#1135 Cold Wind: Healthcare Whistleblower Adult NP, GLPs and more

February 24, 2024Scott Benner

"Kat" is an anonymous Nurse Practitioner who provides insight on working at an adult endocrinologist office. Discussion of GLP meds and more. Her voice and name have been changed to protect her identity.

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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 1135 of the Juicebox Podcast

welcome back to another episode of cold wind. Today we're going to be speaking with a person we're calling Cat. Cat is a nurse practitioner in adult endos office, and she also trains people in nursing. Today we talk about type two GLP is type one. And in the end of the episode, we go over what you might expect in an ER. If you have type one diabetes. Hint, it's you shouldn't expect much. While you're listening today, 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. The cold wind series is looking for more guests. Do you work in healthcare? Does your job let you see what's happening in healthcare? Do you want to tell us all about it? While you're staying anonymous. Go to juicebox podcast.com and send me an email and we'll start to talk and see if we can't get your chilling story on cold wind

a huge thanks to Omni pod not just my longest sponsor, but my first one Omni pod.com/juice box if you love the podcast, and you love tubeless insulin pumps, this link is for you omnipod.com/juice box. This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox Hello and welcome to the cold wind series from the Juicebox Podcast. These episodes will feature physicians, nurses and other professionals who agreed to come on the show anonymously to share what they see in the healthcare profession. I've altered the voices of each guest so that they can remain anonymous and feel comfortable telling us what really goes on at their job. Just listen to how well the voice altering works.

Speaker 1 2:19
My name is Beth and my oldest child has type one diabetes diagnosed in October 2020. My name is Beth and my oldest child has type one diabetes diagnosed in October 2020.

Scott Benner 2:32
If you work in health care and have a chilling story to tell about your experiences in the healthcare field, contact me today. I'll get you right on the show. Your story does not need to be specific to diabetes. So today we're speaking with someone anonymously. And before this person introduces themselves, they get to pick their own anonymous name. So go ahead. What do you want to be called?

"Kat" 2:58
Okay, I'm gonna go with Cat, Cat. Cat KT cat,

Scott Benner 3:03
as unreasonable as it sounds, I'm just gonna say do you prefer that with the C or Okay?

"Kat" 3:07
Actually, okay,

Scott Benner 3:09
okay, we're doing it with a K Cat, cat with a K. Cat. Tell me what you do for a living.

"Kat" 3:15
I'm a nurse practitioner. I work at a hospital system, one hospital system. Full time as a nurse practitioner and endocrinology practice. And then for my side hustle. I go to a different hospital system in a different in a different role as a nursing instructor. Okay.

Scott Benner 3:35
Oh, that's interesting. All right. So you're in a, an NP for an endo for an adult, endo or adult. Okay. How long have you been doing that?

Unknown Speaker 3:47
10 years.

Scott Benner 3:49
Do you have any personal attachment to diabetes? Do you have it or know somebody who does?

"Kat" 3:54
I do not have diabetes. I do not have type one diabetes, okay. 100% of my patients in my practice have diabetes. And it's kind of typical for nurse practitioners in an intercalary practice to focus on diabetes. Okay, I'm going to nurse nurse for 30 years nurse practitioner for 10. And I fell in love with diabetes. When someone said, Hey, we're starting a diabetes program. What do you know about diabetes? I said absolutely nothing. I worked in ICU for 20 years. So I learned from the ground up.

Scott Benner 4:27
How long ago was that? About 20? About 20 years into your career, I guess. Yes, yes. So does the practice do mostly type one or type two? Mostly type two, type two. Okay. And the practice does other endocrine things, but you're specific to the diabetes side.

"Kat" 4:44
Yeah, I like to say chronologist do all the fun stuff that thyroid, parathyroid, thyroid cancers, you know, everything else. endocrinology related,

Scott Benner 4:54
right? Just vaguely what's the percentage split type twos, the type ones that you see

"Kat" 4:59
Probably at 515. Okay.

Scott Benner 5:04
All right. So let's start with my question about type twos. What's the biggest roadblock for you in helping people with type two diabetes? Well,

"Kat" 5:17
I work. I do, too. I unfortunate in my early career in diabetes was in a in a clinic. And when I people use the word clinic two different ways. When I say clinic, I mean, uninsured, not documenting, meaning people who will never have a chance to have insurance. So I was dealing with a lot of, you know, no access to health care, well, we were the access to health care in a truly clinic setting, they had no money. A lot of, you know, it's kind of a buzzword now. But social determinants of health, or social drivers of health where they truly didn't know where their next meal was coming from, didn't have stable housing, English was not their first language. So I felt truly blessed that I worked in an inner city place. And I still do, so that, you know, type two diabetes, along with access to medications was because I had I could use metformin and you know, stuff on arrays, and, you know, Walmart from insulin, insulin from Walmart for about three years in my career. And then I go into a private practice, where about 35% of my patients have Medicaid, which, you know, I love Medicaid, getting Medicaid, you have no co pays. So I know, you can afford your medicine, and you come to see me for free, it just the barrier would be transportation, but now we do zoom calls. So a lot of that barriers be taken away. But you do have some access to food issues and health issues and housing issues I still deal with. But now I have, you know, the other 70% of the population who have commercial insurance, which we all know co pays suck, but every say, those are the people who coupons on me for so please go online and get coupons for your medication. So the barriers to type two diabetes are kind of betting on which population I think I think of my truly, you know, office patients has more to do with, I'm not beating around the bush and tried to

Scott Benner 7:13
say, oh, no, you're doing you're doing a good job. Yeah, no, but

"Kat" 7:18
you know, it's, it's what we eat. And a lot of the patients and you know, including myself, you know, deal with depression and things like that, who gain weight. I just may feel when I talk to someone, it's never, not never a lot of the times and yes, I know we have stressors in our life, and we don't make eating a priority and exercising priority. And I still say it's at 28% weight to understand exercise. When someone says and I see people every three, four months, and I see and you have to change something, you can't do the same thing and expect to see a change. So I think we tell like I hear a lot that we're we made a change. But you know, when you really get down to it, they didn't. And again, I'm doing a little self reflecting here myself. Right think of people, but I didn't put people on Adobe or ozempic or Manjaro, the news found that's coming out next week or in two weeks whenever they're not magic bullets. Yes, they do help. But you really see people get results when they make the lifestyle changes. So I think if you're really honest with yourself, we we aren't doing what we're saving a lot of times we're not doing what we say we're doing and we have the best intentions.

