#1183 Ask Scott and Jenny: Chapter Twenty

April 25, 2024Scott Benner

Scott and Jenny Smith, CDE answer your diabetes questions.

• Let’s talk about statins.

• Let’s talk about GLP meds.

• How high is too high to exercise? At what threshold should we sit or test ketones? What are the preferred numbers?

• Let’s explain delayed onset hypoglycemia.

• What did Jenny do to prepare for her Ironman marathon? What did she eat, set your pump to? Suggestions for longer periods of exercise?

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.

+ Click for EPISODE TRANSCRIPT

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, welcome to episode 1183 of the Juicebox Podcast

Hey everybody welcome back we got another episode of Ask Scott and Jenny here not much more to say than that there's listener questions and Jenny and I try to answer them. While you're listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. You want to help. It's easy. If you're a US resident, you have type one diabetes, or you're the caregiver of someone with type one, you can advance type one diabetes research by completing the survey at this link, T one d x change.org/juicebox. That easy 10 minutes. And just like that, you're part of what's propelling us forward. 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 cosy earth.com You should go join the private Facebook group for the Juicebox Podcast Juicebox Podcast type one diabetes on Facebook. Everyone's welcome. That's just the title. There's links in the show notes and links at juicebox podcast.com. Check it out. Fantastic community I'm sorry I went into the deep voice therapy. It's really great. 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. US med is sponsoring this episode of The Juicebox Podcast and we've been getting our diabetes supplies from us med for years. You can as well us med.com/juice box or call 888-721-1514 Use the link or the number get your free benefits check it get started today with us med Today's episode is sponsored by Medtronic diabetes, a company that's bringing people together to redefine what it means to live with diabetes. Later in this episode, I'll be speaking with Jalen, he was diagnosed with type one diabetes at 14. He's 29. Now he's going to tell you a little bit about his story. And then later at the end of this episode, you can hear my entire conversation with Jalen to hear more stories with Medtronic champions. Go to Medtronic diabetes.com/juicebox or search the hashtag Medtronic champion on your favorite social media platform. Hey, Jamie, welcome back to a another ask Scott and Jenny episode. How are you?

Unknown Speaker 2:45
I'm good. How are you?

Scott Benner 2:46
I'm very well, thank you. Yay, I'm gonna start where we left off in the last one. But we're just not gonna parse words. And we're gonna jump right into it. Because I think we talked around it a little bit last time.

Jennifer Smith, CDE 2:57
I think last time we ended, because we thought it was a little bit longer discussion than we had time left or something if I remember about, I don't remember exactly what it was. But oh,

Scott Benner 3:08
yes. Yeah, it was that and so.

Jennifer Smith, CDE 3:11
Oh, that's right. And I give my, my opinion.

Scott Benner 3:14
Do you did you got a little crazy. So like, I like it. And I want to dig a little deeper into it. So I'm listen at the beginning of every one of these episodes is going to tell you this is not medical advice, you know, talk to your doctor. And I'm not a conspiracy theorist. But you started to dig into it a little bit the last time once they get the okay to use the medication. Now, it's something that just gets distributed, like, you know, oh, you have diabetes, here's a statin, even if you don't show any reasons, to be honest, that that's happening now and a lot of practices. Right.

Jennifer Smith, CDE 3:48
Right. I mean, and that's, that was the baseline for my concern with it's, it's given out almost like, we'll just take this, that's in a general sense, right? You have this condition, type one, diabetes, type two diabetes, whatever, right? And that has predisposed you to these types of things. And so we are trying to be preventative, they're calling it preventative right in prescribing something like a statin went in the case of actual individual looking, you can see that somebody's already got the lifestyle habits that are preventative. It's such a hard thing to navigate recommending being in a medical field to say, just because you have diabetes doesn't mean you have to be on a statin. So

Scott Benner 4:40
I understand. I understand where it comes from. If there's so many people for so long, who have such poor care, and they all eventually end up with, you know, something that requires a statin why don't we just paper the community with it and keep it from happening? But that's I don't know that's like saying that a house burned down once a month in our town, so every night, I have to go outside and close my house off before I go to sleep, it gets a strange decision to make, I think and now if it saves the person, then I guess it was a great decision, you know, but is that the I mean, we don't want to glance over your point about there are going to be some people who are going to lead a lifestyle that will never, that will never lead to elevated levels. Correct.

Jennifer Smith, CDE 5:23
And that's where, you know, in terms of just blanket prescribing this as a medication, there are some standards that are followed, obviously, there have to be, and they're not just prescribed solely on like blood tests anymore. Right, there are parameters that are looked at, there are health risks, you know, even some stats that are being put together by data collection systems that say, this suggests that this person is at this percent of a risk based on these other conditions that are already present, or their health factors or inclusive of lab values, and all of those types of things. Those are considered, you know, in terms of heart attack risk and stroke risk, really, those are the reasons that statins are going to be prescribed. But when we talk about diabetes, they're also being prescribed as I said, preventatively. Yeah.

Scott Benner 6:12
So then that gets into the next question. We have a bulk of questions here from people. Should I be on a statin? If my lipids are okay, what about my numbers are good, but they still want me to be honest that and can we please get someone to talk about statins and whether LDL is really a reliable indicator of heart risk, as some doctors would have you believe so that's the next thing, right? Like, can't you just genetically be predisposed to a higher value, but it doesn't necessarily mean it's going to turn to something or is that not the case. So they

Jennifer Smith, CDE 6:40
look at ratios as well, right? So it's not just total cholesterol anymore, they've broken it down into different measurements, LDL, you can easily remember LDL versus HDL, LDL is lousy cholesterol, that's the one that you want to be lower. HDL is your healthy cholesterol, that's the one you want to be higher, right. So it's kind of easy to remember. But in terms of that, when they look at ratios, they're also looking at cholesterol and LDL and cholesterol and HDL ratio is and they're looking at even VLDL, which is very low density, sort of lipo protein, another component of your total lipid panel, and all of these pieces, along with the other conditions that you might be living with smoking, drinking, you know, lifestyle, activity, all of those things have to go in, when you're considering the potential of prescribing.

Scott Benner 7:35
What about having diabetes makes this worse? So if I have a high, lousy, you know, LDL, the doctor looks at me in between the bloodwork and his assessment, her assessment, it looks like I'm going to end up with actual problems from this, what are those actual problems and how to diabetes make it worse?

