#387 Somebody Call 911

September 28, 2020Scott Benner

Handling a type 1 diabetes emergency

Ginger Locke is paramedic and the host of the Medic Mindset podcast. She's here to talk about handling type 1 diabetes emergencies, medical tattoos and much more.

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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 0:10
Hello, friends, and welcome to Episode 387 of the Juicebox Podcast. Today on the show, we're gonna dig deep into an issue that I see people talking about a lot. It's their concern about what happens if they should have to call 911. And moreover, what happens if emergency services arrives, and they can't figure out that you have diabetes, or they don't know. This is such a concern for people that I wanted to get a very learned response on it. So I have a special guest for you today. My guest today is ginger lock. Now besides being the host of the medic mindset podcast, Ginger is a paramedic, and an associate professor of MS professions at Austin Community College. In other words, Ginger can do it and teach it. And she's had the experience of helping people with type one diabetes over and over again. So we're gonna get your answers for you, you're ready, you're gonna like ginger. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. The Juicebox Podcast is sponsored by touched by type one, visit them at touched by type one.org. We're also sponsored today by dexcom, makers of the G six continuous glucose monitor, you can find out more and get started with dexcom@dexcom.com Ford slash juice box, how would you like a tubeless insulin pump, you can get it the same one in fact that my daughter has been wearing since she was four. It's called the Omni pod. And to get a free, no obligation demo sent directly to your door, all you have to do is go to my Omni pod.com forward slash juice box. After a couple of quick clicks and a little bit of typing on the pod is going to put that pod experience kit in the mail. And then you're going to be able to wear it and see what you think. Both people want to understand this topic. But it's it's two different reasons. The parents want to put something on their kids so that you know, emergency emergency situations they can see they have diabetes. And adults mainly want to know if tattoos are a good way to to signal. And I started thinking about the topic and I just thought why don't we just like why don't we find somebody who has probably had this experience a billion times right? I did my research and you seem to have the most popular well liked podcasts on the subject. So

Ginger Locke 2:49
Oh, thank you for saying that. Oh, of course, um, introduce yourself. Sure. My name is ginger Lok and I have a podcast for especially for paramedic students. That was the original idea and but paramedics that are in the field, listen as well. And it's called medic mindset. And so most of what I dig into is the psychology of paramedics. And a lot of people think when I say psychology of paramedics, I think that means I'm talking about PTSD and anxiety and all that mental health issues. And we do you know, that does come up occasionally but more I'm interested in how they make clinical decisions and their thought process under what's usually a stressful environment. But but but not always how they continue to kind of show up emotionally for their patience even after like long hours of exhaustion or, you know, you flip flop back from like one a really acute patient and then the next call, maybe something very kind of low acuity kind of Monday, and if someone just needs help, you know, standing up right in they live alone or something like that. Yeah.

Scott Benner 3:57
How long does shifts usually run? And are you there throughout the country? My expectation is that there are some who volunteer and do this work. Right. And there are some who are paid, depending on your municipality, is that right?

Ginger Locke 4:09
Yeah, yeah, I think most cities, we are paid kind of paid services, sometimes embedded within the fire department. But sometimes like, for example, I'm in Austin, Texas. It's a third city service. So you have police fire and emfs. And they're three separate kind of independent things. But then for sure, there's small communities that have volunteer based system. Yeah. It doesn't mean they're lower standard or anything like that. It just means that there's people are sometimes there's a longer response time because people are responding from home, right. So.

Scott Benner 4:47
But well, we used to where I where I grew up. So when I was when I was growing up the entire time. My father was always involved in a local volunteer fire department, which I've sometimes come to think of as a way to get away from my mom. I used to drink beer that wasn't our house. But they but they also, you know, I saw him while I was growing up, there were a number of like significant emergencies in our town, from car accidents to people, you know, trapped in buildings and serious fire some there were some pretty big fires as I was growing up, and my dad was the guy who ran out of my house and went to the other place and got changed and got on a truck and went and took care of it. So I tried it a little bit in my late teens from when I was 16 till I was 19, or 20. And I did hundreds of hours of training, just to be a volunteer fireman. Oh, yeah. And then we had, you know, an ambulance service in the town that was partially paid and partially volunteered. And they would even the volunteers would spend their time, you know, in the house waiting for calls. And it was really fascinating. We really dedicated people, oftentimes not making a ton of money doing something really difficult. You know, it was, so what about you? How did you get involved? And how do you practice?

Ginger Locke 6:06
Yes. So I'm a full time faculty now at Austin Community College, I teach future paramedics now. I still get to be around patients, because we do clinical rotations in the ers that are precepted by the faculty. So we go with the students, and we, you know, do patient assessments and start IVs. And rounds is probably the common term that people have heard clinical rounds. But prior to that I was in the field for about five years working as a paramedic, and I still where I teach is in the same kind of area where I work. So just kind of networked within the MS community here and, and thinking about your question about the tattoos, I actually talked to some medics, some friends of mine to make sure you know that my my experience and what I thought was the answer. I didn't want to make sure it wasn't unique. Just to me that it was it was kind of the common thought process about tattoos or markers. Right, you know?

Scott Benner 7:05
Yeah, that's cool. So all right, so we have your INSIGHT Plus some other people's. What's the steps to becoming a producer, isn't it? Our paramedics and EMTs are two different levels of qualification? Is that right?

Ginger Locke 7:17
Correct. So an EMT. Generally, if you think of it in terms of college based programs, and you can become an EMT, in one semester, it's a certification course. Whereas a paramedic is often an associate degreed person much like this, the similar links of training as a Rn, for example, who became an associate degree nurse, so two years to become a medic,

Scott Benner 7:43
I remember listening, I'm older than you, obviously, I'm looking at you and you have here but younger than I am, but I am I'm, we used to have these little squawk boxes in our houses that they gave to us that just kind of like alerted this high pitched alarm to tell you there was a fire, and then you could kind of scratch easily here, the dispatcher, and it must have all been like FM or UHF, or I don't know how it worked back then. Because there was no internet, you know. And you could hear as you were kind of running out the door of your house, you could hear the dispatcher talking. And I always knew if it was an accident, that it was going to be bad because the police on the scene would always want to skip over the medic or over the paramedic and go right to the EMT, they'd ask for the EMTs like to be so there was not I always felt like there were two different rigs that were kind of, you know, stocks are

Ginger Locke 8:38
right, sorry to cut you off. EMT EMT. We classifies basic life support and then a paramedic is advanced life support.

Scott Benner 8:45
I have a backwards. Okay,

Ginger Locke 8:47
yeah, the way you said it was was reversed.

So EMT might, you know, most firefighters are EMTs they come and they can do these basic life support things. But then often a paramedic arrives in an ambulance for the for the transport, and they've got a higher level of medical care IVs cardiac medications EKGs ultrasound, more toys. Yeah. And, and additional schooling, additional education. So they think in a more complex way about you know, what could be wrong with the patient, they do get what's called differential diagnosis, they think about what disease could be causing this problem. Obviously, if it's correct, it's trauma, it's pretty straightforward. But in thinking about diabetes, you know, we've got to differentiate things like diabetic ketoacidosis, from sepsis, and those two can look a lot alike or maybe it's both and, and so a lot of our education is teaching medics how to think about diseases and how to sort them without all of the benefits of things like blood labs in the hospital, we do have glucometer so we do know blood glucose levels, but we don't have things like lactate ions and some of the advanced stuff that's in the hospital.

