#1080 Grand Rounds: Series Introduction

December 8, 2023Scott Benner

Scott Benner and Jennifer Smith RD, LD, CDCES share diabetes insights for clinicians who want to do better..

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

Scott Benner 0:00
Hello friends, and welcome to episode 1080 of the Juicebox Podcast.

I'm incredibly excited to give you a preview of a brand new series that's coming in January Grand Rounds. These episodes are aimed at practitioners, but are also going to be very valuable for people living with diabetes. Our goal is to let doctors know what they should know. I've taken feedback from the Juicebox Podcast listeners to develop this series, we're going to use your words to describe to doctors what they need to know to help you. But moreover, this information is going to let you know what you should be expecting from your physicians and frankly, what you deserve. While you're listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. This series is going to help physicians be the kind of people you want to consult. If you're enjoying this series, please share it with your health care provider, doctors that you know in your life or other people living with diabetes.

This episode of The Juicebox Podcast is sponsored by touched by type one touched by type one is an organization that is dedicated to helping people with type one diabetes. They're asking if you'd be willing to go check them out on Facebook and give them a follow on Instagram and do the same or at their website touched by type one.org. Head over to that website now to see all of the amazing things that touched by type one does for people living with type one diabetes. The podcast is also sponsored today by us med. US med is the place where Arden gets her diabetes supplies from she gets her Dexcom G sevens and her Omni pod dashes. But they have so much more. And I'll tell you about it a little later. For now, here's what you need to know, you can get a free benefits check at my phone number 888-721-1514. Or by going to us med.com/juicebox.

Jennifer Smith, CDE 2:36
Hopefully, none of that was recorded. I

Scott Benner 2:37
did not record any of that. But I'm recording you saying hopefully none of that was recorded. Jenny and I are having a day together. And we're gonna use that energy to build the next series of the podcast. So yeah, let's go. I'm pretty settled on calling this episode Grand Rounds, actually the series Grand Rounds. That is really only from my knowledge of the medical profession as far as I've watched Grey's Anatomy. And because I am old, I've also seen the entire run of er, that's what I know about hospitals, I realized that might not be accurate. But I do remember people saying Grand Rounds, like where all the students would get together and go around with an older more wisdom teacher and they would go from case to case and talk about things. And my idea here, Jenny is this. I feel like we can put a series of of episodes together that would simultaneously teach patients what to expect from their doctors, while teaching doctors what their patients deserve. Because that makes them how to interact, yes, and how to actually feed that information to them. Taking into account that diabetes is probably three pages in a book at medical school and 20 minutes somewhere while you're going through things. And that a lot of people are going to intersect emergency room people, doctors in what like urgent cares in their primary care offices, right? Yep. People who don't aren't schooled on diabetes, the way people who live with it and are correct, what we've done is gone out to the population that listens to the podcast, and so that people know who are listening. I'm talking about 40,000 people on a Facebook group and millions of downloads of the podcast. And we've asked these people, you know, to give their feedback about what would have been helpful, helpful, and what was not helpful. And then we've broken that down. And today, you and I, as we've come to do with the beginning of a series are going to talk through how we're going to build the series. We're going to take this information, put it in some reasonable order. Let people know what to expect. And that's what we're going to do. And you are Yeah, you're incredibly passionate about this. So if you could talk for a minute about why you think this is important. I'd appreciate it.

Jennifer Smith, CDE 4:59
Yeah, I'm, I'm passionate, that's a great word. Because I think that, as you've already stated, general medicine practitioners who haven't had the extra schooling, right, when you complete medical school, then you can specialize, right? Specializing in endocrine, you go on to a fellowship, you complete a fellowship. And so you have that more in depth. In general, a first step, anytime you're sick is going to be a primary care doctor, they're going to be a first step, whether there's symptoms for something or whatnot, you're going to go to primary care, or in the case that really urgent symptoms come up, you're going to go urgent care emergency department or whatnot. And in those cases, they're knowledgeable people. I mean, that's one big thing I want is people to hear that they're schooled. They're schooled in medicine, but they are not schooled in a specialty. And we can't expect them to be either, right. But in order for them to understand what to do, I think it's a it's a two way but right,

Scott Benner 6:14
I want to say right at the onset, that I am almost positive that through this series somewhere, if you're a physician, you're going to feel like there's Doctor bashing going on. And there, there is not we have both have the utmost respect for you, and what you do, and how difficult it is. We just know that the only doctors are the first people to say this, usually, they'll tell people with diabetes all the time, look, you're gonna have this for six months or a year, and then you're gonna know more about it than I am. Right there living with it really is the only way. But the reason that this is so important, even from minute one, is because I mean, Jenny, you know, I'll tell you a little more about what Jenny does as we're going along, but she intersects people with diabetes all day long. I do as well, I have long form conversations with them. And I can tell you that sometimes things that are said to them in the first five minutes, haunt them, sometimes forever. And so when a doctor says something offhanded, it literally it could change their life significantly good or bad. And so why not move it in the right direction is what we were thinking about making this series.

