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Scott Benner 0:00
Hello friends and welcome to episode 1076 of the Juicebox Podcast

CLARIN has had type one diabetes for 18 years since she was 12 years old. She's in her fourth or fifth year of residency. She's a surgeon, and she's got type one diabetes, some thyroid issues, and a great story. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. Apple podcast listeners. If you're using that Apple podcast app, I need you to do me a favor with the last update to iOS 17, the podcast app changed and it might have mucked up your downloading, go to your library, touch Juicebox Podcast touch the top right corner the three dots, then choose settings after settings automatically download after you choose that click on all new episodes, and then everything will be back to the way it should be. Thank you very much for doing that. In return, you can get 40% off of all of your comfortable clothes. At cozy earth.com. When you use the offer code juice box at checkout, there's also sheets and towels and just a ton of great stuff. Just kidding, that would that happens whether you do the thing of the podcast app or not. But the thing of the podcast app would really help me. Apple made some changes to settings. And to be blunt, it's not good for me. And when it's not good for me is not good for you because you want this podcast and I want to make it for you. This episode of The Juicebox Podcast is sponsored by Dexcom Dexcom, of course makes the Dexcom G seven ng six continuous glucose monitoring systems. And moreover, it's amazing dexcom.com/juice box my daughter is wearing the G seven right now. It's small and lovely. You're going to want to take a harder look at it at dexcom.com/juice box links in the show notes. Links at juicebox podcast.com. The podcast is also sponsored today. By ag one that's drink ag one.com/juice box. You can start your day the same way I do with the delicious, refreshing drink of ag one. Get five free travel packs in the year supply of vitamin D with your first order when you use my link.

Claren 2:38
I'm clearing I'm 20 Nope, not 29 anymore. I just turned 30 This past year. Happy birthday. Thanks. Well, it's been a while now. I'm just still not used to being 30 that I take it back on an unhappy thing. But 30 years old. I have had diabetes since I was 12. Diagnosed a few months after my 12th birthday in sixth grade. Wow. And so yeah, going on. I think it's actually been 18 years. Yeah, as of January. Yeah. And

Scott Benner 3:08
you're only 30. And

Claren 3:10
I'm 30 Yeah, yeah, that

Scott Benner 3:11
reminds that reminds me of when a doctor said to me once like don't worry, like complications from type one don't come for like 30 years. And I was like, but she's she's too. Right. And he looked at me. I'm like, so you mean, she'll be 32? And he Yeah, and he goes, Oh, yeah, that's not comforting. And I went right. Thank you. Terrific bedside manner. Thanks a lot. Yeah. Meanwhile, even just that long ago, expectations for diabetes aren't even what they what they are now. Oh, absolutely not. Yeah, really cool. I'm sorry. Good. So you were 18 years ago? 12 years old. What are 12? Yes. What? Yes. 12.

Claren 3:48
And I started with the pins. I think I did. Actually I didn't have pens. When I started. I remember drawing insulin out of vials, and use, I believe human lager Novolog and that was maybe the beginning of like Lev Amir. So I think that's what I started with. I did that for a while and then got switched to the pins. And then got my first pump when I was actually in college and undergrad, and then went back off the pump because I was tired of it being on me 24/7 And then I went to medical school where things got more complicated. And that's when I went back on the pump and I've been on ever since

Scott Benner 4:30
you just made me realize you just made me realize artists never seen an insulin pen in our life. Well, she was diagnosed it too. They gave her syringes. No one ever, like suggested there was something else. And then she got right on Omnipod How about that? Yeah.

Claren 4:50
I did pins for quite some time. So I probably did pins for longer than I've had a pump at this point that we're probably catching up. It's probably about half an hour. And

Scott Benner 5:00
you've gone off and off and on with the pump. What was your first pump?

Claren 5:03
The first pump was a Medtronic, it was blue. I can't remember what the model name was. But it was much different than the ones now it was kinda generic and or like basic, I should say, No, it didn't have like a color screen or anything. And that was probably like 2011 that I was on that maybe 2012 did that for a few years. And then I just didn't want it was a tube pump. I didn't want it anymore and went back to pins and I was doing okay with the pins. I wasn't doing great, but I did okay. And then like I said, got busy when I went to medical school actually got a Dex calm before I got back on the pump. And then it just made everything a lot easier. Yeah. And actually, what triggered me going back on the pump the second time is I was diagnosed with Graves disease, and had a really hard time controlling blood sugar's and it was kind of a misdiagnosis initially, because my thyroid labs were, I had all the symptoms of graves. But when we checked my labs the first time they were normal. So I like went through three more months. I was tachycardic. Er, and just ended up having a cardiology workup because they were like, well, we don't know why your heart rates 120 all the time. And then we're like, let's just reach at the thyroid labs. And at that point, they're like, oh, yeah, this is great. This totally makes sense. Yeah. So that was when I went back on the pump. And I've been on it. And since then, I'm on a tandem.

Scott Benner 6:27
This actually happened to Arden, not exactly the same, but she got her hypothyroid diagnosis, and you know, lived with it, going along just fine. And then she started to I don't know if I've ever been really clear about this or not. But Arden was a very tiny person. And then she got her thyroid diagnosis. They put her on Synthroid, and she grew like a lot. So Arden went from being the tiniest kid in her school, to she's as an adult, five, seven. And so she gains weight as she gets taller. And now I know, looking back, of course her Synthroid needs would have gone up because of the mass change in her weight. And instead, she ends up getting a full cardiac workup for her thyroid symptoms. Right. Yeah. Which was upsetting, as you may be able to imagine. Yeah, yeah. So graves, how does graves Come on?

Claren 7:25
Well, it was, I started noticing, actually, it was my heart rate. I was like sitting in class one day. And I just realized, like, Man, I kind of feel like I'm a little tired. Like, my heart feels like it's racing. And you know, the Apple Watches, you can click your heart rate. And it was like sitting at like, 120, just into a lecture. And I'm like, this is weird. And so I kind of brushed it off, I was exercising quite a bit at that time. And so I was noticing that, like, when I was working out, my heart rate was going like way higher than it had been in the past. So it was kind of a few weeks of figuring that out. And then I was like, this isn't normal. And then I started having, I was losing weight as well. Like I said, I was working out and I was like, Man, I just I'm doing good, a good job. And then I went to see my endocrinologist, I think just like a routine checkup. And I kind of explained the symptoms to her. And she was like, yeah, what could be thyroid, and I don't know if I was due for my yearly labs or whatever. But we ended up checking them and they were normal. And she was like, I don't really know what to tell you. But just see how it goes. And then I was referred to cardiology. I did like the whole holter monitor and got an echo and everything. And of course, it was normal, other than having just a mild, fast heart rate. And then I started having like a lot of anxiety too. And then shortly after that, I've always been a very like type a prompt person. And there was two or three occasions where I was late for work, or late for my rotations that I was on. And my roommates who I lived with were also medical students. And there was one instance where I just overslept. And like I got up late and they were still home and like, they couldn't understand like what I was saying like it wasn't making sense when I was talking. And we think retrospectively what happened is I may have had like, some kind of seizure and I was in like a post electoral state when I woke up and that was the reason I overslept in alarm because I don't have any have any recollection of this. And so I think it was having just such wild blood sugar swings in addition to the attack cardio and the anxiety and the sweats and it all just like mounted to be this graves diagnosis.

Scott Benner 9:31
Wow, that's easy. That's so interesting. I mean for me, not for you. It's terrible for you.

