#506 Listen to the Doctor

Kathleen Moltz, MD, ProMedica Pediatric Endocrinology is on the show to tell Scott what she thinks of the Juicebox Podcast.

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

Scott Benner 0:00
Hello friends, and welcome to Episode 506 of the Juicebox Podcast. it finally happened. I received an email from an endocrinologist who wanted to come on the show. I've been waiting for this for so long.

On today's show, I bring you Kathleen bolts, MD, pro medica, pediatric endocrinology, she's got a title and everything is like legit. I have been waiting so long for this day, to get an endocrinologist, someone who's been helping people with type one diabetes for years. And then they found the podcast and have some thoughts to share. I'm up for this, you know, this is what I'm looking for. I want to talk to more endocrinologist, you've come on, keep coming. I love this. I love this. Please remember, while you're listening, that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan are becoming bold with insulin. And while I'm at it, let me just say that Dr. molts is representing her own opinions right here. And not the opinions of any of her employers, past, present, or future. I edited this a week ago and I am still excited to do this right now. I'm just putting some ads on this thing and get it out to you guys. So excited.

This episode of The Juicebox Podcast is sponsored by the Dexcom g six continuous glucose monitor. You can find out more and get started today. even@dexcom.com. forward slash juicebox. Do it just do it. Just listen to me. Just go do it. While you're out there doing things want to check out the Omni pod dash you may be eligible for a free 30 day trial of the Omni pod dash tubeless insulin pump. I don't know if you just heard what I said. But you could be pumping with insulin for free for 30 days. Find out if you're eligible. omnipod.com forward slash juice box. I'm getting right to this a long episode. I loved it. I was very emotional at points. I don't want to ruin it for you now. But dig in Kathleen's terrific. This is an insightful episode.

Kathleen C. Moltz MD, FAAP 2:36
I'm Dr. Kathleen Moltz. I'm a pediatric endocrinologist and I'm really excited to talk to you, Scott,

Scott Benner 2:44
I'm very excited to talk to you as well, I have been waiting for an email like yours for a very long time. So thank you very much sincerely. I'm genuinely saying that. Okay. So I guess Let me tell you why. I start this podcast. And I think to myself, everybody can benefit from good information. And I think that's counterintuitive to how people think about it. I think I think on some level quietly in spaces and corners, there's the idea that some people can understand this stuff better than others, and that some people just aren't going to do as well as others. And maybe that's maybe that's it, maybe that's just how it has to be. And I always thought, like no, like, we could boil it down to these simple, simple ideas that I think almost anybody could understand. And then once it started to prove itself out on the podcast, I started thinking like, maybe doctors will hear it one day. That was really like, like my thought. And I do get notes from people who tell me that they found the podcast through their physician, which I think is amazing. But if you listen, you know that every once in a while I throw it out there. I'm like, Hey, if you're a CDE or an endo like and you find this helpful, and you're the one that said hello, so thank you so much.

Kathleen C. Moltz MD, FAAP 4:01
That's exactly why I actually sent the note. I actually didn't start listening to your podcast until maybe a month before I sent the note. Okay, just maybe two three months ago, um, I had heard about it before. I mostly listened to other kinds of podcasts, science fictiony types of podcasts on my 70 minute one way drive to and from work. And I got caught up on all my other podcasts. And then I was looking for something so I searched for a bunch of different diabetes podcasts, listened to one super boring listened to another really not focused on type one focused on type two. So I'm like well, I've heard of juicebox before I'll try this and I listen to one of yours and I enjoy So I listened to another one. And I enjoyed that. So then you mentioned the pro tips podcast. And I started at the beginning, just like you recommend. And I listened to the pro tips podcast, and I almost quit listening to you. Because Because I'm excited. Go ahead. Why? You bash doctor?

Scott Benner 5:22
Do you feel that? Is that how it feels?

Kathleen C. Moltz MD, FAAP 5:24
That's how the first time that wasn't just me because I turned to everybody in my group. And I said, after I listened to a few more, I didn't give up. I listened to a few more. And after I listened to a few more, I told the rest of my group I said, Hey, guys, you have to listen to these protests. But you've got to get past the first one because the first one seems to medical bash, I call it doctor bashing because I'm a doctor, but like, it bashes the medical community a little bit. Not. I don't think you intended it to come across that way. To be honest, having heard now Oh, gosh, how many of your podcasts have I heard? I don't even know. I'm 130 140 out of the 50 150 500. Right. Um, but it definitely is harsh. And one of my nurse practitioners who listen to the first one came to me and said, Dr. maltz, I don't know if I can keep listening to this. Does he continue on like this? And I said, No, no, he doesn't, you have to listen, the concepts are really awesome. And it got me thinking about a lot of things. And that's how I binge through all of the pro tips, and then all of the defining diabetes, and then I listened backwards through 2021. And then I started in 2015. And I'm July or August of 2015, at this point, and still keeping up to date on 2021. And moving backwards through 2020. Wow, that's amazing.

Scott Benner 6:57
First of all, everyone should listen like that. Thank you very much for saying it that way.

Kathleen C. Moltz MD, FAAP 7:02
You're welcome. I agree. That's how I tell people to listen, when I recommend your podcasts, I can't

Scott Benner 7:06
wait till you get to the first handful of them. That's gonna be super interesting to hear how you feel about those. So okay, so now I want to say that if I was letting you take this out of our space for a second, if I was a garbage guy, and I every week, I rode by your house, and I grabbed the garbage. And I did a really good job of grabbing the garbage for some people. And for some people, I did a medium job. And for some people, I left trash strewn on their front yard. And, and I was going to make a podcast to talk to all people who are serviced by garbage men, I might start by saying, Hey, I know some of you get great service. And I know some of you get what you think is great service. But some of you aren't getting good service at all. And so I imagine if I'm a, if I'm now the garbage man, and I'm the guy that does a great job. I'm like, Hey, what's this about garbage men do great jobs, but they do a great job, not everybody. And so I get that. No, but I'm super. So is that actually a term like is Doctor bashing like a, like a term that exists in this like ice that I'm just not aware of?

Kathleen C. Moltz MD, FAAP 8:11
It really is. Um, so I belong to a number of Facebook groups. I don't spend a lot of time on Facebook, but I do find I get a good amount of support. And there's great forums for asking questions. Some of the groups I belong to are women physician, some of them are endocrinologists, both adult and pediatric. Some are just pediatric. Some are just like, people who are interested in the same things are going through the same life experiences. And doctor bashing is a real thing. We often I'm not going to speak for we I'm going to say I have come across a number of situations where people will express their disappointment in their interactions with their group of physicians, nurse practitioners, physician assistants, not always being able to tell the difference between us. And many people in the same conversation will agree with them. And then they'll turn and look at me and they'll say, Oh, I'm sure you're different. With very little sincerity. So there is a little bit of what's the right word. defensiveness that many of us come into conversations with when we hear others making critical statements that don't seem to recognize what at least I feel like most pediatric endocrinologists basic motivation is Yeah,

Scott Benner 9:54
well, I would imagine Everyone's so I want to say this. I imagine everyone's Basic motivation is good. Like, I think it would be a weird, a weird profession to take up if you weren't interested in helping people. But I don't know that that makes a difference. For this, maybe maybe I do sound harsh. I don't know if that makes a difference. Ready? Here we go. I don't know if that makes somebody if you're not good at your job. Like intentions not helpful at that point. If, if, if a person comes into a medical practice, and says, Hey, I learned how to Pre-Bolus my meals, and I fixed my basil rate and look, my a one sees 5.8. And then you spend 10 minutes yelling at that person. I don't care whose feelings it hurts. You're not a good doctor. Right? Okay. That is correct. That happened. I agree. A lot, a lot. Actually, two people. That's really sad. Yeah. But now I think I see the other side of it, though. Because if I'm a doctor, who doesn't have great up to date information for people, and I think to be fair, the advent of continuous glucose monitors, pumps faster acting insulin could leave a lot of people who have been teaching people how to manage type one, since the ad is at a loss. And so if they're used to seeing an A one, C, that's 5.6. And thinking, this means these people are having frightening lows, because no one knows how to get an A one c like this, I even get the initial reaction of like, Oh my god, you're gonna kill yourself. But how do you, I don't know how to take that person and teach that old dog a new trick. And so I have to put myself in the position of speaking to the people who are going to end up getting yelled at and empower them. So I'm not bashing the doctor as much as I'm telling the person to expect better and that some doctors might not have better to give. Does that seem fair?

Kathleen C. Moltz MD, FAAP 11:51
That is fair. Yeah. And again, as I continue to listen to the pro tips, and has now become a serious fan of the podcast, in general, I agree. And I think the way you get to physicians and the rest of the world, is by having exactly what you're putting out a really enjoyable, easy to listen to friendly podcast, that goes over information, not just in a dry academic way. But also in a way that's conversational, that brings in real life experiences, that talks to people who are living the diabetes, and not just people who are practicing the medicine for whatever, 10 or 12 hour shifts that each of us does.

Scott Benner 12:47
Well, I appreciate that it struck you that way. Because that was surely my intention. Which because I think it's funny, because I'm sort of I don't think I'm growth Personally, I have a very low threshold for bullsh, I guess. Right. And so I know that I know, people, like I know, that's gonna sound strange. But I think one of the reasons I'm good at communicating with people is because I, there are times where I know what people need, not just what they think they want, and you need good information. But you also need it to be delivered in a way that you can take it and and you need to be able to take it up and it can't be thrown at you all at once. Listen, I've spoken at so many live events, I have lost count of them. And I will stand at the back of rooms when doctors present. And I think to myself, I understand this. And I can't make myself Listen to this. And it's not because it's boring. It's because it's so academic, that it's not even usable. Right. And so you're sitting Yes, it's a failure of people not to understand their audience. And to understand, you know, I'm gonna say something that feels committed to saying I think outside of the box, and I hate that, but you have to meet people where they are.

Kathleen C. Moltz MD, FAAP 14:09
Absolutely, absolutely true. completely true. I think too many professionals of all fields, when they're talking to people outside of their fields, don't do a great job of remembering how little they knew, because before they became a professional in their own field. And

Scott Benner 14:31
let me see what's hard. You may not be able to answer for your own personal safety and 42. Well, I'm 35 that if that's where we're going with this? No, no, no, no, the answer to everything. Oh is 42. Okay, you know, the most commonly guessed number between one and 137. If you ask people for a number between one and 100, they will most randomly come up with 37. Don't worry about that. Let's move on. So I'm going to ask you a question. You might not Feel comfortable answering? Am I better at being an endocrinologist and some people's endocrinologist in regard in regards to giving people information that's usable?

