contact us

Use the form on the right to contact us.

You can edit the text in this area, and change where the contact form on the right submits to, by entering edit mode using the modes on the bottom right.​

         

123 Street Avenue, City Town, 99999

(123) 555-6789

email@address.com

 

You can set your address, phone number, email and site description in the settings tab.
Link to read me page with more information.

Screenshot 2023-03-12 at 2.41.02 PM.png

Podcast Episodes

The Juicebox Podcast is from the writer of the popular diabetes parenting blog Arden's Day and the award winning parenting memoir, 'Life Is Short, Laundry Is Eternal: Confessions of a Stay-At-Home Dad'. Hosted by Scott Benner, the show features intimate conversations of living and parenting with type I diabetes.

Filtering by Category: Dexcom

#538 Hypo O' No

Scott Benner

Kelsey experienced a bad low that she had trouble forgetting.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon MusicGoogle Play/Android - iHeart Radio -  Radio PublicAmazon Alexa or wherever they get audio.

+ Click for EPISODE TRANSCRIPT


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

Scott Benner 0:00
Hello friends, and welcome to Episode 538 of the Juicebox Podcast.

Kelsey is here everybody. Kelsey has had Type One Diabetes for quite some time, almost two decades. When this was recorded, she was 28 years old. And she came in to talk about the last three years of her life where she's been significantly impacted by a traumatically low blood sugar event. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. I want to thank everyone who has supported the show through buy me a coffee.com forward slash Juicebox Podcast. Some new members include Susan, someone who calls themselves someone Yoli, Alexis, Kristin, Jeanette, Sarah, Amy, Steven, and Dell. I'd like to thank them all of you and all the other supporters of the Juicebox Podcast. This show is sponsored today by the glucagon that my daughter carries g vo hypo Penn. Find out more at G Vogue glucagon.com forward slash Juicebox. Podcast is also sponsored by touched by type one, learn more about them on their Facebook page on Instagram, or touched by type one.org.

Kelsey 1:55
My name is Kelsey, I'm a type one diabetic. 28 years old, I was diagnosed when I was 10 years old. So I've had diabetes for a little over 18 years now. through that experience, I actually had a pretty bad event in my mid 20s, where I almost died from a significant load that I could not get back up. And that has caused me to have like very severe anxiety about going low, which of course in turn has made my blood sugar's high. And so I was able to seek out counseling and discover the reason of why my anxiety had become increasingly bad and how I was able to get my bloods back under control.

Scott Benner 2:41
Gotcha. Hey, are you fidgeting?

Unknown Speaker 2:45
Yeah, okay. Yeah,

Scott Benner 2:46
sorry. I was just posing. No. Oh, is that that's fine. Well, we're always okay. My buttons are very loud. That's okay. No, but sometimes people get nervous. And they, they tap their fingers in between words. They don't realize it or anything. But that's just different. So you were literally telling us about your life with diabetes while giving yourself insulin. That's excellent. Are you is your blood sugar higher than you want to be right now? Or are you? Did you just eat? Yeah,

Kelsey 3:08
yeah, it is higher than I want it to be right now. I did a Pre-Bolus. And it didn't do what I wanted it to do. So I just took another little Bolus to see if I can get my numbers to go back down because I'm an arrow up right now to 10.

Scott Benner 3:22
Gotcha. All right. So let's figure this out. First of all, just background, how long have you been listening to the podcast?

Kelsey 3:29
So I've been listening to podcast. And really, actually, since I started going to therapy for it, it was one of my counselors advices to try and reach out to the diabetic community, because I was feeling very alone in my problems that I was having. And so I found your podcast, and it has just helped me so much just to be able to hear other people's stories and the issues that they had. It gave me so much more confidence going forward, like okay, yeah, I can I can handle this.

Scott Benner 4:01
It's excellent. Okay, good. I just wanted a little context for if you have been listening for a while or anything like that. So I guess I want to start with when you were diagnosed, how old were you again? I was 1010 1018 years ago. 2003 ish. about right. It's just right. That's fine. And so technology existed. Was it something that your parents said, Hey, well, you have diabetes now Good luck with that, or were they real involved? What was that diner? My

Kelsey 4:29
parents were amazing. They were incredibly involved. My dad is a firefighter. He's retired now but so he already had a pretty good grasp on what type one diabetes was. And they were so in tune with me. I remember my mom not leaving my my bedside. Like I feel like if you can go home now she's like, Nope, I am going to be here. I'm going to watch what you do. Like I need to know everything. And and so growing up, they were coming Constantly, you know, I've heard you talk about art and having check her blood the middle of the night. parents did that for me. And then I was able to get a pump. And from there, my parents wanted me to learn how to be more independent and not have to rely on them so much.

Scott Benner 5:19
That's kind of a classic story for that time period. really like the idea of like, Oh, you have a pump now. Now you do it. And the idea of just like, but you didn't have a glucose monitor like I continuous glucose monitor.

Unknown Speaker 5:30
No, no. Do you now?

Kelsey 5:33
Yes, I do. I have the Dexcom. And I also have the CGM that matches with my insulin pump.

Scott Benner 5:40
Gotcha. Okay, so it's just that it's interesting that the rest of it gets, I guess, the curtain pulled back on it. As the CGM comes like, I can see how the conversation prior to CGM would be alright, now you know, you know how to use the insulin, you know how to count your carbs, you know, when to put in your in that, go ahead and go do it for yourself? And then what did you do? You waited a few hours and test it again, we're not even.

Kelsey 6:06
Yeah, no. So that was my, my go to test before, I don't know, sometimes tests an hour. And then like another hour, I was my endo told me that I was testing more frequently than most people would. Because I wanted to be in such control at that time, even when I was 13, and 14.

Scott Benner 6:28
So you would, so I used to do this as well. So I would test Arden before a meal. And then I like to know, like 45 minutes in where she was like an hour and a half ago, I had these times where I wanted to know what her blood sugar was. And I would always look before the glucose monitors I always thought of it is I knew something was going on behind the scenes that I just like, I knew there was a lot more information than was available to me. And I was trying to figure it out. But the truth is to try to grab it. Like one snapshot at a time without any real perspective. Like I didn't know how to use insulin back then or anything like that. It was just, it was maddening. I'd be like, oh, now it's high. Now it's low now, you know, like it just right. Yeah. And it was always just wait till she felt low and then do something about it afterwards. That's a young, a young age for you to be doing that at for certain. But you were okay with that. Is that right?

Kelsey 7:18
Yeah, I was okay with it. I just I had accepted it. And like I said, My parents were amazing. And they're like, yep, it's just, it's what you have to do going forward. And so that's what I did. I was very active playing sports. You know, I remember having little glucose tab baby socks pinned to the inside of my soccer shorts in case I went low when I was running on the field. And that's just how it was. I just learned to to take care of myself and not have to rely on my parents so much since I was such an active kid.

Scott Benner 7:50
This is normally not something I would stop the conversation for. But I heard what you said. I wonder if everybody else heard it. You had babies socks? Safety pinned inside of your shorts and inside of the baby socks. Bear with us, Alex.

Kelsey 8:02
Yeah, that's what my endo suggested. Because I would go low constantly during my soccer matches, and I have to run off the field, go grab some juice run back on it was kind of a hassle. And so when my end does was like, well, this is what other people have done you safety pin a little baby sock on the inside your shorts and filled up with glucose tablets and just pop them as you go. Here.

Scott Benner 8:22
We're here the Major League Baseball player, Sam fold on here. And he said that if you see me in the outfield, and I'm chewing gum, I felt low. Oh, no, I haven't heard that. I thought that was I was really interesting to me when he said that. He says like, if you see me chewing gum, I'm below. And if I have seeds in my mouth, I'm probably not. I was like, Oh, wow. But yeah, lots of little tricks around that. So you feel low, you'd reach into your baby sock and grab a thing and keep playing. Yep, exactly. Excellent. And of course, baby socks strong contender for the name of your episode. So, but were early on, things could change. Kelsey, they really could. Now, how many years? Do you go on like this before you have what you described in your email to me as a trauma? Yeah. How long? Was that? Okay, was everything okay?

Kelsey 9:10
Everything was good. Honestly, probably. I think I experienced that trauma when I was 24. So it went on for what? 12 years and 1213 years being totally fine. Um, and then yeah, and then I had that trauma. And that kind of flipped everything around for me.

Scott Benner 9:29
Gotcha. So that's only about six years ago. You're with me, you're out of college at that point, or just,

Kelsey 9:36
I'm still in college. I'm actually still in college. Right now. I'm getting my master's for counseling. Sorry.

Scott Benner 9:42
I was like you should take more than one class this semester. No, no, I understand. So you're taking longer you're taking a longer course. So you were still in college when this happened? Were you at college when this occurred?

Kelsey 9:53
No, I was actually at work when this occurred and and then it led throughout The night and into the next morning.

Scott Benner 10:02
Can you tell me? Does it bother you to talk about? Can you tell me about it?

Kelsey 10:06
Oh, yeah, no, I'm fine. Talking about it now. Okay. But basically what had happened was at that time, I was actually on shots. And so what essentially my endo thought had happened was I was exercising a lot. And then I took a larger dose of the overnight insulin. And so the next day, my blood, I could not get it to stay up for the life of me. And I think I had over 500 carbs by like, noon. And I just could not get it to stick up. And then by the time I went to bed, I had, I couldn't sleep and I had a very bad low or I thought, like, Oh my gosh, that I'm not going to be able to even dial 911 right now. Um, and I was living alone at the time. So that was scary for me as well. But luckily, I forgot I had a juice box in my side drawer that I was able to break open and feed myself before I had passed out. And so after that, point, it the low, still continued, I was able to kind of regain, I don't wanna say regain consciousness, but get a good grasp again, and continue to feed myself until I was normal The next day, and the lamp has had officially worn off. But what had happened, really where my brain went at that point was I had I was like, Oh, my gosh, you know, I'm living alone. Nobody, nobody knew I was having the slow, what would have happened to me, if I passed out, I, that would have been it. And so it led me into that, that anxiety kind of started to develop, every time I would start to go low, I would start to feel that most PTSD in a way, as my counselor described, it was a very, very small amount of PTSD. And I just freaked out and I wanted my bloods to be high, because that was like, my safety zone.

Scott Benner 12:15
Right? So just so I can try to pick it apart a little bit to understand, do you think that you mistakenly gave yourself much more lantis than you meant to?

Kelsey 12:24
You know, what, honestly, they still don't know. I gave myself my normal dosage. And I did my normal things that day. And that's why I was so scared going forward, because I was like, this was my normal routine. You know, of course, diabetes never is the same, right? And so I told my No, she's like, honestly, sometimes, you know, you could have eaten something two days before, or you could have exercised really, really hard two days before, and it's still with you, and you don't realize it. And so, not really having a direct answer, like, Oh, yeah, I, you know, it took 15 or 25. And was part of that anxiety because I had done everything normal.

Scott Benner 13:06
No, it seems like if you can't, if you can't narrow down what happened and feels like it was random, then it could feel like it could be random and ever again, just anytime, you could pop up again, that had this ever happened prior or since

Kelsey 13:20
now, hasn't happened prior since I got back on the pump. And so that has significantly helped me. Because it's just, you know, the continuous background in Flint. I'm not taking one single large dose at night, right? So that's helped a lot. But since then, No, I haven't had any event like that.

Scott Benner 13:39
So after this half, not after this happens after you give yourself that insulin and that it's you spend the day, just constantly low and you can't feed the insulin enough to get to get up over a certain number. Where was where was your blood sugar sitting?

Kelsey 13:54
I probably remained I fluctuated between 70 and 50. I would say, I would you know, go down to 50 each, and then it would bump, you know, start to go back up to like 7075. And I was like, Okay, I'm coming up. And then I'll check again, not even 30 minutes later and back down to 60.

Scott Benner 14:16
Yeah. Wow, that's crazy. So you just how you see Did you have the feeling while you were doing it? Like this will be the time where it'll go up and stay up? Like did How long did you play that game? Like Yeah, like, it feels like a horror movie to me. Where, where you feel like you're trapped in a room that like just get this puzzle, right? We won't cut your head off and you can leave and get the puzzle, right? And then there's another door and you're like, wait a minute.

Kelsey 14:39
That's exactly it's like you know, Okay, I get it this time. I have this hope. And then each time it was like, that's why I feel like it was just so defeating like, Oh my gosh, what can I do? Like, just that loss of? Yeah, defeated,

Scott Benner 14:55
right? Yeah, just the idea of like, I got it. No, I don't I got it. No, I got an answer. I would imagine I'm imagining after hours turn into a half a day turns into a full day and then you've got to go to bed. You're probably just like, oh my god, like, this isn't gonna stop Did it ever? Were you ever in a position where you had the ability to contact the person to like, come sit with you, but you thought no, it'll be all right. Or did you not live in that situation?

Kelsey 15:21
Um, so being 20 what I how 23 at that time and being moved out, I didn't want to worry my parents that I was having this problem. Yeah. So I didn't contact them. And looking back I absolutely should have but I didn't want to worry them. Think like, Oh my gosh, she she can't live on her own like it was happening.

Scott Benner 15:42
It feels like it would have bigger ramifications. If you if you if you said and I'm not judging you. I'm just interested in the thought process that goes through the whole day.

Kelsey 15:50
Yeah, so that was it. It was just I don't want to worry my parents, I want to prove to them that I can live by myself with Type One Diabetes and not have any real consequences.

Scott Benner 16:01
But there was no way to know that after this experience you were going to suffer. But like the PTSD of the situation that it was going to come like you just thought you were getting through a moment it sucked. And it would be over eventually. And even though the physical part was over, you got visited by a different aspect of it that obviously you didn't expect. Yeah, exactly. Hey, Kelsey, that sucks. really sucks. And so how long do you I'm assuming then you start leaving your blood sugar's higher than you'd like. And let's give that a little bit of context prior to the event. Let's call it The Happening prior to the happening. Where was your agency? And then where did you let it rise to to feel comfortable?

Kelsey 16:46
So my agency was what last time I checked, actually just checked the name for coming on. It was at 6.5. Okay. And then after this event happened, it went up to 10.

Scott Benner 16:58
Wow, that's a significant impact on you. Oh, no kidding. Yeah. How long? Did you live like that? before? You thought I have to address this like, Well, let me ask you first, did you just imagine that the anxiety would dissipate at some point, it just never did?

Kelsey 17:12
Yeah, that's exactly what I thought, you know, once again, thinking, Oh, I can handle this. I got this. And I gave it about a year. And at some point, I just kind of gave up on myself, honestly. And I was like, You know what, it just I'm tired. I'm burnt out on this. I don't, I don't want to deal with this anymore. And so not that played into it as well. Yeah. Um, and it wasn't really actually until I got together with my now fiance, who's a paramedic, and he was like, What are you doing? I treat, you know, 10 diabetics a day. Like, if you pass out, I'm just gonna give you some glucagon. Like, you'll be good. And so it was once I started being with him that I was like, holy crap, you're right. Like I, I need to, I need to get this under control to live a long and healthy life. And that's when I started really seeking out that counseling. And I had that desire finally, to want to get myself better.

Scott Benner 18:08
It's just really telling how impactful anxiety can be on on the on the people who are afflicted by it. Because you know, what's up? I mean, you've lived day after day after day after that, you haven't gotten low again, like that. So you, you know if common sense, was the only thing you need in this situation, you'd be like, well, it was a one off thing. It doesn't look like it's gonna happen again. And I'll be fine. But that anxiety just stops you in your tracks. It's fascinating monster really, really is crippling for the people that have decides to attack. Wow, 10s a one sees Yeah, this guy likes you. He's not looking for you to have a 10 a one. See? That's for sure. Okay, so. So you recognize? How do you recognize the steps to take next, like, how do you decide where to begin trying to break free of this.

Kelsey 18:57
So the first thing I did actually sought out counseling on my own. And I just found a local psychiatrist who specialized and anxiety. And so I started seeing him and he did is called CBT cognitive behavioral therapy. And that is to try and essentially get you to readjust your brain is the best way I could say it. I'm trying to like do almost exposure therapy where you're like, Okay, I'm going to get down to 200. I'm going to let it sit there. And I'm just going to it's going to scare me, because that's not it's outside of my comfort zone. And finally, after about I would say three months of seeing him, I just, I was like, Okay, this is not working. And just his method wasn't working for me. So I actually reached out to my endocrinologist and was like, Look, this is what's going on. This is where I'm I want to get better. I'm really determined right now. What do I need to do and so she set me up with it. a psychologist who worked for my doctors and knew about diabetes. And she was the one who actually got me on Prozac. And when she got me on Prozac, I'm like, I'm not sad. I'm not depressed, like, I'm just scared. And she goes, Yes, I know. But here's the problem is that your anxiety is starting to cripple you to the point where you're willing to have these significant possible, you know, lose a foot in the future, just to stay safe in the moment, and we can't have that. And so I started taking that, and that significantly helped me and it helps ease your anxiety, which I had no idea that that does. Prozac was meant for anxiety as well, because it works with your brain chemicals to go Okay, like, yeah, you're panicking right now. But look, this is going to help to relax you. So when I had started having, you know, the triple arrows down, I wasn't going into like this automatic panic mode of Oh, my gosh, I need to stop this blood. I'm dropping what's going to happen? I was just like, Okay, well let it ride and see where it goes. Right. So that's been the pattern I've been doing. And it's, it's just has made such a huge difference. That's

Scott Benner 21:16
excellent. Wasn't whatever helps is the right answer. And I wonder, too, so which is the second doctor says you should reach out and find like, some people who have diabetes to find a community?

Kelsey 21:30
Yeah, she was one because I told her I was like, Look, I, you know, I don't I personally know any other type one diabetics, I feel very kind of alone in this. And that's obviously not helping my fears, because I don't have anybody who I can talk to who can truly relate to what it's like to go low, other than a diabetic. And so she was like, hear, reach out on Instagram, listen to podcasts, here's books. And so I started doing all those things, and joining the diabetic communities through Instagram. And that's actually how I found you your podcast. And I was like, Oh my gosh, like, being able to listen to other people see, they're physically see their graphs on their CGM of them going down to 40 with two arrows down, made me go Oh, my gosh, like, it's not just me, like, these people are scared of that, too. Yeah. And having that kind of outreach really, really has helped.

Scott Benner 22:22
Right? Well, that's my finding is that the feeling of community, I've seen it pay people back over and over and over again. You know, I don't need to study on it to tell me how great it works. So that part is absolutely fantastic. The it's great even that the Prozac work, I looked it up while you're talking and says Prozac, people using Prozac can see improvement in symptoms of anxiety, one or two weeks could usually take between four to six to feel full benefits. That's, that's just that's magical, you know, because it wasn't going to let go of you. I don't think how long have you had a glucose monitor a continuous glucose monitor?

Kelsey 23:03
Let's see, since I got my pump, I have the Medtronic 670 G. So I've had that for about three years now. Maybe a little over three? And how

Scott Benner 23:14
long has it been since you met that this second doctor that you talked about? Just two years years? So one year with a continuous glucose monitor didn't make a dent in this Can I guess? Did it almost make it worse?

Kelsey 23:26
Oh my gosh, I was gonna exactly say that. That's what she said. She's like, because you're able to see your numbers doing the scary, scary drop. It makes it worse for you versus kind of being able to go an hour without knowing Yeah. And I actually she said, I actually developed a little bit of OCD with it too, because I was continuously like, every five or 10 minutes, like okay, Where's it at? Now? Where is it at now. And that's as soon as it updates is five or 10 minutes. And so she was like you have this very interesting dynamic because a when you go low, you feel it. But also when your anxiety kicks in, it almost feels the same as going low. So you kind of are having this crazy double whammy of mentally feeling it and physically having to feel it where most people who have anxiety don't really experience that. I have

Scott Benner 24:17
to tell you that when continuous glucose monitors became popular, like when they they were available in the world and people started using them. There was so much talk from people who had lived with type one for a while prior to continuous glucose monitors, saying how much continuous glucose monitors made them feel anxious. But you don't hear those conversations nearly as much if at all, from people who are born in the moment of continuous glucose monitors who excuse me diagnosed in the moment of them. People who have them from from go. Don't have that like that same. That same impact. Doesn't seem to occur. As for me, this is anecdotally me looking at people, obviously. But I think there's something about like, people who are diagnosed now or have continuous glucose monitors might not recognize the people that lives with diabetes prior to that, like they were, they're alive and doing the way they're doing. But they didn't really know why. They just, they're following the rules, right? Like, do this, count that shoot this, eat that. And you wake up every day? And you go, huh, well, that must work. Because here I am standing here. And then all of a sudden, that glucose monitor comes up and you look and you go, wow, there's a lot of things I could be doing differently here. That's how it hits some people. Some people are then given a picture to what's going on inside of their bodies. And they're like, Well, wait, that's been happening the whole time. Like, that's scary. Yeah. Yeah, no kidding that trend. So can you tell? So I guess I want to ask a question before I asked this one. You've been listening to podcast for a little bit now. Does your blood sugar still fall drastically like that?

Kelsey 26:02
It does. But I don't get us freaked out. I don't suspend my insulin, I don't try to correct it right away. I just let it be and let it ride. And just like from listening to the podcast, it's like, oh, yeah, you know, people you trend down for and downtrend down, and then boom, you level out. And so I now have been doing that and trying to wait for the arrows to stop trending and start leveling. Okay.

Scott Benner 26:31
So can I talk to you like about just like insulin for a minute? So I can, I want to orientate around some context here. So would you say that your basil rates are really good? Or do they need work?

Kelsey 26:42
I would say that my basil rates are very good. And I still have some anxiety issues. So when I see that there sounds silly to say, but when they are, where my levels are, where they need to be, I'm 100, straight line, it still triggers some anxiety, because I'm like, Oh, my gosh, at any second, you know, I could I could start to go down because I have three units on board. And so it's a little more complicated for me to still be able to see, like, I know, my Basal rates are where they're at, because I am where I'm at where I need to be. But yet, in that back of your mind, that anxiety is like, Oh my gosh, but what if but what if? Yeah, and so it's kind of a still kind of a funky battle?

