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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
OmniPod, Hello friends and welcome back to another episode of The juicebox Podcast.

Today, we'll be speaking with Sarah. She has type one diabetes and Addison's. Her father had type one and Addison's as well. He's passed on now from a heart issue that Sarah is concerned she might also have. We're going to talk about type one today as well as Addison's, and how it adds to dealing with type one diabetes. Please don't forget that nothing you hear on the juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juicebox at checkout. That's juicebox at checkout to save 40% at cozy earth.com, when you place your first order for ag one, with my link, you'll get five free travel packs and a free year supply of vitamin D drink. Ag one.com/juice, box. 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, dehydration and even trampolines. Juicebox podcast.com go up in the menu and click on diabetes variables. This episode of The juicebox podcast is sponsored by Eversense. The Eversense CGM is more convenient, requiring only one sensor every six months. It offers more flexibility with its easy on, easy off, smart transmitter, and allows you to take a break when needed. Ever since cgm.com/juicebox, today's show is sponsored by OmniPod five. Do you have fear of missing out on OmniPod? If you do, you have fomu, but I can get rid of it for you at omnipod.com/juice, box. OmniPod five is no longer just a great option for people with type one diabetes. It's also now FDA approved for people living with type two. This episode of The juicebox podcast is sponsored by cozy Earth. Use the offer code juice box at checkout at cozy earth.com and you will save 40% off of your entire order. I

Sarah 2:29
am Sarah, or on Facebook, you'll know me as Sarah vel and the reason I'm giving away my identity right out the gate is because not even my mom calls me Sarah, because there were so many Sarah's born in the like five year time span that I was that it just really didn't make sense to answer to it for most of my youth.

Scott Benner 2:49
What does your mom call you?

Sarah 2:52
Val? Pretty much everyone calls me Val. You

Scott Benner 2:55
want me to call you that I

Sarah 2:56
am. I'm not upset. You can call me Sarah or Belle. I know that you think of me as Sarah. And obviously, people that encounter me online think logically, well, she's got a first name, so I should use it, so

Scott Benner 3:09
at least there's not 1000 Sarah's when somebody's tech, you know, messaging you Sarah Exactly, exactly. Okay, well, I'm gonna see what it comes out of my mouth. What do you think about we'll figure it out. That sounds

Sarah 3:19
great. Maybe it'll be none of these things, or I'll just be known as the April Fool from here on out.

Scott Benner 3:24
So always at the first

Sarah 3:26
it is, Oh, interesting. I was so excited to try and organically get you to say that something in my life happened in the alley behind a Dunkin Donuts, because it cracks me up every time you say that. And today, I got an alert from Dunkin Donuts that they're now being called donuts only, which I feel has to be an April Fool's thing, but I just don't know

Scott Benner 3:50
what's gonna happen. Do people not dunk their donuts anymore?

Sarah 3:55
I mean, if they were going to drop one or other parts of their name, I would think they would go the KFC route and drop the donuts, since they have other things like Dunkin, yeah. Like, I think my app says Dunkin. I don't

Scott Benner 4:10
wanna go too far down this. But donuts didn't used to be like soaked in sugar. They were more like cake. So I get dunking like a cakey donut into coffee, maybe. But I mean, if your donut is pink and purple and has 33 like, sugary things stuck to the top, it probably just melts in your coffee,

Sarah 4:32
yeah, which, I mean, could be, like, a sneaky way to add, I don't know. It was the the OG fancy latte, I don't know, like, listen,

Scott Benner 4:42
I think we're overthinking. I think what actually happened is a over blown group of PR people in a room decided that they needed to do something or they weren't going to be able to keep their job. That's normally what I find happens. No disrespect, I work with a lot of good PR. People with the companies that, you know, the advertising comes through. But there are times that I get on calls and I just, I'm like, why are there seven people here? I'm like, we're talking about an ad for a podcast. There's like, I don't think this many people signed the Declaration of Independence on the first day. Like, what are we doing? Exactly, you know, I think they had to come in slowly to sign it, you know what I mean. And I'm sitting in front of seven people, and they all have like, like, five of them have thoughts, and one of them's clearly the alpha, but not in charge. Then there's the one that's in charge that's more quiet. Then there's two people who don't say goddamn word through the entire thing. And I'm like, what are they even here for? And all I can think is, if you fired four of them, you could give me their money anyway, I don't know what they're doing much, yeah, not nevertheless. So Sarah, you and I live near each other. Is that right? Like, reasonably speaking,

Sarah 5:52
we do? Yeah.

Scott Benner 5:53
Do you think that might be why you like me? Do I remind you of people that you grew up with? No,

Sarah 5:59
because I did not grow up here. I only moved here, like, two and a half years ago.

Scott Benner 6:04
Oh, that goes my whole theory about you online. I just figured that you were like a Philly girl, and I made sense to you. No,

Sarah 6:09
although I think that that my energy very much works on the East Coast like I love it, I love it on the east coast. So I came to college on the East Coast in North Carolina, then I moved back to Denver. I'm from Colorado, like I've lived there a good chunk of my life, but moved out here two and a half years ago, and it's been fantastic, cool.

Scott Benner 6:33
I like you about four inches closer to that microphone. In case you're wondering, you sat back when the dog you sat back when the dog came?

Sarah 6:39
Yes, I actually will also move the mic further back so

Scott Benner 6:42
that, yeah, all right, so how old are you when you're diagnosed three

Sarah 6:46
and a half? Oh, really. And I know, I know that. I think I just heard you talking about, like, how it doesn't really matter if you were the day before three or the day after three, but we all know that toddlers are very into if they're three and a half, or

Scott Benner 7:02
things like that. So at that time, were you very into being three and a half? Probably,

Sarah 7:06
I was. I was probably a pretty textbook three major. So

Scott Benner 7:09
I, by the way, don't care. It's just for the course of storytelling. But when people get lost and, you know, I, you know, it's 1986 and they're like, or was it might have been 87 five, you know, it's because my uncle, he had that haircut. And I'm like, Oh my God, no one cares. Stop. No one's gonna remember. We need a frame of time. It was in the 80s. Keep going,

Sarah 7:35
yes, yeah. So at some point in the mid 80s, I was at some point in the early 80s. So it was March of 81 when I was diagnosed. Nice.

Scott Benner 7:45
So 91 2001 2011 8121 hold on. But I'm counting 91 2001 2011 2021 that's 40. And then three more years. 40? Are you 46 almost 47

Sarah 8:03
I am 46 Yes. Sarah, you

Scott Benner 8:06
look like you're 15. That's why I was thrown off by the counting.

Sarah 8:09
Thank you this. This makes life even better. Wait, you're, you're

Scott Benner 8:13
46 Yeah. Holy crap, good for you. Congratulations. Diabetes keeps you young, doesn't it look at that, something like that? Probably not how that

Sarah 8:24
works. Yeah, I think my body would disagree, but at least my face is is holding up the ruse. So

Scott Benner 8:29
let's give people just a tiny bit of understanding. Are you regular mph when you're diagnosed as a baby? No, I was pork. Oh, wow, you make it that, which

Sarah 8:38
I was highly allergic to good but, but was told this will be a recurring theme in today. But was told, Well, some people just get hives and bumps, and that's what we get, well and obviously, like, it's better than the alternative of like, eat as little as possible and keep moving until you die. Anyway. So well,

Scott Benner 9:01
so Sarah, tell me about this like so even as a baby you got your first injection, you broke out. Or did it not start right away? My daughter is 20 years old. I can't even believe it. She was diagnosed with type one diabetes when she was two, and she put her first insulin pump on when she was four. That insulin pump was an OmniPod, and it's been an OmniPod every day since then. That's 16 straight years of wearing OmniPod. It's been a friend to us, and I believe it could be a friend to you. Omnipod.com/juicebox, whether you get the OmniPod dash or the automation that's available with the OmniPod five, you are going to enjoy tubeless insulin pumping. You're going to be able to jump into a shower or a pool or a bathtub without taking off your pump. That's right, you will not have to disconnect to bathe with an OmniPod. You also won't have to disconnect to play a sport or to do anything where a regular tube pump has to come off. Arden has been wearing an OmniPod for six. 18 years. She knows other people that wear different pumps, and she has never once asked the question, should I be trying a different pump? Never once omnipod.com/juicebox, get a pump that you'll be happy with forever. This is from a listener. Thank you for introducing me to cozy Earth for my birthday, I bought stuff to update my bed, sheets, comforter and a blanket. It honestly made our lives better. My husband and I used to have a conversation in quotes every single morning about who pulled the covers so far to their side, or how we were too hot or too cold. That never happens. Now, both of us sleep better and more comfortably. And don't get me started on the clothes you all should just try one piece. Use the offer code juicebox at checkout@cozyearth.com and you will, in fact, save 40% off of everything you put in that cart. Cozyearth.com use the offer code juice box at checkout. Yep, nope, right away. And they were like, well, at least she's not dead. Keep doing this. Basically,

Sarah 11:04
yeah.