Scott Benner 9:58
So after I I decided that I was going to ask you, I put it out to the community that listens to the show. And I got a lot of questions here for here. So I apologize, but I'm gonna probably hit you with some rapid questions at some point and see if we can't give people a full idea of what they can expect from the emergency response if they have a problem. So a lot of people just want to know, do you open up the health apps on people's phones to look for the information that they put in there?

Ginger Locke 10:25
Yes, we would if they were unresponsive. I think if someone is obviously talking, we would never do that, you know, they're kind of in full consenting ability to just have a dialogue. But when people are unresponsive or in cardiac arrest,

yes, but

it's not the first thing we do. It often comes into play a little later into the call. So the one mindset of medics is a find it fix it approach, right. So if, if the person is on their back, unresponsive and they're snoring or they're gurgling, right, we just open the airway, we do some suctioning. So it's just we find this we fix it, we're not yet thinking what caused all of this. It's just some if they're bleeding, we stopped the bleeding a lot then minutes into the call when you start thinking, what caused this? And is there anything any additional treatments than Yes, we start, we start looking through you know, looking for insulin in the in the refrigerator looking for papers that look like they might be prescription, you know, papers from the pharmacy or things like that,

Scott Benner 11:36
go through purses and stuff like that look at your possessions.

Ginger Locke 11:40
But on the iPhone, there's this functionality to get into someone's medical ID and I teach that I teach that to paramedic students of how to get in there that different iOS is and talking specifically about the iPhone. Sorry to just be talking about Apple but there for a while there was a functionality where you just tap I don't know what button that is. This is volume. I guess it's one of the menu buttons right on the side. You do it five times. I think it opened up the medical info. That's interesting. Don't do it. I don't know. Sometimes it does.

Scott Benner 12:15
Let me try. Don't try to now pay with my credit card.

Ginger Locke 12:21
Doing an emergency SOS right now

Scott Benner 12:23
versus calling for help. I they just added these tap functions to the back. But that's

Unknown Speaker 12:29
that's bad calling 911 Are you really cheap?

Scott Benner 12:34
At least they'll know it's you. Right? Are you gonna say hey, it's ginger. I'm sorry.

Unknown Speaker 12:40
Oh, my gosh.

Scott Benner 12:42
She says

Ginger Locke 12:44
I'm sorry. It was a missed call. I hit my phone five times on the site, because I thought it opened up the medical alert. info. All right. Thank you.

Scott Benner 12:57
Oh, my gosh.

Unknown Speaker 12:59
Okay. Well, we won't sprint. That was great. Please leave that in the podcast.

Scott Benner 13:03
Oh, I'm not taking anything out of the podcast. Don't worry.

Ginger Locke 13:05
Now it did open up my medical ID it was the third step apparently

Scott Benner 13:09
123 opens it? I don't know. But let's go again. Hold on. No, no, don't do it. I so I know two clicks is to open up an app like Apple Pay. And so I keep running into that. But I will figure it out. I'll tell you what, I will figure it out. And I'll put it in here. But, but I think it's gonna be of great comfort to the people who asked the questions that you do look, because I I mean, listen, especially for not, you know, it doesn't matter. I should say whether you're a parent or a person living with Type One Diabetes, your thought is Oh, my God, if my kids alone, is someone going to know if I'm alone? Is someone going to know? And and that kind of brings me to what should someone do when you arrive? And there's a person with diabetes who's struggling? What should I be telling you? Hey, they have type one diabetes, like what do you want to hear from people? That's, that's helpful and actionable. And what's too much? You know what I mean, when people start telling you their life story in a weird situation?

Ginger Locke 14:08
I, of course, yeah. Um,

Unknown Speaker 14:12
so generally,

Ginger Locke 14:14
we want to listen.

And that's called the ope that, that what you just said this telling them the life story that's called the opening monologue. And we, it's actually part of training to try not to interrupt that initial what's called the chief complaint. It's like, why are we here? What are what is, what is your need, and what are we trying to address? But I think of you, for example, being a parent of someone or having a family member who has type one diabetes, and let's say they were critically ill, I think because you've lived with the disease for quite some time. Now you would know to say they have diabetes, they're unresponsive. And then we're gonna do a little bit of work, you know, for a couple of minutes, but then also That additional info is going to be port important. Like when were they last seen, okay. And it's helpful to tell us that they have diabetes, but that that can also do something called I think it's called triage cueing where you're basically sitting us down a path. Accidentally. Yeah. So it's, it's good that we know, but we don't want to only think, is this just diabetes? Could this be also could this be something else? Could this be a stroke or something else? So

Scott Benner 15:29
it's funny, I employ a similar idea, when I'm interviewing people on the podcast, you don't want to say something that takes them away from their thought, or leads them to, you know, believe that they've come to some conclusion. And they might be false, you know, like, so. This person has type one diabetes, they use insulin, we just ate and now she's unresponsive. I think she had too much insulin, or she's generally like, would it help to know this is a generally healthy person versus someone who's struggling? But yeah,

Ginger Locke 16:00
if we know this is out of norm, normally, this is well managed diabetes, this never happens. This is something and then then we think, oh, that it's important that we know that the patient has diabetes, but maybe I don't want to get tunnel vision on that one possibility. I want to remember Oh, just because they have diabetes, doesn't mean they can have all these other health problems, right?

Scott Benner 16:23
And and indicate quickly, type one to type two as well. I'm using insulin not using insulin.

Ginger Locke 16:30
I think knowing that someone uses insulin helps because that means that they're at higher risk for sudden drop in their blood glucose levels, right hypoglycemia,

Scott Benner 16:40
so in an emergency situation that the person is not expecting. The difference between type one and type two is not as important as they use insulin or they don't use insulin because Metformin is not going to make you pass out for instance, like that. I get that. Okay. Do you guys use glucagon do you carry it? will use the person's How does that work? Yes,

Ginger Locke 17:00
I have when I was in the field, we had glucagon, we used it. And then I also had patients who had it at home and what could give it to themselves and they had already used like an auto injector to give themselves glucagon. And when I got there, they were starting to get a little better, right? It takes some time. So glucagon is, as your listeners, I'm sure now releases glycogen stores from the liver. But yes, we have glucagon for that. And then also for

some other things to look at actually

has indications for other non diabetic emergency close down

Scott Benner 17:35
GI tract, right. Is that one of the things that does I had somebody told me they use it in some surgeries to keep people to slow people's gi tracks down and oh, it's interesting. I guess it does a lot of different things.

Ginger Locke 17:46
Yeah, it very well could, as I'm thinking about kind of its mechanism of action. Yeah.

Scott Benner 17:51
Okay, so do you have any stories that stick out because I'm thinking about a close friend of mine who lived his whole life with type one and you know, fell out of bed because his blood sugar was low and broke his arm, you know, got so low that his family couldn't help him? I'm wondering if you have any that that stick in your mind?

Ginger Locke 18:10
I think the the extremes, right, the hypoglycemia is and the hyperglycemia. I think they all stick in my mind because they're pretty extreme presentations. Okay. Right. The DK a patient, that's a perfect, they're profoundly ill, those are ICU Intensive Care Unit, they're going to end up in the ICU. And so they're very obviously, profoundly sick. And same for hypoglycemia, right? When they're unresponsive or altered. They're those two decay and hypoglycemia are not very quiet presentations, right? They're very in your face. The one that's sneaky, is the hyper molar hyperglycemic nonketotic syndrome.