Scott Benner 8:35
So what would you say that the biggest? So there's two populations that you've dealt with professionally. There are people who are don't even like you said to have a place to live. They have a they have a completely different roadblock. Right, right. But yeah, yeah, but in a professional see those patients? Yeah, but in a professional setting where people are insured, and come in, you know, they're almost trying to be proactive, or they've been sent there by their general practitioner for a problem. You think the biggest problem that you see is follow through? Is that you you give people information, and they go home and don't do it?

"Kat" 9:13
Yeah, yeah. I'm not labeling because because I, I know, you know, there's so much more than their life and diabetes and with everything else that goes on with life, and it's not, okay, I just, I can't call the biggest barrier. I'll just say one of the

Scott Benner 9:33
Well, we'll find the rest of it. But let's, let's go through that thought a little more though. So they go home with marching orders of some kind, but they're probably immediately met with the fact that their house is full of food that might not be beneficial to them or their lifestyle is set up in a way where they can't they don't have time to get moving or they don't even know how to exercise or how to begin to exercise or maybe they're already in firm some way and it makes it feel difficult. The first time to get a pay You go while wait for this to stop hurting my knee before I keep going. But you know, like that sort of stuff. So the food that's there, I'll tell you right now I think the first thing that happens to people is they get home and they're like, look, I already paid for this food. I'm not throwing all this, thrown all this out. So let me eat through all this. And then next month, I'll start, except you go to the grocery store and you don't buy things differently. You don't suddenly go, Oh, I'll have a carrot. And you know, like, you're like, Oh, I love I love to read us. And so like, that's the problem is the shift plus, the bigger problem might be that the processed foods, and really kind of like high carb, high sugar foods. I think they have a hold on people. You know,

"Kat" 10:44
120% agree with that. They're super addicting. Absolutely, they do. They truly, truly do.

Scott Benner 10:51
My wife bought these little candies last year, right. And she can eat them, like once every light blue moon. But if I see them and have one on my, oh, I'm gonna have three of those. And I don't even think and I just reach out and I take three. I'm like, these are tasty. And then I'll have three today and then three tomorrow. And then the next day, I'll be like, Oh, I might have six of those. I got three in the morning and three in the and I don't think about it. It's just it's in like what she sees as a decorative jar, that she might take four years to go through. And I'm like, if you leave that where I can see it, I guarantee I'm gonna eat all of those in a month.

"Kat" 11:28
And it's funny. Yeah. And I and I in the same way, it just can't be in the house. I struggle with telling someone Oh, in moderation versus nothing at all. Because then people say, Oh, I'm going to just crave it and go get it. You know, you hear I guess my, my own practice of doing this for 10 years, I'm not sure what way works the best, you know, totally eliminate from your diet and just have it as a treat. Or some people say, I wonder I teach in my love. She says get a shot glass and put your chocolate chips in there that you treat for the night. So you're not depriving yourself. So yeah, I get it. People are one way or the other there. And I find that there's, there's little gray on that with people that I know myself. I can't do the moderation thing. It's got to be out of sight. So

Scott Benner 12:19
yeah. So the people you meet, you feel like they they lean one way or the other either just throw it all away, settle on fire, get it away from me, or, you know, I can do moderation, but but some people can.

"Kat" 12:33
Yeah, and I truly you're fighting I? I can't I can't say that. Well,

Scott Benner 12:40
I can't say that. Nobody knows who you are. Okay,

"Kat" 12:43
no. So this is not the first time you when I met. You actually you actually said to me when I said I'm a nurse practitioner practices in the cloud, blah, blah, blah. You said, Are you good at what you do? Do you remember saying I

Scott Benner 12:57
don't know I'm I'm always making a podcast, even if we're by ourselves. I'm just probably just asking questions. So you, so we met in person somewhere. And and you identified yourself and I said, Are you good at was that what I said? I'm an asshole, aren't I? That's terrible.

"Kat" 13:16
I said I should yeah, I'm absolutely I said I'm very good at what I do. And you can judge that by, you know, different avenues, you know, but one of the ways that the organization where I work encourages that is those patient comments that, you know, you're graded by those and Press Ganey scores, and, you know, you get rated by your patients. So I, you know, we get a lot of patient feedback, you know, with the patient, all I hear you get when you leave the doctor, you get a survey, you can fill out the five stars, but then there are those people that take a little bit further and they actually write comments. So, what's consistent about the comments that I get is that I listen, and I make sure that they participate in their care and I explain things, they know that they know the why behind what they do. And it's something like that. So I, I do pride myself on that, like, I don't just say I'm, you're going on with OB and this is why, you know, I make sure they understand how Ruby works or why the SPLC to me, you know, why recommends protect your heart and your kidneys. Oh, by the way helps diabetes to so

Scott Benner 14:26
like a full explanation. So it's not just take take this Yeah, they get to know why they're doing, what they're doing, how they're going to do it and what the expectation is from it. 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 on 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/juicebox 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. If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily jeuveau Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you storage evoke hypo pen and how to use it. They need to know how to use Chivo Capo pen before an emergency situation happens. Learn more about why G voc hypo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma. Visit G voc glucagon.com/risk For safety information.

"Kat" 17:21
I do yeah. Or they'll come to me their primary care doctor put him on you know the shuttle to just you know Tuesday Jordans for Sega don't want to be out of sugar. But your agency was telling you that he's infection after UTI of yeast infection. Like he I wouldn't have done that with the reader servers in the 250s. Yeah, I can tell you why that he's infection takes me two seconds. Well, now they're like, Well, I don't want to take any more time. But we'll stop it for now. But let's try something else. And I will put you back on it later. Yeah, we'll talk about it. But so yeah, getting back to that roundabout question is Yeah, I do try to explain, you know, things and right. Yeah. And listen, bla bla bla. So

Scott Benner 17:59
sticking with type two is a little longer here. If I since you're going to be anonymous, you can just say what you think, okay, if if people who came in with type two diabetes, whether it was genetic or lifestyle, or mixture, any any number of ways that they've made it to having type two diabetes, if you could literally control their intake and their exercise? Could you help everyone? Or are there some people who even if they ate well and exercise, they'd still have type two diabetes?

