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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 749 of the Juicebox Podcast.

On today's show I'm going to be speaking with Jeremy, who is a nurse and a few other things got a bunch of letters behind his name he'll tell you about in a second. I love the conversation that Jeremy and I had. Jeremy is the exact kind of clinician you're hoping to get when you have type one diabetes. While you're listening today. Please remember that nothing you hear that 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 US resident who has type one diabetes, or is the caregiver of someone with type one, You'd be doing me a personal favor. You'd be supporting the show, you'd be helping people with type one, you'd be helping yourself if you went to T one D exchange.org Ford slash juicebox joined the registry and completed the survey. T one D exchange.org Ford slash juicebox. Got this little bit of time left here. I don't know what to do with it. You should check out the Pro Tip series it begins at episode 210. It's really good.

This episode of The Juicebox Podcast is brought to you by Omni pod five. Learn more about the Omni pod five and get started today at Omni pod.com forward slash juicebox. And if you already have the Omni pod five, don't miss the Pro Tip series just for the Army pod five is a three part series on episodes 736 737 and 738. Today's podcast is also sponsored by the Dexcom G six continuous glucose monitoring system dexcom.com forward slash juice box head there right now and find out if you're eligible for a free 10 day trial of the Dexcom G six, you just may be dexcom.com forward slash juice box on the pod.com forward slash juice box links in the show notes. Links at juicebox podcast.com to Dexcom on the pod and all the sponsors.

Jeremy 2:26
My name is Jeremy I'm a nurse practitioner. I'm also a certified diabetes care and education specialist and board certified in advanced diabetes management.

Scott Benner 2:34
Wow. That's a quite a quite a list of a bone a few days you have there. I didn't. I didn't know I was gonna be talking to a professional.

Jeremy 2:42
Oh, yeah. Yep. Alma, completely obsessed with diabetes. So do you have it it? I don't I actually don't have anyone in my family that has diabetes. I don't even know where my interest with it developed at my first job out of nursing school was on a pediatric diabetes floor. And I think that's probably where it started to grow. And then throughout my career, it's just gotten to be stronger and stronger of an interest.

Scott Benner 3:10
Wow. Good for you. That's a really wonderful thing to devote yourself to.

Jeremy 3:15
Yeah, I mean, everyone's diabetes is different to me, it's like every day is every patient you see is just so different that it makes things interesting. Like it's never the same thing over and over again. When you

Scott Benner 3:27
when you I don't know how to ask this. Alright, well hold on a second. Let me get through it. I almost got ahead of myself. Jeremy, don't don't. I don't want to put the cart before the horse, you know? Yeah. Let me let me ask you this, then. So went to college, to be a nurse. It's what you wanted to do. You're like, I'm gonna get a nursing degree.

Jeremy 3:46
No. So I went to college and got a bachelor's in sociology, and worked in software development for a little bit and couldn't really do much with a bachelor's in sociology. So I went back to become a nurse. And then after I became a nurse, then I went back to school and got my master's in nursing to become a nurse practitioner.

Scott Benner 4:05
Okay, and good for you. And then what made you move? I mean, how it's not what made you but how do you make the move towards diabetes? Just get a job and it's what it is? Or do you have to find that like, you have to search it out? I guess that's my question.

Jeremy 4:18
It took me 10 years after I after I became a nurse to finally get a full time job and diabetes other than that first job I had and pediatric diabetes. I was in primary care and urgent care but when I was in primary care, I was the diabetes guy in the office. So nobody no provider in primary care. It's our it's rather rare that they actually like working with diabetes because it's very difficult for most of them. So I was the guy that everyone would refer their patients to because I loved doing it. So I just like I I was the guy, some primary care it's rare to manage people with type one or anyone that's on a pump and I had so many patient's on pumps. I was just comfortable with it all so, so I was doing that and then I have a job came available at Joslin diabetes Center. And I applied because I, it's what I wanted to do. And they hired me and I've been doing full time diabetes ever since then that's crazy. Good for you. Wow. And then I got stolen by another hospital as

Scott Benner 5:24
well how does that happen?

Jeremy 5:26
I was doing a research project and our we were doing a quality improvement project at Jocelyn. And we were getting really good good results, I was one of the clinicians like heading it. And the program manager of the place where I am now is the daughter of a woman that was on doing the study with me. And she had raved about me to her daughter. And so her daughter, when someone put in there notice that they were retiring where I am now she reached out and said hey, would you be interested in coming to work for us and where I am now they have a nursing union. So the pay is significantly more than I was making. And that's how they were able to steal me.

Scott Benner 6:10
Well, that makes sense. Hi, would you like to there's more money? I'm on my way?

Jeremy 6:17
Yeah, it's the same exact job. I'm doing the same exact thing. So yeah,

Scott Benner 6:21
my gosh. Alright, so what is your day like at work?

Jeremy 6:28
It depends on if I'm so our days are split between or my week is split between outpatient and inpatient. So outpatient, I'll see people in the office, or virtually. Usually, like every new patient, I have an hour as a follow up patient, I have 30 minutes. So I see anywhere from eight to 16 patients a day. And then when I'm on inpatient service, we just are a console service. So anyone that comes into the hospital with difficult to manage diabetes, they consult us or if they have type one, we're the ones managing it. Like no team here manages type one diabetes, except for us.

Scott Benner 7:02
Okay, how many people on the team?

Jeremy 7:06
There are on the inpatient team, there's three NPS and a PA. And plus we'll have an attending like an MD or do on at the same time. Outpatient, there's godly 28 of us, I believe, or maybe, yeah, something like that.

Scott Benner 7:30
When a patient comes in, how do they mostly see you? Do they see a doctor? How frequently do they see the MD etc.

Jeremy 7:38
So I'm kind of a unique situation. So a lot so when I moved to where I am now from Jocelyn I had about 60 patients follow me, so they only see me every three months. And that's what they want. They have the option of seeing an MD if they want. The same thing with the patients I see. Now, some will see me every six months, and then the MD every six months, we alternate further visits every three months. But I would say about probably 70 or 80% of my patients only see me

Scott Benner 8:08
Okay, okay, and then never, like you're saying, like, once a year, even the MD there's no like, like, I don't mean tech legal, I was gonna say illegal, but like insurance reason why they have to or anything like that.

Jeremy 8:23
No, in Massachusetts, we now have independent practice, but there's really insurance wise, there's no reason for them to see an MD unless they want to. It's really up to the patient. I really don't like care one way or the other. But I I've personally found that a lot of my patients don't want to see anyone else except me. So I just continue seeing them unless there's an issue and I have, like, I run into a roadblock where I can't figure something out, and then I'll consult one of my colleagues, but that has that rarely ever happens unless it's a really weird case of diabetes like, like someone that has had a total pancreatic pancreatectomy. Like they're they don't have any pancreas anymore. Okay, those can be really hard to manage. But other than that, I mean, 99% of the cases I see I, I can manage well, and most of my patients have an agency, less than eight and a lot less than seven. So I do a pretty good job. I think hopefully, I mean, that's why I was stolen.

Scott Benner 9:27
Yeah, well, no, I guess talk about that for a second. What is what's it like? All I want to say I guess give people your perspective of what it's like to see 567 however many people a day, and they all have, like you said diabetes is different for everybody. But I think you mean their lives are different like the yes, yeah, the diabetes is the same, right? The way insulin works like the idea about having your Basal right and Pre-Bolus and your meals like that stuff, the same for everybody but what What are the parts that impact people and change things?

Jeremy 10:03
Is lifestyle things like exercise is a big one or lack of exercise, their diet composition. I mean, with type one, the wind can blow in your blood sugars can go crazy. So, I mean, for type one, it's a lot harder in that regard anyway, because it can, it's, it can be very fickle, like, emotions can do it. So like, especially as people get older and have a lot of people with type one that are in their 50s 60s that are then taking care of their parents. And they can have pre like previously a great control before that, and then all of a sudden, they have desexualized stress and their blood sugar's just go crazy, despite them not really changing much other than adding that stress. So I mean, pretty much anything like you talked with Jenny, like, literally anything can be a variable like it, everything affects diabetes, like, that's one of the reasons I like it is a it's literally everything in a person's life affects their diabetes, okay. It's kind of like a puzzle.

Scott Benner 10:58
Yeah. And so how is it to? How is it to figure that out, when you don't see the people for very long.