Kathleen C. Moltz MD, FAAP 15:14
you actually are okay. And I think I can go on record by saying that you also have the ability to make endocrinologists better endocrinologists, if they take what you're saying, and think about it, and turn it around in their own heads and their own experiences. And I say that coming from I actually, before we had this conversation, I sat down and did like a little Google document my career and diabetes tab. And there has I sort of, I sort of want to like, share it with you. And that's

Scott Benner 15:47
okay, I would love you to,

Kathleen C. Moltz MD, FAAP 15:49
um, I graduate, I'm going to date myself now. I graduated from college undergrad in 1986.

Scott Benner 15:58
Oh, bedrock University.

Kathleen C. Moltz MD, FAAP 16:02
Um, and the first insulin pen didn't come out till 1985 was the novo patent. When I graduated from medical school, we were using regular and NPH human and pork, two shots a day, nobody did more than that. And a standard new patient stay in the hospital was six to seven days, right? And so the first day or so you're on IV insulin, and then you went on every six hour regular. And then from the regular, we calculated your regular and mph doses and gave you your meal plan. And that's that's the cut and dry. You have to

Scott Benner 16:41
Can I ask you a question before you go on? What was the medical intention of that? keeping people who otherwise would die alive as long as possible? Sorry, I have a phone ringing and you're not allowed to have a personal life while you're making this podcast. It isn't a personal life. It's a landline I want to get rid of. I think you know, it's somebody right now seeing if you have solar panels on your house, or if you'd like to get an extended car warranty.

Kathleen C. Moltz MD, FAAP 17:05
I may have the liberty to update my market.

Scott Benner 17:09
100% Yeah. So so and so. So that's not a judgment. That's no, no, no,

Kathleen C. Moltz MD, FAAP 17:15
I understand. It was truly, this is the best window that will help people live a reasonable life with low risks of having hypoglycemic seizures and dying. And probably higher than we want risks of having high blood sugars and complications. Yeah. But But as much as we thought that high blood sugars weren't good, the dcct started in 1982. It didn't stop until 1993. And that's the year I finished residency. Wow. So we didn't have all of the stuff that you and your daughter benefited from, which was even checking your blood sugar more than once a day was actually important right now, in those first date, years when I was in residency, like having a patient come in, and having a handwritten logbook, because nobody had download programs, and looking at the logbook to see how many days of numbers were written in the same color ink or pencil. So you could guess how many of the numbers were accurate and how many of the numbers weren't? That was kind of the standard we worked from. And you manually calculated averages for breakfast, lunch, dinner, bedtime, based upon, you know, the three glucose numbers a week in each category that someone might get you, you made a guess about which regular and NPH doses might need to be changed. So wasn't malicious. It was truly what we had to work with.

So So tell me as a person who came up through that, how do Is it just not? What's the question? Why is it so difficult to learn something new when you've been taught a certain way? So you gotta listen to the rest of my story? I'm listening. Go ahead. Okay. So, I graduate from residency, I go into fellowship, humalog is approved at the end of my fellowship, and I have, I think, a really excellent fellowship. Um, I feel like I got excellent training from people who are thought leaders and research leaders. I didn't even through the entire training, have the opportunity to teach another patient how to give an insulin injection. And I joined a practice that was a private, mostly outpatient specialty only practice in the greater Boston area. And the practice model was no one is admitted to the hospital unless they're in moderate to severe decay. A, we teach everybody in our office, the doctor stays after work and does all the teaching. And so I found like my second day of work, I'm like, Okay, I have to teach somebody how to give insulin. And I've never done this before. The practice, I think was really instrumental in my being encouraged and supported and being more assertive. I'm not going to say aggressive with insulin. So we use humor log on almost everybody, we would mix humor log regular and mph or humor log regular and ultra latte. We would do two or three shots a day, we expected our patients to check blood sugar's four to six times a day, we tried to we beta tested a bunch of the original one touch glucose meters, the old clunky ones. And by the time I finished at that first job, I felt like my practice of diabetes was pretty aggressive. There were no CGM still, right. They were just the blinded occasional patients who got the blinded professional CGM, which were really impossible to use. They were painful to put in. It's really hard for somebody to gather enough information that you can look at the less accurate old CGM and make any sense out of it. And it was three days. Yeah. So I moved on to my second job. It was a more academic job. And at that point, when I changed jobs, the mini med Guardian CGM was just released. Um, we were still sometimes using pork insulin. And the Omni pod hadn't come out yet. By now, I understand. So through the next few years, I was kind of the lead in the diabetes section. And I tried to encourage continued proactive, let's give shots at lunch. Let's do insulin multiple times a day, let's I'm a very big pump proponent. So I've never had artificial durations of diabetes you have to have before starting on an insulin pump. And that, by the way, drives me that's loony. I hate sorry for the swearing. I hate I hate when people say you have to have diabetes, for a certain length of time before you can benefit from a pump because it's artificial, right? There's zero common sense or science. Do you think that go ahead, I'm gonna jump in for a second is that just end up being like the pot roast story then? Like, I know, you guys, I love your pot roast story? Yes, it's the pot recipe. It's just that this is how we do it. And it might stem from that's what we've learned through insurance problems, or that's what we've learned through the company. So you just give people this artificial number, so that they're not, it's almost, it's almost the idea of you should under promise and over deliver. Right?

Like it is it is a and there's a surprising number of people that back in the 90s and early 2000s thought that that was very, very reasonable. I, I never did that. I had people argue with me. Um, why are you giving this person a pump? So soon? You know, we need to have X months of data first. And I'm like, why? How is that? How is that going to affect what we do at the time we set up the pump or any of the changes that we make? And nobody could ever give me a good answer. And I've never believed that. Okay. Okay. So, I'm going to kind of skip ahead,

Scott Benner 23:52
go ahead. I'm making it next. I don't want to forget to ask me something,

Kathleen C. Moltz MD, FAAP 23:55
no problem. Dexcom. Seven comes out. The mini med rebel comes out the Dexcom four plus g four comes out. things move forward. And there's more and more pushback from institutions to follow evidence based medicine and national guidelines. And in retrospect, it I didn't even think about this till I started listening to your podcast in retrospect, my my interest in being assertive and pushing that squashed it frankly did. I was criticized for not following national guidelines. I was put in a position of having to defend why I thought a toddler's target range should be 90 to 200 instead of 100 to 200 which is still a ridiculous range to you.

Scott Benner 24:57
It's not really that big of a difference and an odd range. Well, but so my eyes fit it into the rules. Right?

Kathleen C. Moltz MD, FAAP 25:03
Right. So you're trying to fit it into the rules. But also, I, over the years have found a lot of patients, or rather parents whose kids were diagnosed as toddlers, who never got over their fear of double digit numbers. So if the target range is 100 to 200, and you spend the first x years of your child's diabetes, thinking that a 99 is scary and dangerous, double digit numbers are always scary. And I found that if I gave a family a target range of 90 to something, then they would less scared and then I could move it down to 80. Or I could move it down to 70. Yeah, and I was through that barrier of double digit numbers are scary, we can't see them.

Scott Benner 25:50
You needed that 90, just so you could keep the the moving. Yeah, it's a bait and switch, eventually, you're just gonna keep kind of moving the carrot on the stick, you're just gonna keep moving them a little closer and moving them a little closer, but you needed them to see a non triple digit number so that the anxiety in their mind could slowly dissipate. Exactly. So you're brilliant.

Kathleen C. Moltz MD, FAAP 26:11
I'm not brilliant. Because I let I let my interest and I let my enthusiasm get squashed. And there were a lot of reasons for that for profit medicine is part of it. I'm very happy in my current position, which is my third position after fellowship. I will insert interject here and say that nothing I say, is reflective of my current or previous employers that everything I say is my own opinions in my own work.

Scott Benner 26:42
I don't know about you, but when somebody makes a disclaimer, I'm super excited to find out what they're going to say next. So let me get through these ads quickly and get you back to Dr. molts. Let me think this is off the top of my head. Nothing written down in front of me. I can't see anything. The Dexcom g six continuous glucose monitor. What does it do for my daughter? Oh, it lets her sleep easier. lets her go out with her friends. It lets her find out what her blood sugar is, and what it's on its way to being. That's pretty crazy, right? Not only seeing that your blood sugar is I don't know what my daughter's blood sugar is right now. I'm gonna open up my phone and tell you how's that sound? phones open 81 her blood sugar's 81 aren't his blood sugar is 81. It is one o'clock in the afternoon. And it is steady and stable. I can tell that by what the arrows on my Dexcom follow up are indicating. You see, Arden has an app on her phone, you could do this for Android or iPhone, but Arden has an app on her phone. And right now it's showing her her blood sugar. And should she leave the range that we've preset on her phone, it will indicate to her that she's gone below 70 or above 130. You could make your range whatever you want. on my phone, actually, the range is 70 to 120. Nonetheless, nevertheless, whatever that saying is, you will get an alert if you leave the range that you have set. So if you want to know when you're over 150, it'll tell you if you want to know when it's rising quickly or falling quickly, it'll tell you and it'll tell up to 10 followers of your choosing. Now you can share this with somebody if you want to like your husband or wife or stockbroker, I guess if you have a stockbroker and you want to know what your blood sugar is, doesn't matter, you could as long as I guess if your husband was a stockbroker, to for one there, but not the point, right? You can share it with up to 10 followers. That's astonishing. Other people could be looking out for you to think about that, that can be a school nurse even. Right? Are you listen, are you putting it all together with me. And when you know what your blood sugar's doing, and where it's heading, you can make better decisions with insulin, at least that's how I think of it. I think of it as being able to make great decisions that stop rises and stop falls, you'll find out what you want to do with Dexcom when you get it in your hot little hands. And you'll do that@dexcom.com forward slash juicebox head over today and get started. While you're out changing your life on the internet. Get yourself a free no obligation. 30 day trial of the Omni pod dash is for those who are eligible, so you have to go find out if you are the eligible ones. But there's a pretty good chance you will be 30 days my friend 30 days is swimming and playing and jumping and involved in your sports activities. And if you're an adult like stuff you do with other adults, all kinds of stuff the way you live your life cooking in the kitchen, wandering out in the backyard pulling some weeds. I don't know what your life's like, but am I got a crystal ball. I have no idea but whatever you're doing, you can do it with the Omni pod dash on and decide for yourself if this is the way you want to go. If it is you keep going and if it's not what else Right, they're not like holding me up, you can do whatever you want. But a free 30 days to try an insulin pump is a pretty crazy offer. On the pod.com Ford slash juice box, head over and find out if you're eligible or just pick around or you know what, maybe you're already pre sold. Maybe you're in then get started. Get started today, being unencumbered. It's summertime and on most of the planet, which I don't know if that's true or not, it's summertime around that, like you right now might be in Australia, like, Dude, it's winter, but just go with it. Okay. omnipod.com forward slash juicebox dexcom.com, forward slash fuse box, links in the show notes, links at Juicebox Podcast Comm. Let's find out why Kathleen thought she had to make a disclaimer before she kept talking. People that was one take four minutes straight talking top of my head, I'm legit proud of myself, I don't know if you are or not. But just trust me, that's not easy to do, you should try it sometime. Now here's caffeine,

Kathleen C. Moltz MD, FAAP 30:56
you really get into the habit. And if you are used to looking at things a certain way. Unless you're challenged by patients, or by society guidelines, or by, by articles that you read or conferences you go to, unless you're challenged in some way. After 25 years of doing this, there's certain habits that you form, just like you would if you were a car mechanic, and you had to then take care of a newer car that had a newer system, it would be a little bit of a switch.