"Kat" 18:29
small percentage, I wouldn't say yes, we still have type two diabetes, but you

Scott Benner 18:33
think it's mostly those ideas? It's movement and food. Okay. Food, food first. And people you find is true, that some people think they're eating well, when they're not. Absolutely.

"Kat" 18:47
Okay. So here's the best example. We check them out, you're gonna come through the door, and it will be high. And also, you know, during the intake process, that nursing assistant will say, you know, when's the last time you ate? What did you eat? I had blah, blah, blah. I stopped at McDonald's on my way. And, you know, but I don't normally eat that. Well, you don't normally eat that. But you had it you just happened to have the day you came to. I just find that funny.

Scott Benner 19:14
Beyond funny beyond funny cat, you find it a lie. Is that correct? Yes, yes. You think they're lying? Like Like, like your your thought is? Why would you go to McDonald's only once this year, and it'd be the day before the the hour before somebody's checking your blood sugar in a medical situation?

"Kat" 19:34
Correct? Yeah. And here's the deal. I live with a man who takes hasn't lost any weight and I can tell you why. It's not the

Scott Benner 19:44
drug. So So okay, so you have personal experience with a person on Weibo V. Are they how far into the process are they? What's their? What's the dose they're getting right now?

"Kat" 19:55
2.40 that's

Scott Benner 19:57
the full dose. They've been on it for a while. Yep. And he's eating through it. Is that your contention? Absolutely. type of food he's eating through? It is is it's still not good. It wasn't good food before. It's still not good food now, or is it is the bulk of food? Both. Okay, now I can tell you when you met me in person I probably had. Do you remember what month that was my experience? August? Was it really though? Okay, so I've lost 40 pounds, probably 30 of them since I saw you. March, April, May, June. Actually, that's not fair, maybe 20 More since I've seen you. So I've lost 40 pounds on Weibo v. And I was not a poor eater to begin with. Like, I didn't take in a ton of calories. Even though I you know, talking about candy, like I don't eat candy every day all day long. My intake is pretty reasonable. I just have always maintained there's something wrong with my body, it just doesn't work. Well. I believe that to be true, even more. So after beginning to take we go V because even on a non therapeutic dose, I was losing weight. Like right away, I lost weight in the first week. On we go. Yeah, you know, now that I'm down 40 pounds, the weight loss is slower, I don't have a lot more to go, I don't think maybe 15, maybe 20 pounds, I don't know exactly. But it's very mean and see, like at this point now fully dressed standing in front of you, you would not go that person needs to lose weight, I look significantly different. I think that I have a deficiency of some sort that the GLP medication is covering for but you think there are some people who don't have that deficiency, they just have the they eat a lot. And that medical.

"Kat" 21:48
They don't have the deficiency. There's lots of reasons why the IDI binge eating disorder, you know, there's reasons why people continue to eat. But the flip side of that is yes, so I do have patients who come in not losing weight on these medications. But that I do see the people like you who are doing phenomenal, absolutely phenomenal on these medications. And I just I just praise them when they come in. It's just a life changing. You know, it's just so life changing for them. And they change the way everyone in their house eats they're so they're making future generations healthier. They're they're teenagers are now eating healthy. It's just amazing. It's just so inspiring to see that.

Scott Benner 22:34
Yeah, no, I believe I believe what you're saying I actually think that the GLP is might change an entire generation of the country and how it needs but

"Kat" 22:41
did GRPs. And now you've got release coming out with the third one, the GRP GLP. One. And I forget what the third hormone is going to be. Yeah, it's helped me out much. But

Scott Benner 22:53
I don't want to skip over the binge eating thing, because I have input on this. I know what you're talking about. Because for me, we go, we can make your stomach feel fuller, right being that does that by slowing digestion. But it also tells your brain you're not hungry. Right? So like, I have to remind myself to eat. But when I when I remind myself like is this a good example, it's 1030 in the morning, I haven't eaten yet. And I had a long weekend. So I decided to sleep in a little bit, get up, record the podcast and I'll eat after, when I'm done talking to you, I still won't be hungry, my brain won't be hungry, and my stomach won't be hungry. But I will eat because I know I need to eat. But I could over eat. If I wanted to. I could I could absolutely make a conscious decision to eat food and just eat it. Which is which is fascinating because it sounds like it can sound like to the person on the outside or the medication stopping and breathing. It's telling him his brain. He's not hungry. It's telling his stomach. He's not hungry. It's all true for me. But if I just said to you right now I'm gonna go downstairs and eat as much as I can. I could do it. I wouldn't feel good when it was over, etc. But if I had that psychological component of it about the eating, which really does, I think go to prove that that somebody in that situation is not being ruled by anything except psychology in that situation. Do you agree with that?

"Kat" 24:21
I agree. I agree. Yeah.

Scott Benner 24:23
So there is that there is a person that could be in that scenario too. So the person you know, they should be seeing a therapist, you think they're not going to know it's you. So go ahead. You can say whatever you want.

"Kat" 24:36
Yeah, yes, yes. Yeah. And there's better medications. That's why, you know, people can take, you know, wiggly and beyond phentermine, I mean, not to phentermine treats, binging disorder, right and stars, but there are people who do need both. So it's not uncommon for me to prescribe some local tribal phentermine or other medications that also help

Scott Benner 24:59
Did you Just say that Vyvanse helps for binge eating disorder. Yeah,

"Kat" 25:04
it's FDA approved for that. That's also

Scott Benner 25:07
that's that. I just wanted to make sure I heard you because you spoke kind of quickly, and I wasn't certain you said that. Oh,

"Kat" 25:12
yeah. It's also it's the only medication for ADHD.

