#1228 Grand Rounds: Dr. Jessica Hutchins

Dr. Jessica Hutchins is a Pediatric Endo

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Scott Benner 0:00
Hello friends, welcome to episode 1228 of the Juicebox Podcast.

Today, we're gonna be adding to the Grand Rounds series with Dr. Hutchins. She's a pediatric endocrinologist and a member of the private Facebook group for the Juicebox Podcast. 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. If you or a loved one has type one diabetes, and you and that loved one or a US resident, go to T one D exchange.org/juicebox. and complete the survey. This quick survey is going to help type one diabetes research move forward, it's going to help you it's going to help me it's going to help other people T one D exchange.org/juice. Box complete the survey. When you place your first order for ag one with my link you'll get five free travel packs and a free year's supply of vitamin D. Drink ag one.com/juice box. 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

today's episode of The Juicebox Podcast is sponsored by Dexcom, makers of the Dexcom G seven and G six continuous glucose monitoring systems. dexcom.com/juicebox Today's episode is sponsored by Medtronic diabetes, a company that's bringing people together to redefine what it means to live with diabetes. Later in this episode, I'll be speaking with Jalen, he was diagnosed with type one diabetes at 14. He's 29. Now he's going to tell you a little bit about his story. To hear more stories with Medtronic champions. Go to Medtronic diabetes.com/juicebox or search the hashtag Medtronic champion on your favorite social media platform. The touch by type one event live in Orlando is coming up fast. September 14. Tickets are available. They're free. I'm going to be there today I found out Jenny Smith is going to be there head now to touch by type one.org. Go to the program's tab and get yourself some absolutely free ticks. Ticks. That's short for tickets. It's free. Go register now.

Dr. Jessica Hutchins 2:37
Hello. I'm Dr. Jessica Hutchins. I am a pediatric endocrinologist in Georgia.

Scott Benner 2:44
Do I call you Jessica or Dr. Hodge?

Dr. Jessica Hutchins 2:46
You can call me Jessica. Thank

Scott Benner 2:48
you, Jessica. I feel like I know you even though I probably couldn't pick you out of a lineup if I had to. It's been like

Dr. Jessica Hutchins 2:54
over two years, I think at least two? Yeah, definitely. Well over two years that we've I've been on the Facebook group and sending patients to the podcast and the Facebook group. So yeah. Can I

Scott Benner 3:07
start there? How do you make your way to it?

Dr. Jessica Hutchins 3:10
I actually found out from a family a patient. One of my patients moms asked me one day, had you heard of the Juicebox Podcast? I was like no. And honestly, I think when she asked me I wasn't really like I had just kind of started getting into podcasts in general. And so I just had not been a podcast person before and then kind of started listening, dab dab dabbling in podcast listening. And then she mentioned that so then I was like, yeah, I gotta check that out. And then like, since then, was just kind of like, hooked to it. And I really liked a lot of the episodes like, I mean, I enjoyed the episodes of people telling their story, but I actually enjoy the education ones that you and Jenny do and like the series because it helps me have little fun ways to like explain things to patients like it just gives me like little tips and ways to think about stuff. When I'm trying to think of it through the lens of like a parent of a child with type one. So that's kind of the ones I actually listen to more I'll go back and sometimes listen to the story ones but actually like the educational ones best

Scott Benner 4:19
very touching because I think of you as a very tuned in thoughtful progressive Endo.

Dr. Jessica Hutchins 4:25
Yeah, I would consider myself that. Yes.

Scott Benner 4:29
So so you won't know this till I tell you. But you're one of my measurement points for me. Like when when I'm quietly trying to decide if I'm doing the right thing. If I'm, you know, making the best use of the platform. I have all that stuff. I think Jessica is in my Facebook group a lot. And she seems to agree with me. So yes. So I take that as like I'm doing okay. Yes,

Dr. Jessica Hutchins 4:54
no, you're doing great. I think you offer Yeah, it's just it's a All these families because I mean, I, I don't have type one nor do my children. But you know, I just think it's, I always tell families like I literally just saw a new onset diabetic today in the hospital, 14 year old girl. And, you know, no family history like this. And so, you know, they kind of blindsided. But I was telling him I'm like, the parents, I don't know if he listened to podcast, but there's a podcast. So we actually have it. All of our new onset skit like a folder with tons of you know, information, and I have one page is like, books, podcasts and Facebook groups to join and like Juicebox Podcast is on there. And then I have sugar surfing, and the doctor ponders like page, which you've had him on your show before. And we have like a Georgia type one diabetes, Facebook group for like, support group for Georgia. So I feel nice to jump in there. But just, I really think it just connecting families and I always, when I tell families about your podcast, I always say like, you know, his daughter was diagnosed as a toddler. She's now in college, like he's been doing this a long time. And you know, just kind of tell them, you know, there's the new onset to always say, hey, go find go on the Facebook group, they have a list of all the episodes to listen to, you know, for new onset, from the beginning, just that you can wrap your brain around, like, you know, what type one is and how insulin works. I said, because, you know, obviously, they get education in the hospital, but that's what like two days, and then they go home, and it's like, you just got this life changing diagnosis. And if they have no family history of type one, you know, it's it's a lot to take in in such a short period of time. And there's so many nuances and managing it that you can't, you know, like isn't going to be kind of explained in the very, you know, the very beginning, we're trying to just teach them like survival skills to get home safely. And then once they're home, then obviously, that's when they start learning, although, like more they want things that they'll they'll hopefully pick up on over over time.

Scott Benner 6:58
It's funny, the first question that pops up that you don't have an answer from from that hospital visit, and it hits you like a ton of bricks, like oh, I don't know anything about what I'm talking about?

Dr. Jessica Hutchins 7:06
Yes, yeah. And actually it so we have like a really cool setup here. So I'm in Georgia, I'm in like a smaller, like academic facility. And so we have, like residents and stuff like that. But we actually when patients go home, I have a nurse practitioner that works with us, virtually, she used to be works in the hospital. So she worked a lot with our diabetic families in the hospital, but then now she's all virtual. And so when they go home from the hospital, they usually see us in the office in about a month. But up until that appointment, they have virtual visits with this nurse practitioner, to that way, they literally kind of have her like almost at their disposal at first month to ask all the like, you know, silly questions that they can think of, you know, just like, just any little question they can think of, and then she'll review those numbers and adjust their doses and just like helps them kind of, by the time they get to my first appointment, I feel like they're all in a lot better place. Like, just understanding and just from a mental standpoint, just like a mental health standpoint, just they've, they've had that like hand holding for that first month, which has been really awesome. So, so it's been this

Scott Benner 8:13
setup you you like it? I love it. Yeah. And you're seeing, like, you're seeing dividends from it.

Dr. Jessica Hutchins 8:20
I know that parents, I mean, it's hard to, you know, one of the things initially the idea was like, oh, like, let's see if this like decreases like DKA I mean, the thing is, like, I mean, majority of my new onsets aren't like back in decay and a few months. I mean, hopefully not. But you know, we have obviously frequent flyer, you know, kids that come in and DK but for the new onset, I think it's more so the benefit I see is that the families feel more comfortable with the diagnosis, the first visit and the office post no discharge, I think goes by smoother and they've already gotten a lot of their questions answered. And they've aren't they just feel and like the our nurse practitioner that does the program like she's great with them. And you know, she again, she'd handholds a lot which is for people who are listening that are an adult diabetic versus a peds, diabetic, peds and adult world is very different in endocrinology. Like in feeds, we know we do a lot of hand holding and in the adult world sometimes I feel like it's sink or swim like you know, if you're not going to put the effort in then the provider may not put the effort in not everybody but in general when I talk you know to friends who go to adult endocrinologist versus like how I know we operate in peds. I do feel like in peds, we do a little bit more hand holding, because it's just it's a lot because you're not dealing with just the patient the child but it's also the parents and that adds in you know, another level of dynamics in addition to like, you know, puberty and all the stuff, the social, you know, stressors that these kids have at school and things like that. So, so

Scott Benner 9:56
when you Oh, I should ask this did you learn Listen to the Grand Rounds series. Did you bother you or did you like it? Did you not hear it? Today's episode of the podcast is sponsored by Dexcom. And I'd like to take this opportunity to tell you a little bit about the continuous glucose monitor that my daughter wears the Dexcom G seven, the Dexcom G seven is small, it is accurate and it is easy to use. And where Arden has been wearing a Dexcom G seven since almost day one when they came out, and she's having a fantastic experience with it. We love the G six but man is the G seven small the profile so much closer to your body, the weight, you can't really feel it and that's coming from me. And I've worn one. I've worn a G six I've worn a G seven. I found both of the experiences to be lovely. But my gosh is that g7 Tiny and the accuracy has been fantastic. Arden's a onesies are right where we expect them to be. And we actually use the Dexcom clarity app to keep track of those things. That app is built right in to Arden's Dexcom G seven app on her iPhone. Oh, did you not know about that? You can use an iPhone or an Android device to see your Dexcom data. If you have a compatible phone, your Dexcom goes right to the Dexcom app. You don't have to carry the receiver but if you don't want to use the phone, that's fine. Use the Dexcom receiver it's up to you. Choice is yours with Dexcom and now that choice includes direct to Apple Watch dexcom.com/juicebox

Dr. Jessica Hutchins 11:30
podcast have I listened the one that you did recently with another peds? Endo? I listened to that one which is after I listened to that one that's when I emailed him was like hey, let me let let's schedule something I've been meeting like I had been meeting I've been chatting for like two years, like hey, we're gonna do an episode so I've heard like, I haven't listened to like every episode but I have listened to quite a few of those. I don't really get bothered by you know, on the Facebook group or when y'all talk about it on the podcast when when people when people take like hits to the doctors like when my doctors stupid or say stupid things. I don't personally get very offended from that or even you and other people like stressing like advocating, you know parents or if they're an adult type one like advocating themselves like hey, if you want to pop or you want this like advocate for yourself, like I don't really get offended by that personally, the only thing I laugh at is when posts like, oh, you know, like I asked my doctor for whatever, an omni pod and they only want to prescribe a tandem like they must be getting paid from tandem. I'm like y'all are funny. Like, yeah, we don't get any kickbacks from anybody, like trust me, like, if you're in peds and David's because you like you enjoy pizza. No, because

Scott Benner 12:50
I'm not saying I take a kickback, but I've never been offered one.

Dr. Jessica Hutchins 12:53
I mean, the biggest kickback I'm getting is like I get like a free lunch, you know, every few months, when they come in, you know, like, tell us about whatever new thing is going on with their product and update us on what's going on. Like,

Scott Benner 13:05
can you imagine if someone was like, I want an omni pod? You're like, Nope, I'm giving you a T slim because I got a ham sandwich four months ago.

Dr. Jessica Hutchins 13:14
I mean, you know, I mean, we get like Olive Garden sometimes like, you know, it's you know, we're fancy over here.

