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Scott Benner 0:00
Hello, everyone. Welcome to Episode 321 of the Juicebox Podcast. Today's show is an ask Scott and Jenny. And in just a moment, I'm going to tell you what the topics are and who the sponsors are. But first, I'd like to spend a brief second, discussing how I'm programming the show with consideration to the Coronavirus and what's going on in the world. So my family and I'm sure many of you have been held up in your homes. My family's been here at home for almost a month now. And in that time, I've been paying attention to the Coronavirus maybe more acutely than some parts of the country because I live in the New York Philadelphia metropolitan area. And it struck here pretty quickly. Now, some of you may live in places where it might not reach anywhere near that it has in New York. And I hope that for all of you. And some of you may just be a little behind where New York is right now. One way or the other. I felt like it was important for people to understand what Corona or COVID-19 is. So you know, back in mid March I had Adam Edelman Come on. He's a doctor we discussed Coronavirus, kind of in a broad way. Jenny Smith and I talked about Corona The following episode. So these are episodes 314 315 There were a couple other episodes came up. And before I knew it, Sarah who's listening to the show, reached out and said she's a nurse in New York City. And she's got Corona very mild case of Corona, she came on and told us about what a mild case of Corona was like. Adam came back on Dr. Needleman came back on again, just recently did a little bit of an update. And in that time, I was able to interview a gentleman named Justin, who's become kind of famous online for being one of the first people to put a picture of themselves up with a mask on saying that they had Coronavirus and asking everyone to be careful and, and follow the rules. Because it was serious. Justin happens to have type one diabetes, so I couldn't pass him up. Even though I thought I don't want too much Corona stuff on the podcast. Now Justin had a more significant more severe case of Corona, and I interviewed him just the other day, his episodes going to be out after this one. So what I'm gonna do this week is put an extra episode out, I'm gonna try to strike a balance, I don't want people who aren't interested or maybe are having anxiety around Corona to feel like they're not getting content. And for those of you who are interested, I don't want to stop providing the content. Now I can see the downloads and the corona episodes are very popular. And so I'm going to kind of override my inner voice that's telling me too much Corona. And I'm just going to try to continue to provide good solid information that's not click Beatty, and not meant to make you upset, you know, so that you'll come back and get more, which I think is what a lot of media does just want to offer you good information. You can do with it what you want. But there'll be three episodes this week, so that everybody gets what they're looking for. This episode of The Juicebox Podcast is sponsored by Omni pod makers of the tubeless insulin pump that my daughter has been wearing now for a very long time. Now, since she let's think, already got an insulin pump around the time she was four and she's gone. And she's 15. She's going to be 16 this summer. That seems like 12 or 13 years, it's hard to know because my math skills are limited. Anyway, Arden has been working on the pod every day for that time. She's also been wearing a Dexcom CGM. Currently Arden wears the Dexcom G six continuous glucose monitor. And we absolutely love it, you can tell that if you listen to the podcast, that's sort of a no brainer, I don't really need to tell you her meter the Contour Next One blood glucose meter super small, super convenient, lovely and accurate, like they talk about and of course you know near and dear to my heart touched by type one. And I asked you to check them out at touched by type one.org. There are links in the show notes of your podcast player to all of the sponsors. Or you can type their links in yourself. My omnipod.com forward slash juicebox dexcom.com forward slash juicebox. Contour next one.com And of course, touched by type one.org. Let's play the music and then talk about some stuff with Jennifer Smith.