Scott Benner 25:20
Okay. And that helps with that, too. That's crazy or can help with it. And that's something Well, yeah, so Okay, so, Alright, so now we've, we've kind of learned a lot, but we learned about one of the ideas that stops people from being helped with type two, it's not as easy as information, you can inform them, but they're not necessarily going to follow through for a number of different reasons could be financial, could be what they think of is good food could be that they're being pushed by psychology, it could be that they're being pushed by physiology, like all kinds of different possibilities. Yes. And then what happens to them if they don't see gains, if they don't see improvement, it becomes like, I guess demoralizing, and then they stop. When they

"Kat" 26:07
say the medication doesn't work. It's, you know, that's basically it's the medication squat.

Scott Benner 26:14
Okay, I can tell you this, I have an incredibly long view now of my health, more so than I ever have in my entire life. My wife and I were talking about this yesterday in the car, and I said, I, I now don't care if it's a half a pound a week, like, it's fine. It's fine with me, if I reach my goal weight two years from now, like that, like, but in the past without the weego V, because I wasn't seeing any improvement. If I didn't see like a drop in weight constantly. And it didn't seem significant. It was hard to keep going. And you know, don't I mean, you're like, I'm never gonna get there. This isn't gonna work. I one thing yesterday shouldn't happen again, two pounds, like this is like this is just where I'm at. But because I'm seeing improvement, I can afford to be patient, if that makes sense.

"Kat" 27:02
I absolutely. And you should be any pound. Anytime that enemy. You know, also, there's non scale victories, like you know, about I don't, I just don't really look at a scale, there's so many things wrong with the scale. But anyway, time that scale goes down, and I can show a patient Well, I saw you three months ago, or six, you know, six months ago, you've lost 10 pounds in center, like that's 10 pounds. Before we started, you know, talking, that scale was going up and up and up. So it is progress and maybe some progress. I think people see, you know, I can't stand saying this. But you know, celebrities, whoever losing tons of weight on this, I'm like, No, really, your scale is going in the right direction. But let's see what we can do to, you know, make make the document a little faster.

Scott Benner 27:49
Another reason not to compare yourself to somebody online, is that they show you their first picture, when they're when they're at one weight. And then that's not even if they're showing that you're used to seeing them like that. Correct. And next time you see them, they've lost 40 pounds. And you're like, Oh my God, look how quickly that happened. Like didn't have probably didn't happen quickly at all. It probably took them a year. But they were hiding for a year while they were they weren't taking any new pictures during that time. Right. So you didn't see the process of it happen. Yeah, I started making videos online when I started doing weego V. Because after I lost the first 10 or 15 pounds, I was actually comfortable pointing the camera at myself. And then I realized that this will be a good, like visual diary of over time. So I kept doing it. Because even I was like, the first time I made a video. I'm like, oh my god, I look better than I've feel like I've ever looked. And then a month later, I was like, Oh, I looked terrible a month ago. Like look at me, you know? And so I thought, well, I'll keep doing that. Because then people can see the progress instead of just showing them like the finished product and being like oh look, because then it feels magical. And it's not magical. It's it's I mean, I've been doing this since March. It's November now, March, April, May, June, July, August, September, October, it's I'm nine months into this. And there are weeks where I lose a half a pound. And I just have learned to say that's amazing. And I keep going. It's

"Kat" 29:07
yeah, that's exactly. That's amazing. And that's slow. You know, it's, you know, all the cliches that you can think of, it's not a marathon, it's a marathon. You want that to be slow. And I just feel my one of my favorites is when the tide rises, all boats rise, like you feel better and just when people say, Oh, you recruit and just to keep it going keep the momentum going to keep you motivated to put in the effort. So I'll tell you right now, you know, patients come in and say oh, so sick on it. i Since I've been around, you know these medications as young people that have been in the market since don't quote me 2005 With Victoza and I remember when I first started I'm like yeah, let me try that. I don't have any weight to lose with the drug but it was fine. The drug reps like, Hey, you want to try this? And like I said, I was new to new to diabetes. So I had to learn how Metformin worked. Yeah. So I'm like, Yeah, sure. Let me try that. I throw up left and right. Even on the lowest dose. Well, the first week I tried it, I lost four pounds. I was like, Oh, my God, I am not hungry. I feel great. Yeah, we to still on the point six through.

Scott Benner 30:27
Were you eating through it? I know. That's a weird term. But were you just pushing? No,

"Kat" 30:32
no, I just, I had it partially if I drive,

Scott Benner 30:36
so not good for you? Yeah.

"Kat" 30:39
I say sick if the wind changes directions, but then like, Tanzeem came on the market, then you had by Dorian, it was on again, we tried to answer him the weakest one ever tire on the market anymore. Threw up. So then like I would try low dose Manjaro. The 2.5 People say they tolerate a lot better than people do. In my, in my anecdotal evidence, people tend to tolerate low dose Manjaro better than it was epic. So again, you know, I got access to all this crap. I'm again to try Manjaro threw up on it. So not

Scott Benner 31:14
for you. Yeah, I mean, does that make sense? For me? Yeah. No, it makes sense. Um, look, I I've had people ask me like, Are there side effects. And I'm like, I'm like, I don't know that I've had like a bowel movement that I've been super excited about, you know, in a while, but I, but here's, here's my response to that I have a flippant response and a serious response, my flippant response is, I don't dislike a loose stool. More than I dislike being heavy. So like that, that to me is like, Okay, this is what this is, I also think that I have a perspective of my body is reshaping itself. And I think there's a lot of like, this is a very non technical way to say this, but I think there's a lot of badness inside of me, and it's coming out. And I don't think that that's going to be a smooth process. So like, I mean, I'm losing a lot of fat, a lot of fat. And I don't like and you know, if you eat a high fat, if you ate a low carb, high fat diet, you'd have loose stool, like that would be a thing that would happen. Right? Right. So I'm expelling a lot of fat. And that makes sense to me that my body is not perfectly balanced at the moment, but so many other things that have been unbalanced, our balance. So my expectation is, is that at some point, I'm going to have to get on a medication where I can vary the dose a little more. And that perhaps what I'm taking right now is maybe too much or not enough for like I won't know, but like that, I haven't found the answer yet. I also think there are likely other things unbalanced in my body that I'm not aware of. I'm also trying to look into those things as I go along. Great, yeah, but it's just it's to me, it's just, it's a science experiment. It's time you get to keep going. But then that's the problem, right is that I'm a person who a had access to the medication, it was paid for by my insurance, I have the access to food, I have a job where I can actually say to myself, like, alright, well, here's how I'll eat because I don't I'm not up at 6am. And running out the door. I you know, I don't get 30 minutes in the middle of the day to eat, like I have, like, my life is different. You know, and I think those things all impact them. And I think that those same stressors, impact people trying to change their diabetes as well. Absolutely, you know, so I think that our lifestyles, and I don't mean, like around food, I mean, our lifestyles, the way Americans lives work, and the food, the food that we have access to, and the time that we have to prepare it, I think those are the three issues.

