#1195 Fainting Goat

Christian is an adult living with type 1 diabetes.

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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 1195 of the Juicebox Podcast.

Today I'm having an absolutely fantastic conversation with Christian who was diagnosed with type one diabetes in his early 30s. Quite recently. 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. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cozy earth.com. I know that Facebook has a bad reputation, but please give the private Facebook group for the Juicebox Podcast a healthy once over Juicebox Podcast type one diabetes. Hey if you're a type one or you are the caregiver of one and a US resident, the T one D exchange is looking for you. They need your answers to simple survey questions which will help move type one diabetes research forward. T one D exchange.org/juicebox will take you about 10 minutes, complete the survey and you are helping

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 888721514 Use the link or the number get your free benefits check it get started today with us med this episode of The Juicebox Podcast is sponsored by the ever since CGM. And sure all CGM systems use Transcutaneous sensors that are inserted into the skin and last seven to 14 days. But the ever since sensor is inserted completely under the skin lasting six months ever since cgm.com/juicebox.

Christian 2:17
Hi, I'm a Christian to Laszlo. I'm a relatively new type one diabetic from about a year and a half ago. And excited to be here to talk with you.

Scott Benner 2:28
Christian, how old are you?

Speaker 1 2:29
I am 33. About a year and a half ago.

Scott Benner 2:33
Let's get started. Was your diagnosis of surprise? Or do you have type one in your family?

Speaker 2 2:39
complete surprise, no type one of my family.

Scott Benner 2:42
Any other autoimmune in your family? Celiac, hypothyroidism, stuff like that.

Speaker 1 2:49
Nothing, nothing. Got a bipolar uncle. Nothing, nothing.

Scott Benner 2:54
Sometimes people say well, I don't know if it's been diagnosed. But I do have that uncle.

Speaker 2 2:58
Yeah, no, I've nothing. And that's why what really was a shock. Yeah. And it was caught. I basically went in for a routine physical, I was healthy as can be. went in for a routine physical like I do every year as a good boy. And got my routine bloodwork done. And my GP found that my blood sugar, I think it was 122, which on the surface for a healthy 32 year old at the time, or maybe 31 year old was like, okay, whatever, maybe you just ate lunch. And she reran it for the A one C. And she found that it was I think in the high fives and she thought that's a little weird, or even low sixes and sent me to an endocrinologist got more bloodwork done. Turns out, I had all three antibodies off the charts of what's measurable. So basically, they caught it, just at the start of it, my was still making fool nearly full production insulin. I had COVID, about six months prior. And my endocrinologist is under the impression that that probably could have been involved in triggering it. Yeah. And she had several other patients where she's seen similar pattern. So I do wonder about that, but not that it changes but I can do about it right now,

Scott Benner 4:14
of course, but Christian viruses precipitate diagnosis all the time. So if you have the antibodies, you know, you're predisposed when having three. I mean, it's I don't want to speak out of school, but it's pretty much a slam dunk that you're getting type one at some point now you just have to wait for exact Yeah, something to happen for your body to go, Hey, he's sick. I got confused. Let me do this now.

Speaker 2 4:35
Exactly. So once they found those, they basically said, you know, we don't know how long you have. You might you might have three months do you need insulin, you might have three years you don't really know. So they gave me their sort of spiel of you know, start pricking your finger and start watching your carbs that you're eating and keep an eye right. And as that gets more difficult, we might have to reassess. This was when was this you first of March of 21. Okay, now 22. Last year, it was about two months after we found out that we were pregnant with our first child. Oh, wow. So it was a it was a lot of a lot of news in a couple months. Yeah. And over that, you know, pregnancy period where I in my honeymoon period, where I was not yet on insulin, I obviously wanted to kind of stretch that period as long as I could, from like, a mental perspective. And I probably pushed it too far. I basically, I had gotten an appointment with a different endocrinologist that I wanted to see, but I couldn't get it until the following February. So I basically pushed and pushed eating less and less carbs, to try to keep the sugar in control until I got to February. But in doing so I lost like 30 pounds. Yeah. So DKA one, one lesson. If you want to lose weight, don't eat carbs works. On the other hand, if you're trying to stave off us needing insulin when you get diagnosed, don't go too long. Yeah, no, I see that for sure. It's really hard to gain the weight back when you lose so much of it. And that honestly has been my biggest battle sense is trying to gain the weight back.

Scott Benner 6:12
No kidding. Christian, I hate to do this but Arden's home right now, and she's still sleeping. And I don't love her blood sugar. I'm gonna pause for a second. I'm just gonna leave you sitting. I apologize. I'll be back in threes do yes. Okay, I'm back. I'm recording again. Sorry about that. Arden is home from college. And she's beginning to use the tiniest little bit of a GLP medication for probably, I mean, I think the two diagnosis is our insulin resistance, basically, around what is probably PCOS symptoms, which is a lot of like words for a guy who's only had diabetes for a year and a half. But she's only on the introductory dose, point two, five micrograms. And her insulin needs are now starting to shift. So interesting. I just had to move. I've been moving her insulin sensitivity, her Basal. And I haven't touched the correction factor on the food

Speaker 2 7:10
or I'm at your your the moving target phase again. Yeah, yeah,

Scott Benner 7:13
for a while, and it's moving quickly. So yeah. If I'm not mistaken, her insulin sensitivity has gone from 43. So one unit moves 43 points to one unit moves. 62 points. Wow. So it's a significant it's more like mine. Yeah, yeah. So anyway, that's what I was just doing now she got a little low because her daytime Basal rate just isn't working anymore. It's fascinating. I can't wait to talk about it more with people but not what we're here to talk to you about. So let me refocus myself. You get diagnosed, you don't know what's happening. The chest are in the middle of the your first pregnancy with your wife. She's only in her first trimester, you're probably a slow onset. That's how they set you up. And you think I'm guessing let me get the insulin part push till after the baby arrives? Was that your goal? And as far as possible, yeah. Right. And because I because I want to get as much baby under the belt as I can. Before I have to deal with that. It's funny, because if you would have known me then and come to me, I would have said, Christian do the exact opposite. Like, know what you're doing before the baby comes? Because you know, Murphy's Law, right? Like it's gonna like, your pancreas is gonna, like, raise the white flag, like, you know, the day after the baby comes home or something like that. You're gonna be doing both things. So is that about what happened? 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 that 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 888-721-1514 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 Dexcom G seven. They accept Medicare nationwide, over 800 private insurers and all you have to do to get started is call 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 G Juicebox

Unknown Speaker 10:00
Podcast.

Scott Benner 10:02
This episode of The Juicebox Podcast is sponsored by the only CGM you can take off to get into the shower. The ever since CGM ever since cgm.com/juice. Box. Well, I mean sure you could take the other ones off. But then you'd waste the sensor and have to start over again. But not with ever since ever since is a six month where implantable CGM. So if you want to take a shower without anything hanging on, you pop off the transmitter jump in the shower, when you get back out, put it back on, and you're right back to where you started. Come to think of it. You could do that whenever you wanted to. Maybe it was your prom night or your wedding day. Maybe you just don't want the thing on for a little while. But you don't want to go through the hassle of taking it off and having to restart it and you know, starting back over with like wonky numbers and having you know all that that goes with it when you take off a CGM and put it back on Oh, but you don't have to do that with the Eversense CGM. Because ever since is the only long term CGM with six months of real time glucose readings. This gives you more confidence, more convenience and flexibility. The Eversense CGM is there for you when you want discretion, a break. Or maybe just a little adult time. Ever since cgm.com/juice. Box, pop that transmitter off, pop it back on. You're right back where you started without any wasted devices or time.

Unknown Speaker 11:29
It what happened is

Speaker 2 11:30
that hit the fan. Pretty much the first day my paternity leave. So my paternity leave turned into diabetes leave. Right? which was unfortunate. It was bittersweet, right? It was very fortunate that I was able to be off work for six weeks to focus on learning how to use insulin for the first time. But it was also really unfortunate to have that time sort of stolen from what was supposed to be dad daughter time, right?

Scott Benner 11:58
Yeah. Was your wife pissed? I mean, not at you. But what I mean I would have been that's my mask.