In today's Ask Scott and Jenny, we answer 123 questions. Wait. Yeah, three questions couple more bigger. I asked me a question. We chat a little bit about the Zoom meetups I've been doing on Thursdays come on out and check them if you want. There's one In the Facebook page, this Thursday is going to be at 7pm. Eastern time, I guess I should tell you that Thursday's date will be April 9 2020. In this episode, Jenny and I are going to answer a question about shutting off Basal, and how long you can do it safely. I'm going to tell a quick story about meeting some fans in public. I Muse a little bit with Jenny about the social meetups and whether or not they're valuable ways to help people make improvements. And I'll talk a little bit about that at the end of the podcast as well. And then we talked about extreme management. I put extreme in quotes here. Because is being healthy extreme. And why do people think of it that way? Sometimes. I'm going to want you to remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to please Always consult a physician before making any changes to your health care plan are becoming bold with insulin. Helen says, I hear Scott say he turns Basal off. If Arden is running low, we started to do this for my daughter, Ella. And it works amazingly well. However, we only dare do it for about 30 minutes. We were told ketones develop quickly if she doesn't have background insulin. How long is safe to do? I have my answer. Let me go first this time. Let's see how wrong I might be sure. Well, you're not wrong. Yeah, I could be wrong, you hold tight.

Jennifer Smith, CDE 6:32
Hold tight,

Scott Benner 6:33
I'll wait. Here's my thought. If your background insulin, if your Basal insulin is dragging you that low, then taking it away for a little while. It's not really gone, because you probably have too much to begin with. Now, if you take it away for a long while, and create an absolute black hole where no background insulin exists, then I think DK can come on very quickly, depending on a lot of other physiological implications. How was that?

Jennifer Smith, CDE 7:07
I was actually pretty, pretty good. Not bad. Not bad. Not bad at all.

Scott Benner 7:11
I gotta get you know how some people are like online ministers. I just need one like company to start online CDE. And I think I could get one wouldn't be like real, like, you know that while you're being married by a minister of the like, bah, bah, bah, live charge that got something by filling out a form online. It's not really a minister but it's legal. It's legal. I think if somebody would start that around diabetes, I'd be okay. Go ahead.

Jennifer Smith, CDE 7:38
Yeah, no, but you're I think that's a really good like baseline, and even a little bit more. It's a little more in depth than baseline even because you did go into the fact that if you're on Basal alone, there's little, literally nothing else left such as like an overnight, you go into bed, your last meal in Bolus was around six o'clock, it's three o'clock in the morning. And you can see that, like you said, before Arden's friend, she had a bad pump, or a bad pod site, or whatever it was, and she was middle of the night, you could see blood sugar was rising. There was no other reason for it to be rising. None at all. It was a bad site. So that kind of a deficit of insulin was likely started a couple of hours prior to the rise starting Yeah, right. Because anytime you're at a deficit of Basal, you can shut a Basal off right now, you still have circulating Basal insulin going for at least another hour, perhaps hour to two hours, right. So you're really not at that complete, utter zero level of Basal yet. So a 30 minute shut off, is really it's nothing, it's, I'm glad it's helping for the reason that you're using it for, but that 30 minutes is really like a drop in the bucket of nothing, as far as impact for causing decay a right. And the other, you know, piece that kind of goes into that as well. In this scenario. For example, let's say this low is happening during the daytime, and you shut the Basal off for just 30 minutes. And it helps for whatever reason that 30 minutes is really stabilizing things, evening things out into the next hour or two. So you don't stay low or go lower. Great. But you also have to look back and say if this was during the day, the low was probably as long as you've got Basal figured out. It was probably not from Basal. It was probably from insulin on board from a Bolus that drove things too low. Yeah, with whatever other variables in the mix that caused it to happen, right. So just that 30 minute deficit again, of only Basal it's not deleting any insulin on board from a Bolus that might still be in the picture. So again, the risk of decay a while it is higher on a pump than it is with multiple daily injections. Because once you take your injection of Basal it's there, you know it's there, you're never at a base at a deficit of it. With a pump though, you do have to be careful. And our baseline is when it usually comes in and discussions in summer when kids are going to the beach and using their pool a lot or you know, whatever it might be, they disconnect from a lot of pumps that are tubed. We usually say do not disconnect for more than a two hour time period, come back check blood sugar, take a Bolus of at least 50% of the missed Basal amount in that disconnected time period so that you don't have problems with a deficit leading to potential decay in the next several hours. So So yeah, so there's my long explanation.

