#1381 There’s No Such Thing as Free
Kathryn works at Integrated Diabetes Services as an exercise physiologist and diabetes care specialist.
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Scott Benner 0:00
Here we are back together again, friends for another episode of The Juicebox podcast.
Catherine is an exercise physiologist and a diabetes care specialist. She works with Jenny. She also has type one diabetes. She was diagnosed when she was 12. We're going to talk all about her life. Get some pretty deep details about some stuff that happened to her when she was younger, and what else here? Oh, she loops, and she's delightful. Nothing you hear on the Juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. Don't forget, if you're a US resident who has type one or is the caregiver of someone with type one, visit T 1d exchange.org/juicebox right now and complete that survey. It will take you 10 minutes to complete the survey, and that effort alone will help to move type one diabetes research forward. It will cost you nothing to help 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're looking for community around type one diabetes. Check out the Juicebox podcast. Private Facebook group Juicebox podcast type one diabetes. This episode of The Juicebox podcast is sponsored by Omnipod five, and you can learn more right now at my special link, omnipod.com/juicebox you the episode you're about to enjoy was brought to you by Dexcom, the Dexcom g7 the same CGM that my daughter wears. You can learn more and get started today at my link, dexcom.com/juice, box. I start every day with a delicious drink of Ag, one, you could as well drink ag one.com/juicebox
Catherine Alvarez 2:05
Hello. I'm Catherine Alvarez, and I am an exercise physiologist and Diabetes Care and Education Specialist, and I also personally live with type one diabetes. I was diagnosed at 12 years old, and I utilize DIY loop for my personal management right now. But of course, I try everything out. So just recently on trio and wearing all the things nice you are. How old now I am 2727
Scott Benner 2:33
so 15 years with diabetes? You got it? Yep. Diagnosed 12. Any other people to type one in your life for your family? Yeah.
Catherine Alvarez 2:40
So my mom also has diabetes, and it's a crazy thing, you know, you would think like she would be really involved. It would be kind of a story where we enjoyed memories, or, you know, like helped each other through diabetes. Unfortunately, she just kind of ignores her personal diabetes diagnosis. She likes to pretend as much as she can that it's not there. There's no
Scott Benner 3:09
camaraderie between you because you handle things so differently, or because she doesn't talk about it at all,
Catherine Alvarez 3:15
right? She, I mean, she really doesn't talk about it, and we never had that shooting of in relation to living life with diabetes as I was growing up. How old
Scott Benner 3:25
was she when she was diagnosed?
Catherine Alvarez 3:26
She was like, 42 Wait, did
Scott Benner 3:30
you get it first?
Catherine Alvarez 3:31
No, she did. She was diagnosed during pregnancy, actually, with you, my brother, with
Scott Benner 3:37
your brother. Okay, so she was gestational or just and then type one or just type one diagnosis during the pregnancy.
Catherine Alvarez 3:43
Well, they thought it was gestational and then they realized post pregnancy that was actually a type one diagnosis, okay, and he
Scott Benner 3:53
your brother is older than you, yes, okay, so she's got diabetes for a few years before you were diagnosed. Yep, okay, she's 42 when she's diagnosed, pregnant, but you weren't born.
Catherine Alvarez 4:07
How much later? 18 months later, I
Scott Benner 4:09
see that was the part that threw me off. You didn't say, what do they call that? Irish twins? Yeah, no, not twins. No, no, you've never heard Irish. You're so young so far, for people who know, like, who don't know, Catherine held up a cable that had an audio plug on the end of it for headphones. And she's like, I don't recognize this connector. That's how she because it was like, like a round plug, like everybody listening would remember sticking in the top of their Walkman or their iPod or something like that. Anyway, so Irish twins is a, like, a euphemism for, you know, a Catholic person who has babies back to back. Oh, okay,
Unknown Speaker 4:47
never heard that. No. Super
Catherine Alvarez 4:48
interesting. I'm Catholic, so who knew? Yeah,
Scott Benner 4:50
I know, but now, now you do. Yeah, I think it's pejorative, in case you're wondering. But I think it's colloquial enough that we can get away with saying it. She had you right after. And then 12 years later, when she's 54 ish, you're diagnosed, yep, okay, all right. Is there any other autoimmune in the family?
Catherine Alvarez 5:09
There's quite a bit. Okay, yeah, all the autoimmunity in the family. What
Scott Benner 5:16
else do you have? Personally,
Catherine Alvarez 5:19
I don't have any other autoimmune diseases. I potentially, like, I had a test done that potentially rheumatoid arthritis, but at this point, I'm not doing anything to treat it. You
Scott Benner 5:31
had creaky wrists and knees and stuff like that. I have a very crooked
Catherine Alvarez 5:35
elbow, like, it looks like my arm is broken. It's kind of weird, like, a lump on your elbow. No, like, it's, it's literally not straight. Like, if I put out my arm as I'm trying to straighten it, it goes, like, off into a curve. And they
Scott Benner 5:50
think that might be Ra, yeah, interesting. But no pain. Oh,
Catherine Alvarez 5:54
yeah, lots of pain. Oh,
Scott Benner 5:55
you're like, oh, no, wait, did I? I didn't mean to say that. No, there's tons of pain where, like, all your joints, or certain ones?
Catherine Alvarez 6:03
No, it's all. It's just in that elbow. Just
Scott Benner 6:06
in that elbow. Yep, interesting. That sucks. Do they do anything for it? They shoot a cortisol. Nothing. I got cortisone
Catherine Alvarez 6:13
once, and I just it wasn't worth it. That shot is painful. Blood Sugar stuff,
Scott Benner 6:20
yeah, they say the juice isn't worth the squeeze. Have you ever heard that one?
Catherine Alvarez 6:24
I've never heard that, but I would agree with it. You and I are
Scott Benner 6:27
gonna have fun. I can tell Okay, what else like? You don't have to tell me the members. But like, what other like, are we looking at thyroid, celiac? What's going on?
Catherine Alvarez 6:35
Yep, yeah. So sorry, Hashimotos. And actually, nobody has celiac but my aunt. I have an aunt with rheumatoid arthritis
Scott Benner 6:46
and lupus, mostly on your mom's side or your dad's side.
Catherine Alvarez 6:50
Yeah, all on my mom's side, my dad's side is like the picture of health that you're just all live these long, healthy lives. Nothing wrong, nothing
Scott Benner 6:59
wrong with them? Yep. Let's try to understand a little bit what's happening. You're 12 and you're diagnosed, and you've lived your whole life with your mom. Would you say hiding it? Like not? Yeah, just don't see it.
Catherine Alvarez 7:13
Yeah, don't see it. She doesn't check her blood sugar. She does injections, but not, you know, to the point that she should be
Scott Benner 7:22
okay. Do you have any context now as an adult, what her care was like as far as outcomes?
Catherine Alvarez 7:27
Yeah, it was, I mean, it was horrible. She now is legally blind. Unfortunately, she's had a heart attack multiple strokes. Did
Scott Benner 7:36
you become a CD? C? Is that right? CD, CES, why did they change it?
Catherine Alvarez 7:41
Yeah, yeah.
Scott Benner 7:43
All the letters, did you become that to help yourself or to help other people because you couldn't help your mom? Have you talked to a therapist? You know why you did this? Yet
Catherine Alvarez 7:51
for other people? So my mom, I when I was actually, when I was diagnosed, I told her, this is a good thing, like, I'm going to be able to help you, because I'm going to learn about this and you're going to start to do better. And then I did just kind of figure it out. Since I was 12, I always did all my own management. Nobody ever helped me growing up and then why I became a CDC, yes, was actually because of my boss. He hates when I say this, but it's the truth. I read, think like a pancreas in undergrad and and just answered so many questions that I always had, and I was like, you know, everyone needs to know this information. Nobody ever told me this stuff like I've had all these questions. Couldn't find the answer until I read the book. So that's when I decided I want to be just like him and meet with as many people as I can to help educate them and provide these answers to why things are the way they are?
Scott Benner 8:50
So you in college read Gary's book, yep, and then became a CDE back then, well, it
Catherine Alvarez 8:59
was CDEs. Remember
Scott Benner 9:01
you just did this.
Catherine Alvarez 9:03
I mean, it was, what, like, three or four years ago. Oh,
Scott Benner 9:06
so you so when did you take the like, when did you become a CDC, yes, two years ago. Okay, so, did you work for Gary prior to that?
Catherine Alvarez 9:14
Yep, yeah, I got my hours and everything working with Gary. Oh, that's
Scott Benner 9:18
awesome. No kidding, when you told your mom, 12 year old, you Mommy, I'm gonna figure this all out, and we're both gonna be okay, uh huh. And then you figured it out, she is like, never mind.
Catherine Alvarez 9:33
Well, she, she's come a long way. I mean, she finally wears a CGM, which is huge, and she'll talk to me about, you know, like, some blood sugar stuff, why things happen the way they do. But
Scott Benner 9:45
you haven't put her on a on loop, for example, no,
Catherine Alvarez 9:49
not on loop. She, you know, with, with the vision. And so I live in Florida, she's in Pennsylvania, and my dad has to, like, change your CGMS. And. And stuff. It just would be dangerous for her to be on a pump because she wouldn't change it out.