Scott Benner 18:55
We all know that one Tell me,

Ginger Locke 18:56
well, you don't know it, because type one usually results in DK whereas type two diabetes can result in this other hyperglycaemic condition when they're not. p todich. They're No, they're they don't have keto acidosis.

Scott Benner 19:10
But their blood sugar still super high.

Ginger Locke 19:13
Well, yeah. And so they're just sitting there actually, not looking particularly sick, because there's no acidosis but their blood sugar is very, very high, and they're very dehydrated, and all that.

Scott Benner 19:22
Wow. I know, I just had somebody on recently who talked about as they were going to decay. He described it as it felt like the devil was inside of them, just a burning chest and I thought he was gonna die just kept telling people when he got to the hospital, I feel like I'm gonna die. So that's crazy. So you guys have to show up in all of these situations. It really did strike me when you said earlier and I let it get by and I shouldn't have that you could go from a situation that's, you know, an overdose and get back in a rig and drive somewhere else and somebody cut their finger making you making dinner, and you're probably still all like, like, how do you how do you do level? Or is it not possible all the time?

Ginger Locke 20:04
I think the fact that it's work helps a little bit of you can be more objective right then if it's your family member, so that what you know what you just said that we, it's our goal to not really get to maintain just a little tiny bit of emotional or professional detachment, right? We don't get quite that we have empathy. But empathy can get so deep that you're actually experiencing the other person's trauma. You know, it's, that would be terrible. If you kind of went down that Yeah,

Scott Benner 20:34
you're there to help so far not to forget that right? Yeah, I have to say that

Ginger Locke 20:37
I think I think we have it tough, but we get a little bit of wind down and wind up time. So we get to, you know, clean up the truck and do a kind of tidying up and then wait for the next call. I think I've also I've watched er, Doc's that we'll be doing cardiac arrest in one room. And then minutes later, I'll see him in another room, just sit and talk him with a family member about something kind of mundane. And I'm like, that seems like a lot of whiplash.

Scott Benner 21:04
There's definitely a scope. We we came up on a car accident one time that seemed kind of benign. And we were told to, we were going to we're gonna have to extricate, they told us and as we were getting stuff together, I sneaked. I looked in the car, to kind of try to get my vibe for what it is we were going to do. And there was no one in the car. And so I turned back to the the officer on the scene, I was like, there's no one in the car. And he pulled me aside and said, it's an older woman, she was like, in her 70s. And she had not been wearing a seatbelt. The force took her into the footwell, and she was under the dash, like, folded in half under the dash alive. And I was I just that that was the moment for me, where I realized I actually did have it in me to hold it together and still do a thing. Because I feel like, if I didn't, I would have found out that one day, you know, I mean, like, I'd seen dead people dead people wasn't too bad. I've smelled burning bodies like that. That didn't get me too bad. But this one for some reason. Like as I as I was living through it, and then look back at it later, I was like, Oh, my God, she was she was broken in half, you know? And, and I still did my job. So that's like, cool. I might I might be okay at this, you know? Because was it that exact same thing? Because if anyone was going to go running and screaming, that would have been the time it was horrific, you know, really crazy. When a persons with another person with diabetes, say they've had or they're having a seizure? Is there a way to articulate this without you believing that they've odede? Like, are there words to use or not use so you don't get confused?

Ginger Locke 22:41
Hmm. So you're saying you're you're the person you're with is having a seizure? And you believe it's because of a diabetic origin right? hypo hyper hypoglycemia is what we call hypo. Right?

Scott Benner 22:54
Yes. Where they're unresponsive, or they're, you know,

Ginger Locke 22:59
yeah. You want to quickly communicate, hey, we're not doing opiates here. This is a part of the

opioid epidemic.

Scott Benner 23:06
Right? Right. How do you start with this is not narcotics, this is diabetes in a way that we'll believe it, because people will lie about drugs thinking that there's legal ramifications on the way right. Okay. Uh, no, yes, sure. I'm sure

Ginger Locke 23:20
they do. We try to get that you know, across to them that we would never end it's in fact illegal for us to as healthcare professionals to that's your protected health information. We try to communicate that but sometimes we arrive in uniforms that look a lot like cops and it's it gets real messy and confusing, or the cops show up also. Right.

Scott Benner 23:37
So they're there at the same time. Yeah,

Ginger Locke 23:39
um, I think, you know, saying that you know, the person that they have diabetes that this sometimes happens when they have hypoglycemia, and probably just saying if you're concerned about you know, recreational drugs we we don't use or we don't use anymore we haven't used today are just directly saying it. I think medics are incredibly non judgmental about recreational drug use. And they really just want to know what they're dealing with. They're not it's not zero judgment. And it's understandable that the general public wouldn't know that right? So clarity, just

Scott Benner 24:17
just just throw it out there. Yes, I'm, we're, we're This is not drugs. This is diabetes. Please think about that as you're going towards it. Or I know this could look like something else, but it's not. Does DK look like intoxication.

Ginger Locke 24:30
It can smell like it unfortunately. So you breathe off ketones. It has an acetone smell that to some people, it can smell like metabolites of metabolizing alcohol,

Scott Benner 24:44
okay, like fermentation almost.

Ginger Locke 24:46
Yeah, just kind of smells sickly sweet. Yeah, the way

Scott Benner 24:50
sweet breath is one of the ways we figured out my daughter had diabetes all those years ago. And then again, she was too so I guess I wasn't thinking maybe she had too much right brandy or something like that. That Okay, so there can be that. What about the combativeness with those low blood sugars? Like I've heard stories of grown adults whose blood sugars get low, not so low that they're unconscious, but then all of a sudden, they're like the Hulk and about half the weight of they can't think either and that situation.

Ginger Locke 25:19
Yeah, I've, I've run those calls.

Scott Benner 25:20
Yeah, what do you do?

Ginger Locke 25:22
Um, so often they're sweaty to a lot of

pale and sweaty and so

it kind of be I can kind of be a handful.

We have general approaches to what you might call an agitated patient or combative patient. I don't really like to use the word combative, I think of it as more agitated, like, it's often in fear, yeah, that people become so non, you know, not able to kind of follow along with the sequence of events that a normal person would

Scott Benner 25:56
lose the society, you know, I guess combative. I get your feeling. I didn't mean to cut you off. But combative gives the overtone that they're purposefully not Yeah, doing it. Right.

Ginger Locke 26:07
Yeah, I hate that word. Yeah, I prefer more agitated, because it gives you a sense of what's going on in their head, right, they're going through anxiety and

confusion. So

we basically have two, two approaches. One is physical, like if someone were truly combative, like swinging at you, there's basically two approaches. One is physical restraint. And the other is chemical restraint. And both can be used in conjunction as well. I think chemical kind of sedation is the humane thing to do, you wouldn't want to physically hold someone down, right? Because that could be dangerous for them. But then also just like, psychologically

terrible.

We usually try to give them glucagon or some dextrose, you know, we try to first discover that their blood glucose is level. So that means we have to stick them to get a little bit of blood. So that's sometimes exhausting. Just even get a little blood there. They're not liking that.

