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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 everyone, and welcome to Episode 240 of the Juicebox Podcast. Today's episode is sponsored by Dexcom. On the pod and dancing for diabetes, there are links in the show notes of your podcast player at Juicebox podcast.com. Or you can type them right into a browser like this dexcom.com forward slash juice box, my omnipod.com forward slash juice box and dancing the number for diabetes.com. I am almost uncertain about how to explain what this episode is about to you other than to say, Carly has had Type One Diabetes very, very long time. She is a certified diabetes educator. And this was amazing this conversation rocks straight through to the end. Do not skip a moment. Because if you do, greatness will be lost. Carly is dealing pearls gems throughout. And I am you know, delightful. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your medical plan or becoming bold with insulin. And if you're in the United States today, allow me to say to you Happy Fourth of July. If you're in England, let me say this to you. And the rest of you. This is just a regular episode. Here we go.

Carly 1:35
Hi, I'm Carly. And I've been diabetic for 23 years. And I'm also a certified diabetes educator.

Scott Benner 1:49
23 years How old were you when you're diagnosed? If you don't mind saying?

Unknown Speaker 1:57
Yeah, I was seven years old.

Scott Benner 1:59
Seven years old. 23 years ago, I'm gonna do some quick math. This is the no Hold on. It's like the mid 90s ish, mid 90s. But all right, okay, so living at home, obviously one parent, two parents, which

Carly 2:11
I had two parents, very supportive of my diabetes and diagnosis to seven. So kind of, you know, kind of could understand what was going on, but also relied on my parents for a long time.

Scott Benner 2:22
So you were old enough to know that it sucked. And not probably old enough to kind of take charge of it. So they were Yeah,

Carly 2:29
right. That makes exactly it when I was diagnosed. I remember sitting in the hospital room and my parents are both crying and I wasn't. I wasn't in DK and I was feeling fine. I've been pulled out a dance class. So I was like, What is going on? Why is everyone crying? And you know, the doctors came in and they said, what they explained, you know, to my parents kind of what was going on? It was a little bit over my head at the time. Sure. And then after they left, and my parents said, Do you understand what what's going on? And I said, Can I still play outside? And that was my first question. Like, I thought I was dying the next day. You know, I had no idea what's going on.

Unknown Speaker 3:15
Let's start

Scott Benner 3:16
with the basic stuff. Am I going home ever?

Unknown Speaker 3:19
Oh, yeah,

Scott Benner 3:19
exactly. And by the way, I love you guys, but you're not handling this moment Really? Well. No, I

Carly 3:26
think they tried their best, but I thought, you know life is I knew it was over completely. And that really wasn't the case at all. So,

Scott Benner 3:34
gratefully, we figured it out in like the wee hours of the morning. And so when a doctor came in a room and told us and I cried like a small child for quite some time Arden was asleep, so she didn't get to say it. Oh, there you go. Yeah, I've always sort of been really grateful about that. That because I thought in that, like, we had a really good idea of what was happening before we got there. And I was like, now the doctor is gonna come in, they're gonna say it and you're just gonna be you're gonna hold it together. And please like three words into it. I was like, oh my god. So I feel for your parents. I really do. Yeah. Did you guys hit the ground running was did one of them kind of take more of a lead than the other? Did you take the lead? How did the early days of management go?

Carly 4:17
Yeah, so from what I can remember, my parents, you know, kind of took the lead. I think it was a full year before I gave my own injection. So I think by eight I was giving my injections with a little bit of help. I learned that diabetes camp the next summer which I hated and I never went back to again but I learned to diabetes gift to how to give injections so that was I guess a good thing about diabetes camp. But my my parents pretty much helped me with you know, the carb counting and and taking my insulin at the time and I was on might have been loving me on regular but I think it was mph and regular at the beginning. Isn't it funny

Scott Benner 5:00
about like the idea of Camp it's not so much about whether you could use it or not. It's a personality thing. Like there are some people who like camp. And there are some people who don't. And and I don't think if it was died, you probably wouldn't like a regular camp. Maybe you're just like, not, like get together with a bunch of people. And

Carly 5:16
I think I think that was more of a homebody and I had my friends and I didn't want to meet new people. So I think I went to like, church camps and things like that, and I loved it. But I think going to diabetes camp, I was like, these are all strangers. I don't really know these people. And it didn't help I got this stomach bug while I was there. So that probably is the reason I really hated it.

Scott Benner 5:38
I thought you were making like air quotes around stomach bug, like I got sick and had to leave.

Carly 5:42
You know, it could have been a nervous stomach bug. But it was definitely I definitely didn't feel well,

Scott Benner 5:48
I hear you. Okay, so doing shots. And I'm, by the way, I don't think it's a big deal at all that it took you a year to give yourself an injection. I don't know, as I think back on it. Arden moved to a pump when she was four. I don't think Arden's ever injected herself.

Carly 6:04
Yeah. Yeah. And you know, I, I do work with kids occasionally. And I do feel like that was that's very normal to not give injections. But I just remember, you know, at the beginning, it was more of a control thing, probably for my parents. Like, look, we want to make sure we're giving you the right thing. You know, plus, you don't have to worry about checking for air bubbles and all that.

Scott Benner 6:24
Probably you might have been a little dopey. Maybe they didn't trust you. That could be it. They were probably like, I don't think we should give that kid anything sharp. Yeah. Do you pump now as an adult?

Carly 6:35
I do. Yeah, I wear a pump in the CGM.

Scott Benner 6:38
When did you start that?

Carly 6:40
I started a pump in seventh grade. So I would have been? I don't know. 12. I don't know how old are you in seventh grade? Remember, I was in seventh grade.

Scott Benner 6:51
Right? So seventh grade. And was that decision? Yours? Or was it the doctor?

Unknown Speaker 6:56
Did your parents kind

Carly 6:57
of a combination? I think it was kind of just what people did. And I don't remember being extremely excited about going on the pump. I think I don't remember dreading it either. I just don't really remember it being either way. I don't remember it being significant. Yeah. And even even after I got the pump, I don't really remember it being significant. What's

Scott Benner 7:21
not exactly like the 14 year old version of getting a television in your room. It's not you know, right. It wasn't. And by the way, does that even correlate now that people even want TVs in their room anymore? Maybe? Is that an old thought anyway? Yeah, I would get it like it just it's a progression of what your of what's next. You know, you've been to the doctor forever. And now they're like, Hey, you should probably try this pumping. Did you like it at first?

Carly 7:47
I did like it. I don't remember pushing back at all. Now keep in mind when I was when I first got the pump. And I was probably my 1999 I there wasn't an Fazel there wasn't any of these advanced pump features that are really the reason why I love the pump now said it was just a way you know, to deliver my insulin without having to stop and colada and needle. Yeah, no. And I saw I think more than anything that was

Scott Benner 8:18
it. Right. So it's convenient and not having to stick yourself. Exactly back then. Now it's I tell people that that's the least of what an insulin pump is now.

Unknown Speaker 8:27
You know, there's

Scott Benner 8:27
so many Yeah, so much that comes out. Now, let me ask you this, I make you the king of the world. And you get to make all the big decisions. A kid comes in seven years olds is diagnosed, do you hand them needles? Or do you just give them up?

