#1316 Cold Wind: Med Device Sales

September 26, 2024Scott Benner

Mia has type 1 diabetes and does medical device sales. Her voice has been changed and her identiy concealed.

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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, welcome back to another episode of The juicebox podcast.

My guest today, of course, is anonymous, and her voice has been changed to protect her identity. She is a person who has had type one diabetes for over 30 years. We're going to be calling her Mia today for the conversation, and she works from medical device company in sales, 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 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. 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 if you'd like to help with type one diabetes research, and you have type one diabetes, or you're the caregiver of someone with type one and you're a US resident, all you have to do is go to T 1d exchange.org/juicebox and complete the survey. This should take you about 10 minutes, and your answers will, in fact, help to move type one diabetes research forward. This episode of The juicebox podcast is sponsored by us Med, US med.com/juice box, or call 888-721-1514, us. Med is where my daughter gets her diabetes supplies from, and you could too use the link or number to get your free benefits check and get started today with us. Med, this episode of The juicebox podcast is sponsored by the contour next gen blood glucose meter. Learn more and get started today at contour. Next.com/juicebox Did you know if just one person in your family has type one diabetes, you're up to 15 times more likely to get it too. So screen it like you mean it one blood test. Can spot type one diabetes early, tap now talk to a doctor or visit screened for type one.com for more info. Mia, excellent. Mia, it's nice to meet you, so let's find out a little bit about you, and then we'll figure out why you got on the podcast, and we'll do some chitting and chatting. Why are you here? What made you reach out?

'Mia' 2:43
I think that it is so fascinating to listen to people's stories, their diagnosis stories, and I feel like Mine's kind of different. I mean, maybe it's not, but it seems, for me, it seems different. And I just wanted to share that talk with you know, parents and let them know that their kids are going to be okay. Okay. I think that that's some of the things I listen to and see on the Facebook pages. And, you know, parents obviously are concerned and have every right to be having had diabetes for 30 plus years now, and the way it's evolved, and it's fantastic that we know so much, but I just wanted to be, I don't know, maybe a sound of encouragement for parents to let them know that their kids would

Scott Benner 3:23
be okay. That's very nice. So you've had diabetes for most of your adult life.

'Mia' 3:28
Yes, I was a teenager when I was diagnosed. At that time, 30 plus years ago, we didn't have CGMS or pumps and all that stuff. And yeah, started with NPH and regular had to mix my insulin in syringes. But in fact, I've actually never, ever taken insulin with a pen, because they didn't exist before I got on my first insulin pump, and I've been a pumper ever since, and I've never taken a pump break. So yeah, I've never taken insulin, which is company

Scott Benner 3:59
Martin has never used an insulin pen once. Oh yeah, we got this giant box of insulin needles. And the truth is, is that we use them for, I mean, she was diagnosed at two, so we used them when she was two, when she was three, and then the year she was four, four and a half, she got an OmniPod. And we have, we still can't believe I'm saying this. That was in so 2006 she was diagnosed. We probably stopped using needles in 2008 ish, and we're still going through those needles now.

'Mia' 4:35
Oh yeah, I had boxes of them. And so we move every couple of years with my husband's job, and I finally, literally just got rid of them in this last move. That's so funny.

Scott Benner 4:52
I every time I see them in the drawer, I think, oh my god, I'm gonna die, and these are still gonna be in this drawer.

'Mia' 4:59
You. Yeah. And then just at my last doctor's appointment, I was like, you know, I really need to have a backup supply of, you know, long lasting insulin. And so, of course, you know, he sent me some. And then I got three boxes, three boxes of needles that came with it.

Scott Benner 5:17
Came with it. Uh huh, we don't have any long acting insulin in a vial in this house. And we never have after Arden started pumping, and my wife, once a year, looks at me and says, Don't you think it would be a good idea if we had some basal insulin here, in case something happens to her pump, and I go, there's a pharmacy up the street. I always say the same thing. I'm always like, there's a pharmacy up the street. We have a doctor. It's 2000 whatever it is, we can just send an email or call somebody. I'm like, I don't think it's that important. And she goes, What if it happens in the middle of the night? And I go, well, we'll just inject fast acting until until then. And then she looks very disappointed at me. And then we don't talk about it for about a year. Well,

'Mia' 5:59
I have to say I haven't had it for a really long time either, and it's probably only because of our new kind of living situation that, now that I'm by myself a lot of the time, that I felt like I needed to be more proactive and have that so because I was just like, oh, I'll just use an old pump, you know, if my current pump goes bad, then I'll just Use one of my old models that I still have in a box. I'm like, Oh, I'll be fine. But now that I'm by myself for a lot of the time, I was like, I really need to be a little bit more proactive.

Scott Benner 6:30
I'm going to say one more thing, but then I'll get back to that for you. So we literally just two days ago, had this thing happen where Arden's been riding a phone for a very long time trying to keep it going because she liked the color and, you know, like, and I'm like, Arden, listen, you know, using an algorithm, you know, a do it yourself algorithm, like it lives on your phone, like, we can't have your phone be this just terrible, like, janky thing, like, it needs to be stable. So she finally said, okay, you know, I think you're right. I think we should replace this phone. Okay, so we have two things to do two days ago. We're gonna get our eyebrows threaded, her and I together, and then we were thinking of coming home and hanging out for a little bit. I was gonna do some work, and then we were gonna go out to the Apple store and get her a new phone. And so it's this, you know, it's kind of how we had the day planned out. So we go get threaded. I look fantastic, by the way. And then we came back, and we, like, seriously, pulled up to our home, and she's like, so when are we going to do the phone? I'm like, I don't know, a few hours from now or something. She goes, Oh, that's great, you know, because my pump is going to expire in a couple of hours, and like, match it up. Oh my god, it's fantastic. I swear to you, sitting in the car, she tried to give herself insulin for something, and there was an error in the pump, and it shut off. Oh no. And so we looked at each other, and I said, Oh, I guess we're gonna go get that phone right now. And because, because she was like, oh god, what's gonna happen here? I said, Oh, you're gonna go in the house, put on a pod. We're gonna go to the store, we're gonna come back with the phone, and you're gonna have to swap the pod again. And she's like, I don't want to do that. I don't want to do that. I said, Do you trust me? And she goes, why? And I said, Let's go inside, take off the pod, and I'm gonna, like, her blood sugar was like, 130 It was exactly 130 that's why we were bolusing. I was like, I think if we inject, and I was like, Oh, the mall, like, 20 minutes from here, and it'll probably take us, like, 45 minutes to get the phone and then come home, like two hours. I'm like, Let's inject a unit and a half of insulin, and then just go. And she goes, All right, so we go in the house, and I pull out the insulin into the needle, and I'm like, No, you know what? Let's do two. I'm gonna do three. And she goes, How did you go from a unit and a half to three units? And she says, I didn't see you do any math at all. And I was like, I'm like, Well, I mean, the insulin is not really gonna start working for 20 minutes or so, and it's not going to peak for a while, and you're already 130 and we're going to walk around the mall a little bit. And I was like, let's just do these three units. And she goes, whatever, man, let's go. So we just injected the three units, and we left for them all, and we came home, and I downloaded the app onto her phone and got it all set up and everything. And, you know, the Dexcom, we were able to, like, you know, get going and everything's going. We tested her, and she was 98 oh, and I didn't say anything, because when she was younger, I might have celebrated for a second, but like, now I just was like, okay, like, just let her soak up that I was that you were right, so incredibly right about this, you know, anyway, why don't you live near home anymore?