Scott Benner 31:30
Can I ask a tough question? Absolutely. Was I bashing? Or did it just make you uncomfortable to look at yourself like that?

Kathleen C. Moltz MD, FAAP 31:39
I think both. Okay. I think both because if it was just me, that said, this is this is the problem with doctors, I would absolutely accept that it was my own issues. And I do in fact, thank you for the wake up call. Um, but it wasn't just me. Other people that I had listened to the podcast came and said, I don't know if I want to listen to the second prototypes, right. And I said, I have to insist you listen to the second pro tips.

Scott Benner 32:11
I like that there's a person that can force people to listen to the podcast. That's very lovely. I wish everyone had that power. Well, okay, so follow up question to that is,

Kathleen C. Moltz MD, FAAP 32:21
absolutely. And that's that kind of catches me up. I'm sorry, that catches me up to the President, which is like, I find I'm using more of your words, I find I'm listening to my patients who are telling me things that I now can recognize as coming from whether from your podcast or similar concepts, I can recognize what they're saying to me. Yeah, so we're speaking the same language again. And that's, that's really why I wrote it,

Scott Benner 32:47
I have to ask you how that makes you feel like on a personal level,

Kathleen C. Moltz MD, FAAP 32:51
it makes me feel awesome. It makes me feel just as excited about practicing pediatric diabetes and endocrinology as I did the day I

Scott Benner 33:00
graduate. That's excellent. I'm so happy for you that I had any little part in that makes me feel very warm inside. And I'm grateful that you're telling me about this. And, and moreover, that you're willing to tell it to other people? Is there is a God complex among doctors a real thing?

Kathleen C. Moltz MD, FAAP 33:21
I think more so in the generation that came before mine. Okay. So I get I graduated medical school in 1990. I think there was more of that in the people who graduated before that. Um, I don't think it fails to exist today. I think people who have that personality are more likely to be choosing non pediatrics and non pediatric endocrine careers. Because

Scott Benner 33:58
Do you think it's ego? Or do you think it's the protection? Or do you think it's both and provide protection? What I mean is, if I'm the General and I'm telling you where to shoot the missiles, I don't need seven people yelling in my ear while I'm trying to figure it out. It's already enough pressure. And it's on me. Is that is that part of it? Or is that is is there a part of it? Hey, I'm a smart person. I went to a lot of school, you are not as smart as me. You did not go to as much school as me and shut up like it is or is there a black? Go ahead, Tommy,

Kathleen C. Moltz MD, FAAP 34:26
there's a black, there's a black. So I think again, before, kind of the time period I graduated medicine was taught as you are in charge of the health care, you are the leader of the team. And whether it was my medical school, which was very avant garde, or whether it was the time that I was in residency and fellowship. Things have really switched to you are a leading member of the team, but you are not the only member of the team and team based care works better than solo practitioners sitting on their doorstep handing out prescriptions. Without instruction,

Scott Benner 35:13
does it? Does the podcast become more difficult? Because it's a faceless, nameless person who, by the way missed 53 days of his senior year of high school and never went to college? No, okay. It just it just, it's just difficult. Is it difficult to I'm imagining there are some doctors that just probably out of practice, or, again, out of comfort or or maybe security, say, if the system doesn't tell me that these are the rules we're following? I don't want to hear about it. Right?

Kathleen C. Moltz MD, FAAP 35:45
That is correct. Okay. Um, I think my viewpoint has always been, I know a lot about diabetes, you know a lot about your kid, we have to work together to figure out a system that's going to work. And where I fell behind was in recognizing how many internet based resources there are, like podcasts, like blogs, um, that

Scott Benner 36:17
I'm not aware of other resources for anybody, I mean, you have those resources podcast, and then I don't know, Danny, Jenny, Jenny's different. Jenny's a deity. She's a diabetes goddess, right? That's where she is.

Kathleen C. Moltz MD, FAAP 36:30
But she is another resource, and you can contact

Scott Benner 36:34
me, I just don't want people to listen to their pockets.

Kathleen C. Moltz MD, FAAP 36:37
But that is a part that people now have available that wasn't available when I graduated. You got information from textbooks that were already obsolete by the time they came out? Yeah. And whatever Jocelyn published about take care of your diabetes, I actually have a really old Joslin Diabetes book from the 1950s, with glass syringes and a picture black and white picture of a girl at diabetes camp smiling.

Scott Benner 37:06
Well, I think this format is amazing. I'll tell you three is the official number of book deals to write about diabetes, I've turned down. And always for the same reason, because by the time I write it down and hand it to somebody, it's too static, and it's going to change and, and then one day, someone's going to pick it up and make bad decisions with it. I agree. That's why I like this, this way of talking to people.

Kathleen C. Moltz MD, FAAP 37:30
I agree. But go ahead. And I haven't thought I will. I will preface this by saying I haven't looked at your blog. I really haven't. You don't have I don't have a lot of time to read stuff. So I find the podcast to be perfect for me. Yeah. Um, but do you have like, cheat sheets that go along with the topics? know people who want something? Want to hear my

Scott Benner 37:55
theory on? Why not? Okay, yeah, I don't have time. I am literally I am the podcast. I know that guy. There's no one else. So you have that group of volunteers that are like cataloging, they show off a little bit. If I had the ability to yell at them, I might yell at them. So But no, anybody who else is generally nice and amazing. But here's my theory. It has to come in slowly. And it has to come in organically to your brain. Because that's how you'll understand it. So I mass market talking. And you can listen to other people who say like, Oh, I read a lot of people read my blog, or a lot of people listen to my podcast. I know how many people listen to his podcast. Based on numbers, no one's listening to them. Okay. So when you're, when you are talking to hundreds of 1000s of people at a time, you have to come from a different perspective. So I can't speak to everyone. I can't meet people where they are. So I have to start with slow matriculation ideas that are get repeated in different ways. They need to be able to listen at their own pace. They need to be able to go back and listen again, if they don't understand they do need a place to go ask questions if they don't, if they can't get something together. But I think that there are some people you can bring up to speed too quickly. And there are some people who are readily available to the information and can just absorb it. In three seconds. I think there's an episode called diabetes fast forward, where I had a woman on who found the podcast, in the hospital during diagnosis. I heard it and never once experienced any of the problems that you associate with people who live with Type One Diabetes. Now I heard that's amazing to me. All that tells me is that's possible for some people. Right? And for other people, for other people. Like I'm following a kid right now, who's I think had diabetes for four or five years and the mother reached out just said, Look, I'm lost. I listen. It's not hitting me, right. I'm always chasing the insulin around. I don't know what I'm doing. So for her I said you call me on the phone. And I can't do that for everybody. But the process of me speaking to her for an hour, and then getting to watch how she figures it out, helps me talk about it so that other people in her situation can maybe benefit. And I think that's it, I think there's something to do with the way it's disseminated my theory about how it should be disseminated and my understanding of how to speak to people and that I'm speaking to a varied audience, but do not want to leave anyone behind. I've said here all the time, I do not understand when we take a classroom full of people, choose the five that are, you know, need the most help and then abandon the other 15. Because we want to make sure no one falls behind, I think there's a way to teach everybody where they are, without letting anybody fall behind anybody who's interested. So if you, I find that when I speak to people, the one, the one factor that ties them all together, the one reason I can tell they're going to be successful one day for whatever they want success to be, is because they're genuinely interested. And they're trying, that's the, that's what you need more than anything. Now, if you try really hard with the wrong tools, or the wrong information, then you're screwed. And then diabetes will make you insane, you know, because you're going to be like, I don't understand, they said to Pre-Bolus. But if your Pre-Bolus in 10 minutes too long, or five minutes too short, it's not gonna matter if you're Pre-Bolus, he's just gonna create a different problem that you don't understand down the road. Will everybody get to where I am? Where to where Jenny is? I hope so. But I don't imagine they will. But I do think that a lot of people can, can roll around with six a one C's without getting low all the time, and get to keep all their fingers and toes and vision for their whole life and live into their 80s that I think is possible and very humbly, or maybe not. So humbly. I believe that information lies within the episodes of this podcast. So I agree, but I have a question for you. How to phrase this, okay, it's hard, isn't it? Good?

Kathleen C. Moltz MD, FAAP 42:09
It is hard. You're this? I'm not. So, um, I agree with everything that you have just said, I think that having the right tools, and having the information at a pace that you can accept, and understand and implement, and then reassess. And move forward is super important. And so I'm interested in hearing your, your opinion on how new onset education with a family that has no background or information about diabetes can be better?

Scott Benner 42:55
That's easy. See, yes, made easy question. And remember earlier, when I said I wrote something down to ask you, it says, How do you fix the system? I will just erase that. And we'll just start right now.