Scott Benner 11:05
How long did that go on for?

Sarah 11:06
It went on until I got on regular NPH, and things were less bad then, but we'll jump way forward, and then we can go back to the 80s if you want, but I figured

Scott Benner 11:22
out, huh, what's less bad? Oh, well. I

Sarah 11:25
mean, like, less aggressive hives and things like that, like a tall I mean, it's all relatively tolerable. But I figured out last year, with the help like this is how I found the podcast that I am still allergic to now an additive that they put into every single sub subcutaneous insulin. It's just like on an allergy scale, if they go from one to five on probably like a three. We had to rule out a lot of other reasons why insulin never really seemed to work in my body the way it was supposed to, and I was very relieved to figure out that it's not something wrong with my body, but just my body reacting the way a lot of people do to this specific additive. Do

Scott Benner 12:10
you know what the additive is? It's called metacrisal.

Sarah 12:12
Okay, M E T, A C R, E, S, o, l,

Scott Benner 12:17
oh, I wasn't ready to Google. M E T, A C, R, E, S, o, l, I got it organic compound with formula. I'm not going to read you the formula. It's colorless, viscous liquid that is used as an intermediate in the production of other chemicals. It is a derivative of phenyl and is an isomer of p cresol and o cresol Interesting.

Sarah 12:46
I my best understanding is it's either a preservative or an antibiotic. So obviously I understand the need for it, but it is problematic. I found a I'm like, a huge science nerd, but I found a journal article and a study from 2015 where they tested four different insulins of varying metacrisal ingredient strengths or whatever, and within five minutes of exposure, even To the insulins, the cells that touched it were either dead or toxic. This is, I think this is why they really encourage it's not the insulin losing efficacy that they tell you to switch out pod site or pump sites every two or three days. I think it's because everybody's system, like those sites being constantly saturated as a reaction. Yeah, that makes sense. It just is much more aggressive.

Scott Benner 13:49
And did you learn about that? Because I did those episodes with people who had insulin allergies.

Sarah 13:54
It's how, it's how I found it. Oh, okay, so I started. We'd been wondering for a few years. I got on a pump first in 2000 end of well, basically 15, and it worked pretty well for a few years. And then the summer of 19, it like I would change sites and get an almost instant occlusion, or it would last, like, a few hours, and then I do a big bolus and occlusion. I mean, tandem sent me three different pumps just in case it was a hardware issue kept happening like it would happen with a brand new pump. So I just gave up on pumping in the summer of 19 but really wanted to try it again, because it helped my control so much. So I was trying to get back on it, and kept having, like the sites would last, like maybe 12 hours, but I would just keep throwing so much insulin at I mean, when I found the group and the podcast, I think. Like, a year ago or 11 months ago, my average daily was, like, in the 250s

Scott Benner 15:07
Okay, yeah, I was

Sarah 15:09
waiting for your eyebrows to fly off your head. So it's, you know, obviously, like, I'm throwing a ton of insulin at things, just to be like, come down, and then even, like, I found the podcast and heard about Prussian catch it, and I was like, Okay, I'm going to try this. Like, let's see what happens. And would just throw insulin, throw insulin, throw insulin. And it either, well, usually, like, the site would be dead within like, 12 to 14 hours, Max. So I think when I came into the group, I think I'd asked in a tandem group about, like, Is this, like, does this kind of thing happen to anybody, or is it possible to be allergic to insulin? Like, we're starting to see some of the symptoms that I have always had on my face, where we started to realize we're kind of like lesser versions of my reaction to known drug allergies. So we know I'm allergic to pork based drugs. Found out again the hard way in 21 in the ICU when they gave me heparin. It's a, I think, a blood thinner to prevent clots when you're lying in a hospital bed. Nobody checked that it is pork based. So I had, like, a terrible allergic reaction to that, and it's very similar to my sulfa based drug allergy reactions. It's just it's lesser. So we're kind of like, wait a minute, like this is kind of, maybe this inflammation is not based on something I'm eating or some other thing, but between the inflammation and, like, my face gets, like, really red and it burns almost from underneath. It's like a sunburn, but from underneath my skin, okay, which I'm now finding out may or may not also be kind of mast cell issue or a histamine issue. I've met some people that have some similar responses that know that they have MCAS. I don't, but I mean, it's possibility. I suppose anyone with an immune system as active as mine might have something along those lines.

Scott Benner 17:20
Has anyone talked to you about, like, one of the injectables for your immune response? No,

Sarah 17:28
like the kind of things that they do for what is the as the anchoving, like the biologics? Yeah, the biological injectable.

Scott Benner 17:37
No, no. Have you thought about it? I

Sarah 17:41
mean, I guess now I have. It had not it had not previously occurred to me trying

Scott Benner 17:47
to think of the name of them right now,

Sarah 17:49
there's, I know, it's like, Humira, and there's, there's, I think four or five of them,

Scott Benner 17:55
yeah, Zoller, zolar, I think is one they use for like, a lot of things like, like, spontaneous eutic area, which is just hives, and right, idiopathic as well. By the way, idiopathic means they don't know how it happens. That's fun, yeah? Like, when they give it a big name to say, I

Sarah 18:12
don't know what's happening, I know, just to make it even more mysterious, yeah? I

Scott Benner 18:16
mean, I just wonder. I don't know if you want to be injecting more things with your luck, it's probably made with pork, but, well,

Sarah 18:22
yeah, who cares? I mean, I kind of, I've taken the stance of, I have, like, I'm open to using my body as a science project, because I know nobody else, liability wise, is going to and they won't do with the same urgency that I want to get to the bottom of things. No,

Scott Benner 18:41
no. If we waited for everybody's timetable, we'd all be dead by the time something happened. Yeah, tell me what is the real world implications of all this like day to day. So

Sarah 18:52
I figured out last year that it is possible to be allergic to insulin. So and I found four studies, and I think at least one. I think Sasha Sacha the first guest on your allergic insulin, like the one with a really bad allergy, the girl from Canada, thank yeah, thank goodness. My allergy is not anything like that, because I can't imagine, yeah, like mine is tolerable. It just like, things don't work the way that they're expected to. I figured out that it seemed to be better for my body to do kind of a slow drip, basal only for that. I figured out this is earlier than I expected we'd talk about this, but like, Thank goodness for the podcast, because the pre bolusing episode was instrumental for me, not in the same sense as it is for everybody else, but because when I was first like, okay, like, I want to see how long it takes the arrow to start moving, I realized with Novolog in my pump, it. Takes between 90 and 120 minutes, like an hour and a half to two hours. So i i inflame so quickly at pump sites or injection sites even that I just don't absorb. And for as long as I can remember, I've been told like, well, you just have really bad absorption, like you're just going to have to deal with it. Nobody ever talked to me about the timing of the absorption, like, what a wrench that was throwing into the works. And they also told me, you know, diabetics scar badly. We expect to see that, but you scar worse than any diabetic I've ever seen, just as far as our tissue building up and injection sites, things like that. So it was, it was funny. I was telling a friend I did something the other day where they were like, measuring every part of me. And the lady was like, you know, it's kind of funny. She was like, one of your arms is, like, remarkably bigger around than the other. And I was like, I bet it's my left and she's like, it is. How did you know? And I was like, I am allergic to insulin, and I'm right hand. Well, not even allergic, but I'm right handed. Any injections I did in my arm could only be left. Like I wasn't going to experiment with being a lefty to give myself a shot. I'm

Scott Benner 21:17
trying to figure out if I could do with my right arm into my right my right hand and my right arm.

Sarah 21:21
Anyone who can't see what's happening right now, Scott is trying, I look

Scott Benner 21:25
like a bird trying to fly for the first time. Yeah, yeah. And you don't think you could have injected left handed Well,

Sarah 21:33
I mean, you could. I started doing my own shots when I was five. I wasn't really gonna, like, No,

Scott Benner 21:39
I'm saying there's a way you could do it, but you might just have been trained. To do it the way you were doing at that point. Well,

Sarah 21:45
yeah. And I think it didn't really occur to me that, like it wasn't that big of a deal to me, yeah, so, but I haven't done an arm injection. Can

Scott Benner 21:53
you imagine if everybody had to think about

Sarah 21:55
that? Yeah.

Scott Benner 21:58
So you basically have, like bowlers arm you like, you have just or like a pitcher you have, like, stronger. Even my son played baseball the right side of his body was stronger than left side of his body.