"Kat" 33:49
That makes sense. Actually, your patients, you know, leave of absence from work. And they come back and you know, it was just wonderful. And, you know, I'm thinking of one of my patients type one on a pump. He's like, I ate well, I exercise, I didn't have the stress of my job. And, you know, I feel amazing, and my blood work shows it. He's like, Well, I gotta go back to work now. You know? Yeah,

Scott Benner 34:13
like she's all over maybe. Yeah. Yeah. You know, it's funny. I was wondering if you've seen this, before we move on. Let me ask you this question. My wife had an interaction with a person who's on ozempic or we go probably we go via I think it was just for weight loss. So we go v, right. And this person said that they lost like all this weight over like year and a half. And they were almost like down to a maintenance weight. Like they were at that back close to their goal. And they had also made changes she said, you know, that being on the medication had taught taught her how to eat better and like kinds of foods, amounts of foods, etc, exercise. And then suddenly, one day woom insurance calls and says, we're not covering this for you anymore. And so the person said, Well, I'm not going to panic. I am going to keep eating the way I eat, exercising the way I exercise I'm gonna keep doing the things that I've been doing, you know, all the lifestyle stuff. And she said that no lie, absolutely no lie. She started to gain weight slowly. And she's like, I did not eat anything different. I didn't do anything differently. My exercise my intake, everything was exactly the same. And my body just started to put weight on again. And that's how I feel like I am. That's who I feel like I am in this scenario, like this medication is doing something for me. I don't exactly know what it is. But it is filling a gap that I have that my body can't do by itself. That's what I see happening for me. So you see that with others is what was going to be my question.

"Kat" 35:42
I see it, I do. One thing about these medications is you people say I'm on this rest of my life. I'm like, yeah, it's some way shape or form, whether we lower the dose or maintenance dose, take it every 10 days instead of every seven days. Some people take it every two weeks, I have one of my co workers who lost weight on one Coby and she was happy about her weight, and she just stopped it. And then lo and behold, she comes work the other day, really throwing up all over the place. So what did you do? So I took a movie, I said, how she changed. She said, Oh, my, you know, 2.4? I said, What was last time you told me? She said June? I said, Oh God, you can't do that. You literally have to start back over from zero. If you give your body that much of a break. It's your girl. Yeah, so you should be told your practitioner, you know, should we telling you that these are considered lifelong medications even

Scott Benner 36:38
working there, she didn't know that, that you have to because you titrate Up we go visit example, you titrate up when you start taking you it's it's like a quarter of a was it point two, five milligrams to start, right. And then and then you it's four weeks of that and four weeks a point, five 4.7 5.6 Or one one to fight like it goes on forever to get to 2.4 is like a six month like March really to get to it. And so now 2.4 is the highest I will tell you, I don't think 2.4 is enough for me. Because I lose weight in the first four and a half days of the week. And then I put some of it back on in day 567. That's why I'm so all I lose three pounds every week. But my net loss is only point five. I'm

"Kat" 37:26
sure there will be worse clinical trials go with higher doses. It's just it just makes sense.

Scott Benner 37:32
Yeah. So it's just it's all of it's incredibly interesting. Also, I think it points to first of all, I don't mind talking about the GLP is I think it's a good conversation. But at the same time, I think that the plight of a person with a GLP deficiency if there is one, you know, pointing nine out? I don't think yeah, I don't think it's much different than a person who has type two diabetes, the struggle is my point. I think the struggle is very similar. Yeah, absolutely. My gosh, so then what's it like managing a type? Like? So this is a great example, because Jenny says all the time on the podcast, like she's like, you know, most adult endos don't see many type ones. So you said maybe at 515? Is your is your breakdown? So do you know a lot more about type two than you know about type one? Of course, yeah. Are type ones in the same sort of boat as type twos, meaning that they might lack education, access and or desire or ability to follow through?

"Kat" 38:31
Yeah, absolutely. I just in a funny story. You know, the reason what you put out the, the the reason I came was to talk about what happened, she come to the hospital with type one diabetes. I

Scott Benner 38:48
have two thoughts. And then I do want to go over to talking about hospital intake for type ones. Do you think type ones and type twos at a basic level are kind of suffering with the same problems like access, desire, ability, education, that kind of stuff?

"Kat" 39:05
So yes, but, and I talk, I don't want this to come out wrong, but my heart actually breaks for the type ones living where I live with for many, many years, there wasn't an endocrinologist in the city. So now I have people who are in their early 20s who have type one diabetes and did not have good care. So the long term complications, they have the blindness, luckily, and actually blindness, and the neuropathy, the gastric creases, and diabetes distress, the depression is which still there, it's there aren't great therapists or people who are trained to deal with diabetes distress. So that just breaks my heart. So to me It's just to a whole nother, to a whole nother level cat. Do

Scott Benner 40:03
you see those things with frequency at at younger ages where you're at?

"Kat" 40:08
All the time? Okay. potations through the roof through the roof people

Scott Benner 40:12
in their 20s who are blinded by their type one? Yes. And this is because they, so they have insulin. Is that right? Yeah. Okay. They don't know how to use it? No,

"Kat" 40:26
they don't know, I've had, you know, someone diagnosed at age five and just doesn't know the basics of diabetes rate basically hanging on by a thread that they don't, they aren't in DKA because they'll take full, full take for Basal insulin, but they haven't taken human log in a long time. Or they'll take it once every three, four days. You know, so just, you know, we live in an area we live in, in between Philly, New York. Yes, there's children's chop in Philly and New Brunswick and hospitals all we were back, you know, not having the parental support they may need not just, it's it was rough growing up in the city, and not having an endocrinologist not having someone to go to but yeah,

Scott Benner 41:12
yeah. So in that setting, the setting that you're that you're local to, there's not a lot of parental support, which leads to people growing up not knowing what they're doing, which leads to a really advanced diabetes Complications early in life. Yes, yeah, absolutely. How do you, if I gave you a magic wand and said, go ahead and help these people? What do you think would help them? Now they're in their 20s? They have all these problems? I know, they're in a different situation. But what would have stopped them from being in this situation? Should have been my question?