Scott Benner 27:05
I can tell you that even at a reason there's a spot in my daughter's blood sugar, will she'll stop caring, like the kids like in you know, I'll say hey, test your blood sugar shekel, I will. And then it say keeps falling. And it gets to a certain level. And you'll say like, Hey, this is becoming a problem. Like you really need to check and eat something at this point. And she'll get like, it's it for her. It's very jokey still, but she's like, well, if I die, I die. Like she and she's not being funny anymore. But she just gets into kind of like a it's like a twilight almost where she's just like, hey, whatever happens happens. Yeah, a little detached is a great way to put it or dissociate. And you kind of have to keep pushing her towards it or kind of, you know, take something to her and say, Look, do it now. It doesn't happen a lot. But I've seen it happen enough to to recognize the repetitiveness of it. Mm hmm. Let me ask you a couple of questions about about how people can help you if they're by themselves. So people want to know about tattoos, IDs, you know, watch bands, people now have like, you know, Apple watches and there's they make these little snap on things on the bands that people put stuff on there. a QR code bracelets, do you guys scan QR codes. If you're using an insulin pump with tubing, or you're on multiple daily injections, and you'd like to be on a pump, this little bit here is for you. The Omni pod tubeless insulin pump has been a mainstay in my daughter's life. Since she was four years old, she's been wearing it on the pod every day for I think about 13 years now. And it's been a friend in her life with Type One Diabetes. Not only is it tubeless, which is amazing, because you can wear it anywhere you can keep it on while you're swimming or bathing or playing soccer. You know, are you whatever you're doing with like friends or acquaintances, you get what I'm saying? adults, right? Like you can just keep it on. So you're getting your insulin the way you're meant to be while you're doing everything. But for those of you who are still MDI and you're like, I don't know, it's going pretty great. I'm sure it is. And I'm not pressuring you, you don't need an insulin pump. But I want you to think about do you get low, like at the same time every day, like three o'clock in the morning or something like that? Or do you rise up at the same time every day? How cool would it be to be in charge of your basal insulin to be able to make it stronger or weaker. So that things like that don't just, you know, quote unquote, happen to you. If you're always getting low at 1am you could set a basal rate that begins you know, like an hour or so before that would impact that. Same thing for rises that happened in the morning. All kinds of stuff. Being able to manipulate your basal insulin with a pump is next level stuff, being able to do it tubeless Lee, that's even better. But here's the greatest thing about on the pod In my opinion, I mean this, you don't have to listen to me. Because they'll send you a free, no obligation demo, you can try it on to see what you think. And then if you like it, you move forward with the process. And if you don't, it's no big deal. It's up to you. That's how it should be my Omni pod.com forward slash juicebox. Get that pod experience kit coming to you in the mail right now.

Guys, the dexcom g six continuous glucose monitor is maybe one of the most important tools you can have while you're managing insulin. Why? Because you can see the speed and direction that blood sugar is moving when you were the dexcom g six, you can see it right there in real time. And it's not just I'm rising, or I'm falling. It's I'm rising. And this is how fast I'm rising, or this is how slow you're falling. It's spectacular technology. Imagine you're just doing a finger stick and you find oh mama, my daughter's blood sugar. It's 135. He's at 135. And stable, is it going up? Is it going down? There's no way to know where the finger stick. But with dexcom. There is. And you can see it right there on your cell phone. They're saying I'm saying you can follow a loved one a child or a spouse, brother or sister on your Android or iPhone device. Not only can you follow them, but look at nine other people because the user can have 10 followers if they want to. That could be a school nurse, a babysitter, so many options. So many people who are able to help you with your blood sugar, hold on a second, my wife's walking in, okay, I got rid of her so that I could tell you dexcom.com forward slash juice box Dexcom is going to give you an honest chance to keep your stability where you want it, you're a one seat down. So the time that your blood sugar spends in range is greater. How's it going to do that? Well, it's gonna tell you what your blood sugar is, and how fast it's moving. And that's going to give you an honest chance to use your insulin. Trust me, it's how I do it with my daughter. And her a one C has been between five, two, and six to four coming up on seven years. There are links to all of the sponsors at Juicebox podcast.com. And right there in your podcast player. But for today you're looking for dexcom.com Ford slash juice box and my omnipod.com Ford slash juice box. So people want to know about tattoos, IDs, you know, watch bands, people now have like, you know, Apple watches and there's they make these little snap on things on the bands that people put stuff on there. a QR code bracelets, do you guys scan QR codes? Like what what's the good thing to do here? Or should I just put something on my wrist that says I have diabetes and tattooed right?

Ginger Locke 33:03
The main thing you want to communicate is that their blood glucose level should be checked, right? And so just saying diabetes even not even getting into the type, just saying that the patient is diabetic means we will. And honestly, even if someone's just has altered mental status, we check the blood glucose level. It's a screening tool, it's a very low risk high benefit screening tool to just take a little tiny bit of blood it's very inexpensive test to know and so even patients where we have very low suspicion that the blood glucose level is off.

We'll do your take that as readily as we would take someone's temperature

Scott Benner 33:40
for example on a glucometer and you test somebody's blood sugar. It's it's one of the basic tools.

Ginger Locke 33:44
It is a very basic vital sign. Yes. Okay. But to your question, I think it's a good one of you know, maybe how do you get that medic to check the blood glucose earlier in the call instead of I think of a call I had once where there was this older gentleman and he was having unilateral neuro deficits that kind of droopy on one side and we were so certain that it was a stroke. But then finally very late into the call we got a blood glucose levels very, very low. He was hypoglycemia and apparently hypoglycemia can cause unilateral neuro deficits which is bizarre to me. I don't know how that would happen. But it can and so we we miss understood what was going on with him till pretty late in the call. But the way to communicate that information to medics would be to me a necklace or a bracelet that is the universal way all the fancy tech stuff is nice and probably more aesthetically pleasing to the typical person that has diabetes is want to be walking around with those bracelets and necklaces on. But it's just it's quicker. When we see a necklace or bracelet that's got the little engraving on it that says

Scott Benner 34:58
yes, just say it's a bracelet sandwich Girl, you're looking at me now you're probably having such an easy time imagining that. But say I'm a girl and I'm wearing a bracelet that has charms on it. I can't just throw one charm on that's for diagnostic, you're not gonna sit and pick through my

Ginger Locke 35:10
I will never notice that. Right, right. And actually same with tattoos. So this was a conversation I had with other paramedics about do you ask them? Do you look at people's tattoos? And they said the general response was, yes, we noticed people have tattoos, we would not be looking at the content of what the actual image is until later in the call with a stable patient as a conversation starter. But it would never be I'm scanning this for data that can help me take care of this person. Right. So you're looking at it in a very with a different filter. So do you I mean, if it was tattooed right across the chest? That's what

Scott Benner 35:47
I was gonna say, right? Yeah,

Ginger Locke 35:49
it's pretty obvious. But if it were something subtle or small, it could very easily be missed. It's just

Scott Benner 35:54
right are acronyms in a sleeve of tattoos? You know, you're not picking through. But if someone had no tattoos, and tattooed around their wrist where you were looking for the bracelet, it's a type one diabetic, that's as good as a bracelet, you would think, right?

Ginger Locke 36:06
I don't think it's as good as a bracelet.

Scott Benner 36:08
Wow, because you're looking for the bracelet.