Jennifer Smith, CDE 7:53
Yeah, I mean, in terms of diabetes, remember, blood sugar is the thing, we're trying to manage blood sugar being too elevated for lengthy periods of time, or ongoing higher blood sugars than our with a where a body without diabetes would be. It's kind of like rust on a car, right? So the more sugar you've got in your bloodstream that shouldn't be here, causes damage in your vessels, it can cause damage on nerve cells, and all of the different little vessels in your eyes, etc, thus, all of the complications in those areas. But the more elevated the blood sugar's are the more damage and so then the body has to try to repair that damage, but comes in the form of patches or almost like band aids inside of the vessels. And that comes from livers production of cholesterol, it's trying to help the body is a self healing machine, it's trying to help itself get better, right? But you're not helping it with high blood sugars. So that's where it comes in. The more optimal blood sugar management you have, the less or likely no damage that you're causing on the interior parts of your body. And so there is where that risk factor should really be considered. Your blood sugar's are well managed, you've got an E one C, well within target or you've got, you know, a very low standard deviation, which means you don't have a lot of ups and downs and you're well within range. You've got lifestyle that proves all of the things that you're doing, you're at very low risk for anything like that. So then, you know, I mean statin drugs, essentially they they lower cholesterol liver levels by essentially decreasing the livers enzyme output of a particular type of little substance that it kind of puts out, okay, which is kind of something that goes along then with cholesterol production in the body.

Scott Benner 9:49
Now, you would take one if you needed it, right. If

Jennifer Smith, CDE 9:52
somebody could prove to me that I had particular risk factors and a lifestyle that was not proving to be preventative Have enough? I would take what was needed. Okay. Absolutely.

Scott Benner 10:03
All right, I just want to make sure. I'm not telling people not to do it. I'm telling you that there's some ambiguity ambiguity here in between, like, what happened basically was, it became in vogue to gives that into the people with diabetes. And I think it started to get in, it just started to get blended, where people are like, Oh, you have type one, take this. And people are like, I have no risk factors that I can see my bloodwork is not even bad. And they want me to take this, what should I do? That question comes up all the time. So I'm glad, I'm glad we talked about and that's I

Jennifer Smith, CDE 10:34
mean, it's good to clear up because obviously, you know, if taking it because of risk factors that are there, when you do take it, there is good information that says, you know, your bad or your LDL cholesterol can be reduced, it helps to decrease that build up, or that plaque development kind of inside of the walls of your vessels. I mean, all of those types of things can be mitigated by using it, but it's really in terms of whether or not it's necessary. If it isn't, then why are you adding something to the mix that could actually have I mean, another question that probably comes up is what are some of the side effects?

Scott Benner 11:12
Yeah, if I take this and I don't need it like because it's always a give and take with a medication to some level, right, you're gaining something you might but you might be losing somewhere else you get to decide where the value is. 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, G vo 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 G Bo Capo pen before an emergency situation happens. Learn more about why G vo Capo 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. diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email. It's a big button it says click here to reorder and you're done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives we click on a link and the next thing you know your products are at the front door. That simple. Us med.com/juice box or call 808-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and the ducks comm G seven. They accept Medicare nationwide, over 800 private insurers and all you have to do to get started is called 888-721-1514 or go to my link us med.com/juicebox using that number or my link helps to support the production of the Juicebox Podcast. Right Yeah, well speaking of that, let's jump into this very next one. This person said I've been listening to the episodes on GLP so they're talking about my weight loss diary. So I started off by going we go V so I caught it we go V diaries very recently it's changed over to set boundaries, but I decided I'm just going to call it weight loss because I don't know if set bounds gonna be the last glpi use or what so this person says I know that what you've said about we go V and meds like that being much more frequently used maybe one day for type ones and can you go into that a little bit. They also said you know I also hear rumblings about people worried that it causes gastroparesis. So okay, again, not a doctor. But here here's my view of it and Jenny has one too because she's worked with people who are are using gel PISA of type one. For me, I started with for myself. So I sit here before you today for 47 pounds lighter than I was exactly a year ago. Wow. It's crazy, right? And Jenny can tell you she looks at me probably more than anybody else. I look really different. You do. Yeah. So I don't have type one diabetes I started with we go V, which is just ozempic. To be clear for people it was epic is a medication that was FDA approved for people with type two diabetes. During the trials. I think they looked at each other like wow, people are losing a lot of weight on this. And so they moved over and did another trial for just weight loss that drugs called weego V. That's Novo Nordisk Eli Lilly has Manjaro, no type two diabetes, same idea. Is that bound for weight loss. I'm on Jarno and set bound RG LP with a G Ip, we go V is just a G lp. And by the way, the other day I saw news about Novo working on a daily pill to step in for the weekly injection. And they seem very excited about what they're seeing in trials for that. Now, all that aside, I don't have diabetes. So I take it, it tells your brain you're not hungry. It makes your stomach feel full by slowing your digestion, which impacts your insulin usage. I've had a number of other valuable things happen. But I watched it work for me. And then I cajoled my brother who is a type two. And I was like, Hey, man, come on. So he did it. His agency dropped two points, which is huge. The sevens into the low fives is a type two, he lost 35 pounds. But then I started talking about it on the podcast. And so now a week or so or so ago, I interviewed the mother of a 13 year old type one who had had type one that has had type one diabetes for three years legitimately has type one diabetes. Who On we go V for weight loss? Probably not why she took it she probably took it more because this is gonna sound convoluted for a second. The mom has PCOS. The daughter is showing signs of PCOS and GRPs are showing signs of helping women with PCOS. Correct. So she was able to get it through her insurance because of the weight. She really wanted it for the PCOS. And I'm not kidding you that yesterday, the mom sent me a 90 day clarity report 90 days, the kid has not bolused for a meal in 90 days. Wow. And her total daily insulin has gone from 70 units to seven.

Jennifer Smith, CDE 17:33
And that's it's only Basal then she took her

Scott Benner 17:36
pump off even Yeah, she's just shooting Basil is that I'm gonna pull it up so I can cuz I have it right here because still in my message is, again

Jennifer Smith, CDE 17:42
in for clarification to you know, from a listener standpoint, this is a very specific case of multiple components being in the picture. That it's not, it's not the solution. No, this just

Scott Benner 17:56
little girls probably has a very slow onset that just didn't look like a slow onset because of insulin resistance is my guess. Right? Yes, but you're not going to like have had diabetes for 30 years put it and drop your insulin uses 90% But you might drop it a little bit so

Jennifer Smith, CDE 18:13
or even more than a little bit. Again, in person in personal use, not personal me but personal with the people that I've worked with who have used it that a number of people have had diabetes 20 plus years who have started use of it and their insulin needs as well as that appetite suppression piece that goes along with it is very definitely it's something that the medication brings into the picture. People whose insulin needs have gone down. One of the women I work with her insulin needs went down 50% That's not even a therapeutic dose. Oh,

Scott Benner 18:49
so art and my daughter's doing the same thing she's only using right now half a milligram of ozempic a week. Her Basal went from 1.1. During the day to point eight five, her insulin sensitivity went from one unit moves or 43 to one unit moves her 83 and her carb ratio is now instead of one to four it's one to eight and she lost weight and know her insulin needs didn't drop because of the weight loss because the needs dropped before the weight came off. Before

Jennifer Smith, CDE 19:20
the weight came Yeah, I would imagine the weight eventually came off mainly because it is such a it's such an activator in terms of that not an activator but more of a suppressor really, I guess in terms of the digestive impact.

