#756 Swiss Diabetes
Dr. Gurpreet Anand is an endo practicing in Switzerland.
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Scott Benner 0:00
Hello friends, and welcome to episode 756 of the Juicebox Podcast.
Today's guest is an endocrinologist working in Switzerland. As a matter of fact, she's the Doctor of a past guest from the podcast. While you're listening today, please remember 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 US resident who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. Join the registry complete the survey help people living with type one diabetes while you help yourself and support the podcast. Every time somebody finishes the survey, the podcast benefits T one D exchange.org. Forward slash juice box. If you're looking for the diabetes Pro Tip series, it begins at episode 210. In your podcast player, your podcast player or audio app is where you should be listening to the show and subscribing. The podcast is available everywhere you get audio
this episode of The Juicebox Podcast is sponsored by touched by type one I just got back from touched by type ones. In person event, it was fantastic. You can learn more about it and learn more about touched by type one at you guessed it touched by type one.org. Also, please find them on Facebook and Instagram. The podcast is also sponsored today by us med get your diabetes supplies from the same place that we get our diabetes supplies from U S med. You can contact us med two ways by going to us med.com forward slash juicebox or by calling 88872115140. That's right, we're not in the same timezone our way. That's true. I appreciate you doing this. Thank you very much.
Gurpreet Anand 2:25
I'm really excited to talk to you and my personal thanks for the good work you are doing and contributing to the diabetes community. It's it's a great work.
Scott Benner 2:37
Oh, thank you so much. That's lovely. I, I don't usually start these with people's being so kind to me, your throw me off my game. I am very, very grateful for your words. Thank you.
Gurpreet Anand 2:49
Scott, you are a change maker. You are changing lives of people suffering from diabetes, and it's a great work. Oh, that's
Scott Benner 2:59
very, that's very kind of you.
Gurpreet Anand 3:01
My name is Gurpreet Anand I work as endocrinologist in Switzerland. Originally I came from India, I did my medicine there. And here I learned internal medicine and after why afterwards I specialized in endocrinology. I have been working in this field for the last eight years. And I'm really happy to be able to contribute to the lives of people, especially people with diabetes type one because it is a very, very difficult disease, but a very manageable disease, the patient can really change the course of the disease. If the patient agrees to do that. I have got two daughters, and my husband. We are actually all from India. My two daughters are born here. As a child, I always wanted to be a doctor. Because I my mother, she was a nursing sister. And she worked in a hospital and I saw the white coat. And I was amazed by the way bytecode and I wanted to use this byte code. That's why I became doctor and I have never regretted this choice. I'd love to be a doctor. How old are you? I am now 48 years old.
Scott Benner 4:27
Okay. I'm sorry. You said you live in Switzerland?
Gurpreet Anand 4:31
Yes, yeah. Okay, for the last 20 years.
Scott Benner 4:33
Oh, wow. That's great. So I have to ask first, I guess how you find the podcast.
Gurpreet Anand 4:42
I find the podcast great. I was introduced to your podcast to my patient because I wanted to know how what were the things which influenced life of my patient and she introduced me to your podcast and then then I started listening Do your podcast. And I was deeply impressed. And I recommended this podcast to some of my patients as well. And even they appreciate the podcast a lot.
Scott Benner 5:10
That's excellent. I have to I'm trying to remember. If I'm going to be able to mention who your patient was, I think it's, it's better for you if we don't say who it is, is that
Gurpreet Anand 5:22
right? Yes. But I think we both know it.
Scott Benner 5:25
Yeah. Well, I know who I definitely know who it is. And yeah, any astute listener of the show might figure it out, I guess. But, yes, but, but that's really wonderful. So she came to you? And or I guess, how does it How does it happen? Are her outcomes so uncommon for you that it actually made you ask, how are you doing this? Or how did the conversation begin?
Gurpreet Anand 5:50
So actually, I asked this question to each and every patient who comes to me for the first time, what is their experience with the disease? What are their goals to achieve with the disease? And that's why I came to know her and I came to know what deeply influenced this person to better manage her diabetes. And then she mentioned your podcast, I say,
Scott Benner 6:16
did it? Was it surprising to you, if when she said, it's from a podcast?
Gurpreet Anand 6:27
Not in a sense, because I'm always myself very impressed with the podcast industry, not only in diabetes world, but also other guys, because technology has made a lot of advancement. And basically, everyone can get information from everywhere if the information is useful. This is something which we should appreciate and support. And I was impressed after I listened to the podcast, because I really didn't believe her for the first time, because I wanted to know what is so good about the podcast? And as I listened to it, I was totally convinced that's true.
Scott Benner 7:09
No, that's lovely. Do I? What's the question? I guess maybe to you, it's not so different. But it was it odd to you that I don't have diabetes.
Gurpreet Anand 7:23
Actually, you are a person who doesn't have diabetes, but has a real contact with someone close to diabetes, and who could really with his own interest, learn so much about diabetes, with even patients without the VT diabetes to manage to have it in in such an appreciable amount of time?
Scott Benner 7:50
I think that I've always thought I guess that the mixture of my desire to help Arden and yeah, my loving concern for her mixed with the, I mean, the benefit of me not actually having diabetes, right, like so you get to kind of figure things out without going through them directly. You know, it's, it's easier to philosophize about how to manage a low blood sugar when your blood sugar is not low. Yeah, I can see. I mean, obviously, through the years and the conversations, how difficult it must be for people to not understand how their type one works, not understand how their insulin works, be caught in the situation and then be expected on top of all that to figure out the situation. It's just it's a, almost an insurmountable task.
Gurpreet Anand 8:41
Yeah, you're absolutely right. I think the problem is, in in case of type one diabetes, that there is a person with diabetes to be managed, and there is diabetes to be managed. These are two different things. And it is very difficult to separate one from the other.