'Mia' 9:43
With my husband's job, we move often, and when we got to this new place, there were no positions available. I'm a dietician and a diabetes educator. The only dietician jobs that I could find were working at a nursing. Home, okay, and I started to do that. I got a job, and it just wasn't for me. I really love diabetes technology. I love teaching people how to use it, and I had wanted to work for a specific pump company for a while. Told my husband that I was going to try for it, and he was on board, and lo and behold, I got the position

Scott Benner 10:25
from the very beginning. Your kids mean everything to you. That means you do anything for them, especially if they're at risk. So when it comes to type one diabetes screen, it like you mean it, because even if just one person in the family has it, your child is up to 15 times more likely to get it too. Screen it like you mean it, because type one diabetes can develop at any age, and once you get results, you can get prepared for your child's future. So screen it like you mean it. Type one starts long before there are symptoms, but one blood test could help you to spot it early before they need insulin, and could lower the risk of serious complications like diabetic ketoacidosis or DKA. Talk to your doctor about how to screen for type one diabetes, because the more you know, the more you can do. So don't wait, tap now or visit screen for type one.com to learn more. Again, that screen for type one.com screen, it like you mean it.

'Mia' 11:26
And so now I have an apartment in one part of the state, and I'm in the other state, so I have

Scott Benner 11:33
that. Do you think that right now, people listening are going, huh? They won't say her name and her voice has been altered. I wonder what's about to happen, because I have to tell you something. I don't know what you're going to say, and I am absolutely sitting on spokes. Do you know that one?

'Mia' 11:54
It's not so much. I think, like there's nothing with the company. It's just my satisfaction, and my eyes were opened to how big, basically, it's still a pharma company, right? There's still money that needs to be made. And my ideal was that I was going to be able to go and teach people how to use their product and walk away and have, like, a relationship with the patients. And yes, sometimes I still can, but that's not the focus, okay, that's not the focus of the company. I mean, it is, don't get me wrong, they it's a fantastic company, but it's just more than it's not, it's not what I was hoping to do. I'm still expected to, you know, be in front of providers asking for the sale, which, of course, that's what they need, right? I don't want for companies to not make money, because if they don't make money, then they're not going to create good products. And if they don't create good products, who's going to suffer me, right? I'm going to be the one that's, that's, you know, I'm suffering in that situation, and so I understand all of that from a financial point of view, but I really wanted to just focus on patient care, and that's not necessarily truly the case. Okay,

Scott Benner 13:13
so I'm trying to figure out what you're talking about here. So first of all, I'm laughing, because in my head, I think the all the pump companies just heard that, like, oh, hopefully she'll say something that indicates it's not us. The truth is very likely that this would apply to any device manufacturer or pharma company or anything like in the end, like at the end of the chain, right from scientist, engineer thinking something up to, you know, finance guys going out in the world and getting money to, you know, put it together, and the years and time, and the FDA approval and everything that happens to get it out to market. The end of that chain is sales. It does not help if they created the greatest whatever in the world, if nobody knows about it. And you know, insulin pumps are already not as widely adopted among type ones as you would imagine they are.

'Mia' 14:03
Oh, yeah, exactly. I mean, our biggest competition is not the other pump companies. It's the patients on MDI. Are multiple daily injections. And so that's really who they're, who they're trying to compete with, compete with, you know, and that is totally fine, and all of that is good to do, but I wanted to be able to go in and talk with the patient and provide the education and let them know, you know, hey, this is, you know, this is what we what we can do. This is how I can help you go to the providers and say, Look, this is where they're at. This is what I can do. But I'm not. I'm not able to do things clinically. I can't make insulin recommendations, like if the doctor asks me, then yes, I can provide that information, but if they don't, and they don't want to follow back. Up or anything like that. Then, then I can't say anything. But

Scott Benner 15:03
now that's not your company's rule, right? That's FDA, isn't it?

'Mia' 15:07
Yes, exactly. I mean, it is, it's, it's, it's, I am. I'm there to teach the patient how to use their product,

Scott Benner 15:14
the buttons, and what this means and what this menu does, and etc, but exactly

'Mia' 15:19
and how to use it, but not to clinically manage. And yes, it's, it's more of a FDA, I don't know for sure that's an FDA thing, but it's, it's, we're not allowed to because, basically, we're not prescribing, right? We're not able to prescribe, so we can't, we can't manage patients clinically, right? So I really missed that more than I thought I was going

Scott Benner 15:42
to. You knew that was going to happen right when you took the job. I did

'Mia' 15:46
know that it was going to happen, but I guess I just didn't know how many people would be asking me, and how many providers necessarily don't know how to do pump setting.

Scott Benner 15:56
Okay, so now we're getting into it. So you thought this is a great job like, I want to support a company that, you know, supports people with type one diabetes. I can use my degree and my knowledge to help then you, you know, apply for the job. Obviously, you start to understand that this is not exactly, you know, you're not gonna be able to use your your talents that way. But there's other, plenty of other ways I'll be good with this until you get into a room over and over again with a clueless doctor and a person in need, and you have to sit there with a Barbie look on your face and go, I'm sorry, but I can't answer that question. Yes, and that's soul crushing. Soul crushing. Yeah, the contour next gen blood glucose meter is sponsoring this episode of The juicebox podcast, and it's entirely possible that it is less expensive in cash than you're paying right now for your meter through your insurance company. That's right. If you go to my link, contour, next.com/juicebox you're going to find links to Walmart, Amazon, Walgreens, CVS, Rite, aid, Kroger and Meyer, you could be paying more right now through your insurance for your test strips in meter than you would pay through my link for the contour next gen and contour next test strips in cash. What am I saying? My link may be cheaper out of your pocket then you're paying right now, even with your insurance. And I don't know what meter you have right now. I can't say that, but what I can say for sure is that the contour next gen meter is accurate. It is reliable, and it is the meter that we've been using for years, contour next.com/juice box. And if you already have a contour meter and you're buying test strips, doing so through the juicebox podcast link will help to support the show. I have always disliked ordering diabetes supplies. I'm guessing you have as well. It hasn't been a problem for us for the last few years, though, because we began using us Med, you can to us med.com/juice box, or call 888-721-1514, to get your free benefits. Check us. Med has served over 1 million people living with diabetes since 1996 they carry everything you need, from CGMS to insulin pumps and diabetes testing supplies and more. I'm talking about all the good ones, all your favorites, libre three, Dexcom, g7 and pumps like OmniPod five, OmniPod dash, tandem, and most recently, the I let pump from beta bionics, the stuff you're looking for, they have it at us. Med, 888-721-1514, or go to us. Med.com/juice box. To get started now use my link to support the podcast. That's us med.com/juice box, or call 888-721-1514,

'Mia' 18:53
it is. It's. I mean, it really is. It's so hard to watch this happen and patients don't know what they don't know, I'm trying to then teach them how to use a product, how to advocate for themselves, and how to like like, lead them in a way. Ask your doctor about changing this setting. Ask your doctor about, you know, making adjustments to you know this or that, and if they're able to one, remember that two have the time with their provider when they go back in again to do that. And it's just, it's so it's so hard to watch and be a part of it breaks my heart. And then they're asking me specifically, what would you do in this situation, and

Scott Benner 19:41
then you go, I can't answer that question. Yeah. Or do you ever get like, Listen, you start whispering. Do you go, here's what I would do to make the insulin sensitivity like, three points more aggressive. Now, aggressive is a lower number. I know that's crazy here. Like, do you ever like, do. The thing you're not supposed to do. No comment.