Sarah 22:08
Well, I'm sure, yeah, so it's not even, it's not even strength for me, it's, it's my left arm. I haven't done an arm injection in probably 10 years. It is still one inch more in circumference, like around than my right. Do

Scott Benner 22:24
you think you're just inflamed in general? This episode of The juicebox podcast is sponsored by Eversense, and Eversense is the implantable CGM that lasts six months ever since cgm.com/juicebox, have you ever been running out the door and knocked your C jam off, or had somewhere to be and realized that your adhesive was about to fall off? That won't happen with Eversense ever since won't get sweaty and slide off. It won't bang into a door jam, and it lasts six months, not just a couple days or a week. The Eversense CGM has a silicon based adhesive forge transmitter, which you change every day. So it's not one of those super sticky things that's designed to stay on you forever and ever, even though we know they don't work sometimes, but that's not the point, because it's not that kind of adhesive. You shouldn't see any skin irritations. So if you've had skin irritations with other products, maybe you should try Eversense, unique, implantable and accurate. So if you're tired of dealing with things falling off or being too sticky or not sticky enough, or not staying on for the life of the sensor, you probably want to check out ever since, ever since, cgm.com/juicebox links in the show notes. Links at juicebox podcast.com, I mean, yes, do you have trouble losing weight when you want to

Sarah 23:55
Yes, let me say my thing, and then you say your thing, because I can't wait to hear what you have to say. Okay, good. I started thinking last night, like I've put on a ton of weight in the last eight or nine months, 2000

Scott Benner 24:08
pounds. I'm just kidding. No,

Sarah 24:11
not an actual thumb. I'm carrying like 50 extra pounds right now, and probably 30 of them came in the last eight to 10 months, which lines up with when I started pumping again. And I am starting to wonder if this full body inflammation is my body's response to the basal insulin, like that constant supply. So I'm starting to think as much as I like love and really feel like I depend on being able to manipulate basal. Now that I understand how to do that, I might try a traceba, just to see how that works. If like any of this will move the other reason I. Feel like I have a lot of trouble losing weight and come up now or later, but it's, it's related to my Addison's. So okay, and not the steroids or not directly, the steroids

Scott Benner 25:10
and not the doctor from Grey's Anatomy, either. No Addison Montgomery, never mind. I only,

Sarah 25:16
I only think of her as Addy. So

Scott Benner 25:21
tell me about the Addison's now, Addison's,

Sarah 25:24
I think, well, maybe the easiest way to get into Addison's, well, Addison's was diagnosed finally in 2011 I've been severely symptomatic for two to three years leading into that which was extra frustrating because I'd been in a study for like, a decade, like they knew I would get Addison's. It was a when and not an if, or a most likely when. And they were, you know, every time I went to clinic, they would draw an extra vial to send upstairs to the doctor who was doing this study to test for Addison's related things. So they missed that coming on somehow, really, really awful for two and a half to three years in looking back at it now,

Scott Benner 26:18
oh, go ahead. Val context, really awful. What? What was awful?

Sarah 26:21
So exhausted, like fatigue, does not begin to describe I call it soul level exhausted, like would sleep for 16 hours a day, sleep as late as I possibly could in the morning before, like peeling myself out of bed to get to work, but then leaving myself enough time on the way to work to pull over in this park that was about five minutes away from my office, and it's only a 12 minute commute, so it should not have been this difficult, but to pull over in this little park and to vomit three to five mornings a Week every day for two plus years, and like, so dizzy that I didn't know what to do with myself, and then I would come home from work and fall asleep and peel myself up off my futon like at least once to let my dog outside, and then, like, fall back into bed and repeat the whole thing the next Day. For me, those were the most noticeable symptoms. Now, knowing what all Addison's and low cortisol symptoms are like, I suspect that a lot of the freakishly low blood sugar events that I had during those times were much more cortisol related than insulin or diabetes related.

Scott Benner 27:40
Yeah, tell me what you what do you notice between cortisol and blood sugar?

Unknown Speaker 27:44
So

Sarah 27:45
cortisol first. Anyone who's listening to this like, please listen to episode 649, cuatro immune with Christina. It like, literally saved my life when I found it. Christina does a spectacular job explaining the relationship between cortisol and blood sugar, but really, cortisol and insulin are the body's system for managing blood sugar. It's not cortisol or it's not insulin and glucose. Cortisol helps our bodies know when to release glucose. It triggers the liver to release glucagon, to release stored glucose. It also helps to metabolize carbs or anything else to achieve blood sugar, to be able to get into your systems when there's too much insulin on board, either as a non diabetic human, or as someone who's taken too much insulin, or not eaten enough, or whatever set of variables may line up. I have gotten my diabetes now in the last year to the point where insulin is incredibly predictable. Yay. For the first time in my life, insulin and diabetes are predictable. So I now know that if my blood sugar is low, it is a cortisol low. Took me a little bit to realize that, but I didn't know until a year ago that the reason sometimes I would drink what felt like a whole liter of juice and my blood sugar wouldn't get above 50 is because my body didn't have the green light to be able to process it. So

Scott Benner 29:28
it's crazy bomb. Why would you be vomiting in the morning? Do you like, functionally understand that that's

Sarah 29:34
an that's an adrenal crisis. Okay, so and I basically, I've started calling it a muted crisis. Basically, my thyroid was so absentee during this time that it like slowed down everything enough that I didn't wind up in the hospital or dead. That's how most, most people are diagnosed, kind of like Christina was or in the hospital. Yeah. With Addison's, like, it's very rare for people to catch it without some kind of catastrophic event, which is so

Scott Benner 30:07
frustrating. Yeah, and to button this up for context, once you find out you have Addison's, how does it, how is it managed?

Sarah 30:15
So I take steroids daily to replace the cortisol. It is not the nightmare that most diabetics think of when they think of steroids, because when you're at the proper replacement dose, it just keeps your blood sugar level. It doesn't shoot you sky high. So the reason that that diabetics get high blood sugars when they take steroids is because the steroids are called glucocorticoids, like the people forget about the glucose part of that. Its purpose is to create blood sugar and to create insulin resistance, because in fight or flight days, it would not help you to have a bunch of insulin being super sensitive in your body and to not have enough blood sugar or actual energy to run from a bear or a saber tooth tiger or whatever thing was happening. So the reason that either, if I'm over replaced, my blood sugars will get high, regular diabetics without adrenal issues will have that is because that's their whole job is to create blood sugar and insulin resistance. I

Scott Benner 31:24
would run from a raccoon with the same ferocity as a bear. I just want everybody to know that you don't have to go to saber tooth tiger to get me upset and get me running the other direction. I'd be like, That thing,

Sarah 31:33
trash pandas. The trash pandas strike fear into your heart. I

Scott Benner 31:36
gotta go like, for sure. Oh my god. So Sarah, Have I ever told the story of the raccoon that jumped on Arden's car? You

Sarah 31:44
have not or not in, not in any episodes that I've heard, at least, just

Scott Benner 31:48
coming down the road we live on, and it gets a little windy at one point, a big curve, a lot of trees, you kind of have to slow down, you know? You can't go through it too quickly. So she was driving my wife's car, and she's coming through there. There was a raccoon on a trash can. And she looked over and she's like, Oh my God, there's a raccoon. And as she thought that the raccoon jumped onto the moving cars hood. That's all. That's the whole story. I just love it.

Sarah 32:14
Omnipodsi Raccoon would maybe, like, maybe there's a greater were you like, would you have run from a raccoon before this,

Scott Benner 32:21
I don't know, but you might have just named the episode kamikaze raccoon. Yes, good job. Because before I was like, metacryl allergy, that's boring,

Sarah 32:32
super boring. I'm way more fun than that. Like, please,

Scott Benner 32:39
fantastic. What do you do for a living?

Sarah 32:41
My main job is I am a tax attorney. Which I make sound or I make way more fun than it sounds. I for a long well, maybe this will tie back into the Addison's a little bit, at least. So Addison's is, you don't make cortisol your body physically cannot handle stress, physical, emotional, mental, any of the things my job at the time I was in onset and diagnosed, was negotiating against the IRS or the state or city taxing people or businesses or people that fall behind with their taxes, not like Surgery, where a bad day means that somebody dies. But a bad day could mean somebody's bank account gets cleaned out and they can't pay their employees or keep the lights on, or any of the things and love like love, love, love, the work I still do things in that vein, just not as much anymore. But the worst part of it was the industry of tax resolution is completely based on make these people that owe the scariest people on the planet, aside from the mob, make them pay our company for you to work for them, and if they won't, you threaten them with withdrawing your power of attorney and, like, leaving them hanging in the wind and given monthly quotas to like, like, twist the arms of these people who I then get to know on the phone every day, see their financial statements, but management's just like, just hit Your number

Scott Benner 34:18
so you're the heavy in this scenario, pushing people? No,

Sarah 34:23
no, no, I was not in management. I'm the one being told, like, get them to pay you,

Scott Benner 34:29
but how do you get them to pay you? It's collections. No, no,

Sarah 34:32
it's not collections. Because I'm not the IRS, okay? I'm effectively the private defense attorney to the IRS being the prosecutor. Okay,

Scott Benner 34:42
hey, you said the scariest people are the mob. Who the next scariest people? Well,

Sarah 34:47
I mean, I think a lot of people are pretty scared of the IRS, or, like, the state tax people or whatnot. Yeah, wow.