Ginger Locke 36:10
Because I'm looking at tattoos and thinking that's a tattoo. And I don't, there's no data in that for me, other than this is just a person that has a tattoo. Okay, but it I'm not looking at it for. I mean, sure, I may see it. And it may be helpful. But a bracelet is it's, you know, those really ugly bracelets that have the terrible chain and the rectangle, and they're just so uniform. And so kind of institutional looking. Those are the ones I'm used to seeing. Do you know the ones

Scott Benner 36:39
I do? See, what you're saying is the classic medical ID is what you're looking for, because that's just, it's what you're trained to do. It's what happens more over than not. And you're also in a heightened situation, at that moment to

Ginger Locke 36:55
correct. So you're, you're working on a little less cognitive bandwidth and somebody who's relaxed, and you may get there, it just wouldn't be as quick you. So you'll get there after you've done a couple of things and you're kind of your physiology is calming down and your field of vision expands a little bit, then you'll start noticing those little things. I've talked to people about their tattoos a million times, but it's when everything has stabilized afterwards.

Scott Benner 37:20
So if mike tyson got a face tattoo that said, type one diabetes, and you rolled into the room, and he looked low, you might just look at him and go, I don't see that and keep going, I get that I really do. And there's this extra thing that doesn't belong on the body. And that draws attention. It looks like all of the other things that sit do that job. And so that makes your brain stop and go that's a medical ID.

Ginger Locke 37:43
Yeah, right. It's about picking a lot of what we do is pattern recognition, because we're moving so quickly and thinking so quickly. And there was a study done for radiologists to find. They were told to find basically cancer on all these CT scans right in their black and white images. They're told to find cancer to screen these CT scans quickly for Do you see anything it looks like a mass chest CTS and because masses are cancer usually shows up as white on a CT, they missed. There are all these little black tiny, they place a tiny black gorilla and all the CTS and they did not see the little thin outline of a little black gorilla on a CT scan. Because they weren't looking for that they were looking for White. Okay, and so it's just what your body your brain kind of selectively notices and and the way a medic thinks is not to go hunting through tattoos, they're looking for other stuff.

Scott Benner 38:46
So I have a tattoo on my shoulder or my forearm and I'm wearing sleeves and nobody's finding that. Not until later from your

Ginger Locke 38:53
you know, you point to your forum. I think about that where we might put a blood pressure cuff or start an IV I mean, those arms are better than legs. If you're Yeah,

Scott Benner 39:03
you're not gonna get away not you're definitely not taking my pants off during this situation.

Ginger Locke 39:08
Sometimes Actually, we do make patients all the way naked. Just go hunting for what do you think? Yeah, injuries and stuff like that. But

Scott Benner 39:16
But okay, but but I hear what you're saying. How about in the car? seat belt? How about those things that go on the seat belts are stickers on the window? Do they kind of fall in this? How do I how do I brand my car say I've got a 17 year old driving with Type One Diabetes? How do I make it so that when you come to the door, you know, this person has diabetes?

Ginger Locke 39:34
I think even if it's on the car, I don't know that that person that is that person's car. Right? So we're often the way our mindset is we're thinking I want to keep all the possibilities open. So yes, I have this piece of data that says somebody put that sticker on there, but I don't know it's specific to this patient. So I don't know for sure that conclusively that that patient has diabetes.

Scott Benner 40:00
When we're buying when we are branding things is the caduceus the most like thing that makes you think medicine. It's that set the snake thing with the rod. I like that you said it like that. Yes, it is.

Ginger Locke 40:12
Yeah, yeah, that's the one in red. Oh, am I so

Scott Benner 40:14
old that I know words for things people don't use anymore? Is what I just started one.

Ginger Locke 40:19
Well, I was just kind of is, is is a good word I forgotten

Scott Benner 40:23
now I'm wondering why I know it. So, okay, so I mean, it's just like this add to that you can do as much as you want to hopefully trigger that emergency person's thought to like, oh, diabetes, but until they go through their process and do their things, there, they're not going to know for sure. Without that, that jewelry around the neck

Ginger Locke 40:46
around the wrist, or something in a wallet of someone

will help as well. So we

typically will look through a wallet looking for prescription, you know, medication lists, or names of, you know, some people have that they've had surgeries, certain type of implants and stuff in their body, they'll have little cards in their wallet that will find

Scott Benner 41:06
what about a lockscreen image? What about I push the button once the lock screen pops up? But it says Great,

Ginger Locke 41:10
well, that actually, this is pretty genius.

Scott Benner 41:14
Okay,

Ginger Locke 41:15
that's, that's pretty smart, because we will go to the phone pretty quickly. And I've watched at the hospital social workers really just the phone is the lifeline to getting to the family and trying to figure out who people are and kind of doing all that detective work.

Scott Benner 41:29
Okay. All right. Well, there you go. Finally, the cell phone, not ruining lives saving. I don't know if anybody's seen the there's that Netflix documentary about social media right now, that tells you everything about your phone that you already know is wrong, and how it's trying to kill you that you choose to ignore it because you love it. And it's not, it's not killing you immediately. So you're just like, I love my phone. Please stop saying bad stuff about it. Okay, let's see, well, while people are waiting for you to get there. Mm hmm. What do you think people fail to do in that time when they're panicking, like what could they be doing? Does that make sense? Is there something to talk about,

Ginger Locke 42:11
rather than saying what they've failed to do, I could just kind of list off some useful things to do. clearing a pathway between the road and where the patient is. So if they're in a back room, right, moving things out of the way just to get a stretcher through or even be able to walk through with bags, clearing that pathway. As far as sick and unresponsive patients that many have religious may have heard of what's called the recovery position, right? This is laying on the side that allows and if they were to have any vomitus or spit to kind of drain out of their mouth with gravity towards the floor, rather than back into their their airway. coming outside to meet the fire truck or ambulance is very helpful as well. Sometimes, homes aren't very well marked, or an apartment complex, it's may be hard to figure out exactly where you are as quickly. It could save, you know, a minute or two. Right? If you were to come out and be what's called a flagger where you kind of wave down the the

responding. It's a good

Scott Benner 43:14
idea. There really is no lights on on the outside of your house, stuff like that.

Ginger Locke 43:18
Yeah, turning lights on. That's that's a great way, especially at night when the lights are on. I'm like, Oh, I know. What's that house? Yeah. Because ever all the other houses look asleep at 330.

Scott Benner 43:24
In the morning, this house is lit up like I bet you they're the ones that called us.

Ginger Locke 43:30
That's a good one. Yeah. And then just then assembling medication lists, putting all the meds in a little baggie that we could take with us. Just kind of assembling some key stuff that if we needed to leave quickly, that stuff is all together.

Scott Benner 43:43
I guess too. If you're you're likely going to take this person with you. If they have some personal stuff that they use to manage their type one, they're going to want to make sure that gets in the rig with them and or somebody goes with them too, if possible. Do you like to take a family member if you can?

Ginger Locke 43:59
We do so COVID times is messed up all taken all the family members and things like that. But yes, let's talk non pandemic times. It's great to take a family member, especially with patients who are unresponsive because they're there all the info there. The patient's history. So we talked about when we do assessments, there's a history and a physical exam. And when a patient's not talking, you have zero history, and you only have your physical exam to rely upon. So they become the surrogate historian. Okay,

Scott Benner 44:27
yeah, no, that makes sense. Hey, when I call 911, can I say I need an EMT? Not just a paramedic? Will they take me seriously if I do that? Well, well, they'd be like, Hey, who are you buddy? I know you've seen ER and everything but you know.