Speaker 2 12:05
No, she honestly she's been amazing with it. Oh, good. We sort of staggered our leaves. She obviously was off right away when she had the baby. And was was had a good, good long maternity leave. And the baby was born in September. And then around February is around when I she went back to work. And I started maternity leaves. We staggered them to sort of spread it out. Yeah, so around February of this year is when I basically it was coming home from a course that I was teaching and finally went in to see an endocrinologist and TierPoint got in there and they were like you need insulin and carbs now or you're like gonna die. I was starving to death. Yeah. So yeah, God started right then got us to I did about a week of long acting injections only until I had my Omnipod training. And then God started with the pumps. I've never done MDI at all you

Scott Benner 13:05
just they gave you enough bait. They gave you basil for a week and then got you right to a pump.

Unknown Speaker 13:10
Correct? Yeah. Oh, wow.

Speaker 2 13:12
I've never actually shot fast acting insulin in myself ever

Scott Benner 13:17
for meals, or for corrections. You know, it's funny you started off. I was I thought the comment in the beginning. Wow, your GP really knocked out of the park. Like what a great catch in an unbelievable GPA. Yeah, yeah. And I even like the setup of how they they were like, look, this could be a long onset. Like they were probably thinking you could even have Lada and maybe it might take, it might take years for you to need it. And so they didn't know. Yeah, but you were the rate limiting factor here because you were trying to cheat the system. And you didn't give up when you were doing that. Yeah. Well, I understand what you were trying to do. But how much did you weigh when it started? What do you weigh now, when

Speaker 2 13:53
it started, I probably weighed about 165. I'm six foot by the time I when I was when I got on the pump, I was probably down to about 135 Wow. So that's about 30 pounds. Holy hell. And as I lost more, so I often hear oh, you get put on insulin and then finally your weight pops back up. That did not happen for me. i

Scott Benner 14:17
You stopped eating low carb at some point too. I did.

Speaker 2 14:22
Yeah. But But slowly, right. Because every time you stop eating Loga the more you increase the carbs are scaling up the insulin as well, which mentally is such a sure an interesting journey to sort of take out you feel like you're taking on more and more risk every time you shoot more and more insulin, which probably isn't actually a healthy way to think about it, the more I work with it. It is not. But it's a very natural way to feel about it when you're new at it. Yeah,

Scott Benner 14:48
no kidding. I would. I would. I felt that way. I understand what you're saying. And I think everybody else does too. It's just like, wow, this is it feels like wow, this is a lot. Like you know, were

Speaker 2 14:59
you genuine still hard like I travel a lot when I travel, I lose weight every trip. Because I don't know all the reasons I think part of it is I'm more risk averse. I'm trying to be extra careful because I'm alone. I'm traveling around the world. And if I'm in that situation, I really, really, really don't want to risk going low. And I'm only going to go low. I learned from you from going high. Right? That it's I really, I think I just hold back I'm almost nervous to eat when I'm traveling. And it's hard to find healthy food to eat while traveling in airports and stuff. Those are the toughest dates.

Scott Benner 15:35
It's terrible. Like really, you know, I say on here all the time, like get good food, and then I go out in the world. I'm like, Where the hell are people getting good food from? Everything I see is garbage.

Speaker 2 15:44
Sweet green, man. Yeah, I order sweet green. Every city I go to. Oh, really?

Scott Benner 15:48
Is that how you? You're able to do it? Yeah, I

Speaker 2 15:51
ordered a kale. I order a kale Caesar I can order in any city I fly to I can land there in order on DoorDash. And I'll be at the hotel and I'm there.

Scott Benner 15:57
See you somebody's people are looking for more than a salad. You know what I mean?

Speaker 2 16:01
And so and so who am I? That's the problem. Yeah, yeah. Well,

Scott Benner 16:05
okay, so you have like a pretty focused idea about coming on the podcast. So let's start by telling people like what you do for a living and what made you want to come on the show.

Speaker 2 16:17
I work with medical devices, not with diabetes devices, but rather with deep brain stimulators. So I work with conditions like Parkinson's and a central tremor, dystonia, OCD, epilepsy, various neurological conditions that use basically a pacemaker, but for the brain. What I do with that is I basically am a teacher. So I teach new hires when we're teaching people how to use the products, I help run courses to teach clinicians. And then I sort of work on the development of the products as well as I take the learnings from all of those users. And because of that background, I just, I naturally want to teach this stuff, right. So as I've even though I'm very new at this, I just naturally, really want to share the little that I have learned and try to maybe give some other explanations or descriptions or analogies or anything I can to help people understand how to work with the tools that they have, and how to get started when they get, you know, into this situation, right?

Scott Benner 17:20
Describing difficult or complex ideas to people in ways that they can understand is a skill. It's a, I'm wondering what you did in college or in professional life that got you to a point where you can do it. Well.

Speaker 2 17:38
It's funny I have I'm sort of biology backgrounds that that helps. I've always enjoyed explaining things. I you know, thinking back to being in high school taking physics class, I used to love trying to explain, like Newtonian physics to people and friction and ohms. lawns, I love coming up with easy ways to explain that stuff. And now in my job, it came full circle, I get to do that I get to do jobs all the time, I get to explain it in very simple terms that people understand. And I just found that I love it. How long would it take you to explain it to me? I can do right now. So Ohms law is often taught as sort of an equation, but that's not terribly useful to people better way to think about it. And nomos is something that describes the behavior of electricity, right? So when you think about, you know, if I were to push something across the floor, where to take a box and push it across the floor, how hard I'm pushing on that box is voltage. So voltage is how hard something is pushing electricity through a wire. And the only reason that box doesn't fly across the room, is because there's friction, right? sliding across a carpet, it's sliding across whatever that friction, that resistance of the force is impedance, or resistance, depends how you look at it. And that's another variable in ohms. Law. So you're you have a certain amount you're pushing, you have a certain amount that things are pushing back in the case of a wire, that's just the actual physical resistance of the metal, or whatever the material is that's resisting the movement of electricity. So you have a certain amount, you're pushing a certain amount the material is pushing back, and then you're going to have some sort of result. How fast is the box moving across the floor, right? And that's current, that's how much energy is actually moving through the wire. So then you can sort of build intuition around and think, Alright, well, what if suddenly, that carpet is ice, and it's really slippery, but you're still pushing with the same voltage? What's gonna happen to your current? It's gonna suddenly shoot up, right? Okay, because now it's really slippery, you're still pushing the same amount, but you're pushing it across ice, so it's gonna go really fast. Why does that make the current? That's the idea of going through a really low impedance wire versus going trying to go through say, something that's an insulator or something that's wooden. That's like pushing a box into a wall, right? You can push as much as you want. You can turn the voltage up as much as you want. The current is not going to flow through that wood.

Scott Benner 19:58
Okay, and we want that it because with, I'm guessing a smaller wire we can send more.

Speaker 2 20:06
That's really more. The reason it matters. It impacts a lot of mold impacts a lot of things, but impacts how you design things it impacts for the brainstem, which I work with it impacts, you know, why might you want a system of being something called constant current, constant voltage, most of there's different ways you can deliver electricity, you can tell a machine to maintain a certain voltage, or you can tell a machine to maintain a certain current. So you can sort of think of it like cruise control on a car, right? You can tell the car to hold the gas pedal at a certain spot with your foot. But if you come into a hill, your car's gonna slow down, right? Or you can go into cruise control, where it's going to detect that you're, you've hit a hill, and it will press the gas pedal down for you. That's constant current versus constant voltage, right? It's, it's trying to maintain a steady speed even though the impedance is changing. It's going to change the voltage in the background. So the current it's constant. Okay. So there's implications for things like that. What are you trying to maintain a steady amount of electricity? Are you do you want the device to just push with the same amount the whole time interest? There's different ways of thinking about electricity. Okay.

Scott Benner 21:13
What's most interesting to me is that that's how your brain works. And there's something about the way I talked about diabetes that made sense to you. Yeah, big time that I find interesting, because trust me, I'm not going to understand electricity. If you and I talk for another four years, I swear to you, what's been in the news lately, that makes this point? Tesla moved one of their cars from a 12 volt system to a 48 volt system? Yeah. And that means fewer or less wiring or something like that. And all my brain said was, I don't understand why the number go up. If it's, I don't understand. I

Speaker 2 21:48
asked the same, but so it's really funny, that whole Tesla thing, I read more about it, it's really more that they're using essentially Ethernet to connect everything right? They're using, yeah, it's less about the voltage and almost more about the, the methodology with which they're connecting things. But I also found that very confusing.