Scott Benner 19:33
For sure she's not eating as much but last thing about this little girl last 90 days average blood glucose 109 G mi 5.9, standard deviation 23 98% and range range of 65 to 180. Wow, I don't know how long that's gonna last but God bless her as long as it does. You know what I mean? Like fantastic. Right? So I would Oh, sorry. No, I was just gonna I want to remind people that that these GLP meta gauges are not FDA approved for type ones, and you're not gonna get it through your insurance. If you're just the type on the

Jennifer Smith, CDE 20:05
right there have to be some specific diagnostic codes and or reference notes and letters relative to a reason for prescribing and trying that could get it covered. I know there are a number of people who at least, you know, monetarily have the ability to pay out of pocket for it. Yeah, I know a number of people are already also going to Canada.

Scott Benner 20:27
That's how we're getting Arden. So mine is covered for me. My wife uses it too. By the way. My wife story is her own to tell. But I've spoken enough about what happened to my wife when her thyroid went poorly and nobody would give her Synthroid for seven years. And my wife has been doing this one week shorter than I have, and she's lost 70 pounds already. Wow, that's amazing. Doing so she does she just looks like a completely different person.

Jennifer Smith, CDE 20:51
And initially, it was very slow for her your weight loss was very quick to begin with. And hers took time if I remember, right, yeah,

Scott Benner 20:59
it's different for everybody. And I'm not going to tell you. It's not magic. Okay. No, I felt some people call it nausea. I felt like my food stopped somewhere like in my breastbone when I swallowed it. Like it didn't really, but that's the feeling I had. But then I'll say like three months into it, it just disappeared. And I really just, I was like, I'm losing weight. I'm powering through this, like, you know, they kept telling me it's gonna get easier. We go V, they also say may have a couple more side effects than SAP bound. It's one of the reasons I moved. I also plot toad. I think I plateaued at 194 pounds on weego V. And I was like that for months, like I would gain and lose the same two pounds every week. So my doctor moved me to zap bound where I quickly lost six more pounds. And then I think I've lost two more since then I've only been on it like six weeks or so I have I have more weight to go like, don't misunderstand. But then do I have to stay on it people are well, you're gonna have to stay on it forever. And here's what I say. I don't care. Like yeah, if I do, I do, like, you know what I mean, but I'm just gonna have a heart attack. So this got to be better. You know? Right,

Jennifer Smith, CDE 22:03
right. Absolutely. Well, and in terms of, as you just brought up, do I have to stay on it forever. I've worked with a couple of women who have used it. Right

Scott Benner 22:12
now we're going to hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is Mark.

David 22:21
I use injections for about six months. And then my endocrinologist at a navy recommended a pump. How long

Scott Benner 22:28
had you been in the Navy? Eight years up to that point? I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

David 22:37
I was medically discharged. Yeah, six months after my diagnosis.

Scott Benner 22:41
Was it your goal to stay in the Navy for your whole life? Your career? It was? Yeah,

David 22:45
yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we've made the decision, despite all the hardships and time away from home, that was what we loved

Scott Benner 22:58
the most. Was the Navy, like a lifetime goal of yours? lifetime goal.

David 23:03
I mean, as my earliest childhood memories, were flying, being a fighter pilot, how

Scott Benner 23:08
did your diagnosis impact your lifelong dream?

David 23:10
It was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant, I was not prepared for that at all. What does your support system look like? friends, your family caregivers, you know, for me to Medtronic, champions, community, you know, all those resources that are out there to help guide away but then help keep abreast on you know, the new things that are coming down the pike. And to give you hope for eventually, that we can find a cure, stick

Scott Benner 23:36
around at the end of this episode to hear my entire conversation with Mark. And you can hear more stories from Medtronic champions and share your own story at Medtronic diabetes.com/juice box,

Jennifer Smith, CDE 23:50
sort of prior to preconception time. And then because it is ABS, it's not approved. While there are some studies in the preconception time in in first trimester in those who have type two, who have continued to use it with with results that are interesting, I'll say it is not approved in pregnancy. So the idea is if you're going to use it, use it well prior to preconception to gain whatever loss really might be in the picture. I know a lot of women in preconception or may have difficulty getting pregnant, if weight is a big piece in the picture. And once that part is, you know, down to more optimal weight for their body and insulin needs, especially the resistance that's in the picture oftentimes there. Once the resistance has come down. It really does lead to a more optimal environment to actually allow conception. Yeah, which is lovely. But then we end up turning around as I've seen in a number of women, where we end up needing to refigure settings and doses because without the Met Vacation. Your needs will go back up.

Scott Benner 25:02
Oh, you have no idea Arden's in the middle of her finals right now. And three days ago, I said, Did you shoot that? GLP? And she goes, Oh, I forgot. I'm like, I can see it on your graph rd like in days. So I think they it's a once weekly, but I was listening to this doctor online who says that the life that half life's about five days maybe? Yeah, right. Yeah. And I noticed that too.

Jennifer Smith, CDE 25:24
It peters out pretty quickly. Yeah. So again, from a preconception standpoint, it gives you enough good time to be able to say, okay, I can take it up to this point, I can kind of figure things out, trying to conceive, et cetera. We're at

Scott Benner 25:38
the very beginning of something here with this because you can find there's Facebook groups where they talk about having ozempic babies, like people who could not get pregnant, their entire adult lives. Go on to GLP and end up pregnant in two months, right? Like crazy. There was this crazy thread in Reddit. I know people are like it's read it, but no, it's where people are talking. You know, people who have I never pronounce this right, Jenny, here's danlos. Damn. What's that? Autoimmune issue with the joints? Eres danlos? Oh, I don't I never say it right, hold on a second. It's not very common ears. It's e h r s o l e r s Danlos Syndrome, a group of illnesses passed from parent to child notice inherited defects, skin joints and blood vessels. It's a very rare condition. Right? But there's this group of people. It's like your connective tissue, right? Yeah. Like if you can, like hyperextend your joints and stuff like that. Some people have like real pain from that. And I found this group of people on Reddit who are like, Hey, I have this and my symptoms are going away. And the only thing I've done differently is taking a GLP medication. And it got 15 people in the group were like, Oh, my God, I thought I was crazy. Like, I think that's happening to me, too. So inflammation may be like, who knows where this is all going to like, eventually, like shake out? All I can tell you is it saved my life. Like for sure. And you know, and what I'm seeing it do for Arden is huge. It really is. So I don't know where this is all gonna go. But if we wake up in the world one day where you're getting a GLP along with your type one diabetes, I'm not going to be surprised when it happens. Yeah, right. You