"Kat" 41:45
Well, I mean, it goes back to all the social determinants of health, you know, with the food, you know, access to food, just the education piece not being local and not being able to follow up. And again, unit technology, so much better now. But just not having just not knowing how important it is to know what your blood sugar is. Or they just don't know the complications, diabetes, erectile dysfunction, and somebody who's 26 years old, you know, is something I see is I talked about erectile dysfunction all day long, basically.

Scott Benner 42:21
To try to scare them into thinking if I take care of myself, I can keep having sex. Sure, yeah. That makes sense to me. But okay, yeah.

"Kat" 42:30
They're going to urologist and each one exists. But anyway, it's just the complications. Let's

Scott Benner 42:33
think deeper. I get what stops them. Right. I get their problems. I know, I heard what their problems are, I understand what they are. Let's say they still have those problems, is there a way to help them like it because you can't fix their problems, right? You can't pull them out of poverty, you can't give them a you can't give them a smarter brain. You can't give them a parent that cares about them. You can't give them all those things. You're talking around some stuff, but I hear what you're saying. Like, so you can't do those things for those people. Are they lost causes? Or is there something we could do for them? Like, is there something they could be told? Is there something they could be shown? That would like alright, yeah, they're gonna go to McDonald's before they go to the doctor. We can't stop them from doing that. But could we teach them how to Bolus for the McDonald's? Oh, absolutely.

"Kat" 43:19
Absolutely. And that's where I'm just gonna get at the CGM. Knowing what their shares I know, I just think, yes, I work with a team of people. I work with wonderful diabetes educators. We had to have tons of resources in our office, I love where I work. I love what we do. Just the education. And once you, you know, once they're engaged, they come and once they see progress, you know it, they're excited. So yeah, I don't think they're nervous because I just, I'm just so I just love the fact that that part of my job where I get to help and if they take one thing away from an appointment, hey, you're on a pump. Now, you know, I have aggressive the other day she was diagnosed at age five. She's never been on pumps. You know, I did what she knew even when a pump was how they worked. And she's been on one for a couple months now. And I just pulled up her CGM and her pump report and like, well, look what happens when you Bolus before you eat. Wow, I didn't have spikes and she doesn't have blood sugar in the 400 you know that she may peak to 250. But that's pretty freakin amazing when you lived in the 402 50s

Scott Benner 44:26
not great, but you're not going to be blind when you're 26 to 50 either like so you know, maybe it buys them more time to have an epiphany or to mature or to meet another person that can help them with their like it buys your time to do better. Well, it changed your

"Kat" 44:43
life because her stomach your gastric resists, like she couldn't eat she spent the first six hours she was awake, try not to throw up but now that her blood sugars are coming down and do much more steady. For some it feels better. So she sees it. It's that instant gratification that instant instant, but you know, she feels it now. Already, she feels better.

Scott Benner 45:06
Can I ask you a question? And this was not my intention when you came on. But is there a world where the hospital you work at would let me come give a talk to people in that situation to help them understand how to use insulin? Where would they never let a person in? Who doesn't have credentials? No, I

"Kat" 45:22
think you're open to it. I think they would be. Do you

Scott Benner 45:25
think that would help? Like, if we just did that like high level, this is insulin, this is how it works thing, here's why it's important. Like, give them an hour and a half of late and then let them ask questions and then send them back on their way is that is that because there's a part of me inside that thinks that the podcast is successful about management stuff, because it is very clear about when and how to use insulin, and why changes need to be made. Sometimes, depending on food, I'm saying this thing. I think one, if you're going to be amazed by how the podcast helps people, it's that I'm not having a two way conversation with the people are listening. So I'm able to like dispense the information in a way that they can pick and choose from and help themselves without being able to re ask a question. And without me knowing their specific situation. And I think that having figured out a way to do that, maybe that would translate to people who are in the situation that you've spoken about, like maybe that makes sense. I don't know if that made sense or not. But I mean, I'm I'm also not, I don't know, I'm sure that I'm sure you could do it, I'm sure there are plenty people that could do it. But I think that what they might need is for someone to like, instead of doing an a, you know, an appointment, if you did a large group, collection of people, if you just if you just said look like, you know, come out on Saturday at one o'clock, you know, there's going to be this there'll be food, like, you know, like make it enticing, like make it a thing. And you know, while you're here, someone's going to explain, you know, Pre-Bolus and your meals to you, or getting your carb ratio set or stuff like that, like real simple, basic stuff that they could maybe and then maybe have nurses and doctors there to actually help them get their settings, right, like on site and stuff like that. Like, it seems to me that if you did a health care, like a three hour health fair like that, you could make a pretty big impact. And then maybe you could start that process that I've started hear on the podcast, which is if you can get a core group of people to buy into the thing that's happening, they actually go tell other people about it. Because they're they're super excited because their life has changed. And then they meet another person with diabetes. They go you know what, I used to have this this, this is my problems, but I don't anymore, because I learned how to do this. It wasn't that hard. You know, like that. That kind of stuff? I don't know. Like maybe I'm being Pollyanna. Maybe there are some people who are just never going to be okay. I don't know, but it seems there are some

"Kat" 47:52
people are never gonna be okay. That is that is a yes, that is an accurate statement. Like,

Scott Benner 47:57
it's a harsh truth, right? You're just you're not reaching every little. Right? Like, they got a bad roll, and they're not gonna be able to rebound from it. Oh, yeah. And there's some people get a bad roll. And they find their way through it. There are some people who like stand up immediately and say, I'm not letting this happen to me. There's different versions of responses when somebody gets diabetes, for example. And a lot of that is contingent on things that outside people can't help. Is that fair?

"Kat" 48:22
Yeah. And it's also learned responses. Yeah.