Scott Benner 22:06
Yeah, I was like, I don't understand why this is happening. I also was a person for two years was like, I don't understand insulin sensitivity. Why does the number get higher when it gets weaker? And I mean, I understand. I understand why. But I really do. I mean, we just talked about it a minute ago, like, you know, one unit moves you, you know, if one unit moves you 10 points, then two units moves you 20 points, that's, you know, obviously, the lower the number, the more insulin you use, I get it like I really do. But all my brain thinks is why did the person who designed this idea, not make it more intuitive? Like because you're like,

Speaker 2 22:41
can you describe why can you just come up with a power value? Yeah, like a strength? Yeah, you

Scott Benner 22:45
grind but a different ways that it makes sense, instead of your dorky engineer way that you thought of saying this, which I know is completely accurate. I'm not arguing with people who understand it. It's just I'm telling you, for regular people, you hear it and you go, I don't understand why did the number go up, but the insulin got weaker? That's confusing. So let me ask you, just very quickly, how do you find the podcast?

Speaker 2 23:06
How do I find the podcast? So I had a friend in college, who was also diagnosed as an adult. And when I reached out to her to give her the news, the first thing she did was send me the links to the Pro Tip series saw. Cool. And she said, this is this is where you start? And yeah, it changed my life, man.

Scott Benner 23:26
Oh, well, I want to know how and I want to know why it struck you the way it did. And you know, what was valuable for you, I really would like to pick through your experience with it.

Speaker 2 23:36
Yeah. Part of the story. And part of that I think the problem is getting diagnosed as an adult, I don't think you get the level of education and support that you might get as a kid, or as, or even as a parent of a kid. You're not at some pediatric endocrinology Center, where it's you have this big team, you're seeing an endocrinologist, an adult endocrinologist, and they're gonna prescribe you your stuff and give you your basics. And that's basically what you get. Yeah, finding a place to learn about the variables, you know, the variables of Pre-Bolus thing and the different variables of the food and the different for me, you know, in the same that I just described Ohms law. I needed that explanation for insulin. I needed I needed intuition around insulin, because that's my whole thing when I teach is I don't want people to understand I don't want them to write down an equation to be able to calculate Ohms law. I want them to have intuition around ohms law, and I needed intuition around insulin. And that's exactly what you were able to provide to me. Wow.

Scott Benner 24:39
Okay. I'm stunned honestly. Because if I had Oh,

Speaker 2 24:42
I mean, your description. I remember your description about tug of war, right. And sort of the the tug of war between the insulin and the carbs and the idea of getting the insulin to start pulling the sugar down to get some momentum before you get the carbs digesting and just that whole concept

Unknown Speaker 25:00
is so

Speaker 2 25:03
you know, key to all of this. Yeah. And then you add on to it, you start to layer into it the idea of an algorithm and insulin on board and all this stuff. And it really is about building an A true intuitive understanding of what's going on. If you I feel like if I tried to control my sugar, just with numbers and counting alone, I can hardly keep my sugar controlled doing the way I'm doing it. So yeah, it's I just think it's really important to have that understanding because it also takes some of the fear out, it allows you to be dynamic and reactive in a way that you can't. If you're simply following a checkbox, you know what I mean? Yeah, then the fear gets eliminated because you have at least some idea of why. What happened happened? Yeah, yeah. And therefore what you might need to do to fix it. Exactly. Yeah, this happens, right? If you're, if your only fixes are what your doctor said, Oh, this happens, do this. That's covering one situation, right? Having some understanding of how things work is so so valuable. Say your your tug of war description certainly helped me, I've been trying to think of analogies of my own as I, as I think about it, I sometimes think of it sort of like a fire, where when you eat the food, the foods going to combust in your stomach, and sort of put off heat. Right, and that heat is gonna make your blood sugar go up. And Insulin is the the hose the fire trucks spraying water on the fire. Yeah, I've heard it said that way too. And sometimes that just sort of makes sense, especially the idea of because the, when you think about the timing of all this, right, the fact that the food takes time to digest, it's sort of this slow burning fire, and sometimes it lights right up because you eat a candy bar, and it's an inferno. And it burns out really quick, because the super hot fire, or you might have you know, your, your pizza, and it's this slow burn that gets hotter and hotter and eventually fades out. Right? And that needs different water. Right? If you douse that slow burn with a ton of water, it is drowns, right, you have to sort of match the fire to the water that you're providing it, right.

Scott Benner 27:19
Yeah, you know, before I figured out to talk about the tug of war, which I think is elegant, and it's simple, necessarily simple, I used to say, and you should be interested, I think you'll be interested in this, I used to say to people imagine a scale of justice. But on each side, there's a small hole in the pan. And you know, think and you're putting kind of carbs and insulin on either side, and then they're draining out at different speeds. And then you can reach in and take out some of the insulin or put some more in or add more carbs.

Unknown Speaker 27:53
I love that.

Scott Benner 27:54
It's a good idea. It's too convoluted to explain well to people.

Speaker 2 27:59
But let's it step two, right, you start understanding the tug of war, but you need to eventually graduate to what you just described, because that's happening, whether you like it or not. Yeah,

Scott Benner 28:09
what I realized is if I explained the tug of war to people, they didn't need the second explanation, because once they understood the tug of war, they figured out the rest on their

Speaker 2 28:16
own. Yeah, that's fair. And they'll see those variables in their own way. Right. And so I let it go, also bear bones.

Scott Benner 28:23
You don't know how much time I spent explaining to people what like a scale of justice was. And it would throw off the teaching moment,

Speaker 2 28:31
and you're getting into a whole description of the house scale of justice works.

Scott Benner 28:34
Yeah, yeah, yeah. Well, that's exactly what happened. And do you? Have you ever heard me tell the story about where I came up with the tug of war thing?

Unknown Speaker 28:39
I don't think so. No,

Scott Benner 28:40
I was just prior to the podcast, I was a blogger, who would just find themselves in a situation where people online would tag me in posts and say, That guy can help you. That was sort of like how it started. And I would eventually have these, like private phone calls with people to the point where my wife's like, Oh, my God, what are you doing? I actually one day, I took off a Friday. And I talked to somebody every 45 minutes all day long. Because I felt bad about them piling up in my inbox. I basically just explained insulin over and over again, all day long to the strangers on the phone. And I remember thinking, you know, if I recorded this, I wonder if I wonder if they couldn't all listen at the same time. Well, it's so

Speaker 2 29:27
funny. It's so similar to what I do for a living because there's certain topics for our products where I'm kind of the guy who explains that topic. So whenever that question comes up, it's sent my way and I explained end up explaining the same thing a lot. So I get that

Scott Benner 29:43
but you have to though, because as much as you can say I've already recorded it, which I have. I have to be honest with you Pro Tip series runs from it's been remastered runs from Episode 1000 to 1026. Just go listen to it. It'll change your life. It'll put your one C in the sixes probably in the last six months, if you really understand what I'm saying, you can get into the high fives without much trouble. And I'm not talking about being low carb, I'm just talking about understanding how insulin works. But the problem is the way social media works. And the way even podcasts work is that everything, no matter how valuable it is, it becomes old at some point. And then people cycle out. And as much as like right now, this is kind of convoluted, but like, I can picture 10 People in my Facebook group whose avatars I know. And these are very active people, they're very engaged right now. But six months from now, those 10 avatars will be different people. And so it's my job to keep to recognize when the turnover have to rehash Yeah, and just go over it again. Except you can't, except that I also have longtime listeners who've been listening to podcasts for years, I can't refeed them the Pro Tip series, every, like every four months, like here they are again, you know what I mean? Like I, I had to spend a lot of money to remaster the Pro Tip series, just so I'd have a good reason to put them back out again, because I thought it was going to piss people off, if I just put them back into the feed again, and it would have it would have pissed off the old timers. And it would have made everybody who's new, super happy. So you're always playing this game of keeping the only the best way I've ever found to explain to people who are not involved in this business, which is like reaching people digitally, is it's like trying to keep a rock hot with a match. You know, you can get the rock up the temperature and keep it there if you hold the match there. But the second you pull the match away, the rock is stone cold again. And so you're constantly trying to keep the rock warm with new content. So like you told me before we started recording, I've listened to like, like your management stuff. It changed how I think and it was very nice of all what you said earlier, by the way, what you said Christian when nobody was listening doesn't do me much good. But anyway, but I don't listen much to the conversations. But I have the conversations a because I think they're interesting be because I think staying involved listening to people with diabetes helps you stay involved with your own diabetes. Absolutely. The business the secret of it is, is it keeps you involved in the podcast. And so that you keep hearing new ideas. And so that when I figure out something that I'm like, oh, people need to hear this, and I put it out, you're actually still here to get it. And so that's like, yeah, that makes sense. Yeah. What's the Greek guy that pushes the rock up the hill? That's how I feel. Yeah, I can't I can't believe I can't think of the name. It's because I can't pronounce it. Hold on. What I