Ginger Locke 44:43
So you said in reverse again.

Scott Benner 44:48
Alright, can I okay. So,

Ginger Locke 44:50
here is when you call 911. They will have already a pre planned response, right that is appropriate for whatever it is. Your job is to report what's going on where you are as best as you can, right as a patient breathing as a, are they breathing? strangely? Are they bleeding? Do they have a pulse? Are they talking? Those are the types of questions, very simplistic questions. And then the response will be kind of triage through dispatch about what resources should be sent.

Scott Benner 45:22
So I shouldn't get all obviously I definitely shouldn't. Because I'd end up asking for the wrong thing. I'd be like, I need the guy that went to more school and then I say it backwards. They'd be like, Oh, he only wants this. They send over for band aids and a nice cages on his first bag. Alright, so yeah, don't don't think this situation because obviously you're gonna do it wrong. And and be very clear about what's going on in that assessment when you're talking to 911. All right, that makes more sense.

Ginger Locke 45:51
And the first question that's usually asked is not what's going on, but where are you?

Scott Benner 45:57
Okay.

Ginger Locke 45:58
Like, are usually your location

knocked what's your we think they answer with what's your emergency? But it's not they want to know where you are? And then once they start hearing What's wrong, then they'll start sending people to that location? Gotcha. Because it mean, no one can do anything until we know where you are. Everything's on pause. Well, we know that

Scott Benner 46:21
you're in a medical crisis. I'm as if I'm the responder, my first crisis for me is getting to you. And then figuring out what's like you said, going through those checklists and getting to let's not let you die before we can figure out the bigger problem, and then stabilize you and get you to the hospital if that's necessary. Mm hmm. How many people? Have you treated with the diabetes situation and left behind versus take them with you? How often do people have to go to the hospitals that

Ginger Locke 46:51
for the hypoglycemic patients that are awake and talking and breathing when we get there? It's rare that we would transport them because what they need is food.

Scott Benner 47:01
They need to have it there.

Ginger Locke 47:03
Yeah. We will discuss you know, what may have caused the hypoglycemia? Was it too much insulin? Was it that you have an underlying infection that you didn't even realize? Or you know, and that maybe there's something more going on today? So it's not just a simple we fix your blood glucose level and lead? It's okay, let's explore why you became hypoglycemic. And are we all confident today, you just took your insulin and forgot to eat? Okay, that's the story.

Scott Benner 47:27
All right. No reason to pay for the, for the, for the taxi ride and going to the hospital and all that other stuff, because it's over. It's one of those medical things that once it's over, it's over, right. I know, my daughter had a seizure once when she was first diagnosed. And we, it was a Sunday afternoon. And we just gotten back from somewhere and put her in a crib. And she was she was napping after a car ride. And she just started grunting. And you know, it was clear she was having a seizure. We're trying to figure out how to use the glucagon. She'd only had diabetes for a short time, we didn't know what we're doing. We got our son who I think at the time was like seven, we got him to call 911. And we were messing with him the next day. I know there were a couple police officers in the house and and then you know, the emergency services were right behind them. And once we got her stabilized, we went to the hospital. And I think we were there for five minutes before my wife looked at me and when we didn't need to come here. And I was like, No, we didn't, did we and then by then it was too late. They had our insurance card already. And we already took the ride. So we just went over and and it was fascinating how little actually happened at the hospital where they were just like, well, she looks good now. So yeah, you don't want to do that. Again, it was sort of like that.

Ginger Locke 48:36
Well, that's a big trend in EMF not to go too far down the MS. Tangent, but I do want to say that emf is evolving and that the more education that paramedics are getting, the more independent they can be in making those decisions about where's the right what's where's the right paid place for the patient. Right. We used to be there's kind of a saying you call we haul, right? You just call us we're going to the hospital because we can't think for ourselves now. With more education really good physician oversight, we can have longer discussion about what's going on and create a plan that's right for you today. And not just this prescriptive, like everybody goes to the ER thing got it.

Scott Benner 49:13
Hey, um, a lot of people asked this question when someone has a low blood sugar you figured out they have a low blood sugar and they need food. Is it common to over carbohydrate them like to jam them up and make them super high because the people who are normally pretty cognizant about keeping their blood sugar stable in a lower range who've just had what they consider to be a you know, an emergency situation? They are not looking for you to make their blood sugar 450 but are you are you

Unknown Speaker 49:40
Why?

Ginger Locke 49:42
I love your question. I love the way you asked it. Yes, we are thrilled that you're no longer hypoglycemic. But, so if we're going to air we're going to err on the side of you maintaining consciousness and not becoming hypoglycemic. So sometimes Yes, that means we overshoot it,

Scott Benner 49:59
but you're not going to show up Go, hey, try these three Skittles and wait 15 minutes. So let's see what's happens you're gonna write,

Ginger Locke 50:03
you're gonna usually it's like poor, I, you know, can bring some orange juice, put some sugar in it, you know, it's like, it gets ridiculous. But we also give intravenous dextrose. Okay, right. So for patients that can't eat can't swallow.

Scott Benner 50:22
I know, it's something that

Ginger Locke 50:23
you haven't talked about yet, which is you've talked about glucagon, you've talked about oral kind of sugar. But then there's also intravenous, what we call d 50. It's 50%, water, 50% sugar, it's a lot of talking about carb load. So we used to just give like the whole thing. Now we've started kind of giving half of it, and then wait and see how that does not we do we are cognizant of the fact of trying not to overshoot them so so much, because that's, that's rough on you guys. Yeah,

Scott Benner 50:51
it's terrible. And then I wonder, too, with all the new technology that people with diabetes are wearing. It's a lot of people have continuous glucose monitors. So an ability to see their blood sugar in real time and how it's moving. Do you will you employ those once you're aware, and things have calmed down a little bit where you say, hey, let me see your blood sugar on that you would, okay.

Ginger Locke 51:12
And we're gonna double check it with our educational course. Yeah.

Scott Benner 51:15
But I mean, in easy way to say that, like this dextrose has gotten you to like 125. And it seems pretty stable. We don't have to push the rest of this. Yep, I got it. Okay.

Ginger Locke 51:25
And going along with the clinical presentation, too. So it's like, with the number looks good. And you are looking better.

Scott Benner 51:31
Right. So yeah, so the stuff that you would normally do visual check over. It's not just these numbers. Okay.

Unknown Speaker 51:37
Right. Do you

Scott Benner 51:38
have, like at one, obviously, I think you do. But when you're teaching your course, what do you tell people about assessing diabetes?

Ginger Locke 51:49
Um, we tell tell the many things. It's a whole module. But, you know, some of the teaching points are that this may be the first day that they've realized they have diabetes that they may not have known. Often it results in some emergency to for them to even become aware. Right. And so that's, that's an important thing for paramedics, I think, to understand that. People can be having a diabetic emergency and not even know they have diabetes. Wow.

Scott Benner 52:21
Yeah. I never thought of that. Like they're everybody's first time is somebody who is Yeah, everybody has a first time and not everybody ends up in the hospital, passed out their first time, they might just have some of the symptoms of high blood sugars. Yeah, it's funny, I think so much about the problems we that people have when they're being diagnosed because doctors offices, it's, it's almost disturbing to hear you talk about how obvious it is to do a finger stick to check on somebody's general health because they don't do that doctors offices. So a lot of kids get treated for the flu or other stuff like that for a long time, then end up in DK because no one took the time to just, you know, check their blood sugar very quickly.

Ginger Locke 53:02
You know, what's interesting about that is I I've thought about that same thing, because I've got two kids. And it bugged me that they weren't they didn't know my kids blood glucose level at any point in their life until I think maybe they check there's a there's a routine, routine screening age, I think they finally do check. I don't remember for eight or what, but it did bug me.

Scott Benner 53:23
Yeah, it's a huge problem. There's a lot of different organizations that try to help you there's these letter writing campaigns that go to like pediatricians offices and all these things, because a lot of kids you know, there are people who die every year from undiagnosed type one diabetes. And really, you know, when you look back on it, you realize that for whatever a test trip costs $1, maybe, you know that somebody just kept treating the flu, the flu, the flu, the flu and never looked that next step is it's disturbing. And that's why I felt I found it really comforting and interesting that you were like, Oh, we would just do that all the time. That's a great way to

Ginger Locke 53:54
find out routine. It is. I mean, it's not only our paramedics educated to do that is very routine, we work under kind of standards of care or protocols that are written and it is a very standard thing that any altered mental status patient, right, even if they're just a little confused, little grumpy, sleepy, lethargic, and so not just unresponsive, but altered mental status, that is a very routine test. And, you know, you said it's inexpensive, it's also low risk, there's very little risk. It's not it is very hard to hurt someone with a lens set.

Scott Benner 54:31
Right, right. Yeah, you're gonna be okay. That's

Unknown Speaker 54:36
the high yield low risk test to make sense.

Scott Benner 54:38
So when people have a higher blood sugar, so you get there and you assess them and they're not DK but their blood sugar's 500. Do you help them? Like do you want them to have insulin? Or do you leave it to them? Or do you just say, hey, look, you don't have enough insulin? What if you get them What if you have to transport them do you carry you don't have to carry insulin with you.

Ginger Locke 55:00
It's a great question. We generally in the outer hospital setting, paramedics are not using insulin No. And it's because it's a very strong drug that does other things besides move glucose into the cell, it also affects other electrolytes and things like that. So abrupt changes, someone's really hypoglycemic and they take a ton of insulin that can do a lot of other things to their body, besides just fixing their blood glucose level. As I said earlier, and you guys who are listening know it's a these are very critical care, very fragile, sick patients. And so insulin is not a very common out of hospital. medication. Yes, yes. I can think of a few maybe remote places where it's used, but nope, not on the trucks in. In Central Texas,

Scott Benner 55:44
would you turn to the verse and say, Look, you have insulin here? You should probably take it as your doctor has instructed? Or do you don't mean like, you're obviously not going to give it to them? I guess? Because you don't know any other way.

Ginger Locke 55:56
I wouldn't even know I don't even know all the scales and all that stuff. I don't know how to do it. Yeah, I would be because of kind of my lack of knowledge about, you know how much insulin it takes to get someone's blood glucose level? To me. 500 is the number use is a pretty scary one. And I would be afraid it's not just simple hyperglycemia? I'd be worried is there more going on. And I would not be comfortable if they if they? So usually, if someone's quality msmes are sick, they don't feel well. Right. So to also see a blood glucose level of 500. It's like, okay, I want to make sure you get screened for many things at the hospital that I don't I feel a little out of out of my

Scott Benner 56:38
zone on that the word purview kept coming into my head, like that's outside of your purview. What?

Ginger Locke 56:42
A little bit, just because it's like 500, or you're pretty sick? And if, depending on your clinical presentation, right? If you look really sick, yeah. And there may be more,

Scott Benner 56:53
I guess, you have one problem you're dealing with, you don't need to add a secondary problem before you get somebody to help, right. But let's just interesting, like, you really are there for an emergency situation. So if somebody called you in that scenario, you got there and said, Look, you know, this is what your blood sugar is, it looks like you probably need to be checked for a number of different things. I can take you to the hospital if you want, or you should make your way to your own physician, or I guess there's a lot of different. It's interesting, your job is very specific. Yeah, we

Ginger Locke 57:22
we talk about paramedics, our healthcare navigators, so they're not just responding to emergencies. They're responding to people that aren't sure what to do next, with wherever, however, they found their condition to be and so maybe they're new, newly diagnosed, and they're not very good at taking their insulin, if it's daytime, and we can call their doctor and talk through all of that, then sure, but if it's the middle of the night and

Scott Benner 57:46
can't get a hold of people, then maybe then the hospital becomes the way

Ginger Locke 57:49
Yeah, and you you know, maybe they have a headache to go along with it. Well, headache can be a lot of things that I can't test for, like meningitis or strokes, right. So there's so many things in that hospital setting that we can't test for that we do end up taking a lot of people to the hospital for additional testing, when, you know, we can't really get in touch with their primary care physician.

Scott Benner 58:10
Do people try to use you improperly? Meaning Do you ever get to people and this is away from diabetes, I'm wondering this, and they clearly need a hospital but don't want to go to the hospital, you have no power over that. Right? If I refuse to go I just that's it.

Ginger Locke 58:25
Correct. If you don't want to go to the hospital, I'm not kidnapping you and taking you anywhere you don't want to go as long as you have mental capacity, right? So as long as you aren't incredibly intoxicated, or unresponsive, or something's in a way that you like you're not making your judgments impaired.

Scott Benner 58:43
So you can make medical judgments about their ability to make judgments for themselves.

Ginger Locke 58:48
So if I say we do it a directively with tests like Do you know what day it is? Right? Do you can you explain to me what's wrong with you today, and that you're preferring to stay home? And you understand that you might become worse and die here in your home? Or you if they can explain it back to me then.

Scott Benner 59:05
Then that side everybody's got their own freedom. But now if I say I don't want to go to the hospital, then I pass out are you allowed to go ups? Oh, well, I've been put them in the truck

Ginger Locke 59:13
is called it's that it's called implied consent. And the idea is that a reasonable person would want to go to the hospital if they had known they were about to become unresponsive, right?

Scott Benner 59:22
Oh, that all makes sense to me. Okay. Is there anything I didn't ask you or that we didn't talk about that I should have to answer these questions for people, which by the way, started out with our medical tattoos, okay, and then turned into all these great questions from everyone.

Unknown Speaker 59:40
Um,

Ginger Locke 59:45
I think you know, you're asking how does how do you signal to somebody come into your home that someone in the house has diabetes? I think the probably the top places are a bracelet in your wallet, the refrigerator Another place we go look on the front of the refrigerator, people will put lists of medications and stuff. Yeah.

Scott Benner 1:00:07
So my last question, which a lot of people ask, because of the timing of when I put this out into the community, and when everybody started asking the questions, there had been something in the news recently, where a gentleman had a very low blood sugar. And the, I guess the people who showed up his house, were just certain he had odede. And would not listen to the other people in the House about it. What do I like? What do I do? If if like, really like, Is there something you can think of that would snap you out of that mentality? If you were thinking this is drugs? This is drugs, and I knew for certain it wasn't like, what do I do to get you to stop thinking that way? Because timings of real issue at that point.

Ginger Locke 1:00:44
Yeah, I love the question. Because you're talking about cognitive pitfalls. It's not that these people are jerks, right? The medics that come to your home, they got into ms because they want to help people. And they're not just jerks. But they can if they've run, you know, maybe they're in a community with an opioid epidemic. And they're, you know, that's 2020 calls back to back to back to back, they kind of get their brain gets stuck, as you said, So what can you do to get them unstuck? There's this really great book called how doctors think, and it might be something you know, and your listeners are interested how doctors think is really neat, because it talks about how clinical decisions are made. And it's recommended to ask of your doctor. What else could this be?

Scott Benner 1:01:30
Okay, that's that's phrasing that gets them to start thinking a different way.

Ginger Locke 1:01:34
It's like, okay, right now you're thinking overdose. But what else could this be? And it just opens up their brain to

the possibility and a reminder of the

fact that other conditions can look just like this. Ah, so you're

Scott Benner 1:01:48
tricking them into doing their job that they are somehow stuck in can't figure out how to do I love language? I really do. I think sometimes I get done an episode of this show. And I'll listen back when I'm editing and think, like, I'm proud of myself how I got someone to something without telling them to go to it or, or fooling them into understanding it, but just sort of asking a question that makes them then think about something different, and then see where it leads them. And that's really what you're saying, you're somebody gets stuck on this idea. This guy, he odd, odd, odd drunk or whatever. And you start, you just kind of break that you break that, that pattern he stuck in, or he or she or stuck in, and then you you get them thinking about something different. That's kind of brilliant, and simple, isn't it?

Ginger Locke 1:02:36
Another pitfall is that we forget, it can sometimes be two things. And so it could be opiates in this case and diabetes the patient could be having experiencing both, right? And that's probably one of the harder things because we love the binary, it's this or that. And

Scott Benner 1:02:55
it's like the most human thing. Pick one who wins either or black or white. Be both. Can I not be high? And my blood sugar be low? No, he's a good guy. It's his blood sugar.

Ginger Locke 1:03:07
Yeah, yeah, no, no, I hear that. Once we once we find the cause that there's something called the I think it's called the second fracture phenomenon where, let's say you, your arm hurts, and you've been in some type of car wreck and they find a fracture in the arm. They're like we've done testing, we found the cause, well, sometimes there's a second fracture that gets missed on the X ray, that they just don't see because they think they found the cause. So same for

Scott Benner 1:03:33
this. No, it's almost like anecdotal evidence, like you feel like you've got the answer. So you stop wondering, gotcha. This is excellent. And now it's making me if I can make me wonder if I can get Jerome groopman, the author of How doctors think they come on the show. Because that's, I think, this that this specific thought translates into people's personal doctor's visits. Oh, yeah. You know, when you get into the room, and you realize, like, you've got this whole thing figured out, and they don't see it that way. And then you just sit there feeling defeated. And instead of another one,

Ginger Locke 1:04:02
as you're saying that another one I've used with my own doctor, is I'll say, How do we know it's not x? Right? So I have asthma sometimes. And I'll say to my doctor, how do I how do we know it's not pneumonia? Or how do we know this isn't?

whatever other respiratory disease? Yeah, and

Scott Benner 1:04:21
you're not asking so much for him to tell you how he doesn't know you're asking him so he'll think it through again.

Ginger Locke 1:04:27
Think of all the tests that might need to be done or not done.

Scott Benner 1:04:30
Yeah. Damn, ginger, you're pretty smart.

Ginger Locke 1:04:32
This sneaky.

Scott Benner 1:04:35
By the way, you live in the part of the country that I often tell my wife, we should run away and go live there. But I guess other people think that too. And you're probably all very sick of us coming there. So I won't say it out loud.

Ginger Locke 1:04:45
But well, you're very welcome to come.

Scott Benner 1:04:48
Thank you. I'm looking for lower humidity. Not so much snow. Is this the place or no,

Ginger Locke 1:04:52
there is pretty low humidity and definitely no snow. I'm

Scott Benner 1:04:55
on my wife's. Alright, just give me your address. And I'll just I'm gonna pack up right now and go Because I am tired of the snow, and I am tired of sweating just because it's June. So I'm done with it. Now, I don't mind a dry heat. I just don't want to be wet. While it's happening, you understand? Hey, tell everybody about your podcast.

Ginger Locke 1:05:14
Sure. It's called medic mindset. And what's neat is it started as a podcast for paramedic students, but the paramedic started listening. And then I got some medical directors who are emergency medicine, physicians listening. And so suddenly, emergency medicine kind of residents or med students started listening. So it's, it's expanded to, to reach beyond kind of its original intention. And it's, it's, I really spot one episode a month, something I really enjoy just talking to paramedics or people that work in emergency medicine about how they think through problems, errors they've made, why we you know, kind of the cognitive theory about why they may have made that error.

Scott Benner 1:05:54
That's very cool. Isn't it interesting how you start something like that, and then it grows, and it finds other avenues to help people. And like I told you at the very beginning, I started this podcast because I thought my blog was kind of dwindling, because people stop reading. And it's got millions of downloads now. I love that crazy, isn't it? Like I just I love that it helps people and it was just a very unexpected treat, I guess at how well it worked out. Um, so I'm really glad for you. And I'm gonna I'll put a link in the show notes. And and hopefully there's some people listening to this that that might come over and check you out too.

Ginger Locke 1:06:28
Nice. Yeah. Thank you so much. You're welcome. Thank

Scott Benner 1:06:30
you for being By the way, as we're as we're wrapping up here, thank you for being how you are, because I just was at my son's baseball game one day. And I decided, like, I'm going to get somebody on to talk about this who, who's got a podcast that talks about this stuff all the time. And so I'm have my headphones in, and I'm sitting in a chair under some shade, because like I said it was human. And I'm like, like, oh, here's one I tried listening a couple of people in there, you know, but I got to you and you were measured and thoughtful. And you had a nice clean microphone, I could understand you and then I started reading like reviews. And then I just started listening to an episode and I was like I would like it if this person was on my show. So you want out I didn't just like I didn't throw a dart at podcasts about this I really listened and I think you're doing a really great job not that what I think means much But

Ginger Locke 1:07:20
no, I appreciate that. It actually means a ton because

your podcasts yourself so you know kind of what you value in and talking to you what this has done. I was hoping to get to hear more about your daughter and your journey. So what this has done is made me now I want to go back and and hear your previous episodes.

Scott Benner 1:07:37
Oh, cool. Yeah, I do everything so that people will listen, everything's just a carrot on a stick to get you to download my show. I need listeners dammit. Keep listening. Tell people. No. But But seriously, I appreciate that. I'd be happy to tell you more about it. But I know we're up on time. And I you have children who I think at one point I heard outside going Hey, when's this over? So go live your life. And thank you very much. And I really I can't thank you enough. This was wonderful.

Ginger Locke 1:08:05
Thanks, guys. I appreciate you

Scott Benner 1:08:06
having me on. Oh, absolutely. Hey, huge thank you to ginger for coming on the show. And thanks so much to Dexcom and Omni pod for sponsoring this episode of the Juicebox Podcast. You can go to my Omni pod.com Ford slash juice box to get a free no obligation demo of the Omni pod tubeless insulin pump. And to learn more and get started with the Dexcom g six go to dexcom.com Ford slash juice box. And please don't forget to visit touched by type one.org there are links to all of the sponsors in the show notes of your podcast player and at Juicebox podcast.com.

Would you like to hear more from Ginger? Check out medic mindset wherever podcasts are available. Or go to medic mindset.com her shows available on Apple podcast Spotify everywhere that you listen to this show. You can listen to ginger and medic mindset