Scott Benner 27:32
What about overnight? Where do you sit? stable overnight

Kelsey 27:34
at? Yep, overnight, my line is perfectly straight.

Scott Benner 27:38
What number is still around that? 100?

Kelsey 27:41
No, I overnight, I'm still reading around 150 to 170? Because that's still kind of my safety net? Sure has, yeah, with that, just with the anxiety of it being asleep, and not being able to see exactly what is happening all the time like I can when I'm awake, right? And it's still a jump I need to overcome.

Scott Benner 28:01
Yeah, and please keep in mind, I'm not trying to talk you out anything I'm trying to figure out. Structurally, why are you Why is your blood sugar falling during the day, so so so, you know, the way I think of it is, if you're higher overnight, like that, then when you come into the day, and you hit that, you know, feet on the floor, like life anxiety thing, and your blood sugar wants to start going up. Now you're going to be bolusing more aggressively at numbers and leaving the the meal insulin or the corrected insulin, whichever it is you're doing or maybe both at a position where at some point, it's going to become counterbalanced or out of balance with the number than or the carbs or the need. So you start at a higher number. It makes you Bolus more food, eventually, the food leaves your system, the insulin remains behind, and then you come crashing down. And as I realized that this is a specific scenario, we're talking about anxiety, so but if you came, if you and I were having this conversation, and it was just about management, and there was no anxiety in it, what I would say is that if you can keep your blood sugar stable and lower overnight, and even a little lower during the day, then you wouldn't be making up for your basil deficit with Bolus insulin. And the likelihood of having a low after a meal would be significantly less because you'd be using far less meal and so on. Does that make sense?

Kelsey 29:32
No, that's what makes that's a really good point. And I actually honestly haven't thought about it like that. Because I'm so used to, you know, for the past three years, just when I get high, just continuously taking little micro doses. Yep.

Scott Benner 29:47
So you end up stacking insulin up because of that, which is weird because I don't usually say stacking because what I'll tell you is, if your settings are right, and you need insulin, like I say if it's it's not stacking if you need it, but You can't, you can't stack to make up for a basil deficit. So one of the most interesting things that happens, Kelsey when I'm talking to people, and they're just like, look at my graph, I don't know what to do. I have this peak here, and this peak here. And the peaks are always, you know, after meals, and then I get really low and the really lows always like two and a half, three hours after meals. And you know, and when I'm, you know, when I look when they're away from food completely, their blood sugars are super stable around 140 or 150. And then I'll look at that. And I'll say, well, your basil, I think your basil needs to be higher. Because first of all, when you're super stable away from food, or, or Bolus insulin, you know, if your basil was where it needed to be perfectly, your blood sugar would be super stable, but it would be super stable at 85, not at 150. So there's what 65 points higher, that you can eat out of your blood sugar with basil insulin, and that ends up being a lot of insulin. And so now you're counting carbs later, you know, your blood sugars are stable at 150. you're counting carbs later. And you're like, well, this is 30 carbs, that's three units, or whatever your ratio is, and you put it in, but you're, you have a deficit of basil every hour, it could be half a unit depends on your size, right? It could be any amount, but whatever amount it is, that you've been missing all night long and all day long. like think about it, if it was in there, it would be in there but it's not. So you're just sort of bolusing but your Bolus is just going towards the basil instead of going towards the carbs. Right and then you keep you keep you keep both now your Bolus thing the number, the number, the number, the number and then eventually the food digests out of your system stops impacting your blood sugar and then straight down.

De veau hypo pan has no visible needle, and it's the first pre mixed autoinjector of glucagon for very low blood sugar and adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G Vogue glucagon.com forward slash juicebox. g Vogue shouldn't be used in patients with insulin, Noma or pheochromocytoma. Visit g Vogue glucagon.com slash risk.

Do yourself a favor visit touched by type one.org. Today to see really wonderful things being done for people with type one diabetes touched by type one.org. You can also find them on Instagram, and Facebook. The ads were pretty quick here. So let me add in add into the ads. I didn't mean to say that. Let me add to the Jesus I'm lost in the weeds now. Anyway, I just want to remind you that the diabetes pro tip episodes are available in your podcast player beginning of Episode 210. Or you can find them at Juicebox Podcast comm or diabetes pro tip.com.

Right? Have I described your life?

Kelsey 33:25
Yeah, pretty. Yeah, that's exactly what I've been doing off to try to try increasing my Basal rate that

Scott Benner 33:34
that makes a big you increase your basil and get yourself where you're super stable. And I'm saying whatever number you're comfortable with, obviously. But the lower you go with that comfortable number, the less insulin you're going to need at meals and the less insulin, you're going to need for corrections. And then you can start, you can start setting your alarms on your on your CGM to actually help you so like, you know, you set it at 130 as you drift above 130. And I say this a lot, but the amount of insulin it would take you to bring a 130 diagonal up back to 90 is a pretty small amount of insulin. But the amount of insulin that would take you to bring a 250 back down is a lot and again, it's going to get out of balance with the with the insulin need at some point. And then you've find the low so it seems counter intuitive. But those people who show me the peak and then the low and then the peak and the low they're like oh it peaks up after I eat then it gets low and then I eat something that jumps back up again this keeps happening. And then you say to them well I think if you turn up your basil this might not happen here are the reasons why a lot of people here but no, I get low a lot more insolence not the not the answer. And what I'm saying is it may actually end up being less insulin. You're just shifting where it is and the job it's doing.

Kelsey 34:52
Yeah, and that which totally makes sense because I know that with one of the things with the anxiety is that having A large amount of insulin on board because you know, when you have that large amount that you're more likely to go low. Yeah. So that absolutely makes sense to raise your basil to only have to do those little micro boluses to get you to where you need to be.

Scott Benner 35:14
Yeah, definitely helpful. Can I? I'm sorry, I know you didn't think this was gonna happen. But what are your What are your Basal rates at? Hold on, let me pull up here. And then get ready for the part where I ask you how much you weigh. Sorry about that. So

do you have like one singular rate? Or do you have a bunch of different rates? I have a bunch of I was gonna guess that? Yep. Yeah, a

Kelsey 35:42
bunch of different rates. Okay, so let's see here. Okay, so from midnight to 330, my if that 1.1 3:30am to 8am, point eight to five 8am to 12 1.2 12 to 3.953 to 7pm, point 375. And then seven to midnight, one unit?

Scott Benner 36:17
Well, so you're basically you've set up a bunch of different basil programs trying to outsmart problems that you have. Is that about, right? Yeah, that's pretty good, right? Especially with the weird hours I work. I work 5am to 5pm. And so I set that because I know in the morning time, I'm not going to be eating for three hours. So I know that my bloods naturally going to drop during that time. Do you work in a hospital? No, I actually actually work in a jail. Oh, that's more fun. That's a much it's a much more different answer than I expected. So I'm not saying that there aren't times a day when your basil needs need to change drastically when you're in your pot when you're on a pump. Arden uses frequently less insulin overnight for basil then during the day, but it's not that significant. So like 12 to 3.95 going into three to 7.375. That to me sounds like you're like incredibly active at work and not eating at a certain time. Is that about my guess? Right?

Kelsey 37:21
Yeah, that's right. So during that time frame, I've noticed that as when my bloods will just crash, because it's after eating, and I'm not going to eat again until seven. Right? And yeah, running around at work. It just drops during that time period. Yeah. Okay.

Scott Benner 37:37
So I'll bleep this out if you want me to, but how much do you weigh? So right now? Yeah, bleep it out. I'm at one, now, okay. All right. So I would say if your blood sugar's are consistently overnight, in the 150 range, and consistently during the day at the 100 range, when you're not, when you're not using insulin at the moment, and there's no active food or insulin in you, then I think there's a lot of space in your basil. Like it really is. So and I'll bleep this out, too. And I'm sorry for the people listening. I'll give you some generic answer later, but we're talking to calcium protecting the parts of our life she wants to keep to herself. I would say that I frequently, when I start guessing about people's Basal rates, I usually guess point one per 10 pounds. Now, that's it, that there's nothing mathematical about that. And there's nothing there's nothing medical about that. It's just something I've noticed, and some people don't fall into it all. But like a kid that weighs like 35 pounds, sometimes they're like point two 5.3 in that space, you know, somebody 100 pounds around a unit, like that kind of thing. Like Don't get me wrong, 100 pound person might only need point eight, they might need 1.2. They also there and there's always outliers, who, you know, you see people's graphs, they're absolutely amazing. And their Basal is like half unit an hour, and they weigh 120 pounds. And I'm just like, that falls outside of my thing. But what I'm saying is, if you just tried to bring everything up a little bit, I wonder what would happen and I would start on a day when you're not at work. Like a day off from work, and just I don't know, like 10% of the time, just move it up and see what happens. Now I'm going to do that. Yeah, because if you could create because I'm listening to what you're saying about the anxiety, right? You're you're afraid of falling quickly, and that fear is precipitated by having a lot of insulin on board. Because insulin on board feels like falling. I'm going to tell you that. If you're there's a wolf in your house. I'm going to tell you that if your basil is rock solid You do a good job of counting your carbs. And your ratio is pretty close. Right? And I'd say you need to understand the difference between carbon packs, meaning that, you know, white rice or big potato is going to impact differently than maybe, you know, I don't know, watermelon, or grapes or something like that. If you can keep that stuff straight in your head, I've, I don't want to, I definitely don't want to flip you out. But my daughter's eating Chinese food right now. Her insulin on board is like 18 units or something like that, oh, my goodness, that would freak me out. But her blood sugar is also not going to get high. And it isn't going to get low later. Because these 18 units are active, while the food is also trying to impact her. And so that becomes the last bit of it is that you have to understand where the insulin, you have to you have to understand how to get the insulin working while the carbs are working. So if you've never heard the Pre-Bolus there's a defining diabetes, no way. I don't know my own podcast, diabetes pro tip Pre-Bolus. That episode talks about how to line up the insulin, the you know, the impact of the carbs with the action of the insulin and keep them sort of working at the same time so that they're working against each other. And then as the food digests, the insulin wears off, and then there's no high or low afterwards. It's not that it's Listen, it isn't like, don't get me wrong, like you're not gonna, like get off the thing and be like, Oh, I got it. But it's, but that's to me the information that gets you to a place where you won't see a bunch of falling. And you won't have to be putting in a bunch of extra insulin all the time. And then hopefully, one day you can roll out for a pizza and not feel weird about it.

Kelsey 41:52
Yeah, that's I'll definitely have to listen to that episode. And try again, if we're going to try that going forward. because like you said, eating how Arden's eating Chinese food right now i i am very limited in my diet, because I don't want to eat higher carb things, because I know that that's gonna mean I have to take more.

Scott Benner 42:10
Yeah. Yeah, listen, for most for people who have not had the problem you've had, you know, the the trauma that you've had. It's still a and for me as well, like, it's still a great leap to get over. You know, like, I'll never forget when Arden was growing, and the first time you're just like, you know, I mean, you just got to remember like, I remember setting basil rates like point two, five an hour. And when I got to a unit, I was like, Oh, my God felt insane, you know, but now now there are times around her period where I'm like jacking her basil up to like three units an hour.

Kelsey 42:42
Oh, yeah. The hormones behind it. Oh, my goodness. Yeah. Yeah. It's a lot to try and remember and taken,

Scott Benner 42:50
it certainly is. I mean, listen, there's there's just no doubt, but I also hear in your voice, that you're, you're really do want to find the other side of this. It sounds like to me. Oh, yeah, absolutely. Yeah. That it just it didn't seem like I'm scared. And I'm okay. Staying here. Like, it seems to me like you're like, Okay, that's enough of this. I gotta, I gotta move forward. Plus, I take advantage of this time you're dating this paramedic. So right.

Kelsey 43:18
Exactly. Yeah. And so yeah, especially with, you know, weddings coming up. And we want to have kids like, my numbers have to be prime. So I'm not so scared anymore. As much as determined. I'm trying to be with it.

Scott Benner 43:34
Good for you. Yeah. No, I mean, can you imagine if trying to have a baby? And having this is still like, afflicting you, you know, like the I can't do what I can't bring? I can't give myself more because there are parts of pregnancy. I've had a number of pregnant women on the show, there are parts of pregnancy where your your insulin needs just skyrocket?

Kelsey 43:55
Oh, yeah. I've listened to those episodes. And I'm like, Oh, my God, you have to literally double your insulin. So knowing that going forward, I I know this is something that I really need to conquer and get a lot more control of.

Scott Benner 44:10
It's really admirable that what you're doing, I know, it's probably to you feels like you're lost in this like slog trying to figure this whole thing out. But you I mean, I hope you know how many people are listening who are in the exact same situation you're in and have not found a way to even try to address it. It's very common, what you're talking about.

Kelsey 44:33
Yeah, and that's part of the reason why I reached out to you because I'm listening through your stuff. I noticed that there wasn't too too many expressions of people who have anxiety and have had to get counseling and like me have had to get on Prozac or whatever you need to do. Because there's some shame behind it. Like when I first started I was I was a little bit shameful myself because I knew I wasn't doing good and it's kind of getting over that. That hurdle. And being like, you know what I write, I'm not alone. And I want to be able to make myself better so I can make my life better for everyone else who's in it

Scott Benner 45:11
is overcoming that shame. Like one of the first steps,

Kelsey 45:15
I would say, so, for me, originally, when I was having this problem, and people asked me how my diabetes was going, I would sometimes I would just break down, it'd be like, as soon as I started talking about my diabetes, I would just start crying because I was like, Oh my gosh, like, I don't have anybody else to share this with like, this is, you know, it's so scary. I know, I'm doing bad. And so I think once you kind of start, for me, it was admitting step a was admitting like, yeah, I have a problem. And then seeking the help to try and fix that problem helps you to overcome that shame, or at least it did for me to help overcome it by just simply admitting it and having people be like, okay, you know, like, we're not mad at you. We're not like, oh, how dare you have high numbers of everybody has been so helpful. And, you know, open arms about like, yeah, let let me know what you need. Yeah. And I think that was a really big, important step.

Scott Benner 46:18
Does this shame feel like something you end up putting on yourself? Like, you think it's going to come from disapproval, but it's the fear of disapproval? I don't know. Like, do you understand the mechanism of that?

Kelsey 46:29
Yeah. So for for me personally, um, my shame was within myself, because I knew how good I had been doing previously Of course, and then now to go to my endo and However, she literally the first time I went in, she gasped, she goes, Oh my gosh, what happened? And I know that a lot of people have that fear of going into your endo because it's like, oh my gosh, this is it like you're on trial to see how good or bad you're doing. And so a lot of it was put on me. And because I wanted people to be proud of me and my numbers, because again, in my very small town I live and I'm like one the only diabetic so when people ask me how you're doing I'm like I'm great. And not be like oh gosh, it's so bad.

Scott Benner 47:21
As the person who's standing up for all of us at this longitude and latitude let me just say I'm doing terrific because I'm you felt like you were the correspondent for diabetes for your for your songs. I mean, the whole thing is because I I'm trying to imagine you have this episode The you know this terrible low and this traumatic thing and you go back to your doctor next time you're a one sees hire like what if she would have just said or he would have just said hey, well this is really out of character instead this in her head You know, this is really our character Something must be up let me find out what's going on let you tell the story of the the load day and the impact it's had on you and help you out of it and then you don't get stuck for the last six years in this you know, it maybe or maybe not maybe maybe your brains wired in a way where like any trauma would have would have been something that stuck with it. I don't know like do you think if you ever had a car accident you'd be afraid to drive or I guess there's no way Oh right. No,

Kelsey 48:18
I mean, I guess there's no way to really truly know that if you haven't been in a car accident and I think that I you know I've been in a fender bender right I was basically a little cautious after that but now I'm like okay, you know you're back to I continue my life yeah, I'm back to normal and so I think that if people if my endo maybe had not reacted so strongly it wouldn't have instantly put that that oh my gosh, okay, I need to not tell her anything Yeah. How it's really been

Scott Benner 48:52
you do live in a small town I just heard the steam engine go by it's probably gonna pick up at the bank and then take cattle into Kansas right? Yeah, forget that. Seriously, it felt like it was in a Western for a second. I was like I can't help the train No, no, no, I it's been one of my favorite things has happened so far today. Don't worry about it. I was like this is great. I'm waiting for for guys with masks to to ride out of the dust now would they be wearing masks because of COVID? Or because they were going to rob the train? I have no way to know probably. Yeah, could it be I don't you keep I hate to be the one to say this out loud. But don't you keep waiting for there to be a ton of bank robberies because we're all wearing like, Am I the only one who's been like sitting around going we're all the bank robber. He's gonna have oh my gosh, yes. Especially when someone walks in with sunglasses. I just I just keep thinking like some industrious robbers gonna be like, Huh, you know, but I guess not. I guess there's more to robbing a bank than wearing a mask. I don't know. I've never I've never looked into it. But anyway, I just I there's an 11 year old inside of me that just keeps waiting for there to be 9 million bank Rob. That's the silliest thing. I've ever thought as an adult, but it really does happen. When's it gonna happen? Well, so listen, I think it's interesting because I never know, like, so you're listening to the show more for community, not as much from management. So I'm gonna say this to you. If I'm you, I go to Episode 210. It's called diabetes pro tip newly diagnosed are starting over. And it's the beginning of the diabetes pro tip episodes. And they're very management. Rich, and not, they're not boring. I don't think it's me and my friend, Jenny Smith, who's a CD, she's had diabetes for, like 32 years now. And she she was really nice enough, this is going back a couple years. Now, I said to Jenny, I have these tenants like, I realize I'm saying the same things over and over again, the podcast, I'd like to drill down deeper on specific ones that I think lead to stable management, right. And so she was nice enough to come on and have these conversations with me. And I'll tell you, that the feedback I get about them is stunning to me. Like, I can't believe that people find them as helpful as they do. I meant for them to be helpful. I thought they were, but I can't believe the feedback. So if you have, you know, 20 hours to listen through a handful of episodes, I would think that the things we kind of chatted about today loosely would come into focus for you. And I would love to see you not be I would love to see everyone not feel that anxiety. Because, I mean, again, being the parent of someone with diabetes, it does give you this the this passionate feeling where like, you're like, well, if I make someone low, it's not making me low. And I'll still be here to fix it if it happens. You know what I mean? So like, there's

Kelsey 51:44
no, I 1,000% Get it? Because that's, that's how my fiance is, you know, he's like, as soon as I got the Dexcom He's like, share that with me. Yeah, I you know, cuz he knew I, you know, I have this fear. He's like, I, if he works nights, or whatever, that actually really helps when I got it, because I was like, Okay, I'm sharing this with somebody else. So if I go low, it's not going to be just me home alone, I'm going to be able to alert somebody that like, hey, something's going on

Scott Benner 52:11
this. You know, I've never done this before. And as I'm saying it, I don't know why I've never done it before. But would you be willing, while we're talking right now, would you take a screen grab of your 24 hour Dexcom graph and texted me real quick? Yeah, grab my phone. I'm gonna tell you it's not pretty. But no, no, it doesn't matter. It just needs to be what it is. I can see it. You know how to turn it sideways and choose 24 hours? Yeah. There we go. And I'll definitely remember to bleep out your weight now because I'm not the Bleep out my cell phone number. is important. Keep my weight and I know you said, I stick with what you said. Don't worry. All right. Okay, go ahead with your numbers. I should bleep out the bleeps with curses. But I really

Okay, there we go. I got it. All right. Yeah. You don't have enough basil.

Unknown Speaker 53:17
Okay.

Scott Benner 53:20
Most days like this.

Kelsey 53:22
Okay, yeah, it's that that roller coaster of high then like, as you can see super high overnight because again, with that anxiety of not being able to sleep, it's something I really need to like,

Scott Benner 53:38
don't you don't apologize. This is very, very fixable. Call me with the low line of setup, though. Where's the low alarm at a low alarms at 7070? Where's the high one at one at 180? Is that right? 170? Yeah. All right. Yeah, you could easily or you could easily be doing 1.3 units an hour for basil. You think that's where I'd start. And as crazy as it sounds, I'd write down all your settings. Right? So you have them. And I would just go to what 24 hour Basal rate? That's how I would start. So I would I start, I'd start. How would I start? What's your overnight 1.1 overnight and 3/8 is point nine five. Okay, so we got to enlist the boyfriend. We got to do we got to do it on a Friday night. Right? And you just 6pm on a Friday night that you're not working? You go to listen, let's try we'll try 1.3 right. And if it's 1.2 it's 1.2 if it's 1.4 is 1.4 whatever. And you just you want to get down low and stable like meaning get to wherever level is for that Basal rate. Get this table, and then just let it roll for a while and see what happens. So let's say it gets you to 110. And you're, you know, it's six o'clock, because he changed it at 6pm, it's not really gonna start taking effect till 7pm, maybe by nine or so you'll see about what what's up right now at 1011. If you start drifting lower, fair enough, right, like if you if you get lower than you mean to then take a little bit of the Basal away, make it you know, 1.2 instead, until you come stay stable where you want to be. But just keep in mind, you are going to go stable somewhere and at 1.3. At from what I'm seeing from this, I'm guessing you'll be stable around 100, maybe. And then if you don't have any active insulin in you overnight, okay, so you don't make a big Bolus at nine o'clock or 10 o'clock or 11 o'clock, something like that. I'm not a doctor, and you certainly shouldn't listen to me because my wife says I'm an idiot, okay. But you're not going to have a drop. If your Basal rate is where it belongs overnight, you shouldn't see a significant drop. And if you do like it one o'clock, you start drifting down, and you get to, you know, 90, and you're not comfortable with that, well, then maybe, maybe from 6pm till midnight, then it's 1.3. And at midnight, it's 1.1. Like, I don't know, but well, definitely, that's something we're gonna do that and I'm pleased so that, you know, he'll say I'm making up numbers right now. You have to you have to figure the numbers out for yourself. But this, this graph can handle a lot more basil throughout the day. And when it and when you have it, because I see your I see your meals, like you're shooting up immediately. And staying up after a meal, which is an indication that you're not using enough insulin for the meal and your basil is, is low to me. And I'm getting that from the angle of the pitch that your blood sugar goes up at after you eat. So and I can even see here, you make corrections that are pretty aggressive. And it takes some a couple of hours just to get back to 200. And then it just bounces again. So yeah, so it's you. So in order, get your basil, right, figure out your Pre-Bolus time, what's a fair amount of Pre-Bolus time for you learn the glycemic load and glycemic index of foods meaning that 10 carbs of potato might need, like say you were 10 units, let's say you were one unit per 10 carbs, right. And so if you were one year for 10 carbs and 10 carbs of potatoes might need a unit and a half were 10 carbs of you know, strawberries might just use the unit. So So meaning you're gonna have to learn that there are some foods that punch above their weight, they need more insulin than your ratio indicates, just as there are some foods that need less insulin than your your ratio would indicate. So then you got your Basal, right, you understand Pre-Bolus Singh, meaning you want to get the timing of the insulin, you know, lined up with the impact of the food. And then you know, have a reasonable understanding of what foods need what kind of like strength. And from there, the rest of stay flexible, which might in possible might be the hardest part for you in the beginning. And meaning that you know, you know, if you if it tries to get higher, you might have to correct it. If it tries to get lower, you might have to bump it back. And I swear and try those protip episodes. If you're not living a different life in a month, I'd be surprised.