Scott Benner 10:04
So do you have any hindsight on why she ignored everything so much? I guess it's
Catherine Alvarez 10:09
kind of her personality. You know, she did the same with kind of other health related things. I think pretending it's not there is her coping mechanism.
Scott Benner 10:18
Did she understand the ramifications of ignoring it, or did she just think it wasn't going to happen to her? Do you have any idea what her expectation was when she wasn't paying attention to it? My daughter is 20 years old. I can't even believe it. She was diagnosed with type one diabetes when she was two, and she put her first insulin pump on when she was four. That insulin pump was an Omnipod, and it's been an Omnipod every day since then. That's 16 straight years of wearing Omnipod. It's been a friend to us, and I believe it could be a friend to you. Omnipod.com/juicebox whether you get the Omnipod dash or the automation that's available with the Omnipod five, you are going to enjoy tubeless insulin pumping. You're going to be able to jump into a shower or a pool or a bathtub without taking off your pump. That's right, you will not have to disconnect to bathe with an Omnipod. You also won't have to disconnect to play a sport or to do anything where a regular tube pump has to come off. Arden has been wearing an Omnipod for 16 years. She knows other people that wear different pumps, and she has never once asked the question, should I be trying a different pump? Never once omnipod.com/juicebox, get a pump that you'll be happy with forever? Yeah,
Catherine Alvarez 11:37
I think, I think she was so scared of it happening that it put her in a point of not even being able to deal with it. If that makes sense. Like, I know that, like, rationally it doesn't, but you know, kind of going through it, I think she just, like, didn't want it to happen so bad that she made it happen.
Scott Benner 11:55
I'm just not going to look. And then there, if I don't look in the closet, the guy with the AX won't jump out. Exactly, feeling. Okay, all right, exercise physiology, that's what you got out of college, right? Yep. Okay, then you go find Gary. Sounds like you lived in Pennsylvania for a while. Gary's in Pennsylvania. You go find Gary. You get a job. What are you doing for him? At that point,
Catherine Alvarez 12:15
I was so as a little intern, I was mostly running the social media. And then I was also helping get people scheduled and sitting in on a lot of appointments.
Scott Benner 12:25
Okay, so through sitting in on the appointments, you gather your hours that way. Yes.
Catherine Alvarez 12:30
And then I also began, so I had to also teach people in getting those hours as well. So I did like exercise programming. We did a class at a local hospital, so I was able to actually help teach that class.
Scott Benner 12:46
Okay, so then you gather enough hours to take the test. Is that how it works? Yep, you think the podcast counts as hours. It doesn't. And I've never looked into it, but I'm assuming it doesn't. I don't know there's
Catherine Alvarez 13:01
this, like, unique pathway. So, like, I think you can, like, run your own business, and, like, as long as a diabetes education, I don't know if you can make your argument. I feel like anything's possible, interesting.
Scott Benner 13:11
I don't want to be a CDE because they changed the CD CES, which did no one say it out loud before they changed it. It's hard to say, right? Your brain gets lost in it. You're like, CD C. Wait what
Catherine Alvarez 13:25
nobody is that. It's not a CDC asking, CDC, yes, that's just
Scott Benner 13:29
no. Also, it doesn't flow like there's no rhythmic loveliness to it. Do you see I'm saying, Yeah, CDE, bang, bang, bang, lovely. Yes, like that. Yeah, everyone knew what you meant. No,
Catherine Alvarez 13:38
it's okay. Thanks. Yeah. No, just, I just say I'm a diabetes educator.
Scott Benner 13:42
Yeah, you know, they change it back, if they could, I bet, I bet there's four people in a room. There's like, what do we do there?
Catherine Alvarez 13:47
Yeah, I feel like JDRF is probably feeling the same way. Oh, you
Scott Benner 13:52
think we're breakthrough? T, 1d,
Catherine Alvarez 13:54
yeah, great. This just not taken. Everyone's still saying JDRF just
Scott Benner 14:00
floats. It floats off the tongue. Hard to change the name. It's, it's, you know, you can't even change like the color in Facebook. People have a
Catherine Alvarez 14:07
stroke. So exactly, people don't like that change. I
Scott Benner 14:10
don't mean to go back to your mom for a second, yeah, do it. But as she's having poor outcomes, and you're diagnosed, and she's not interested in helping you. Do you have, like, a, like, a personal separation from her that happened over that? Like, did your relationship go differently? No,
Catherine Alvarez 14:30
it was more like, I wanted to take it all on. I didn't want anyone else to be involved. So she, like, I remember the first week, like she was doing my shots for me. Very faintly remember that, but I remember the way she did it was painful. And then our good friend was a dentist, and he did it, and he just kind of jabbed it into me, and I realized, like, all right, well, The Way She Does It is just slow and painful and traumatizing. So I. I mean, I think that if she had to, she would have done it for me. I think I just realized very quickly that I would be happier if I did it myself. Was
Scott Benner 15:09
it I'd be happier if I if I was in control? Or was it like she doesn't seem to know what she's doing?
Catherine Alvarez 15:16
I don't know. I guess it was like a combination, like the way she did it was painful, more painful than what I realized it had to be. And also, you know, at 12, you don't want to stand out. You're trying to do everything you can to fit in. Yeah, if I had control over it, I can. It's a lot easier for me to be
Scott Benner 15:33
able to you can manipulate how people see you, if you're in control of everything exactly, yeah. So it wasn't you cognitively saying, like, I don't think the lady knows what she's doing right now.
Unknown Speaker 15:43
Yeah, right.
Scott Benner 15:44
What age do you realize that that's true? Probably 12. Okay, same year. Like, you would handle a meal differently than she would. She'd have problems afterwards. You wouldn't like that kind of stuff, right?
Catherine Alvarez 15:58
And then, you know, I wasn't perfect either, but like, I was this crazy 12 year old. I had my little car book. I looked everything up, I wrote everything down, and, you know, figured out how to make things work. Plus,
Scott Benner 16:10
you're right in that age when kids start thinking, like, I think dummy and what's your name over there? Don't know what's going on, like that, which is the thing that happens, wait, do you have a give any kids? Not yet? Well, you get one one day, and then wait like, 1015, years, and then it'll look at you one day and go, I think you're an idiot. Like, Oh, okay.
Catherine Alvarez 16:27
None of us really know what that we're doing. Then
Scott Benner 16:31
you have to make that decision. By the way, do you double down on pretending your way through life? Or do you just look and go, Look kid? I gotta be honest with you, there are days I'm stunned. We have a roof over our heads. I don't not know what's going on. I'm trying my hardest. You're working with Gary. You're doing your thing. You get your hours, then you have to go take a test, right? Like an actual Yep, yeah. How many times you have to take it to win? Just once, look at you. Show off, yeah. All right. And so now you become a newly minted diabetes educator, and you start working for Gary in like you cut, you do what Jenny does, right? Yep, yeah. So you see patients, yeah,
Catherine Alvarez 17:09
virtually, yeah. And Jenny and Gary were really they mentored me through it, her and Alicia. In addition, I sat in spent so much time with them, just learning talk about
Scott Benner 17:20
that a little bit like when you sit in a room, just use Jenny as an example, because people know her, although I know a lot of great things about Alicia, but like, there's Jenny. She's got away, she talks to people. What is it you learn? Like, is it how she asks questions to get to what's going on? Is it like, what do you take from it that you think, okay, that's the piece of Jenny that I'm going to move into who I am. Well,
Catherine Alvarez 17:41
Jenny just has an incredible way of connecting with people, and I think she's very empathetic and just really good at forming relationships with people. So I think just from Jenny, one of the biggest things that I took away was I always want people to feel that they're incredibly cared for, because that's definitely what Jenny gives like she makes everyone feel like they are important, and she's there for them, and she wants to see them succeed, as
Scott Benner 18:16
much as I think that comes across when I'm recording with her. I've had private conversations with her, and her desire to be helpful to the to people is so much stronger and deeper than you would even imagine, right? Yeah, she's really driven incredible to be valuable to other people with diabetes, yeah, yeah.
Catherine Alvarez 18:36
She's a very special person.
Scott Benner 18:38
I know everyone's different, but when you meet a new person, how long, just general, these are generally, you know, generalized numbers. But how long does it take you before you go, Oh, I know what's going on here. Do people fit into boxes? Like, like, how do you virtually help somebody be you're not with them, like you. And I talked before we started, and I said, you know, I've been talking to somebody online, and the person's just lost, and I'm basically right now just asking them a lot of questions. I'm half trying to see if I can figure out what's going on from the questions, and I'm half hoping that the questions make them think of something that they haven't considered yet. But at what point do you think, Oh, I know which way to take this or I know how to attack this problem, and how often does that actually even work? Dexcom g7 offers an easier way to manage diabetes without finger sticks. It is a simple CGM system that delivers real time glucose numbers to your smartphone, your smart watch, and it effortlessly allows you to see your glucose levels and where they're headed. My daughter is wearing a Dexcom g7 right now, and I can't recommend it enough, whether you have commercial insurance, Medicare coverage or no CGM coverage at all, Dexcom can help you. Go to my link, dexcom.com/juicebox, and look for that button that says, Get a Free. Benefits. Check that'll get you going with Dexcom. When you're there, check out the Dexcom clarity app or the follow. Did you know that people can follow your Dexcom? Up to 10 people can follow you. Dexcom.com/juicebox, links in the show notes. Links at Juicebox podcast.com and when you use my link to learn about Dexcom. You're supporting the podcast before. Ag one, I didn't have a comprehensive idea about how to support my gut health, but now that I drink ag one, I do my goals for 2025 are simple, stay on this path drink ag one, every morning, and keep things moving, and I mean that figuratively and literally in the right direction. So this year, try ag one for yourself. It's the perfect time to start a new healthy habit, and that's why I've been partnering with ag one for so long. Ag one is offering new subscribers a free $76 What is this? Offering new subscribers a free $76 gift. When you sign up, get out of here. You're going to get a welcome kit, a bottle of d3, k2, and five free travel packs in your first box. So make sure to check out drink AG, one.com/juicebox For more information, check it out.