Scott Benner 13:21
I didn't know. I didn't know they were handing out diarrhea. The doctors never. Exactly,

Dr. Jessica Hutchins 13:25
yeah. So there is no kickbacks, especially if he's in debt. And really, I mean, honestly, and in pharma and pharma. There is like that all got I mean, years ago, a long time ago, before my time as a physician, they there was a lot of probably shady stuff going on. But there's they can even give us free pens. And

Scott Benner 13:42
what is that called? That? Is it the Sunshine Act? Is that like,

Dr. Jessica Hutchins 13:47
they really and they actually keep track of all that. Like, I think you can actually look up like any provider and find out like how even like for me, I was like because every time we get a meal, we have to sign that we accepted the meal. And so I think there's like somewhere you can look up to see like how much any provider has like gotten, even if it's like meals, like just the money, the money value that they've gotten from like every different company or something like that. But yeah, I think for me, like when it comes to like that, so like the technology stuff, like pump type, I mean, for the most part, like how I'll give people what they want there. Sometimes I think there's some pumps because all the pumps are a little different. There's some pumps that work better, I think would work better for certain patients, but in general, but yeah, I don't really get I don't get upset when people talk about. I say bashing doctors to an extent like I mean, I think because I do know that there are some patients that are not listened to or not heard and I get why families get frustrated.

Scott Benner 14:46
Does it feel like bashing to you when you read it even though you're not upset by it? Where do you see their perspective?

Dr. Jessica Hutchins 14:53
I see I see their perspective but I could say I could understand where the other like other providers Just who maybe I think some providers are just very like, I'm a doctor, and I know everything. And you're just a normal person. And you know, don't know what you're talking about. Doctor

Scott Benner 15:11
voice. Hey, can I ask you a question? Are you nervous? Or do you just talk fast?

Dr. Jessica Hutchins 15:15
I just talk fast. Okay,

Scott Benner 15:16
I know, don't be sorry. I think this is the first episode, people might be able to turn the speed down on. Fascinating. When I think that you speak quickly. You speak quickly. It's like, when I hear somebody go, like, like, like, Scott talks a lot. I'm like, huh, I do. And then when I get into a conversation, I'm like, I can't even get into this conversation. I'm like, Oh, my God, these people are like, professionals. You can keep me out of talking, then you're doing something. But I love all your Don't. Don't Don't curb yourself. Like I like what you're saying. I just want to tell people real quickly. The Sunshine Act is officially known as the physicians payments, Sunshine Act in the US. It's a law that aims to increase transparency in the financial relationship between healthcare providers and pharmaceutical manufacturers and acted as part of the Affordable Care Act in 2010. It goes online, you can totally google it. If you want to understand how it works. Yes. But I think prior to that, though, a lot of those lunches happen on Waikiki. You know

Dr. Jessica Hutchins 16:12
what I mean? Oh, yeah, for sure. And like the golf like, I mean, I'm not a golfer, but like, yeah, like, oh, let's go play some round of golf. And you know, hear about, you know, whatever.

Scott Benner 16:22
This is a famous golfer, he's gonna play with us today. Can I tell you about our insulin pump? No, exactly. Yeah, that

Dr. Jessica Hutchins 16:28
doesn't. That doesn't happen. I did get I mean, this isn't like, this is not a kickback. This is, this was really cool. I my T slim and Dexcom. Rep. Both of them nominated me to go to their facilities out in California to go I get to go and tour both of the facility. Okay, because they're both really close to each other. And get to here, I guess, I don't know what they're going to tell me like, I guess here all the new stuff. I don't know. But let's have my reps nominated me. So I do get together that I am excited about that. But that's like, literally go there, see it and come back the next day? So

Scott Benner 17:06
yeah, oh, yeah. There's not gonna be you're not going to be luxuriating in San Diego for a couple of weeks. No, let me ask you a question. In the course of a year rough number, how many people diabetes or families do you talk to?

Dr. Jessica Hutchins 17:17
Gosh, like talk to?

Scott Benner 17:19
So I'm going to assume like one person you see a couple times a year, so don't don't count them four times count before?

Dr. Jessica Hutchins 17:26
Yeah. Okay. So in a given week, my like scheduled template for my clinic, I probably have about 15 to 20 diabetic patients, that's type two and type two, type one and type two a week. Well, I know last year, or we had a little over 80 new onset submitted to our admitted to our hospital, which we had met all of our new onset type ones, because of just the amount of education and then we admit any presumed type two that's going to need insulin. So if there a one c is greater than 10. So we had met all those just because of the amount of education and we serve a rural area. So a lot of patients live two and three hours away, and don't have, you know, like local hospitals or local hospitals that are mostly adult focused, and so we just feel safer admitting them. And that's Aedes that's type one and type two, you know, we have seen an increase in type two diabetics and in pediatric patients in the last few years, especially post COVID. We also get a lot of new onsets in the clinic, mostly type twos that are not on insulin that we see like as new patients. So we are the numbers have been, I think, I started where I'm at now. And 2019, right before six months before COVID hit. And I think at that point, it was about 16 Iwan sets a year admitted, so we've been like, slowly increasing. So

Scott Benner 18:57
tell me something, I'm trying to figure something out. I'm trying to figure out how much information that goes into people's heads ends up coming out in their management, like meaning, like, how many people take seriously what they heard, put more effort into it, because if you see 80 people a week, then just based off of you, my podcast should be bigger than it is. And you're not the only doctor out there whispering in people's ears if you put it in a on a pamphlet, which, by the way, I really appreciate but you know, what happens in the hallways, and a lot of the offices while they're walking in or out, the practitioner will grab you and go juicebox podcast.com. Yeah, like, right, like, right, like, Yeah, I know what the guy in there is about to say to you go find a Facebook group called like, you know what I mean? So, like, what's that like being a doctor knowing that you're going to talk to 80 people and only a small percentage of them are maybe going to elevate from what you've said to them? Yeah,

Dr. Jessica Hutchins 19:52
it's definitely and I think, I mean, I'm pretty sure on the adult world is very similar in the peds world. There so many dynamics. And also for me particular, the patient population I serve. You know, there's a lot of, for instance, a lot of my families, I, I'm talking to a mother who is a single mother with multiple children, working two jobs, and has, you know, grandma and aunts and uncles and friends and just older siblings that are caring for helping to care for their child with type one. And so whether it's diabetes, or say they're coming for pre diabetes, and obesity, sometimes I feel like, I try to be realistic and my, like, I want to give them the information, but just to be, you know, when I'm realistically thinking, like, when does this person have time to, like, sit down, and you know, like, so much of our family's life, like, they are living in a constant state of trauma and flight or flight mode, like 24/7. So and then you added on this, like, very, you know, big chronic illness on top of that. And so I think that's a lot of it. And so it can be, it can be frustrating, and it can be disheartening and sad when especially when we have the patients that come in, you know, multiple DK DK episodes a year. And you know, every time you see them, it's still like, you know, a once he's greater than 10. And you, you feel like you talk to you're blue in the face. And it just seems like nothing's getting through, you know, I tried to simplify management as much as much as possible for families, especially if, you know, like, either maybe education level isn't as high and or they just like, they just can't they just, there's too much going on in their life. And, you know, they're just worried about like, can I put food on the table and a roof over my kid's head. So it's just,

Scott Benner 21:51
it's hard to worry about 30 years from now, when you're not 100% sure that on Friday, the water is going to be hot. This episode is sponsored by Medtronic, diabetes, Medtronic diabetes.com/juice box. And now we're going to hear from Medtronic champion Jalen. I was

Speaker 1 22:07
going straight into high school. So it was a summer heading into high school was that particularly difficult and imaginable, you know, I missed my entire summer. So I went to I was going to a brand new school, I was around a bunch of new people that I had not been going to school with. So it was hard trying to balance that while also explaining to people what type one diabetes was, my hometown did not have an endocrinologist. So I was traveling over an hour to the nearest endocrinologist for children. So you know, outside of that I didn't have any type of support in my hometown.

Scott Benner 22:40
Did you try to explain to people or did you find it easier just to stay private?

Speaker 1 22:45
I honestly I just held back I didn't really like talking about it. It was just it felt like it was just an repeating record where I was saying things and people weren't understanding it. And I also was still in the process of learning it. So I just kept it to myself didn't really talk about it. Did

Scott Benner 23:00
you eventually find people in real life that you could confide in, I

Speaker 1 23:04
never really got the experience until after getting to college. And then once I graduated college, it's all I see, you know, you can easily search Medtronic champions, you see people that pop up, and you're like, wow, look at all this content. And I think that's something that motivates me started embracing more, you know, how I'm able to type one diabetes,

Scott Benner 23:26
Medtronic diabetes.com/juice box to hear more stories from the Medtronic champion community.

Dr. Jessica Hutchins 23:34
Exactly. And that, that, that adds a whole nother level of like, you know, just nuance to with patients. And I can't remember there was one episode, I can't remember what episode it was. And I was thinking about it. And even talking to my rep with tz old tz old is the newer infusion that recently got FDA approval, it's been over almost two years now, I guess. FDA approve that if you catch someone that has two antibodies or more for type one, and they're in that pre diabetes stage, you can give tz old which is a two week infusion to 30 minute infusion and the hope and what the clinical trial showed is that you can delay onset of type one. Yeah, so I have not personally been able to give this give it yet. One is finding the patients and two is like just logistics. Because it's every day for two weeks. So you know, and even talking to my rep. I was you know, saying really hard again, I serve like a rural part of Georgia. So when patients live two hours away, one I'm going to give this like in the hospital I'm not going to like do this infusion at home I don't feel comfortable doing that yet just because of the side effects I can have. Yeah, and they you know, again, if people live you know, really far from like, a decent you know, like a hospital that I would feel comfortable them comfortable than with them going to. So it's like then again, how do I if I have you know, A single parent that has other kids and then has like a job where she doesn't get PTO that it's like, Oh, hey, come to, you know, come here for two weeks straight for a 30 minute a day infusion it's like look like it just how is that going to work logistically like it just. And so I was telling my rep I said, I feel bad I said, because I feel like, it almost feels like it's an injustice of who can even have an opportunity to probably use this because of just the dynamics of like, their social situation. Like I just don't know how to do it. It's

Scott Benner 25:31
an inflammatory word. But this is where your privilege comes in. Yes, you're sure you have it? Yeah. Yeah. And I don't care. Listen, I don't mean privilege in the in the zeitgeist overtone that's gonna make half of you pissed one way and half, you piss the other way. I'm just talking about like the opportunity, or the, you know, like, I interviewed a white lady one time, I don't know that it's ever going to be on the podcasts. I'm trying to get along. She got a job. And the job is trying to block her from being on the podcast, but Oh, no, but you know, and she said, like, you know, the TZ old infusion, it was here, we got a hotel, we stayed for a week. And I'm like, Yeah, that's already more than most people can do. Oh, yeah. Yeah. And, you know, like, so that's the kind of stuff that you don't understand. The reason I'm asking you about it, is because you're in a unique situation, like, you know, good information to tell people, and you're willing to tell them about other stuff they can go find on their own. And yet, you're having the same frustrations, you and I have the exact same professional frustrations, like, unless I'm wrong, and I, I'd love to hear from you on it. But I think you go listen to that Pro Tip series, you'd have to really not understand it not to end up with an A one C and the six is in the next six months or a year after that. Do you think that's reasonable to say by me? Again,

