#1130 Grand Rounds: Human Story

February 13, 2024Scott Benner

Scott and Jenny discuss the human side of diabetes.

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Scott Benner 0:00
Hello friends and welcome to episode 1130 of the Juicebox Podcast

Welcome back to the Grand Rounds series today Jenny Smith and I are going to be discussing the humanity of type one diabetes, that healthcare is a human story. We don't want doctors to forget that part as they're helping us and treating us. 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. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box. Don't forget to save 40% off of your entire order at cozy earth.com. All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cozy earth.com. If you're not already subscribed or following in your favorite audio app, please take the time now to do that it really helps the show

this episode of The Juicebox Podcast is sponsored by the insulin pump that my daughter wears Omni pod, learn more and get started today with the Omni pod dash or the Omni pod five at my link Omni pod.com/juice box. This episode of The Juicebox Podcast is sponsored by touched by type one touched by type one.org. And find them on Facebook and Instagram touched by type one is an organization dedicated to helping people living with type one diabetes. And they have so many different programs that are doing just that check them out at touched by type one.org. So what are we doing today, Jenny? We are going to do? We're going to do a topic that I don't like, I don't like what I have typed above it is its moniker. So we have to like hammer this out. First, I just have the word humanity and mentality which, you know, aren't that descriptive. I think they're meant to lead us in a direction. But I don't know that they're a good title for an episode. So when you think about doctors needing to consider the humanity of the person that they're speaking with. And I think what did we mean by mentality when we wrote this down?

Jennifer Smith, CDE 2:52
I don't know about mentality. But I do know, I remember sending you either an email or a text about us remembering to discuss that. Like healthcare is a human story. It's not just all about data, it's not just all about numbers and lab results and that kind of stuff. There's, there's a person behind all of this, and you have to remember that maybe in their you know, when you're talking to them, how their mental health is affected in the way that you discuss something with them,

Scott Benner 3:24
right. And when you talk about that, it makes me want to expand on that. They're not just, they're not just the person that's in front of you. They have relationships and responsibilities and other problems and joys in their life and all these other things. And you're asking them to do this incredibly, a difficult and time consuming task that feels like of course, you know, the outcome is life and death, you know, to them, of course, and, and they need to go fold this in to the rest of their life when they get home. You know what I mean? You can't just I don't know how they how you, you know, I'm saying

Jennifer Smith, CDE 4:04
and folded it in a way that's very, it's not like folding in a medication for your heart. Right, right. It's not like taking a pill every morning at six o'clock and be like, Oh, that's it for the day. Not until six o'clock tomorrow. Do I have to take another medication? Right. folding this in is really like it becomes a piece of you.

Scott Benner 4:23
Yeah, yeah. You have to like Teach them that the routine is what makes it feel like take a pill at night am like so like What do you mean what I mean by that is sure it's simple to send someone home and say take one of these you know dinner, make sure you eat first. Great, right? Even by the way people have a hard enough time with that.

Jennifer Smith, CDE 4:44
Right? Absolutely. Thus the pill minder apps and all

Scott Benner 4:50
with the days Oh, by the way, the first time you get a pillbox is my experience, but you go ooh, I'm old. Damn. It happened. I have a box with my five Consider, but yeah, like people have a hard enough time remembering to take a pill with a meal. And then one miss day turns into two miss days. And then that thing happens. I watch it happen here in my own house sometimes. My daughter said to me the other day, she takes vitamin D, she needs to write she has to her vitamin D level drops without it. And she misses it for a couple of days. And she goes, I haven't taken this in a couple of days. And I feel fine. Right? Yeah. And I'm like, well, that's not how that works. But what happens when I don't Bolus for my meals, but my blood sugar goes up to 200. But it comes back down, but I feel fine. And I feel fine. Right? Yeah. So okay, so there's that part of it, why don't we go through some of the feedback, and we'll find out as we go. The first thing is from a listener that says, this can be very difficult, and mentally and physically exhausting. And you and I kind of translated that into like, you know, offer people grace, which I know is a is a hot thing to say nowadays, you know, to give someone grace, but what do you think that means for you? I mean, you're personally diabetes, what are you looking for from a doctor?

