#576 Hard T1 Questions from Kids

OmnipodJuicebox PodcastDexcomInterviewType 1 DiabetesType 2 Diabetes

Nov 12

Erika Forsyth, LMFT is back to answer some difficult questions sent in by children of the listeners.

Erica is a licensed marriage and family therapist who herself has had Type 1 diabetes for over 30 years and who specializes in working with people with diabetes and their families and caregivers—from those newly diagnosed to those experiencing it for decades. She and Scott discuss burnout, emotions surrounding diagnosis, and dealing with diabetes distress and constructive ways to prevent it from impairing one’s function. http://erikaforsyth.com

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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
You are listening to Episode 576 of the Juicebox Podcast

I'm very excited to tell you that Erica Forsyth is back. You may remember Erica from Episode 407 479, or 514. She's been here quite a bit talking about the emotional side of type one diabetes. Erica is a marriage and family therapist. She also has type one, and she's been incredible on this show. Today, Erica will help me tackle a number of incredibly difficult questions that were sent in by children. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're a California resident, and you think Erica can help you check her out at Erica forsythe.com. As you may know, I'm on a mission to add as many people to the T one D exchange survey as they possibly can here in November. It's my own little diabetes Awareness month thing I'm doing T one D exchange.org. Forward slash juicebox. US resident who has type one, or is the caregiver of a type one, head over take you less than 10 minutes to fill out the survey. It's amazing, you'll help people you'll have to show. This episode of The Juicebox Podcast is sponsored by trial net, you know trial net, they provide type one diabetes risk screening at no cost to the relatives of people living with type one. I'll tell you all about them a little later in the show, trial net.org. Forward slash juice box. About five months ago, I had what I thought was a good idea. I thought I would do like a defining diabetes series for children based on their questions about diabetes, I thought it was going to be great. So I go on Facebook. And I asked Hey, can you tell me some of the questions that your kids have asked about diabetes. And then what happened next was not what I expected. I am looking at a Facebook thread here that is now 22 weeks old, that has 256 responses in them. One more heartbreaking than the next. And so I didn't know what to do. And I thought I'm gonna do it with Erica. And so I don't know what this is supposed to be. I'm just gonna jump right into it. Okay, and I'm gonna get your top line responses. And I think the conversation will find its way that's my okay. So good. Yes. So I just threw up there. And I said, Hey, do your children ask diabetes related questions that are difficult to answer. And, you know, like, I just thought it would be like, even put up some examples like, well, I have diabetes, the rest of my life. You know, while I still have diabetes, I'm six like that kind of stuff. These are the things that Arden asked me when she was younger. Right? The very first one out of the box. Somebody says, My child has asked me what happens if my blood sugar goes to zero? Mm hmm. And I'm like, so what? So let's just start there and see how far we can get through this. Okay, how valuable is it for children? And at what age to understand the real consequences of them getting too much insulin? And do you run the risk of scaring them about their insulin too?

Erika Forsyth, MFT, LMFT 3:37
I think my first thought is, I wish I knew what age each child when a parent was writing in because I think it's has to be so relevant and appropriate and make it age age appropriate. Right?

Scott Benner 3:51
for you here. Don't worry.

Erika Forsyth, MFT, LMFT 3:52
Okay. Okay. So do you want to tell me do you want me just to guess?

Scott Benner 3:59
They said, they said the child is six years old. Erica, you're breaking up? You're gone? Actually.

Erika Forsyth, MFT, LMFT 4:10
No, I'm here. I'm sure. I didn't press anything.

Scott Benner 4:13
I know you didn't. The system. It booted you like you had a weak signal or something like that. Okay, so sorry about that. So yeah, six years old. What happens if my sugar goes to zero?

Erika Forsyth, MFT, LMFT 4:22
Okay. So I think and keeping it appropriate, and not fair, you know, causing any inappropriate fear, but also you want to create a respect around the insulin. I think if if I were the parent in this, in this response, I would say well, we have all of these precautions and tools to prevent us from going to zero. And that would be the case particularly with you know, the CGM. And I think that the child seems to be so that kind of worst case scenario thinking. So I would just I would start and maybe end there to say we have all these tools to make sure that you don't go to zero. And, and we know what to do when you start to go low when you start to feel, you know, all the symptoms of when you feel low. To prevent that from happening

Scott Benner 5:22
at a certain age, though, don't people deserve to know, what happens if their blood sugar goes to zero? And what how do you figure that out? It's got to be case by case, right?

Erika Forsyth, MFT, LMFT 5:33
Yes, and I don't know. You know, the stats, to be honest around how many people are have hypoglycemic unawareness and end up having seizures end up having to be hospitalized, or even death. And we all know in our community, those are real possibilities. And I would imagine, it's probably a small amount of people who have hypoglycemic and awareness. So I think at some point, I would say, I think maybe maybe closer to 10, when maybe even eight to 10, when children have more understanding of death, they might not understand it completely. But they might start asking questions, if grandparents are dying. I think you can connect it to that developmental understanding of that things that can happen. But that, but not to link it to a to their personal fear that because I think you could you could create a real fear of going low. Yeah. And we want to try and avoid that. Right, right.

Scott Benner 6:45
Oh, also, I would say that you don't want to attach it to their personal success or failure. Like you, you definitely don't want to say to somebody, Hey, listen, here's why you should do a better job because you don't want to die. Like that's, I don't think that's a valuable way to talk to people, generally speaking, correct?

Erika Forsyth, MFT, LMFT 7:01
No fear, fear based motivation, particularly with type one does not work. In terms of, you know, even going the opposite way of you don't want to go high of us, you're gonna go blind. And you don't want to go low. Ross, you're gonna die. I think they know those. Those are, number one, really, it's really rare. And number two, that doesn't, that isn't going to lead to, you know, solid management, blood sugar control, right?

Scott Benner 7:30
Yeah. People don't don't generally do their best thinking when they're in fight or flight mode, correct? Yeah. So here's another one ready? My children who don't have diabetes, always ask me if they're going to get done. Hmm.

Erika Forsyth, MFT, LMFT 7:45
Yes. And I can even share from growing up. I was I was diagnosed first at age 12. Two years, and in between that time, I have a younger brother. And he was approximately four years younger. And I know he was concerned. Two years later, when he was 10, he was diagnosed with type one. And so then, my parents had my sister do the trial net at the time, I think it was still called trial net. This was many years ago, 30 plus years ago. And she did not have any of the antibodies. But I know that that was a certain, you know, it is a very real fear for siblings who do not have type one, particularly when they see how it can change your life at particularly in the beginning of diagnosis. And so the what was the specific question, what do I tell my children?