Jennifer Smith, CDE 27:19
know, it always makes me I had a conversation with a friend the other day, also an educator with type one herself. And it just makes me really consider in the, in the grand scheme of things, what what have we really shifted so much in our recent, let's say, even the past 50 to 75 years of what we're doing. That's something that is naturally produced, interestingly, right? It's naturally supposed to be there working the way that we were created in the human body for it to work. Why is it not doing what it's supposed to be doing any longer? How

Scott Benner 27:56
do we kill it off? Yeah,

Jennifer Smith, CDE 27:58
how did we kill it off? How did we kill off the function of what and why? For some people? Is it so necessary? What are people who aren't using it? And who will find no real reason to even use it? What's the difference? Yeah, like that, like the rabbit hole of thoughts is where this life leads? No.

Scott Benner 28:15
Well, why are there so many autoimmune issues? Why there's so they so much more frequently? And like how is this? Listen to me, between you and I, I think when we start genetically modifying seeds to grow in weed killer, I think maybe you've got part of your answer right there. You know. So, yes, that's all the I don't know. Thank you said Yeah, well, I don't know if people realize that or not, but they make weed killer. And then they genetically modify the seeds. So the weed killer doesn't kill the seed, so that you don't actually have to pay someone to go out there and pull weeds to choke out the thing. You just plant the stuff, spray the field, everything dies, except the modified seed and your corn comes up or whatever. And that can't be good for us. I know. I know. Like people are like, don't click on Teflon. I don't don't microwave your plastic. I don't like you know what I mean? Like, you know, I try to avoid all that stuff, too. But big picture there. Plenty of people have autoimmune issues and never had a Teflon pan. So I think maybe we're unit I mean, like Yeah, that's gotta be something systemic like that. And so my point is, I would like that fixed. But I also understand that by the time they fix it, I'm going to be dead already. Yeah, yeah. So I gotta live. I gotta live now.

Jennifer Smith, CDE 29:25
And hopefully at this at that point, you're not gonna be dead from heart disease.

Scott Benner 29:29
Not now. I thought, Oh, come on J but I had a stomach. That was that would have been clearer. If I had a heart attack a doctor would have looked at me went Hmm, that makes sense. Like, yeah, and now I don't, so maybe I get to live longer. Makes me make more. For me. I don't know how good is for anybody else.

Jennifer Smith, CDE 29:46
All right, good for everybody. Yeah, absolutely. So

Scott Benner 29:48
that's where I'm gonna land is that I've seen a number of type ones using GLP is at what would not even be considered a therapeutic dose. They're having a lot of gains. Now look To the person's last point, it's not for everybody. Nothing's for everybody, right? And there are side effects that are on the label. gastroparesis. I've seen intestinal blockage, stuff like that. You also don't know where those people were before they started the medication, or how they ate once they had it. And I'm going to give you an actual example of a person I spoke to in public. Awesome. I saw them a year ago, I saw them recently. They've lost a ton of weight. I said, Oh, my God, we looked at each other. And he was like, you lost a lot of weight. I said, you did too. And I said, How'd you do it? He goes, GLP medication. I said, that's how I did it. And then he goes, How do you like it? And I was like, I was great. I went over everything about it that, you know, pros and cons that I saw, how was it for you? I said, he goes, I vomit all day on it. And I'm like, wait, what? And he starts talking, and then I recognize he shooting the GLP. But he's eating these high fat, like meals and like, he's, he's, I don't know, you know, I don't know what to say he's doing. But it's not in the spirit of the idea is what I'm gonna get like, it's not magic. You can't like you can't shoot the stuff and then eat a five pound bag of sugar and lose weight. It like doesn't work that way. Right? Right. He's slow, just digestion down. He's had type one diabetes for a pretty long time, it was not greatly managed. I don't know what nerve damage he has or doesn't have, like, so know who you are before you jump into this. But you know, I don't know. I just my, it's just my experience. So yeah, no,

Jennifer Smith, CDE 31:30
that and you bring up a really good point. Overall, you've had success. But I also know, you know, just in our discussions privately that you do a very good job of awareness in terms of what you eat.

Scott Benner 31:43
I'm not taxing this, this situation. Yeah, you're working

Jennifer Smith, CDE 31:47
with it. I guess that's that's the thing. It's like anything, you have to work with a system even, you know, automated insulin delivery systems, you have to work with the system, it's not going to do everything for you. The same thing with medications in general. They're a piece of the pie. Even as we started out talking about statins, great amount of statin now I can go out for burger and fries like it because it's gonna No, no,

Scott Benner 32:08
no. I know that that's it happens a lot more than you might want to believe to. Yes, yes. The number of people who have basically told me I eat through my GLP. Like, yeah, it tells me I'm not hungry. But that doesn't stop me. I'm like, oh, okay, that maybe see a therapist then? Not up. Like if you're not hungry? No, and you're still eating? That's a different situation. Let's jump. Let's finish this one up, because I think this will take a little chunk of time. Okay. Exercise. Oh, exercise with type one diabetes? Oh, that's a broad topic. Oh, well, let's pick through the three questions I have here. This one was interesting to me, how high of a blood sugar is too high to exercise with. Go ahead. I'm interested in what you're going to

Jennifer Smith, CDE 32:54
say no. And that's I'm trying to frame the way to say it. Because

Scott Benner 32:57
you know, everybody gets told, don't exercise when your blood sugar gets high. Correct.

Jennifer Smith, CDE 33:03
So if we're talking about it, just from, from an angle of overall performance, there were some really good studies done. It was a doctor at the Barbara Davis Center, if I remember correctly, he did studies within the realm of athletes with diabetes and athletes without diabetes and optimized performance with blood sugars in certain ranges. And what was found is a blood sugar range of somewhere between like 100 and 180 was where performance worked well, right there, muscle performance, their endurance and all of that kind of stuff. So in terms of targeting, when you're looking at performance, there's a range to kind of work with. But a lot of people also as you said, they need to they feel they're also needing to start with a high blood sugar in order to allow the fall that they know is going to happen in their blood sugar. So then comes in the question, well, how high is too high? What should I be looking at? If my blood sugar is too at do I have to wait for it to come down to get my blood sugar moving? Not necessarily.

Scott Benner 34:09
Have you heard people talk about that? They've been told it's dangerous to exercise with high blood sugars?