Jennifer Smith, CDE 6:04
Right. So you know, from a doctor, the piece when I talked to my Endo, especially who's she's super great. And even her nurse practitioners really nice. Grace is not being nitpicky, from their angle of picking out just the one particular day, which was just your like, Crap show of a day, right? Well, what happened here, like, clearly, there's a wider picture. And as a clinician, you can see the scale of how things have been. So instead of picking things apart, you do have to give a little bit and if something is brought up, in that case, by the person to say, Hey, don't pay attention to this, or, you know, I was on vacation for these days or whatever. But you do have to have a little give and take back and forth in order to work together, you know, person with diabetes and care team. I mean, my doctor always asks me, What is it you know, we need to pick apart today, what is it that you really need from me today? And I think they are as a person with diabetes, you have to be ready to come to your clinician as well, with some thoughts

Scott Benner 7:12
that they ask you. You're a person who people come to and ask that question of all day long, like help me, when you go to your doctor, you ask them for help. Today's episode of The Juicebox Podcast is sponsored by Omni pod. And before I tell you about Omni pod, the device, I'd like to tell you about Omni pod, the company I approached Omni pod in 2015 and asked them to buy an ad on a podcast that I hadn't even begun to make yet. Because the podcast didn't have any listeners, all I could promise them was that I was going to try to help people living with type one diabetes. And that was enough for Omni pod. They bought their first ad. And I use that money to support myself while I was growing the Juicebox Podcast. You might even say that Omni pod is the firm foundation of the Juicebox Podcast. And it's actually the firm foundation of how my daughter manages her type one diabetes every day. Omni pod.com/juice box whether you want the Omni pod five, or the Omni pod dash, using my link, lets Omni pod know what a good decision they made in 2015 and continue to make to this day. Omni pod is easy to use, easy to fill, easy to wear. And I know that because my daughter has been wearing one every day since she was four years old. And she will be 20 this year. There is not enough time in an ad for me to tell you everything that I know about Omni pod. But please take a look. Omni pod.com/juice box, I think Omni pod could be a good friend to you. Just like it has been to my daughter and my family.

Jennifer Smith, CDE 8:55
Absolutely, there are things that I bring in as questions in my I've gotten to the point of knowing that my questions really have to be what I can't do myself or what I've got relevant, like questions about that I'm not able to take care of because my own diabetes management clinic. I don't really need my endo for that. But there are other pieces to that other considerations, especially as you get older, when to have these types of evaluations for like heart health, and this type of an evaluation for this firm, Women's Health kind of perspective. And those are all things that I expect them to have a good answer, not that I have no clue about them. But I want a little bit more direction. And so I can come to my doctor absolutely with questions. Do I send even though I look at my own reports, I send my reports to my doctor because if they don't have in between information to keep up with things, then it's kind of like a load that you're piling on their plate, three, six months worth of data and you expect them to figure something out about it. Right.

Scott Benner 10:06
I'm glad to hear that that's your answer. But I also wanted to ask the question to point out that, you know, for all the people who you're like, Oh, they're a nurse, they understand it, or that person's a doctor, I don't need to explain this to them. That's not the case normally. So you know, you can't just disregard somebody because you think they might understand it's right. Yeah, I think that's important. Also, isn't it interesting. When you show somebody a report a graph with, I don't know, a one seat, it's in the low sixes and not a lot of variability and looks great. But there's a couple of bad days here. Why is it your thought to say, Oh, my God, what happened here? Instead of? Wow, so much of your time is so well managed? Congratulations. Like you don't I mean, like, you picked up the one problem. That's what the person remembers when they leave? That is, yeah. And it

Jennifer Smith, CDE 11:00
is human nature to pick for the bad. Like, you see, I do it a lot with all the people that I work with to, you know, they come in either having emailed a bunch of things that they definitely are, we got to zone in on this, you know, and whatever. And I see those questions, and they're important to address. Absolutely. But I also really tried to look at the wider scope, and say, if we could filter out these, these incidents that you think are the majority of the time, you'd actually see that like, 80% of the time, you're doing a phenomenal job, like look at all of this, and these little, these little blips that you don't want, that have become what you're highlighting. They're not the big picture.