'Mia' 20:04
I strongly tell them, like, you can make the changes when, when I leave this room, and like, if you know how to make the changes you and you've talked to your doctor, you know I always have to tell them to talk to their doctor. Always, always. I mean, I haven't given them specific numbers on that, because I, one, I don't want to lose my job, and two, just, I just can't do that.

Scott Benner 20:28
So, but the system has it set up so that a person like yourself who could really be valuable to this, this other person's life. We're now with them. We got them the tools. We taught them what the buttons do, and what we need now are three more sentences to really straighten this person's life up with diabetes, give them control and better health and all of this stuff, take away the anxiety, etc, all of that. It's all right there. And then we just, we're not allowed to do that, yeah? So that that doesn't happen. Then what happens? They go back. Do you even see them again after that? No,

'Mia' 21:03
I call them or I text them a few days later, make sure that the product is working correctly and that they don't have any questions about it. If they have any blood sugar questions, I have to direct them back to their doctor. Yeah, I

Scott Benner 21:17
was gonna say that caller text is a sales tactic, right? It's a the company really cared about me, the person called back,

'Mia' 21:24
it might be, I mean, I don't know. I mean, maybe that's how it came across. I mean, for myself, I really genuinely care about them, and I really want to make sure they're doing okay. I

Scott Benner 21:33
don't doubt that, but your company, but part of your process is to follow up, yes, and if you actually can't. So basically the follow up is, do you know where all the buttons are? And, yeah, and, but there I'm telling you that from a sale like, probably from a sales perspective, their takeaway is, company B really cares about me. After I got all set up, they, they the lovely woman I met. She called back and tried one more and checked on me. And so I get that, because it really is, but you know what it's like to be me? How about that? I didn't realize that.

'Mia' 22:04
Yeah, I know exactly, and I've thought about you many of times, because I know you've talked about trying to get into, like a hospital setting to provide education for people, and then as soon as they find out you don't have credentials that, they just say no, right? And so I really, I really feel for you and that situation. I mean, you have a fantastic platform, and you know how to help people you know, and your hands are tied sometimes. And so with me having having the credentials of an RD and a diabetes educator, I have to be really careful, because I could lose my credentials. I should have those taken away. And so I don't want for that to happen at all. And yeah, so I'm, I've, I've determined that I'm going to go back to school and I'm going to become a PA, a physician assistant, so I can't do those things nice so, but that's, that's what I Well, I'm in the process of applying. Hopefully, I could get into a school for PA, for PA school, okay? Because then I could actually answer the questions. I could help manage patients clinically. I could help, you know, write scripts for patients. I could adjust settings, you know, I could do all of those things where my hands are tied at this point, but

Scott Benner 23:24
you couldn't, even if you're a PA, you can't do it through that job you have now, though, no, no, right, yeah, no. Meaning, if those companies hired pas, they'd still be restricted the same way you are. Right?

'Mia' 23:37
Yes. So we have to take our clinical hat off and put on our, like, training hat, so and so that was, you know. And of course, they were telling you all this in training. And, you know, the training was fantastic. You know, all of that is there. And they tell you all of that stuff, but it's just, I guess I just didn't really, day to day how much it would impact me in those situations.

Scott Benner 24:02
Yeah, so when I jump on this podcast and I say something that sounds outlandish, like I figured out a way to help people, but I'm tormented by the fact that I can't reach more people. You understand what I'm saying, whereas I think there's sometimes people would hear that and just go, he just wants this podcast to be bigger so we can sell more ads, or something like that. But that's not really how I feel. Like what i you i just feel like, wow, we found a way to help people. It works, and now there's always another step. Well, how do you get it to them? And for you, it's I found the person they're here. They've got this amazing device, they've got clinical care, they have everything they need except the the map to put all of it into play. They just don't know how to do that. I know this is going to be just, you know, not accurate, but every 10 doctors you meet, how many of them are good at setting up pumps?

'Mia' 24:52
Maybe two or three.

Scott Benner 24:55
Are they generally type ones or not necessarily?

'Mia' 24:58
No, they're not necessarily. And. Seen it. I shouldn't say they don't know how to push the buttons, because there's they're just too they're they're too busy doing other things, taking care of the patient. So that's where we come in. But the ones that know how to do the settings, they're very few and far between, like know how to really understand what's going on the settings and why you want to have a duration at this point, or, you know, duration of insulin action time for this or that, and you know the ins and outs of things. And the pediatric doctors probably know that a lot better, because they're probably dealing more with the type ones. But if for adult patients that are type one, they necessarily don't, don't have a provider that necessarily knows that. I mean, some do, but not often based

Scott Benner 25:50
on your interactions to an outsider, right? Who doesn't have diabetes isn't a doctor, they would look at this scenario and say, This doesn't make any sense that an endocrinologist is specifically to help people with endocrine issues. Diabetes is a big part of their job. Probably. How is it possible? I always use the same thing, like, example, over and over again, but like, you don't go to a tire place to buy tires and expect to find a person is like, Man, I know what the lug gun does, but I'm not real comfortable getting the tire on and off of the wheel like that. So we're gonna have to bring in someone from the tire company to do that part. But then I'm gonna send you home and put the tires back on your car yourself, because I don't want to get involved in that. I'm not very good at that part. Like it's a crazy thing. Is it not like, did you think? Listen, you've had diabetes forever, so I imagine you've had a couple of endos along the way, and probably a couple of good ones. But did you really think that when you got in here it was going to be, you were going to find what you found? No, I

'Mia' 26:51
had no idea that it was going to be the to this extent. To this extent, yeah. Okay,

Scott Benner 26:55
so based on your experience when I started up the Grand Rounds series this year. By the way, I got mostly people, people with type one you know, were, were mostly like, Oh, this is great. Like, this is the stuff doctors should be telling us. And but I still got my fair share of like, oh, when you started that doctor bashing series, I was like, again, if the guy couldn't get the tires back in my car, and I went and told people, hey, look, I wouldn't go to this tire place. Like, I didn't even know how to use the lug gun. He doesn't know how to get the tires. Doesn't know how to get the tires off the wheels, and he doesn't know how to put them. Like, I wouldn't be tire bashing. I'd be leaving a reasonable review of a person who told me they were going to swap my tires. But then in the end, we're like, I can't really do that for you. So like, I don't see it that way. And I also think that people must think that like, oh, Scott's taking an example from like, one person's story, but most of the doctors out there probably really know what they're doing. He's finding the ones who don't to make a point. And I'm not. I, first of all, people just tell their stories and up to me what they're gonna say when they come on the podcast. I don't stop people from coming on here based on how they manage, how they eat, what they think, nothing. People just come on, as a matter of fact, Mia, I am still waiting for someone just to get on this podcast and be like, You're an asshole, and I came on to talk about it. I'm like, All right, cool. Like, I'd be like, fine, whatever, you know, but like, point being is that I'm not filtering who's coming on, and I'm not filtering what's going out you guys here within, you know, a couple of like, crazy things that have happened over the years every recording I make, right? And overall, people don't come on to say, My God, my doctor's fantastic. What a lovely person. And you should see my five and AFA one saying, I know how to bolus for French fries, and I know how to bolus for being low carb. That's not what happens. So three out of 10 maybe?