Kathleen C. Moltz MD, FAAP 43:06
And I'll share with you my ideas after

Scott Benner 43:08
I am. I'm very excited to hear your ideas. I'm excited to hear anybody's ideas about this for me what I've seen work. And I want to say something I'm going to preface this by saying that I came up through a community of bloggers about diabetes, I have been podcasting about diabetes for this is the I'm halfway through the seventh season. So seven full years, no no BS 20, you know, episode seasons, like, you know, every week, seven and a half years, I have still not caught up to podcasting for as long as I blogged. Okay. And I came up through a system where those people no matter what they would say public facing, would say to each other privately. I am not teaching anybody about how to use insulin, because I'm not getting sued by somebody. Okay, so they there were people who knew and would not say, and there were people who didn't know. And those people who don't know, and still want to say exist today. I'm fascinated by you, people. If you're listening Shame on you. I know what your a one C is stop acting like you should be telling other people what to do. Okay. That's, that's very scary to me. But the idea of not giving people information is even more frightening to me. So you can't say there's no one that gets to decide who gets the information and who doesn't get the information. There. There are some honest truths about the world. And some of us don't know how to do algebra. I'm one of them. Okay, but you don't not teach algebra because I don't understand it. So everybody gets to hear it. Hopefully they'll all respond to it well, if they don't, protecting them is not protecting everyone. So you can Not, should not, in my opinion, hold back information for the fear that someone's not going to react well to it. So what do you tell people when they're newly diagnosed, you say, Listen, this sucks. This was this is a bad turn, I am sorry, I'm not going to lie to you, this ain't going to be fun for a while. But on the other side of this feeling, and you will go through a number of the of the impacts that you would associate with any kind of loss, right, this is a loss of health, you're going to feel that way, it's going to be overwhelming sometimes. But there are some empirical truths about using insulin, I'm going to teach them to you. And then with any luck, they'll start making sense to you over time, and you will find a rhythm. And one day, it won't feel like this anymore. That is the first thing I would tell them. And then I would say the word basil about 1000 times until they believed it. Because people ignore basil. In a way that is frightening. It is absolutely the basis of the entire thing. If your basil is not well tuned, if you are not flexible, about about your basil growing as your honeymoon ends, if you're not flexible about using your basil, when you have your period, or when you go from being active to inactive or whatever, nothing else works. And basil is spoken about, like you inject it, and you never think about it again. And that's that that is a travesty to not teach people how to use Basal insulin, they should be the most important thing in the world. I agree. Okay, after that. If they're honeymooning, and that makes you uncomfortable telling them the Pre-Bolus. Fair enough.

But you have to tell them in a normal situation, we're going to need to Pre-Bolus your meals, we can't right now, because your pancreas is still working a little bit. But moving forward, that should be your expectation, you don't leave that bit out, and then get them used to doing it one way so that when it's time to do it the other way, they can't make the leap, right, you got to show them the 90 so they they believe in the 90. After that, you have to find better words for glycemic index and glycemic load, because they're boring and they feel like school. And and because of that doctors see people glaze over. And don't go over it enough. Understanding the difference between 10 carbs of white rice 10 carbs of basmati rice, 10 carbs of banana and 10 carbs of mashed potatoes is the whole thing. You have to be able to like stand there and kind of groove with it and go, alright, my insulin to carb ratio says this, but I got a ripe banana here instead of an unripe banana. So I'm going to go out and a little harder, you have to be able to do that. From there. You have to tell them that they're always going to need to be flexible. And there is some vigilance involved. But that over time, these things become so Matter of fact in your life, so obvious to you that you won't be thinking about it the way you're thinking about it. Now, it won't, it won't take up so much space in your brain one day. And the faster we get to that, the more quickly that you have experiences to learn from the less often that you have one of those experiences, and then run around crying and screaming and full of drama. I almost killed somebody. Isn't it crazy that a cookie saved my life? Like it's crazy to cookie save your life? like okay, like, let's let's keep going now, right? Like, why did you need the cookie? What happened here? Don't waste this experience, right? The more more experiences you waste, the more experiences you're going to have to have go wrong before you figure it out. You tell people that and then trust them. And some people are going to want to do well, some people aren't some people are going to struggle, some people are going to thrive. And then you figure out who those people are and reorder them and go over it with them again. But I have I have about 90% confidence that there is no one you could find that I couldn't speak to for an hour and stabilize their blood sugar's in less than 48 hours after that. And if I can do that, then everybody listening should be able to do that if you're a doctor and endo and if you can't, you got to look at yourself and ask why. Like, why is this my job if I can't do that, it would be like saying I change people's tires. But I can't do the cars was six lug nuts. It's just beyond me. I can't figure it out. You can figure it out like and if you don't want to figure it out. have the nerve to tell the people that say look, I'm going to do a good job for you. I'm never going to do a great job for you. We're going to get your a one c two, seven. And if that's okay with you, I'm the right man for your job. But if it's not stop looking at me like I have the answers because while you're not and I'm directly speaking to doctors, while you're in helping those people, those people believe you are helping them. And then they go home and have experiences that counter that feeling. And you are making them crazy. You're telling them It's okay. And then they go home. It's not okay. They don't know what to do. They can't trust how they feel. They want to trust you. And there's a mental conflict that happens that I've seen burden people to the point of wanting to end their own lives. So you can't just you have to at least be honest with them. there that was way more than your answer to your question. I'm so sorry. I talked forever. I'm going to talk

Kathleen C. Moltz MD, FAAP 50:37
to a lot. So thank you, first of all, um, I think I've worked with a lot of different doctors, nurse practitioners, diabetes, educators, dieticians, social workers, psychologists over the years. And there's definitely something that some people do well, and some people don't do well. And that setting up the fact that what someone needs to know, in the crisis moment of learning that your kid has diabetes isn't all there is to know.

Unknown Speaker 51:21
I'm

Kathleen C. Moltz MD, FAAP 51:23
my entry into a room for years has been Hi, I'm Dr. Kathleen Moulton, I'm sorry to meet you. Your kid has diabetes, none of us wanted that. But I'm glad I'm here to help you. And what we're going to teach you for the next couple of days in the hospital is going to be the beginning of what you need to know. And I think giving people all the information at once, when they're struggling with figuring out the beginning stuff doesn't necessarily work. But making sure everybody knows all of the stuff exists and has access to it, right? I think is important. So like to give the to give the off off label example, you're not going to have somebody read Shakespeare if they can't identify the letters of the alphabet.

Scott Benner 52:22
know for certain, I mean, if you ask me more directly, I'd say the defining diabetes series is huge, because it takes weird terms that you don't know, it puts them into some context, and gives you an example that you'll probably bump into along the way of it. That's huge. I, I have to say that at the end of all that I would probably tell them, everything I just said to you is probably going to fall out of your head in the next 30 seconds. And I don't expect you to hold on to it. But here's where we're going to start, I'm going to try to help you get your Basal insulin, right, we're going to figure out your own son to carb ratio. And then we're going to move forward. But I think what you need to leave with them is the idea that this is going to change, these ratios are going to change, right? That because the amount of time that I see people who can't take their basil rates from point 252, point three, five, because they think it's an exhaustive amount of insulin that's going to kill everyone, right? You know, like, they they like no, no, it's point two, five, I use my personal example all the time, someone handed me novolog in a hospital. And for five years, I just believe that's what insulin was. I didn't know there were other brands of insulin, I had no clue. Because the guy in the white coat was said, Hey, here's your insulin. I was like, Oh, this is insulin. I never once could have questioned that. And when someone told me, You should try a Piedra. I was like, oh, like I remember the moment I said, how would I be able to do that this is insulin novalogic insulin, I wouldn't be able to try another instance, the doctor didn't say another insulin, you get caught in that loop so quickly about trying to get somebody to Pre-Bolus trying to get them. So you can't My point is Yes, I understand. They can't know too much. They can't run before they walk. That's obvious. But you can't tell them walking is the only thing that exists in the world. Because then they get scared and screwed over and they get stuck walking, then

Kathleen C. Moltz MD, FAAP 54:15
agreed? Yeah, agreed. Yeah, no, I think we're I think we're saying the same thing. I think I think a lot of people, really, a lot of doctors, a lot of educators don't do that second part. I think we're all pretty good at doing the first part, which is this is what you need to know to survive and get your kid home from the hospital. Or if they're not in the hospital. This is what you need to do to survive. And the part that a lot of people miss is and everything is going to change, right? And 90% of what we thought was true 10 years ago is now not true. And that's going to be the same thing. 10 years from now.

Scott Benner 54:57
Two questions about the same sentence. Do you I agree with the sentiment that that's do not die advice. And do you hate that? That's the way I say it. Yes and no. Oh, thank you. The more you agree with me, the happier I get just so everyone can understand my psyche.

Kathleen C. Moltz MD, FAAP 55:15
No, no, no, that's very. You like you like being right? I do. Most of us do.

Scott Benner 55:21
I don't, I don't like being right. Because I Well, I like everyone likes being right. I'm just stunned when I'm right. Sometimes like, and because the podcast is completely off the cuff. So the first time I said that's do not die advice. Those are just the words that popped into my head. While I was saying it. That pro tip series that you that you listened to was not in any way scripted. And many of the episodes started with me going, Hey, Jenny, you want to talk about Pre-Bolus thing today? And she'd go, okay, because I didn't even tell her what we were going to talk about until we got on the call. So those are real, legitimate conversations that were not pre planned in any way. That's why this works. Yeah, I think so too. That's why this word Yeah. You start writing down bullet points. I just know how my brain works. If I started, if I started some jackass came on a podcast and started reading to me from the Pink Panther book, I'd be like, whoo, I'm out of here. You know, like, pretty quickly, even even if, and here's where I'll talk to you. Forget diabetes for a second. As a communicator. I always say, I don't think I've ever said, Maybe I've never said it out loud on the podcast, but I've learned something about people. Okay. If you put dog crap in a bag, and offer it to somebody, they don't want it. But if you call it free dog crap, they'll be like, cool. I didn't know it was free. Like so there's a there's a, there's a psychological thing that people people will take a free thing. I learned that in a marketing job I had when I was little. Here's what I learned about podcasting. If it sounds forced, or fake, or it's noisy, or people click when they talk or breathe heavy after they talk, people will not listen, it turns them off. Even if you told them 45 minutes into this conversation, you have to listen to all 45 minutes, but 45 minutes into this conversation exists the secret to life 65% of the people would shut off, if you just clicked your words, if I popped my piece, they would just they'd leave. You have to give people they don't even realize it about themselves. But you have to give it to them in a way that they're happy to take it in so that when that information comes out, they're having a good experience already. And so everything that gets said, gets absorbed, you're actually doing a great kindness for people in the future right now. You don't even realize it. But by giving me kind of your quote unquote seal of approval, anybody who hears that, the next time they hear me say something that that rubs them wrong. They'll take an extra second to listen. And so that's where the trust piece comes in. It's super important. I just told a woman this morning, she told me her 14 year old daughter is difficult and won't listen about diabetes. I responded, You're hilarious that you think it's your 14 year old daughter. That's difficult. I also said that. I also said, by the way, for anyone listening, I like I like girls who who ask a lot of questions and aren't pushed around. I think they end up being amazing adults. And it's a little difficult when you're parenting them. But it's a great sign for the future. But she said Why won't she listened to me? And I said, my best guess is you've been wrong about this a lot. And she said I have been I said, so you've come to her with a bunch of stuff about let's try this. Let's try that it's not worked out. And now you're saying I found a podcast, we should try this thing. I was like in the back of her head. She's like, lady, you don't know what the hell you're talking about. And then what is the kids say all the time, I've got this. Every parent listening has heard their kids say, I've got this and then they go do it. And I mean, honestly, most of the time, they ain't got it, you know, but they they're tired of you being wrong about it. And so, that's another thing for doctors to know, every time you say something in that room. And then some parent goes home and tries to assert with that child this thing, and then your thing doesn't work. That kid gets farther and farther away from being able to believe their parents. And lastly, being able to believe you. So you're hurting your own Cause if you're not giving them good information up front. That's correct. Thank you. I'm so worried I'm gonna stop talking you're gonna be like that's completely wrong it

Kathleen C. Moltz MD, FAAP 59:40
Yeah. I'm gonna circle back to the don't die advice. Go ahead, please. Don't die advice is still important.