Scott Benner 10:45
Oh, that's a great explanation. And and it brings up you know, what it reminded me of, you reminded me of how proud I am of the podcast, and how we can have long conversations about stuff like this, because 15 years ago, in the diabetes space, this was the message, you're more likely to go into decay with a pump. Because what if something happens and you stopped getting your insulin, and then that became the rule pumps are dangerous. And then people thought that for years, until people got other people bought pumps, and wore them and proved everybody hey, look, I'm still alive. I have a pump. So saying something, and it's not a wasn't a, an incorrect statement, right? You could be sleeping and Rick, rip out your site. And now you're not getting insulin. And that is a

Jennifer Smith, CDE 11:29
danger that could chew the to but you don't know it. I wish I could name this

Scott Benner 11:33
episode, the cat that chewed the tube, but no one would listen to it. But but but the point is, is that we used to say these very basic things, because that's what communication allowed. And then people were allowed in their minds to take the scariest part of that and run wild with it in their own imagination. Yeah, so I like that we can talk more about this. I like that. Helen can now think if I give a Bolus at noon, and I need to make it more aggressive upfront because of the nature of the food, but I know that at three o'clock, my kid's going to get low. I can still make that Bolus at noon. Turn Basal off at two o'clock, create a deficit of Basal at three when the Bolus from noon peaks and balance those things out. That is so cool that we can talk about that like that.

Jennifer Smith, CDE 12:24
That's great. Yeah. So I appreciate your tools, more tools for the toolbox.

Scott Benner 12:27
It's just more stuff to understand. I saw Jeremy in the Facebook group. He's being helpful and making fun of me at the same time, which I appreciate. Oh, because when people sometimes people are like, I don't know, like, how am I supposed to get to this place where a lot of you are what Scott's talking about? And my answer always is, you got to listen to the podcast. Like just listen through it because these things will build it's not it's not a checklist of five things you just do. And it all of a sudden works. There's you know, variability and, and nuance and everything. And Jeremy's like Scott's gonna say to listen to the podcast and, and he's like, but try this year. And he's both right in making fun of me. And he's right about what he said, too. Because this is not a quick fix. And it's not information that your brain just learns. Hearing it one time, you know. And

Jennifer Smith, CDE 13:23
when you since we've got some time now

Scott Benner 13:27
turn it up here.

Jennifer Smith, CDE 13:29
On those headphones, go for a walk with your dog, push your stroller, listen to it while your kids are running around in the backyard and whatnot. Actually, somebody yesterday that I talked to she and their family, they had come down to Atlanta for the JDRF conference to hear you, which was great. But all the way there and all the way back. They actually listened to the podcast to the podcast, because they had like I think she told me it was like an eight hour drive there an eight hour drive home. So they drove there and back listening to the pod.

Scott Benner 14:02
That's really nice. I thought was really cool on my way to Atlanta. I was I had to park my car to an airport, and I got a little shuttle bus to get to the airport. And there was this woman and her like 17 year old ish son sitting next to me, and we start driving out of the lot. And she just stands up and like goes way, way, way, way way. And like everybody's like, Oh, you know, what's this? She was I still have my key. So she was valet parking. So her car still running somewhere. But she left with her key, right? So she the driver stops, she runs out takes the key to the valet. And I turn to the boy and I say is that your mom? And he goes yeah, I said, my wife and I embarrassed our kids all the time. And he looks at me really strange, to the point where I thought Ooh, did I just offend this kid? Right and I felt bad. So I kind of withdrew back into myself and stopped talking to him. She gets back on the bus and begins to very kindly apologize to everybody on the bus. Oh, I hope I'm not making you late. Meanwhile, it was 30 seconds. You know, she just I hope I'm not making you late, Bob, I'm sorry, but and I looked up at her and I said, I just did something really stupid with my key two weeks ago. If you sit down, I'll tell you about it. It'll make you feel much better about this. She looks at me and goes, Are you Scott from the Juicebox Podcast? And I went, what? Because you know, we're on a bus at an airport with only eight other people. And I said, I am. And she goes, Oh, I saw you speak at this thing. And we listened to the show. And just as that happens, the kids CGM beeps, and I turned to him and I go, Oh, hey, and he looks at me. And he goes, I thought your voice sounded familiar, but I couldn't place it. My mom and I listened to the show together. And I was like, just think he wasn't mad at me. He was like, oh, man, why is this guy's voice seem familiar to me, you know, and it was just absolutely crazy. And then days later in Atlanta, I literally walked into them in a hotel lobby. I was like, they're there again. Funny, it was very, very strange. But, but nice. It was it was lovely, actually. So it might be different. You're being kind, but I appreciate that those it was very strange. It happened two weeks after I was recognized in an airport in Dallas. And that threw me for a loop. That was a woman approached me. He told me about Yeah, you're just sitting. Like, I was getting ready to get on a plane trying to decide when I was going to change my shirt, my sneakers, you know, like, and a person I have music on. And this lovely woman comes up to me, she kind of puts her hand out. And you know, you're just like, what's about to happen? You don't I mean? So I'm like, Hi, how are you? And she goes, good. I'm like, Can I help you? And she goes, Sure. Are you Scott? And I'm like, Uh huh.