Scott Benner 34:54
So, so anyway, you've got this job with, like, a lot of right? Like, a lot

Sarah 34:58
of stress well, and I literally. Would go in every day and not know if I would still have a job at lunch or at the end of the day, like they fired people willy nilly for not making quotas, or just because it was a day that ended in why? Like, yes, gotcha, but especially for not making quotas. And my personality was, I'm going to do the like, I'm not going to be a jukebox for these people. Like, if the money runs out, I'm not just going to stop helping them. Like I I am a helper. Like, lots of write ups and screaming sessions and screaming voicemails left on my work phone from owners about, like, Get your together, or get out, or, you know, Quit letting these people free ride. And

Scott Benner 35:45
does the Addison's make that job more or less difficult?

Sarah 35:48
Put me in the ICU four times after

Scott Benner 35:52
I was diagnosed. What's the process that that happened when

Sarah 35:56
your body can't handle that much stress? Basically, your organs start to shut down. For me, I know when I'm going into adrenal crisis, when the vomiting isn't just once, like I was vomiting just once on the way to work, maybe twice, like in a row, if I start vomiting now I know that it doesn't stop until I'm in the hospital with IV steroids and IV Zofran. So I mean, basically your your organs start shutting down. There's also, like some really intense electrolyte imbalances involved with Addison's, and I seem to have an even more aggressive form of it. So I trend to super high potassium levels when I'm in crisis? Yes,

Scott Benner 36:41
Sarah, does anyone in your family have these issues?

Sarah 36:45
Here we are where I thought we'd be at the beginning of the podcast.

Scott Benner 36:49
Now John Travolta is alive again. He's on the toilet, that's all

Sarah 36:53
so I am the Medical carbon copy of my dad. He was type one diagnosed when he was 13, he diagnosed me, well, I guess, unofficially, but and then Addison's when he was 18, hypothyroid at some point in there, he is why I was in that study to see when Addison's what happened, because they knew I had the antibodies, and they knew that I was his carbon copy, basically, yeah,

Scott Benner 37:21
wow. I hate that for everybody, because it feels like, once you know, once you see it somewhere, you think it's probably coming, you know, and you just gotta Yes, yes

Sarah 37:33
and no, I think I never really, I think the study didn't start like, they never told me, like, Addison's will, for sure be a thing until I was probably in my must have been when I was in my 20s. Okay, my dad died when I was 18. How old was he? Then? He was about to turn 51 so he was 50. He died of a heart attack, massive. Well, we thought so. Okay, I actually got my mom to send me his autopsy last night, because I've had a theory for a while now that it wasn't actually a traditional heart attack or a heart attack because of severely blocked arteries, like kind of what we think of as the heart attack, but the the autopsy says that there was no definite evidence of an infarction. So the the myocardial infarction is the like, that's what Bailey had on Grey's like, that's, that's the heart attack, right? But instead that it was, gosh, I don't remember all of the words right now, but basically it was an issue with cardiac insufficiency, so his muscles, his heart, wasn't pumping enough blood, right? Are you ready for me to make it like real full circle, right? Now, go ahead. So when I am having an Addisonian issue, not always in crisis, but most of these have been in crisis. My potassium gets super high. Like, I think the normal, like, top edge of normal on most labs is 5.1 or 5.2 I have found out several times when I am above seven, my legs become temporarily paralyzed, like they become so weak that I can, like, flex in your chair right now, if you were going to stand up, I feel how, like you flex your quads. Yeah, you can feel everything flex, and then you stand up, right, right? So I can flex, but I don't, like, I'm physically unable. You don't go,

Scott Benner 39:43
how long does that last for?

Sarah 39:45
It lasts until I get to the ER and they pump me full of insulin. Helps to reduce potassium, because potassium and the blood attaches to blood sugar. So when insulin moves blood sugar. Sugar into the cells. It takes potassium in with it, lets sodium back out of the cells. I don't think anybody really understands how important electrolyte balance is, because it is normal for most people, steroids, one of my steroids, helps to suppress potassium, and I recently found out that also thyroxins can help to suppress potassium. So I don't really know what my levels would be like if I didn't take all three of those peds daily. Oh

Scott Benner 40:30
yeah, yeah. And what's the relationship between your heart and the potassium? Potassium

Sarah 40:35
is what helps your muscles to be able to flex or not flex, I think. And have thought for a little what like within the last year, since I started figuring out all of this potassium stuff, for me, I have been thinking that my dad's death was he had, like, just a flood of potassium in a system, and it was so much that it also paralyzed or severely weakened his heart. Okay, so the first time I went to the hospital for the leg paralysis thing, because it happened at least once before that, when I was in the airport. And thank goodness, I don't know, like, I think I just had figured out, like, oh, when this happens, I just have to chug a bunch of water. It's usually when my blood sugar's really high. Okay, so in the airport, it resolved itself enough that I could get on the plane. The next time it happened, my friends were able I was, like, meeting with a bunch of friends. They were able to, like, slide me into a wheelchair at the building where we were meeting that happened to be there, get me out to a car, get me to the ER, they are, like, freaking out in the ER, I think it's just like, I didn't really know I'm, like, cracking pasta puns. And they are, they are transferring me to the ICU, which I figure, I mean, it's standard, because if you have to get admitted as a diabetic, they put you in the ICU, right? Like, that's, that's just what has always happened for me, I think, because of the insulin drip, right? So they're like, Yeah, we're putting you in the ICU. And I'm like, You guys always do this, like, can you just, like, my legs are better now. Can I just go? And they're like, No, you're going to the ICU. And they told me when I was ready to get out of the ICU and be discharged, buddy, you can't be this close to the mic. Everybody's going to think both of us are heavy breathers. They were like, We have been in the hallway with the crash cart this entire time waiting for your heart to stop, because that's what happens when potassium gets this high. So I learned that night that potassium is the lethal part of lethal injection. Oh, really, because it stops, stops your heart.

Scott Benner 42:48
We're killing people with banana extract.

Sarah 42:50
Is that crazy? Yep, too much or too little, potassium will stop your heart.

Scott Benner 42:55
I'll tell you what. You're a party, calling your mom and asking for your dad's autopsy. Yeah, she must have been like, Hi, honey, what's up? You're like, Oh, no. I

Sarah 43:03
mean, she like, I don't know, March is the anniversary of when he died, so we tend to, like, all think of talk about him a little more, yeah, yeah. So, and it's been 28 years now, so it's a little bit more removed. And leading up to this obviously, like, I've been peppering her with questions about all sorts of things, just because I'm like, oh, like, I mean, when you're three, when you're diagnosed with diabetes, like you don't really remember any of it. Well,

Scott Benner 43:32
I don't, I don't know how much our parents remember either, because I don't know how much I remember at this point. By the way, potassium chloride to potassium salt, which increases the blood and cardiac concentration of potassium to stop the heart be an abnormal heartbeat, and thus cause death by cardiac arrest. That's the the lethal injection definition about that. All right,

Sarah 43:53
so since then, I think I've been to the ER, five or six times with potassium issues. The worst was in 21 it got so bad that my legs were gone, but then also my arms were starting to go, and it was getting really like and then my neck and it was getting really hard to breathe. So I think now being further removed from it, it was probably my diaphragm was starting to go,

Scott Benner 44:25
Yeah, no kidding. That's where the pasta joke comes from, right? Like, you can't, that's what you were saying.

Sarah 44:30
No, that was like, that was way, way before then you meant like your limbs were like, noodles. No, I mean it just like I my, my policy when I'm in the ER, especially, or in the hospital at all, is to just be like, the nice, funny patient that people want to come back and check on if they have, like, a gap in therapy.