Speaker 2 32:44
was gonna say same thing I can I can kind of say in my head, but I'm not going to try to say it on a microphone. So I just Googled Greek guy, FFS or Sufis

Scott Benner 32:53
Sisyphus, Sisyphus, right. Sisyphus. I think that's how you say, so I close, just so for everybody who knows, like, anytime I sound too smart. I just Googled Greek guy who pushes rock. Love it. But now let's find out pronunciation.

Unknown Speaker 33:11
This is a facade. Right?

Scott Benner 33:12
I think I have it right. Almost like I have to turn up the volume on something else.

Unknown Speaker 33:18
Sisyphus, I got it right, hold on.

Scott Benner 33:22
I knew it. I didn't. I'm smarter than I thought it was years ago. By the way, I don't think I'm that smart. So I'm not sure what that says. So it's a good day that I think that I'm good at explaining things in ways that people understand. Because of my upbringing. I'm adopted by really lovely, hardworking people. I used to say they were blue collar. But I think people will find that insulting. I don't mean it insulting. Because I grew up in a blue collar household, I have had a number of blue collar jobs. I've worked in sheet metal shops and done things that trust me are not fun. And don't pay well off it. Because I'm adopted my brain work differently than theirs did. So I think I was operating on a different level than they were. But I learned to speak from them. So my ideas are one thing they come out of my mouth in a really an easy way to understand because I don't know a lot of big words.

Speaker 2 34:20
And you probably had to learn unique ways to explain yourself to them for them to understand you. So you probably learned some good skills at finding different alternative ways to explain where you're coming from. Yes,

Scott Benner 34:33
I had what they would consider to be big ideas that I thought of as simple ideas. And so when I would just say them simply to me, I'd get like staring. So I've gotten very good at explaining things to be helpful Christian, you're the first person to figure that out. Good for you. That was nice. I've never said that out loud before. Total sincere and so then this all happened to Arden and I started writing a blog and help people. People stop worrying. Doing so I moved to podcasting. And I realized that those phone calls I was having with people were probably be interesting to listen to. I was pretty much 100%, man. Yeah. And then 15 years later you got diabetes? Yes. Act like crazy. And then I'm still here. And that's the other secret, by the way to helping people is to not get bored by your job. Sure. Yeah, absolutely. I could easily wake up one day and go, I'm not doing this anymore. I've done it once I've done it 100 times, not doing it 1000 times. But I don't see God

Speaker 2 35:30
doing a job that helps people that I'm very, very blessed to have a career in this industry where I, I, you know, it doesn't always feel like it every day. But in big picture, I get to wake up and know that my efforts there are going to help someone eventually. Yeah, no, that's exactly how I feel. It really, it makes work not work. That's

Scott Benner 35:51
incredibly true. And it sounds, it sounds so like Pollyanna, right? After I just said I don't really it sounds cheesy as hell. But it is undeniably true. Yeah. Now my life is better because I do this. So much so that I've been pretty pissed off for the past few weeks, because Apple changed how their podcast app works natively. And so yeah, I'm out of my mind. Like, and it happened today. Like I watched it happen to a person today. They said, Where did this app is I thought there was going to be an episode here. That's not the first one on my podcast app today. And I was like, it's there. You have to just go look for it. Like, oh, God, you naughty what it's worth.

Unknown Speaker 36:27
That's why listen on Spotify. Yeah, no, I

Scott Benner 36:30
know. But actually, I just got done having this conversation with somebody else. I don't want to rehash the whole thing on the podcast. But I think that because of the,

Unknown Speaker 36:37
like, publishing wrong to Spotify, as well,

Scott Benner 36:40
no, no, no, no, I was gonna say something you're, you're not trust me. You don't know what I'm gonna say it. I just don't know how to get it out of my mouth. I don't want to be insulting because I don't feel insulting about it. But I think that the podcast is overwhelmingly listened to by people who can afford an iPhone. And so they also are not very tech savvy. So they just use the app that's available to them on their phone. And so I have a really crazy unbalance of Spotify to Apple listeners. I'm going to use round numbers, because I don't feel like pulling them up. But something like the last 1.2 5 million downloads of the podcast, a million of them are on an Apple device, yet doesn't surprise me. Yeah, so and only like 70 I forgot the numbers, like 70,000 of them were on us on Spotify. So I don't even like on Apple. I chart like a major podcast. But on Spotify, I don't pop up on charts at all. I don't. And I just don't have enough downloads for that to make sense. And so I don't know exactly. But you're right. I listen, between all of you and me, I listen to my own podcasts on Spotify. So I downloaded on a couple of apps so I can understand everybody's experiences. Sure. I mean, you already cursed one. So the editors already listening for curses, but they just they, me and anybody who puts out a lot of content, Apple day by changing their their podcast app. That sucks. Yeah. Because now people aren't going to, I guess their thought is, is that if you put out content every day, then every day somebody goes and looks for it. But that's not really true. People wait for the app to tell them about that there's something there, you know, and hopefully they'll figure out that it's a mistake. But in the meantime, I'm now having to come up with other ways to engage people. And you know, remind them that there's content there all the time without pissing them off and being like, being like, Oh, my God, I hear from this guy from the podcast every week, like you don't need me like, I just I just want to listen to your show, man, I don't want to hear your problems. So anyway, this is what's going on in my life right now. Merry Christmas to me, Christian.

Speaker 2 38:47
Well, listen, if it's interesting to you, I took some notes over the past nine months, I want to hear because I realized in those early months, I recognize just how insane those first months are, when you're diagnosed, and just how underwater you are and how much there is to contend with. And I knew that by the time we recorded this, because I knew that was going to be in December, I was gonna have forgotten where my head was at then. And I wanted to be able to speak to people who are in that place. Nice, do it. So I took a few notes of just random, random topics that I thought would be worth speaking to. One was placebo effect, and the effect of how data impacts how you feel. And that's the whole idea of once I had a CGM on which thank God for CGM. I honestly can't fathom how anyone does this without one. But I will say there is such a real effect especially when you're new at this and you don't you're not even familiar with what low really feels like or high or anything. You'll see a down arrow and you immediately feel low. Because your brain goes down, I'm dropping, I'm supposed to feel low. No kidding. And I think that's gotten better for me. But it was a very real effect for several months. I don't know if that's true for other people. But I wanted to at least share it in case it is. And it's gotten better. It's gotten much better, because now I can, as you will say, you know, you have to trust that what's going to happen is going to happen, right? And that takes time. You have to build that trust and until you have it, you're just kind of looking to the CGM to see hey, CGM. How am I supposed to be feeling right now? Right. Yeah. It has a very powerful effect, sometimes to a detriment. Like, you'll really found that very interesting.

Scott Benner 40:42
You would like panic. Oh, yeah. Yeah.

Speaker 2 40:45
I would just feel it I would, I would, I wouldn't feel low. I'd hear an alarm and look at it and say, at diagonal down, and suddenly I feel well, in a real way.

Scott Benner 40:58
Do you think it's possible that it wasn't coincidence that it was just timing and that, you know, the, that you were actually low at that point

Speaker 2 41:07
could be or that I was feeling it in a vague way, but I was kind of unfamiliar with the feeling. And then once I saw it, it was sort of validation of Oh, that is going on? I'm not just tired. Oh, crap. I do feel weird. I got ya know, when you're when you're so new to the feeling?