All right, I'll definitely do that. I'm excited. I'm excited to do that going forward, actually. Cool. Kelsey, I'm telling you now Now you've interested me now I want to stay involved if you want me to. I want to hear how things are going after you try this. Now. There's no pressure whenever you do it, do it. But I would. I would love to know your graph looks a lot like a newly diagnosed kids graph. Yeah, it's a hot mess. Listen, it all right. You know what? Why am I disagreeing with you? You're an adult. It's a beautiful. It's a bit of a mess. But at the same time, but at the same time, the fix isn't difficult. It's just it's basil than Pre-Bolus than understanding foods. And if you do those three things, listen, you're back to your six, five. I mean, you do those things, you're back to your six five pretty quickly. But that's not the important part. The numbers aren't what we're talking about. What's important for you is is cut being comfortable.

Kelsey 59:40
Exactly. Yeah. Being being able to be at 90 continuously and not being like oh my gosh, I'm 20 points away from being at 70

Unknown Speaker 59:47
Oh my goodness.

Scott Benner 59:48
I don't know if this makes you feel any better. This will just be worse. But the way it makes me comfortable to think about it as this is that I don't have type one diabetes and For most of the day, my blood sugar's 85. That there's a large group of people who don't have type one who they throw in glucose monitors on, who will experience blood sugars of 64, sometimes hours at a time during the day. And really, yeah, and that you're not going I know this is like, I don't usually say this out loud. But your blood sugar's got to be pretty low for you to have an actual seizure. And if you're going to be with your man and trying this thing, you know, I don't you know, it's going to be different for you in the beginning, because your I think your body is going to be accustomed to higher blood sugar's so you might have to do this in segments, because you might get the 150 or 140 stable and feel low for a while. I don't My gosh,

Kelsey 1:00:46
yeah, that's so funny. You say that. That's exactly what my, my endo, in my, in my psychiatrist said, She's like, you will feel low, because you're so used to running so high.

Scott Benner 1:00:57
Yeah. And that's your body actually trying to you ever, ever hear somebody talk about the idea of like, your body is trying its hardest not to die. So when you start doing something that's killing it, like having blood sugar's high like this, it tries to adapt to it, it tries to live with that longer. And so there's something about the way your blood vessels are blocked, I don't know, again, not a doctor, something about how your blood vessels are helping you to not feel high blood sugars, will then it'll feel it'll feel normal blusher normal blood sugars as lower blood sugars for a little while I've seen I've seen people get through it in a couple of days, I've seen people take a week or so. But you know, I would, I would definitely expect that to happen. But you're gonna have to prepare yourself mentally, like I'm not actually low, I just, this is a feeling I'm having because of this. So maybe you're gonna want to, maybe you're gonna want to titrate this, maybe you're gonna want to start on a Friday and go, you know, just start with a one unit across the board for 24 hours, and live like that for a couple of days. And then push it up a little up a little up a little and just keep bringing it down slowly. I mean, maybe that really is the best idea for you. Again, I'm not a doctor. Just

Kelsey 1:02:09
know. Yeah, that's, that's essentially what they want me to do is they call it exposure therapy is to see that, again, retrain your brain and to be like, okay, Matt 110. And eventually your brain will learn like, okay, like, you're you're not dying. You can be here and you can be fine,

Scott Benner 1:02:30
right? No, I mean, and so I think and if that's what you're going to try, like forget everything else I said, if you want, that's fine. But if that's what you're going to try, I still think a stable basil rate across 24 hours to start with, is a great way to start. Because if you try to start, if you try to start adjusting off of 123456 different basil rates, the variability, they're so great, you're never gonna figure it out. I'd rather see you set it at one, and then come back and say, You know what? One is keeping me super stable at 140. This is terrific. But while I'm at work from three to seven, turns out I needed to be more like point five now or something like that. Like, like, it's so much easier to figure those things out when you're starting from one basil pro one Basal, right? I think

Kelsey 1:03:20
Yeah, no, that totally makes sense. That way, you can see exactly where you look fluctuate and from what time to what time.

Scott Benner 1:03:26
Yep. And when you make that adjustment, just remember that. Just like just like your Bolus insulin doesn't go in and begin to start working immediately. Your basil doesn't either. So if you are consistently getting higher at 3pm, or consistently getting lower at 3pm, you need to change your basil more like at 2pm. So that it has time to either ramp up the stock to high or to start titrating down to get in the way of allow. I'm telling you, I think you might really love the pro tip episodes. Yeah, I'm definitely gonna listen to that. Like, as soon as we're done here. But you already then apologize to the paramedic for me. Is he an EMT, or a paramedic? I forget. He's a paramedic. I apologize to him. Because the very likely days from now you're going to be like, you know, Scott says, and he's gonna be like, please stop doing that. Yeah, yeah. Trust me, I get a lot of notes from people are like my husband's tired of hearing your name. I I'm sorry. I know, I, there's part of me that wanted you just to explain your whole thing and go on. And then like, halfway through, I was like, I wonder if I couldn't help her. get through this. So I shifted my gears a little bit. Is there anything that we didn't talk about that you wanted to?

Kelsey 1:04:40
Um, no, I think we basically hit all the points that that I wanted to talk about.

Scott Benner 1:04:44
Cool. That's amazing. How do you feel after like making like some sort of a, even though it's just a kind of a subconscious decision, like I'm going to I'll try that. Does it make you nervous? Or how do you how do you feel about it? Um,

Kelsey 1:04:57
I feel good. I want to say I feel I guess the best word would be empowered going forward? Because I'm like, Okay, you know what, I have a plan. I'm a planning kind of person. So having some kind of timeframe and a plan of what I'm going to do, what I can do, really actually helps me quite a bit.

Scott Benner 1:05:18
That's excellent. Can I ask you? It's a little off topic, but not really. Are you an anxious person? Aside from the diabetes?

Kelsey 1:05:26
Um, yeah, I would say I'm a little bit more type A, I definitely like to have, you know, a plan and then 15 steps if that plan doesn't work out.

Scott Benner 1:05:41
You got lists of things around the house? Yeah. Yeah, pretty much. Yeah. My wife hands me lists a lot. And I'm like, What do you need for me on this? And what I've learned over years, is she just needs to see me crossing things off the list.

Unknown Speaker 1:05:56
So I'm telling you, that's the key. Yeah.

Scott Benner 1:05:58
Please, if she ever hears this, there are times where I can't get this something off the list. So I'll start a second list of things I need to remember to do and put my line through on her list so she can feel better about it. Turns out it doesn't matter. By the way, if you do the stuff on the list or not. Yeah, yeah. It's meaningless. Different different. Write something on a list. Never get to it. Find the list a year later and go, Oh, I never did that. Oh, yeah. And then realize you're still alive and nothing has changed. Yeah, exactly. Like, oh, I guess it was fine that I didn't do this. Yeah. It once you get mellow in that space, now you're living in my head, where I'm just, I just keep I do actually keep a list of things I need to do. But I keep it very flexible. And something that's at the top of my list today could easily end up at number 10. And something at 10 could add up at one I just stay. I try to stay flexible with what what the needs are around things. And I think of diabetes the same way as a matter of fact. Yeah. I'm super, like, hopeful for you and really interested, I am really serious. Would you keep me in the loop on this? Like you don't have to report in but if this works for you, or doesn't, would you let me know because this episode won't go up for a number of months. And I'd love to be able to put like a, like a follow up email at the back of this and let people know how it went for you. Oh, yeah, absolutely. I'd love to do that. Thank you very much. I really do appreciate that. So as we say, goodbye. What kind of dog Did I make you take out of the room? It sounds like it

Kelsey 1:07:16
sounds like dogs actually. So one is a basset hound, and one is a German Shepherd.

Scott Benner 1:07:22
I thought was the was the shepherd the one that barked. Yep, dammit. I thought that sounds like a German Shepherd. I should have settled I would have seemed like a genius. Now it just feels like I'm making it up afterwards. Damn it. Damn Damn. Well for anybody else who thought it was a German Shepherd. I was with you. Beautiful dogs.

A huge thank you to one of today's sponsors. Je Vogue glucagon, find out more about chivo hypo pen at G Vogue glucagon.com forward slash juicebox you spell that? g VOKEGL Uc ag o n.com. forward slash juicebox. Thanks also to touched by type one. Don't forget to find them at touched by type one.org. And of course those diabetes pro tip episodes can be found at Juicebox podcast.com diabetes pro tip.com. are right there in your podcast player, beginning in Episode 210. Thank you so much for listening. I'll be back very soon with another episode of the Juicebox Podcast.


Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate

#537 Haley is a Tandem Pump Trainer

Scott Benner

Haley White is a PA, T1D and pump trainer for Tandem. She’s on the show to talk about using Control IQ.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon MusicGoogle Play/Android - iHeart Radio -  Radio PublicAmazon Alexa or wherever they get audio.

+ Click for EPISODE TRANSCRIPT


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

Scott Benner 0:00
Hello friends, and welcome to Episode 537 of the Juicebox Podcast.

On today's show, Haley joins us. Hayley is a trifecta. She has type one diabetes. She works in the medical field, helping people with type one diabetes, and her side hustle. She's a trainer for tandem control IQ. And she's here today to talk about just that. As you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care

Unknown Speaker 0:58
plan.

Scott Benner 0:59
We're becoming bold with insulin. If you're new to the show, and don't know where to keep going, like you're like, I like this episode. But what do I do next? Check out Episode 411. It explains how different people listen. People who are more interested in community Some are more interested in management, Episode 411 will point you in the right direction.

This episode of The Juicebox Podcast is sponsored by the Dexcom g six continuous glucose monitor. And you can learn more about it@dexcom.com Ford slash juice box. The episode is also sponsored today by Omni pod makers of the Omni pod dash m the Omni pod promise, which I'll tell you about in just a little bit. To learn more about Omni pod, where to get started today, go to Omni pod.com forward slash juice box. There are links to these and all of the sponsors in the show notes of your podcast player, and at Juicebox podcast.com.

Haley White 2:14
Hi, my name is Haley White. I am a physician assistant at UPMC Children's Hospital of Pittsburgh, and the endocrine and diabetes division. I also work for tandem doing pump trainings and startups and also have type one diabetes. I was diagnosed when I was three, and I'm a former patient at Children's Hospital of Pittsburgh. So I'm happy to be here. And hopefully this information can help others because that's exactly why I got into this field to begin with.

Scott Benner 2:48
That's excellent. I don't want to go too far into your personal stuff because it will take away from our other conversation. But

Haley White 2:53
certainly How old are you now? I am 33. I'll be 34 in November and I will celebrate my 31st diversity in October.

Scott Benner 3:03
Wow. Look at you. That's it. Yeah.

Haley White 3:05
So I was like shortly before counting three is when I was diagnosed. That's a long. Yeah, it certainly is. So like the technology that we have available now is just so obviously so different than what my parents had available. When I was at age, the insulins are so different. It definitely makes management, you know, easier, and much more level. My cousin's daughter actually was just diagnosed last week, she's seven. And I was, you know, telling her that that things are at least a lot better than they, they used to be moving in the right direction. The technology advances are pretty cool.

Scott Benner 3:44
Yeah, it's amazing. How do you end up so you have a full time job at the hospital? I imagine, right? How do you end up doing training? Because a lot of people do this, like, do training for pump companies on like, Is it a side job? Or how do you

Unknown Speaker 3:56
Yep. So usually we'll meet like on evenings or the weekends, things like that. And which is usually more flexible with family schedules as well. I usually do most of just kids patients that are patients at our clinic. But can also do adults as well. So yeah, it works out pretty well, too. With my schedule in their schedule.

Scott Benner 4:19
How many people do you think that you talked to in a month? For tandem specifically? Yeah.

Unknown Speaker 4:27
It really depends. It kind of comes and goes like this month so far, I think I've done four trainings. So it really it kind of varies from month to month, but I would say four, three to four is pretty average.

Scott Benner 4:43
What's the goal of the training? So obviously, it's to see you understand the pump, but more specifically, like where are you trying to get them when you get off the call.

Unknown Speaker 4:54
So we actually will meet in person and the way we do things that children a little bit different than how they do things in the adult world. So if they're new to pump, brand new to pump, we will, I'll actually meet with them first. And they will go on sailing. And they'll practice using the pump, just using sailing for like a week or two. And then they'll come back, and they'll meet with our diabetes educators and kind of review something, see if they have had any issues, and then they'll leave that day, using the pump with insulin in it. So and the other thing we've been kind of doing, which I think will probably change also varies from patient, to patient and family to family. But we have been starting them out on Basal iq, if they're brand new to pump just to get them used to pump therapy in general. You know, it's kind of like getting your driver's license and then buying a Ferrari. So going from absolutely nothing to control. IQ can be a lot, sometimes, depending on the family and patient. So we have been typically starting them out on the Basal iq. And then after they get used to that, then they'll do the upgrade to the control IQ.

Scott Benner 6:07
So there's somebody making a kind of quiet assessment of the people and trying to decide what it is they can handle. Yes, and that's typically the provider, the provider does that. Gotcha. Yeah.

Haley White 6:19
So like I had a patient whose mom has type one has been on a pump. She's on a Medtronic. She's also a nurse, you know, and so we we started him on insulin right away. And on control, like cute right away, because that's obviously a savvy family who is already familiar with pumps therapy in general.

Scott Benner 6:38
I see. So but to my original question, it's interesting, because you have the perspectives of two different entities, like, I just occurred to me, like you have the goals, you have the practice in mind. But then when you work for tandem, you have different goals in mind. So that's the thing I'm interested in specifically is when I you know, I get together with you to do my pump training for control IQ. When I leave, what is your goal? Is your goal for my blood sugar to be in a range? Is it for me to understand how the how the algorithm works? Like what is it you're trying to impart in that first meeting?

Haley White 7:15
Yeah, so that's a great question. So it's really to, to understand how the pump works, and how to use the pump properly and safely. And then the adjustments in terms of getting the blood sugars into a tighter range typically goes back to the provider or the diabetes educators at the hospital. So as a, as a contracted employee, I'm actually not legally allowed to give the patient's medical advice on, like how to do extend boluses or Temp Basal aals? Or, you know, making insulin dose adjustments, etc. but can give that advice as a medical professional at the hospital, if that makes sense.

Scott Benner 8:00
Do you actually, like literally have hats that you take on and off while you're speaking?

Haley White 8:05
Yeah, so I will say, you know, I, you know, I can't say from a tandem perspective, but from a children's perspective, this is typically what I would recommend to my patients, you know, but I would double check with your provider, specifically, because everybody is a little bit different on how they manage things. And I'm sure you know, I say, all day long diabetes is not black and white. And there is a ton of gray. So it is a little challenging, because I'm legally not allowed to give specific advice as a tandem employee. But you know, since I do work for children's, I can kind of throw that in on the side off the record kind of thing.

Scott Benner 8:44
Yeah, I think it's beneficial for people to understand that device manufacturers are prohibited by the FDA from giving medical advice. And so to kind of make it super simple to understand if Ford makes a car, and Ford is Dexcom, let's say, then, I can tell you that the pedal on the left stops the car. I but I can't tell you how hard to push it or when to push it. And that would be a driving instructor who would tell you that? Correct? Yep, exactly. So you can say, Hey, listen, this is where you put the insulin. And this is what happens here. And this is how the algorithm works. But you couldn't say to them, for instance, the algorithm would work a lot better if you Pre-Bolus your meals.

Haley White 9:32
I mean, we do talk about some of those things that of course, we talk about like safety issues. So prevention of decay, prevention of site infection, things like that. So there are some things that we can discuss in terms of management, but really where it gets iffy or we're not really allowed to discuss is like dose adjustments or what specifically to do, if that makes sense. So we can do a little bit of that. But at least I think until you know, my boss hears this podcast, and then I get in trouble. So

Scott Benner 10:07
I think you're gonna get in trouble for being on the podcast.

Hayley White 10:10
No, I just saying unless they're like, Oh, you've been you've been doing that off the record, you're not allowed to do that or something. So, so we'll see

Scott Benner 10:18
Haley, I have to tell you something. It'll be a fun place to put this. I did an amazing interview last week with a person who is in your almost exact situation. Oh, yeah. Your job is not the training part, the part of the hospital? Right? Okay, we got completely done. When we got done. I said to the person, I don't think we should ever share this with anybody. And they go, Yeah, I was just starting to think I'm going to get fired, right? I was 100% going to get fired if I put this up. So anyway, it's interesting to see the back workings of things. But

Haley White 10:50
yeah, and there's obviously some things you have to say in terms of safety as a medical professional. Because once again, because there is, you know, not black and white, like we give black and white instructions, but then there's always a caveat to those as well. So it can you know, that's why diabetes management can be sometimes challenging. So sometimes what you would recommend professionally versus personally could be different. So I always say, Do as I say, not as I do in clinic. But But yeah, that's where it can get a little bit iffy. Okay.

Scott Benner 11:25
Alright, so I think we have some good background on who you are, and how you think about things. So that's perfect. So I want to just jump right into so I mean, I think it's obvious for people who listen that, you know, I have a ton of experience with on the pod. And I have a ton of experience with loop. And Jenny comes on all the time Jenny uses on the pod as well. And then Ctrl IQ comes up. And people are like, you know, I need to know how to use this. Now, in my mind, it's probably not much different than loop, which will probably be not much different than on the pod five, which will probably be not much different to whatever Medtronic comes up with and tide pools, algorithm, etc. I think they're, maybe they get to what they're doing differently. But I think it's more about understanding the settings that, that so for, I've spoken to a number of people on control IQ, who I've tried to help, understanding that I've never seen it in my life never held it never looked at it, never used it. And still, I've been able to help people, but I have to like listen to their stories, and then like, go Okay, well, I think maybe try this, and which is not not a productive way to try to get it to the masses. Right. So I'm hoping that you can, what I would like to do in this episode is to have a real firm understanding of how the algorithm works, and what's and what settings are available to you as the user. So

Haley White 12:52
yeah, so there, you know, I agree, I think all the automated systems, you know, their goal is to obviously get the present time and rates should be higher, prevent hyper, and hypoglycemia. But the algorithms are all a little bit different. So I think the thing that is nice about the control IQ is it does use your program, Basil rates, carb ratios, correction factors. And you can have up to six different profiles. So you could have your primary profile that you typically use day to day, and then you could have, for example, an illness profile where your insulin needs maybe a little bit higher. Or for females, you can maybe have a like menstrual profile, you can have an activity profile, weekend verse weekday profile, you know, grandma's house, profile, whatever, where things may be different. So you can have up to six different ones that are already programmed into the pump. So it's very easy to just go in and turn on whichever profile you want to use. And then the algorithm will use that as a starting point. So the only things that are set in the algorithm are the insulin onboard time and target blood sugar. So the target butcher is actually whenever you're just using it, the primary mode, so there's just your regular mode, there is an exercise mode, and then there's a sleep mode. So for that primary mode, the target is 112 point five, which I know is random. And I believe it was, you know, an engineering thing, how they came up with that number. And that was, you know, where you could get basically the most time and range from the majority of people with you know, last hypoglycemia. But actually in the pump, the pump settings at the target will be 110. So essentially it's keeping you between 110 or 112 point five to 160 is the target range with the algorithm Have them. And then if it predicts, so the other thing about the algorithm is it's looking 30 minutes ahead of time, and predicting what it thinks the blood sugar is going to do based off of the Dexcom values. So for predicts, you're going to go above 160, it'll start to increase the basil rate from whatever your pre programmed Basal rate is. And then if it predicts, you're going to go above 180, it will actually give a correction Bolus, the caveat being, it's only 60% of the calculated dose. And that's usually because it's, you know, as you're writing, it's increasing the basil as well, and then giving the correction on top of that. So it comes out to be, you know, not quite 100%. But it's still more than if they gave 100% of the correction, you know, that would definitely predispose you to drop below. But it's using your correction factor that's programmed in your pump settings, whenever it's calculating that, versus I believe the Medtronic algorithm doesn't use like your pre programmed Basal rates and things like that, and it just pauses comes up with them on your own. Yeah. So. Um, yeah. Okay.

Scott Benner 16:13
So if I put this on a person who's eating like, no carbs whatsoever, they're like, on a really strict low carb diet? Would I if everything was going well? Would I just see a graph? That's just 110 24 hours a day?