Scott Benner 44:53
Remember me. Please, please remember me. Or just like, Hey,

Sarah 44:57
she's funny, or like, she's really nice, and like, Thank. Thanks us when we go in there, rather than yelling us at you know about things, like, I just am and plus, like, I know that they get so much of that otherwise, I'm like, I'm here regardless, I might as well be a good human about it. Like, you're

Scott Benner 45:12
like, you wanted them out in the hallway, thinking, let's save this Val check. Like, if there's two people to save and we only have enough time for one, let's go get her. There's two code blues, like, let's be here. That girl was funny. Let's go this way. Okay, yeah. I don't know if that works or

Sarah 45:28
not, but it might. I'm gonna be like, No, they were mostly just like, you are, like, we're literally waiting for your heart to stop and to restart it, and you're in here, like, making jokes, like nothing is happening. Yeah? Wow, yeah. So my potassium when, like, everything was going was at 9.2 and in talking to any medical professional, it's usually kind of entertaining to see their faces when that happens. Because, I mean, eyebrows gone, yeah? Because they're all like I have never spoken to anyone who has been at that level and is still alive. So I I don't know why I keep surviving this outside of in the last year, I've gotten really involved in type one communities, Addison's communities, and then there's a condition called either it's basically potassium related periodic paralysis. Most of like the primary version of that, is all genetic. It's a genetic condition. So I know that I don't have that. I have some version of secondary periodic paralysis, but being able to make connections between all of those, like the people in the too high potassium paralysis group, are told, like, eat a high carb diet, and it's I was able to connect the dots for them. This is why, when your blood sugar goes up, your body releases insulin, and that moves the carbs, blood sugar and the potassium back out of your blood, and they're like, Oh my gosh. Like, see, nobody ever understood why this was a thing. We just did it because it works. I

Scott Benner 47:11
was getting ready to say, I wonder if a GLP wouldn't help you with weight, and then have you using less insulin too, and then you wouldn't have so much with the allergic reaction with the insulin. But every

Sarah 47:23
time I hear your zebound or we go via weight loss diaries, I'm so tempted. I think the issues are twofold for me, the biggest being because, as I understand it, part of the job is to change or to slow down metabolism in the stomach, right? It slows digestion. So I think that that will mess with my steroids, because they're pills. I mean, it is possible to pump cortisol, I just am not ready to wear two pumps.

Scott Benner 47:55
So it's a little pill, right?

Sarah 47:59
I mean, it's a little pill, but it's my day supply of this life giving substance.

Scott Benner 48:04
So is it down there being digested very slowly?

Sarah 48:08
I mean, not currently, you know. I mean,

Scott Benner 48:10
like, does it go and it's just absorbed and then you have it for the day? I think I would check on that, because I listen, let's be clear about two things. I'm a fcking idiot, and I don't know what I'm talking about. Okay, I don't think that a GLP would slow down the absorption of your steroid pill, but if I'm wrong, I'm wrong, but I would ask,

Sarah 48:27
I know that people with like I know that Christina from that episode 649, she also has Addison's a type one. She also has gastroparesis, which I know is an aggressive like, it would be an aggressive side effect of a GLP, if she has had to start pumping cortisol because she, like, was not absorbing her her oral meds anymore. Yeah, so I just don't know. The other reason I'm concerned about it is because Addison's causes low appetite. Like, I just, I don't really have an appetite right now. I also was recently diagnosed with ADHD, which the diagnosis was a blessing, because, like, every system in my body that might have an effect on emotional regulation kind of exploded at the end of last year, beginning of this year, leading to, like, a bunch of mental health health crises and like all sorts of things, like, almost check myself into a facility one weekend. So, like, the diagnosis is so helpful, because I know what's happening, but right now I need to be on meds, and it is a massive appetite suppressant, so I'm, like, having to force myself to eat anyway, yeah, most of the time, yes. So

Scott Benner 49:42
GLP agonists may slow down the absorption of certain orally administered medications. So you got to figure out if that's one of them that's going to be touched by it. But the hunger thing is different, because I had like a project around the house this weekend. Yesterday was Easter, so I had. Yeah, I'm gonna tell you everything I ate yesterday because I was really busy. I had four Marshmallow Peeps. I had them in the microwave. No, I like them stale, so the person who left them out for me opened the plastic the night before. So then you're

Sarah 50:13
gonna go HAM at the stores on the 50% off sales today. I

Scott Benner 50:16
love you. Just open the package and let the air get to it for 24 hours before you eat them. I had four Swedish fish before I said to my wife, I don't think Swedish Fish are a thing I can eat anymore on GLP meds, because they make it feels kind of heavy, interesting. I had a glass of water, and then I worked like all day. I just didn't eat. And then at like, six o'clock, my son's like, can I eat something? And I was like, Oh, I see what he's saying. He's saying, will you make me food? So I had a baked potato and a steak, like a, I think it was a New York strip steak for dinner. I couldn't finish the potato. I ate most of the steak, and that's all I ate yesterday. And I don't think I was ever hungry once yesterday. So that is what GLP will like, yeah, do now

Sarah 51:08
well, and I already have that two fold between the Addison's and the Yeah, I

Scott Benner 51:14
don't know what was happening. I mean, maybe it couldn't get worse, you know what? I mean, I'm not sure. Yeah, it's tough, because the the

Sarah 51:21
other interesting thing with Addison's is, annoyingly, that loss of appetite is a sign of low cortisol, and it is also fasting is a cortisol drain, like your body, like should be pumping out more blood sugar to give you literal energy To live when you haven't eaten in a long time. This is why we see Dawn phenomenon, because it's to break the fast, right? So,

Scott Benner 51:49
so maybe this would be counterintuitive to you. It's possible, it's possible, it wouldn't work at all. I

Sarah 51:56
don't know. I like, mull it over all the time, but especially every time you air a new episode, because I'm like, Oh, I'm so tempted every time I hear all

Scott Benner 52:04
I can tell you is, I was active this weekend and busy, so I ate less. I am two pounds lighter this morning than I was on Friday. Like, I mean, and I feel better and better every day, like, but it's just I'm not dealing with, obviously, all the other things that you're doing. Yeah,

Sarah 52:21
that's crazy. No, it's always interesting to think about.

Scott Benner 52:25
Let's talk about your diabetes here at the end. Okay, in your note, you said that you've, in the past, had upwards of a 14, A, 1c, how long ago was that? That was

Sarah 52:38
at some point in the 90s, I think it was like nine or 10 years after I was diagnosed. Okay, so, I mean, it wasn't like I was because I wasn't diagnosed in DKA, like my dad had noticed over a few days, like, I started wetting the bed again, which had not been a thing for a while. Super thirsty, super hungry, really extra, like, cranky all the time. And so they started like, lining up Little Dixie cups of urine and using the test strips, because that was the thing in 1981 like there was no at home blood meters for regular people, at least. And so that was what like he, I think he was taking me to preschool one day, and, like, I was extra feisty about something, and probably either, like, really wanting more water or something. And he like, turned the car around and was like, let's start, like, testing. Like, I think this is diabetes, yeah. So they figured that out. So I wasn't in DKA when I was diagnosed.

Scott Benner 53:44
How was his management? Do you think it

Sarah 53:46
was as good as it could have been at the time with the tools that that he had available? So he was diagnosed when he was 13, so that would have been sometime in 58 Wow. I mean, he was on either bovine or pork insulin up until, like, the same time that that he and I both

Scott Benner 54:06
switched. Did he have any of the allergic stuff with it, too? Not

Sarah 54:10
that I know of, okay, but I mean, my allergy, like, it's not aggressive enough that anybody would have ever, like, I didn't even know it would could be a thing. Like, it's, it's, it's not, it's not like immediate open sores at injection sites like the girl from Canada or things like that.

Scott Benner 54:27
So there would have been maybe no way for them to put that together back then when, yeah, if you had that problem. Okay, so through your life, let's break it up into sections. Do you know what your a one C's were like from three to 15 years old.

Sarah 54:40
I mean, I think I was just looking back as far as I could find records of and I think, like, more often than not, it was between like nine and 13 most of the time, some some eights. When I was in college, what do you attribute that to? Well, probably high school and college, I played volleyball, okay, all through like, from when I was 12, played year round, like club school, whatever I could do, from when I was 12 all the way through college. I see played for my college team. Don't remember testing my blood sugar, really ever during college, like, did a lot of treatment based on how I was feeling, which we all know is basically never accurate.

Scott Benner 55:30
If you're always 250 for example, and you or higher, and you throw in some exercise, you're not probably still getting low all that often. No, yeah,

Sarah 55:40
no, I don't think, but I I would feel like I was getting low, because at a normal, like, dropping so much so then I would still, like, chug up. Like, I would like, stop and practice occasionally, and like, chug a thing of juice, and then, like, get back in. But I was probably like, just to get me from 150 back to 250 where my body felt okay, yeah, that's what I

Scott Benner 56:00
was gonna say. Your body's so used to that higher blood sugar. You're probably you're probably treating a low feeling to get yourself from being at a number that I mean, at this point, you wouldn't be okay being at absolutely

Sarah 56:10
terrified of lows, because I had seen my dad have so many seizures through my childhood, and I'd had a few myself, like that, alternative was not an option. Yeah, I think also that probably a good chunk of my dad's seizures and lows were Addison's based, rather than diabetes. Okay, okay, but nobody, I mean, even, like, I learned about this cortisol blood sugar connection from the podcast and from Addison's groups on Facebook in 42 years at that point of being type one or 12 years of having Addison's no doctor has ever mentioned it to me.