Scott Benner 8:41
Well, let's just I mean, you don't have to tell her what to tell them. What would you do? Because I'll tell you right now that my answered that question when it was asked of me with I hope not, but they're statistically you have a elevated chance because Arden has diabetes, but I hope it doesn't happen to you. And then I took my son to trial on that.

Erika Forsyth, MFT, LMFT 9:00
Yeah, yeah. Yeah. So I mean, I think we we can't make any guarantees to our children, right, that they're never going to catch a cold or they're never going to break an arm. So I think when you know, am I is this something bad gonna happen to me in life in general? I think we want to tell our children well, we hope not, but we're gonna do our best to you know, let you live a life of freedom and enjoyment and play in soccer and sports but we're and we hope that you don't have to break an arm. I'm kind of globalizing this response. Yeah. But if something does happen, then you know, we're going to be here to support you and we're going to get through it as a family. It's how I would respond.

Scott Benner 9:43
It's 99%. The same vibe is what do I What happens if my blood sugar gets zero? What happens is we're gonna try really hard for that not to happen if it tries to happen. We're gonna do our best to fix it with everything we know. And here are some of the things we know.

Erika Forsyth, MFT, LMFT 9:57
And yeah, I think it's you know, this the children They're asking questions because they're scared. And I think as parents, we want to reinforce that, you know, that things do happen. We can't protect them from everything. But if something does bad happen, or something that we're not planning for that we are going to do our best to support you as our child to get through it, and we're gonna get through it together.

Scott Benner 10:20
Okay, ready? Yes. Eight years old. When will my pancreas work again?

Erika Forsyth, MFT, LMFT 10:26
Ah. Yes, I often still ask that question.

Scott Benner 10:33
Still wondering that myself? What is happening? Oh, I apologize. Hold on one second.

Erika Forsyth, MFT, LMFT 10:38
Yes, yeah.

Scott Benner 10:44
Hey, it's a little early for the ad. But it's a natural break in the conversation, and then everything will just flow after this. So I'm putting it here. I'm here to tell you about trial net trial. That, of course, is a type one diabetes risk screening organization that offers that screening to you at no cost. This is for people who are relatives of someone with type one who's eligible, you qualify for free risk screening, if you are between the ages of two and a half, and 45. And have a parent, brother, sister or child with type one diabetes, you also qualify if you're between the ages of two and a half and 20. If you have an aunt, uncle, cousin, grandparent, niece, nephew, half brother, half sister, who has type one. last way you can qualify. If you have tested positive for auto antibodies, outside of trial net, like through another service. Don't forget this is free to you. All you have to do to sign up is go to trial net.org forward slash juicebox. answer a few quick questions to see if you're eligible. And then you join 1000s of type one families who are on the pathway to prevention. Here's how you get screened with an in home test kit with a lab test kit, where by going to a trial that location, alright, so you can either do it at home, they'll send it to you, you do it with a finger stick, and you send it back with FedEx, like they come to your house just pick it up. Or you go to a lab like quest where LabCorp where they'll do the blood stuff in the sending. Last way, you can ask if there's a trial net location near you, where you would go to get the blood draw done, then your results right this is what you want to know about. Your results will be received in four to six weeks. If your results show that you are in the early stages of type one. Trial net we'll schedule a follow up visit to see if you are eligible for prevention study. Here's a couple of reasons why you may want to know if you have the auto antibodies. Type one family members are at a 15 times greater risk to develop T one D than the general population. Type one screening will detect if you are in the early stages of type one. And if you are identified as at risk trial net is here to help you. They have prevention trials. If your screening results show that you are in the early stages of type one, you may be eligible to join a prevention study testing ways to slow or stop the disease progression. They also offer ongoing monitoring by top type one researchers in the world. And if you do develop type one being monitored in a clinical research study like trial net decreases your chances of DKA from 30% down to three. And you know what else? It helps the greater good a future without type one diabetes starts with you. Research can advance with participants. Research can only advance with participants. The more participants who are involved in clinical research, the faster we'll find answers, so you're in a unique position to identify treatments that will slow or stop type one from happening. In the last 20 years trial net has been the leading network and type one diabetes prevention research. In addition to being able to accurately predict who is going to develop type one trial, it has now found a way to delay it by leading it to plus a mob prevention trial to please the mob is the first drug to delay type one for a meeting of two years. This is an incredible advancement that gets us one step closer to our ultimate goal. Trial net.org forward slash juicebox when they ask how you heard about them, tell them to Juicebox Podcast, but you have to complete the process for it to account for me. So don't just order the kid at home and sit on it. You have to do the work and send it in

Okay, so I'll start over again because we got interrupted I apologize. A young child when will my pancreas work again?

Erika Forsyth, MFT, LMFT 14:51
Yes, so that is a tough one. I think it is. You know when I was diagnosed there was still a lot have tacos, let's Brina work, we're fighting for a cure, we're walking for a cure. And I think those are all lovely things, I think it's also really helpful to not plant those seeds of not necessarily false hope. But I think you want to be realistic. And so what I was what I was told, and when I talked to, you know, younger children in my office about, you know, was Will this ever will ever get over this? Will I ever get better? I'm just, you know, in terms of like, the sick narrative, right? And I think to do you have to be honest, reticulating, eight, you know, I think the child can, can understand that, you know, the pinkness might not work will probably probably not work the way it used to. Without help. Now, I think there, obviously, there's a lot of hope for the future about all the various ways that maybe they transplant aside, I don't think that's like a really realistic thing to go into with children. That has a, you know, enough complications of its own, but I would, I would say, you know, I don't want it probably won't work the way it used to. And we have all these other ways to to help it to help your body function, even though it's not going to work the way it used to. But I think in that allowing space for all of the other emotions of you know, that tease the child's trying to find some hope in the diagnosis. Like, what are things ever going to change? And so allowing space for the anger and the sadness around? It's a loss? I know, we've talked a lot about that already. But I think allowing for instead of quickly going to well, but it's going to be okay, because we have our pomp or CGM are we have, you know, there are all these other cool possibilities out there that might happen in the future.

Scott Benner 16:55
Let them write, let them have their feelings experienced their complete feelings about it. Yeah, I listen, the way I talk about out loud is I hope for a cure, and I live like there isn't going to be one. Yes, yeah, I've

Erika Forsyth, MFT, LMFT 17:06
heard you say I like that. Yeah,

Scott Benner 17:07
I just think that that's, that just seems reasonable to me. I also, you know, to get a little more thoughtful about it, we haven't exactly cured a whole bunch of things in the course of human history. So, you know, there's a lot of things that need to be cured is, and I think it and I not just think, but I've seen the idea of there's going to be a cure stop people from taking good care of themselves in the moment thinking, Oh, this won't matter, because in a few years, this won't exist anyway. Mm hmm. And use that as a crutch to not take care of themselves, which.