Jennifer Smith, CDE 7:24
Correct. And I think in general, when we're talking about overall medical personnel, clinicians, we're not doing any bashing. That's not the idea here at all. So that's, that's great to clear up. The idea, though, is for a communication piece, to be more in the forefront of the mind, both on the person maybe with diabetes, and how they can communicate better, but also from the physician knowing that I think a forgotten part of healthcare is that, like, health care is it's it's human care. Yeah. So we're not looking at just talking in a very flat manner to somebody, we're looking at talking to somebody about something that's going to affect their life. And with diabetes, it impacts the life on a 24 24/7 note, right, there's no shut off to it. And so as you said, you may make a statement, as a clinician, that's a statement you think may need to be in the conversation. And maybe at some point, it does need to be there. But in a, in a different way, different context, at a different point, you have to learn, you have to learn what somebody is coming in with the need for at that moment. And that takes talking, right.

Scott Benner 8:44
And there are also I think you have to build more than just a spreadsheet in your mind evolve. First of all, tell him about this. And then the next time I see them all mentioned this, like, you need to know where they are like you might deliver the information, like Jenny said too soon or too late, you might deliver it the wrong way. And I know that you could also be listening and think well, how am I supposed to know where they're at? You could talk to them. Now, that'd be a really great way. Right? And you really have to understand that no matter how much you think you can put yourself in the shoes of a person who needs manmade insulin, or the shoes of a person who is charged with caring for someone who needs manmade insulin. You can't. It's far more impactful, and potentially destructive, and difficult and time consuming and exhausting than you'll ever be able to imagine. And the only thing that will help those people not live like that is the stuff we're going to talk about in these episodes. And you can listen to these and pick it up and apply it to what you're doing. I really think you can help and that's not just me saying I make a podcast. So here's my next topic. We've been doing this a long time. We have a lot of feed back, we know what works. So I hope you guys listen. And if we sound like we're bashing you, at some point, I promise you we're not. We just feel really strongly. And we've also heard from a number of people whose lives have been, I mean, honestly, sometimes derailed by by bad medical advice.

Jennifer Smith, CDE 10:17
Right. And I think something to go along with that is bad medical advice, or misguided even really understood, right? When you are a when you're a practitioner, and someone is coming to you, that's out of your wheelhouse of being able to answer than your best ability is to say, You know what, I can't answer that the way that you need the answer to come or I don't know enough about it. My job is to direct you to the right person. So it goes along with saying the right thing are saying it at the right time. And in this instance, if you don't know enough, the better thing is to not pretend that you know, and it's to direct somebody to the right person in your healthcare system. So that the answer can be given in the right way and in the right time frame around the right context, you know, to not scare people,

Scott Benner 11:15
and I think don't just think of that as like, I said something to them that was incorrect. Like, here's an easy one, right? If I went up to your general practitioner, and I said, I use insulin, will chicken make my blood sugar rise? I think most general practitioners would say no, if there's no carbs in that, you'll be fine. Right? Like, I think that would be the answer. And it's what most people get, except proteins broken down, it's stored as glucose makes your blood sugar rise? Is it a significant rise for some people, for some people, not depending on variables, too great to even go into right now. But if you tell that person, no chicken won't make your blood sugar rise, you're the deity in this situation, you got the white coat on, they believe you, they'll never think again, is my blood sugar high because of chicken, you've told them that won't happen. And then that that's gone from their mind forever now. And then if someone comes along 10 years from now, and tries to tell them, they'll fight to defend you and what you told them 10 years prior it You mean that much to them? Right in their life. So it could be that and it could just be you have no idea could just be Miss speaking or saying something. Without enough description. I for years. For years, I only thought Novolog was insulin, you didn't know that there were other No, because

Jennifer Smith, CDE 12:36
they gave us dialogue was insulin and that insulin, this

Scott Benner 12:40
is insulin, and I went alright, and I took it now this is insulin, right. So I now now when my daughter has struggles, I don't know that I could look into other kinds of insulin, I had no idea. It just would have never occurred to me, because I've already been predisposed to believe that what I was handed is insulin. And there shouldn't be any questions after that. Right? That's all right. And again, this could seem like nitpicking, but I've interviewed over 1000 people with diabetes. And I'm sure Jenny's talked to way more people than that with type one and type two. And it's got an impact on their lives that you, you can appreciate till you have those conversations with them.

Jennifer Smith, CDE 13:18
And even the simplest statement could be misunderstood. And so that's why really unless you have a good enough idea how to give a simple but correct answer, the better idea so you know what? I don't I don't know, either. Let's look that up. Let's take the time to gather to understand it in office, I think that goes a long way with actually trust from a person with diabetes to the clinician, because the clinician is willing to take that step with somebody or say, You know what, we can set up another visit and or I'm going to have another clinician who knows all about this be the one to present you with the right information, and timely visits, I think within that are an important thing to consider when you're the clinician scheduling somebody out. It's somebody has a question. Oh, it looks like three months from now you can see this person who can answer I know, no, having worked clinically how scheduling works, I get it, but a question needs an answer. And it doesn't need a delay to it.