Claren 9:35
That's interesting. I know. Yeah. Hey,

Scott Benner 9:37
I do have a question. What was it like to like, suddenly be hit with a wave of anxiety? I'm assuming you weren't an anxious person prior. If you're a longtime listener, you probably know that I've been drinking ag one for a couple of years. Not only did it replace my multivitamin, but I love that every scoop also includes prebiotics and digestive enzyme For gut support, you know that there's magnesium in there too. Vitamin B it's, it's just a good mix. And it's easy to drink and tastes great. I mix my ag one, just a scoop with some cold water right from the refrigerator. You know, shake it up real good and the shaker bottle that they gave me with my first order. And it goes right down. I know some of you are probably thinking, I don't know what does that tastes like but I have a very particular palette, and I enjoyed you one. It is not difficult for me to drink, not in the least. So if you want to take ownership of your health, it starts with ag one try ag want to get a free one year supply of vitamin d3 k two and five free ag one travel packs with your first purchase. Go to drink ag one.com/juicebox That's drink ag one.com/juice box, check it out. Hey, it's the end of the year, good time to be buying stuff with your medical insurance, you've probably already fulfilled your deductible. The rest of the years, you know, no out of pocket, you know I'm saying maybe this is a perfect time to check out Dexcom dexcom.com/juicebox Whether you're looking for the Dexcom G six or g7 my link is the way to go. Once you get there, you can just simply click get started or take a look around because the new Dexcom G seven is fabulous. Dexcom G seven helps us to manage Ardens diabetes confidently, it's an easier way to manage diabetes without finger sticks. Dexcom G seven is a simple CGM system that delivers real time glucose numbers to your smartphone or your smartwatch. No finger sticks required. Effortlessly see your glucose levels and where they're headed. So you can make smarter decisions about food and activity in the moment. dexcom.com/juice, boxers videos, there's information. You look around, you can see how the app looks right there on Wow, that's nice actually, it's like a little graphic. It shows you how the Oh, look at that shows you how the clarity app works. This is a new graphic. I hadn't seen this one before. Anyway, you're gonna love it. dexcom.com/juice box when you're using my link, you're supporting the podcast. And that is very much appreciated. Don't forget one two there. Hit that Get Started button. Watch this. I'm going to tell you Arden's blood sugar right now. My phone is in front of me. It's laying down. She's not here, she's at a friend's ready, watches, pick up my phone, swipe up. Phone opens blood sugar 97. and stable. Amazing right there on my iPhone, you got an iPhone, you might have an Android, you can use either one. You know, you want to learn more? Check out my link.

Claren 12:46
I'm baseline kind of anxious, but I think it's like the amount of anxiety that makes me functional. Like, I'm just always like, go go go. And like I said, very type A and it's just my baseline level anxiety is just my normal. So

Scott Benner 13:07
was it like shock? And by the way, way to like strong, strong title possibility baseline anxious to do something else to get us off of that one. But was it enough that it was like a conscious thought? Like, I'm not usually this anxious? Like, yeah,

Claren 13:23
I noticed a difference. And it was, I was just a lot more like in terms of studying, I felt like I had to do more. And I wasn't doing as well. And I just felt like I wasn't functioning as like as highly as I used to. So I was more worried about the fact that like I'm trying to I'm trying harder to accomplish things. I'm not achieving the same outcome. Because I was having that anxiety that was just like creeping in and really affecting multiple areas of my life.

Scott Benner 13:56
I was at a an event this weekend where I spoke to a lot of people with diabetes. And first thing I thought to tell you when you told me about the pump you had was that somebody pulled an animus ping out of their pocket and showed it to me this. I was like, where did you get that? Yeah, I can't believe that still works. The other thing is that I spent a lot of time trying to explain to them impacts that they'll have from things like thyroid, low iron, hormones, things that I don't I don't believe a lot of people are even made aware of let alone know to look for when something starts happening. So and you said you said my favorite thing around thyroid, which is and I hope people heard it. You had all the symptoms. But they look at you and said oh no, your labs are fine. So we'll just ignore the symptoms. And

Claren 14:41
yeah, I wouldn't say they ignored them. It was just okay. We need to find out what's going on if this is not so, and it probably took three months before I had labs rechecked again, and by that point, I was just like losing my mind.

Scott Benner 14:54
Yeah, but were you in there on day one thing, there's something wrong with my thyroid?

Claren 14:59
No because, like I said, I had been exercising quite a bit, I was just stressed out from being a medical student. And I mean, I had lost maybe five or 10 pounds. So it wasn't like that much. Because it was just really like, there were things to explain the symptoms. It just was all together when you hear all of them now you're like, Oh, that's a thyroid problem. Yeah,

Scott Benner 15:20
but it is. maddening, right, that so many autoimmune issues all share the same core symptoms, right? It's just really as frustrating. You say for things. They're like, Yeah, that could be this. It could be this. It can be like, great. Good, big help. Okay, so you get that worked out with medication? Did you ever swing around, I hear stories. Sometimes people start graves, and they'll get hypo. And they'll come back again, like, where are you?

Claren 15:46
So I actually, I was in third year medical school about to start a rotation in surgery. And I've since decided to become a surgeon. And I knew that leading up to that, I was just not going to be able to function in that surgery rotation. If I was still having any kind of those symptoms, I was just not performing at my highest. And so I went to my first week, my endocrinologist tried the methimazole. And I actually was having like, an orthostatic type of response to it. Like anytime I'd stand up too quickly, I feel like I was gonna pass out so I didn't do too well with the medications. And she was like, well, the other option is you can do the radioactive iodine to ablate the thyroid or we can just schedule you for surgery or get you in to see a surgeon and you can take it out surgically and that's what I ended up choosing to do. So about I think it was like eight days after I was diagnosed. I tried the medicine for like a week and then I got in with the surgeon and then the next week we had a thyroidectomy.

Scott Benner 16:44
So we take that out and then we some now we supplement with Synthroid

Claren 16:48
Synthroid. Yes. And that works for you. Yes, it does. I actually also just had twins about four months ago. So the that was really fun to figure out the dose adjustment to that with the Synthroid way, up way down. Way. So my base dose, which is actually higher than I would expect for my weight was 137. And I was taking ended up taking up to 200 a day when I was pregnant. Wow.

Scott Benner 17:13
Yeah, I mean, it sounds like a big number until you remember that the thyroids? not there at all. So yeah, you don't have to supplement with any teeth or anything. Your energy's good all that. Well, exactly. Say

Claren 17:24
my energy is about as good as it can be for new mom with four month old twins, a

Scott Benner 17:29
30 year old lady that just had two babies and as a doctor, yeah, yeah. I'm standing up, Scott. It's all good. Yeah, most days. Yeah, most days, right. Oh, that's, that's really something. So I guess go back a little bit. You're diagnosed as a young child like you, do you manage it yourself? Do your parents help you? How did how were the first few years. first

Claren 17:52
few years, it was actually I was diagnosed right around the time that my parents were actually getting a divorce. And so I lived with just my mom at the time. And I remember, she spent so much like effort counting out everything specifically, like we'd have pre portioned like green beans and containers and like, you'd have to count everything by the exact carbon, we just were like, to the tee for the first few years. And then I'd say probably a year or two into it, I was like, you know, 13 years old starting to kind of want to do things on my own. And that's probably when I switch to the pins. And I just kind of took over from that point in time. Okay. And that's, she would like checking in with me. But it may be more like irritable as a teenage girl to feel like she was constantly checking up on me than to just manage things on my own. So it ended up being really just me managing it from that point. And I did an okay job. I think retrospectively, I didn't have the dex calm and it was, I didn't check it as much as I should. But few times a day, I would check it, I'd say it was decent numbers. And then of course, every now and then you just would have highs or lows. And I just treat them how I knew treat them. And it's just so different now.

Scott Benner 19:12
Now, were you able to take that knowledge you had from growing up in school, were you able to take it to college and maintain your level of management?

Claren 19:23
I'd say undergrad, kind of when I I'd spent my first year at college locally and commuted to college and then I transferred to a larger university and lived away from home and probably that's when I had less control over everything just because I was eating on my own eating more fast foods, things like that. And just had the freedom to do whatever like whatever schedule I wanted. So I probably had a onesies up to the like eight, maybe even nine at that point in time for a very few short years and retrospective and like, Why was I doing but by the time I got to medical school I was, I'd say I kept them probably around seven, which is crazy to think now because I'm doing much better control wise now. But at the time, like, my endocrinologist was happy with that. And I was under the impression like, that's good enough. And that's when I had gone back on pins. And I didn't have the Dexcom yet. And it's just my standards now are so different from my standards, then. And I felt like I was doing fine, probably with I just wasn't putting in the effort that I should have. How do

Scott Benner 20:36
you think about it? When you look back? Was it really like not putting in the effort? Or were you taxed to the point where you had to let something go? And that's what you let go?

Claren 20:44
I think it's both because I was probably just kind of in audit mode with how I handled the diabetes like, I didn't Pre-Bolus like I should have been probably that's the the main thing that I needed to do differently. I don't think my like numbers, or my doses were crazy off. It was just, I wasn't always taking insulin before I ate or I wasn't always eating healthy. And then I would just either correct it how I knew to correct it, or just worry about it later. So

Scott Benner 21:17
at that point, undergrad, you don't have a Dexcom. You said you got that in medical school. Right? Correct. Yeah. Wow. That's crazy. I mean, how often do you think you were testing? In college?

