Indians, the prevalence of diabetes 60% 60% because they accumulate significant amount of disorder of fat. You

Scott Benner 28:36
said something, I make sure I didn't misunderstand it if, if I take that same person, like you said, black women in America. Does that mean that black women on other continents don't have the same issue? Is there something to do with them being here or no? Not necessarily.

Speaker 1 28:51
Distribution of fat is entirely different across the globe. Like for example, if you are in the Mediterranean area, South Italy, South France, Greece, North Africa, we will accumulate fat in their periphery, in the lower area of the body, in the side. This is what is called pear shaped right obesity. This is entirely different than Apple shaped obesity, where the fat is accumulated around central

Scott Benner 29:17
area. Is one better than the other. Of course, yes, pear actually,

Speaker 1 29:20
if you have a pear shaped that fat will be protective. Ah, not even, not even harm. It is protective for your body. I want

Scott Benner 29:30
to get my belly into my ass. Is that what you're telling me?

Speaker 1 29:35
But not by transplantation, yeah, let me. Let me tell you something which is so funny. Yeah, when we did our study of the 7% weight loss and we found that insulin sensitivity improved that much, ballistic surgeons said, Oh, that's easy. Let us go and suck 7% of the body fat. Did that work. I will tell you they actually sucked the. 10% of body fat, 10% and I don't know how they suck the 10% i My brother is a plastic surgeon, and I asked him, how you how we can suck 10% of the body? He said, Oh, we have new techniques and and procedures and so on. But do you know the results? 00, benefit, because the what they removed is a wrong fat. They remove the subcutaneous fat, not the visceral fat.

Scott Benner 30:23
I see, oh, that's so disappointing, because I was going to start saving my mommy. When you talk about, I've heard people talk about before their doctors tell them that they sometimes have fat between and under their organs. Is that visceral fat?

Speaker 1 30:37
Visceral fat is inside the intra proteinal cavity, around the organs, around your intestine, all the entire organ and, of course, in the in the liver and around the stomach and all this, all that fat in the visceral lady, when you open the protein, the muscles and protein, you'll find that visceral fat.

Scott Benner 30:59
So the fat I'm left working on now is more about vanity and not about health or no, what

Speaker 1 31:06
you need? You need to reduce a visceral fat. That's that's the aim. You know, if you need health benefit, there's aim. But if you need to maximize the health benefit, you increase muscle mass, okay,

Scott Benner 31:18
the the way to get rid of this fat now is to build more muscle and

Speaker 1 31:22
build more muscles, okay, okay. And by the way, building muscles is the most important thing they can do in your life, especially in elderly population. Okay, so let us go back to the GLP one medication. Yeah, okay. And, but this is around the numbers about, you know what we have been talking about. If you lose weight by just cutting caloric intake, 25% of the weight loss is muscle. So if you lose 10 pounds, 2.5 pounds will be muscles, right? If you do exercise during weight loss, around 15% of the total loss will be muscles. Okay. So if you do nutrition, hypocaloric diet and exercise, the percentage of in muscle mass from the total loss is only 15% okay. When you inject the GLP one hormones. 40% of the total loss is muscle. Why

Scott Benner 32:23
is it different with the GOP than without it? You know,

Speaker 1 32:26
for, yeah, for many, many reasons. You know, a version of food loss of appetite, protein in general, is nussiating. People don't eat that much protein, macro nutrients becomes, you know, lower there is a lot once you suppress appetite and you are not eating, basically imagine someone in the hospital, sick not eating. They lose significant amount of muscle mass during that period. So 40% this is equivalent to around 20 years of loss in one year, 20 years of age, related loss and muscle mass. So this is not a small amount of loss and muscle mass. Like for example, if you look to the studies that had been done on semaglutide, the step one study, they take group of the population, and they did Dexcom to study body composition, and they found that people lost 17 kilogram in average, 17.57 kilograms are lean mass. Okay, seven kilograms are lean mass. This is around 4140 41% okay, of the that that loss, in a year, you are losing all point 5% of the muscle mass. So if you are aging normally, I told you, you lose around 5% ever, every 10 years, right? So in one year you are, you lost nearly around 20, 20% but lean mass is you have also the defined in mass. Lean mass is soft tissue, organs and muscles. Fat, free mass is different. Fat free mass is bone and muscles and all other tissues. But lean mass and muscles is nearly 50% of the lean mass. So the absolute loss in muscle mass, if you calculate it from that whole equation is around 10% 10% of your muscle mass is lost.

Scott Benner 34:25
But you still said you want people to lose the weight, so, like, Dan, so we have to, you got to keep eating, right? Like, I mean, listen, I've been using it for almost two years, and there are days that you have to just walk into the kitchen and say to yourself, I'm going to eat. I'm going to eat something good for me, because I it can happen. I'm not going to lie to you yesterday, I think at five o'clock yesterday, I thought to myself, Oh, I don't think I've eaten yet today, and I did not know it. I wasn't hungry, like my brain wasn't hungry. My stomach wasn't hungry. I was not hungry that. Doesn't happen to me often, but a number of things happened yesterday. People in my house got sick. Things got tossed around. I find it to be incredibly valuable to tell people like you have to eat like chicken, beef. You know, these things like nutrients, get your nutrition, take your supplements, do everything you can do to keep that going while being active, lifting weights, weight training. That's how I've tried to talk about it so far.

Speaker 1 35:22
You know what? We need to educate our patients who are getting on this medication, yeah, that you need to eat high quality protein and do enough strength exercise to mitigate the loss in muscle mass. So usually we will our average we will eat or the recommendation are 0.8 gram per kilogram of body weight. We recommend at our institute 1.2 to 1.5 gram per kilogram of adjusted body weight. But in general, after barretic surgery, the usual patients eat 1.5 gram per kilogram of your ideal body weight of protein, and it has to be high quality protein, right? High quality protein is not plant protein. High quality protein is mostly animal protein. So we have to differentiate, because the Amino the essential amino acids are very important. This is a building block of your hormones in your body. Insulin is insulin growth hormone, other protein based hormones are all a need for that essential amino acid.

Scott Benner 36:20
So now that we understand this about weight loss type two, like, let's sort of pivot a little bit, because a lot of type ones are starting to use glps for insulin resistance. I know it's off label still, but it's happening, and I'm seeing it more and more, to be perfectly honest. So do you have thoughts about how type one should be managing this?

Speaker 1 36:41
Yeah, it is not of label for obesity. Indication, no, no, of course

Scott Benner 36:46
not. But there are type ones now that are getting it for insulin resistance. So what they're doing is they're going to their doctor, and they're the doctor saying, Look, if you didn't have type one diabetes, you'd have type two diabetes, because I see insulin resistance here, and they're getting it covered. You

Speaker 1 36:59
know, I am among the people who created that term in the old days, double diabetes. Double diabetes, really. So double Diabetes means you are type one by auto immune mechanism. You are taking insulin, and so is a growth hormone. And every time you optimize your insulin, you're basically putting in your body more growth hormone blast. They are exposed to the same environment like anyone else, the environment of this activity and high carbohydrate eating and so on. They gain weight. Then they start to be insulin resistant, and then their need for insulin becomes higher, and the insulin is a growth hormone, makes them gain even more weight. So reality, we did that. We published a very nice article about obesity type two, and we were shocked, 53% of type one. Sorry, obesity type 150. 3% of people whose type one diabetes are actually overweight or obese now. Wow. This is totally different from 2030, years ago. Yeah. Let

Scott Benner 37:58
me tell you this, Dr him, because you don't know my daughter. The reason I come by this podcast, my daughter was diagnosed with type one when she was two years old. Yeah, and today she's 20 years old, almost 21 yes. She also seems as near as we can tell to have PCOS. Yes. It shows its head through acne, through painful, longer periods and insulin resistance. Like at some points in the last two years, my daughter's insulin to carb ratio was one to four, and her insulin sensitivity was as low as, gosh, I think 42 one to 42 and so her doctor put her on a GLP and her insulin sensitivity is now more like one unit covers 8085, her carb ratio is up to, like, almost to 10. It's like eight, between eight and 10. She did lose some weight. She did not have a weight issue, but it did, like, just through hunger. It knocked 20 pounds off of her. And she's tall, she's five seven, but she was probably 571 40 when she started, and she's more like 571 30. Now she got to 120 it was too much like she had lost too much weight. So we were stuck because she was doing Manjaro, just 2.5 and it was working great on her insulin resistance, working great for her PCOS, but it was making her not hungry. So what we ended up doing was we now take clean vials and milk the pen into a vial, and then give her less than the 2.5 and we have found the balance where it controls her blood sugars, helps her with her PCOS, but leaves her hungry still, and that has been like the sweet spot we found for so she gained back 10 pounds. She's at a very healthy weight now, and she probably uses, I'd have to guess, 20 to 25% less insulin than she was using before. And she just looks

Speaker 1 39:53
at that's usually the case. You know, we're an hour why wait program around 30 40% and. Range are type one, and we have significant experience in managing obesity in type one. You know, actually, we published several papers about it, and we have to differentiate between two issue, good. This is a benefit of JP one, or the benefit of weight loss.

Scott Benner 40:15
Yes, okay, yes, I know, and I, I struggle with the same thing. Yeah, the

Speaker 1 40:19
benefit of weight loss is huge. You know, you said that she went from 140 to 130 you mentioned at one point she lost she lost the 20 pounds. If she lost that much, she is now more insulin sensitive, she will use less insulin. For sure, the answer is more efficient, because every time that you become more insulin sensitive, your body responded to insulin is much better way. Yeah, so even less insulin can improve. But the most important is that she should continue to do strengths exercise, especially younger. Younger people benefit a lot from exercise because they they can build the muscles more than what you can do now. You know, from age of 40 up, it's very difficult to build the muscle, but in her age, it is easy to build the muscle. Yeah. So my advice for her is to eat more protein, enough protein, and by the way, protein per se, will improve hair diabetes as well. You know, we know that for years, and it doesn't raise a blood sugar up like carbohydrates, right? I have to

Scott Benner 41:22
tell you, like talking about it technically like this. It makes sense. Everything makes sense. It's the the actual living with it and losing your appetite and then having to eat and like, it seems like a vicious circle, like it's not, it's clearly not a perfect fix. But I've done two interviews this past six, eight months that I found astonishing. One was just with the mother of a then 13 year old girl who had had diabetes, type one for four years. She was using almost 70 units of insulin a day. She has antibodies. She has she's type one, right? But her mom had PCOS, and had used the GLP to lose weight and changed her life. The girl was gaining weight, so the doctor put her on the GLP for weight. But today, I'm still in contact with her. Today, her daughter's not wearing an insulin pump anymore and injects like one unit of basal insulin a day. I'm not saying it cured her. I'm certainly not saying that, but she's having an amazing impact on it. And I also had on a gentleman in his 50s who was type one for like, six or seven years, admittedly, Lata, right? It was a slower onset. He got put on zepbound for weight, which I know is Manjaro. He lost so much weight, they took him off his insulin, and he hasn't been on insulin for a while now, but he's got antibodies, and he is type one. And I expect one day that Lot of will complete its path and he'll end up on insulin. But for the moment, it's astonishing.

Speaker 1 42:48
It's quoted all. What you mentioned is not a surprise for me, Wow, because you remove the type two component, yeah, when they lose weight, the type two component, an insulin resistance component, is gone. They remain was type one. So the need for insulin becomes less and less and less. So to be down to one unit per hour on insulin pump or or sorry, or less, or whatever, not surprising, your body become insulin sensitive after you lose weight. Whether you are type one or type two, if you are type two, you get remission. If you are type one, you remain on answer, but in a very small dose.