Jennifer Smith, CDE 16:56
And who are you?

Scott Benner 16:57
And I was like, Were you just at my talk? And she goes, No, I'm in town. My daughter's running a marathon. And we're here to support her. And I was just like, wait, what? Like you weren't just at the thing I spoke at? And she's like, No, she says, My husband and I were sitting over there. 10 minutes looking at pictures of you online trying to decide that he's finally I think that's him. Go say hello. That kind of stuff. I gotta be honest with you. From diabetes podcast, I never thought and now it sticks in my head when I'm in public now. Now I'm like, Hmm, is there?

Jennifer Smith, CDE 17:27
Anybody knows what I look like?

Scott Benner 17:31
You just got to keep a lower profile. Because Because now I find myself thinking like, do I have to be nicer in public? Not that I'm not but like, am I gonna be judged by? Like, is there gonna be a story online one day, we're like, I saw this guy from this podcast, and he was being so he was being rude to a lady, you know, which I'm not. But now I'm worried about it. Right. So silly. Absolutely. So So I said, Jenny, let me ask you a question. I haven't asked Jenny question. I have. I'm doing that thing tomorrow on tomorrow, the first, you know, kind of group meet up for people. And I was thinking during this Coronavirus thing of starting like some sort of a challenge to lower your a one, see your deviation, your variability, like all that stuff, like we're all just sort of sitting around. Like, I wonder if we shouldn't, like try to help people like, right, like, I'm wondering if when everybody comes on this, this zoom later, if I'm not just gonna go through one by one and be like, Alright, everybody hold up your 24 hour graphs. Let's look at your Basal insulin. And then, and then talk about getting Basal adjusted for people, and then maybe see if we can't get back together once a week and see what we could do about like, I do a cool thing to do I do it with single, like people by themselves. Like, I think I could do it with a group.

Jennifer Smith, CDE 18:52
I not do it together and teach a big group. Right? Yeah,

Scott Benner 18:55
that might be fun. I think that would work.

Jennifer Smith, CDE 18:59
I do. And I think from the standpoint of looking, you know, I, in terms of looking at data, when you look at so much data, as I do, every day, lots and lots of data, lots of people's different kinds of data, you actually start to notice more things, right. And from a teaching tool, sometimes when it's only your own data that you're looking at, you can kind of get lost in it. Right, right. But when you bring together a big group, kind of like, like a kids for diabetes camp, or kids with diabetes kind of camp, you know, they they do a lot of things that are interactive like that, and they bring the information together and that sort of camaraderie. in a setting like this, yeah. where everybody's showing a graph. Somebody might be like, Hey, that looks like this is happening, right? Or, Hey, that looks like this is happening. And not only is it like a learning experience, you're also helping other people. You don't necessarily know.