Jeremy 11:09
So I'm kind of a micromanager with my patients. So I'm seeing them in the office every three months, but I'm usually touching base with them every couple of weeks to go over things, especially the people that aren't, don't have good control. And I basically micromanage until we get good control. So I'm frequently like calling people on my inpatient days when I'm like, between patients to follow up, adjust their regimen, based on how they're doing. And going from there. So I don't limit my time to the patient to just the office visit, I don't I find that that's kind of funeral. So I actually find that my office visits are fairly quick, because I talk so much to them between visits. But I think that's just my practice style. And not everyone is like that, okay?

Scott Benner 12:03
Do you feel like, do you feel like when they leave, they know what to do, or they kind of have marching orders. And then after they marched to that beat of that drum, so many times it starts to make sense to them.

Jeremy 12:16
Ah, so my guy beat he's educator too. So I also make I do pretty thorough education with them, especially if they don't understand concepts. For newly diagnosed type people with type one, I'm usually seeing them for their initial visit, and then usually touching base with them every like two or three days for four to six months, until we kind of get things where they need to be. Because it's type one is just a different animal. Whereas type two, I can throw someone on something like ozempic or trulicity. And it typically corrects itself. And we don't really have to do anything much other than the ones that we injection, right. So it's really

Scott Benner 12:59
tell me about that variable. Give me that for a second though, the I'm meeting with people every two or three days meeting with them how text messages, video chats, how on the phone,

Jeremy 13:09
I usually by phone, okay. But usually, I'll have like, especially if they're type one, I'll have like, index calm, like, go on clarity, and I'll be able to see what's happening. And we can go over specific things that they ate, they'll keep a log, and we'll adjust based on that. But diabetes is so complex that I also don't want to overwhelm them all at one visit. So even if it's not a new diagnosis that, like you can't talk about diet and exercise and like sick day managed and all the different other variables at the same time, because nobody's going to absorb that. It's just too much information all at once. So the way I do education is kind of piecemeal, like, I'll make sure they get one concept, and then I'll move on to the next one, when they have kind of solidified that. Because, I mean, when I was new like it, I knew I know I overwhelmed patients like throwing everything at them, and it just nothing stuck. And it just wasn't, it wasn't a good use of my time. Or there's

Scott Benner 14:13
how did you learn that it was overwhelming? Like what? Like what, like, I'm imagining like a real life situation happen. And then like, what what, like, you know what I mean? Like, what made you go, Oh, hell, no, no, no, I'm doing this wrong.

Jeremy 14:33
I think it was the, I mean, a lot of it's the look in their face when I'm done. Like, they have that deer in the headlights kind of look. The other thing that I found was that I would do all this education. And then when I'm following up with them a week or two later, to touch base, they don't remember half of what we had talked about and I'm having to read, I was having to redo it. And so when I started doing that enough I was like, Okay, this is clearly not working. And I started to break it up. And that was much more effective.

Scott Benner 15:06
I take your point. Yeah, I'll tell you this. So this is kind of just is random. But I spoke to two people this morning, I don't know. So two people who kind of banged on my door and often was like, Oh, my God, I really need somebody to help me. And I had a little bit of time this morning. And so I talked to to two mothers of have young children. And you Please understand, I don't know them. I've never met them before. I don't think about them, right? And how am I going to try to get them moving in the right direction. So this is how the phone call starts. I say hi, you know, and they're like, Hi. And sometimes people listen to podcasts. And there's a moment where like, it's the guy from the pocket. So I'm like, calm down. Like I'm taking out my recycling now. Like, you don't I mean, nothing's nothing special is happening over here. And then I say, Listen, First, I need you to understand I'm not a doctor, this isn't advice or two people chatting. If I say something, you misunderstand, or, you know, I just flat out get wrong. And I mean, and someone ends up dead. It's not my fault. I need you to audibly tell me you understand, you know, and they're like, yeah, now I kind of say that, so that they understand that, you know, like to be careful. You know what I mean? Like, you need to be careful. But right, but then I initially I immediately, I go like this, I go, Alright, I'm gonna ask you some questions, just answer them real quick. How old? How long? What insulin? Do you think you're honeymooning? How much do they weigh. And then I say what's going on? Then they blurt out all the stuff that has stuck inside of them for the last however many months or years, which ends up being very kind of therapeutic for them, I completely understand. Here's what I think has to happen next. And then I immediately go to basil. Like I want to see the basil right before we talk about anything else. And then make sure that they're, you know, reasonably Pre-Bolus eating their meals, understand the impacts of different food. And then from there, where I'm lucky and you're not as then I get to like hand them episodes of a podcast and say, you know, here just keep, like broadening your understanding of this. And

Jeremy 17:08
I actually recommend the podcast to a lot of my patients, I have the list of like, specific episodes printed out that I want them to listen to, and I actually refer a lot of people to your podcast. So

Scott Benner 17:19
Well, Jeremy, now now you and I like each other much more. Okay. I was already enjoying, you know,

Jeremy 17:25
honestly, I was kind of not scared to do this interview. But my practice style and the things that I tell patients when I'm listening to you, I'm like, holy crap, we sound like the same person. So I'm like, and I was like, Oh, we're not gonna have much to talk about because I do the exact same thing that he does.

Scott Benner 17:45
And you were afraid that we were going to be like, Oh,

Jeremy 17:47
I agree. I agree. He was just gonna be agreeing. I listened

Scott Benner 17:51
the first time I fell in love with Jenny is when she like, I got off. And I thought, wow, she and I think about this very similarly. Yeah, I just love that, you know, because I love Jenny. Oh, my God, there's, there's not enough. There's there's not enough understanding at the level where, where you are at your job? Like, I just, it's just true. You don't I mean, there are too many people who see too many practitioners. You know, it just happened this morning, I said to the second lady I was talking to I said, Hey, how many Basal rates do you have? And she's like, I think it was like he gets four all day, I'm again, but you're on a pump. I'm like, how many different rates use I don't know, like off the top of your head, you don't know how many different Basal rates the kids has. And she opened it up. And every two hours was a different rate. By the way, none of them anywhere near how much insulin the kid needed. And, you know, and I said, How did this happen? She goes, Well, my, my diabetes educator kept changing it. And it's this, it's, you know, it's not always the same. Jeremy, I wouldn't want people listening to think like, this is definitely what's happening to them. But so frequently, I see people use too little basil. Then they over do it with meal incent or corrections, they call it, they cause lows, then they show the graph to a practitioner who says, Oh, you're getting low. Let's turn your basil down. It's fascinating.

Jeremy 19:13
It's, yeah, I see that a lot too. And to me it? I don't know. So yeah, a lot of providers do that. And I've, a lot of times when I see a new patient, I'll start from square one and make them do a Basal rate evaluation where I have them either fast for 24 hours if they can do it, or have them fast for like eight hours at specific times during the day during on different days to actually fine tune their Basal rates and see what they actually are. And every time I do that, they are markedly different from what they should actually be. Yeah, it it's just, to me that's just fundamental like you need to have like I agree with you like you need to have the Basal right to know what their Bolus should be. Otherwise you're just going to be adjusting and working in the dark.

Scott Benner 19:59
It It's all just, you can say it any number of different ways, right? But if you were building a car and you didn't know how much the car weighed, you wouldn't know how to throttle the car. Right? Right. Because the amount of horsepower you would need to drive this vehicle forward would be different if the vehicle weigh 2000 pounds overweight, 6000 pounds. So you the basil is that weight, it's the base, and everybody skips over it like it doesn't exist. I mean, I'm telling you like, throughout the early days of Arden's life. Basil was never spoken about like it was of any importance. It was just like, here's a number that's right. Now let's move on to all the things you're gonna screw up. You know, and I don't know it just it seems like very common to me Well, I'm going to ask you something because on your intake questionnaire, you you really caught my attention. This idea has been in my head for years about a podcast so Jeremy, I think you might genuinely be the perfect person to talk to this talk talk about this topic with me so I'm

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concerned that people don't do a good job of interacting at their doctor's appointments. And I think it's more of a communication thing. And I think it's because I think it's because we get put into maybe a subservient category, when we slide into some people getting the doctor's office and it feels like that person is in charge. They're smarter than me, they know more than me, I'm gonna listen, my ideas aren't important here, I'll kind of keep quiet, where I think it needs to be more of an actual human interaction. You know, and I think you you have to come in ice forward looking each other in the face, and, and making declarative statements and asking for clear answers. But I don't think people do that. And I was wondering what you thought about it?

Jeremy 26:45
So yeah, so I have a lot of thoughts about that. So I personally find not so much younger providers. I don't want to throw like baby boomers under the bus. But it I think when they were going to med school, it was more paternalistic. And so I think when they're, they get conditioned, after seeing their provider for so long that that's how visits should go. Whereas I'm more almost like a coach, like I don't tell patients what to do i elicit information from them. And I'm like, Well, how about how would this work? Like, and we kind of troubleshoot together? But for them, when I'm doing that with them? A lot of people will, it takes them a few visits to actually they clam up, get it? Yeah, they don't. They want me to tell them what to do. And it's like, no, you live your life, you need to tell me what, like how that I can help you. Because I don't know how they live, I don't live their life. And if I don't, if I can't get the information from them, then any suggestion I make is going to be useless because it needs the you need to meet them where they're at. You and I find that a lot of I think it's actually rare to encounter someone with diabetes, whether it's type one or type two, that doesn't have some form of disordered eating. And Jenny's a dietitian, I believe Correct? Not a nurse.

Scott Benner 28:08
So she might she's got a couple of things going on over there. Yeah, um, she,

Jeremy 28:12
she might be able to speak better to that. But I find that like, people come in, and they have aversions to food, different foods, like they don't want to eat fruit, they don't want to eat this or that. Because their provider told them like you're eating too many carbs. And you can't have this and you can't have that. And that's another barrier to overcome to that they just get into this mindset of they can't do things. And to me that, like, life is way too short to live like that. Like I if I if someone told me right now, like if I had type one right now, and someone told me I can't have like mac and cheese ever again. I probably would flip them off. Just like,

Scott Benner 28:51
yeah, Jeremy, you and I are aligned very well. So I think that it's, I don't take a paternalistic view of it. But I do think that, in some cases, with some people, my knowledge might be fuller than theirs. And maybe they don't sometimes know what's important. And you know, I find they're these. These sort of like, these dangling ideas, when you ask people questions, I've talked about it before you ask somebody how how's it going with your diabetes, and people go great. And there's no context to that, like with a number or, you know, variability or whatever, however you're measuring doesn't matter. Because great to them is just better than whatever bad was to them. So whatever the worst they were, if they're a little better than that they're doing great. They have a seven and a half, eight, one C, like I'm doing great. And again, you're not doing great, you're not doing bad, but you're not doing great. And so the the reason that's all important is because the person on the other end of that conversation, when they hear great, they ascribe a number to it. So I've been in conversations where somebody says, I'm doing great, and they're a one C is seven, and when I hear great, I think oh, they're a one c must be five and a half. They're doing great because that's My measuring stick, it's so important to say it out loud. And then that translates the food. How do you eat a week? Right? Yeah, well, you know, if you grew up in a house, where you didn't eat on Tuesdays, because that's how we save money, you might think your McDonald's is great, because it's way better than what was bad in the past. And now you over here, you know, as the practitioner who's eating leafy green vegetables and fish on Tuesdays, you're like, oh, they eat great. They eat fish and leafy green vegetables and take vitamins. And it's, there has to be an honesty. Now, the problem comes is that when sometimes patients are honest, then they run into a time where they get admonished, you know, and then you're like, Well, I'm not saying nothing, because this guy yells at me all the time. So Exactly, yeah. It's a huge problem.

Jeremy 30:50
Oh, yeah. Especially, I think more so in pediatric diabetes. Because I think providers think, Oh, they're kids, and they'll do whatever I say. And then when they become adults, they come with that same baggage, I actually had a patient who her peed her pediatric endocrinologist lost his license for the way he was treating patients. But he has given her so much PTSD, with her diabetes, that it's hard to get her over the anxiety of everything to effectively manage it because of how awful he was to her.

Scott Benner 31:26
So Jeremy is poorly as I feel for this person, I have to ask for a tiny bit more context, how do you lose your license? It like how what do you have to do to for that to happen?

Jeremy 31:36
I'm not aware of the specific she told me about it. And then I asked colleagues at work, and they had heard about him and heard about him losing his license. I don't know what specifically he did. But it was bad enough that he lost his license to practice insane.

Scott Benner 31:49
Now that's really crazy. I would I'm so sorry for her, she went through that. I think that we have to start speaking concretely. But without judgment. And what I mean by that, yeah, if you listen, if you're, you know, I don't care how you eat, honestly, like, if you're a vegetarian, If you're a carnivore, if you you know, if you're at McDonald's every week, all these people, they deserve their blood sugar's to be stable. And so it doesn't matter to me, there's no judgement about how you eat, I just need to know how you eat. So we can know how to talk about this. Because you can't just randomly say to me, my blood sugar goes up after dinner, and it stays at 250 for five hours, but not tell me what you ate. Because that's not enough information. You know. So, I mean, I think that's the first thing is if people are listening, when you go into your doctor's office, you just have to be honest. And if you if you're met, if your honesty is met with, you know, a response that is doesn't make you comfortable, then you need another doctor, because because if you don't get one, you're just going to start lying to the doctor. So now you're going to tell the doctor what they want to hear. The doctor is going to give you advice based on the lies you're telling them and your outcomes are going to be just as bad. That makes Exactly yeah. All right. Okay.

Jeremy 33:04
Yeah, I make them get into specifics. And I have a very non judgmental approach. I'm very honest with my patients to that. I had my own struggles. I think why I identify a lot with people with diabetes is that I had my own struggles with obesity my entire life up until like two years ago, I'm actually on ozempic, which is for people with type two diabetes for weight loss, and was very successful for me, I'm now like 150 pounds, like, I'm at a normal weight now for my height. But it was a struggle. And I I completely empathize empathize with the people that like eat fast food and like, because that's what I was doing. Like, I wasn't eating like, healthy like I should. And I mean, I still don't need like, perfect, like, completely healthy, but I try to, but I don't like when they tell me what they're eating. I don't judge it. I just figure out what we need to do to manage that what they're eating. Yes, once and I focus basically on getting their agency down once they're at once he's at goal, then I start bringing up the subject of like, how can we incorporate, like a healthier diet for you, and then work on that. But for me, it's one thing at a time, I'm not going to make someone make drastic changes to their diet, and then we adjust their insulin because that's just going to it's too much change at once people will freak out with that. Yeah,

Scott Benner 34:15
it's just it's, it's not reasonable. Like if that exactly. If that was reasonable, then we'd all weigh our goal weight, and we'd all we'd all look like we were on getting ready to fight in the UFC, right? I mean, because if that's how it worked, and you would just, we would designate a person in every town to walk around to every person and go, Hey, be healthier. And they'd go exactly, and they'd go, oh, hell, I'm glad someone told me. I'll go turn myself into a UFC fighter right now. But that's not how it works. So you can't, you can't ignore that portion of the human condition. And then just start talking about how insulin works because you're ignoring you're ignoring the bigger picture. The bigger picture is, you're trying to manage them based greatly on what What's going in their mouth? And so you need to know what that is. And you can't be stupid enough to think that you saying to them stop eating. That means they're going to go out the door and go, Oh, well, thank God that guy told me to stop eating that because I'll never do that again. Because that's so I love cheese. Jeremy, look at you. I love you. Tell me how much you would you tell me how much you weighed at your at your, at your greatest number?

Jeremy 35:27
Yeah, I was 220 at my highest. But I'm only for like five, seven and a half. Okay. It was an for my body frame, it was not an appropriate weight. Like I was like, like greater than 50% body fat. I was over fat and under muscled. I got down to 140. And then now I've been working out to like build muscle mass back on because I don't have a lot. And so I'm up to like 150 now because of that.

Scott Benner 35:53
How long was that process for you?

Jeremy 35:55
So I started ozempic.

Scott Benner 35:59
March, by the way, Jeremy, you got to stop saying that word. Because in my head. Now I hear oh, I can't think I can just hear that commercial in my head. But anyway, go ahead.

Jeremy 36:09
Yep. So I started that March 2020, like right before the pandemic started. And by I was walking to and from work, which was three and a half miles each way. So I went on that. And by September, I was down to 140. I lost 80 pounds in that six months, and I've kept it off since

Scott Benner 36:29
then, well, good for you. What does the drug do for you?

Jeremy 36:33
It controls your appetite. So before I was on it, I never got the signal to my brain that I was full. So I could just, I remember being like 2122, like doing my prerequisites for nursing school. And I ate a large Chicago style pizza, I was living in Chicago at the time, I ate a large Chicago style pizza, mozzarella sticks, a large fry, and a bunch of other stuff. Like for dinner one night. And I still felt hungry after I finished. Once I started on the ozempic. i i I actually like feel full like halfway to like three fourths of the way through a meal now, and I never, it was kind of a shock to me, because I never felt full before. I likely have a deficiency like ozempic is a hormone that your body makes, it's just changed a little bit so that it lasts longer. I I'm I'm willing to bet that I had a deficiency in it. And that's why it corrected it so dramatically. And most people with type two diabetes have a deficiency in that hormone as well, which is why it works so effectively for that.

Scott Benner 37:41
Is it written off label for you.

Jeremy 37:44
And it's so I'm on we go V now which is the same exact medication. But it's just we go V's the weight loss version, basically, that's more that is FDA approved for weight loss. But I was on ozempic initially and my I had prediabetes actually, like my agency was 5.8 or 5.9. And that's how my provider was able to get it approved. And that Menomonee ones he's like, I think five. So it definitely helped a lot in that department.

Scott Benner 38:14
Wow, once weekly. Yeah, once a

Jeremy 38:17
week. Crap, hmm. And actually use it a lot. And people with type one as well that struggle with their weight. And it does great, it actually makes their blood sugar's a lot more predictable and easier to manage. So I'm hoping eventually we'll get coverage for for people with type one because it does amazing things for them. It also suppresses glucagon release, so you'd need less basil overall as well. And it slows gastric emptying, so you don't have to Pre-Bolus as much or as long before so it does a lot. It has a lot of good metabolic effects. And I mean, I'm sure you know, like the killer. People don't with diabetes don't die from the diabetes, they die from things like heart disease or kidney failure from the uncontrolled diabetes damaging those organs and medications like ozempic and trulicity reduce dramatically reduce your risk of having a heart attack or stroke. So it's very good for someone with any type of diabetes to be on it

Scott Benner 39:14
does that I by lowering you're able to see your blood sugar.

Jeremy 39:18
Right? Yeah.

Scott Benner 39:19
Okay. Well, that's it. I didn't know we were gonna learn so much from you.

Jeremy 39:23
I try. I actually have an NP student who has type one, she is a normal weight. But she was like, oh, I want to try ozempic and see what it does for me. I want to experiment so I prescribed it for her got it approved through her insurance. And her average blood sugar went down by about 60 points just by starting that and she didn't lose any weight on it. But it made her blood sugar's so much more predictable.

Scott Benner 39:54
No kidding. Any side effects that like did you grow a tail or anything weird?

Jeremy 39:59
Biggest thing artifact with it is nausea. And it typically goes away after you've taken it for a couple of weeks. Like I got nausea for the first two or three weeks, but it was a kind of here or there thing. The nausea though was actually predictive of someone responding really well to it. So if you do get nausea, it usually means that you're going to be a very good responder to the medication. Once your body gets used to the increased level of a hormone that nitric goes away.

Scott Benner 40:22
Wow, that's really wonderful. Look at that science, huh? Yeah, you go. Well, thanks, Novo Nordisk. I mean, yeah, that's who made that right. They make both of them actually.

Jeremy 40:38
They make, I believe they make ozempic and trulicity or not, I was embiggen. We go V trulicity. is made by I think, Sanofi, I don't really follow the manufacturers of the different products because I don't like to be biased. And it's a lot to remember. But I think it's Sanofi.

Scott Benner 40:56
That makes trulicity trulicity.

Jeremy 41:00
Which is the medication it's in the same class. It's just a different medication.

Scott Benner 41:03
Okay. Okay. I understand. Well, I thought you okay, it doesn't matter. I don't know that ozempic song though. Whoever wrote that. Freakin mind control, genius. marketing genius. Because I don't I don't like half know what those Empik is. I don't need it. And I could sing that whole stupid song. Same reason I know about mounds that Almond Joy from the old Charlie Brown TV shows when I was a kid. I've never had a mouse or Nam enjoy my life, but I know exactly how they're built and what's in them. Yep. Yeah. Jane goes to law star Jeremy. Anyway. I'm still like, overwhelmed. As you're talking that you have you don't have diabetes. I think it's terrific. You know, like, like, your amount of enthusiasm for it is exceptional, especially after you've been doing it for a number of years. Is this I don't get bored of it at all. Does it feel like a challenge? Do you feel like you've fixed the like, now I'm gonna pick into your psychology like so. You like we've we've learned a lot about you. Like you said, you don't know why you went into like, why did you go into nursing? Do you think?

Jeremy 42:05
So? When I so when I was young, when I was 10. My father, it was actually national news. And there's like, a true crime show on it. My father murdered my stepmother. And going through that, and I was very close with her. It. It made me kind of want to live my life to not impress her, but to honor her memory. She was a very caring person, and I just didn't want anyone to

die a miserable death like she did. And so that initially, I was actually gonna become a social worker.

And then, when I learned that I, it's really, you don't do much as a social worker in a hospital? That's when I switched to nursing.

Scott Benner 43:01
Okay. All right, hold on a second. I don't know what number episode years will be. But I have like 620 of them out. I think I have about 60 More recorded. I've spoken for 1000s of hours to people with type one diabetes. You stopped me in my tracks in a way that no one has before. That really? Just really shocked me. Just tell me one more time. Your stepmother? Yep. was murdered by your father. Yes. Your your birth father?

Jeremy 43:37
Yes. Correct.

Scott Benner 43:38
I'm so sorry. Okay,

Jeremy 43:40
how old? I was 10.

Scott Benner 43:44
Okay, you all live together?

Jeremy 43:47
So I split my time between that house and with my mom. So I was there on like, Friday, Saturday, Sunday. And then with my mom during the week,

Scott Benner 43:59
okay, but you had a your parents had been split long enough that you're you had a real relationship with your stepmom? Oh, yeah,

Jeremy 44:05
I met her when I was I think three and I was really close with her like she was a mom to me.

Scott Benner 44:12
Wow, your father's in prison?

Jeremy 44:14
Yep. Yeah, he gets out. I think in eight or nine years,

Scott Benner 44:20
I have to ask you a question has nothing to do with diabetes. But does that make you question yourself that somebody who you're that directly related to did something like that?

Jeremy 44:30
It does i It makes me scared to be angry. Because I'm worried that I'll turn out like him. It like I don't have a violent bone in my body. But like, if if something upsets me I don't give my permission to give myself permission to get angry essentially. Because I don't want like I live with that fear that I'm going to hurt someone Looking back

Scott Benner 45:00
as an adult now, do you see prior to it happening? Do you see your father as someone? Like who could have done that? Or do you think it was like a crime of passion? Do you think he snapped or do you think that's so

Jeremy 45:13
it on the true crime? So I think the it was on a TV show, I think on Investigation Discovery called most evil. They called it a crime of passion, except when you read the court documents and know what went on, he planned it, like weeks in advance.

Like, this wasn't just like, he knew what he was doing. So sorry, I forgot like, part of the question you asked.

Scott Benner 45:37
I just meant to do you in hindsight, like looking back as an adult? Did you think he was a person who could have died? Or do you think he just kind of snapped?

Jeremy 45:45
I don't think he snapped. I think he was very controlling, um, his, he had been married, I think, two or three times before he had married my stepmom. The his first wife, he beat her so bad on the lawn that she pretended to be like, knocked out or dead so that he would leave her alone. And then he left went to work one day, and then she escaped that situation. So he already had that history. The morning after it happened. We went to visit my stepbrother and he had witnessed the very beginning of it. And I he told me what what had happened. And I believed him like it. He saw firsthand what was happening. And I didn't really like my dad, he was kind of a jerk to both of us. He was never like a warm and fuzzy dad, it was like You kids are in my way get out. So I was taught like, I was very confused by the adults in my life, wanting me to continue to have a relationship with him and believing him that he was innocent and that he was self defensive. To me it was kind of obvious and at 10 When all these adults are being contrary to you. It's I don't know, it was very mind boggling.

Scott Benner 47:13
So when the adults are like, I can't believe this happen. You're like I can like that kind of feeling. Yep. Yeah. I hear you. Wow, man. That's okay. Well, now we know why you're a nurse. That's good. Yeah, figure that out. Like I you know, I hate to feel like I'm boiling people down to like, but I think people are caregivers for a reason, like something happened to them. They want other people to feel better than they felt at some. I mean, it just kind of seems obvious, but and then you had a weight problem too, which then made me want to dig a little farther into it. Meanwhile, I know nothing about psychology. I just it was enough of a clue for me to ask. I did not think you were gonna say my father murdered my stepmother. But I thought maybe you were gonna be like, you know, there was this girl in eighth grade. She just called me a name or I didn't know we were gonna get here. I'm sorry. I'm you. You're okay with all this talking about it?

Jeremy 48:03
Oh, yeah. Oh, yeah. Like I'm very I got I've went to therapy for years. I'm very, I've always been very open about it. Right. I'm not a very private person at all. Like most people in my life know about it.

Scott Benner 48:14
Okay, no kidding. You went to therapy? Oh, yeah.

Jeremy 48:19
Definitely necessary.

Scott Benner 48:20
God. Well, I'm, I'm glad for you that you weren't there. Your mom must be like, she dodged a bullet. I would imagine. Yeah, she does. Yeah, no kidding. Wish. Was she her his first wife?

Jeremy 48:32
No, they never married. Okay. She was like this third I think relationship in that chain.

Scott Benner 48:41
Wow. No kidding. Is your mom had your Did your mom ever remarried? Did you have a stepfather?

Jeremy 48:46
No, my mom actually ended up coming out as a lesbian when I was in seventh or eighth grade. She had a girlfriend but the girlfriend slash partner didn't really like me so that was interesting growing up with

Scott Benner 49:00
Jeremy at least she didn't kill you. I mean, yeah. Talking about talking about what level of grief there is like you're you're the first person I've ever met that not being murdered is like an upgrade. So my goodness. Well, this is ridiculous. You know, I'm not for people listening. I did not know this was gonna happen. I I love I love talking like this because the way things come out, but I'll tell you no, no lie. Man. You stop me like when you said that. My brain when I think he's talking about a television show, like but it sounded like he said it was his real life. Like, I could literally feel my brain like arguing with my consciousness like that. Well, you probably misunderstood that. Ask it again. You know, wow, man. That's nuts. All right. Well, listen, I understand. You know, I would I would tell you I don't think you're your father. But you know, I would think that that most of that stuff we model unless it's hard why? I heard which are you don't seem hardwired to hurt people. I think a lot of it's modeling and it sounds like you weren't really around him. So,

Jeremy 50:07
right. Yeah, he didn't really want much to do with us as kids. So yeah, although having

Scott Benner 50:11
said that, I don't want you to be in a jail cell one time going to guy on the podcast told me to let go of my anger. My goodness, all right. Anyway, this is fun. Jeremy.

Jeremy 50:24
Having a good time. A lot of come entertaining.

Scott Benner 50:27
Well, listen, not many people come with, you know, something that's been on True Crime television. I appreciate you sharing. Wow. Okay, so watch me do this 180. I'm laughing? Because I feel like it's a transition. That doesn't make sense. But I want your opinion about what people can do, like, Forget you, like forget the kind of provider you are in a generalized situation, what do people do coming in the door to give themselves the best chance at a good outcome?

Jeremy 51:03
I would say taking their diabetes seriously. And I mean, for the best outcomes, the biggest thing I see that prevents people from getting good control is their fear of lows. And it takes a lot, especially if someone has an anxiety disorder, it can be really hard for them to accept that, you know, 75 to 90 is a normal blood sugar. And we really should aim for that at all times, like, at least like between meals, because they're so scared that they're going to drop low. But if you have the Basal is correct, and you know their insulin to carb ratio, and which is something I don't like the concept of and correction factor, right, then they really shouldn't be in any danger, but they get so scared of lows instead of being scared of highs that it it impedes their success. So I think getting over that fear and being willing to experiment is how people are going to be successful. Like you essentially experimented with art and and that's how you're able to find out what worked well for her. Because every person is different. And by experimenting, you find out what works for you. And then you can, you'll know your body better and know how to respond to thanks.

Scott Benner 52:26
I just love just when you said you don't like the idea of insulin to carb ratio, it is kind of bull like it is

Jeremy 52:32
it's meal content, like 45 like 100 grams of carbs, when you're eating pizza is way different than 100 grams of carbs. If you're eating rice, like it's theirs, they're not the same at all. Like it's you need to look at meal content cuz they don't it does food doesn't behave that way.

Scott Benner 52:47
That's why when I talked about an order, when I say Basal Pre-Bolus glycemic load index, like I don't even really go to you would think the next thing I would say was make sure your meal ratio your meal in some ratios, right. But it doesn't mean unless you eat the same types of food constantly, and then your ratio will probably be pretty close. But if you go from one day from a salad, to, you know, to Pizza the next day, and the third day french fries, and then back to you know salmon and a little balsamic vinegar add on in a little bit of maybe a tiny bit of basmati rice and like, you know, something light like that, that that ratio is not going to work on those four days the same way. And exactly and people, people get it into their head. They believe in they believe in things like Right, like, you know, simple example is, you know, our news is a picture now, but it was hard for me to believe because a doctor handed me NovaLogic and said to me, this is insulin, and I went this is insulin, okay? Thank you. I didn't think there were other insulins when somebody gave me Novolog I believe that was insulin, when someone tells you your insulin to carb ratio is one unit for every 15 carbs. You never question that again. Even though what comes next should make you obviously say to yourself, I don't think that ratio worked for this meal. But you don't do that you think there's some diabetes fairy came down, tapped on the shoulder and messed you up and you're not allowed to eat carrots or whatever the hell? You know, like it's, it's interesting to watch people's minds jump over all the common sense to the next thing. And that's why I agree with you. I think that's it, we should call this a We should call this episode meal ratios are both

Jeremy 54:28
they are they really are. I mean, what I do with patients also is remove or I work to remove a lot of the guilt associated with it and kind of put it in their head that you have very little control over when your blood sugar's go crazy if you're using something like an insulin to carb ratio because you're if you're doing it appropriately and you still don't get good control. It's not your fault that it messed up. It means that there's something wrong on I would say my end like we need to figure out what your meal content is. isn't what we need to do to adjust for that. So I try to actually try to take the blame on to myself if things are going wrong, because then I find that people are more willing to experiment that way. And they're not as scared like people blame themselves for everything. Yeah, that's

Scott Benner 55:14
my fault. We should try this. And then, you know, like that. Yeah, they're gonna go, it wasn't me. It was him. This guy, idiot. Yeah. You know, somebody told me recently, I must have said at some point, that you wouldn't take a bucket of water and try to put out a house fire, but you can put out a I don't know, a campfire with it. And why do you think that the same amount of insulin would work on? You know, one impact is that would another impact they said that person said that just like they were like, oh, yeah, that makes sense. It's interesting. It's interesting, what I've seen over the years, like flip switches for people. It's never the things you think it's going to be like the real just, you know, bullet points. Very medical. No one really. It most people don't jive with that. You know, there's some there's some Taipei's, you don't I mean, there are some people who just are like, ooh, marching orders. This is great. You know, but I don't think most people think that way. I was wondering, you don't need to be specific, obviously. But for every 10 people, you see how many people struggle versus how many people are just cruising in there, like give me my scripts, Jeremy, so I can get going again, because I'm great at this, like, what's the what's the delineation?

Jeremy 56:29
Ah, so for patients that have been seeing me for a while, I would say it's probably like eight out of 10 that are fine. Um, new patients that I see. It's usually like, one to two that are out of 10 that are fine. And the rest really need a lot of work. So I'd probably say like, on the grand scheme of things, like four out of 10, that I see what's that are doing?

Scott Benner 56:55
Okay, what's the time from A to yay? How long does it take you to get there?

Jeremy 57:00
Um, it depends on the patient. But I would say, if someone's really out of control, I am following them very closely. I would say within six months, we usually have things in a much better place, if not fully where they need to be.

Scott Benner 57:13
How much of your liability slows you down from moving them as quickly as you want to? liability? Yeah, like, I mean, if like, if this was a game show, and I said, you fix somebody's blood sugar in an hour and a half, you think you could do it?

Jeremy 57:29
I mean, yes, but like, that's what we do with DKA. But you don't want to actually, that actually brings up something about the Facebook group. You don't want to correct someone's blood sugar that quickly because it can cause a lot of problems. So I went on the Facebook group a few months ago and joined and we're like, Hey, guys, I'm a, an NP and certified diabetes educator. And I'd love to be able to help you guys. And I made a comment in the, in my initial post that said, you know, if you're able to, like, I see a lot of people worrying about getting their agency down as quickly as possible. And I was like, it's a marathon, not a sprint, you don't need to get from an agency of 14 to an agency of five within three months, because it's actually dangerous. So you can actually get what's called treatment induced neuropathy of diabetes. Or you can get treatment induced retinopathy of diabetes where you rapidly correct someone's blood sugar's and their body just can't adapt to it. And they start having developing complications from diabetes. And someone who was an internal medicine doctor, I think, in Kansas, like commented, and was like, No, you're completely wrong, because her child has type one diabetes. And I think she thinks that she's a diabetes expert now. And then we got very contentious I was like, posting articles being like, No, I'm completely right. Like, you really shouldn't correct all that fast, more so in like teenagers to adults. But even in kids, you it's better to slowly walk them down versus overcorrect quickly. So that's what I tell patients like it's a marathon, not a sprint, you want to get there, but we don't need to get there tomorrow. Because that also puts a lot of pressure on them that, like, if they don't get it there, then they feel like a failure.

Scott Benner 59:16
Right? Put put some context to it. Like, I think it's obvious you don't want to go from like some outrageous, like, you know, you've been living with a 14 a one C for 10 years, and tomorrow, it's gonna be a five. But if you're an eight, and you can get to a six, that's not a big jump, right? Oh, no, that's not a big jump at all. Right, right. You're talking about from real high to real low. Real quick. Right, right. Right, right. See it? May I make a suggestion? Don't try to talk to people on Facebook. It's not a great idea.

Jeremy 59:47
No, it really wasn't. I deleted my posts and left the group. I was like, this is gonna Yeah, I didn't want to get into fights.

Scott Benner 59:53
Right? You would, but I guarantee you, you should go back in there and just lurk. Don't talk to anybody. resist every one of your urges to say anything. You'll learn how people think, oh yeah, you'll learn their desires, you'll learn their fears, you'll learn what works for them and what doesn't. That's the Masters class and talking to people, I learned more watching people on Facebook and not interacting with them than I do interacting with them. So it's, it's, it kind of goes back to the how you eat thing. Like, it's nice to think that this is how it should be, or whatever this is. But the truth is, it's how whatever it is, you know, however people live whatever their impulses are, their fears, their you know, the things they're willing to listen to, or not willing to listen to. You have no control over that. There is this kind of like, I think I've done this thing by mistake where I've kind of created this almost nebulous ball of information, that does a good job of feeding everybody, not just ascertain somebody. And that's not something you can do one on one, especially when you get ganged up on. Oh, yeah. Then by the way, reposting articles. That's not the way to go.

Jeremy 1:01:08
Yeah, I was like, here's evidence woman, she's a physician. Well, supposedly a physician who knows if she's actually is. But I was like, that's when I would talk to a colleague like here's a bunch of evidence that actually supports what I'm saying and why you're wrong. But yeah, it was just it was just so contentious. And I didn't, she was she was posting a lot of misinformation to other people. And I ended up deleting it, because I'm like, These people don't need to be hearing wrong stuff. I mean, I'm sure she's a great mother. I'm sure she manages your child's diabetes well, but just because you manage your own child diabetes, well, doesn't mean you can extrapolate that to other people, because everyone is different. Yeah, it's

Scott Benner 1:01:40
a very interesting thing. Is everybody thinks that their thing applies to everybody, like when you really if you really listen to me, if somebody you know, did a thesis on this podcast one day, you would really find no matter what episode you were in, that what I'm talking about is Basal Pre-Bolus, glycemic load index, stay flexible, everything is just off of that. There's nothing else I'm not saying anything crazy anywhere else, if you and I'll tell you what, if you're a one C was five last month, and this month, you're in DKA, you know, your, your pancreas just shut off. I don't think there's a ton of concern bringing you from on the 11, a one C down into the sixes and sevens. But if you've been nine, even for years, then you're going to want a slower matriculation. But then you do the math too, right? Like, these people have been suffering for so many years. And now suddenly, they realize it's a hardship like as an adult, like imagine living for however many years with anyone seeing the nines and the 10s. And then learning one day that if your Basal was just point seven higher an hour, and you gave yourself insulin, 10 minutes before you ate or 15 hours before you ate, and that fat causes a rise later, you have this feeling of like last time, last time and lost health. And now it's easy to say, just let's do it a little bit at a time. But if you're the linchpin in that, like you're the thing that you have, and the people you help have, that most other people don't have. Most other people don't have constant contact. That's what they need. So how do you give them enough that they can go away on their own and get to a good place like you're doing? Like, I think people would say you're doing the Lord's work, like, like staying in contact with people like that. Whereas most providers aren't going to do that.

Jeremy 1:03:38
Which I think does a disservice to the patient's like, I think on that those providers parts like they're practicing wrong, like diet. diabetes isn't something that just happens to them every three months, like you really should be in contact with your patients. Yeah. Don't just don't to me, that's just fundamental.

Scott Benner 1:03:53
Don't you feel like the way it's handled is basically you take a it's like you're taking a box of 50 baby birds that are really close to being able to fly, and you go up in an aeroplane and throw them all out and you go, Oh, I think most of them will be okay. But I'm not going to check.

Jeremy 1:04:08
Yeah, essentially. Yeah, same exact thing. Yeah. And hopefully,

Scott Benner 1:04:11
it'll be alright. I mean, I've done all I can do. I put them in the air and they fly. They're close to their age. It's fine. Let's see what happens. And then you come back three months later, and you're like, this didn't work. And they go, Huh, about that. We'll try again, you know, and they don't remember you. You've been living for this for 90 days. It's like being in a war. You don't I mean, like you're, you're, you're, you're steeped in it. You're behind enemy lines. You've got your head down constantly. You always think you're about to get your nuts shot off. And then you show back up this person who hasn't been in this fight with you for 90 days. It goes Oh, I remember war. Yeah. And then they reorient themselves with the last time you spoke to them 90 days ago and try to make another decision. It's a fool's errand. You can't you really can't do that. And then they don't want to hurt you so they see a low somewhere and take away all your baseline and start the whole thing over again.

Jeremy 1:05:00
The Ben just has a self defeating cycle basically.

Scott Benner 1:05:04
And that's how nine years later you end up being an adult who's had an a one to 10 for nine years. Because

Jeremy 1:05:11
yeah, and having kidney failure and everything else that that comes with that a onesie being so high for so long. Yeah.

Scott Benner 1:05:17
So listen, Jeremy, I'm going to tell you something in less they can get you. I think that I've, I think I've put the thing in the world that works the best so far that I've seen for people with diabetes.

Jeremy 1:05:29
Like I Oh, I would agree. Yeah, thank you. That's why I sent so many patients to like I sent people with type one and type two to you, because I think it's applicable doesn't all.

Scott Benner 1:05:37
Did you? Well, if you were in the Facebook groups, though, you would have seen John, last night, a type two, who showed us all his graphs from the months and months before the podcast and the months after, and he is doing spectacularly and he's lost a significant amount of weight. Just from listening to the podcast and having type two diabetes, and I never specifically talked about type two diabetes usually. And yeah, yeah, yeah. I didn't even feel weird saying it when I like as it was starting to come out. And I'm like, Oh, you're gonna say something nice about yourself. And people are gonna think that's weird. But I just genuinely believe it. Like, I think that what we've discovered over this last hours, you need consistent conversation, it can't be getting jammed down your throat, it has to be something that you can hear, believe and take in. It has to be something you can do on your own. And it can't be all at once you need it matriculated over time. And that's what the podcast does it. And then there are other people that tell me that even after they're in a good place, they use it almost like maintenance. Like I it's probably the the equivalent of like an AAA meeting for some people. Like let me just go listen to a person who has type one today. So I keep my head in the game a little bit, you know?

Jeremy 1:06:50
Yeah. And actually, that's what kind of what I like about listening to the podcast, because I get to hear people living with diabetes and their own lived experience, which I don't. I mean, I get that from my patients, but you go much more in depth than and it's more like different perspectives that help inform me of like, what it's like to live with diabetes. There was one guy, I it took me like, four or five days to get through the podcast episode, because he would start you were talking to him about I don't remember his name. You were talking to him about complications from diabetes and how he was living with his complications. Might Yeah, and he would start breaking up and crying and I would lose it. I would just like start bawling. So I was like, Okay, I'm gonna pause it and come back to it when I feel emotionally ready. But like that, that one wrecked me like that, oh,

Scott Benner 1:07:42
it's really important. His conversations incredibly important. It is yeah, you just, you can't live every day, like you think your kidney is going to explode 50 years from now, and you can ignore it, that it could happen. You know what I mean? You have to be somewhere between, you know, a little blissfully ignorant, you know, day to day, when you get a blood sugar, it's 180. You can't sit around like, you know, out of your mind and a puddle on the floor. And you can't forget that that's not okay. either. You have to find a psychological middle ground that you're willing to live in, so that you can live today. Well, and live tomorrow and in the future. Well, at the same time, because it isn't, I mean, listen, I don't really outright say it very often, but you ignore your diabetes, some bad's gonna happen to you. Like, that's just what's gonna happen, you're not going to avoid that you're not going to be the you're not going to be the 110 year old lady smoking cigarettes on the local news go and I'm gonna live forever. Like, you know, like, it's your Listen, I'm not I'm not a I'm not a doctor, okay, but there's a certain amount of sugar molecule that belongs in your blood, it keeps your brain running. You know, if you have too little, you just thought your brain shuts off the sugar in your blood is energy keeps your brain going, you have too little you shut off. That's it, you don't get to turn it back on. Again. Once it's off, its off. Too much sugar is acting as an abrasive agent inside of your blood and your blood flows everywhere down to the tiniest capillaries, like through arteries and veins and everywhere. And it's it's flesh, and it's scraping now that sugar is in there scraping and scraping and scraping and eventually a hole pops and one of them. And that is a stroke. If it happens in your brain, if it happens in your heart, it's a heart attack. If it happens in your toes, you can't feel your toes anymore. Like like that's what you're avoiding. You need a balance of that sugar molecule in your blood needs to be the right amount. Not too little. Not too much. And it sucks, but that's the truth. You know, Seattle. Get in the game. You know what I mean? Like, what what do you think of the pro tips? Have you been through them all?

Jeremy 1:09:51
Yep. I mean, I love them all. Like that's what i Those are the episodes that I like send to patients for them to actually listen to

Scott Benner 1:09:59
them. I'm glad, I'm glad we worked hard on them. Actually, we're going to add to them this year to show awesome yeah, Jenny and I are finishing up a defining thyroid series right now. And then we are going to basically do like director's commentary, ish types of stuff for the protests, we're going to go back and listen to them. And then we're going to come and kind of like add to them a little bit with new episodes, just to kind of, maybe supercharge them a little bit. So

Jeremy 1:10:27
yeah, and one thing that I'm hoping changes in the future, is the whole Pre-Bolus thing, thing. So I use um, so I would say for 90% of patients, it's impossible to Pre-Bolus for every meal, because it takes a lot of planning, especially people with kids, it can flip their day upside down. So I actually have been switching a lot of people to either fiasco or limb Jeff, which are more rapid acting. And the changes are so much better, they can give it right when they start eating. And it gives them the same effect as if they gave it 15 minutes before. But that's one thing I think pharmaceutical companies need to focus on is making insulin function more like actual human insulin so that people can live a normal life.

Scott Benner 1:11:09
Yeah, I also think that I'm right there with the DIS cannula technology. So to cannulas, they should be working on materials that don't look foreign as best they can to your body. Because, you know, bad sites are also an issue you get on me, you go through all the things we just talked about, get all your settings, right, do everything. And then your site starts going bad. You know, like she's got, you know, it's not one thing. It's another, I will tell you that I tried to ask for Arden. It burned and and left her feeling bruised. She could power through it. But it was very, very unpleasant.

Jeremy 1:11:45
I believe it's the niacin that's in it that makes it act faster, which will also cause a burning

Scott Benner 1:11:49
Yeah. So then we transition that boom, Jeff, that was she described as twice as bad as the fee is for her. Oh, interesting.

Jeremy 1:11:56
I've had a lot of people with it, using it through a pump that have had do great control, but also have burning. So they went back to human log and said, Yeah,

Scott Benner 1:12:05
so I'm telling you Arden could wear the Fiats shoe or if he asked pod for weeks, it always hurt her the site was sore it burned going in, but she dealt with it. The loom Jeff, if I'm saying it right, two days, less than 48 hours, she's like, take this pot off. Like she couldn't get through it. So it's no luck for us. So you know, whatever they figured out makes it work better. They got to figure out this piece next.

Jeremy 1:12:31
Yeah. I mean, Peter works really well, too. But I find that it's hard to get insurance coverage for it. Usually insurance will prefer him a logger. Novolog. And if both of those don't work, I can usually get it covered. But a lot of it's an insurance game to like the insurance companies are awful. I hate them so much. Yeah,

Scott Benner 1:12:49
I imagine Arden has been using the pager for ever. At this point, it gets so long. I don't. I couldn't remember when she used to use Novolog it was so long ago. And I find it the way I describe a Petri dish that's incredibly smooth. There's no there's not a ton of like, oh my god, it's working too much now, or it's not working enough now and you can kind of Pre-Bolus and, you know, you can use larger amounts, at least for Arden and it's just there's not a lot. I don't see double arrows ever. Like honestly a straight arrow up or down is fairly uncommon around here. I mean, a straight arrow downs really uncommon around here. A straight hour up. Okay, if we miss a Pre-Bolus, like you just said, but double arrows in either direction. I have not seen in forever. I love a pizza. Actually. I wish they would advertise on the show. Honestly, I would I I'd have no trouble being able to talk about a pizza. That's for sure.

Jeremy 1:13:44
With Arden's What 16 or 17

Scott Benner 1:13:46
She's 17 going to be 18 this summer.

Jeremy 1:13:49
When is she going off to college in the fall? Yes. How do you feel about that?

Scott Benner 1:13:55
home she doesn't talk to any boys.

Jeremy 1:13:59
Like in terms of her diabetes, like do you think she's gonna? I mean, from listening when you had her on the show? I think it was a few months after the episode aired. Yeah, um, I honestly, like love that episode. Because she I have a very similar sense of humor. So I was laughing the entire time. Like she i i loved her attitude. Do you think she's going to do okay, managing on her own?

Scott Benner 1:14:23
Yeah. So I mean, keeping in mind that the podcast episodes a moment in time, like we've been working on this getting ready for Arne to go to college for 10 years. Yeah. And we're still doing it now. Like she and I actually had a really long conversation. About a week or so ago, when I said, Look, you know, I know right now she's applying to colleges. She's just about done. She's been accepted to a number actually, she's been accepted to every college that she's applied to so far. Oh, awesome. She's super excited. She has one that she definitely wants to go to. She's holding out to here about one or two more before she decides. But I said as soon as this whole college application process is over. You and I are going to go back on the podcast and talk again, nuts and bolts, and then we're going to put that stuff in practice in our real life. Now, keep in mind like, I'm not up her butt constantly about her blood sugar. You don't I mean, I helped her, but she I also think the process, I honestly think you're learning through the process. You know, like, you know, she changed a pod about 45 minutes before you and I started recording. And I said to her, I'm like, I don't know what's gonna happen here. Right? So maybe 20 minutes before you and I got on, I saw an arrow like she started going the wrong way. So we took took her old pot off site looked a little angry, is that a good way to put it? And yeah, and I could tell that the site wasn't working as well as I wanted it to for about the last five hours. So much so that I sent her a text while she was at school because she caught some adrenaline from gym. And the algorithm couldn't do anything about it. It was trying and trying and it wasn't having impact. So I said to her, Hey, I think the pods done, we're going to change it when you get home. For now. Let's make a bigger Bolus. So we Bolus a little more we turned this 150 back into like a 120 By the time she got home. But as soon as we popped the pot off and put the new one on, maybe 20 or 30 minutes later, we started seeing up again, she started going 131 40 Diagonal up. And I told her what to do there. Like I said, let's open the loop, which for people who don't know about like pumping like basically turn the algorithm off. Let's run this like a normal pump. For now I want you to get your background Basal insulin, because we're going to make a correction Bolus here. And we don't want the algorithm to take away the Basal. So we opened the loop turned off the algorithm made a Bolus that I knew would correct it. And probably about five minutes ago, actually, while you were talking, I texted her again, I said close the loop her blood sugar's 95. Now. So would she know how to do all that? Huh? Ish. You know what I mean? But we're going to have that conversation more as she just to make sure she understands like the ins and outs of the algorithm. I also think it's incredibly possible that Arden is going to be using on the pod five when she goes to college and not a loop.

Jeremy 1:17:23
Hopefully, the FDA needs to get that approved. Now, like I have so many patients that need to go on.

Scott Benner 1:17:27
Yeah, I think that's I think that's going to happen in any any second now. So that I'm happy about. But also, I don't want to spend a ton of time over explaining the algorithm she's using now only to move her to a different one. So I'm waiting for that little gap in time. And then we'll keep going. I honestly think she's going to be okay, I think the bigger issue with her being away, is going to be the impact it has on her at nighttime. Because there is still now you know, a time or two a month, where you change a pot at the wrong time of day. And then you end up with a high blood sugar as you're going to bed, you make a Bolus for you over do it. And then somebody has to help you to in the morning. Like that's the time I'm more concerned about for her. Yeah, you know. And even at that, you know, the other day, I did say to her just kind of in passing, I was like, Hey, listen, we should start paying more attention to when we change your gear. As like, we don't do it now, because it's not really problematic. But there are times of day where you should start thinking about changing your palm so that you don't have overnight issues. I'd rather you have an a daytime problem than a nighttime problem when you're at school. And she was just like, alright, you know, and so that's the stuff we'll do, but I don't see. I don't see her leaving as some finite ending to our story. Like, you know, I can write, I can do diabetes blindfolded. And I can do it just at a distance to I won't have any trouble helping her get settled at school, I don't think

Jeremy 1:18:55
I think I was actually more interested in like the alcohol conversation if you've talked about her with that, with how that's going to affect her. Because I mean, hopefully she doesn't drink until she's 21. But it's college. And that's a big sticking point for a lot of my pain, my young adult patients, managing how to consume alcohol and also manage their pump.

Scott Benner 1:19:15
Yeah, I imagine my kids don't aren't drinkers, either. My wife and I like it would be incredibly shocking to me if my children drank to access.

Jeremy 1:19:25
Oh, good. Yeah, I mean, even one drink like one glass of wine can affect can be pretty dramatic for some people.

Scott Benner 1:19:32
My kids have grown up with we talked about modeling earlier. Like, in our extended family. There's modeling that is made my children they don't want to drink.

Jeremy 1:19:43
Oh, good. Yeah. So avoiding alcohol in general is good, but with diabetes, it's always a good idea anyway, but yeah,

Scott Benner 1:19:50
yeah, kidding. I mean, can I tell you she's never going to do it? No. Can I tell you she's not going to change into a completely different person. I mean, I don't think so. She's pretty headstrong, but I think she knows who she is. To enough, I don't think I don't think you could push Arden off of who she is, if that makes sense, to if that ends up being who she is, then we'll have to figure out how to handle that. But I'd be surprised, I guess we'll say, you know,

Jeremy 1:20:15
she seemed like she had a good head on her shoulders. She was very bright. She's

Scott Benner 1:20:19
basically me with like, in a girl's body. She's very just kind of like, she has a dry sense of humor. She's confident that she's smart. She knows. She knows what she knows. She knows what she doesn't know. She doesn't try to play and you know, she doesn't try to play in Sandbox, if she doesn't understand she's, you know, she's consistent. So and she's tough. Like, she really is a tough kid. So we'll see what happens. But yeah, I do. I know. It's in the back of my head. You know, I'm like, it's gonna happen. One of them's gonna turn into a heroin addict or something, you know, oh,

Jeremy 1:20:55
well, you have clarity on her anyways, if she dropped below in the middle of night, you get an alert on her, correct? Yes,

Scott Benner 1:20:59
yeah. But she's gonna be too far away from me to do anything about it. So

Jeremy 1:21:04
that's what I usually recommend parents do is actually get to know the roommate of them. Oh, and have their number. I actually had a patient who was on an omni pod. This was like six or seven years ago, who was on Dexcom. She was something happened to her partly because of malfunctioning pod where it did something to her Basal rate. And she was like, basically, she was like, 30s overnight, and she didn't wake up to it. And her mom got the alert at like three or four in the morning, or actually woke up to it, and called the roommate and the roommate actually was able to go in there and give her her glucagon and, and bring her back up. And without that, I she probably would have died.

Scott Benner 1:21:45
Yeah, that's crazy, though. I'm gonna make sure I have 19 different ways to get to her. Don't worry about that. I probably put an air raid siren in her dorm room, and I'll I'll just control it remotely. I don't know.

Jeremy 1:21:57
Yeah. I mean, I tell that to like husbands and wives. I tell that like to anyone that has any sort of partner or like in their life, to get clarity and share it and make sure that you are always connected. I had one person, another person who went low in the middle of the night, she was on a business trip in Japan. Her husband got the alert, called the hotel. They had to break into the room to wake her up because she didn't wasn't responding to it. And then she was able to treat it and be fine. But if she didn't have that, who knows what would have happened? Yeah,

Scott Benner 1:22:28
terrible. Who really is. This diabetes sucks. It's not it's not great news. Alright, listen, Jeremy. We've been we went over time. Is there anything? I didn't ask you that you want me to?

Jeremy 1:22:40
Um, I don't think so. But I'd love to do this again. I love talking about diabetes.

Scott Benner 1:22:45
To me, I don't see how you're not gonna be back on the show. What do you think of that? Oh, that's great. Dude, you came with stories. You have a clearer view of how to handle type one. Let's stay in touch. I really appreciate you doing this. I really do. Yeah, thank you for having me knows it was a it was a real pleasure.

A huge thanks to Jeremy for coming on the show and talking with me about what he does for a living and some of my ideas as well. Thank you, Jeremy. How also want to thank Dexcom and remind you to go to dexcom.com forward slash juice box to see if you're eligible for a free 10 day trial of the Dexcom GS six. And of course, Omni pod.com forward slash juice box find out about the Omni pod dash and the Omni pod five and get yourself going with a tubeless insulin pump that Arden has been wearing since she was four years old. On the pod.com forward slash juice box links in the show notes, links at juicebox podcast.com. To these and all the sponsors, where you click the links, you're supporting the show. If you're into helping people, especially people with type one diabetes, I'd like to ask you to go to T one D exchange.org. Forward slash juicebox. When you get there, fill out the survey completely. And you've helped somebody all you need to be is a US resident who has type one diabetes, or is the caregiver of someone with type one, t one D exchange.org Ford slash juicebox. Join the registry, complete the survey. Help someone with type one diabetes, help yourself perhaps and support the Juicebox Podcast. You will do all of this in the fewer than 10 minutes that it will take to go to that link and complete the survey. The survey is very simple. You'll know all the answers to all the questions. It is also HIPAA compliant and completely anonymous. T one D exchange.org Ford slash juicebox. There are links in the show notes of your podcast player and links at juicebox podcast.com to All of the sponsors, and two T one D exchange, when you take the time to click on my links or to type them in a browser, you're telling the sponsors that you came from the Juicebox Podcast. And that is a wonderful way to support the show. Are you looking for a vibrant and intelligent community around diabetes? look no farther than the Facebook page, the private Facebook page for the Juicebox Podcast. It's called Juicebox Podcast, type one diabetes. The group has over 28,000 members. And those members are responsible for between 70 and 110 new posts every day, on the Facebook page. Every conceivable conversation around diabetes is happening at Juicebox Podcast, type one diabetes on Facebook, you're gonna see great questions, thoughtful answers, and supportive people. No matter if you're an adult living with type one diabetes, or the caregiver of someone with type one, this group is for you. Doesn't matter if you eat low carb, or high carb or somewhere in between your questions and thoughts are welcome on our Facebook page. I hope you check it out. Last little bit. If you're looking for the diabetes Pro Tip series, or the defining diabetes series or any of the other multitude of series that exists within the podcast, you can find them in a number of ways. They are at juicebox podcast.com. They are at diabetes pro tip.com. And if you belong to the private Facebook group, you can find them listed in the featured tab. Now if you're enjoying the podcast, please consider sharing it with someone else that helps the podcast grow more than anything word of mouth is definitely how the show has become what it is. If you have already shared it with everybody you can think of and you've bought it on the pod or index comm or supported one of the other sponsors. You've done the T one D exchange survey. And now you're looking for another way to give back to the podcast. Super simple. A five star rating and a thoughtful review in whichever audio app you listen in would be amazing. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.