'Mia' 28:41
Yeah, it's crazy. It's crazy.

Scott Benner 28:45
So is that part of what makes you hate the job? You do hate the job, right? It's

'Mia' 28:49
a really strong word. I love when I get to to work with the patients, it's a lot of the extra stuff, the sales. You know that part of it, I don't, I don't care for I just want to help patients get better and teach them. I would love to be able to just say, Okay, this is how we're going to make the adjustments. Give me two weeks with them, and you know, then I could help them 100% give them more education, how you bolus for this, how you bowl this for that. But that's just not, that's not how it's done, that's not how we function. And so it makes it it just makes it really hard, makes it really challenging. And you know, why

Scott Benner 29:30
do you think you have that knowledge? Is it because of your professional background, because of your diabetes life? Is it a mix? Why I think it's

'Mia' 29:38
a mix? I mean, before you know, I've been a dietitian for a long time, but didn't get enough hours working professionally to become a CD diabetes educator until 2018 I started progressing in my my my jobs, and I worked in urban clinics, and I've worked in rural clinics. And I've seen just a lot of different backgrounds, of people dealing with diabetes, you know, I've had patients that are homeless, and I've had patients that are living in shelters, and patients that live out in the middle of nowhere and don't have access to the internet, you know, and so, so it's just all of those things. So it's just really tried to drive me to figure out, you know, how to help them the best, and just listening to their stories and reading and following people and watching things you know, just kind of makes me want to learn more about how I can help people. So yeah, I think it would be a combination of both. And then my experiences with not having technology at the beginning, and how we functioned, and how much better my control has gotten over the years, because I've made changes and because I've done things differently. I think that's kind of where I get a lot of my knowledge

Scott Benner 30:57
from my point in bringing that up is that, I mean, I could easily, like, turn my hat around right and argue well, even if they were allowed to give this information, it would be incredibly difficult to train up that many people to actually be able to disseminate that information well and leave people with a firm understanding, especially in short visits, even if it was over a couple of weeks. But as I would argue that away, I would tell you, like, you know, I help people, and I don't even know who they are. Like, I don't, I don't see them, I don't know their situation. And yet, a grand amount of people come out of this podcast with something, an idea, you know, that helps them pull things together. I think that's the disconnect, is that idea that that what you're trying to do is turn all the dobs exactly where they belong, explain to them exactly how to cover all their food and what to do in all the situations. And people would say, Well, I can't possibly do that. I can't explain every food choice. I can't explain activity versus not activity. I can't explain to them when to take off their pump to go swimming if they're on a tube pump, but don't forget to put it back on because, you know, like all the little details that you feel like you need to know, I think that a company or academics could get held up thinking if I don't leave them with a firm understanding of every one of these myriad of variables, then we can't say anything. And what I've learned is that if you explain to them properly that it's really all about the timing and amount of insulin they're using, and that that idea applies to everything from activity to food to inactivity and etc, then they can have these experiences in their life. They learn from it, and before you know it, they wake up a few months later and like, yeah, my a, 1c, like, six, two, and I don't get low very often, crazy, I swear to you, yeah, you're all overthinking it, yeah, it's timing and amount, that's it. Yeah?

'Mia' 32:57
I mean, I agree, and I think that, you know, people are afraid of insulin, right? I mean, you have well, so it's a huge, a huge issue. So I think one we have to think about, where do patients go for their care, right? They aren't able to get in to see endocrinologists because there's not enough endocrinologists around. The wait is six months, right? Some places longer, other places, they can't get there because they don't live close enough. I mean, so there's all of those issues, right? The access to care, all of that is so then they're going to the primary care doctors, and the primary care doctors don't have enough time, or they don't have the specialty knowledge about diet insulin, so they're giving people a fixed dose, right? They're giving them here take eight units with this meal, you know, every day. Well, that might work for a meal that has, you know, some carbohydrates, and, you know, maybe a minimal amount, depending on what their ratio is. But nobody's figuring that out for them. Nobody's telling them that. They're just saying, Take this amount. Yeah, well, all it takes is one instance where they take, you know, the amount of insulin, and maybe they only have a salad, right? So they have a salad, and then they have a really scary low. And so then it's,

Scott Benner 34:08
they still think they're eight units like they're told to do it a meal, right? Exactly,

'Mia' 34:12
and it's too much, right? So then they're afraid to take insulin because they had this really bad low experience. And think it's just the insulin fault? Well, I mean, yes, it was because of insulin, but it's not just insulins. Because you weren't told to eat enough food to cover that, or you were told to take this fixed dose, and that's all you take, right? And so then the patient ends up at the bad low and then they don't want to take any insulin, and

Scott Benner 34:37
that's it. So everyone who's given incomplete understanding is eventually going to run into a scary incident, and that scary incident is very likely going to stop them from taking as much insulin as they need. And then you tumble down that rabbit hole to health issues, right,

'Mia' 34:54
exactly. And I just feel so strongly for those patients that something has. To be done better. We have to treat them better, right? They have to have better access to knowledge, to technology, to care, and that is where it, just like breaks my heart, that those people that went I don't mean that those people in a bad way, but people that are in a situation where they are only have access to their primary care doctor, and they only get 10 minutes with them at a visit, and they have other things going on as well, but Plus, they're trying to manage their insulin levels, our insulin amounts. And it's, it's just, it's a nightmare. It's,

Scott Benner 35:32
what's the answer? What's the answer? Yeah, you don't know. You don't know, right? You're in the middle of the fight. You don't know the exact answer. Well, my thought is

'Mia' 35:40
that, you know patients, they just need more education, right? We totally need education. But then how do we? How do we give that to them? How do we, how do we have time for them? So my goal is to hopefully be able to be a PA where I can work in a primary care clinic and take all of their diabetes patients be the diabetes specialist for them in their primary care clinic, and take the time to see them and offer education classes. But diabetes doesn't pay, right? So that's the other thing. Is that insurance doesn't necessarily reimburse for providers very much. Those diagnoses may not bring in as much money. Diabetes educators don't bring in a lot of money, so it's all of that stuff together that really, I think is such a I don't know the right words, but it just makes me upset.

Scott Benner 36:30
I know you, I could tell you're flustered and it is upsetting. Listen, I'm upset by it every day. So fair enough. We should spread it around on other people a little bit. Do you really think that's going to happen? Like, are you going to take the time to become a PA and then go out in the world and find a bunch of doctors? Are going to be like, Look, I can't afford to pay you because I can't build that well, and I can't let you spend that much time with people because I can't bill it. And aren't you just going to get flustered again?

'Mia' 36:57
I might. I may. I mean, very well. I talked with my husband about this all the time. He's like, Are you sure you want to do this? You're gonna run into the same situation where people aren't being able to pay and, you know, or whatever. And I said, Yeah, but I said, I can't stay in healthcare and not have the ability to do the next step. Here's

Scott Benner 37:17
another potential problem. So you'll eventually say, Okay, well, I'll help the people who can afford it, and then you're gonna realize that you're only helping a certain sector of people, and then it's gonna get right back in your head, like, well, all those other people who were disenfranchised that I wanted to help before, I'm not helping them now, because I can't spend the time, because they can't pay and nothing changed. I just made a lot of middle aged, white ladies better.

'Mia' 37:43
Yes, I do think about that. Yeah. I mean, I really, I mean, in a perfect world, I would be able to help, you know, everybody, obviously, I think us as caregivers and people that know this information, they want to do that. And so yes, I may have very high in the sky ideal attitude about all of this, about how I can help people, but I mean, surely there's got to be something better. There's got to be a way. And if I don't stop what I'm doing and try and make that difference, then how do I expect anybody else to do

Scott Benner 38:19
that? No, I don't listen. First of all, you should absolutely put your effort where it makes you fulfilled, and you're not going to save everybody. I was playing devil's advocate a little bit, but it's true, because

'Mia' 38:29
I'm in my, you know, I'm in my midlife, and I'm about to maybe embark on this huge financial commitment of taking on going to PA school. I mean, it's not going to be cheap. And are we willing to do that? And hopefully I can get finished, and then, you know, as as long as my husband is still working, you know, I'll be able to pay off the school loans, because I don't have 100 grand just sitting around to pay for it. May

Scott Benner 38:53
I say something, this isn't directed at you, but like, help me spitball this idea. So my podcast is very popular, okay? And it's popular, because people come on and talk about all the things that you just outlined that people need to know, that nobody's able to talk about in a clinical setting, right? And that hurts people, but it also hurts the company selling the stuff, because what the rest of you don't understand, that I'm guessing Mia knows is that you put this like state of the art pump in someone's hand, and they go home and they don't know how to use it well, and then when their blood sugars get low or high or they bounce around, what they say is, this thing doesn't work. They don't say, I don't know how to do diabetes. I don't understand how insulin works. My Settings are all wrong. My doctor sucks. They just say, this pump I just got, it doesn't work. It's supposed to keep my blood sugar stable, and it doesn't. And then eventually those people will leave that pump, try a different pump, or to go back to MDI, or whatever they're going to do. Wouldn't it make sense for pump companies to start like to fund? To another business full of people like you to go help people, because, in the end, that's part of the reason why some of them buy ads on my podcast, because if they keep this podcast going, then people understand management better, and they're more likely to stick with their stuff once they have it.

'Mia' 40:17
Oh, I agree with you. 100% Yeah, 100%

Scott Benner 40:19
I don't, by the way, I don't think of that as a dirty secret of the podcast. I think it's pretty obvious, if you pay attention to it, but, but that's one of my value points for advertisers, is that as long as I'm making this podcast, a mass amount of people who are likely going to find their products are going to know how to use them and stay on them. Oh yeah. I mean, I don't know, like, I don't want to spend other people's money. I don't know how much these companies make, right? And some of them make crazy money, and some of them don't. But if you took a couple of percent of your of your money and started it's, it doesn't even have to be a brick and mortar business, right? You just hire a bunch of people like you, and then after you put them on the pump, say, Look, we have this other business over here. It's, you know, it's healthcare provided your will take your insurance. If we don't take your insurance, you can, you know, you can submit afterwards, like make it easy for them, and basically do what Jenny does for a living, except, except have a bigger company behind it. Oh,

'Mia' 41:15
yeah, I agree with you 100% because what I see is providers then don't have time to make all those setting adjustments all the time, right? And some participations need to be seen more frequently than the providers can see them for those adjustments and tweaks and teaching them how to use, you know, extended boluses if they're going to do that, or, you know, just whatever, whatever it is,

Scott Benner 41:42
yeah, sometimes it's about having a conversation. Sometimes it's about jumping on a call for 15 minutes and just saying, Look, you know, we keep having this meal and it keeps going poorly. Can I just walk you through it so personally the other end can go, wait, wait, stop. Did you say this? Oh, yeah, you should have maybe thought about that, and, you know, or we could have extended this longer or made a larger bolus here. Or have you tried going for a walk after you eat? Like, all the things that a person's not going to think of that you could, like, you see it happen in my Facebook group constantly, right? Like, there's, by the way, there's a reason, there's a reason that the podcast is super popular, and so is the Facebook group. And it's because people, in the beginning listen to the podcast. They listen to me talk about diabetes. They upped their game. Then they got into a space, and they were like, Oh, I'll answer these people's questions. It's see one, teach one, but digitally. Yeah, exactly right. No, no, trust me, I know I got this whole thing worked out. Just nobody listens to me. Well, the people listen, listen. I'm talking. You know what I'm saying anyway. So like, you go into the group and you say this, like, I don't know, like, I had this happen, and I don't know what to do. And every once in a while, like a like a keyboard Crusader, will come in and be like, you could just search the group for that answer. And I come in and I say, No, don't do that. Like, you want this conversation to happen, because, from an outsider perspective, have a limited understanding of what I see, as far as the numbers are. So like, when someone posts something and you think, Oh God, this is asked and answered 10 times in here already. Like, just search. I don't want anybody searching. I want the conversation to happen over and over again. Because what you don't see, you know, from the outside, you'll see, you know, four people having a conversation. Five more people come in. In the end, you think, oh, there's nine people here. What a waste of time. Blah, blah, blah. I've seen this conversation a million times. You can't see what I see, which is how many people see the posts? And it's 1000s and 1000s and 1000s of people. Yeah. So you have that conversation over and over again. Now you're helping a person who never asked the question, didn't have to answer in the Facebook group, didn't have to even like, like, put their hand up and say, I don't understand. And they walk away with the knowledge. They take it back to their house. They try it a few times till it works, and then they're good. And it's just, it's so freaking simple. It's frustrating to me. Look at me. Your your frustration is now on me. God damn it, and it's early, it's gonna ruin my whole day. I'll tell you that right now.

'Mia' 44:06
Sorry, sorry. It's just been like, you see it over and over and over again. And, you know, I have people that will ask me about, like, I, you know, my own Facebook group, but usually during the month of November, I'll post stuff about, you know, Diabetes Awareness. Over the years, people have come up to me or, you know, sent me messages, like, I just saw this doctor, and they told me my a 1c, was 9.5 and they refused to give me test strips. They don't want me to check my blood sugar. They just want me to come back in three months with, you know, they put me on Metformin, and I'm like, You need to check your blood sugar. Well, they won't give me a meter. I'm like, well, then you need to ask for one. So, you know? And I'm trying to teach people how to advocate for themselves and how to how to do all these things. I'm like, why are we waiting three months? Why are we all. The patient who has an A 1c of 9.5 wait three months and just hope that Metformin works. Low

Scott Benner 45:05
expectation. Having motherfers is a thing I heard in a movie one time. Yeah, I don't know what it's from, but that's it like, I

'Mia' 45:13
mean, their blood sugar is already so high, right? A 9.5 what they're sitting at, I don't know. I can't even remember all the numbers and what they equate to. But just like, that's just not fair for that person to have to wait three months. And we know that Metformin, yes, it is the first line of defense, but once you're higher than, you know, nine, I think that I can't remember the standards off the top of my head, but you know, you're supposed to start all these other things, if not before

Scott Benner 45:41
well. So the problem is, is that everyone's limited. So everyone has it, everyone every touch point you have with a person, right? Is a person who works for somebody and is limited by something. I'm the only one who's not limited, because nothing you hear on the juicebox podcast should be considered advice medical or otherwise, always consult your physician before making any changes to your healthcare plan. So there. So now I come on and I say, Look, this is what I do with my daughter, or I interview you. And I say, Hey, tell me what you did, and you tell me, and then other people hear it. This is the only current outlet that is actually able to say things out loud that people might find valuable. And you, you can say to them, like, I'm going to treat you like an adult here, like everyone's not going to understand. I get that over and over again. God, for years I've been saying this. You can't not tell everybody the secret, because you think some of them won't understand it. Because it's not that big of a secret. It's, it's the amount of insulin, and when you use it, timing and amount, timing and amount in every situation. I swear to God, I haven't said this in a long time. Everybody would be mad at me if this happened, but the podcast should be four minutes long. It should be music and me introducing myself and going, Hey, everything about your insulin use is timing and amount. Apply that to every situation. I'll see you later. That's it, right? Obviously, there's more details, and you can have bigger conversations, and that's where people learn, right? It's campfire stories, like you tell the campfire stories. That's how people learn and but the fact that you have so many people, it's your doctor who doesn't know or is limited by time or knowledge. It's the nurse practitioner who doesn't know, or is limited by time, by knowledge. It's the fact that the pump company can't help you, your CGM manufacturer is not going to speak to you about any of this like there's everyone has set themselves up in an insulated bubble where they're not in charge of telling you how to actually use this stuff, and therefore there's no one in charge of that, right? And so then what? Then? My point is, what's the rush? Two months? Three months, come back? What's it matter? They're never gonna figure that out like so it doesn't matter. That's where the horror is in this idea that your pancreas stopped functioning the way that it's supposed to You are now on a different life trajectory than other people. You don't get to be as healthy as everybody else you lost. That's how you get treated, and that's my biggest problem with it. Not, yeah, you don't even 100%

'Mia' 48:11
Yeah, 100% Yeah. It's this clinical inertia that doesn't, you know, change. Nothing's changing, and we're just okay with that. But I, you know, and then I'm like, the patient shouldn't have to feel that way, right? So, crap, when you're that high, and you know, they don't, may not even know it, right? Because they've felt bad for so long, and they don't even know it until they start having good blood sugar control, and they're like, oh my gosh, I have energy now, oh my goodness, I can think clearer. I can do things that I didn't know I was missing out on, and so we're limiting the patients from having that opportunity, and just complications are just going to keep getting worse if we don't make changes earlier on.

Scott Benner 48:54
It's an underlying attitude of dead man walking. Yeah, you got diabetes. Oh, wow, this ain't gonna go good for you. I'll tell you right now, because I can't tell you what to do because, you know the FDA. And that guy over there, he can't tell you what to do because, you know, he don't know. And that lady over there, she's not allowed, and that's, ooh, yeah, your ANC is gonna get higher. You're gonna get foggy in your head. You're not gonna be yourself anymore. You'll probably have complications later. I'd help you, but sorry and like that's really what's happening. It sounds so harsh, because I don't think that's what anyone's actual mindset is, but I do think that it's what happens. Agree, yeah, it's what happens. Because at some point in every person's conversation that they have in their own head, whether it's somebody who works at a pump company who's not allowed to tell people how to use insulin, if it's a doctor who didn't bother learning, you know, somehow calls himself an endocrinologist, but doesn't understand how to adjust basal and everyone in between, all of those people, at some point, make a deal with themselves to not worry about it. They get to the. Into that thought, they go, Oh, I really I'm not helping as much as I should have. But. And then there's always the but that writes it off. I'm not allowed to. That's not my job. It's not my place. I don't want to scare anybody like they'll there's that excuse that stops you from feeling bad about it. Yeah. And then we just all go off and do a half ass job for people, and they get to live half assed lives and then they die. But okay, well, I wasn't allowed to tell them, yeah, I'm not okay with that. Like, that's the the entire crux of the podcast, like going back 10 years now, is that I'm not okay with that. I know I say this too much, but It's recently been been a thing that's back under my my saddle a little bit is when I started making this podcast a prominent person in the diabetes community, and I'm making air quotes around that, because, you know, just because you make content and say you're you know about diabetes, doesn't mean you're actually helping anybody literally came to me and said, It is dangerous for you to share how your daughter uses insulin and how she lives her life With diabetes. You can't do that, and 10 years later, I don't honestly know how many 10s of 1000s of, maybe hundreds of 1000s of people have been helped by this podcast. Common thinking would have been shut your mouth. Don't tell them. They don't get to know, you know, that's a nice thing for you. You don't say it to other people. That's how people think. Yeah, so there you go. Now, I'm been now you've made me cynical on top of angry.

'Mia' 51:28
You know, you see it day in and day out, and it's just it's so hard to watch. And, you know, I feel like there's more that I can do to help people, right? There's more that I can do

Scott Benner 51:40
listen. I have your notes from your intake. Can we switch gears pretty harshly, since we're already saying things people aren't going to like, I have a question about something. Might as well make me unlikable. On another topic too, sure, in your initial intake, you said binge eating like you just like, why did you want to talk about an eating disorder.

'Mia' 52:01
So when I was initially diagnosed, you know, back a long time ago, we didn't have all the stuff to tell us things, and so I would have high blood sugars no matter what I did. Like, if I ate salad, I would have high blood sugar. I would, you know, I we didn't know, of course, as much as we know now. So, so then I would just eat whatever I would want. I would eat ice cream. I'm like, I would just, I literally would go and get the little pints of ice cream, and I would just eat it. Because I'm like, Well, my blood sugar's going to be high anyway, so I'm just going to eat whatever I want. Um, it doesn't matter what I do. So I would just eat, like, binge eat food, and then see what my blood sugar would be, because I didn't know how to manage it any other way. Looking back, I am amazed that I was okay. But yeah, I just we didn't know. I took NPH and regular and all we did was check our blood sugar a few times a day, if we if we did. But every time I checked, every time I checked, it was always high, right? Didn't matter it was, it was always high. And so, so, yeah, so I would just start binge eating because I didn't, you know, I already felt bad about myself because I was high. And so I just was like, Well, fine, if I'm going to be high, I'm going to give myself a reason to be high.

Scott Benner 53:21
Did you feel like you had an eating disorder?

'Mia' 53:23
I was definitely down that path, for sure, for sure. I met my husband, and he kind of helped pull me out of that before, I mean, before we were married and stuff, and kind of helped me start to see myself worth besides just a number kind of makes me cry. But, you know, he really helped me was that a lot of faith and prayer as well, that is a big part of who I am as well, and so that helped me kind of get on the right track. Finally, was able to go to a doctor who didn't judge me. You know, there's a lot of judgment. I remember being at this one medical place, and there were a whole bunch of med students there, and they all came in and, like, asked me the same questions, you know, how many times did they see people with type one diabetes, you know, and my ANC was high, and they're, like, asking me my why my a 1c was high? What am I doing? You know, just like, but there was probably like four students that came in, and they all had to do a health intake on me, right? And, you know, it was just so demoralizing and so judgmental, and I just felt like I was the worst person in the world for that, because my my blood sugars were high, and so for the longest time, you know, I was just like, Oh, if my number is high, then that means I'm a bad person, right? My self worth was tied up into it. And then I met my husband, and he really kind of helped me through all of that. And then I finally had an endocrinologist who just talked to me like a person. Yeah, that kind. Of made me like, Okay, I need to take care of myself and really try and get on the right track. And she was like, Are you gonna have children someday? And it's like, well, yeah, I want kids. And she's like, well, then you have to start getting your blood sugars under control. But she talked to me as a person, like as a female, as a mom, you know, I wasn't a mom, but, you know, if you want to have children, what, what do you want for your kids? Do you want for your kids to have one if I was even able to have healthy kids, if my blood sugars were to continue in that path? But how do, how was I going to be, you know, as a, you know, how was, how was I going to expect my health to be okay, to take care of my kids if I didn't really start, you know, making changes or learning how to take care of things,

Scott Benner 55:46
what do you think the process was that got you there? You diagnosed as a teen, okay? And 30 years ago, like, there's the management was, you know, not what it is now, obviously. And so being high was probably, like, you know, law of the land, right? You probably, probably high most of the time, then you get crazy low once in a while. Is that about what it was like? Yeah, yeah, okay. And that was just it, right? There's no measuring tools, really, to speak of. You're not like, meaning like, you're not looking at a CGM. You're not like, not able to really dial in what you're doing. Nobody talks about you weren't covering carbs at one point, I would imagine you were just No, we didn't,

'Mia' 56:23
yeah, we didn't count carbs. It was all fixed doses. We did the exchange list, yep, but it was just like, Okay, this is how many exchanges you eat, but you still take, took the same amount of insulin for all of that, which I guess, in a roundabout way, is carb counting. If you know exactly what you're doing, right, you know? And then I it was, it really wasn't until I I wanted to have children, where I was really like, Okay, I really need to start taking care of this. And we moved to another place, and I met a diabetes educator there, and she was a nurse. I remember her to this day, and she just helped me. She took me in, and she taught me about taking, you know, did she talk teach me about taking different doses? I don't remember exactly, but anyways, she just really loved on me and made me feel like I was not a terrible person if my blood sugars were high, and so I wanted to do well because, you know, I wanted her to be proud of me, yeah, and also because I wanted to start having two kids. And she said, Well, you know, you need your a 1c to be better. And so, so I did. So I started make, you know, really making changes. And I don't, it's probably not so much that I made changes about my food, because I wasn't eating terribly at that point. But it was like making sure I took my insulin right, making sure that I did take the amount that I was supposed to take. And so it was probably more of those things that really kind of helped me, you know, get better.

Scott Benner 57:56
What happens when you go from Exchange diet, or, you know, regular mph, world to fast acting and mealtime, or mealtime and basal insulin, and there's not a lot of like direction there, back in the day, right? What is that like, mid, late 80s? Is that about, right?

'Mia' 58:13
I was diagnosed early 90s. Okay? I started, I think I started on humologue, I want to say right before my pregnancy,

Scott Benner 58:23
okay, but I'm saying, Once you make that shift, there's not, there wasn't a ton of direction back then. No, no, no, no, no. So it was like, now we're just going to use this factorizing insulin, and then it's the end of it. Then you don't, like, even, yeah, know what the hell you're doing. And my point is, that. So you start in a hole that's driven by what's available, right? There's nothing anybody can really do about that. There's some people who've, like, you talk to some of the old heads, sometimes they really figured it out somehow, like they're rolling around with like, a stable five and a half, a 1c on regular and mph, or something like that. And you're like, okay, but most people don't figure it out. So you have a health suffering. Then, then you fall into this situation where insulins change, and the again, the medical profession is not ready to explain it to people, yeah, and so now people are just lost again. And now there's endless years of people misusing insulin, not understanding it correctly, blah, blah. Then all of a sudden, CGMS happen. And I'm telling you right now, that's the core of everyone doing better now, like, it's, it's being able to see your blood sugar in real time, right? So now these CGMS happen, and people understand them. I'm going to tell you, like, for clarity, like before art and CGM the ideas I were having were all like, they were academic. You know what? I mean, I was like, I think this is what's happening. Or I would try to test her a bunch to try to see if I could see a pattern or something like that. But, I mean, I was really just guessing. Still. I was guessing, right? But I was still guessing. It's not until the CGM comes where I was like, Oh, I get this now. Like, now I see what's going on. I can get I can get ahead of these things. I can make my. Their decisions, etc, so on. I think the point is, is that by the time the only thing that really happened to you, right is that you it's this confluence of events. You meet the educator, you meet your husband, you have this idea of like, I can't feel like this anymore. And then on top of that, you have to live with people asking questions doctors and physicians asking questions that they don't mean, like they're not trying to make you feel bad, right, right? But because of the situation you're in, these are horrible things to hear. Is that? Right? Yeah, yeah. Okay, exactly. And then somehow all that stuff, luckily comes together, and you pull it together, yeah?

'Mia' 1:00:40
Once I started to feel better, when my blood sugars got better, you know, it, it definitely started to really click, right? And then when I got on a my very first pump, it was like night and day. I mean, even back then, with the type of pump that we, you know, pumps that we had, it was like night and day. My a 1c, have been less than seven probably, I think there was two times where it may have been 7.1 or 7.2 over the years since then, and now they're, you know, now they're even much better, and time and range is much better. But, but yeah, it was like, Wow, I feel good. You know, I'm starting to feel better. So if I feel better, I can do better.

Scott Benner 1:01:26
Yeah, and so not a thing you realize when you're going through it. You don't

'Mia' 1:01:30
realize it until you start to feel better, and you're like, Oh my gosh. And then I remember when I finally got onto, I wouldn't say the first CGM, but when I got onto CGM, consistently, I could really tell a difference. I realized that it was because my blood sugar was dropping, but since I'd had hypo unawareness by then, I didn't really know that that was what was happening. But I would just get kind of irritable, and then I would eat dinner. And you know, this was usually in the late in the afternoon, early dinner, you know, early evening, we'd eat, and then I would be fine. But it's

Scott Benner 1:02:04
heartbreaking again, yeah, yeah. There's a moment in my day where my kids look at me and think, crazy lady and, and that's because my blood sugar's low, and I don't even know, yeah, exactly, it's up. See, that's my that's my point is that, and I the best way I feel like I've ever found to say it is, is that with stable and in range blood sugars, you have an opportunity to be the person that you were supposed to be prior to your pancreas not working well, and all this coming into your life, like, there is a way you would respond to your children, to the news, a way you would exercise love, laugh all this like, like, fundamentally, who you are gets changed by diabetes when it's not well managed, And no one teaches you how to do that. So, so it's not just my pancreas, you know, shit out on me, and now I gotta take this insulin like that is a very surface way of looking at what diabetes is, because it when your blood sugar is too high or it's too low, you are altered. Your brain works differently than it would if your blood sugar was 85 Yeah, that's it, exactly. And that's not right. Part of my my focus is for my daughter to be able to live her life as herself. And I don't mean like, you know what I mean like? I mean on that level. I mean on a molecular level, and what comes out of her mouth and how she feels and sees things and speaks like that's the to me, that's what we're trying to do, like the health, the health comes with it. That's great, but it's more about getting to be yourself. Yeah, exactly. I

'Mia' 1:03:53
would agree 100% and I think that that's what kind of makes me really feel for people when they don't have that as an option, and that's not given to them as an option, or they're written off as somebody that's non compliant, or that's not capable of making changes, like it's because they've never had the opportunity to feel good, right? Or they've never been given the opportunity to have technology, or they've never been told, Hey, let's try this instead and see if this will work. Yeah, let you see how your food responds. Let you see what this you know happens when you forget to take your insulin, or when you do take your insulin, you know the differences. And when they start to see that, I believe 100% that people will improve.

Scott Benner 1:04:43
Well, they'll at least have the opportunity. That's for sure. Yeah, yeah. So, like, very simply stated, like, if you have a 200 blood sugar for the last 10 years, you're not experiencing the world. And the world is not experiencing you as you would or they would if. Your blood sugar had been 85 most of the time for the last 10 years. That right there is then, now suddenly, like you said, you go into a doctor's office and maybe you're short tempered, or you can't focus, or whatever ends up happening to the point where you don't do what the doctor says, even though we assume most of them might not even be saying anything all that incredibly valuable to begin with. And then they, they they literally take a pen and write non compliant in your chart. I feel like non compliant means I don't have to worry about this one anymore. They don't want to be healthy. So my conscience is clear, right? Yeah, exactly. Not for everybody. But I know it's just a, it's an insurance thing for, you know, just they have to write it down, like, in a lot of places. So I'm not saying everybody feels that way, but the thing that I spoke about earlier, about the well, my job doesn't allow me to do that, so I can write this off, right? Like, that's non compliant. Well, they didn't listen. Oh, well, not my fault. I told them, yeah. Like, Yeah, but you're telling a person who's altered and then you're upset because they didn't accept it. Well anyway, there's a lot more going on than we think, and none of this has to happen. You just get them in the hospital when they're diagnosed, and you explain its timing and its amount. It's this and it's that. Look, I this is going to sound like a commercial. If you just got that bold beginning series I made when you were diagnosed, you have an exponentially better chance of being healthy.

'Mia' 1:06:24
Oh yeah, that's it, yeah. And when I was when I was diagnosed, I didn't even go to the

Scott Benner 1:06:30
hospital. It's fine, but

'Mia' 1:06:33
it was like, so my brother has type one as well, and he was diagnosed two years before me. We were both around the same age, but, you know, just two years apart. And so my mom took me to the doctor, and he's like, okay, take insulin, and just sent me, sent me on my way. I didn't go. I didn't have, like, education right away or anything.

Scott Benner 1:06:56
Guess what, Mia, you're in the family business now, see ya. Yeah, exactly.

'Mia' 1:06:59
Yeah. So it was kind of crazy, but I'm thankful that people that you know that it is taken a lot more seriously, and that they usually are sent to the hospital for a couple of days to learn things and stuff. But yeah, it was just kind of crazy that that didn't happen for me.

Scott Benner 1:07:18
I hope for everybody that they find the information that it lands with them, if it doesn't land with them, that they find a place to go speak in a community setting where somebody might be able to speak their language and get it to them. That really is another great value of the Facebook group, which is, let's say I lead you down a path, but you don't jive with me, but you still go, oh, something's here. I don't understand. I didn't understand I didn't understand how that guy said it, but it does exist. I'll go to the Facebook group and go find somebody who speaks my language, you know what I mean, and then I'll now, I'll go find it over there. I still, first of all, I still see that as me helping. And the other thing is, is like, not everyone's gonna like me or or hear me the way I speak. Like, like, it doesn't mean they don't get to have good blood sugars, you know, right? I'm just doing my best. Like, I'm just, I'm out here doing my best, and hopefully I'm leading people towards a path that will, will, will just, it'll walk a healthier life for them. That's really all I care about. That's the rest of it just works itself out honestly. So is there anything we didn't talk about that we should have?

'Mia' 1:08:25
I don't think so. I kind of went off on, you know, I guess I'm pretty passionate about what I would I want for people to have care, and so if I went on that too much, I apologize. No, no, this

Scott Benner 1:08:40
was lovely. And also, Mia, seriously, like, don't be sorry about going being passionate about it. Like, I'm not a therapist, but a therapist might tell you that you're trying to do for other people what you wish would have happened for you.

Unknown Speaker 1:08:57
Probably don't worry.

Scott Benner 1:08:58
That's exactly what they say. I just save you the 40 bucks. People did their best for you. Their best was not nearly enough. The technology was not nearly where it wanted needed to be. That's nobody's fault, right? We're just we're getting better as a society in that stuff, right? You were born in a time where this was how it was going to be, and then you got to see the new time, and now you can hold those two things up against each other and go, Oh my god, like I lived a lot of my life the way we just described, and I don't want that for other people, yeah, and I, I'm telling you, I started this whole thing because I just thought, like, there's no reason for people to, like, spend two years crying the way I did when my daughter was diagnosed. You know what I mean? Like, like, I all this stuff I figured out, like, why don't we just go tell it to somebody else? They can skip it. Then it makes sense to me. It's really like this podcast is verbally what AI will be one day for information, which is, like, you could spend six years. Is learning how to do this, or we can just go past that, and now here it is. It just it works. Now, do that. Now see what's beyond this. Like, that's progress, by the way. Like, some people will see that as, like, a loss of, like, old school things like, oh, you know when they people say, like, if everybody has a calculator, what do I need to add for like, how do I like, I don't have to learn how to add I have a calculator. Well, there's an argument to be made, but we would like you to learn how to add. I think that'd be important. There's also an argument to be made for like, Yeah, that's probably right. Just use the calculator. And that's how I see kind of the diabetes information. Like, you can struggle for 10 years and hope to figure it out, but you're probably not going to. Why don't we just let somebody who already figured it out just tell you what to do? What to do, and then you can go build your life on the shoulders of that idea, instead of starting in the hole that you got dug into when your pancreas was like, I don't think so. I'm not today anyway, that's how I think about it. Yeah. All right, this was lovely. I appreciate you doing this. I hope you become a very successful PA and find a doctor who cares more about patients than money. And

'Mia' 1:11:05
I know, I know, I know that that's kind of way out there. I think I would be disappointed with myself if I didn't even try. I say, take

Scott Benner 1:11:13
your hippie attitude out in the world and try to make it work. Yeah, yeah, so that maybe you could do it yourself, like one person at a time. There's nothing wrong with that, right? Like, why couldn't you start a business where you help people with diabetes? I've

'Mia' 1:11:26
thought about that. I've thought about doing that too, but I would like, like, not being a PA, but then I would still have to say, you have to follow up with your doctor, and they have to make the changes, unless the doctor gave me the, you know, the permission to make the changes.

Scott Benner 1:11:42
Well, there are, there are companies out there that help people, and they do exactly what you're talking about, and they're not run by doctors. Yeah, yeah. Well, just remember, 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. Now, have you ever thought of bolusing for the fat in your french fries? I bet you haven't. Let's talk about it. Thank you very much. Hold on one second. Okay,

'Mia' 1:12:07
thanks. Okay.

Scott Benner 1:12:17
Did you know if just one person in your family has type one diabetes, you are up to 15 times more likely to get it too. So screen it like you mean it one blood test can spot type one diabetes early tap now talk to a doctor or visit screened for type one.com for more info, this episode of The juicebox podcast was sponsored by us Med, usmed.com/juicebox or call 888-721-1514, get started today with us. Med links in the show notes, links at juicebox podcast.com, Arden started using a contour meter because of its accuracy, but she continues to use it because it's durable and trustworthy. If you have diabetes, you want the contour next gen blood glucose meter. There's already so many decisions. Let me take this one off your plate. Contour, next.com/juice box. I want to thank you so much for listening and remind you please subscribe and follow to the podcast wherever you're listening right now, if it's YouTube, Apple podcast, Spotify, or any other audio app, go hit follow or subscribe, whichever your app allows for, and set up those downloads so you never miss an episode, especially in Apple podcast, go into your settings and choose download all new episodes the diabetes variables series from the juicebox podcast goes over all the little things that affect your diabetes that you might not think about, travel and exercise to hydration and even trampolines, juicebox podcast.com go up in the menu and click on diabetes variables, the episode you just heard was professionally edited by wrong way recording, wrongwayrecording.com. You.