Scott Benner 41:22
Yeah. Yeah. There's that moment where I can see that Arden know, she's low, but it's not low enough for her to care yet. Yeah. And it's not bothering her. She's not sitting there going. I know, I feel low. I'm gonna get have to jump up and do some

Speaker 2 41:37
years of competence. Right? That's because she's done this for long enough. Yeah. She knows that there's quick solutions to get out of that low. If she gets off her button gets the juice. Right. When you're brand new. You don't know what's gonna, what's gonna take?

Scott Benner 41:51
I don't know what I don't know. Yeah, yeah. I think that she also has a vibe for how she feels and what that means for how long she has to do something. Right. Yeah. And that you definitely don't have in the beginning.

Speaker 2 42:07
Yeah, you know, you don't have any intuition. You only have that data, right. So the data is incredibly educational is incredibly informative to for you to learn the behavior of the insulin and of your digestion. But it can also kind of rule you until you build any level of intuition of your own.

Scott Benner 42:25
Yeah. And it's with you still. I mean, you're you talked about it earlier, right. Like you still have, like, there's a fear that you're living with 100% Yeah. Are you sharing that with your wife by chance? Absolutely. Okay. And it shall become part of your system. Very

Speaker 2 42:43
much. So yeah, it only gets easier, right. And my three days after I had the pump, or maybe two days after I had the pump on for the first time, I EMS came to my house pretty like passed out in the kitchen. Oh my gosh, and my wife found me unconscious on the floor. Turns out, I was high. I was high had one of my first alarms on a CGM with a pump on. I went downstairs, I hopped out of bed to go downstairs and I realized I forgot to bring my bag up that had my, my finger picker. So I went down to check it. And in the anxiety, sort of panic of oh my god, I'm in the 200 and rebending, the two hundreds before I've got this pump on for the first time. I think all of the adrenaline just made me think quite literally Christian, you freaked yourself out. Yeah, I proved myself out so bad that I just went unconscious. And ambulance came they checked me out I came to I was fine. Right. They left I denied I was I was fine. All worked out fine. But yeah, it's it starts out or it can start out just so it's like you said you don't know what you don't know. And that can be just so scary. That's it. But it also was a really important lesson in like, you just have to stay calm. Nothing happens so fast that you can't resolve it. Especially, you know, if you're dealing with highs, nothing is happening so fast that you can't resolve it. Right. And it's just but it's until you have a couple of good experiences. And you can see that happen. Yeah, it's amazing how powerful your own thoughts can be.

Scott Benner 44:25
Can I ask a question again, I don't mean this pejoratively. But let me ask it anyway. Now prior to diabetes, alright, were you a lightweight like, Could I upset you easily?

Speaker 2 44:35
No. Okay. So I've been pretty quiet even keeled. But I'm a very, very rational very, I'm a very practical, rather, I'm an emotional person, but I'm a highly highly practical person, right, which usually allows me to overpower that. I think this was the emotions associated this were powerful enough and the fears were powerful enough. That practicality couldn't win and practicality takes knowledge, right? And I didn't have the knowledge so I couldn't talk my way out of the emotions and of the anxiety because I didn't have the knowledge to do so.

Scott Benner 45:12
But you weren't like one of those Tennessee fainting goats before, like, you know the about those goats that just paint? Yeah,

Speaker 2 45:19
I've had a few drops, Basal vagal drops in my day I have okay. I'm raising that home to that. Okay, okay. Not crazy. Not crazy.

Scott Benner 45:28
I'm bright. I think that this is an indication of how much anxiety and stress and panic you were feeling around this high blood sugar. Absolutely. Wow. That's really something. Absolutely. Your wife think you were dead. And it's just it's the first time right now.

Speaker 2 45:41
I mean, I'm to a one right now. But I'm not panicking. Right? Like, Oh, I get Bolus for this. This is just my presentation court was all kicking my butt. Which is not which is one of the hardest variables I've had to learn to deal with. Honestly, guys, because I teach for a living, right. So doing what I'm doing right now is what I get paid to do is sit on a microphone and talk to people, and sometimes hundreds of people. And I enjoy it. I enjoy sort of being on and doing that. But God does it kick your sugars. But yeah, it hypes you up like huge. It's unbelievable the impact of it. Yeah, when I do it, it's the closest thing. I'm not a like a drug person. So it's the closest thing to like, a high that I that I feel,

Scott Benner 46:24
is that idea of like, oh my god, there's 300 People here. And I have to say something valuable to them right now in a way of genuine buzz. You get it? Yeah. Your head gets floaty afterwards. It's interesting. Yeah. Yeah. So

Speaker 2 46:37
Matt floating is that the same chemicals are causing a floatiness? in you? Cause crazy insulin resistance in us. Right? Yeah. So it is remarkable the impact that's I'm still learning that I've learned the hard way, you know, trying to stay in automated mode on my Omni pod when I'm teaching No way. I'm going manual mode Temp Basal increase at least 25 50% for the whole day. And even then I'm correcting through the day. So the algorithms working well for you otherwise, but you just can't expect it to, to kind of cover such an a crazy out of nowhere leap. The algorithm is working. Okay. Okay, that's the algorithms interesting thing. So, a couple things about that. So I think the algorithm for me, because I've been honeymooning, most of the time that I've had this, I've been sort of moving in the direction of meeting more and more, the algorithm certainly has a tough time keeping up, because it's based on that total daily insulin. And here's job I find unless I'm going into manual and sort of cranking it and forcing it to have more TDI to go off of right, it's not increasing on its own. Okay. So that's been a bit of a challenge. And as a result, I've actually stopped using auto during the day. I have, I'm now only using auto at night, and I've had a lot better control during the day and manual. Even with just this I have a single Basal rate for during the day that I've determined myself, I don't have you know, multiple get or anything, I think I do need more in the morning. I'm gonna play with that. But overall, even just having a flat rate through the day has been better than the automated I think part of that is some of what I've heard people, other people talk about where you'll be in such a Basal deficit, by the time you get to your meal, because it sort of caught the last Bolus for you that now your next Bolus is all screwed up, because you have no Basal in you. So you end up shooting up anyway. Right. And I And part of that is I probably need to account for it with my own carb ratio, right? So my balls are stronger. But this is the stuff we're out the algorithm is so wonderful for what it does big picture, right? The fact that it will put the brakes on if you're going low, and you can't stop that low, what a miracle, right? I wouldn't give it up to the world when I'm sleeping. But it introduces these variances into your day. That unless they're really perfectly countering the bad variances that you're having in your day, they're just introducing more variants, right? Which makes things harder, not easier I find. And what's been also really interesting is I said in the beginning, I've never done MDI in my life. I started right on a pump, right on automated pump, which from one end is like, how amazing is that for people who are listening who had to do years of MDI and waited for years for the automated, they're like, lucky you, you got to start with that day one. And that's it has been amazing, right? I've been able to sleep better than probably many other people because I've been able to have peace of mind. And that's incredible. What's really hard, though, is trying to actually build intuition around the action of insulin, when you have an algorithm messing with the action of the insulin in the background. Yeah, right. It's really, really hard. Because you'll you'll have an idea of what of how much you need or how it's behaving. But then you look at your, your trace and you see the red and you're like, oh, so that was kind of The right amount. And that's kind of the curve that that amount of insulin causes with that Pre-Bolus. Except also with no Basal, right? It's like, so it's not I'm not actually learning the behavior of the insulin to the amount I would like to. And I found it that that in, especially in the beginning, when you have no intuition, I found that to be a challenge and a part of me wonders for that reason alone, could it have been worth it to do a little bit of MDI, just to learn that a little bit? I don't really regret it. I, you know, I'm not going to double back on now. I'm have built some intuitions I wouldn't go back. Right. But that absolutely was an interesting challenge at the time. Yeah.

Scott Benner 50:42
Well, that's super interesting, actually. And, you know, the truth is, is by putting it in manual mode, you are, I mean, you're MDI without the injections, right? You're, you're, you have one Basal rate that's happening, and you're, you're making decisions about like, I'm going to inject now I'm going to give

Unknown Speaker 50:58
my son and I'm hungry and nudging manually, myself, yes.