Scott Benner 14:26
So you know, I think it might be important to dimension here before we go through what we think are going to be the topics the topics in this in this series. Everybody who has diabetes has diabetes supplies, but not everybody gets them from us med the way we do us med.com forward slash juicebox or call 888721151 for us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor For Omnipod dash, the number one fastest growing tandem distributor nationwide. And they always provide 90 days worth of supplies, and fast and free shipping. That's right us med carries everything from insulin pumps to diabetes testing supplies, right up to your latest CGM, like the FreeStyle Libre two, n three, and the Dexcom, G six and seven. They even have Omni pod dash and Omni pod five, they have an A plus rating with the Better Business Bureau and you can reach them at 888-721-1514 or by going to my link us med.com forward slash juicebox. When you contact them, you get your free benefits check. And then if they take your insurance, you're often going and US med takes over 800 private insurers and Medicare nationwide. better service and better care is what US med wants to provide for you. Us med.com forward slash juicebox get your diabetes supplies the same way Arden does from us med links in the show notes links at juicebox podcast.com. To us Med and all the sponsors, when you use my links, you're supporting the show. You know what I'm gonna let it go. I'm gonna let it go. And I'm gonna bring it back up in a second. So let me let me jump forward to the time has to make a note for myself here maybe doesn't fit right here. Okay, so what we've got here is a fairly, a fairly big list of of ideas and thoughts. But I wouldn't want a physician or even a person listening who's like, what am I going to what should I be expecting from my doctor? I wouldn't want you to think, how am I going to put all this to memory? What am I going to carry bullet points around with you make sure he asked me about this, make sure I've talked about that. To me, that's not how this works. To me the way it works as these conversations you listen to them. And you sort of just fold the information into your understanding of diabetes, so that when these things do come up, your natural inclination will lead you towards answers and ideas that will be helpful for you. So don't think of this as like a study guide. And don't think of it as a list. Think of it is it broadening your understanding so that you can ask or, or give the right information? Correct. That's what I was thinking so. So we have a broken down diagnosis, hospitals, insulin food, CGM, and bgmc, insulin pumps, the humanity and mentality, communication, management and pregnancy at the end. And I actually, as we started talking, wandered out loud and wandered on my notepad to myself, do we do want at the end for school nurses too? So let's make a good

Jennifer Smith, CDE 17:48
one as well, I do we have, you know, one that came to mind since you had insulin in there, right? is safety. I think safety would go right along with that insulin topic.

Scott Benner 18:03
You're hearing Jenny and I morphing the list as we go. So the reason

Jennifer Smith, CDE 18:07
is, because I've I've seen too many things that circulate around insulin, and the topic of safety. It's not discussed the right way and or the tools that are there for safe measures aren't talked about at

Scott Benner 18:24
all. And you might, as an example, oh, everyone knows that. But I quite literally spoke to a woman two weeks ago, who is in her 30s and has had diabetes for 20 years, who until two years ago, did not know that insulin could be dangerous to her. Right? That's it. So that is a thing that I think a doctor wouldn't expect. Right? You know, and so you so you don't say also, here's a good example, and we'll go over that episode. You don't give them the insulin and say, Hey, this is really dangerous, it could kill you. Because if you use too much of it, it can kill you. You don't tell them that. That way you. You want them to know the truth about how it works. You don't want them to be scared to use it. Because all that's going to do is drive people to have higher blood sugars and complications one day, and it's just these are the things we're talking about. So yeah, I

Jennifer Smith, CDE 19:19
think within that insulin and that safety is tactics of discussion, honestly, because I think too often you brought up, you know, just the word scare. Too often, the strategy that's used, it's not a direct thing, but I think too often scare tactics are used. That shouldn't be the way that people are educated.

Scott Benner 19:46
You can't lump everybody together into one mindset. Like there are going to be some people who don't do a good job taking care of themselves. That might be because they don't understand it. That might be because they're afraid aid, it might because they're apathetic, on and online. But what you what you see happen, the stories you get back from people are that the doctor just assumed I didn't care. But that wasn't the case. And often people have, you know, psychological reasons why they can't do the things you're asking them to do. There's plenty of times and plenty of stories where you as the doctor, you think you're giving great advice, and you're not. And that person is at home, breaking their ass trying to make this work. And they come back to you, and you say, Well, you're not trying hard enough. That's how much you believe in information that is not actually very valuable to them, or you haven't done a good job of, of giving it to them in a way that that they can pick up and use. And

Jennifer Smith, CDE 20:42
that's the reason that, you know, you have to with each person, that human piece to it again, you have to bring, like your whole wealth of knowledge into those visits, and your your understanding of being human and all the variables that impact your life up to that visit time, because people are going to lean in and respond and ask questions. And that gives you who they are. And it leads you the route of simplified information, more extensive information, this type of technology to discuss Nope, we're not there yet. I mean, it leads you down the path to help this person on an individual level. But you have to be willing to listen. And I know in today's world, I don't think that doctors don't want to listen, I know that there is a time constraint, I 100%. Understand that. But I think even the first couple of minutes of of a discussion could be enough to be able to feel out the avenue, you're gonna go down for that visits.