Catherine Alvarez 21:19
Well, we before we even meet with people, we have them fill out a very intensive assessment packet. So oftentimes, just from that alone, you can identify some of the important points for education, just from all the questions that are asked in there. You know, we're asking things like for their data so we can look at all of their patterns and blood sugars and insulin delivery. We're asking them about like the glycemic index, and, you know, asking us, asking them to explain these different things to us to see, you know what their starting point knowledge basis is. That's really helpful. I would say we really just start with, like, the educational points in conversation. You just eventually are identifying these things that are coming up, and we have their blood work and everything as well. So
Scott Benner 22:14
yeah, so there's other outliers, like untreated thyroid or something like that. You can see that as well, right? Okay. And so then how much of the conversation that you have with them is about continuing to mine information, and how much of it is just, you like, tearing the whole thing down, starting over at basics and building them back up again?
Catherine Alvarez 22:36
Oh, yeah. It really depends from, you know, the person that everyone is kind of coming in at a different point. So some people, and they come in and they they know their stuff, like they have done so much self education, you know, just kind of clarifying pieces, and then really teaching some of them, just like that. How do you analyze your data and know what adjustments need to be made, or helping them pick, like, what system might work better for them based on their goals, what other people they need? Like, you got to cover every educational piece with them, because they're kind of starting from up spot of
Scott Benner 23:19
and it doesn't matter how long they've had diabetes, right? You can see a person who's like, I'm lost. I don't know what I'm doing. I've only been doing this for six months a year, but you could meet somebody who's been doing it for 10 or 15 years, and they could be in the same position, yeah,
Catherine Alvarez 23:32
exactly. Because a lot of times what happens is these people that have been living with it for so stinking long, I mean, they get a little burnt out, and they they don't follow up with the latest stuff anymore, where these people that were just diagnosed, especially if they have a little one like, they just pour themselves into everything that they can find. Yeah,
Scott Benner 23:50
yeah, no, I know there's this thing like that. I'm always trying to figure out, like, at what point that a person's had type one for a really long time, do they just end up going, like, I don't know, like, I can't impact this. It is what it is. I'm just gonna live as long as I can. Like, you know what I mean? Like, and and what happened to them that got them so off kilter? Like, Is it as simple as someone didn't explain basics to them, and therefore they're having all these responses to insulin and food that they can't make sense of and and then they just get to that point where they're like, Oh, I guess this is what this is. Or is it a burnout thing, where you're just like, I can't put any more effort into this. Or does it, do you get burned out because you're putting so much effort in, but you're putting it in the wrong places because you don't know any better, and that's what causes burnout. Does that all make sense?
Catherine Alvarez 24:42
Yeah, yeah, absolutely. And I think everyone's reason for getting to the point of burnout is different. I think some people are just doing too much and having like, their life revolves around diabetes. Some people, you know, just the fact that they have to do so many extra things. Every single day just gets to a point of it just not feeling fair, and they don't want to do it anymore. So I definitely think it comes from a different from different places.
Scott Benner 25:10
I always find it the saddest when a doctor misreads that. You know, when someone's is putting in a bunch of effort, but they're learning so quickly and having such great, you know, these great outcomes, and they're really putting all the pieces together. And just as it starts to make sense to them, by the way, just as they get to the point where I think they're actually not going to have to put as much effort into a day to day, because they really kind of got it down a little bit, a doctor will sometimes step in and say, oh, you know, you're going to, you're going to make yourself crazy. You got to stop. But I want to see your a 1c go up next time. Yeah, that really beats people up when that happens too.
Catherine Alvarez 25:45
Yeah, it really does. I mean, it almost makes some people, like, some distrust, I guess in the end, though, because they feel like, you know, they're doing so well, and the end is like, well, now you're doing too good. Yeah. I mean, I've, I've said similar things before, if you're not sleeping because you're just panicking about your kid all the time, and you're dosing them every five minutes because you're scared when their blood sugar gets to 120 that they're going to die. I mean, those are unrealistic. It's
Scott Benner 26:14
a different problem. Yeah, yeah.
Catherine Alvarez 26:17
So there is times where I mean that commentary is true. They are over obsessing over diabetes. And, I mean, it is true that that will likely lead to burnout or a heart attack for that parent from not sleeping. Yeah, they're just in a constant state of stress. Yeah,
Scott Benner 26:35
I'm always hopeful that they can transcend that moment and that, you know, after some time of, you know, like you said, Bolus, single 120 blood sugar, you know, like that, they can start saying, oh, you know, what, if I would have done this in the past, then we wouldn't have got to this 120 or like, same thing with a low like, you know, if you're always stopping lows, you can start looking back at your meal and saying, you know, maybe if I would have used the insulin differently at the meal, we wouldn't be low here. But I do take your point, and I do believe, from what I've seen, is that as many people as can transcend that moment and move forward, making better decisions earlier, stopping problems from happening more frequently. There's also the same number of people probably who get stuck in that moment, aren't and are treating that that number forever and ever and ever, until, like you said, they can't sleep anymore and they go crazy.
Catherine Alvarez 27:24
Yeah, well, and, I mean, in some ways, the technology is is almost hurtful, because it's so in our face. So, like, we almost feel like we should always be responding. We see it, and so naturally we want to do something. But so
Scott Benner 27:39
interesting how the different personalities react differently. Like, there's some people who like, Oh, thank God, this thing beeped. I can do something about it. You know, a different person would be like, This thing keeps beeping. I hate this, and I don't want this to happen anymore. There's so many different variables about who you might be in this scenario. Like, that's why I think seeing a person one on one should be helpful, if you can get somebody to actually focus on you. So why are you able to Why is Jenny? Why is like when somebody basically pays a concierge person to help them? What's the difference between that and a doctor's appointment? Because people want to say it's time, and I know the time is limited with a doctor, but do you not think it's more than that? I think it's more than just the time doctors have to give.
Catherine Alvarez 28:25
I think a big difference is just the compassion of it. You know, all of us personally, we live it, we experience it, and we want everyone to thrive like we don't want anyone to be held back. We want to see people happy and healthy just that point of living with it. I think we're so much more motivated to stay up to date on all the latest technology and
Scott Benner 28:55
and to ask bigger picture questions too, right? I mean, I'm in a weird position, whereas I don't normally speak to a person like face to face, you said something really kind before we started recording about like, you know, you talk to a lot of people who listen to the podcast and they like the podcast. I don't want to put words in your mouth, but it helps them. Is that about, right? Yeah. Okay. So how do you help people without knowing any of their details. You know, that's why I think over and over again, I just, I stick to the basics. I think that that has the best chance of helping the most people. Like, I don't think it's going to help everybody. I don't think everybody's going to have the same response. You know, for every person who's like, oh my god, this saved my life. I'm sure there's somebody who's like, I listen to what you said, and I gotta be honest with you, my life's no different. I know that that's the case, but it's all I have, right? Like, it's, it's, it's the best that I can do. I just said, look like here are the things that I figured out on my own that seemed to help my daughter, and I hope they help you too. Or maybe you can cherry pick. On it and take some of the stuff that helps or doesn't help. You know, it isn't until, like, I meet Jenny, and we start talking to each other. Like, my first thought about Jenny when she came on the podcast the first time as well, she and I think about diabetes so similarly, like, it's, really is, like, it's, it's awesome. Like, you know, like, it's crazy. How, like, like, lock step we are like when somebody says something, our responses are so similar. I realized later, because I don't really know at that point, this is going to sound crazy to people, but I've never read Gary's book, and I think I've only met Gary one time, and it was in passing where someone was like, Scott, that's Gary. He wrote, think like a pancreas. And I go, Hey, how are you? And someone goes, Scott writes a blog. And then I think we walked past each other. I've spoken to him on the phone once, and that was only more recently, like in the last six, six months, and that was maybe for 15 minutes, and had nothing to do with diabetes. Yeah. So I'd never read his book. I don't know any of the like conclusions he's come to, or the things he talks about. But then when I meet Jenny, and I realize Jenny works for him, she's probably working off of, like, some ideas that he, at the very least, like that. He's, you know, talked about, and I thought it's crazy, that book and this podcast are incredibly similar to each other. And then I meet one time I speak with Dr ponder, and he starts talking about how he thinks about diabetes, and I think, but that's how I think about it. And then you realize, like the people listen to Dr ponder have a lot of success, and the people that read Gary's book, Gary's book seem to have a lot of success, and the people listen to the podcast seem to have a lot of success, overwhelmingly, not everybody. And you go, oh, there's got to be building blocks basics within this that lead a lot of people to an understanding that helps them continue on and to have better outcomes. And it's interesting, isn't it, that three people saw it in their lives differently, like a doctor, and you know, I mean, who has type one, Gary, who has type one, and myself, who, like, you know, just raised somebody with him, is just looking at it from from an outsider's perspective. But in the end, we all came up with similar, like, touch points, right? It's really interesting. You know what I mean? Anyway, I don't know why I said all that, other than to say, like, I think, I mean, it's
Catherine Alvarez 32:09
like, the fundamentals. You just, you know, that's you find these fundamental things and, yeah, kind of take off with it.