Dr. Jessica Hutchins 26:46
I think if you if you have to use the word privilege, if you have the privilege to sit down and listen to a podcast for 24 hours, absorb the information, be able to apply it knowing again that like you may, it's not just you there's other caregivers involved, then yes, I think if like because I have patients who again, probably do have more privilege like that, they they have listened and they have been able to apply and you know, they're doing great. They can they can get these, you know, amazing AOCs, like in the fives and sixes. How do

Scott Benner 27:21
you make the time and the space for that if you're running from one job to another and then home? And then

Dr. Jessica Hutchins 27:26
yes, you know, I mean, even I mean, even for me personally, like, just in between, like, I have three, three kids, three young kids, I have three young kids full time physician and then like, amongst other things, and then you know, even trying to listen to like, you know, I'm in this like parenting coaching group that I like pay money for. And like it has all these lessons about, like, really like a gentle, gentle conscious parenting because I've been trying to like, adopt more of that and my parenting style. And like, I've been in this thing program for like, two years, and I barely get to listen to all the episodes and that I'm that I'm paying for because I just don't have to die. So like, I can't imagine

Scott Benner 28:06
like, what was your parenting style, like that got you to want to join the group. I

Dr. Jessica Hutchins 28:10
didn't really have one. But I was me and my husband were raised like very differently. So like it just immersive, that's like the gentle positive parenting is more about like connection, over like, the shame and guilt that we often do. And parents, and honestly, part of it, I felt I feel like a lot of times with my families with you know, parents, especially in the teenage years, and maybe you can speak to this with you and Arden, but the teenage years can get really rough. No, and when the kids are more independent, and they're more out on their own, but the parents still wants to control a lot. And you know, when I have families coming in and it's like, you know, the kid is like, you know, never Bolus saying you know, I give them all that later they have all the technology they have the pumps, they have the sensors, but they're just like not doing squat and you know, the parent and the kid are always fighting you know, and I hear you know, half the visit is the parent just like throwing the kid under the bus to me the whole time and like oh tell her Tell her how you like keep sneaking snacks and tell her you know whatever and say like I don't

Scott Benner 29:12
think Go is Oh my God listen to me you're all such terrible communicators

Dr. Jessica Hutchins 29:20
and so it's always this weird dynamic and are then touchy when you add driving into the mix it's like because I mean as a parent like if my child was type one like I would like you know really be worried about them being behind the wheel I mean obviously probably more for hypoglycemia than hyper but I mean sometimes when your blood sugar is really high you are not right the hit like you feel really you know affected by that too mentally, you know, between driving and just privileges and like, you know, are all struggle with like, oh, they get get they get things taken away because of they're not managing their diabetes. And when I compare that to like, the things I'm learning with like more like positive conscious parenting I'm like I don't know if that's gonna help, you know, like, but I don't know, like, it's hard because I'm like, I'm not the parent of a type one. And I just in my head I like I'm like, I just don't, I don't think that's going to work like taking things away from them or not letting them go out with friends. But then I still am personally still trying to figure out like, How can I help these parents, especially at the teens? Like, yeah, how can I help them get through this rough patch? Because I feel like it can be an I mean, it's frustrating for me as a provider, because I'm like, their agencies going up their parents, you know, the kids getting older, they're more independent. It's like, they want to be more independent, but they're not doing it. So then it's like, okay, well, where does that like, you know, sometimes I try to approach the kid and I'm like, Hey, like,

Scott Benner 30:39
your mom seems crazy. What?

Dr. Jessica Hutchins 30:43
Like, when you're home, like, why don't you just like, let your mom do it? Like, if you're on the pot, like if they're on the pot mom, like, you're home and you already either, like, let let your mom do it for you like, but it's like, again, one of those things where like the you know, mom is texting or asking the kid like, what's your sugar? Did you give your insulin, your blood sugar is going high? Or did you treat your low? And it's like, the kid is like, frustrated? And it is this like this battle back and forth. And sometimes I'm just like, I, I don't know what to tell this, this parent or this kid, like how can Hey,

Scott Benner 31:11
listen one time are in push back on me. And I sent her a number. And she goes, and it was like $1 number and she goes, What's that? I'm like, That's how much college is going to cost you if you don't change that pump right now. Because, um, but we also have like, a, we have a similar sense of humor. So I think it helps to, I mean, listen, if you're going in the doctor's office, and making Jessica, judge, jury and executioner for the things you can't get your kid to do. That is not going to be a winning formula.

Dr. Jessica Hutchins 31:39
No, it's usually not like, oh, like, and I try to make the kids feel better. And in the parents like, less than like, you're not the only one. Like, your kid isn't the only one that like eats food and doesn't Bolus and doesn't tell you they eat like, this is like this happens. This is

Scott Benner 31:57
regular kid stuff. But it's magnified because of health. Exact otherwise, you would ignore it. You'd be like, stop playing Call of Duty and they wouldn't stop and you go up. Yeah, he loves Call of Duty. Exactly. Yeah. And then that would be the end of it. Or I wish they'd stop looking at tick tock I told him not to but they're not going to and then 30 years from now, when something happens, you'll be like 70 unit, but like, I try my best.

Dr. Jessica Hutchins 32:18
Like, right? Yeah. When it's when it's their health, like you're hurting me. As a parent. I get it. You feel. Jessica,

Scott Benner 32:25
do you know the funniest thing you've said, so far? We've been talking for 28 minutes and 41 seconds.

Dr. Jessica Hutchins 32:31
What is the funniest thing I said?

Scott Benner 32:32
I'll slow down.

Dr. Jessica Hutchins 32:35
Slow down. I think I did slow down for like a few minutes. My favorite parts when I talked about I think when I talked about TV, all that slowed down. Because you

Scott Benner 32:44
were like, oh, there's things legally I have to say here. I think Well listen, let me say this because I tried to jump into that part of the conversation. It did not work for me. Screen it like you mean it by the time this episode comes out, there'll be sponsors on the podcast. And it's screened for type one.com SCR II N fo RT y p e one.com. Screen it like you mean it's for. I don't know how I'm like, allowed to explain it. But I think it's a public relations movement to talk about the importance of screening your extended family for type one diabetes, but you'll hear those ads throughout. Because they're on I think a completely almost impossible journey. Like they're gonna go tell you, Hey, listen, does your kid have type one diabetes, you should go tell your sister and her kids that they maybe should get screened for type one, which penalties is great advice. Right? And but man, how do you get people to do that? Like, based on your, on your conversation about how we can't even find time for people to go listen to a podcast? Like how are they? How are they going to go get screened for type one diabetes, when that doesn't seem like one of the top 100 things on their list today?

Dr. Jessica Hutchins 33:55
Yeah, well, and then honestly, even parents of some of my type ones, when I mentioned about screening the siblings, I have some that don't, they just don't want to know, right? They they would rather just watch for the symptoms, which, again, if you know if you have like an a parent who's paying attention and has the ability to pay attention, and recognize the symptoms early than you know, but even then by the time you're having symptoms, you're you're probably you're gonna probably be already past the point where you could get the TCL because you Yeah, you have to be like in that pre diabetes range. And so I mean, I get it for some parents, knowing that the other kid has an antibody is more nerve wracking and anxiety provoking. Then than not knowing again, everybody's personality is different.

Scott Benner 34:38
I think it's all about your level of anxiety and how it screws with you. Because the same because anxiety could make one person say I have to know and that same and anxiety touched the different persons slightly differently makes them go I can't know that this is coming. It's interesting.

Dr. Jessica Hutchins 34:56
I tested my son even though we have no history but he he had, he was set six or seven at the time, but he had like, wet the bed a couple times. And it was he had not done that, really since he had been potty trained. And I was like, what? What's going on? And so like, one day he was in my office and I, I checked as a onesie on our like pointed care machine in the office, and it was 5.7. And I was like, Why do you have a 5.7? A one C? Like, that makes no sense. So then I ordered the kit that at that time was I think it was an maybe enable sciences like you could order the kit. they mailed it to your house, you did a finger stick and you just had to put like three blots of blood on the little card and you mailed it back and they checked, I think three of the antibodies, and three in those three were negative. So I was like, okay, like, and I started out over, no, and actually, I repeated as a one C and it was like 5.6, which still I'm like, he shouldn't have a 5.6 I would see i One day he did something else that like even after I had the antibody results back I like, I can't remember he was like just being more drinking more has something about him just seemed too often I like, grabbed, I was at home and I like it was like the day before we were going on vacation somewhere and I grabbed his finger and like I had a meter at home and I just like no, let me just check your blood sugar. If I stupidly did not wash his hands before I did this. And I just like grabbed it and poked it and it was like 390 And I was like my heart like stop and my boss then I'm pretty sure like, walked into our bedroom. It was like praying. Like he like was that scared? And then I was like, no, let's go wash your hands. And anyway, he washed his hands and we rechecked it. It was like 94 I was like, Okay,

Scott Benner 36:42
could he be could he have anemia?

Dr. Jessica Hutchins 36:44
I'm trying to think when he if he would have checked that at his last day.

Scott Benner 36:49
Doctor? Well,

Dr. Jessica Hutchins 36:50
you know, like his primary care. Yeah.

Scott Benner 36:52
I mean, I heard you just slipped into the a onesie machine one day, so

Dr. Jessica Hutchins 36:58
I'll have to get I can probably check when he actually has a checkup coming up next week. So I asked

Scott Benner 37:03
our overlords check GPT forro. Can children have an elevated a one C and not be diabetic or pre diabetic? Yes, children can have an elevated a one C and not be diabetic or pre diabetic hemoglobin variants, iron deficiency anemia and chronic kidney disease stress and illness medication or laboratory error.

Dr. Jessica Hutchins 37:20
I mean, really like a one C? I mean, it really isn't like the best test really time and range is like a better, you know, a better

Scott Benner 37:31
CGM on him. Well, I

Dr. Jessica Hutchins 37:32
tried one on him, but he was not having it. He was, you know, he, they've seen me wear them because I've worn all of them just to like, you know, try them out. And so they've seen me wear it. But when I attempted to put it on on him, he ran, he ran circles around the house and was screaming, I was like, Okay, fine. Hey,

Scott Benner 37:50
when you said you and your husband were raised differently, can you give me context for that?