Scott Benner 20:01
I just, I see it in the private Facebook group. So if you go on Facebook and search juicebox discussion group, I think that's what it's called. I named it, I should probably know what it's called. But it's a private group where people talk, and there's times people put graphs up. And I'll like jump in to say what I want to say, and somebody will have settled already, like, oh, great, you know, and I'll like, like, somebody comment and put a finger under it, like pointing to it. Like, this is what I would have said, Yeah. And then there are other times where somebody makes an explanation. I think that's better than what I was gonna say. And, you know, terrific. So I'm thinking like, maybe we can do it. Like, again, a mass like, you can get 100 people together and bring everyone's blood sugar down, Louis, Zoom call. I'm like, I'm like people. Yeah, I think I can. It's so and then like, yeah, I hope so. I really hope it works out. So I'm gonna even have

Jennifer Smith, CDE 20:51
like, focuses, like you said, kind of like Basal or like, even like a challenge of, okay, your challenge today is to go home and just Pre-Bolus for all of your meals. Right? And let's look at what that did from today. Compared to tomorrow. What did that do?

Scott Benner 21:06
That's what I was thinking. Alright, I like that you are doing. Jenny makes me feel better about myself. Sometimes. Like you said, one, though. Seriously, you said one time, I forget how you put it. But you said something about, like, you could do this for a living. I know you don't have the credentials, but you could. And that made me feel really nice. I just I never told you that. So thank you. Okay, let's see. How are we an hour and a half today?

Jennifer Smith, CDE 21:38
I set up for about an hour, hour and 15 hours.

Scott Benner 21:41
Okay, so let's do we'll do one more. Um, ah, Kelsey, I'd be curious to hear Jenny's thoughts from a clinical perspective on the post from earlier regarding extreme she without in quotes, management tactics versus being bold. And what her take is on lower a one sees and the pushback in the medical and sometimes social community based on available studies showing no benefit. Also thoughts on lag time of published studies and the advances made in the last decade? Have we talked about this? I brought this up in passing with you once. I just mentioned it as an article. I don't know if you've seen it or not. Right. But so I guess what Kelsey wants to know if I'm, by the way, that's a very well written question, Kelsey. It is no, so many smart people are listening to this podcast.

Jennifer Smith, CDE 22:34
They're all smart. Everybody's smart in different ways.

Scott Benner 22:36
Yeah, no kidding. But I'm saying this is a really well written question. Usually people's writing doesn't read. Well, Kelsey can write is what I'm saying. So, but but to boil down what she's asking. I think what she's saying is that there's a way that you know, the medical community generally talks about this, right? Like, oh, a seven a one C is fine. And then you see somebody say, Well, you know, me or somebody else. My kids got a five five and I just handle that by stopping spikes you know, making sure her blood sugar's Well, I don't think anything I'm saying is crazy, right? Like it's and, but to the, the masses, it seems like over management to them, because they've been given such a baseline of like, just do this, and whatever happens is fine, and go live your life. Right? So is her question really? Well, her, you know, let's ask answer a question first, like, what's your take on doing what you want, you do what I do with art, and with a lot of people listening to this do and what happens when those poor people then go into their doctor's office and then get sometimes really chastised for it? Like, like, I know, that's a hard thing to wrap your head around you and I talk about this privately, sometimes, but a lot of people that listen to this podcast, their next leap to make is to then talk their doctor out of being upset about it. Correct?

Jennifer Smith, CDE 24:03
Correct. And he we even get, sometimes not often, but again, a lot of the people that end up coming to us to work with us is because with all the information that is out there now and is so available online, we can not only see what other people are doing, but we're also reading such as she refers to, you know, these studies about lower isn't necessarily proving to be better in the long run, etc, etc, whatnot. But people want to do better, and they want to do better from the standpoint of understanding and I know that we addressed this somewhat in another podcast, there was a brief talk about this because I had referenced the fact that a one C for the population of people without diabetes is under 5.7%. Yeah, Why are we not aiming for that in a safe in in safety, right? With safe constraints? I'm not saying run at a blood sugar of 55. So you can get an A one C of 4.7. By no means, however, why are we not aiming for the goals that people without diabetes already have? Because their body does it for them? Right. And I bring it in to and I think I commented before as well about like pregnancy targets. If pregnancy targets are what, what we're aiming for, which is the normal blood sugar that the population of people without diabetes already has naturally, if we're aiming for that in pregnancy, why should somebody go back to aiming for higher or loosening that up? Once they're not pregnant anymore, but the baby's healthy? I guess I can, like, you know, lighten up on everything,