Scott Benner 51:01
So you had the experience. But I, I mean, it's not lost on me what you're saying. It's actually one of Jenny's concerns about modern life with diabetes. She keeps saying, like, these algorithms are getting so good at doing everything, and not even like explaining to you what's happening. She's like, there are going to be people who are having success, and they have no idea how they're having it. And I wonder, yeah,

Speaker 2 51:27
and then when their pump breaks, they're in trouble. Yeah, well, yeah, I

Scott Benner 51:30
mean, you're going to be just gonna say that of luck. But I don't think you'll be that far in trouble. But you're gonna be in the position you were in where you're like, I have to figure this out. Not everyone is going to do that. Not everyone's going to figure it out. Some people are just going to light their hair on fire and panic until their new pump comes. And and natural. That's interesting. I'm glad you did what you did. You know what I mean? Like, like, I like that you put it on manual so that you can get because it gives you that opportunity. It's not why you put it there. But it does give you that opportunity to use it.

Speaker 2 52:00
When the other interesting thing you were talking about the CGM support, you're asking about my wife and sort of the communication there. And one of the interesting things that came up was, especially in those early months, I was really just watching that number, right, I have the Apple Watch on. And it got to a point where she was starting to become concerned, like, I think you're becoming genuinely obsessive watching your sugar. Okay. And I'm sure this is something that has come up before and that, you know, is not an uncommon thing, especially when you're new. Yeah. And my explanation to her, which I still very much stand by, it's how I looked at at the time, is, that is my only way to learn. The more I watch that number, if I watch every single dot, I will be building as much intuition as I can to understand the impact of my actions on my sugar. And I still kind of see it that way. But there is also of course, a balancing act because it will take your life over. Right? So it's like anything you you want to give it your all but you can't give up your life in the process. And it's when you're really early and in it. That's a hard thing to keep tight on.

Scott Benner 53:16
There really is between obsessive and learning. Yeah.

Speaker 2 53:20
And in that way, I envy the people that have CGM, right, like oh my god, you get to go to ours and just not think about it and just hope for the best. How lovely. Right?

Scott Benner 53:28
Well, until until the finger

Speaker 2 53:31
prick and your 400 Right. I mean, that's the that's the trade off. Yeah, yeah.

Scott Benner 53:35
Until you're till you're a fainting goat. And then you're like, oh, geez, I guess I could have

Speaker 2 53:39
a CGM. Exactly, exactly. So it's ignorance is not bliss, right. But there's also then there is another other end of that spectrum. And I, my wife was concerned I was there. I don't know if I was there. But it's definitely a conversation that came up on numerous occasions.

Scott Benner 53:56
Yeah. Isn't it funny, if you gave her a low blood sugar? She'd be right next to you in five seconds. She'd be like, Oh, God, you're right. We should watch this. But no, it's very. It's interesting that you that you bring it up like this, because a lot

Speaker 1 54:08
of what I knew about diabetes

Scott Benner 54:13
was built off of me testing Arden a lot in the beginning, so no, no CGM, no pump even. And I would test test test test test. And my endo would be like, Why are you doing that? By endo Ardennes and why are you looking at that so much stop testing are so much he tested her 15 times today. There's no need for that. I was like, I don't know what you're saying. I'm trying to figure out what's happening. Like, I don't know. Well, I

Speaker 2 54:38
wouldn't do the same thing. Man. i My daughter will be fingerprinted every 10 minutes so I can learn how to keep her as healthy as

Scott Benner 54:45
possible. Yeah, I'm like, I'm like, I don't know what's happening right now. I have to figure it out. And so before CGM, I acted like a CGM.

Unknown Speaker 54:54
And I just was like, I get that. Yeah.

Scott Benner 54:57
And actually, as Oh, What did we do during COVID? We I was doing all these zooms during COVID with people. And this one lady came on one day, and she's listening to everybody. She's like, she raises her hand. She's like, I don't have a CGM, like what do I do? And I said, I don't know if this is scientific, but test yourself, like every hour, and make a little graph, like draw out like on a graph, and just it won't you won't know what's happening in between, but maybe get a

Unknown Speaker 55:24
contour next, and I'll draw your graph for you and your phone.

Scott Benner 55:28
Okay, well, that was this a couple of years ago. I don't know if that would have done that. That. But that's a great idea. There's a trust that what that app does, hold on Christian. Yeah, contour next.com/juicebox. There you go.

Speaker 2 55:41
Yeah, I just pulled mine up right now. It's brilliant man. It basically will draw every fingerprint you do. If you have the app open on your phone, it immediately sends it from Bluetooth to your phone, and will. So it's also nice, because especially if you're dealing with a low or something and you're not mentally, at your best, you do the finger prick the numbers on your little thing on your meter. You're dealing you got your pump controller out, you're trying to figure out what to do. Now the meters gone black, because you timed out? Well, you can just pull the phone ads, it's got the result, right, there's notification. It's available to you. And also if you're dealing with like, if I'm dealing with an issue a high or a low that's taking some time, right? Like it's not a one finger prick, low, you know what I mean? Yeah. And it's really nice, because you can see a bit of a trace, it's gonna plot the last, like you do a couple of fingerprints together, it actually pulls it up zoomed up on the screen to see those couple as a line graph. It's really clever. I

Scott Benner 56:39
have to say, you just taught me something. I'm sure the people from contour listening now and going great. They said he doesn't even understand how the app works. But I'll shift this conversation. That app is even better than I tell you it is in the ad. What do you think of that?

Speaker 2 56:50
So and I would say like anyone who doesn't have a CGM, it's a no brainer, because it like to your point. It's kind of a, you know, non CGM CGM. If you if you do it enough,

Scott Benner 57:02
what I ended up saying to the woman was like, Look, maybe this will help you, like do it every hour, create yourself like a little graph, it's gonna be jagged, but at least you, you know, I said, just kind of smooth those curves out in your mind and try to imagine what might be happening in between. And she did it. And we were doing the Zooms like every I forget, like pretty frequently during COVID. And one day, she came back and she started to like, get control of things. And she's like, this really helped. And I was like, God, damn, I was guessing but cool.

Unknown Speaker 57:31
I just said anything. Yeah,

Scott Benner 57:32
well, not anything. But yeah, like, I was like, I didn't know if that was gonna help or not. And sure enough, it did. But anyway, my experience with the doctors telling them that all those years ago, is basically what your wife was saying to you. Like, stop paying such close attention to it. It'll be okay. But I think there's a fine line between the learning and being obsessed the obviously don't want to be education, right? You can't learn about the data. Exactly. Otherwise, you're just guessing, guessing guessing constantly. Oh, good for you. Your feelings,

Unknown Speaker 58:01
which is very rough. I mean, oh,

Scott Benner 58:03
people are. So frequently, how do I put it usually like chasing ghosts around diabetes, they always think they know what's happening. They're almost never right. So yeah, having actual feedback and data is really helpful. But once you get this whole thing figured out, Christian, I would like it if you didn't look at your CGM, unless the damn thing alarmed, moving forward

Speaker 2 58:24
as we are. And so my wife, Jeff, thank you for that. And

Scott Benner 58:27
when you get comfortable, and there'll be a moment when you get comfortable, and we'll just happen. That's

Unknown Speaker 58:31
all. Yeah. What else to go on? It's

Speaker 2 58:34
definitely happening less so. But what I find now, the way it started to transition is the alarm go off and I think to myself, Oh, I don't even know where I was at. In gotta kind of relieving way like, oh, I hadn't looked at it for a while. Yeah. I love that. And then it developed into, hey, I haven't looked at in quite a while and you check it and it's good. And you go, wow, this is cool. I

Scott Benner 58:56
have to be honest, like since I broke and went to check Arden's blood sugar, so I went checked, Arden's blood sugar, she was 55 and I gave her a little bit of juice and a couple of carbs. And she was asleep. I was like, Hey, she's awake now, by the way, but I was like, hey, you know, eat these your low. I said, also, I'm going to change some of your settings right now, which I did write that in there. I knew what I did was right. I haven't looked again. To be perfectly I just picked my phone up now because I realized I haven't looked since then. And as you have true faith in juice, you know what juice is going to do for her. I knew what the giver and I knew what it was going to do. And sure enough, that was an 30 It's 1110 I haven't looked in 40 minutes and this thing's not beeping and so I'm not looking. You know, that's that. That's how I handle it.