Scott Benner 56:56
Wow. So you have genuine information that's helped you about Addison's and insulin allergies from the podcast. Yes, oh, well, I didn't realize that I

Sarah 57:09
will unabashedly credit the the podcast and the group and the like inspiration to join other communities on Facebook. I will unabashedly attribute that to saving my life? Oh, well. And I, like before, until last year, was just pretty sure that, because I'm the Medical carbon copy of my dad, right, that that my fate was also to die of a heart attack around age 50.

Scott Benner 57:37
Yeah, it's the only thing I haven't asked you yet that's on my list here, of as Yeah, you think, you think you're in at the end,

Sarah 57:43
you tell me your schedule is much more. No,

Scott Benner 57:47
not the end of the podcast, the end of your life. Not

Sarah 57:50
anymore so. But until, until, until last year, I was really, like, just kind of resigned to this is, I mean, it was, like, a very aggressive version of, well, that's just diabetes, right? Like nobody ever said, like my doctors would say, like, Okay, well, let's aim to get you into the single digits next time. But no concrete ideas about how to do that. Do

Scott Benner 58:17
you imagine if you went to a money manager and they were like, Hey, let's focus on making you a millionaire. Next time I see you, get out of here. Now, you silly kid? Yeah, going. How would I do that? Sir, anybody? No,

Sarah 58:31
like, a suggestion, at least, like, point me in a direction. You want to whisper a stock name right here, doing, like, the, the weird thing where you blindfold me and have me spin around a bat and then try to get, like, I

Scott Benner 58:42
just, I find that the most fascinating thing, like, Let's get your a 1c down. How are we gonna do that? No mention of that wall. Yeah, yeah. Well, what a great idea. I also should be taller, works,

Sarah 58:52
works, works for me. Like any, any ideas, like anything, it's fascinating. It's, well, I'm just, you know, constantly having the idea that it was all something wrong with me versus so it's really hopeful. Now I still am in touch with one of the nurse educators who's also type one at my old clinic, and I texted her in October when I got my first ever six Well, a 6.1 but like, first time in my life I'd been in the sixes nice for a one C's yay podcast. And told her about figuring out the allergy and that I was doing pump basal and then bolusing only with a Fresa because it does not have any additives. Nice so. And she was like, Oh my gosh, this is like, Can I share this with your Endo? And I was like, please. And she's like, we have a patient that we're pretty sure has a really, like, a pretty bad insulin allergy. And I like, want to see if this might be an option. And please, let this help somebody else. How

Scott Benner 59:55
come you don't do that? Are you just strictly a fresn and. Is an a basal. At this point

Sarah 1:00:01
I only bolus with a Fresa. So when I the podcast episode 530 is about tunneling and leaking. And so I was like, oh, like, maybe this is part of why. Like, maybe the tunneling is why my sights go bad so quickly. Then I started experimenting with, like, how big, I think, in the in the episode, it says, like, sometimes it can be, like, in the neighborhood of five units bolus, where people start to see problems with, like, putting in that much insulin at once, right? So I was like, okay, like, I'm gonna see what happens. And, you know, tried at five, tried at four, and it would still like, within five to 10 minutes, like the site would be pretty much done. So then the next time, so I got down to figuring out that my body can deal with a bolus of point eight units at a time, even if I go up to one unit, I can literally feel it itching underneath my skin. It's not like a skin, like I feel it underneath my skin. It's itching. And then not long after the site is gone.

Scott Benner 1:01:15
Did you ever try fiasper loomjev? I use loom

Sarah 1:01:19
JEV in my pump right now, okay, it takes, it's about a 45 minute delay, like, it takes me about 45 minutes to see the effects of a temp basal increase or a decrease, like, if it cuts it off or low. So I right now, I got really lucky, because I got my new basal IQ pump on the last day when basal IQ was an option from tandem. I did not know that at the time, but I knew that I needed to get back on basal IQ because control IQ, my delay with insulin is too much. Where even in like sleep mode, where it increases the basal to deal with highs, I would see that affect, like 45 minutes later, but I'd already bolus with the fressa, so then it would bottom me out and cutting off the insulin still only, like saves me with a cortisol low, because where I keep staying low, because it takes about 45 minutes for The absence of insulin to start showing our eyes. It's fascinating

Scott Benner 1:02:23
that you have multiple things trying to kill you, and those things are also fighting with each other. That's yeah,

Sarah 1:02:30
yeah. Well, and, and they're the things that keep me alive, right at the same time.

Scott Benner 1:02:36
Jesus, Are you tired from all this? I mean, mentally, yes, but I

Sarah 1:02:43
don't have an alternative. So

Scott Benner 1:02:45
just what it is, are you married? Do you have kids? Do you have any of that stuff going on?

Sarah 1:02:49
Not married? I would have loved to be a mom. I was told through my 20s and 30s, especially after the Addison's diagnosis, that getting pregnant would basically be a death sentence for me and or baby. I have, since in the last year, met multiple people online with both who have had numerous successful pregnancies. I think, really, my doctors didn't, they just didn't know what to do with me. Yeah, so it was easier, easier to say like, to scare me, to ever think about having a baby instead of being like, Okay, well, let's figure this out. You think

Scott Benner 1:03:27
having been told that about children stopped or changed the way you dated?

Sarah 1:03:31
No, although I like, am grateful that I don't have children with any of my exes from those points in my life, like it would be terrible to be tied to most of them for a period of years. It recently, it led to a breakup within the last couple of months because the guy I was dating, I think now, even if I did get pregnant, I don't know that I physically have the energy and steroid reserve, basically, to be able to to, like, raise an infant, much less a whole child. And although I don't feel like the end is within the next five years for me, I am still fairly confident that my end will be earlier than a lot of people's, unless we can figure out this potassium thing, because sometimes it happens outside of crisis, and I don't know why that is, I'm incredibly lucky to have made it through all of the times that I should have died. But I'm not really trying to test like, how many more that may be? Yeah,

Scott Benner 1:04:43
no kidding. So here's a question, do you feel like you have a medical team that's helping you get to this answer? Or, Yeah, are you literally just picking through the internet and listening to other people

Sarah 1:04:53
picking through the internet? My current endo is helpful only. And that he will write whatever prescriptions I tell him to write. But that also comes down to I am literally figuring out what my dosages should be on your own, completely like for for things like t4 and t3 meds, and when you have too much thyroid on board, and it burns through your cortisol super fast and puts you straight into crisis. Found that out in November when he medicated me into crisis. So I figure out my doses now, but I like, I should not be the one figuring out these kinds of things. Yeah, like, I feel like I've done an endocrine residency in the last four years, but I have zero certificates to put on the wall. Like nobody else should listen to me. But yeah, I don't really have a team right now. I am probably moving back to Denver, like, by the time this airs, we probably won't live near each other. Why? Well, because I moved out here for the guy,

Unknown Speaker 1:06:00
this boy, I know. No, no.

Sarah 1:06:02
I mean, I did the breakup. Scott, like, Please, please. No. I

Scott Benner 1:06:06
mean, the relationship, I know how they end. I'm just saying that guys cheat or women break up with you. That's how relationships well. And

Sarah 1:06:15
it's just, you know, he, he's a lot younger than me, and wants to have kids, and it's not fair for me to have him choose no kids to be with me, especially when I don't know how I feel about maybe signing a kid up to lose a parent early, like I did, because I know that pain. Do you ever

Scott Benner 1:06:38
think about not wanting a kid to maybe have Addison's or diabetes? Oh,

Sarah 1:06:43
I mean, obviously, yes, okay, I think right now, the the bigger thing for me, I think honestly, like, between, like, how the last year has been, and like, with the way that I know that things are going, and with tools like the podcast, like, let me keep the diabetes, like, I like whatever, and if, if a kid had diabetes, I would deal with it. Okay, Addison's is more of a challenge, but I'm figuring out a lot of that now. The bigger hesitation is getting through this thing in my head of like, not wanting to sign a kid up to lose a parent at a young age. Yeah.