Scott Benner 25:57
go back to racing to my death,

Jennifer Smith, CDE 26:00
aiming for a target, you know, under 250. Target under 140. I, I don't I mean, from my personal and my clinical perspective, I don't know why that is the recommendation other than as we've also sort of alluded to, or really commented about previously, a safety factor from the conventional system of management that we have kind of that we've had to use, because that's all there is. There is a safety component that I think many, many, many practitioners, they, they don't see the every day. And so when they see data that's showing them and they're only looking at an AE one C, somebody comes in with an A one C that's 5.7. They're thinking, Well, gosh, this person's got to have a whole bunch of lows, or there are this a one C would not be 5.7. But if they looked at the actual data, and now that a good portion of people are using CGM, we should be looking at that to go along with the actual glucose management indicator, or the a one C or the average glucose, because if they're achieving an A one c that is phenomenal, 5.56, you know, 5.1, whatever it is, and their time in range is phenomenal. And their percent low is not more I mean, we as a practice, aim for less than 5% low. So if they're achieving that, why are you? Why are you upset that they're managing something? So well, a lot of preventing problems, a lot

Scott Benner 27:43
of people that reach out to me with a story indicate that the doctors even presented with the data, it doesn't stop them from being upset. They're so pre programmed to believe if you've got a great day one, see you did it wrong. And that no one can get that. And

Jennifer Smith, CDE 28:01
I'll tell you that I've had I had one really, really, really phenomenal Endo. In, I've had a couple of really good ones. But one really phenomenal one. When I lived in DC, he was fantastic. He he could side by side power with me on the level of information that I needed to talk at. And he was like, he was like a go for it. You know, it's here, let's attack this, I see this could be a problem area, he was happy when my a one C was like 5.4%. He's like, That's phenomenal. And your lows are not in the picture causing this. I mean, he could really talk on that level. And he was comfortable about that. Because I was also and I think maybe this is also a piece too. If you have the ability to talk back to your doctor about what you're doing to get there and to manage that. I mean, if you go in being like, I don't know why I'm here, I don't know how I achieve this, or whatever they're gonna be like, well, that's this isn't this isn't safe, I don't see data that's proving that this is safe. You don't really know what you're doing, obviously, but from the standpoint of many of the listeners, and many of the people that I work with. I don't love the data that I read the report that you mentioned the research report. I don't don't love that it's kind of telling people that they should aim higher when we know and diagnose pre diabetes and diabetes at certain emergency levels. If you're pre diabetic above this level, if you're diabetic at this level, why? Why is that then healthy for somebody to maintain once they do have diabetes?

Scott Benner 29:58
I think to that anecdotal evidence is more valuable in a time where we can all talk like this. Because, you know, calcium makes the point. You know, when was the study even done? You know, and just because data collaborate, right didn't look right, that study could be years old, just to get it out the way that's, that's and I'm not saying that the scientific community shouldn't do their studies the way they do. But the problem is you do a study with, you know, the proficiency of starting a fire with matches. And five years later, when you put your your data out, there's a flame thrower Now, that doesn't match up anymore. You know, you mean, I've got a flame thrower. I'm not using matches. Your dad is 100%, right about the thing that you thought I started thinking about four years ago, except we are in a different world now. So you're using CGM, and pumps, and you know, algorithms and everything else. And they're giving you you know, they're giving you advice from five years ago? Correct? I think too, it's important to remember. Not everybody's a bad student. Sometimes there's bad teachers. And so if you're failing, with bad information, are you failing? Or are they failing you? Right. And so if you start with a person who Jenny mentions having a great endo in Washington, right, so she met a person through happenstance, who really wanted to be a hands on endocrinologist, and sunk in and found out things and learn things, and was good at sharing them with other people. For every person like that, there's going to be a handful of people who, you know, we're coming out of high school and going, what should I do for a living, I'm good at math and science, I'd like to have some money, I'll be a doctor, my doctor goes on vacation twice a year, this is perfect. You don't just like there are some people who really want to teach children. And there are some people who just want to have off in the summer, they both end up being teachers. You don't I mean, and so not everybody's the great doctor from Washington. So if I'm just giving you look, I read the articles, this is what it says to tell people with type one diabetes. So this is what I say to them. And if they're failing, that's their fault, because I gave them the directions. You didn't tell them how to use the directions you didn't you left out all these other things. And so again, I used to talk about this a lot more in the podcast years ago, you have to just believe in yourself a little bit and what you're seeing, you know what I mean? Like you can't keep having outcomes that you know, are bad. And then turning back to the guy in the white coat. And he says, No, you're doing great. And then you swallow on that big fat pill and just going okay, I guess it's alright, the guy said, It's okay.

Jennifer Smith, CDE 32:37
And I think sometimes it's also hard. I mean, I've heard from many people, not many, but some people who've actually said, Well, if I, you know, if I choose, I choose to work with you or your practice, my endo doesn't want to see me anymore. Or if I do all of these things, and make my own adjustments, I get hand slapped every time and that doesn't change. Well, you know, in our healthcare system here in the United States. Thankfully, many of us with our providers, we've got the ability to change providers, we can look at our network, we can see who else could I go to, with social, you know, connections and whatnot. Now we can even ask, Hey, in your community, who has a really good Endo, who's a really good pediatric Endo, who do you love? What do you love about them? I mean, we can like network that way and actually make some different connections. I mean, I got an email from a woman in Canada, actually, probably at least a month ago, who she was asking how they could work with us, because she said, our endo makes all the pump adjustments. We literally get hand slapped. When we come to the office, if we made any adjustments. She's like, I even like, I save the adjustments My My doctor gave, I go home, and I make my own adjustments. And we go back to the office, I make them to back to what the doctor recommended. She's like, I know, he's also not really looking at the data, because otherwise the doctor would see that clearly. We weren't running on the profile that they told me to run on. I made my own adjustments or no, but they're also being told that a glucose value, you know, that's in United States milligrams per deciliter term was like a blood sugar of 105. They were being told overnight, was too low, to run their child at overnight. And so from that standpoint, you have to say, you do you have to say enough is enough, but I can't work with this practitioner. They're not willing to expand and allow me to manage something that's 24/7. It's not every three months of management that I come in, and I get your feedback. I look at this every single day. Every hour of the day. There is no shut off.

Scott Benner 34:55
Yeah. And at some point, you just have to The, you just have to say I can't change this person's mind. And the reasons why are unimportant. Like what it be, maybe the doctor doesn't understand, maybe the doctor is lazy, maybe, maybe, maybe, maybe who cares why it's happening to you just, you know, you have to remove yourself from a bad situation. And it's tough because some people will say, Look, I don't live near that many doctors, I need these prescriptions. And, listen, I don't know what to say about that. If you've got to suffer a fool to get your prescriptions, then you're gonna have to find a way around it. But stop trying to stop trying to make it. What do I want to say here? I have my example popped into my head, but it's too personal to share, because it's not about me. Not everybody does the right thing. And a lot of people want people to do the right thing. You can't make the fight, teaching someone else what's right, sometimes you just have to get through it on your own. And so if you've got some chucklehead, but they've got a prescription pad, then you've got to put yourself in that mindset, I'm going to go play a part for 15 minutes, and then I'm going to get out of here, and I'm not going to worry that he's wrong. I'm not going to worry, I'm just going to do what I need to do for myself. And I'm sorry, if you find yourself in that situation, but if you do still got to protect yourself. Yeah.