Claren 21:27
I'd say probably like four times a day. Yeah. So probably anytime a when it came down, it

Scott Benner 21:34
made me laugh, because I thought like, what if I took your CGM right from you now and said here, you can just ask, do you think you'd test four times a

Claren 21:40
day? And probably charge like 14 times?

Scott Benner 21:44
That's something how it's just a little more technology leads you to, to so much more, what makes you um, I mean, people come on here and tell stories all the time, I grew up with diabetes. And that's what made me want to be a physician or nurse or something. Did that have any impact on you?

Claren 21:59
Yeah, initially, I had wanted to go to medical school and be a pediatric endocrinologist just because when I was growing up, I didn't really like any of the physicians, I saw. I saw some nurse practitioners as well. That just nobody really, like, I just didn't like them. And I was like, I'm going to be a cool doctor that it's going to be understand what's going on, kids are going to be able to be comfortable, like telling me about their problems. And then I go to medical school, do my pediatric pediatrics rotation, I was like, Man, these parents are really hard to deal with. And then I went to, like other rotations. And I was like, it's just not for me to work with the kid. It's, I would love to be able to do just diabetes care, just type one diabetes care for kids. But there's so many other things that come with doing peds in endocrinology, that I just didn't really have interest in.

Scott Benner 22:50
Yeah, so yeah, actually, diabetes is a pretty small part of their practice, right?

Claren 22:55
It's a very small part of the practice. Yeah, yeah.

Scott Benner 22:57
I honestly, I think that in the 16 years, Arden was in a peds hospital. I don't know that we laid eyes on that doctor, maybe a half a dozen times. It's about it's always the nurse practitioner or, you know, a CDE or something like that that was helping you. So no, make that that makes sense to me. And if you don't have the interest, then what are you gonna do? Right? So you lean towards surgery eventually?

Claren 23:26
Yes. And that was just because I feel like you can you can fix people's problems with surgery. They show up. They're like, Hey, I'm having this gallbladder pain. You take the gallbladder out, and they feel better. Yeah. So it's things like that. It's just more of an instant gratification than some like in medicine, where you can't really fix anything unless a patient's willing to change something on their own, whether that's their lifestyle, their diet, they're willing to do exercise, things like that. And it's just Yes, you can you can change things. I shouldn't say that. But it takes longer times and a lot more effort. And that's just not how America is. Yeah.

Scott Benner 24:06
And the failure rates higher too. Right, right. Yeah. Hey, can you give me something called, let's see Thoracic Outlet Syndrome surgery, because I'm starting to think I might need that.

Claren 24:15
Once you remove your first rib,

Scott Benner 24:19
my like for like the last 10 years. I have a lawnmower right? That I have to reach out to drive. And when I do it, my left hand gets cold. And more recently, it's been if I sleep on my stomach with my hands over my heads, my hand gets numb or cold. And now yesterday, I was like pushing a cart around the store. And my hand was getting numb and cold. And I was like unbelievable. So I texted a friend of mine who's a different kind of surgeon. And I was like I said if I'd said that, every time I raised my arms, it feels like something either in my shoulder or my elbow was is pinching like I don't like it doesn't feel it there but like it's the only thing that Get like I can imagine like, it feels like something structural is happening. And he's like, Oh, it might be this. And I was like, Yeah, I was hoping for something with a pill. And he got used to there's no pill for this. And then he just sent me a big knife in text messages, which I did not find that comforting, but I thought he must have found amusing. By the way, Claire and I think he had very quick access to the knife emoji as if I'm not the first person who's received the text message. Anyway, I have not been to a doctor. I don't know if that's actually what's wrong, but it is really fascinating. Like, if I just lift my left arm up for too long, my hand goes numb. So would I look thinner without the rib? Or would I look silly?

Claren 25:41
Well, I don't think you'd look much different. Damn.

Scott Benner 25:46
Well, then, what's the point? I'll just keep my arm down. Yeah. So what kind of surgeries do you generally do?

Claren 25:54
And I'm still in residency. Basically, after my four years of undergrad four years in medical school, I'm about to start my fourth out of five years of residency. And then I'll be doing general surgery which is things like gall bladders, hernias, colon surgeries. That's just the kind of bread and butter I'll do thyroids. parathyroids, wow.

Scott Benner 26:19
Oh,

Claren 26:19
mutation.

Scott Benner 26:21
Wait a minute append appendix, right. Appendix. That's

Claren 26:24
a big one. Yeah,

Scott Benner 26:25
I'm sorry. I said, Wait a minute, because I'm like, amputations. Yes. Oh, I see. So if someone needs something amputated, so if you're seeing a doctor for x, and then oh, then they come back to a to a general surgeon for something like that.

Claren 26:39
And it can be vascular surgery, too, or orthopedic surgery. But a lot of the times, and that's another thing that when I started medical residency, I really was like, Man, I gotta get my diabetes in gear, because I was amputating so many toes and things like that. And like much older people, not on people my age, but still, it was just seeing the complications of long standing diabetes. I was like, Okay, this is real.

Scott Benner 27:04
So do you think that? Well, let me ask this first, do you have any other diabetes in your family?

Claren 27:10
No, not even type two.

Scott Benner 27:12
How about other autoimmune stuff?

Claren 27:15
I think I have an aunt with that, or that takes thyroid medicine. And that's pretty much it.

Scott Benner 27:19
Okay, so you didn't have context for diabetes? And then you get it. And then when you go to when you go to medical school, like I guess this is a question I should ask everybody who's a doctor as type one. Like when we all are out in the world going? It seems like they don't know anything about it, like talking to like your general practitioner or your kids doctor or stuff like that. Is it because they really don't?

Claren 27:44
I'd say they know like the textbook answers of like, these are the complications that happen from long standing diabetes. These are the numbers that generally you don't see complications with if you keep it within this range. But unless it like you said, as a general practitioner, somebody who's doing endocrinology and sees this repeatedly, I'd say most doctors don't have very much information on especially how to manage diabetes. They can do like sliding scale, insulin in the hospital, things like that. But day in and day out. Management is not taught. Typically. Give

Scott Benner 28:18
me one second here. I'm gonna walk you through this. Arden's doing a project at school right now. She's distressing a skirt that she's made. And so she went to she went to the fabric store to get this tool that you use to distract like distress the skirt, and they didn't have it. So I said go to the home store and get like lemon zester, which is basically the same thing. Yeah. And she's said, Hmm, so let me see if I can figure this out. Home Goods type store.

Claren 28:48
Maybe cheese grater.

Scott Benner 28:50
Yeah, like a cheese grater, lemon zester or what else? sandpaper? Heavy grit. Right. Claritin helped me what else what else would work like that?

Claren 29:09
I feel like three options is enough. Yeah,

Scott Benner 29:12
you think so? Oh, no. Um, oh, wait, wait, wait, what's the thing? The thing for dry skin on your heels?

Claren 29:22
Oh, like the thing that yeah, pumice stone.

Scott Benner 29:26
Yeah, hold on a second. That's a good one. I'm sorry. We'll get back to you. Just a second. I think it's probably

Claren 29:34
it sounded weird when I said it.

Scott Benner 29:37
I just Googled heal grader and by the way, came up with a pedicure foot like this. This is what parenting has turned into since you went to college. It used to be more I used to. I used to be more involved with the bigger decisions. Alright, I've done my part. Also, I also I paid for the college. So actually yeah, actually You guys paid for the college, so thank you. But yeah, I mean, that's gotta be I said homestore like a cheese grater, lemon zester or sandpaper, heavy grit Wait, wait, try skin thing for your heels. And then I set up a picture of it, she'll figure it out. Okay? Otherwise she's like picking at it with tweezers to pull it apart. And like it's taken her for like, it's going to take her a year. So yeah.

Speaker 2 30:23
Anyway, she made her first like she made like a skirt. It looks amazing. It's kind of exciting. Because she had been talking about it for so long. Alright, so sorry. I want to know about residency.