Jennifer Smith, CDE 34:14
Yes, and that's the clarification there is relative to whether or not there are ketones present. So

Scott Benner 34:21
if there are so if I have an elevated blood sugar for a long time and I have high ketones, I should not be exercising, you

Jennifer Smith, CDE 34:27
should aim to clear the ketones and get blood sugar moving and both of them require insulin. Okay, right. If to clear ketones ketones require some extra hydration, electrolytes as well as extra insulin to get the ketones to move. High blood sugars also require more insulin, so you're kind of adding extra on top of just bringing blood sugar down and at that point, then, if ketones are present, again, we're talking in a normal realm not not ketosis or whatever you might be living in naturally. You're aiming to get those ketones down. Now if you check ketones, your ketones are barely visible or not even there at all and your blood sugar's to 80. Go ahead and take a walk.

Scott Benner 35:09
Yeah, I was gonna say this doesn't mean I can't miss a meal balls and go for a walk afterwards, just because my blood sugar went to 250 or something like that. Exactly what happens if I exercise with high ketones like that. So if you exercise with high ketones,

Jennifer Smith, CDE 35:22
the idea is that the way that your body is going to you're at a deficit of insulin, high blood sugars, and high ketones mean that you're operating without enough insulin in your system, and without enough insulin in your system, what ends up happening with when you add exercise, your body is trying to drive energy or glucose into your cells in order to be used. Well, if there's not enough insulin there, even exercising isn't going to help because also the ketones are present. So you can actually make blood sugar go up. It's a huge stress on the body with ketones present, as well as the high blood sugar oxygenation, also at high blood sugars with ketones changes. So you may find effort much, much harder. And there are a lot of things that are the reason that the general recommendation is if your blood sugar's above 250, you don't go and exercise. I mean, that's, that's the baseline. That's

Scott Benner 36:16
a very clear explanation of that. By the way, the best one I've heard so far. I appreciate that. Oh, yeah. No, seriously, because I've been janky on it, too. Like people are like, why you're not supposed on like, well, you're not supposed to have there's ketones, but you can't if your blood and I'm like, I don't know, it's hard to explain, you know, it is here's the next exercise question. What are the preferred numbers for exercise or sports? When high at the threshold? Should we let the kids sit? So it would you set that again, but go over that one? Where do they what numbers? Should they not be running around? And where should there be testing ketones? That is it a number or is it an amount of time high, or a little bit of both?

Jennifer Smith, CDE 36:54
It could be a little bit of both, I mean, high blood sugars. That's the reason that most meters and even insulin pumps these days still remind you to check ketones and blood sugar if you're if your blood sugar is being recorded at 240 or greater, right. So that is kind of that that that level of evaluation, but also, if you are used to running blood sugars that are well within target, and now your blood sugar has been sitting at 200 or 220. For hours on end, it's a good idea to check ketones no matter what, yeah, no matter what, right. You know, there are certainly reasons that you could have ketones at lower blood sugar numbers as well. And you know, in that instance, maybe your blood sugar's high, when it normally isn't, because you are at a deficit of insulin because your pump sites partly pulled out, or it's leaking or something is wrong. I mean, there are evaluation steps along the way that you definitely have to take into consideration. Yeah, and you know, just an hour of a high blood sugar. Technically, you shouldn't have ketones from an hour of high blood sugar, especially if it's not a pump, or a site or an injection issue. It's probably you just didn't Bolus enough or you timed it wrong, or whatever it is, right. Yeah. So then in exercise, I think another one that kind of always is in the same line here in my thought is, well, what if exercise causes the high blood sugar, right,

Scott Benner 38:18
okay, like lift, like lifting,

Jennifer Smith, CDE 38:20
like either lifting, lifting those anaerobic exercises, right, they drive adrenaline, you might have a quick rise in blood sugar, or over the course of the time that you're lifting, you might have a rise in your blood sugar, which requires insulin, many people find that especially lifters, they need to take some injected insulin or some Bolus insulin with their pump or maybe a Temp Basal increase or something to accommodate for what's going to happen. Some people however, and I see this a lot, you know, kids and adults alike, sort of that a game or they're a the race that they've been working so hard, and they get there. And all of their training has been well managed. They haven't had high blood sugars or issues, but they get to that like, really, like, hacked up energy level of this is my game, and up goes the blood sugar. And what do you do with it? Right? Do you correct for it ahead of time knowing that this is a aerobic exercise, and that you will be moving for a fairly long period of time? Do you just let the high happen? And then let the exercise bring the blood sugar back down? Or does that rise leave you set high? So you may have to analyze and this is where some experiential sort of watching to see what should we do

Scott Benner 39:37
figure it out over time? Yeah. How good is the blanket advice. If you don't want to fall during exercise, try very hard not to have active insulin in your body before you exercise. And wondering Is that pretty good advice like exercise without active insulin if you can, if

Jennifer Smith, CDE 39:57
you can, right. That's pretty good. Exercise now, are you completely at a deficit of insulin? No, because you've got basil there. Yeah,

Scott Benner 40:04
no, I don't mean no basil. I mean, like, don't eat a sandwich two hours before you go out and run around iob.

Jennifer Smith, CDE 40:10
Yeah, in general, that's an if you can plan your exercise that way, that's a great way to mitigate that having to snack not having to, you know, adjust in another way, or having to eat along the way to prevent a drop in blood sugar. Absolutely. That's, that's a great recommendation,

Scott Benner 40:29
I'm gonna throw in one question for myself. How do I mitigate the idea of I've exercised today or played a bunch of games or done something like that. And then I don't get low until like one or two o'clock in the morning. Why does that happen? First of all, this kind of like late and lows. It's

Jennifer Smith, CDE 40:47
called delayed onset hypoglycemia. It's got a name. It's got a name, dope. You're a Simpsons fan, delayed onset hypoglycemia. Most people are like, Why? No.

Scott Benner 40:59
So I know you're saying

Jennifer Smith, CDE 41:02
you say it better than I do. But the reason that it happens is, you know, in the aftermath of exercise, this is often exercise that's more around an hour or longer. And often exercise that can be more in the afternoon or the evening, you may see the later hit of the mobilization of insulin and faster uptake and better use of it. Hours after that exercise kind of is finished. And some of the reason you may not see it initially is because afternoon evening exercise is often coupled with meal or food that comes right after it. And so you may sort of miss the sensitivity that's coming. And exercise. I mean, aerobic exercise, especially, I mean, it's x, its effect could certainly be eight to 12 hours. Yeah. So I've got, you know, one team that I worked with a while ago, and he he was on injections worked better than pumping for him. But because of the buildup of activity through the course of his week, we actually found through testing, we found adjustments in his Basal dose that needed to be paid by Thursday, so that by Friday and Saturday, he wasn't just eating, eating, eating to feed his insulin, because so much of the activity had built up through the week that he just was needing a lot less.