Scott Benner 59:50
Yeah, not dying is hugely important.

Kathleen C. Moltz MD, FAAP 59:52
I mean, I mean, so and this is a bummer and a downer but like i Last two patients in the past year. And there were horrible tragedies. And I spend a little bit of time every day thinking about what could I teach? What could I do differently? So that doesn't happen again.

Scott Benner 1:00:20
Can I ask these people and I'm sorry for your loss? Did these people die from uncontrollable high blood sugars or from low blood sugars?

Kathleen C. Moltz MD, FAAP 1:00:30
fees? Well, the two this year in the past 12 months, were related to high blood sugar's a couple years ago, it was related to low blood sugars. I don't think there's a single pediatric endocrinologist working, that doesn't have memories and scars on their heart from the people we've lost. And the do not die advice isn't something to be just thrown away, and it's just not enough. Like you have to start with a please don't die. And then you have to go to the end. You I want you to thrive. I want you to have a good life. I want you to enjoy yourself, I want you to have appropriate developmental stages, both in your regular life and in your diabetes life. And then you have to move from the thrive to the really excel

Scott Benner 1:01:21
when you hear me say do not die? Do you take it the way I mean it? Meaning Do you hear me say there's more to this than that? I do now. Okay. You did? I didn't at first, because you have a different perspective than I do. And and the people listening, none of us have had to shepherd along a person who doesn't who's not with us anymore.

Kathleen C. Moltz MD, FAAP 1:01:43
And to be frank, I don't imagine anyone listening to your podcast, or it would be a very rare person listening to your podcast, who has lost a family member from what I can only list as a diabetes error. Yeah, and whether that error was in action in understanding and technology in what they were taught in what they took in insurance coverage of what they needed, in the Postal Service, in parenting.

Scott Benner 1:02:19
So when you get back to the beginning, you're gonna you're gonna bump up on a, on an episode, I think just called Matthew haulover. Oh, so

Kathleen C. Moltz MD, FAAP 1:02:29
so you forget that I went back to the beginning that I'm listening. From beginning forward and backward. I'm

Scott Benner 1:02:36
doing both. So my experience speaking with Lindell about her son who passed away in college. I took I can't remember any of that conversation except the part where she said that she would have rather her son have 21 exceptional years, over having 40 scared years. And that really, really stuck with me. And so I have, I'm money where my mouth is because my daughter could pass away. Like there's nothing to say that she couldn't. And I just kind of, I believe right now, in this moment, that if that were to happen, I think I could say what Lindell said, at that moment. I believe that academically right now, I also want to point out that one of the things doctors lack through no fault of their own, but I get to have, and it's an amazing benefit of the podcast, is that I get to, and the more the more popular the podcast gets, the more of the world that it covers, the more far reaching it becomes, and the different stories I get to have. So you guys get to listen to them, which is one experience. I listen to podcasts that I don't produce, and it's one experience. But having a conversation like this with a person, every time I do it, the one we're having now, but when I had yesterday, the one I'm gonna have on Tuesday, they changed me and informed me differently every time. And then, and this is gonna sound really high minded, please don't take it that way, then I become a conduit for that information. So then it's my privilege to stay here and have these conversations, and then say something off the top of my head. That just occurs to me, but it doesn't just occur. To me, it comes from this amalgam of conversations that I've had. And so there's something about having like a sphere of information that can listen to you, and then spit back out the best guess it has based on everything that it's heard, that I think is really valuable. So that makes sense.

Kathleen C. Moltz MD, FAAP 1:04:41
It does, does and to some extent, like as a physician we hear over years 1000s of stories, and as a pediatric endocrinologist, I have the privilege of helping and watching kids grow up And getting information from them and learning and then kind of letting it stew and transforming it into something that someone else can use is the same thing I feel like I get from listening to your podcast and I feel like other medical professionals, if they listen can get from listening to your podcast is very cool.

Scott Benner 1:05:25
I will tell you to you're at a disadvantage because I imagine that the stories you hear are probably fairly similar from person to person, and never the good parts. It's probably always Moreover, the struggles what's not working. And then once in a while, like, Hey, thank you get this happen, like, Look, I'm gonna tell you right now one of the best memories of my life is the first time I got Arden's a one seater really move after we got to Dexcom. And I left the room. And we were going out to fill out paperwork at the at the end, and I happened to look up and see the the nurse practitioner there. And she looked me in the face. And we did not have the agency yet, because we actually got through the whole visit without it coming out of the machine. And she goes, Oh, I was just coming back to see you. And she told me Arden say one se and then I broke down uncontrollably sobbing in front of her. And then this tiny little woman hugged me. And she's like, you're doing a good job. And I was like, thank you, like an all I could think was like, I've been trying for years for this to happen. Like, like, I really didn't think I could do this. I never, I never thought this was gonna happen. I always thought I was killing my daughter, like constantly felt like that 24 hours a day, seven days a week, in the middle of the night, I opened my eyes. And my first thought was, is Arden alive. I'd put her in her bed. And the last thing I think when I left the room was please don't die tonight. Like Like, that's just like, my whole life was like that. And no matter how hard I worked, or no matter what I tried, or how much I cared he once he just sat in the eights. I didn't know what I was doing. I had no idea. And I go to what I think you would consider to be a really good Children's Hospital on the east coast. Yes, right. I know which one yeah. And it didn't matter. It just didn't matter. I didn't have the tools, I didn't have the understanding. I'm a pretty bright person. And I couldn't figure it out. And I could see my whole life was going to be like this. And then I could see her whole life was going to be terrible. And I have the perspective of my friend Mike having type one when we were in high school. And Mike in the last two years has passed away. And I can tell you right now, Mike passed away because he didn't understand what he was doing. And when technology got better, he did not move along with it. So I'm never going to make that mistake. I think that as much as what we do right now for Arden's care probably will work better than any retail available algorithm that's going to be available in the future coming up right now that most people living with diabetes will benefit significantly from being on one of those algorithms. And it's so exciting to me, that that exists in such a short time, right? Like, what it's 2021, the Omnipod five is gonna come out soon. That thing's gonna learn and make changes, right? That's insane. In 1988, my buddy was diagnosed with diabetes, he couldn't even make it to see that technology. That's how different the care is from the late 80s. Till right now, that's mind numbing. Everyone needs to know that who has type one, everyone who uses insulin needs to know that. And I'm going to take the last 10 years of my professional life trying to make sure people understand it. If sometimes I talk in a way that makes a doctor uncomfortable, you have to see the bigger picture of what it is I'm trying to accomplish. And you being here is such a fulfilling thing for me. And a note that I got the other day that said someone just changed their major because they want to be a CD now because of the podcast. Like I this is gonna sound crazy, because I'm too direct. Like if I spoke more flour early around this, it would probably sound better. But I'm going to change the next generation of how people talk about diabetes. Like that's my goal. I want my if my daughter has a kid with type one, she better never go to a doctor's appointment, where they're like, Oh, you got a seven, five, you're doing great. Get out of there because somebody ever I'm gonna come back from the dead and find somebody if they say that to my grandchild one day. Okay, so I just, I want to make a bigger impact. And I want there to be people who talk about it this way. And I think if I just keep talking about it, then other people will learn how to talk about it like this too. My goal is that one day I meet people who are so much better If this than I am, who tell me Hey, I figured this out through your podcast, that that's that's my very overarching high minded idea about diabetes. So I don't even remember what we were talking about, but

Kathleen C. Moltz MD, FAAP 1:10:11
it's okay. Because I have a couple responses, please. And the first one is I think your legacy is changing the way people talk and think about diabetes. Hope so not that you have to end that now.

Scott Benner 1:10:28
Yeah, don't make me cry either. It's sad.

Kathleen C. Moltz MD, FAAP 1:10:30
No. Okay, but I'm gonna now. So the other thing I really feel like I need to say to you, is that even though you spent all of those years every single day, thinking, am I killing Arden? Is she gonna wake up? You every day saved her life. And you learned from what you did. And you were flexible enough to take advantage of technology, even when it wasn't what was recommended by your professionals, like the Omni pod. And if people can start from a place of, I'm saving my kid's life, and I have to get better at doing that. How much easier would it be to accept your own faults and your own advantage advances? You saved Arden's life all those years, and now you know how to do it better. And now you're sharing it with other people. But you didn't fail her? You didn't fail this child. You succeeded. You saved her.

Scott Benner 1:11:49
I think, um, um, I don't know how to answer that. But I think that we all if this podcast means anything to anybody listening, like you really have to. Sound sounds crazy, but you have to be grateful for how poorly Mike's life went with diabetes. Because I have to tell you that it was such a part of our existence. And he was absolutely my best friend in the whole world, that when Arden was diagnosed with type one, it took me weeks to realize that Mike had Type One Diabetes to it didn't even occur to me. His care was so in the background, and almost an afterthought, that when my daughter was diagnosed with Type One Diabetes, my first thought wasn't my best friend has type one diabetes. I didn't think of him that way. And that care model? It it led to it. I mean, that led to his demise. It really did. Yeah, and, and so I can't sit here and know that there are still people giving that advice. And it happens.

Kathleen C. Moltz MD, FAAP 1:13:04
It does. It does. And that's wrong. Right. I have to not the same but similar to Mike's that I think about when I was in kindergarten, there was a little boy, I still remember his name, if you're out there. And I remember you, um, and he was diagnosed with diabetes between kindergarten and first grade. And I remember I remember, as a six year old as a five year old thinking, what is diabetes? What does that mean? And I can't remember ever seeing him do anything for his diabetes. He disappeared from the school I went to after first grade, I have no idea what became of him. But I always wondered like, how was his life. One of the first patients I took care of, in my first job out of fellowship is another person who was probably a victim of what we didn't know and what didn't change. I picked her up as a young adult patient, because in that practice, I also saw young adults, and she already had retinopathy and neuropathy in her early 20s. And she passed away. I believe, a month before her nephew was diagnosed with Type One Diabetes. And her brother brought his son to see me and said I don't ever want what my siddhart my sister went through to happen to my son, you have to we have to do better. You have to do better. Tell me what to do.