Dr. Jessica Hutchins 37:54
What just like he grew up more like in a Yeah, like his parents would use like spankings and my mom was not a spanker. At all, my mom was more like,

Scott Benner 38:07
I love you, Jessica, why are you doing this, she would just fuss at you. And then

Dr. Jessica Hutchins 38:11
like, she was just tired. Like, she worked and had three kids. I also am a lot older than all my siblings. And so honestly, I was a pretty good kid. And once my siblings came, I was like a little, another little mom, like I helped with the kids and babysat all the time. So my mom could just use like, a tone of voice with me and I would cry. So like, she didn't really have to, like do much, you know? I mean, maybe like once I was in high school, I think I got grounded a few times for like, going to a party when I said that I was going to be at a friend's house or something like that. But in general, like I was a pretty good kid. So

Scott Benner 38:48
not a lot to do for you. Okay, let's see some stuff you just said. I'm open to talking about anything looping pumping, diet, thyroid, working with families, etc. Okay, so let's pick through this list a little bit. How much time do you have for me today? Okay. Okay. Arden by the way, on her way home from college right now she's driving home from Georgia to here as we speak. That type of drive. Yeah, I think she just got into South Carolina because she just left about an hour and a half ago. She had to pack all her stuff like for her boyfriend flew down helped her move into her next place for next year. Yeah, and then he's gonna tandem drive with her on the way home she's exhausted. She's been doing all nighters for like, off and on for like a month and a half getting through her finals.

Dr. Jessica Hutchins 39:31
What does she want to do when she's done? Like what will be its what's her dream job?

Scott Benner 39:35
I think she wants to design her own line of clothing and manufacture and sell it herself in a in a like maybe a small setting. Cool. Yeah, that's your goal. But she's where you are right now is what I was just gonna say. Yeah, just a little East maybe. Yeah. Okay, so let's let's pick through your list. Let's go to pumping first. So do you put families on loop. Where do they come to you? And then you go, that's fine with me if you want to do that, but I have to tell you legally that I can't support it. Like, how does that all work?

Dr. Jessica Hutchins 40:07
My first Looper was that was actually the dad and his son both had type one. And they were both on Omni pod. This was pre Omnipod five, and he was getting ready to like he had another year before he was going to college. A mom was like, anxious because she wanted him to be on a closed loop system. For Omnipod five, you know, you know, in the beginning, it took forever for it to come on. I felt like there was like one as they kind of come and say she was just like, I don't like waiting anymore. And I had mentioned looping to them. The dad, the dad is an engineer and the patient like he also like, he's, he's at Georgia Tech, with doing engineering. So both very, very smart. And like, I was like, you know, there's this looping thing. And so they looked, they looked it up, they think the kid and the dad built, you know, built it themselves. And so he was my first looper. And then after that, I had another family who because they had really crappy insurance, they were using the libre, because the Dexcom was too expensive for them as for the out of pocket costs, they use the APS system and so they can they could live with the libre and they have this little thing called the bubble that they put like that the libre like goes around the libre and that would allow this was on the libre two that would allow the libre to to like talk to the APS app. De loop and his dad is like in the medical field, like he's a PA, I think. So he was you know, they're very, like the parents were like, they understand how insulin works. So like, and honestly, because the APS system and the looping like on the iPhone is a little bit different. And so honestly, like, I feel like they understand it better than I do. Because I can't go through, like all the pages and books and all the education they have to do to like, like, learn every little intricacy of the system. And then I have recently in the last few months, put a toddler on loop. And that was, again, I suggested it to mom. And then I have another family the mom, the mom is a math teacher, they were on op five. And she just she just wanted more control. So I was like, why don't you do looping? They actually ended up using T one pal, I think is the Yeah. Like help them? Yeah, they like put the they build the system for them. And like help them get set up. And then she ended up paying like extra money to do some sessions with somebody from Integrated diabetes. I think Virginie works, after she started looping. And so

Unknown Speaker 42:42
that's how she got four. Yeah, there you go.

Dr. Jessica Hutchins 42:45
Are leapers thinking

Scott Benner 42:46
about having like, you know, opportunity can afford to become an app developer can afford to, or to pay somebody to do it for you can afford the call Jenny and have her explain the whole thing to you. That's probably I mean, I'm guessing 1000 to $2,000 of you know, extra income to get set up on this thing? Yes, yeah. Yes. For sure. Yeah. So there's varying levels of people's abilities, right, varying levels of their effort, their understanding, etc. You have to assess those people? Do you put them on a pump based on that? Like, do you really mean like you look at somebody and go, you're not really going to be that involved with this, take the Omnipod five, or you're gonna probably want to be more aggressive. Why don't you try tandem? Or, or you're never going to count a carb right? Have you heard of the islet? Like, is it going? Is it going like that?

Dr. Jessica Hutchins 43:35
Yes. And then some people, you know, like, Well, some people, like I said, you know, come in and they already Googled for the kids but on tick tock or something, and they already have like, decided they want something. Usually it's probably the Omni pod because it's tubeless. But it depends on the family. Like if somebody basically just what you said, like I have patients who you know, now that Isla is out, I have a handful of patients on the island. Now, if they were already we're not carb counting like I already had them on like a set dosing regimen because they weren't carb counting and you know, they chronically have not controlled their diabetes. Well, then I've been like, kind of showing them the eyelet most patients I show, I like him I was like, Well, I don't I don't actually have anybody on Medtronic. I have not been a huge Medtronic fan. So far in my career. Have

Scott Benner 44:24
you seen the seven at GE?

Dr. Jessica Hutchins 44:25
I have not used it. I have seen it, but it's still

Scott Benner 44:28
in America. It's still using the old CGM, though, right. I

Dr. Jessica Hutchins 44:32
think it's Yeah, I don't think it's I don't like the CGM. I don't like that. You have to like, charge the transmitter and then it's like all that weird tape that you have to put on it. I mean, I know you don't have to, like calibrate it anymore. That you know, like you used to, but I think for me, even when Medtronic first came out, I felt like it was false advertisement because it was you start to calibrate and it really I just did. In the pediatric world of personally, people that were on it, they were very rarely in the like auto mode or whatever, I felt like they were getting kicked out all the time. And so they weren't really getting the benefits of an AI D pump anyway. And so I think

Scott Benner 45:15
when Medtronic gets when they're gonna really like blades back into this, it's going to be when they're newer CGM comes out in America and they pair it with the 780 G. I think that's when people will take it seriously. Again,

Dr. Jessica Hutchins 45:26
I mean, I've seen there's been some, some guy that's been posting in the in the Facebook group about the seven ad and how much he loves it. And I've seen pictures of his graph. And like, it looks promising, I think I mean, from my understanding their target goes down to 100, which is the lowest, you know, on the market outside of looping. I think just because I hadn't, hadn't really been working with it much. I just have steered away from it in general. But

Scott Benner 45:50
by the way, shout out to Bill whose name I know, because I know who you're talking about. Because he does post about it all the time. And I always say, Yeah,

Dr. Jessica Hutchins 45:58
and it looks good. Ooh, that looks good. Anyway, so but yeah, so usually, I would show patients, you know, showing the tandem show I'm Omni pod, like, Okay, which one do you want? Some patients? You know, I'll tell my diabetes educator like, hey, like, you know, just show them the island because like, there's no way they're carbs. There's no way they're carb counting. I do feel like, like, as far as like, the carb counting issue outside it before the islet came. I do feel like Omni pod five is a little more unforgiving for patients who struggle with doing that, because we've caught with carb counting. Once you're too hive. Well, like if you're not announcing meals are like really off on your carb counting. Because if you stay high for too long, it will make it will kind of force you into manual mode.

Scott Benner 46:46
Just let me ask you a question. Because that fries my mind. People don't Bolus their meals regularly? No. Okay. Yeah, I'm so used to talking about the way that I know works and the way we do it. And I'm, I have to tell you that one of the things that I get shocked about more than anything, to put all this kind of high minded effort into this podcast and all this, like, there's, here's the variable series, the finding, if you understand the definitions, you're gonna be able to do it better, blah, blah, and people come to me, they go, Oh, my God, I'm doing so much better. I go, What did you do? They're like, yum, Pre-Bolus eating my food. I'm like, Wait, that's it. Like, yeah, they just, like, it feels like some days, it feels like the podcast could be three minutes long. One episode, and I'd reach just as many people and and yeah, but so that's that's not just me, this is what you see, too. Oh, yeah.

Dr. Jessica Hutchins 47:36
I mean, that's a lot. I mean, again, especially especially in the teenage years, I mean, whether it's the kid like a younger kid who just like gets into snacks and doesn't cover or like the teenagers who just, they just eat and don't Bolus, they just they weren't, they were the pump. And they just, they just let it ride and hope the basil covers it. And so the way that Omni pod fight is algorithm works with like the learning. And so, you know, they get kicked into manual mode. And the one thing I keep telling my rep is like, when you get when it forces them in the manual mode from a high, then it doesn't alert you that you're like, still in manual mode. So like, they'll I'll look at the report, and there'll be like a manual mode for days. And they're sitting there wondering like, why am I still high? Because the pump isn't, you know, obviously adjusting for the high, because they don't realize that they're in manual mode. And so, do

Scott Benner 48:32
people not know they're killing themselves? How do you stop yourself from saying,

Dr. Jessica Hutchins 48:37
I mean, we talk about the effects of uncontrolled diabetes, and honestly, like, with, especially with my teens, like, a lot of times the parents will be like, you know, they'll have you know, maybe family members that are like type two that have like, lost limbs and are on dialysis. And so sometimes the parent will be like, you know, like, oh, like, you're gonna, you're gonna die or you're gonna, like, you're gonna have dialysis and sometimes I'll use that but personally, like, again, like the teenage brain in particular, well, like all kids, but like teenagers in particular one, they're in that phase of like, thinking they're invincible, too. They're like frontal lobe is not developed enough to like, understand, like, future consequences. And so for the most part, to me, telling a teenager who's not controlling your diabetes about like, Oh, you're gonna die or you're gonna lose your, you know, lose your toes or whatever. Like, that probably is like, literally, like Charlie Brown, like, you know, wow, they don't, they're not hearing me. What I do try to bring up in kids is like, especially if they're athletes, like hey, like, if you want to be stronger if you want to be faster, especially like the boys like if you want to, you're trying to gain muscle, like you're, you know, in the weight room because you play football and you're like not picking up muscle mass. You need to take your insulin like the glucose cannot get into your muscle cells, unless you take the insulin, the insulin is the key to open that, you know, open that door. And so I tried to like focus on that. And then other the other thing I sometimes mentioned to Teenage boys has erectile dysfunction. Yeah, like hey, like, I mean, I'll like always preface that, like, I'm not condoning like, section your teenage years. But like if I'm

Scott Benner 50:12
trying to imagine me being like 16 in my office, and my doctor looks up at me, just because like, Hey, you want to Boehner? Is that deep? Because that ain't gonna happen? And you're like, oh, wait a minute, I didn't know what you're talking about important stuff here. Oh, yeah, I'm like, Would it be quicker to tell them that a high a one C makes their place? They should not work? Like, would that be fair? Because as you're sitting here talking, right, I know this, I understand the nature of man, I know the seasons of growth and understanding and your brain and your understanding of life and your desire. I mean, listen, you hear me, I tell people all the time, people help each other, help themselves normally, for other people before for themselves, like you have to go through these have experiences. So you understand. And hopefully, you'll be lucky enough to be, you know, like, still healthy to take advantage of these things you've learned. Knowing it. And then hearing you say it is two different things. For some reason to me like it just like it just flipped me out and made me upset. I was like, like,

Dr. Jessica Hutchins 51:10
I can have patient I have patients, I have patients that I mean, I've been like, I have been carrying them for years. And literally, they're a one c is greater than 14% on my machine every time I check it, kids, a kid Yes. Or their parents not involved. Sometimes, but sometimes again, like it's that the privilege thing, like, I mean, they're there, but

Scott Benner 51:34
privilege runs beyond your ability to do beyond your ability to afford something and it might run into like, do you have the privilege of having a parent who is interested enough intellectually minded enough, etc, to actually help you with this thing? Exactly. Exactly. Gotcha.