Scott Benner 48:26
meaning they've, they've grown up with the idea that their life sucks, and that it's gonna go poorly, and so that when it does they just go okay, well, here's more of that. Yeah. Right. Now, that's upsetting, but I understand what you're saying. And I appreciate you being so direct about it, too. Thank you. Let's take the last little bit of this time and go over this, this piece here, right. So people type ones. I guess we should do both right. Type ones are type twos, they come into the hospital for something emergent. They should not expect anyone to really understand their diabetes. Let's start with type ones. They shouldn't really expect anybody to understand that their type one diabetes in the ER, is that right?

"Kat" 49:07
Absolutely correct. Okay. You are giving staff members way too much credit. I read all the posts in the comments. And no, please don't expect that you have to be your own advocate as a lot of people have mentioned. Do not take your pump off. Beg plead. Stand up for yourself, do not take your pump off. Unless there's an you are in DKA or have a severe hypoglycemic event. Or you know, obviously test some tests. But there is really, very few reasons why you would need to take your pump off. That is I when I were I'd work with a very so the two hospitals where I work. The one hospital is very robust. We have a diabetes test for force we meet once a month. We have inpatient diabetes educators. Who are amazing, which you do not find that in hospitals anymore when budget cuts happen, that is the one of the first positions that go it's a full RN salary. You know, asked around how many hospitals have inpatient diabetes educators and I will tell you, not many. I can think of 10 hospitals in the area. And where I work is the only hospital that has inpatient IVs educators. So nurses who will who will go see with the bedside, you have a CGM, when you have a form bond that you meet with you, they mature everything is, you know, per hospital policy, which means we know you're wearing it and everything's okay. Very, very few places have that tooting our horn a little bit further. When our nurses get oriented our dogs educators do in servicing to everyone that walks through the door. We do quarterly in services to our residents and interns. Having said all that, it's like whenever I have to say the nurses have a little bit more knowledge than nurses who don't receive our, our education, but there's so much more to be done. From the time that Scott that you posted about this topic. I could list so many stories to doing yesterday between that time and today. A week. You know, someone was under our care in the hospital like DKA How does that happen? It happens. Someone was in the ER came in by ambulance with a blood sugar 600 from a doctor's office seen by the doctor but the nurse didn't get to the patient patient didn't feel like waiting. Went home three hours later came came back the next morning and full blown DKA backup less than five super super sick. What happened someone the patient comes in on some pump hounds that ER staff come on insulin pump. Okay. Communication gets lost. The first provider on the hospitalist sees the patient document in the chart, insulin pump was removed. They gave the patient you know 3040 units Lantus. I remember the dose. A couple hours later, they're hypoglycemic. The nurse says oh look, no, they're they've got their insulin pump on it wasn't a pump. It was a CGM. Remember it's not disturbed. But anyway, the patient had the pump on gotta dosa Lantus. And the staff had no clue what that piece of technology was. This. This isn't a week.

Scott Benner 52:34
This isn't a week art. It was in the ER for something not diabetes related. And she had to go back once it was while she was at school people are going to hear me say this a lot because it's so crazy, but I'm gonna keep saying it here. So she was in the ER 12 hours one day, one day off 12 hours the next day, and in 24 hours of care over two visits. You should guess how many times they checked her blood sugar? Just pick a number how many things in 212 hour visits? How many times do you think they would have checked her blood sugar? Never. They never once checked her blood? No. Oh, Jesus, never. They never paid attention to the fact that she had type one diabetes the whole time she was there. And they put her on morphine when she got there. So she was not able to handle herself. Didn't check on her blood sugar. Trust me, they didn't know she was on an algorithm that's like fine tuned with an inch of its life or that I was managing it remotely through one of her roommates who was in the room. They didn't know any of that. They just never checked on her again. That was it was all just left up to chance. So and she came in, I have type one diabetes. This is my insulin pump. This is my continuous glucose monitor. These are my things. You would think that that would put her on a protocol where they would check on her but never they never even came in and said Hey, what's that CGM say your blood sugar is? Well never ever give those people that education but it doesn't stick to them. No.

"Kat" 53:56
Some. So when you get oriented to hospital, you're bombarded with speaker after speaker after speaker presentation presentation. That's what I'm talking it up to because the information was you know, was reviewed. It's simple. It's this is this the pump. This is a CGM. Please know what it looks like. We're here to help call us. So I'm losing. It's not better. But it's not great. It's not great at all. And again, we have these resources. I can tell you, there's other hospitals that don't even address this stuff. And we review every hypoglycemic event that happens in the hospital. We review every DKA event, you know, we review this stuff, we talk about it so we have root cause analysis. We haven't, you know, updated and improved and provided education. We know these things happen and they continue to happen.

Scott Benner 54:56
Can I ask a scary question and maybe we can As you do you do Nurse Education. So you're gonna have the, you might have the pulse on this one, put diabetes out of the out of the picture for a second. How many other things did the nurses not understand? Just so many. So our expectations of nurses is is incorrect. Correct? Yeah, yes. And then when you get to the doctor level, the doctor doesn't really see the patient that much. And is it also not true that the nurses can sometimes depending on the doctors, be afraid to go back and speak to the doctors?

"Kat" 55:32
Oh, absolutely. That mean that I have to admit, over 30 years of doing this, that culture has changed. I still say I do get a practitioner. I'm a provider. But I do get up if I see a doctor comment if there's no seat. And if somewhere else I can go I mean, yes, I get I still do that. It's I know That's old school have made but now the culture is you're not penalized for making an error. So it's we want you to know you're encouraged to speak up, they call them good catches. One hospital boy, where is you know, you report a good catch maybe the patient's date of birth, when the name brand name band didn't match up with what it should have been, like, you actually get recognized for that. They'll say, Hey, good job, your name gets put in a raffle, you get chosen, you get eight hours PTO time, like it's that culture is changed. And it's a whole read back and verify type thing. If I say to you get eight units. We're not allowed to give verbal orders anymore. By the way, it's got to go into the computer. But the nurse is supposed to dismiss a question everything and I, we do want to texting, you know, secure message. Hey, you said to give 14 to human world sounds like a really high dose. Is that? Is that what you want? I'm like, yes, thank you for clarifying. You know, so the nurses, it's a different culture these days, they are supposed to ask questions and not just accept something they think is wrong.