Scott Benner 1:07:19
Well, let's finish a little bit with, um, with that, because you're, I mean, you're 46 and your dad passed when he was 50, but that's a number of years ago now, right, yeah, but it's still very effective, impactful to you. I can tell when you're talking about it, like, yeah, yeah. So you're still upset that that, that he's gone well, I mean, yeah, yeah. I mean, I don't know, like, I'm adopted, and my dad didn't live with me for a while, and he's been dead for a while, and I'm not that upset about it. So I think,

Sarah 1:07:49
like, in addition to being the medical, like, I'm very similar to my dad and personality, and like, he was, like, he was a lawyer, like, like, to help people didn't always accept, like, tangible money and as payment from them, like he found a way to make it work for like, a lot of those things carried through, right? And I was like, Absolutely, a daddy's girl, until I wasn't. So

Scott Benner 1:08:15
I see no. I mean, so how about your mom? Did she remarry? She

Sarah 1:08:18
has and it's sorry mom, like, I know she will listen to this. It's sometimes it's really sad, because even her current husband acknowledges, like, I will never be like Ken, like they all kind of know that he's, he's the the runner up.

Scott Benner 1:08:38
Your dad was a good guy, great guy, yeah? And that's not just you,

Sarah 1:08:42
like, no, like, universally acknowledged as a great guy, yeah.

Scott Benner 1:08:47
Well, I'm sorry that sucks. If he was a dick, you wouldn't even miss him. That'd be maybe, maybe, did you disservice by being such a good person? No,

Sarah 1:08:54
no, he was, yeah, probably not, probably not. But, you know, it's perspective is everything. So maybe I'll think about, like, oh, like, if only he hadn't been such a good guy. Damn it. Is

Scott Benner 1:09:05
there anything we haven't talked about that we should have? Because I have one more thing for you, but I want to make sure we get to all your stuff.

Sarah 1:09:11
I think the biggest thing for me is, man, there's so many things. No, I think for me, the biggest thing maybe stems off of of what I just said about perspective is everything. So if nothing else, if you are listening to this, there's a few podcast episodes that I feel like our perspective must listens for everyone. Go ahead and those are, I think Christina's so number 649, cuadmune, Mike, number 531, like at some point Scott to like that episode has had such a deep impact on I think everyone who's heard it, huh? Yeah,

Scott Benner 1:09:48
I just re, I just recorded again with Mike last week.

Sarah 1:09:51
Oh, I can't wait to hear that. He's really an incredible human I'm so grateful for him his episode, I think kind of really. Like, like, that was the one that made me be like, Okay, I'm going to figure this out. So, oh, gosh, I had a list of them, both of Nicole's episodes. Hold on. Oh, it's like 251

Scott Benner 1:10:10
maybe I'll help you, because two

Sarah 1:10:12
or 151 and 261

Scott Benner 1:10:15
Hold on, one second, 151 is complications are complicated. Yep, Nicole has multiple serious complications with and what was the other one? One?

Sarah 1:10:25
And then I think she's 262, 61 maybe is when she came back on pre owned pancreas. Yes, yeah, yes. And then Sheila, the space musician, I'll

Scott Benner 1:10:38
piss were you that she wasn't really a space musician. That's 940

Sarah 1:10:44
it, um, I think I was pissed about that. Sometimes, also your episode titles really catch me off guard, because there was a recent one DJ eight years. Yeah, and I've probably like my cadence in saying that is not how people would expect it to be. But because the podcast that I listen to, as often as new content comes out, are yours, and then I listen to a tax podcast from a like a woman who is very similar to me. So basically now I I teach mostly DJs and creatives and people in that space about how to do their taxes and to not be so scared of their taxes. Oh, that's funny. So I've been super involved in the DJ and music community for like, 25 years, and then the other podcast that I listen to regularly is about DJs. And so I 1,000% was like, Wait, does that say juicebox or DJ? Eight years I thought it was his, like, his stage name. And I

Scott Benner 1:11:48
Well, that's how I did it. So, yeah, I mean, that's why I made the title like that, because, yeah,

Sarah 1:11:53
I was like, this is a such a collision of universes. For me. It's

Scott Benner 1:11:57
so funny. It didn't end up that way, yeah. Now, by the way, your microphone changes colors. That's the thing you should mention to people, because I thought I was having a stroke for a while.

Sarah 1:12:06
No, no, it's, it's pretty entertaining.

Scott Benner 1:12:10
You said you do streaming.

Sarah 1:12:12
I do so I teach, I stream on Twitch, and I teach, I teach people about tax stuff, like I talk about tax and business stuff. Yeah,

Scott Benner 1:12:22
that's so cool. I think about going on Twitch once in a while, but then I, like, seems like a big commitment of my time.

Sarah 1:12:28
I had no idea what Twitch was pre pandemic. It Like It saved me during pandemic, because all the DJs in the world pretty much started streaming there when Instagram Live and Facebook Live would shut you down immediately. If you weren't like Jazzy Jeff or someone famous, they would stop you midstream. But Twitch will let you stream as long as you want to stream. They just mute it afterwards, so they're not breaking copyright laws. But so I connected with people all over the world in those Twitch streams just by like, getting to, like, be in music again, and like, it feel like you're going out and whatever, like, that's how I met the guy that brought me here. So, yeah, what's

Scott Benner 1:13:14
your handle on Twitch?

Sarah 1:13:16
It's Miss Vel, M, I

Scott Benner 1:13:18
s, s, all one word,

Sarah 1:13:21
yeah, I was cracking up when I was getting ready. Because I think when you were live on Insta the other day, somebody was talking about like, you're gonna do, like, when pretty girls go online and just work. And I do not put myself in the pretty girl category, but I haven't streamed in a while, and I need to, so I'm just probably going to do a like a co working stream today, where I will just be repping taxes, talking out loud

Scott Benner 1:13:46
what you're doing with your taxes. Well,

Sarah 1:13:47
not even, not even talking out loud, like I'll just be working. But then if people want to pop in the chat and ask questions, or, like, just chat, then we will.

Scott Benner 1:13:56
It's so funny because the the aspect of how Twitch works. I was on that a couple of years ago, and I thought this is really perfect for talking about diabetes, but so many of my people are in Facebook. I don't know how to get them anywhere else. It's hard to get anybody else to it

Sarah 1:14:11
was, it was a thing. I think a lot of us that fell in love and found so much community during pandemic were really frustrated by is like, trying to get our like, non Twitch friends to come, like, check it out, yeah, and so meant, like, probably 98% of them never would, and it's just like, well, then we're finding our new people now. So I mean, if you, if you used twitch or like CO, like, co strained then, or even like played a YouTube recording on a channel and just sat in the chat to answer questions or whatever. Like, you would find new community, but probably the Facebook community would not come with it for the most part. Like, also be there,

Scott Benner 1:14:55
yeah, no, I'm absolutely I know it's one of the things I keep in the back of my. It though, okay, I'm gonna go because I think we've done a good job here, but I want to just ask for a favor first. I just realized, while you and I are talking, because I don't do video all that often, that I've lost enough weight now that I think I can readjust my camera. So I'm gonna have you help me with that, right? Okay, so this is me looking to the bottom of my monitor, but this is me looking to the top of the monitor. Which 1am I more handsome in? Bottom, bottom, bottom, okay, because

Sarah 1:15:26
bottom is close. It's more eye contact adjacent. Okay, like it looks more like you might like, like you're looking at someone in that range. But it's at the same level as like, oh, you might look over to your right and see like where my camera is. Now,

Scott Benner 1:15:43
let's see this. I did not, I did not used to be able to handle straight on because my head was too wide, but now I think I can hold on a second. This is very exciting for me.

Sarah 1:15:51
This is like the eye doctor, like camera what? Or like camera one, Camera two. Like

Scott Benner 1:15:56
in my house, when I say things I used to say. So when I first started losing weight, I bought some shoes, and my daughter was like, you had like, one pair of shoes forever. And I was like, skinny. Scott likes shoes. I

Sarah 1:16:08
was mostly thinking like, new shoes is a strange like first purchase when you've dropped a bunch of weight, like, did your feet change

Scott Benner 1:16:15
significantly? Not about my weight, just about my willingness to let people look at me. I guess so. Then I went to more clothing, and I made a proclamation to Kelly. I'm like, I'm gonna wear nicer. Even when I'm wearing a t shirt, it's gonna be a little nicer. I'm gonna spend a little extra money on T shirts so I don't look like slovenly and and she's like, okay, then I changed, upgraded some other stuff, and then one day, Arden's what's going on. I'm like, skinny Scott loves fashion. Now I think skinny Scott might enjoy a head on camera angle. All of a sudden it works. It's better this way. I used to have to be like this. I don't know why. As well, I was more comfortable with myself, but now I'm okay like this, and you helped me realize that today by haranguing it with turning on your camera, just

Sarah 1:16:56
it feels I mean, I didn't expect you to keep it on. I just figured one way, like we're doing our pre interview things. No, once

Scott Benner 1:17:02
I liked how I looked, I didn't think to turn it off again.