Dr. Jessica Hutchins 51:50
Yeah. And it's like if the kid you know, and it's not common, but you know, there have been times where like, kids have ended up in foster care, but that ends up not lending nest, usually any better. Yeah. Because they get put into homes where the person isn't always educated by diabetes, we, you know, we don't always know when they're gonna get moved to a new foster home to educate families ahead of time. And so it can end up being just as much of a hassle like conflict the kid just and then, you know, that adds the whole nother, like, social dynamic of now you're like, what this person that's like a stranger, and you're taken away from your family. So then you're not happy about that? How

Scott Benner 52:24
often do you see desire without intellect? Like, I want to help? I just can't I don't I can't do it. I can't think my way through it. Is that common? Or is it more common for them to have the ability but not the drive?

Dr. Jessica Hutchins 52:35
I think it's probably more like, they could have the ability, but not the draw, I say, I say the ability, like I think they're like, intellectually, they could do it. But I think not lack of drive. And just like our lack of like, again, like if you are literally like, again, like I said earlier, like just trying to feed your kid and provide a roof over their head, you know, you care about your kid, you love your kid, like, they'll come to the appointments. And they, I mean, like, you can ask them the questions and they can answer them, like, you know, even the kids like, what's your current ratio, which your correction factor, like they can rattle it off. They know how to do the math, like, it's not a lack of knowing is just like they just, you know,

Scott Benner 53:14
I always think like, what are we doing this for? If we haven't future proofed it? Like, like, why am I go into those jobs and exhausted and having these fights and standing in the grocery store at 730. And like, you know, arguing with these kids and living in a place like, you know, maybe I can't even afford and I have all these problems in my life. And you mean, I'm gonna fight through these things, to raise that kid to watch something terrible happened to it when it's 30? Like, what did we do it for them? Like, like, you get put is that not? I'm upset is that

Dr. Jessica Hutchins 53:49
it's maddening? And it's just it honestly, it's, it's sad, like, and I, you know, some providers, like, you know, may kind of like discharge patients, you know, they're just non compliant. I, in general, don't do that. Like, because I'm like, what does that date it's not gonna solve anything. I mean, I think sometimes, like, you may as a provider, you may recognize like, okay, me and this patient in this family are not like clicking, you know, like, we're not on you know, we just happen, right? Well, yeah. And like, do you think okay, that another provider may be able to, like, help them better in general like, I mean, unless you're unless the family you know, if somebody's like being disrespectful to like my staff or like, you know, whatever, then they may get discharged. But in general, like, just for like, you can't get your agency in control. I'm like, I'm like making you go somewhere else isn't gonna solve a problem probably either. I

Scott Benner 54:42
mean, kick a kid out of class for not being able to fly like you're trying to teach them something they're fundamentally not going to be able to do Yeah, and so you're then become what their, their guide through as good as we can get it.

Dr. Jessica Hutchins 54:55
Yeah, essentially, and I just hope like honestly, I have, I don't know If you follow there's a girl on social media her her Facebook is T one D chick, she, she's probably in her 20s or 30s. But she her and her brother, both type ones. And I follow her on social media and she talks about, like, when she was a teenager, she, you know, had like, greater than 10 A once he just had those years where she was just like, in a funk and just wasn't applying herself. I mean, and now she's, you know, like, actually now she's pregnant. And so, you know, obviously super tight control, but she's on a tandem and she like is like a diabetes influencer now, and you know, usually maintains an agency in the fives. And so like, sometimes I see her story, and I'm just like, I just in my head, just think, please, like, let that be all my patients that I

Scott Benner 55:41
have right now. That's where I want them to get. Yeah, like, hopefully one

Dr. Jessica Hutchins 55:45
day, like, just that frontal lobe develops, and you know, they just take care of them. And I think, and I think too, like, again, a lot of these patients again, if you're like living essentially, if you're like living in a lot of trauma and living, in some ways, sometimes like a hopeless state, I think even for the kid, like, it's hard for them to understand like that, like, life can be better like life. I mean, it's just, I think it's easy to get, you know, like, if you have like, Y'all struggle at home, and then you have diabetes, and you have people at school, like you know, teasing you or like you feel different because you're you're wearing all this technology,

Scott Benner 56:22
I've had my fair share of seeing some parents, like say like, I don't know why my kid won't do this. And I look at them. And I think God, if you were my mom, I'd give up to you don't no one ever sees themselves in these situations. Right? Like, yeah, I just think

Dr. Jessica Hutchins 56:33
it's just hard for some of these kids. And I mean, just the mental health aspect, you know, is, is a lot

Scott Benner 56:41
is the answer for people finding themselves in that situation. Islet? Is that the answer?

Dr. Jessica Hutchins 56:45
For some of them, I'm trying actually, like, I just ordered the eyelid on to my patients who are frequent flyer decay patients. And again, like a one c is greater than 14, like all the time, and I told my educate my diabetes educator, I'm like, You know what, let's just try the eyelet. Like, at this point, what do I have to lose? Like, you know, a lot of times, you know, as an endocrinologist, when we're like assessing is a patient pump ready. One of those things is like, well, they're always like, coming in DKA, you're hesitant to, you know, and not paying attention, you're hesitant to start a pump, because it's like, well, that could increase their risk of DKA. If they're not paying attention to their Dexcom. Like when they're running high and going through all like checking the ketones and changing your pumps, I thought it off, but they're not doing that anyway. Right? Exactly. They're not taking their long acting, they're always indicates and that's why I told my educator, like, at this point, like, what do I have to lose, like, they're gonna go in decay again, like that already happened. I had this one kid, I will like and actually still see him but he, like, always had anyone see above 10. And he was just like, really quiet, like, super introverted. And I was just like, the mom was a nurse, like, she's not a lack of education. And I just like want to ask the kid I'm like, like, dude, like, what's the deal? Like, he's like, I hate injecting myself in hurts. I don't want I he would take as long acting, but he just like, wouldn't take a short acting. He's just like, I hate injecting myself and I, but he would wear that he wore the next camo. I was like, You know what, let's just try. Let's try tandem. And he has been on a tandem now, I think for going on three years with an agency and the sexes ever since then went from above 10 to sixes. And it was just like he just needed. He just didn't like injecting was off. But once he got on the pump, I mean, it's like all business. Beautiful. Yeah,

Scott Benner 58:29
that's what you're looking for. I listen, I think that I think that's old timey backwards thinking about yes, if they're ready for a pump or not like, well, they're not doing this thing you're not going to just try doesn't make any sense. Or there's the stories of when people have their pumps taken from them. I'm always like, there's nothing about that story. That would make me think you shouldn't have this pump. It feels like knee jerk reactions from doctors sometimes.

Dr. Jessica Hutchins 58:54
I did actually, like about a year ago, I had one kid that I did tell him like, we're done because because we literally went from a onesies usually like, I mean, not stellar, but like, you know, eights and nines, but like, started the pump and had multiple decay episodes and a onesie went up to 14. So I was like, No, you were

Scott Benner 59:15
at least, at least you're injecting your long acting insulin.

Dr. Jessica Hutchins 59:19
Yeah. And so we ended up switching to the end pants. I was like, that way I could still get the data, you know, from the shots and the short acting.

Scott Benner 59:27
So is there a piece of your mind that says, Look, I just I can't save everybody.

Dr. Jessica Hutchins 59:31
I mean, yeah, I mean, I try but like, I mean, it's just, you know, again, I literally always just hope like, okay, maybe like, it's like, you plant I'm planting seeds now and the hope that like, they'll turn into that person who pulls it all together, that person that can figure it out and you know, and not someone who just, you know, continues down this path of just like, you know, and I think it's hard to take is the other thing I think about when I'm talking to my teenagers is like, Okay, what's your plan for life like kind of job are you gonna have like, like you have diabetes? Like you need a job that has like good insurance? Because this is an expensive disease? Yeah.

Scott Benner 1:00:07
Oh, you think a person who can't inject their insulin is planning for 10 years from now? Well,

Dr. Jessica Hutchins 1:00:13
no, but like, I've heard talking about her because I'm like, Okay, what's the plan? But like, you know, yeah, I mean, I do have those patients who like, or I have some, especially teenage girls sometimes are like this, like, they are stellar in school, like straight A student cheerleader, does all the things but then like, diabetes control, like they just like, they just can't put pull it together. Like they just don't Bolus and whatever. I have that sometimes, but more often than not, the kids who are not managing their diabetes, while are also not doing well in school and are also like struggling at home. You know, there's like family dynamics that are like, you know, yeah, not ideal at home. So it's usually like their whole life that's like, struggling, you

Scott Benner 1:00:53
know, what I've noticed, helping Arden the dynamic settings in the Iaps are really valuable, like adjusting her Basal. Her insulin sensitivity and her carb ratio based on like, perceived need based on like, the history of what's happening. I think that's taken another level of having to think about diabetes away from hard. Like, I think it's what got her through her finals. This this last time I see you're saying, Yeah, cuz you can adjust all that stuff. Yeah. Because it's easy to think like, oh, yeah, well, Scott's kid does it. It's easy for him to say, my kid won't do it. But there's plenty of times my kid doesn't do it. She Bolus is her food. That's a thing, right? And she Pre-Bolus is most of the time. So I'm happy. But if she's in the middle of a project in college, and she misses a Bolus, and her blood sugar goes to 200. She's not correcting. But the algorithm corrects. Exactly, yeah. And it hits hit and now Fair, fair, she believes it's going to do that now. So maybe she feels like I don't, I don't need to look, this is how this works. Yeah, there's probably been five times in the last six months, I've texted her and said, Please, Bolus, whatever suggested insulin there is, because this algorithm is never gotten ahead of this. But in keeping with what it's trying to do, and I won't even get, like, I don't even get a response. I just see on Nightscout at the Bolus that she does it. Yeah. And I'm like, okay, good. No, but she's also she's incredibly busy. Like, I do want to point out that she is really busy. But you know, there could be other kids who are going to be, you know, really drunk or really busy or studying or like, whatever. So like, there's always levels of why am I not looking at this? And all this is just because this whole conversation is just about the way humans minds work. Oh, yeah. It's all this is right. So

Dr. Jessica Hutchins 1:02:39
literally, I mean, you would probably cringe like, I mean, I can look like, I will have some, you know, I'll pull up a Dexcom clarity report. And literally, it will just be like, greater than 400 for like days in a row. And I'm like, I don't

Scott Benner 1:02:56
why not? It's what even once just for fun, like, yeah, the wonder what would have nothing, they're literally not looking at all? No. So

Dr. Jessica Hutchins 1:03:06
those are the patients sometimes, like as far as like, the pump candidates, like for people literally who I can tell, like, you're not even looking at your Dexcom. Like, I do sometimes get worried about putting them on a pump, because I'm like, oh, man, they were uncontrolled. But not in DKA a lot than those patients I do get worried about because I'm like, okay, they probably were at least taking their long acting, lease, like half the week, you know, or something, just enough to keep them out of decay. But like, if they're never looking at their Dexcom, I do worry, like, are you really going to change the pump and pay attention? And you know, troubleshoot it? If you know, if you're let

Scott Benner 1:03:38
me pivot here for a minute and ask you so obviously, what I'm hearing from you is that I have successfully found a way to reach certain people. Now, yes. Is there something that could be done for those other people? Like, am I just not creating the right content? Like, is there a thing I say that if I said it differently, or presented it differently? Where would they just never look? Even if it was there? Like how do you lead the horse to water? And and once they get there? Is the water that I have available the right water for them? Or do they need different?