Scott Benner 57:03
I'm following up, though, on something another person said to me on one of these episodes, so is it not possible that some doctors are terrific, but some of them are kind of ego driven? And if I'm the patient, I'm like, Look, I need insulin. And the nurses wife talk to the doctor about it. And I said, well go talk to the doctor about it that the nurse may not be in the situation with like, I don't want to go talk to that guy. Because he is he's an asshole. And like, this isn't going to go well. And he doesn't want to be told what to do by the patient, let alone by me. And I know that's not going to happen. So I'll slow walk through this and try to forget about it. That's that stuff not happened to

"Kat" 57:35
us. But that's how nurse like look at your, you gotta look at yourself, okay, in that situation? And I'm saying, yeah, there's there's lots of nurses out there, there's nurse residency programs, where brand new nurses are hooked up with a mentor, and they have a nice year long orientation. But you know, at our hospital, there's 80 nurses in that residency program right now. And you combine that with 100. medical interns, you tell me, you know, who's leaving who here

Scott Benner 58:05
and people come through so quickly, so eat. So even if we like, even if we choose type one diabetes as an example, and say, Look, we're going to teach them, we're gonna give them a crash course on type one, it doesn't stick to them. It also leaves open about 1000 Other things that they don't understand that they you don't have time to give them a crash course on. So then emergency medicine really is just, we're going to ignore everything else about you. And the thing that's got you here trying to die we're going to try to get in front of Sure. Yeah, that's it. But is there a better way, honestly, or is that what it has to be? I

"Kat" 58:36
don't know if there's a better way, it's what it has to be right now. They will tell you it's because they're short staffed, you know, there's the throughput is slow, meaning patients are hanging out longer in the ER than they should. It's called they're holding in the ER er hold, we got 20 year holds. So now the ER nurses are taking care of the ER holder and they really should be taking care of the ER, true ER patients who have been triaged yet the patient's just aren't moving. Yeah,

Scott Benner 59:03
why are the holds not taken upstairs?

"Kat" 59:05
There's no room for him upstairs. Therefore, there's no nurses to care for him upstairs more. So it's because there's no, not room upstairs. There's just no beds available

Scott Benner 59:15
to space and staffing is a problem as well.

"Kat" 59:17
Absolutely. And it will, it will continue to grow. Yeah.

Scott Benner 59:21
Because there's more sick people than there is hospitals. Yeah, it's

"Kat" 59:25
seasonal. You know, we're, you know, it's that time of year where things are ramping up again, but yeah, better

Scott Benner 59:32
to get sick in the spring than in the winter.

"Kat" 59:36
Yeah, yeah. And some hospitals because of the staffing shortages. It may be a 200 bed hospital, but they're only staffed for 125 beds. So you can hold 125 patients, despite the fact you know, the hospitals went broke paying for agency nurses spent, you know, I can't even tell you the numbers the amount of money per month that they spent there. recouping from that. So they, they do what they had to do like close units to using the staff, they have staff beds that they can.

Scott Benner 1:00:08
So no different than when I go to a restaurant and there's tables, but they don't see me because they don't have waitstaff. Perfect.

"Kat" 1:00:15
Perfect. Yeah. Yeah.

Scott Benner 1:00:17
I say, Well, you've painted a lovely picture for us. Thank you so much. I'm so sorry. Sorry, no, this is what these what these episodes are gonna be the people in the medical field coming on telling the honest truth about what they say at work. So I appreciate you doing this very much. I really do.

"Kat" 1:00:34
You're welcome. I have wasted wasted.

Scott Benner 1:00:37
Oh, we did. We did fantastic. You were great. I liked the mix of of talking about, you know, in the hospital talking about, you know, in the office, talking about significantly underserved people at the same time. And you were really honest about a lot of stuff. I'll tell you the one thing that bothers me is that when we talk to people, we say like, well, what would fix this? And you say, Well, the problem is that they don't have this and they don't have that, and this isn't the way they grew up. And I'm like, Okay, what then? Then there's no answer after that, like you, people are incredibly good at pointing out why things are going wrong. Not very good at stopping them from going wrong. Or, or saying, Look, we can't stop them from going wrong. But here's what we could do next. We seem very good as a society at saying, Well, you know, that person, they this is what happened to them. So but nothing we can do. You know, like and that is where we get to we get to nothing we can do. And maybe that's true. And maybe it's not. That's kind of what I'm trying to get at. I'm trying to find out if there's something more that can be done. Or if really it is just sometimes life is just luck of the draw. Yeah, so anyway, this is a bummer. I'm gonna go hold on for me once. Sure.

If you'd like to wear the same insulin pump that Arden does, all you have to do is go to Omni pod.com/juice box. That's it. Head over now and get started today. And you'll be wearing the same tubeless insulin pump that Arden has been wearing since she was four years old. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Tchibo Capo pen at G Vogue glucagon.com Ford slash juicebox. you spell that GVOKEGLUC AG o n.com Ford slash Juicebox. Podcast. Once there was a time when I just told people if you want a low and stable a one C, just listen to the Juicebox Podcast. But as the years went on, and the podcast episodes grew, it became more and more difficult for people to listen to everyone. So I made the diabetes Pro Tip series. This series is with me and Jenny Smith. Jenny is a Certified diabetes Care and Education Specialist. She's also a registered and licensed dietitian and a type one herself for over 30 years and I of course, am the father of a child who was diagnosed at age two in 2006. The Pro Tip series begins at episode 210 with an episode called newly diagnosed are starting over and from there all about MDI Pre-Bolus Singh insulin pumping, pumping and nudging variables exercise illness, injury surgeries glucagon long term health bumping and nudging how to explain type one to your family. Postpartum honeymoon transitioning all about insulin Temp, Basal. These are all different episodes, setting your Basal insulin, fat and protein pregnancy, the glycemic index and load and so much more like female hormones and weight loss. Head now to juicebox podcast.com. Go up in the menu at the top and click on diabetes pro tip. Or if you're in the private Facebook group, there's a list of these episodes right in the feature tab. Find out how I help keep my daughter's a one C between five two and six two for the last 10 years without diet restrictions juicebox podcast.com Start listening today. It's absolutely free. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com