Speaker 2 59:43
You know, I had a similar last night. In fact, I was at Newark Airport last night about midnight, getting in from coming back from from Minneapolis. Essentially. I was waiting to get picked up and I went low, not that low, the low for me. I was sort of Low 70s Down Arrow, which for me is like red, a red alert.

Scott Benner 1:00:04
I think that should be for everybody, by the way, but go ahead. Yeah.

Speaker 2 1:00:08
And so I'm sitting there. And, you know, I first I'm thinking, a couple of months ago, this would be juice for sure. Right. And I'm thinking, I'm about to be sitting in a car for 45 minutes. And I know I always end up climbing when I sit in that car after a flight, or 45 minutes. So I had four Skittles, and I chilled out. And it was fine. Look at you. That's excellent. But a couple of months ago, it would not have been that way. Right? You would have

Scott Benner 1:00:37
ran back in the airport and spent $75 on a bagel and think, oh yeah,

Speaker 2 1:00:42
I would have I would have plugged one of my my juice boxes. I traveled 12 Apple juice juice boxes, I traveled an insane amount of stuff. I like being around and at some point. It's interesting when I listened to those early podcasts from you and you're talking about you talked about some some travel stuff and talked about the idea of being prepared right? You don't have to be anxious you don't have to be scared if you're always prepared. And I truly believe that I travel with a pelican case. Having a big plastic suitcase. Yeah, no carry on size. That's completely filled with pumps, CGM comes, restock of all of my sugar things that I carry in my fanny pack. So I have two juice boxes physically on me when I'm flying and traveling. But I also know if I go to Europe, and I use those juice boxes and customs where am I getting more juice boxes when I go low and another hour? So I always have a bunch of stuff to restock my load treatments because I don't know where I'm gonna get the restock it

Scott Benner 1:01:43
as a Christian I just I'm giggling because I imagine the person that the at the X ray machine, they're like, Oh, here's one of these. Love me international jewel thieves or maybe a sniper coming into town to take out a local dignitary with the Pelican case.

Speaker 2 1:01:59
Yeah, no, they open it up and it's filled with with Big Bird juice boxes. Sure, sir.

Scott Benner 1:02:05
Excellent. I was thinking he pops out open opened the box sales going on and who cares?

Speaker 2 1:02:13
Excellent. I've still I've given up. I used to take the CGM out for the X ray, I don't anymore, I haven't had a problem. That has been worth it to me. Because the impact it has on getting through security is vast, about 90% of the time the Pelican case gets stopped and gets searched. And that's fine. And then wipe it down. About 90% of the time I walked through the X ray machine and don't have to get patted down. And that's really nice. So most of the time and I fly a lot. Most of the time I walk can walk right through as a person. My my Pelican case will get inspected. That's okay, it takes a second. And that's my most normal situation. Yeah, once in a while, I have to get patted down. Because whatever the X ray situation is or beeps, whatever it is, but when I had to take the Dexcom out and have them intentionally wipe them down every single time. That was the amount of anxiety caused me to have to declare that ahead of time spiked my sugar so much that it wasn't worth it to really

Scott Benner 1:03:12
yet because they swab them to make sure they're not explosives. They do right pods and insulin, a number of different things. So

Speaker 2 1:03:19
but for those who, you know, I know a lot of people don't fly a lot and don't travel, especially if you have diabetes. And as someone with my job was forced to sort of dive right into that and learn it very much the hard way. It's very doable. Yeah, it's, you know, they're, they're not your easiest days by any means, but it is absolutely doable. Yeah. I have a good story for you. In fact, please. My first time trying to go for a trip for work was probably about five, six months after I started the pump. I was sort of grounded from travel for a while I had that paternity leave period where I was really getting my crap together, trying to get my weight back up a little bit which was not going well that that took until I started lifting about nine months nine weeks ago and I finally started gaining weight when I started lifting. I went to fly to Minneapolis. I'm sitting on the plane in Newark. I'm already nervous, right? This is my first flight dealing with any of this I've read about pumps putting out too much insulin on the plane and everything right you read all this stuff, you get all nervous. We ended up sitting for six hours on the runway in a thunderstorm and can't go back to a gate all the gates are full. Eventually the flight gets canceled. I go home and that was my big success of the first the first flight it was sitting on a plane for six hours eating protein bars keeping your blood sugar up hope hoping for this thing to end. And that was supposed to be my first time away right my first time sleeping in a bed alone on insulin right with no supervision, no backup no wife. She was already scary. Right going off to Minneapolis to be alone in a hotel room. Well, about two weeks later was the next trip that didn't Not get canceled and that was in Switzerland. My first time sleeping alone in a in a bed with insulin was in Switzerland. You were really by yourself?

Scott Benner 1:05:08
You were Yeah. Did you tell it terrifies your wife know that when you leave how concerned you are? Yeah, yeah. Especially those

Speaker 2 1:05:16
early ones. Oh my God, it was terrifying for both of us. That's why I have so much stuff I travel with. That's why I go to the overkill I go to or feels like overkill. But yeah, that that being the first one, there's just so much to figure out. And it was during the summer so I'm going to switch over to the summer. There's no AC over there. It's like 90 degrees. Yeah, the little the little mini fridge in the hotel barely cools it at all. So I ended up having to give, you know ice packs to the hotel restaurant to put in their freezer twice a day to keep my insulin even cool from being you know not I'm not trying to keep my refrigerated insulin refrigerated. I'm just trying to keep my walking insulin from DNA Turing. It's so hot. So yeah, it was it was an interesting trip. But But it went okay, right, I got through it and learned a ton. And every trip sense, and it gets a little bit easier that the flights get easier. I'm not scared sleeping in hotels anymore. The first couple of times? I mean, how many alarms can you turn up to allow before you go to bed the first time you're in a hotel room right? Now it's it's just another night. So it is amazing how the difference just a few months can make if you you know, right? If you keep exposing yourself to the stuff that's scary and you learn from it. It's it stops being scary. Yeah,

Scott Benner 1:06:33
even you know, just the algorithms in general like using Arden's example from oh

Speaker 2 1:06:39
my god today? Well, I wouldn't I wouldn't have done it without the algorithm. I don't know if I would have I don't know if would have been responsible for me to go fly to Switzerland sleep overnight without an algorithms you

Scott Benner 1:06:48
were so bad early, didn't know what you were doing. Yeah, I was gonna say that even if like I didn't go like, you know, intercede just now. And I don't certainly want our blood sugar to be 55. But it would have, it would have hung around 55 Until she woke up, she would have woke up and not felt well, and all that other stuff. But she would have been alive and she wouldn't have had a seizure and all that other stuff, you know, so even when it can't stop you, you know, even when an algorithm can't stop you exactly where you want to be. I mean, not that they're foolproof. But man, they're fantastic, you know? Yeah,

Speaker 2 1:07:19
ya know, as actually, it's an interesting segue for algorithms. One of the other things that I found very interesting as I was learning, when I was trying to build my understanding of insulin, timing, and sort of how to fit in, I was saying that because I started with an algorithm, trying to learn the behavior of insulin was a little bit more difficult, because it was clouded by the algorithm. That meant I had to then layer in the algorithm into my understanding. And the way I kind of did that is I think of it as based on like, trying to learn how much extra insulin can your algorithm eat for you. I guess, if you're on an algorithm that can take care of highs the Omnipod doesn't really write it will only put the brakes on if you're going low. But if you have an algorithm that can address highs as well, then the question would also be how many extra carbs? Can your algorithm eat for you before you would have have to have actually given yourself more insulin to overcome that, right? Okay. For my purposes, it's just how much extra insulin? Can that algorithm eat? Right? Because that way, if I see myself dropping, and I see that all right, it's gone red, the algorithms putting the brakes on and I can look and see, well, what's the insulin on board? What's the number? And how aggressively? Is it going down? Because with no algorithm, you're going to have one understanding of how much you need to treat and how long you have and everything else. But with the algorithm, that's a different answer. And the answer to that question, in my mind is, how many extra units can that algorithm eat up for you so that your body doesn't have to eat them up? By turning the basil off? Right?