Scott Benner 42:27
Yeah, I just spoke to somebody who added swimming to the regimen. And they had to make adjustments to their insulin because they were swimming every day. But then they said if I miss swimming even a day or so then my blood sugar's shoot up again. Because their their sensitivity changes just from the loss of that. Yeah, it's really interesting. I wrote down two words that you're going to say next, we'll see if I'm right. Oh, I'm gonna read a question. And then I believe the next words you were utter out loud, are these two words, I heard Jenny completed an Ironman marathon. First of all, I think that's amazing accomplishment. But what did she do to prepare for diabetes wise? What did she eat? How did she set her pump? And what do you suggest for longer periods of exercise? And you're gonna say,

Jennifer Smith, CDE 43:09
I tested things.

Scott Benner 43:11
I thought you're gonna say, I thought you're gonna say half marathon Half Ironman.

Jennifer Smith, CDE 43:17
But you are correct, it is. I did a half Ironman.

Scott Benner 43:20
She doesn't want you to think she did a full Ironman when she did a half one I thought that was

Jennifer Smith, CDE 43:25
I do have to say that I did the mid my husband did a full Ironman. And I did the majority of training with him. So I guess despite not competing in the actual thing, I did a lot of the training with him. Do you think before I could have done it, the actually the funny thing about it is that we were actually we were planning kids. And the team that I was planning to do the Ironman with. Just happened to pick the timeframe where we were planning to have kids and like planning kids and training for an Ironman. Could they go together? There are plenty people out there who do it. Absolutely. But that was not in my wheelhouse of managing. So he actually did it with the team that I was going to do it with. But again along the way, I did a lot of the trainings. So could I have done it? Yes, I loved I wish that I still had time in my life to do triathlons. Because they are they're super fun to train for. But yes, half Ironman

Scott Benner 44:23
environment. Okay.

Jennifer Smith, CDE 44:24
I've done a couple of full marathons though. Yeah. For clarification. Yeah.

Scott Benner 44:29
I want solid on television. Okay, so people are running everywhere. Yes. So what did you what how did you prepare for it? Like what what steps you took to to get it accomplished?

Jennifer Smith, CDE 44:41
Yes. So I already had a fairly good base for running and for biking. Because I had done enough distance up to the point that I signed up to do the Half Ironman. The first time. I had done, century rides for are cycling. And I had not yet done a half marathon I had done 10 milers, but I hadn't done even a half marathon yet. So I had a good base for how my blood sugar needed to be managed and insulin adjustments and fueling for that type of endurance movement, what I needed to add to it, and what was the most trying was adding them all together and learning my adjustment for swimming. The swimming piece of it, thankfully, I wearing Omnipod, I didn't have to take my pump off, which made it a lot nicer. But a lot of it was experimentation. It was go in with this expectation based on what I know about my response to movement and do this, and what was the outcome and tracking that I kept a lot of notes, a lot of records. I kept what worked well, in terms of nutrition, like if I was going to go for a run in the morning, how did my stomach feel when I headed out based on what I had for dinner the night before? What worked well for fueling during long runs and long biking. So all of that had to be then pieced together because you do swim, and then you jump on your bike. And then you run. So you

Scott Benner 46:18
had to figure out not just how to go into swimming from the day before but after you did it successfully. Now how do I go from that to the next thing? And then when I do those two things in a row, how do I get to the third row? It's a lot of prep months, right?

Jennifer Smith, CDE 46:31
a month? Absolutely. My In fact, my prep started I would it was about a year ahead that we had all as a group we had signed up to do a half Ironman together. We did the Longhorn in Texas was a lot of fun. Okay, was very hot.

Scott Benner 46:49
And humid, right, was humidity. It was not it

Jennifer Smith, CDE 46:52
was just it was just just dry. It was in Austin, but it was mostly dry heat. Yeah. But overall, it's a lot of trial and error. And I think the biggest thing that I found in the endurance part of it was that insulin adjustments for that length of movement, meaning time of movement was it was not as much insulin adjustment off in terms of Basal. Because what I was filling the space with for maintaining my muscle performance was fuel. And that fuel was for a purpose of movement. But when you have diabetes, that fuel also has to work with your blood sugar management plan. It's a strategy that you definitely I mean, it's beneficial to work with somebody to kind of look at all your records, with perspective that's not your own and be able to get feedback. But yeah, I found fueling things that worked and fueling things that I was like, oh my god, I can't even I can't eat this, you know,

Scott Benner 47:56
you know, you just made me think of something, I have to say, Oh, we eat like you get up in the morning, eat breakfast. And that fuel keeps you going for a number of hours until you run low and have to put some more back in. But there's I didn't it never occurred to me, I don't know why. To think of it this way. That there's an amount of effort you can put your body through that it needs fuel almost constantly, because you can't over fuel it or you won't be able to make do the running or whatever you're doing the activity. But you also can't go large gaps of time without any so you have it's little bits along the way. I see. Okay, yeah,

Jennifer Smith, CDE 48:32
that was a learning that's a really good thing, just for you to notice in terms of endurance exercise, the way that you end up fueling is not like, oh, it's, it's on the hour, let me take in like, you know, three goos, or whatever you're using, right? It is an it from a blood sugar management perspective. It's a strategy, I had a watch that had a timer set. And it was a timer for both hydration, it was a timer for my next fuel, so that I constantly had the reminder that, Oh, it's 15 minutes, it's 20 minutes, it's time for this and I had it, packet it out essentially in the right amounts for the whole time through that long duration of movement. Alright, I'm

Scott Benner 49:12
gonna ask you one last question. Don't be embarrassed. Okay. I'm gonna look away from you. When I say how much of training for this? How much of the information that you got out of that? Do you use in other parts of your management? And I'm specifically thinking about sex? Because it seems to me right now you're an active person. So I would imagine that I would. I would imagine that there's not a big activity difference between your activity already and you being intimate, but for people who are maybe sit around a lot or don't move around as much, and then suddenly are working very hard for short spurts of time. I shouldn't have said for short periods of time. Damn it

Jennifer Smith, CDE 49:54
sure that I'll get a laugh. You got me.

Scott Benner 49:56
I didn't I didn't mean it. But but the Is that? How it's got? I can't think but that's got to have that feeling right. Like, that's why I had people on are like, I have to stop in the middle and drink a juice or like stuff like that. That's why right? It

Jennifer Smith, CDE 50:12
would be different. And I would expect that it's probably, as you said more relative to the activity level that the person is already at. Right. Right. And or in their intimate time with their partner. How active? How active that gets or how fast it is, or how slow it is, or whatever they're doing together right, Thursday,

Scott Benner 50:32
or is this a party? Right?