Haley White 16:31
Pretty much. Yeah. So as long as they're so bullish thing for, you know, the small carbon take that they are having into account the fat and protein? Yeah, I mean, whenever I don't always eat low carb, don't get me wrong, I love doughnuts, and fried food and all that fun stuff. But during the week, sometimes I do a little bit lower carb. And when I do low carb, I mean, my my tracings are like, pretty straight with very little minimal ups and downs. So that can be achievable with this, if you're doing you know, I think that kind of shows that lower carb is beneficial. Now, of course, in some kids, we don't want them doing super low carb for growth reasons and things like that. But in general, as an adult, you know, lower carb is a little bit easier on blood sugars in general, and then the system is able to make some of those micro adjustments more easily than a bigger adjustment.

Scott Benner 17:29
Okay, so let me let me say this, then, Arden, my daughter, about an hour and 15 minutes ago had two big homemade pancakes and seven strips of bacon, and her blood sugar 75. Right now in super stable, you're talking about? Is that not attainable? With control iQ? Or no,

Haley White 17:48
I mean, so the algorithm will decrease your basil, if you're trending below between 70 and the 112. point five. But that's not to say that you can't, that you're constantly then at like 112, point five, there's plenty of times where you could be in the 70s 80s or 90s. So it's just trying to prevent the low. And then if you if it's predicting you go below 70. That's when it will actually suspend the Basal

Scott Benner 18:19
will that create a highlighter? Or can it cut that off?

Haley White 18:23
So that's a great question. And one thing that I don't love about this system is, you definitely need to treat Lowe's less aggressively than you're used to, which I think is hard for people depending on how symptomatic they are. It's sometimes can be hard for parents, if they're anxious, you know about the low blood sugar or whatnot. But if you do over treat, and then you start to rise, then it may be increasing your insulin again. And if you're way over treat, and you don't dose for the extra carbs eaten, then you know and you're it's trending, it's predicting you're going to go above 180 then it'll give you that micro Bolus. And that often does precipitate another low. So it is really key to treat loads less aggressively and to find kind of what works for you personally, whenever the system does shut off that basil. So not necessarily like there's some times where mine might shut off and if I'm a little tight, I may actually just let it ride and then I'm fine. But if I have a lot of insulin on board or a patient has a lot of insulin on board, and they go you know they're in the 50s or 60s where they're much more symptomatic You know, I'm guilty of overtraining my lows at time. So I do find that you then have to, you know, be proactive and dose for the extra carbs eat and if you know that you overtreated it.

Scott Benner 19:45
Yeah, I find very simply that it takes a little while to figure it out. But after was on loop for a while. I saw there are some lows you treat and don't Bolus for and there are some lows you treat and almost half the Bolus Uh, you know, 60 70% of it pretty immediately.

Haley White 20:04
Yeah, exactly. So, you know, if, if it normally takes you 10 to 20 grams on this system, you know, to bring you up, then I would say subtract that from whatever you did he and Bolus for the rest of it. Even if you're nervous about it, you could always do a little bit less. And then you, you know, as as time, as always, you you see what happens, and then you learn from it and make an adjustment the next time

Scott Benner 20:29
but yeah, that's exactly how I think about. Okay, see, I

Haley White 20:32
think some people think that, you know, like, I actually initially was hesitant to upgrade from the Basal iq, because I love the Basal iq so much. And I was like, Well, I don't want to be necessarily 110. All day, I sometimes like to be a little bit tighter, especially overnight, but you can have lower numbers than just the 1/10. I think that's a misconception that I sometimes hear from people.

Scott Benner 20:57
Okay. Well, yeah, I mean, that's everyone's biggest concern about algorithms is, why can't I move the target? blood sugar?

Haley White 21:07
Yeah. And so I think in this scenario, I hear this a lot also about the insulin on board time being set, you know, with an algorithm, something that something has to be consistent and static, because if you can change the correction factor, the basil rates, the target and the insulin on board, that the math isn't going to always add up. And there's going to be actually a lot like the algorithm is not going to work well in that scenario. So something has to be consistent. So if you think about it, that's why with like Medtronic, for example, you don't have a set basil, it does that for you. But you can adjust your target, you can adjust your insulin on board time, things like that.

Scott Benner 21:48
Either giving you access to the different side of the settings, and then it thinks about it differently and tries to accomplish the same thing. So it's exactly how the algorithm is written to work. And, exactly. So let me ask you question is, does the algorithm work in such a way that if one day, they said, Look, we just need to make this thing more aggressive? Like, we're going to let you set it at 90, if you want your target to be 90 with the algorithm just work the way it works? But But you know, 22 and a half points lower, then, like, Is it just Oh, just an FDA thing? Like, is this just like, I think this is what we can get through the FDA right now? Or do you think this is just how these things are going to stay?

Haley White 22:30
Yeah, so that's a great question. And I think they're looking into that a lot, because they do hear from people that they want more flexibility, whether that's for, you know, like activity, the activity profile, or the exercise profile. It that targets you to between 140 and 160. And some people might want to be higher than that, or some people like I know, you've mentioned with artists, you know, she's pretty stable and can exercise when she's lower. So they are looking into being able to adjust some of those things, but I don't know exactly where they're at in that process. But I do think, you know, to get it approved, initially, they use that, you know, 112, point five, because that was the number where you saw the most time and range without increased hypoglycemia. So it was really a safe option, which, you know, is important, of course, when you're when you're thinking about diabetes management, especially as a parent, is to look at the safety. Oh, and it's

Scott Benner 23:30
so important to remember that this is the first iteration of these things for all these companies like, then we're gonna come out the door going like, you can just set this anywhere between 68 and 150, whatever you want, you know, like, right, do that that's not you have to, I hate to say it like this, you have to teach the masses how to use a thing before you can just do that. Yes,

Haley White 23:51
you're 1,000% correct with that, because, you know, I think a lot of people listening to this podcast, or a lot of people on the Facebook group or, you know, people who are savvy, they do want that tighter control, and they want that flexibility to have that tighter control. But that's not the majority of people. Unfortunately, I would I would love if all of my patients, you know, we're hesitant to upgrade to their control IQ because it targets you to 110 you know, that would be great. Yeah. But that's that's unfortunately not the case. So, so yeah, you're exactly right. They're looking at the like, the average, you know, patient with type one when they're when they were initially thinking about this a 112

Scott Benner 24:31
target, which for you people overseas is 6.2 that target is an A one see a 5.5 if you kept your blood sugar to 112 constantly, you're a one seat would be 5.5.

Haley White 24:44
Yeah, and that's the other thing to look at, you know, it's like it. It's always is very tight control. So sometimes it's like, you know, you have to think about diabetes burnout as well. And sometimes I think if you're expecting perfection, Share with diabetes, you can be setting yourself up for failure and burnout down the road. So, you know, expecting to be 90 all the time, you're gonna be at an increased risk of lows, which come with other consequences as well. So, yeah, it's not like riding at 1.5 is, is bad for sure.

Scott Benner 25:17
I want to say before we move forward, let me put this out there. One, what is it? 1.8 million Americans have Type One Diabetes that the number right now like so.

Hayley White 25:26
Yeah, I believe it's around there. Yeah,

Scott Benner 25:28
I'm gonna tell you that. This is you are right now, Haley speaking on the most popular diabetes podcast in the world. And I don't touch even a small percentage of 1.8 million people. And yet, and so for all the people out there who don't understand this in a bigger way, and who aren't kind of like Zen about it. And just like, oh, put some more in there. Correct. And alone. No big deal. Bolus two thirds that excetera. How much is that? I just Bolus Arden for pancakes. If you think I measured the pancakes, you're out of your mind. You know, I was just like, this much. Yeah. And so yeah, so my point is, you take this control IQ, you take on the pod five, you take Gloop, and anything and slap it on most people, and you've just significantly improved their health in their life. Significant

Haley White 26:19
1,000%. Yeah, exactly. Because we're seeing, like, even in well controlled patients, you know, in the clinical trials, and even in the real life data, I don't know the exact statistics. But it was like timing range went from, you know, like 65 to 75%, or something like that. And so you're already taking someone that's already in range 65% of the time, though, which is, you know, pretty good. Versus there's a lot of people out there who are not in frame 65% of the time, unfortunately. So I have a colleague who says better is better. And I love that slogan, because, you know, it is better than 8.5 8.5 is better than nine. So yeah, if we can take their time and range even from 25% to 30%, would be better. But the patients who don't do well at all who really struggle with bolusing, who, you know, have really poor glycemic control, they're actually seeing a better improvement with this compared to patients who are in tighter control. So they're not obviously having a higher, the highest percent time and range. But the difference in improvement is pretty tremendous. So it's allowed me to be a little bit more flexible with patients who maybe in the past, I didn't feel like we're the safest patient to put on a pump. But with this Dell kanila option. You know, I think this has really been a game changer for patients who are willing to wear a pump with tubing willing to do this, they'll Kiani law. And this, I think, is really going to improve a lot of lives of you know, people with diabetes, not only their glycemic control, but the quality of life as well to not have to think about your diabetes as much. And that's where I really have seen the improvement in my life is I don't have to micromanage or think about it as constantly as I did before and that after 30, you know, almost 31 years. That's huge. So I think that, you know, those two things, and of itself are, you know, just truly spectacular about this system and not all the automated pump. Oh, yeah,

Scott Benner 28:23
no, I mean, overnight, just overnight, if if the automated pumps didn't do anything else, the amount of sleep you were going to recoup, having an algorithm is going to be spectacular. You're gonna be magical. And, you know, little things like Arden went out last night, she was out for a long while in the evening, and she got home. And she was out with friends. They were driving around, I think she was the driver. I think they stopped in places did things hung out talk moved on, they were just out and about, you know, and at one point, I watched her blood sugar look like it wanted to go from 90 down. And then I watched the loop algorithm stop, but it's 72 and bring her back to nine. It was like it saw she was getting lower, and took away all her basil. And she dipped down and came back up very, very smoothly. And all I could think was I didn't have to text my 17 year old daughter while she was with friends and say to her, Hey, stop what you're doing and look at your blood sugar. See this thing? Yeah, grabbed ahold of it was amazing. Yeah, it really is it really Yeah. Like it's impeccable. So they went to a fair after that, or a carnival or something. And there was a time where I saw the algorithm try again, and it wasn't gonna do it. Now, she didn't know that yet. But I know it because I can see it. So I texted her. I said, you're gonna need a little food here. And she's like, great. I was gonna eat anyway. So I see is a Bolus for like 35 carbs. Everything's good. She's on her way. And then she gets home, she gets in bed, and I can see your blood sugar trending down, like she stopped. Now there's probably still some active insulin from the food she ate, you know, etc. And she's gonna get low. So I go into and I'm like, hey, it's really late, but you need some carbs here. And I'm trying not to tell her what to do. So she took in probably more carbs than she needed and fell asleep. But when her blood sugar started to go back up now was I thrilled that Arden's blood sugar was 136 for about four hours overnight. Last night, I wasn't, but keep in mind the scenario, she was asleep, I went to sleep, this thing stopped her blood sugar at 136. And by the time she woke up in the morning, was bringing it back down again. And then leveled her out at 90 and went on went on its way. So these are the things you're looking forward to if you're listening, but but Hayley, for everyone else, okay, for the rest of the people listening to this podcast? How do I tell them? Try an algorithm? Watch your a one c go up. But it'll be easier for you because they're not going to do that. So is there a way in control IQ specifically, for me to be more aggressive with my settings and have stability at a lower number than 112? Like, like so what I hear people say is I put that thing in sleep mode and always leave it in sleep mode. What What does that do exactly for as a jumping in point.

Omni pod would like to make you a promise. They would like to make you the Omni pod promise. Here's what that says. There's no need to wait for the next big thing from Omni pod. Because with the Omni pod promise, you can upgrade to Omni pods latest technologies for no additional cost. As soon as they're available to you and covered by insurance terms and conditions apply. But you can find out all the deals, the deals, you can find out all the details at Omni pod.com. forward slash juice box. Let me be clear on the pod promise isn't something you sign isn't something you have to pledge. They don't send you a certificate in the mail. It's just their promise to you. If you buy something from Omni pod today, you'll be able to upgrade to their latest technologies for no additional cost as soon as they're available to you and covered by your insurance. Right now today, you can get a free 30 day trial of the Omni pod dash when you go to my link, go there now and find out if you're eligible. A free 30 days of the Omni pod dash that is a month or 112 of a calendar year have you use an insulin pump for the free on the pod.com forward slash juice box head over now and check it out.

I don't know why I said that. I don't want you to head over right the second I want you to listen while I tell you about the Dexcom g six continuous glucose monitor. continuous glucose monitor continuously shows you your blood sugar in real time. No testing every couple of hours or guessing or doing that lag. I think my blood sugar's okay. And that's not how you find out what your blood sugar is how you feel doesn't necessarily say where you are. You know I can tell you where you are the Dexcom I'm gonna whip this thing open right now here. This thing being my cell phone to tell you about Arden's blood sugar art in left school today, she can drive now. And she actually she's a good driver. That's not the point. And her and a friend went out for chicken and waffles with real syrup. she handled that Bolus all by herself. And I got to watch it here on my iPhone. Now if I had an Android phone, I could still watch it on my Dexcom follow up but right now today iPhone I can see Arden's blood sugar coming out of school. I see the little dip when she Bolus, I see a tiny little rise. And then I see the insulin takeover come back down again. And I even see a spot a number of hours later, where the fat from the chicken fingers tries to come back and get her again the fat and protein from the chicken fingers. If you don't know about that you should check out the pro tip series. But I see it and I'm able to send our the text and say Hey, your Bolus was really tight. Really great today, but I think we need a little more insulin right here. And she responded back to me. You know what she said? I'm going to get it right out of my text. She said I already did. How cool is that? dexcom.com forward slash juicebox the number your blood sugar is the direction it's moving, and how fast it's going in that direction at your fingertips, whether you're a follower of the person wearing the device, where the person wearing it, everyone using insulin, everyone using insulin can benefit dexcom.com forward slash juice box Omni pod.com, forward slash juice box. Let's get back to Haley, we have a lot more control like you to talk about.

Haley White 35:32
Some people do that, yeah, what the sleep mode does is actually will not give any automated correction. But it will adjust the basil to keep you between 112, point five and 120. So it's a much tighter range. So if you're, if it's predicting you're going above 120, it'll start to increase the basil versus the, you know, typical, the typical algorithm is the cutoff is 160. So it has a tighter range in general. So it's keeping you basically between that trying to keep you between those numbers. Right here, I will tell you anecdotally, most most of my patients have had not only improved time in range, which I would argue, is more important than the agency, but have also had improvement in their agency. So I think, you know, if your settings aren't working accurately, and you're doing your and you're doing what you're supposed to be doing, unless you're a once he was like insanely low, I don't know, like 5% or something super low. There's no reason that you couldn't keep an ANC in the fives or, you know, low 6% that is definitely attainable with this system.

Scott Benner 36:44
So then, can this with the system allow me to keep a five a one. So if that was my goal, like what if I'm pregnant?

Haley White 36:51
Um, yeah. So yeah, great question. So it's not approved for pregnancy, which is part of you know, the reason is because they do want much tighter control during pregnancy, but they basically want you to be low on a lot during pregnancy, which I've never been pregnant, but my colleagues who have type one and have been pregnant, you know, they don't they don't feel great whenever they're like that all the time. So that's, that's one thing to think about. But I don't know, I haven't seen anybody with anyone see a 5%. I would say not to get too into numbers my last day when he was 5.6%. I was only using the system for a month at that time, though. So it's hard to say exactly how much of that was the system. But the problem is it doesn't, you know, you can stay between 70 and the 112. point five. So you probably could achieve an eight one C of five. If you are if you were doing the right things. I just can't say I can't say that from personal experience or professional experience. For sure. But I don't see why you couldn't because it's not like it's not allowing you to have blood sugars in the 70s and 80s.

Scott Benner 38:02
Okay, well, listen, Arden got hurry once he done last Monday and hers was 5.6. Now Oh, look at that where we can be diversity. Oh, she would be. She would just cringe right up into a ball. She heard you say that. But okay.

Hayley White 38:17
Yeah, and I have patience. Do you cringe too, and then Bolus by younger ones. They're the ones that you know, they love that. So I don't even think she saw her meter. If I ever meet her, I won't say that.

Scott Benner 38:27
I, you really want to listen to the episode that I just did with her to understand fully what I've just said. But

Hayley White 38:33
I haven't had a chance to listen to it yet. But I do want to, obviously, I feel like I know her, you know, from listening to some of the other episodes and hearing you talk about her. So you're up to literally Yeah, like hear her speak and everything.

Scott Benner 38:47
But I take your point. And I agree with your point about timing range, right. I do think that the one fear I have about talking about time and ranges, some people set their range between 70 and 400. And go I'm in range 100. But you know, yeah, you're you're right timing range. I think of it less than the way I think of it, I think of 160 is high. I think of 180 is I've made a fairly big mistake. Anything over 180 just doesn't happen. And if it does, we're FUBAR. Somehow like the pot you know, the pot the palm sights bad or like something like that, right? Like I but to tell people that aren't a one C was just five, six, and I want to be clear with you. Arden xavc was just five, six ardens a one C has been between five, two and six two for almost eight years now. And so time and range is super important. But I don't want you to think that Arden's blood sugar doesn't go up because it does, like I got pancakes exactly right today. And so did she. She's still 75 and we've been talking for a half an hour, okay, like I go back in three hours. She hasn't been over 90 or under 75 in the last three hours. And my point is that There are still going to be times when we're going to do pancakes and mess it up. And her blood sugar is going to shoot up like everybody else's does, right. And there's when I know how to circumvent the loop, that's when I know how to say, okay, we're going to shut the algorithm off. Now I'm going to crack this, bring it back down, get it straight, again, let the algorithm take back over, like, I can take a mess up and turn it back into good in an hour. So you know, if my if the insulin is doing what I expect, which is just the way of me thinking about like, if my if the pump sites working the way I want it to. But what can people do? I'm gonna ask this question later. I'm good. I'm so sorry. I said all that I'm going to come back to that question later.

Haley White 40:42
No, that's okay. But can I interject? Just about the timing range for a second? Yeah. So yeah, I agree with you. Because it actually, the timing range kind of default is 70 to 180. For this algorithm, as well as just like the, like Dexcom, clarity report, things like that. And I know, you can customize those as well. And I believe that that's also what the ADA had their range at, when, you know, making recommendations for how often you should be in range, etc. So, I agree, you know, I typically recommend like 80 to 140 would be ideal range. But you have to think if you're consistently even between, you know, 140 and 180, that's still so much better than some people do, you know, not everybody is as savvy as you are, or as you know, they just, there's some people out there who have really awful control. So I totally get what you're saying when you're having a tighter time and range. But you know, I think, and I would argue sometimes, too, like, should we make that lower, but that's what the ABA looked at. And their goal is to be in range 70%, or more frequently. So just kind of wanted to touch base on that a little bit more so that people aren't discouraged thinking like, Oh, I'm in range a lot. But that is 150 or 160, you know, and then feeling like they're not doing enough.

Scott Benner 42:14
And I appreciate you saying that. And I appreciate your perspective. From my perspective. I agree with you. I wouldn't like if somebody told me my blood sugar's you know, 150 constantly, and that's the best I can do. I'd say, that's great. I think that's amazing. Good for you. I also don't think that's the best you can do. So I think that aspirational is important. And that the perspective of this is what the ADA says, the FDA doesn't let me say this, because I work for this company. I don't want to say this, because I don't know, once we start factoring and all that other stuff, we take away good information from people who, okay, it might be over their head, but it also might not be over their head. And if we don't tell them, we'll never find out who's who. And so that's Yeah, that's why I talk about it like this. Like, I'm not saying, like I could be saying something right now that may be over a person's head who's listening, and maybe they'll never be able to put some of those things in practice. But I don't believe that to be true. Like, I think I've seen anecdotally, again, enough people listen to this show, who are the kind of people that the machine would say, Oh, they can't figure this out who have figured it out. And it's harder for them in the beginning, but I just don't, I don't like the idea of not telling them that the idea exists. So my only my daughter's blood sugar jumps up to, we just don't stare at it for five hours. You know, and

Haley White 43:40
that's really the point of this system is that you can trust it to bring you down and you don't have to worry about it as much. And then if it's not coming down, then yeah, that's when you would think well, is this a pump site issue? Or this is a typical What's going on? And so the so yeah, and, and I think that's the subset of people that listen to your podcast also are more high achieving than, unfortunately, some of the sub some patients in general, too, but I do see what you're saying, right?

Scott Benner 44:09
No, but I my goal is to reach those I listen, if if I if you asked me right now how to talk to people about diabetes, I would tell you to tell them to get their Basal insulin right to Pre-Bolus their meals to understand the different impacts of different foods and stay flexible. And I think if you

Haley White 44:26
i i agree, I'm not I talk about this all the time about Pre-Bolus ng and the glycaemic index healthbar to Pre-Bolus, all that stuff. And I agree, like having your basil set. And being accurate is so important. And I think a lot of people don't and sometimes, even as health care providers, we sometimes increase the basil more than it really needs to be in patients who may not have the best habits, because we're trying to compensate for what they're not doing and we're trying to, you know, obviously in a safe manner as well. But then the basil rates end up being a little bit higher than what their true basil needs are. So then if they do go on this system, you know, I will tell them, you know, over time, I think we've compensated, this is what I think your basil rates should be around. And then, you know, try to test to see if that is accurate or not before like going on this type of system.

Scott Benner 45:19
Yeah, oh, no, I can't imagine in your line of work, right, there's that you must walk a line where you go, Okay, this person doesn't Bolus for their food. So how can I get their basil without making them low. So that offset a little bit their bad bolusing habits or that person or this person won't count carbs are this person for the life of them doesn't want to understand that, you know, french fries are going to hit them differently than something else. And they won't see those references. My point is, is those people are always going to exist. But when we start treating everybody, like they may be that person, then no one has an opportunity to have like a solid five, a one c five, a one C with a time and range of like, 90%, if that's what they want, and that's what they're willing to work towards. So my my question about the system specifically is, what are the settings? I'm gonna make notes while you're talking? Like, what are the settings? I have that I have access to if I'm using control iQ? In terms of like, what can you adjust? Yes.

