Scott Benner 4/21/24 Scott Benner 4/21/24

#1179 Cold Wind: Institutional Nursing

"Jessica" has been a nurse in a home for the elderly and a hospital for criminals.

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Scott Benner 0:00
Hello friends, and welcome to episode 1179 of the Juicebox Podcast

you didn't hear what just happened to me while I was trying to say Hello friends, but I'm going to cut it out put it at the end so you can hear it later. Why am I here? Oh, I'm here to tell you that this is another cold wind episode. I'll be talking to a person today who we're going to call Jessica. Jessica has had type one diabetes since 1993 When they were diagnosed at 22 months old. That's right, she's 32 today. Jessica is a registered nurse. She's worked at an assisted care facility with an elderly population. Currently, she's in a criminal justice based system that deals with people who have committed crimes or have significant psych issues. Please don't forget 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. Hey, the T one D exchange is looking for US residents who have type one diabetes, or are the caregivers of someone with type one they need you to take a survey the survey takes about 10 minutes your answers to completely simple questions that you will know the answers to help to move diabetes research forward specifically type one diabetes research. So if you want to help type one research, go take the survey T one D exchange.org/juicebox. It's quick, it's easy, and you'll actually help. Today today's episode of The Juicebox Podcast is sponsored by touched by type one. This is a fantastic organization that I've been dealing with for years. I go to do their speaking events. They care about people with type one diabetes, they're doing terrific work for them and I'd like for you to go check them out at touched by type one.org. Go find out what they're up to, and then follow them on Facebook and Instagram. Today's episode is sponsored by Medtronic diabetes, a company that's bringing people together to redefine what it means to live with diabetes. Later in this episode, I'll be speaking with Jalen, he was diagnosed with type one diabetes at 14. He's 29. Now he's going to tell you a little bit about his story. And then later at the end of this episode, you can hear my entire conversation with Jalen to hear more stories with Medtronic champions, go to Medtronic diabetes.com/juicebox or search the hashtag Medtronic champion on your favorite social media platform. This episode of The Juicebox Podcast is sponsored by the ever since CGM. Ever since it's gonna let you break away from some of the CGM norms you may be accustomed to no more weekly or bi weekly hassles of sensor changes. Never again, will you be able to accidentally bump your sensor off. You won't have to carry around CGM supplies and worrying about your adhesive lasting. Well, that's the thing of the past. Ever since cgm.com/juicebox. Let's find out a tiny bit about you first. Jessica. Do you have type one diabetes?

"Jessica" 3:08
Yeah, since 1993 93

Scott Benner 3:11
How old were you then?

"Jessica" 3:13
22 months?

Scott Benner 3:15
Oh, no kidding. Yeah,

"Jessica" 3:17
I was I was a little tatertot

Scott Benner 3:19
that's gonna say that's young. How about that? 93,003 1323

"Jessica" 3:24
and 32. Now Wow, look

Scott Benner 3:26
at that. Good for you. How you doing?

"Jessica" 3:30
I'm with my title. I'm okay. I have some early stage complications. But I'm but since going on a POM those have kind of slowed down. What were they? Um, neuropathy and early stage renal disease,

Scott Benner 3:43
neuropathy and your feet, your hands. But but your eyes are perfect. Okay,

"Jessica" 3:48
perfect. It's just my kidneys. And I was really stressed out my blood pressure was high. And that doesn't know my jobs. And so they put me on a blood pressure mat. And guess what? Everything. The protein urea cleared right up.

Scott Benner 4:02
Oh, when they got your blood pressure under control. That's

"Jessica" 4:05
why my diabetes went better. Like when I went on a pump.

Scott Benner 4:08
How far into diabetes. Were you when that happened? I

"Jessica" 4:12
was 25 years in.

Scott Benner 4:13
Okay. Do you think? How would you categorize your care for the first 25 years your outcomes? I

"Jessica" 4:21
mean, I was on old school insulins with peaks and valleys called it's not even made anymore. It was called 90 and ultra Plantae. And regular like Lintian Ultra linty aren't even made anymore. Yeah. Did you have monitoring? Yeah, we would check my sugar four times a day

Scott Benner 4:37
with a finger stick or some other way. Yeah, finger stick. Do you know what your A onesies were when you were growing up?

"Jessica" 4:43
Back then they wanted you to ride higher. So they were between seven and eight.

Scott Benner 4:47
Okay. And you think they actually were and that's where they wanted you. Yeah. Okay.

"Jessica" 4:51
Yeah. Because they didn't want those to happen in kids because there was some study somewhere that said they wanted there was brain damage. From lows, I don't know what the new research shows, you know, because this was 30 years ago, but they didn't want all these lows, like I would get low and have seizures. Of course, every time I dropped, I would get diabetic seizures like every time I hit 40.

Scott Benner 5:15
And how often was that happening to you? Oh, God, I

"Jessica" 5:18
can't remember. But I do remember how much I hated the seizures because I would I would get tired after but I wasn't like an epileptic seizure. You know, where you don't remember. I could remember how much it hurt to jerk around like a fish out of water. I

Scott Benner 5:34
wonder if I wonder how much that had to do with the existing insulin? how it worked, because 40 is a little high to seize. You know what I mean? Although the monitoring probably wasn't terrific, either. So who would even know you don't I mean, like exactly what your blood sugar was. Right?

"Jessica" 5:47
And the meters were old. And sometimes we didn't check immediately. They just knew oh, god she seizing gave

Scott Benner 5:53
you a bunch of stuff, check your blood sugar. And now you're 40 Yeah, all right. I gotcha. Well, that's interesting. And in any other episode, we would keep talking about that. But because this is a cold one, we're gonna fast forward significantly. And you have

"Jessica" 6:08
you probably just like the background of how people how much damage they have based on the control from the backer, you know what I mean? Well,

Scott Benner 6:15
I just, I want I want people who are talking to know who they're talking to, and what kind of understanding of diabetes you have. Because we're going to be talking about it moving forward. And you know, this should just know who you are a little bit. I don't know about like, you know, I just followed the course of your conversation. So I if, you know, some people are fine, they don't have any complications. But I just want to know, you know, a little bit about when you were diagnosed, what you know, and what you've been through, you know, two different jobs of yours we're going to talk about today, let's do them in chronological order. So the first one is, tell me about what your job was in the nursing home. So

"Jessica" 6:48
I was a registered nurse, meaning, you know, of course, the duties of a nurse, she would do assessments, admissions, administer medications, monitor for side effects of medications, basic registered nurse duties that people are aware of that you would see in a regular hospital. It's just these are elderly, frail. Sometimes we'd get younger patients, sometimes with diabetes complications that could no longer take care of themselves, because they were, too they were falling apart from bad care, or just sheer self neglect, you know, earlier in

Scott Benner 7:21
life than you would expect. Okay, so there's kind of two different kinds of age groups. You see, you see older that you expect to see in a nursing home and you see slightly younger who have had enough medical issues that they've they've ended up there a little more quickly than then the older people. Just let's first of all, just talk about nursing home care to begin with. Let's say I bring my parent there. They live there. Now I leave, they take a couple of medications a day. They've got some, I don't know, they've got some exercises they have to do they live in in a room basically by themselves, right? The room, what's the room? They

"Jessica" 7:57
would actually I've been in one facility that will only work there for a month, but my predominant facility was three years. They'd have four roommates.

Scott Benner 8:05
How large was the room? Well, it

"Jessica" 8:07
was like you'd have a bed. Probably 10 feet a room and then another bed. Wow. For being across the hall. That's it? Yeah. We they fit for people. Yeah. So

Scott Benner 8:16
east, the West in between beds. Yeah. And north to south. And they

"Jessica" 8:20
were it was like you could hear everything. When you're doing care. There was only a curtain. You'd have up to four people or at least two. It depends on your insurance, though. If you had better insurance, you had a single room. You were on Medicare or Medicaid. You had all the roommates.

Scott Benner 8:37
Gotcha. So more money gets you fewer roommates in this first place. But not privacy. Does it get you better care? More money? No,

"Jessica" 8:46
because you still have nurses are still taking care of 26 or more patients.

Scott Benner 8:51
So 26 Plus patients on the floor? How many nurses to those 26. One,

"Jessica" 8:58
I would have 26 patients I was responsible for how long was your shift? Eight hours? Three to 11.

Scott Benner 9:08
One nurse for eight hours for 26 people. They all need something pretty consistently or no?

"Jessica" 9:15
Yeah, everybody's completely debilitated with multiple comorbidities. Okay.

Scott Benner 9:19
How do you even manage that? Like do you just run from buzzer buzzer? Or do you just wear to you do what you need to do and try to get to people for the extra stuff when you can. This episode of The Juicebox Podcast is sponsored by the ever since CGM. Ever since cgm.com/juicebox. The ever since CGM is the only long term CGM with six months of real time glucose readings giving you more convenience, confidence and flexibility. And you didn't hear me wrong. I didn't say 14 days. I said six months. So if you're tired of changing your CGM sensor every week, you're tired of it. Falling off or the adhesive not lasting as long as it showed or the sensor failing before the time is up. If you're tired of all that, you really owe it to yourself to try the ever since CGM. Ever since cgm.com/juice box, I'm here to tell you that if the hassle of changing your sensors multiple times a month is just more than you want to deal with, if you're tired of things falling off and not sticking or sticking too much, or having to carry around a whole bunch of extra supplies in case something does fall off, then taking a few minutes to check out ever since cgm.com/juice box might be the right thing for you. When you use my link, you're supporting the production of the podcast and helping to keep it free and plentiful. Ever since cgm.com/juice box. This episode is sponsored by Medtronic diabetes, Medtronic diabetes.com/juice box. And now we're going to hear from Medtronic champion Jalen.

Speaker 1 11:03
I was going straight into high school. So it was a summer heading into high school was that particularly difficult, unimaginable, you know, I missed my entire summer. So I went, I was going to a brand new school, I was around a bunch of new people that I had not been going to school with. So it was hard trying to balance that while also explaining to people what type one diabetes was. My hometown did not have an endocrinologist. So I was traveling over an hour to the nearest endocrinologist for children. So you know, I outside of that I didn't have any type of support in my hometown.

Scott Benner 11:37
Did you try to explain to people or did you find it easier just to stay private?

Speaker 1 11:42
I honestly I just held back I didn't really like talking about it. It was just it felt like it was just an repeating record where I was saying things and people weren't understanding it. And I also was still in the process of learning it. So I just kept it to myself didn't really talk about it.

Scott Benner 11:57
Did you eventually find people in real life that you could confide in, I

Speaker 1 12:01
never really got the experience until after getting to college. And then once I graduated college, it's all I see. You know, you can easily search Medtronic champions, you see people that pop up and you're like, wow, look at all this content. And I think that's something that motivates me started embracing more, you know, how I'm able to type one diabetes, to hear

Scott Benner 12:22
Jay Lynn's entire conversation stay till the very end, Medtronic diabetes.com/juice box to hear more stories from the Medtronic champion community.