Scott Benner 9:02
How frequently are people's personalities? A speed bump for them having success? I mean, what do I mean? Are there just some people who, through the sheer fact that they don't want diabetes, or they have, you know, some sort of I don't know if you would call it PTSD, but they're still shocked from their diagnosis, or angry does? Does that stuff weigh in very heavily when you're helping people?
Gurpreet Anand 9:36
Actually, in my experience, this is the main factor influencing outcome of diabetes because as you know, we have technology we have sensors, we have insulin pens, we have insulin pumps, we have hybrid closed loop systems, we have everything which can manage diabetes, but if the patient who has to To really get to know this technology and invest some time, it's not ready. Nothing works. It is the patient is for me, the main factor affecting outcome of diabetes and diabetes denial is so common. In the beginning at least, that it really it's the greatest barrier people used to call hyperglycemia as the greatest barrier. But I would say, acceptance of the disease, which is potentially manageable is the greatest barrier
Scott Benner 10:35
and not accepting it. There's real no click, there's no clear path to success if you're fighting against this the entire time. Yeah, right. It's going to win, right? It's just, it's got more stamina than you do. You know, diabetes doesn't need to sleep. And it can come after you when you're sleeping. Or, you know, in the middle of things, I'll tell you right now, like, break right now, as we're speaking, Arden is on a class trip. So she left. It didn't start well, and you knew it wasn't gonna start? Well, she had to be at her school at 1:30am. And then they sat them there for an hour, put them on a bus, bus them to an airport, sat them in the airport. And you know, by 615 in the morning, she's climbing on a plane for a three hour flight. Now, she hasn't been asleep, probably for close to 24 hours at the time that the plane takes off. And you know, we had had just multiple conversations and like art, and you're probably gonna get low on the plane when you close your eyes after all this. And sure enough, she did. Her CGM woke her up, she was able to handle it fine. There was no Wi Fi on the plane. So quite literally, no one knew that this was happening. But her, you know, in her seatmate who was a longtime friend, she managed that fine, she got out of the airport fine back on another bus. And then they dropped the kids in the middle of the Disney, I think Disney World, right? That's Florida, Disney World. It's 60, you know, between 50 and 60 degrees warmer in Disney than it was when she left New Jersey. And she's not allowed to go into her room for hours. And they just start marching around this park and the heat. And we did a good job. Like it wasn't too bad, we kept her blood sugars together. They weren't anything like what they usually look like here. But by the end of the evening, she tried to eat something she Bolus for it. And, you know, then the next five hours 10pm 1112 one two in the morning, we were just holding on with our you know, with our fingernails, trying to keep our blood sugar above about 65. And finally, at about one 130 In the morning, it just, it just kept dipping down and we couldn't stop it. And this is with an algorithm like taking her Basal away and trying. We got her stable, she slept fine overnight. And now this morning, with just a few hours rest, everything is much more stable. And I'm learning because this is a new situation. For me. I honestly think that her lack of sleep was the biggest problem in this whole thing. Because now that she's arrested, we haven't changed anything, she's back out in the heat and things are going very well again. I just I'm surprised every day at how this thing can throw monkey wrenches into the system because I'm about as good at this as somebody can be. And we were not good at it yesterday for about six or seven hours. But it is really testing my knowledge today. It's I don't know, I just I don't know how she would have gone and done this without this technology or someone helping her. I mean, without this stuff, she would have been, I would say scary or dangerously low two or three times already in the last 24 hours.
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Gurpreet Anand 16:52
Scott, thanks for sharing that with me. Because I think this is a perfect example of technology working at its best person who knows the technology working at the best. But still, blood sugar has some inherent variability in Saline application has some inherent variability. And we have to learn to accept that, that there are going to be situations where we do have 100%, right. And the result is still not what we want. And we have to be really fluid flexible as you always tell just flow with the flow of diabetes because you cannot manage it perfectly well in all the situations there are situations which are going to surprise you time and time again. And this we can imagine how difficult it could be for people who don't even know what they can do. They can change I would
Scott Benner 17:57
like people to know when I told the story so that I could follow up with this is that when she was drinking the juice overnight, the the school had hired a nurse so there's a nurse living on the floor, you know of the hotel, and that nurses She's lovely. She's following Arden CGM. And I had called Arden to wake her up the nurse would have not known at that time that I was awake watching Arden's blood sugar. And I called out and woke her up, had her drinking juice. And at the same time I heard the nurse come into the hotel room. And she was speaking to her and she's like, are you talking to your dad on the phone and it was happening at that exchange right there. I want to be honest, that is the closest I came to crying in quite some time around diabetes, just that it was the middle of the night and Arden was trying to be on this class trip. And instead, you know, there's a stranger standing in her hotel room seeing if she's okay. I almost cried. I just listening to the exchange over my phone. And instead I reminded myself that without this technology, this would have been much worse that I knew what to do. And she knew what to do. Arden's been doing a terrific job while she was gone, and in the end, she has type one diabetes, and that is the factor I can't impact like that's always going to exist. I can't I can't sit there and be sad about something that I want. That doesn't exist, you know, so I decided to deal in the reality of what was and I pushed on my eyes and wipe the tears away and got her back on the phone and told her you know, I was going to watch to make sure her blood sugar came back up before I went to sleep and she should go ahead and go back to sleep and her blood sugar came back up and leveled off and we were good. But yeah, she's had diabetes since she was two. I don't really remember the last time it made me sad but but last night came pretty close. Yeah, yeah.