Hayley White 46:21
So your Basal rate, your correction factor, and your sensitivity factor? sensitivity arc, sorry, and your carb ratio, and carb ratio? Yeah.

Scott Benner 46:34
Okay. So, obviously, simple things, starting at carb ratio, if you have your carb ratio, right, then great. But if you don't, then you got to make adjustments to it. But how do you make those adjustments if the sensitivity factor is wrong, or the basil is wrong? So I start with basil, I like the idea of away from food away from boluses. I think your basil should hold you stable at the number you're looking for. So I agree. Yep. Okay, so then the first step, but how do I get my basil set? If, you know if I go into the office, and somebody just says, your insulin sensitivity factors 43. But it's really 40, let's say, and they say, your correction factors one to 100, but it's really one to 80. And they say your basil is point five, but it's really point nine, that's, that's lost, that's lost in the weeds. And it's going to happen, like people are going to go into offices, they're going to everybody's going to do things a little more carefully, carefully leads to up and down, up and down leads that I don't this thing doesn't work usually, right? That's usually what they say the pump doesn't work. Yeah. And yeah. And so I think that people have to have enough autonomy to go home and say, I need to find stability away from food and boluses with my basil, because now I can say, my basil is point nine that I know for sure. Then correction factor, super simple to fix after that, because you just let your blood sugar go up, let it get stable, and then correct it and see what happens. And then you can Yeah, you can hone your correction factor pretty quickly. insulin sensitivity is the one that I have to admit, even I just kind of turn the knob till it works. So how do you

Haley White 48:26
tell Meaning? Meaning because correction factor and insulin sensitivity factor are the same thing. It's just they're different companies use them interchangeably. They use them differently. So they're the same thing.

Scott Benner 48:37
Okay, sorry. So what's it called in in control IQ.

Haley White 48:41
It is correction factor. But it basically is saying one unit of insulin drops my blood sugar by X number. So it's the same as your insulin sensitivity factor.

Scott Benner 48:54
And I think that's really. So what you're seeing there in my conversation just now, is that when I first started using loop for my daughter, I just went from a brand where they call it correction factor to a brand or they call it insulin sensitivity factor. And for months, I didn't understand that those were different things.

Haley White 49:13
Yeah. And that's not uncommon. And I will admit, just as I, I mean, obviously, did I confuse them because I just said that you said, instead of carb ratio, I did them twice. And I use them interchangeably as well. So honestly, there's no rhyme or reason necessarily. If I say sensitivity factor, correction factor, it just kind of whatever comes. And so tandem does call it correction factor. I would say in general, we probably refer to it as sensitivity factor more. I think Omni pod calls that sensitivity factor, but that yeah, that's exactly exactly right. That's one of the confusing things. So I think that is important to note

Scott Benner 49:56
that so then is that then is setting this system up as easy as getting Your Basal, right learning your correction factor, and then understanding the implications of different foods, meaning that if I, meaning that if we decide carb ratio is one unit for, I don't know, you know, it's funny, what's your carb ratio? one unit? To what?

Unknown Speaker 50:18
No, yeah,

Haley White 50:20
my carb ratio varies either one to 10 or one to 12. Yeah. Versus my correction factors like 65. So my correction factors, pretty, I would say, wimpy and conservative compared to like my carb ratios.

Scott Benner 50:36
Can I ask your Basal?

Haley White 50:39
Yeah, so my basals are like point eight, you like most of them are point eight. And my total basil dose is usually about 21 or 22 units.

Scott Benner 50:50
So keeping using that number, basil, point eight correction factor, like one to 10 excuse me, a carburetor ratio ratio one to 10 correction factor, like one for 65. If you just made all of those stronger, would that? Would this pump keep you stable at a lower number? Like if you just said, I'll just make my Basal point nine, I'll make my correction factor a little stronger, maybe I'll make it 60. And I'll turn change my carb ratio one to nine instead of one to 10. would would you just suddenly have? Do you have that kind of control? Or does the thing just keep shutting itself off to try to get back to one?

Haley White 51:30
Yeah, that's a great question. So there's probably a little bit of flexibility there where you can try to find that, you know, those magic numbers that will keep you above 70. But the second that it predicts you're gonna go below 70, it's shutting that insulin off. So you know, and depending for how long it does that, and then if you do end up going low, you know, and if you over trade, then that's when you start to see more of a like roller coaster type of pattern. So it's not as easy as just making them more aggressive. And that's why I think tandem is looking into being able to customize those targets a little bit more for your personal preference.

Scott Benner 52:09
I understand. That's great. I love this conversation, because we're walking people through all the different thought processes they're going to have when they're thinking

Haley White 52:17
Yeah, right, exactly. But I agree with you, I think getting the basil setup is super important. The one thing I like about this system is when you go on your, when you log into T Connect, which is where like, you can download your pump or save your pump information to the cloud, there's actually an app on your phone where you can go in and look at it real time. They're looking into getting a Bolus from phone thing approved. And that's the FDA right now. But when you go and look at your report, it'll actually give you your actual basil doses compared to your program doses. So it basically is telling you what your actual basil needs are based on how the pump is adjusting. And when you look at the download, it'll kind of give you it's it's hard to explain without like looking at it. But it's really nice to be able to sit with families and explain you know, when you see this, when you see this, this is how you know what's going on. But there's basically a baseline, that's your typical basil rate. And then the bar will, you know, be either above or below that if it's giving more or less or you know, there's like a diamond on the report where it'll show up if it's suspending the Basal on its own right. I think that's really helpful to look at overall, this is what the pump has been delivering and this is where my I'm set up something needs to be adjusted.

Scott Benner 53:44
Yeah, I'm very visual to like I remember in the beginning just seeing like, well, it's cutting our basil a lot the basil is too strong. Or maybe the correction factor is too strong. Like that's it like Ardennes is really interesting. Like she's now that she's on birth control and she's become like regulated and stable on birth control because she had that because her her poor Ardennes, like was getting her period constantly. And like literally like 11 days, two days off 11 days, two days off, like it just never stopped. She was just it was killing her. We might as well just cut open her vein and and sped the process up like she was on her way. She's probably anemic and she was feeling awful. She had to get like ferritin and iron infusions, stuff like that. Yeah, so the point the point is, is that now that she's stable with that, her basil is between point nine and 1.2 depending on the time of month, and her correction factor is somewhere between 40 and 43. Now the one thing that I will say is that we are really aggressive with our carb ratio, I think ardens carb ratio is one unit for four and a half carbs.

Haley White 54:56
Oh wow. Right. Yeah, that's, that's quite aggressive. Yes. And so But that's what works. Like, that's what she needs. And that's the thing like, you know what you're doing, you're doing things properly. And that's clearly what what she needs, and it's working for her,

Scott Benner 55:10
I could also probably change her Basal rate to 1.4 an hour and make her carb ratio weaker. And

Haley White 55:19
then the problem is, if she's, you know, not eating or whatever. And let's say you're waiting on a Dexcom supply to come in, and she doesn't, she's not using the loop algorithm, she's gonna be super low. Yeah, exactly. But that's basically what we do for kids who don't go as regularly or who like, vastly underestimate their carbs, we may bump their basis up to try to compensate. But the nice thing about the system is, it's compensating not only with the Basal, but it's compensating, like your carb counting accuracy, could be a little bit off, and it's going to prevent you from going as high as you would without the system. And it's also going to bring you back down to target range much more quickly than if you were to try to do it on your own. That's helpful too, for teenagers who may not, you know, I'm like, I know, you're not going to take your measuring cups to college with you. And you're not going to be getting out your food scale, you know, you're kind of eyeballing things. So I think that's another nice feature of this pump is that it does kind of help a little bit with the, you know, if the carb counting is off a little bit

Scott Benner 56:24
in my mind, the basil and the correction factor, are the tools that get used away from food. And then we show up when there's food and bang very hard on the foods head with a with a an aggressive Bolus. And so, you know, I don't even know it doesn't even matter for factors right anymore. It just means what what, what works is, what do I mean by that? What works is when she looks at a plate and decides on a number of carbs, it translates well with the factor that we have set up right now. And so it's you know, is it real? Like, is she really that? I don't 100%? No, you don't I mean, like, it just I can just tell you it works. And by works. I mean, there's a balance between our, the way we look at food and go, I think that's 60. And what the number says that it works. So I just looked again, she's now like an hour and a half or more outside of these pancakes. And she's finally 97 diagnol. Up. And so yeah, I mean, that's, that's impeccable, we're good. And I'll tell you right now, if that thing gets the 115 and doesn't level off, I'm gonna Bolus, like, you know, because because of what I know, pancakes will do to her, if we miss it. With the loop, we're able to tell it that we think the impact of the food is over a certain time. You can't do that with the control like

Haley White 57:52
No, you can't. And that is something I love about the looping. I think that's a brilliant, like feature. Because what is it like a lollipop, a taco and a piece of pizza or something? Isn't it? Yeah, so it's like easier to think in that terms versus like, you know, go up and go and look up the glycemic index of this food and blah, blah, blah. So that is one thing that I I do really like about the looping that you don't have with the control IQ. The other thing with control IQ is you can still do extend boluses However, you can only extend it out by two hours. So which I find is often not enough. But you know, you can either Bolus the additional what the additional needs later. Or sometimes the algorithm if your settings are right, sometimes it kind of just kicks in and works can pick you up on your own. Yeah,

Scott Benner 58:46
I've listened. Sometimes the algorithm can get it, sometimes it can't. I tried to think of like as a fat, like a fat rise, for example, like French fries is such a good example for that. But in that situation, I just think of the fat is more carbs or more insulin need, and then just come back around an hour and a half or two hours after you're done eating and just Bolus again if you weren't able to stretch it out enough in the beginning.

Haley White 59:07
Right, exactly. So now the other thing you can do, which I don't think is, you know, I wouldn't recommend to most patients unless you for sure know how to dose for something and you know it works. And same thing with activity, you can go and turn the controls IQ off. It's just an easy toggle on the pump, and then do what you need to do extend it out and then after that time, you would just go and turn the control IQ back on. So there's no like really warm up period or anything like that. You just have to simply remember to go in and turn it back on.

Scott Benner 59:43
I think of it this way. If we make no mistake when this happens for us personally and I'm going to guess for many people, you've messed up a meal. Like if you find yourself in that situation you haven't Pre-Bolus or you under Bolus the meal now you're flying high, the algorithm screwed It's like you're 60% of what I think you'll have I'll reassess in an hour, you're gonna be 400 by the time it reassesses. And so like you've messed up now. And now now your blood sugar's flying up, I open the loop, or as you say, like turn off the algorithm for for this, and then I treat it like, you know, like this is MDI or regular pumping, I crushed the blood sugar, and then catch it. And there's a, there's a skill to catching it and when to turn the algorithm back on. And it took,

Haley White 1:00:28
I think that's, I think that's a steep learning curve. But with with trial and error, you certainly can figure that out. The other thing is, you can go in and give a manual correction or a manual Bolus with the algorithm on as well. So that is also an option. Now, the pump will only deliver the auto correction once an hour if there hasn't been any boluses in the past hour. So if you do that is not going to deliver one for another hour. But you can go in and do that. But I think sometimes, you know, I would encourage people to kind of get used to the system first before they're adding in all these extra variables. But over time, I do think you start to learn, just like you do with traditional pumping or with MDI, how certain foods or activities affect your sugar and how to kind of compensate for that.

Scott Benner 1:01:19
Yeah, you can't you first First things first, you got to get your settings. Right. And you got to watch the little exactly how it works. Yeah. Because if Yeah, if this systems working even reasonably well, for most people, it's pretty cool. It's only three ideas. It's basil, correction factor and carb ratio. And then the rest of it is your understanding of how to manage meals and the differences in foods and things like that. Can I go back into control, like you say, an hour and a half ago, ate something I said, That's 45 carbs. And I realize, Oh, it's 55? Can I go edit that? And will it make a change after I edit it? Or? No,

Hayley White 1:01:52
you cannot. So you could go you could just go to that extra 10 grams of carbs. So at that point,

Scott Benner 1:01:58
can you put in a new Bolus and change the time? Like so if it's one o'clock, you put in 40 carbs at at two o'clock, you realize, oh, that should have been 50? Can you go in at two o'clock put in a 10 car Bolus, but tell it It happened at one o'clock?

Haley White 1:02:14
No, you can't. So yeah, so that will Yeah, the later dose then we'll you know, it's then if you dose the extra 10 grams at two o'clock, that it's going to be taken into account for that five hour insulin on board. So yeah, that's one thing that you can't do. Yeah, but it probably has already given you extra. Like, if you're only off by a little bit, it's probably it's already compensated by giving you extra basil. And then if you do go, if it's predicting, you go above that 180, or you go above 180, it's giving you that micro Bolus. So if you're only off by a little bit, I feel like it does a pretty good job of bringing you back down on your own and prevents you from going, you know, into the mid or high to hundreds right? Now, if you're off by a lot, then yes, that is going to be a different scenario. But

Scott Benner 1:03:02
these algorithms are not, they don't think it's important for people understand, I don't care which one you're using, I've even seen on the pod five yet, but I'm going to tell you right now, I can't think on its own. So if it only knows what you tell it. And if and if you for some reason, don't understand that 45 carbs of Fruity Pebbles is more impactful than 45 carbs of I don't know, you know, eggs, bacon, and some, you know, ketchup and whatever else you're, yeah, if you don't know the difference between those two insulin needs, this thing doesn't, it doesn't know you've set these settings up, you've told it This is 45 carbs, and then you put rocket fuel in. So those are the things I think these algorithms are all amazing. And I think that you need, but you're you're always going to need to understand the basic ideas about getting your settings right, and making good solid doses for different foods. If you can do those zactly you're gonna sleep like a baby. It's just so yeah, you know.

Haley White 1:04:03
And, and I think the other thing to kind of add on to that one important thing that I have noticed with this system is just like you said, the pump, you know, the algorithm isn't doing the thinking. So if you take your pump off, and don't suspend the insulin, the algorithm has no idea that it's not actually delivering insulin has no idea that you're in the pool or you're in the shower or whatever. So you definitely need to suspend and then resume insulin after you reattach your pump. I know you've that's something you guys wouldn't have to think about with, you know, with an omni pod, but I think a lot of people with with pumps with tubing are just used to taking it off and not necessarily suspending it. But that's one thing that's important to know because it could be adjusting your insulin, thinking that it's attached to you and it's not so that's one thing. I think it's helpful. The other thing is if For whatever reason, you do want to give like a sub q injection of insulin, if you feel like your site's not working, you just want to give this up to you injection, make sure it's getting into your system, the algorithm doesn't know that you did that either. So the way to get around that, you can just detach, you know, disconnect the pump from your body, let's say you gave four units, put in four units blindly. And then you know, just deliver that into the sink or whatever. And then the pump thinks, you know, it delivered four units, even though the pump didn't deliver it, it's taking that four units into account whenever it's looking at the insulin on board. You know,

Unknown Speaker 1:05:39
we don't get a lot of to pump tricks and tips on this podcast. So that was good. That was excellent. Yeah,

Haley White 1:05:45
yeah. Because there was, like I said, those are things that you just didn't have to think about before, when you didn't have an algorithm, like you gave a sub q injection and went on with your day, or you just take your pump off. I think the other thing with new pump users, I like the suspend feature, because the pump after 15 minutes after it's been suspended for 15 minutes, will beep very loudly. And it's very annoying. But that's a safety feature to say, hey, like the pump is not attached, because I you know, my biggest worry is for kids to like forget to reattach their pump, and then they go to bed and you know, end up super, super high with ketones and whatnot. So I think that's a good habit to get into to begin with. And that also reminded me so this pump is you do have to charge it. And it comes with a charger. Usually, they say a full battery will last about a week or so. But I typically charge mine while I'm getting a shower, since I'm taking the pump off anyways, I take it off, I suspend. And then I hook my pump up to the to the charger just give it a little bit of juice. But it is something that you do have to remember to charge it.

Scott Benner 1:06:55
Yeah. Cool. Is there anything that we didn't talk about? That we should have?

Haley White 1:07:00
Yeah, you know, I feel like there's still kind of a lot of stuff that that we could have talked about. I mean, there's just I could be here all afternoon talking about things. Um, you know, I think, I think the big things are, like he said, make sure your settings are right. Have some patience, if you're switching over, you know, from a different pop, or just getting started, you know, while while things are getting figured out. But you know, I really think this system works really well. If your settings are, are accurate, you're doing what you're supposed to be doing. I think it's safe. And I think it really improves, you know, your quality of life. And I think that is so huge when you have diabetes. I'm trying to think if there's any other kind of big things, the only other thing that I sometimes see, so the insulin on board is set at five hours. And I know some people you know, have their set for shorter if they're on other pumps, or, you know, if they're on MDI, they're not necessarily even taking that into consideration unless they're using an N pen or something. So leading up to starting on this, I think it's a good idea to gradually extend that insulin on board timeout on your pump or your income, so that you can kind of recalculate your settings. Because if your insulin board is, let's say three hours, your sensitivity factor is, you know, calculated. taking that into account, if you're someone who's vigilant and doses every two to three hours, if you're not someone that doses every couple of hours, it may not be as big of an issue. But if you've figured out okay, this is, you know, my sensitivity factor, whenever you know, I have an insulin Board of three hours, that's going to be different than whenever it's spaced out to five hours, often it will probably need to be a little bit more aggressive. If you have good control to begin with. If you don't, that's something else to kind of, you know, like you said it's easy to test after you know that your Basal rates working properly. But sometimes I don't know how other clinics work, but I know sometimes, personally, my patients I might make their crutches after a little bit more aggressive as well, if I know that they don't compound accurately or I know they're not dosing regularly and they're only dosing once a day, based off of their blood sugar to get them a little bit more in somewhere I can, but then I'll tell them that going on to the system like hey, I made your correction factor 30 I really don't think it needs to be that aggressive. Let's try this to begin with. So but that's something that I see some people kind of get concerned about that insulin on board being longer. So that's something that I think can help to re evaluate your settings. spacing that insulin on board out.

Scott Benner 1:09:42
Just time for me to ask you a couple questions. Yeah, sure. Cool. So if put put yourself in this scenario, it's overnight okay. There hasn't been Bolus since 8pm. It's two o'clock in the morning. Now. If blood sugars are going up and going down, like like choppy well You don't even you're not getting that smooth line with your basil. Is that like, what would you look at first and control IQ if it was like going from like, I don't know, super stable, and then suddenly goes up to 140, then comes back down to 80. And back to 140. If this has happening over and over again, what settings are we supposed to be looking at then?

Haley White 1:10:22
So that's when I would really look at the download and see like, what is what is the basil doing? And I would, you know, also want to know, like, What did you have for dinner? And what was your activity like that day? But it really unless you in you know, I'm not someone that's in favor of having like 12 different days or AIDS throughout the day. But unless your bases are really like variable and change frequently? I would say that's pretty atypical to see that pattern unless the, you know, unless unless that's like the reason unless it's food or activity related.

Scott Benner 1:10:57
Could it be the algorithm sick? Could it be a basil is too strong, and it drives you down, and then the algorithm sees it cuts off, and it bounces back up? And the algorithm comes back on? and it drives you back down? Again? Could that be a sign of

Haley White 1:11:10
Yeah, that's a good thought. I think it's it's a much slower, it's typically a slower trend. So when to expect it to be as like, up and down and choppy, it would be kind of more of a gradual rise and decrease. But But yeah, if it's especially if it's shutting off for a longer time, that could then you know, cause you to rebound a little bit higher. So I was you can see on your pump, when you wake up or at any time, there'll be a vertical, like red vertical line on the pump screen when it shuts off your insulin. So you can kind of get an idea of how often it was shutting off. And for about how long and if you're seeing frequent red bars, then I would say it's probably that your Basal is too high.

Scott Benner 1:11:56
But that's probably not correction factor. If I'm seeing the red bars, that's basil.

Haley White 1:12:01
Yeah. Because overnight, so I guess, I don't know, I can't remember what we talked about honestly. So overnight with the sleep mode, it does not give any auto corrections. So it will only adjust the basil. So that's what's one thing, then you can kind of roll out that factor. And assuming you didn't give any correction before bed or anything like that.

Scott Benner 1:12:20
It's more it's more aggressive with basil and sleep mode, right?

Haley White 1:12:25
Yes, correct. You have to today I want to mention about sleep mode. Sorry, I forgot to mention this. So you can pre program the sleep mode, there's two different profiles. So most people will have like a weekday versus a weekend, or they may have like if you do shift work or something. And then it comes on automatically. So you can have it set from like 10pm to 6am, for example, on a weekday, and then, you know, 11pm to 8am, on the weekend or whatever. And it will then turn on automatically. And then depending on your needs, you know, if you're someone who is eating later at night, and or, you know, kids that might struggle with grazing, you may want to start that sleep mode a little bit later, so that they're getting a correction before going to bed versus you know, a younger kid or an athlete who might be prone to like delayed lows, or something like that. You may want to start that sooner so that they're not getting any corrections before bed. So something to keep in mind.

Scott Benner 1:13:27
How does it know? The range? So if we tell it, if we tell it your basis, point one an hour, and it's aggressive, does it tell itself where to stop being aggressive? Do you know what I mean? Like can like if can this thing like if I'm in sleep mode and it sees something crazy coming? Can it change my base little like for an hour where there

Haley White 1:13:49
is a max, a max Basal limit, but you can set in the pump. That is, I think three units per hour. So but if you're someone that's really sensitive and three units per hour is going to you know, really plummet you like a really little kid for example, you could set that max basil at one unit an hour or a third normal base rates point one you could set it at point five units per hour. So I would say two and a half times higher than your typical basil is probably the highest I would set it to start with and then kind of go from there. Like let's go I'm sorry, go ahead.

Scott Benner 1:14:30
I'm just gonna say what if I'm a 250 pound grown man and my basil is two and a half already. is the max still three?