Erika Forsyth, MFT, LMFT 17:47
Yes, yes, absolutely. No, I love that phrase of Yeah, I mean, I think it's okay to hope. But to be realistic with that hope. Yeah. And live like there isn't going to be one.

Scott Benner 17:58
Okay. Oh, here's one. That's a specific question. But I am going to make it a little more generic. This person just says, Does this mean I can't live in my car now and says that their child had an ambition before they were diagnosed, to live in a car and travel around. But I think what they're asking is, are my dreams not possible now?

Erika Forsyth, MFT, LMFT 18:16
Wow. Wow. Right. Yeah. Can I I was hoping to do whatever it is. And now with this diagnosis is that impossible.

Scott Benner 18:30
You know, the people usually use use the Hey, used to be Oh, you can do everything except be in the military or flight airplane, like a like a passenger. Like it used to be like that thing, of course, until you meet a kid that wants to be an airline pilot. And it's not as comforting. But that idea of like, you can do anything except for these two odd things over here, which you don't want to do anyway. Don't worry about it until we want to be in the military or something like that. So. So what is the real question? The real question is, AI? Are my dreams, not possible? And I would think if you're young enough, the answer might be, I might say, Look, I know right? Now you want to do this thing, but you might learn or grow or think of something different, and you'll be able to do that fine. And if you can't do this thing, I bet you we could find a way for you to do it. Because I don't imagine much you can't do with diabetes, honestly.

Erika Forsyth, MFT, LMFT 19:22
Right. Yeah. And I know you think you can be in law enforcement with it.

Scott Benner 19:28
I've interviewed a police officer. Yeah,

Erika Forsyth, MFT, LMFT 19:30
that's what I thought. That's what I thought. Okay. So yeah, in terms of traveling around in a car, or living in a van or traveling around, you know, the US or wherever, I think that's definitely doable. I would probably want to make sure there was a a CGM or something of that nature just for safety. But it feels like I think upon diagnosis, it feels like there's a loss of freedom. And so So whether it's this particular child or any other children, you feel like oh, no, are all my other all my other dreams or all the other things that I feel like I can do freely? Or without planning? Is that is that going to be taken away from me whether it's a certain job or a certain activity or birthday party, you know, all of those things? And it is it is a mental shift. So I would say, you know, yes, I think most dreams most jobs, you know, having children, which I was told would might not happen, you know, 35 years ago that we are we are evolving within obviously, our diabetes treatment, man and management, and that most things are possible. Yeah, it just takes planning. I mean, that's really it just takes more planning.

Scott Benner 20:48
Yeah. And if you are in one of the things that's blocked, like military, like, there's a question here from somebody that says that their father was a Submariner, and that the kid wanted to do that, and they can't do that now. And so, but I do think that's a valuable, like, you know, I mean, honestly, look, there's a lot of nine year olds that think they want to be something that don't want to be at when they're 18. That's right. So maybe just like, it's maybe you you go hopeful, we'll we can take care of it. And then maybe privately, you hope it, you know, they changed their mind, or you can actually figure out a way to get to it. I'll tell you. That's an overwhelming question here. Here's another overwhelming question in here, some version of why me? Uh huh. Uh huh. So, yes, know what to say about that.

Erika Forsyth, MFT, LMFT 21:32
And I, I remember, I think every child for the most part goes through this stage. And even as the parent is, the caregiver might explore that in their own processing. I remember even reading a book. And I think it was right after I was diagnosed, called Why me about a child who was diagnosed, it was a fictional book. And I think, if we were to zoom out, most kids with any kind of sudden change or diagnosis of you know, that shifts their their lifestyle is going to go through that. And I think, you know, we, I spend a lot of time with my children clients processing this, and there's really, you can't rush it. I think it even will come and go throughout maybe your lifetime. Even if you come to a place of acceptance, some, some children are incredible, and say, Well, this is just going to be my thing. And I'm going to make it work. And they can get there very quickly. Some, some children really struggled with the anger, because it's, it's hard. It's hard as a child, you know, to manage this, and even as a grown adult. And so I think, like any kind of grief process, you might come to a place of acceptance, but it it's okay for it to come back. And there isn't we can't we can't answer that question. Right. We can't say, Well, this was, you know, this was your plan for your life. I think that we that's the hard part, right when our children ask us questions that we really can't have clear answers for. And we can say we, you know, we don't know, but we know it feels, I imagine it feels this, this and this, and let's continue to talk about how it feels.

Scott Benner 23:29
Yeah, yesterday, I was with Arden while she was getting her senior portraits taken by a photographer. And some point, she moved a certain way. And the woman was like, is that in a pod? And Arden goes, Yeah, right. And the lady goes, Oh, my daughter's best friend has diabetes, and she wears an omni pod. And you know, I mean, like, it's no great thing. We were only like one town away from where we live. Like, it's not like I was in Massachusetts, and I grew up in New Jersey, and the woman said the kid's name. And I said, Oh my gosh, I put that kid's first insulin pump on her. Oh my gosh, she goes what so the kids like five, six years younger than my daughter, but had played softball, actually, they listened to this. So this is where they're going to hear this. And I remember them just being if I remember, like, apprehensive about putting on an insulin pump the first time and I was just coming to my house and I'll I'll do it for you. And all these years later, there we were with a woman taking my daughter's picture. And she's like, Oh, my daughter's friends with that girl. So the woman knew about all this and it started a small conversation. And I don't remember the exact question she asked him, but it was about like, is this you know, like, how is it living with diabetes kind of thing? And Arden's because she just says, I'm good with it. It's fine. And she really meant it. She meant and I did think in that moment, I wonder if it'll always be that way or she'll wake up one day when she's 36 and just be like, Oh my god, I still have diabetes. This just still happening. Hmm. But I appreciate your answer. So, okay, you're gonna keep going. We are going to be crying by the time this is over. Just see oh, my gosh. Well, we already covered when will I go? When will it go away? So it's not fair. Why me? How long can I go without insulin? That one is I think right along it's I think that falls right into the what happens if m zero like right figure, it's the same kind of scenario like it's a real health issue it could end with it could end poorly with, you know, decay or death. Right? The answer has to be, you need insulin all the time, you need Basal insulin, and you need to Bolus for your meals. I think it just has to be like, like very cut and dry when you talk about stuff like that.

Erika Forsyth, MFT, LMFT 25:44
Yeah, and I think I might be reading in too much to the question, but also kind of like, am I gonna have a break from this? Is there ever going to be a period of time where I can just not take my injections or have my pump on my body? And I think that's the that's the child trying to process like, Is this ever going to end? Yeah. Yeah.

Scott Benner 26:05
Well, here's the next here's three questions later. If I don't do insulin, will I die? Mm hmm. And I don't know. Like, again, down to age again. Right,

Erika Forsyth, MFT, LMFT 26:15
right. Yeah. How did you know how old that child is? Okay, well, I guess it probably doesn't necessarily matter. I could probably answer this, depending on the age bracket is kids

Scott Benner 26:28
younger, because they had three questions I love. Here we go. The kids said, If I don't do insulin, will I die? Then she said I love my diabetes today, but I didn't love it yesterday. When will my diabetes go away? When I was in your tummy? Mommy, did I have diabetes, too? Oh, so. So she's little.

Erika Forsyth, MFT, LMFT 26:47
Yes. She's She's processing what does this mean? And like, also, because you know, a younger child has a hard time but time

Scott Benner 26:57
Tommy thing got me. God damn it. Yeah, yeah. Go ahead.

Erika Forsyth, MFT, LMFT 27:02
Yes, I think processing like the timing of you younger children don't know that yesterday, today, tomorrow, you know, in two hours in two weeks, right? So they're trying to understand the permanency and that's a really hard concept. And like, was I always this way, did they always have it? Ah, it's it is painful. And I think for you, the younger children, I would stay you know, day to day. Not? I would maybe because I don't think they really understand like, well, this, you're going to have this forever. Just say, Well, today, we're gonna we're gonna do our best today and then we're gonna go to bed and then tomorrow, we're gonna do our best again. I think the was does she start off with if I don't have insulin? Will I die? First one? Yeah. Yeah, I would say for the younger children. I would. I don't think you need to go to the death. Like, I think we say well, if you don't have insulin, you I would start in the affirmative. Like you need insulin to feel good. And excuse me and to, to live the life that you want to live and play and have, you know, go to school and have playdates and play on sports or dance. And so you need insulin every day to do all those things.

Scott Benner 28:22
Is reframing important than because, yes, they're asking the questions sort of in a defeatist way. You need to like flip it around and reframe it so that it's not, so that you hear if I don't do insulin, why die? You don't even address that. You say, Oh, no, let me let me explain to you right now you need insulin to feel good. Insulin keeps you healthy. You know, so you, you accentuate the positives. And don't don't skirt the question, but don't lean into the sadness of it.

Erika Forsyth, MFT, LMFT 28:52
Well, or the. I mean, obviously, we all know that that's the reality, right? If we don't type ones don't have insulin, they will die over. You know, I don't know what the actual length of time is. I usually generically say a week to people to try and like when I'm explaining what my type one is to other people.

Scott Benner 29:12
You're like, if I eat this cookie right now, I'll be dead in seven days.

Erika Forsyth, MFT, LMFT 29:18
Oh, my gosh. Yeah. Those questions like, can you eat that? Yeah. So I think for the Yeah, for younger children, I would say probably up to like the eight to 10. I mean, I think as younger children, even the 567 year olds, they will understand death acts outside of their own body, right. They in terms of pets, dying, grandparents dying. I think relating it to their own concept that they will they might ask those questions even when they are exposed to death. Will I die someday? And I think you can say, Well, we, you could also globalize and say we know what we're all gonna die someday. Depending on how your child is, in our experience around death, if there's no experience around death, I would keep it in the affirmative of saying, we need insulin to keep you alive. Or to keep you healthy. We need insulin to keep you happy, and doing things you want to do. I would say later, eight to 10, you could have more kind of realistic conversations around, you do need it to keep you alive.

Scott Benner 30:30
I listen, I go back all the time to a story that a woman told on here once very quickly, her child with diabetes was younger with eating, they had an older child that didn't have type one, the mom had to leave the house. And the kid, the older kid was put in charge of making sure that the child ate because they had already given them insulin. Mom leaves the kid doesn't want to eat her food, his or her food, excuse me. And then the older kid in a desperate attempt to get them to eat says, you know, if you don't eat that you're going to die. And no one had ever said that to the kid before. Hmm. So the child was just wrecked when the mom got home, like sitting on the floor crying, because no one had ever told them that diabetes could kill them. Yes. So that's how you don't want to find out is my point.

Erika Forsyth, MFT, LMFT 31:15
No, that Yeah. Yeah, I think you would you want to have the these types of conversations with your child. So that yeah, they aren't shocked?

Scott Benner 31:26
Yeah, you're gonna have to take some responsibility to really feel your kid out and make sure you're having these conversations at the right times. Like nobody can tell you what the right exact age is to do something like this. Alright, yeah,

Erika Forsyth, MFT, LMFT 31:37
it really depends on your family. The way you talk about things your family's life experience, exposure to death. And your personal, your, your comfort level, I think you need to be I think it as a caregiver, it might be hard to come to terms with that concept, right? That your child might die if you don't, your child could die if you don't do all the things. But I think I think going back to like the stats, I really I don't know, maybe you just got but like how often people die from a low blood sugar. I mean, obviously there's chronic, if you're not in good in you know, and you're not in your in your managing well. Yes, yeah,

Scott Benner 32:21
I don't know the numbers. But I have to tell you that it's an idea that I lean on pretty heavily for my own daughter, right, which is that a lot of people have diabetes, I don't wake up every day to the news that 20,000 More people have died from local, overnight, we have the best gear we can have. It benefits her health to do things the way we're doing. And I really hate to say this, but if that's how she goes out trying to live well. There are worse ways to die. And so I just think that, um, I think that the answer is we're going to do the best thing for you. We can yes, there's risks and everything. There's risks in this too. Yes, yes. All right. So Erica, the next two questions are both equally horrible in different ways. So here's one for you that asked a lot. And I genuinely don't know how to answer this one. Because I don't have a lot of experience in this space. But why did God give me diabetes? Mm hmm. So if you're a very religious family, you may be living your whole life on the bend of like, hey, what we have that's good in the world comes from Jesus, but we have it's bad in the world comes from Jesus, then all of a sudden, this happens. And you know, Jesus loves me, why am I why I've diabetes?

Erika Forsyth, MFT, LMFT 33:30
Mm hmm. Yeah, that's, I hear that question as well. And I think it comes down to yes, your relationship with God. And if you are, if you have a faith and you believe in God, it's it's very natural for a child to then say, Well, if God is in control of everything, why did he let this happen? To me? That's kind of the question I hear, why didn't he protect me from this? And I would explore with the child, you know, what, what is their understanding of how things work in the world. Like, God doesn't plan for people to have car accidents, like bad things happen, that are out of our control. But it doesn't mean that God is not with you, or that God doesn't care or that God doesn't love you. And ultimately, where children will, will land as well. You know, God didn't necessarily give this to me, but he can help me get through this. In terms of if they have a faith or trust in him. Yeah,

Scott Benner 34:43
right. If you have a religiously faith based life, you don't want to destroy it in one fell swoop by saying, I don't know. I guess he sucks. You're like, right, yeah. You just gotta like you that alright, that makes sense. But

Erika Forsyth, MFT, LMFT 34:54
I think I think that that is also you're wrestling with and trying to find a reason and why you were diagnosed, and you're going to be angry at anything and everything initially, right? And so you're there trying to find like, Well, God, I'm angry at God, I'm angry at mom and dad, I'm angry at whatever it is we're trying to place. Find a reason or place blame when some when things just happen that are out of our control,

Scott Benner 35:19
I find that randomness like comforting like that something bad happened, and it's not for like it just happened, like some people's genes just kept, you know, people like the way I think of it. My daughter has diabetes, because a really long time ago, two people met each other had babies, and along the course of that happening over and over again, lead to this auto immune issue. And that's why she has it, it almost feels like it's nobody's fault. And right. Yeah, and that's, like comforting to me. I guess my brain just works backwards.

Erika Forsyth, MFT, LMFT 35:48
No, I think that's helpful rationale as well, you know, that? I mean, it obviously isn't anybody's fault. It's our how our genes have, as you said, mutated, right?

Scott Benner 35:59
It's horrible. To look at your wife and think, had I just picked the other girl This might not, you know, you know, or she would have just said no to me, then, you know, this wouldn't happen, but then the kids wouldn't exist. And I'm not willing to give them up for that. So right. You have to be okay with this. Right? You know,

Erika Forsyth, MFT, LMFT 36:17
yes. All right.

Scott Benner 36:18
Here's a little twist. I'm going to tell you what the kids said. But then I'm going to ask you a question for parents. Okay. Three years old, had had diabetes for about a half a year falling asleep on night says, Mom, can you take my diabetes away? Because I don't want it anymore? Can you take it away? In the morning, and he wanted to wake up and not be diabetic? She said, oddly enough, at the time, they didn't talk about this stuff, because they thought the kid didn't have the capacity to even talk through it. But obviously was having these thoughts. So my question around this one is, what should she feel after that happens? Like, like, and I'm going to just give you another one. Like I was putting art into bed one night, a long time ago. And we were just testing her blood sugar before she went to bed. And she just very, like matter of factly says, Hey, what, how am I going to do this when I'm in college? And she was like, I don't know, seven or eight. And I said to her? Well, I'm figuring things out right now so that I can teach them to you, and then you're gonna know what to do. And you'll just be able to do them. And I said, and if you have trouble, you could call me. And I could help you because I really understand it. And I'm sure you'll make friends who will help you. And I did all that. But that's not even the story. The story is that I barely got out of a room and closed the door before I cried a lot very early. So what do we do for the people who are being asked these questions?

Erika Forsyth, MFT, LMFT 37:46
Oh, well, I know. Yes. My heart goes out to parents who are I mean, it's it is incredible that the child asked this, I know, many caregivers have shared this, you know, wish to me. I know my parents shared this to me, like, oh, we would do anything to take it to height have this instead of you. Yeah. And you know, as parents, you know, you want to protect your children as much as you can. And the fact that this three year old is verbalizing, like when I will just go away, can you take this away? That's really, really painful. I think. So as you asked, How should she feel in the morning, meaning the child or

Scott Benner 38:30
the parents? I mean, the parent, like, what would it mean, you can say whatever you're gonna say, that's gonna be valuable for the kid and their progress. But when you get out of the room, you realize I can't take this away. That's all this kid wants. And now I'm a failure. Yeah, no,

Erika Forsyth, MFT, LMFT 38:44
I think you go, you go out and have a good cry. And you because I think you're there's a good there's probably that's going to trigger some grief around the permanency and around hearing actually, that your child doesn't want this, right. Doesn't want to live with this. And I think so understanding that's going to obviously, it's causing grief, it's causing sadness, and that we are you are out of control. We can't take it away from your child. And so the next morning, I would if, I mean, it depends on how the child would wake up, but I would have a conversation with my three year old and just thanking thanking them for sharing that and saying any, you know, encouraging that those continued conversations around, you know, wishing it were gone, knowing that we can't take it away, but I think affirming her ability to express that is where I would lean into as a parent. And I think it's okay to be sad, sad with your child.

Scott Benner 39:55
Well, my take away from what you just said is that it's going to take a long time for this to be okay. and that it's a continuing conversation, you don't want to just shut it down or think you're going to fix it with one statement today. And I think that's hard for people to hear. But if you have diabetes in your life, it could take years and decades for this all to, to flatten out and feel like it's normal. And it doesn't mean that it's not worth doing. I just think it's a very long process like life, it's a very long, you know, when they be people say, like, Oh, you're married, like, if you got to work at it every day. You don't work at it every day with the idea of like, well, once we've done it for 20 years, we won't have to work out. It doesn't go that way. So this is part of your life now. And, and having conversations about it, and these conversations are going to morph, they're going to change, the questions are going to change, and you have to keep having the conversations where it'll get bottled up somewhere and cause a problem. So

Erika Forsyth, MFT, LMFT 40:49
yes, yeah, I think just Yeah, accept accepting the fact that once your child or you as a caregiver has accepted, it doesn't mean that it's all going to be you know, rainbows and flowers for the rest of your life. Like it's okay to go back to the frustration and sadness.

Scott Benner 41:12
So here's the thing that parents do a lot that I think they think is kind and it might be and I just want to understand, but it comes up a lot in this thread. Because then their children ask why they say it when parents say, I wish this was me and not you. Mm hmm. Is that something you want to put on a kid? Like, is that kind or is it scary?

Erika Forsyth, MFT, LMFT 41:34
Yeah, I think those are the parents thing. I wish this was me and not you. I wish I could take this away from you. I wish I had it. And as I yeah, I remember distinctly my father saying that multiple times when I was newly diagnosed. And I think that's their, their, their processing their grief, and sadness, and not being able to control you know, a protect, quote, unquote, protect their child from hard things. I also feel like, is that a second? Is that a hard thing for a child to hear? Is it scary?

Scott Benner 42:10
Yeah. Should you keep that to yourself first, does it help them to hear it because at a certain age, I've I've said to Arden, not that but I've said something to her about? Like, I know, this is hard, and she'll be like, No, you don't? And I'm like, Oh, she's right. I don't really know. So you know, like, Is that the same kind of vibe? Like, I wish I could take it away? But that's nice, but you can't so why are you saying it to me? Like I don't know if that as you get older if that can be a concern?

Erika Forsyth, MFT, LMFT 42:34
Right, I think, sorry. I don't know. But this making that noise. Sorry. Turn that off. Yeah, I think what the Oh, my goodness, what is that? I don't know.

Scott Benner 42:47
Hilarious. You're like, don't worry. I've got this. I'll shut it right.

Erika Forsyth, MFT, LMFT 42:54
Let me see. It might be okay. All right. Well, hopefully it doesn't happen again. Apologies. Okay. So I would say. So the parent, what the parent is trying to express is there is their sense of loss, right in their sadness. So is it helpful? I don't know. I mean, I don't remember feeling. Just personally, I don't remember feeling angry when he would say that. I think now, if you're to kind of pull out and zoom out a little bit more again, to in general, is that helpful? That yeah, the parent can't take it away. But what they're really trying to say as I'm so sorry that this is happening to

Scott Benner 43:40
you. I would do anything for you. If I could. Yes. Yeah. I know. I know. Listen, I don't think I'm not making a judgement about it. I don't have a feeling about it one way or the other. I'm just it makes me wonder. Because a lot of people say it. Do. Yeah. So I think

Erika Forsyth, MFT, LMFT 43:55
I know this is hard. I think you're trying that, you know, you're trying to validate and empathize with your child. I think maybe it could be reframed to. I I don't know how hard this is because I don't have it. I'm not I'm not the person living with it. Yeah, but I can imagine it's really hard.

Scott Benner 44:17
I'll tell you this. I stopped in under, I stopped wondering if I could put myself in my daughter's shoes. When she said to me one day she referring to a severely autistic kid that she know who had a lot of deficits and whose life wasn't easy. She said that she'd rather be him and not her because at least he can't die from his thing. Mm hmm. This kid is feeling life on a level that I did not understand. And I am not going to try to put myself in her shoes again in front of her. Because I mean, she was not very old when she said that.

Erika Forsyth, MFT, LMFT 44:57
Wow, that is profound. And I'm sure with really hard to hear? Yeah, yeah,

Scott Benner 45:01
I'll tell you one of the things I'm great at because of diabetes is staring into the eyes of a person I love without crying when all I want to do is cry. So yeah, yeah, super good.

Erika Forsyth, MFT, LMFT 45:11
Yes. And I think kind of, you know, that's a really normal process, though, of comparison of like, illness comparison. And gosh, I feel like this would be easier. And that's all you're all. That's all just kind of trying to gamble make sense of it? Like, I wish, it feels like it would be easier with this illness and with the other one. But we know that all of it is hard to do, like you're trying to make sense of it.

Scott Benner 45:39
Right? Well, there's a lot of sentiment in here about bravery too. And I, I fall very weird on this idea, because I understand the sentiment of my kids are so brave, for the bravest person I know is blah, blah, blah. But I also don't think that I don't think people deal with medical stuff out of bravery, I think they deal with medical stuff out of necessity. You know, like, I mean, I would be happy for you not to think of me as brave if I didn't have to get injections, or you know, or, or have a pump put on me or whatever, you know, excuse me stuff that I don't want or that might hurt for a little while or be I don't know that that's bravery. It's just, it's um, I mean, that's the will the live really is what it is.

Erika Forsyth, MFT, LMFT 46:29
Right? Yeah. And I hear this concept a lot. Or, you know, in parents or think or they're trying to affirm their child in taking steps to keep themselves alive. And I think bravery in the concept of living with a with type one could be instances where maybe the child has finally felt comfortable sharing with their peers. And they maybe have been hiding it for months or years. Or maybe bravery is standing up and teaching your class about it. You're, you know, a general information. I don't know, just kind of smaller steps within living with it. I think, yes, I guess you are being brave by choosing to do the things to keep yourself alive. I think I've learned Yes, it's out of necessity to know,

Scott Benner 47:25
I mean, and I'm not trying to denigrate it, but like, I've heard interviews with people who are like been in natural disasters and like, This guy's a hero, and the guy's like, listen, I was just trying to get out of the building, those people were in front of me, it wasn't happening. So I coordinated and got the hell out of there and got everybody else out to like, I was just trying to stay alive, you know, and it benefited other people. And so I mean, I'm not a hero, like, Do you know what I mean? And I don't know if there's any. Also, is there any psychological reasons why you wouldn't want to set up a seven year old to think that they're, you know, the end all and be all like, I don't know, like, it's just a weird, it's a weird spot to be in because of diabetes? I think, a lot of questions, and I don't know all the answers to them.

Erika Forsyth, MFT, LMFT 48:06
Yes, I think there can be brave choices, while living with type one, and brave decisions or brave actions, while doing all the things that you have to do to keep yourself alive, if that makes sense. Yeah, and I think those are fine to affirm. Like, maybe it's the child was scared to go back to dance class, because they didn't want their they didn't want their friends to see their their pump, or their CGM. Or maybe they were afraid to go back to play sports because they didn't want to go low. And I think affirming those decisions, that I think that that is being brave, of doing something that they're scared they were scared to do or fearful or intense and anxiety around because of the type one and they chose to do that. I think it's I would affirm that as being brave to do those things that they were scared I

Scott Benner 48:57
yeah, I definitely agree. I didn't like I said, I don't want to come off. Like I think that living with diabetes isn't brave. But here's the here's a nice one. It starts off terrible, but then it ends nice and and you don't have to answer it. So take a break, breathe for a second. Okay. When her daughter was first diagnosed at six, she would always ask how long will I have diabetes and when will it go away? But then at nine years old told her mother that it doesn't matter anymore because she still has friends. And I think that maybe is an insight into how kids minds aren't as you know, sometimes they're not as they're not looking for the same things that you're looking for as a resolution maybe? I don't know, I just thought that was very sweet. Like it's

Erika Forsyth, MFT, LMFT 49:41
that is you know, and I think yeah, I think it also is very appropriate age appropriate, right? Because it's six they're not understanding the permanency and then at age nine, because and not understanding is this going to take away My friends, it's just going to change my life. And then at nine, they're saying, Oh, well, actually, I can still, I still have friends, I can still go to school, I can still hopefully do the things I want to do after school. And I still have to, I sought to manage, but I still can do the things I want. And I have joy. It's really

Scott Benner 50:17
Yeah, I didn't see a degradation of the things that they were hoping to have. Now. I mean, there's another kid that said, you know, why does diabetes ruin everything? But I, that also could be? I mean, listen, a big part of why this podcast exists is because I believe that a lot of the psychological, like, lightness that can come is after you really understand how to use the insulin so that you're not constantly chasing things around, and you don't know why things are happening. So maybe that kids stuff is being ruined. Because, you know, they're constantly chasing blood sugars, and they're high and they're low, and they're stopping from doing things. But that's why I think that it's important to understand how to better manage, so you can lessen those moments.