Scott Benner 1:14:54
Well, I'm going to tell you something that I think is going to make you kind of shocked and happy. You said you started listening to podcasts a handful of months ago. Yeah. Okay. Do you believe that the way you're doing your job is better than it was prior to that? Different more enthused, I

Kathleen C. Moltz MD, FAAP 1:15:15
think that's a, that's a that's a correct statement, I feel better about how I'm doing my job. And I think I'm doing my job better.

Scott Benner 1:15:22
So do you know I have a website called juicebox, Doc's calm, where listeners, I've heard of it. They're sending their doctors that they think do amazing jobs for them. And three days ago, someone sent you in. So you're up there now to think did a gentleman sent you in and the stuff he said about you was really very wonderful. So I think you'd be thrilled. Okay, now you're gonna make now you're gonna make me cry? Well, I've been saving that for the whole hour. You mean, me? Okay. But you know what, thank you. Thank you for telling me No, but what made me think to say it just now was that you said hello to the kid in from kindergarten. And you said, if you're listening, and I thought he might be listening. Because that's crazy to me, like, I get an email and it says, Hey, this is an entry for Juicebox Podcast, a really like thoughtful thing about why the doctor should be in here. And then I looked down it and it was you. And I thought, that's so full circle crazy. It's it's like there's a story, that from the Facebook page, a couple weeks ago, a woman walks into a Costco with a Juicebox Podcast t shirt on. And she intersects a woman who points at her shirt and goes, I listened to the Juicebox Podcast, and they have a quick back and forth, and they go on their way. The woman with the shirt comes to the Facebook group and says, You'll never believe what happened today. I was at Costco, and blah, blah, blah, blah, blah. And in a half an hour, someone else comes in and goes, that was me. And I'm like, Oh, I'm building an empire. Like, that's all like, I know, I thought it was such a lovely thing. But but the Joking aside of that, I thought, I started a podcast about type one diabetes, not even about diabetes. And a lady just walked into a Costco in New York, and walked past another listener of the show. And I was fascinated by that, just that piece of it. But then that they both are in that other space. I was like, wow, maybe this is the model that helps people. Like because of like this distribution. I mean, the joking aside, and it is cool that I have a podcast that people recognize and etc. And I'm not saying that like, but that the distribution works that well, was very heartwarming to me. I thought, I think I'm onto something like I think this works, whatever this is right now works. So if you're a doctor listening, and you've listened to something and thought that guy's bashing me, I want you to please just know that I have never sat down in front of this microphone, and consciously started talking about anything. I've never once thought today I'm going to talk about this or that. I've never taken a note the people I speak to, I don't even let them talk to me before we do it. So we start Truth Truth. Yes. Okay. So I don't like that actually, everyone. And sometimes I leave it in because it fits. But mostly what happens is people get on I say, Hello, we get the tech set up. And I tell them in a moment, introduce yourself any way you want to be known. And then I'll ask you a question. And then in an hour, we'll be done talking. And that is as much consideration that I've given any of these recordings so far. So because I like I like what comes out of this, like this thing, whatever this is we're doing like you and I are making an amazing episode of this podcast. I understand that on one level. But personally, we're just having a really great conversation. And then on another level, we're helping people with diabetes. And on another level, we're helping physicians that help people with diabetes, like there's so much happening within these minutes. And I'm not aware of them in totality, while it's happening, and just I'm just answering the questions the best way I can. And I think there's something to be said for that for people who don't

try to make everything seem so professional and clean that it doesn't work for most people. So I don't know where I got that from. But anyway, it's cool that somebody bought a T shirt even that freaks me out caffeine that somebody was like, like I being serious to to see how growth works. I have never in my life thought to myself, I'm gonna sell t shirts. I don't want to sell t shirts. I don't like that. It makes my life more complicated. It doesn't make me very much money. You know, but people said, When enough people come to you and say I want a T shirt. You think this isn't about shirts. Make them a T shirt. When very recently, it's gonna sound weird the wording, but I had to put up a buy me a coffee campaign, because that's how many people said to me, I want to give you a couple of dollars, and there's no way for me to do it. And I just thought like, That can't be right. Like when the first time that gets said to you, you think, Oh, this is an outlier. It's a crazy person. That's so nice. I'll thank them. And, but when the 50th person tells you, I'd like to give you three bucks a month, because it'll make me feel better. It's an odd feeling. But you have to it's sort of the same thing with a T shirt, you think this is something they really want to do. I know that I'm going to end up with $3 when it's over. But I think I have to let them do this. I don't know if that makes sense or not.

Kathleen C. Moltz MD, FAAP 1:20:51
It makes sense. And you do have to let them do this. You are providing something. You're doing it for free. People have ads, it's not free. Well, okay, yeah. But for the people, it's free.

Scott Benner 1:21:07
I understand,

Kathleen C. Moltz MD, FAAP 1:21:07
okay, there's no fight, you've said it, and I will repeat it. There's no firewall. There's no content hidden that you have to put in your, you know, password to get to. This is just all out there. It's available. It's waiting for people, for doctors, for nurse practitioners, for anybody who wants to have another way of thinking about this. Have your perspective and all of the people that you've talked to. And if somebody wants to give back to you for the hat, accepting the gift honors the giver,

Scott Benner 1:21:46
that's I, it took me a while to get to that because it just felt wrong to me the whole time. There's one person whose name I won't say who Badger's me more than anyone else. And I finally was like, Okay, I'll do this, no one's gonna do this. She's like, Yes, they are. And I'm like, No, they're not like I, it's not necessary. I do make money from the ads. It's not about money. But then I started having this other thought, as crazy as it sounds, the more I could make from this, the more I could do with it as well. And I'm not telling you, I wouldn't pay for my cable bill or send my kids to college or anything like that with any of the money people would send. But there is like bigger ideas, like I have stuff going now, that takes money I'll tell you about afterwards that I think you'll be excited about. But there's no doubt that more money would help that. Like there's no no doubt that it would be nice if I could pay somebody to, you know, prep the shows for me, because we're up to, I don't know where the listeners are up to like 498, maybe. But I already have the next seven prepped and up, I've already recorded the next 60 or so they all need to be edited, put together, like there's a lot that goes into like an hour of listening for you is probably eight or nine hours of my life, I would guess. And so at least at least it's a lot and, and this is 100% a full time job. Now I work on the podcast six days a week now. And there are times where I have to stop myself, and I have to walk away from it. And I'm gonna get a big fat. But if I keep sitting here, so I got to get up and move around a little more, although I have a fairly flat, but I don't think I could make it. The fat will just go somewhere else probably Catholic. But I don't think it's an item, I think I'd end up being a big balloon with a flat but if that happened to me, but but but joking aside, I do see the value of it. And and I don't in any way disregard people's ideas that they would like to do that I understand it. I am a person who not on purpose. And not by design receives about 10 emails a day that at some point, say you saved my life. And that's heavy and it's it's hard to absorb sometimes, you know? So

Kathleen C. Moltz MD, FAAP 1:24:00
it wasn't what you set out to do you set out to share ideas. You have Episode 497 posted. And somehow my pod player says there's 507 episodes that I've listened to 126 of them. Yeah,

Scott Benner 1:24:15
there's probably some extra ones in there before I knew how to really number them and do all that stuff, probably.

Kathleen C. Moltz MD, FAAP 1:24:20
But 497 is what's up right now. That's what I'm listening to before I go back to 2015. Yeah, we're actually interesting. It's interesting to hear your different style to just for reference, like I would say to people who are hearing this or who have been told to listen to juicebox. Scott is right. You got to listen to the pro tips. You've got to listen to the defining diabetes, and then listen to whatever strikes your fancy. Yeah, do what in whatever order you want, because there isn't a perfect order for anything. They're all good episodes and they're All, providing different information,

Scott Benner 1:25:03
I have never put up an episode and thought that is crap. But I need something today. So I'm putting this up, I've never had that feeling there, there's, there's some, like, I know, there's so much if you're listening, I know there are so many episodes and it feels overwhelming and promotive, you're not gonna be able to listen to them all. And I get all that. But I think that to be a good content provider, you have to provide content. And if I put up one episode a month, or one episode a week, I would never get to all the stuff that I've recorded. So I have to do exactly what Kathleen just said, I have to put it out there, and you have to pick through it, and nobody can hold your hand you're gonna have to fit. And I know I don't help you. I know that some of the I know some of the titles don't have anything to do with anything. And I mean, there's one up now called monkey's eyebrow. So good luck figuring out what that's about. And but I can tell you this about it. I couldn't give you a synopsis of that episode right now to save my life. But what I know about it is I spoke to an adult female type one who moved around the country a lot, has a really heavy job is super smart, talked about what it's like to live with diabetes, had a really funny father with a lot of great stories. And I had a wonderful time talking to her. Will you take something different away from that? That I will probably, but I can't tell you what that's going to be I have no idea. You know, it's a very strange art form. Because I don't think it's the same thing to other people. I also think, am I getting better at it as I go? Yes, yes, absolutely. Makes sense. But I don't know like talking to you right now. I can't academically tell you. I speak more slowly. I listen better. I don't feel as forced to be funny. Like that. I know, I've learned over time. So I definitely have gotten better at it. But then that just makes me feel like I'm such a competitive person with myself. That that sentence just makes me wonder like how much better I can be at it next year. It doesn't make me feel happy about this space. It's like the downloads. I get so many downloads every day. Every time I see the number, I just think about how to make it into more downloads. I never think, Wow, a month and a half ago, it was 30% less than this. I never think that I'm always like, well, if we hit this, I wonder what we could do here. And yes, that's about distribution. Because the more people that listen to show, the more likely somebody is to want to find out more about a free 30 day supply the Omni pod dash, which makes people continue to buy ads, but and I do take money. Like Don't get me wrong, but what it really gives me a side of the money is the ability to keep making the podcast and to keep putting effort into it the way it deserves. And the way everybody listening deserves it should this should not be a fly by night thing. Like I might sound unprepared. But I actually have a kind of a fabric woven concept of what this all should be like, as by mistake is this all seems it's incredibly on purpose. But I try to hide that because I don't want you to feel like you're being talked to, if that makes sense. Talk that I guess I mean, anyway, now you know something about making a podcast? Never gonna do it. Yeah. Yeah. And no one else should either, by the way, dammit. I don't need the competition. Just shut up and listen to mine. Dammit. You're here. Yeah. Thank you, Kathleen, is there anything that we have not spoken about that you wanted to talk about?