Haley White 1:14:36
Yeah, so that's a great question. So the max basil rate you can have in this pump is insanely 15 units per hour. But I believe that it will still only give three units per hour max if the control IQ is on I have to I could double check off because I was actually getting reading something about this recently. And I know if it shuts you out of the control IQ. So if the Dexcom and the pump aren't reading for more than 20 minutes, it, that's the only time where the control IQ will not work. So I know like with the 670, G and 770 G, like it'll kick you out of auto mode for certain things. This is really the only reason that it would kick you out of the control IQ and then it goes back to your program settings. So I know if it kicks you out, even if your programmed rate is higher, it only goes to that three units per hour. And I think that's a safety thing. But I don't know for sure how high it can go. And I apologize for that. But I can definitely find out for you and let you know,

Scott Benner 1:15:45
you sent me an email packet in the end of the episode. Can I ask a fun question now that we're sorted? Yes. So you're in the business, right? What what's the word on the street about how on the pod five is gonna work? Because I hear people calling it Oh, learning system. You hear people calling it a what? Like a learning system? like it'll it'll make different decisions based on historical data. Is that true?

Haley White 1:16:10
Hell, I. I've heard that too. But I don't know. I haven't had that. be confirmed by anybody that works with an omni pod. Yeah, they won't say anything that way. I know. Some I know. I know. They're so tight lipped. Yeah, yeah. But that's kind of how my tronic is. And I see the theory behind that. But it's kind of there are pros and cons to that as well. So yeah, I mean, I think that people are going to have success with that as well. I think people are going to have success with any sort of automated insulin delivery system, but I am, I'm excited for that to come out. Because I do have some patient to you know, absolutely don't want to being or they've been on Omnipod. So they want to stay with Omni pod, you know, so I'm really, really excited for it to come out. But it should be interesting to see, you know, how it works and everything.

Scott Benner 1:17:00
Yeah, I agree. I

Hayley White 1:17:02
so I do have some patients that do the looping, we just can't obviously, it's recommended.

Scott Benner 1:17:09
weird thing when, when it comes down to that at Arden's appointments, they're like, I need you to look in the app and tell me what the total basil is for the day and what this like they act like it doesn't exist. But then when when that technical parts, I was like, hey, this loop works really great. And I was like, Yeah, like, it's funny when they're, it's it? I understand. Yeah, you know,

Haley White 1:17:29
and the problem is, too, we don't like it's a lot of work on our own to kind of research and learn how it works and stuff like we don't get any formalized education or training on how the algorithm works. Luckily, for me, I have a, a dad with type one, his daughter uses the loop and that, you know, Dad uses it to and he helps actually get people set up on the looping system here in the Pittsburgh area. And so he's a great resource to have that I you know, can shoot him a message pretty quickly. But But yeah, I mean, I agree, I think it works well, once again, for patients who do X, Y, and Z. Some patients still struggle with bolusing or whatever. And then they still have, you know, erratic numbers, because the problem is right with the loop, or I think there's a newer version, you can correct me if I'm wrong, but it only adjusts the Basal is that correct? I know

Scott Benner 1:18:16
that. There's one that corrects the basil. But Arden uses Auto Bolus where boluses Okay, so there is one that it'll it'll Bolus and keep bolusing. So I think it's, I think it's 40% of recommended, but like, let's say it, it wants a unit. It'll Bolus point four. And then the next time it comes around, if it's still reading higher, it'll it'll go again. Now, it still only does like that percentage of the thing. But the percentage is actually customizable. If you're willing to go into the programming, you can change the percentage to if you relax and trust and if you really want

Haley White 1:18:52
me to be nervous as a provider of Well, once again, depending on the families, you know what I mean? Like you have to take that into consideration. Some people are like, super savvy and great with it. So it's very independent,

Scott Benner 1:19:08
you can get into the loop and change that setting. You're You're pretty knowledgeable to begin with, because it's not it's not like Yeah, right. It isn't a door Mark make this stronger. You just have to like knock on it. It's it's hard to get accomplished. But I have three episodes called Fox in the loop house with a gentleman named Ken Fox, Kenny Fox, who's a dad, I understand that you won't understand Luke, listen to those. You'll understand it when it's over.

Unknown Speaker 1:19:31
Okay, yeah. So, um, that's,

Scott Benner 1:19:35
I mean, I really know what you're doing this. I know, you can talk forever because you have like, unlimited points in your head about this. But I

Haley White 1:19:44
know only the only other thing I want to throw in there is the activity mode, just cuz we didn't talk about that at all or that or the exercise note, I mean, right. So that will target you just real quickly between 40 and 160. And we'll suspend on it. Instead of 70, so it is meant to keep you a little bit tighter, it still will give higher basil. So we'll give auto corrections that are 60%, if needed. And the one thing I found is, you have to really start it at least an hour, if not two hours before. And for some people, that's still not enough. And so sometimes what I'll have my patients do is either if they know what to do just turn to control, like you often do what you did before, which is honestly typically what I do. If you're not in, you're just it's new learning either way, then I have them create a separate profile, like an exercise profile, where their Basal rates, correction factors, everything are less aggressive. And they you just have to remember to turn that on. And the activity mode so that it's giving you more time to target you to the 140. But then if you are trending up, it's gonna give you less insulin, so you're gonna have less insulin on board, you know, heading into the exercise, I find

Scott Benner 1:20:51
that people's biggest problem with exercise is they want to do it with a ton of active insulin. Like they.

Haley White 1:20:58
Yeah, and then it's just like that insulin is supercharged. Yeah, you could have like a half a unit on board, depending on your insulin sensitivity. For some people, that's fine. But for me if I have a happy unit on board, my plummet, so yeah, it's I think exercise is a learning curve for some people. But some people like want to turn it on right at the beginning or half an hour an hour before, and it's often not enough. I just didn't want at least mentioned that. Sorry. No, I

Scott Benner 1:21:25
appreciate I'm fascinated always that people don't recognize how insulin works in time, like how they're just like,

Hayley White 1:21:31
Yeah, right, like the basil doesn't affect you right away. Obviously,

Scott Benner 1:21:34
I'll just throw a light switch, and it'll be fine. It's like, that's not there's already the insulin from the last hour that was meant for that. So the thing that I said on here, Haley that I think is important, is that insulin you're using right now is for later. And more importantly, the way you have to think of it while you're making the adjustments is that insulin from before is for now. So you don't get to say I'm going to start running now. I'm going to shut my basil off because you can shut your basil. You can take the pump off and throw it across the room if you wanted to. You're still going to already failed. Yeah, it's too late. Right? Yeah. So you have pre planned for that. And then you get into that's a real human failing of the idea of pre planning. It's why people are so bad at Pre-Bolus thing. And why? You're exactly right. Yeah. And why I tell them all the time, they're like, I don't know what to do here. I'm like you have to pre boss. I don't want to well, then you're gonna buzzers, Hey, hi, I don't know what to tell you. Like, like, this is just how it works. Like, I'm sorry, it sucks and everything. But the insulin is an instantaneous and it's even more so with basil. Because it's not so much of it, it's this little like, like your, your, you know, demean every couple of minutes, you have a little more, a little more a little more, even if you're a unit an hour, you're getting these little spurts over the minute, you you need those spurts to stop so that when your activity begins, the basil is gone. And the way I think of that is like you're creating a black hole, where there's no basil in the future. So you take it away, you take it away at noon, so that at one o'clock or 130, you know, whenever you're going to start and however long you learn it takes for your Basal to stop impacting you after you take it away. When your body tries to fall, it can't because the gravity is too heavy. So you come in or two or two weeks. So you come in and instead of the gravity or the basil pulling you down, it doesn't exist anymore, you just kind of float over that timeline of activity, and then turn your basil back on so that when your activities over and your buzzer starts to go back up again, it's met with the resistance of the basil again,

Haley White 1:23:35
and yeah, in like taking into account your bolusing to within a couple of hours of activity as well like and that is where planning is so vital and important for like tight glycemic control. But yeah, you have to take that into consideration. You know, the one thing I do like about the insulin on board for that this pump is it takes into account the the basil and the Bolus insulin. So if it gives any additional basil, it's taking that into account for your insulin onboard calculation.

Scott Benner 1:24:03
Cool. That's excellent.

Hayley White 1:24:05
Yeah. Which I think is nice.

Scott Benner 1:24:06
Yeah. Hey, listen, when we stop the recording, I'll tell you what I think I know about on the pod size release date. Okay, great. Thank you very much for doing this. I really appreciate it.

Hayley White 1:24:16
Yeah, you're welcome when I'm, you know, hope that it's helpful to some people out there. So thank you so much for having me.

Scott Benner 1:24:21
Thank you. Hey, huge thanks to Haley for coming on the show and sharing all that information about tandems control like you. Thank you so much Hayley. Thanks also to Dexcom makers of the G six continuous glucose monitor. And on the pod makers of the Omni pod dash and the Omni pod promise, learn more about Omni pod at Omni pod.com forward slash juicebox and of course that Dexcom go dig into it right now@dexcom.com Ford slash juice box when you support the sponsors, you're supporting the show, and for that, and so many other things. I really appreciate it. I hope you enjoyed today's episode. We'll be back soon with another


Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate

#536 Twinning with Rachel

Scott Benner

Rachel is a D-mom, a therapist and a fun person to talk with.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon MusicGoogle Play/Android - iHeart Radio -  Radio PublicAmazon Alexa or wherever they get audio.

+ Click for EPISODE TRANSCRIPT


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

Scott Benner 0:00
Hello friends, and welcome to Episode 536 of the Juicebox Podcast.

On today's show, I'll be speaking with Rachel, Rachel is a therapist. She's also the mother of a few children, one of whom has type one diabetes, and is a twin. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin.

There's no better day than today to start with the diabetes pro tip episodes. They begin at Episode 210 and are also available at Juicebox. Podcast calm and diabetes pro tip calm. Are you newly diagnosed or don't understand some of the terms that you're hearing on the podcast? Check out the defining diabetes series, also available at Juicebox Podcast Comm. And in your podcast player, I also have episodes about algorithm based pumping. And after dark topics, check them out, go go visit the website Juicebox podcast.com.

This episode of The Juicebox Podcast is sponsored by touched by type one, check them out at touched by type one.org. When you get there, you're going to find a wonderful organization whose mission is to elevate awareness of type one diabetes, raise funds to find a cure and inspire those with diabetes to thrive, touched by type one.org. The episode is also sponsored by the Contour Next One blood glucose meter. You can learn more at Contour Next one.com forward slash juicebox. Let's how you that this is my first time using a different computer setup. So I okay, I have a high level of concern at the moment. Okay, I was about to ask you. If I was about to say something like you know, when you've done something a million times, but you're still not sure if it's gonna be okay. And like why would I say to somebody who has diabetes or even understand? No, I've never felt that way. Yeah, I just like a silly question to ask. Have you ever thought help? But anyway, it seems like it's working, which is really cool. I'm going to take a split second to check your voice on the recording. So I also have like a mic, like an actual mic that I could set up don't mean to do that. You sound really good.

Okay, if I sound good, then I will not mess with technology on my end either. Like, we'll just make it worse, or it'll or it'll sound better. And but it'll take 20 minutes, and it won't

Rachel 3:01
exactly know I don't trust that if I hook up this mic that like I won't have to like download drivers and whatever. So

Scott Benner 3:08
yeah, let me guess give me a half. I'll be here. But you sound great. This is recording. I win. Every great. I did it. I am. So you're the first person to benefit from this. Let me tell you about this kind of interesting. So I share about the T one D exchange on the podcast, which is a an organization that I think does really cool stuff. And they have a difficult time as everyone does getting someone to follow through on, you know, filling out a survey. So it's all it is is a survey. So every time I've done it, I'm almost positive that I have done it. Well, thank you. Because every time someone uses my link for the survey, I make some money. Oh, nice, lovely. It's a T one d exchange.org. forward slash juice box. I just realized I'm leaving this part in the episode. But anyway, I was able to use the money I made recently to buy a dedicated computer to record the show on. So that was really cool. Because it I've been doing the whole thing on one computer and it the hard drive fills up and then the computer slows down and it gets difficult. So this is a big deal. And I appreciate everybody who filled out the survey at the end exchange. And this is

Rachel 4:26
so honored that I get to be the first person on this computer.

Scott Benner 4:29
You are the first one exactly right. Why don't you introduce yourself and then we'll start talking.

Rachel 4:35
Yeah, I'm Rachel Gibson, and I'm a clinical social worker that works in private practice and a mom of a kid with T one D and we are about a year and a half into our diabetes journey. I hate that I said journey. I really don't like that but it came out I also have two other kids. So my my type one diabetic kid is a twin. So I've got a non diabetic twin and then an older kid who older one is 10. And the twins are eight. Yeah. Wow,

Scott Benner 5:16
very nice. Did you just not want to say journey? Because it sounds it's so kind of like,

Rachel 5:20
Yeah, I don't like when therapists say journey. It's like when we call messed up situations, opportunities, these are just things that I try to avoid as a therapist.

Scott Benner 5:33
So yes, the car fell on your house, then your house fell on you. But this is just an opportunity for you to dig deep like Shut up.

Rachel 5:40
Amazing growth opportunity you've just been presented with on your journey.

Scott Benner 5:45
You think people say that? Because what else are you gonna say? Other than Wow, totally bad luck that your car and your house fell on you? That really sucks. That's what I say, as a therapist. I'm like, that sucks. Yeah, I got I have no upside. There's a number of times while recording the show that I just say that because it seems like the most honest response.

Rachel 6:04
It's the most validating to me, why would you I don't, I am a big proponent of not trying to move too quickly to any sort of meaning or bright side or positivity. Like that will happen naturally from the person. But if it's externally applied, like if I as an outside person come in and say, but at least you know, you're at least you, you know, didn't get a, you know, you didn't break any bones, you just got a life altering brain injury, that's incredibly invalidating and frustrating. And now you're not allowed to have any negative feelings. You know, I

Scott Benner 6:42
yeah, I have to tell you that I completely agree. And I've, if you've listened through this whole podcast, which by the way, it's, you're probably recording what'll end up being like Episode 570, or something like that. But I mean, I'm up to 500 ish now out. And I genuinely believe that you can't say to somebody, well, at least it wasn't this because it kind of, although it's a very real response, like I've had the thought myself hearing response. Yeah, but it doesn't, but it it can do under the surface, what you just said, which is kind of minimize what diabetes is. Right? And diabetes is hard. And everyone's experience with anything by this is gonna sound New Agey, but everyone's experience with everything is theirs, and you can't judge it or read it or put it into a category like it is what it is, if the worst thing that's ever happened to you is diabetes. Well, that's the worst thing that's ever happened to you.

Rachel 7:44
Yeah. And it can still suck. I mean, the thing is that there will always be people who are suffering more and suffering less. And there's no fairness. I mean, that's my, I think people could have an argument with me, but my feeling is, you know, it's it, there's not fairness or justice about the individual struggles that we each have, it just happens. And when you're the one struggling, it always sucks. And I don't find it very helpful. Nor do I recommend it to other people to compare yourself to people who might be suffering more, because you can have empathy for them and recognize the depth of their suffering. But that doesn't make your suffering, feel any better, at least to me, it's like, no, everyone has their own suffering, I think it's, I find it more helpful to sort of join in the human experience of suffering and recognize that we're all doing the best we can. And sometimes it's helpful to just be with others who are feeling like life is hard, as well.

Scott Benner 8:46
Yeah. Do you think that it's fairly common and maybe even normal for people to do that, though, to seek out someone who's in their eyes not doing as well as they are so that it makes them feel like they're succeeding?

Rachel 9:00
I mean, I sure I think it's, you know, comparing yourself to other people is very, very human. And, like, it's also very human to, you know, recognize that it feels good when you're coming out on top of that comparison. Yeah. And it's okay for that. I mean, I, my, you know, therapeutic philosophy is, it's, it's good to notice all of the thoughts and feelings that you're having, including ones that you don't necessarily like, you know, and then you know, feeling open to all thoughts and feelings that come with it. So my, you know, if I were in therapist mode, my next question would be, well, what is going on for you that you need to help yourself feel better? Like what why why do you need that comparison for you to feel better? What is that giving you and what are you not getting that makes you need that extra validation, you know, like, there's always more to it. But I think it's good to be curious about

Scott Benner 10:01
why aren't you enough? Yeah, exactly. Interesting. All right, Rachel, listen, I did my best thinking on my end. I can't figure out how, why we booked you on the show. So can you?

Rachel 10:14
Yeah, it was, um, to lean into, like this mental health side, and a little bit of siblings experience with type one, in that I've got this interesting situation with a twin. So we've got these like, little justice, they want everything equal, and then one gets diabetes. And that equality gets blown out, blown out of the water. So that was one of the things that we had talked about in terms of leaning into the mental health aspect of type one along with sibling dynamics. All right, well, that sounds are you happy? you booked me? Oh, no,

Scott Benner 10:54
I am. Trust me in the moment, I was like, this is the right thing to do. I just really am by myself over here. So I totally get it. It would be nice. If I could send an email to someone and be like, Hi, Rachel is coming on this morning. Just remind me what we're doing again. And then I looked at my notes, and I actually changed one of the intake questions so that I could see it more easily. But you signed up before that could happen. So I'm not embarrassed. I really am not like if I recorded one of these a month, and I couldn't remember then I'd be like, Oh my god, I'm an idiot. But you're the third one I've done this week so far. So that's Yeah, that's wild. And I'm more than happy to tell you why I'm here. So how long ago was was the diagnosis?

Rachel 11:41
The diagnosis was in January of 2020. So it's been about a year and a half. Okay. All right.

Scott Benner 11:46
That's pretty soon and you're saying that? So digging into the the idea of twins, are they I don't imagine this doesn't matter whether they are fraternal, or are they identical, um, boy girl. So fraternal definitely not identical, then I see. If you would have said, it's a boy and a girl, I could have made that decision on my own, but not a lot of but I get asked that a lot, though, you'd be surprised that I'm very proud to say I could have figured that out. Well done. So there's this kind of feeling like this happens with siblings to begin with, I have, right now a 21 year old and an almost 17 year old. And they both I think always have an underlying feeling that the other ones being treated better or more fairly or differently. And it's impossible for them to see that they're, they're individuals, and that they all don't have the exact same situations, they don't need the same responses. They have different, you know, ways of thinking, and so we pair them differently, you know, but when they're twins, does that ramp it up?

Rachel 12:52
It ramps it up. So we, you know, we have the twins and we have an older so we kind of have this kind of comparison, all kids are like the equality police. So that's it's a pretty universal parenting experience. But for me, and you know, when I've talked to other multiple moms, it does get it's more intense between them, and they really monitor the equality of each other more than they monitor it with the older kid. I think partly because they, you know, being the same age, they should have the exact same privileges the exact same, you know, time special time spent with parents, and they they keep track of everything.

Scott Benner 13:33
Yeah, it's, uh, do you see it? I mean, this is not for you, for your kids, or you even professionally. But isn't it weird when you see it with adults? when they're in their 30s? And their 40s? They're like, Mom likes him better. And you're like, Oh, my God, like, let it go. Let it go. It's time to move on. What is this about exactly? Like, why are you think you're raising your own children? Now you're still worried that your sister gets a bigger piece of Turkey on Thanksgiving, like Calm down, get that I know.

Rachel 14:03
But what I'll say with empathy is, you know, a lot of people snap back into their childhood stuff when they're with their family of origin. Like it's pretty funny to see like, when you, you know, when you're watching a family of adult children, and all of a sudden you're seeing the sibling dynamics play out as if they were younger. It's it's pretty funny. Humans are funny.

Scott Benner 14:23
Yeah, no kidding. Do you think? Do you think it's important? Alright, so there's an interesting question. If I if, if it was an absolute, and you could only do one or the other. Would you say that adults going back to visit with family in a big setting like that should definitely happen or never happened? If you had to pick one? Are you asking me if adults should go like spend time with their family? Like, you know, like, you know, Lion just walks away from its cubs at one point. It's like, that's it. You know, I think I would definitely say let's continue the relationships and yeah, right. So there's nothing like harmful that comes from it. It's just really funny to watch everybody turn back into like eight, five and nine.

Rachel 15:02
It's it's a mute fruit fruit for relatively healthy family. It's pretty amusing. Kind of, isn't it? Yeah.

Scott Benner 15:10
I can actually still hear my what my wife talking about, like they wouldn't watch the TV show I watched or like something or you know, my parents didn't like my gymnastics, but they like my sister soccer.

Rachel 15:23
Yeah, I'm not going to give specifics because they might listen to it. But yeah, this I can see it happen with my husband's, you can ever see it with your own family, you know, because, like you're in it, so you don't know what you're doing. But I see it when my when we go back to my husband's family and all the kids are there. It's just really funny. But you can. Again, I'm not going to give specifics, but yeah,

Scott Benner 15:46
your husband's family's a mess. I hear what you're saying now. So. No, no, I what I was gonna say for real is that one of the kind of joys of being married once you can get over feeling like someone's picking on your family, is you finally get an outside perspective from someone you trust? It is so true. Yeah. Yeah. Because but in the beginning, when I was younger, I'd be like, Why is she like, like, like, Why does she see them like that? You know what I mean? Like I've written the past in my head, I guess for the things that you're used to what you're used to, you know, super interesting. Okay. Alright, so these kids. Alright, I guess we should find out real quick. Like, how was the How was your child diagnosed? What was it like DK or you just saw?