Erika Forsyth, MFT, LMFT 51:00
Yes, yes. And yeah, we don't know maybe that. What's what's going around with surrounding with that statement? Is he not feeling good? A lot of the time?

Scott Benner 51:10
Well, yeah, there's a ton of questions in here about why do I feel angry when I'm higher? Why do I feel anxious when I'm lower? You know, all that stuff? And I mean, listen, we've answered those questions in the podcast a million times, you know, your blood sugar fluctuations. impact your impact your brain. Yeah, absolutely. Everything else. To me, the answer to that question is, I don't know. But I'm gonna go back to Episode 210 of the podcast, listen to the protests and try to figure it out. Like, I mean, honestly, that that's a good answer. Okay, here's one. That's hilarious. Why does the insurance company take like two or three months to get me a pump? Why can't they have more than one person working on the paperwork?

Erika Forsyth, MFT, LMFT 51:48
Good question. Yeah.

Scott Benner 51:50
That we all say yeah.

Erika Forsyth, MFT, LMFT 51:55
Oh, my gosh, yes. I don't know. That's, that is sad, though. Is it still does it take that long? I don't, I can't. I don't know. What

Scott Benner 52:02
this kid doesn't know is that one day, they're gonna have the pure joy of getting on the phone with the faceless person in an insurance company and cursing at them. It is so cathartic, you're gonna love.

Erika Forsyth, MFT, LMFT 52:14
Yes, and yeah, we just, they're, they're excited. And they want it. I get it. Yeah, no,

Scott Benner 52:19
but I just love it. Trust me. You don't know how great it feels to yell at somebody on the phone? Who you don't know and have no relationship to wait till you have. It's a lovely moment. Oh, my God. Have you never said the F word to an insurance company? Erica?

Erika Forsyth, MFT, LMFT 52:31
No, I have not actually I find it the quickest way to

Scott Benner 52:34
get resolution.

Erika Forsyth, MFT, LMFT 52:38
Oh my gosh, society's

Scott Benner 52:39
different. Now people don't accept things as well. But I love cursing at people on the phone. I think it makes things actually, you know, I try very hard not to be in at all confrontational. Like I like things to go smoothly. But when it gets down to it, I think a well placed F bomb gets you somewhere sometimes.

Erika Forsyth, MFT, LMFT 52:58
I'm glad that that has worked for you.

Scott Benner 53:01
Feel better? For a couple? Yeah. All right. Let's finish on a. They're all low notes. So let's just finish off our note. Will someone want to marry me? And can I have a baby?

Erika Forsyth, MFT, LMFT 53:15
Oh, oh, I resonate with that one. As a little girl. I definitely asked that. How I'm curious how old is this child? Oh, if you if it's clear or

Scott Benner 53:31
written, it is not clear. Okay. I can tell you one thing. I've interviewed people, women, specifically, a lot of different age groups that I think wonder this? Yeah. You know, like, is somebody gonna want to take me on as a burden, I think is how it feels. And yes, terrible.

Erika Forsyth, MFT, LMFT 53:49
Yes, no, it's a really normal, the both of those are normal questions to have. And as we know, back in the day, I don't know how many years ago but probably even 4050 years it it was very scary to have children with type one. And we know we know now obviously that that you can and it takes work. The but the relationship piece, I think what the child is kind of revealing by that question is do I am i Is there something wrong with me? Is this yeah, as you said it is am I going to be a burden? And I've had children ask this as well. And we talked about you know that there's no no one is perfect going into a relationship or marriage and that when you find the the best fit for you that they will everyone will figure it out together, you know, and we'll work together.

Scott Benner 54:56
I tell people and I'll tell you I tell my daughter the same thing. Anybody Buddy, who doesn't want to be with you because of diabetes? You don't want to be with first? Yeah, I listen if, Eric if they don't want to, if they don't want to marry you, because you got a ton of college loans that I understand, okay, but but but if if somebody, if it's who it's not, it's not who you are maybe per se but it is something that you that you live with. And so if they're not up for that they're not up for you. And yeah, and I don't think you want to spend a lot of time trying to talk somebody into it to be perfectly honest with you move on. And it's one of the reasons why. Like, I think every question that we've asked here today, I've answered already throughout the podcast, and but I know people can't listen to everything. So I try to have people on all the time who are in great relationships with other people who are supportive of their diabetes. And I do that partially so that you'll get like, wow, he found a woman that loves him, she found a guy like cetera, that these two girls got together, whatever it ends up being, people found each other, and the diabetes wasn't an issue. And and I do think that's the answer to that question. The right person won't care.

Erika Forsyth, MFT, LMFT 56:09
Right? Because ultimately, that reveals more about them, then, you know, if if they are, if that if it's too scary, or too much, yeah.

Scott Benner 56:19
And also, maybe it's not even a judgement of them. It's just something they can't deal with. Or maybe they didn't. I mean, it's hard to know in the moment when you're dating, but there are people you feel like you're in love with who you know, 20 years later, you realize, like, I did really love that person back then. But I couldn't have been married to them for 30 years. Like there's something special about my wife and my relationship. Because I don't know how aware everyone is but like, you're really hard to be in another with another person for this long. It doesn't. Yeah, if a lot of things that you can't even imagine when you're young, if they don't mesh well. It's just it's very difficult. And it's too easy to get out of a marriage. So people will will bail before they even try sometimes. But that's not my point. My point is, seriously, the right person won't care. That's right. That's what I think. So and you'll probably still end up divorcing them for different reasons. So don't even worry about stopping people to talk to her divorced. It's like wanting to isn't it?

Unknown Speaker 57:18
Oh, I don't know. Yeah.

Scott Benner 57:21
Always wanting to be upbeat. I had someone on here recently. I know you have to go by. So I'll end by telling you I just interviewed somebody a couple of weeks ago, who at the end of the interview told me that their family saw you and it was a huge help. Oh, that's wonderful. So I won't share anybody's personal details, because I think that's wrong. But they were very, very complimentary about the time they spent with you. Oh, thank you. Thank you very much. Still big patients in California.

Erika Forsyth, MFT, LMFT 57:50
Yes, that is still the rule. Yes. But yeah, anywhere in California, because we now have the telehealth comfort. So that's a great option. Oh, cool.

Scott Benner 58:00
Well, I will definitely put in your URL here. I want you to know that as I just kind of like highlight something here, we got through what I would consider to be a very small fraction of this thread, which I have been scrolling through the entire time I was talking just now. Okay, and so I just wow, I just got to the end. Now a lot of them might end up being worded differently, but being duplicates of each other. But I really appreciate you spending the time going through this with me because I felt a real responsibility to this thread after I posted it and I did not know what to do. Like I got I really like I there was a moment when I was like, Oh, I messed up. I shouldn't have done this. Like, like I'm not qualified I in my mind. This was gonna be like Jenny and I doing like short episodes about questions. Right. Just did not go that way.

Erika Forsyth, MFT, LMFT 58:53
Well, I'm glad we were able to get through a portion.

Scott Benner 58:55
Yeah, me too. Oh, so listen, at the end. Let's share this with everybody. My favorite place to cry is in the shower. Where's yours?

Erika Forsyth, MFT, LMFT 59:02
Oh, you know, I'm I'm a good car crier. But also the shower. Yeah.

Scott Benner 59:06
I actually think that's good for people to know that. I think that at some point, all this is overwhelming. And you have to just let go of it. Because if you hold on to it, it's just it's, it's debilitating. And it'll it'll impact you in ways you'll never see. So I like getting in the shower and crying. You can do it.

Erika Forsyth, MFT, LMFT 59:24
Yes. Yes, I affirm and support that 100%

Scott Benner 59:30
Okay, thank you very much.

Well, first, I want to thank everyone who sent in all those questions. There are actually more. I'll probably go back and do the rest with Erica at some point. And speaking of Erica, thank you so much for being a great voice on the Juicebox Podcast. Check her out. If you're in California at Erica horsethief.com I'd also like to thank trial net for being a sponsor of the Juicebox Podcast. I know that ad ran a little long, but it's very important, and there's a lot to understand. Trial net.org forward slash juicebox. When they ask how you heard about them, please choose Juicebox Podcast with that drop down box

I hope you have a great day. I'll be back very soon with another episode of The Juicebox Podcast. He need information about the podcast, check out Juicebox Podcast comm you looking for management stuff, go find those pro tip episodes, they begin at episode 210. You're also looking for the defining diabetes series, how we eat afterdark algorithm pumping and all of the rest. Check it out at Juicebox Podcast calm. And don't forget about the private Facebook group Juicebox Podcast type one diabetes, it's completely free and has 17,000 people on it talking about diabetes. Alright, listen the episodes over. But if you want to hang out for a couple more minutes, I'm going to explain to you why I think taking the survey at the T one D exchange is so important. If you don't want to hear it, it's cool. Just push up and go listen to another episode of The Juicebox Podcast. I'm here to ask you to join the T one D exchange registry. And that sounds like a lot something to join. Right. But you're really just taking a survey. Why am I asking you to do that? Here's why. The T one D exchange is a nonprofit research organization dedicated to accelerating therapies and improving care for people living with type one diabetes. So that's a very official statement from them. It's 100% True, but it's also kind of dry and boring. And, you know, I understand if you're not super excited by it. Here it is bare bones. You go to this website, you answer a few questions, it takes you less than 10 minutes. You can do it from your phone, you can do it. You know, while you're sitting on the toilet, if you want to, I don't really care. Although you shouldn't sit too long, because well, anyway, you don't want that problem. Let's get past why you shouldn't sit too long on the toilet and get back to this. The T one D exchange does good work for people with type one diabetes. It's why I took on this thing. They came to me and they said can you help us get people on the registry? I said I could try I don't know if I can. And I've gotten a lot of people on the register, I'm not gonna lie to you a lot. But this is diabetes Awareness Month and I thought maybe, you know, maybe you'd be in the Spirit to help people with type one a little extra. In November, the T one D exchange still needs 1000s of you to answer the survey. Why? Well, because they translate real world experiences into real world solutions. And those solutions make lives easier for people with type one. It's their goal to help type one families through research at the clinical level, through their quality improvement collaboration. And through research at the personal level through their ti 1d Exchange. Now, what's the exchange, you can read all about this, by the way AT T 1d exchange.org forward slash juicebox. But I appreciate you listening to me as I explained it to you. So the exchange is a research study that's designed to gather evidence real world evidence firsthand and to gather it easily and quickly through the survey. The questionnaire can be done anywhere from your mobile device, or you know, like I said earlier on the can if you want doesn't matter to me, it could be laying in bed, or just while you're sitting around at home. And since type one is a chronic condition that people live with their entire lives, participants can complete the questionnaire annually if they want to help researchers understand surviving living with type one. So imagine what this is, is you're helping with type one diabetes research without leaving your home. You don't have to go to a study center or sign up for some long thing that you have to be in for months or travel for. It's a way for you to help right from your house. Now, there may be opportunities later I've seen people on Instagram send me pictures when one girl sent me a picture of herself at the airport. She was on her way to go do a study that she was going to be paid for actually. And she learned about it through the tea Wendy exchange and was thanking me because I told her about the exchange. I can think of another person that I saw online, who is in the middle of a study for adhesives for a very popular CGM. She had a bunch of adhesives all over her and she was testing them. That was the thing that she was getting paid for. Now, not everybody gets paid for things or gets chosen for stuff, but that opportunity does exist. But you won't find out about it unless you sign up. And you know, complete the survey. Now you don't have to do those other things. They might contact you with an email and say, Hey, you want to do it at ease of studying you might go? No. And that's it and no harm no foul. You haven't hurt anybody's feelings. So that's it really it's super simple. It's T one D exchange.org. Forward slash juicebox when you get there click on join the registry today. And then answer the questions. I've done it. The answers are incredibly simple. They're not probing or terribly personal. They're general stuff about living with type one diabetes, and then you finish the survey. And that's it. You've helped them. You've helped people living with type one diabetes, and you've supported the podcast.

Alright, let's go for it. Right. We have all of November. I don't know how many we can do. I think we could do a lot. Honestly, 30 days, what do they say 30 days out in November and April, June and December all the others up 31. I don't really know all the words to that. Not really the point. But I can tell you this. I have a calculator right here. If I take 1000 123 zeros and I divide it by 30 days, 33 people a day and we'd have 1000 at the end of the month. 60 people a day 2000 It's doable. There are so many people listening to this podcast, if just a small percentage of you did this, we'd make a huge difference.