Scott Benner 32:15
Thank you. That's my point. My point is that those fundamentals are so important to learn and then to try to adapt them and apply them is, is the part that I can't be helpful with. The book's not going to help you with, like, none of that's going to help you. Like, you learn this part, and then you say, Okay, how does that apply to what I just ate, how I just ran around, how I live my life, how blood sugars act in me, like all that other stuff. It's not like they're not hard and fast. Rules that if everybody just does them, it's just all gonna work out great every time it's it's not that. How long have you been doing this now, where you're actually sitting down one on one with a person trying to help them figure out the problems they're having? How long you've been doing that? A few
Catherine Alvarez 32:55
years. Yeah, I guess I'm, uh, like five years now, okay, it's a
Scott Benner 32:58
fairly long time. If I asked you, what are the fundamentals? What are they from your perspective? Well,
Catherine Alvarez 33:05
a big one is gonna I mean, it really depends on what system they're using, in a way too. But basal testing is huge, knowing what we need just kind of in a steady state, from a background, insulin standpoint, and how to do that type of testing, how to test your insulin to carb ratio, what factors in lifestyle are important to note and because they're going to have an impact. So just kind of like, you know, learning about stress impact and sick day management, growth hormone, those kinds of things that you see a huge impact on blood sugar with
Scott Benner 33:43
when you see people struggle, is there a is there a generalization to make? Like if I said, do you finish this sentence, most people struggle with what pops into your head?
Catherine Alvarez 33:54
Definitely different, but most people struggle, I would really depends on the population. I think most parents struggle with the unpredictableness of their child. And really that growth hormone is a big one, where adults, they struggle with food. Food is a huge thing. Yeah,
Scott Benner 34:14
consistency with Bolus,
Catherine Alvarez 34:18
yeah, that timing of the doughs, and then, I mean, protein, fat really gets people. That's a big one. Yeah?
Scott Benner 34:25
No, I know. Until we started talking about that on the podcast, I didn't even realize how many people were like, wait, what?
Catherine Alvarez 34:31
Right? Yeah,
Scott Benner 34:34
carb, carb, yeah. They're just counting carbs, right? And they're and they're not really thinking about the I mean, for me, making the podcast over the years, like, the impact that timing of digestion has on diabetes. I mean, now seems like an obvious thing to me, but back then, like, when I first started, I didn't think about it, and it wasn't. It's interesting how it all builds, like, right? Like, until someone said. Said, you know, fat slows down digestion. I was like, wait. And then the carbs are in there impacting longer, right? And they're like, Yeah. And I'm like, oh, that's what happens with pizza, yeah. And then you start applying it to other things in your life. You're like, Oh, my God. And then it just all starts to come together. You're like, oh, that's what happened when I had a cheeseburger and exactly, ice cream. Like, it really wasn't until, like, one time, I think when Jenny, like, said to me, like, you know, pizza isn't pizza. It's bread and sauce and cheese and, like, it's four things, you know, and maybe there's meat on it too, like, there's a protein to hit, like, and what about more cheese or less cheese? And, like, no one looks at their pizza and says, Oh, that's a thick cheese. My spike is gonna come later. You know what I mean? Or like, this is a hand tossed Neapolitan pizza that just has a couple of pieces of mozzarella put over it. Like, this isn't gonna hit me as hard and it's but now I think about all of that when I look at food, you know, again, like when people are so stuck counting carbs, like cheese, in your mind is like, free, like, Ooh, you know? And then the extent that you get normally, when you learn more is somebody goes, cheese isn't free, it's not free. But then it's not followed up with more conversation. It's just, you know, and you're like, Well, what do you mean? I flip the package over, it says zero. No such thing is free, right? Everything's impacting something somewhere, yep. Yeah. Okay, tell people a little bit about like you do something. I don't know if you call it part time or you do it like, in addition to your job, but tell people the other thing you do, yeah.
Catherine Alvarez 36:34
And I think that this has really helped me clinically, because I've experienced, I can't say what it's like to be a parent of a person with type one diabetes, but much more for San experience. So what I do is I also help a family where their little guy has type one diabetes. I moved from Pennsylvania to Florida two years ago, and he's five now, and I've traveled all over the world with them, and I spend most week days about two hours with them, but I also have sleepovers sometimes Tim as well. So I've just kind of learned for a very little one how different everything is, trying to be a pancreas for an ever changing little human being that you never know what they're gonna do next, and just the uniqueness and the challenges that comes with
Scott Benner 37:32
that. And so you think that just being around him, right? Yeah, being around this little boy, and seeing all the different impacts. Like, do you feel yourself leveling up constantly with diabetes? Yeah,
Catherine Alvarez 37:45
I think I mean, just professionally in this experience, it made a huge difference. I meet with most of the super little ones now that come to Integrated Diabetes services, because I have that first hand experience, yeah,
Scott Benner 38:02
it's a different world, isn't it? When, like, when you're trying to measure quarters of units in syringes, and, you know, they they eat, then they jump up and run around all of a sudden, and you're
Catherine Alvarez 38:13
like, I wasn't expecting that activity. Yeah, I didn't
Scott Benner 38:17
know that was gonna happen. And the growth
Catherine Alvarez 38:19
hormone is wild. I mean, like, just what they need sometimes, at when they first fall asleep, is just nuts,
Scott Benner 38:30
growth, menstruation, pregnancy. Those are the three that are just like, boom. I would maybe add to the end of that list, like the unexpected nature of how some anaerobic exercise impacts people,
Catherine Alvarez 38:44
right? Yeah, exactly. And I mean, just competitive sports like the adrenaline, that adrenaline, yeah, that's gonna that's tough to navigate, especially like when you have these different types of activity, you need a different strategy for practice versus game day. And, yeah,
Scott Benner 38:59
yeah, no, that's why I like the story that I ended up eventually telling on the podcast that I think has been the most valuable for people, because I hear them talk about it over and over again, is the idea of bolusing for a juice box if you think there's going to be adrenaline. And so, you know, I don't know if you've heard me say this, please stop me, but I have, oh, go for it. Okay, so Arden is, like, I don't know, young at the time, and she's playing this, like, in this little Sunday basketball league. And she'll show up, you know, it's always nine in the morning. These these games, they drag your ass out of bed. Like, you know what I mean? Like, you go over to the local school, to the gymnasium, bunch of little girls play this other bunch of little girls, and Arden has had diabetes at that point for a while, but still, it's like six years. And the truth is, is we're using a pump and a CGM at that point, but it's an earlier version of CGM, so it's kind of okay, like, you're still, like, hoping that the Bluetooth signals bouncing around on the metal deck ceiling of the gym and makes it back. Of the receiver, like, like, that kind of stuff, which, by the way, used to actually work, like, you could be in a room with a metal ceiling, and the receiver would work farther away than it would be if you weren't in a room with them. Anyway. So we'd get to these games, and some days her blood sugar would jump, like, into the mid two hundreds. And then some days it wouldn't. And so one game it would the next week, it wouldn't back and forth. And we, I was like, what is happening? And my wife and I are sitting there talking, and all I'm saying is, like, I we can't let her blood sugar keep going up to 250 like, like, we can't do that. And, and my wife's like, but, but last week it didn't So, what do we do? And I just, like, blurted out, I'm gonna Bolus for a juice box right before the game. And she's like, what? And I said, Well, if this adrenaline, that seems to be what it is, adrenaline, right? Like something's hitting her. And we actually eventually figured out where the adrenaline would come from and not come from, which is kind of funny, but I was like, here's the insulin. If the adrenaline pops off, then the insulin will will cut off the adrenaline rise. Now, she would still need food after the game, like it was still too much, but at least it got in the way of the adrenaline right? Yeah,
Catherine Alvarez 41:09
that sensitivity eventually kicks in. Oh, yeah. And that's, that's the big thing, is trying to figure out, well, how much insulin do you need to combat adrenaline rise?