Scott Benner 21:53
I think if you heard that, and you think, Well, look, I told them what to do if they don't do it too bad. Like, if that's your feeling, I'll say this to Jenny and I both from different perspectives have an incredible amount of experience, helping people who we are not sitting in front of. Right, and Jenny does it one on one through a video chat, right. And that's a special skill. That's why she's talking so much about getting to know people because that's what she knows, works. And for me, I have a different skill. I help people without knowing who they are. Right, I can't see them. I don't know their circumstances. And, and I'm left to give information in a way that I imagined that the most amount of people can pick up and use. And you need to be able to deliver information in a very digestible way when you do that, because I don't know who I'm talking to right now. Like I could be. And I know I There are doctors, physicians learned people whose kids get diabetes, and they can't figure it out. And they listen to this podcast to figure it out. And I have spoken to people who have not graduated from high school, and who struggle financially, who have mental disorders, like all like all different kinds of people have written to me to say, I'm better off now for listening to the podcast. And that, to me, at its core, is about delivery of the information. Absolutely, because if I said to any doctor, right now, I want you to explain diabetes to a faceless person, I can't tell you if they're male or female, if they get a period, if they don't, if they're an adult, or a child, or if they're 100 years old, or 50. And you can't give them bad information. But it needs to work for as many of them as possible. I think it would freeze them in their tracks. I find it kind of simple to do. And so it's just I don't know why. I don't know why I'm good at this. I don't know why you're good at the thing you're good at but people should, should pay a little bit of attention to this.

Jennifer Smith, CDE 24:02
Yeah, I think one of the biggest pieces that is not it's not personality based that you you start from and it's very directed to insulin, right. Your your big emphasis is all around understanding insulin. And that insulin understanding can get very precise person to person and variable to variable in lifestyle. But in general, if you have an idea of how insulin works, it doesn't matter whether you're male, female with hormone action, a child a 90 year old, you know, whatever. Insulin is meant to work a certain way and if you start to understand that, then the person becomes important because then the action and the use of insulin can be a Just based on the person, I started

Scott Benner 25:02
this podcast almost a decade ago, based on the idea that if you understood how insulin worked, that was the starting point, like I looked at all of the different things that people are told about their diabetes. And there's so many. And I looked at each one of them. And I thought, is this the core idea? No. Is this the core idea? No. What's the core idea? Like, what do I have to know on day one moment one, and it's how insulin reacts in your body. That's it, you need to have some starting point, so that you can begin to have experiences, and then witness those experiences, hold them up against your knowledge, and decide what happened there. And how do I make it do what I want? How do I bend this thing to my will, instead of sitting here waiting for diabetes to happen to me, I'm going to try to happen to it. And because

Jennifer Smith, CDE 25:54
that's where individualizing your use of insulin comes into the picture. Right?

Scott Benner 26:01
Yeah. And I think what ends up happening in a, I mean, we'll talk about it through the the episodes, but you know, you're diagnosed, there's a lot of fear right away, okay, like and good reason to be good reason to be scared, it's a scary thing. And then terms start flying around, and rules. And this could kill, you don't use too much don't use too little shoot for this range. Like they start saying things like that. It's overwhelming. It's incredibly overwhelming. And your brain picks and chooses what it's going to remember. I think most people's brains work, the way they talk about astronauts making decisions, the only problem in front of them is the next thing that can kill them. And then once they once they get that one, then they go to the next thing that can kill them, because everything in space is trying to kill you. So you don't worry about everything you worry about the next thing coming for you. And I think you can get put into that situation when you're diagnosed with type one, or type two honestly, like like, like, quite honestly, this is where at diagnosis, not saying the wrong thing is almost more important than saying the right thing. Correct. So Jenny, the next thing after being diagnosed is for a lot of people, they end up in the hospital. And for a lot of people, just as many actually sometimes I think more they end up like just being sent home adults are sent home at to me what seems like an alarming rate when they're diagnosed with diabetes very quickly. Yeah. So that's going to be we think, right, that's the next episode. So we're gonna start with diagnosis have a big conversation about being diagnosed. Correct. And then we're gonna talk about hospitals. And that first setting that you're in, because that's the next opportunity for a different group of clinicians to be in contact with you. Correct lot of nursing staff is going to be in contact with you. A lot of roving doctors are going to be in and out. I'm not saying you guys send them in just so you can build. But you know, there's a lot of people coming in and out. And they all have to say something to you, if they want insurance to cover it. So we want them to know what they're saying. There might be nothing more disheartening, when you're dealing with a doctor than when you're sitting there. And you realize they don't know what they're talking about. And they know they don't know, we're just talking at each other. Because boy, does that take the air out of you. Because you don't know what you're doing. You're looking to this person, and they're just glad handing you or just talking around things like oh, they're not saying anything. And

Jennifer Smith, CDE 28:33
sometimes that's a process. I mean, having worked, you know, enough hospital time, it's almost an intermediate step of sorts of not that you've given a diagnosis, it's diagnosis, that is something maybe nobody has ever heard of the heard of it, they don't know anything about it. And it's a you know, 100% brand new as diabetes diagnosis typically is. And I think from the clinical standpoint, that is where they don't just want to leave you with this diagnosis. And even if they don't know enough about it, because they're not specialized in it. There's a sense of not leaving somebody just with that new information. And so there's, you know, I need to stay here and talk but I really don't have anything to talk about because I don't know enough to give you answers to all the questions that you have. So I can they kind of skirt around answering things in a direct way because they don't want to miss inform. I don't think any any clinician really wants to give the wrong information at all. But I do think that that time between really talking to the knowledgeable Viet an educator or nurse practitioner or the endocrine team that's going to come in and really give you the in depth right. There's also a time segment where they may not be in the hospital yet, right? If you take your cell For a child, or a teen or a loved one in at two o'clock in the morning, you're likely not going to see a knowledgeable, true condition, physician or team until the normal hours of the day.

Scott Benner 30:14
But again, I think that's why this will be important, because you could listen through this one time, in a few hours in your car while you're working or whatever, and then actually have something valuable to say, even if you are the one at 2am. You know, like, even if you're the one at 2am, who just says, Listen, this is going to seem very overwhelming at first, and I don't want to lie to you it is, but it's doable. You and your team, you know, your family, you're gonna find your way through this, I guarantee, I'll tell you that nicest thing you can say to a person with diabetes a year from now, it's not going to feel like this. Right? It's just just going to be learning some new stuff. And it's not a test. It's not learning like that. It's just having experiences and learning from them and moving on and applying. It's gonna take a little time, but you'll see it'll be okay. Not don't promise them it'll magically be okay. Like you don't I mean, don't don't don't do the thing. That's been happening for decades. Jenny has no idea what I'm going to say right now. But what does everybody told when they're diagnosed? Oh, that

Jennifer Smith, CDE 31:15
it's going to be cured in seven years? Where did you come up with the magic number of seven to begin with? Right? Five years,

Scott Benner 31:22
seven years? 10 years? It's happening. I read an article in Forbes, he didn't say it. It's almost over like that. Don't do that to people don't do that. Right. Cuz then they don't take care of themselves. Yeah, I think it's almost over. Right. Right. So I mean,

Jennifer Smith, CDE 31:35
you asked, you know that what's the biggest thing that I really want? I want? If I if I had like my full 100% wish, this whole, like Grand Rounds, it would be part of like medical school education? It really would. It would be because I think regardless of what specialty somebody ends up going into, it may very well not be diabetes, because diabetes is it's on the rise. Yeah, you're honest, you are going to touch somebody or be touched by somebody with diabetes, whether it's type one or type two, or maybe even gestational diabetes, you know, whatnot, the more you have than the basic of the one class you took in an hour's worth of your medical schooling, you will find somebody that it's valuable for you to know just a little bit more. So that's my goal.

Scott Benner 32:31
Yeah. Because the better chance you'll have not to frustrate that person and make another person who doesn't believe you are listening to you. You know, don't be the dentist that says you shouldn't use candy to stop a low blood sugar to a woman whose four year old will only take candy when they're when their blood sugar is falling, and she's afraid the kid is gonna die. Like that's not a good time to tell her that Skittles are bad, right? I'm gonna curse for a second. She knows Skittles are bad, Jenny. He's in a situation here. The space capsule is breaking open, and she's trying to stay alive and you're telling her Hey, you probably shouldn't eat Skittles. That's what's wrong. Yeah. Like have Don't be the eye doctor who asks if you've tested your blood sugar today, you have type one diabetes, you have tested at 53 times.

Jennifer Smith, CDE 33:14
You are my one of my favorite questions at the eye doctor is Do you know what your blood sugar is? Nope. Right this?

Scott Benner 33:21
No, no,

Jennifer Smith, CDE 33:21
I was up. I was supposed to check. What No, I

Scott Benner 33:26
never look. It's crazy. It's a certainty that they don't know what the hell they're talking about.

Jennifer Smith, CDE 33:32
It's because it's on a questionnaire. It's part of the checkoff. Yes, you've asked this Yes, you've asked this. And I know Yeah, even listen,

Scott Benner 33:40
if you're a doctor, just for self preservation, you want to billable person to show back up every couple of months, I wouldn't leave them with the idea that you don't understand their diabetes, because they're gonna bolt from you very quickly if you do that. So there, let's break it down to money, if that makes it better. Like you need to understand this. So you can do good for them. But so that you can also be a viable option for other people. And if you don't think people will go online and tell them don't go see this one that's happening constantly. So, you know, that's how these people stay alive by finding each other and making a community and telling them you know, where the good information is, this is good, don't go there. Just get it you could get a reputation as just being somebody who gets that they don't know and is willing to be in a partnership with someone with it correct? Right. There's a lot of ways to think about so. So anyway, that stuff in the hospital. So those are wanting to to me, but I'd still put insulin one except I'm not asking the person the nurse in the hospital to tell you about insulin, but you're gonna get to endocrinology general practitioner Next type two type one depends on what you are, I guess, adult or child, you're gonna end up in that scenario. This is it. This is when you start explaining insulin to them. And we Jenny and I are gonna have a long conversation about how when Some work so that when you're done listening, you can really understand it too. And I know you think you do, but you don't. So I mean, if you have diabetes and you're listening, then you're just giggling along, like,

Jennifer Smith, CDE 35:11
I know you think you know, insulin, you really

Scott Benner 35:14
are not using insulin, you don't understand how it works, and not for nothing. thyroid medication, right? autoimmune issues kind of run together. So I happen to know a lot about thyroid. Most doctors are terrible at prescribing thyroid medication, they're not good at it. They don't know how it works. And I don't just mean, take it in the morning before you eat. I know you think that that's the whole thing. But it's not and you don't know. And maybe it's not your fault, you don't know. But that little decision, not understanding how to medicate someone's thyroid problem causes them problems with how their insulin works long term and how their weight reacts. And if they're heavier, then they need more insulin. And now you already didn't teach them how to use insulin. And now you're putting them in a situation where they know they need more of it. And you don't know that, you know, because you don't have a thyroid problem and diabetes, and it's cool. Like not to know, we'll explain it to you. So we're gonna go all through insulin, not just how it works, but just any brought up all your safety now. Food is next on our list, huh? Okay,

Jennifer Smith, CDE 36:18
can I say

Scott Benner 36:20
please go? Also tell them you got letters behind your name? This makes this even more impressive. What are you that

Jennifer Smith, CDE 36:26
which is the reason? Yes, so I'm a registered dietitian and certified diabetes care and education specialist. And to be quite honest, as a registered dietitian, you go through a lot of schooling specific to human nutrition. I did many years of education in human nutrition, and an internship program and application in clinical needs, etc. By no means should clinical staff that hasn't had the education be giving out nutrition information. You just really I mean, and this goes, as far as you know, years ago, when I started as an educator, so many people brought up well, my doctor told me not to eat white food. What does that mean? So I can't eat apples, because they're white. And so in general, my statement is, I would never try to tell somebody what to do for a brain tumor. I would say I'm not a specialist. Sounds like you got a problem. You need somebody specialized, though. Please don't tell people about nutrition, because I guarantee that the majority of them don't have nutrition degrees.

Scott Benner 37:41
Well, also, if I'm being told about nutrition from somebody who does not personally appear like they understand it, I have a hard time taking you seriously. Yeah,

Jennifer Smith, CDE 37:49
yes, yes, if you're the doctor who smokes and then tells people not to smoke, I guarantee with your

Scott Benner 37:55
yellow fingers, you know what you're doing, that's really hurting you smoking, I heard about it. It's bad. I think Jenny's point is and you know, it's funny when I think of you and where your value lies, for people with diabetes, obviously, being a nutritionist, and a CD is important. But I Brank. Just as importantly, you've had diabetes for over 35 years. So that's a long time and a lot of lessons. And then you, you couple in that education on top of those lessons, then you couple in the experiences you're having talking to people every day, on top of those lessons. Jenny knows what she's talking about. She's not here by mistake. And I

Jennifer Smith, CDE 38:31
I also think within the topic of food, I do think that it's under discussed in the right way. So and I find this both for kiddos, and like all ages, let's just say, you know, the whole idea around food, as you said before, you know, something nice to say is that a year from now, this will look different. And it will be it will be better than it feels right now. Right? Something around food that often gets said is that you really don't have to change anything at all about what you're doing. And I think as an in a nice way. The clinician is trying to just say, hey, it's it's not that bad, right. But in general, there is a lot to understand about food there is and it's not just as cut and dry as take your insulin and eat your food. And the other consideration there is each person again, going on the individual, very personalized basis. Each person needs to know how much they should have. It's not just a well gosh, if you just take your insulin and your time at the right way you can eat whatever you want to eat. And I think that that's that's a widespread problem. Whether you have diabetes or not is just the intake of food is not managed well because we don't understand what our real needs are.

Scott Benner 39:57
Understand food most Have it's processed, yeah, they don't have access to good food to begin with. All these are different problems. And then you just say to them, nothing has to change if you're trying to be kind. It's the same kindness, by the way, that's meant by Oh, I heard there's going to be a cure. It's the same. They're trying to alleviate your your sorrow, I get that. Don't worry, nothing's gonna have to change. Well, yeah, that's true. Unless you unless you eat like, horribly, and you know, like, and then you send them home, go, don't worry, it's gonna be fine. Then they get up in the morning and have a bowl of Captain Crunch and their blood sugar's 350. And you didn't teach them how to use enzyme anyway, by the way, I get both bucket bowls for Captain Crunch. But that's not the point. Like the point is, it's going to impact them hard. And then they roll into lunch, and it's frozen pizza. And then they roll into dinner. And it's processed chicken nuggets, and a friend and oil and all this stuff. They don't know they think they're eating well, right. I promise you. I've talked to a lot of people. I think the majority of people who are eating poorly don't know they are. Right. I honestly believe that. I don't think it's I don't think it's apathy. I don't think it's ignorance. I think they just don't know. And now you're telling them Don't worry about it's not a problem. You don't know what they're eating? How could you possibly say that? Right, right. So yeah, and how does food impact insulin? How does insulin impact food? We're going to talk all about that. Because if you don't understand that, I don't know how you're possibly directing people I am going to share with you that online the other day in the in the private Facebook group, I watched somebody tell a story, where they were in a doctor's office and said to the doctor, look, you're giving me this information. But the truth is, is that 10 grams of this food and 10 grams of that food impact my kid completely differently. Right? And they said the doctor looked at them crazy, like just sideways. And and he's like what he does? Well, there's there's obviously a personal as to the podcast, we're like, well, the glycemic impact of this food is not the same as that, right, and the loads different with this one because it's more complex. And therefore one of these needs a different amount of insulin, actually, it also needs kind of an extended Bolus, and all that and this other ones are simpler. And they're having this conversation and the doctor stopped them and said, This burned in my head when I watched when I read it, you are completely wrong about that. A carb is a carb is a carb. That's what they were told. So now this lady was, you know, educated enough that she could fight back. And by the way, she didn't fight back. You want to know what she did to look for another doctor? Yeah. So but there she was in a room that how many people? Is he saying that to? Correct, right? Yes. And that's not right. And if you heard that just now and thought, oh, wait, a card is not a card is the card for a person with diabetes, you might want to start wondering what else you don't know? Because that's a pretty basic one. And it's huge.

Jennifer Smith, CDE 42:53
Right? Right. Absolutely. Okay. And I think in today's in today's technology use that has become much more visible years and years ago, not so much, right. But in today's world, which we've had technology long enough, now, it's very visible that you can, you know, know the difference between food versus food, even though they technically fall within the same macro.

Scott Benner 43:21
And that's why the next piece of this is going to be glucose monitors, continuous glucose monitors and blood glucose monitors. Yes, because again, it's they're more than I think they're more than what most people think when they prescribe them, and the value that they have, and how you can interpret that value. And the information is huge. So that's going to be the next step. Then we're going to talk about insulin pumping. And I'm probably going to rail against all of you who think that you have to have diabetes for a prescribed amount of time before you get an insulin pump. And we're gonna talk about how they work and how you can support people with them. Then the next piece that Jenny keeps bringing up over and over again, when she and I talked about this, before we got together today is just the mentality and the humanity behind everything. You know, and how important it is to, you know, like we said earlier to treat people, not like a patient and not like a customer, but not

Jennifer Smith, CDE 44:15
like a checklist of things that you have to get through because they're necessary to ask about, while they may be important, you have to remember the person coming in is it's got a life, full of a lot of things beyond just the diabetes, which may very well be part of the part of the communication or the conversation that you have if you take the time to listen. Right.

Scott Benner 44:42
And that takes us to the next part, which is communication. We're going to talk a lot about how we have found the talking part of it to be so important. And the tactics I hate to say that word but the tactics that that Jenny and I both use it In what we do separately and together, when we're talking to people together, we're doing it now, by the way, you don't realize it, if Jenny and I were talking about this privately, it wouldn't exactly sound like this. We're delivering this in a way that we think that would interest doctors without making the mad. So they'll keep listening in a way that will let patients hear it. So they know what to go like advocate for. But without making them mad at the doctors, right, like, right, that's what you're hearing for the last 45 minutes is being given to you purposefully. And there's a way to do that. By the way, both ways, doctor to patient, patient to doctor, because, you know, if you just walk in there as the patient, and you're a big pain in the ass, the doctor still a person, and they're going to put up a wall, you know? Namie, right? Absolutely. You're gonna be like, Oh, this one is how they're gonna think when you come in. Right? Yeah, that's not how you want to get your your doctor in get any mean, you want them to be excited to see you. And, you know, and there's responsibility on both sides for that, then we have management Jenny, and I have to scroll down a little bit. To be perfectly honest with you. To see what that is a long list. We put this together a couple of weeks ago. Okay. So this is going to be kind of a big, a big kind of overview about education, you know, kind of don't just teach a man to fish. You know, right, you know, teach them how to fish kind of a situation more about ratios, like real kind of more nuts and bolts stuff that I think that isn't that difficult if you're a physician that you could understand. Right? And then Jenny added pregnancy at the end, because it's one of the things that she does, and she can be really valuable. And that I will probably not say as much during that episode, but we'll talk about that. And then I don't know, Jenny, do we? Do we like adding school nurses to