Scott Benner 1:08:58
Yeah, you can kind of go back to and say, okay, my insulin on board is a unit, but wow, it's cut. It's cut my Basal off for the last 90 minutes. And my Basal insulin is an a unit an hour, I think this is going to be okay. Like, you can kind of do math a little bit,

Speaker 2 1:09:15
you can mathematically sort of derive how much it's going to eat for you. Yeah, right.

Scott Benner 1:09:20
Now it's, it's the value is incredible. I've been the rest of what I didn't say earlier was that as much as I understood with finger sticks, then, you know, I added to that knowledge with CGM which Ardens had for you know, Arden's had a Dexcom forever. And, you know, I was able to learn from watching those but then my next big leap, besides making the podcast talking about all the time trying to figure out ways to explain things was an algorithm. Like the first time Arden was wearing loop. I would just look at that the companion app for Nightscout and I was like, Okay, it's cutting or basil here, and then I'd watch and see, winds up putting it back on and how much is it giving her back? And how interesting is it that it Bolus here but then took away the basil. But that didn't work. So her settings must not be right. So you go back and you fix the settings. Then the next time at Bolus is it takes the basil way and it actually manages the blood sugar correctly to okay, my settings are good now, watching it happen on that little screen over and over again until one day, it just makes sense to me, like I flatly just understand what's happening when I look at it. Almost every time

Speaker 2 1:10:27
I'm trying, I'm still I'm still trying to even piece together like, for example, if every time I Bolus for a meal, it's having to put the brakes on the catch that Bolus. Does that mean something is wrong? Does that mean I'm boasting too much if the algorithms having to kick in? Or is that okay? Right. That's the kind of stuff that I don't know the answer to. Yes.

Scott Benner 1:10:47
So it's all about how the algorithm is built. So for the moment, I can talk about Iaps, because that's what Arden's using, sure. It's very aggressive with Miele insulin, and then it manages backwards. So I think most of the algorithms kind of work this way, which makes

Speaker 2 1:11:05
sense, even put the brakes on the put the it's safer to put the brakes on automatically then put the gas on keep

Scott Benner 1:11:11
Bolus and plus it keeps you from getting higher. So if so if you're 90, when you start a meal, and you put you put in your carbs, it's going to, you know, each algorithm is going to decide to distance in the future a little differently, depending on how they're, you know how they're written. It's gonna say, look, insulin action is this amount of time. So I'm going to give enough insulin here to cover this food and the bolt and, you know, Basil needs out for a certain amount of time. And then I'll take away Basal insulin. If I see an up drift that I believe is not going away, I'll start adding the basil back again. I think that's what I

Speaker 2 1:11:48
meant, does it so then when you hear about, oh, you might need a slightly higher carb ratio on an algorithm pump. That's kind of why right? Because, yeah, it actually it has to actually be enough for the food. And that basil that it's trying to throw into that Bolus, right? It's

Scott Benner 1:12:04
why the people who don't consider fat and protein have trouble on algorithms. Yeah. Because they're just covering even if they even if their settings are rock solid, and they're counting their carbs correctly. There are other impact women. Yeah, yeah, there's other impacts coming that they're not accounting for. And so that insulin,

Speaker 2 1:12:23
and then that Basal turning off is what screws you because the timing is such that that time when the basil is off by about an hour, hour and a half later, when that will be kicking in is right when you start to rise from that fat

Scott Benner 1:12:33
time. Right. And even if you Bolus right then in there, you haven't had basil for so long. You're kind of fighting a battle and play for front. Yeah, yeah.

Speaker 2 1:12:41
And I think that's why I've had more success in manual mode to a degree. I think my I've had less issues with that late rise, because it isn't turning that basil off in the beginning of the Bolus. It's it's continuing. So yeah, that's interesting to think about.

Scott Benner 1:12:56
I'm proud of us both for getting you to that point. Yeah. So if you're, if if when you're eating lower carb stuff, your carb ratios seem like they work really well. And you're having trouble in automation, I would look harder at fat content, probably first fat and protein, things that are going to create a rise later that you're not accounting for with your initial Bolus. And, you know, people will say, well, on Omnipod, five, like, how do I do that? You know, depends on your digestion and how the foods hitting you. I mean, maybe you can put it in in the initial Bolus. Or maybe you'll have to make a secondary Bolus for the fat rise. That maybe I don't know. You'd have to. You're basically having to Pre-Bolus the fat fries. That makes sense treating it as another Exactly.

Speaker 2 1:13:39
Yeah. And I've tried both. I've tried doing the second Bolus all together, right, like a an hour later do another small Bolus for the coming rise.

Scott Benner 1:13:49
I've tried. I certainly tried to play to the extended Bolus is sometimes to a not so great result going well. Just a lot of learning to do still with that. But I was definitely effective, though, it's undeniable to me that using a normal Bolus for every food will not be successful. It's all timing. Now, some foods always need more. Yeah. And it's and there's reasons for it. It's not magic. So and it's timing, right. The whole thing is timing and amount. I swear to you, I could make a podcast that is six seconds long that I just said you have diabetes, you're using insulin, use the right amount of insulin at the right time. Figure that out and you're done

Speaker 2 1:14:27
those golden words. You said Man, if they stick with me, it's undeniably true.

Scott Benner 1:14:31
Listen, Krishna, I've promised my wife that I wouldn't stay on too long today because she's on a call and our dog is old. And she's like, Please don't make me get up off of a work call to take the dog outside. So I'm going to wrap up with you here. Yeah, I'm having a really good time. This was terrific. I would I don't say this to everybody. And the other people I don't say this to should not be offended. But if you were to reach back out in a year or so and want to do this again, I'd be up for this. I like the way your brain works. And I'm interested in what you're going to figure out in the next year or so.

Speaker 2 1:15:00
I'd love that man I'd be. I'm personally very curious to know to your point where I'll be in a year from now, because I went when I see how much easier it's gotten and how much more manual is become in eight, nine month and still really hard to be clear for anyone out there is at my point to I'm with you, it's still really frickin hard, but it is moving in the right direction. So I am also eager to see and would love to update you with some time. Yeah, reach out,

Scott Benner 1:15:27
please. Also, I regret to inform you that your episodes called fainting goat, Ah, sorry

Speaker 2 1:15:32
that it's there. There are plenty who know me who will say yep, that's about right.

Scott Benner 1:15:37
Also, I know we didn't we try not to say where you work, but I think you gave it away with your air schedule. So for people who really

Speaker 2 1:15:42
that's what, that's what discretion is all about. Right? People know, a little mental math and that's okay.

Scott Benner 1:15:48
Those people will figure it out for sure. Anyway, this was terrific. I really do appreciate it. I love I love the way you're you're thinking through all this. And I'm genuinely grateful that the podcast has been valuable for you. And,

Unknown Speaker 1:16:00
and I'm grateful to you, man.

Scott Benner 1:16:02
Very grateful. No, I appreciate it. I really do. Okay, hold on one second for me.

A huge thank you to ever since CGM for sponsoring this episode of the podcast. Are you tired of having to change your sensor every seven to 14 days with the ever sent CGM, you just replace it once every six months via a simple in office visit. Learn more and get started today at ever since cgm.com/juicebox. Arden has been getting her diabetes supplies from us med for three years, you can as well us med.com/juice box or call 888-721-1514 My thanks to us med for sponsoring this episode and for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links at juicebox podcast.com to us Med and all of the sponsors. If you're ready to level up your diabetes care, the diabetes Pro Tip series from the Juicebox Podcast focuses on simple strategies for living well with type one. The pro tip episodes contain easy to understand concepts that will increase your knowledge of how insulin works and so much more. My daughter has had an A one C between five two and six for since 2014 with zero diet restrictions, and some of those years include hurrying College. This information works for children, adults, and for the newly diagnosed and for those who have been struggling for years. Go to juicebox podcast.com and click on diabetes pro tip in the menu or head over to Episode 1000 of the Juicebox Podcast to get started today. With the episode newly diagnosed we're starting over and then continue right on to Episode 1025. That's the entire Pro Tip series episode 1002 1025. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

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