Scott Benner 11:42
It is fascinating, isn't it? That as people it's not our inclination to, to gravitate to the things that are going well? Yeah. It's just really, it's not it's not the only place that happens. But it's one of the places where it's, it's really important. So if you're a doctor, and your mom always picked on you, like, don't do it other people. Oh, I mean, I wish all my doctors respected my desire to understand my disease. And there are treatment options. So this is a person telling me, I want to be included in this. And it's not enough for me to be even doing well, I need to understand how we got here. Right? Yeah, I need autonomy. I need. Because that's not just about management. I think that's about psychological comfort to it is

Jennifer Smith, CDE 12:28
yeah, absolutely. And I think that all goes along with meeting the person where, where they are, as well as where, what are their goals? What are your targets? You know, I as a clinician may have targets and ranges and things that I want to help somebody get to. But you have to know where is the person starting? And what what are their immediate goals? And how can we bring things together so that they kind of both meet in the middle? In a way, right? And understanding is a big one, then, for people who have this particular goal, and you really would like to see them get a little bit further. What do they understand about how to get there?

Scott Benner 13:12
I think that maybe far too often, a doctor or it doesn't have to be adultery, any personal interaction, right? between two people. I have an intention about what I'm saying. And you hear something else. And listen, here it is bare bones. It was pouring rain here last night, and it's trash tonight. And my wife had thrown a bag of garbage on the back step. And that's not the direction of where the garbage gets taken out. So it's raining, it's late. I'm like, I gotta take it. I waited all afternoon thinking it would just stop for a second. So I could just bet Okay, now I'm all bundled up and everything. And I say to my wife, I'm gonna get wet, and I am complaining. I'm like, I'm gonna get so wet. But anyway, I'm gonna go out to the trash. But I'm gonna walk around the back of the house to get this one bag of trash that she put out back. Instead of bringing it through the house. It's been outside, it's been raining, and she's mopping the floor in the kitchen. So in my mind, what I was thinking was, I don't want to bring the bag of trash to the house because she's just mopped it. I don't want to make a mess of it. But when I said, Oh, I gotta go all the way around the house to get the bag. I'm gonna get soaked. She thought I was complaining about the fact that I was going to get wet. And I was confused. I stopped and I was like, Wait, what's happening right now? Like, I'm seeing this nice thing. And she's taking it wrong. Or maybe I'm saying it wrong. So I stopped and I just said, Hey, I want to be clear. I'm not upset about getting wet in the rain. I'm trying to save the clean floor that you just made. And I'm gonna go back out. When I said I was gonna be all wet. I meant I didn't want to walk all wet through the house. I'm trying. I'm trying to respect what you're doing. But that simple little moment between two people who've known each other for like 30 years, there was that confusion. So when you look at a person and in a healthcare situation, they go Hello What happened here? Right? You might mean, hey, this graph looks terrific. We just got one little problem. Let's fix it. Let's fix. You didn't say that the way it's taken. Yeah, right. So you didn't say that, or they didn't hear that one way or the other. If you walk away from that conversation having not clarified, you now have a problem. And you'll never get you'll never get rid of it again. So

Jennifer Smith, CDE 15:20
well, and I think what you really what you just sort of pulled all together, without probably thinking about it is the word communication, right. And that's what all of this, all of these that we've kind of put together. Now, they're all about the right type of communication. And communicate communication means that there is an understanding from both parties. And as the clinician, you have to make sure that what you're trying to either teach or discuss is not only being received the right way, but also that there's an understanding that's taking place so that there isn't miscommunication where somebody then gets irritated or angry or walks out. Thank you. Ah, I didn't get any of my questions.

Scott Benner 16:06
Right. Here's the next thing on our list. Let me see if I'll say something, you tell me if you agree with it. Okay, if you're a type two, using insulin, or you have type one diabetes, your management is pretty much the same. take insulin, big picture, not very, like not granular big picture, you're gonna take insulin for food, you're gonna have a background insulin, pretty much the same. Yes, you and I talking about it here. We get what we're saying to each other, right? Yes. But if you say it like this to them, This person says, I was told by my endocrinologist that it didn't matter if I had type one or type two, my treatment would remain the same. He asked me why it mattered to me. Why does it matter to you, if you have type one, or type two diabetes? It's going to be the same either way? I wouldn't have said that to a person. But I was comfortable saying what I said to you. Right? You know, like, why would you add on that little thing? At the end? Why does it matter to you? I almost cursed who would say that to a person. It matters to me, because it's me. Because