Rachel 16:26
No, it was actually it was we were I feel really fortunate. We never hit DK. It was wetting the bed for like a week. We just saw weird stuff. She was wetting the bed. She was drinking like a fish just just sort of strange. And I had googled. So I knew that this could be diabetes, but I also just assumed that I was being kind of paranoid and jumping to the worst case scenario. But that being said, after one night where she had wet the bed twice, and you know, she hadn't been wetting the bed for years. I went to the doctor with her and I was like, You know what, I? I'm sure that I'm being ridiculous, but can we just check this out? And they were like, I also am sure that you're being ridiculous, but let's do this. And we got sent straight to the ER, and her blood sugar's were at, I think, eight like over 800 to 900. Somewhere in there. Wow. That's pretty, pretty high. But she was happy as could be. And I mean, luckily, we, you know, we didn't have any major medical complications. We just stayed in the hospital getting her blood sugar's down, and you know, getting the crash course and what to do. Well,

Scott Benner 17:39
hey, you want to hear something interesting. That's completely off topic. Yes. Fish don't actually drink water down through their mouth. But obviously, they need water. Like all living things need to live. They generally absorb it through their skin. It's called osmosis. Same way. hormones and nutrients are absorbed into our blood.

Rachel 17:58
So as I said, that phrase, I was like, What a dumb phrase. But I decided not to interrupt myself.

Scott Benner 18:04
No, no, I said,

Rachel 18:05
I had the same thought. Actually, as it came out of my mouth. I was like, that's what a weird phrase. Anyway, because I was like,

Scott Benner 18:13
I think she made that up. I'm not certain. I

Rachel 18:17
think it's a phrase, but I could be wrong. It could be that I like made it up. Or like kind of like Ricky Ricardo did some sort of, like common phrase and put it together with another one. I don't know. I'm sure your viewers can tell us.

Scott Benner 18:29
I've heard a fish to water. Not a different phrase. Yeah. But it has nothing to do with actually being thirsty.

Rachel 18:36
Yeah, no, that's that's like when you just pick something up really easily.

Scott Benner 18:39
Yeah. Yeah. We should go through all the things have the word fish in it.

Rachel 18:45
I could keep going. I've got like the feminists, like, you know, men, like fish needs a bicycle. So I mean, we could keep going with this, but we should probably refocus.

Scott Benner 18:54
We should. I don't know like a fish needs advice. I get that. Okay. All right. That's good. Don't Yeah, it's probably true. Like it you. Listen, you're not divorced, right. poor husband. He says, What is he just like a like a? Pause, right? Just a classic feminist quote that I did have on my wall during college. I'm sure that just drew all the boys in. I went to a women's college. I was not about drawing and the boy. It's great. It's wonderful. Okay, so you get the diagnosis. It's only a year and a half ago. Yeah. Do you leave with any kind of technology?

Rachel 19:34
No. And I had to just ignore everybody to get the technology because they, the doctors were saying, we probably wouldn't get a Dexcom until, I mean, like six months and probably not a pump for a year. And I asked why. And they were like, Well, you know, insurance. They like to make sure that everything's stable first. And I just basically I just thought That was so stupid. And so I just independently got everyone's approval. And then, like made it happen. Yeah, I just ignored that. So we had a ducks calm about two months in, I want to say and then a pump about like four or five months in.

Scott Benner 20:17
I believe that all that is bull that Yeah, the times and you know it has to be this long you have to have this number. I think if you have insurance, you can push it through if your insurance covers it,

Rachel 20:30
you just have what I did. I just said like, I basically just call the insurance and said, Hey, the doctor wants a duck's comment, a pump, how do we do it? Exactly. And then I call the doctor and I said the insurance is willing to cover it. How do we do it? And I

Scott Benner 20:45
said, look like an old timey movie. You're like, I'll just do a little Mr. Action over here.

Rachel 20:50
I'll just say everyone approves and make them talk and then it worked. So I feel great about it. I

Scott Benner 20:55
feel like you took a towel, hold it over the phone. You're like, Hello, this is Rachel. For her daughter. Rachel can't come to school today. She's sick.

Rachel 21:07
Yes, it was classic Mr. action, and I recommend everybody do it. Because because it was stupid. Like why? Why would we not going to ducks calm? Especially? I mean, that's just it. You know, it's just it's wonderful technology, they and we should leave the hospital with it.

Scott Benner 21:22
I once called Arden's aren't my insurance company, like six days in a row. And finally, on the sixth day, you could hear in the person's voice, they were like, I am going to spend all day today making sure this happens so that you do not fall back tomorrow. I mean, that's how you get it done. Yeah, I actually used the phrase. Listen, I'm a stay at home Dad, I have very little else to do. I love it. I love the threat of just being a nuisance. I want to stay focused on this just perfect. Excellent. So you don't get home with anything particular. Was it a surprise? Is there any other type one in the family or other autoimmune?

Rachel 22:00
It was definitely a surprise. We, my maternal grandfather was diagnosed with type one very late in life. So like in his 50s or 60s, he was diagnosed. So you know, I had that exposure, but it really never, that's the only person with type one that we can identify. And we can't really identify much of an auto mute. So it was definitely a surprise that was not, you know, all the things that you worry about as a parent type one was not really on my radar.

Scott Benner 22:31
How about that? That's cool. interesting to hear. Because everyone has I think it's all kind of, you know, everybody thinks there's a rule once they see something, you know, they don't think of it as maybe just random. But, you know, obviously, there's type one in your family if your maternal grandfather had it. That's that. Like, you know, I interviewed somebody recently who was diagnosed at like, seven and so was their father. And you could see how at while I was talking to her, I was like, tell me the truth when your kid was like seven years old, were you just staring thinking like, this? Is it get on me? It's gonna happen right now. We're like, your father dies of a heart attack at an age and people have that very bad age in your mind. Yeah. Like, this is what I'm gonna live to get to. That's our sort of, I mean, meaningless, right?

Rachel 23:19
Well, I mean, I think it's just we carry it with us. But in terms of I mean, I think the mistake that we make that we can often make is that it making it fact don't even mean like it because what those are, those are feelings. Those are fears. Those are, like milestones, but they're not. I don't it doesn't actually make anything happen. You know what I mean? Like it's, but it can feel predictive almost.

Scott Benner 23:45
So tell me what you do for a living therapist. Practice or

Rachel 23:51
private practice, and I kind of I work with at my specialties are millennials and families and then specifically, I work with a lot of gender expansive kids, so kids that are exploring gender or transgender.

Scott Benner 24:07
I have to ask, why is millennials a category?

Rachel 24:10
I just love them. I'm an old millennial. So I was born in 82. So I'm like the oldest millennial that you can be. And Millennials are so much fun in therapy because they tend to see it more as an ongoing practice, like going to the gym and getting regular checkups, which just leads to adapt. And, like an exploration that is just sort of fun. As a therapist, I just really enjoy that population.

Scott Benner 24:41
It's not like that timeline has like a real like leather fetish or something like that. They didn't have something specific. It was no gotcha. They see the process. I can understand that that would be I would think more fulfilling for you.

Rachel 24:56
Yeah, it's it's really just sort of like they're fun. They're they tend to Be very, like long term committed to mental health. And that's it's fun to work with people who really care about self improvement and learning about themselves as a practice of general health. It's just fun.

Scott Benner 25:14
So you're saying to other therapists, if you've got bills, you want to get those, you know, Millennials do not make enough money to be funny. They are not the cash cow here. I know. Very, very dialed into the process, but chase him around for $5 constantly. Yeah,

Rachel 25:35
no, it's that's that's one of the things they're stressed about. So yeah, no, they're definitely not the money makers, but they are very committed,

Unknown Speaker 25:43
committed and broke. Well, in a nutshell.

Scott Benner 25:49
That's interesting. So they came up at a time where they got over educated, and there's not work to Yeah, I say,

Rachel 25:56
and also kind of promised this like prosperity but isn't really available. Um, yeah, it's it's kind of stuff.

Scott Benner 26:05
Yeah, I can see that to where that feeling of just go to college and things will be okay. Exactly. I'm gonna do a vibe, when the truth is always going to be that the early bird gets the worm. Like, what? You got to go out there and fight a little harder, try a little more do do extra. And if you're not willing to do that, the ascensions probably not there unless you dumb luck into something. But yeah,

Rachel 26:32
but I'll also say that the I would say that even with hard like, that is true, you do need those things. And you can do those things and still not get, you know, get anywhere. And so that's what's tough is that just trying to figure out, it tends to be that like, other general older generation, say, you know, hey, hit the pavement. Get out, get out there. And that's not been the experience for a lot of millennials is like, No, but I did that. And I'm still struggling. I'm still in like, an entry level job. Yeah. So anyway, that's it's it's, it's definitely a complicated, like transitional generation.

Scott Benner 27:08
Right. I wonder if the older people who say just work hard, and it works out. They had such lower expectations. Right, like, they just wanted a house. Yeah, they weren't looking to be fulfilled, they didn't have any expectation of what like,

Rachel 27:24
I think that's, that is definitely there's a big aspect of that, but even like having a house now I'm in LA. So having a house having a house here, it's kind of, it's a lot. But, um, but yeah, but like, even sort of more humble dreams. Like, you know, owning a home that you can afford with a full time job is not always in reach for some of the younger generations. I mean, things have changed a lot. And just the amount of debt that you acquire going to college is really different from previous generations. So it's easy.

Scott Benner 27:57
No, it's Yeah, it really is. Okay, so how does your profession lend itself to parenting? Or does it not help? As much as you might think,

Rachel 28:09
oh, it helps far less than I wish were true. And my husband will often I mean, I literally teach parenting classes, and my husband will look at me sometimes and say, like, aren't you an expert in this? Like, I don't know what to do? Um, um, yeah, it never translates well, to your own life. But I think what it does do is I have the ability to kind of like, recognize two different answers, like might the answer that I'm doing, that's probably good enough, but not great. And then the more ideal answer that I can strive for, and that can definitely help when I feel really stuck with parenting

Scott Benner 28:49
is that then the disconnect is between knowing what to do and not being so emotional that you can't get to it?

Rachel 28:57
I mean, that's the disconnect for everybody, right? Like most of us know what we're supposed to do, like, Hey, stop yelling at your kids, right? But it's surprisingly hard to stop yelling at your kids, when they're driving you crazy.

Scott Benner 29:10
Yeah. Why do I have to give Rachel my $40 copay when I know I shouldn't be doing this. But the answer is that I can't You can't stop yourself for some reason. Yeah. Yeah, exactly. Interesting. Do most people want to be better? Or not? These are bad words, but I don't have a good word for it. Like do most people want to be good people or there's some people you just meet that are like, where does that become a mental illness like that? So

Rachel 29:37
I think I think there's a that's a complicated question. I actually think that moment, at least, you know, my clients and the people in my life, I think that they are good people and want to be better people and want to keep that in mind. Um, so I do think that there's like an inherent goodness with certain exceptions to most people and Think that often the work that people do on themselves they've put off for a long time, because they think it's not that important or that it's more important to focus on others. But it's, it turns into that kind of like, put the oxygen mask on yourself first. And I mean, I think that's definitely true. And when you get a serious diagnosis like diabetes in your family, it's like, you do have to take care of yourself deal with your own stuff. Because you've got a marathon in front of you, and you, you have to be available and present in order to, you know, run the marathon.

Scott Benner 30:39
What about our wiring? Like, do you think about that, when you're talking to people like I, from my perspective, I've been alive a while I pay attention to things that are going around, you know, with myself and my family and people that I mean, and I think that when you're young, that desire to protect everybody provide for everybody is so overwhelming, and to make babies like, I know, we think of it differently, like, it's our sexuality, or I want to be like, you know, but really, like, you're just like, I have got to eat and have sex. Like, that's kind of you don't think it but you don't I mean, like, it's your drive and, and for, you know, very maternal women, it could very easily just be like, I need to have a baby. Now I have a baby, I need to take care of this baby, like nothing can I joke about like, my son was born. And I just became my wife and my son's assistant. Like, she was like, She's like, Oh, it's here. Go stand in the corner until we need something. You know, like, it wasn't like that. But it could feel like that to me. And then I'm just like, no, desire me, so that we can make more babies like it right. A real like crazy. It's people should not have children. But yet, it's fascinating to watch it happen, right? But yeah, but now we're trying to as time moves forward, and people get more thoughtful, and are paying more attention. And I think we get to pay more attention because life is getting, you know, grand scheme of things easier, right? Like, I don't have to go chip a boulder a way to get to a cave anymore. I got more free time. So I can think about things. And then you're fighting against your instincts. And it's, uh, I don't know, it's I find the whole thing fascinating even with like the kids, like, like, look at me, don't look at that one. That one got more than me. Don't do this. Like, that's got to be something primal. Like, look, some of us are going to die. I don't want it to be me pay attention to me.

Rachel 32:31
Hmm, no, I do think that there's a lot that's primal. And a lot of how a lot of it is how we're wired. And, and I think it's when I don't, I don't think it's necessarily good to work against that. I think you notice it, you sometimes you recognize the ways that it's still helping you like when, you know, when my daughter was diagnosed. I didn't need sleep or food. Like I mean, I needed you know, enough of those things to keep going. But I might it's like, I don't remember having needs during that period. And that's fine. Like, that's survival, that's your instincts kick in, and you're trying to protect like your cub. And I think there are some ways that it's really, really helpful. And then ways that it the wiring goes wrong when you are, you know, like anxiety is sort of that wiring going wrong, because now you're worrying about things that are not life and death, but your brain is interpreting is life and death because our life is so much easier, logistically now. So yeah, I think that the wiring is really it is really fascinating and, and understanding it can be really helpful. So that you, you know, you know, when to go with it, and when it's really helping you and when you might need to, you know, introduce another storyline rather than just the the the hardwiring that we come with.

Scott Benner 33:50
Yeah, I cannot have 50 kids with 14 different women. Like I know, I wouldn't recommend it. Yeah, but there's somebody out there walking around right now is like, yeah, I'm gonna move on, make some more babies, you know, that kind of feeling. It's just, I don't want this to be morbid. And I certainly think we're 100 years past that. So it's not, but 100 years or so ago, my daughter isn't alive anymore. Yeah, you know, either as yours and you would have had this short painful experience with a bad illness and they would just be gone. Yeah. And and it would have been so for many, many met, my wife had a bad bad ear infection. It's when she was a child. I genuinely don't think she would have lived. Yeah, you know, that that kind of stuff. I my relationship with life and death. Yeah, it's crazy. My appendix when? I don't know, gosh, it's got to be like 1819 years ago now. I mean, prior to medical intervention, that would have got me Wow, I should have been really crazy. You know, like that kind of to really wrap your head around that sort of thing. Okay, so I sorry, I found you interesting. And now we're a half an hour into this. Can you imagine if you weren't interesting, nobody would be alone. Listening anymore, so it doesn't matter. They might not Anyway, we'll see Whoa, whoa, whoa, whoa, I pride meaning I don't know how interesting I am doesn't matter if you're interesting. I can make you interesting, but you happen to be our thing. So this is easy. So your kid has the diabetes, the other kid right away? What are they? What are you seeing like with both of them the older child and the twin? Is there an immediate feeling of Oh, they're paying more attention to her than us.

When you buy a new television, a new car, a sofa, a mixer, you think I want to get the best one that I can afford. But when someone told you you needed a blood glucose meter, you just took the one they gave you. It's okay, happens to everybody. But you're in control. And you can go to Contour Next one.com forward slash juicebox. And learn more about the Contour Next One blood glucose meter you can take your blood glucose meter fate into your own hands and make a decision instead of just being handed whatever's around the Contour Next One blood glucose meter is the most accurate easiest to use. Lovely to hold brightest lightest, brightest light lightest actually it is the has the brightest light I've ever used with a meter and it is very light. So okay, brightest lightest blood glucose meter that I've ever used. Contour Next one.com forward slash juice box, check it out. meter is a very affordable with or without insurance. But it's possible that you're paying more through your insurance right now for another meter, than it would cost you to buy this meter in cash even I mean, don't get me wrong, your insurance might cover it. But I mean, it's possible right now you're paying more through your insurance for another meter that may not be as accurate, then it would cost you to just buy the Contour. Next One in cash. not crazy. They even have a test trip savings program, which you should look into it this this website is actually got a ton of information, there's a savings program for strips, meters, just go take a look Contour Next one.com forward slash juicebox. There's links in the show notes and links at Juicebox Podcast comm Get yourself a blood glucose meter that's easy to carry, easy to use, easy to see at night. And is incredibly accurate. plus, plus bonus Second Chance test strips so you can go in hit the blood not get enough, go back and get more without changing the accuracy or ruining your test strip. Use my link and get the remarkable accuracy of the contour next test strips at an affordable price Contour Next one.com forward slash juicebox. And when you're out on the internet, doing your business like you do, don't forget to check out touched by type one.org. We're also on Facebook and Instagram. Go see what they're up to. Is there an immediate feeling of Oh, they're paying more attention to her than us?

Rachel 38:20
Yes, I mean, I think that the immediate immediate was genuine concern or at least I'd like to think so. I'm

Scott Benner 38:29
bigger than mine. This is

Rachel 38:31
I think that there was like when when she got hospitalized, it was very shocking. I mean, we just literally got told to go straight to the ER. And so I think that there was an you know, initially there was concern and but once once everyone was sort of like, okay, you know, she's going to be okay, this is a big adjustment. But you know, then she started getting gifts in the hospital and you know, she stayed home from school for a week. And so then like the what they saw as benefits so when she got eventually she got a freaking iPhone. So, watch her numbers, you know, I mean, then the like upsides started to show and I know that for my older one. And I will say that according to research, this was very typical that my older one tended to internalize. And my younger one the twin tended to externalize which is borne out in research so the the older one got very quiet and very good. Like didn't rough didn't make waves didn't complain to ruffle feathers just sort of got quiet. But he would sometimes come in with some really heartbreaking sentences like there was you know, she was diagnosed in January his birthday is in March and he said it sometime in like February. Do you think that because we would keep saying you know, this is that we're not I know this is taking a lot of attention but you know, we're not really good at this yet. We're going to get better and then it will not take up so much have our attention. Well, this isn't the new normal yet. And he asked, Do you think that this will be you'll be better at this by my birthday, because what I want from my birthday is for you to essentially pay attention to me, which was a real gun.

Unknown Speaker 40:17
It was just, it was terrible kids. Break Your Heart. No, oh,

Rachel 40:23
I No, no, it was it was like a just a full gut punch. And then the younger one really just like kept tabs, he really, he complained a lot. He monitored what presence she was getting and sort of demanded equality, which mean we didn't give them you get diabetes, you'll get presents to

Scott Benner 40:45
have an era poster, he was wandering around with these, like,

Rachel 40:49
it felt like it. Um, so he and so he really sort of externalized he was very, like verbal and, um, you know, kind of like, was the squeaky wheel. Which, you know, I mean, both both are valid, both are fair, because it was it was a big change. But that's sort of how each of them responded in the immediate aftermath

Scott Benner 41:12
have either asked if they're going to get diabetes,

Rachel 41:15
yes. Um, and I think at various times have expressed more concern, more or less concern. Um, you know, and when we're honest about, you know, you have, like, more of a chance, but still not a huge chance. And the good news is, we would know what to do a lot better. Cuz we, we've gotten, you know, we've gotten the hang of it with with Hana. So there's, there's definitely some anxiety there.

Scott Benner 41:43
I have to say, it's interesting, because that's the right response, we would know what to do better if it happened to you. That's exactly what I would say. But if I go back a half an hour in our conversation, isn't that like saying to them, don't worry if a house falls on you? It's not as bad?

Rachel 41:57
I think it depends on how you say it. I mean, it would definitely, I mean, I'll say I wouldn't only say that. Um, and you know, we do not in this house, we complain about diabetes, we do not Brightside, diabetes. So I think that, within that context, I think they feel okay about talking about, you know, that we would be able to do better, but we're not telling them to be okay with it. Like we're not saying, you know, just because we can handle it better doesn't mean that you have to feel good about it, or like it. And we what's nice is we sort of externalize diabetes in this house so that we can all be mad at diabetes, we can all dislike diabetes, and that way we're not disliking Hannah, we're not disliking the, you know, the, like the the extra care or attention that she needs. That's just how that's just how our lives are. And that's okay. Yeah, but we can all be mad at diabetes for different reasons, and at different times. And, and that's okay, too.

Scott Benner 43:05
Yeah. Isn't it interesting that you have to walk this kind of tightrope? Because she's not diabetes? Right? Yeah. And we need to keep those things separate. And at the same time, I've spoken to a lot of adults who feel like you have to embrace it.

Rachel 43:22
Yeah, it is such a balance. And I agree with the embracing. So here's like, so one of the main things I talk about as a therapist is acceptance. And basically just dropping a struggle against your feelings against your circumstances against, you know, all of the things in your life, you don't have, it doesn't mean that you like it. And it doesn't mean that you're resigned to not changing anything, it just means that you're honest about, you know, what's going on for you. And so I do try to layer in that, like, Look, we're not going to fight diabetes. And in fact, I have a little bit of a pet peeve with, like, you know, like her fight is my fight. I agree with the sentiment, like, certainly, you know, diabetes is mine, and hers. But I don't want to fight with diabetes, because it's here, it will always be here. And it is it is, it is a difficult balance to like externalize it to the point that we can all be on the same team and talk about diabetes as something separate, but also accept that diabetes is part of our lives, it is not going away, and that we all have diabetes in our family.

Scott Benner 44:39
I think that all these things lead me to be happy about the podcast because it was always my thought that whether you think her fight is my fight is a rallying cry or you hear it as like, Oh, you shouldn't be fighting like that's, that's all just the way people think about things like I don't right, but the one that I've always maintained was, if it was easier to take care of your blood sugar, all of this crap would be easier. And so true, right? Let's get to a point where we understand how to use the insulin so that when we have real human feelings, or we're the kinds of people who push down human feelings, or we're whatever we are, at least it's not going to be as difficult and our health isn't one of the issues.

Rachel 45:23
100% Yeah, and I will say that, like listening to your podcast was definitely a turning point for us. I started I was recommended to me about three months in and I started listening to it and immediately turned it off. Because I was just like, wow, that's too much. I'm not ready. And then I came back to it about eight months in and sort of went through kind of the main, like recommended ones for being bold with insulin. And it it really was a game changer in terms of tackling our own fear. And using insulin appropriately and more aggressively. assertively, I should say, you can't. It was a it was a it was a really, it was really helpful.