Scott Benner 41:18
Yeah, well, so I still don't know how much was right, but what I knew was, if the adrenaline didn't come, I'd basically just pre Bolus the juice box. So if I didn't see the spike at some point, five or 10 minutes in the game, I'd be like, here real quick drink this juice to combat the insulin that we put in, right? And then after that game, she wouldn't need as much food. She still needs some, but not as much as if it the insulin was in there to battle the adrenaline. Now listen, this is very Listen, this is very rudimentary, but it worked, and it got us through it,
Catherine Alvarez 41:45
yeah. So you found your way. And this is what, this is one of the things I learned from Think like a pancreas, and I still use it to this day as like the starting point. But of course, everyone's different, so you gotta adapt every starting point. We say, okay, so her blood sugar usually went to 250 so we're gonna give a correction, assuming that's where she's gonna go. But because you are physically active, you're still gonna be more sensitive to that insulin. So you would do 50% less of what you would typically need to correct a blood sugar of 250 for the starting point, and then kind of go from there. What
Scott Benner 42:21
we figured out was, is that when she got to the game, like, Arden, like, was really competitive, and she'd assess the girls on the other side. I don't even think she knew she was doing it, but if she thought the game was going to be hard and that they would put up a fight, then she'd get this spike. And if it look, I usually say, like, if it looked like there were like, five little marshmallows on the other side, she'd be like, Oh, we're gonna kill these girls. And she didn't. She never got really excited about no problem. Yeah, listen again. It's a rudimentary way to take care of it. We got through it, everything, etc. But telling the story allowed people to realize, like, oh, adrenaline does that, and insulin will combat adrenaline, except later the adrenaline disappears, the insulin is still there, and then you have a problem, but I can still workshop that problem and try to get through it. And then eventually, one day, I adapted the idea. When a person said to me, you know, it seems like I need more insulin, but I don't know how much more to give at this meal, because we're not huge carb counters. Like, more like, Hey, I think this meal takes about this much kind of vibe. People would say, like, all I agree. Like, it looks like I need more at this meal, but if I've counted the carbs correctly, but I still need more, how do I make the leap of giving myself more? Like, it seems really scary to people to do just another unit or something like that. And so I adapted the thing from the basketball. And I said, Why don't you Bolus for the food that you know you've counted, plus a juice box, and then if you're too much, you can use the juice box to combat it. And if it's not too much, well, now you know that this much insulin plus this led us to this outcome. Do I need more or
Catherine Alvarez 43:56
less, right? And that's a cute way, I mean. And people think like, yeah, a juice box. You're right, that's not, it's not so scary. Doesn't seem
Scott Benner 44:03
too scary, etc. And that thing, when I go out into the, you know, into the audience, and I say, hey, because I've done this recently, I was like, Look, you know, over these 10 years, I've said so many, like, colloquial things that people will like, parrot back to me. Can you make a list of them for me? Because I don't. I've lost track of all of them, you know. And one of them that came back overwhelmingly was Bolus for a juice box. If you don't know how much more insulin to try, as crazy it is, is the slow progression of that story over years led people to be able to be a little more aggressive at their meals to see if maybe a little more insulin would be valuable for them. Crazy, you know what? I mean, yeah. So I like it, yeah, it's awesome. Like, the same thing with like, when people are like, I don't know how to pre Bolus for a little kid, they never eat. The same thing, right? You never know what they're gonna eat. And I just said one day, I was like, Well, is there a minimum amount that, you know, the lead, it just pre. Lost that much, and then, as you see it, go in, do the rest? You know, if more goes in, and that ended up being helpful for people, because the minute they see a pre Bolus actually work at a meal, it opens up a lot of other ideas for them,
Catherine Alvarez 45:13
right? And even a percentage of a pre Bolus is going to make a huge difference, yeah, yeah.
Scott Benner 45:19
So anyway, it's like little things like that that come from conversations and like and so you're getting to see those things with this little boy, plus you have type one. You actually have a rich layering of perspectives, because you watched your mom, I don't want to say she didn't take it seriously, but she wasn't putting the effort in where it needed to be put right. And then you figured it out for yourself, and now you're getting to watch a little kid live with it like, how long do you think you're gonna be like a Zen master at all this?
Catherine Alvarez 45:46
You know, something else that's super crazy too, that we haven't even talked about is my aunt. She has type 3c so she had her whole pancreas was removed because she had pancreatic cancer. Okay, so I get that too.
Scott Benner 46:01
Your mom's sister, yes, interesting. That can't be coincidental, right? The pancreatic cancer and the diabetes.
Catherine Alvarez 46:08
Well, right? I'm always so in all of us, my mom, my aunt and myself, we have it's called the Bronco two gene, so it puts us at, like, really high risk for breast cancer, pancreatic cancer, ovarian cancer. So my aunt, of course, was very unlucky and wound up with all the cancer. Okay,
Scott Benner 46:29
so what's your mom's background? What's her family? Her
Catherine Alvarez 46:34
family? Well, actually, Mom, we got a DNA test and found out that we're asking Ushi Jew, so that's why, that's where that everybody
Scott Benner 46:41
is. Everybody gets, like a 1% I believe, yeah, not everybody, but a lot of people, well,
Catherine Alvarez 46:47
a little bit higher percent, which puts you at high risk for this bracket two gene, really,
Scott Benner 46:51
no kidding, that's what does it right there. But are you guys like Irish English?
Catherine Alvarez 46:55
Yeah, Irish and Norwegian.
Scott Benner 46:58
I sometimes talk about my friend Mike, who's passed. I don't know if I've ever, like, added this layer of detail about his his life, but he was diagnosed type one when we were in high school, and his mom eventually died of pancreatic cancer, so I don't know it. And they're Irish and, like, you know what I mean? Like, I don't know how many different times you got to hear people's stories where you're like, this seems like, I hear about this, like a pattern, yeah, a little bit of a pattern here somewhere interesting. Are your mom and your aunt similar in their personalities, or did your aunt No, so your aunt took over and did what you needed to do.
Catherine Alvarez 47:34
Yeah, my aunt, we're kind of, we have similar personalities. She definitely is, but it's tough because she has a whole extra layer, like, we don't even realize, like, I never really appreciated the small things that my pancreas does do
Scott Benner 47:47
digestive sometimes. Yes,
Catherine Alvarez 47:51
yeah, it's just her, her trying to eat. Is it's quite complicated. Yeah, listen,
Scott Benner 47:58
I'm not a doctor and I'm not a researcher, I'm not anything, but, like, I hear a lot of people's conversations, and I so often when I see people with type one, you know, they always, Oh, my stomach hurts, or after I eat, or something like that. And I was like, Why does no one ever tell you, Hey, your pancreas does more than just this. And right? You know, a lot of you seem to have trouble digesting food, and then they'll tell you immediately that the doctor will jump to, well, you have gastroparesis then. And what if, just, maybe, you just don't have enough digestive enzymes, and you could buy them over the counter, by the way, and they're not particularly expensive, and they work really well. Like, why is that not talked about? I assume it's not talked about because they don't know the doctors, right?
Catherine Alvarez 48:44
Yeah, I always wonder that that same thing, you know, kind of talking, why? Why don't they mention the alpha cells? Yeah, I think it's just that. I know we talked a little bit about their time constraint. Maybe that's it. But,
Scott Benner 48:57
yeah, but how many times does somebody have to tell you my stomach hurts and they have type one before you go there, maybe I should say this out loud. And the amount
Catherine Alvarez 49:05
of people that don't even get checked for celiac antibodies is just shocking, right?
Scott Benner 49:10
Yeah. Or how about how many people's TSH has rise, and the doctor's like, that's fine, we're not gonna do anything about
Catherine Alvarez 49:15
that. Oh, right, yeah, as long as it, you know, they they're not looking for huge bumps every time. And as long as it falls within the range they're they're not going to
Scott Benner 49:23
see it. I love when a person's like, my hair is falling out, I'm cold all the time, and I can't sleep and I'm exhausted. My TSH is four, and the doctor's like, it's not that. And I have type one diabetes, and my brother's got celiac, and my sister's got a bump on her elbow. We're riddled with autoimmune issues. Like, that's probably not that, though.
Catherine Alvarez 49:42
It's probably your diabetes, honestly, yeah,
Scott Benner 49:44
have you tried cutting out flour? My thyroid is not well, you know, like, or I'm making it, my body's not picking it up correctly. Like, help. Help me. I. Leads me to ask you, have you. Helped anybody yet who's been added had a GLP added. What have you seen with that? Yeah,
Catherine Alvarez 50:06
yeah, there's, you know, definitely has increased in popularity, especially with these people in the DIY community, and doing it with unannounced meals. I've used it myself as well, but I'm not now, because I love to share too much information, but I'm trying to conceive, so can't take it during that time, but it's it is truly incredible just helping with that meal time and the fact that we are lacking in it really replaces a lot of what we're lacking in. So can make a make a huge difference.
Scott Benner 50:36
Have you seen anybody use it and it just didn't change anything for them with their blood sugars. Well,
Catherine Alvarez 50:41
what's more common is it did help them, but it negatively impacted them in many other ways that it wasn't worth it. Okay?
Scott Benner 50:50
So someone's like, Listen, I have diarrhea now, but my blood sugar is better. I'm gonna choose not having diarrhea, something like that, right? Okay, yes, but you haven't seen anybody just taken and just flatly, has not impacted their blood sugar.
Catherine Alvarez 51:03
I mean, you see people where it doesn't impact them from a weight standpoint, but no, from a blood sugar standpoint, I have not seen that. I'm sure I will. You know, no,
Scott Benner 51:11
I'm just trying to decide, like, I'm not in charge of anything. But I'm trying to figure out, like, Why did a guy come on the podcast, who was, I think he was, I don't know, 58 right? And he had diabetes for like, six years. He was probably lot. It was probably a really slow onset. He was overweight. They put him on GLP, gip one, and he loses a bunch of weight. But more importantly, like is literally not taking any insulin now. And he has excursions at meals. They go up 180 or so, they come back. He's clearly going to need insulin at some point, but his beta cells, like, had functionality. He was using a lot of insulin, like, as much as would make you I mean, he was comfortable calling himself a type one. So was this doctor. He was using that much insulin, right? And now suddenly he's not using any. What did that GLP do to free those beta cells up to handle the load, more or less? Like, do you know what I mean? And like, is there a world where his beta cells just weren't far enough along so they were able to be helped, like, with a crutch? And is there going to be a world where somebody's beta cells are so wiped out that even if you add that crutch, you're not going to see a benefit like, that's what I'm wondering, right?
Catherine Alvarez 52:23
And I think that would be the case, because if you think about, just think about people in the honeymoon phase in general. I mean, there is times where people don't need to initiate insulin right away. You know, they can supplement in some vitamin D, and with physical activity, they get away with not having to take insulin,
Scott Benner 52:41
or I wonder how much of that is inflammation, because
Catherine Alvarez 52:44
exactly that's yeah,
Scott Benner 52:46
I go back to, like, back before the podcast, where there was this one researcher who was trying, I don't, I don't remember any of the details about this. But other than to say this, one researcher was saying out loud, I don't think the beta cells are dead. I think they're frozen. They're inflamed to the point where they can't function. And I was like, Oh, that's weird. And then that's like, kind of the last time you thought about it again, right? Like it was back around when people were talking about stem cells a lot, and now you listen to people talk about GLP medications. Like I was just listening to a DR Drucker, who's like, kind of one of the pioneers of GLP, and I was listening to, like, a two year old grand rounds he was doing at a hospital recently. He's just talking about how the inflammation impact from GLP is almost like instantaneous when you put it in, like, they can see it impact your your inflammation markers almost immediately after it's put in your body. And like, I'm like, all that, like, wait till we figure out all this. But still, when they talk about it, like the researchers, I don't mean people who are like, you know, coming along, trying to find other research and uses for it. I'm talking about the people who, like, pioneered this thing. They still say we don't actually know how it works. Like, we have no idea what the heck is going on, yeah, which is not uncommon in man made medication, but to hear them say, like, yeah, you lose weight. Like, we don't understand why, yeah,
Catherine Alvarez 54:06
well, and not everyone does, though there's also some research. There's like, a blood work that you can do. I wrote an article about it. I wish I remembered it more like in a better way to explain it, but they can test something and see, like, predict if they would be a responder, really? Yeah,
Scott Benner 54:28
oh, that's interesting. So there's a blood test you can do to tell you if you're going to respond favorably to GLP,
Catherine Alvarez 54:35
right? Yes, huh? Yeah, I, I wrote a little article on it. So, yeah, I know it's out there somewhere.
Scott Benner 54:44
Is it a genetic test?
Catherine Alvarez 54:46
I don't even, I couldn't tell you. You know, I write so many different things. I wish I had a better memory. But
Scott Benner 54:55
no, don't, don't, please. I you know, again, these, how these good. Com. Conversations happen. Like, that's why none of this is, like, you know, it's, it's not medical. Like, this is a podcast. You don't even like, you're talking, you know. And you see if people don't hear something and go, Oh, I wonder if this is, you know, something I should look into. A C peptide test is one method that can help predict whether a person will respond well to GLP, right? So
Catherine Alvarez 55:21
well that, yeah, that's not what I read. That's not
Scott Benner 55:24
what you're that's not what you wrote about. Yeah, I
Catherine Alvarez 55:27
know C peptide, well, I would remember that. Yeah, no,
Scott Benner 55:29
but I mean, like, that's not what you're talking about, but it is what we were just saying about the other guy. Like, you know, if your beta cell still have the ability to, like, do some stuff, but it's just being held down by your body's inability to process the insulin and get the result, etc, that you want. Like, I can see why. I don't know, taking some of the like, it's weird to talk about even because, like, are you increasing your insulin sensitivity, or are you decreasing inflammation? Are both of those things happening, like, like, is it like a mix, and then it's just crazy when you hear the actual researcher talk about and they go, I don't know, but it works like, okay,
Catherine Alvarez 56:06
okay. I actually, I found the I found the article that I wrote about. It's called Hungry gut gene test shows who will benefit most from a govi, hmm, so yeah, I guess they're grouping them based off of this gut test, and it is a gene test. There's
Scott Benner 56:22
a genetic test available that's often referred to as hungry gut gene test, which identifies people who might respond better to GLP, one receptor agonist like semaglutide for weight loss. The test analyzes genetic variants associated with how the gut and brain regulate hunger and satiation. In studies, individuals with the hungry gut obesity phenotype showed greater weight loss up to 19 and a half percent compared to those without the phenotype. There you go. Yep, there it is, just like that. Yeah. Anyway, my point is is that this stuff's gonna is gonna help people, you know, and it's gonna get to helping people with type one. We were talking last night, like in a little private group, about how one of the big speed bumps for doctors, about giving glps and type ones is that in some people, and Dr Blevins has come on the show and talked about this too, it can lead to DKA, because their insulin needs go so low, right, that they almost can't use enough insulin to ward off the dka, because they obviously still Have type one diabetes, yep, and their beta cells aren't helping enough to ward it off too. So they're looking at protocols that will then make the FDA comfortable with the prescription being written. And that protocol may be as simple as you get a ketone meter and you have to test a certain number of times a day to make sure you're not in DK. And
Catherine Alvarez 57:41
that might get that good old precision x Oh, but yeah, yeah. But
Scott Benner 57:45
that literally might be the thing that helps it get written for type ones,
Catherine Alvarez 57:49
yeah, yeah. And it'll be a part of our CGMS. It sounds like too where alert us if we have ketones.
Scott Benner 57:56
You think CGM are going to tell people about ketones one day? Oh, yeah, there. I
Catherine Alvarez 58:01
mean, that's already kind of something that has been in the works, but it's almost like, is it too much information? Just kind of have to find that balance, yeah,
Scott Benner 58:09
yeah, overwhelming people with stuff. But anyway, I think that's interesting that like. So what this means is, if that thing is right about the ketone meter, is that the FDA knows it helps people with type one diabetes, and they just need to be able to put it into the world in a way that's not going to cause anyone to have DKA. And once they can guard against that, then they'll be okay with it being written, which then means it'll be covered by insurance too,
Unknown Speaker 58:31
right?
Scott Benner 58:32
Yeah, so that's exciting. Wait, wait, you trying to make a little Catherine? What are you doing over there?
Catherine Alvarez 58:37
Yeah, we want to bring a little human in to the world. What
Scott Benner 58:42
happened? You started watching this kid and you got what they call the baby fever.
Catherine Alvarez 58:46
I think I've always had the baby fever.
Scott Benner 58:48
Oh, are you like a little caregiver at heart? Yeah, I
Catherine Alvarez 58:51
just, I just love there's something so special about little ones. They're sweet innocents, and just adore them. How
Scott Benner 58:59
long have you been trying,
Catherine Alvarez 59:01
I guess, like eight months now, really, yeah, so taking a lot longer than you know what we had thought. But I think I'm probably just been stressing too much about the whole thing. So
Scott Benner 59:12
do you have any PCOS symptoms? No,
Catherine Alvarez 59:15
no, and I've been tested in everything
Scott Benner 59:19
stressing. Yeah, it's probably all it is no kidding. They say sometimes you just like, I'm sure I've said this before, but I'm adopted. My parents adopted me after being told like they could not have kids. Then, keeping in mind, this was the late 60s, early 70s, when they were being told that, and I'm not sure what the level of discourse was around this, they adopted me, and five years later, my mom got pregnant. I
Catherine Alvarez 59:42
keep hearing stories like that. It's so incredible. Yeah, and I told, I told my husband, Kenny. I was like, maybe it's just like, our calling, that we're supposed to adopt and then we can have far because, I mean, there's so many like, people need to adopt. It's has to happen.
Scott Benner 59:58
Yeah? Well, they. Doctor told my mom it was a fluke. She probably just relaxed enough for it to happen. I love the way they talk to women about their health. Literally, you don't have to worry about that. It's never going to happen again. And then five years later, she got pregnant again, pregnant again. Oh my gosh. So my brother is, like my youngest brother's, you know, 10 years younger than me. Yeah, it's huge. Yeah. We should have seen my mom, in her 60s, dealing with my like, teenage brother. She was like, Oh, the hell's going on here. Also, what was your husband's name? Kenny? Yeah. Kenny, yeah. I mean, Kenny wants a baby. But he's also like, I can't believe this. The fun part is lasting so long, this is awesome, so he's fine with it. Yeah, yeah. I bet you haven't heard him complain yet?
Catherine Alvarez 1:00:40
No, you're getting
Scott Benner 1:00:44
to the point where you're like, listen,
Catherine Alvarez 1:00:47
it's like, what's wrong with us? Yeah,
Scott Benner 1:00:49
well, you know, once it's on your calendar, now you're like, something's not working right. Where you're like, does it say here Thursday at two make baby. You know so well, I wish you a lot of luck. I'm I know it can be incredibly frustrating, for sure, yeah,
Catherine Alvarez 1:01:03
but you know, we're happy we have a crazy dog that really keeps us on our toes. So nice. Uh, because dogs are good practice, yeah, it makes me feel like I was not at all prepared. We, uh, we found our dog. She's a dumpster baby, and she has really humbled me. Oh,
Scott Benner 1:01:20
wow. Somebody threw puppies in a dumpster.
Catherine Alvarez 1:01:24
Yes, that happened. I
Scott Benner 1:01:25
guess that does happen. I don't know why I'm so surprised every time something horrible is brought to my attention, but Oh, wow. How did you like so somebody found them, brought them to a shelter, and you came and got one.
Catherine Alvarez 1:01:35
No, we found her. You found her. Yeah, just hurt her and, oh, my god, Catherine, what
Scott Benner 1:01:42
are you doing in a near dumpster? Are you okay? You're not living in an alley or something, right?
Catherine Alvarez 1:01:49
No, no, I'm not dumpster diving or anything. Gary's paying you, right?
Scott Benner 1:01:57
So you, you and Kenny are walking down the street and hear a dog in a dumpster? Yeah, we
Catherine Alvarez 1:02:04
just had eaten at our favorite sushi place. And yep,
Scott Benner 1:02:08
oh God, it wasn't the sushi place's dumpster. Was it?
Catherine Alvarez 1:02:11
Yes, it was,
Scott Benner 1:02:13
oh god. Did it make you wonder what you just ate in the sushi place? No, luckily,
Catherine Alvarez 1:02:16
the dumpster did not smell. So no, I
Scott Benner 1:02:19
don't mean that. I mean you anyway, oh, okay, I see what you're like, uh, oh, so you took the puppy out. It was a puppy, yep. What kind of dog is it a mutt or like, yeah, she's
Catherine Alvarez 1:02:31
mostly, she's pity Staffy bulldog and Boxer,
Scott Benner 1:02:35
wow. And how does it humble do?
Catherine Alvarez 1:02:38
Well, I mean, she is. She has eaten two couches, multiple dog beds, multiple shoes, purses, tampons.
Scott Benner 1:02:52
Yeah, it's a low moment when your dog's running around the house with the tampon.
Catherine Alvarez 1:02:56
Yeah, yep, and then has to go to the emergency vet because that's not freaking very bad.
Scott Benner 1:03:02
Oh my god, two like, so just chewed through sofas. Yes, so obviously you can't wish that you didn't hear the dog in the dumpster because of the moral implications of it. But have there been moments when you thought like, oh God, dogs not for us? Or just, no, I
Catherine Alvarez 1:03:19
love her so much. Like she has an Instagram I'm totally just at a reels for this dog. Did
Scott Benner 1:03:26
that? Flip you out when you realize the dog owned a phone, we're like, oh my god, the dog's smart enough to post on Instagram. Why doesn't it not know not to eat the sofa? Yeah,
Catherine Alvarez 1:03:36
I know, right. She is. She's really smart. I mean, she's gone through like, a lot of training, spent so much on that, and she knows she knows how to be a good girl.
Scott Benner 1:03:49
Oh, you're at this point now where you're looking at the dog going, I know you know not to do this. Why is this happening? Yeah, my wife thinks the dog looks at her differently. Sometimes she's like, he knows I'm like, I don't think he knows anything. I think his brain is the size of a walnut, and I'm pretty sure he doesn't know anything. Actually, Arden said on the podcast recently that, um, that she learned about consciousness and that dogs don't have it like, the the way dogs have consciousness is different than how, like, higher beings have it, like, it's something about the mirror test. Interesting.
Catherine Alvarez 1:04:22
Well, she makes these very like, I'm very sorry mom faces at me after she does something bad. So
Scott Benner 1:04:29
I believe they say that that's you giving human feelings to an animal. There's a it's called Adam. I can, I can never, like, pronounce the word Hold on a second. I sound like an idiot.
Catherine Alvarez 1:04:43
Do you know about that? I mean, it makes sense, but no, I don't anthropomorphism,
Scott Benner 1:04:47
it's a term that refers to the tendency to ascribe human traits, behaviors or intentions to non human entities, including animals, objects and even natural phenomenons. For example, saying, Oh, look, the dog feels guilty because of its body language after doing something wrong. That's a form of anthropomorphism. So you are doing that, not the dog.
Catherine Alvarez 1:05:11
Well, I'm still gonna believe that my dog is very sorry.
Scott Benner 1:05:16
You just want the dog to be sorry, whatever the just want the dog to be sorry. You're like, it must be regretful, because that sofa cost $1,000 No, she's sorry. Because if the dog's not regretful, you're gonna take it back to the dumpster and like, so you have to, like, tell yourself, it's not that you would do that. I'm assuming you would take it to a shelter and abandon it properly. Yeah, I would never abandon please take care of your animals. Like, please don't take on responsibility for an animal. Like, that's why. Catherine, how much do you listen to this podcast?
Catherine Alvarez 1:05:48
I wish more, but, you know, I not a lot. That's fine.
Scott Benner 1:05:50
So you don't know that I have a chameleon. Or you do know this? No, I don't know. Okay. So my family gets me a chameleon for Christmas. And my first thought was like, Oh God no. Like, I don't want to be responsible. Like I have, like, a strong sense of responsibility for things. Like, if you put me in charge of something, I'm gonna feel that very deeply. Yeah, and I actually think that's helped me with the podcast. And you obviously have that with that dog, or you would have lost it outside, lost it in quotes. Do you think that helps you at your job.
Catherine Alvarez 1:06:21
I guess. I mean, I guess I could make the argument that it does. Do you have
Scott Benner 1:06:25
less feeling that people feel guilty when they do something wrong than when the dog does it?
Catherine Alvarez 1:06:29
I think that my dog feels more guilty. Okay, let me
Scott Benner 1:06:33
ask you another question, because you've dealt with so many people. Okay. I've been asked this question. I've heard it said a lot of times. I don't actually think people don't care about their health, like, you know how people they'll say, like, they don't take care of that they don't care. Or I don't think that's true. I think everyone cares. I think that the way, the tools they have to attack that the problem are greatly varied between person to person. But I don't think there's any person who's like, I'm not gonna Bolus for my food today because I don't care. Like, I just, you know what I mean? Like, I don't, I
Catherine Alvarez 1:07:10
think they're, yeah, they're overwhelmed by it, or, you know, there's something else going on.
Scott Benner 1:07:14
I genuinely believe that too. Like, I'm not saying you can't get into a situation with mental health where you physically and intellectually can't I know that happens if, I mean every day to day person walking around who's not stricken by horrible depression or, you know, mental illness or something like that, I don't think there's anyone out there who's just like, I don't care if I live or die. And even if they say that, I don't think that's necessarily true. I just think they are lost and they don't know what to do next. Yeah, yeah. That sucks, yeah. I
Catherine Alvarez 1:07:44
mean, I think, yeah, they're just in such a such a dark place this world. I mean, sometimes it's hard to find the good in it. So
Scott Benner 1:07:52
yeah, is it hard when, like, you're younger, right? So, like, let's think about you for a second. You said you over shared. So let's keep over sharing for a couple more minutes before I let you go, right? Yeah. So you're diagnosed at 12. That sucks. You've got a mom who has type one but is of no help to you. You feel pressure to help her, because you realize she's not helping herself. That doesn't work out. You know, you get this job that you've always wanted because you know, you've read this book and you're like, oh my god, I could work with this person who you know taught me so much stuff. You go do that, you train yourself up. You become a certified diabetes education and care specialist. Does anyone hear it when I'm saying it? Why did you think this was a good Certified Diabetes Care and Education Specialist? Yeah, see what you did. You made it bad. Okay, so you become that thing, and now you're helping people, then you go off to like, you know, you help this little boy, you're trying to build your own life. You're having your own struggles making a baby. Like, all this stuff's happening. And when I gave you the opportunity to say something, you said, like, the world's hard sometimes, so why are you not beat down by it?
Catherine Alvarez 1:08:57
It's a choice. And I mean, so to add to it, like the hardest thing by far that totally overshadows, like all of my other struggles in life, is that my brother actually passed away. Oh my gosh, I don't think I'll ever go through something that was would be as hard as that was because he was like he was my
Scott Benner 1:09:18
person in life, unexpectedly from an illness. It
Catherine Alvarez 1:09:21
was from drugs. Okay? So, yeah, he was, he was just 21 but, you know, we were really close in age, and we really did everything together.
Scott Benner 1:09:30
This is only seven or eight years ago. Is that right?
Catherine Alvarez 1:09:33
Yeah, yeah, I'm sorry, yeah, like, I just came to a point in my life where it's like, am I gonna let like? Is this gonna be where my life stops, or am I gonna choose to keep going and almost try to make him proud?
Scott Benner 1:09:50
That could have happened? You could see that moment as an inflection point where you just kind of gave up to Yeah, yeah. How long did it take you to get past that feeling? Yeah?
Catherine Alvarez 1:10:00
Around two years, wow.
Scott Benner 1:10:02
Would you consider yourself depressed during that time? Oh, yeah. Did you have to do anything like, like, what did you do to manage that?
Catherine Alvarez 1:10:10
I tried talking to people I really fell into a dark place with, like, alcohol for a while in my college days. But eventually I, and this is going to sound so like cliche, but really, exercise is what ended up turning my life around. I found CrossFit, and I got really into fitness, and it was exactly what I needed to to heal me.
Scott Benner 1:10:40
I'm glad you found that. Yeah, see, now you should listen to more of the podcast, because eventually everyone says something like this, after we've been talking for a while, and then later they'll say, I don't know why I told you that, but I appreciate you sharing that with me. That was really lovely to be that open. Did you ever consider like because it feels like you went towards diabetes because of your mom and you. But did you ever think like, I could also help people with like, addiction or drug use issues, like, like, where does that like lay in your mind? Yeah,
Catherine Alvarez 1:11:11
that so I think that. I think that just hits too close to home. You couldn't be around it like that. I don't touch that so much, but when someone does lose a loved one, I think that I can definitely be a person that they feel safe confiding in,
Scott Benner 1:11:28
yeah, oh, okay. I know it's hard. I'm sorry. You okay? Oh, yeah,
Catherine Alvarez 1:11:32
I'm good, okay,
Scott Benner 1:11:33
I was gonna ask a different question. No, it feels like such a pivot. I'm sorry. Um, after you make your little, not dumpster baby, but but your actual own human baby. After that does, happens and the baby comes, comes and is in the world, are you gonna go right back to using a GOP again? Well,
Catherine Alvarez 1:11:51
I think that I will want to bring more babies into the world. So No, not right away, getting gonna
Scott Benner 1:11:57
do Irish twin it up. You're gonna go. Go twice. Real hard. Maybe. Let's do it again. My gosh, oh, my gosh. Well, that's, that's crazy. Like, we didn't talk much about or at all, because it just sort of came up. But you know, the amount of people that I hear come through here, like, when you say, you know, when you said earlier, like, you can kind of see pathways, like when I'm when I said, like, oh, I don't know how many people I have to interview who are like this happened to me. You know, I interview a lot of people who also have, like, a bipolar person in their family, or there's depression in their family. When you start thinking about depression, or, like, you know, bipolar and inflammation, and, you know, like, how this stuff seems to go hand in hand through bloodlines. Really? Do you think that the depression you had was solely from the incident, or do you think that it's a thing you've had or have had since? I
Catherine Alvarez 1:12:50
think, I mean, it's, it's definitely, you know, ongoing, it's a trauma that will always be a part of me now, yeah, but
Scott Benner 1:13:01
it started at your brother's passing. Or you think it was before that? Oh, it's probably before that too. Did you notice any alleviation on the GLP, no,
Catherine Alvarez 1:13:12
you didn't. No, no, no, it didn't, not with that aspect, not
Scott Benner 1:13:17
that it should, just that. I you, you don't know this. But like, a lady came on recently who said that GLP medication alleviated a lot of her child's bipolar issues, there's so many questions. And yeah, no, I was just wondering if you noticed, like a lightning of your load in that time or not.
Catherine Alvarez 1:13:32
Yeah. Well, I don't think I personally suffer from depression. I think that, I mean, I do. I have medication? I eventually found the right SSRI for me personally, that's,
Scott Benner 1:13:46
I'm glad you found something Well, I think you have laid out perfectly why people might want to contact you. I think maybe Jenny's calendar is going to open up now, because right now, if you try to get Jenny professionally, what's it take? Like, six months, right? Yeah, oh
Catherine Alvarez 1:14:00
yeah. Jenny is hard schedule to get on. Yeah, she's, uh,
Scott Benner 1:14:03
she made a lot of fans, so you can go steal some of those people. Now, would you share your email address at work? Yeah, it's
Catherine Alvarez 1:14:11
just my name. Actually, it's my old name. So it's K Gen teal, my old last name at Integrated Diabetes, com, G, E,
Scott Benner 1:14:21
N, T, I, L, E,
Catherine Alvarez 1:14:22
you got it?
Scott Benner 1:14:23
Okay? Well, if you're interested in Catherine helping you with your diabetes, that is how you would reach out to her. That's, I know that's not why you came on, but I just, I thought you did such a nice job, and, you know, laid out, you know, a path of of what you think and and how you know what kind of a person they might intersect when they reached out to you. So, you know, I hope you don't mind me saying that. Oh, thank you. Appreciate it. Oh, it's my pleasure. Did we talk about everything you wanted to talk about? Yeah, yeah, absolutely, I did. That always surprised. I
Catherine Alvarez 1:14:53
mean, I really didn't even have any plans, like, I was just like, No, can't wait to talk to Scott. This is gonna be super
Scott Benner 1:14:57
cool. We spoke on the phone once. Four, is that right? Yeah, you
Catherine Alvarez 1:15:01
helped me make friends at the children with diabetes conference.
Scott Benner 1:15:05
Oh, that's right. They don't let me come there, but I still knew some people. By the way, that's not fair. They just, I've never been invited. I'm sure it's fine, but I
Catherine Alvarez 1:15:13
think, yeah, they, I think they just have, I think they have a different approach. I don't know. I think I so. I've gone for the past two years now, and I love that conference. Oh my gosh. It is really fun. Yeah, I
Scott Benner 1:15:26
swear to you, I don't like I have no ill will about it. And if you know it's not a problem at all, I just every year I'm inundated with, are you going to be at friends for life? Are you going to be with children like people? So every I know it's like, on my calendar, almost like this is when it starts happening, when people ask me if I'm coming. And I'm coming, and I'm always like, I've, you know, I would come if I was invited. I've not been invited, that that's all,
Catherine Alvarez 1:15:47
yeah. So yeah, yeah. I just decided to volunteer, um, this past year, nice. And I hope that I get to volunteer forever, because I was tell me what you took from it, the connections that I got to see form, or the connections that were already formed just from so many years of attending. It really is just like they're a family, if you're looking for a family feel. I mean, I don't think there's a better place to be. Yeah,
Scott Benner 1:16:13
I just got back from an event where I was around a lot of people, and, like, I had so many different interactions that were just heartwarming and stuff I won't forget anytime soon, you know, from like, little kids who are just doing better, and you know, since the last time you saw them or watching people make friends, you know, had this really cool little conversation in this group of children where, like, we didn't Talk about, like, you know, and talk about diabetes management or anything like that, but I just there's, you know, I don't know, 50 kids in this room, and I just went around and just asked them questions, like, you know, like, What's it feel like to be low? What's it feel like when you're higher? You know, you know, you know. What do you struggle with? And then, as you let them talk, from like five years old to, like, 15, when they started relating to me the questions they had about their health and their life, and you really started seeing the things that they were thinking about. Like, not that I didn't think kids were thinking about that stuff, but it's, it's eye opening to hear them articulate it. You know what I mean to have a nine year old tell you I don't understand, like, what happens to me, and I wish I understood better. And you know, because I go to school and I try to take a test and my blood sugar shoots up and I don't feel well, and I don't know if I should Bolus or not, like, all this other stuff, like, and it's just this young girl, you know what I mean. And you know, then to explain to her, like, what adrenaline does to her, and then to watch all these little faces in the room go, Oh my God. And then they can start relating it back to their own lives. Then five or six people put their hands up. It's like, my blood sugar always goes up here. Like when I get to school in the morning. I said, Oh, that used to happen to my daughter. And I said, and then does anybody's blood sugar drop really fast when the school day is over? And so many of them are like, how do you know that you know what I mean and like? And just to see them feel like, Oh, this is not like an I'm not crazy, and this is an abnormal, yeah, and that guy's saying that it might be because of this, like one little girl, if anybody's listening, I would love to have her on the podcast. She came up to me afterwards with a notebook in her hand, and she had been taking notes the whole time. We were talking, like, in the in the hour. And I said, is that a notebook? And she said, yeah. I said, What are you writing in it? She goes, I was just writing down things, you said. And I was like, Okay. And she goes, would you sign it for me? Almost like, only if you want me to cry, like, you know, like, so, like, I signed it, and I was like, thank you. She goes. Thanks a lot. I have a lot to talk to my mom about. And then she just went away. So, so adorable. Yeah, it was awesome. I love those things, those those those groups are, are awesome. I'm glad you found them too. Okay, I'm gonna let you go. You've been on a long time. I apologize for keeping
Catherine Alvarez 1:19:00
you, yeah, well, it was an absolute pleasure. I'm glad
Scott Benner 1:19:02
you had a good time. Thank you.
A huge thanks to Dexcom for being longtime sponsors of the Juicebox podcast. Dexcom.com/juice box. Head over there. Now get started today. Omnipod five sponsored this episode of The Juicebox podcast. Learn more and get started today at omnipod.com/juicebox links in the show notes, links at Juicebox podcast.com, I'd like to thank ag one for sponsoring this episode of The Juicebox podcast and remind you that with your first order, you're going to get a free welcome kit, five free travel packs, and a year supply of vitamin D that's at AG one.com/juice box.
Are you starting to see patterns? But you can't. Quite make sense of them. You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, if you're starting to think this isn't going the way the doctor said it would, I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group. Just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 okay, well, here we are at the end of the episode. You're still with me. Thank you. I really do appreciate that. What else could you do for me? Uh, why don't you tell a friend about the show or leave a five star review? Maybe you could make sure you're following or subscribed in your podcast app, go to YouTube and follow me or Instagram. Tik, Tok, oh gosh, here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page you don't want to miss. Please do not know about the private group. You have to join the private group as of this recording, it has 51,000 members in it. They're active, talking about diabetes, whatever you need to know. There's a conversation happening in there right now, and I'm there all the time. Tag me. I'll say hi. The episode you just heard was professionally edited by wrong way recording, wrong way, recording.com, you.
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