Scott Benner 43:24
So then this double diagnosis isn't just a way to trick your insurance company. It's important to know if you have both of those impacts,

Speaker 1 43:30
we don't have COVID for double diabetes, right? You know, you cannot tell insurance that that person has double diabetes. The insurance understand from ICD 10 that either type one or

Scott Benner 43:41
type two. Your opinion, should there be a double diagnosis code, double diabetes? Yes, we should

Speaker 1 43:45
diagnose double diabetes in in people. But my advocate for that term to be used scientifically, rather than just be used that way. I want to thank you

Scott Benner 43:54
for a second, because I didn't really know where our conversation was going to go today. You've indicated me because I took a fair amount of crap online for putting those two episodes up where type ones used the GLP and then came off their insulin. I got a lot of pushback from that. I mean, I understand why, like, type ones don't want you running around telling people, like, don't take your insulin, which is not what I was, you know, definitely not what I'm saying either. I think it does point out how much over the years, old ideas get folded into new ideas, and then along the way, like something gets lost in translation along the way. Do you know? Do you know what I mean by that? Because you said something earlier that made me feel the same way, and it was around the double diabetes, because I had heard people say that in the past, and then other people come along and they poo poo. It like you're either you're type one or your type two. It's then that becomes the argument. You know,

Speaker 1 44:43
let me Scott, let me make it more complicated. We are looking in the future in precision medicine of diabetes, and there will be no type one and type two. There are five different phenotype clusters. Okay, each cluster is treated in entirely different. Way. So type one will be under a cluster called auto immune, severe auto immune diabetes, or said sa ID, severe auto immune diabetes. This will include type one and ladder the antibodies are positive in them. There is another group that exactly similar in the phenotype, but without antibodies. It's called severe insulin deficiency, diabetes, and this is around 18% of people with diabetes, so they are not making insulin. They are lean people, but if you test antibodies, it's negative, and then you have mild obesity, diabetes. This is a common type that we think that, or most people think that this is type two diabetes. That's actually 22% only of all people with diabetes and the diabetes in mild obesity, diabetes is related to obesity. Take the obesity out of the door, diabetes will go out of the window. And this group significantly benefit from weight loss, whether multidisciplinary weight loss or by pharmacologic or by bariatric surgeon I see, and then you have another phenotype cluster called severe insulin resistant diabetes, or cert this group had the severest insulin resistance their body, all the body is resisting insulin, liver, muscles, a divorce tissue. This group, weight loss can be very beneficial. If you see one of those people, they need 100 units of insulin, even 200 units of insulin, sometimes. And then you have mild age related diabetes. This is the biggest one. When you get older, you get diabetes. This is around 39% of people whose diabetes, wow. Basically, understanding the phenotype clusters in the future can tell us who will benefit from what we call it now, type two diabetes is not all of them, but mild obesity diabetes, which is around 15% 22% and the severe insulin resistance around 15% so 27% 20 37% of people with diabetes will benefit significantly from weight loss.

Scott Benner 47:00
What's the roadblock in making this more well understood in for clinicians,

Speaker 1 47:06
you know, this is a classification that you expect to come in few years from now. Okay, there is a cooking for this classification now, and many countries did phenotype clustering, and it looks like the five phenotype clusters are reproducible in a good way. This will help precision medicine in the future. You know, similar to cancer breast, for example, not all cancer is the same. You know you have genetic based cancer. You have hormonal based you have what you know you can manage it in the very precise way. So

Scott Benner 47:42
we're in the not, maybe the infancy, but we're still in the beginning of understanding diabetes then and the way it gets treated more more over at

Speaker 1 47:50
any point in your history of diabetes, you are beginning to understand diabetes.

Scott Benner 47:55
Damn perfect. That's what I wanted to know. Awesome. And for all the people who give me crap online, ha. Dr hand, he just said that I was right. That's awesome. I'd finally write about something. This is great. Listen. I'll tell you something that maybe you'll find interesting, because you're a researcher. I have so many conversations with so many different people who have diabetes, so I record this podcast sometimes more than once a day, but at least once a day, I've had 1000s and 1000s of conversations with people. Have type one. Who are the parents of type ones with people, have type two. With people, have lot of like, all this stuff. After a while, I step back and I say to myself, like, it's not really the way that we're talking about it. Like, until somebody, until you just said what you said, I have to be honest. Like, I never, I'd never heard it, you know, put technically to me, but that all makes perfect sense to me. After having these conversations all these people, they're not all having the same experience, but we call it the same thing. And you know, it's confusing, and then the human component gets twisted into it, because often type ones don't want to be thought of as diabetic or type two, because type two is so closely related to a thing you did wrong instead of, you know what I mean, like, instead of like it happened to me. And I think that argument is where so much of the the resistance to seeing the differences comes into play. But you really think this will be lay the land in a few years the way, the way you spoke about it, yeah, yeah,

Speaker 1 49:23
absolutely, you know, change. The definition of diabetes has changed over time. Many, many times, sure, oh, at the beginning it was just one diabetes. Then they call it after that fatty diabetes and lean diabetes, and then juvenile diabetes and other tons of diabetes. And then insulin dependent diabetes and insulin non dependent diabetes, and then type one diabetes and type two diabetes. But the future will remove all type one and type two and become the five phenotype clusters. And then once we identify the cluster, and by the way, each cluster develop different complications. Okay. Okay, okay. So I told you there are three mild form, three severe form, and and one mile and two mild form. So for example, severe auto immune diabetes, develop micro vascular complications, diabetes, retinopathy, nephropathy, neuropathy, all those kind of complications, severe answer, resistant diabetes, although they are also severely insulin resistant, they only develop diabetes retinopathy and diabetes neuropathy, okay, mild obesity, diabetes, don't develop that much complications. They can develop maybe cardiovascular complication, if they have this liberty or hypertension, severe insulin resistant diabetes, develop hepatic steatosis and mesh and develop Corona kidney disease at younger age, mild age related diabetes, basically don't develop complication except cardiovascular if they have this liberdemia and hyper and hypertension. So if we know the clusters very well, I can tell you what is a prognosis will look like in each one very soon. I had been using the phenotype cluster for two years or three years now in my practice, and I hope in the future, we can educate primary care physician to identify those clusters and treat them in a proper way. Good luck. That's

Scott Benner 51:15
incredible. I'm so happy you came on. Do you see a world where who are type one who don't have weight issues are going to get in my mind, and this is probably a very simple way of thinking about it, the glps have to start coming in vials, so that doctors can help you with dosing, so that it can help you with the things you need without impacting the things you don't because the like, if you don't need the hunger to go away, But you're seeing a ton of help in other spots, just the PCOS help, right? Which is awesome for people. There are people who have PCOS who don't have weight to lose. So, like, what do they do? Like, how do you imagine that endos are going to mix glps into type one care, I guess is my question.

Speaker 1 51:59
PCOS, by the way, related to type two more than type one. Okay, you know, it's kind of care when anyone but it is mostly related because it's part of insulin resistance, and the best treatment is actually not only weight loss, but also some medication that improve insulin sensitivity, like Metformin. And you know, nearly Most cases of BCS are treated with metformin because it improve insulin sensitivity. There are several other hormone medication that also improve insulin sensitivity, but But mind that BCS, they secrete more testosterone hormone, and actually testosterone make their muscles much better. You know, this is a building a block for building hormone for muscles.

Scott Benner 52:42
If I told you my daughter has a bit of a deeper voice, that wouldn't surprise you, then, like, if she has PCOS,

Speaker 1 52:50
you have to measure the three testosterone level. That's the most important point, and then find the reasons. Maybe the testosterone is not just coming from the others. Maybe some other reasons for higher tests.

Scott Benner 53:03
Okay, okay, this is just the thing that happens. Like I said, I talk to a lot of people, and this comes up a lot with women with who have diabetes, or people who have it in their family, and they're talking about their kids or their, you know, sisters and brothers and things like that. Siblings like, I see the same stuff coming up in conversation. This probably is apropos of nothing in our conversation, but the frequency in which someone with type one diabetes tells me they also have a bipolar person in their family is pretty significant. And I don't know if that has anything to do with anything or if it's just

Speaker 1 53:38
random. Yeah, a lot, you know, if we go to the the whole issue of the causes for obesity and hormonal and neurotransmitter changes and so on, you know, we can spend, you know, 345, hours really, because, you know, I wrote many chapters about obesity in mid e medicine, Even textbook, Sister textbook of medicine, and we are explaining a lot of a lot of stuff, but there is a lot that need to be be done. But let me explain you one, one simple thing. Do you know how many hormone and neurotransmitter controlling your body weight in your brain? I have no idea. 34 hormone and neurotransmitter. 34 and it is a very delicate balance. It's like a web all interlaced with each other. So neurotransmitter that related to mood swings and reward system, there is very small, tiny area in the brain called the ventral tegmental area. You know very, tiny area. They know that very tiny area is called the reward center. Reward center is rewarding you for any behavior that you do, so if you are not addicted to anything to make that area happy. The best addiction and the easiest addiction is addiction to food. Okay, a lot of people start to work on blocking the hormonal aspect in the brain, like endocannabinoid receptors. People kill themselves during the study, really, they get severe depression, and they ended up with committing suicide. You know, the brain is very delicate in relation to all those mental issues and all the psychological issues and body weight in the same part. And that, for that reason, many of the major anti psychotic medications, the major one circle and the bricks and the cost significant to again, significant to again, even we will develop diabetes because, because they work on the appetite center, open your appetite to the maximum, okay, antigenic and the significant amount of food, and again, significant weight. So there is interaction all the time between six hormones. For example, you know, melanocortin pathway, which is responsible for skin. Do you know, if you block that bus way, or you stimulate that bus way, you can change the body weight significantly up and down. You know, there is a lot this is a web interaction in that web has to be very delicate, so we are lucky to have a hormone that's relatively safe and working on the appetite without damaging a lot, but still, psychological issue can occur in that scenario as well. How

Scott Benner 56:37
far do you think we are from glps Being a thing of the past, and what you're discussing being the way that you manipulate your body to do what it should be doing. It

Speaker 1 56:46
has to be on the periphery. It has to be with medication that makes you lose weight and preserve the muscles, okay? And there is actually medication in research now that does a job. It's called the myostatin inhibitor, or active in inhibitor. It actually makes the body fat goes down by 20, 30% and the muscle must go up by four or 5%

Scott Benner 57:08
How come that one didn't take off? It

Speaker 1 57:11
is about, it is about what is called the BMA group map, and it is infusion every month. And you know, one of the big companies now got that medication to combine it with GDP one, wow. What's it called? Again? Pima group app. Pima group app, thank you. And it is a monoclonal antibody. Sorry

Scott Benner 57:29
about that. I'll try it better. I'll just say I'm of the opinion Life is short. My body was not doing what I needed it to do to have a long life. And then I have to tell you, like, I really started doing this, like, these are not things I would have normally done till I saw the end of my mom's life, and I thought, I can't let that be how the end of my life goes. Like I'd have to try something. And this is what was available. My point is, if something better comes along, I would certainly be open minded about it. Can I ask you if you could give me some advice? I've been making this podcast for 11 years now. Can you tell me about a couple of things that are coming along that I should be paying attention to and having more conversations about? Besides what we've talked about now,

Speaker 1 58:14
it is definitely we need to understand exactly how the mechanism for weight loss, because this is not even touch it in our conversation, how we can do a multi disciplinary approach for weight management. And we have been doing it for, as I told you, for very, very long time since 2005 and do you know what b will up till now? Are maintaining weight loss? We publish data on five years, 10 years, and we resented that. And the American Diabetes Association for 15 years, and they are still maintaining 8% weight loss. So actually, multi disciplinary, which is proper nutrition, balanced exercise program and Cognitive Behavior modification and medication adjustment, by the way, for people whose diabetes during weight loss, there must be an algorithm for medication adjustment and then good education. When we do that, it is very expensive, but it works very, very well. And people can maintain weight loss for very long duration, but people just take it very, very simple, I will cut my caloric intake, and I will lose weight. This is a commercial way that commercial weight loss, that can end up with people recycling and recycling and recycle. And when you take GLP one, you are in catch catch 22 if you stop the medication, you will gain all the weight back, right? If you continue the medication, you continue to lose muscle mass. So you have to understand very, very well. And this is advice now that intake of protein is very important with those medication strength exercise is very important, and especially high muscles, quadriceps, same string, gluteal muscles, those are the muscles that get weaker and weaker. So I usually ask my brain. Chance take more protein, more animal protein, in a very efficient way. Or you can even take some shake that has protein, especially the I had a shake liberal diabetes, yeah, and do 2030 minutes of strength exercise every single day. And if you don't do it, don't take the medication you need to do 2030 minutes of strength exercise, especially with your soy muscles. Elliptical, against the resistance. Stationary bike against the resistance, squatting, stretch band under your feet. Rowing machine. Squat is quiet, yes, would a rowing machine help? Rowing

Scott Benner 1:00:35
for rubber? Oh, that's for more rubber and lower

Speaker 1 1:00:37
that's absolutely fine, okay. If it is against the resistance it will be. I'm not all looking for a speed. I'm looking for, yes, muscle action.