Jennifer Smith, CDE 17:07
it's me. And because I think that that clinician is also missing the grander picture of we know, in the diabetes community, despite many people not wanting lines being drawn, there are very hard lines drawn between I have type one, no, I have type two, and the community is learning to work or the communities are learning to work together, which is great. But there still are very drawn like, no, no, I have type one is not type two, and that clinician

Scott Benner 17:44
is not seeing the picture. Yeah, well, you know, I'm probably gonna say something I don't mean to share with people. But whatever I'm trying to help. So to Jenny's point, I've tried very hard, I've had this podcast for like, 10 years now. And I've tried very hard to have a one tent mentality about diabetes. And I do it pretty well on Facebook. And I do it pretty well, here, I don't have a ton to share about type two. But you and I put together a really comprehensive Pro Tip series for people with type two diabetes, a great primer, something get you going if you don't understand that your doctor is not being very helpful. And Jenny knows this, and only a few other people in the world know this. But I knew when I was producing that material, that I was going to lose a certain percentage of my listeners for presenting type two material. And I did, I

Jennifer Smith, CDE 18:32
put out a type as you've been seeing mainly as a type type one. And

Scott Benner 18:36
but I think, moreover, that there are a number of people with either type one or type two diabetes, that do not want to be associated with the other side. And so most of 2023, I spent rebuilding the listeners I lost from just offering type two information. And by the way, don't get me wrong. It wasn't like, here's three weeks of type two information. It's in the course of a five day period, which I put out five episodes, for like eight weeks in a row, one of the five episodes had type two information. And it angered or annoyed people to the point where I lost, I think about 600 listeners, right, which is good. I think

Jennifer Smith, CDE 19:15
it had started as you kind of mentioned with the comment from this clinician to this person, right? That's unfortunately that's where it kind of gets lost is how you're maybe how you're diagnosed or how you're told about it. And honestly, the lines in terms of the types of medications now are very blurry between type one and type two. Yes, there are some very well and very specifically defined meds that are really type two or the reason and the how they were in the body that you wouldn't use in type one diabetes, right. But now a lot of the meds that are available despite them being classified or whatever, you know, prescribed as a type two, they're finding an awful lot of benefit in type one. And so I think we've got this line that's getting blurred, that despite being two distinct conditions, for different reasons, management is kind of crossing over, honestly.

Scott Benner 20:18
Yeah. And I think what Jenny's saying, like, without saying it is that you're gonna see GLP medications used more frequently with type ones in the future. Yes, I'm gonna have people on the show this year, handful of people who are type ones who, you know, maybe started for weight reasons, they got weak ova or something. And then they started seeing all the impacts on their, on their health. We're seeing people using it for like, PCOS symptoms, and they're having a significant reduction in their insulin. So yeah, it's possible that maybe this issue goes away moving forward. But for the moment, just look up, see sports, politics or anything else. People like being on a team? And yeah, you know, so and by the way, that part of the conversation aside, how about, he asked me why it mattered to me, that might not have nothing to do with that person wanting to be on Team type one or team type two? And maybe it's just I'd like to know what's happening to me, please. Right. You know,

Jennifer Smith, CDE 21:14
and honestly, as we've said, there are now I just said, there's there is a distinction between the reason between type one and type two in the majority of cases, right? And so for somebody to say, Well, I just really want to be in one or the other. Because there is a different community aspect, as well, in either one or the other.

Scott Benner 21:37
How about I'd like to look out for the rest of my family and see, you know, maybe I maybe I could be going back to my sister and saying, Hey, listen, you have a kid, like, look out for this, because I have type one diabetes now or, you know, who knows? Like, there's so many reasons why. I have some feedback here that says, I want the doctor to know that when I go in, in with a problem, it isn't always related to my diabetes. So that point is a good point. But for this specific conversation, I think what that means is Don't look at me and just see diabetes, please don't go, oh, that's a diabetic. If they're complaining about this, it must be because they have diabetes. Maybe it will be. But I think you make a mistake when you do that. And I can only relate a personal anecdote. But when my daughter was young, I taught myself. This was before CGM, so she'd come home from school, I didn't know where her blood sugar was. I was worried out of my mind, about the 20 minutes that was between when she texted me, I'm getting on the bus and my blood sugar is this. And when she actually got home, I first had to stop myself from standing at the door, like, oh, my god, are you okay? You know, and then I realized I can't ask her what her blood sugar is, when she comes home right away. It's dehumanizing. It really is. And you you might not think it to hear it out loud. But it is you are it's a dehumanizing thing to have someone look at you and say, What's your blood pressure? what's your what's your blood sugar? What's your but like, it's like, I'm a pull person here, you know, and so I take this person's point. But in that specific example, if someone comes to you and says, I'm having headaches, don't treat them like a diabetic having headaches. I mean, maybe you can in your mind and like be looking for things. But also they get real people sick too, which is a thing. People with diabetes, say because, right, it's so misunderstood, you know?

Jennifer Smith, CDE 23:37
Well, and those are the cases that I think some people because they have gotten to have a relationship with their Endo, and maybe don't really use their primary care as often because they just don't get sick, or they don't have some of those minor things, sometimes a lot of endos or endocrine nurse practitioners or whatever, they may actually feel some of these questions that are, I've got a headache. And so they are in one particular field of care, you know, diabetes, and obviously the other kinds of things endocrine takes care of, but they have to think first is this relative to diabetes. So those questions may come out from the clinical side of consideration. But then their job is to also say, you know, what, everything looks really great, you know, in in your numbers in the data that you've given me, and I think that this is a consideration for your primary care. I'm going to refer you back here, or I'm going to refer you to ask for this type of, you know, clinician to seek out and get information from because you can't expect your endocrine team to manage all of your questions. Their job is to consider will this have impact on your diabetes? And if not, I'm going to refer you. Do you

Scott Benner 24:58
know that there have been times We've taken my daughter to a specialist for something else. And I'll tell her when we go in, do not mention your diabetes. At first, like, let's explain what's happening, get their unbiased opinion of what you've said. And then we can layer that on afterwards. But that's just I've just found if you walk in and go, I have type one diabetes. And that's it, you're done. Like, they're going to just their brains gonna checklist down, find the thing that fits and not bother thinking about your issue. Now you tell them at some point, but I'm like, let's get it out first, and let them really consider it. Right, you know, they'll get a confirmation bias, and they won't even know what's happening. Right? This is something this person says, I wish that my doctor understood that shaming and judging me and other patients for not checking our blood sugar as frequently as they think we should, is absolutely not the way to get them to check their blood sugar more often. It makes me resent coming to the doctor.

Jennifer Smith, CDE 25:54
And from an explanation standpoint, or a clinician, again, there you are, it's really important for you to explain more about why you're asking for this, right? Not the blame game of, well, why aren't you or I don't see enough information here. It's what's going on? That's a problem. Right? What else in your life is kind of deterring the ability, you know, to get this information, and from a clinical Is this the reason this would be really helpful, you've brought in these other questions and these other things that are bothering you. And if I had a little bit more information, I might be able to say whether or not diabetes is really a piece of this or not, right? So,

Scott Benner 26:44
you know, it occurs to me while we're talking that if if you are listening to this, and you don't know you and I, it could almost seem like we're doing some Ultra woke like, be nice to me or like, you know, we're not, we're not, we're trying to sit, we're trying to say, the way you start is the way it finishes. And that people are going to be obviously unique and different and hear things in a ton of different ways. But there is a way for you to approach everyone, whether it's, you know, me or you or a little kid in a way that you can get the information you need from them, help them and not leave them in a situation where they're resenting you as they're walking out of the office. Like, even if you're right, like, I want to say that like even as a doctor, if what you're hearing right now is I need to know how often they're checking their blood sugar. This is very important. I think it is too. I'm not saying it isn't? Yeah, I'm saying that the way you get that information can go a long way towards building a good relationship. And by the way it you know, it might sound like I don't have time to figure out every person that comes into this office, I know exactly how they want to be talked to. But that's not really the case, there is a way to approach this, that covers everybody. And you don't have to have 1000 different statements to get you to your answer. There's there's ways to talk to people where you don't leave them feeling badly about your interaction. So that's what I'm talking about.

Jennifer Smith, CDE 28:09
As a clinician myself, I always consider it from how do I want to be approached when I come in for my own visits, right? And, again, the reason that I like the team that I work with is because it always seems to start the way that I actually start a visit or a conversation with the people that I get to work with is like, how are things tell me about your family? And what's going on? And like, oftentimes, like the first five ish minutes or so is just how are we like, how are things going in the past month since we last talked or emailed or whatever. And that's what I expect when I come in, you know, I know clinician visits in office, they're limited in time. So there's only so much that you can expect them, you can't give their whole life story for three hours. And then finally get to what you need to get to. But there is that human side of connection, that may very likely open the door to them providing enough information for you to then give them what's really important.

Scott Benner 29:07
Well, what you end up giving them eventually to is this autonomy to make decisions? Yes, which is what you want, you know, you want to give them confidence, and enough tools. And you know, like lead them in the right direction. Once they go do something and watch it go well, and then they get excited and do a better job. And then before you know it, it's commonplace, then they're just going to be in there asking you for their prescriptions, and hey, how are you? How are the kids and let's go, and everybody's healthy and happy and what you want. It's doable.

Jennifer Smith, CDE 29:37
It is doable. And I think that those tools, you made a good like connection there and those tools that you may use to give somebody they change based on the person. And if you spend even five minutes in a visit, in which you start to get to know somebody's life, and what's going on the tools you pick out of your toolbox to help them they're going to be specific Add to that person's need, you're not going to tell them to do this when their time constraints are ridiculous in their day. And even though you want them to do something that's time consuming, you can now say, okay, they don't have time for this, I have to, I have to figure something else out, that's going to be relevant to get them to do what I think is important, but that they can do they

Scott Benner 30:18
need a win, too. They do. They need a win to build on, everyone needs a win to build on. So you got to you have to find a way to give them one. It doesn't fit here. But I just had an experience with somebody yesterday. And that's what I figured out. I was like, she's just she's drowning. Like, she just needs to take four breasts in a row where she doesn't feel like she's drowning, and it's gonna get better. And I'll tell her this one little thing that will move her in a better direction. And sure enough, two days later, the content and tone of her message. This is by the way, I'm not even speaking to this person is just typing the content, the tone of this lady's message shifted in 48 hours, and now she feels empowered. That's it. Right? Not that hard. By the way, this one is written like it's from a listener, but I think this is huge Eddie. Oh, don't tell your newly diagnosed patient that you need to see them again in three months only for them to go out to the counter and find out you're booked out for five months. Yeah,

Jennifer Smith, CDE 31:15
that's really annoying. Yeah, it is. And I think it's the reason that many offices, again, endocrinology, specifically, there are not enough endocrinologist, there are just not and when you break it down even to pediatric endocrinologist, they're even less, right. And then thankfully, we're now bringing in more nurse practitioners and PAs into endocrine practices. So that, you know, if it's six months until you can see the endo will maybe in three months, you can see the PA or the nurse practitioner and you do kind of a handoff back and forth every three months. But you're you're right. I mean, if you've been told to check in, and the check in point is going to be six months down the road, instead of two or three, you're left hanging in this in between void of, well, who is going to help me here? Am I even gonna get an answer back is somebody going to look at my information? This

Scott Benner 32:14
is Jenny talking about it from like a maintenance, like a management perspective, I'm going to talk about it from a psychological perspective. You just told me, it's very important for me to come back in 90 days, then I walk outside and the girl that things like we can see you in June, I was like, June, it's December, she said for me to come back in three months, we can't do that, right? Is that important? Is something bad gonna happen. She said, 90 days. And you leave people in turmoil, always causing them turmoil and churning up their guts and then sending them on their way to be by themselves. It's confusing very much is, I wish my doctor would not have connected food with guilt, because that was a mistake that lasted a lifetime. Yeah. So it does suck. But as bad as that is to do to a person who doesn't have diabetes and isn't using insulin, it's maybe 50 times worse to do somebody using insomnia, you freeze them. And either cause I mean, you cause an eating disorder in one way or the other. They either restrict their food, or they just go woohoo, I'm not going to pay attention to this. Right? It's terrible. Like you can't do that. There's a

Jennifer Smith, CDE 33:20
and a major, a major part of your diabetes management is tied to food. It's insulin. Right? So now that you've tied this piece that's necessary, I mean, two pieces that are necessary for human life, right? We've got food, it's a basic necessity, we have to have food, not too much, just enough. But you have to have the insulin to get the food in the right place in your body. And so now when you connect them in a negative way, they say, Well, you know this all about this food, and oh, there's too much here and oh, look at that. And all these blood sugar changes that we don't want to see. Oh, this must have been a really horrible meal. You see, though, oh, that was the bring in? Well, gosh, should I just eat lettuce or nothing at all? Yeah,

Scott Benner 34:02
there's an entire movement right now of us identifying a problem. And then blaming the person that's happening to you could ask an eight year old at this point, what's the problem with food and American? They're gonna be like, Oh, it's processed and not good for me. Blah, blah, blah. And then you know, you go don't talk to my kids. Your kids don't know Jenny, raise those kids. They think a carrot is candy. And so but but you know, most people are gonna say, oh, yeah, I know there's a problem in the world processed food, fast food. It's troublesome. So much soda. You know it, our bodies can't handle it. Everybody understands it. But then when you get to the How to functionally help somebody, that's their problem. They're eating it. Have you ever driven around America and tried to stop and getting some deed? Good luck finding something I'm using we go V for weight loss. So now all of a sudden, I realized that in the past, if I was traveling, I would just eat what I could get my hands on. Even if it wasn't something I would Normally, but now I'm very careful not to eat like high, like anything that's fatty or greasy, even once in a while. And I have found myself going, there's nothing for me to eat here. And then going to another place and going, there's nothing for me to eat here, there's no food, I'm gonna have to go into a grocery store and get an apple. I can't physically walk it. We've set up a society, where this is how food has gotten restaurants, convenience stores, those sorts of things, and then fed people a ton of bad food, and then told them in the end, it's their fault for eating it. It's all they have. Right? You know, so I don't know how that happens. Like, how do you say to somebody, or you live in a volcano, your problem is your feet are hot. Thanks. Can I suppose to do with that? You got shoes that don't get hot? Can I? Can you hang me from the ceiling? Is there a like, don't tell me the problem. I know the problem. Give me an answer. Anyway, that's

Jennifer Smith, CDE 35:58
no, that's 100%. Correct. And I think there are too many. I mean, this is a hot, this is a hot sort of piece in my mind that it bothers me when when clinicians who have no nutrition educational background, dole out blanket statements. Yeah. Right. Because one, you have to be blind to be completely or, you know, unaware of what's going on in our food society. The majority of the stuff that people call food, or that is readily easily available, is it's not hard, right? And I wish there was an easier way to define it. But it's also the reason when you go in a grocery store, the grand majority of that grocery store is not stuff. That's really great for anybody to eat. The tiny little natural food section.

Scott Benner 36:54
That's the food. The rest is tastebud Playland there. Yes. Yeah. But but that's fine. But then don't as the doctor slip into bro science and be like, it's your fault. Right. Great. Thanks. Do you want me to do I make $250 a week? Could you help me? Yeah, hey, I don't know what to do it anyway, it's you're blaming people for a thing that you can say they're in control of, but if you look at the big picture, they don't have any. Yes, they're in control, but they don't have any choice. And so it doesn't matter. They're doing the thing that that's keeping them or at least they're eating, and they're staying alive. You know, and they probably were brought up thinking that it was good. Anyway, cheese. All right, now I'm all upset. Don't tell people they're non compliant, there's a free tip. You can think it if you want. And I know you probably have to chart it for, right, but you can't let them say it either.

Jennifer Smith, CDE 37:48
Well, and that's the thing too, with today's you know, II charts and everything that are readily available, and even electronic medical records that now we have access to as the person who has the health condition, right? When I log in, I can absolutely read everything that was written in the doctor visit, right. So I think that word in an overall it should be totally removed. Because I think there are very, very, there's a very minimal amount of people who that truly would even apply to, and even that minimal amount, it's very likely the fact that they're not, they're not by choice, non compliant. It's there are things in their life, that are not allowing them to know enough about what to do, even in the simplest way that could make things better. And that's your job as a clinician again, to get to know them, and figure out how to help,

Scott Benner 38:46
right. And also, by the way, there are going to be times where you give information to a person that knows better than you. And then you think they're non compliant for not listening. And if you think that's a crazy statement, then I'll introduce you to the 1000 people who've told me that they've lowered their a one C safely and in a healthy way and then go on to the doctor, the doctors tried to tell them to put it back up again. So you know, that actually happens to people as well. Caretaker burnout, you should include that conversation when you're talking to parents or people who are helping adults with diabetes that this and this kind of leads into the other part I want to I want to finish up here with is that I understand that the doctors might be burned out as well. Yes, you know that they have this compassion fatigue, maybe, you know, and that it's hard to like, I would imagine it's hard every 20 minutes to be like hey, how are you? What's going on with the family? You know, like I just did this with the last person being so needed like that being so needed from you not fake by the way if you fake happy people read that in two seconds, like Oh, absolutely, yeah, you can't fake the happy like you have to really mean it. And you have to have if there's good communication skills, and you know all For people real empathy, not like, right, you know, I know I'm supposed to say I feel bad for you. I know this is hard, but you know, and

Jennifer Smith, CDE 40:08
something that I've found to within that realm is the ability, the ability of the clinician to connect as a person to. Right. A lot of times, we've heard that term like white coat syndrome, right? And to take that down a notch and bring a comfort level in, when you're asking about somebody, many times they'll ask, well, how are you? And that's not a well, how are you? I just want to know that you say, Well, I'm okay today. Most often, they're really they're interested, right? And if you, if you give yourself a personality, or if you give a little bit about you, and how your life has been and whatever, you don't have to give where you live and where your kids are going to school or anything, buy real, something, something real, something that's that's connectable, right? That makes you, I guess, and the information you want to provide a little bit more receivable.

Scott Benner 41:06
Yeah, sure. You be a real person, although, yeah, some of us are going to run into doctors who are fantastic doctors, because their personality lends themselves to understand science and sit and study for years and everything. And maybe sometimes that doesn't lend to like, you know, personality, personality. Yeah, like, like, like a real life. Not that they're terrible people, but they just might not be like gregarious, and, and inviting sometimes and stuff like that. I mean, it can happen to anybody, but I'm just saying, I've met a couple of doctors who were brilliant doctors who, you know, you're in there, you're like, oh, was this heart? Yes. Great doctor, but hoof. I mean, what's the way to say that like, no bedside manner, what that really means is they lacking communication. But I don't come in and say, Hey, I fixed your toe, I put the ligament back on there. Let's do the exercises come back in six weeks, it's gonna be fine. You know what I mean? Like, this is a bigger thing. It's a lifelong thing that this last little bit here is this person says, sometimes it's like, they don't realize that I've been living in this body longer than they'll ever spend hurriedly glancing over people's notes while rushing into an office to talk for five or 10 minutes. Yeah, don't minimize my experience. You know, and I don't believe a physician rushes in and out, looks at your notes, tries to help you and thinks I'm minimizing this person's human experience. Right? They don't think that but no, this is how it's received. You just wouldn't know that. So in the end it Jenny, this is why you'll hear people say over and over again, if you can find an endo who has type one diabetes. Bolus? Yeah, yeah,

Jennifer Smith, CDE 42:48
absolutely. Or, you know, a clinician in their office that they are using for their education piece, right, either a certified diabetes, you know, educator or they're working with a, an, even a dietician or a nurse in their office that participates in some of the education that they have type one diabetes, and those are the ones that I hear from, in terms of the people I work with that I really love my office because of this one person, right? They really get it or they're always taking my calls, even though I know I call a lot. They're taking my calls, and they're getting me some information or some answers, you know, so, listen,

Scott Benner 43:28
I've heard this story a handful of times. And it's always lovely. It's like you said, like a nurse practitioner who has type one, or somebody else involved in the practices in the room, maybe when you're talking to the NFL, and they'll walk you out and down the hallway. They'll lean in and go Juicebox Podcast, and people and people people go want to go you want to listen to the podcast, it's called juice write it down juice by know what the doctor just said. But listen. So yeah, having somebody who really gets it is very helpful, but I appreciate you doing this with me. Thank you very much. Thank you.

A huge thanks to touched by type one for sponsoring this episode of The Juicebox Podcast. Check them out on their website touched by type one.org or on Facebook and Instagram. A huge thanks to Omni pod, not just my longest sponsor, but my first one Omni pod.com/juicebox If you love the podcast, and you love to Bolus insulin pumps, this link is for you omnipod.com/juice box if you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes

if you're looking for the diabetes Pro Tip series, it begins at episode 1000. In your podcast player or you can find that at diabetes pro tip.com or juicebox podcast.com. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way. recording.com