Scott Benner 30:37
I want to know about so you know, get doctors get like a textbook version of diabetes. But then if you don't go into if you don't go, how is it? I guess my question is, that even the endocrinologist seems a little flummoxed by it once in a while. And why is it that no general practitioners seem to do a good job of explaining people's type two? I mean, if type two is so prevalent, like, wouldn't that be something you would just be able to, like, I can talk about type two with my eyes closed? Like, why can't they I guess, I think

Claren 31:08
a lot of it is the time constraints that doctors have on how much time they can spend with patients and the amount of education they can give patients and hear their side of things and understand why they're having trouble. Because I mean, you may have a 10 minute time slot to see a patient, you have to understand what's going on with them, what they're worried about how, and then explain to them like, this is what we're going to going to do to fix it. And this is your part, and this is my part. And then, okay, go out into the world and do this for a few months and come back and see me and there's just you can only get so much done. And I feel like you can't understand, really the the intricacies of any disease in that situation.

Scott Benner 31:52
It's just such an odd thing. Like you. Just if you hear from so many people with the same issue, it's and

Claren 31:59
they're also seeing a ton of other medical problems on any given day. So maybe, yeah, we are seeing millions of people with diabetes, but you're also seeing tons of people with every other medical condition too. So

Scott Benner 32:12
Oh, no, the the one thing that I think doesn't get enough attention is that it's like boggle almost I imagined it like that, like you're you walk into a room and you're settled and someone looks at you and you go, Okay, there's Claritin. And I don't really know who she is, but she thinks I do because I'm her doctor. So now I'm going to look at I'm going to look in the thing here, oh, try to make myself ready with it a little bit. I've got 15 minutes to talk to her. And then you walk out the door. I imagine you take a deep breath. And then you push down the boggle thing and your dice pop all over the place, you walk in the next door and you start over again. And it's just like being shook and then settled and then go and I don't know this. You know, I've brought this up a couple of times. And it like around diabetes specifically. I don't know why we do that. Instead of bringing everybody in for 15 or 20 minutes. Why don't we bring 200 people and put them in an auditorium and talk to them all at the same time. And give them the big the big picture stuff that they need in a setting where you say it once people ask their questions. And then everybody heard it instead of like, and they heard the entirety of it, instead of getting a tiny bit of like, well, here's the things I can remember to say this time. I just make sense to me. I don't if it's like a HIPAA violation problem or something, but just make sense to me like that would make

Claren 33:30
more so just convincing people to come do that, too. Oh, you

Scott Benner 33:33
think if they didn't think it was a doctor's appointment? They just wouldn't go to begin with. Awesome. Is that a burden? Like knowing that you're gonna come see, somebody's gonna come see you. And you're gonna tell them the exact thing they need to do and they're gonna walk out and just not do it? Oh, yeah. Yeah, it would weigh on me, honestly.

Claren 33:51
You're like, well, here's, I mean, at the same time, like, I don't want to eat great and exercise all the time, but I know that's what I should do. And it's just I feel like human nature.

Scott Benner 34:00
Yeah. Like, Does it almost feel like these things are gonna just happen to some people and there's nothing you can do about it? Um,

Claren 34:07
yeah, probably just if they're not willing to change their lifestyle but I mean, being a resident two is an I've been off work for maternity leave. But being a resident working 80 hours a week, eating hospital food as quickly as I can. Like, when I'm when I'm working. I don't have a great diet. I don't have time to exercise. And it's, you just do what you can. You can't you can't tell people to do something and then not do it yourself necessarily.

Scott Benner 34:36
It would be tough if you you were like you should go for a walk. And they were like, Yeah, you too. Great. A lot of fun. Oh, my goodness. So when you're in residency, can you describe like you just said 80 hours a week, but can you actually describe what what a week is like? Um,

Claren 34:54
yeah, so Monday through Friday, typically wake up at like, four 430 and go to hospital, round on your patients, check all the charts and then depending on your cases for the day operate, or go to clinic, and that typically sometimes you're done with actually doing the surgeries or clinic patients by noon, sometimes it's like 5pm. Sometimes surgeries go all through the night. So I'd say on average, leaving work at like six on a NABJ day five, if we're really lucky, and sometimes 9:10pm and then wake up the next day and do it again. And then for the first three years of residency, the way our schedule was set up is that every other weekend, we did a 24 hour shift. So that was either Friday morning to Saturday morning, and then you go home sleep Saturday and work a day shift on Sunday. So you have a small break, and then every other weekend off, or you work a 24 hour shift on Saturday, and then rest Sunday before the week restarts.

Scott Benner 35:55
I was out when you said get up at 430. I know. It's terrible. That's like That's okay. I'm good. People can figure out their own health. Yeah, oh, it's terrible. And that goes on for years. Yeah,

Claren 36:07
years. That's three years. And then the next few years that I'll finish, I'll do home call instead of doing the 24 hour shifts on the weekend. So we'll go in and round. And then if somebody comes in and needs me, I'll go back to the hospital. Does

Scott Benner 36:22
that? What am I trying to say? Does that like sorority fraternity thing exist? Like low man gets on by the person above them? The person above them? Does that exist too? Or does that not happen so much. It's

Claren 36:35
there's kind of a hierarchy. But in the program that I'm in, we try to do a really good job of getting the younger residents in or early. So yeah, they're the ones that are going to be in charge of doing like all the wound care and the things on the floor that we don't want to do. But overall, we try to, to get people in to learn how to do surgery as early as possible and share the load.

Scott Benner 36:58
What are the procedures that you all stand in the hallway like Rock Paper Scissors to try to get out of

Claren 37:05
who I'd say like draining like abscesses and things like that I don't like to do that. made

Scott Benner 37:12
me upset when you just said okay. Yeah, like just Well, anybody is almost like what you would you try to shift to get out of something? Would you like does it

Claren 37:20
turn out? No, no one's got to do it. So it's just whoever's available and like you said, usually lowest on the totem pole.

Scott Benner 37:25
Yeah, that's that's gotta be. Yeah, that's gotta be upset.

Claren 37:29
You gotta learn how to do it. So it is what it is.

Scott Benner 37:31
Do you ever hear that episode of the show called butthole? Adjacent?

Claren 37:34
I think so. Yeah.

Scott Benner 37:37
That wasn't like Hans Basal. Yes, basically just had a that's something like that, that just like, came apart and like exploded. And I was like, Oh, my God, that's absolutely crazy. But it's not crazy to you, right? It's just something you see, like popping,

Claren 37:52
that's just something that I might do on a Tuesday, Tuesday. That's, we

Scott Benner 37:56
call that Tuesday, or, Oh, my God, I just saw, I don't know what happened. What the Chinese government is trying to do to me or whoever, but the TIC tock algorithm has decided that I want to see people with feet that look like rocks underneath of it be exfoliated. And I just want to say, Oh, my God, the algorithm. I don't want to see that. And I don't know where you got that idea from?

Claren 38:18
It's because you were looking at the Pumicestone. You think

Scott Benner 38:21
it got me that fast?

Claren 38:22
That was really fast.

Scott Benner 38:23
I just like I'm watching it and all that can go through my head. Is that something that I'm wondering if it goes through your head? How did we let it get like this? You wonder that every day?

Claren 38:39
Sometimes? Yeah, yeah. Sometimes I

Scott Benner 38:41
just it seems baffling, like without, like, description, like, How could you let the bottom of your foot look like a rock? And there's, it's just, it's fascinating, like,

Claren 38:53
do I mean it's pretty gross, but like we have patients come in with really nasty feet wounds with maggots on them. So it's like, how do you not notice there's maggots on your foot? But it happens.

Scott Benner 39:05
Like yeah, how do you make it to the hospital with the maggot? Right, right? Yeah, right. And they're not like, it's not like they have neuropathy, and they can't feel it or something like that. It's just, typically they do Oh, typically they do. Okay,

Claren 39:15
if it's that bad. Why do you think you at least look, I don't know, wash it

Scott Benner 39:20
off, maybe for like, if I if I was going to show you any appendage at all. I would make sure it was clean and presentable before I brought it to you. But that's not the case either, is it? Yeah.

Claren 39:31
And people who have are underserved and don't have access to health care, that's a lot of the issues too. Okay. So you can't always fix problems if you don't have the resources to do so. Yeah,

Scott Benner 39:43
I was talking to a hygienist. This is a dental hygienist. And she said the number of people who come here with their teeth are dirty, because they're like, well, you're going to clean them so why would I brush Why would I brush them?

Claren 39:56
Oh my gosh, yeah. I hate going to the dentist. If Have like had a snack in the car on like, you're gonna think I'm dirty? Oh my No, I

Scott Benner 40:03
went to get like a crowns on one day. And I walked in I said, Hey, I'm very sorry. But I need I realized I was going to be like nom and wouldn't be able to eat afterwards. So I need like, I need some floss and a toothbrush before I can come in. Like I'm not I'm not going to like just go in there go like, Hey, could you dig that out of there for me like? Ridiculous. I mean, your your points? Listen, your point about having access is good. But I don't know how much access you have to have to wash your foot before you show it to somebody. I know. Yeah, that's something

Claren 40:34
that's not not always an excuse. But there are certain cases where it's just

Scott Benner 40:38
automatic problem. Yeah. So you in your note to me, you, you said that there's stigma surrounding diabetes within the medical community, I wondered about that.

Claren 40:49
I should have read that note before I logged on to this call. But um, so just in terms of like, instead of people who come in needing like toes amputated, there's always the stigma of like, well, they didn't take care of themselves. And this is or even the things like obesity, and it's more of a type two issue. But it's just like, can you not control your diabetes enough to prevent these complications, people don't understand how difficult it is to all day long keep your numbers within X and Y points. And people just assume because I have this pump and this Dexcom that I strap it on, and it controls everything for me. And it's just not the case, as you well know. But I'd say even medical providers, if they're not seeing this on a daily basis, like we talked about, then they have no clue, the the, the worries and the anxiety and just the effort that goes into preventing those complications, and you may not be able to so there's stigma that goes with that. And then just the amount of effort, like I said, they just don't realize that this is a 24/7 disease. And it's different for type one and type two, but the outcomes can be the same. And people may not realize that there is such a difference in type one and type two.

Scott Benner 42:06
Do you think that that stigma leads doctors to unfairly kind of in the back of their mind, assess people while they're talking to them? Like, do you think they can look at you as

Claren 42:18
not only some people? I wouldn't? I'd say it depends on what the situation is. But it depends also like on the numbers you see, because you say you have a patient come in and their blood sugar's 400. And it's like, you automatically assume this is an uncontrolled diabetic person. But it may just be that they're sick, and they've got, they're dehydrated, and they've got six other things that are contributing to this number of 400. And unless you sit and talk with the patient, you're not going to be able to fully understand that. So maybe you walk in, and that's your bias that, yeah, they're probably an uncontrolled diabetic. But that may not be the case at all.

Scott Benner 42:54
So if I'm an adult, and I look like I'm a little overweight, and I show up with a high blood sugar, somebody's gonna think type two diabetes right away. Probably yeah. And II and even because I hear these stories from people, where they're sitting in that moment, and they say, Listen, my brother's got type one, or my mom does, or there's a ton of autoimmune in my family, like, Are you sure this couldn't be type one? And they go, No, couldn't be. And it always ends up being, you know, when I hear the stories, because, of course, that's who I hear from mostly. But it's just just kind of, I don't know, it's interesting, because you paint an equal picture of people who are taxed the old beyond reasonability, about their time and their energy they are getting, you know, I guess a bit of information on so many different diseases, like, what's that saying about doctors, like they have a little bit of information about a lot of things. And then we like, I was most struck by thinking about being with my mom one day early in the hospital. And she's like, I don't know where the doctor is. They said, I don't know where the doctor is, it was early in the morning, and I thought, Oh, they were at home trying to sleep. Right, like trying to get up enough energy to come do this thing again for 12 hours. And it's just interesting that nobody sees each other says, scenario situation.

Claren 44:14
Another thing like that you learned in medical school. So like you say, an overweight adult coming in with high blood sugar. 82. Like, if you hear hoofbeats think, don't think it's a zebra, like it's more likely to be a horse, it's not going to be this Safari creature, it's going to be the horse. So you think most likely common things are common. This is going to be type two diabetes. So I think that's just kind of part of the algorithm based learning that a lot of medicine is especially in your training years is like okay if this than this, and you have to really get experience and patient perspectives and just kind of know that yes, this can happen, even though it's less common, but that's just what medicine teaches us. Common things are common. And then if that's not the answer, then you think more of the the zebra plus

Scott Benner 45:06
it would be, it wouldn't be like a reasonable thing to start just like pontificating about, oh, it could be this or this or like, it's upsetting to another person, actually, do you know that I'm doing the math in the last seven days? If you hear hoofbeats, it's probably a horse, not a zebra. That's the second time I've heard that. Interesting, because I was with a, because when I spoke last weekend, I was there with somebody who has a medical background, and they were trying to trying to describe the similar thing that you just said, I was like, wow, they really do tell them that they do. I always think about the people who, like the zebras at home, who were just like, nobody's listening to me. Right. You know, they all think I'm a horse. Anyway, that's interesting. So okay, so I understand how the stigma could lead to, like, people jumping to conclusions that makes complete sense to me. Is there a I mean, you're in a unique position, right? You're, you're at the coming to towards the end of your of your residency? Is there at least things that we talked about? Is this just as good as it gets? Or are there ways to fix this? Like, do you? Do you see a way like using diabetes, specifically, where doctors could understand diabetes better? Or would it? Is it just too big of a mountain to climb?

Claren 46:25
I think, one, it's, it is a very big mountain to climb. And two, there are so many different ways we can treat diabetes, and so many different standards that people have for diabetes, like we talked about, like 7%. And below is what people consider, okay. And that's, like you say, is the don't die number like we want to prevent lows more than we want to prevent highs. But it just kind of depends on can you reach that many people effect to be able to make them effectively manage their diabetes, I don't know it with the time constraints that you have in visits or within certain I'm like losing my train of thought, you know, the time constraints you have within visits and in the that specific person's scenario. So what can we teach this person today? That I can help them as with as a doctor is different than what can they they implement on their daily routine? So there's a difference, I think in what a doctor can tell you and what you can actually do? And then the question is, can you get people to implement that to actually make a difference? I don't know.

Scott Benner 47:44
So then the thing that I say a lot on here is ends up being very right, I guess, which is you are really in charge of your own health. And yeah, you can go get an answer from somebody, or they can run a test for you, you don't have access to or change your prescription you don't have access to but in the end, like I usually tell people, when you go into a doctor's office, you have to remember that you are the only one who ultimately cares about how well you are like, like, it's not that the doctor doesn't care, but you're gonna leave and they're not gonna think about you again. And, you know, I just I learned that watching my mom, I realized how much my mom believed that doctor just knew who she was. And, you know, I was the one looking out the hall watching them, like pour through papers, trying to figure out who they were about to go talk to. And you know, and it just, it's up to you like your health. I mean, it sounds obvious, right? But in a, in a society where you believe, for the most part, because when you're growing up everything that happens to you, for most people, everything that happens to you gets fixed. Didn't you mean? Like, you get a sore throat and they give you a pill and your throat isn't sore anymore? And, you know, like, if that's the expectation, like that kind of light switch idea, like, you know, like you said, like, I want to do things I can fix like, you show up sick you leave, you're not sick anymore. But that's not most things, not when once you find serious illnesses, those are not how they work. Yeah, yeah. And everybody has an expectation of health to no matter, no matter the amount of effort they put into their own health. Everyone. Exactly. Everyone expects it back. Right? Like

Claren 49:22
are they expect to be able to Google something and they say, This is what I think I need. And that's a whole nother topic of conversation.

Scott Benner 49:32
I want some akinesia. And I would like I want an essential oil. I'm gonna put on a cotton ball and put it under my pillow and I think I'm going to be fine after that. Right. And, and when it's not that, you're saying that basically the things that can be impacted by diet or exercise or effort ends up being just something. If you tell people that and then it's a coin flip if they do it or not. Right. Yeah. It really has to take

Claren 49:58
in terms of Diaby It has to it has to take the person wanting to make that difference. Having the support and the resources to do so, like

Scott Benner 50:06
something shocking almost has to happen. Yeah, yeah. What happens if you're shocking thing is the only is the only warning you were gonna get to. Right. Yeah. Actually

Claren 50:17
on a kind of a related note. It's kind of I'm thinking I mentioned that email I sent you as a, I guess, probably a year and a half ago now. I had like routine labs, I was doing really good with blood sugar's everything. I think my agency was like in the mid fives, and I was so proud of getting that number back. And then I got the rest of my labs back the next day because my doctor called me and he was like, hey, like your kidney numbers are elevated, like, just want to let you know, I think it was like the equivalent of like, stage two kidney disease is the the numbers that I saw. And I was like, What are you talking about? Like, I've been healthy for me. Yeah, I've had 18 years, but I've been healthy. And I don't know what to do about this like it. That'd be a fluke, can we recheck them and they were still elevated? And I was like, this is okay. This is like eye opening, like, am I having kidney problems as a 29 year old. And we had talked to my husband and I had talked about having kids at some point, but we didn't know how to do that with being in residency and having diabetes with a difficult pregnancy that comes with diabetes. And so I went to see a nephrologist. Basically, thankfully, it ended up being just like an acute kidney injury for me not drinking enough water and staying hydrated while I was working. It was really, like you said, a shocking thing that I was like, okay, yeah, I am susceptible to kidney damage, I am susceptible to these long term complications. And that's what made us to decide to go ahead and I put my training on hold for what ended up being a whole year and decided to try to get pregnant, we magically got pregnant with twins, which was double what I bargained for. But now it's been really good overall. And it was something that I prioritized. And now I have about six weeks left before I go back to work. So

Scott Benner 52:07
Wow. So you actually had that feeling where? Okay, this wasn't the case this time. But I'm so hit with the reality of the fact that it could have been like, I'm gonna make these babies right now. Yeah, that makes sense. To me.

Claren 52:20
That's like one thing we really wanted in life. And if I would have let my job come in front of that, actually, an infertility is a really big deal. And actually, women physicians are much have a much higher likelihood of having infertility issues. And I was coming up on 30. I was like, I think we got to do it now. So we did.

Scott Benner 52:42
Was that a hard decision to make? I mean, you were so close to the Yes. Oh,

Claren 52:47
yeah. And that pregnancy itself was was very difficult. And the the main reason you have so many blood sugar issues is the hormone fluctuations. And that comes from the placenta. And with my twins I had to placentas. So it was like, double the difficulty. By the end, I probably take her before I was pregnant for I took like 35 units of insulin a day. And I was taking like, 130 Oh, by the end of it. Wow.

Scott Benner 53:14
Did you make the babies the way? They were intended? Or did you? Yes, yeah. And you got twins.

Claren 53:20
And we got twins.

Scott Benner 53:22
She's very happy about that. I would have been like, oh,

Claren 53:26
we were just shocked. No, we're happy most of the time. But it's been. It's been very difficult. And we live eight hours away from our closest family.

Scott Benner 53:35
I'm just thinking that if you're lucky, because I'm hearing Your husband's a doctor, too. Oh, no, no. Okay. I felt like you said residency like we were both in it, but you just

Claren 53:45
kind of does feel like we're both in to deal with me, too.

Scott Benner 53:49
So just about the time you get on paying for your degree, you should be able to pay for two kids to go to college at the same time. Yes,

Claren 53:54
yes. I will probably still be paying for my degree. That'd be great to get a podcast,

Scott Benner 53:58
because that helped me with my daughter's.

Claren 54:01
Yeah. Well, all my free time. Yeah,

Scott Benner 54:04
by the way, too many people have podcasts. It's enough. Okay, like yeah, like I don't plan on making it. We all got it covered. Now, I wasn't talking to you. I talked to the people listening case they get like a wild hair up. They're like I'm gonna make I just thought it's good. I gotta cover you're fine. I mean, how many people I got to fight with over this podcast thing, but no, that's okay. So I do want to hear about the pregnancy. Obviously. I got a little lost asking about your job, but yeah, so you said it was difficult. It was it? He started the beginning. Easy to get pregnant.

Claren 54:33
Yes. What was easy for him to apparently What

Scott Benner 54:36
do you mean? Oh, I thought you meant to easy like you only got to try once, but we did only try once. Oh, your husband must have been pissed about that. Yeah. Maybe you too. I don't know. Maybe he's great at it. And you were like, oh, so

Claren 54:50
Well, he's like, he's a very like athletic he's 662 50 big guy and he was kept telling me like I'm gonna have this NFL playing. So I'm like, going to be going to be the best. You know, I'm going to be this sports dad. And we go and we find out that we're having twins. And they're both girls. Yeah. He's got two little princesses now to us. He's gonna turn them into college golfers. That's his now that's his plan. That's his new goal. Yeah,

Scott Benner 55:18
tell him I tell him I watch the kid play college sports. And honestly, I don't even know if I would tell you to do it. I can't. I can't even wrap my head around whether it's a good idea or not yet.

Claren 55:28
Well, it's just so they can get scholarships because he thinks that as long as they're decent at golf, and women, then they can get a scholarship.

Scott Benner 55:34
I don't think he's wrong. I still think he's wrong. Yeah, my son saved a fair amount of money playing baseball. So but the rest of it's just like, I might have given it all away. And I don't know the stuff we did to get them to that point, like, yeah, that's what will end up happening is, trust me the money you save on college, you'll have spent teaching them how to play golf. And well, he also wants an excuse to go golfing. Yeah, that's what I was assuming. Yeah. Well, maybe there'll be really tall. I mean, how tall see? Six, six. How tall are you? Five, three. Well, that must be hilarious. Hilarious. Did you see the first tall guy you dated? Oh,

Claren 56:11
yeah. And I actually I hit on him at a bar. And apparently, and I was a little tipsy at the time, just enough to where I was like fun. And went over to him and I said, Hey, Tomboy, do you like pizza? And we went and got pizza that night and ended up just like talking for hours. And then he was on family vacation, visiting his family in Florida where I lived. And the next day, he's like, Hey, we exchanged numbers. He's like, you want to come over and like watch football at my parents condo? Whatever. And I was like, You know what, this goes against everything. I know. But sure, let's let's do it. So I went over there and his parents had gone to a movie became home or League. So I met his parents the next day. And then we dated long distance, and six months later moved together to start residency. And now we're married and have twins. Oh, that's

Scott Benner 57:02
crazy. You met his parents? You were wearing your pants when that happened, right? Oh, yeah. By the way, you you didn't the episode. Wearing my pants? No. Hey, Tallboy.

Claren 57:12
Hey, Tomboy. Do you like pizza? Yeah,

Scott Benner 57:15
that's what I'm going with. Unless you come up with something else. I really liked like that. That's just like, I don't. I mean, I always say to people, I dated girls. You're like your height. My whole my the whole time. I was young. And then I meet my wife one day, and she's like, my height. And, and there are times now as an adult, I'll go do like events and stuff. And people like, by the way, I think it's very lovely that you want to take pictures, but I'm not very comfortable with how I photograph people. Like take a picture of these. I'm doing that all the time. And I'm standing next to women who are shorter again. And I have this feeling I'm like, Oh, this is what my life would have been like had I not found a tall girl to marry. And like I feel tall. And I never feel tall in my life. And I was like this what will happen? Your husband must feel like a giant is my point. Right?

Claren 58:09
Especially holding these babies. Oh my gosh, like they're so small. Also massive 250. Yeah, about 250

Scott Benner 58:17
His hands like the size of your face. Yeah, probably. Oh, my gosh, that's amazing. Well, that's very cool. So you so anyway, you get knocked up. And then I said anyway, but you get pregnant really quickly, you get pregnant really quickly. And then what becomes difficult about the pregnancy, just

Claren 58:36
the constant shifts in how to manage blood sugar, because you know, they want ideally a blood sugar less than 120. And above 65. Really, they they say it's okay to be under 140 after meals. But that doesn't take into account that you're constantly changing insulin doses. So I would go probably every two days, every three days, I was making an adjustment on either changing my basil changing the carb ratio, or changing a correction ratio or something like that. And I basically just did it myself. For the eight months I was pregnant. And it was certain foods would impact it differently. And it was just constant paying attention. And I hadn't been doing that as tightly as I could have, because I'm on the control IQ with tandem and I do it in sleep mode. And it does a pretty good job of keeping me in range. And I basically was able to stay on that for the first trimester. And then by the end of the first trimester, I was having to go back to the manual pump mode because I just wasn't able to keep low enough numbers with the loop technology with tandem. How

Scott Benner 59:44
How, how frequently did you end up giving yourself an amount of insulin you're like, Oh, God, that was too much.