Jennifer Smith, CDE 50:35
Exactly. So is this vacation in Paris? Or is it like? I don't know. I'll jot

Scott Benner 50:41
that down and send it off your husband Paris, we'll get it done.

Jennifer Smith, CDE 50:46
We've been there already.

Scott Benner 50:49
Okay. I didn't know it was a memory. Okay.

Jennifer Smith, CDE 50:56
Not really. But that's a really good question. Because it is something that again, working with the large amount of women that I work with, it is definitely something that comes up. I don't know that I've ever had that conversation with a gentleman. Yeah, I

Scott Benner 51:12
have.

Jennifer Smith, CDE 51:14
Yeah, but women definitely it's, it's something that gets brought up because it is a consideration. And also, I mean, the consideration of the ability to actually feel good if your blood sugar is sitting at 52. In that type of setting. Yeah. Yeah. Probably not able to enjoy as much as you should be able to. Because not only is your alarm going off, but your brain is not really I mean, there's a whole host of things that are done. Yeah. And then

Scott Benner 51:46
on top of that, if you're foggy because you're high or you're dizzy because you're low. And yeah, okay. All right. Oh, that was a good way to

Jennifer Smith, CDE 51:54
go. I never I never really thought about my exercise prepared me.

Scott Benner 51:57
Well, I mean, you, you know a lot about it. Now. I do. So if I have type one, and I go to my, my, my mate, and I say listen, I've got to get this right, I'm gonna need a lot of experience. And he told me if I just trial and error, trial and error, I'll really figured I probably just need six months, I'll get it straight. Don't you worry. I just need your help.

Jennifer Smith, CDE 52:18
I'm quite sure that they're made is going to be like

Scott Benner 52:23
alright, thank you for doing this with me.

Jennifer Smith, CDE 52:24
I appreciate. Thank you.

Scott Benner 52:30
Mark is an incredible example of what so many experience living with diabetes, you show up for yourself and others every day, never letting diabetes define you. And that is what the Medtronic champion community is all about. Each of us is strong, and together, we're even stronger. To hear more stories from the Medtronic champion community or to share your own story, visit Medtronic diabetes.com/juicebox Don't forget, we still have marks conversation at the very end. It's a terrific kind of mini episode about 10 minutes long. That goes deeper into some of the things that you heard Mark talking about earlier in the show. A huge thanks to us med for sponsoring this episode of The Juicebox Podcast. Don't forget us med.com/juice box this is where we get our diabetes supplies from you can as well use the link or call 888-721-1514 Use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. A huge thank you to one of today's sponsors G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. If you are a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CDC es a registered dietician and a type one for over 35 years. And in the bowl beginning series Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. This series begins at episode 698 In your podcast player, or you can go to juicebox podcast.com. And click on bold beginnings in the menu. And now my full conversation with Medtronic champion, Mark. Mark. How old were you when you were diagnosed with type one diabetes? I was 2828 How old are you now? 4747. So just about 20 years.

David 54:46
Yeah, 19 years.

Scott Benner 54:48
What was your management style when you were diagnosed?

David 54:50
I use injections for about six months and then my endocrinologist and a navy recommended a pump.

Scott Benner 54:56
How long had you been in the Navy?

David 54:58
See eight years up to that point.

Scott Benner 54:59
Eight years. Yeah, I've interviewed a number of people who have been diagnosed during service. And most of the time they're discharged. What happened to you?

David 55:08
I was medically discharged. Yeah, six months after my diagnosis.

Scott Benner 55:12
I don't understand the whole system. Is that like, honorable? Yeah.

David 55:15
I mean, essentially, if you get a medical discharge, you get a commensurate honorable discharge. I guess there could be cases where something other than that, but that's that's really how it happened. So it's an honorably discharged with but because of medical reasons,

Scott Benner 55:27
and that still gives you access to the VA for the rest of your life. Right?

David 55:30
Correct. Yeah, exactly.

Scott Benner 55:31
Do you use the VA for your management? Yeah, I

David 55:33
used to up until a few years ago, when we moved to North Carolina, it just became untenable, just the rigmarole and process to kind of get all the things I needed. You know, for diabetes management, it was far easier just to go through a private practice.

Scott Benner 55:47
Was it your goal to stay in the Navy for your whole life, your career? It was? Yeah,

David 55:50
yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we made the decision, despite all the hardships and time away from home, that was what we loved the most. So that's what made it that much more difficult

Scott Benner 56:07
was the Navy, like a lifetime goal of yours or something you came to as an adult,

David 56:11
lifetime goal. I mean, as my earliest childhood memories were flying being a fighter pilot and specifically being flying on and off aircraft carriers. So, you know, watching Top Gun in the 80s certainly was a catalyst

Scott Benner 56:24
for that you've taken off and landed a jet on an aircraft carrier, hundreds of times. Is there anything in life as exhilarating as that stat No,

David 56:33
but there there's a roller coaster I wrote at, I think it was at Cedar Rapids up in Cleveland Sandusky, and they've got this roller coaster rotation from zero to like, it's like 80 or something, you go up a big hill and you come right back down. So the acceleration is pretty similar. I would say to catapult shot, I'm

Scott Benner 56:51
gonna guess you own a Tesla.

David 56:54
I don't I I'm a boring guy. I got a hybrid rav4 I get made fun of I get called. You know, my wife says I drive like a grandpa on the five miles per hour over the speed limit person. No more than that. So yeah, in the car. I'm boring Scott. So

Scott Benner 57:08
you've never felt a need to try to replace that with something else.

David 57:12
You can't replace it. It's irreplaceable. That's what I thought. So up until the point where someone you know, buys me an F 18. Or allows me to get inside a two seater and fly it you can't replace it? How

Scott Benner 57:22
did it make you feel when you saw or maybe you haven't seen? gentleman named Pietro has his large aircraft license. He's flying for a major carrier. Now he has type one diabetes. Does that feel hopeful to you?

David 57:33
Yeah, it does. You know, when I when I was diagnosed, that wasn't a possibility. The FAA prohibited commercial pilots who had type one diabetes, but I think it was 2017 when they changed their rules to allow type one diabetics to be commercial pilots. And part of the reason I did that was because of the technology advancements, specifically in pump therapy, and pump management. So I don't have any aspirations of going to the commercial airlines. But one of my sons who has type one diabetes very much wants to be a commercial pilot. So, you know, in that respect, I'm very hopeful and thankful. Yeah.

Scott Benner 58:05
Do you fly privately now for pleasure?