Gurpreet Anand 19:59
I can really only share my feelings because I personally have no experience with someone close having type one diabetes, I have patients. That's true, but I never experienced hyperglycemia. On my own I experienced with my patients, yes, but it is an entirely different different experience. If you have this experience in person. It can be a close patient, it can be your relative, and it is absolutely a different reality. Because once you experience hyperglycemia, every patient processes hyperglycemia in his or her own different way. Some people they don't want to have another episode of hypoglycemia. And that's why they keep their blood sugar levels high so that they don't fall. That is one barrier to better management of diabetes. The second barrier is once they even see the blood sugar level is just sinking. They overcorrect because they don't want blood sugar to follow. These are so many difficult issues which patients face. That it really sometimes
Unknown Speaker 21:23
it's very difficult to convince the patients
Gurpreet Anand 21:24
to do the right thing,
Scott Benner 21:26
right? It's paralyzing it stops you. Yes, I'll tell you the most proud I've been in quite some time is this morning when I woke up and saw that Arden had had breakfast, she Bolus for 50 carbs, and texted me later and said I said I got a bagel and ate some mixed fruit. My blood sugar was I forget what it was like 136 When I woke up, and she's like it's going down. Now, I don't know if this is going to go right. And I looked at it. And I said, this looks great to me. I said we've we dialed back or settings about 20% for the day for her to be out in the heat walking around. So because she's on an algorithm, basically, everything's dialed back 20% Her Basal correction factors, carb ratios, everything's just kind of dialed back right now. And I said, I'm looking at the graph, it looks very much like it's gonna level out to me, I think you did a great job. And now this a number of hours ago, she's, she's been very stable about at 115 bout between 112 and 116 for the last two and a half hours. But she did not act scared that she got up in the morning. And she did what she knew was right again, and just went right back to it. She was a little nervous. But I think the nervousness was, it's because she's alone. And she's still about to go out and live a day that is not normal for her trudging around the heat, you know, for however long they're going to be doing this. But I was proud of her that she just she didn't blink, she did it again. And, and did a good job. So I think it's there. You know, I don't think there's any shame in leaving her blood sugar a little higher for today. Yes. And I know that some people might hear that and think, you know, that's ridiculous. I'm saying like 112 is a little higher, but for her it is it's it's probably 20 points higher. You know, which is a pretty big deal for, you know, long term, but for the next couple days is meaningless. So anyway, I was proud of her that she she got back out there and tried it again, like she she doesn't give up. And she's knows what it's like to be low. And you know, so far so good. Nothing's happened. That scared her too much. But I've also spoken to adults that have had such scary. Like you said, you know, such scary situations where they were alone that they just have a hard time trying again, how is it for you to? But I guess my first question should be do you treat all of your patients with the same information? Or do you tailor tailor it to what you believe they can manage and accept?
Gurpreet Anand 24:10
This is a great question. I think it is impossible to treat, all type fine one patients alike. Because every type one patient brings a completely different kinds of resources to the consultation. And I have to accept and respect the values because everyone is going to reach the goal, which he or her self establishes the goal because the diabetes management is management to the patient himself. I am just a coach. I'm just an advisor who can help give basic understanding about diabetes. But the management is left to the patient himself because he has to deal with the diabetes 24/7. And I have to deal with the diabetes every three months. And it's an entirely different situation.
Scott Benner 25:08
Yeah. So what do you give them? Like a high level overview and hope that they pick out the details? Or do you do literally look like? Is that a weird thing to have to do to judge somebody because you are quietly judging their ability, right? So that you can make, I don't mean judging in a bad way. I mean, it like you have to assess them, and decide what they can handle. Is that right?
Gurpreet Anand 25:36
That's right. So it is different in every scenario. For example, let's take the example of someone who has a new diagnosis of type one diabetes and comes to my consultation for the first time. The first reflex from me is to just get to know this person, how this person is coping with the new diagnosis, it is mostly a shock for everyone who has the diagnosis. So it is okay to talk about this shock, shock or believe it the patient tell them that it is a shock for most of the patients. So it is normal, just normalize the shock situation because it is normal for each and every one who is going to have diabetes, especially type one diabetes, and then tell them that it is a slow process to get to know the disease to get to know how to manage the disease, but it is going to get better each and every day, we mostly treat the type one diabetes patient on ambulatory basis. Early earlier patients used to get hospitalized. But nowadays, it is so much ambulatory management, they have to come to the diabetes nurses, they have to come quite regularly in the beginning so that they know how they manage hyperglycemia how they managed hyperglycemia. This is kind of repeated education on on a daily basis in the beginning. And afterwards, we can change the frequency and see the patients every month afterwards every three months. But it is a process they have to go through the process. And I tried to give them the analogy of driving a car, it is very overwhelming in the beginning, because you have to understand that you don't speed up the car, you know how to put on the brakes. These are the things they have to learn in the diabetes as well. Sometimes they have to come off the mark. But there is also a learning and they learn how to apply brake slowly, they learn how to push the gas pedal fast, they learn and it gets better, but it needs time.
Scott Benner 28:03
I understand why you like the podcast you and I think a lot like about these things, don't we have you
Gurpreet Anand 28:11
I can also really say yes to that because I think we as human beings. We want to live life normally. And if we can bring the understanding of diabetes same as how we live our lives, we can get the patients to understand better what what they expect from the disease, what they expect from themselves. But what I mostly end on a positive note is that everything you do has a consequence, if you decide to treat the disease, it is your choice. If you don't decide to treat the disease, it is also a choice. You cannot not decide you have to decide something and you're going to see some results.
Scott Benner 29:00
It's not happening to you as much as you're deciding which path to take once it becomes clear that this is your story and you have to go live it. Yes. This is kind of an odd question. But do you ever walk into a room and just not recognize a patient? Like I'm trying to think of how hard is it to keep everybody's story straight in your head? I realize you take notes and you have charts. But do you ever just walk in and think like I do not remember her and then have to look down? And because if you don't I mean you're in a really interesting relationship. Because you see a lot of people, they see one doctor. So in their minds, you've probably been thinking about them for the last 90 days. And you're just waiting to see them again and help them like that's the attitude you come into a doctor's appointment with like you have questions. You've learned things you have, you know, new ideas to try. And then you look up and this person who hasn't seen you in three months is standing in front of you I was wondering how difficult that is as a physician.