Claren 59:51
I don't think the too much was an issue. It was mostly not enough. Because as as I went on, it was just I became more carb resistant and that was the main issue. And I we had like an exercise bike at home and my husband always tried to give me credit for it. He's like, if your blood sugar was like skyrocketing middle the night like you would get out of bed and go ride that bike until you could get it down. Just because I felt that was another thing that brought me new anxiety was I just felt like I was hurting these babies, even though retrospectively they were totally fine. And I I know that I was being silly, but pregnancy hormones can get the best of you. Oh, yes,

Scott Benner 1:00:27
he's giving you credit for it. And you're being drugged out of the bed by your, by your hormones, right? You're not even like, like I have to go. And that's something I actually felt like. Like, that felt nice, because even though it sounds like you were tortured by the idea of it was nice, because I thought I bet you she wouldn't have done that for herself. I bet if you weren't pregnant, you wouldn't have jumped out of bed. And then like, I'll go for a walk to bring my blood sugar down for me. Right? But you would do it for them. Yeah, that's so human. I get such a constant through all of these conversations that I've had, and people that I've met, like, but you can't get anybody to do anything for themselves. But you put somebody else in the way of it. And then people jump right to that become heroes. It's interesting. So the biggest problem is just the insulin fluctuation more and more and more. How soon they say I hear people say I delivered the placenta, and it all went back. Is that about how it went?

Claren 1:01:25
Yes, I took I think it was like 128 units of insulin on the last day I was pregnant. And then the first day I was not pregnant. I took six units. Oh, my gosh, that's correct. Crazy. And I just put the pump back in the control mode. So it would suspend basil if I was gonna go low. And it had given me a total of like six units over 24 hours.

Scott Benner 1:01:46
Wow, when you tried to use Control IQ during the first trimester did you have to expand like the max, Basal and Max Bolus number so it could work? I did.

Claren 1:01:55
And I've probably one of the Facebook pages that like gives you all the tips on how to keep your number lower on the control IQ. So I was already kind of doing that in preparation to get pregnant. That it was, it was a lot of tweaking. Yeah, I don't even know what I did. At this point in time. I just knew that I like kept a little journal and was like, okay, my blood sugar was high at this time a day, like two or three days in a row time to do more basil.

Scott Benner 1:02:22
So so a nine month science experiment, you're not sure what you're going to be working on every day when you wake up, right? Yeah, just stay home for the whole nine months.

Claren 1:02:31
I was working through the majority of first trimester just to finish out the year of work. And then I was home for probably three to four months, maybe up to five months. And I delivered them at almost 37 weeks.

Scott Benner 1:02:49
C section natural. Yeah, C section. I was gonna say a lot of babies. How much did they

Claren 1:02:55
pay? Were five pounds, eight ounces and five pounds four ounces.

Scott Benner 1:02:58
Lovely. Did you name them after me any chance? No, I did not know Don't worry about somebody will wander.

Claren 1:03:07
But they're healthy and didn't need to go to the NICU or anything like that. They did have some one of them had issues with low blood sugar for about 24 hours. And that resolved. So how

Scott Benner 1:03:19
long did it take you till you're worried about whether they'll have diabetes one day? Oh,

Claren 1:03:23
I was worried about that. I'm like the time I got pregnant. But that's right now I'm trying to I technically am pumping that bread giving them breast milk. They were because they were preemies. And I don't know what issues exactly brought this about. But they were never really able to latch to breastfeed directly. So I exclusively pump breast milk for them, which is about four hours of my day I spend attached to a pump. Ridiculous, so that's lovely.

Scott Benner 1:03:51
Oh my gosh. Because there's two of them. Yeah, it's

Claren 1:03:55
so much. And they drink. I think about 60 ounces of milk a day between the two of them if

Scott Benner 1:04:02
you told him to eat a lot of you said, Look, why not? 30?

Claren 1:04:06
Yeah, well, that's that's like the high end of normal for one babies. 30. So I'd have I have plenty of milk for one baby that just because there's like that one study that shows the babies who have breast milk have a decreased risk of type one diabetes. And I know that's like one specific population and one specific scenario but in my head if I can do this for them, and that gives me any chance, then that's what I'm gonna do.

Scott Benner 1:04:32
How long do you think you'll do this for?

Claren 1:04:33
I'll go back to work when they're about six months old. So at least six months and then I'll try to keep it up at work. And the end goal would be a year but we'll see how

Scott Benner 1:04:43
it goes. Wow. If you do that for a year, I'll send you an award of some sort. Yeah, yeah. It sounds like your nipples need a break is what you need. Yeah.

Claren 1:04:53
They need an award. Exactly.

Scott Benner 1:04:56
Yeah. You know, I only bring this up because like Just getting ready next week to put up an episode about it. It's 26 year old girl came on, she's type one, she had a baby. And five, six months after she had the baby, like, you know, she's like, I know, people told me about the baby blues, but she got real, like serious postpartum. And I was wondering how you prepare yourself for like looking for them,

Claren 1:05:22
I think it's gonna be really hard when I go back to work, because I have been home with them. So I see them all day, every day, which part of me is like, it's going to be nice to go back to being like a real functional adult in the world. But the other part is, I know, I'm really gonna miss them. So I have to, like you said, just kind of take this in, as I'm here and home with them and prepare myself for the, to let myself feel like I'm setting an example for them. Like, okay, you can be a mom and a surgeon and have diabetes and do all these other things. And it's ultimately going to be an example for my babies to grow up and they can do whatever they want to do.

Scott Benner 1:06:05
On the off chance they can't become professional golfers. Right? Yes. Although it is obviously gonna happen. I'm just telling you, if they're half as tall as your husband, they've got a great shot. Yeah. That's really something. Yeah, her story was just, it didn't, it came on slowly. It started as she said, there was this moment, like, your episode is gonna come out after hers. And I don't know at this moment, as I'm talking about, I don't know what it's going to be called yet. But you should go listen to it. Because she had this. She walked away from the baby one time and the baby just got a bug bite. And that like simple thought of like, I left the baby alone, and it got hit by a bug by the way, the bug was fine. It didn't hurt the baby at all right? It just set it sent her cascading down, like a rabbit hole of I can't let the baby alone, something's gonna happen like and then the thoughts got intrusive, and she couldn't get away from them. And by the end, she she said the first serious thought she had was, I'll just like 20 minutes, she started getting the idea that her family would be better off without her. And that she was failing the baby and that all this stuff was happening. And I mean, it's just heartbreaking to listen, she's fine. She's fine now. And she said that. She said she was thinking through just waiting for 20 minutes before her husband got home and just putting the baby in the crib. Because she's like, I know that baby would be okay for 20 minutes and then just leaving. And then her husband was a police officer. And she said one day she has no idea how it happened. But she found herself standing next to the the piece of furniture that he keeps his weapons and like considering considering killing yourself. Like, out of nowhere. And then she just kind of like obviously didn't do it. And then she was like, oh my god, that was that was bizarre. And then she started looking for help. But she she said looking backwards that she had. She's like I in hindsight, there was plenty of time I should have known I was in trouble. And she's like, I just couldn't. Like it didn't feel like depression, it felt like I was failing the baby. So I was just terrible. Like, and she's 26. And you know, like it's so it's just crazy. Anyway, be careful. I have a soft spot for this this week. So please, yeah, I don't want to hear it. Oh, well,

Claren 1:08:24
and my husband's wonderful and he's very good about communication and checking in with with me and making sure I'm good. So I have a wonderful support system.

Scott Benner 1:08:33
And if diabetes comes for the girls, he can just scare it away. Is he one of those big gentle guys where if I bumped into him in the street when I find myself apologizing to him immediately when I saw

Claren 1:08:44
he's a big softy lover? I mean, he looks like he could be intimidating. Yeah,

Scott Benner 1:08:49
I have I have a brother in law that like, he just he looks like he could grab you by your face and just like move you. And like I said he's the nicest guy get on me. So. Alright, I want to ask you at this point, if there's anything that we haven't spoken about that you wanted to?

Claren 1:09:07
I don't think so. I think we kind of hit the main things.

Scott Benner 1:09:09
We did it. Because you you alluded to an email and I have to admit, I was like, I don't remember that email.

Claren 1:09:17
I was just like the initial thing about like, Oh, tell me about you coming on the podcast. Oh, cool. But I I forgot that that was like six months ago now. So

Scott Benner 1:09:24
can I ask a question of you? Which is a weird thing to say because I think I've been doing that the whole time. But you said a couple of things throughout the show that make me feel like you listen to this. You do is it how is it listening to this podcast and being a doctor at the same time?