Dr. Jessica Hutchins 1:04:11
I honestly feel like that like education, like the episodes like you and Jenny do. I mean, I feel like for the most part, those are very, I say, dumbed down. You know what I mean? Like in layman's terms, and like,

Scott Benner 1:04:27
Yeah, I know. Exactly. Yeah.

Dr. Jessica Hutchins 1:04:28
I mean, like, not in a derogatory way dumb, but it just is in layman's term. It's not doesn't feel like Doctor talk. And so, I mean, I feel like from that standpoint, that helps. That part is fine. Again, it's just it's just the broken healthcare system, you know, and just like, what is

Scott Benner 1:04:46
it or is it just there in a like, I mean, you're saying to me that these people would magically respond if the healthcare system was different.

Dr. Jessica Hutchins 1:04:53
Well, broken healthcare settlement, okay. Not just health care, broken health care, but also just like a broken I just have I have a broken system like, you know, again, when you talk about privilege and food deserts and racism, and all of the things like I think that's where a lot of that can come in. And just, that's not

Scott Benner 1:05:14
wrong, by the way, right? Like, even from a doctor to look at somebody go, I know you people don't do this. So I won't bother bringing it up. Like that kind of thing, where I know how your people eat or something like that.

Dr. Jessica Hutchins 1:05:24
I mean, you have to ask, you know, I mean, like, I mean, we shouldn't assume but like it happens, right? Not? Oh, yes, it happens. Yeah, that's even part of the issue. And that's where I even like, when I was talking to my tz old rep. That's what like, we were talking about that I said, I said, Honestly, there's some families who I probably wouldn't even mention it to them, because logistically, I don't see this. They don't know if they'd ever be able to use it. And that it's like, Is this even it feels like you're just dangling something in front of their face that they're never able to access. But then, but then I was telling him, I said, Then I was checking myself. And I said, Well, really, I should, should always I should be mentioning it to everyone. And then let them be the one to figure out if they can make it work or not, you know, but

Scott Benner 1:06:03
that's you making an assessment based on your knowledge and then saying, like, geez, well, maybe everybody wouldn't have that. But I also don't have a ton of time to go over every goddamn last thing. Like I gotta make decisions about what we're going to talk about. Yeah,

Dr. Jessica Hutchins 1:06:14
exactly. Yeah. And then I just, and sometimes it's again, just like finding resources. I do think sometimes I do feel like having community I think helps, even for the families like if you just having that community my nurse practitioner, we were talking she had a patient of hers, too. It was a type one and then I don't know if it's like the moms knew each other and somehow the kids met or something but the other the other girl that's also our patient was a type two but insulin dependent type two and always in very poor control. And then the moms ended up like linking up the girls and then all of a sudden like the type one who was very controlled like rubbed off on the tight on this little girl at type two and like literally that the girl with type two used to always have like a onesies yeah great but then 14 and has been in running in her agencies in the eights for like over a year now.

Scott Benner 1:07:12
That's why I love the Facebook group actually is because having that like positive peer push, it allows you to sit in the background and watch it happen without having to be involved in the conversation it just sort of like rubs on you a little bit you're like yeah, I mean all these people are doing this I could probably do this. I

Dr. Jessica Hutchins 1:07:28
do mention the Facebook, you know like I mean I'll mention the podcast but I know a lot people may not even they just don't do podcast but like I do notice like I have quite a few people in the Facebook group and again even if they're just like a fly on the wall watching it and like listening watching posts, I still think it they can learn from it and

Scott Benner 1:07:44
do you have that personal pain? I know what the podcast does for people like I've I've tons of feedback it's not it's not just one person or a couple of people that happen to you'll hear like varying levels of like I started episode one and I took me a year and I listened to the whole thing and hey Mia once he has five five Look at this. Like right like I see that I see people are like I listened to the Pro Tip series and I got my one seat down to a six and a half and I'm like god it's great or you know, newly diagnosed into bold beginnings which is basically kind of pro tip light for newer diagnosed people and like and it got me on the right path and two years later here we are like I know it works and when I can't get it into people's hands it feels like a like a personal failure. And when you see like the Facebook group is such a great example brings in 150 new people like every three days and I don't see those people one to one translate into listeners and and I think oh my god I got you I feel like I brought them like right to the finish line. And I couldn't I couldn't talk them into taking the last three steps and and do you feel like that and your job like oh my god I know what to do I could help you if you listened or if blah blah blah. Does it feel personally like forget all the business aside and like what you feel like as a doctor like when you're at home and it's quiet Do you think like I feel like I let people down? Do you ever feel like that?

Dr. Jessica Hutchins 1:09:10
I don't know if I felt I honestly feel like I let them down because I feel like I'm trying like I'm trying I mean I get frustrated and I get I get sad like I get it just that this is the state of it for many patients like I can educate till I'm blue in the face and it just it doesn't seem to be like getting in or whether there's a lack of understanding or a lack of ability or drive or whatever that is and more so I mean I think I get more like in my head I like Okay, what else could I do like what what else could we do as an office or you know as a health system like to better support these families it's probably more aware like not as like that I let them down but just more so like more of like okay, what what are we missing? What can we do? Yeah, to try to, like reach these people to try to help this person not, you know, come in and decay again or you know, to, to get that success of like, coming into our visit and their agency like coming down.

Scott Benner 1:10:13
I have an idea, but I'm going to share with you when we're not recording because people will rip me off and I can't have that seriously. The other day, I watched, like you said earlier about like a diabetes influencer. And I wanted to joke and say, like, I didn't know, there were other people doing this, I thought it was just me. But I do see people like, I'll put out an episode about something on Monday, and by Friday, they're talking about that topic. And they're, you know, on their channel stuff. And I'm like, you sons of bitches. Just damn idea and leave me alone place. But listen, the other side of that is, I feel like I'm having a positive influence on the noise that happens in the space, it helps people move towards good stuff. And so I am very happy about that. Like, but yeah, business side. I'm like, you know, have your because these are, trust me, those all those influencers? They're all making money. Oh, yeah. Or they're trying? Yeah. And God damn, trust me, because I've seen it, I see it happen every year. If they can't make money off it, they're gonna stop helping you with your diabetes. I'm the only one who was like, I'll do this for free. I think I can turn it into something. And I've turned it into something that's popular enough that I don't have to worry about my electric bill getting paid anymore. Just it happens now, right? So I can throw myself into the podcast. Most of those people are not in that situation. They are trying to make $100 from a pump company to say a pumps name out loud. Yeah, it's a hustle. Trust me. Yeah. You know, but I have an idea. And I think it'll work. I'm worried that I'm not the right one to face it. And then I don't know how to handle that. Yeah,

Dr. Jessica Hutchins 1:11:53
definitely. Yeah. Tell me your Yeah, we'll

Scott Benner 1:11:56
see. You can steal my idea. And I'm just getting like, no, because I do want to get your input just not when we're being recorded.

Dr. Jessica Hutchins 1:12:01
Yeah. Yeah. I think like I mentioned just the community aspect, I think I think there is some benefit to that, especially when I think as parents like raising

Scott Benner 1:12:10
is that where camp could come in for people who are struggling like that?

Dr. Jessica Hutchins 1:12:13
Yes. Yeah. So we actually last year I started. So in Georgia, we have camp kudzu, which is based out of Atlanta, the children's type one camp for children with type one diabetes, it's actually this is the 25th year. I've been involved with that camp since I was in my year off between undergrad and medical school when I worked at an adult endocrinology office, which is where I discovered my like love for endocrinology, and started volunteering at camp and had been kind of on and off throughout my training and whatnot. And so this past year, we started a new like session closer to in like the middle and South Georgia area to serve the patients that I serve. And so we started that session last summer, we do to the overnight summer camp, but we also do like little one day events, they can't cuz he doesn't all over Georgia and different cities, in just a chance for the family to come together. And they also do family camp on weekends, I think two or three times a year. So I'm hoping that I'll get a family camp session going at the location that I use for my camp session, again, just to pull people together. When we did one of our one day events, Dr. Ponder actually came and talked on it. And he gave a sugar surfing lecture to the parents while the kids were playing. And then then we all kind of came together and did games and stuff with the whole family and the kids. And I mean, just the parents like hearing his lecture lecture and then like getting some time just to like talk to each other. Like, from that it like spawned a whole like they made their own little Facebook group and they you know, like just being able to meet other families that are going through what they were going through was such a, you know, eye opener and the kids I mean, all loved it to the kids. One of my patients, he's type one and Down syndrome. He came to our overnight camp last year and we did an interview an interview about camp a few weeks ago and like literally, like the bright when he first saw me he was like Dr. Hutchins, like what's going to be the carb count for lunch on the first day of camp and I was like, I have no idea. But he was just so funny. Like he was like, literally could not stop talking to you by camp like he was so excited about camp and I've never been invited. I just want to say Oh, I would trust me like that is like something I yeah, that's in the works. Especially when I saw Arden was in Georgia. I was like okay, Scott's gonna be in Georgia so I gotta figure it out when he's here and I can get into something that is that is in the back of my head.

Scott Benner 1:14:46
I would definitely come. So but there's no pressure obviously if you don't you don't want me and as far as like,

Dr. Jessica Hutchins 1:14:52
um, a lot of my patients listen to the podcast and like they would definitely I mean even Dr. Ponder coming was a big deal and but a lot of people didn't No ponder, like if they were like newer diabetics, just because it was I felt like some of the older diabetics, you know, are familiar with his stuff. But newer diabetics are familiar with you.

