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Scott Benner 0:00
Hello friends and welcome to episode 1226 of the Juicebox Podcast.

In this episode Jenny and I are going to define glucagon. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box. If you have type one diabetes, or are the caregiver of someone with type one and a US resident, please go to T one D exchange.org/juice. Box and complete the survey. Your answers will help to move type one diabetes research board that may help you to T one D exchange.org/juicebox. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are now 50,000 members who are sharing stories and ideas. Go check out this amazing private and free Facebook group. Today's episode is sponsored by Medtronic diabetes, a company that's bringing together people who are redefining what it means to live with diabetes. Later in this episode, I'll be speaking with Mark, he was diagnosed with type one diabetes at 28. He's 47. Now that at the very end of the episode, you can hear my entire mini interview with Mark to hear more stories from the Medtronic champion community or to share your own story. Visit Medtronic diabetes.com/juice box and check out the Medtronic champion hashtag on social media. Why don't we do glucagon? So you all might know listening the defining diabetes series as well over 50 terms. And every once in a while I get a note from someone that says I can't believe that this isn't on here. No kidding. We didn't have like, I think Basal insulin wasn't on there for a really long time. Like we just missed it, you know, they made that's

Jennifer Smith, CDE 2:32
really interesting, because we define terms even like the symbol V effect, which I think was humorous, because I think you tried seven times to

Scott Benner 2:39
I don't know how to say yeah, Smokey, whatever. You're making fun of me, and then we need to find it. But apparently, I mean, we you and I've talked about glucagon a number of different times in the podcast, but we've never just defined it for the defining diabetes series. So let's do that now. So I think we when someone hears glucagon, and they have type one, my expectation is that they're thinking of the manmade stuff that they got through a prescription. I don't even know if do you think people even think because Ghunsa thing my liver makes?

Jennifer Smith, CDE 3:13
It's interesting because I think so but quite honestly, it's not made.

Scott Benner 3:20
No it's the alpha cells. Okay. All right. Yes, he in Korea. So there you go. Like I as I said it, I'm like, that's not right. Your pancreas makes glucagon, right? But what so what does your liver have to do with the release of it?

Jennifer Smith, CDE 3:32
So essentially, glucagon is involved in your livers, sort of fat metabolism and amino acids, which are like protein metabolism, it helps in how your body uses energy, all of that stuff, which is the reason as I mentioned, that other hormone that we talked about, right, Amylin, and how its action helps to actually sort of suppress glucagon, because we don't want as much of it output in the aftermath of actually taking in a meal. So when we look at where kind of you know, the liver comes in, what else is the liver stores? Glycogen, okay. So when we take in glucagon, right? We are using it for specifically in diabetes, hypoglycemia, okay. So we want to get a release of glycogen from our bodies, stores, liver, fat, muscle cells all store glucose or glycogen. So in order to get a release of that, in an episode of hypoglycemia, what we're going to look at is glucagon,

Scott Benner 4:48
so, okay, so it's, it's made by the pineal

Jennifer Smith, CDE 4:53
Yep, it stimulates hepatic or liver glucose. Production.

Scott Benner 5:01
Oh my god, I we have to do this more like street level Hold on a second so

Jennifer Smith, CDE 5:05
it helps. Oh go ahead. Go ahead.

Scott Benner 5:09
Glucagon is made by your pancreas. Glucagon

Jennifer Smith, CDE 5:11
is made by the alpha cells, not the beta cells. And there are multiple different types of cells in the pancreas. That's why we are not owners of a dysfunctional, completely dead pancreas doing

Scott Benner 5:21
stuff. So the alpha, the alpha cells are making glucagon. It's being stored.

Jennifer Smith, CDE 5:28
Is that right? So glucagon isn't stored so to speak is made in the alpha cells. Yes. It's pushed out as your body kind of needs it. The liver stores usable. Glucose, okay, glycogen glycogen is that that word? Alright.

Scott Benner 5:51
So the glucagon that the pancreas is making has nothing to do with the glucose that's stored in the liver, right in a way that they work together. All right, but they're not the same thing. Not the same thing. Okay. And then, if I have type one diabetes, I've used too much insulin, I get low and I use an emergency glucagon thing, it signals to my liver to release the glucose that's stored there.