Claren 1:09:40
I think they're just they're two separate things in my head and I listened to it one for just like people's stories. I did listen to all like the pro tips and all that probably two three years ago at that this point in time. But now it's just kind of something I'll listen to to hear about other people's stories and Like, like you said, I listen to this, the girl that dealt with the postpartum anxiety and depression and just be able to relate to that. So I see it more as like a community than from a medical perspective, I feel like the medical stuff, I've kind of figured that out to what works for me at this point in time. And some of that didn't come from the podcast, but it's more of just I like to hear how other people are living and how they're making it. So

Scott Benner 1:10:28
you can kind of leave your white coat at the door to listen to it. Is that the vibe? I think so. Yeah, because there was a moment I said something very, like an hour ago. And there was like, it wasn't harsh, but there was a second where you like took up arms for doctors, I don't remember what the context what the context was anymore. And, and it was very reasonable what you said, and I agree with you even. But I'm, you know, if I'm coming from a perspective, on this side, I'm usually coming from the perspective of the type one when I'm talking, like trying to, like, stick up for them. And I just heard from doctors like that they don't they don't they think of it as like Doctor bashing. And yeah, you know, and I, I'm like, I don't mean, this, just people's experiences, you know, what I mean? And what I think is common sense responses to as so. But I understand there's

Claren 1:11:15
also a difference in what how a doctor interacts with the patient and the way they perceive the interaction and how a patient perceives the interaction with the doctor. So sometimes a doctor may tell you, you should do this, this and this, and the patient hears it one way versus the dark, which is different than the doctor hears it. So unfortunately, I do think a lot of medicine is practiced defensively, just because you have to you have to protect yourself from a legal standpoint, and you have to follow the criteria for these are the numbers that keep people healthy, long term and things like that. So there is a lot of algorithms based things that come with it. And then the personal side of it can be interpreted, I think, from one perspective or the other. So that's

Scott Benner 1:12:02
cool. I think that that's why sometimes when you suggest something to a doctor, they go Yeah, sure. But they wouldn't have suggested it to you like now that you brought it up. That's fine. I couldn't say it. But now that you said it, sure, we can give you Synthroid for a 2.5, TSH, no problem, but I wasn't gonna suggest it. So

Claren 1:12:23
go ahead. I'm sorry. That's I was just agreeing.

Scott Benner 1:12:26
Oh, Oh, perfect. I love that. By the way, that was sarcasm, which is just between you and I, because of what we talked about before we started recording. Well, I I really do genuinely appreciate you doing this. And congratulations on being 30 and the babies. And I hope it's not too hard for you when you go back to work. I

Claren 1:12:46
did. I do have one really weird thing that happened to me while I was pregnant, that this happened to anybody else. But it was the day before my 30th birthday, driving down the road and listening to music in my car. And then I realized I can't hear very well out of one of my ears. And I texted one of my friends who works in en ti and I was like, hey, is this like a pregnancy thing? Like, is this normal? And she was like, well, it can be related to pregnancy, but it's pretty rare. Can also be XYZ other thing is you should go see an end like urgently because you need to treat it if this is what it is. So I texted a local EMT and he's like, sure come in tomorrow and go in and I've realized that I'm missing like 75% of the hearing in my right ear. And I was like, what's going on? Like, is this a pregnancy thing? Is this a hormone thing? And he's like, Well, maybe but basically what they did is they treated it by putting a steroid injection into my eardrum. I had that done twice. And my hearing did not come back. So the ultimate thing we've come up with is it's either related to pregnancy, it can be an autoimmune thing. It's called sensory neural hearing loss. Or it could just been like a virus that got my ear or just idiopathic and nobody really knows why. So that's another thing the baby stuck for me was the ability to hear out of my right ear and

Scott Benner 1:14:13
the comfort of your nipples. Yeah, I hate to say this, but did they image your brain?

Claren 1:14:19
They have not but it's pretty. I guess I shouldn't say common but this is the only symptom I'm having. I don't have any other symptoms. And I had a brain MRI actually, when I was having the weird grave system symptoms, which was normal. So again, they discussed it No, I mean, I had the same thought as you They discussed it but they're like yeah, it's just this happens it can be something as simple as a virus. And if I if I have any other issues I'm sure I'll follow that but for now I'm okay and too busy to think about

Scott Benner 1:14:53
you know, it's funny how my I've such a strange life. I come to realize like you said that and I was like like two weeks ago I ever caught up with a lady who had a benign brain tumor, and she couldn't hear anymore in one year. And like that's, that's like what popped into my head like, I don't think I would have thought that had I not ever spoken to her obviously not a doctor. But that's Oh, that's crazy. So 75% loss, what's the impact on your day? I'm

Claren 1:15:18
mostly used to it now. But if I'm in a room with like multiple people, I had a really hard time focusing on which one person's talking.

Scott Benner 1:15:26
Any chance that comes back? I had my hearing checked

Claren 1:15:29
about a month ago, and it was the same. So I doubt it. I'm sorry. It's just annoying. It's not that big of a deal. Yeah, well, that but 10 years

Scott Benner 1:15:38
now, and the kids are acting crazy. You can be like, I am partially deaf in my one year because of you. Now sit down. It's not good parenting, but you'll do it eventually. What kind of a parent do you think you want to be?

Claren 1:15:52
We want I wanted to know, their loved but I want them to also be able to follow the rules and just like be respectful of other people and want to, to pursue whatever interests they have. I guess I should say, Nice.

Scott Benner 1:16:09
That's lovely. I just find the kids knowing that they've got their back is a big part of it. Oh, absolutely. Not even the thing you have to say out loud, really? I mean, you can and you should but I mean, just that knowledge of like, I can take a step. And if it doesn't go right, it's okay. Like it's okay to be kind of adventurous and bold and stuff like that.

Claren 1:16:30
My husband actually says that quite a bit. That's the one thing he wants for them is to know that for them to know that he's always he's always gonna be there to love them. And no matter what they do, yeah,

Scott Benner 1:16:41
I definitely want to stay alive long enough to see the first boy that comes to the door to pick up one of your daughters. And that mountain opens the door. ruins that kids night. Absolutely. Hello, sir. I you know, I don't even want to kick her out of a mark. Nevermind. I'm just tell her goodbye. I'm gonna go now. That's really something good for you. Well, congratulations. It's, uh, I mean, you know, he got through a lot to, to have them. And and I mean, just the idea of getting through medical school. Like, I don't know how anybody's a doctor. Yeah, I mean, honestly, like, I don't understand why, like, after you start telling me about, I mean, not the bummed me out. But I'm sure you're obviously already aware of this. A friend of mine said physician like malpractice insurance alone, I don't know what you're doing. That's so expensive. And yet, and then you know, all the all the things you've just kind of like detailed about why this could be you banging your head against the wall for the next 30 years and trying to help help people and it's just at the time, I just I was having a conversation today. And all above anybody out, but a friend passed away, I was at a memorial today. And a lot of the boys that my son played baseball with in college were there. And my son can't be there because he's out of state. So I'm sitting and getting back in touch with all the kids and talking to them again. And the one is like, I don't know what to do. Like, there's just, he wants to work in mental health. And he's got a job already in that space, which he thinks is going to help him get into grad school. But it's like, I might want to get a doctorate in this. And a sec, I think I might need to to do the thing I want to do, but I won't be in the real world until my early 30s. If I do that. And he's just like, I'm watching him go through it in his mind. He's like, I just don't know if I want to give my 20s away. And I can't tell he's like, maybe I should just get a master's and just go a different direction. And like he didn't. He's a bright, lovely kid. And he just doesn't know what to do. You know? Yeah. It's a lot of time as my point. Like it is

Claren 1:18:48
a lot of time. And then I'm still not done. And I'm 30. And yeah, there'll be a few more years from now.

Scott Benner 1:18:54
And hundreds of 1000s of dollars in loans. Yeah, exactly. Yeah, but all sounds fair. Oh, my gosh, there's gotta be a better way than that. Right? For sure. All right. Well, thank you so much. I really appreciate Can you hold on one sec. You? Oh, no, it's my fault. My pleasure. Can you hang on one second for me? Sure.

Let's thank CLARIN let's thank Dexcom let's thank ag one drink, ag one.com/juice box, dexcom.com/juice box and of course clarity for coming on the show and sharing her story with us. Don't forget to check out the private Facebook group Juicebox Podcast type one diabetes. We're coming up on 44,000 members. You could be one of them. And please, please, please, Apple podcast listeners. Open up the app. Go into the library. Click on Juicebox Podcast up in the top right corner click on the three dots, hit settings. Go down to the download stuff choose download all episodes. You are going to save my big If you do that and save your podcast thank you so much for listening I'll be back soon with another episode of The Juicebox Podcast