Carly 8:42
Yeah, so this, you know, I think it really depends on for kids. And my opinion, I think it really depends on the parents. Now there's kids that I have seen enough. To be clear, I don't work with kids very often, I mainly work with the adult population

Scott Benner 8:57
because they don't let you near kids.

Carly 8:59
I do insulin pump training, mainly for my job. So I could I didn't I don't do i do kids occasionally, mainly in patient diagnosis. So like new type ones in the hospital. So yeah, that's it. That is a very good point. Because I've heard now on this podcast and another, you know, circles, just, you know, why don't we just stick a pump on people that would seem like it'd be so much easier. And for a large percentage of the population? I think it would be especially since that's where a lot of people end up, end up going anyways, more than anything, I think we should be slapping big ends on everyone. As soon as they get in the hospital. I was gonna leave because I you know, we feel safer as health care professionals. I feel so much safer as a diabetic and as a parent of a diabetic. I mean, aim over. It's like pletely completely different. Yeah. Sorry. Yeah.

Scott Benner 9:57
So it's, you know, as much as I think There are incredible benefits the pumping the end, you know, obviously, the suggestions you can make with how your insulin works that are, you know, not available to you if you're using a slow acting insulin. But the idea that you don't get a CGM, the minute someone tells you we're going to start pumping manmade insulin into you is better bizarre? Like, yeah, you know, to me, because it exists. And, and, you know, I get that there are plenty of people who don't want these devices, and it's fine with me, I don't, I have no opinion about you not wanting it, if you don't want it, you don't want it. I just made myself the king of the world a second ago. So I get to make all the decisions. And I'm saying to you that, you know, the benefits like, you know, I hear people say, Why don't want to wear anything, a lot of people have that feeling in the beginning, especially about their children, they don't want them to feel like machines, which is something that I experienced when we thought about it in some pump the first time it really, it really scrambled my brain to think about attaching something to Arden took me a little time to get over that.

Carly 11:02
I will say when I was in high school and beyond high school, even until the last maybe five years or so, I used to go on pump holidays a lot. I would every time I went to the beach, maybe it was a body image thing, I don't know. But every time I went to the beach, I would take my pump, I would go on injections. My control was terrible. I mean, you know, I was basically guessing at long acting doses, or my doctor was guessing a long acting doses because that obviously doesn't work the exact same way. So they would do the conversion and stuff. But I would be struggling with highs and lows the whole time. But for me, it was so nice to not have a pump on. And that was when I was on a tube pump. So you know things have changed quite a bit and now I don't go on pump holidays. And you go to the beach. Now you don't think anything of your pet which pump do you have? I have the Omni pod right now. Okay.

Scott Benner 11:54
And so I even get that like I get the idea of like I do hear people talk about you call it a pump holiday hear people say pump vacation, like you know, like, I'm gonna stop using my pump for a while. I can't fathom how that's easier. And maybe I'm just connecting it to the word vacation that thinking of a vacation is something that is relaxing, but maybe I'm not thinking of the psychological aspect of it. Like I just don't Yeah,

Carly 12:17
if I go for a diabetic free CGM. Okay, now pre CGM is it's completely different story. I wouldn't, I wouldn't go anywhere do anything without my CGM now, but prior to a CT scan, it was in my control is not that great anyways, so, you know, if I have something to 300 on my vacation, it's okay.

Scott Benner 12:40
dumpster fire. Let's throw some more gas on. It's not good. Exactly. I

Carly 12:43
mean, I didn't really know what I was doing back in the day when I was pumping. So to have to have go back on injections wasn't that big of a deal? Now, I would not be able to do it. I mean, there's just no way I would be able to do it. But back in the day, even I was thinking back on my wedding day. On my wedding day. I went off my pump. And I had 305 minutes before I walked down the aisle. I mean,

Scott Benner 13:14
you wish you kind of had that moment back where your blood sugar wasn't that high?

Carly 13:18
Yeah, absolutely. I mean, like, you know, that this was before? And before the the Dexcom? Of course,

Scott Benner 13:27
I can tell you that. I don't think it's I don't think it's considered a lot. You know, when people are thinking about diabetes in the beginning, but this week alone, I think I've spoken to like three different families and have this conversation with them. A few days later, you get a nice note back from them, Hey, you know, we cut the spikes out. We've got we're figuring it out. It's really common along but each one of the three of them has remarked at the significant change in the overall happiness and attitude of their kid. You know, like just oh my god, he seems so much happier. She doesn't you know, she used to feel sick to her stomach all the time, like all of this stuff that just get a nice stable blood sugar somewhere. And you don't i don't think you realize what those 250s Pro long what a 200 prolong with a 300 that goes to a 60 that goes back to a 300 how badly it makes you Yeah, get used to it, you know,

Carly 14:21
it affects every aspect of your life. You have your day, you know, like your effects. Your energy level affects your mood, it affects your level, you know, how soon you're ready for bed that night affects so many different things. So it's, it's pretty amazing.

Scott Benner 14:38
None of us could have known all those years ago, when we fled British oppression, that one day,

Unknown Speaker 14:45
that freedom

Scott Benner 14:47
would lead to the Dexcom g six continuous glucose monitor. Let me just tell you about history for a second. Some people there was like a king. Nobody liked it. I mean, some people didn't like it. So they jumped on a boat. They like sailed across the ocean. They were probably thinking they were gonna like salary off the edge of the globe. Who knows what they thought I wasn't there. They get here. They moved across the country. Next thing, you know, bang, America. Fast forward a little bit. Some guy says it wouldn't be cool if we could figure out what your blood sugar's doing. I mean, honestly, this is exactly what happened. I don't know why they don't teach this in school. But, you know, wouldn't it be cool if I could see how fast my blood sugar was moving and what direction I was going in? And I was like, Yeah, I mean, that's why the, you know, they got on the Mayflower so we could figure that out. And they were like, Oh, my God, rockets red glare. And then they set off some fireworks and had corn on the cob, and watch the parade. Then the guys from Dexcom, they got back to work because the holiday was over. And they designed the Dexcom g six continuous glucose monitor. After that, they called the FDA and said, We think this thing works so well, people won't need to use finger sticks anymore, then the FDA agreed. And that was pretty much it. Now here we are. So seriously, if you'd like to find out more about the dexcom, g six continuous glucose monitor, go to dexcom.com forward slash juice box, find out about a world where you can see the direction and speed that your blood sugar is moving. And where you can see a loved one's blood sugar remotely on Android or iPhone. You sent me a note, we're going on like maybe nine months ago, and you said you had just found the podcast. But how did you find it?

Carly 16:32
Yeah, actually, I had heard about it through I think a doctor that pediatrician that I kind of work with and it just mentioned that it was a interesting podcast for type ones. And I thought I should listen to it. So I thought I listen to it. And I haven't really stopped.

Scott Benner 16:55
Appreciate that. And I appreciate. I want to stop for a second. Any medical people who are listening who are telling other people about the podcast, I really appreciate that I got a note from the from the chief, pediatric endo at a really large hospital the other day that said that they were listening to the podcast and I thought oh, this is this is great, because my overall goal for it has to be for doctors and NGOs and CDs to start talking about the stuff this way. So I don't have to do this forever. Because I'm gonna get too old to do this at some point. So we need to win. At some point, it can't be cool to listen to a podcast like run by like a 60 year old guy. So we got to get done. Not that I'm 60. Now I'm just saying. But like so seriously, like, the podcast has taught me more than anything. But if you give people good information sooner, that they don't have to go through a lot of the problems that we think of as the stuff you have to go through while you're learning about diabetes. Yeah, yeah. And you know, so I love that. So can you talk a little bit about how, as a CD when and you said you deal a lot with adults? How do you instruct them? I'd love to know what that first couple meetings is like. Dancing for diabetes, calm dancing, the number for diabetes, calm dancing for diabetes, calm on Facebook, on Instagram, online checkout dancing for diabetes.