Jennifer Smith, CDE 6:15
Yay. Yes, because glucose or glucagon essentially acts like a mobilizing kind of thing, right? It goes to the transporters like, hey, let's get some let's move it out into circulation. But it's not moving. Glucagon isn't what it's the stored glucose in your body stored glycogen that gets released. And that increases your blood sugar,

Scott Benner 6:35
don't you? Don't you imagine that most people just think that the emergency glucagon you shoot in and what's in there makes your blood sugar go up. But that's not it just signals your liver to let go of the glucose, which is why you can't do it over and over and over again, to some point because eventually your liver will run out of glucose

Jennifer Smith, CDE 6:52
back to your glycogen stores put essentially be depleted enough that it's not going to work

Scott Benner 6:58
work. And you'll get diminishing returns to the very least. Yes. Okay. All right, hold on. As you're listening right now, this is why I didn't like go to college. This is just some

Jennifer Smith, CDE 7:10
this is this is great. We're gonna get to break it down.

Scott Benner 7:14
Yeah. All right. So glucagon made by your alpha cells, glucagon, also the man made thing that you get as an emergency kit both have the same name. Your liver is storing glucose. If you have a low and use an emergency kit, the emergency kit signals to the liver to release the glucose that's there, which brings your blood sugar up. Yes. Yes. I feel tired from that. I'm setting because you understand it. So clearly, I'm looking at you look at me, and I'm like, I feel bad.

Jennifer Smith, CDE 7:49
Because this is I mean, even my understanding is a very, like, it's, I'm clearly not like, no, like, you know, biology. Like I understand all of the little transporter I beat I couldn't tell you the enzymes that release blah, blah, blah, and what happens but right in the gist of things, this is this is essentially how that works for you.

Scott Benner 8:10
Okay, are we going to mention here that if you're drunk, emergency glucagon might not work as well. And why? Because your liver is busy trying to get rid of all that booze you put in there? Us? Yeah,

Jennifer Smith, CDE 8:22
her likes to focus on. I mean, it's our detoxify. It does a lot of other things, you know, besides detoxifying? Your liver is an amazing, it's an amazing Oregon. Really. It really, honestly. But you're right. If you have a lot of toxins such as alcohol in your body, then your body's liver is working on taking that and kind of getting it out of the system. Yeah. And so it's it's less likely to focus on what's happening with your blood sugar.

Scott Benner 8:52
Okay. All right. I was the wrong person to lead this, obviously. But do you think we were clear about what glucagon is?

Jennifer Smith, CDE 8:59
I hope so. Yes, I do think that we were clear, and

Scott Benner 9:03
the glucagon that my alpha cells are making is not the same thing in the emergency kit. Right? Where is it? It's a synthetic version of it. It's,

Jennifer Smith, CDE 9:16
that's I think that's the easiest way to go. Okay.

Scott Benner 9:20
All right. So I see. And so glucose, your body's using glucagon to keep kind of like a homeostasis with your blood sugar.

Jennifer Smith, CDE 9:30
Correct. So even in somebody who doesn't have diabetes, right, their alpha cells are still making glucagon and they're making them in there it's making it essentially in order to allow a fasting state in order to allow some navigation through especially more endurance exercise, all of those kinds of things right. So the the human body has this, like

Scott Benner 9:54
a float valve almost like if I try to get too low, my body, my alpha cells, let out some glucagon and keep me stable.

Jennifer Smith, CDE 10:01
Correct. Right. So and remember in terms of our own body's glucose output, and this homeostasis kind of point. Why do we use Basal insulin?

Scott Benner 10:14
The same thing? It's it's this to hold down this the natural rise of what happens in your body? Yes.

Jennifer Smith, CDE 10:21
Okay. Correct, which is coming from this drip, drip, right? We're supposed to be getting, we're supposed to be getting insulin, we're supposed to be getting a little drip of glucose, especially in fasting states. So if we have no insulin coming in, our bodies still gives that drip, drip, drip, drip, drip, drip, but doesn't know it's that good.

Scott Benner 10:40
So you, Jennifer, you without Basal insulin, get the your body goes, Oh, here's a little glucagon, your liver goes, here's a little glucose and your blood sugar just keeps going up and never stops. If I don't take Basal, and we put it in manmade insulin to stop that from happening for me. My body is going here's some glucagon, that gives me some glucose. And then as I get too high, my body goes, here's some insulin, and they're just playing ping pong back and forth with my blood sugar. Yes. Ah, now, our bodies

Jennifer Smith, CDE 11:13
are a beautiful system. Our bodies are the most complex computer ever. There it is. It's amazing what it does.

Scott Benner 11:22
That's insane. I don't know why I've never thought of it like that before. That's really interesting. Okay, well, now I understand it. So if you look at we did it. And Jenny has to go. And it's Friday. Oh, so you only have a couple of minutes.