Kathleen C. Moltz MD, FAAP 1:28:32
I think we covered almost all of it. Okay, I think the only thing I can say is

I would really encourage people to tell their physicians, nurse practitioners, diabetes educators, what they like about the podcast, what they've learned from the podcast, so that it's not seen by some medical people, as this guy talking. Because there's so much value that I've I mean, just me I feel like I've received so much value from listening. And I feel like there's so many other people that can receive that value. Also, if they have time to listen,

Scott Benner 1:29:20
can I ask a question based on I'm assuming, you know, a lot of doctors. What would it feel like if I'm a doctor, and the best time doing lead somebody to a 8.1 a one c? And then they come in three months later, with a five nine and I start to freak out and they stop and go No, no, don't worry. I'm not having frequent or extended lows. And I'm not spiking Look, look at my data. And when the doctor says Where did you learn that? And they say, from a podcast. Do you think that's hard for a doctor to hear? What do you think they're just happy for you?

Kathleen C. Moltz MD, FAAP 1:30:00
I think the number one thing is happy, right? I actually don't think most doctors freak out at a 5.9 anymore if we have CGM data to look at. And I, truly I think truly, it doesn't hurt that somebody got information somewhere that helped them. In the end, every pediatric endocrinologist wants every kid with diabetes, to have a long, healthy, fulfilling childhood, and a long, healthy, fulfilling life.

Scott Benner 1:30:42
I'm lazy,

Kathleen C. Moltz MD, FAAP 1:30:42
we want to be we want to be extraneous. We want to be like, how can I add value to this person's life? Because they're already doing great.

Scott Benner 1:30:50
That's what I was thinking, yeah, that's what I want. I'm lazy. I would, I would tell everybody out the podcast and be like, Oh, my God, I'm gonna look like a genius. If everybody comes back with a nine, nothing to be amazing. I see if I'm the doctor. I'm like, I'll just keep getting the checks. I'll probably play golf a little bit. Maybe I'll learn to fly a plane. Maybe then like, I'll just be like, all mine have five nines. I don't know what your problem is. And I'm glad to hear that you think that's the case? Can I ask you? Your thoughts on why? adult endos don't seem to be like, Why do people say the best care I ever got was from my pediatric endo. What's the disconnect?

Kathleen C. Moltz MD, FAAP 1:31:28
I think there's a few things. So and again, this is my opinion, it doesn't reflect that everybody I've currently or in the past worked with.

Scott Benner 1:31:37
Um, but bill, now I'm just getting good. Excuse don't die before we're done, I need this.

Kathleen C. Moltz MD, FAAP 1:31:44
I have this, I have this thing where if I could laugh, I sometimes cough, so I can't make me laugh anymore. Um, I think so much of training for adult endocrinology is type two diabetes, which doesn't mean, they shouldn't also be aiming for a 5.9. But there's a lot of emphasis placed on the comorbidities and 40% of people who already have nephropathy, when they're diagnosed with type two diabetes, and the heart disease and the feeble little old lady who can fall and break her hip and we can't let her have a low blood sugar. I think it's difficult for a lot of adult endocrinologists to individualize what they're telling to fit the person that they're actually seeing in front of them. And not the fear that they've experienced over and over again, when something bad happens.

Scott Benner 1:32:45
What does it say to you that the most well controlled, I know people don't like that word, but it paints a picture, person with Type One Diabetes that I meet, all see their doctors as the nice people with the prescription pads, and the a one c test. What does that does that I

Kathleen C. Moltz MD, FAAP 1:33:03
think they should see them as the nice people with the prescriptions and a one sees, and they get to talk about, you know, the kids play or what the dog is doing? Or, Hey, did you know that there's this new product? You know, you're in Europe, and I watching to see when it gets to the United States that I think is really good. I hope you like there should be more that we can offer, then correcting or incorrectly correcting things that somebody is doing right?

Scott Benner 1:33:34
What does it feel like when you take someone's pump and make a change? And you I because you have to know I'm inferring this on you. But you have to know that this is a crapshoot that you're about to involve yourself in right. I'm going to turn a couple of dials, push a couple of buttons and hope this thing gets better. I'll see them again in three months. Does that feel bad?

Kathleen C. Moltz MD, FAAP 1:33:53
So I don't, in my practice, see them again in three months? I say look, I kind of reviewing the data, you told me what's happening here. What do you think about making this change? Right? I could do this, I could do this. What are you more comfortable with? Is there something else that you would like to try it? They put it in the pump. I teach kids to program their pumps with their adults watching. And then I say, Look, do you have a computer at home that you can upload two in three days a week? If you do, I would be happy to look at this. Even once a week. I probably can't look at it as often as Scott would look at his own daughters. But I'd be happy to look at this once a week if you want to shoot me an email and say hey, we upload it. Can you go look? So in my practice, it's not three months, it's never like unless somebody on their end doesn't want to think about it for Three months. That's not what I offer.

Scott Benner 1:35:01
Well, that's excellent. I bet it's but it's a common thing that I've described, right?

Kathleen C. Moltz MD, FAAP 1:35:06
Oh, absolutely, absolutely. And that is a crapshoot. And in the end, like, there are things that I don't get finished in my job, then there are things I don't get to do with my family. Because I've got stuff I've got to take care of. If they ask you, if a family wants to reach out and say, Hey, can you look at this, right? I'm never going to tell them no. And it doesn't matter whether I can build for it or not. Like that's just that's what I'm here for.

Scott Benner 1:35:36
If I picked you up and dropped you in a setting where there was a person with uncontrolled blood sugar's 250, managed is that the words we use,

Kathleen C. Moltz MD, FAAP 1:35:45
manage, we don't say controlled, you can't control diabetes, it's a wild animal. You can tie it out, I

Scott Benner 1:35:51
do a pretty good job over here caffeine,

Kathleen C. Moltz MD, FAAP 1:35:53
you can tie it up you test insulin, he you can tie it up, okay? I can't control it. Because you know, something is going to change, I'm

Scott Benner 1:36:00
gonna give you your my respect on your feelings around the world. But if I, okay, a person who's having that experience, I drop you in their home, give you full control? How long until you've got their blood sugar low and stable?

Kathleen C. Moltz MD, FAAP 1:36:16
I see. You're asking me a question that I've never experienced. And I've thought about

Scott Benner 1:36:21
you should try it. kidnap one of those kids just take them home.

Kathleen C. Moltz MD, FAAP 1:36:27
I have people asking me to take their kids home, right? Um, my family is not at that point at the moment. Um, how long would it take me? It was a it would take me longer than you. Because you've been doing this for a long time with people remotely. I think being able to see what's happening, being able to make adjustments continuously. I think I would have things in a healthy, stable place. I'm going to give myself five days, yeah. So five to seven days,

Scott Benner 1:37:12
I'm gonna make a suggestion to you. And I don't know if this is possible, you should do it. You should pick a person and do it because the experience will be invaluable to you. It puts you in the mindset of Do you remember before people could remotely take control of your computer, you'd have to call them on the phone to find out like my computer is broken. Here's how I need you to fix it for me. On the other side of that phone call was a person who could imagine your computer without looking at it. It's a great, great skill to have around diabetes. It's very cool to be able to know the parts, the variables that you can ignore for the moment to make the bigger changes. Right. Like I this morning. The woman I spoke to this morning, her kid had a waffle. And I sent her a text and I said you need to Bolus more this is about to go wrong. No, no, no, no, no, he's doing an activity right now. It's going to be fine. Well, now the kids blood sugar's to 40. And guess who was right? You were right. You were right. And but but she just doesn't have the experience to know she will one day, but I could see it across the country. Just looking at the Dexcom graph. And knowing this, the kid got up at this time got this much insulin ate this. And then I can look at the time, I can start inferring from the graph. And I'm like, No, no, the insulin is gone. The food still there. This is about to be a problem. Do it now. That came from talking to all these people. And and I can I use it for my daughter all the time. Like last night Arden's blood sugar has been trying to go up at like 11 o'clock the last few nights. I don't know why. I don't even care why. I just know that's happening. So around 1030 I looked at her blood sugar last night, and I start saying things like, let's, you know, we basically she's looping we jacked up her intensity, like 50% lowered the targets a little bit. So it would be more aggressive, put some insulin and like all that stuff, blood sugar went to like 145 and came back down again. If that doesn't happen tonight, cool. If it happens one more night, whatever. Like that flexibility comes from knowing how to react in the moment. Because while it is true for most people, and I'm interested in what you think about this, like when I tell people that what you do now with insulin is for later, but it's more appropriate to think about it as what you've done in the past with insulin is for now. Do you understand what I mean when I say that?

Kathleen C. Moltz MD, FAAP 1:39:40
I do. I do. I think what I'm trying to teach residents or newly hired people about how do you figure out what to do with the pump. And somebody comes to me with a graph and says Look, they're having all these lows at this time I was going to change this Basal rate. I'm like now No, no, you have to go back a few hours, right? That isn't happening because of what's going on now that's happening because of what happened before

Scott Benner 1:40:07
his blood sugar goes up every night at 11 o'clock makes me think you're bad at dinner. That's the first thing. I think when it happened.

Kathleen C. Moltz MD, FAAP 1:40:13
No, it makes me ask the question, when was dinner? Okay, and how much did he have to eat between dinner and night time? And did he get bonuses for anything? Right snack time between dinner and

Scott Benner 1:40:23
latency. Now, you're 100%? Right. I would agree with you in spades in court. But what you just heard me say is the leap that I've learned to make from having been asked the question by so many different people, and that's where the shortcuts come in, to teach it to people. Because your, your questions are all right, in my opinion there. But if you said that, to me, as a person who's had a kid for diabetes for two years, I'd start going like, Oh, hold on a second. That's a lot. Right? Right. Where I were, what I'm saying is, dinner is getting messed up some way and you're drifting highlighter. Let's go back, make sure we're Pre-Bolus and dinner that we're using enough insulin for that we're thinking about fat and protein that might cause a rise two hours after you eat. Let's let's simplify like, I'm all about turning diabetes into t shirt slogans. Right? Because I think that's how they're actionable in the moment. Not that you're you're 100%. Right. But I think you and I just said the same thing. You use more words than I did.

Kathleen C. Moltz MD, FAAP 1:41:20
Well, I said, No, use more words. And I think I get one of the things I'm working on improving myself as I get lost in the Why did this happen? When it doesn't always matter? why it happened? It happened.

Scott Benner 1:41:32
It happened. Yeah. I never was like,

Kathleen C. Moltz MD, FAAP 1:41:36
that's part of that's part of what I've learned about myself. Yeah, is that I can get sidetracked wondering, why did this happen? And, like, in the end, good. Just got to take care of it.