Gurpreet Anand 30:04
So, my personal take is definitely I don't remember all the stories in my head. That's why I take notes. But I try to remember something in their personality, and try to link that something in the personality with the story. So that I just have some basic cues, because each and every human being likes to be acknowledged as a person, without judging them, just just like something, if someone is a good tennis player, I tried to discuss with them their hobbies as well, because so that they just have the feeling, it is not always the disease, it is the person who has the disease, which is in in main point, because if the person is addressed, the disease gets addressed on its own. Because, basically, if managing the disease is so important to this person, this person is going to manage the disease very well. And I have to address to this person who is coming to me.
Scott Benner 31:15
Yeah, you know, I tell people, what, I have spoken to a number of people privately in my life. I mean, as a matter of fact, I think part of what got me ready to make this podcast is that I used to be a person who others would direct people to, they'd say, Oh, you want to talk to this guy, like, maybe he'll call you and talk to you, like he talked to me. And so there probably have been hundreds of personal phone calls, that would have made great podcast episodes, you know, trying to talk people through new ideas and get their, their minds kind of straight. And what I've noticed more often than not, is that the desire to do well, is maybe one of the most important parts of this. And I guess you could like call that attitude or, you know, frame of mind or whatever. But if you if you want this to go well, and you have successfully searched down good information and tools and an understanding of how to use them, usually things do go well, you know, and the level of what well means, you know, you've pointed out very clearly is up to the person. And I tell people all the time when they're talking about like, how do I set my basil, I learned to say, basil, his job is to hold your blood sugar stable at a number you want it at? You know, because the number I want it to sit stable, I might be different than yours for a number of reasons. But I just think that I can't put my finger on it. You know, exactly. I don't think I can articulate it perfectly. But the people who want it did go well. I know this doesn't sound completely clear. But oftentimes, they get what they expect. And I find that to be repetitively proven out. People who have their heads down, or they seem over too overwhelmed at the time, you know, might be a way to say it might be they're not ready for the information. It's just it overwhelms them too much. But there's something about that energy that like I'm going to do this. It's important. You know, I guess the in AAA they call it fake it till you make it. Right. But I think it's important. I think that that attitude is it's one of the tools.
Gurpreet Anand 33:44
You're absolutely right. I can tell you an example from a patient who came to me, he had a bipolar disorder. And he got the second diagnosis of type one diabetes. So it was very, very hard, because he was already finding it very difficult to manage bipolar disorder. So the diabetes was on top of it. He was also the patient I had to take in. I had to admit the patient just to let him know the basics of treating diabetes first. And it was very difficult, but I talked to him, I told him in the beginning. It is difficult, but it gets easier. When you see you can establish a routine. And it starts with the looks like a lot. But if we break all the pieces down to very basic information, it gets easier and easier. And luckily this patient has gone into the honeymoon phase and he's still in the honeymoon phase and he has very little amount of insulin and is so stable, what my motivation is with the new diagnosis of type one diabetes, because I have seen that in so many people nowadays, that I stress the need of starting in Saline, as soon as possible to just make a few beta cells which produce insulin in pancreas to just give them the chance to survive the insult, because in the end, we don't know what kind of insult happens in a patient with type one diabetes, how early are we can we save some beta cells, and if we can save some beta cells, this is like a big, big advantage for type one diabetes patients, because these patients are going to have much better time managing the disease if the start or the end, mostly, people see that it works very well. My second motivation is even though they are in a shock situation, by the new diagnosis, I tell them, the body is going to give them much better fitness segments. As soon as the blood sugar values are not in 20s. So we use the unit's 20 millimoles per liter. And it is in the range of four to seven, they are going to see a difference. And that's so true. It is very important to tell Typhon patients in the beginning, not about complications, but about the quality of life, because that is something they can relate to it in the immediate period, if they really put efforts to it.
Scott Benner 36:53
I wonder sometimes if people's lives have gone, so unlike they've hoped that they don't imagine that this is possible. Do you know what I mean? Like hope is Hope is something that sometimes built from hope. So if your life has gone, you know about the way you've hoped or the way you've expected, and then you run into this diagnosis, I bet you it's easier to believe that this can work out well for you as as you know, too. But if everything has just gone wrong over and over and over again, and then on top of this, you have I mean, think about bipolar disorder, and then type one diabetes. I mean, I wonder where you mind that hope from? You know, and that's where it's obvious it has to come from the physician, or the or the support system? Because they they don't have it to use, somebody has to give it to them. Yeah, that sounds incredibly thoughtful. Have you I've had at least three or four people on the show who have bipolar and type one. auto immune, inflammation, these things. It's a real it's a real scourge on humanity, that, you know, the idea that we have not found a way yet to, to stop that autoimmune response is, I mean, it would just be one of the greatest things that happen to people. There's part of me that's very hopeful that AI sounds crazy, maybe but that COVID has shined a light on the need for research. And I think I think maybe now that COVID is is omnipresent. I really, really think that we might get some more answers about how inflammation works and how to stop it over the next handful of years. But it's just it's terrible. I mean, to have one or two. I mean, they feel like your body's attacking you on multiple fronts is it's overwhelming. Yeah, yeah. Okay, so what? This is the fun part, when I talk to a doctor, what do I do that you think is right? And do you do I ever say things that you're like, Oh, God, don't say that.
Gurpreet Anand 39:11
Do you mean as a patient?
Scott Benner 39:12
I mean, as a as a podcaster? When you're listening to this podcast, do you ever think like, he shouldn't be saying that? Or do you generally speaking, agree how what's your experience like as a listener, I guess?
Gurpreet Anand 39:28
I must say, I generally agree because because you resonate with the people having this difficult to see is and I have the feeling. All your advice comes from a different level of experience, because you talk openly about your experience with Arden. And what I particularly like are your podcasts with Jenny Smith, because she brings some input From her experiences well into the podcast, and I literally love your podcast.
Scott Benner 40:08
Thank you. I was, I didn't know, I honestly didn't know what you're gonna say. But I mean, I would have been interesting. If I was you're like, oh, never say this again. But the wait. So the way I sort of see it, it's, um, you have to understand you mentioned earlier that the medium is valuable. Like, you have to understand that 100 years ago, if I had information that I thought I was going to share with people, that maybe the best I could do is to write it down somewhere and hope they saw it, or stand in the middle of town on top of a, you know, a crate and yell out to them. This, this is, this is the best way we have to communicate right now on stuff like this. And but I shouldn't have said that, I should say, but, but there are constantly new people coming into it. So you have to create this entity that has the information, but is entertaining enough to hold people as listeners. And the reason that's important is because if the podcast doesn't exist as a popular entity, then when new people need the information, it won't be here for them. So so the stuff with Jenny, the management stuff, or when we talk specifically about management stuff, there's an argument to be made that you could just make those episodes. And you wouldn't need the interviews with other people, although I do think communities a huge portion of managing type on but the problem is, is that if it was just the static information, people wouldn't find their way to it. So you have to create this kind of living entertainment that brings people in so that once they're here, they can go find the guy in the corner who's standing on the woodbox yelling with Jenny about Pre-Bolus thing. And it's a, it's a delicate balance. It really is. I think that's where we go wrong. A lot of times helping people with diabetes is that we say things like, oh, that's on a website, or you know, here's a pamphlet, people aren't attracted to stuff like that. And they're already in a bad situation. And now you're telling them go read a pamphlet, go read a book. I don't want to read a book, I just found out my kid has diabetes, I just found that I have diabetes I want I want this to work, I want to be saved, I don't want to feel like I'm getting my blood sugar's going low every four hours, I don't want to be scared to go to bed, I don't want to be scared to put food in my mouth. And that that turmoil is happening for them 24/7 You need to be able to come in and just give them enough that they can make a meaningful step forward. So that they can believe that there are other steps forward to take. And then you just sort of keep layering the information over top of them and they and then they absorb it as they can because then that's the next problem for me is that everyone who's listening isn't in the same place. So I can only put out one set of episodes. And they somehow need to capture the imagination, invigorate the hope of and hold the attention so that people can spend enough time inside of a ticket out of it what they need. It's a it's a unique platform that allows for all that to happen. I'm very grateful for it because I used to write about this stuff, and it's not as effective.
Gurpreet Anand 43:36
Scott, do you know why is it effective?
Scott Benner 43:42
Well, I can start off by joking and saying I'm delightful. And that's why. No, no.
Gurpreet Anand 43:49
That's absolutely right. But I give you another reason. Out of my perspective. We as humans, have not changed a lot over 200 years. We used to value word of mouth, we still value word of mouth. We used to value something valuable for us. We still value something valuable for us. If someone some patient with type one diabetes, find value in your podcast. No one is going to prevent him from listening to your podcast. That is the main important message you want to be of value and you enjoy doing it. And you bring your authenticity to it. And that's why your podcast is so valuable.
Scott Benner 44:45
Oh, that's very nice. I am I do really? I really do enjoy making it. I am genuinely fascinated when I talk to people. I don't think I've ever had a conversation on here where I've But gotten off and thought, Well, what a waste of time, you know, like, I just want to get to know somebody or to hear their specific story for people to get there to get there to be able to get their thoughts out, you know, there's someone else listening who thinks something similar. And there's just such a, there's such a comfort in hearing someone else say something that you're thinking, you know, and to, until be able to give that to people who are in such turmoil at some point, I think it's a gift really, I am, I never, you know, as a as a kid growing up, or even as an adult. You know, I think we all think the same way, right? We're trying to sustain ourselves, I'm trying to make money, I'm trying to buy food, I'm trying to put a roof over my head and help my children. And, you know, there are times when you come to the conclusion, like, I'm going to have to take a job because it pays me to expect that your job would actually help somebody would be a huge win. If you had a job that you didn't like, that helps somebody, it would be a huge win. But to have a job that you like, that helps somebody and puts a roof over your head. I couldn't possibly feel more lucky about that. And that's why I work so hard to keep it going. Because I a see what it does for people. But honestly, it's the best situation I've ever been in. You know, I don't, I don't want this to stop. And the only way I get to keep it going is if it continues to innovate and help people and find ways to new newer people and find ways to to keep older listeners entertained and with value. Like I don't want to just come on here and say stupid. You know what I mean? Like just for people to come on. Like, I want you to leave this hour feeling heard and seen. I want you to feel like you learned something that's going to be valuable to you. And I want you to feel like it wasn't a drudgery to get to that information. I don't know I love this. I guess you're right. I guess if it was a couple of 100 years ago, I think I would probably be doing some form of this get on talking to people, I really do enjoy it.
Gurpreet Anand 47:19
You would have been surrounded by a group of people like a campfire. All Okay, one patient's just surrounding you, and asking you for your advice. I can really imagine that team.
Scott Benner 47:33
Well, that would be nice to do it
Gurpreet Anand 47:35
beautifully.
Scott Benner 47:36
Thank you, it would be nice because I could stand up while I'm doing it. Because I'll tell you the one downside of this job is I am sitting too much. So I do need to get up and move around a little bit.
Gurpreet Anand 47:47
That's, that's important for your health.
Scott Benner 47:49
Yeah, you guys are gonna kill me making this if I if I ever if I go over while I'm making it all, I'll teach someone in the house how to put the episode up so people can still hear it. But But No, but seriously, it's it's a joy. But it really is a joy to do. And you have to be a little single minded about it too. I record this show, I mean, at least four times a week. There are times when I do it twice a day. My schedule is I mean, you and I are talking in February, if you wanted to be on the show right now. I think you'd have to book in November. Yeah. So it's, and that's that's the part of it that doesn't get spoken about enough. It's the people's willingness to come on and share or ask questions. It's the only way other people are going to get the content. You know, if there's no one for me to talk to this ends pretty quickly. You know, you eventually get tired of me talking to Jenny. We're talking to myself.
Gurpreet Anand 48:55
I think as long as you are offering your hard work, you're offering your interest, you are never tired of talking about diabetes. We can feel it in your podcast. That is so important because the way you do it, you bring freshness to the podcast, you bring value for your audience, and that is all which matters in the end. In the end it is the value added to your audience so that they really find it worth listening to your podcast. And that is the biggest multiplier you have. If your audience finds value, it's going to attract even more audience and satisfy your podcast is going to keep on living and I would really wish your podcast to keep on living because it is helping coming community of diabetes type one patients
Scott Benner 49:53
I have to tell you that you know there is an avalanche of notes and letters and even on the Facebook page at this point, I think that's how most people try to contact me. At this point, there's an overwhelming number of people who are a little farther down the road now, and they come back to tell their story about, oh, I found the show six months ago and like, look where I am now. And they're sharing their, you know, their successes. And I think that's great. I think that other people need to see, they need to see someone that's a little ahead of them on the path, having success, telling them, I used to be back there with you. But I really think you could be up here with me. And the truth is about the value. So So sort of a weird business, the side of it is that if people didn't listen, I couldn't make the show. And so it's their support that creates the value. And one specific example is, like we're doing a series right now about thyroid disorder, right? On Fridays, Jenny and I are like putting out these short episodes explaining hyper and hypothyroidism, Graves disease to people, which is something that is incredibly common in a type one, you know, diagnosis, and people don't have the information about it. And oftentimes, doctors are not particularly good at managing it either. But it's not. It's not a it's not at the top of people's minds. So my ability to dig down and do smaller topics, is because I know the listeners will support it. So you know, all of the all of the kindness aside about how the podcast helps people and, and how much I enjoyed doing it and all of that, there's still that component of it, that if it doesn't get downloads, then advertisers go away. And when advertisers go away, my wife is going to ask me to make money a different way. You know what I mean? And then the podcast disappears. So it's people supportive the podcast, their willingness to listen to topics that maybe, maybe they wouldn't believe is important to them. But I think they find the podcast valuable enough that if I put something out, they think, Well, if he's telling us about this, maybe I should listen. And, you know, when we're done with thyroid, we're going to do celiac. And, you know, we're going to continue to pick through things like that there, that are going to come up in a lot of people's lives, and they should know how to look for it and, and how to manage it if it should happen. But again, that doesn't exist without the support of the people listening, you know, if they don't, if they don't download the show and listen to it, then I can't keep making it. So it's really as much about their effort as it is about mine. As far as longevity goes.
Gurpreet Anand 52:45
Yeah, you're absolutely right. I don't know whether we are ever going to come to this. My main reason for coming to this podcast was to tell community of type one diabetes patients one tank, and that one thing is their management of type one diabetes, and their management of their own life is going to be totally aligned. If they are having a good life, they are going to manage their diabetes better. There is no question about it. If they're having difficulties in their lives, it is almost impossible to get the diabetes well managed, because diabetes and life go goes hand in hand. And that is very important for type one diabetes patients to know that means if their life is not going well, they can intentionally put some efforts to manage the diabetes well, because it is going to have repercussions in their lives. The same goes the other way around. If they are managing their life, well, they are going to get the motivation to keep the diabetes well as well. And it is very important. That's why to have good routines. That means if they know how to manage situations with hyperglycemia, if they know how to manage situations with hypoglycemia, and they keep on doing it, they are going to do it almost the same way in difficult situations. But it doesn't happen if the life gets difficult. And they start then to manage diabetes. Well it doesn't go this way. Because in periods of difficulties, we as human beings are at our worst. Only when we we are feeding Good, we are feeling happy we find life worthy living, we are at our best. So that's why there is another reason for type one diabetes patients to just gather enough courage at the maximum diagnosis of diabetes, to invest some time and effort to get to know the disease so well, so that they can manage it. Because ultimately, they are the manager of the diabetes, and they can do it with today's technology, we have so much support. So many things get managed very, very well.
Scott Benner 55:41
Are you also talking about the personal happiness and contentment, calm? Things like that? Are you talking about just a general ease in their life, staying away from people who are difficult to on their psyche? Jobs that make them upset, like how far are you talking about this about having life in a good place, so that the management can be easier.
Gurpreet Anand 56:11
It is actually on a very, very broad face. That means if they each and every one among us, wants to have some control in our life, on this disease, and if we have this feeling of control, a feeling that we can manage the situation, it is a very different feeling of contentment. And it goes so much for life. If if I can tell, I can choose my profession, I can choose my lifestyle, I can choose and manage everything the way I want. That is contentment. It is true for diabetes, as it is true for life. So just imagine if you have to do a job, which you don't like to do, that is almost guaranteed discontentment for your whole life.
Scott Benner 57:10
But when you when you're given diabetes, almost like a job that you don't want to do, then the key after that is to find a way to do it in the easiest, most comfortable way for you, so you're not fighting against it constantly.
Gurpreet Anand 57:29
There again, I try to give an example to my patients, I tell them, Look, this is not a disease, which any human being is going to choose. It just comes and when it is there, there is a choice to be made to manage it. Or let the disease manage itself. And it is far better to manage the disease yourself. Because then you can have phases where you can decide, okay, now I'm not feeling very good in my life. Now I'm deciding to just ignore the management of diabetes, but you have the control, you have already managed it. Well, it would be very difficult, then for you to manage it badly.
Scott Benner 58:26
Yeah. And then from there, then that's when you need to know, like, what's next. Like when you've made the decision, like I'm going to do this well, like I'm gonna put in the effort. And I'm I want these results. The truth is that you can put in a lot of effort in the wrong way. And it just ends up being frustrating. I think that's why I can't believe I'm going to say this year, but I think that's why those pro tip episodes with Jenny and I are so important because you have to know how to let lay down that foundation like okay, I've decided, I'm going to build a new house for myself now. What's the foundation look like? How do I get the walls up? How do I get the roof on? How do I do this in the right order? You know, how do I stop myself from, you know, trying to I don't know, you know, nail in a screw and I need a screwdriver. Like you have to understand the tools for the job, how to build that foundation. And then once you do that everything you're talking about becomes much, much easier. Yes, so I guess cliched to say but you want to put the work in up front so that you can enjoy it afterwards. You know, it's hard to build a house. It's harder to live 20 years in a refrigerator box. So, you know spend three months in the beginning, getting a roof over your head, and then that kind of happiness and ease that you're looking for is so much easier to find and maintain. It's just you got to put the work in I'm always a little saddened when people reach out out to me and say, Look, I hear everybody saying this podcast is helpful, but I don't have time. And I always answer them, like, very honestly, I'm like, honestly, I think you, you don't have time not to like you have to give time to this. Yes, you know, do a little work now. And, and the rest of the time is much easier. Can I Can I ask you a question that might have nothing to do with this, but sort of does? In your culture? I'm, I'm speaking specifically about in the Indian culture, there's a wave of type two diabetes. Is that surprising to you? Is it? Is it something you can put your finger on? Like, why does it happen?
Gurpreet Anand 1:00:42
That's a good question. It depends upon our basic change in eating habits in India now. And the ethnic relationship to beta cell mass. People in Asia, they are from their ethnic built, they are thin people. And nowadays, with change of eating habits, they tend to get more fat deposit on the abdomen. And that's why type two diabetes incidence is exploding in India, China, because these people have changed their eating habits to more or less to the western culture. And their body is not adapted to store fat in healthy places, they store fat in the abdomen, and they get very easily type two diabetes,
Scott Benner 1:01:43
I have to say that I live in a part of in the United States where there's a pretty large Indian population around me. And my daughter has a number of friends who are Indian, so we get to see Indian families. And I think that the one thing I've noticed, is when people immigrate into, into the US, that the availability of food, and it being so everywhere, you know, it's so easy to go to a restaurant or to a store and buy things. They they sometimes people fall into that trap of just Oh, it's you know what I mean? They're always at restaurants, or they're always doing this or that. And it's, I don't know, I see it, I see it a lot, honestly. And I hear all them talking about my husband has type two, my wife has type two. But you know, I just didn't I don't completely understand it. I thought maybe you'd be in a unique position to explain it. So I appreciate that very much. It's a so that you're saying the thing to do is just eat cleaner, eat healthier, and exercise, try to keep that that weight off your abdomen.
Gurpreet Anand 1:02:58
That is true. Yeah, eat healthier, and sometimes also plan some phases with which you just don't eat. Like time restricted feeding. Because in our culture nowadays, it is getting more and more importance because people are snacking almost every time. They have snack in the afternoon, they are having their main course meals. That's too much storage happening in our body, whichever body doesn't need because we have the move of ourselves.
Scott Benner 1:03:30
Yeah, I believe that, that restricted time eating is is helping me a lot as I get older. I try I try very hard to eat between like 11am and 7pm. It's the best I can. And it's a big deal. Like I've noticed a great benefit for myself. So far. Okay, so is there anything that we haven't talked about that you wanted to have I skipped over anything or, you know, do you feel Do you feel a calling to say anything else, I want to make sure that you that you get everything you want out of this experience?
Gurpreet Anand 1:04:05
I just want to tell your audience that in the management of diabetes, the most important variable is not diabetes. It is the patient himself. If he thinks it is verted to manage the disease, whole technology doctors they are available to help you but the first step has to be taken from you. If you tell you want to manage this disease, this disease can be managed very well. Nowadays, a patient with 6% Hva warranty can have 116 years to develop long term complications. That means long term complications out of the picture. Nowadays, it is the question how well we can live despite the stack font diabetes, and it is possible to live an absolutely normal life, but it comes with the price of getting a different routine established and following this routine. Your whole life. That is the hot price.
Scott Benner 1:05:27
Okay. Yeah, I appreciate that so much. I can't tell you I. I have I am so sorry. If you give me a question, hold on one second. It's gonna be kind of strange. But Arden's trying to call me she has a question. So I will hold on to you. And then we'll get back to our conversation for one second, but she's just in an awkward situation. Hold on. Hey, yards, go ahead. So I.
Yep. You can just test one more time. And then yes, just make sure make sure that numbers like not wrong, right. Not right. Do you have other stuff with you? Okay, yeah. So go ahead and just test and then see if have you been sitting on the sensor maybe or something like that? Oh, okay. So go, I'll stay with you while your test, okay.
So I think the thing you're running into is that you Bolus really well for breakfast, but you probably still have some active insulin. And then you're walking around so much. So you might need to do you have one of those bars with you though?
Okay, so you drank the juice when? Yeah, I think so. All right. And then and then just Arden, when you when you go on that ride, stick a juice box in your pocket, make sure you have one with you. Okay. All right, text me when you get back
by. I'm so sorry about that. No problem. I'm gonna tell you what she said in a second. But I also wanted to, I don't want to skip over what you said. You know, I think you're right. I think that for everybody who has access to that technology, they really do hold their own possibilities in their hand, you know, and it is, it's so important not to ignore it. And if you can't get that technology for some reason, I still think that there is a way with targeted testing and paying attention that you can, like you said that you don't need to be running around with a five a one C right. Like a mean what you just said a six a one C is a is a pretty good shot and a long and healthy life. Yeah, so that's important. So where Arden is is that this um, you know, she's, she's in Disney. And she is using their past the the disability pass. So what it allows them to do is to schedule a ride, and then show back up at a certain time to get on the ride. So I think what's happening is she's walking and doing a ton of walking in between, right. So she has this meal this morning, which is a perfect like her Bolus was absolutely terrific for and then they go out and they're walking and then they get the note. Hey, come back to the ride. It's time for you to go. So they're hustling back to the ride and just when that happens, her blood sugar just drops like it just it heads over. So she said to me that I like can I go on this ride still? Because she's, you know, she's like, it's time to go on. Like we've been waiting an hour and a half to get on this ride. It's now our time to go on. And now my blood sugar 65 And I have an arrow down on my Dexcom she's like so I just drank her juice. But I want to know like, Can I can I get on the ride she said I tested a little while ago is 120 and she's like now all of a sudden so she tested again. She got a 60 you know a matching blood sugar on her on her test versus her CGM and She's like, What do I do when I was like, she said, I'm going to eat some gummies, I really want to get on this ride, she's like the juices in, I'm going to eat the gummies. And then I said to her just stuffing other juice in your pocket before you get on. So hopefully, I mean, I have to be honest with this is a real time situation. Hopefully this goes, okay. And I just told her like, you know, get a hold of me when it's over. Now the nurse that's on site actually just texted her to to check on her, it's been very nice that that this person exists. But it's fascinating for me to see, even at a 20% reduction of her insulin, once she's walked around for a couple of hours with any kind of active insulin onboard, it's just, it's hard. It's our settings are obviously are obviously meant for when she's in school. And when she's kind of sedentary, you don't I mean, I'm not moving around very much. It's incredibly, incredibly interesting, I'm going to have her take away another, probably 10 or 15% off of her settings for the rest of the day after she gets back from this. Anyway, it's been a real learning experience for me, I think that um, and her. And I think it's a good example of, you know, you can think you have this thing all together, and then you change a couple of variables, and it almost feels like a completely different existence. Sorry, that'll happen in the middle of your thing.