David 58:08
I do. Yeah. One of my favorite things to do is fly my kids to the different soccer tournaments they have all over the southeast us so last week, my wife and I and two of our boys flipped to Richmond for their soccer tournaments up there, and Charlie, who's my middle child has type one diabetes, so you know if I can combine flying family and football and one weekend to me that's I think I've just achieved Valhalla.

Scott Benner 58:32
So then it sounds to me like this diagnosis was a significant course correction for you. Can you tell me how it affected your dream?

David 58:39
Well, I you know, if I guess three words come to mind first, it was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant. And I was not prepared for that at all. The second emotion was, it was scary. I hadn't thought much about life outside the Navy, certainly not life as anything else, but a fighter pilot. And Heather and I were getting ready to move to France, I was going to do an exchange tour with with the French naval air force. So we were taking French classes. So pretty quickly, I had to reinvent myself. And then probably the most important thing at the same time that all that was going on, I had to learn how to how to deal with type one diabetes and how to manage it effectively. The third thing that pops into my mind, I guess, is challenging, you know, new daily routines, I had to establish first with injections, and then eventually, you know, through pump management, and then learning how to count carbs and recognize highs and lows, how my body reacts to blood sugar trends based on exercise and stress and those types of things. And my goal at that time, and it still is today is to leverage technology and make sure my habit patterns are effective so that I take diabetes management from the forefront to the background.

Scott Benner 59:46
Have you had success with that? Do you feel like you've made the transition? Well,

David 59:50
I have I mean, I believe in continuous improvement, so there's always more to do. I will say the technology since I was diagnosed specifically with pump management is just It's just incredible. It takes less of me intervening. And it's really done by the pump itself and by the algorithms through the CGM, and to me again, that that should be the goal for everybody is to not have to focus so much on the daily aspects of type one, diabetes management, you know, we should let technology do that for us.

Scott Benner 1:00:19
What else have you found valuable? I've spoken to 1000s of people with type one diabetes, the one thing that took me by surprise, because I don't have type one, myself, and my daughter was very young when she was diagnosed. I didn't really understand until I launched this podcast, and then it grew into this kind of big Facebook presence. I heard people say, I don't know anybody else who has type one diabetes, I wish I knew more people. But until I saw them come together, I didn't recognize how important it was. Yeah,

David 1:00:48
I think similarly, I didn't know anyone with type one diabetes growing up as an adult up until when I was diagnosed. And then all of a sudden, people just came out of the woodwork. And when CGM is first hit the market, certainly within the last five years. It's amazing to me and my family, how many people we've noticed with type one diabetes simply because you can see the CGM on their arm. I mean, I would say, a month does not go by where we don't run into someone at a restaurant or an amusement park or a sporting event or somewhere where we see somebody else with type one diabetes. And the other surprising aspect of that is just how quickly you make friends. And I'll give an example. We're at a soccer tournament up in Raleigh, this past Saturday and Sunday. And the referee came over to my son Charlie at the end of the game and said, Hey, I noticed you're wearing pomp. And he lifted up his shirt and showed his pump as well and said, I've had type one diabetes, since I was nine years old, I played soccer in college, I'm sure that's your aspiration. And I just want to tell you don't let type one diabetes ever stop you from achieving your dreams of what you want to do. And this gentleman was probably in his late 50s, or 60s. So just having that connection and seeing, you know, the outreach and people's willingness to share their experiences. It just means the world to us and just makes us feel like we're part of a strong community.

Scott Benner 1:02:08
So would you say that the most important things are strong technology tools, understanding how to manage yourself and a connection to others? Yeah,

David 1:02:17
technology for sure. And knowing how to leverage it, and then the community and that community is your friends, your family, caregivers, you know, for me to Medtronic, champions, community, you know, all those resources that are out there to, you know, help guide away, but then help help you keep abreast on you know, the new things that are coming down the pipe, and to give you hope for eventually, you know, that we can find a cure. You

Scott Benner 1:02:39
mentioned that your son wanted to be a pilot, he also has type one diabetes, how old was he when he was diagnosed.

David 1:02:45
So Henry was diagnosed when he was 12 years old, was just at the start of COVID, we are actually visiting my in laws in Tennessee, we woke up in the morning and he had his bed. And several years before that, we had all four of our boys tested for TrialNet. So you know, predictor of whether or not they're going to develop type one diabetes, and whether or Henry and one of his brothers tested positive for a lot of the indicators. So we always kind of had an inclination that there was a high degree of possibility he would develop it. But we always had at the back of our mind as well. And so when that event happened, at the beginning of COVID, we had him take his blood sugar on my glucometer. And it was over 400. And so right away, we knew that without even being diagnosed properly, by endocrinologist that he was a type one diabetic, so we hurried home, to get him properly diagnosed in Charlottesville. And then we just started the process first grieving, but then acceptance and, you know, his eventual, becoming part of the team that nobody wants to join. How old is he now? He's 15 years old. Now.

Scott Benner 1:03:51
When's the first time he came to you? And said, Is this going to stop me from flying almost

David 1:03:57
immediately. So like me, he's he always had aspirations of flying. In fact, he out of all four boys wanted to be in the military, that was a difficult part of the conversation and maybe something that we don't talk about as a community. But there are some things you cannot do as a type one diabetic, and that's a hard fact of life. And unfortunately, joining the military is one of those hard and fast things you cannot be you cannot join the military as a type one diabetic. So it was very difficult for him and for me and in my wife to get over. Then we also started talking about being a commercial pilot. So I saw that same excitement in his eyes because like me, you know, he can be an NFA teen or a 737 or a Cirrus SR 20 That I fly and be just as happy. So he still has that passion today and still very much plans to eventually become a commercial pilot.

Scott Benner 1:04:42
I appreciate your sharing that with me. Thank you. You have four children do any others have type one. They

David 1:04:48
do? My oldest twin Henry has type one diabetes and my middle son Charlie has type one diabetes as well. The boys are twins. The oldest two are twins. One has type one diabetes, my middle son who is not at When has type one diabetes,

Scott Benner 1:05:01
I see is there any other autoimmune in your family? There isn't I'm really the

David 1:05:05
only person in my family or my wife's family that we know of with any sort of autoimmune disease, certainly type one diabetes. So unfortunately, I was the first to strike it rich and unfortunately pass it along to two of my sons with celiac thyroid, anything like that. Not at all, nothing. We're really a pretty healthy family. So this came out of nowhere for myself and for my two sons.

Scott Benner 1:05:28
That's really something. I appreciate your time very much. I appreciate you sharing this with me. Thank you very much.

David 1:05:33
Anytime Scott,

Scott Benner 1:05:34
learn more about the Medtronic champion community at Medtronic diabetes.com/juice box or by searching the hashtag Medtronic champion on your favorite social media platform. 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