Scott Benner 1:15:09
This has got nothing to do with Dr. Ponder, but it's so hard to stay in the zeitgeist once you get into it. And like that, I tell people, like, I'll say it on here too, like, but I talked privately about all the time, like, like, you know, doing business and stuff like that. And people are like, what are you most proud of? And I was like, longevity. I was like, Yeah, keeping this train Moving is hard. And keeping it popular is hard. Like, you can say something really valuable. But how do you say it again, tomorrow without people gone? I heard you say that already? Yeah. And how do you stay in it long enough to get to the next group of people? And then how do you not get bored? Because you're like, Oh, I just said this to a bunch of people three months ago. Like there's that, like, that's hard. I'm good at it. Like so. Like, that's it, meaning I don't get bored by helping people in the early parts of their diabetes. Yeah. So it's just and it's so in the social media part of it. Like I listen, I I'm not begrudging anybody who's trying to knock out a couple 100 bucks at a time going, like if I weren't on the pod, like good for you. Like, I think that's terrific, right? But that's not a thing. You can keep going for long. Yeah, yeah, you have to, it's not a real job. It doesn't grow into the thing you think it's gonna grow into? And then how do you keep and it's content. People want content constantly. I laugh when I used to sit around, and I rang my hands for two years. Could I put two episodes out a week? Or would that make people upset? I don't know what I should do to I think they're going to stop listening. If I put two out. And then I put two out and people like, Oh, my God, this is great. Can you do more? And I was like, Sure. Here's three. And they were like, well, what do I suppose let's do on Thursday. And I was like, valid point. And then you know, like, and before I knew it, it was like five days a week. And then I like last weekend, I was like, I've got all this extra stuff, like I'm just gonna pull up on the week. And I thought, well, this is definitely gonna piss people off. Except this was a really popular week of the podcast, if there being two episodes on on Saturday and Sunday. That's too funny. Like, I was just downstairs right before you and I talked, right? My son is applying for a job. My wife is at home working. And I'm like, Hey, I gotta go work. And my son laughs because he's like, you're gonna go sit and talk to somebody? And I was like, Well, yeah, that's work. That's my job. Like, it's my job. And so I'm gonna go do that. And I sit down, I'm gonna take a quick break. And then I'm gonna do it again. I'm in a half an hour, Jessica. I'm recording with Erica, on a resilience series that we're putting together.

Dr. Jessica Hutchins 1:17:38
She's the site the site. Yeah, yeah. I've listened to some of hers. And

Scott Benner 1:17:43
then I'm getting to get done. And I'm gonna take a deep breath and eat something. And then I'm gonna come up here and put episodes together for you guys for next week. Yeah, if that's not actually your job, there's no way to keep it going. There just isn't. So these are the influencers, who you're thinking of right now. Like in your mind, you're like, Oh, I love this person on Instagram or something like that, write their name down, and then go into your phone and say, Hey, Siri, 12 months from now remind me to go look for this Instagram account.

Dr. Jessica Hutchins 1:18:12
The other group one of the things I mentioned on the list of things I would talk about diet. So the other group that I follow, and I guess that I'm quote unquote, popular and is the low, low carb group. And so I am low carb friendly. In your practice, in my practice, like a lot of peds endos are not low carb friendly. I have, you know, a few patients who come to me because, like, I'm familiar with, like Dr. Bernstein's method, and the like, type one, Greg, type, type one grid, and like, let me be 83. So I have some who like, just come to me for that, like with a new onset, I'm not like, Hey, you must do low carb, you know, if people asked me, you know, I did have a patient that when I first started, it was actually a friend, a person I met at church and then she found out I was a pediatric endocrinologist and then she was like, Hey, you like my son has like a pre diabetic agency and his pediatrician been watching it and I was like, Okay, check the antibodies he had like, all for like for the antibodies were positive and like, okay, he is going to get type one and like, at this point is a once he was like 6.2%, and I was like, and I didn't start work for like, another month. So I was like, Okay, so now until then, just like, try to go lower carb just, you can maybe delay this until I start working. And so they went lower carb he was actually able to go two years like he basically honeymoon with a completely normal agency in the low fives for two years. It was amazing. And he's still low carb because they at this point, they're used to it and he now is at the point where he needs injections pretty much every time he eats but they're like some of my low carb patients, they use the regular insulin for like the protein to match the like Rise of the protein. And so they use like long acting and they have to use are not not Every meal, mostly dinner because that's when he eats like a lot more protein is at dinner. So I am like, familiar with that. As far as like dosing with our and so yeah, in that way, like you mentioned earlier about me being progressive. So I feel like in that ways like with the looping and like being like low carb aware and friendly, it makes me a little bit more progressive,

Scott Benner 1:20:19
because that's who you are. Judge me on that? How am I with how people eat?

Dr. Jessica Hutchins 1:20:24
I think you're like me like you're like you do you like, because you'd like did the whole diet series where you like, and you had low carb people on there. Not yet. I think in the Facebook group, like some people, like can get back and forth about it, you know, whatever. But I mean, I think you're like me, I think you're like you do like, if that's what you want to do, then you can do that. At the end of the day, you just want to make sure like they know how to manage and so on. So

Scott Benner 1:20:49
that's exactly how I feel. But I every once in a while I'll get like, the somebody comes after me like a very like, zealous person will come after me and be like, you're stopping us from talking about this. I'm like, I'm not stalking you about anything. I'm like, you just can't come in here. And like, ring a bell and proselytize and tell people that if they eat a car, they're gonna die like or, and that's like, that's not what I said. I'm like, You should reread what you just wrote it because I don't have a horse in the race. I don't even care. Yeah, it's meaningless to me how you manage your your food, you should eat whatever you want, I really genuinely mean that. And but when I'm managing the group, it's a different scenario. Like I have to I have to protect everybody, not just some people, like there's a post that went up the other day, I'm actually going to get the record with the person soon. And I'm excited about that, because it's a really nice kind person who's trying to share what they figured out. And they put up this, this post, and I can't wait to ask them face to face. Like, what did you think the tone of this was? Right? Because I bet you they were excited and sharing good news. And if you read it, it feels a little like, if you just did what I did, you'd be healthier. Yeah, like, right. And and so I'm also not saying that's not true. Like I'm just saying like, yeah, I guess my point is, is that if just telling somebody what the right thing to do was than the last hour of our conversation wouldn't have sounded like it did? And the answer to those, those people's problems isn't eat low carb. Yeah, for

Dr. Jessica Hutchins 1:22:18
some people, that's not even, that isn't an option. Again, it goes back to like the privilege, like, it can be pretty, a little bit more expensive to eat lunch. Also,

Scott Benner 1:22:27
if just saying the right thing out loud made the world correct, then we wouldn't have any of the problems we have. You just go Oh, no, no, you know what, you can't do that. And people go, Oh, I didn't realize and that would be the end of it. That's not how it works, right? And so when these people come in with their super excitement, and I'll say, hey, look, you know, just please be keep in mind the tone of what you're saying here, it feels a little judgmental, blah, blah, blah. And then somebody will go, will you tell people they can eat a cupcake. And they come in here and ask how to dose for something on a restaurant that's obviously got 150 carbs in it. And that's not healthy for them, and blah, blah, blah, blah, blah, I'm like, what does that have to do with anything? I'm not telling them to eat that any more than I'm telling them not to eat. I'm not telling them not to be low carb. And I'm not telling them to go get a waffle with a pancake on top of it and a Sunday. Like I didn't say that either. You know what I mean? Like, all I'm saying is, whether it's the waffle with the pancake with the Sunday with the cupcake, or it's a steak, you got to know that there might be a protein rise from that steak. Exactly. And you got to know that the waffle with the Pig egg with the thing is gonna need like a half an hour Pre-Bolus And like, like a cartload of insulin, and you might get really low later. And you should pay attention to all that like, exactly. It's not my job to teach people how to eat. And by the way, it's no one's job. And if it was your job, it would be an absolute loser of a job that you would never all you you're gonna preach to the choir and think that you're converting people, but you're not you're just converting people who were up to be converted anyway. And I feel comfortable saying that, because there are times that I think my podcast maybe isn't as valuable as I think it is. It's just valuable for the people who is right for. And I would like it to be valuable for more people. That's what I'm trying to figure out. And I got them well guarantee that telling them what to do is not the way to get them to it. So I just mixed two issues together, but at the same time. Oh, yeah, they're the same thing. You're a doctor. I feel weird. And you go to church and I just cursed. bleep that out. Rob, please. Gosh, my. You're also from the south. I assume you're cursed all the time.

Dr. Jessica Hutchins 1:24:29
I laugh because like my husband, like petite, I did not grow up going to church. My husband did and so like, Oh, he's dry. I curse he like gives you the side eye and I'm like, like, you're fine. Like,

Scott Benner 1:24:41
isn't that interesting? The lady who got was brought up nicely didn't go to church, the guy who was getting backhanded did go to church. Well, I don't want to get into that right now. But

Dr. Jessica Hutchins 1:24:52
don't you know that that's what you know, the Bible says, well, the rod whatever.

Scott Benner 1:24:57
I don't know. Listen, I don't want to hit P before but every once in a while, it'd be nice if I gave him a five minute pass. Yeah, I'm sure we all feel like that. Anyway, ya

Dr. Jessica Hutchins 1:25:07
know, so I get I dropped a few curse words there every every now and again. So a person does not offend me.

Scott Benner 1:25:14
I love to curse. It's one of my favorite things. Alright, well listen, you have your own problems. You gotta go figure out how to parent small children, which it sounds like, if I'm being honest, you're struggling with and. And by the way, I want to thank you for coming on here. People know who you are. You're a physician. You're an endo. And you said a lot of things that sounded like Oh, no. And I thought that was really honest. And I appreciate that very much. Because I think it'll help people to hear you say, like, I can't get my kid to put on a CGM. And you know, like, he ran away from me like what do you want me to like? And you were just like, whatever. So chasing down right?

Dr. Jessica Hutchins 1:25:55
I chased a little bit but then it was like, was there currently then yeah, if he if I knew he was if he was actually did he actually had diabetes? His butt would be wearing a sensor like there wouldn't be an option.

Scott Benner 1:26:06
Did you consider money? I would have dropped money on the problem like nothing. Either been running away I've been like, can you smell this? 20 I'm waving in the air smells like Legos. American.

Dr. Jessica Hutchins 1:26:17
He responded to money he probably would he would probably respond to like Roblox, you know, like money on his Roblox sign pad game or something.

Scott Benner 1:26:25
I just gotta explain it to them correctly. That's all you got. Understand where the push and pull comes from? Yeah, you're great. I I'm sorry. It took us so many years to do this. Oh, no, you're fine. And at the very end here, let me thank you personally for the help you gave me when Arden wasn't feeling well, last year. I appreciate it. So

Dr. Jessica Hutchins 1:26:41
now, I know you've been on for a long time. But I do want to hear more about her GLP as you were talking about that, at our r&d, the GLP one

Scott Benner 1:26:49
you want five minutes. I'll give you five minutes. Yeah, you can. Yeah, give me give me. So I had Dr. Blevins on yesterday. And he'll be on again in a few weeks and on again a third time answering questions. He is another care ologists from Austin, Texas, who I found through YouTube. I was watching YouTube videos back when I was trying to understand what it was I was taking. I had that moment, a few minutes, a few weeks or into my use of a GLP medication for weight loss where I was like, I should probably know what this is. Well, I try to understand exactly what I'm injecting into myself. Right. And so I looked into it, I found him just doing a talking head video that I just found to be very clear and thoughtful and well sourced I thought and so I invited him on. Anyway, he's been on there's an episode about a 15 year old girl whose daily use if you haven't heard this one, Jessica, her daily use. She's a three year type one. She ended up on we go V because of what they thought was PCOS weight gain. And her daily insulin has gone from 70 down to six. Like daily. Yeah, she took her pump off. And she's only shooting Basal right now after having type one for three years and using 70 units a day. And so that's happening. I am almost to my absolute lowest weight right now since I started back in April of 2023. Is that when I started? That's awesome. Yeah. Arden is using it. We are like scraping it together any way we can. We're about to get our doctors about to take a different stab at getting it covered by insurance again. So we're getting ready for that. But she's doing five milligrams Manjaro right now. Actually last I would say weekly, but last week, she's like that I shot it like nine days after I shot it the next time she's like I just I was in class and I forgot. Yeah, she has forgotten but you can literally see the difference.