Unknown Speaker 11:38
Alright, well have a great week. Yes. Was way fun. No, we're

Scott Benner 11:41
gonna do more. Listen, we're gonna come back. The next time we do it. You and I are going to do total daily dose of insulin total daily and some are going to do duration of insulin action or insulin action time. We're going to do I might be it for that list. Oh, I don't know. Also, I've been told by the powers that be, which is Isabel who tells me what to do. She said that we need a bulb beginning to episode about correcting mistakes. Like if you were to inject the wrong insulin, that we should have a conversation about how to handle that. That's a great one. She thinks we should do a bold beginnings episode about CGM accuracy. Okay, she thinks we need a part two of the diabetes pro tip for fat and protein. Okay, she thinks that we need by the way, Isabel, thank you so much. She said we need a diabetes variable for men and not being able to finish. Okay, and they have type one and it's maybe not well controlled.

Jennifer Smith, CDE 12:41
So we're talking about erectile dysfunction. That's what

Scott Benner 12:45
we're talking about there. And okay. Yeah, she's got a whole list of stuff. Like, basically you and I work for Isabel is what I'm looking at her. She she tells us what to do. And we do it. Fabulous. Thank you. She's like, I don't even know that was happening. Okay. All right. Thank you very much. I'll talk to you soon. Awesome, thank you.

diabetes diagnosis comes with a lot of new terms, and you're not going to understand most of them. That's why we made the finding diabetes, go to juicebox podcast.com, up into the menu and click on defining diabetes, to find the series that will tell you what all of those words mean. Short, fun and informative. That's the finding diabetes, the diabetes variable series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about travel and exercise to hydration, and even trampolines. juicebox podcast.com, go up in the menu and click on diabetes variables. 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 14:11
Yeah, 19 years?

Scott Benner 14:13
What was your management style when you were diagnosed?

David 14:15
I use injections for about six months. And then my endocrinologist at a navy recommended a pump.

Scott Benner 14:21
How long had you been in the Navy? See eight years up to that point? 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 14:33
I was medically discharged. Yeah, six months after my diagnosis.

Scott Benner 14:37
I don't understand the whole system. Is that like, honorable?

David 14:39
Yeah. 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 reason,

Scott Benner 14:51
and that still gives you access to the VA for the rest of your life. Right?

David 14:55
Correct. Yeah, exactly.

Scott Benner 14:56
Do you use the VA for your management? Yeah, I

David 14:58
used to up until 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 15:12
Was it your goal to stay in the Navy for your whole life, your career? It was,

David 15:15
yeah, 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 the most. So that's what made it that much more difficult was

Scott Benner 15:31
the Navy, like a lifetime goal of yours or something you came to as an adult,

David 15:36
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

Scott Benner 15:48
was a catalyst 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?

David 15:57
No, 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,

Scott Benner 16:16
I'm gonna guess you own a Tesla.

David 16:18
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. I'm a five miles per hour over the speed limit person. No more than that. So yeah, in the car, I'm boring

Scott Benner 16:33
guy. So you've never felt a need to try to replace that with something else.

David 16:37
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.

Scott Benner 16:47
How 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? Yeah,

David 16:58
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 17:30
Do you fly privately now for pleasure?

David 17:33
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. So

Scott Benner 17:56
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 18:04
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 19:11
Have you had success with that? Do you feel like you've made the transition? Well,

David 19:15
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, it's 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 comes in 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 19:44
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 20:13
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 a 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. Yeah.

Scott Benner 21:33
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 21:42
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 champion's 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 pike. And to give you hope for eventually, you know, that we can find a cure, you

Scott Benner 22:04
mentioned that your son wanted to be a pilot, he also has type one diabetes, how old was he when he was diagnosed,

David 22:09
so Henry was diagnosed when he was 12 years old. That 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 trial net. 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.

Unknown Speaker 23:12
How old is he now?

David 23:14
He's 15 years old. Now,

Scott Benner 23:15
when's the first time he came to you? And said, Is this going to stop me from flying

David 23:21
almost 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 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 24:07
I appreciate your sharing that with me. Thank you. You have four children do any others have type one?

David 24:12
They 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 a twin has type one diabetes.

Scott Benner 24:26
I see. Is there any other auto immune in your family? There

David 24:28
isn't I'm really the 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 to my sons,

Scott Benner 24:43
but celiac thyroid, anything like that. Not nothing. We're

David 24:48
really a pretty healthy family. So this came out of nowhere for myself and for my two sons.

Scott Benner 24:53
That's really something. I appreciate your time very much. I appreciate you sharing this with me. Thank you very much. Anytime, Scott. 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