Scott Benner 1:00:46
You can't see this because I have a green screen, but I'm putting my hand on a bike. My office is making this podcast a bicycle to keep my legs strong. And if I'm being honest with you, a pet chameleon that's over there that you can't see Perfect, that's all to watch you need keep me relaxed. Yeah. Oh, this is, this is fantastic. I really appreciate this. Let me ask you, like, a question that I think people are wondering, we hear so much that it's the food. Like, are foods bad food? Like, you'll hear people say, like, oh, I went to Italy and I ate pasta and it didn't make me sick, but I eat pot. Like, is our food inherently causing this? Or is it just speeding it up? Like, what is it about Americans in general that that puts us in this situation?

Speaker 1 1:01:29
There are two problems in the in the US, you know, and we did tons of research and nutrition. Let me just to make it very clear, high carbohydrate intake, this one big problem, process the food is another big problem. Okay, if we eliminate as much as we can both, you know, process the food, any food you have in a refrigerator, processed or even minimally processed, you have to avoid whole food is a way to go if you need healthy eating. And then carbohies, and you have three major carbo problem, sugar, whatever, added sugar in dessert, in juice, in whatever, any sugar, wheat flour products, bread, basta, beets, bread, so bagels, P and peas, right? Starchy food like potato, rice and corn okay. If you cut those significantly down, you'll find significant with weight loss and soft drinks that has high sugar as well. So usually, when I tell people in my practice do that, say, Okay, what we eat. Vegetables is okay. Fruits are okay, legumes are okay. Bees, beans, whatever. And then dairy products are very, very beneficial all kind of dairies, eggs, chicken, fish, lean meat, Turkey, dark chocolate, even I have no problem, right? Tea, coffee, cinnamon, you know, there is a lot that people can eat, but not just a low nutrition. Sugar, for example, is just empty calories. There is no nutrient. Nutrient effect, right? It doesn't have any macronutrients or any any value. Would you

Scott Benner 1:03:10
think that I should take as low a dose of GLP as possible as long as I'm not gaining weight? Like, does the dose matter? Like, should I not stay on a higher dose if I'm not trying to lose weight? I'm not just talking about me. I'm talking about me. I'm talking about people in general. Like, should they titrate down to where it's working? But not as much as,

Speaker 1 1:03:27
yeah, you got it. You have to be, if you would like, maintenance, and you don't need to regain weight back be on the main the minimal dose that suppress your appetite, and more the state, is suppress appetite. You don't have to have what, you know, 100% suppression, because, you know there is tolerance to this medication. You need more doses and more. By the way, we don't know the ceiling of those medication you know, like, for example, semaglutide, oral revulsus. You know it is in the market, four, seven and 40 milligram, but the company is testing now, 2590 or 100 or 75 milligram. So they are testing, we don't know what is a ceiling for those medications.

Scott Benner 1:04:08
Rebels is an example. They're seeing what's happening with the injected and they're thinking they can maybe get that pill to a point where it's in pill form and helping people.

Speaker 1 1:04:18
It will not work with I don't think that will seem like, look like I guess. But there are other medication coming in the future in oral format, synthetic, non peptide, small molecule, that will cause significant weight loss and improvement in diabetes as well. And this will Bush away all the injectable, yeah, that's good. I don't think that injectable will be the future. They will be only for people with very, very high BMI, but oral will will come in the future. And the prism, how

Scott Benner 1:04:47
long do you think for that next year? No kidding, that's awesome. I actually told my daughter the same thing, as odd as it might sound to some people, my daughter has a fairly significant needle phobia. It's pretty traumatic. Or to have to do this every week like she does Okay, putting on her insulin pump and her CGM and everything, but she's been banned with needles since she was little, and she struggles through it because she sees how much it's helping her. And I kept telling her, I'm like, Look, I think very soon this oral medication, I think it's gonna do the same thing, and you can get off of this. So it's it's comforting to hear you say that too. Thank you. Is there anything I haven't asked you about that I should have? I actually think I could talk to you all day, but I assume you have a life to get back to. It's wonderful that we've met. I'd love to invite you back on if you ever have anything else you want to talk about. This was fantastic, but anything we didn't talk about,

Speaker 1 1:05:34
we need another podcast to talk about nutrition. Yeah, because we didn't, we didn't spend enough, enough time talking about nutrition. Those nutrition, you know, people start to understand the nutrition and the history of nutrition, and how this stuff changed over time, and why we're eating what we're eating right now. But you know, this is very important. Maybe, you know, it's a very, very big topic to discuss.

Scott Benner 1:06:00
I'd be happy to also, let me tell you that. I guess you'll be happy to hear that just this morning with the nutritionist, who's also a CDE and a 35 year type one that I do some podcast episodes with. We were just talking this morning about how the next series we're going to do is about nutrition. We're going to do a whole series about it. I'd love to do an interview with you and fold it into the series, that'd be awesome. Absolutely thank you so much. All right, I'm gonna say thank you for now, because this was absolutely terrific. Ask you to hold on for one second, and then I'll set something up with you for something else. Hold on one second. Thank you

Unknown Speaker 1:06:33
again. Okay, thank you. You

Scott Benner 1:06:44
if you'd like to wear the same insulin pump that Arden does, all you have to do is go to omnipod.com/juicebox, that's it. Head over now, and get started today, and you'll be wearing the same tubeless insulin pump that Arden has been wearing since she was four years old, touched by type one is hosting their very first steps to a cure walk. And you can register right now to participate. Touched by type one.org Go to the Programs tab, click on Steps to a cure and sign up today. You can sponsor walk or volunteer. Check it out.

Are you starting to see patterns, but you can't quite make sense of them. You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, you're starting to think this isn't going the way the doctor said it would. I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group, just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 I want to thank you so much for listening and remind you please subscribe and follow to the podcast wherever you're listening right now, if it's YouTube, Apple podcast, Spotify, or any other audio app, go hit follow or subscribe, whichever your app allows for, and set up those downloads so you never miss an episode, especially an apple podcast, go into your settings and choose, download all new episodes. The episode you just heard was professionally edited by wrong way recording, wrongway recording.com, you.

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Scott Benner 1/19/25 Scott Benner 1/19/25

#1409 Weight Loss Diary: Sixteen

Sixteenth installment of my GLP journey

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Scott Benner 1/17/25 Scott Benner 1/17/25

#1408 Yeah, Yeah, Yeah

Ashley's son wa diagnosed a year ago. He uses an iLet pump.

Diagnosed unexpectedly at a well visit, now using the iLet pump without doctor guidance.
Managing puberty, sports, and challenges with consistent bolusing.
Support from unexpected places has made a big impact.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Ashley's son was diagnosed about a year ago. He's 12 years old. We're going to talk a little bit about their diagnosis, and a lot of talk actually about their new eyelet pump, which was given to them with no help from the doctor. Surprise

me, music, Hello friends, and welcome back to the Juicebox Podcast. 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. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout. That's Juicebox at checkout to save 40% at cozy earth.com and if you're a US resident who has type one, or is the caregiver of someone with type one, visit T, 1d exchange.org/juice box right now and complete that survey. It will take you 10 minutes to complete the survey, and that effort alone will help to move type one diabetes research forward. It will cost you nothing to help the diabetes variables. Series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about, travel and exercise to hydration and even trampolines. Juicebox podcast.com, go up in the menu and click on diabetes variables if you're looking for community around type one diabetes. Check out the Juicebox Podcast. Private Facebook group. Juicebox Podcast, type one diabetes. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate, and waiting for you at contour next.com/juice box. I'm having an on body vibe alert. This episode of the juice box podcast is sponsored by ever since 365 the only one year where CGM, that's one insertion and one CGM a year, one CGM one year, not every 10 or 14 days Ever since cgm.com/juicebox.

Ashley 2:18
Okay, hello world. I'm Ashley, and I'm here talking about my son who got diagnosed a year ago. Okay, unexpectedly, very unexpectedly. So I'm here to talk about that with you. Scott master Jedi,

Scott Benner 2:33
unlike Oh, I didn't know you're gonna say something nice about me. I wouldn't have talked over you. I'm so nice, so so nice. Yeah, I mean, I do you think most people are like, get diagnosed with things? They're like, I knew this was coming. I've got lambago. Like, or, you know what I mean, what is lambago?

Speaker 1 2:47
Well, I didn't know what lambago I I knew as much as what you just said, as I knew what type one diabetes was when he got diagnosed. Let's just go with

Scott Benner 2:57
that. Yeah, you just didn't have any knowledge of it. It wasn't in your life. It was not

Speaker 1 3:01
in my life. It was not in my family history. It type two was in my husband's family history. His grandfather had it so he had the sugars, as some would say, but he was in his 80s, and didn't really take that great of care, but at the same time, he did the best he could. But yeah, I didn't, I didn't really even know the difference between type one and type two. We went in for a well visit for Trevor. It's my son's name, and we had no idea, virtually no symptoms, besides being a angsty tween. Gotcha

Scott Benner 3:38
Wait, listen, let's go backwards for a second. First of all, lumbago is a general term used to describe pain in the lower back it can be caused by various factors such as muscle strain, etc. Anyway, it's lower back pain. There you go. There you go. Okay, that makes sense. It's got to be something I've heard like on an old TV show, because that seems like a word from like, like, hold on, when in time? Would this word be used frequently? Okay, it's got to be, like a, like an old timey word on a second. Also you said you're nervous. So I'm going to try to, like, figure it out the late 19th and early 20th century. Well, guess what? I don't know what that means, because I grew up in American my schooling was terrible. Well, wait a minute, when did the 20th century start? I just realized that nobody knows 1901

Speaker 1 4:28
really, I don't know. I think it was on Jeopardy some point,

Scott Benner 4:31
1901 god damn Ashley, get out of here.

Unknown Speaker 4:35
You know, well

Scott Benner 4:36
done. All right. Now people are like, Oh, wait, he doesn't know general knowledge. I'm making my meal bonuses off of something. He said, Okay, so you're not expecting it. You go in for a well visit. You said he was being a little cranky. How old was he then I'm sorry he

Speaker 1 4:54
was oh, let's see. Well, he his birthday wasn't. Year

Scott Benner 5:00
ago, how old was he now he's 12. So was he like, 11?

Speaker 1 5:04
Yeah, he was 11. We had the well, visit a little later than his birthday. So yes, he was 11. I

Scott Benner 5:10
want people listening to know before we go any farther, Ashley, that you and I have had a brisk half an hour to get to know each other while you're figuring out how headphones work. And so this isn't just me, like, jumping in and being snarky with a person who I met six seconds ago, like you and I, yeah, you and I are basically, like dating now. You know, we've been through like, a number, honestly, that's true. She did. She heated up, took off a layer of clothing, and I thought this is going great, actually. But what I said was, turn your camera off. I don't need to see this, although now I feel weird, Ashley, anyone would be lucky to see you take your shirt off. Okay,

Speaker 1 5:48
so I do, I do have multiple layers on. I just want to be clear. Yes, in

Scott Benner 5:52
fairness, she wasn't down to an undergarment. No, but, but nevertheless, why are you nervous? Do you think

Speaker 1 5:57
I just want to make sure that I'm emulating the right message, and I'm not going to say something that's going to offend or upset my spouse or my son. Should he care to listen to this? Because, you know, the internet's forever,

Scott Benner 6:14
right? I mean, I hope so for me. I mean, I put Can you imagine, like, if who painted the Mona Lisa? What was that guy? He's an Italian guy, right? Uh, fairly certain. Yeah. Okay. Anyway, if somebody paints the Mona Lisa and they put it online, it would have disappeared eventually, because people would be like, Oh, that's not a hot new thing anymore. I don't look at that anymore, thank God. Like, so I need the Internet to stay forever, or this will all just disappear one

Speaker 1 6:40
day. Do you really not know who painted the Mona Lisa. I just need to. I

Scott Benner 6:44
can't think of it off the top. It's playing art at Da Vinci. Da Vinci. It's very early in the morning. For me, I want to I am two for two. First of all, your general knowledge is rock solid. Well, I did go

Speaker 1 6:55
to school for art. Oh, wait, you did. Yeah, I have a sculpture degree.