Scott Benner 46:05
I'm glad I am very glad you can't force people into being in the place, which is why just why the podcast is, is valuable, because it's a living document, kind of a feeling. So it's not like you send them to a blog post or one thought, and then they hit it and like you didn't go, Oh, I'm not ready for this. And then you walk away from it. It's a I don't even know, like, I think of the podcast is, you know, sort of like a warm rolling wave that just sort of keeps ma forward through my experience with Arden and Arden's experience with diabetes. Yeah, you know, sort of just kind of it keeps going, it's always going to keep going, I could see that 20 years from now I could be doing an episode about Arden's having a baby or a wedding or, you know, I'm giving myself a lot of credit for me able to stay alive for 20 more years, but but you know, that kind of, I don't see how this narrative stops. And I can see how left behind is a time capsule that one day could end up being just as valuable to someone in 10 years as it is to someone today. I can see that too. I think that's great. So I just, that's, to me, this is a perfect medium for that. And I'm not all that photogenic, so it really is kind of perfect. Even better. It's funny, I look in the mirror, and I'm like, I'm pretty handsome. And then someone takes a picture of me. And I'm like, that's not the guy in the mirror. Like what's going on?

Rachel 47:30
So yeah, welcome to ageing man. That's just I think that's just the way it is from here on out.

Scott Benner 47:36
If I stayed far enough away from the camera to be comfortable with it, you'd be like, I think someone back there was talking about. But But anyway, I just think that it's, it's interesting to see the kids all have different experiences with it. And at the same time, I don't know that it's very much different than any other experiences they had. It's just sped up. Right? Does that make sense to you that life's happening kind of slowly, you don't notice it. And these problems or difficulties arise, and you get more time to deal with them. But this thing just comes in a wash. It's there right away? Yeah.

Rachel 48:18
And you can't, you can't like slowly figure it out. You've just got to get on board.

Scott Benner 48:24
Now you're standing there trying to figure out how to parent it. You're thinking about how to manage it, like from a technical aspect. You're thinking about the impact on three different children. I'm assuming at some point in the quiet moment, you're worried about your husband, you know, they mean like he's worried about you, you're worried about yourself, or he's worried about himself. Nobody thought this was what was gonna happen. You know, it takes away the picture you painted in your head, like, what we'll do is we'll make some babies. Rachel's a therapist, it's great. I have my job. We'll buy a house one day, it'll be good. Like, you know, now all of a sudden, everything feels like whoa, none of that matters right now. Yeah. How do I stop this toast from making my kids blood sugar? 300 all day? Yeah, yep. Yeah. And then your other kids, like, I want to play soccer. And you're like, I'm trying not to kill your sister. Leave me alone. That's so true. I don't care if you like soccer all the sudden. And then you feel terrible for feeling that like, and, and blah, blah, blah, blah, blah. And everyone has their own experience in their own feeling. Now, here's the question. When when a child comes to you, your trained person, right, and they ask a question, does your brain go through like the Dewey Decimal System of proper responses and just pull out a card and start reading? Or are you not able to do that? And if you aren't able to do that, how the hell am I supposed to be able to do that?

Rachel 49:43
Well, I think there's, in my best moments, yes, my brain does that. And then I mean, but there's also a difference between pulling out the card and application of the skills on that card which usually goes sideways. Because kids are very unpredictable, and they have not read the research about what's supposed to be effective.

Scott Benner 50:06
And look at you, by the way makes you feel bad about yourself. And then you're like, Oh, this kid knows, I don't know what I'm doing.

Rachel 50:13
Yeah. But the good news is that there is a lot there. All the research suggests that you do not have to be perfect or even near perfect to be a great parent. So also keep that in my mind, too, is that you just really have to be good enough. It's literally a scientific phrase good enough parenting. Yeah. And so when a kid comes to me, I do. If I'm at my best, I will cycle through some of the things that might be effective. And, and try to pick a strategy. But the more important thing is not what strategy you pick, but that you're sending the message that when they come and share something with you, you take it seriously, and you refocus your attention on them as soon as you can. If it's not in that moment. You tell them when you can, and then follow through on making sure that you're connecting with them, then that's actually the more important thing than any one strategy.

Scott Benner 51:04
How important is your intent? Like that? You mean? Well,

Rachel 51:10
intent is very important. Yeah. Um, I think that the message is, I care. And even if you aren't quite sure how to help them with the specific feeling or situation that they're coming to you with, the more important, you can still send the message that you care and that you'll help you'll, you know, work with them to help figure it out. And that's, that's really the the most important message because that one applies to all things.

Scott Benner 51:39
Let me ask you a question. I feel like I notice that people give up on parenting too soon, in age for their children. Is that something you notice when people like they're all like, you know, their babies? And they're like, yeah, this is I can do this. And they're all intent. And you know, the kids sex and some kid touched them on the playground, and you're at the school ready to beat up a six year old, like, you've got all that like energy for children. And then suddenly, they hit an age where they seem like, they don't need you anymore. And they act like they don't what it's like 12 1314 where they disappear to their room for a while, or they act like they don't want to be a part of the of the family as much like that, like pulling away starts. And people get their feelings hurt, I think, or just think that the kids like, Oh, look, look how self sufficient and then they start like, I always did want a pink. You don't I mean, then suddenly, you're not parenting as harsh. And that's, to me the exact wrong time to stop paying attention. Cuz now they have genitals that they're aware of. And, and, and someone's like, have you tried vaping? And they're like, vaping? Is that like sex? Can we do them both at the same time? Like you don't need me and like suddenly, your

Rachel 52:45
your brain has, you've just demonstrated an anxiety spiral with absolute accuracy.

Scott Benner 52:51
Thank you, I and I don't feel that way. By the way. Like, I feel like, I feel like I am gonna be connected and parenting until it's appropriate not to be. And I do not allow my children to dissuade me from being a good parent, much like when you hear me talk about when I was little. I had this like, I got sick one time and there was this giant pill like people are so much better making medicine now you don't even realize was this big, dry thing stuck in your throat. And I tried to be like, Oh, I don't want to take it. And before I knew it, my dad's giant fingers. Were just shoving it down my throat and I was like, okay, like, it's like 1975 He's like, I don't care what you think. Here we go. I sat in here in the kitchen all day staring at you crying about this pill like that kind of feeling. When now I hear people say like, Oh, you know, we moisten the adhesive for 47 hours before we pull off the CGM, because Billy doesn't like it. If it stings, my dad would have just grabbed it with a fist and pulled it off with part of my arm. You know, I mean, and not to say he was right. But we're in a weird time right now with parenting. And yeah, you don't I mean, just in general. Can you talk more about that for me?

Rachel 54:02
Yeah, I mean, I think I think what you said about parents, parents getting their feelings hurt. I actually think that's a really important note. You know, we saw kids pulling away about that age or like wanting more independence, wanting more privacy, that's developmentally appropriate. And it has nothing to do with the parents. But it can feel really personal when it's your kid and that's okay. Like you're entitled to those feelings. It's okay to have hurt feelings. But to recognize that, that doesn't mean that it's about you. That's it's just a feeling that you have and it's valid and fair. But it it, you're you're you're kind of centering yourself in a situation that developmentally they're doing what they're supposed to do, but they absolutely still need parents and parenting. And the hope is that in like the interactions that you do have with them, that you are being very clear and powerful and sending the message that you are available and interested in them? Whenever they, you know, they feel comfortable with that, and insisting on certain times. So you can you are still the parent you can still set rules were like up, this is family time you can moan and groan if you want, but we're all hanging out. And, you know, I think that it's really important to to continue to parent with, you know, focus and intentionality through the entire I mean adolescence is, it's wild, like so they do need parents, and they do need parenting during that time. So I definitely agree with the assessment. But that's not when we should be. That's not when we get to take up painting. Yeah, that might be around the corner. But it's not. It's not here yet.

Scott Benner 55:46
Rachel, I love you. We could have been married and enjoying our life together as adults not having sex. And I think we would have been very happy. And let me tell you why. Because everything you just said, I completely agreed with. And I was about to say, I was like, Oh, I hope she goes deeper into this. Let me have this thought in the back of my head in case she stops. But you were Oh my God, you're so good at this. Congratulations. Yeah, your kids grow up to be serial killers and monsters, probably. But I'm gonna take no responsibility for that. Oh, listen, life life. I didn't have anything. But I still, like my son's in college. He's a reasonable kid. And and and there are still times where I'll say to him, Look, he might he might go, look, I'm not interested in your thoughts. And there are times where you have to evaluate and go, Okay, you know what, this isn't a hill to die on for me, right? It's not that important. But there have been times and there will be times in the future where I say to him, listen to me, I have put the last 21 years of my life in existence into you. And if you think in this moment, I'm not gonna say something you're out of your mind. Like, I didn't go all this way for you to drop dead now jackass. Like, you know, they mean, like, I'm gonna leave me here by myself with my thoughts. Like, that's not happening. You know, but But seriously, sometimes you have to go to them and just say, look, I hear how you feel. I think that's reasonable. And here's a perspective you don't have yet because you're 30 years younger than me, please take five seconds and listen to me. And sometimes you have to, sometimes you have to take the pill and stick it in their throat and be like, Listen, I'm not standing here all day with you. You need to swallow this. We're doing this thing right now. It's important.

Rachel 57:31
You know, and as as now, a grown up, which, using the word grown up to describe myself does not make me feel like a grown up that feels like a kid saying I'm a grown up. But I have reflected with my mom quite a bit about how all the advice that I didn't want growing up and into even young adulthood was 100%. Right? Yeah, totally correct. And of course it was, she's older, she knows what she's doing. But even when it was unwelcome, and even when I didn't take it necessarily at the time, I can remember it. So I think it's important to recognize that you are still an influence, you are still a voice. And you do have knowledge and experience that will benefit them. Even if they don't listen to it. It doesn't vanish, you're still you're still participating and connecting. And that's so important. And maybe when they're grown up like I am, they can come to you and say, Yeah, I guess you were right that whole time.

Scott Benner 58:29
I just don't want to. I am trying not to get cancer so that my kids can come back to me and tell me I'm right. And then I'm gonna drop dead happy. That's all I'm looking for. It really is like, I just want one little bit of validation at the end, and I don't care. As long as I can cognitively hear it. I know that I can look him in the face and go, I told you but no, but again, but seriously. Absolutely. That's impeccable advice. It really is it life is a long game. Parenting is a long game. Diabetes is a long game. If you think you're going to win today and get to sit back on the beach. You're you You're misunderstanding life, not just diabetes are parents

Rachel 59:12
now life? I mean, yeah, it's all of this is unknown, unpredictable. And, and a long game. And yeah, it's it's you, you don't always see the like the fruit of the seeds that you plant. And that's a lot of how I think of parenting is, you know, I might, you know, I might not ever get the Wow, I learned so much from you. And you were right, the whole time speech. I'd be sad if I didn't. But that doesn't mean that the seeds that I'm planting now and the connections that I'm making now aren't paying dividends in the future because we're teaching our kids how to be in the world. And they're there. They're watching us and they're learning and that is something that they will take with them. And, you know, hopefully, we do good enough parenting that that they're taking that they're taking A positive and a healthy worldview with them when they leave the nest.

Scott Benner 1:00:04
So I'm going to share something with you. I've never said on the podcast before I opened up my reminders on my computer. So Apple, I need you to stay in business for a long time. I have a reminder set for Christmas Eve. 2033. Wow, it says, Call Arden and see if she enjoys having Christmas pictures of herself. She owes me $100? If she does, this is a bet I made with her when she was nine. I've had that reminder in my computer for eight years already. But does she want Christmas pictures taken? I was trying to take pictures on Christmas Eve. And she's like, I don't want these. And I said, Well, you will when you're older. And she said No, I won't. And I was like, Oh, yeah. Your commitment to I told you so is amazing. It's it's, it's just that I listen, I don't begrudge a person who would rather sit on the beach their whole life, right? But I am, I have been a person who's been built to have children since I was little. And it's, you know, my dad leaves. When I'm 13. I take care of my little brothers, I see the impact my mom gets from being divorced and being. And this just becomes, you know, I've said it before. But you know, if I owe my dad anything, he really showed me what I don't want to be. And so it's incredibly important to me, I don't have anything more important than my health, my family's health and my children's future. Like that's what I want to do. I think if you want to know what I think life's about, I think life is about leaving somebody else better off than you are. I really don't i don't think there's some big payoff at the end. And so in a, in a slog like this, where if I'm lucky and don't get super sick, I could live at some years in that kind of a fight. At the very end. I just want to know that it was not even worth it. Because it's worth it to me no matter what I want to know that I had an impact on it. Yeah, I think I don't want to tell her I told you. So. I wanted to I wanted to say I have that picture. And I enjoy it. And then I think like okay, I spent my time well, you know, yeah, that's

Rachel 1:02:22
Yeah, I think of it like ripples, like I want the ripples of my life to positively impact the people around me and to ripple out and hopefully create new ripples. And I might never see the the ways that my life has impacted others. But I really hope that that I am somehow positively impacting people in even very small ways. And yeah, I agree with you that like that's how I think of life. And where I think the kind of the satisfaction comes from that satisfaction comes from your effort

Scott Benner 1:03:01
in the moment not in seeing the fruits of your labor, or it's just not going to work. That's why it for me. I don't know if you realize this, Rachel, but if I ever find a genie lamp on the beach washed up in the ocean, I already have my wishes all like set up because I don't want to mess up because I know in the moment I'm just going to ask for like the Heather Locklear off the poster when I was a kid and like a car like I know. Yeah, so you the first the first wish is, no matter what happens. My next wish was definitely come true. Your second wishes, unlimited wishes, you just go like that. And then. Right? Yeah. And then the first thing I'd want to do is, even if I couldn't live forever, which I don't know, I would want to or not, I'd want to come back like once every 100 years. I have key. I've said this so many times. Yeah, just to see, like live here a year, every 100 years just to see what happens.

Rachel 1:03:56
I just want to see what's up with people like, hey, what have we done? I want I have said this so many times that like I, you know, I don't necessarily want to like follow like, check in on my immediate family because like they're gonna be fine. Like, of course I care. And I'm curious. And that would be amazing, but they're going to be great. I'm really curious about like, the big picture stuff. Yeah. What are we doing as a species? I think that's gonna be really interesting.

Scott Benner 1:04:21
I want an electric car for the same reason I bought a computer when I was 13 years old. Just want to see what it is. Yeah, you don't I mean, I want to see how it's different from the thing I already understand. And, and for people. You know, it might be obvious. It's funny as I'm talking and maybe the people listening are like, Yeah, well, Scott, this is what the podcast is for people with diabetes, but like, it's not as obvious to me. But I just keep thinking, like, you know, change the way people see insulin change the way they see success for themselves change, you know, so that everybody doesn't feel burdened, make people who want to be, you know, diabetes practitioners. We're gonna think about it this way, like, really try to impact the space in an important way. And so when you hear me say, like, share the shows, so it grows like that is so I can charge money for ads. But that's so that I can keep making the show. Absolutely. Don't get me wrong, I love money just like everybody else. That's not what I'm talking about, like, totally, I want to make the podcast bigger so that it reaches more people so that the ripples go farther, so that it can continue to work. Like that kind of thing. Like that's, that means a lot to me. So I just wanted to I just want people to live a better life, I saw somebody this morning online. And I can say this now, because this won't come out for six months. But their, their child talked about using insulin and appropriately to hurt themselves six months after a diagnosis because the kid doesn't want to have diabetes anymore. And you know, some people are going to feel that way. Well, what happens next is what's important, like, you're not going to stop somebody who's going to feel that way from feeling that way. But the help you get them next could redirect their lives. And I want that answer to be obvious and available to people for awesome. I'm talking to a person now who's in their 30s, they've had diabetes forever. And I've been following them on their their Dexcom for a while. And I'm just telling you, it's a it's just years of managing type one in a different way. And now having different tools and not knowing how to let go of the past and bring these new ideas into their management. Like, I just want to I keep telling the person like you have to Pre-Bolus your meals, right? Well, that's hard for me, I'm like, I don't care, like you want all this other stuff, right? But you won't Pre-Bolus the Pre-Bolus thing is why the other stuffs not coming like what either either do it or don't but don't keep telling me you want it but you're not willing to do it. And it's not her fault. It's she's in this is ingrained in her. Yeah, you know, and so I'm just trying to imagine that 30 years from now, it's ingrained in people in a different way. And the technology is that much better. And God, maybe there's no something that makes the whole thing easier, go away or whatever. But until then, I think about her, like I think about that woman the same way I think about your two year old when somebody sends me a message, they're like, they're like, look at my kids graph there to like, and I'm like, oh God, like I can't let this be like this, this is so simple to fix, like, so let's let's I just, I don't know, I have no idea why but I am. I feel sometimes responsible for things I'm not responsible for. So

Rachel 1:07:36
well. But that passion is definitely like, the, that passion is creating the ripples that are impacting people and people are hearing me, I think it's a great example of, you know, what we hope to do and being in the world. And, and the fact that you have the passion, and now the expertise to do it and to impact this change. It's, it's wonderful. And that those, those are the ripples that you're creating, it's great,

Scott Benner 1:08:02
I appreciate that. I'm, I love doing it. And I am I passionate it is absolutely the right word, like when I see somebody selling these ideas online, but they're like, you know, for six months, you can get my package, and I'm like, please do not give that person money. So they can explain to you that you need to Pre-Bolus and your basil has to be right, like, please don't do that. And yet they do. And people pay them $600,000 to get told something that three episodes of this podcast would be happy to tell you for free. And, you know, and and so that's where I'm still very, I'm a very American thinker about that I'm, I'm a capitalist, I think that I should get my money from someone else. And you should get the information for free,

Rachel 1:08:42
which is amazing for all of us. Because I definitely was benefiting from the free information.

Scott Benner 1:08:49
It's a barrier. If I imagine you get told to go to a podcast like you were you already got there. And you're like, wow, this is too much money, or too much information. I don't need it right now. If it costs money, would you ever come back? That's true. I don't know, I probably would have negative feelings associated with it. And so I had a person contact me recently. And they're like, you know, your podcast is big enough, you should have a Patreon. And I was like what she goes, people would be happy to give you money for making the podcast. I was like I make money for making the podcast. And she goes, Well, how many listeners do you have? And I told her how many the estimate is? And she said, Can you imagine if 10% of those people sent you $5 a month and I went Oh, I can't I never did before and then I was like, wouldn't be a bad thing, would it? And she goes, What would you do with it? And I said well, I would probably expand and I started thinking about how I would make the podcast better and how I could help the podcast reach more people and I thought should I do that? Like Like, did it mean and I'm stuck in that feeling because she's not wrong. It would generate funds and the funds would go a long way towards doing stuff for the show. And at the same time, I can't like I'm not of that generation. Like, it feels like I'd be making money for not doing anything for being me. And that doesn't seem right. Well, the therapist in me has lots of follow ups. Go five minutes, feel free to pick me apart?

Rachel 1:10:23
Well, I just I am curious about what like what it means to you to be getting money from like, what is that? What is the story that you're telling about? Why about getting money from people who enjoy the podcast?

Scott Benner 1:10:37
Well, I mean, I'm already making a reasonable amount of money for making the podcast. Mm hmm. And I really don't want to take money from people. So they can learn how to be healthy, I wouldn't want somebody to put their hand out to me and said, I can explain this to you for $5. And I realized that the podcast wouldn't be it wouldn't be. I think I'm right. To say that I'm wrong about this. I think it wouldn't be a big deal. If people who wanted to send a couple of dollars a month were able to do that.

Rachel 1:11:06
Well, because you're not you're not charging. It's not a paywall. It's not. So I think that the the hang up is not necessarily. It's not necessarily in that it, like changes your sense of values, or what you know, your vision is for the podcast, but there's something that you're there's a story you're telling about what it would mean, that I think is the hang up.

Scott Benner 1:11:33
Yeah, and it's not real.

Rachel 1:11:34
It's not real. I mean, we all tell stories to ourselves. That's, that's what we do. And, and I don't, I don't think it's useful to argue with stories, either. You can see them and notice them and be curious about them, but then also make some space for other stories. Like another story in this case might be, hey, somebody might really feel compelled to want to offer money as a thank you not because you're charging and not because you expect it. But to say, hey, this has been an invaluable resource for my family. And I want to say thank you. And it's, you know, just a way that you're making that option available. That's another story. And neither one is more true. It's just recognizing that it's, this is more about the meaning that you're making of the situation than necessarily the thoughts involved with this choice.

Scott Benner 1:12:21
Your Listen, you're right, because that already happens. Yeah, like people already send me like gifts. Yeah. And I'm, I'm like, Oh, I'm happy. The podcast helps you. Thank you. And you know, and you're right. It's something about me saying it out loud. That feels wrong to me by saying, Hey, I have a thing and you could support because I know what I would do. Like, I'd be happy to like, like, shut off the recording and tell you like some of the things that I've got going on right now that would be a lot easier with with some more money. You know what I mean? So, yeah, all right. Let me make some room for other stories and see, see how that feels. All right, Rachel. I'll think about it. Thank you. Alright. Hold on one second. I appreciate you doing this. By the way. Did we talk about everything you want to talk about, by the way?

Rachel 1:13:09
Yeah, I mean, I, I mean, I could get real clinical and talk about some of the things that siblings might experience but I feel like I feel like we've done more just having a casual conversation.

Scott Benner 1:13:20
So do I. That's my magic. By the way. I'm only good enough. Yes, this is one of them. I want to thank Rachel for coming on the program and having this wonderful conversation with me. I'd also like to thank the Contour Next One blood glucose meter and reminds you go to Contour Next one.com Ford slash juicebox. If you want to look in the show notes of your podcast player, there's a link there or I keep the links at Juicebox Podcast comm there's even a link to touched by type one in those exact places where you can just type into your browser touched by type one.org. Thank you so much for listening. I'll be back soon with another episode of the Juicebox Podcast.


Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate