#137 Dr. Jessica Lloyd, T1D

Jessica was diagnosed at age 27 while in medical school...

This episode offers the perspective of a person living with type 1 diabetes who happens to also be a physician.  

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

Scott Benner 0:00
Hello, welcome to Episode 137 of the Juicebox Podcast. This episode of the podcast is sponsored by Omni pod and Dexcom please go to my Omni pod.com forward slash juice box, or dexcom.com forward slash juice box to find out more. In this episode, Jessica Lloyd is a adult with Type One Diabetes, she was diagnosed while in medical school at the age of 27. So it's a pretty interesting mix of a physician and a person with diabetes, talking about diabetes, great perspective from two different ends of the conversation that I think you're going to enjoy. Here we go. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before being bold with insulin. And speaking of being bold with insulin, thank you to everyone who's already placed orders for the bold with insulin t shirts and other swag. If you're interested, go to ardens de.com forward slash store with links in your show notes. Those of you who have already received your shirts or about to receive them. If you get a chance to take a picture of yourself put them on social media hashtag the bold with insulin and Juicebox Podcast. I'd love to see them on you. Alright, here comes Jessica.

I'm almost a little happy that your that your camera popped up there for a second because you're really young. Are you I am?

Dr. Jessica Lloyd 1:32
Yeah, I'm 32

Scott Benner 1:33
Wow. Because your resume reads like you're like 50

Dr. Jessica Lloyd 1:39
that's like the nature of medical training. You know, it's a long road to hoe, but you can stick a lot of things one after the other on your CV.

Scott Benner 1:46
It's really something like I got it. And I was like, Wow, that's a there's a lot of impressive words on there.

Dr. Jessica Lloyd 1:52
You know, they trained us that in medical school, how to make gum, you know, even just going to the bathroom from fancy.

Scott Benner 1:58
My wife's works in a pharma company. And at her last job many years ago, she had a title that I pointed out to her once had to made up words. Ah, yeah. And I was just like, I'm like, those are farmer words. Those aren't real words, you know? And she's like, no, everyone said, I said, it says pharmacovigilance. I'm like, it's not a real word. I don't I don't care what you say. So, yeah, it just had the same feeling. So it was really cool to get your note. And especially sort of the way you the way you spoke about the way you spoke about the podcast was interesting to hear it from another person's perspective, because I guess it is sort of that way in life. Right. You know, it's, I don't want to call the podcast art, because I don't believe that it's art. But I think that when you kind of create something from nothing, that you have this image of what it is in your mind, but it ends up being something different to the people who consume it sometimes, you know.

Unknown Speaker 2:55
Yeah, yeah. And

Scott Benner 2:55
so when you said that, that it almost felt, I don't know. Like it just it was just really interesting. We'll talk about it. So go ahead, introduce yourself, and then I'll say more about that.

Dr. Jessica Lloyd 3:05
That sounds good. Well, my name is Jessica Lloyd. I am a urologist. I should a fellow in the respective urology, and I was diagnosed five years ago with Type One Diabetes and kind of reached out to you Scott, just given my experience with diabetes, and then also being kind of behind the curtain as a medical person.

Scott Benner 3:24
Jessica, when you talk, something's happening. It sounds like there's a tiger crawling behind you when you speak but not Oh, God.

Unknown Speaker 3:32
Yeah.

Unknown Speaker 3:33
The cat is purring. Let me get rid of him.

Unknown Speaker 3:35
It is. Yeah, that's

Dr. Jessica Lloyd 3:36
exactly what it was. I'm gonna go to a different room where they can't pester me. That's so funny. I didn't realize that this the mic was that powerful.

Scott Benner 3:44
I said, Oh, she's talking and I'm like, I can't decide how I feel about the microphone. But is it good? I guess we have to get rid of that weird sound.

Dr. Jessica Lloyd 3:51
Yeah, here and now. I'm Stein's cat. Can you hear anything? Oh,

Unknown Speaker 3:55
no, I couldn't hear that. He can't believe that. But I thought it was happening was actually happen. I

Unknown Speaker 4:01
mean, I was like, Oh, this little jerky. Well, I'm sure I can't hear

Scott Benner 4:08
you like, Hi, my name is just gonna wonder if someone's like pouring concrete next to her house or one time. It's funny how these mics work. They're they're so advanced that when you're speaking, they're grabbing sound and when you don't speak, they sort of know not to work as hard.

Unknown Speaker 4:26
But

Dr. Jessica Lloyd 4:27
my name's Jessica Lloyd. I am a fellow in female pelvic medicine and reconstructive surgery. And I'm also a type one diabetic diagnosed five years ago when I was in residency. And I'm just eager to share my thoughts.

Scott Benner 4:42
Well, so first of all, that's a it's an impressive little resume there. But is female reconstructive surgery?

Dr. Jessica Lloyd 4:51
sure that that's a really good question. It's a subspecialty within urology actually can get to it through GYN ob gyn residency as well, but it's additional training after residency for people that want to help women that have trouble with incontinence prolapse voiding dysfunction, kind of different features of the female genital urinary tract that can be corrected surgically.

Scott Benner 5:12
Okay. So you were just like, Hey, I'm a doctor now. But I want to be more specific. How does that? Is that is that is that a especially that that sort of cost you during your training? I mean, it's, I don't imagine that something you like, launched out of your four year degree, and you're like, you know what I'm gonna do? Or maybe it was?

Dr. Jessica Lloyd 5:29
No, you're very right. I think a lot of people go into medicine with ideas about I'm going to do XYZ actually went to medical school thinking I was going to be an orthopedic surgeon. And it was totally wrong, no interest in that. And when I started my urology residency, not sure I really had a great sense of what I wanted to do, I kind of liked everything. There was a while when I was kind of high on the idea of PT reality. But as you get a little bit more experience, you start realizing what you like what you don't like, and for me female urology is just a great fit.

Scott Benner 5:57
That's really cool. It's just interesting how I guess it shows itself as you're, as you're going down that path and trying to figure things out. But you said, How old are you now? Do you mind saying,

Unknown Speaker 6:09
Oh, no, I'm 3232. And

Scott Benner 6:11
how old? were you when you were diagnosed with type one?

Dr. Jessica Lloyd 6:14
I was 27.

Scott Benner 6:15
So you were in school?

Dr. Jessica Lloyd 6:16
I was a resident. I was in my third the beginning of my third year residency and residency six years.

Scott Benner 6:21
Wow, okay. I'm sorry, I'm, I'm remembering back to the first time I got a car loan. And I was like four years? No, yes. Did you like, you know, I was in residency for six years. Now. I'm assuming you have an undergrad degree. So what do you have in total? Right? How much? How much education in yours?

Dr. Jessica Lloyd 6:39
Well, I think I started kindergarten when I was four. And today, so if you say 32 takeaway for what's at 28 years, if you include all the you know, addition to the introductory stuff, Jessica, my longtime

Scott Benner 6:52
major props are going back to kindergarten, when I asked you how long

Unknown Speaker 6:56
you know, you might as well get credit for everything you do.

Scott Benner 6:59
Yes. So I never even considered that. But I am, I'm gonna start talking to people like that to say in my, my 12 plus years of education,

Dr. Jessica Lloyd 7:07
yeah. But, but I guess if you skip out on the sort of high school stuff, it's four years of college, where he's in medical school, and then six years of residency, and my fellowship is two years, which, that's certainly just a special brand of torture that I elected for myself, you know, that's optional,

Scott Benner 7:22
we will you make time in your 60s is that which is your

Dr. Jessica Lloyd 7:27
goal, you know, unfortunately, I'm married to someone that has a real job and has really pulled his weight, supporting my family financially for a long time way to go. But my joke with him is that, gosh, you finally when I get a real job, and start being able to pay back my loans and contribute in a meaningful way, you know, you can just take early retirement,

Scott Benner 7:44
I wandered around, so I've been a stay at home dad for 17 years. And, and I, the first time I you know, I got an ad on the podcast, like it was a really struck me as if I haven't made any sort of money really ever. Going back to when I when I you know, when we were like, hey, one of us should quit our jobs and stay home with this baby. And, you know, we did the we did the loose math and my wife had a, my wife had a reasonable trajectory, we were young, in our early 20s. And I, you know, I always say that if my wife would have quit her job, and I would have elected to take care of the family that we'd live, probably in a swamp somewhere, you know, on the in the panhandle somewhere just you know, in a trailer trying to try to avoid gators with the amount of money I could possibly bring in. And my wife just had such a better track that we you know, we kind of stuck with her. But way, way back then, I was doing graphic design for this, like little credit union. And I did a couple more jobs after I quit my job to make money to buy my wife and engagement ring. Because we'd been married. We'd been married for five years, almost without an engagement, right? And at that point, and so I did that. And then I just hadn't worked after that. And now like I do speaking out, I'll go speak places and everything. And then those checks are really nice, but it's once in a while and it's you know, it's not an overwhelming amount of money. But so the podcast came in it was the first time I got like a check in a while. sighs I hung it on the refrigerator, like it was an art pop. Like it was an art project. Yeah, you know, and then and then one time, I was like, Hey, we bought something I was like, I'm gonna consider that I paid for that. And she's like, if it makes you happy, and I was like, yeah, that's a little bit actually. It's a weird thing to I don't know how to how to I always say to people, like it's odd to have your wife's birthday rolled around, and you go buy her a gift and then recognize it's her money you've bought her a gift with and then later you give her the gift. She doesn't like it. You're like, wow, I took her money and bought her something she didn't. So anyway, I'm sure you're being compensated slightly for your job. As a physician, I'm just saying with all the loans for the scallions of years of education that you had, I'm assuming euro You'll be paying this back for a while. But, um, but anyway, so you have, I mean that that's a really cool, like specific, you know, you know, track of medicine that you're involved in. And so you do search. So you do perform surgery on people, is that correct?

Dr. Jessica Lloyd 10:16
Yep. The nice thing about urology is it's a nice mix of kind of medical management and surgical approaches to disease. So, you know, within the field of Urology, you can do huge cancer operations, huge reconstructive operations, more sort of outpatient surgery, stone surgeries, which are often pretty simple. And then we do, like I said, a variety of medical management in the clinic as well. So it's a nice Gambit for people that want to be specialists but still want to have their hand kind of in both the medical and the surgical side,

Scott Benner 10:43
you're also helping people in with a specific issue that, you know, I'm assuming it's not, it's not completely easy to find great care in some of those specific specialties like that, too, you know, so it's cool that you gave your time and your and your whole focus to it. I think that's amazing.

Dr. Jessica Lloyd 10:58
It's cool. But it's also like a total treat for me. Like, I think the reason that I'm willing to be in training for a zillion years and, you know, put my family through, like the financial hardship of carrying my weight is like, it's great medicines a great job. And it's probably, you know, a little bit easier to say that as a fellow, because one thing that I protected from is a lot of the billing side of things, I have to do very little on that side. But like, forming relationships with patients, seeing patients in clinic, have people come in and say, gosh, you know, I didn't think that there was a way to fix my problem, but I'm hearing for you, maybe there is like, that's cool. It's great. I would pay someone for the opportunity to do that. So the fact that I get paid to do it is like, Wow, what a fortunate world I found myself in. So you

Scott Benner 11:41
have that really cool. You have that feeling that, you know, I don't want to, I'm not trying to like match up what you're doing what I'm doing. But sometimes I'll get an email from somebody and they're like, Hey, you know, I'm having a much easier time with my blood sugar than I used to because the podcast, I'm like, oh, wow, I help somebody today. Like that. Yeah, it's great.

Dr. Jessica Lloyd 11:57
It's a great feeling. Yeah,

Scott Benner 11:59
it's hard to replace, though it's not a, it doesn't really compare much with other things that I've experienced so far. Okay, so you're diagnosed while you're in school? and married? I'm assuming to right? Yep. Do have any kids. Okay, I'm just gonna say, I don't know how you would possibly make a baby while you were doing all that. But but just in case, you guys were just like, crazy. multitaskers? I thought I would. Yeah, but so. So So when you're diagnosed, and you're, you're in school? How does it kind of present to you?

Dr. Jessica Lloyd 12:30
Oh, gosh, that it was a bad scene. I was in my third year of residency. And our third year where I trained was a research year. So you have 12 months off of clinical duties more or less to conduct scientific research. And you know, medical people, we're kind of overachievers. And one thing that they tell us in medical school, and then in training is get your disability insurance, when you're young, you'll be insurable. It'll be relatively cheap. You can keep it for years and years. And then, you know, God forbid, something happens to you, you've got some some options and financial stability. Okay, it's my research here, I have like this nine to five schedule, I'm going to make an appointment with the disability insurance people and go ahead and get that done. So I met with the guys and one thing they do is, you know, whole battery of blood tests, and someone comes in and checks your blood pressure and your heart rate, blah, blah, blah. So I send off all my blood and they get a call back a week later, hey, do you have diabetes, your a one C is 6.3. And I was like, it was like the floor dropped out from under you, you know, like, I was not expecting that at all. So I didn't have a primary care doctor. I was 27 years old, healthy, ran marathons, like never really thought twice or anything, wasn't having really any symptoms. Although when I think back now, maybe I was having a little bit of weight loss, but nothing really to speak of. And so I like frantically call get like a primary care doctor go in? And she says, Well, you know, she's just a generalist, she cares as well, you know, you look pretty good. But you told me, you could maybe clean up your diet a little bit. So why don't we just try that and come back in three months and get another agency. So you know, I wasn't like, eating terribly to start as vegetarian, but I wasn't eating terribly. But I tried to be like a little bit more vigilant. And I don't really even know at this point, what that meant to me then. But I try to be a lot more vigilant, went back three months later, and my agency was 6.9. At that point, I said, Oh, I need to see an endocrinologist. So I tried to be good and just do it kind of the standard way that a normal patient would do it. And it called the appointment line where I was resident, and it's a big tertiary care hospital, you know, not a little put in place. And they sent it we can get in to see somebody in like, it was like two or three months. And I was like, Are you kidding me? Like, by world is crashing down like right now. You know, I need to see someone else. And so that actually was kind of the first time when I saw what I had options for kind of as a doctor in the system versus as a patient because I called up a buddy who I knew worked with an endocrinologist. He was actually the person I wanted to see and said, Hey, this is the situation I'm in. Like, can you help me out. And he routed my email to her to her the endocrinologist I went to see she said, hey, I've got time in my clinic tomorrow. And you come and I was like, Yes. But you know, just just the fact that that option was available to me because I had this entree into the system versus what, you know, general public has to deal with. Maybe say, gosh, you know, this feels unfair. But I still took it. Oh, yeah.

Scott Benner 15:24
This is wrong. And right after I get myself together, I'm gonna fix this for other people. And no, I would listen, everyone would have done the same thing. Right. Right. But that isn't that insane. That, that that that gap of time? Well, first of all, what you hear is that because you're an adult, even though it looks like you have type one to the doctor, like, well, let's wait because you probably don't. So it's even even with physicians who shouldn't be thinking that way. I've interviewed people 59 years old diagnosed with Type One Diabetes. So you know, like, even for physicians who probably shouldn't be thinking that way, it's still sort of the norm, you know, like, like, well, you're probably too old for it. So maybe it's something else. I'm just trying to imagine. When you're vegan, and you don't feel like you're eating very well. Does that just mean cookies? What does that mean? Exactly?

Dr. Jessica Lloyd 16:09
You know, it's so funny, like, so actually, my diet has really changed since then. I wasn't vegan, I was vegetarian. But like, you know, I would eat for breakfast, probably like a Clif Bar. And then for lunch, I the one thing that I really remember is I would make this coconut rice stuff. And it was kind of like a curry rice with egg and like some peas and green beans. And then for dinner, I'd have like a big salad. My husband hated those salads. When we really want to get diagnosed, we really changed the way we ate. I think it was like the happiest guy. But um, I think the big change I made is I I you know, like many people, I kind of like desserts, especially then I really had a sweet tooth. And so I would oftentimes have like, not one, but two desserts after dinner. Oh, why not? 27, you still got a metabolism running all these races. And so I think I cut back from two desserts to one dessert with like the big change that I made.

Scott Benner 16:58
I like the way you think that's I've really cut back, I'm just having one of these cookies, or whatever it is. So Wow. Okay, so that's kind of crazy. Now. Now. So you're in there. And I'm assuming because I have to admit like my, my, one of my best friends in the whole world is my is my children's pediatrician. And so there is something to being able to like text a picture to somebody and being like, hey, do I have to go see a doctor for this real quick? Could you tell me and wow. And it's great. So you're in there and not that you know, this doctor that you got the appointment with, but now there's a professional courtesy going on, they recognize what's you know that you're a physician, and they are too and you're going to get sort of like, what you would assume is I don't want to say better, but I guess better care, like she's gonna they're gonna pay closer attention to you. What was your feeling for what your life was about to become as you left that appointment?

Dr. Jessica Lloyd 17:51
Oh, Scott, it was like really devastating at the time, because I'll tell you, especially on the surgical side of things, we don't see people with diabetes who are flourishing in the wild, we see people who are sick for potentially a number of other reasons, who are in the hospital with like, bad problems. And I can tell you as a as a urology resident, we do a year of general surgery training to start our training. And you're involved with the vascular surgery service, and they do amputations for you know, diabetic foot ulcers, and I've been in on those surgeries. And they are honestly, they I perceive them as pretty gruesome. I've seen people come in with gangrene and you know, like toes that are falling off. I've seen people waiting for their kidney transplants, because of poorly controlled diabetes. I remember a woman who was who lost her vision at 31 that I remember her face to this day that was actually in medical school. But you have all these visions. And granted many of those patients. They weren't like me, they they weren't type one. But even so some work. And that's kind of the vision that I have. And I literally, I think one of the first thoughts that went through my mind is I'm not going to be able to practice medicine anymore. Like how will I get hired by a consulting firm to do medical consulting? I actually I think I went to the McKinsey website like that night, and looked at like how you sign on as like a, you know, early career professional to be consulting.

Scott Benner 19:12
You know why that's so interesting, because I have a few friends who are police officers, like lifelong lifelong police officers. And something I've noticed about each and every one of them is, you know, after a decade or so of being a police officer, there's sort of just this knee jerk reaction in their mind that everybody they meet for the first time is up to no good. You don't recognize till later, when you really step back and look at their lives that when they go to work every day, most of the people they speak to are lying to them trying to get out of something or breaking a law and so that they that that sort of becomes their norm for what the world is. And I guess when you're a physician, that could be the same thing, right? Like there's, there could be a million people in the world with diabetes. Obviously, there's many more, but if you could have a million people 900,000 of them could be living really well. Well and healthy with it, but the hundred thousand that aren't you say? Right, right? And then so that's your expectation for it. That's really something you must have been. You see, that seems unfair to you actually. Because when I come in when my with my daughter and I know nothing about type one and some doctor says, Hey, you know, even though they're not very good at it, they say horrible things like your life's about to change forever and you can't stay alive without this insulin, you're like, wow, there's probably a nicer way to say that. And you know, and then all that stuff, but I still have like the hope of the medical community and the hope of tomorrow and that I have never once seen an ulcer ridden foot in surgery. And like, right, so I'm, I have a better outlook, but you probably were really devastated. Jessica is gonna answer that question. As soon as we talk about on the pod. Flexible, precise, simple, discreet, waterproof, that is the peace of mind that you're going to get with the Omni pod tubeless insulin pumps. And there's a really simple way for you to find out, if you're going to enjoy it, you just go to my Omni pod.com Ford slash juice box to try your free no obligation demo pod. You plug in the tiniest little bit of information about yourself, send it off to Omni pod, they're gonna contact you and send you a pump. Now it doesn't work work, but it is the exact pump. So you can wear it, see how it feels and decide for yourself? Is that stuff Scott's telling me on the Juicebox Podcast? Is that true? You get to decide. And if it's not no harm, no foul, you just don't do anything. But if you love it the way I think you're going to think you just keep moving in the process. And on the pot is going to make it super simple for you to either switch from the pump you have now or start using an insulin pump for the first time. As a matter of fact, if you happen to be an animist user right now on the pod knows that things are changing quickly in diabetes technology. And they understand that that can be stressful, they are really committed to the diabetes community, and to their tubeless insulin pump system. So for atomists users right now, there are zero upfront costs. And they hope that that helps you ease the transition because they know how much it hurts to leave a pump that you love, and to find another one. But they are also very confident that you will love on the pot. So whether you're an Atmos user who's been abandoned, and you need to find a new pump, or you're just somebody who wants to try it and some pump for the first time. Here's what you need to do Miami pod.com, forward slash juicebox. Give it a try today, I think it'd be happy to eat it. I mean, honestly, given the choice between tubing and no tubing, is there really much of a decision to be made to buses? It's better.

Dr. Jessica Lloyd 22:37
It was really hard. I really, you know, how are you at this point devoted four years of medical school and two years of residency up to that point to urologic surgical training? And I really had a lot of question about like, will I be able to be a surgeon any longer? And it's turned out actually it's totally fine. Like, it requires a little bit of thought, but it's totally fine. I have no doubts about that now. And you know, it's certainly not been what I thought it was. But I was really concerned. And then the other thing again, sort of having this ending my rational mind said, Well, I'm not going to be one of these people that hopefully has, like, quote, horrible complications. I'm putting that in air quotes you can't see. But that's, I think, a very loaded term. But anyway, you know, I probably won't, this probably won't be me, but my kind of non rational mind, you know, it's just running a muck kind of saying these worst case scenarios.

Scott Benner 23:28
I'll be dead nine months. Yeah, right, right. No, no, I Oh, wow. That's not okay. So did you get um, how did you? How did they set you up? needles, pens,

Dr. Jessica Lloyd 23:39
Paul. So it's interesting. You know, I guess Ada now is talking about stage one, two, and three of type one diabetes, stage one being you have anti beta cell antibodies, Gad antibodies, but your glycemic control is normal, you don't have any dysglycemia. Stage Two is you start having some displacing the elevated blood glucose in the presence of auto antibodies, but you're not, you know, meeting criteria for it, you know, in England see a greater than 6.5, or kind of the other standard criteria, type one diabetes, and then stage three would be overt symptomatic, auto antibody positive. And so really, you know, where I was kind of that stage two place, I had some dysglycemia. But I I probably wasn't at a point where I could really tolerate systemic insulin. So the decision was made, like why don't we just put you on some into hypoglycemics? Once you go on Metformin, and start checking your blood sugar, and we just forget some patterns, and we'll keep a close eye and you know, probably within the next six months to six years, you're going to need to to go on insulin, but you're not there yet. And so that's where I started. So did they see you

Scott Benner 24:39
as a type one in that moment?

Dr. Jessica Lloyd 24:42
You know, the phrase that was put on it with Lada latent autoimmune diabetes of adulthood, I think was very fair. But no, I don't think people knew exactly where I was going to shake out and there wasn't a lot of counseling that was able to be given. So

Scott Benner 24:55
with it with hindsight now and with your background, because you do hear this happening. to adults a lot, right? There's either their misdiagnosis type two and their type one or they're told Lada and it's something, you know, and it's type one or you know, like, do you see that path that that process goes through? Does that have to be like that? Is it just such an in specific situation for the for the doctor who's diagnosing you? Because I think some people see it as, as mismanagement on the doctor side. But sometimes I listen to the stories and I think, well, I don't know how they would have come to a different conclusion immediately.

Dr. Jessica Lloyd 25:29
No, I think in my case, I don't think I was mismanaged. You know, it was this really fluke thing that I got this, you know, insurance bloodwork, and had I not done that, I think what would have happened is I would have gone about my life, and then eventually, you know, really gotten to sort of overt insulin dependence. And come in, you know, who knows, and DK are probably your epilepsy, all those things you usually hear about, and probably would have gone straight to type one diagnosis. But I had this long runway because of this fluke thing of being kind of caught where I was. So

Scott Benner 25:58
that makes I don't, yeah, yeah, that makes sense. Oh, gosh, oh, well. So at what point could How did you? How would How did you enjoy the metaphor

Dr. Jessica Lloyd 26:08
was fine, I had a little gi distress To start with, okay. But that was when I decided, like, you know, just from some reading on my own, and things that just sort of made sense. And I think that one direction that our conversation may go is like, in some ways I kind of was out in the wilderness, because I'm not the standard track. And I have like, just enough knowledge to be dangerous, though. And like the busy world of doctors, I think a lot of people kind of trusted me to manage myself in my own way sometimes, which is probably good and bad. But I decided at that time, like, you know, I was on the super carb, heavy vegetarian diet. And I was like, this is not going to be sustainable. So literally overnight, I went from, like very carb dependent vegetarian diet, to a more low carb paleo diet, I added meat back in, which is like, a boon for my husband, and really cut out all the grains, almost all the carbs, to sort of a veggie protein fat diet.

Scott Benner 27:01
It's like, it's like, it's like a bad sitcom where someone asks your husband, are you a vegetarian? He says, No, but my wife is so yes. And

Dr. Jessica Lloyd 27:08
no, you're exactly. The grocery store.

Scott Benner 27:13
But so, so listen, were you a vegetarian? not to get too far off track. But were you a vegetarian for just dietary reasons? Or did you? Do you have did you have? I'm trying to imagine, did diabetes put you back into eating meat? And you didn't want to for

Dr. Jessica Lloyd 27:27
yes, no, you're exactly right. Scott was a very astute pickup. So in college, I kind of decided that I wasn't really sure about the safety and environmental ethics of how meat was typically produced. You know, they talk about the number of gallons of water that it takes to produce pounds worth of protein from animal protein versus a pounds worth of protein from plant protein sources. And it's like some, you know, tenfold difference quite a bit, or, you know, methane that's produced by cows, or and then also, you know, what are all these hormones that's put into the meat systems. And especially when I was in college, I was broke. And so it's not like I had the money to buy kind of ethically sourced organic fancy stuff. And so I said, I'm just going to pull myself back from this system. And until I know more, or until I can afford to do what feels for environmentally and ethically right to me, I'm gonna just not eat this stuff and make it really simple. And so that was from college until into your diagnosis. That's a long

Scott Benner 28:25
time. That's like 10 years it's a big chunk of your life. Yeah. And so that you know, I always always hear people that have to make dietary changes I just spoke to someone yesterday who's episode won't be out for forever but whose child was diagnosed with type one and celiac at the same time and there was this big switchover in the house for dietary reasons, but it never occurred to me that there could be like your social like, ideas could be affected by it. I just that never shocked me at all. That's interesting. But I guess that makes sense. Did you did you enjoy the first hamburger afterwards? Or did you feel bad I want to know that

Dr. Jessica Lloyd 29:02
you know, I think the first time I actually like you know did a little reading on like, well when people reintroduce protein after not having eaten animal protein for a long time What should I do? And like the whatever website I went to on the internet said Oh, go with something bland do like a chicken breast and created I think that I probably had never prepared a chicken breast in my life because I went from high school at home where my family more or less cooked for me to college where then I stopped eating meat to now Okay, I'm gonna drink because and I think it was terrible. Like, just like, dry and probably I didn't have any sauce or anything on it. And I was just like, this is what I had to do some learning. It's amazing.

Scott Benner 29:43
I'm sorry, I did that just really caught my attention when you're saying it. Oh, you're not I know. That's probably not why you came at a talk but still.

Unknown Speaker 29:50
So okay, so do you.

Scott Benner 29:51
Do you use a pump an hour glucose monitor any of the kind of technology?

Dr. Jessica Lloyd 29:55
I use a CGM. I've had it for probably two and a half years. I love it. My dexcom is Like, just the best thing. And I'm actually just in the process now of going for multiple daily injections to getting on a pump and shout out Tommy pod. That's

Scott Benner 30:09
the pump that I've selected. So I'm just waiting to get all the insurance stuff cleared up. And that's really cool. So, this this is interesting. So you've been doing injections. I'm gonna I'm gonna go down a lot of different paths with you today. So you've been doing injections with a dexcom? Where are you willing to tell me about the Ranger a once a season? Sure.

Dr. Jessica Lloyd 30:27
So my probably range for the last year was or my average for the last year is about 5.7. Wow.

Scott Benner 30:34
And do you feel like and so you can see a bunch of you do you have a plentiful amount of lows or anything like that?

Dr. Jessica Lloyd 30:40
I have more lows than I would like. That's one of the reasons I'm going on the pump. It's funny actually, going from being a resident to being a fellow is like night and day in terms of lifestyle, like my work hours in a week, for as a resident were probably like close to 70 hours. And my work hours as a fellow are like 45 to 50 with a lot of flexibility. So even though you think, gosh, residents, they're working all these hours, that sounds so brutal, it was actually very easy to be very regimented. Because every day look the same. It involved Work, work, work, and then more work. So I wasn't exercising, I wasn't going to restaurants, I wasn't, you know, having two glasses of wine. There were not any variables. Yeah. So I was very able to, like, really know what was up. Versus now as a fellow like i three days a week, I go to these, like pretty intense interval training class, I go CrossFit, you know, so that does a number on my blood glucose. And you know, the weekends, my husband, I go out, and maybe that does a number on it, too. And so now that now I need a little bit more flexibility because of a lifestyle that allows for that,

Scott Benner 31:39
yeah, you bring up something that I don't know that I say enough is that I have an easier time managing art. And while she's in school, because after the first couple weeks of school, it's she gets up, she eats or doesn't eat in the morning, she goes to school she eats or does, you know, she eats at a certain time she gets home at a certain time, once you figure out the pattern of that. It's just like autopilot after that. It's summertime, that's worse, because now she doesn't always get up at the same time. Now, sometimes she wakes up at noon, and it's like, I'm gonna have pancakes instead of, you know, like, Oh, I, you know, used to eat at 1030 at school and now and it just the variability is it's cheating almost when your life is really structured, it is almost cheating a little bit with diabetes, because you you sort of don't have a lot of unforeseen things happening to you. You're right. Yeah, that's really something so. But so but you did say so you have more lows, and you want so you're having lows? Because Because the reason I asked about the Dexcom in the injections is I've gotten a fair number of messages from people are like, Can you talk about how you manage your daughter, but how you would do it without a pump. And swing dried, I had someone on the show it hasn't aired yet. And you know, they have a child with you know, and we just kind of tried to talk it through and 20 minutes into it. I was like, I guess I can't do it. Like, I don't know how to you don't mean like how do you look at a 140 and say, you know, I'm gonna inject the tiniest little bit of insulin to try to bump my my blood sugar down 30 4050 points, like, you're not going to I don't know if an adult might do it. But I don't know a lot of parents who'd be like, hey, come your eight year old, you know, I'm gonna push your blood sugar a little bit here. And you're gonna have to stick with another needle. I know, some people are bothered by it. But it just in my mind, that's the only way I could really consider it. So are you excited about that? Is that the is that the most exciting part about thinking about getting a pump is just smaller adjustments?

Dr. Jessica Lloyd 33:30
Absolutely. Because you're so right, like, and I use pens too. So I've got one unit is my smallest dose. I can't even bolus myself with a half unit recorder unit or something like that. And then the idea of like Temp Basal. Oh my god, every podcast of yours I listened to and you said I'm just gonna put our note at Temp Basal. I just like you my eyes get big. And I'm like, I can't wait.

Scott Benner 33:49
It is I've been repeating myself. But even before I really knew what having a pump meant. When we went to that first pump class, and we were having that discussion with the nurses and everything at the hospital. And they started describing it. I was like, oh, wow, like, we won't use the slow acting insulin anymore. Like that didn't even occur to me back then. I was just like, oh, so the pump will do the whole thing. And then I was like, wow, you so I could stop it and start it. Like, you know, like, it was just a dream come true. Because I've said it a million times. But there were so many times I'd look at my daughter and her blood sugar would be like sitting at this spot. And I think I wish I could just shut her off right now. You know, and or, yeah, I wish I could just make it work a little harder a little faster. That was my first excitement about a palm pump was the idea of manipulating the basal insulin. So you're gonna have such a good time. I know. It's such a geeky diabetes thing to say I guess. But great. Yeah. So hey, we're gonna keep recording, but we're gonna do ardens balls for lunch real quick.

Unknown Speaker 34:47
Oh, perfect. Yeah.

Scott Benner 34:49
So this is a day one of a new pump. So it's working extra good at the moment.

Unknown Speaker 34:56
She

Scott Benner 34:58
had a little thing this morning. She just got Contact lenses the other day. She's a little struggling still with the the in and out of them. So she comes downstairs, she's like 10 minutes early to go to school. And she and she comes downstairs, she's like, I'm just gonna pop in my contacts and then we can leave. I was like, okay, it 20 minutes later, she's 12 year old cursing in my kitchen, like poking at her face, you know, and she's now late for school and, and I'm like, it's okay. Like, I don't want to freak her out of that, because she's doing well with it with a contact, you know, so I'm just like, Don't worry, it's all good, you know? And so, and so I didn't want to freak her out. But I think she started getting a little kind of agitated. Uh huh. And so I say I'm looking at her blood sugar just starts heading up. And on our way out the door, somebody left a soft pretzel on the liver. It's a lot of softball baseball, played here yesterday afternoon. So a lot of for northeast people, a lot of wildlife as it's happened yesterday. And so there's this she's like, I'm just gonna take a piece of this soft pretzel, she Yanks off this just nondescript hunk of a soft pretzel, and I was like,

Unknown Speaker 36:04
okay,

Scott Benner 36:06
so I was like, I said, Why don't you hold on we're gonna do a nine unit extendable is 30% now and the rest over? She's 76 right now. Her blood sugar I like so here's the rest of the story. Not she eats the pretzel. I'm like Bolus two units, because I don't know what to do. She was like 110 dybdahl up, she's grabbing this piece of software sound like do two units. She does a two unit she gets in the car seat in the press order. There's no Pre-Bolus like, everything's gonna get a little upside down. So about an hour ago, she like level like she just kind of climbed and climbed and climbed and leveled at 170. So I gave her this like point seven Bolus. And now she's 70. Like I said, 76 now, but now I have to I have to Pre-Bolus for lunch of the rest of the day is going to be like a magic carpet ride to hell. So. So I'm thinking that this extended Bolus, if I put three units in, she won't start falling in the next 10 minutes off of three units, because it won't even get started. By the time she starts eating the rest of it'll start working for the exam. It should be fine. All right. I'm shutting the I'm shutting down the text method. Sorry. Oh, no problem. So so so now you're going to get a pump, you're going to make these adjustments you're going to is that your nature? Like is? Are you going to be like super geeky with it? Do you think

Dr. Jessica Lloyd 37:25
Oh God, yeah, I know, you're not necessarily a data guy, although I think you actually are a data guy at heart based on how you kind of manage, and I'm going to even use the word experiment in like a really loving way, with with artists management, but I'm like, totally a data guy. And so I can't wait to be able to make those little changes. And, you know, sort of do a little experimenting. I think that that's one thing that I've really learned in my management, because again, I know just enough to be dangerous. And I think that that's sometimes led my doctors to give me a little leeway. And now that I'm coming and kind of getting this pump education, like I'm realizing that, you know, I didn't learn the classical teaching. But in some ways, that's really freeing, because as long as you're able to do it safely, it gives you a lot of empowerment to manage your disease for yourself, because you always say this, you know, you see the endocrinologist once every three months. As an adult, I see the endocrinologist once every six months. And if those were the only times I was making changes to my regimen, I mean, forget it.

Scott Benner 38:25
He said the one thing I have had going for me that it's such a weird thing, because growing up, I don't think this was a trait that anybody would want their kids to have, but I don't really enjoy being told what to do. And so I and and I have just enough narcissism to really believe in myself, for reasons that aren't really valid. But, but I so I believe in myself, I don't like being told what to do. And so then when I get into a situation where people are like, you can't do this, or you need to do it like this, my immediate natural reaction is well, if you like, like, I'm gonna, I'll do it, you know what I mean? Like, and, and I. And so, like I said, I don't think that's something you'd want to look up and see your 16 year old employing in their life, and I'm sure my parents weren't thrilled. But when once Arden had diabetes, and I would see the doctor saying, you know, do it like this, and then that wasn't bringing any kind of a resolution that I was looking for. It was very simple for me to just go I'm not going to listen to you. And I think sometimes not that I don't think you should listen to your doctor. I think that sometimes when you're seeing things happen right in front of you, and they're happening over and over again and you're not insane, you should probably trust that they're actually happening. And you know, and to go back to this person every quarter who says no, no, no, this is the rules do it like this. The one thing that I you know, there's a number of things that I see in the community that make me feel terrible, but people who are caught in that pain of I want to do something positive. What they're telling me to do isn't working but I have been raised or my brain works. In such a way where I can't buck power, you know, like, I feel terrible for those people who were stuck because because they can see it. Like, I always feel like they're standing at the finish line, they can see that like one more step, they're going to be in a field of wildflowers, you know what I mean? And, but there's a guy on the other side and a white coat go and you can't come over here. Stay put, yeah, and and then they do it. And so I'm just like, oh, that's horrible. And so not only is it horrible, that they're not getting to this health resolution, or living a, you know, a healthier

Unknown Speaker 40:29
way.

Scott Benner 40:30
But but that they're tortured by it at the same time. Like they're, they're, they're, they're cognitively aware that they're being tortured. Like, that's how it feels to me when I see him do that. So, I don't know. So like, that's the side of me, I like to let out when I'm talking because I hope that people find in their heart, like just the, you know, in the end this very simple, you know, advice, which is, you know, just trust your gut a little bit. I think trust your gut is great advice. But if you're having trouble doing that, you could definitely trust the dexcom g five. This continuous glucose monitor is the core of how we take care of art. First of all, there's sharing follow apps, right? These apps are available for Android and for iPhone. So Arden has the Dexcom share on her phone, and the Dexcom follow on my phone as my wife and anyone else, we want to be able to see Arden's blood sugars. So we set these ranges on her on her device, and it tells us, hey, her blood sugar has fallen below 70, or it's rose above 130, then we get to make these kind of quick and simple little adjustments to our blood sugar that keep things from getting way out of range, causing that ride on the roller coaster that I know everyone hates. This is all really due to the data that's coming back from the Dexcom. These rise and fall alerts are the key to how you can make quick decisions, decisions that keep big problems from ever happening. Now, of course, my results might not be your results. But you listen to the podcast, you know how it's working for me, I think it's very likely it'll work for you the same way. In addition, FDA has already said you don't even need to test anymore, you can use you can use the Dexcom to make dosing decisions. So for instance, just a few minutes ago, while I was doing this, I gave Arden insulin for lunch while she was at school, she didn't have to test her blood sugar, she just sent me a quick text, we talked about it for 30 seconds, we did a bolus with around the pod. And that was it. Her blood sugar is cruising along, she got a great Pre-Bolus for her meal, everything's good. You definitely want to be able to see that information when you're making these decisions. Go to dexcom.com Ford slash juice box. And when you get there, fill in the information. And you'll be on your way to a life with diabetes, much like the one I described here. dexcom.com forward slash juicebox. Do you ever wonder like maybe you're not in a similar situation? But is it? Is it odd to listen to a conversation that goes, I go to my doctor, this person who went to all the schooling and really is trying very hard to do the best thing. And the help they're giving me is very mediocre fast is that? How do you see that from a physician side?

Dr. Jessica Lloyd 43:04
There's so many angles to how to answer that question. One is, you know, kind of the individual health versus population health question, you know, and then one is the question of what's gonna kill someone today versus what's gonna kill someone in 30 years, you know, here's a perfect example. I was at this pump class two days ago. And you know, there's some audience participation, there's maybe six people there. They're all doing a pre pump training. And the CDE there says, Okay, well, if your blood glucose is 70, what's your correction? And kind of everyone goes around the table. Okay, well, here's what I would do blah, blah, blah, and the standard teaching and what the CDE wanted to say was, well, 15 grams of quick acting carbs, putting for me 15 grams of carbs is going to raise me 100 hundred 30 milligrams per deciliter. And that would put me from 70 to 170 200. You know, and that, that, especially with the Dexcom, the I don't need that. But, you know, for people that don't necessarily have a dexcom don't know, well, hey, Was I a flat error was I double down arrows, you don't have that, or don't have kind of the same insights into their disease or aren't going to retest, you know, say, hey, do 15 grams of carbs, you know, that person is not going to then it's likely not likely to then have some sort of terrible outcome of you know, acute hypoglycemia seizure or something, you know, so on so forth. So they're really I think, really incentivize our doctors are really incentivized to say, what is going to address this problem right now. You know, it's like triage, as opposed to sort of thinking more into the future.

Scott Benner 44:32
Yeah. And it's, it's something to because it's such a specific idea when you said when you asked the question your blood sugar 70 what are you going to do? My first question is, well, is it moving? Why

Dr. Jessica Lloyd 44:41
need to do anything? Exactly.

Scott Benner 44:43
Do I know isn't this where I pull out that little champagne popper and make confetti go up in the air? Like, aren't I? Yes, I did my blood sugar 70. And, and at the same time, if it was 70 and falling, I would have an answer. If it was 70 diagonal down, I would have an answer. If it was, you know, 70 and she had that insulin in four hours. I don't I have a different my answers are would be so varied. But I get what you're saying and I get I get what they're doing, which is they have to assume that everybody in this 70 situation needs to bring their blood sugar up, because not everybody has the same grasp of it, not everybody has the same technology, etc, etc. And they can't give you an amount of carbs, not going to save your life in case you're in trouble. So 15 is random. It's not random. 15 is the number you know, like 15 carbs, if you're not falling, should be enough to move your blood sugar back up again. And you, Jessica are going to use 15 and end up with a blood sugar of 170. And someone else is going to use 15 and up with a blood sugar of 85

Dr. Jessica Lloyd 45:39
weights. Maybe they were doubled down. Maybe they're not Dexcom users, they would know. But so their situation,

Scott Benner 45:44
right, right? It just so many what ifs and it is like I was I don't know when it was anymore. Now, it's been a few weeks, but I was up at a little later at night. And I was just sort of flipping through a bunch of different things. And I ended up on Facebook, where this person is like my daughter's blood sugar's 95 is like 130 in the morning, what should I do? And I was, I was like, Oh my god, I would like to take off all your clothes and run around the house and scream how happy you are. Yeah, that would be fantastic. Because Because this one see that you're that you're, you know, that you want so badly. That's how you're going to get it by leaving her at 95 all night. Yeah, you know, and so. But sure enough, so many people came in and said, You need 15 carbs Have a drink of juice wake her up, or something to eat. And I was like, wow, I 95. And I actually there are times I see my daughter's blood sugar at 95 and steady overnight. And I do think I wish I could get just a little lower, like, Oh,

Unknown Speaker 46:43
that's cool. You know, oh,

Scott Benner 46:45
my blood sugar is not 95. And I'm sleeping as well. Right? So you know, it's just it's but it's not very understandable. Everything you said about why doctors do what they do is very understanding. So now that's sort of your medical opinion of it, which I hear. And by the way, let's just say Jessica is not a doctor right now she's a person on a podcast. She's not here being your doctor. But But it's interesting to hear her insights, because she's got a lot of different hats here. So now, what's your what's your perspective of it as a person with diabetes with an MD? What do you wish they would have said in that pump training class?

Dr. Jessica Lloyd 47:21
Oh, gosh, you know, I guess I'm a little bit trapped at being that person that sees someone standing on the other side of the finish line saying don't go and then I just stand there because I understand why they would say that. But like, my answer honestly was, like, I'm certainly not going to take 15 grams of carbs, I might not even take four grams of carbs might not take any carbs. And I just sort of kept that to myself, you know, I sort of kept that very quiet. Because I felt like that would be very controversial, you know, so maybe that speaks to a little bit of, we all I think, have some reticence to disagree, not maybe not disagree, but to bring up contrary points to our CDs, our doctors, etc. Because oftentimes, they're so nuanced, you know that. I think it takes a special CDE or special endocrinologist to be willing to sort of accept that gray zone or that variability.

Scott Benner 48:12
I also think I brought it up while we're talking about it, because I really would like to people listening to here, like this is the reason you need to make sure that your physician that's helping you with your diabetes understands who you are and what your understanding of everything is, because they can, they will answer you differently if they recognize who you are, you know, for anybody who's listening to this, who has ever called me privately, and there's a few of you. Everyone's going to know that at some point in the conversation, they've heard me say, You sound like a bright person. So let's talk like this. And it is in the first couple of moments of the conversation, you kind of listening, I listened for a few things, right? their goals and their intent, how focused they seem on what they're trying to accomplish. And do they do I feel like in my estimation, I'm not a doctor. But in my estimation, if I start saying next level things to them, are they going to jumble them up in their head? Are they going to keep them straight? Are they understanding the nuance of what I'm saying? Or is it going to go beyond them? You know, and so, and even just a private conversation, that's clearly not medical advice. But still, I still think like, it's funny, it hits me to like, well, I wouldn't want to say this to that person, but I could see that person you know, so it's so important to let your doctor know who you are. You know what I mean? Like this is my love. I mean, don't don't go in there telling them you know, the AP classes you took as a senior but you know, but but you do want to give them the idea when you're speaking that look, I'm a bright, clear headed person goal is to make my blood sugar, my child's blood sugar more stable, lower, whatever it is, your goal is, let them let them understand that that you understand because then I think that in a lot of cases unless you've got a junky doctor, you are going to get a different level of direction from them. Do you think that's true? Do you find yourself doing that?

Dr. Jessica Lloyd 50:00
Absolutely. And I'm just going to call out one thing that you just said in that statement, which is, have some goals for your visit with your endo or your CDE. Before you can either think about it or like, honestly write it down, you're going to forget it when you're in the office. This is these are the two things I want to address, or this is the one thing I don't understand. And the one thing I want to work on, could we really touch on these things today? Because you'd be surprised, at least in my world, like, you know, as a urologist, the number of people that kind of come to the office and are a little bit all over the place. And it's hard sometimes. Well, it's not hard, I end up focusing that conversation on the things that I decide are most important. But that's that's me deciding, you know, rather than a patient driven visit, which is what we all aim for,

Scott Benner 50:41
do you think Jessica and I'm gonna be light hearted here for a second, those people are actually nervous because they're about to show you their lady bits. You know, it's

Unknown Speaker 50:47
hard to say.

Scott Benner 50:50
So by the way, update, Arden's blood sugar is now stable at 63. And the Pre-Bolus has been in for 10 minutes. So I'm going to assume that that first three units is starting to work on our a little bit, because she's down 10 points from where we kind of started 10 or 15 points where we started, but she's beginning to eat right now. So she's not falling, it's a 63 and stable, and the insolence starting to work, the food's gonna start working in a second, this is gonna work out, like perfectly, like I, this is gonna be one of these lunches, her blood sugar doesn't go over 95 for at least the next two hours. And, you know,

Dr. Jessica Lloyd 51:29
I know, Scott, part of the reason you're able to say this, this is your very experienced parent of a person with diabetes. But one thing I really love about listened to your podcast, is I don't often hear a lot of non productive judgment, you know, of yourself, when you talk about managing artists, diabetes is always kind of like, this is an opportunity to learn, you know, I'm watching this and see what I can learn. And I'm gonna try and do better next time. And I've really had to find like, because I used to get really nervous, with highs actually coming from this background of, oh my gosh, any blood sugar that's higher than, you know, a normal person's blood sugar would be, it's just going to lead me to down this terrible path. And I finally just sort of come to say, like, Hey, this is what I did. This is what I tried. It didn't work. Next time, I'm going to do better. But then actually, you have to do something different next time. You know, you can't be that person that sort of says next time will be better, but then does the same thing again and again. And again.

Scott Benner 52:22
Yeah. Because then that's sometimes the fear or the insecurity the instant the uncertainty grabs a hold of you right there. And so listen, I will tell you completely opposite story from less than 24 hours ago. So yesterday, right yesterday was so yesterday was this my son was playing baseball at four o'clock, a town over from here, Arden had been baseball softball practice after school that ended at 430. She was going to play a softball game, literally across the street from where my son was playing a baseball game. She had to be there at 530 his game was going to be over at six. So as a parent, I saw this opportunity to go see my son play for half an hour, then take my daughter over to her thing, drop her off, go back across the street, watch Coldplay for 20 more minutes, then go back over and watch her play. So I brought all I tried to do the right thing. Dammit, Jessica, I get this big meal. I bought her sandwich and all kinds of stores fruit and chips. And like it was a completely like kid friendly basket of joy. And I get her there and I'm like, Okay, I know you're hungry. She's like I am. I'm like, look at all this food. I bought it and she and she opens the sandwiches. I don't like ham. How do I not know I don't like ham. And there's turkey in there too. And she's like, and then there's that. So now the sandwich has been jettisoned, decide, by the way. I had it for breakfast this morning. So now the sandwiches aside, and then it's well I don't want and then she gets a little irritated. I'm like, oh my god. So I'm like, Okay, look, let's do three units right now. Go ahead and start eating. I'm gonna walk over there. Talk to this gentleman I know. And I'll be back in 10 minutes. And her blood sugar was great. It was literally like 95 and and so I went over I talked I came back I said, so what did you decide to eat? Because I thought, oh, we're gonna need more insulin. She goes, I had two Oreos, and I was like,

Unknown Speaker 54:08
Oh, no, that's all you did. Okay.

Scott Benner 54:10
And so here's the thing, I didn't realize that she went up softball practice after school, and didn't drink a drop of the water that I sat with her. So she's now she ran around for an hour and a half and she's dehydrated. So these Oreos are now going to hit her way harder than they would have normally. And because she had enough insulin going for them and it would have been okay, but I still said look, but I saw a little diagonal up. One 110 I was like, throw another unit on there. And we'll we'll address it with more cards. So I don't want you to be high while you're playing. And so everything's fine. I take her across the street at 530. My wife shows up over at her game stays with her. I said to my wife, I'm going to go back over and finish watching coal. And I'll be back and I get back around 620 and she's up there and watching her play. She's doing great. And I don't know exactly. I think it's I think they were warming up. So She was way off on the field away from her bag. And so there was a signal drop of about 30 minutes in that 30 minutes Arden's blood sugar went from 115 to 297. And, and I was just like, okay, so I first looked at my wife, and I'm like, What happened? She was, I don't know. I don't know, either. So I walked over to her. And I said, Look, I am going to give you a toe pressive amount of insulin. And we're going to catch it with juice if we have to. But I'm not going to leave your blood sugar high like this, especially while you're trying to do this. I gave her three units for a stable 297. And an hour later, do you know what her blood sugar was?

Unknown Speaker 55:36
was 290.

Scott Benner 55:41
And now the game was ending. And our favorite restaurant bars up the street and everyone wants to go and have bar food for dinner at 830 at night. And so I looked down and I said, Okay, well, it's been an hour, the three units didn't do anything. Here's three more units I cranked or bazel up, I gave her three more units. And by the time 20 minutes later got by, and my son was, you know, coming to meet us for dinner and everything. She was like 270, diagonal down. And so I said to her, what are you gonna eat, and she's like, I'm gonna get fried shrimp. And I was like, Okay, and then we got this basket of french fries that everybody was going to pick out of. And so there was no way to, I don't know what to do. So basically, what I did was when we go there, this is about how much insulin it takes her to, to go there, right. So it was also the end of a pump, the pump was going to get changed when we got home. So I just aggressively gave her nine units on top of the other three units. And we sat there waiting for my son to show up. So it bought us a little time I was like pushing liquids on her a little bit. The more she drank, the faster her blood sugar started falling. For anybody who thinks that being dehydrated doesn't have any to do with how insulin works. And it's falling, its falling and it's falling and falling and falling and falling and falling got home, changed her pump. And I would say that when she went to bed at 1030 her blood sugar was 110. And then around 1130 I did have to give her a juice because she made it to 65. But it didn't affect her life. I did going way back to your point. I did not feel bad about it. I didn't sit there going oh my god, what do I What did I do? there? She's a little low now while she's eating, but it's perfect because she's eating. I didn't think what did I do? Oh my gosh, this has ruined everything. I did feel bad for her because I thought she might be a little sluggish. She's gonna be sluggish playing. But just I kept my head clear. And I was like, how am I gonna fix this? Like, fix it right now? Like, not mess around with it? And, you know, it all worked out fine. Like it really did. And then you know, Now like I said, Do pump new pumps site is working like a champ. And it's funny had this day happen on day one of an insulin pump. It wouldn't have happened exactly like this. So I think part of what happened was that end of the end of the canula cycle, that is, you know, so and I always talk about it. I'm not ever 100% sure that I'm right. If somebody told me maybe you know better. The longer the candle is under your skin, your body sees it as a foreign body. Is that right? Correct. And so it sends white blood cells to it.

Dr. Jessica Lloyd 58:21
That you know, I don't know exactly the sort of immune mechanism of whether there's some immune mutagenesis, immunogenicity against the insulin versus just against the kanila tip. But there's more immune system stuff happening there that's preventing your body from absorbing that insulin the way that

Scott Benner 58:38
that it wants to, in my mind that thinks of things like cartoons, I always imagine the the white blood cells just clogging up the end of the cannula. And I don't know that that's accurate as to what happens. But the reaction that I get on my end, the physical thing that happens on mine, it that's how it feels, you don't mean it feels like it's restricting the flow that even though I know she's getting all the insulin, you know, maybe it's just the site is oversaturated after three days, or guys, there's so many possibilities, I guess, you know, but But nevertheless, I think it is really important to do what you were what you were talking about, which is just a knot. Do your best not to judge yourself in that situation and just do your best. Yeah.

Dr. Jessica Lloyd 59:20
How long did it take you Scott to sort of get to that framework because it probably took me four years.

Scott Benner 59:25
So if you keep in mind that I didn't have the technology with Arden has been diagnosed for a decade. My first two years were mostly just feeling like I was hanging off the edge of a cliff and crying at the same time that that's what that's what it felt like then I did find a way to have more of it makes sense. And maybe she was even just older. So her being able to communicate with me differently probably alleviate a lot of the of the issues that we had. It was a lot of time spent staring at her. You know Shilo What are those dark circles our eyes mean like you know, like that kind of stuff. But it was too at two years in before I felt comfortable and back then comfortable man, I had needles in a meter. And then it was two more years when she was four. We got her and on the pod. And then that started to feel better because then I actually was able to move her her a one C for the first time Arden's a once he was always in the nines, or the eights in the first like four years, sure, right. And so and and so I actually was able to move her a one C, and then that made me feel a little, like emboldened, I guess. And then I think the next thing that actually happened was the Dexcom came into play. And then that sort of took away a little bit of the fear about Lowe's, which was pretty cool. And then then I had that big moment that I talked about on a podcast before where I texted her upstairs to give herself some insulin based off of what I saw on our desks calm. And it just struck me like a ton of bricks. I'm like, Oh, she's upstairs, but she could be halfway across the world. Like, why can't I do this more often. And then she stopped going to the nurse's office at school. And that was such a big leap for us. And then we just started, I guess, I don't know, then we just really started figuring it out. And then in that space along there, when she's around second or third grade, everything that I had been seeing, since I got the glucose monitor. It all just sort of like started making sense for some reason. You don't I mean, like it just all started, I started thinking about more about manipulating the insulin and making the insulin do what I wanted it to do when I wanted to do it. I started thinking a lot about not being afraid anymore. And really, really like cognitively thinking, I can't be afraid of this because it was that texting moment when I texted her and I thought why do I not text her while she's at school? Like, why is it okay that She's upstairs? And I'm not with her. I don't see her. I'm running through this, this scenario in my mind, right. But I wouldn't do it. And I realized the only difference is my is my fear. And so once I had enough historical kind of like empirical knowledge of, when I do this, this happens. And I can trust that now I can make decisions, but they're not being there with me and not be afraid. And once I got past the fear, then everything got easier. So, but it was a long process. So in the specific answer to your question is probably five years ish. Yeah, yeah. But I also started with a person who weighed 18 pounds and couldn't really talk very well.

Dr. Jessica Lloyd 1:02:30
So well, you couldn't predict what she was going to eat. I mean, I can only imagine how challenging that was. Because I know the challenges I've had is like a very regimented, 27 year old loads diagnosed, and you're just in a different league. It just, it's

Scott Benner 1:02:41
one of those specific things. But I do think that hindsight, tells me that having gone through that whole thing with her, these things we talked about on the podcast now, like the more precise understanding I have of things, because we all went through that, like she and I went through that together, my wife and all of us, because without the, you know, without the moment where I realized I had to learn how to press on the syringe just hard enough for a drop to come out. You know, like without having to work through that and figure that all out, then I didn't, I don't know if it ever would have hit me how powerful the insulin was, and just how much so and I don't know, I just feel like everything that we've done before is is informing what's happening now.

Unknown Speaker 1:03:19
Yeah. So

Dr. Jessica Lloyd 1:03:20
you know, it, I just drew this parallel in my mind. And if you heard of like the It Gets Better campaign for LGBT youth? Sure. Yeah. It's sort of like the It Gets Better campaign for diabetes too, because like, it takes a while to get your stride. But I think there's a stride to be gotten.

Scott Benner 1:03:36
I think that I think that the largest disservice that happens is that everyone in when you most people you find in a community, you know, whether it be online, or even listening to this, or something that people these are people who are, are either struggling and trying to get to something better, or have hit a plateau and want to get better. But there are many more of you out there who are like me, but they're just off living their lives. They didn't stay behind in the commune, there's no judgement about that. Like it just, it just, you know, it's this great thing that I think I've spoken about here before, like there's, you know, I'll post something on my blog, and I'll see someone come in and comment on it. And then I see them over on the Facebook page, and you're like, Oh, look, here they are, and they're around a lot. And then all of a sudden, about six months later, a little less a little less than they're gone one day. And that makes me really happy because in my mind, I think they accumulated all the knowledge that they wanted and that they needed and they're off just living like this this happy life that was like it was before they they found out they had diabetes, like so. You know, so I love that feeling that the people it sucks that new people come in, but it's really great when they leave again. Like as as counterproductive it is to the idea of my podcast. It's almost like I can't wait till people stop listening to it. You know, and so I don't know I just feel like it for me. For whatever reason, there's and I've talked about here before, I probably have a real caregivers mentality. I'm adopted, my adopted parents split up, I'm very adverse to, like, you know, family separation, like, then I have I have my own psychological issues that make me really want to take care of the people who are around me who I love, right? Yeah. And then so, one day, it just, I don't know what happened. I just I had a blog, I gave someone advice, or I said something, I wrote something down, it helped somebody. And then I had this really, like, this heavy feeling like that, it would genuinely be wrong not to do it again. You know, like, like, I feel like it's, I just feel like for me, it's wrong to to know something like this and not to look backwards and tell the person coming up behind you, hey, not only is this going to get way better, but here's maybe a shortcut to it. And then one day, you're not going to feel like this anymore, you aren't going to be on this path anymore. I just don't seem to have it in me to leave the path for some reason. So you know, like, I just feel like I belong here. And I don't know if that might be narcissism. I'm not 100% certain, but I don't feel like it is I feel like it's just my desire to be valuable to people who just aren't as far along in this as I am.

Dr. Jessica Lloyd 1:06:12
It feels good, right? It's a noble thing. And it feels good. It's a pleasure to do.

Scott Benner 1:06:16
It's better than eating potato chips. Yeah. No, I shouldn't be flippant about it is really one of the if I if I got hit by a car today, and I was on er, having my last moments with George Clooney, I would definitely tell him that, you know, doing this podcast and the things like this, and diabetes has been some of the most like joy bringing satisfying stuff I've ever done in my life. So I just think it's really great.

Unknown Speaker 1:06:42
I certainly appreciate it.

Scott Benner 1:06:43
I appreciate that, that you've reached out and even mentioned that to me, because that's the one thing about doing stuff like this, that's internet based is that a lot of times you just don't hear back from people. So you have these this, you know, you have this data, you can watch to see, you know, more and more people downloaded every day. That you know, so you go Oh, it must be helpful. But until you hear back from somebody, there's no way to really know for sure, you know? Oh, my gosh, did we talk about any of the things that you wanted to talk about?

Dr. Jessica Lloyd 1:07:12
We talked about all kinds of things. I thought it was great.

Scott Benner 1:07:15
I did want to say that one thing in your email that I just thought was really interesting is that you called the podcast like its own sort of open source thing. Oh, yeah. And that's what I alluded to it like an hour ago, and we never got back to is that that? That concept really struck me like I thought that was like that was something I'd never considered about it that I was just really glad and happy to hear from you like an inch. Could you tell people a little bit about how that feels to you?

Dr. Jessica Lloyd 1:07:40
Sure. So I discovered your podcast not that long ago I am. Maybe it was like a slow adopter of social media and kind of the diabetes online community. I read some blogs, but it didn't really follow anybody like on Instagram, I wasn't getting any diabetes related tweets. I know I sort of fell down the rabbit hole like six months ago, and started seeing what people were doing out there. And like, here's a really simple thing. I was never that happy with where I were my Dexcom I work kind of on my upper but most the time sometimes on my arm. But now there's like this whole not mean but like trope on diabetes, Instagram of people that were the Dexcom on their upper thigh. I switched to my upper thigh like two months ago. And it's incredible. I love it. And the only reason I learned that was because of looking at these other people. But I also said, Oh, well, I'm learning a lot about diabetes on Instagram. Where else can I go? And so I started searching for podcasts. And that's how I found you. And it just sort of, you know, I consumed so many so quickly. But a couple that really stood out to me were Dana Lewis and Scott Lybrand and their APS project. They're open source, artificial pancreas project. And then also, and I'm forgetting his last name, it's Anthony, last name unknowable. Who is working on? Like open source? insulin? Yeah. Right. And so, you know, I don't really think what they are doing is that different from what you were doing in that you are a clearinghouse for ideas, people, influencers, leaders in the community, people like me, or just kind of people with diabetes that have a viewpoint, come on, share our knowledge. And it's available for people to take both at their pleasure and convenience, but also at their own risk, because that's kind of what open source is. You know, and here you are, and you're putting that content out there. And it's just again, for me, it's been really eye opening to, to hear about different approaches to hear about different technologies, and sort of feel like I have this some, you know, sense of what's coming down the pike that I otherwise wouldn't know. So it's, it's been really cool. And like I said, I think that you are in that same group with those guys. So

Scott Benner 1:09:32
that was really humbling to hear when you you email that because I thought, wow, I first of all, and now I'll say it was humbling, and then not sound humble immediately. But I don't mean it that way. But like, it was really humbling, because I never thought of it that way. But as soon as I read your words, I thought, Oh, I think she's right. You know, like I never considered the podcast like that. But that this is exactly that. It's just, you know, to call it a clearinghouse for ideas is I thought just really accurate and And in stunning to me, because as I alluded to at the very beginning, it's not how I think of it. So, you know, like, and I have that I joke sometimes with people, I said, I have just not enough self confidence, blended with just enough narcissism that I'm able to get through my life, but I've never quite, I'm never the person who's like just running around going, I'm right. I'm right. Because I never feel that way. I'm always sort of when I'm good at something. I imagine everyone's good at it. And so that's a lack of self confidence, right? Like, because when, when I'm good at something, I think, Wow, if I'm good at it, that everybody must be good at it. Because it's not possible that I could be special in any way. Like, I definitely have that feeling. It's not as strong now in my 40s, as it has been when I was younger, but I definitely had that that hits me a little bit. I wrote a book. And then people liked the book. And I thought, Oh, it just must be easy to write about. Because Right, right, right, people like this. Oh, I,

Dr. Jessica Lloyd 1:10:57
I just got lucky. I just picked the right topic. It's easy to sell ourselves short. But no, I, I certainly really appreciate what you're doing. I think it's very cool. And not, it's obviously not easy to do, because show me other podcasts are like yours, you know, only one

Scott Benner 1:11:10
and look how artfully I just got you to say one more nice thing about me. Well see me like I don't trust myself at all. And so you're

Dr. Jessica Lloyd 1:11:17
gonna pay me later, right? Was that part of

Scott Benner 1:11:19
a huge check coming? these podcasts are very, very lucrative, I make hundreds of thousands of dollars a month off of them. So I'm God, I hope people hear the sarcasm in that. But nevertheless, you and you actually said one thing, and I'm gonna I'm gonna mention it here. Because I've never mentioned it before. I'd never considered it before. But But I do have it. I never once talked about it. You said something that that really helped me feel how valuable the podcast was for you. And I've gotten really wonderful emails from people, and they're lovely. And but you actually were like, Can I give you money for this? And I was like, wait to support it. And I said, Wow, really? I was like, why I do have a donation button. I never tell anybody about it. But I do. And I told you about it. But that's not the reason I bring it like, I need you to sort of as we're ending here. I guess Tell me what, because to have that feeling. Like I would like to hand someone some of the money I've made. I guess I need to know what how being invited forget the podcast, right? But how getting information out of the community has helped you or changed you enough that you feel like I would give someone $1 for this like, like, Can you explain that because I know community is important. And I say community is important. But I feel like you might be able to put it into words for some reason.

Dr. Jessica Lloyd 1:12:41
It's just all about hope. You know, I certainly wasn't feeling in the doldrums about my diabetes. But being part of the community has made me realize, oh, little things can make a big difference. And I can be even better. And you not only kind of your day to day management, but again, sort of hearing about these potential future technologies, you know, artificial pancreas, what dex comms got in the works, what Omni pads got in the work, because I know you interviewed CEOs and C suite folks from those companies to just it feels exciting, it feels like the future is going to be bright. And you can't put a price on that feeling. You know, it's just incredible.

Scott Benner 1:13:15
It's another aspect of it. I didn't imagine so just it's just it sort of adds hope to know what's coming in a world where you wouldn't normally hear about what's coming.

Dr. Jessica Lloyd 1:13:25
Right. And it just there's such a personal and intimate face on your podcast compared to you know, a lot of the diabetes blogs out there, I think are very good. And certainly there's some big ones that that keep us pretty abreast I think of what's going on. But it's a lot different kind of reading those press releases sort of statements versus, you know, you're talking to the CEO of new product design from wherever, you know, that's, that's just an entree that we wouldn't have otherwise,

Scott Benner 1:13:50
I agree with you, I and I hope more companies agree with you too, because the ones who have been kind of bold enough to come on and talk in a way that's not customary for them with their business, I've noticed that the information they've gotten out is easier to digest. It's, it's more understandable. people's responses back to them are more human good only mean like, Wow, it was so interesting to hear the guy talk like a real person speak about it, and not be guarded not to be speaking from some, from some PR, you know, writing is, I think really valuable. And I hope they hear what you just said and want to do more of it. Even if they don't do it here. Just do it elsewhere to help people with diabetes feel hopeful, while they're waiting for you to develop and get through the FDA these things that you're trying to make to help themselves. Alright, cool. Jessica, thank you very much.

Unknown Speaker 1:14:40
Good. Yeah,

Scott Benner 1:14:41
I'm gonna say goodbye to and then just hold on one second. Okay.

Unknown Speaker 1:14:45
Okay, so it's perfect. Thanks

Scott Benner 1:14:45
so much. Thanks. Huge thanks to Jessica for coming on and sharing her perspective both as a physician and as a person with Type One Diabetes. Thank you also to Dexcom and Omni pod for sponsoring this episode, please go to dexcom.com forward slash juice box Are my omnipod.com forward slash juice box for more happy world diabetes MONTH DAY extravaganza, whatever you're calling it. Please, please, please, if you love the bold with insulin concept and you want to wear a beautiful t shirt, adorn yourself with the phrase bold with insulin, go to ardens de.com Ford slash store or hit the links in your show notes. Lots of guys have ordered already really looking forward to seeing them in social media. I hope more of you do. We're going to be using the proceeds from the church to get me out in the public and have these conversations firsthand with people live and in person. So I need a little bit of equipment for that and a little bit of travel money. Other than that, you know, that's pretty much it. Right now. things to say. See you next week with the Juicebox Podcast. Oh, wait. I'm back. Been a lot of great reviews on iTunes lately. I want to thank you for those. And I want to thank you for sharing. I see you guys a lot in forums and on social media telling people Hey, I think you should listen to the Juicebox Podcast. That's where we talk about blah, blah, blah, blah, blah, all that stuff. All that great sharing is really helping the podcast grow. I really appreciate it. Now I'm really leaving goodbye.

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