How do you instruct them?

Carly 18:29
Currently, what my what I'm doing is pump education. So I do literally pump into jams all day. So really, I can only get about two of those in because you know, they take a while. But a lot of the times it's kind of a working education, right? Because I'm teaching them about their product. And then I'm also kind of throwing in some little things about dosing, and I get a lot you can get a lot in assessing patients as far as like how they're doing what they do. Now, based on just your conversation. I don't like to go in and say, how do you carb count? How do you do this? Because ultimately, that's, you know, my fellow diabetes educators might say why you don't teach them how to carp? Not really, I mean, I do card counting is important important to know quite what you're eating. But it's different with with a pump there with pump therapy and a CGM. So I do my I do my best to follow the American Association of diabetes educators kind of guidelines for things, but I also kind of have my own little twist on things. I live it and I get it and I know how it is and not that diabetes educators that don't have diabetes, can understand but there is a little bit of I have no leeway. I feel like that I give my patients versus if I didn't live it because I understand it's not. It is not black and white. It is more gray than anything else. There is

Scott Benner 19:56
Yeah, I don't know how someone who doesn't have diabetes before. Know to tell somebody, you know, I think one of the more valuable things I say to people is, when something goes the way you don't want it to go, you can't think of that as a mistake, you can't get depressed or Solon or dramatic, you have to, that's the best moment ever. Because what you have now is amazing data about what you did what happened. And then you can make an adjustment to it the next time, it is such an incredible moment. And if you lose that moment to like, what was me, then you're gonna keep having that problem over and over again, and never learn from it. I don't know how a doctor would think to tell you that, you know,

Carly 20:33
yeah, yeah. And, you know, it's scary for healthcare professionals to tell patients to take fast acting insulin 30 minutes early, or take, you know, take your insulin early, I mean, that for, if you don't see exactly what it's doing on a daily basis, when you do something like that, it is scary, it sounds scary, you know, you're told that when kids are diagnosed, you're told doses insulin after they eat, they don't know, you don't know what they're gonna eat, you know, that, that kind of thing. And so it is, it is a little bit scary to tell people that so I choose my patients that I kind of teach, you know, bold with insulin or Pre-Bolus seen it, I choose my patients carefully, because some patients are just truly not there, like they can't, their knowledge basis is just very poor. So they might be coming in on a pump. And they might have all of the tools that somebody else has, but but I would not feel safe sending them out with a hidden gem, I would not feel safe giving them that information. So I kind of do kind of choose depending on the patient's level of education. Did you feel like myself and a lot of people like on the podcast are just a portion of the population of the diabetes population?

Scott Benner 21:46
Okay, so you're saying something that I don't think I've ever said out loud, which is, if you're listening to the podcast, you found it because you were in a moment that you thought this isn't right. I know, there's better than this, let me go figure out what else I don't know. And you as an edge as a, as a doctor, you know, a doctor has to see every one. And so you you're being very polite, but what you mean, and I think and what I say privately is that when I meet people, they are of all levels of intellect. And, and I i've, the way I come to think of it is like a classroom. If you put 20 people in a classroom, randomly, you're going to get three incredibly bright people, three people who are incredibly challenged, and maybe 14 in the middle are just average. But how do you assess that? meeting them for the first time in a doctor's office? Right? And so you and you have to and so you're saying that you adjust the information based on your assessment of what they can handle? Is that right?

Carly 22:47
Correct? Yep, correct. And, you know, a lot of its access, like, you know, I, I just want it sometimes I want to scream from the mountaintops like because I do, I do inpatient education, too. So I do pumps and then I also go to like hospital rooms, and I educate patients that are acutely ill and DK a type twos, you know, lots of different, everything, you name it, I'll see that in patient. And so sometimes it will come across like a type one, and I'm like, I want to scream from the mountaintops, this can be better, you know, this can be so much better. You don't have to, you know, you don't have to run up in the 15% range, you know, a Wednesday wise and you can feel good and you can be you can have a life, that's better. And so sometimes I I want to, you know, yeah, I want to give everyone a Dexcom brochure, and I want to say get this, you know, are a lot of its accessibility, socioeconomic status, just desire at all to, to, you know, they have diabetes, at least, their concerns, because they got so much other stuff going on in their life. So. So that's where I think as healthcare providers, I think a lot of the times this specific, like, podcast population is such a small percentage of the people that they see, but being but that being said, like, I find this podcast, so helpful, and I, like, look forward to listening to it, and I learned something. I learned something from every person you've interviewed.

Scott Benner 24:24
Yeah, I try to tell people that when they come on, I think almost every person who's ever been on this podcast says, I shouldn't be on because I don't have anything to add. And I always laughed. I'm like, you have no idea just if you come you're gonna help somebody.

Carly 24:37
Yeah, it's so true. I mean, no matter what level you could be on injections, you could be have been had diabetes for two months. Like it doesn't matter. You still it's more just it's like a support group. It's like Yeah, yeah,

Scott Benner 24:48
you get it. Someone has a different perspective on something or they'll say something. You may have heard something said six different ways and it not strike you and then on the seventh way, there it is, and and I'll I don't think I've ever said this on the podcast. But you've heard me I imagine, draw kind of that image of a tug of war about how to balance insulin right? And it's in it's an incredibly simple idea that and I've said it a million times privately. And I've said it on here, that comes from a person who contacted me privately Once, when they got on the phone with me. In a moment, I realized that I, I struggled to say it like this, but intellectually, they weren't where they needed to be. And, and, and I just, education wise, they were, they were just, they were, I feel so badly saying this, but but it was tough. It was tough for them, right to hear what I was saying. And so I still really wanted to help. And in that moment, I thought to myself, like, how do I distill this down further? Like, how can I get this down to a spot where everybody can understand it. And that in that moment, I said to her, I want you to imagine a tug of war. And in the middle of that rope is, is a flag. And unlike tug of war at school, we don't want one side to win, we want them to both pole, get tired and stop pulling at the same time leaving the flag in the middle, we want to start with your blood sugar at 90, that's the flag, we're going to give the insulin a head start because it's at a disadvantage. And then once that insulin starts pulling, the foods going to start pulling the insulin is going to increase in its intensity, everyone's gonna get tired at the same time and drop the rope and your blood sugar's never going to move. And three weeks later, I got a beautiful email back and she figured it out. And and that's the moment when I thought of all these tenants that we talked about on the podcast, they all have to be boiled down. So far, there's nothing left no fat, nothing to confuse you. And that's where sentences like, you know, you have to trust that what you know is going to happen is going to happen. That's such a bigger idea. But I figured out that that's the sentence. If your blood sugar's high, or your blood sugar's low, you've mis timed or miscalculated your insulin. That's it. And you know, like that kind of stuff. And so my question to you is, could it be put to a person in a clinical setting? in those very distilled terms, do you think that even the most challenged person you speak to could hear it? Hey, those of you that are at a family party right now, or picnic for the fourth, and you have one year, but if you're sitting up against the wall, listening to the podcast, I want to say hi to you, especially to all of you, I want to say, on the pot. When you think of an insulin pump, do you think of a device with a bunch of tubing connected to a site where you get your insulin, because if that's what you think that's not what the pot is, I think you need to see it for yourself, go to my Omni pod.com forward slash juice box. When you do that, on the pod, we'll be happy to send you a free, no obligation demonstration pod, they call it a pack. It's a pod experience kit a little it's like a box with a little pod in it, and you can wear it. And that way, you don't have to imagine what wearing an insulin pump is like, you'll actually get to see, at some point, this episode, you're going to hear Carly described her concerns about insulin pumping, and what she found when she found on the pod. And I think you're going to have a similar reaction. Now the great thing is if I'm wrong, no skin off your nose, because free and no obligation demo gets sent to your house. Right? It's not like you had to sign away like a child, or, you know, shoot yourself to Mars to get it nothing like that. Just fill in some information. They send you the pod and you give it a shot. Go to my on the pod.com forward slash juice box, or use the links in your show notes or Juicebox podcast.com. Give it a try today. And at the next picnic or swim party you're at. You'll be getting your insulin continuously whether you're swimming, playing volleyball or sleeping on a hammock never having to disconnect. Do you think that even the most challenged person you speak to could hear?