Scott Benner 1:41:48
Do you have a type A personality? Um, my family would say so. Yeah. Well, they're probably right. There's times you need to listen to other people. That's one of them. I know, because you would never know. But so to me, that's one of the things that I've spoken about on the podcast for years. It's super important that I think that I can't infer to you in a moment. Because if I just say to you Don't worry about what happens. You're gonna mess everything up. That's a vibe. Not an idea. Right, that's the like, Arden's been getting hired. 11 o'clock, I don't really care why it's happening. It's gonna stop happening soon. I just need to get ahead of it. Like, I'm all about staying ahead of problems. It's so interesting to listen to somebody, with your perspective, talk about all this.

Kathleen C. Moltz MD, FAAP 1:42:33
So like, one of the things that frustrates me that I'm trying to wrap my head around is the attitude I get from a lot of patients. Oh, your blood sugar's were high on last week, but that's because they had a cold, so I didn't change anything. And it drives me crazy.

Unknown Speaker 1:42:50
I'm like, No, no,

Kathleen C. Moltz MD, FAAP 1:42:51
there's nothing wrong, you should have changed something, the cold is gonna go away faster. If the blood sugars are high, the white blood cells are going to work better. If the blood sugars are Ty could have always changed it back.

Scott Benner 1:43:05
I mean, what you just said made me think that people would probably really enjoy hearing the five minutes of Jenny and I talked before we start recording. Because it because the way I see my job, and I guess this is my job now it's self appointed. But yes, it's my No, it's your job, right? is that there are confusing things that people think that that mess them up, and they don't even know it. And being cognizant of that, and being able to stand back and see it happen, it's super easy to feel like that like, like, how could you ask this question like, but the truth is, it's everybody's first day having this thought somewhere, right? And what builds a really strong community is never, like, you can think that stuff. And I think it's sometimes too, but it's it's never saying it out loud. So that the next person feels free to ask that question. Again. It's, it's the idea of there's never a dumb question. Right? Exactly. And you have to see how cyclical The space is. I hope I use that word, right? Where people I really should have went to a couple of those days in high school, probably where new people come in there. It's very interesting. In my, in my current day, there are any number of 1000s of people who interact with me, who all feel like I'm a very good friend of them. And I'm aware of their little avatars like I see them. They make sense to me, but those people are constantly getting the information they need and dropping off, which to me seems like a huge success. I don't want you living your life in a Facebook group. Right, right. I don't want you living your life worried about what happens if my daughter's blood sugar goes up at 11 o'clock at night. I just want you to be in this kind of like loose mode, where something happens. You recognize it, you jump all over it. It stops being a problem. You move on you go to the next thing I wish For everybody, and I have not figured out a way to teach it to them yet. But I wish for everybody that you could look at a graph on a Dexcom and have the thoughts that I have when I look at them, because I just see them immediately as basil issues Pre-Bolus Singh issues, insulin to carb ratio issues. And it's just they're incredibly obvious to me. But I don't know how to teach that to you, other than to say, you should talk about diabetes every day, until it starts making sense. And of course, I

Kathleen C. Moltz MD, FAAP 1:45:27
would just to back up, I would never say, why don't you change things to a patient? Like, that's a teachable moment? I'm glad you told me, right. Um, I. So in all of your non existent free time, maybe if the world provides you with more assistance, it would be lovely to offer insight into inside the mind of Scott voiceovers as you look at things. Yeah,

Scott Benner 1:46:01
I wait, definitely. It's on the left people to see it's on the list. Teaching graph reading is definitely on the list. It really is, I let me finish by telling you this and asking you your opinion. So it's possible and I have my fingers crossed, that I'm about to go to a hospital, and sit down with the staff of an endocrine chronology department and explain to them how I talked to people about diabetes, and what I think they should be saying to them. So I'm gonna sign you up, oh, I would definitely do that. I'm dying to do that. It almost happened last year at a really big institution. And then that fell apart. And now it's happening again, it's a smaller hospital, but it's in a big healthcare system, which is exciting for me, because I think, I think that I could spend two hours talking to people, and then they could go do a better job talking to people. And is there anything obvious about the set the setting that I'll walk into? That knowing me from listening to the podcast, I will be ignorant of? And how do I not make enemies walking in the door? Is my question, let me think for a sec, I want everybody to be open minded.

Kathleen C. Moltz MD, FAAP 1:47:18
I think the first thing you should be aware of is probably that a number of the people working in the environment are going to be people with diabetes. Okay. And they may or may not enjoy following your podcast. Yeah,

Scott Benner 1:47:37
it's hard to hear from somebody who doesn't have diabetes, it doesn't have a degree, right. Um, I hear that.

Kathleen C. Moltz MD, FAAP 1:47:43
But then the other thing I think is, I would emphasize that this is a process that what you want to explain to people, and what you want to share with them, is a process that took you years to figure out, you've kind of distilled it down to this little bit. And that no one is going to walk out the door with a certificate of excellence in a better diabetes. Like, that's just not going to happen. But that if people practice using some of the ideas and tools that you give, that better is better. Yeah. And that things will be better for a lot of people.

Scott Benner 1:48:30
Okay, I would definitely come out and do it at your hospital, I would enjoy the first five minutes where they threw rotten fruit and vegetables that make the tomato maybe in the side of the head, but as long as it's soft, I'd be fine. No, I listen, I'm not gonna just put a banana under your foot. I'm not gonna front as the kids would say, this is one of my end of life goals is to do this. So I've been on a plane since COVID. And I'm not afraid. So give me a call.

Kathleen C. Moltz MD, FAAP 1:48:58
I one of the things I wanted to ask you and I actually put it on the after the broadcast was, do you have any plans for teaching the teachers for teaching the physician to the professionals, I really thought

Scott Benner 1:49:09
it was going to happen at a huge institution last year, and then my conduit to the idea switched jobs. And I now have a new conduit, which is just a listener who wrote me a nice note and said something to the effect of If I hear someone say 15 carbs 15 minutes one more time, I'm gonna go off in this place. And so and then we started talking about it and I made the offer and it actually looks like it's moving forward. So I have my fingers crossed for that. I think it's well, let's talk offline. Yeah, of course. I think it's amazing idea. I have to let me wrap up by saying this. You do not come off like you know how brave this was. So let me tell you that I thought this was really astounding if you to do and I appreciate it very much. I think it will mean more coming from a doctor to other doctors that it will ever mean coming from me. And that you were open enough to hear something that made you think differently and feel poorly first. And that you stuck with it and got to it again is really astonishing. You must be an incredible person privately as well as professionally. And that's not for agreeing with me. That's for being open minded. Oh, it's a little bit for agree for agreeing with me. There's other things that are great about.

Kathleen C. Moltz MD, FAAP 1:50:28
Thank you. Thank you very much. I don't I guess I don't see it this brave. I'm not I'm not a particularly brave person. I'm rather risk averse.

Scott Benner 1:50:35
But don't many people are gonna hear this, maybe you'll start feeling more brave after that.

Kathleen C. Moltz MD, FAAP 1:50:40
No, I don't want to think about that. Okay, I'm just talking to you. I'm sitting in my like home office, and you're sitting in your home office, and we're having a conversation and I need to remember that's part

Scott Benner 1:50:50
of my superpower. It feels very personal. This conversation we're having that everyone's gonna listen to you later. Excellent.

Kathleen C. Moltz MD, FAAP 1:50:57
But I have to say thank you, because having the opportunity to chat with you is is really meant a lot to me too. And I would be ecstatic to like, circle back with you at some point

Scott Benner 1:51:08
I talked I told you before we recorded and I mean, it right now that this is the most excited, I've been to record the podcast in like a year and a half. So I I think that the far reaching implications of what you share today are incredibly important for people living with diabetes, people who are helping people living with diabetes, and people who may get diabetes in the future. So I think this is really cool. Thank you very much. Thank you. Appreciate it. We have to have Hold on. Where's my little button that I need?

Unknown Speaker 1:51:42
participants?

Scott Benner 1:51:46
Jessica, come back on. I'm still recording. Yes, I'm unmuted now. So for everybody listening the PR person at the hospital that Kathleen works that has been listening the whole time. And I am dying. You're being recorded. Are you okay with that? I'm fine with that. Yeah, how they do give a list of notes.

Unknown Speaker 1:52:06
I don't have a list of notes per se. But I think this is great. I have a lot of respect for Dr. motes. I've heard from other patients. And she when she told me about the podcast, I listened to several of your episodes and thought they were real. And I wish this kind of access existed for other diseases, other conditions that were patients could access in this way. I think it's really important. I appreciate both of your advocacy.

Scott Benner 1:52:38
That was so professional. Jessica, I was hoping you would I am professional like that. Be like buddy, 18 minutes and 17 seconds, we're gonna have to talk about what was said here, but uh,

Unknown Speaker 1:52:49
no, all right, really, I just like to listen in to kind of pull out you know, we're gonna want to help share this and get the word out to more people too.

Scott Benner 1:52:58
So, Jessica, I have one last question. And then I'm gonna I'm gonna stop the recording and we can keep talking if you want to after that, but I'm okay with this work as a live event. Yes, okay, that was all I had. I'm gonna stop the recording now so you can start cursing and saying your weird stuff just right. That's it. That's what I'm gonna do. I know dirty you get.

Well, I hope you enjoyed that. I had a great time making that episode for you. And I really appreciate kathlyn coming on. Thank you also to Dexcom makers of the G six continuous glucose monitor. And of course, on the pod the bestest tube listen until in this this pump ever. By there's no words there at all. I love on the pod. It's a tubeless insulin pump. You might love it to find out on the pod.com Ford slash juicebox, bestest, and tubeless in this list is not a word, either. Those are words or not words I, I got confused. If you're a child listening, try to forget these last couple of moments. But if you're an adult, why don't you go see if you're eligible for a free 30 day trial of the Omni pod dash. And seriously, if you're an endocrinologist, and you want to come on the show, send me an email. Don't forget, we're putting out some extra episodes this week. So be subscribed in your podcast app so that you get a notification that lets you know they're coming out. There'll be episodes on days you're not expecting. They're going to be the diabetes variables episodes, in case you're wondering. But I just need to catch up a little bit over here. So help me out if you can, and subscribe in a podcast app. Also, thank you so much for listening. Tell a friend, share the show with someone it grows when you share. I know you hear me say this all the time, but it's incredibly important. And it's really true if you need anything. And the advertisers that I have on the show are up your alley are what you're looking for just using my link to check them out is a big deal to the show as well. Thank you so much for listening. Kathleen. Again, thank you so much for coming on. I look forward to talking with you again. Soon

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