Gurpreet Anand 1:11:27
No problem. First of all, I just wanted to I just heard your talk. I didn't hurt the art inside, but I heard your talk to the art and she must be proud to have us father.
Scott Benner 1:11:42
Oh, I hope so. I think she is Yeah, I don't know why you're saying that. Because I'm just being myself, but, but I appreciate it.
Gurpreet Anand 1:11:52
You're, but you're just being yourself is so helpful for her. And it relieves her a lot. And she's also actively thinking because it's her disease, she she is managing it perfectly with your health. But you are a great resource for her from the beginning onwards, because she was just too she could not manage the disease at that time. It was you. It is so nice to see such such a good father, who who could learn to manage this difficult disease, and is not only managing that he's offering his help to the whole community. This is worth appreciating Scott,
Scott Benner 1:12:41
thank you. Wow, it's very kind of you, I really do appreciate it. I'm now just sitting here wondering if everything I just said to her is gonna work out. So
Gurpreet Anand 1:12:50
it is going to work out. But one thing I just want you to tell also your community is in case of movement, just shutting the insulin down is not going to help alone, it is definitely going to reduce the amount of further reduction of blood sugar. But there is a need of additional carbohydrates because of a body normally manages also on the basis of two different hormones, which are counter regulating effect of each other. Of a body in case of movement. When our body produces insulin on its own, gets the help of glucagon with activity that means we produce more glucose on our own without supplanting it, supplementing it with food. That's why someone with type one diabetes who is very good managed has to add carbohydrates at regular intervals, especially if there is a lot of activity going on. And this is something which people who love to do sport don't like to supplement every 30 minutes to 60 minutes give themselves some amount of carbohydrates. But this is needed because this is replacing the work of glucagon which of a body can naturally do
Scott Benner 1:14:24
Yeah, yeah I mean there's less than the algorithm does its best right and but taking away insulin taking away and so like you said everything listen, I talked about time, everything about insulin, his timing and amount, right. So as you can see over the last couple of hours, I'm looking at Arden's last three hours 133 101 15 112 112 I mean this goes on two and a half hours, and then all of a sudden she gets a little rise to 125 and then I'm gonna guess and that was a bad About a half an hour ago, I am going to guess that I know what's happening. Her algorithm is set up to auto Bolus. So she hit 125. And it auto Bolus with no concern for the fact that she's walking the whole time. Yes, that's what happened. So I am going to have her turn off the auto Bolus feature. Right think that's going to help her while she's walking around. Okay. And by the way, just for people listening, we're talking about loop. It's just DIY loop that she's using this during this recording. But also, what she called me with was exactly the right thing. She knew what to do. And she did it. She was just looking for confirmation. She was like, Look, can I get on this ride or not. And, and right now we have a diagonal down arrow, which is an indication to me that the carbs hit her. And she's gonna bounce the other way this, this algorithm is going to start bolusing when she gets the 120. And I'm going to let it Bolus a little and then we're going to shut off the the auto Bolus, and I think that might get her through Disney the rest of the way. Okay, cool. Well, I appreciate you helping me with this. And I appreciate all of your insight and your kind words, and the work you're doing for people. We didn't spend any time with it. But someone with your perspective, and your knowledge. And the I mean, obviously, you're just the kind person who sees the, the need for all the things that we talked about today. You know, there are a lot of people who don't get lucky and get good doctors like you. So I appreciate what you're doing as well. And I think it's wonderful.
Gurpreet Anand 1:16:43
Thank you very much, Scott. It was wonderful. Having the opportunity to talk to you and my best wishes for keeping on doing the good work you're already doing.
Scott Benner 1:16:55
Thank you. I appreciate that. I absolutely well, I have no plans on stopping
Well, I'd like to thank you, Preet for coming on the show. This was absolutely terrific. I also want to thank you, us Med and touched by type one, first of all touched by type one.org. It's easy to remember it's easy to type. Go check them out. And then of course us med is that 888-721-1514 Get your diabetes supplies the way we do from us med us med.com forward slash juice box, links in the show notes links at juicebox podcast.com. To these and all the sponsors. If you're enjoying the Juicebox Podcast, please share it with someone else who you think might also enjoy it.
Hey, you can also check out the private Facebook group. For the Juicebox Podcast. It's called Juicebox Podcast type one diabetes. It's a private group that now has nearly 29,000 members in it. You can be one of them. There are people in there with type one diabetes, type two diabetes, there's caregivers, people living with diabetes, all talking together about type one and type two diabetes, how they use insulin, what they eat all kinds of answers to all kinds of questions like if you ever thought to yourself, I don't understand why this blood sugar won't come down. I wish I could ask somebody at Juicebox Podcast type one diabetes on Facebook, you can have as many friends as you like and they'd all be happy to lend a hand. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
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