Carly 29:14
Oh, yes, I do. I do think that and no matter what I feel like when I even when I speak with patients that have that struggle, and I do think that I can I teach them and I do think they find value and some of the things that I say even just even just, you know, listen, I know it's hard and I know it's tough and it's constantly going to be that way but it can be easier. Here's how and giving like little analogies like like tug of war or you know, just any any type of balancing act is really what it is. And I do think that that helps a lot and patients come out with it's more of a kind of have just like a state of mind that I think you have to get patients in first and then they can really, then they're willing to accept the education,

Scott Benner 30:09
I always, always say that, like, you have to hit a spot where you're so desperate, that you'll listen to anything, because then that allows you to ignore all the things that have been told to you in the past. Mm hmm. Right. And so

Unknown Speaker 30:24
I'm gonna, I'll tell

Scott Benner 30:26
you a story about a person who I met around Christmas, got on the phone with them explained everything no differently than I explained it to somebody two days ago, who already has it, you know, down pat, and just kept struggling, couldn't get it straight. The other day was talking to them, said something else that all of a sudden clicked for them, just like that. And it was, it was amazing to see that it was just this tiny little piece that just didn't strike her correctly. And so it was still holding her up. So I said that. And she's like, okay, absolutely. I understand it. Now. Boom, a day later. Here's my graph everything clear as a bell. And I'll tell you, I'll tell you that I went into a hospital recently and did a support group. So 40 people maybe right, more newly diagnosed, mostly parents, couple of adults. I spoke for an hour gave the pretty classic presentation that I'll give like at the jdrf events, I'm going to this year, and then weren't able to do a q&a an hour past that. So I was there for two hours to start to finish. 80% of the people in that room have contacted me since then. And they're doing so much better. And as excited as I am about that. All I can wonder is why did the other 20%? Like how did it Why did it not hit them? Yeah. Do you mean like, that's the part I think about them? Like, how did I What did I not say that didn't reach those people? And I think in the end, to your point, it's they might not have been ready to hear it?

Carly 32:05
Yep, absolutely. Absolutely. And, you know, some patients do have a hard time with the CG ends. Because, again, I mean, what, what, what you do for art and and what you know, now most of your listeners do is, you know, we dose based off of our Dexcom. And based off our trends and based off of all of these things, and we Pre-Bolus when we see arrows, and we you know, we do all of these things that help keep us keep us way more in line. But there's a lot of people that just can't, the fact of having two things is too much. So, you know, that was how I was a long period of time, like when I was in high school, especially high school and college. I was like, I don't want a second thing. Like it's already too much to have a pump with this tubing and with this site and to have a Why can't they make it the same site? That was always my my biggest thing. And I talked to patients all the time about this. And they're like, I just can't have two sites. And I'm like, understand I was there. Again, it can be better. So a lot of is just getting patients to that point. Yeah, of getting the getting the product that I have the time I feel like I'm in sales. Because I'm like, I need this, you need this, you know, it's gonna help so much.

Scott Benner 33:24
I feel that way. Sometimes when I do the ads for Dexcom. And on the pod I think I hope people believe what I'm saying because I really mean it, you know, like like it. But it does have to be, I think back to Michael and I know Michael listens all the time sent me a note one day and said, it's such a simple email it said, okay, you win. I'm getting an omni pod. And I remember I remember laughing about that thinking, How many times did he hear? This is great. You should have this before he went Ah, okay. All right, fine. Like I beat him into it, you know what I mean? And now, he's thrilled with it now. But I get that like, I knew somebody who did injections for years, they just didn't want to pump just didn't want

Carly 34:09
even going from a tube pump to a tubeless pump. Again, you know, I do I do pump show and tells also so like a patient will come in and they'll say I want a product and I'll show them all the products and ultimately it I feel like the question I always get is because it you know comes up that I'm diabetic, I don't ultimately share that right away. But that just comes up it's really hard to you know, not share that and I want I'm totally open I'm totally want patients to understand that I get it and then you know, I think it breaks down some walls. But, you know, they'll say, Well, what do you wear? I'm like, Oh, you know, and then I have to go into that hole. What I wear and there is pumps, you know, a lot of patients there's a pump for everybody. And so not everyone you know, wants the Omni pod and that's totally fine. Is that you know, it's patient choice. Yeah, every

Scott Benner 35:04
one of those and I got Go ahead. Sorry, I was gonna say at the end of every one of those ads, I say, look, try it, and you'll decide if it's right for you like, yeah, I'm not saying it's gonna be right for you. I'm saying try it,

Carly 35:14
you know? Exactly. Yep. And I mean, when I, I used to work at an endo office, and when I, I worked with a nurse practitioner who was like, you have to try the Omni pod, you have to try the Omni pod? And I was like, Okay, I don't know. And so I did. I eventually tried it. And, you know, it that took away a lot of my, you know, I don't want to say I am, you know, I don't know, they in or that I, you know, worry about my, what it what it looks like, but I did, I cared a lot about that about how I how I wore it and where I put it. And so I switched into the Omnipod I thought it was going to be too big. But it wasn't, and it really has been amazing through, especially like through pregnancy. And after pregnancy. I don't think I could have had a two been and dealt with all of that.

Scott Benner 36:09
So it's uncomfortable to begin with

Unknown Speaker 36:12
that one more time.

Scott Benner 36:13
But what about being pregnant was the the you were uncomfortable as you were pregnant, and you just didn't,

Carly 36:17
I think it was mainly just like, I didn't want to have to deal with a tubing, as well as just kind of feeling uncomfortable there, all of that. And then after you have a child out, just there's a lot going on. So I think it was really nice to just have, you know, I didn't have to worry about you know, getting my tubing pulled out while I was trying to get up off the couch and I had a C section. So you know, recovering from all that and Nope, got to feed the baby and have to change my sight, that kind of thing. So I think it was just really nice to just have notices contained. It's on my skin is predictable.