Scott Benner 7:00
Oh, tell me about how handy that's come in paying the electric bill over the years. Well,

Speaker 1 7:04
you know, my husband's in healthcare, and I am the complete opposite, so, but I do dabble. I I am a floral designer. So, yeah, I I see now I am very handy with my hands.

Scott Benner 7:22
Is that why wait? I'm sorry. We haven't believe that. Okay, yeah, you're like, Oh, my son might listen to this. So are you saying being a sculpture, a sculpting major, yeah, got you a doctor? Is that what you're saying?

Speaker 1 7:38
No, he's not a doctor. He's an IT guy, but he just landed in healthcare. I'm just saying like he is one side of the brain and I'm the opposite. And, you know, opposites attract that way.

Scott Benner 7:49
Very true. Also you and I have something in common, although I have never arranged flowers professionally. I boy, I know for sure. I haven't said this on the podcast. I do very much enjoy doing it. Oh, very nice. Yeah, I do it like low rent. I go to the grocery store where they sell, like, bunches of flowers for like, no money, and I stand there very thoughtfully and grab things, and I'm like this, and this, this will go here. And then I go home and trim them up and arrange them in a vase. I give them to my wife, who seems completely unimpressed, because she's, you know, Irish and English, and she has no real heart inside of her, and so like, I'm like, hey, look, I did this for you. And she goes, they're nice. And then that's the end of it. But I sometimes think if I should have gone with a more Mediterranean background, because I feel like those girls would be, like, more passionate about stuff like that. I think you did a good job. I don't know. She's fine. I'm not saying anything like that. You're pretty Caucasian. Would you be excited if I brought you flowers? Or no

Speaker 1 8:54
actually knowing my profession, you should never buy me flowers. That's the last thing I want to see after I design flowers all day. Oh,

Scott Benner 9:04
I thought it would be because you'd look at me and be like, you did it wrong, or you shouldn't have put that red with that yellow, or something

Speaker 1 9:09
like that. Well, I mean, I have an appreciation for flowers for sure. No, I can appreciate flowers for what they are, but it's the end of the day when you work with flowers and then you come home, I

Scott Benner 9:21
understand, yeah. People used to ask, like, I worked in a bakery for a little while, and they were like, don't eat all the food. I'm like, Oh, that. That idea goes away pretty quickly. So can't do the same thing over and over again all day long. Yeah, yeah.

Speaker 1 9:33
So okay, oh, I just did a Scott. We did the Yeah, yeah, yeah. Do I

Scott Benner 9:38
do that? Oh, I do that, yeah, yeah. You do? Yeah. I don't know what I do. This episode of The Juicebox Podcast is sponsored by the ever since 365 get 365 days of comfortable wear without having to change a sensor. When you think of a continuous glucose monitor, you think of a CGM that lasts 10 or 14 days or. But the ever since 365 it lives up to its name, lasting 365 days. That's one year without having to change your CGM. With the ever since 365 you can count on comfort and consistency. 365 days a year, because the ever since silicon based adhesive is designed for your skin to be gentle and to allow you to take the transmitter on and off, to enjoy your shower, a trip to the pool or an activity where you don't want your CGM on your body, if you're looking for comfort, accuracy, and a one year wear you are looking for ever since 365 go to Eversense, cgm.com/juicebox, to learn more. The contour next gen blood glucose meter is the meter that we use here. Arden has one with her at all times. I have one downstairs in the kitchen, just in case I want to check my blood sugar. And Arden has them at school. They're everywhere that she is. Contour, next.com/juice, box. Test strips and the meters themselves may be less expensive for you in cash out of your pocket than you're paying currently through your insurance. For another meter, you can find out about that and much more at my link. Contour, next.com/juice, box. Contour, makes a number of fantastic and accurate meters, and their second chance test strips are absolutely my favorite part. What does that mean, if you go to get some blood and maybe you touch it, and, I don't know, stumble with your hand and, like, slip off and go back, it doesn't impact the quality or accuracy of the test. So you can hit the blood, not get enough, come back, get the rest without impacting the accuracy of the test. That's right, you can touch the blood, come back and get the rest, and you're going to get an absolutely accurate test. I think that's important, because we all stumble and fumble at times. That's not a good reason to have to waste a test strip. And with a contour next gen, you won't have to contour next.com forward slash Juicebox, you're going to get a great reading without having to be perfect like that's very important to go over right now. I don't know what I'm saying or why I'm saying it, or anything like that. This is just I am so unaware of,

Speaker 1 12:22
well, I'm sorry to have knowledge that that's one of the things you say, then just keep doing you. No,

Scott Benner 12:27
no, no, I'm okay with all that. Don't worry. I like, I like, knowing it's just, by the way, I'll forget, like, a week from now, somebody will be like, do you say? Yeah, I don't think, no, I don't think. So. Okay, so how many kids you got?

Speaker 1 12:39
I have two, I have a almost nine year old girl, and then I have a 12 year old boy, and he is the only type one that we know of in our family. How long have you been married? Oh, the married since. Oh, eight. So what is that going on? 17 years?

Scott Benner 12:58
Oh, congratulations. That's nice. You've gotten through all the difficult parts. There's one more coming up, and then it's just smooth sailing to death. All right, I don't know, yeah, right around 20 years. Oh, okay, you'll reassess in your brain. You'll be like, Am I really gonna do this till I die? And then you'll make that decision, and then it'll just be then it just goes, fantastic. This is the cruising part, right here, yeah, without all that pressure to have sex and do other stuff, it really gets easy.

Speaker 1 13:23
I love that. Looking forward to it. Oh

Scott Benner 13:27
yeah, it's gonna be great. It's also less expensive, because the kids get older and you stop paying for stuff that they do.

Speaker 1 13:33
Well, until the 26 year mark, I guess from Trevor. We'll we'll see how that less expensive part goes. Oh, I see. Do you worry about that? Yeah, I guess I do worry about, not on our end, but on when the transition happens. I I've already looked up jobs, you know, transitioning, you know, what kind of jobs he should maybe look into that has better health care, that kind of thing,

Scott Benner 14:01
yeah, well, don't work at a hospital that apparently doesn't do they, for some reason, they don't have great health care. Yeah, yes, and no. People in pharma have really good health care. You know what I find, generally speaking, if you work for a company that makes a lot of money, then they spend more money on health care. It's pretty much it, yeah? I mean, yeah, if you're gonna work for like, the lady up the street, who's, you know, you're, you're screwed. Definitely

Speaker 1 14:26
not a florist. That's not, don't be self employed.

Scott Benner 14:29
Yeah, no, that's horrible. I don't I mean, I get all my health care from my wife, and if I had to, I'm sure whatever. I mean, God, what could I do? You know what I mean, I'd be buying out of, I don't even know how that works, right? Like, how does a, how does a self employed person get health care?

Speaker 1 14:47
How does anything really work? I mean, somebody just says, This is how it works. So,

Scott Benner 14:53
you know, it's interesting. You say that because you're going to be the only person who knows this. If I see this out in public and. Next couple of months, I am going to know you gave it away. Ashley, okay, Arden and I are making a series for the podcast called I don't understand. And we just have this never ending list of things we do not understand, and we sit down and figure them out together. It's pretty fun. Yeah, it's gonna be good. Sounds great?

Unknown Speaker 15:17
What a great way to bond, too. Well, yeah, also,

Scott Benner 15:20
I figure most people don't understand those things, so might be interesting to listen to it get figured out. We'll find out. Nevertheless, yeah, you said earlier that I am like, fantastic. I forget the word you used. You were wonderful, fantastic. Something like that, a Jedi, I think I said, like, a Jedi Master or something masterful. I hear, heard you say. So what does that mean? How did you come to that? Why did you find the podcast? How's it helped you?

Speaker 1 15:49
Oh, um, so right after Trevor's mystery diagnosis, we were in the hospital. And, well, he was, like, barely in the hospital, because he wasn't in DK or anything. And I was completely overwhelmed, because not only did I not understand the differences between the types of diabetes, but I just was trying to just open any door and window and anything of trying to get education. And my husband is very much. He buys books on Amazon, and he just loves to just page turn everything. So he's doing that. And I went to Facebook groups and podcasts, and I found yours. I happen to come across yours, and got into just the you and Jenny, and listening to all of those pro tips. And it was really, really helpful. We did a lot of troubleshooting, a lot of I would listen to a couple get super overwhelmed, and then I would just stop and say, You know what? We'll figure this out. I'll let my husband take the wheel, and he seems pretty good. Get a good handle on what the books are saying. So let's just go that route. And then it was, Oh, let the doctors, you know, split that. And then that would kind of crumble. And I'm like, You know what, I'm going back to Scott and Jenny. Then I'll listen to those some more. And then I feel like I'd, you know, get some traction. And then I'd say, You know what, let's try this. And then that would work. And then I'd feel like, get some more confidence, and then a little bit more, a little bit more. And I'd listen to yours a little bit more and figure out glycemic load index and all the variables and fat, protein. And it was just and then you just kept saying, like, eventually it's just going to click. You just have to try and it'll click. You. So try it. It'll click. And I knew, like, I just needed to get over that hump. But you know, like you always say, we got to be bold with insulin. And of course, I thought I killed my kid a couple times, but we didn't. He's still here an event. You know, we're only a year in, so we still have a lot of learning to do. But I definitely feel like it's it's getting better, good. It's not getting easier. It's getting better. If

Scott Benner 18:00
you don't find yourself running through the house in the first 18 months going then you're not trying hard enough. You know, like things go wrong. And you know, that's why I would repeat over and over again to people like, you know, it's experiences, and then learning from the experiences, like so many people do the hair on fire thing, and then they lose the moment Right? Like, you like, yeah, it went wrong, but just step back and examine what's happening right now, because this is your answer to the next time and keeping it from going wrong again. Like, you have to have the experience. It almost has to go wrong, so you can understand what right would have looked like. And, you know, and that's a hard thing to like. How do you explain that to someone who, a couple of months prior, never thought anything like this was going to happen to them? You know what I mean? It's a big leap. And so I would imagine that what happened to you is pretty common. Like you listen, you go, this is a lot. And then something I said rings true, and you go, That guy might have known something, or that lady said something, let me go, like, find out again, because your husband was never going to get it out of those books. I don't think anybody I listen. No disrespect to people who read. There's so much right when you when you say something out loud, you have takeaways when you leave the conversation. And yes, that can happen with reading, but there's also so much information, it's so static, and it even if it was rock solid, you know, when it was written two years ago, now suddenly there's like, maybe you're using an algorithm pump and reading a book that was written before those existed, and then it's not apples to apples anymore. And you know, it's just, I don't know. I think this is the best way talking, you know, for me, I'm sure there are plenty of people are like, look, I read fine. I know there are people who read the transcripts of the podcast and don't listen to it. And actually, I

Speaker 1 19:53
do both. I do both. So I I think that's really helpful. Sometimes I do both.

Scott Benner 19:58
I'm glad to hear that, because. Is making those transcripts is a huge and utter pain in my ass, eats up a ton of my time. And I because I have to type each word out as I listen back, that's not really what happens. I just drop it in, AI, it's AI, but it's still, it's like, very time consuming, and like, in my heart, I'm like, nobody uses these. Like, that's how I I felt in the beginning. I was like, I'm going to do this, because three people asked me, but nobody's going to use these. And then I hear back from people all the time how valuable they are. So maybe I'm wrong about reading. I don't I don't know. How do you use them? Can you explain to me how you incorporate a transcript? Well, I used

Speaker 1 20:37
it yesterday, actually, when I was listening to a podcast, and I didn't have enough time to listen to the whole thing, so I read some of it, and I was like, okay, skip, skip, and read a little bit more. And then I got to what I thought was a juicy part, and then I skipped to that part. And then I was like, I don't have time to listen to listen to all this, so I'm just going to read it. And I was able to read faster than what you guys were talking and so I was able to read through it, and I went and then I was like, oh, man, I skipped this. I need to go back. So then I was able to go back and read. It's kind of like my, I don't know, I probably have dyslexia of some sort. So then I was able to get, I'm

Scott Benner 21:20
worried that you don't even know, like reading a book, and

Speaker 1 21:22
you're like, I need to get to the end and see what what happens, what happens? And then I go back and I read the whole thing.

Scott Benner 21:28
Do you mean dyslexia? Isn't dyslexia when you read? See things backwards? Yeah, I

Speaker 1 21:34
probably messed that up. Yeah, there's one point for you. Two for me, one for you. Scott, no, not that we're keeping track,

Scott Benner 21:41
you're gonna really enjoy the episode where Arden and I try to figure out what a blind person sees, color, blind or blind, no. Blind like a person who's completely blind, right at what percentage? What are they experiencing? If they're completely and totally blind, what is it they're experiencing? And is there context where we like we went through it. We tried to figure it out. We got, like, first hand accounts from people who were blind, like it was, that was us trying to figure out. Anyway, dyslexia is a specific learning disability that affects an individual's ability to read, spell, write and sometimes speak. Do you have dyslexia?

Speaker 1 22:15
No, I don't. I just, I guess I'm I can't focus.

Scott Benner 22:22
Do you have ADHD?

Speaker 1 22:23
Probably, yeah, I was the kid that got in second or third grade that got put in the gifted program, and then couldn't focus, and got all their work done super early, and then wanted just to, like, play around with all the kids got in trouble, and then they're like, put her in gifted program, and then they just always on stage, made my own, produced and wrote things and got on stage and got bored of that, then went back and became like a a B student.

Scott Benner 22:51
I couldn't get a B on purpose, that's for sure. I'd have to have a really bad teacher to get a B like that person would have to really not care that I was cheating, and then then I could pull a B, but of my own accord, a C, if I was lucky. Yeah,

Speaker 1 23:06
you're pretty smart that. I think you got it. You think you did pretty well for

Scott Benner 23:10
yourself there? I don't know. Usually, in a schooling situation, I look like a lead balloon underwater, just like that thing's never getting out of this, you know? I mean, like he's he's not getting out of here. He live here until he's 90. They're not even gonna let him out. I was terrible at school, like, really, genuinely bad at it. Hospital stay, not too long even.

Speaker 1 23:31
No, we were, well, like I said, we were, like, blindsided, like completely blindsided, by this diagnosis. He went in for the well visit. And honestly, I thought he had ADHD. I thought my son was, he was starting to get in trouble at school in fifth grade, and he was starting to get in trouble for, like, little things, you know, like someone, he took somebody's pencil through it, or did something. And I was like, You need to write an apology for that. And you know, they're like, Well, maybe he'll turn around after winter break or something, and then something else happened after winter break. And so I was like, Well, I don't know. So we did the whole had the teachers fill out the Vanderbilts and kind of like the first step on seeing if there's something there, okay, and we kind of piggybacked that doctor's appointment for the Vanderbilt with his pediatrician to go over those with his will visit. And when they went in with that for the well visit, they just happened to say, Oh, we also between ages nine and 11, somewhere between there, we'll do a finger stick. I didn't think anything of it, because he's my first born, and I never, never, we've never done that before. We never done it before. So I was like, Okay, go ahead. They finger stuck him, and it came back a little high. They, well, they weren't sure at first night. And I did understand what that was for. And I did mention, like, Well, he did just eat cereal about an hour and a half. Go about an hour ago. So just to let you know, like you did just have something sugary, like, okay, no worries. That came back and it was pretty high. I It wasn't astronomically high, but it was high enough that they said, Hey, this is concerning, but it could be a lab error. What do you want to do? And that's what I would say, what you want to do? What they asked me, what I wanted to do.

Scott Benner 25:22
What do you want to do? Like, Well, I I like to talk to somebody who went to medical school. What do you want to do? Jesus Christ, what do you want to do? You're like, like, I thought I was coming here to get a lollipop. Like, I'm making medical decisions now. Anyway, I'm sorry. What did you want to do?

Speaker 1 25:37
Well, I said, let's get a they, well, they gave me options. This is what they did. They didn't say, like, completely blindly, what do you want to do? They're like, you can either, you know, come back in and get a finger stick again, or you can maybe get lab tests. And I was like, let's just go ahead and get lab tests. We have no baseline of anything. Like, I don't even know those white blood cell red blood we don't have anything. So we had this scheduled. It just so happened that that was the same week that he had state testing for a school. And the school system, as you know, are pretty rigid about these schedules for their state testing, and I didn't want him to have to, like, go in for a makeup test for these he wasn't thirsty, he wasn't Bedwetting, not that I knew any of these telltale signs, but there

Scott Benner 26:20
was nothing extra. What was the finger stick? Do you remember what it read?

Speaker 1 26:23
I think it was like in the 160s okay, maybe somewhere around one I think it was around 160 I remember they were like, not overly concerned, but they were like, wow. So little high. So anyway, they had scheduled a lab testing, and it was right up the street from where we lived, and that it was the same morning he had to be fasting, obviously, but obviously we we're supposed to have a great morning breakfast and then send your kid to school for state testing the next day. And I was like, Oh crap. I forgot about that. So I'm like, well, we're not going to do the lab testing today, because we have state testing, we'll just skip that. We'll do that another day. We'll do that on Friday instead. So the next afternoon, when he's supposed to have his lab results, the pediatrician called him, like, hey, we never got those results. What's going on? I explained the testing, and they're like, actually, you really needed to get those we really need those results. We really, really, really need those like, it's Pam. Was like, I just didn't understand why they were what was, what was so important, big deal, yeah. And then they were like, explaining the dka and all this and that, I'm like, really, is that that big of a deal? And he has, he's never went and then they were explaining what that meant, and then I pushed back, saying he doesn't even drink water, like he doesn't even go to the bathroom. He's never wet the bed. You

Scott Benner 27:50
guys are screwing this up. I brought him in for ADHD, okay, so you're getting this all wrong. Yeah.

Speaker 1 27:56
No, I understand. So, yeah. So Friday is when he had his blood test, and that came back on my chart pretty quickly, but they also ran as a 1c that didn't come back until Monday. So all the results over the weekend came back fasting glucose was, I think, 109, his white blood cells were really low, I believe, and is late. Let's I think we're really high. He caught it really early, right?

Scott Benner 28:29
Super early. Yeah. I mean, a fasting 109, is still high, right? You shouldn't, like, if you're you don't have diabetes, your fasting blood sugar should probably be like 80, in the 80s, right? So especially for a kid and but still, that seems really early, so you didn't see no offense, like you weren't like, there's something wrong with my kid. He just, he threw some of the kids pencil one time, which, by the way, I don't know if that's getting to do with diabetes or not. Like we used to take pencils from people and throw them all over the place. I realized it's a different world. Now. People are like, nice to each other, but I think that's just what they say. I'm sure the same stuff still happens. Yeah, yeah. And you're like, hey, let's do the Vanderbilt test and see if he has ADHD. My dad would have just hit me. The 70s were so much different. You're like, let's get some testing to make sure he's okay. And my dad would have been like, Hey, did you throw that kid's pencil? Don't do that again. I would have been like, Oh, you're making a lot of sense, and that would have been the end. You're not supposed to hit children. I just want to say that out loud, no, and I'm not advocating it. I'm just telling you a story about 1978 when somebody would have just beat your ass for that, and then you would have never done it again. But it's okay. I know you said your husband grabbed the books and you went to online and everything to try to get your information, which is terrific, but like, can you dig down deeper into the actual like, in your gut feeling about all this? Do you feel like somebody shook up your snow globe? Are you in denial? Like, where's the deeper

Speaker 1 29:53
emotion? Deeper emotion I was I was grieving. I was. Grieving, but I was also thankful at the same time, it was like a weird juxtaposition of I was mourning that for Trevor, that he was no longer gonna be living a life with food that was gonna be free of just no longer after I understood what type one was like that. Yeah, he could live a normal, healthy life, but he has this relationship with food that I have, that he doesn't have, that he can no longer eat things without thinking about what it's going to do to his body, like I obviously have to do that too, but not in the way that he does not a life or death. He has to wake up every day and choose to live like that's just mind boggling. Yeah, no, I understand. I didn't mean to make you cry like I mean. And another thing that I I, I feel like it's important to say like he was, we were also shell shocked to this, like he was not in DKA, obviously. But when we got home from the hospital, his a 1c was eight, was 7.8 and they called on Monday and told us I did have the ADHD medicine and I was gonna go. And by this point, like on Monday anyway, I was gonna go. And so everything was, like, seemingly normal after that first result, or after the blood test, and everything the a 1c came back on Monday. By that point, I was just going off of the original blood, blood results, not even knowing what the a 1c was. And I my husband and I had just said, you know, let's just go ahead and try this ADHD medicine. Because they said, Yeah, we he might actually have a little bit of that. So I was walking into the pharmacy to just go ahead and try that medicine to see what that said. And that's when they called and said, Hey, a 1c came back. You need to get over here. Get over here now. Yeah, and he's going to be admitted to the hospital. What did you tell him? What do we tell Trevor? Yeah, I mean, we were honest with him. We told him what it was. We told him that we there's many, many, like millions of people that have it, infants, older people, you can live a long, healthy life. He's a soccer player. He plays competitive soccer. We told him about Jordan Morris, we told him about, you know, Nacho we told him about a whole bunch of athletes in a whole bunch of other fields, right? So he wasn't discouraged about that. You feel like that helped him? He thought, No, he didn't. It didn't help him at all. He felt like he didn't have it. We felt like he didn't have it. I mean, so, like, that's another thing that was, that's a huge thing with this whole whole thing. And I think we're still, he's still kind of in that little bit of a rut, even a year into this denial. Yeah, I think, Well, I think he's in acceptance now, but I feel like he kind of slips back into denial. He's always been the kid that's he's telling the stoves hat, and he's just has to put his hand on it, just to double check. So he just doesn't and also he just doesn't care. I think it's, I don't know if it's the age, I don't know. Listen,

Scott Benner 33:16
first of all, I don't think anybody cares. You don't even mean like, they don't want to, like nobody wants to think about this stuff. And we listen, you say the right thing, and it is the right thing to say, and I believe it, which is, you can live a completely normal life for this. Obviously, I think that right, but it doesn't make it go away. Now you're just doing more things to live normally, which, by definition, is not normal, and that's when it becomes attitude. That's the decision right there. Like, am I going to just accept this as part of my life so that I don't fight against it constantly, and I'm not always feeling like I got the short end of this stick somehow? Or am I going to decide to be ultra literal and say, No, this isn't normal, and I am getting screwed compared to people who are not going through something like this. That's where it's mindset. And I don't know how you get somebody to the right mindset like I think that. I mean, you can do the right things and as the parent and say the right things, and hopefully they end up there. But I don't know if you can force it, you know what I mean? Like, you mean, like, you're like, look, Jordan Morris, he plays soccer and has type one diabetes, and the kids probably like, yeah, that's good for him. Like, I don't want that though, you know, like, so, like, and he's too, yeah, he's young, so he's also going to start hitting puberty. He already has. He's like, nine feet tall or something. You know what I mean? How tall are you? By the way, I'm sorry I fairly know your kids, six feet tall. How tall are you?

Speaker 1 34:48
Yeah, I'm five seven. Okay, seven tall for a girl, as they say, is it? That's what they always want to be, five nine. So I didn't hit my goal.

Scott Benner 34:58
Yeah, listen, go ahead. A five three girl, if you're tall, so And how about your husband? Was he like a giant? No,

Speaker 1 35:06
he had potential to be. He's six one. People always think he looks really tall, though, but he's six one, yeah.

Scott Benner 35:12
How about tall? People in his family like, where's Where does a six foot? Girl was

Speaker 1 35:17
six four. My cousins are 6566, okay, my father in law is six four. I think 636

Scott Benner 35:24
they have any autoimmune stuff, those guys like, maybe, okay, I

Speaker 1 35:31
have Raynauds or raynoids. Look at you. Maurice, overachiever. Yeah,

Scott Benner 35:36
your hands cold. Do they turn your fingers turn blue?

Speaker 1 35:39
Oh yeah, they're getting pretty purpley right now.

Scott Benner 35:44
How come are you sitting a certain way? Is it? Do you know what brings it on? Oh, gosh, it could. Tuesdays, days it ends in y, stuff like

Speaker 1 35:54
that, yeah. Days, it ends in y. That's it. Yeah. Okay, so

Scott Benner 35:58
you have uncles with eczema, and you have Ray nods.

Speaker 1 36:02
My No, the eczema comes on my husband's side, on the

Scott Benner 36:06
husband's side. Oh, there it is. They should give a test when you're dating. I'm telling you, this is we could avoid these auto immune things if we just did a quick questionnaire before it got too serious. Darn here's a crazy question, how long you've been married?

Speaker 1 36:23
I think I said 1716, or 17? Yeah, I don't know something like that. I'm bad at math. Don't worry about I'm an art major. I didn't I didn't have to take math in college. That's one of the perks. I

Scott Benner 36:33
don't think that's math. I just think that's counting. But nevertheless, like, go back to dating. Okay, 20 years ago, whenever you were dating,

Speaker 1 36:39
and was 18 when I met him. I know that you were 18

Scott Benner 36:43
when you met your How old are you now? Oh,

Speaker 1 36:46
where I just I this was part of the podcast interview. Oh, wait, you don't want to I just turned 40.

Scott Benner 36:53
Oh, my God, you're almost gonna die. That's horrible. You shouldn't told anybody about that. So you're 18. You meet this guy, told the world, it's okay. You know what I tell people all the time, and I genuinely mean this, I'm old because I'm alive, the alternative not as good. You

Speaker 1 37:09
understand like, you know what I mean? Yeah, thank you for that perspective.

Scott Benner 37:13
Also, I saw you for a couple minutes. You're looking you're doing fine. Don't worry about it. Okay? Thank you. Arden asked me the other day, it's now on our list of I don't understand. Why do older people look younger than they did in previous generations? And we were in a restaurant the other day where the waiter guessed my age as 40. And I was like, oh, no, I just had a birthday. And he goes, Oh, happy birthday. How old are you? And I said, 53 and he was genuinely knocked over. And I was like, oh, is my hair is dark, and I act like a child. That's pretty much probably why. But the point is, is that when my dad was 53 he looked like he fought a war, you know what I mean. And his father, when he was probably died before he was 53 and probably did fight a war, you know. So no Stolen Valor here. I don't know if he was actually in a war or not, but point being that you look fine. You're don't argue about your age. But my question is, is, if I go back to you dating 18, Jesus, what did you know when you were 18? Nothing. Not diabetes, yeah. And I say to you, listen to me, Ashley, I'm from the future. Okay? And if you marry this guy, you're gonna have two kids. They're gonna be great. Here's all the great things are gonna happen to you, but your son, when he's like, 11, he's gonna get type one diabetes. And here's what type one diabetes is. So if you want to, just like, you know, you can date this guy if you want, but like, let's make sure we use a condom and then break up with him. You start loving him. See if you want to get out of this, would you have done that? Oh, 100% I would. You would have bailed on him when you were 18. If this, no, no. I mean, I would do it. I would do it. You still as at 18. You can look back and say, It's okay. I would, I wouldn't leave this situation.

Speaker 1 38:54
Yeah, yeah. I know what my husband looked like when I was 18. Yeah,

Scott Benner 38:58
of course. Oh, he was super handsome, is what you're trying to tell me he still is? Yeah, I would totally I love where that's so honest. Ashley's like, listen, I was 18 and he was hot. I'm not going anywhere.

Speaker 1 39:09
I'm not going anywhere. I'm locked in. Is

Scott Benner 39:12
that really what you meant? Yeah, that's fantastic. Thank you for being honest. I appreciate that. Are you still nervous?

Speaker 1 39:20
No, no, I really was, I mean, I was nervous, but I'm not, like, too, too nervous. Okay. Why'd you

Scott Benner 39:25
want to come on the podcast? Obviously, to meet me. I'm fantastic. Skip over that. What did you want to tell people? Yeah,

Speaker 1 39:31
I just wanted to let people know that screening, you know, I know, like screening super big right now, and that it really is important, because it truly. I feel like it saved our family. My son from going into DKA, which obviously he did not, although we're going through the psychological part of what type one can do to a family, I feel like that goes especially from listening to your pod. I feel like that is true in any regard, like what you just mentioned, like you just, you don't know, really, what your journey is going to be, as far as after diagnosis, but knowing is half the battle. So after you get that, you just, it's just what you do with it, what you do with the knowledge, what you can do with knowing what you know. Yeah, so I just, I wanted to come on the podcast to share our story, and then also to share how we're doing a year in we're on the islet pump, and to kind of answer any questions about how that's going with the kid on puberty. Because, shoot, I mean, you mentioned it before. He's six six feet. And I mean, he started this with he was my height, he was five seven, and now he's almost six feet. Wow, just shade under six feet tall.

Scott Benner 40:52
Well, let's talk about the eyelet pump. But before I do let me say this screened for type one.com. Is a sponsor right now, if you go into the show notes to the podcast player, there should be a link there, or you can type into a browser. I think there's links at Juicebox podcast.com now, that's if they're still sponsors six months from now. If they're not still sponsors six months from now, then scroll, don't. No, I'm just kidding. Do you know why it's because you said screening is like, is like, all the rage right now? Do you know why that is? I would think

Speaker 1 41:22
it's because of the the medicine that they can take to help prolong the Plymouth. Yes, there you go. Yeah, which is called, know what that was now called, you go ahead, you know what it is?

Scott Benner 41:36
It's because there's a push. Because, you know, I don't know if I'm supposed to say all this, but I mean, what are they gonna do? Sanafi bought tea sealed from a company called prevention bio, and this medication seems like it might be kind of revolutionary, like, at this point you take the infusions. I don't have all the details, so I don't want to, like misspeak, but there's these infusions that you get every day for a certain amount of days, and what they're seeing is it's pushing off people's diagnosis if you take the infusion early enough. My expectation is, is that they they think that it's possible that in the future, they're going to learn more about it, because that company paid a lot of money for that drug and so And honestly, you know how much they paid for it actually

Speaker 1 42:23
three. Dare I say $3 billion bill, oh, I was gonna say 1 billion. 1 billion.

Scott Benner 42:30
No, no. They bought prevention bio for $3 billion so I'm like, listen, they either think they know something, or, you know, somebody with an ego trip had the checkbook that day. I don't know which one it is, but like, point being that you know, if you get screened early enough and find out that this is in your future, and do this infusion, they're seeing it put off people's diagnoses for a year or more. And I think if you read between the lines in a lot of the interviews I did with prevention bio back in the day, I think they're hopeful that it one day might stop it from happening, or maybe modified somehow, might be that. So anyway, then when you think about that, like, how do you get people to screen for type one diabetes if they don't think they're going to get it and they're not showing any signs, because you really have to find out early. Yeah, that's a Herculean problem to get people to screen for something like that. So that's why you're hearing about screening so much. Anyway, screen for type one.com now that was not an ad, because I'm sure I said stuff in there that I'm pretty sure I'm not supposed to say if it's an ad. So anyway, that wasn't an ad. That's okay. No, it's okay for you, but I don't know if it's okay for them or not. But well, we'll find out. Well,

Speaker 1 43:43
it's really important. I feel like, I mean, the, I mean, listen, we go to a really great number one in the country, pediatric Children's Hospital for endocrinology. So the fact that, when we were there, they kept saying they we had multiple doctors coming in in the two day span asking, Hey, were you the kid? Was this the kid that got diagnosed with a they just a well visit or a finger stick. You give your pediatrician a gold like they that's an I just cannot believe it just to hear that that is unprecedented. I

Scott Benner 44:20
should stick on that for a second, Ashley, because I'm, I'm obviously quick to give doctors crap when they don't do something right. That was really well done by your pediatrician.

Speaker 1 44:27
Yeah, seriously, yeah. And probably I'm so thankful, yeah,

Scott Benner 44:32
saved your kid from being in DKA and saving him from, you know, but I mean, that could kill a person. First of all, is very serious, and you know, all the trouble that that goes through, plus you get a slower, you know, you're the onset still happening. You get a little time to figure things out before it gets wonky. Do you think he's honeymooning now, still? Or do you,

Speaker 1 44:51
oh, no, no, no, I feel like honeymooning ended in the summer. That was when I was saying. I was listening, dabbling. In your podcast, my husband was reading books. We were doing our first vacation. I think that's when we crashed and burned. It was

Scott Benner 45:08
all of a sudden, the need rose significantly. Yeah,

Speaker 1 45:12
we were insulin it was like, ours is insulin resistance was going on. It was just nothing was happening. That's when I learned about combo bolusing. That's when I learned about all sorts of things, all fat, protein rises. That's when I learned all the things. But that also that's when his honeymoon left.

Scott Benner 45:30
Did you sort of take over? Because it You made it sound earlier, like you're like, my husband's got a book. I'm gonna let him handle this. But are you that really is what you said? You're like, he's good with books. He'll probably take care of the diabetes. But, like, is it mainly you now, or do you guys do it together? No,

Speaker 1 45:47
no, I really feel like it's, it's a great teeter totter combo. You know, like, some days he's really great, some days I'm really great. It's a really good teamwork, nice. Yeah, and he's, like, I said he's, he's, my son is really into competitive sports, with mostly soccer, and he trains a lot and off seasons and does Futsal, and so, you know, we are really good at tag teaming and figuring it all out. It's just kind of like a little dance. It's

Scott Benner 46:19
excellent. Good for you. I didn't mean good for you. Like, shut up. Good for you. I want to move on. I just, I'm looking at the clock, and you did take 25 minutes to get your headphones on.

Speaker 1 46:27
So I'm trying to, like, talk about beta eyelet or something. We can do

Scott Benner 46:31
that. I have a phone call in a half an hour. So, yeah, go ahead. Somebody's inviting me next. What questions you got considering speaking in Canada next year? So I have to have a phone call to find out what they want from me. But my question is, once he has diabetes, is it syringes? Is it pens? Is it a pump? What do they give you? Do you

Speaker 1 46:50
an MDI? We got a g7 we were thankful that we had a one of our good friends is a an adult endocrinologist, and she had a sample g7 because he was diagnosed in April, and I think that was right around the time that it was available in the US, is that, if I'm wrong, I'm sorry. So she had a sample g7 and she gave one to us and said, Hey, try this. This works pretty well, from what I've heard, interesting. And we plugged that one on we plugged one of those on them. And at the time, I don't think it was on the formulary on insurance, but it quickly became on the formulary. And so we were able to get that for Trevor, so he's always been on the g7 and we are also doing that with MDI up until December, when the beginning of December is when islet became compatible with g7 and you've

Scott Benner 47:44
had it for almost eight months,

Speaker 1 47:47
islet, yeah, oh, yeah. We got the eyelet in January, January 7. So this

Scott Benner 47:52
is interesting, because you have no other experience with another pump. No. So what was his a 1c on MDI, but he was probably honeymooning.

Unknown Speaker 48:01
Um, he's always been in the sixes, sixes,

Scott Benner 48:03
okay? And he he wanted a pump. You wanted him to have a pump. He was

Speaker 1 48:09
always apprehensive to do pretty much anything so. But when the pump became available, we went through pump. We went through pump training in November, and there was like, nothing's available for g7 you can go back to g6 and we're like, we never run g6 and he was like, I am not doing anything other than g7 so we're like, well, we gotta figure out what's compatible with that. And so when the islet became available, we were like, Hey, let's go time if you want this and try. You ended

Scott Benner 48:36
up with an eyelet because it was g7 compatible, or because you liked the function of it and how it worked both we

Speaker 1 48:43
liked the function of it. During the pump training at the hospital, I had asked specifically to get a representative for Ilet to get more information about it. Again, the adult endocrinologist, my friend, had mentioned that this was going to be available and just kind of the ins and outs of the ease of what it did. I had also had you had also had somebody on talking about it, so I had listened to that in conjunction to, like YouTube influencers and things like that. Kind of like listening to other pumps and Trevor's endocrinologist at his three month appointments. Had also said, you know, asked him about like, Hey, are you guys interested in pumps? And Trevor had always been like, No, I think I'm okay with where I am, because he just got steady with something. And was like, This is it, it's working. This is it. This is working. This is it. And his endocrinologist point was like, let's get a goal of looking on YouTube and trying to see what pumps are available, what pumps you might be considering what pumps you're not like, just baseline. Just try and get try and get options. And so that was one of the options, was islet, because he liked the ease and the functionality of it, of like, not having to carb count. Okay, when that became available in December, I was like, hey, this one's available. Do you like this? Option. I mean, it's tubed, but, and he's like, Well, yeah, let's try it. And I was like, what's the harm of trying it? And then the summer, if you wanted to do Omnipod, there was no contract on that, you could always jump to that one for the summer time and then go back. I mean, there's options, right? So that's why we did that.

Scott Benner 50:18
Excellent. What was your finding like you, you started using this pump which explain to people, in your words, how do you announce a meal on an island, for example,

Speaker 1 50:27
depending on what his initial number is. Let's just look at what His number is right now, for example. Oh, well, let's not use this number for right now. Well, let's just say from when he woke up, his number when he woke up was like 140 if he is going to eat breakfast, I would have him announce a breakfast usual, because he usually eats his usual breakfast. And then I would have him wait about 15 minutes, and then he would eat so you are still pre bullish thing, and then he would eat his usual breakfast.

Scott Benner 51:03
They'll tell you not to do that. You know that, right? Like eyelet says don't Pre Bolus. The company

Speaker 1 51:08
beta biotics. Well, certain individuals at the eyelet will tell you not to do that. Other representatives will tell you it's okay,

Scott Benner 51:16
okay, gotcha. And that's all I just wanted to say. Then what happens? Like, like, just now, you're like, oh, let's not talk about this.

Speaker 1 51:24
I think he just ate. He might not have announced but

Scott Benner 51:27
so you think he ate without eating or without using insulin? Oh, yeah, yeah.

Speaker 1 51:32
So this is also what it is about him. When I said earlier, like, oh, he just doesn't care. And but also, he's a tween boy, so he could just be downstairs, just watching a show, and he might have gotten excited about whatever Lego build he's watching on YouTube, or whatever it is. I got some adrenaline. Yeah, adrenaline. And it just might have kicked it up a little bit, okay, and so. But what happens is, if you don't eat and your numbers shoot up a little higher out of range, it will, the algorithm will see that after a little bit of time, and will give you a little shoot of insulin, like a little herbs, a little bit, a little bit.

Scott Benner 52:21
Where is his a 1c, on islet, he's still in the sixes. And what about excursions at meals, like, what are high blood sugars look like, and how long do they take to come back?

Speaker 1 52:31
It just depends, uh, he can be in the two hundreds, or he could stay level. It just depends on what he's eating and the what if, is it raining outside? I mean, I don't know. So

Scott Benner 52:44
if he hits a 200 for example, off of like, say, a fatty meal, like something with, like french fries or something like that with some grease in it, how long do I expect him to be in the two hundreds? Does he get low when it comes back down? Honestly,

Speaker 1 52:56
it really just depends on the day. Is it a Saturday? Is it a Tuesday? Did he just work out? These are the things that I need to know. Right going he is going through puberty right now, so it is a crap shoot whether or not he's going to go high or low. Was he dehydrated? Did he have a soccer match? Is he going to a soccer match? Is he going to burn that off? I need to know what the fat, protein rise is going to be in that because if, if he's going to be high and he has a soccer match later, it's not that big of a deal, because he's going to burn it all off, in my opinion.

Scott Benner 53:26
Does a high blood sugar affect his ability to be athletic? No, he doesn't slow down, get tired, easier, stuff like that. No,

Speaker 1 53:36
a low blood sugar, for sure, does okay. He gets really weak in the legs. He gets like tingling, tingly in his leg. How low does that have to be for that to happen? He usually feels that around like 70, really, 6870

Scott Benner 53:52
okay. Is he generally higher than lower?

Speaker 1 53:55
No, he's usually around 161, 70. Okay. And do you know you would probably consider that very high?

Scott Benner 54:04
Well, I don't consider, I listen, I don't judge people. Okay, so, but I mean, I know, all I know is that I'm sitting here right now my blood sugar is probably 85 and 160 sounds like it's twice as high as 85 and so if my kid's blood sugar was 160 I'd be like, we need more insulin. But does the pump bring him from 160 down to a lower number? Or does he live at 160 like I'm trying to figure out, like, does his graph look generally lower, 80s, 90s, 100 and then big pop it food, and then back down again. Or is he always like, 121, 3160, with some pops to 200 and come back again,

Speaker 1 54:46
again. It kind of just depends on the day, I would say, like on his good days. Like, meaning, like he doesn't have a really strong or a really heavy, you. Athletic soccer, or a heavy training day where there would be like adrenaline spike, or what I call a false high, he would be somewhere around, like the 130s Okay, mostly, okay. And then the after he eats, he would go around highest would be around one, or would be around 190 200 and then he bought back down and like the 160s maybe, or back down to 120 and then that'd

Scott Benner 55:27
be like a good day. How does this reality compare to MDI?

Speaker 1 55:31
So much better. But the same time, we were at the very beginning of diagnosis, and he was binge eating because you were newly diagnosed, and he was finally, maybe, you know, getting the insulin he needed, hungry his body needed, so he was hungry, ravish Lee, eating. Who knows? I mean, there's so many different, like, so many different variables, that it's hard to see, yeah, and so I'm not quite sure. And now we're going through puberty, and he is an athlete, and it's also kind of challenging to really see a grand picture of, like, a great steady line all the time, because he gets these, I like to, like, I said, I like to call them false highs, because he gets huge bursts of adrenaline when he's working out. And, you know, he's starting to, like lift weights, pseudo kind of lift weights. And the liver is really shooting out that glucose, and then the muscles are really, you know, getting ripped apart. And then afterwards he drops because, you know, the recovery, because he's getting the muscles now. So,

Scott Benner 56:38
like weight lifters type one would tell you you have the Bolus to do anaerobic exercise so, but you can't do that with the eyelet, right? You can't say, Hey, I'm getting ready to lift weights now, Bolus. It's only for me. It's

Speaker 1 56:51
not really lifting weight. He's doing more like plyo stuff. And I'm not sure exactly what he's gonna do when he goes in for these training sessions. So I'm like, sometimes he's just running around in circles, and then he's, like, trying to do splits and stuff, and he's mostly a soccer training so I'm like, oh, a lot

Scott Benner 57:08
of running, yeah, a lot of running, yeah. Cuz, not really a sport. You can't use your hands and everything. I

Speaker 1 57:13
understand we really like the pause feature. That's really helpful. What is that? It's a new feature on the islet. It just rolled out about a month, a month and a half ago, maybe where, when he is disconnecting. So when he is playing soccer or on the pitch for a game or a match, sorry, on the pitch for a match, in his boots, um, he'll Disconnect his eyelet, and we will pause it so it's not spitting out anymore, basal or trying to adjust his numbers, and then you can pause it for up to two hours. And then once he gets done with his soccer match, we'll unpause the islet, and then it'll plug back in or reconnect.

Scott Benner 57:56
Is he high after he gets done playing? Um,

Speaker 1 57:59
he can be, but sometimes not generally, he usually is, but it's a then he comes straight back down, because that's an adrenaline high, and then he comes right back down. And usually we have to give him stuff. We usually have to give him a jerky or trail mix and stuff uncovered. Well, usually that's low carb stuff anyway, but we usually give him, you know, things uncovered in addition to protein, things

Scott Benner 58:24
to hold him steady after the exercise. Yeah,

Speaker 1 58:27
and we do that, we usually give him that kind of snack before he he goes in as well to work out, too. Okay, nice. And you're finding it's working for you some days, yes, some days no. I mean, sometimes we nail it just like pizza. Sometimes it's like, yes, we killed it, we did it. And other days, we're like, you know, what

Scott Benner 58:48
is it fair to say? You don't when it goes right, you don't exactly know why it went right.

Speaker 1 58:54
Are you at that point right? You're like, yes, we knew it. We rocked it. Rocked it hard. And other days, when it goes wrong, you're like, what happened? Are you

Scott Benner 59:02
ever able to, like, figure out what happened?

Speaker 1 59:06
Some days, some days we find the the candy wrappers. Some days we don't, you know, I mean, some days, some days it's that. Some days there's nothing.

Scott Benner 59:15
So your biggest concern right now is to get him to consistently Bolus for food. Mostly, yeah,

Speaker 1 59:21
mostly, if, I mean, yeah, I would say yes, we want him to learn how to manage, obviously, on his own accord, but also the right balance of pushing him to start to care. But as you well know, if you've done this so many years, you have to people care about what they want to care about. Yes, exactly right. So there's a right balance there.

Scott Benner 59:46
The goal is to, like, get them to care about it, or see the value in it, and, you know, etc, like, that's the kind of stuff it's that's where all the parenting comes in and not freaking out. And, you know, because you can't just yell at somebody. To do is like, despite what 1978 would tell you, hitting somebody is probably not a good way to get them to do what you want to do in the moment, doing that right, right? Yeah. My point is you can't force people to do things, right, yeah. Often when you try to force them, it just goes the opposite direction anyway, yeah, yeah. So that's pretty much the hill you're going to be climbing for the next couple of years. Yeah.

Speaker 1 1:00:20
I mean, the goal, obviously, is to get him to do this sooner. I would say, by high school. You think you will? I mean, if not, then I would hope girls would probably, or whatever he's into, would help the situation. I don't want to shadowing his dates. But if it comes to that, I think, hopefully that'll help. I don't know. So

Scott Benner 1:00:44
your expectation is, is that once he starts dating, he won't want people to see what's going on, so he'll take care of it, so it doesn't happen. I

Speaker 1 1:00:51
mean, he doesn't want anybody to know that he has his diagnosis. That's another hurdle we're trying to jump right now, is just trying to have him be open and honest with people, but at the same time, it's a heck of a difficult age to be diagnosed. So why do you think he

Scott Benner 1:01:08
doesn't want people to know? I mean, he's

Speaker 1 1:01:09
already standing out at a six feet tall person, six foot tall boy, so he's already that going for him, but I don't know. I think he's just, it's just his personality. I don't, I don't know. I can't answer that for him. I He just does not want anybody to know, to the point where he doesn't want to go swimming, he doesn't want to do things. Says he doesn't care. But we know that's just a 12 year old mindset right now. I don't know.

Scott Benner 1:01:35
Do you do therapy for that? Do you just keep working? We do? Yeah,

Speaker 1 1:01:39
he goes to and I love having that outside person that also has diabetes to help him and help nudge him. And we always see a great, great turn around after seeing that that's also with the hospital, you were able

Scott Benner 1:01:54
to find a therapist with type one. Yep, nice. So, oh, that's excellent. Yeah. See it is personality. Because if I was six feet tall and 12, I'd just be walking be walking around going, I'm so much taller than you like, I'd be so thrilled, you know what I mean. And then you see people who it happens to them. They're they're, they try to shrink. You know what I mean? Like, they don't want to stand out, or, like, I don't want to stand out. But I would definitely take that as a dominant thing and run with it. I'd be like, Oh my God, you're all so short and, you know, just like, live in the moment. But that's not how he feels about it. Yeah,

Speaker 1 1:02:22
yeah. Again, I don't, I can't get into the mind of of my son, but yeah, I don't know. Does

Scott Benner 1:02:27
he take after you or your husband with his personality? Me, okay,

Speaker 1 1:02:33
we are like oil and water when we get together. I see it very

Scott Benner 1:02:37
much. So because you're so similar, it's hard to get along. Yes. How would you manage if you had diabetes? Would you think you'd hide it from people? Probably, yeah, I think I would. Why? I think back in when I was his age, I would be in the blame and shame game for some reason or another. Yeah, just to but do you think that's what he's doing? Probably, in some regard. Yeah, I mean, I touched on this earlier, and I don't want to bum people out, generally speaking, but whatever, it's just, it's the end of the podcast at this point. So they're still listening. They'll go with it. It's the mindset you're going to need if you're going to be successful, which is, like, you know, I really don't care if I have diabetes. These are the things I do. It's normal. I can't sit around and belabor it and, you know, be like, Oh my god, Woe is me. Or like, want to blame somebody, but if you are doing that, I mean, I get it, you know what? I mean, like, you can live a normal life even you have diabetes, yeah, but it's not really a normal life. It's a normal life with diabetes. You know, like, no matter what would it? Forget diabetes. If you were born with nine fingers. You could live a normal life with nine fingers, but it's not exactly normal. You have nine fingers. You know what I mean? Like, it's that feeling in there. Again. I think some people get stuck on it and some people don't care about it, and I think you're gonna do better if you don't care. But how do you get people who are stuck not to care? That's like the million dollar question, or the $3 billion question, you know, if you're sanafi, but like, seriously, like, how do you, how do you make that leap to understanding that if you just accept it, it's better, you know what I mean? Like, there's that, um, I don't know how I haven't talked about this in a long time, but it came up in my life recently I was talking to, I shouldn't say who I was talking to. I was talking to a younger person in my life that isn't my kids. And I was explaining this, this commencement speech called This is water that was given like, I forget when by by an author who has since taken his own life. So, I mean, I don't know how much of his insight you're interested in hearing or not, but,

Speaker 1 1:04:41
well, I bought the book after I heard you on your podcast, so I'm sorry to hear that he's since deceased. He's long

Scott Benner 1:04:48
deceased, and not that. That makes it better. But nevertheless, this is not we're talking about. We're talking about it's this one idea in his commencement speech that I find to be like at the core of living. Happily. And, you know, I won't paraphrase him, I'll just tell you the way I think of it, which is, if you're driving down the road and someone drives past you like an absolute lunatic, they're probably an asshole, right? They're probably just driving unsafely, but they also might have a great reason for it. Their kids at home and sick, or their house is on fire, or they gotta take a okay, like there's a reason why they're doing this. They're not an asshole. They're just they're in a bad situation. My point is, is that you're in your car, they're in their car. They've just sped by you. You're never gonna see them again. You don't really know why they're doing what they're doing, and it benefits you to assume the best, because if you assume the worst, you're just going to have this anger, you're going to it's going to live inside of you. You're going to distrust people, you're going to have a bad experience. You know, the all these reasons why, if you decide to guess that they're just an asshole, it's bad for you. And if you just say, You know what, I hope they're okay, you know, and that whatever's happening is happening for a good reason. That's it. It's nice and light and airy, and you let it go. And I see the connection with diabetes there, which is you can decide to say, hey, you know what? You can tell me, I'm normal, all you want, but I'm wearing a thing on me that's giving me insulin, because my pancreas doesn't make insulin, and my blood sugar gets low, and my legs get tingly and etc and so on. And there's 1000 things about this that aren't normal, but if you just accept it, it just is easier on you. Like, I just that's, that's it really, like, just let it be easier on you, because life's already hard enough, and now it's harder. So give away as much of that anger as you can, because it's just better for you, like you're doing yourself a favor by just assuming that that person drove past you for a really good reason. And don't think about it anymore. I know that's probably overly simplified for people, but I just gave that book to two college graduates in my life, I was like, here. I read this a couple of times a year. It really helps me keep perspective, and it helps me be kind, and I hope you, you know, enjoy it now. Will they ever read it? I don't know. I mean, they're like, 20 some years old. They probably are just like, Man, I just want to smoke weed. Leave me alone. But who knows. Anyway, everyone smokes weed now it's a big thing. Ashley, as you know, all right, what did we not talk about that we should have?

Speaker 1 1:07:26
I don't I think we cut mostly. Did we do it? I think we pretty much did it. You

Scott Benner 1:07:32
sent me, like, two emails and the thing that you put in here, so I'm hoping I got to the stuff that you wanted to

Speaker 1 1:07:38
talk about. Yeah, I mean, I think that's pretty much it, unless you wanted to talk about Steve Logan, that's pretty much all. Wait,

Scott Benner 1:07:46
Steve Logan, what is that? Who is Steve Logan, yeah, I have no idea who that is.

Speaker 1 1:07:50
Oh, he is, like, arguably one of the best UC bear, cat basal players that's ever lived.

Scott Benner 1:07:57
What is that? Is that, like, a college,

Speaker 1 1:08:01
college? Yeah, University of Cincinnati. Oh, my God, you don't know who that is. No, of course not. Oh, Steve, okay. Steve

Scott Benner 1:08:10
Logan is an American former professional basketball player. He played college basketball for the Cincinnati bear cats. He's 44 years old now. He's 510 How do you play basketball in your 510 he must be like a super person. He was drafted in the second round in 2002 but it doesn't seem like he played professionally anywhere, because I don't see a listing for that. What does he do? Does he teach in the area now? Well,

Speaker 1 1:08:32
he was at a basketball camp that Trevor was signed up for. He did play professionally. He got drafted. Thank you. Oh, drafted for Golden

Scott Benner 1:08:41
State Warriors. He's a hands on man. Good for you. Steve, nice and hands

Speaker 1 1:08:45
Yeah, no, he's, he's really good. Well, anyway, it was so we had already had Trevor diagnosed. And so we had already had all these camps for Trevor, because you had to sign up for camps in February. Had diagnosed in April, and so we had all these basketball camps sign up. That's when Trevor still played basketball. He'd sent he has since quit basketball. He doesn't think he's good enough at six feet. I'm like, how do you I don't think you're good enough. But anyway, so we were still an MD guy and super nervous, and he had a whole week, all day long, all week at this University of Cincinnati camp spoiler. We live in the Cincinnati area.

Scott Benner 1:09:19
Come meet us. No, I'm just getting good. That's fine. As

Speaker 1 1:09:24
we're going to this camp, we're really nervous. The staff there is the trainers are wonderful. They supply lunch. They're all sponsored every, every day for lunch. So we're trying to figure out the combo, or the trying to figure out the Bolus is for every day. They're they're even able to give him the the injections for his lunches, which is great. So the last day, I gave thank you cards and gift cards to the trainers. And as I was there for the last day, I ran into Steve Logan, and as I was because I was one of the only parents that was kind of walking around. Uh, during lunch time, and he stopped me and was like, Hey, how's going? And just kind of chatted with them a teeny bit, and kind of explained, like, why I was there, just kind of handing out these thank you cards. And he was like, hey, you know your kid. He's the one with pink shoes, and Trevor had, like, neon bright pink shoes, like he couldn't miss them. And I was just blown away that he even knew that my kid was because there's hundreds of kids at this camp, yeah. And he's like, Ah. I was like, is he in your group? He goes, Oh, no, no, no. Some of the beginning of the week had mentioned that your son had type one, and I actually know the signs. So I decided right then that I was going to keep an eye on your kid, because I I have, I have type two, and I know it's not the same, but I know what to look for. So I've been keeping an eye on your kid all week, if any, if he needed anything, I just wanted to let you know that I had him covered. And also he's been, he's been doing pretty good. He's been working hard. And I was like, Oh my gosh. I just like, my heart dropped. And I just like, can I give you a hug? I know I don't know you, but I just also want to give you a hug. And he's like, yeah, yeah, sure, of course. And I looked at him, and I was like, my husband has always told me that you were his favorite basketball player, and I just want to let you know you are now mine, and I'll just never forget that. I just thought that was beautiful, so, so nice, unless

Scott Benner 1:11:30
that's how he gets the moms to hug him and then it's crazy. No, I'm just kidding. That's wonderful, though, and I can see why that's so touching to you. Yeah. Did you see I got uncomfortable with your emotion, and I tried to change direction. I know, I know. I was like, Oh, you're crying. Like he's probably just being creepy. No, I'm just kidding. He probably was not totally joking. That's really wonderful. It was so, so nice. And he has tight he told you, as type two. Yeah, that's something. Well, good for man. See, see, there's decent people all over the place.

Speaker 1 1:12:00
Yes, I feel like throughout this whole year, there's just been dabbles of that, just here and there. It's like, right when we needed it, things happen, someone you know, like the doctor, our friend who had the g7 I had no idea even which CGM to go for, look for, or even how to insert it, and all of a sudden, bam, there. It was wonderful. We had a neighbor down the street. She was the nurse. I had no idea what a 1c was. When that test result came back, she's like, did they check his a 1c I was like, I have no idea that came back. She knew exactly what to help me with. I mean, there's all these little steps all along the way. Ever since it's just been

Scott Benner 1:12:38
solid pieces together. You find a podcast, you read a book, you meet a person. No, no, no, I don't I didn't sound like I was trying to lump me something. I'm sorry. I didn't mean No, no, no, of course, you're lumped in there. No. But like, you know, these little things happen along the way, and you ascend and get better, and it gets easier and etc, and that's going to keep happening for him. You You understand right now. And by the way, if my phone rings, I gotta go. But like, I'm so sorry. No, don't be sorry. It's your fault for not knowing how to plug in your headset earlier. But that's Don't be sorry about it. It's no one's fault. It happens all the time. Seriously, please don't worry. But you know, like you're on a journey, he's on a journey. Your husband's on a journey. You got another kid who, trust me, is being impacted by this. You might not even notice it, yet. You're on a journey together, separately, and everybody's on a different timeline. So you just keep supporting each other, and it eventually, hopefully, people have the experiences they need to have the tools that they require, and they accept what's going on. And yeah, there you go. You know, yeah, that's what I'm calling the episode, by the way, yeah, yeah, yeah, yeah. So that people can incessantly listen for like, maybe they'll turn into a drinking game. Scott says, yeah, yeah, take a

Speaker 1 1:13:47
shot. I think it should. Let's put one right there. What do you think I mean

Scott Benner 1:13:50
by Yeah, yeah? Do I mean I hear you shut up. We're moving on. Do I what is I

Speaker 1 1:13:55
think it's your Matthew McConaughey is all right, all right. All right.

Scott Benner 1:13:59
He sounds much cooler when he's doing it. Yeah, I did not do it justice. I know, no, not than you, than, I mean, than me. I wasn't saying your Matthew McConaughey was terrible. I was saying, Oh, it is. No, it is. But that's not what I was saying. What I was saying was that I my, yeah, it's not as cool as his. All right. All right. All right. Don't you think? Do you think he gets tired of it? Do you think once in a while he's like, oh, people are waiting for it. I'll whip it out here.

Speaker 1 1:14:22
No, absolutely not. He's Matthew McConaughey. He doesn't know. His ego thrives on that. Oh, you think he loves it 100% okay, all

Scott Benner 1:14:33
I know about Matthew McConaughey is, I think his wife is hot. That might not even be true. That's just the thing. I think. Also, I'm a man, so this is pretty much how I judge the world. It's something I'm so sorry. Oh, she is, I'm looking, yeah, okay, very beautiful. Yeah. Certainly is. What are the man? There's a reason to be famous. That lady will talk to you. Goodness gracious, yeah, I should have, I mean, it wouldn't have helped. Anyway. Oh, here comes my call. I gotta go. All right. Well, have a good one. Thank you. It's nice to do this with you. Hold on one

second. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next.com/juice, box. Are you tired of getting a rash from your CGM adhesive? Give the ever since 365 a try. Ever since cgm.com/juice box, beautiful silicone that they use. It changes every day, keeps it fresh. Not only that, you only have to change the sensor once a year. So I mean, that's better if you're not already subscribed or following in your favorite audio app. Please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Hey, what's up? Everybody? If you've noticed that the podcast sounds better and you're thinking like, how does that happen? What you're hearing is Rob at wrong way recording doing his magic to these files. So if you want him to do his magic to you wrong way recording.com, you got a podcast? You want somebody to edit it? You want rob you?

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