Sarah 1:17:06
I just like, it feels a little strange to talk to someone about all of this stuff without at some point being able to, like, have eye contact. Yeah,

Scott Benner 1:17:15
I hear that. I don't feel it at all like I can. I know I'm so radio oriented with how I like things I listen to. I actually have a I have this thing in front of me that Kelly got me on. I'll show it to you. It's just this little cutout she bought. I like it. It says, Be bold, and it's sitting on top of some of my, um, my equipment that you guys won't see because it's behind the camera, and usually without the camera. I sit here like this and basically stare at one of the letters in that while I'm talking and making the podcast, it

Sarah 1:17:45
was my secret trick to make sure that you were mostly awake while we talked.

Scott Benner 1:17:50
Do you think I fall asleep? Have you ever thought? No, I'm just giving you a hard time. Oh, but one time,

Sarah 1:17:56
it's part of the reason why I was like, I'm just gonna let this dog, like, sleep on my lap, because I know I've heard you say, like, usually I'm like, feet on the desk, like, leaned way back, like, just relaxing while we have these conversations. One

Scott Benner 1:18:07
time it happened, one time I was back like this, like, way back, like this. And I thought, you got to sit up, man, or you're gonna fall asleep. And it was, it had nothing to do with the conversation. The conversation was, like, absolutely terrific. Just

Sarah 1:18:20
the comfort, yeah, I

Scott Benner 1:18:21
just thought it's like, that's too I sat way up, and I was like, God damn, don't do that again. Plus, you have to close the doors, so I lose my ventilation during it, like, so it gets a little stuffy while I'm talking, okay, so I can, like, like, this is me head on. I'm okay, yeah.

Sarah 1:18:35
So the one you're great.

Scott Benner 1:18:37
I hate that. When you're head on, you can't look away from the camera to see yourself, because then you don't actually see what you look like when you're head on. Does that all make sense? Or is that just like a fat person? No,

Sarah 1:18:46
it does. I know I usually have to like, in zoom settings, a like, I think everybody knows that. Like, occasionally you're going to see eyes move to like, Look at the camera or look at the the monitor. I also will usually try to, like, move the little thing where it shows the faces to somewhere, like at my eye level, and then, like, most of the time, like, when it's just the two of us, it's easy, obviously. And I know that my camera's, like, just up a little bit. You could also always get a little tripod for your camera.

Scott Benner 1:19:20
My camera, it's on an arm. It moves all over the place, yeah, okay, so do i So, I mean,

Sarah 1:19:25
you could always put the camera, like, right in front of our faces, like, what? Like, that's what I'm doing to the monitor, than where, then where my mic is, yeah, that's

Scott Benner 1:19:34
what I'm actually doing right now, because I'm because I have a listen, I have a pretty large monitor too. So, like, I'm trying to think about, like, Where do I sit, so that I'm looking at you. I don't want to stare at the camera. I want to I want to feel like I'm looking at you, but where it doesn't feel like I'm looking away from you. So like, then

Sarah 1:19:50
I would put the camera in front of the guests. It is the guest screen right now.

Scott Benner 1:19:56
The camera's here, and your face is right next to it. Okay? So. I look like I'm talking to you right now. Yeah, yeah. I think we figured it out. Okay, let's do lighting too, not too, too bright, right? Yeah, too, too damn or good.

Sarah 1:20:09
I think it's good. Okay, some people might like, I like, but I don't need

Scott Benner 1:20:14
a lot of I can go warmer and go cooler. Cooler makes me look very Caucasian, yeah,

Sarah 1:20:19
it makes you Yeah, and well, and a little bit ill. Okay, yeah, there's yellow,

Scott Benner 1:20:23
like, right there, maybe, what do you think there? I think that works. This has been very helpful. Thank you. I can't do this with Kelly. I've tried before. I'm like, hell, just jump on, Zoom real quick and tell me what this looks like. And she's like, Get the out of her doing that. She's like, go find one of your people for that. I'm like, You're my people. She goes, not for that. I

Sarah 1:20:45
love how your entire family refers to all of us as your people, people. Yeah, you're whether, whether or not we're gonna help you or or murder you. One like,

Scott Benner 1:20:54
good or bad. It doesn't matter. Hey, those people are gonna kill you. Are responsible for everything you want somebody to say something nice to you. Go talk to your people, and I'm like, okay, so although not here to affirm you husband, I listen. I'm we're gonna end on this. Okay, the thing I spent all weekend doing, I'm a little embarrassed, but I'm not so behind me right now. You can see, see the chameleon in the I also

Sarah 1:21:16
really enjoy that with the new head on the

Scott Benner 1:21:19
chameleon enclosure, what do we call it? I think it's an enclosure. Yeah,

Sarah 1:21:24
okay. Is like, just there, so that, like, it's a little bit of interest, slash, like a more interesting background then. So

Scott Benner 1:21:33
there's going to be another one, another chameleon, or this one's going to slide that way, and then there's going to be a one there that's actually going to be wider, so it's going to be it's that whole wall will almost look like two chameleon cages when I'm done. But I bought that one because I didn't know what I was doing. I've since then made one. This is very embarrassing. I spent my entire weekend building a chameleon enclosure out of quarter inch acrylic, impressive. So I spent a lot of time online, on YouTube, videos and podcasts, listening and learning you're a chameleon connoisseur. Now, I've had this very interesting experience over the last four months where I've come to realize, I know this is going to sound like something. People are like, yeah, no idiot, but the all the ups and downs, the ebbs and flows of the diabetes community that I've built, like, you know, where it works, where it doesn't, where people struggle, how they learn, that's mimicked across the world and everything. If you go into like a chameleon community, they have the same ups and downs and concerns. It's really it's all just people, right? And so it doesn't matter what the topic is. Anyway, I used those resources the way people use me about diabetes, and was able to, fast forward, teach myself how to build an acrylic like it's going to be, I'm so embarrassed by this, but it's going to be four by four. That's awesome, two feet deep, because the chameleon that I got will, if all goes well, possibly grow to be 24 inches long at the end of it. Wow. So anyway, I built this. Is

Sarah 1:23:04
that the reason for the separate enclosure? Or can chameleons be friends? Like, can there be

Scott Benner 1:23:10
no, as a matter of fact, in between the two, I have to make it so they can't see each other. Yeah, yeah. So

Sarah 1:23:16
and, and not do a mirror. Like, isn't that what messed up people do with like, the the beta fish or whatever that like,

Scott Benner 1:23:21
you shouldn't do that either. Yeah, they shouldn't be seeing other millions. Yeah, they'll be together, but they won't be able to see each other, like, and neither here nor there. I got all done with it. It was all weekend, like I was at it from like Friday afternoon when I stopped working on Friday I started, and I didn't get done till like 11 o'clock last night on Sunday, and I got in bed, and my wife goes, Hey, you did a really good job making that thing. And I was like, Oh my God. Like, this is, like, the 50 year old version of sex. I was like, this is lovely. Thank you. I was like, Thank you. You really think so? She's like, Yeah. And I was like, why are you saying something nice to me made me upset. I thought I was maybe like, she's gonna be like, and the doctor called, and you're

Sarah 1:23:59
gonna be like, she's like, like, sandwiching things between, yeah, compliments. Also, I'm

Scott Benner 1:24:05
leaving like, like, you know what I mean? I don't know if she's trying to lift me up before she dropped me a little bit, but no. Good thing, you'll

Sarah 1:24:10
have two chameleons now,

Scott Benner 1:24:11
she just said something positive, and then it stopped. Hey, here. This is lovely. My God. Also, I can't tell you how thrilled I am with my my head on camera view. It's fantastic. I've never once felt comfortable like this in my entire life, and I do now. Well, shouts to skinny Scott, no Sarah, you've, you've, you've, you helped me a lot today. I wouldn't have said this to most people, by the way. I just I'm very comfortable with you because of how you've interacted with me online. Thank you. Thanks. Yeah, all right, this one's definitely called Kamikaze raccoon. That's it. I'll see you later.

Sarah 1:24:46
Hold on one second it's happening.

Scott Benner 1:24:54
I want to thank the Eversense CGM for sponsoring this episode of The juicebox podcast. GUEST and invite you to go to Eversense cgm.com/juicebox, to learn more about this terrific device, you can head over now and just absorb everything that the website has to offer, and that way you'll know if ever sense feels right for you. Ever sense cgm.com/juicebox, OmniPod five sponsored this episode of The juicebox podcast, and to get rid of your FOMO, go to omnipod.com/juice box. That's omnipod.com/juice box. No more FOMO. Huge thanks to cozy Earth for sponsoring this episode of The juicebox podcast. Cozy earth.com use the offer code juicebox at checkout to save 40% off of your entire order. 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, wrongwayrecording.com. You.