Scott Benner 36:50
A long time ago on the pod had a tagline. They said, well, like the DOM, the pod makes diabetes a smaller part of your life. And I find that to be true. I try to kind of hammer home the amazing thing, you can switch it on the pot in like three minutes. It's Yeah, it's crazy how quick you can like go from one to another when it's time to change it. I see people there's a there's a YouTube online where this girl is changing her like to pump and even at fast speed. It goes on for 10 minutes. I'm

Unknown Speaker 37:17
like, how long was she at that?

Scott Benner 37:18
Like she's going in fast for if I did one of those videos, it would be over like this. And that would be the end of it.

Carly 37:25
I will I mean occupies so fast. And it's so nice that you just there's only got your vial of insulin and you have your pod that's, that's it, right? I think for more than anything. It's that because I will say when I was on a Medtronic pump for most of my life, and I got very quick at it. I mean, I could do it in less than two minutes. Yeah,

Scott Benner 37:42
but it's a pit. It's a pit stop eventually, right? Like you get eventually it's

Carly 37:46
Yeah, but more than that. It was just the pieces to it. Right? It was the app to have these two things. And this this third thing and you know, the to the pump and the old tubing and yeah, so I think that was more the changing of it than anything but yeah, it is so easy and so nice.

Scott Benner 38:04
Well, I love it aside. Oh, hold on a second. Arden sang lunch, give me a second. We're gonna do her. We have to do a Temp Basal increase. I'll tell you all about this in a second. 95% for an hour. Bolus, boy, here we go. This is gonna be something

13 units

60%. Now everybody's gonna be like, well, he's going so slow. Why is this happening and the rest? over a half hour? I'll tell you why. And then we'll get back to what I want to tell you about ease. So Arden's in high school now and she's sick. She told me two days ago, I don't feel good. My head's full. And we've been upping her insulin since then. She goes into school today, blood sugar's 106. She gets a little diagnol Barrow I tried to bump it back down the bump doesn't work. I give her a little more. Then she says her friend and her gonna go get a muffin for breakfast. There's a muffin at this high school Carly. It's a bomb. It's a it's a carbohydrate bomb is what it is. Okay, like they call it a muffin is unfair. It's it's anti having diabetes. So I'm like, okay, and we move up the basal rate, do a big bolus. I'm like, this is gonna be enough. And she just sits at that 150 and sits and sits and I'm like, Hey, did you finish them off finish because I just finished like, Okay, great. Give a little more did a unit then. Oh, hold on a second. She's not saying my text. I texted her back. And then she said hello. I don't think she I think she's had and now she's being irritating to me. Like I assume I am when I say to her She, when I text her, and she thinks that she can hear almost like, I'm not sure. Let me see, we'll go back this for a second, I would see if she's hearing it or not. Sometimes she gets in a bad signal spot. And

Unknown Speaker 40:15
I'm gonna say it's probably what it is sometimes goals are bad at that.

Scott Benner 40:18
Yeah, let's say, all right, she hasn't Hello, dad made the 16 times. So let's assume she saw it. So she, she gets them off, and it's holding her steady at 150. I blame the cold a little bit. She did a great job of Pre-Bolus saying, you know, telling me ahead of time, so that wasn't the problem. Then all of a sudden, the diagonal up with the straight up, which we never see. Now we're throwing insulin on. I'm like three more units, do this throw up the base on she went to like 270. I was like, Oh my God. And now she's like, 220, and she's coming down. But she's walking into lunch. So I'm now trying to it's a different game now.

Unknown Speaker 40:55
Oh, yeah.

Scott Benner 40:57
And I just did this with a mom, please. No one ever do this. Okay. But a woman I've been talking to her for a very long time, was having trouble her poor kids blood sugar was 301 day. I got her thinking about it in a different way. And then she's like, you know, we're getting off the phone. And she says, Oh, my God, he's hungry. What do I do? And I said, you want to? I said, Are you desperate enough to try something stupid? And she goes, I think I am. And I was like, All right. So I said, how much insulin Do you think gets him from 300 to 90? And she said, I think a unit we're talking about a pretty small kid. And I said, how much insulin Do you think he'll need for lunch? And she says, I think a unit and a half. And I was like, Okay, give him two and a half units right now. And I said, we are going to create a freefall in his blood sugar. And then we're going to put the lunch at the exact right time. This person on the West Coast basically. So it's me on the East Coast, or on the west coast. We're doing it through text messages. 90 minutes later, that kid had had his lunch, and his blood sugar was 75 and stable.

Unknown Speaker 42:03
That's awesome.

Scott Benner 42:03
Oh my god, it was so exhilarating and fun and horrible all at the same time. And I'll tell you why. Because, like, we created a double arrow down on purpose. And so you know, around a certain number. I was like, okay, like, give me this food now. And he ate it. And but the double down held on for a while, like 201 8171 50 she's like, what are we doing? Like, hold tight? You know, like, like, I felt like we were you know what it felt like, Star Wars when they have to blow up the Death Star. And you can see him like what he wants to shoot up. But he's waiting. And I'm like, hold just wait, wait, wait, stay on target. Right. And I was like, like, keep going.

Unknown Speaker 42:38
Yeah, you were probably more nervous than the mom. No, no,

Scott Benner 42:41
I was doing okay. And then I was like, okay, right here. Let's give him a few sips of juice because we want to cut that arrow from two to one. And she says, We don't keep juice in the house.

And I thought, Oh, I just killed a kid. Goodbye. And then I saw it was like I was like, What

do you mean? She says, Yeah, we use jelly beans for Lowe's. And I was like, Is there any liquid in the house with sugar in it? That's not soda. And she goes, we have lemonade. And and she's probably listening to this now being like, Oh, my God, that's me. And I was like, Okay, give him four ounces, eliminate two hours with a one hour one hour winter diagonal down came in for a beautiful landing. And so we talked about it later. And my wife and I were talking about it in the car, because we were going somewhere after this. And she's like, wow, that was like a Master's class and how insulin works, like a 90 minute crash course in learning how insulin and food affects you. And yeah, absolutely. It was amazing. And now three days later, they are doing so good on their own.

Carly 43:39
That's awesome. Yeah. And you know, what's interesting about like that lemonade, and the Jelly Bean situation is, I found with the Dexcom. I don't 15 grams. You know, that's what we hammer in people's heads, 15 grams, 15 grams, you retest 15 minutes later to see where you're at. I need seven, like, right or less, or I'm way high. So it's pretty interesting. You know, everyone's different, and their sensitivity to food and insulin. And so that's been pretty eye opening for me over the last three years realizing what actually what food actually does to my body.

Scott Benner 44:17
Yeah, I tell people all the time, you have to think about it differently. Like you know, the way you think about my blood sugar is x and I affect it with insulin. You also have to be able to think of my insulin is this and I can affect it with food. Yep, like if you flip that upside down and think about it like that. That's brilliant. Because, like you said 75 and steady that you just wish was 85 maybe is three jelly beans. Maybe Yeah, two sips of something like right like stop just don't just drink the whole juice box because you have the whole juice box like that. That doctor telling you 15 car 15 grams, 15 minutes. That's don't die advice. Like Like that's, that's I don't know what's happening. I won't be there. So just drink. All because that should stop it

Carly 45:01
and know CGM advice because in the past, whenever all of these, you know, kind of rules or these, you know, recommendations were made it was, you're probably 50. When you find out you're low or been crashing, which is why you feel so low. Yes. And so it's just a different it's a different scenario altogether.

Unknown Speaker 45:22
Absolutely.

Scott Benner 45:23
No being blind to what your blood sugar is the speed, it's moving in the direction it's going changes this whole thing. If, if trust me, if I tested my kids blood sugar, and it was 50. And she's wearing a CGM, I'd go Alright, drink a little, let's turn off your base. Let's see what we can do here. If I don't have a CGM. I'm like drink the whole thing. Have a banana? You know, do you want anything else? You know? Like it just yeah, it just changes the whole thing. But yeah, I want to go back for a second, you talked a lot about ease of technology, like, you need technology to be easy. And that people can only handle so much in their life, which I believe so. So thoroughly. And I think that what we've kind of created here on the podcast, does make diabetes, a smaller part of the considerations that you have to make during the day. Do you find that like bumping and nudging and setting your tolerances closer, so you can reaction or does that in? In real practice? Yes. Tell me about a little bit. Hey, everyone jumping back in just for a brief second, again, to say, I hope you check out dancing for diabetes. It's an organization run out of Florida, that helps children with Type One Diabetes, through dance, dancing for diabetes is wonderful and life affirming. And I hope you take a second to check them out. You can do it on Facebook or Instagram, but really go to their website to really see what they're doing dancing the number for diabetes.com.

Carly 46:52
Yes, I do. So, you know, I know you've talked about diabetes burnout on here before and it's a huge topic among diabetes education world because we see it daily. And, and what I always say is diabetes, burnout is not the act of managing your diabetes, it is not the it's not the checking the blood sugar, it's not the insulin, it's not the treating the lows, it is doing all of those things, and having terrible results. Because you can't you know, you're working so hard, and you have nothing to show for it. You know, you go into the doctor a one sees eight or nine. And that's not acceptable for an endocrinologist and, and, you know, and patients don't like it either. But they're feeling like I'm doing all this work, and there's nothing to show for it. And so, yeah, when we with with your diabetes technology, it takes out that portion of it, it's less stressful, it's you feel better, so you're more capable of managing it with the, you know, technology that. See, thank

Scott Benner 48:00
you. Thank you for that. Because I don't know, I again, I assume nobody believes me, I had no idea what you were gonna say there. And so you could

Unknown Speaker 48:07
have completely disagreed

Scott Benner 48:08
with me. And I would have been like, I can't hear you. Nevermind. But no, but no, I just, I think that to your point, burnout is and like, I just watched my wife do this big project that work that took her nine months. And for nine months. She's like, if anybody has input, if anybody has input, if any, and everybody's like, No, no, we're good. We're good. Then on day 90, you when she locks it down day, 99 months, how many days is in nine months, like on whatever day that was she goes to lock it down. someone's like, Oh, I have something to add to this. And what seemed to kill my wife was the idea that she had to go back and do it again. Yeah, right, like and so I think that that's it like if you count your carbs, and put your and I don't think doctors give enough consideration of this. If you count your carbs and put in your insulin and wait three hours and test your blood sugar's 330. Well, obviously, something didn't work. But when a doctor tells you No, no, that's the right thing to do. You never go back and think about those pieces, because someone's already assured you that you did the right thing. So that's when you get to people saying, well, that's just diabetes, which to me is a is a sentence that should be thrown out of the world. But when you find yourself saying that's just diabetes, what you mean is I don't understand how insulin works. Yeah, because if I did, this wouldn't have happened. Because even what happened with Arden today with her blood sugar, I knew this was going to happen. Like I let her have this muffin. I knew her blood sugar was going to shoot up. I didn't want it to go that high. But her having the cold was an extra level that I kind of couldn't quantify. And yeah, and but I knew it was gonna happen. And now I know how to take care of it. I'm going to get it back again. But when things are happening that you can explain. It's demoralizing. It's exhausting. And it acts and it makes you feel like why am I trying?

Carly 49:58
Yeah, and so when patients do come To me, and they say, you know, I have, I'm struggling with this that, you know, I feel like no matter what I do, you know, I can't, I can't perform like I can't. I, you know, and these people are people pleasers, you know, they want, they want people to be proud of them, that they're there. They're trying their hardest. And they say, I just can't, I just can't do it. And I go back, even I mean, I only became, I only became a CDE. Like, a few months ago, I've been doing diabetes education for a couple years. And my whole the whole rest of my life, I've just been a diabetic. So that's really where i, where i like to sit isn't being a diabetic, because, you know, I don't do myself as being an expert in diabetes at all, but I think I'm using my life and you know, now the, you know, knowledge in the best medical knowledge that I have, now I can, I can be a good diabetes educator. But my point of saying that is that it wasn't that long ago that I was sitting right where they were, that I was struggling to get my agency down that I was, you know, as a bedside nurse that I was walking around with a blood sugar of three 400. And my coworker would say, my patient's blood sugar, so Hi, there so noncompliant. And I was like, yeah, that's funny, because my blood sugar's 275. Or my blood sugar's 350.

Unknown Speaker 51:20
And would you give yourself a day? Yeah.

Scott Benner 51:22
Would you have considered yourself not, quote, unquote, non compliant?

Unknown Speaker 51:25
I don't. That word,

Scott Benner 51:27
I don't either. But would you have thought of yourself that way? Is what I'm saying?

Carly 51:30
No, I would never have thought of myself as that. And usually it was stress it was, you know, not getting lunch or getting low and having to slam some juice while I was go trying to run and do some for a patient or whatever it was, that was my job. It was it was no CGM. So it was just a flying by the seat of your pants. I'm hoping that your blood sugar when you checked, it was within range. Right? And that's what I remember. For most of my life. No, that's, that's been the, you know, at least 17 years of my diabetes life has been that Yeah.

Unknown Speaker 52:04
And that we're What?

Scott Benner 52:05
I'm sorry,

Carly 52:06
I didn't know. So I that's where I sit with my patients when they tell me that they're frustrated. I totally understand.

Scott Benner 52:12
And I think that word non compliant is a medical word that's been unfairly applied to a lot of people with diabetes. So there is there is a medical, there's a medical concept that somebody can be non compliant. If I tell you take one of these pills every day for 30 days, and you flat out won't do it. You are non compliant, right? But But if you have a brain injury, and you don't remember the pills every day, that's not non compliant, you have a different reason. And and if I, as a doctor set you up with a plan that is so boneheaded that you had no chance of ever keeping your blood sugar in line, and you get so tired of it that you just look at me and say, Look, this isn't working. I don't know what you want from me. That's not noncompliant. That's you being a bad doctor. You know, so, and you can't just, I think it's ego on the doctors part, I think they write people off as non compliant. So they don't have to think that they failed them.

Carly 53:07
Right. And, like when you said, even with pills, like even with pills, I'll go in, you know, because I, again, I see some type twos, I see a lot the type two, so I'll go in and see a patient. And so why aren't you taking your januvia or whatever? Why aren't you taking your medication and, you know, the in the chart, it's non compliant. But, you know, in reality, when I get down to it, it's, Oh, my, my sister took januvia, this is just an example. This is not something that actually happened. But so my sister took Geneva, and then she died two months later. So then she thought that the reason she died was from taking this medication, or whatever. So there's so many different examples I could give. So even things like that, when you really sit down and talk with somebody, there's normally a reason, and it might be a silly reason to, to most of us or to, to a doctor or to me, but to that patient, it's a very, like,

Unknown Speaker 54:09
life and death just yeah,

Carly 54:11
it's life and death. It's a very justifiable reason. So for most patients, if they don't have the access, or, you know, they're going through a lot of, you know, really tough stuff at home. And again, they don't care about their diabetes right now. Are they non compliant? No, not really, they really need to probably see it. psychologist or they need it, you know, they need some support in their life or something like that.

Unknown Speaker 54:32
So they need a podcast. That's what they need

Unknown Speaker 54:35
a pod

Scott Benner 54:36
will listen. And that's just it's just an amazing point that it doesn't make someone It doesn't mean they don't care about their health. It just means that they've gotten to a point where the information they have they can't win. I mean, let's put it into a different context. You put me on a football field with a professional football team and make me the running back 47 years old. And tell me run the ball. Now these men are going to crush me over and over and over again, I'm not going to take two steps before a 300 pound guy comes flying through and knocks my head off. If I tell you I don't want to do it anymore, am I a non compliant football player? Or am I just a person with common sense? Who says, Listen, this isn't working. And so I'm not doing it anymore. Right? It just, I just think that it is incredibly incumbent upon us to give people like I would implore anyone who's listening in the medical community that over the next, by the time you hear this, we're going to be months into it. But you guys have heard for the last couple of months, starting in February of 2009. Jenny Smith is going to have been back on the show. And we're gonna break down my ideas about the podcast into these little simple to digest bits. shareable read listenable short, talking about Pre-Bolus. And talking about Temp Basal, and like really breaking it down an easy to understand digestible ways. I'm telling you, if that's how you talk to people about diabetes, from my experience, I'm telling you, you will elevate and fast forward people in a way you can imagine. It is that simple. I know everyone's different. But there are some basic things about diabetes that are not different for almost everyone.

Carly 56:20
That's true. And you know, a lot of it's fear of low blood sugar, or there's many different things that can be and I don't think anyone wants to be non compliant. Of course, they might not want to be diabetic, but they don't want to be non compliant. Step one is fear. By the way,

Scott Benner 56:37
none of the things I talked about on the podcast work if you're afraid of your insulin, none of them they can't, you know, and it's easy to say if you have a CGM, I'm not gonna I'm not going to die that I mean, the person who I told you I took from 300 to 75 and 90 minutes with a meal and stable and Didn't you know that? I mean, without a CGM. I don't know how you do that with it. I mean, I guess you could probably test the kid a dozen times. You know, but so I guess in that, in that regard, it's not not doable. It just, you know, it's not as easy and it's not as I don't know what the word is. I it's not carefree. Because I was there for 90 minutes. It wasn't carefree. It was a little intense. But it wasn't. I never worried about it. Because I've done it so many times. I know how to do it. Like, yeah, you know what I mean, and that the mother was there she was with them. They have a CGM. You know, I had her test a couple times to double check the CGM. It couldn't have been any safer. And in the end, all we did was It's crazy. But all we did was put in the right amount of insulin. Sorry, time.

Carly 57:44
Yeah, timing is just, it's, it's life changing. I mean, it's a whole different game. It's a game changer. And when, when I, you know, talk to patients about like, Pre-Bolus, or, you know, just getting ahead of that, that low, or making sure your blood sugar is kind of on its way down before you eat. It's, it's, it's, I love the feedback I get, because you do feel. And I'm sure when you started this, you were like, I don't know how people are going to take this. I don't know how this is gonna go. And the same thing because I'm, I'm talking to patients, and I don't again, I don't do do with everybody. But I have those patients that say I struggle with meals, every meal I struggle with. I'm like, well, let's change the time of your insulin. Every time. They're like, Whoa, like that.

Scott Benner 58:30
But like my blood sugar is high all the time. Like, would you use more bazel? I'll tell you the one thing you must see as a person who educates somebody about using a pump. Because I see it constantly from the people I hear from, oh, I switched to a pump. And now my blood sugar's high all the time. Why do doctors lowball the amount of insulin for a basal rate when they set up a pump? Because then the people think it's the pumps fault. So they have reasonable control on their their injections, right? And they're using, I don't know, 10 units of basal insulin a day. And then you put their pump together with six units of basal insulin, then their blood sugars are 225. And they call you and you say, well, let's you know, keep going. And you know, maybe well, I'm like, What are you talking about? I talked to somebody the other day, I'm like, you went from 10 units of slow acting insulin to six. That's why your blood sugar's high. It's it's, I mean, look, it's not brain surgery, right? You went from this much insulin to this much insulin and your blood sugar went up. But that poor person was so confounded because that's what the doctor told them. Yeah, I never considered that part.

Carly 59:31
Yeah, that's true. And and I do think the reason why they do that and is because you do utilize your insulin way better when you're on all fast acting insulin versus the long acting insulin that you know, forms a crystal and your skin is slowly release and the absorption isn't always the best. And so when we switch to fast acting insulin, more often than not, I find that we have to back off even more. Which that's not every patient but I do find that that's that's case, so But why

Scott Benner 1:00:01
them wait three months before you make another decision, tell the person look, I'm going to set your pump up at six units. By the end of the afternoon, if your blood sugar is high, we're going to push it up again, like why three months later, like that, because, you know, throw me a text message at five o'clock, and tell me what your blood sugar has been like. It's not, we're telling those people look, I'm going to put let sex right. But if your blood sugars are abnormally high, I want you to go, here's how you go into the settings, change it to seven for 24 hours, you know, and then wait another few hours. And if it's abnormal, change it to eight, and we're gonna keep pushing it up. There's no reason to wait that Yep, you know,

Carly 1:00:38
I asked for pump downloads within a couple days. And then we can make frequent adjustments. And I always say, look, this is something you can do all the time, like you don't have to, because a lot of times what happens with diabetes, and this is why the burnout occurs, is, you know, you see your doctor every four or five months, if you're lucky three months is like, doesn't even happen anymore, it seems. And you you go, you go that whole four months, with high blood sugars, or with crazy blood sugars, and then you get to the doctor, and they're like, hey, anyone sees high rolling the lower this, and then it helps a little bit, and then we don't fine tune in anymore. And then four months later, we're back where we were. And so, you know, it's like a vicious cycle. So it's like, just just download your pump and send it in and we can make adjustments and but then next week, you'll be feeling great. So

Scott Benner 1:01:27
this person told me the doctor said, Well, we have to establish a pattern I said we already did, they gave you less insulin, the pattern is you're not using enough insulin like like, it's just it can't be if your blood sugar is high, you don't have enough insulin or it's Miss timed, or a combination of those two ideas. That applies to bazel, too. And then people are like, you know, now my meals are crazy. I'm like, Well, yeah, your meals are crazy. So in this example, they went from 10 units a day to six units a day. And now their bonuses weren't working like their mealtimes were organized. Yeah, because your bonuses are just replacing the basal insulin that you're missing. Well, yeah, you know, I'm like you, you haven't even addressed the food or the, the the action of the carbs or the momentum that those carbs are going to create because the insulin is not, you know, giving you enough resistance against those carbs. There's so many reasons why it's based. I tell people all the time when you're bolusing too much. You're basals wrong. Like it's it's just simple. I can't keep saying this, Carly. It's just it's too easy. I think that a lot of what you said here today, if not everything you said here today, I hundred percent on board with I'm thrilled that you came on. And I'm glad you're in the business now. Like I'm glad you're one of the people helping other people.

Carly 1:02:42
Thanks. Yeah, it's it's definitely the right job for me. I love it. But you know, it does. It's, it's interesting to live it and didn't do it as a job too, because you run across lots of different opinions, lots of different times. And it's sometimes tough to navigate.

Scott Benner 1:02:59
Yeah, I mean, listen, you can't, you can't argue with people's experiences. And you can show them what you think. And hopefully that'll make sense to them. You know, I just said to somebody the other day, like, they're like, you know, I'm getting low every morning, like at night at like, 1am. And, you know, I my blood sugar drops when I'm sleeping. I'm like, No, no, there's something about your dinner Bolus that's doing this. He you know, like, it is like, I know, you don't see that. But it is. And it people are very reactionary, like I for somebody put it somebody, I forget how somebody put it to me the other day on the podcast that I really thought was great. But oh, yeah, I think somebody said like, you know, I arrested 10 people today, they all had a blue shirt on. So blue shirts cause crime, right, which is, which is not true. So just because it's one o'clock in the morning, doesn't mean that that's why your blood sugar's low, you have to look at the bigger picture. And so we looked at it. And sure enough, you know, this Bolus, they were using it dinnertime needed to be aggressive. But long after the aggressiveness of the Bolus was done doing its job and the food had, you know, digested through their system. There was still some of that Bolus leftover. So they, they had to change their bazel rate. And like I forgot, like 1011 o'clock for like an hour and a half so that the tail of the Bolus, then replace that bazel instead of you getting the tail balls and the bazel. And then there they didn't get low anymore at one o'clock. Yep.

Carly 1:04:32
Yeah, because you know, the larger the Bolus and people don't agree with this. The larger the Bolus, the longer last. It can last up to seven, eight hours for me, I can bottom out later and there. I know it's from that Bolus I took. I tried to keep my Bolus is a little bit smaller because of that, but it just you just need to Temp Basal you know later on and decrease Temp Basal to avoid that low, but you can kind of counteract that food but yeah, it's that that's not everyone's opinion.

Scott Benner 1:05:00
Yeah, I know. And it's fine. Because they're like, No, I've been doing this for 10 years. And I'm telling you I get low overnight. I'm like, I don't know how to argue with them. They've been arresting people in blue shirts for 10 years, they must think blue shirts cause crime. And I you know, so that's why I listen, I I say all the time. Here's the best. Here, you can call this advice. If you haven't CGM lower your high alarm down as low as you can get it 131 20. Because when you get the 120 Dagnall up, it takes such a little bit of insulin to get you back down under 120. But when you get to 200, or 250, or 180, it takes so much insulin, you just heard about Carl, he said that insulin could stay in you forever and cause a low hours later. But when you bump into a bump a blood sugar with point 4.5 a unit, you know, you know, if you're a 200 pound person using a unit, that's nothing. And so, so highs cause lows, because of the amount of insulin you use. Yeah, you know, so use less insulin controlled sooner, and then you think about it less. You see 120 you bump it, it goes back again. That's so much better than finding out you're 150 straight up, and now you're fighting with this blood sugar for the next three hours. Yeah, yep, we're making too much sense here, Carly. Okay, yeah. So we're up on an hour? Did we not cover anything that you were hoping to talk about?

Carly 1:06:19
No, I think we did. Um, I think we pretty much covered everything that I wanted to talk about. But I just kind of, you know, I wanted to make sure that that, that you, even though I said that sometimes, like, it's not the right patient population, like, you know, this podcast only reaches a certain kind of subset of the diabetes population. I think it could reach more, I think, as we share it, and I think as people learn about it, but I want you to know, I find it very valuable. And as a diabetic, and, you know, even talking to parents of kids, I think that's so helpful for me, just as an educator talking to listening to, you know, when you talk to parents of children, it's, it's, it kind of brings you back to reality, because it's very different to be a parent of a diabetic than it is to be a diabetic. And so I think that's helpful for me. And I think it's helpful for all diabetics, because most of us have parents. To help you see the other side,

Scott Benner 1:07:19
it is a different perspective to, I think that I've said before, like, I think my greatest gift in this is that I can be dispassionate about it, because it's not me. And because my daughter's health is more important to me than anything else. So I can remove myself from the drama, and the anger and the pain and just focus on what needs to be done.

Carly 1:07:40
Yeah, yeah, that's true. And that's, that's also why when you're like when I was pregnant, why it's crazy how your control gets, you know, how, how you think before that you because you ultimately care about your child, and my case, my unborn child, but you care about their health so much that you, you somehow tighten, tighten your control, even though you thought you were doing it as good as you could before. And it is, it's, it's just, it just happens, you just you pay more attention, you're more into it. And that's when I started Pre-Bolus thing is when I was pregnant,

Scott Benner 1:08:18
doing something, doing something for love is way more powerful than doing it for yourself. That was

Carly 1:08:22
a you know, I have continued that it's my agency is about the same as it was now that it wasn't I was pregnant. And

Scott Benner 1:08:30
that's been really nice, good for you. But Congratulations, and thank you very much for being on the show.

Unknown Speaker 1:08:37
Nice to talk to you.

Scott Benner 1:08:39
Thank you so much, Carly for coming on and being so open, especially from your perspective. And thank you to Dexcom on the pod and dancing for diabetes for supporting the Juicebox Podcast please go to dexcom.com forward slash juice box to get started with the G six continuous glucose monitor today. We're going to Miami pods.com forward slash juice box to get a free no obligation pod experience kit sent right to your door actually do both. And after you do that, check out dancing for diabetes. It's dancing the number four diabetes.com. Just as I was about to push stop and button up this episode, I got this note. Scott, your podcast has changed my life. I wish school and camp nurses can somehow be required to listen to the whole thing as part of diabetes training. But I guess if they can at least require them to listen to the pro tip series. I bring that up actually because we spoke about that Carly and I spoke about that a little bit here. And if you're interested head back to Episode 210 for diabetes pro tip newly diagnosed or starting over and you'll be able to listen through the pro tip series that way. At this point, I think there's 11 episodes and even though I think I mentioned in the podcast that I thought by the time 2019 was over, I'd have a dozen episodes. The group Great news is that Jenny and I are going to keep going. And these episodes are going to keep coming once a month throughout the rest of 2019. So there's already like 11 there, and there's more coming. Please don't miss them. I can't tell you that they're life changing, because I'll sound like a jerk. And then somebody leaves a review that that guy is all full of himself. And so I can't say it, but Abby just did say it. And if you don't believe me, you can go to my Facebook page right now and see where Abby said it. Anyway, I really think that these episodes whether you are newly diagnosed, or if you're a person who has been living with Type One Diabetes forever, I think these episodes will help you bring things into focus in a way that can improve your agency and your daily control in degrees that you probably don't think are possible. Alright, check them out. Listen through. Don't forget on Friday, there'll be another defining diabetes definition. And next week just in time for the Major League Baseball, all star game. Sam fold will be back on the podcast. Sam played for the athletics cubs, Tampa Bay. He is one of the current coaches of the Philadelphia Phillies and Sam came on you know, so we could like man up the podcast a little bit. He and I are going to talk about how diabetes is oddly like baseball.