Jennifer Smith, CDE 36:16
And I think from the standpoint of even, you know, her question going further into like the research part of it, I think, if this is the kind of information that doctors are looking at and saying, Well, gosh, you know, running with an A one C of 5.5, doesn't seem to be any better than running with an A one C of 7.2. So why why would my patient want to get down here? I'm going to just tell them that that seven 7.2 is just as good? Well, again, we don't know necessarily where and when was the data collected? From what kind of information? What was the lifestyle of these people, etc, etc. I mean, we do know that glucose values that are well controlled, decrease, and for the most part, do limit potential complications down the road. We know that right? Now, is that to say, you're never going to get a complication, even if you did this sweet management your entire life. No, of course not. Now, sometimes things they they happen, right? We don't know necessarily everything because we we don't know 100% of how the body functions, right?

Scott Benner 37:24
We don't, don't you find that most questions around management are probably at the very core of their question. Hey, Scott, Hey, Jenny, how do I stop from anything bad ever happened to me or my kid because I have diabetes. And it's such a sad thing. But you have to, you just have to say to yourself, I can, this is my situation. And I'm going to do the best I can with it. And put myself in the best position to hopefully thrive for as long as possible. And that's sort of it you know, the rest is sort of out of your hands. Right. But the part you can control. That's the part you should focus on, I think. All right, Jenny, I'm gonna let you go live your life. Okay. This was excellent. You do? Yeah. Thank you. Oh, I'm gonna record again in 45 minutes with somebody.

Jennifer Smith, CDE 38:09
Oh, good. That's fun. Yeah,

Scott Benner 38:10
I'm doing today. Jenny Smith works for Integrated diabetes calm. She's also lived with type one diabetes for over 30 years. Jenny holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator and certified trainer on most makes and models of insulin pumps, and continuous glucose monitors. She's also pretty damn lovely. Check her out at Integrated diabetes that com if you'd like to hire her to help you with your type one, diabetes management. I have more to say you want to chill out for a minute. Okay. So we did a meet up? Two weeks ago, there's been two already. There'll be a third one this week. As I told you on April knife that I say the knife. Yes, April knife. It's a Thursday going to be 7pm Eastern time, not the point. Point is did the first 175 People rolled in very cool. And I thought people would just hold up their graphs or ask their questions and we'd roll through their answers and their answers may help may help other people and other people may have helped for them. And it did mostly go like that. But there was something that happened. I didn't expect. And I don't know why I didn't expect it. Because now in hindsight, of course, it seems obvious. But some people were very quiet. And they were not wanting to hold up their graphs. As a matter of fact, the amount of notes that I got out that I got afterwards. That said I was embarrassed or ashamed or nervous or a lot of different words to describe how people felt to talk during the thing but could you help me now? That piece makes me feel like that what you heard me say to Jenny about like we should all just come together and do a challenge. Like it would be, you know, I maybe that doesn't make that reasonable. Perhaps most people aren't interested in sharing that much. And I get that. So in the second meetup, I just realized, let's make it informative. Some people will speak up, some people will be willing to share their data, and some will learn from watching. So while I like the idea of a challenge, I don't think it's reasonable. But what I found afterwards was that getting together is hugely beneficial for everyone there, no matter how they choose to participate. So I hope you come out. Like I said, there'll be links in the Facebook page for bold with insulin. I'll try to put something up on Instagram to remind you there, but here's a reminder right here. I think it holds 100 people. So it's kind of first come. The two we've done so far have been in the afternoon. So I'm going to shift it to the early evening to help accommodate other people. So 7pm April 9, it's on Zoom. Anybody can come and hang out. Just look for companionship, meet new people. There's a chat people can go off and chat on their own. Listen to the conversation. It's just a nice way to distract yourself during this time of crisis. Today's Juicebox Podcast was sponsored by Omni pod makers of the tubeless insulin pump that my daughter has been using for most of her life. You can get an absolutely free, no obligation demo of the Omni pod sent to your home by going to my Omni pod.com forward slash juice box and filling out a little bit of information. You can learn about the Dexcom G six continuous glucose monitor@dexcom.com forward slash juice box and to see if you're eligible for a free Contour Next One blood glucose meter go to contour next one.com Learn more about touched by type one at touched by type one.org 10 second dance party