Jennifer Smith, CDE 46:51
this? I like adding school nurses? Absolutely. All right.

Scott Benner 46:54
I'm gonna tell you why. Now, just briefly, and then I'll remember when we make the episode to tell you the whole story, but I'm going to tell you in the nursing, the school nurse part, the story that a guy named Joe literally just called me last night and told me about, and just remind me when we get to that episode to tell you Joe's story about school. Okay. Okay, thank you. I really appreciate this. I'm super excited. Yes, that you're willing to do this with me. And and I can't. I'm excited. It was a great idea. Well, so that's my idea. But thank you. It was everybody's idea. I'll tell you what, being serious. It was a thought I had just out of nowhere, I think I was in the shower. And I was like, What are Jenny and I going to do next? And it popped into my head. But it's only an idea that popped in my head because of the countless hours of conversations I've had with you. And on this podcast and hearing back from people, all of that stuff together. Like it's not some stroke of brilliance? You know what I mean?

Jennifer Smith, CDE 47:52
No. And I think that at one point, I said to you, I wish, I don't know, maybe it was after a particularly frustrating conversation with somebody who was really just, they were frustrated with their, their clinician, and what they were not necessarily getting, or what they had gotten and forced them to kind of change physicians. But I think I had said to you, I was like, I wish that we could just like package the prototypes and send it out to all clinicians that are out there. I wish we could just do this so that they could understand it from this

Scott Benner 48:26
level. Right? So we have this series called diabetes pro tip. And it's this 26 part series that I mean, if you're you know, if doctors are listening right now, I can tell you that most people report back in a one seeing the low sixes the high fives just from listening to these these podcast episodes. It's with Jenny and I. And she's just like, why can't we just like, like, how do you do that? And I kept thinking, I'm like, I don't wouldn't begin to put them on thumb drives and mail them to doctors offices, like, like, yeah, that's not going to work. And, you know, and, you know, how do you talk somebody into getting information that they don't know they need? So my thought was, there are plenty of doctors that listen to this podcast that are that like the podcast. So maybe we'll put this series together and maybe they'll start sharing it amongst colleagues. This is kind of how we were hoping so anyway, I appreciate it very much. Hope you have a good weekend. You

Unknown Speaker 49:18
as well. Thanks. Thanks.

Scott Benner 49:28
I want to thank you all for listening. And I want to thank you us med for sponsoring the episode us med.com/juice box or call 888-721-1514 To get your free benefits check and to get started today, getting your diabetes supplies the same way we do from us but I want to thank Jenny and remind you that she works at integrated diabetes.com If you'd like to hire her and I'd also like to let you know that this series starts off properly in the first week of January 2024. If you're not subscribed or following the podcast right now on Apple podcast, Spotify or another audio app, do that right now, to get the very first episode of the Grand Rounds series, this series will run for my gosh, I think it's going to probably be 910 10 or so weeks. Once a week, you'll get a grand rounds episode. But there's going to be more than that in the first quarter, maybe the first half of the season of the Juicebox Podcast, which by the way, 2024 will be the 10th season of the Juicebox Podcast and thank you very much for being a longtime listeners and supporting the entire show. But we're not just going to get grand rounds, we're also going to get something called cold wind. That's a healthcare whistleblower series. Wait till you hear the whistleblower episodes. These are professionals working in healthcare, from emergency room nurses to human resources, professionals, doctors, everybody in between. They're going to be on the show, anonymously, with their voices electronically changed so that they can feel free to talk about the business they work in. I don't want to give it away, but you're going to be well, it's going to be chilling. So cold wind, healthcare whistleblowers coming in January to the Juicebox Podcast. In the meantime, you're invited to join the private Facebook group for the Juicebox Podcast. That's if you're a physician, other health care provider or someone living with type one. It's called Juicebox. Podcast type one diabetes, it's a private group. It has over 44,000 members in it, it gets over 100 posts a day of people living with diabetes. If you're a physician, if you're a nurse practitioner, or if you're just somebody helping someone with diabetes, you've heard this and you think, maybe I don't really understand this enough. Just being in that group. You don't even have to participate. But just being there will help you learn more than you can imagine. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.