Dr. Jessica Hutchins 1:28:41
I remember yesterday, you were saying on the episode. Now excited. She wasn't really like overweight. Did she lose weight to or not really? Oh, she lost

Scott Benner 1:28:47
weight? Yeah, she did. Yeah, she looks. Now there are going to be some people. And Dr. Blevins and I are going to talk about this on one of the episodes where people just have this knee jerk reaction where they're like, You're too thin like that feeling. She's not too thin. She looks incredibly healthy, healthy. I'm not too thin. I think it's possible. We're all just used to seeing heavy people at this

Dr. Jessica Hutchins 1:29:06
point grade. Yeah, I mean, I mean, often, like we get referrals for like, obesity. And, you know, a lot of times I feel like the family will be like, I mean, they look normal to me. And I'm like, I mean, honestly, like compared to a lot of their peers, they probably do like about average. And it's like the kids who are like normal weight. The parents like they're so skinny. I'm like, Nope, they're 50 percentile. They're perfect.

Scott Benner 1:29:26
There are times that people put pictures of their overweight kids online eating really crappy food. And I think, oh, wow, this is an indication of what they feel is normal. Like, it really is interesting, right? Because even just from like in, I mean, I'll tell you from my personal perspective, if if when I was 45 pounds heavier, you weren't gonna catch a picture of me having a pancake somewhere. Like like you don't even because you're like, because you're self conscious about it. Oh, because I'd be like, I probably look like that because I eat this pancake. And so like but you know, like, but it's Interesting. I'm not judging people. I'm saying it's a very interesting look into popular culture and all that. Then my point being is that people will come up to me and go, Oh my God, you got to stop losing weight. And I'm like, I need to lose 20 more pounds. Yeah, you're like, I'm not at my ideal weight. Yeah. And forget ideal. Like, do you not see the fat right here? Like, this is right in the heart attack spot? Like, yeah, you know what I mean? And like, and they're like, oh, no, you look great. I'm like, I look better than I used to. And I And listen, I do look great. But I'm not healthy yet. And that I don't care how I look. I care about not dying. Like, right. Yeah. So are you with Arden

Dr. Jessica Hutchins 1:30:34
out of curiosity, so I know does she have to Windows JLC or regular Endo? And then also the one that's like, the lady that did the thyroid episode, she just sees her now. Okay, he's very curious. I was like, what her? I was wondering, did her other endo prescribe the GLP? One, or this is the one that's more like, functional medicine, naturopathic kind of, like sees it. And

Scott Benner 1:30:55
makes sense. Yeah. Because when when Arden turned the age, chop was like, Get out of here. And they were like, you know, she's in college right now. So we'll help her for another couple of months till you can get back. But then you gotta get out. And I'm like, Okay, I would think you'd want the guy from the podcast around, but that's fine. And so lols and insurance and everything. Exactly. One of the luckiest things that's ever happened to Arden is that Addy took her on as a type one patient, because it doesn't even take new patients type one, okay, and she doesn't manage type ones, for the most part. You manage her type one.

Dr. Jessica Hutchins 1:31:31
I mean, like, it was like she she just refilling your insulin and your pods and Dexcom. She's like,

Scott Benner 1:31:37
she's like, What am I supposed to be looking at here? And I'm like, Oh, don't forget to ask about her eyes every once in a while, like, you know, like, but But no, like, she's terrific doctor and looks into things. She's the one who was telling me two years ago, like, hey, maybe let's try putting it on Metformin and see what happens to her insulin sensitivity,

Dr. Jessica Hutchins 1:31:53
that it helps I use metformin and my type one we never did,

Scott Benner 1:31:57
we went right to the GLP. The GLP has happened so quickly that by the time we got our head wrapped around what we were going to do, she's like, let's just give her a GLP. Now, you're right. It's not covered by insurance. But we got a sample pen, and a couple of them. And then we hit her with the pen. And I was like, I will do anything for her to have this helped her so much. Yeah. Now, in fairness, it is not costing me $1,200 a month. We're buying a pen. We're using it more sparingly than that, like that kind of stuff. And we've we've relied on a couple of samples here and there. We're literally in a flux period where I have to find a way to get insurance to cover it. Yeah, like I can't keep doing I

Dr. Jessica Hutchins 1:32:37
have had I had one patient with type one. And now he aged out and he's in the adult world. But he was type one that weighed like 300 plus pounds. And not the most compliant teenage boy and I with lots of fighting with his insurance. And I think they had like anthem or something or one of those at the time. It was private insurance. We were able to get it covered. And this was actually like, three years ago. So that was a Victoza because that's what was like kind of out then

Scott Benner 1:33:07
what they're doing now is you're getting a double diagnosis. They're basically diagnosing you. You have type one and you have insulin resistance.

Dr. Jessica Hutchins 1:33:13
Yeah, well, and you're morbidly obese. Like, I mean, you're you need it for your well that Yeah, I mean, nowadays, when he was on it, he lost like 20 pounds, he'd never lost 20 pounds. And I mean, his a once he got it got a little better. I mean, again, he still wasn't very compliant with its insulin regimen. So but that

Scott Benner 1:33:29
person now could would be right for week over years that bound and it would probably be covered by their insurance for heart and like, you know, it's going to be it's going to be insulin resistance, like like, so does it meet the the BMI criteria? I'm assuming you didn't meet the criteria. When we started. Yeah, yeah. But what she does meet is her insulin needs significantly dropped. Her spikes are lesser her acne is cleared up, or periods are easier. They don't have studies yet on what it impacts. And yeah, but if you go to any reasonable OB, at this point, they're going to be like, Hey, if you have PCOS, try to get GLP if you can, that's literally how they talk about it to you. They're like, Hey, if you can talk to a doctor and given it to you, you should I've had a GYN tell RT and like I can't prescribe it, they'll turn it down. Like she's like, but if you went to your Endo, and like there are there are other reasons. And so we started off with like, like, this is just good. Try it. Now we're about to we just my wife just switched jobs. So we're about to put it back into the new job and try again. And I think ADDIE is going to just say, Look, you call it whatever you want, but this girl's got insulin resistance, and she's got type one. So if you want to say she's type two because of coding, I don't care. This is what's going on. Now. I don't know how long insurance companies are going to do that because right now they seem to be doing it, but they could change their but I

Dr. Jessica Hutchins 1:34:51
have a lot of Medicaid patients. So Medicaid like I mean, I can get my type twos on it but like obesity and Anything outside of a diagnosis of type two, like they're not good, they won't cover it. Yeah. And even then a lot of them, it's like, they'll cover trulicity, which I just did. Trulicity isn't really working.

Scott Benner 1:35:12
Like this stuff. This stuff's like, I don't want to call it magic. But holy crap, magic. Yeah, I upped my dose two and a half weeks ago, I've lost six pounds,

Dr. Jessica Hutchins 1:35:20
I need to get on it. I had gotten a sample of like, the logo V A long time ago, but it was like, the backorder was so bad. And so like, I got the sample the point two, five. And I didn't really feel anything on the point two, five. But then when it was time for me to like, get a refill on the next dose, like it was nowhere to be found. And then I just didn't go back and pursue it.

Scott Benner 1:35:41
You need it, do it. It's

Dr. Jessica Hutchins 1:35:44
worth it. Yeah, I have a two and a half year old and have yet to like lose that extra 30 pounds. Because baby,

Scott Benner 1:35:51
let me tell you something right now, I was out today. And this young girl comes to help me. And I looked at her and I thought, how is she like, it's the middle of the day, how she not in school. And then I thought, oh, high school is over. And so I said to her, I'm like, Oh, I was just about to say to you like, shouldn't you be in school? Like, you know, and she goes, I should but I'm in college. And so you can even say her like see her going? Like I know people think I look really young and everything, but I'm not in high school. I'm in college. And I said, Don't worry, looking young will really help you when you get older. And we were chatting for a second. And she goes, How old are you? And I said, Guess she goes you're in your? And she's like, I don't want to insult you. And so you just say what you think you know, and she goes mid late 30s. And I went, I'm 52 You're like, yeah, and I was like, This is great. And like, but no, but like, but she was really son. I'm like, even if you were being polite by 10 years, you were still off by seven years. Yeah, that's nice. And I said, this is my point to you. I was like, yes, it sucks now because everybody thinks you look like you're 12. But when you're 52 and someone goes already, you're 3540 years old. You're gonna love this. But the truth is Jessica, that a year ago, she would not have said that to me.

Dr. Jessica Hutchins 1:37:01
Because you looked old because you were Yeah, healthy. Exactly. Right.

Scott Benner 1:37:05
I am at a level of health now. Like forget, I don't care about how I look. It's fun to like joke about everything, except every once in awhile when somebody leaves me a review. And it's like, you're so privileged that you have this like, I know I am calm down. I feel better. I am better. Health wise. It's got I mean, if I still looked like I looked a year ago, and I felt like I felt today am I glad I came back like they came back recently. I would still tell you I'm taking this stuff. Yeah, I mean, so anyway, I have to go but I was gonna I wanted to ask you about low dose Naltrexone and auto immune Have you gotten involved in that at all? I have not. Okay, well, I'm gonna save that for another episode. I'm going to try to find somebody who has been using it or something like that. Apparently, apparently, you know what it is right. I have heard of it, but I've never used it. People are using it for like autoimmune issues now. And for like pain and swelling and stuff like that inflammation. Anyway, look into off to Google it. Yeah. Let's catch up to tell you about it. And then it'll tell you how to build a bomb that it will use on us one day. Thank you for doing this very much. I

Dr. Jessica Hutchins 1:38:13
appreciate it. Yes. All right. Have a good day.

Scott Benner 1:38:15
Yep, hold on a second.

A huge thanks to touched by type one. Don't forget to go to touched by type one.org and get your tickets for the big upcoming event in September. Jalen is an incredible example of what so many experience living with diabetes, you show up for yourself and others every day, never letting diabetes define you. And that is what the Medtronic champion community is all about. Each of us is strong and together, we're even stronger. To hear more stories from the Medtronic champion community or to share your own story visit Medtronic diabetes.com/juice box and look out online for the hashtag Medtronic champion. A huge thanks to Dexcom for supporting the podcast and for sponsoring this episode dexcom.com/juice box go get yourself a Dexcom g7 right now using my link, 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 the hydration and even trampolines juicebox podcast.com. Go up in the menu and click on diabetes variables. 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

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