"Jessica" 12:33
Do what you need to do, and then get to the extra stuff if like they're on the floor, of course, because they bring their buzzer and weren't tended to quick enough, I would have to stop what I was doing attend to that somebody had chest pain we had somebody with or in the case of diabetes, a hypoglycemic episode, you'd be tending to those emergencies in between juggling the basic stuff like administering medications and assessments.

Scott Benner 12:57
Is there any advanced doctoring going on? Like, having a problem that isn't quite figured out yet? Do people actually try to diagnose what's going on? Or is it just there's orders from their doctor about medications? And we do that thing, and that's it?

"Jessica" 13:12
Um, well, if there is a change in condition, we would get them further care, we would call the doctor and say, hey, this person is exhibiting this, but typically, it's just you get admission orders from the hospital, because they would come from a hospital typically, okay, you know, because they, the hospital would determine they needed further care along with the family. Sometimes they would be directed MIT's from family, it just depended on the situation. They would get their basic orders, like basic, everybody got the same basic admission orders. Yeah. And then they would get their basic medications that they were prescribed by the doctor, and then they'd be seen once a month. If they were on Medicare. I can't speak on the private pay. But Medicare patients can only be seen once a month. And then, which was kind of challenging for some patients because they were so sick and their conditions were rapidly changing. Once a month wasn't enough. Yeah. So everything would be done by phone.

Scott Benner 14:07
Okay. And that would be through the nurse and through the facility, not because you're not asking the patients to speak for themselves at this point about their health, right? No, okay.

"Jessica" 14:17
Everything's done by the nurse.

Scott Benner 14:19
So then you're counting also on the nurse understanding what's happening and, and relaying it properly. Yes. Simple things like medication. I'm supposed to get something at noon. How likely is it? I'm actually going to get it at noon? We

"Jessica" 14:31
had an hour before or an hour after window to give medications. I would be given nine o'clock meds at 1030. Okay, but that 11

Scott Benner 14:41
I gotcha. Because your verse rushing around. You're literally just can you tell me if there's 26 rooms in a row? Do you go get all the medication for 20? Sounds like you wouldn't, you'd probably go back and forth over and over again. Right? Because you don't want to waste things up.

"Jessica" 14:54
Right? You don't want to miss anything or have a meta or No, I know some nurses would do the 26 but the thing is then if you have to hold a medication because their blood pressure or something was low, then you'd be picking through the cup trying to figure out what met it was okay. So I would just go back and forth and pop the pills out of the container, right? Because they came in little med cards. So I would just do that as I would go. But you're going back and forth, back and forth, back and forth to the med cart to the rooms.

Scott Benner 15:21
What about a simple thing? Like a person who's wearing an adult diaper? They wet themselves? How long could they sit in that before it can get handled? Sometimes

"Jessica" 15:30
I'd have one scene for 40 patients, and nurses can help a scene out but of course, we had our nursing duties to tend to write our medical care, but I'm a cena with 40 patients, they'd be waiting for hours.

Scott Benner 15:43
Tell people what Cena means. Certified Nursing Assistant. Okay. Now, my mom has passed now, but she spent the last couple of years of her life in an assisted living facility. A certified nursing assistant, in my personal experience was some poor kid with a part time job. Or some lady who was working her second job or something like that, running around like crazy. And if you ask them any question, they didn't know the answer to anything they were they're performing tasks. And that was it. Am I undervaluing that? Or Is that about right?

"Jessica" 16:17
That's about right, because they don't have a lot of clinical knowledge. A lot of them I had some really good ones that do basic things like keep the head of the bed up on a tube feeder, when you had those CNAs that had basic clinical knowledge. Like some of them would say, you know, this dizziness isn't normal. I'm not going to get them out of bed, because I'm going to go call the nurse. So some of them had more common sense than others.

Scott Benner 16:39
Okay, so the good ones could do a little more thinking, yeah. And

"Jessica" 16:43
then they would be able to tell the nurse when something was going on. Yeah, we had some of them that knew the signs and symptoms of like low blood sugar and are brittle diabetics. They'd be like, You know what, you're acting funny. I gotta I gotta get the nerve

Scott Benner 16:55
to get the nurse to tell me something. These these people and you difficult job being asked to run around like crazy for 26 people for eight hours. These other poor people are changing diapers and bowel movements and cleaning people up afterwards. Crazy good paying job, right? You drive a Lamborghini, you were making like a million dollars a year. Now? What is that? What is one of those scenes make?

"Jessica" 17:17
When I worked at the nursing home? About 1314? an hour?

Scott Benner 17:21
Yeah. So for $13 Now I get to change people's diapers all day. Right? What am I? What a joy. Okay, and you're completely anonymous. Jessica. So what were you making?

"Jessica" 17:32
I was making 30 Originally, and then I went pool as they call it. So I went up to 37 an hour

Scott Benner 17:39
30 to 37. And not just and you'd only been doing it for three years. Yeah. Did you consider that a reasonable compensation for what you were doing? No,

"Jessica" 17:48
no, the amount of tasks I had to do in liability I had on my license with that many patients, it was not reasonable.

Scott Benner 17:56
Explain that part to people liability on your license. What is that? So

"Jessica" 18:00
what would happen is if you provided poor care, you could be or something adverse happened based on the quality of the care you provided. They could file a complaint of your licenses, the state, the state with an investigate your license, and you could actually lose your job. Okay. And your license your livelihood, if there was an incident that something happened, which could be a lot of different things. So with 26 patients, I can't monitor all the minor changes. I can't prevent every wound from occurring, because I can't turn everybody every hour. People are getting bedsores. That's a liability. People are falling. That's a liability because I've had, it wasn't my patient, but I know one woman whose patient fell and died. Okay. And she was in hot water because they're like, Well, what did you do to prevent the fall?

Scott Benner 18:48
That was on her? Right? And then there's a layer above you, like there's the administration of the facility, and then the owners the ownership, which you don't know or see the administration's under as much pressure as you are? Right, because they want

"Jessica" 19:02
to pass the state inspection to get funding from CMS, the center of Medicare and Medicaid Services,

Scott Benner 19:08
okay. Okay. Even at your 37 at your highest number. You're 37 How much cash in your hand at the end of the week did you have? I

"Jessica" 19:16
was working part time. So I was working about 12 hours a week. So 37 times 12. I'd have to do that math, which wasn't very much,

Scott Benner 19:25
but you had full time you'd still be making 37. Right. Okay. Okay. Did you feel like the administration had your back as a nurse? No,

"Jessica" 19:36
they were clueless. They walked around like no idea what was going on.

Scott Benner 19:39
But there are people who previously had your job though, right? The deal when

"Jessica" 19:44
did the director of nursing the administrators typically a business person, they have to be a licensed nursing home administrator, but their background is business and finance. So

Scott Benner 19:55
it seems to me like your job is the difference between spinning plates and Being told if they fall and break, we're gonna sue you or you're gonna get fired or something like that. And the plates being on a shelf and just it's like, oh, it's your job to keep the plates there. Like, I can keep those from falling, meaning eventually the plates are going to fall. Like you just you can't avoid it forever, right. 26 older, frail people with a lot of comorbidities, you're running around like a lunatic. And this the place make money? Yes. Like, could they have hired two people for an eight hour shift is what I'm getting at? Yes, yeah. Okay. So this is a cost cutting thing. Would you say? A person in that situation living in that situation? Is it just like, I hate to say it like this, but is it storage? Like is the idea like, Listen, you don't have a lot of time left, we're just going to do our best here just so you don't suffer and that you're getting what you need. But like we're not, you're not looking for quality of life. At that point, right. In

"Jessica" 20:56
theory, you are always looking for quality of life, because that's how the patients maintain their well being. But the way the system is set up, you can't provide quality of care or quality of life, right? I couldn't do range of motion like you're supposed to do. I couldn't sit everybody up. You know what you're supposed to I couldn't turn everybody like you're supposed to the basic nursing stuff you learn in fundamentals in nursing, I couldn't do because of time, because of time constraints Exactly. Like in nursing school, they recommend people that can't sleep, try something like a warm lotion and BackRub like, you know, nice tasks like that. But the elderly appreciate. Couldn't do it. Like everything, just open them up on pills to get them to fall asleep. Instead of trying non pharmacological intervention. Just dope them up on pain meds and put them to sleep that way. Yeah.

Scott Benner 21:43
Yeah, I had to stop them from doing that to my mom. At one point. I was like, Hey, I think my mom's high all the time. What are we doing? And it wasn't what she was looking for either. I even thought like stuff that they would say like, oh, there's a community room she can go down to, we're not going to help her get there. Or you know, whatever. Yeah, like, but if she can get there, great. And then if she walked out in the hallway and made one wrong turn, they'd be like, Your mom doesn't seem to know where she is. Like, it's a big, like, expansive corridors, like she just got there. Like, I wouldn't imagine she'd know where she was, you know what I mean? And then they act like, well, so she can't go to the community room. Is everything felt like an excuse to limit or not do something? Yes, yeah. Do you really mean and when stuff didn't happen? It was kind of hilarious. So in my mom's room, at the first place, she was there's, you know, a cord, your pole for a bell, right? Goes to the nursing station. So my mom falls in the bathroom, and she pulls the cord. But it doesn't work. It never alarms, the nursing station, nothing happens. So luckily, my mom was trying to go to the bathroom and tidy herself up right before she knew somebody was going to come in. So she only spent about 10 minutes on the floor. But she was 10 minutes kind of folded on herself not in a precarious position. But luckily for her someone was coming in. So she got found pretty quickly. And that made me Of course, call the place and say look, you know, she pulled the bell, the Bell didn't work. And she was oh, no, you know, we'll we'll check into that. Then no one ever gets back to me. And then I press it. And it's like, oh, yeah, the wall. So there's a problem with the bail system, but we're getting it fixed. And I was like, Okay, great. But I called back in two weeks, is the bail system fixed? No, I'm gonna call you in seven days is the bail system fixed. Now this went on and on and on until I really got upset and pressured it, we're gonna get somebody out. We can't get somebody out here because of COVID. And I said, you can't get somebody out there to fix the Bell system because of COVID. I was like, that doesn't make any sense. What is COVID have to do with any of this? And then they didn't have an answer for that. And then finally, one day, I was in my car. And Jessica, you don't? I mean, you know me if you listen to the podcast pretty well, but you don't know me know me. Scott in his 20s didn't have a good temper. So it's got as an adult as okay. But I get a call one day I'm sitting in my car, I pull over to the side of the road, and a person gets on the phone and says, Hey, we just wanted to let you know, when your mom fell. People didn't come not because the Bell didn't work in her room. The bell in her room works fine. And I went, Okay. And I said, Why didn't they come? And she said, The Bell didn't work at the nurse's station. So the system works fine. It's just at the nurse's station, there was a problem. And I went, No, this system doesn't work fine. If one and it's a walkie talkie if one of them works and the other one doesn't work. The walkie talkies don't work, because now your mom's walkie talkie works. And we had this inane conversation that went on for a couple of minutes until if I'm being honest, I screamed at her and hung up the phone. And I believe part of what I screamed was fix it and 24 hours or I'm calling the state. And then 24 hours later, they it was fixed. It was amazing. Yeah,

"Jessica" 24:57
well, this is a little outside track, but I was Allstate. I did it for eight buttons. I was a state licensing surveyor for nursing homes. With that I was going through and making sure they were following the licensure guidelines. And something like a call bell not working could be a tag, like you said, yeah. Because that puts the patients in danger. Anything that puts the patients in danger, it results in a fine. Yeah,

Scott Benner 25:20
as crazy as that all was, by the way, and by the also in the time that that that whole conversation was going on, like I told you weeks into a couple of months, they put literally bells, like you would see on a desk like you remember, like old movies, you'd walk in, there wasn't somebody manning the desk, and you ding ding the bell, they put those in their rooms next to their bed, I'm like, Well, how does that help her in the bathroom? Like, I don't, what are we doing so they were literally ringing a bell to get people. For a while, it was pretty horrible. Anyway, to me, the amount of times that the person I was on the phone with the amount of times that she insisted that if one side of the walkie talkie worked and the other side of the walkie talkie worked, and you were holding the one that worked, the system worked. That told me everything I needed to know about that place for the rest of my life. She had something in her mind that she thought would keep me from being able to sue them. And she was not going to she wouldn't say the system wouldn't work. If both sides didn't work. She said your mom's worked fine. She just kept saying that. And it was I was like, Okay, well, I'm I'm, obviously the truth isn't going to come out here. Let's talk about people with type one diabetes. In that setting. What is being done for them? Your type one is just how you'd want to be taken care of tell me the whole thing, really. So

"Jessica" 26:41
what would happen is you would be on AC HS blood sugar checks, meaning before meals and at bedtime. So you'd get checked four times a day, just like I did in the back in the day when I was first diagnosed. So they're doing an old school, right? Yeah. And then they would be on what's called for insulin a sliding scale. I don't know if you know what that is from. Okay, so from when your daughter had it, I don't know if she was on a sliding scale

Scott Benner 27:08
she never has. But I've talked to 1000 people have done it. So yeah, so

"Jessica" 27:12
it works like you know, zero to 150, no insulin 151 to 200, you get x amount of units, 200 to 250, so many units, and so on and so forth. And the scale typically stops at 400. And then at 400. You give 11 units, just a example number, and then you call the doctor immediately. Okay? So it's like, you're not getting meal coverage, you're just getting so many units.

Scott Benner 27:42
So could I, before a meal be under a certain level, and they would even give insulin for the food? Correct. So if my blood sugar is 149, and you won't give me insulin, typically no. Okay, in most sliding scales, but I'm about to eat. So you come back to me before the next meal, where I'm assuming you find my blood sugar in the three hundreds, and then I get insulin for that.

"Jessica" 28:07
Yes. Oh, so it's kind of like you're good at breakfast, because you get your Lantis you know, at night, which typically it was a lot of our facility use a lot of land tests. Okay, that was what was on formulary. You know, and this was it's just it goes off the formulary, right, so you get your Lantis typically a bedtime. And then you'd usually get enough Lantis to where your blood sugar was great at night. So you were almost like feeding the Basal, you know, because you wake up great overnight, and then they would expect that sliding scale to cover you for breakfast, or the blanches to cover you for breakfast, which we all know Basal rates isn't supposed to cover a meal, yeah, you would only get meal coverage after like a month or more a bad blood sugars, then they might give you two units for a meal, like a very small amount for meal coverage. But that was only when the sliding scale failed.

Scott Benner 29:01
So were most of those people living with higher blood sugars, correct? Yeah. And that affects their ability to be happy, I would imagine. And if they're in the middle of healing, that also slows that down.

"Jessica" 29:13
I would just, it's not conducive to their well being. Right, right.

Scott Benner 29:17
But it's not a consideration. Nobody says Mary has a wound on her arm. Let's try to keep her blood sugar tighter so it heals more quickly or so that we don't talk about like that. No,

"Jessica" 29:27
we just do wound care like the wound care that the wound care dock orders, but the diabetes perspective is never considered in that. Yeah.

Scott Benner 29:34
So these people are basically being treated like an old car that's falling apart that we can afford to replace. So we'll just fix whatever falls onto the ground and then hope the bumper stay stuck. And if it doesn't, we'll glue it back on until the door handle falls off but we're not trying to we're not trying to renovate the car I guess is what I'm saying.

"Jessica" 29:54
They're not sure I don't know what the ANC goal is of the ADA. Now, like I said, My date was below seven. I think it's still below seven. We weren't shooting for that. It was just like you said, just repair on their agency came back at eight, we might modify the insulin, depending on the patient, right. But they weren't shooting for an agency of 5.5. Yeah.

Scott Benner 30:16
Do you know if I asked you what the average amount of time is a person stays alive after they enter a facility.

"Jessica" 30:24
We have patients that were there for 10 years, but those ones were generally had less conditions. They might have just had like severe disability like muscle weakness and wasting, and they were private pay. So the private pay ones lived a little longer, because most of them were less sick.

Scott Benner 30:39
Okay, so private pay people that would indicate I had, I can't live at home by myself anymore. I don't have family to live with. And I've got some cash so I can afford to move into another place. So they show up a little sooner. But they're not as sick when they get there. Yes. Okay. The sicker you are when you get there, the less time you have. Correct. Okay. How would you feel if your diabetes was managed the way there's this horrible, that's the sliding

"Jessica" 31:09
scale is what we did back in the day, when I was first diagnosed. And my dad recently looked at my logs, and he goes now I'm surprised you're not dead today. And he was he's that type A, like personality, like perfection. Yeah. But we didn't have half unit syringes. And I was, you know, 22 months. So you're guessing game based on one unit and eyeballing a half a unit on a syringe. So he like I said, he looked at those numbers and said, How the hell do you not have much bigger problems? Yeah, yeah. And he tried his absolute hardest, like to have a normal childhood, yet have good numbers.

Scott Benner 31:48
Jessica, if I Google, how long does the average person live in a in the next word that populate self populates in Google is America but the second one is a nursing home. That's funny, and I don't I think it's a pretty average question I'd ask the current average length of stay in a long term care facility is two and a half years. Yeah,

"Jessica" 32:13
that sounds about right. If you look at admission dates on the computer, and then adapt date.

Scott Benner 32:17
Yeah, that's on NJ that's from nj.gov. Probably because I'm in New Jersey. So Google fed me back something local. There was tough, because you had that thought when you're when my mom went in, like, I felt like, oh, like it felt like you're on a countdown. Like she can live two and a half years. Honestly, it worked out almost, you know, almost exactly like that. So then the question is, is society doing something wrong? And are they doing it just because of money? Like so if all those people no matter how beat up they were, if they all had their own nursing care and could see a doctor more than once a month? Do you think they'd last longer than they do? Yeah, yeah. Okay. Is that a reasonable thing to ask? And as you're a person who's got type one, you worked in that setting, even if all the money was available, and the facility was willing to spend it and put all the nurses in there? Like how much would that change their lives? Do you think?

"Jessica" 33:12
significantly? Really? Okay, yeah, because no one feels good at 300. We'd have patients writing in the three hundreds all day. But then it's like I would do that previously in life, because we had didn't have CGM in my mid 20s. I was on Medicaid. So I didn't have a CGM. So I purposely write high, because I couldn't feel my lows. And I pass out at work right at that I passed out at the nursing home twice. Okay. And that was scary. They almost dial 911 for one of them. You know why? Because you can't have the nurse go down.

Scott Benner 33:44
So I laughed, because there's not one more nurse there to help you. That's the part that made me laugh.

"Jessica" 33:51
So luckily, I had one nurse that was able to help with the dementia Ward, which was like harder because the people would refuse care. You know, I'd get hit all the time that they took me off the dementia Ward upon my request, because it was just too crazy. But yeah, I passed out and my coworker slapped me across the face to get in response to pain, literally, like, slap me frontwards and backwards. And then she forced us down my throat like I could suck with a straw just enough to get the juice out my throat out of it. Wow.

Scott Benner 34:23
So I tell you keep your blood sugar higher. And but now that monitoring exists, you were CGM. Now. Yeah, yeah. And I love it. You don't keep your blood sugar 300 anymore. No, no. Okay. Is there any way in that setting that you could manage someone who couldn't help themselves? The way you're managing now?

"Jessica" 34:47
No, not what the number of patients I had that average 26 divided by eight. I can't I'd have to do a calculator. How many minutes you had to care for them, but it was less it was like 15 minutes if that okay. If I'm only seeing you 15 minutes a shift, I can't manage you as tightly as I, as I could. Yeah. And then we're not trained in pump therapy. Most people don't come in on pump therapy. And depending on the state, Medicare, Medicaid, or Medicare might not cover pump therapy. So the facilities take away anything that would provide tight control, because they don't want the liability of somebody accidentally overdosing on insulin with a pop. So

Scott Benner 35:27
did you ever see an older adult who just really understood their diabetes? And like, listen, I can do this? Or do they lose their ability to take care of themselves once they get there? Legally, we

"Jessica" 35:37
had a lot of people that were alert and oriented times for person place time situation, and they knew that they weren't being managed, and they're demanding to call the doctor. Right, you know, because they knew what was up. They knew it wasn't healthy to be 300. And have the nurse laws a fair use a sliding scale? Yeah, because they would just be on the yo yo, you're giving them no units for zero to 49, then they're up to 400, then you're slamming them with 11 units. And then they skip their meal because they're not hungry because they feel so crappy, right? No one likes being 400. And then you're slamming 11 units, and um, which I know everybody's insulin needs vary. But then they bottom out. Yeah. So they just get on this yo, yo, and I can't provide the care. But I know that they need

Scott Benner 36:22
right. That's never gonna happen. There's no fix to it. Right? Correct. Yeah, this is slightly off topic question. But I want people to have some context. Did you ever experience a family, bring an older person in get them settled? Say, hey, we'll see you Monday and literally never come back.

"Jessica" 36:43
All the time? Where they literally abandoned?

Scott Benner 36:45
Yes, yeah. So I learned how common that was from a friend of mine. And it really did shock me. So they get their parents to the facility, get them checked in, and then just ghost them. Like don't pay the bills. Don't ever talk to them again. They just disappear. Yes, yeah, that's not uncommon. Yeah. Okay. Well, we're all we're all doomed. That's fine. Least you picked a good name, Jessica. That's nice. We can be happy about that for a couple of minutes. Can I ask you the first time you realize that happened? What did you think? Do you remember the first time you realize this person has been abandoned here?

"Jessica" 37:25
It breaks your heart because we become your family, you know, and I can't provide you that same emotional support that I could if I had less patients. And those patients need a little more love. We would be hugging patients, you know, the ones that were allowing us to, if patients crying and you'd be holding their hand, but you're holding their hand for two minutes, not until they're done crying, right?

Scott Benner 37:50
You're like, Okay, I gotta go. I have to say that the people that my mom intersected with personally in her room were always terrific, always. And nobody was unkind. I always felt like you're describing like, there's, listen, there's not enough time for me to do the thing that needs to be done here. And if you want something to happen, you have to do it yourself. Like I would have to call doctors and browbeat them into just doing their jobs. Like Like, just really just push and push and push. I had a general practitioner who was mismanaging my mom's blood pressure, for example. And I finally just said to him, like, why won't you send her to a cardiologist? Like you're using a really old medication? It doesn't seem like you know, what, what's going on here? Like, why don't we give her to somebody that could help her. And then he did that. And then they were able to bring her blood pressure down. But for the months that he messed around with it, she couldn't get her cancer infusions to help keep her cancer away. And then my mom dies eventually, because her cancer comes back. But my mom's cancer comes back, possibly, because this guy messed around getting her blood pressure down. And so she couldn't get these infusions that were meant to help keep the cancer away after they've been removed. It feels hopeless. While they're there, everything about it felt hopeless. And the only thing that kept my mom from feeling hopeless, was her trying to keep up her good attitude. And that's the other thing is she's trying to keep up that good attitude. While basically most of her life is puzzle books and television and music and not much else in a tiny room, and nowhere to go. And nobody to help her go somewhere if she wanted to. So here's a hard question. And then we're going to move to your next job. If you got to the age where this was going to happen to you, you were going to have to go into an assisted living facility. But you had a switch, you could just turn your lights off and and be done. Would you turn yourself off or go into the facility?

"Jessica" 39:44
Turn myself off. You would because I don't want to die of a bedsore. I don't want to die of diabetes complications where you suffer you know like with the going to die dialysis being poked and prodded out there. Like I said, bed sores are very common in nursing homes because people are not being turned every hour like they're supposed to be. I don't want to die of drowning in my own fluid from heart failure because they couldn't get my blood pressure under control. I mean, just the variety of problems that occur. I would just like you said, I would just keep the switch off and call it a night.

Scott Benner 40:23
And even personal like, affirming personal interactions with family, there are too few and far between to be meaningful right.

"Jessica" 40:33
Now families like we had one lady where her debt hurt songs only concerned if she was eating. That's it. Because when people stop eating, that's when you that's when you're ready to go. Yeah, so he would call me every week, at the same time. And it was my shift. It was I don't remember if it was a Monday or Tuesday, but he would call and I would just tell him, it was a five minute conversation. Your mom is eating, I pull up the screen about 25 to 50% per meal. And he'd go is she taking her supplement? Because we'd have venture shakes? You probably know what venture shakes are. Yeah. You know, we've all seen them on the TV, is she taking her ensure at least Yes. And eventually she was eating 10% of a meal. You know, it got less than last minute she passed. But the song appreciated just a nurse, like calling him and telling him, this is how your mom is doing.

Scott Benner 41:24
So he could understand what was happening is horrible for everybody through by the way, I'll tell you like, I'd go visit my mom a lot. And by mom, I'll be back I'll see on Friday, like but you know, you go out the room and you close the door. You just stand there for a second and you're just like, oh my god, I can't believe I'm leaving. I can't believe I'm leaving her here. I feel terrible. She must be doing the same thing on the other side of that door that I'm doing right now. She must be sitting there thinking, oh my god, I can't believe he left. I can't believe he's not going to be back till Friday. Like, you know, it's just, it's tough. Listen, I'm sure there are plenty of people who have quality of life at the end of their life. But for the ones that don't, it isn't great. So okay, so they're not getting good care for their diabetes. They're the it's just like I said, you're just you're gluing the mirror back on when it falls off. But we're never going to, we're never going to pull the car over for an hour, pull all the mirrors and bumpers and doors off, strip it down payment and start over again. It's just let's see if we can keep this thing together. As for as long as we can drive it down the road. Your next job, where did you work at the next place? And is that where you are now? Yes. Okay. It is

"Jessica" 42:27
a forensic psych facility, which is state operated and run for patients that have committed a crime and they go there instead of jail because they were I don't like the term crazy, but they were crazy and were mentally ill at the time of their crime. Okay. I won't say the legal status because that could identify the state but as a particular legal status.

Scott Benner 42:48
Okay. All right. So people ended up there because either they were mentally ill and committed a crime or mentally ill temporarily while they committed a crime or said that they were once they got the court and the court believed them. That's pretty much how you end up there. Okay. People who have killed people. Okay, yeah. So from murder to something

"Jessica" 43:08
like maybe attempted murder or vehicular manslaughter. Okay, we had one guy that had bipolar disorder, and was driving a car recklessly and harmed a person,

Scott Benner 43:19
I think. All right. So you're running the gamut there with that situation? Now, are these people they're there for their? For the the mental health side of it. They don't necessarily have physical problems, right?

"Jessica" 43:33
Correct. But we do get people with physical problems, right? Because, like right now we're taking care of it. We have a type one on my unit. Okay.

Scott Benner 43:41
So let's talk about that. That specific situation, type one diabetes on that unit? Vi I guess first of all, how many people are you taking care of in a shift? How long is a shift?

"Jessica" 43:51
12 hours? You have two nurses for a house of 20.

Scott Benner 43:56
Well, that's better. Are you getting paid any better any worse? Slightly

"Jessica" 44:00
better, but I have more experience. Now. I'm making about 40 an hour now,

Scott Benner 44:05
making 40 for having more experience. You don't get a VIG for them having murdered somebody and you still have to help them. That doesn't work. Okay. Are you ever frightened for your own safety?

"Jessica" 44:16
Sometimes? Yeah. Because Because these patients have committed a violent crime they murdered somebody one time they lost their marbles murdered somebody one time. What if they go What if their mental illness start cycling again? Are they going to become violent?

Scott Benner 44:30
And you are in a room with them? They're not restrained or anything like that, right? They're just, they're living. Yesterday,

"Jessica" 44:36
I had three guys almost beat each other up. I had to get like one I had to pull off and say you go sit down in your chair. You put your shirt back on and sit down. I was firm. I mean, maybe not the most therapeutic but these two guys needed somebody blonde and short right? So I was like, put your shirt on it sit down.

Scott Benner 44:56
First of all, why is your shirt not on and secondly, stop hitting it. What do you You know what they were fighting about some

"Jessica" 45:01
girlfriend thing there was a bunch of girlfriend drama and they were playing a card game and the other guy was mocking him because he lost. So one guy was mad because he stole his girlfriend and and the other guy was mad at the same guy. Because he was mocking him over a card game. These

Scott Benner 45:14
guys have girlfriends. Yeah, like

"Jessica" 45:17
gruff six units.

Scott Benner 45:18
Oh, the girls that are other women in the facility. They're not people coming to visit them that are their girlfriends. Sometimes they are really, okay. And how many people in a room in that situation? Usually, like if

"Jessica" 45:29
we have visitation that's pre scheduled, we have a staff supervising of course, because they're not allowed to like, be too personal, like a peck on the cheek, maybe one peck on the lips, and then that's a wrap. Okay, you're not allowed to sit there and get touchy feely with each other. Right. But on other units, we have six units total, I work on the intake unit, the initial admission unit. So it's a little wilder,

Scott Benner 45:51
because they haven't settled into their lives yet. Correct. And once they settle in how many people live in a room? Are they singles are there multiple people in those rooms, on

"Jessica" 46:01
the intake room at singles on the intake unit, because patients are too unstable. And then on the regular units, that's about two per it's two people per room.

Scott Benner 46:10
Two people per room, okay? Okay, varying age ranges, very young, very old.

"Jessica" 46:16
We've got 18 all the way up to their 60s, sometimes seven days. And if

Scott Benner 46:22
that 18 year old, murdered somebody and had a license, they'll live there the rest of their life. It's

"Jessica" 46:28
a privilege system. I won't go into that. But they could be released early, kinda like probation. But they're still under the jurisdiction of the court. You know, they have to follow the rules of their release. If they don't they come right back

Scott Benner 46:41
to the hospital. Places always full, never an open bed. Right

"Jessica" 46:45
now we got a few open beds, but we're filling up again, we've got to get people moved along to the release unit. But that's all up to the courts.

Scott Benner 46:52
There's this cycle throughout the year. I don't know how this is gonna sound but you know, I run a pretty big Facebook community. And there are certain times a year that people are a little less stable than other times of year, like Thanksgiving to New Years is one of those spots, for example, like do you see that? ebbs and flows?

"Jessica" 47:11
Yeah, because the holidays are hard on people because like, daily can get visits for the patients that do have families in the area. But we had a couple people, one guy who was just passing through,

Scott Benner 47:21
and he did committed a crime, and now he's there. Yeah, he's got a 10

"Jessica" 47:25
and a half year sentence. And he served about six of them. And but a holidays, he's just calling his family. He's not there enjoying the cranberries and no stopping. And, you know,

Scott Benner 47:36
is there a moment when somebody's been there long enough that you see them as the person they used to be? Like, do they get to a point sometimes where you're like, oh, my gosh, like you don't even belong here anymore? Like, how does that work?

"Jessica" 47:51
Well, hopefully they get their meds right. Not everybody is severely mentally ill some of them just had a psychotic break. Like we have a postpartum depression case that really breaks my heart because she was postpartum and couldn't get the help that she needed, you know that. So she was temporarily insane. She wasn't fully but we keep her on her meds to keep away any signs of depression, but she's not on heavy duty meds, right, like antipsychotics, then we've got other patients where we hope to get through any psychotics up where they're good. And they, they're completely normal. Yeah, like they can talk coherently. They know what's going on, they're not hallucinating anymore.

Scott Benner 48:27
So they almost feel like they're experiencing that place the way you are. Yeah. And I

"Jessica" 48:33
also live with a serious mental illness. And they're, like me, like functional and you're like, Wow, you could go get a job if you wanted. You're

Scott Benner 48:42
having not made that mistake away from being me. And do you ever feel like and I'm having made your mistake away from being you ever think about that? Not that we're here to dig through you a little bit.

"Jessica" 48:54
I'm like, you always wonder like, wow, how did I get so lucky to have the treatment team that I did? That didn't let me down? Right?

Scott Benner 49:00
Because that's, that's how you see what's happened to them sometimes? Yeah. Okay. All right. So if one of those people has type one diabetes, how are you managing for them? Oh, we'll

"Jessica" 49:12
call him. Paul. We got two patients. I've managed one of them's now on a different unit. But we'll call the one guy Paul. Paul was managed with a sliding scale, like in my long term care facility, right. His numbers were so up and down. He was like, we weren't sure if he was a brutal diabetic as they used to call it. Yeah. Or if we were just mismanaging it. I thought the facility was mismanaging it because I know how to treat Type Line, right? I know how to use Lantis and carb counting and correction factors. Again, just a sliding scale. Yeah. Yeah. And you couldn't eat snacks, but he would eat snacks because what would happen if you need carbohydrates uncovered? They go up. So we weren't covering it and the guy was hungry like in between meals. He wasn't like overweight. He was very active actually. And poor Paul would just skyrocket. But it was like, Sorry, dude, I can't give you when someone, you know when I would feel bad because I know I just Bolus whenever I want to eat right? Yeah. But we don't have that option. It's just before check the blood sugar before meals, bedtime and as needed. Like if they're showing signs or symptoms of hypoglycemia. Well, I gotcha. So I just Paul, though, I have nightmares of him. By his sugars were so badly managed, he'd go to 40 to 401 day. And

Scott Benner 50:36
it doesn't matter because we're not actually actually proactively doing anything. We're just doing something on a schedule of when the meal comes up. That's it. I mean, I can't imagine that this is much different. There's no answer to this question, either. We can't let Paul have his own medication, right? He can't be in charge. Even if he was younger and not sick. You wouldn't put insulin in his care, I imagine. No.

"Jessica" 50:58
And it was sad because we wanted him he was also illiterate. Okay, English was not his first language. So poor Paul was different language speaking without revealing what state I work for. And it was like the one doctor wanted to put him on a pump. We don't have a patient with a pump. But we had another patients to the facility to get on a libre, right? Because he said, I want to be on the best control possible. So he successfully sued the state to be on a libre, because they're very, you know, they're more expensive than checking the sugar four times a day. Yeah. But he had to sue the state to get that right.

Scott Benner 51:34
Is that a thing? He actually did? Or did his family step in and do it for him? He had his

"Jessica" 51:39
lawyer do it, him and his lawyer because he knew that this tech was out there because his family told him about it. And they watch TV, right? So they can see, they see. And they watch cable where all the ads are. I saw libre

Scott Benner 51:49
ad last night during the Oscars. So they're watching it and they see

"Jessica" 51:53
this tech, and then they're like, why can't I have that? And they were like, Oh, well, we're not going to pay for it. So he sued, and he got it. It was otherwise he'd have to pay fight pay him out. But now

Scott Benner 52:03
that you see the blood sugar constantly, are you doing anything about it?

"Jessica" 52:07
They referred him to endocrinology. Is he

Scott Benner 52:11
getting better care now is the CGM answer.

"Jessica" 52:14
I would say it's a big proponent, because you can see that we would never do something as advanced as carb counting, just because a lot of my nurses are not trained in it. They don't know how to carb count. Half of them are bad at math. The computer system doesn't permit that. Okay, like the medical record, the one we use does not permit that carb counting with the correction factor and all that. It was horrible. Because I mean, it's numbers. We saw how bad they were. Just

Scott Benner 52:42
to get did you just say half the nurses are bad at math? Yes. Like, I mean, counting,

"Jessica" 52:50
like doing division, like I have 32 carbs and it's a ratio of one to eight, like the kid we got now. He's 18 diagnosed at nine. Right? This is a different patients. So Paul was our bad non English speaking diabetic. We have a new one. We'll call him Jonathan. Okay. So Jonathan knows how to carb count. And apparently when he was in juvenile hall, they would do carb counting. I didn't know that. But his ratio, he goes, my ratio is one to eight, which I laughed about because I'm in a one to eight ratio,

Scott Benner 53:20
like twinsies.

"Jessica" 53:24
So I was like, okay, so I go, because he's like, if I eat 32 carbs, I get four units. I goes to your ratios. One day, he goes, Yeah, what I think so. But he knew we ought to do that. Yeah. So he knew it. And he's like, why aren't we doing this for me? And I said, Well, the doctor wants to see a pattern of your numbers. He goes, You guys are just giving me numbers based on my number. You're not doing anything to manage the carbs. Why am I not getting insulin with my meals? Even if I'm 140? Yeah, same thing you asked earlier, right? This kid knows how to manage his numbers because he committed his crime in his early teens, and he sentenced to life. But he knew how to manage his sugars, which was really hard because he knows what's up. And I'm sitting here, I know what's up. And he's just, we're not giving him the care of it he deserves or the care he was receiving before. He's 300. I was like, I looked at my coworker yesterday is we give this kid 11 units because he was 318. He goes, You know, I'm like, this kid's gonna be blind by 30.

Scott Benner 54:25
So you know, what's happening? Does the administration understand it? I

"Jessica" 54:29
have nothing against nurse practitioners, but they're not endocrinology specialists. They're not an endocrinology and T. They're a generalized nurse practitioner. Yeah. So they start simple. And then they might refer them to endo if they can admit that they're not doing a good job. But it takes a little bit of their ego away, Jessica,

Scott Benner 54:47
for people who might listen to this and say, oh, yeah, sure. These people don't know. But look at the places they're working. This is where we house people that we've given up on or who have, you know, committed crimes, but you could go be a nurse in a regular hospital. No trouble, right? Yeah, yeah. Your credential. Do you understand? You could handle it? Yeah,

"Jessica" 55:07
I've worked in a hospital before. Right. Okay.

Scott Benner 55:10
I just, you know, not I don't think that by the way, I just imagined it's possible that some people could be listening and thinking that you're the nursing equivalent of the lady that makes the fries. You know what I mean? Like, but that's not the case like you, you're an RN, just like everybody else.

"Jessica" 55:26
I'm an RN, just like everybody else. Now, sight gets a bad rap, because we're not the heroes. But we treat the patients that nobody wants society's throwaways. Because mental illness still has a strong stigma attached to it. Of course, my patients have committed heinous crimes, but I still treat them with the same level of respect that I would somebody that hasn't committed a crime, they get the same amount of love and care that my long term patients did, or that I wanted to go to my long term care patients. I get upset when they're sad. I get upset when their blood sugar's aren't being managed, you know, I feel like that bad for him and pity. But I have empathy for my patients, despite them doing horrible thing.

Scott Benner 56:04
Yeah. When you offer them compassion, do you see them change? Sometimes?

"Jessica" 56:08
Yeah. You know, like I, the one guy that got into a fight yesterday, he asked to go outside for a walk. So I took them outside, you know, to help them cool down. And he appreciated that we just talked for a little bit. I told them, hey, what you did was not appropriate, he reflected on it. And he cooled off. He appreciated that.

Scott Benner 56:26
It makes me wonder, it's not what we're talking about. But it makes me wonder if like, maybe if somebody would have done that for him when he was younger, or something if maybe like his situation wouldn't have changed. I know some people's mental illness is unstoppable. But I wonder how many times people are kind of pushed into situations as well. Anyway? Well, I'm gonna say again, what I've been saying at the end of these cold wind episodes for a long time, I don't know why I thought this was a good idea. But I can tell you, they're actually really popular. So people enjoy listening to these conversations. I think it's because I mean, for me, like, again, you didn't say anything here today that shocked me. But it's still eye opening for someone to say it out loud. You know, you're gonna send your mom to this place. And let's be honest, this is the end the you know what I mean? Like, if you think they're, they're living like a pony running in a field, that's not probably not happening, if they have health concerns on top of that, they're going to be managed as well as possible. But, you know, possibly by one nurse every eight hours for 26 different people, which sounds. It sounds like you must have gotten there, taking a deep breath started working. And before you knew it, it was eight hours was over. Yeah, but I can't imagine there was even like a half a second in there anywhere.

"Jessica" 57:44
Don't you didn't like I said I would have to ride it. 200 Because otherwise I pass out. I was clocking 24,000 steps a day. Just take as you're running

Scott Benner 57:52
around like crazy. Yeah. About them. Is there anything I haven't talked about or asked you about that? I should have something that no,

"Jessica" 57:59
it's just like I said in the psych facility, the blood sugar's are managed just as bad as long term care. And it breaks my heart because I got, like I said, the 18 year old I don't want him blind. Yes, he did something horrible. But he's actually like, nice. And I would never wish diabetes Complications upon anyone.

Scott Benner 58:18
Yeah. Well, listen, if we're going to house people, it's got to be compassionately at the very least, I mean, I know you can't do something, if one of my nurses just judges me for what I've done. And they don't want to help me anymore. But they will. But they're just I'm going to get bare bones from them, because they're not as compassionate maybe as you are. But you also have, it's interesting, isn't it? You have a personal reason to be able to maybe understand their situation a little better. I mean, you can share your thing if you want, but I'm not asking you to, but like, you have a bit of a connection. Is that right?

"Jessica" 58:46
I would say so. Yeah. Because I live with it. I am actually all job more medicated than some of my other patients to keep my condition stable. And I function very well. Nobody knows. I told that to coworkers. And they're like, I would have never guessed. So I managed to pull off the stable appearance.

Scott Benner 59:06
Are you stable, you just appearing stable?

"Jessica" 59:11
At least at least at work.

Scott Benner 59:12
One day, you don't think one day that the like, somebody is going to look over from the other bed and go didn't used to be my nurse

"Jessica" 59:22
when I wasn't taking because I go up and down taking my meds because there are pain to take. And I also have to face living with a really bad disorder. It's a story. I'm more apt to take care of my diabetes in the mental illness. Yeah.

Scott Benner 59:32
Well, this has been something I really do appreciate you coming on and, and sharing this with me. It's a it's a unique perspective. And it's also kind of nice to hear that no matter what we did for my mom. I don't know if this makes it better or not. But at least I know I wasn't missing something. But this is the situation what I saw happening is really what happens that she wasn't being treated any more poorly than anybody else was when she was being true. and poorly, I might opt for the switch to so you know, Jessica. Alright, thank you very much. Hold on for one second for me, I want to talk to you at the end here bio. Okay

Jalen is an incredible example of what so many experience living with diabetes, you show up for yourself and others every day, never letting diabetes define you. And that is what the Medtronic champion community is all about. Each of us is strong and together, we're even stronger. To hear more stories from the Medtronic champion community or to share your own story, visit Medtronic diabetes.com/juicebox And look out online for the hashtag Medtronic champion. Thank you so much for listening. I hope you enjoy my full conversation with Jalen coming up in just a moment. A huge thanks to a longtime sponsor touched by type one, please check them out on Facebook, Instagram, and at touched by type one.org. If you're looking to support an organization that supporting people with type one diabetes, check out touched by type one. A huge thank you to ever since CGM for sponsoring this episode of the podcast. Are you tired of having to change your sensor every seven to 14 days with the ever sent CGM, you just replace it once every six months via a simple in office visit. Learn more and get started today at ever since cgm.com/juice box if you're ready to level up your diabetes care. The diabetes Pro Tip series from the Juicebox Podcast focuses on simple strategies for living well with type one. The pro tip episodes contain easy to understand concepts that will increase your knowledge of how insulin works and so much more. My daughter has had an A one C between five two and six for since 2014 with zero diet restrictions, and some of those years include her in college. This information works for children, adults, and for the newly diagnosed and for those who have been struggling for years. Go to juicebox podcast.com and click on diabetes pro tip in the menu or head over to Episode 1000 of the Juicebox Podcast to get started today. With the episode newly diagnosed we're starting over and then continue right on to Episode 1025. That's the entire Pro Tip series episode 1000 to 1026. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. And now me trying to say hello friends. Hello friends. Hello friends Hello Hello friends and welcome to episode 1179 of the Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

#1178 Two Old Scotts

Scott Has type 1 diabetes, celiac, asthma and more.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends welcome to episode 1178 of the Juicebox Podcast

Okay, so Scott is 55 years old not me, Scott Scott, who you're going to listen to today on this episode with me so two old Scott's that's why we call it that he's 55 years old he has type one diabetes celiac asthma Raynaud's Gilbert's vitiligo, he's a marathon runner. Today we're going to talk to Scott about his life and some things that he's worried about, not the least of which is how newly diagnosed people are under informed. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan. T one D exchange.org/juicebox. Take the survey help type one diabetes research to leap forward you need to be a US citizen. Have type one diabetes or be the caregiver of someone with type one. The survey should take about 10 minutes to complete. You can do it from your phone or your tablet. You could probably do it while you're sitting on the toilet because it doesn't really take that long. He won the exchange.org/juice box but don't sit too long you'll get hemorrhoids.

US med is sponsoring this episode of The Juicebox Podcast and we've been getting our diabetes supplies from us med for years. You can as well. Us med.com/juice box or call 888-721-1514 Use the link or the number get your free benefits check it get started today with us med this show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox do this episode of The Juicebox Podcast is sponsored by ag one drink ag one.com/juice box. When you use my link and place your first order you're gonna get a welcome kit, a year supply of vitamin D and five free travel packs.

Scott 2:24
Hi, my name is Scott. I live somewhere in the Midwest near the mountains. I have type one diabetes. I was diagnosed in June of 2020. My doctor actually called me while I was mountain biking to tell me that I probably should eat less carbs for a few days. So they figured out what was going on. No family history whatsoever. But I have five other autoimmune disorders.

Scott Benner 2:46
Wow. which one came first.

Scott 2:50
I was diagnosed in my teens with Go Bears, which is you know, it's benign that my father actually had it. That's how I why I was tested for it. And then I have slight hands of arthritis. But it's I don't take anything for it. That was diagnosed when I was in my 20s. And then I got Giardia from drinking contaminated water in the woods one time and my doctor gave me blood tests for all this the medicine you have to take for it. My liver function was really weird. So I spent months in and out of tests before they finally decided I had celiac.

Scott Benner 3:28
Okay. And how old are you then? Cheese?

Scott 3:31
2000. So that was in my 30s. Okay, like 32 I have I've had asthma my entire life, which could be considered autoimmune to some extent because that's, you know, it's just inflamed inflammation. Yeah. And then was diagnosed in 2020 with type one. Did you ever DKA No, nothing.

Scott Benner 3:50
Okay, hold on. So I actually think this doesn't happen very frequently. I should have a sound effect. But I don't know anyone's ever said Gilberto's before to me. So common harmless liver condition in which the liver doesn't properly process bilirubin. Yep. Do you do anything for it? No,

Scott 4:09
the only the only effect it has on my life because I can't donate blood.

Scott Benner 4:14
Well, listen, that's not been. Exactly. He did a couple of things to get me out of responsibilities. That'd be alright. Wow. Okay, but how did how did you avoid type one for so long? You're like, uh, you don't I mean? Yeah,

Scott 4:29
it's so funny. So my wife's a nurse, a very, she has like, all these letters after her name on her badge and stuff. So she's, she's done some crazy stuff. And when I was diagnosed, she was actually at work. And I texted her my, my labs and she goes, type two, and I'm like, I have no idea. I mean, all I had was the lab. All I had was my glucose was like, 600.

Scott Benner 4:52
Yeah. What's your body style like Scott?

Scott 4:55
I mean, I'm a distance runner. Okay. Yeah.

Scott Benner 4:59
Is that why when she was like type that type to doesn't make sense to her she thought

Scott 5:03
nor did it to my my son. My pa is actually also a runner and I've run with her like around town, which is hysterical. We didn't know each other till so we moved here I never we moved to where we live now and I had never established a doctor here. Like a permanent doctor, I had gone to a group of doctors for you know, just do the checkups but did not have a specific position. So I made an appointment with this person just for you know, I had these weird symptoms. Um, I felt like my mouth was on fire. Like all the time, I couldn't eat anything with hot peppers in it. And I love hot peppers. I absolutely adore spicy food, and I couldn't eat anything. And that's why I went to the doctor.

Scott Benner 5:45
Did you ever figure out what that was? Yeah, it's as

Scott 5:48
soon as my blood sugar got back to normal. I was back to guzzling. Siracha like it's water.

Scott Benner 5:54
Oh, my goodness. That's interesting. Again, it's kind of your like a like a, like a virgin delete here. Yeah, no, no, I mean, you just saying so many things I've never heard before. I'm delighted, which I'm sorry that your medical maladies are delighting to me. But I mean, I've had a lot of conversations. I don't hear a lot of people say stuff that's different sometimes, you know, in this part of the conversation, so that's interesting. So you couldn't handle spicy food while your blood sugar's were high. Yeah.

Scott 6:20
And, like last night, I had rice we had we had Thai food last night and I went way overboard. And you know, when you go way overboard, obviously your pump fails or your pump site fail. So I was like 250 and like I could literally feel my mouth burning and I'm like, This isn't fair.

Scott Benner 6:40
That's quite the deterrent actually, isn't it? I can't I get when my bloods are good. I or my mouth will go on fire. But that's it, man. That's what else you got going on, that people don't know about? Like, is there any other weird stuff happening? No,

Scott 6:54
no, I think that's about oh, and I'm gonna say it wrong. I always do my doctor last meet vitiligo, vitiligo.

Scott Benner 7:01
Oh, it's, yeah, it's been a Lago. I spent the last week of my life with my wife mocking me pretty openly, because I'm enjoying the television show, Mayor of Kingstown. And I've been saying it a lot in the house. I'm like a child. And she says, it's, you're saying the word incorrectly? And I was like, is it not? Kingstown? And she says, no, no, the other word. So I said of, because I was screwing around by that. And she goes no mer, you're saying Merong. You're saying like ma Ra? And I was like, Yeah, and I was like, Mayor, and she goes, Nope, wrong. And I'm like, Mayor, and she's like, nope, and now it's now it's an Abbott and Costello routine. Like I'm like, mejor. And she goes, that's weird. And I was and so anyway, this goes back and forth. Then she gets frustrated with me. And then I think it's not even just frustrating. I think she looks at me and thinks I probably shouldn't have made another human being with him. I feel like I feel like that's where it is. Anyway, this went on for days because I like, like a Heiser. I don't know if you want to get it but I blew my way through two seasons of that show because I was enjoying it so much. So I've been talking about it for like two weeks. And anyway, I don't know how to say the word so don't feel bad about that a Lago which I only know because Michael Jackson had it. If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes, because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, G voc hypo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you store G vo Capo pen and how to use it. They need to know how to use G vo Capo pen before an emergency situation happens. Learn more about why G vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma visit G voc glucagon.com/risk. For safety information. It's very important to me that the supplements I take are of the highest quality and that's why for the past number of years, I've been drinking ag one. Unlike many supplement brands. Ag one is researched and developed by an in house team of scientists, doctors and nutritionists with decades of experience in their respective fields. Taking care of my health shouldn't be complicated and ag one simplifies this by making it so that there aren't a million different pills and capsules. For me to keep track of just one scoop of ag one mixed in water every day, and I'm on my way, ag ones ingredients are heavily researched for efficacy and quality. And I love that every scoop also includes prebiotics, probiotics, and digestive enzymes for gut support, as well as vitamin C and zinc to support my immune health. I've partnered with ag one for so long because they make such a high quality product that I genuinely look forward to drinking every day. So if you want to replace your multivitamin, and more, start with ag one, try ag one and get a free one year supply of vitamin d3 que two and five free ag one travel packs with your first subscription at my link, drink ag one.com/juice box that's drink ag one.com/juice box, check it out.

Scott 10:51
I was in a research, a research trial for a COVID vaccine. And I got to be really good friends with some of the PIs that work for the research hospital. And they have me at the top of the list they said which means I might have a chance for a study they're doing with some new topical and light therapy and all that. So I'm hoping to get into that.

Scott Benner 11:15
Wait a minute. So that's for the vitiligo Where do you have it on your what do you have it on your body?

Scott 11:19
My hands, my face, really all over? So like, I have scars on my legs because I fall a lot. And every time I get a cut on my leg, it leaves like a white line that never never read pigments. That part does. I mean, it doesn't bother me. I told my wife all the time that it would be nice not to look like a tattooed freak for a little bit. And she laughs because that that nobody notices that. You know, everybody notices.

Scott Benner 11:44
Well Are you are you incredibly Caucasian.

Scott 11:47
I can get a tan with a flashlight. So okay, it's and and I live in the high desert. So I'm in the sun a lot.

Scott Benner 11:56
So is it it's interesting, like so your skin tone is? I don't know how to do this. Are you like Italian like that? That kind of skin tone?

Scott 12:06
No, I'm mostly German and Eastern European. So okay, if you put me in a cave for a year I'd be pasty white. Yeah, probably

Scott Benner 12:14
be able to see through you. I got I there's European and my kids from my wife. And more Italian from me. And they tan well, but they they go to translucent in the wintertime. It's it's pretty interesting. Really is oddly interesting how, like pasty they get without the sun. That's your whole life. The vitiligo or no? Yep, that's been well,

Scott 12:40
I mean, I so I was like 19. And it's kind of funny. I was a bartender and hair halfway down to my button. My mother hated it. My mother thought that I look like a hippie. And I guess it was 21 I was driving home to see my mom. And I just literally stopped the haircut place, like halfway in the middle of Pennsylvania, and got it all cut off. And when the lady cut it off, because you have gray hairs, and I'm like I do not I'm 21 or 22 or whatever it was and she's like, No, but you pull one out. And that's when it started. That's when I noticed that that I started losing pigmentation and within a year I you know, I was partially gray and within like five years I was completely and totally gray and had patches all over and every doctor I went to went yep, that's what it is. It's

Scott Benner 13:26
always encouraging when they do that. We were at a we were we were at a doctor or Arden was getting she had a lot of shoulder pain. She got a like a steroid injection in her shoulder, right. She had like some inflammation, I guess and and it was fascinating how quickly like he put the injection that went away immediately was crazy. But not the point like while we were there. She's like, you know, I'm pretty bendy. Like Arden's not like super flexible, but she's got, like flex to her. And he's like, ah, that's probably that ILS Dan Lawler. And we were like, yeah, we've we've considered that that could be that we don't know, she doesn't have a diagnosis or anything like that. Bah, bah, bah. And he goes, Yeah, there's nothing I can do about that. He just he just said it. Like, you're gonna want to let that one go. He's like, you can exercise and stuff. And then he just sort of stopped talking. I was like, what a lovely bedside manner you have, sir. Okay, so your autoimmune stack up as you get older. Now your mom and dad don't have any autoimmune stuff or they don't have diabetes.

Scott 14:27
My dad had Go Bears and that is the only thing we know about as far back now I did have an uncle who this would have been like, in the 50s or 60s Probably had celiac because I always remember it's Bill never drank beer. That was the whole family knew this like never offer bill a beer because he'll get sick.

Scott Benner 14:45
Oh, no kidding. And that was that. Yeah. And I

Scott 14:49
also remember him when we go to would go to their house. Like he would eat steak and potatoes. And that was literally the only two things he would eat was was was red meat and potato He knows how long do you live? Not long like 60

Scott Benner 15:05
The way you giggled Scott was almost like devious. No, we got him Don't worry. No, I mean, yeah, because I mean, there's a couple of other nutrients you need.

Scott 15:16
You kind of want to balance that meant maybe have a salad once a week

Scott Benner 15:20
or whenever throwing a vitamin even. Yeah, but yeah, that's it. Your dad was the Go Bears and nothing else and maybe an uncle with celiac blade just all jumped on you now. Do you have kids? Yeah. Did they have anything?

Scott 15:31
I have a 22 year old, a 25 year old and 28 year old and we made them all do trial net. We had them all tested for celiac. When I was diagnosed. Nothing, absolutely nothing. And I'm good with that.

Scott Benner 15:47
Geez, did you grow up under a powerline? Or something like that?

Scott 15:51
By train track? Does that count?

Scott Benner 15:52
I don't know if it does or not. I just remember those stories about people whose homes burned near power lines, then they turned into Spider Man or something like that? Yeah, which of these things has the biggest impact on your life?

Scott 16:05
Probably the celiac because it just minutes. I live in a place where we're like, even the breweries have tons of gluten free selections. It. It's amazing how much like gluten free beer I can have. But like getting, I can't stand gluten free pizza. I just I don't like the the texture and the taste. And so it makes it hard to work in sales. I should note that I so I go out with customers and take them to dinner and stuff. And so the celiac really impacts that because I don't want to like, oh, yeah, I have to eat gluten free. Let's go pick this place. Or I'm diabetic. Let's go pick, you know, someplace that's low carb or something like that. So the celiac makes it hard to sometimes to you're

Scott Benner 16:53
gonna say you're a bummer in the car. Like, let's get pizza. Now, we want to Chinese. I want my blood sugar to be high all night. No, what about

Scott 17:03
these conversations? Yeah, I'm sorry.

Scott Benner 17:04
What's it like in a bit in a because that's a real business setting. That's even beyond business. Because it's not like it's not like the people sitting around you in a cubicle or the the people you work with every day. Like when you have to sit down at a meal and give yourself insulin. Does that come with a description every time when you meet a new person? Yeah,

Scott 17:24
so I'm running loop. And I work in a very, very high tech field. So I work with a lot of people who are programmers and software guys and AI and all that. And I always chop loop and the pump and the CGM and talk about you know, the fact that we're running pirates or not pirated, unapproved code and all that. So it's a great icebreaker with some people like that. I've had people who have literally built lube for their the one guy built it for his nephew.

Scott Benner 17:52
After seeing it with you. Yeah. That's pretty cool. All right. So cool. So I mean, you're an older you get me you're in your 50s. I was just thinking about this this morning. The the lessons that come with being older, about like patients, I was thinking a lot about patients this morning, and how, like when I was young patients felt like apathy. But that doesn't feel that way anymore. And, you know, I'm assuming you've learned along the way that none of this matters. So, you know, it's just tell people who cares. If they don't like it? What are you going to do? I wouldn't imagine it's ever gotten in the way of business, right? Like nobody's ever like curled up and been like a like that. Right?

Scott 18:30
That my last job. I had a meeting on Tuesday at 11am, every other Tuesday. And I would I would have to prep for that meeting. Because it was that was my biggest customer. And like, I would hear from my management on a routine basis that this customer leaves, so do you. And they were unhappy, and I was getting so that they are the reason I left my old job because I was under all this pressure and I was getting no support. And I just Life's too short to hate your job and I hated it. So I left and then bit every Tuesday I would have to prep for this meeting, I would have to take a unit of insulin, like 15 minutes before the meeting because I would spike and I would I would go from you know a flatline of 90 with no carbs whatsoever. 280 in 20 minutes, meaning just the stress of it. Yeah, that is the only thing that I could possibly come up with it. The diabetes impacted my work, okay.

Scott Benner 19:26
I used to hate ordering my daughter's diabetes supplies. I never had a good experience. And it was frustrating. But it hasn't been that way for a while actually for about three years now. Because that's how long we've been using us med us med.com/juice box or call 888721151 for us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omni pod dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor index. com customer satisfaction surveys. They have served over 1 million people with diabetes since 1996. And they always provide 90 days worth of supplies and fast and free shipping. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM, like the libre three and Dexcom G seven. They accept a Medicare nationwide and over 800 private insurers find out why us med has an A plus rating with the Better Business Bureau at us mad.com/juice box or just call them at 888-721-1514 get started right now. And you'll be getting your supplies the same way we do. Yeah, you know, it'd be beeping, while these people are already like pissed about something that's not nothing you can really do about because you're just you're just in there like you're a mediator, right? And that's scenario. Like they're mad about something that's not you're doing it's the business and now you have to go in there and explain to them why they shouldn't be mad.

Scott 21:06
Yeah, I was the designated apologize or

Scott Benner 21:10
is that on your CV? Is your business making people upset? Scott can handle it. Started tap dance and singing a song at the same time, right is what it feels like? i Yeah, yeah, yeah, no, I almost know what you mean, I didn't before I had this job. But now I I'm in a weird position where the value of the podcast to advertisers is something that some of them just intrinsically understand. And some of them don't get at all. Like it works. But they don't know why. And they want it to be trackable. And you're busy explain to them. That's not really how this works. Like, I know you want it to work that way you want it to be person A clicked on this thing, they bought that thing, it came through my link, you can attribute that to me, I have value. And that's literally, you know, that's the business side of my life. Except that there are plenty of things that people go into doctors offices, and they're like, Hey, give me a one of these. Or the doctors like do you need a blank? And they go yeah, I'll take blank because they might not even think it's because they heard on the podcast, but it is. And that's not trackable for me. Yeah, some of them really get it actually a lot of them get it, and a few of them don't. And having meetings with those people. That's what it feels like. It feels like I'm tap dancing on the head of a pin, singing a song and juggling at the same time and trying to get them to see something that they don't understand. And it's it's a ton of pressure, because it's a diabetes podcast. Like there's not a never ending list of people who are super interested in advertising. You know what I mean? Like, it's, I hate the pressure, honestly, I wish I could just make the podcast and not think about that. Or they would just agree that I'm fantastic. And just send the ad revenue, and I'll do the ads for him. You know what I mean? So that'd be nice. But I take your point, I would. It's nice that you were in this situation to get away from that. I don't want to make it sound like I'm like burdened or anything like that. I make a podcast, Scott, you don't I mean, like might be after I do this with you, I'm gonna have lunch with a friend, and then I'm gonna get my hair cut later today. So I'm not like, it's not the worst thing in the world. Anyway, I'm gonna get to your diabetes in a second. But I'm interested in you having to go to basically your adult children and telling them they have to get a medical procedure. So was that met easily with them? Were any of them like, I don't want to do this here to talk them into it.

Scott 23:44
So I have two mini me's The one is the anxiety ridden bundle of nerves, me and the other one is the sarcastic and rude me. And the bundle of nerves is the boy and the sarcastic one is the girl and the boy said, I'll do it. But I don't like needles. And the girl said I swear to God, if I get diabetes, because of you. You're you're going to the what was it? Oh, she said you're going to the county nursing home, not the paid one.

Scott Benner 24:16
There you go. Even the anxiety Scott, I think might be a little like, I'm not going to tell you anxieties autoimmune because that would be silly. And I'm not a researcher. But I do think that after having so many conversations, I don't even know how to put it but I think there are things that run in that river. You know, like how many people have I spoken to who are like, Oh, I have a bipolar uncle. I'm like how many people would type one have to say that to you before you go play? That seems like more than a coincidence. And you know, or the even just allergies. I had terrible allergies when I was younger, like really bad. And they've gotten better over time. Oh my but my son got blasted with them when he was is like a senior in high school. And they've gotten better over time. But he's always like a like a little sniffy when you say him or something like that. You don't I mean, yeah, I

Scott 25:11
am this time of year just the dust here is crazy. And when the the wildfires are really bad No, we escaped so the central part of the US escaped most of the the Canadian model file fire smoke this summer, like it always back East. And that's really weird. But when we get the Utah fires and stuff, it's absolutely terrible. Here, I ran a half marathon and air quality that was kinda sketchy. Like afterward, looking at the news, we probably shouldn't have been running. But I spent like a week using an inhaler because of it.

Scott Benner 25:42
Really, just from running out doors in that. Yeah, yeah,

Scott 25:47
it was a bad day. Like, it's funny. I picture shows up on my Facebook memories all the time. And it's like, you can't even see the sun. It's just like this blur in the sky. There

Scott Benner 25:57
were days here where it was dark during the day. Yeah, and yellow. Like, the sun couldn't get through at all. And the sky was dystopian, but like, no kidding. Like, I'm not over exaggerating. And it you couldn't see, sometimes you couldn't see down the street. And that was from Canada, and I'm in New Jersey. And it was just, it was not a thing that happens around here. So it took it was really off putting hard to breathe. You go outside, you couldn't get a deep breath. Like you know, you cough it was really something else, actually. Bye bye

Scott 26:31
have to wait for you to release some of the Canadian ones that you Canadian people that you interviewed this summer to see if you're blaming them for oh, I

Scott Benner 26:38
blamed them all heartily. And I know Canadians that I would text personally, and tell them that I don't know what you're doing up there. But please pull it together. I said, if this was America, we'd have this handled by now. I don't know if we would have or not, by the way. I just you know, like, come on. And so you're saying that your, your level of I don't know, like tolerance for that changes by the like, in the year? Or is it more about the dust in the air?

Scott 27:06
It's more about the dust in the air. It doesn't help that I have two very, very dogs and a cat. And, you know, any normal person without with bad allergies would probably start by not getting a couple of dogs and then you know letting them sleep on the bed with you.

Scott Benner 27:19
Yeah, no, that's a bad decision. I'll tell you right now my son loves our dogs. i If he ever gets ones and adult Arby's I'll be stung. There's one of our dogs if he touches it, he he can't even touch the dog. Oh, you know, and my wife has gone through bouts of that through the years where she could wrestle with the dog. There was no trouble down though I can't touch it back to its better again. And it's actually difficult as a parent and as a husband. Because there's part of me, it's like, I should take this dog for a walk and not let it come back. Because it's like, this is a really terrible for my family. And there's part of me that's just like, I don't maybe dogs just don't belong in a house. You know? It because this is it's more than they can handle. For sure. You know, I get like, sometimes I'm like, is it bad for everybody? I don't know. I don't think I'm gonna turn people off on having a pet but I take your point. I don't know why the hell you would do that. I was like your Do you like my dogs now? Well, hey, listen. I like them, too. You also like pizza, but you stopped eating it? What are you gonna do put pizza in the dogs in the same box and put them in the garage? Yeah. But it is. Pizza is good. It's terrible. Sorry. I'm really sorry.

Scott 28:35
You were talking about what affects me the most. I hear you talk about your pizza recipe. I would love to do that. I love to cook. I'm actually fairly competent at it too. I would love to cook pizza like you You made but you just can't make gluten free pizza like that. It doesn't

Scott Benner 28:52
work. You need the gluten. Actually, it's what you need. It's all about that mean when you learn to make the dough there's nothing to dough by the way. It's like flour and salt water to me yeast. But when you really like go dig down deep and learn about what makes a good pizza dough. It's all about that building of those those gluten molecules in there. And that's what makes it fluffy and crispy and airy and everything you're looking for. So yeah, it sucks, man. I'm sorry. There's so much good. Like if you told the story about your whatever uncle or whatever, the beer guy that couldn't drink beer. And obviously that's a really long time ago. I'll be before it sounds like he was before a factory farming. Yeah, right. But now there's so many people are affected by it. It really does make you wonder like, what's on the wheat? Like, is it something they're spraying on the wheat that's like, causing it more like I don't know, obviously. But the the incidence has gone up so much over the last few decades. It's just seems crazy to me. Honestly.

Scott 29:52
It's amusing to me that my wife and kids love to poke fun at me like we'll go to a restaurant and be like, hey, the spread is good. You want some? Or you know, they did this to me all the time. And we all laugh and joke about it. My wife went to the doctor yesterday for some stomach issues she's been having. And the doctor told her he wants her to go gluten free for a month. And she came home almost in tears. And I'm like, I don't I feel bad for not that bad. She

Scott Benner 30:19
upset because of the gluten or because of the crap she thought she was going to take from you. No,

Scott 30:25
no, no, because of the gluten. So she was she's like, she never met a carb. She didn't like she has she and the dogs have breakfast cookies every morning, which sounds terrible. But they have these the best coughs I mean, you

Scott Benner 30:41
want to tell her to go on we go V because she just wouldn't care about food at all. And then that would fix that I because we had we made something for dinner the other night and it just went poorly. I bought the wrong. It's a long story. I'm not going to bother you with it. But I bought the wrong meat. I usually get it into one place. I got it another place, went to eat it. And we were immediately both of us were like, This is terrible. Now we've been cooking all day. And we just like swallowed hard and threw in the garbage. And I was like, I'll go get a pizza. It was just a knee jerk reaction from like my life before being on weight loss medication. And then we got the pizza. And both of us took a couple of bites here like we don't want this is terrible, like so heavy and greasy. And like nobody like really. It's very interesting how that those GLP medications just tell your brain like I don't want this. Like I'm not telling your wife to do that for that reason. But I'm telling you if she was using that she wouldn't give a crap about those breakfast. Things. She wouldn't care at all. It's fascinating. I was explaining it to my, my dentist yesterday. He's like, how's this working? And I said, Well, I think I might have a GLP deficiency because as soon as I started taking it, I started losing weight. Well before it even like caloric restriction could have helped me. But I just said I'm like my brain is not my brain never tells me I'm hungry. And my stomach never tells me I'm hungry. And so I need to an even when I'm incredibly hungry. It just feels like oh, it would be nice if I had a meal. Like that's the extent of the pressure I get from it. I think they're going to do more testing. And I think you're gonna see type ones get GLP medications in the future. Yeah, I'm talking to a couple of people. Eventually I'll have some of them on the podcast, who are experiencing a significant decrease in the amount of insulin they need. And they're a onesies are going down their blood sugars are more stable. They're using the GLP medication for weight, but it's actually working so well in other places. Anyway, that's not what we're here to talk about. I have a question about Raynaud's. How does that present for you?

Scott 32:47
Mostly after exercise? Like, if it's below about 60 degrees, my hands will get like completely numb. And there have been times that I literally had to go so come and water because it gets painful. And you know with vitiligo, my hands were already mostly white, but they turned like like a corpse white, like printing paper white. I've had people stopped me and asked me if I was okay, because I looked at my hands were so white,

Scott Benner 33:18
like a stranger.

Scott 33:20
I ran a I think it was half marathon. And at the end, I was just like bent over catching my breath and the medical staff came come over and they looked at me like are you okay? And I'm like, Why? Why are you asking? And they started pointing my hands and they're like, your hands are really really white and like, Oh, it's just we're not don't

Scott Benner 33:39
worry, I have a lot of autoimmune issues. I I like that you said corpse white. That's not a color you're going to find on a on a wall paint ever, I don't think but it does paint a picture doesn't it? So numb or cold? Both

Scott 33:54
so I can I can like it'll get painfully cold and then it'll get numb and then it'll get painfully cold again and then it'll get numb.

Scott Benner 34:03
And there's no way to warm your hands. Right? It's just

Scott 34:07
it goes away. You know after 1520 minutes I draw my hands in my pockets and put gloves on and it goes away. As

Scott Benner 34:14
you're sitting here talking about I'm squeezing my hand I'm like why am I squeezing my hand while I'm doing this? A couple of weeks ago I went to touch by type one Orlando and I spoke at their event beautiful event really terrific. It was all day Saturday. I flew home early Sunday morning to be with my I was like oh I don't want to miss the whole weekend with my wife so I'm going to take an early flight to get home. That was a mistake. Here's why it was mistake 6am Flight had to be up at three o'clock in the morning in the hotel didn't go to bed till 10 o'clock at night the night before got up was exhausted like you know middle of the night Uber to the to the airport, get there and then my flight gets pushed back an hour and a half which is just has nothing to do with the story but is incredibly frustrating because you started thinking I could have slept till four o'clock. And anyway, we finally get on the flight. It's this as you might expect on a Sunday morning. A very sparsely you know, but distributed flight. There's people in seats here and there. And before we take off, stewardess comes up, and she just makes the announcement. Listen, there's enough people on this flight, you guys can all have your own row, just feel free to get up and move. So I go to another row, I'm on a very low budget airline because it goes to an airport very close to my house. And so I'm like, Alright, I know that the seats are basically concrete with a piece of paper overtop of them. But like, whatever, you know, like, I'm going to land 15 minutes from my house. So this is the thing I want. So I go into the row and I'm like, I'm exhausted. I'm gonna lay down and I lay across the three seats, I just curl up on my right side, like a baby and I go to sleep. In my cozy Earth joggers, by the way, in case people are wondering, cozy earth.com Use the Africa juice box to save 40% And I'm laying across the thing. I hope they're, I hope they're still get relaxed or six months from now this comes out, I pass out Scott like, I'm gone. And I am awoken by my right hand asleep. Like that's what wakes me up like how painfully my right hand is asleep. And I'm so tired. I just flip over. And I go back to sleep. I sleep for another like 90 minutes. And when I wake up, my right hand is still asleep. I was like, that's weird. But I had no idea about time like I had been so like, sound asleep. I didn't know. Anyway, I'm getting my bag. I'm getting off the plan. I'm shaking my hand out in the parking lot. I'm shaking my hand, I get my car. I'm like what is happening? And it is now three weeks later, and I still have numbness on my right hand. I think I slept on the metal rail, right on my elbow where that nerve passes through your elbow, like near like where I guess people would call it like your funny bone. And I think I damaged the nerve in my arm. I think I was that passed out on this hard thing. So it's getting better very, very slowly. And the internet. Please don't laugh of me. If you're listening. The Internet tells me this could take months to go away. Yeah, yeah. So I'm not like going to a doctor because I have like full, like strength and range of motion, all that stuff. And it does seem to get better as time passes, but incredibly slowly. So and my point of telling you that is that every day, I'm bothered by it. And I can't imagine what would happen if I went for a run and my hands were freezing cold I'd be I mean, I would find that upsetting. But I guess you're used to it. It's weird, though

Scott 37:30
I don't seem to have the problem skiing, or like hiking, or it's just that it's it seems to be just after some sort of strenuous activity.

Scott Benner 37:39
Yeah, I'm gonna definitely end up with a problem as I get older because I have a lawn mower that I sit on and my arms are out in front of me. And if I do that, in the cold, my fingers go numb. And they actually a doctor told me they think it's the where the nerve passes through my shoulder. That gets pinched. And I was like, well, can they do anything about that? And he's like, oh, there's an incredibly difficult surgery you could try. It's like, nevermind, I guess maybe I'll just get a different lawnmower or, you know, whatever. But yeah, you love it when they're like, Oh, it's a surgery. It's really hard and like, thanks. But anyway, this thing with my elbow, and my hand is it's hard not to be concerned every day. Like, you know, just When water hits it, and it feels weird. Like, it feels like my half of my arm and half of my hand like the skin on top is like half asleep. I don't know another way to put it. Have you seen a doctor about this? I looked on the internet, Scott. And the internet said to me. Yeah, that's the same thing. I also called My shoulder surgeon. Because I thought that maybe it was emanating from my shoulder. He of course was like that's not your shoulder at your neck. I'm like, Dude, it's definitely not my neck, it might be my elbow. And he said, well, listen, if it persists, and I was like, right, he said, Go see a doctor and I was like, what kind of doctor and he said two different kinds. You can either see a psychiatrist or a neurosurgeon or neurologist, and I was like, alright, neurologist, I understand loosely I'm like a psychiatrist. He said they have access to drugs that actually impact nerve pain. So apparently there's something that psychiatrist prescribed for something else. That also helps nerve pain and I was like Alright man, I'm gonna believe you but I'm also gonna go with I think it's gonna go away. So as long as it continues to get better, I'm not going to think anything of I'm just going to let it go. I think I've given myself two months and then I'm gonna go to a doctor. You think that's too long it doesn't get worse like I can sit and work all day at my desk doesn't change. So I don't know it's I probably should go sooner Is that what you're telling me? It's it's amusing

Scott 39:53
because we're talking about my my discovering ahead diabetes story about how I The Burning Man thing, but I for like four or five weeks I had been drinking we, it was June, and it's hot here. And we've been hiking all over just tons of hiking, no one hike, I took a two liter backpack of water or two liters, like a Camelback style backpack with two liters of water and drank it all, and then tried to get my wife to give me hers before that, but I did the same thing. I'm like, I'm gonna, I have this this thing I'm concerned about, but I'm going to I'm going to set a timeframe it's going to be like, if it's not better in two weeks, then I'll go to the doctor.

Scott Benner 40:33
Well, the internet said that my this nerve thing could last of the six months. I won't let it go that long. But, you know, I mean, also, where am I getting the neurologist from, and you know, I'm gonna go to a neurologist held my hands asleep, and I know, he's gonna be like, Oh, that'll go away. I'm just gonna be so angry. But I also think about, I shouldn't maybe I shouldn't say this on the podcast, not like big stuff like not like your blood sugar being 300 every day or something like that. But these little things. I also do like a cost benefit analysis in my head about how long I think I'm going to live. Mike, can I just deal with this until it's over? Salad feels to me sometimes. I mean, and Madison thinks about things that way too. Like, if you need a hip or a knee, they're going to tell you wait as long as you can. But we can't wait too long to get too old. But we need to wait long enough that you'll never need it again. Because you can't you the next time this hip goes out, you'll be too old for the surgery. Like so that is I mean, partly our bodies are what they are, and they're not just eminently fixable all the time. This is some bullshit. I'm not gonna lie, the amount of it feels really weird. Like just sitting there, my path, my hand tingling, and not tingling enough that you're like, stop just enough that the world feels different. And anybody who's had their hand goes sleep knows what I'm talking about. But anyway,

Scott 41:55
I busted my thumb up on a snowboarding on some feature. And I went to the doctor after three weeks of agony. And the doctor said, Well, we can cut it up and, and fix all this stuff inside of it. Or you could take Motrin for another two, three weeks and just live with it. And so my left arm doesn't look like my right thumb, because I was not having having my hand and the cast for six months, because my thumb felt weird.

Scott Benner 42:18
You know, we're gonna have to call this episode to old Scots, because I just had toe surgery. And I will gloss over it because I think I've mentioned it on here, but I just woke up one morning, I'm embarrassed over a year ago, and maybe longer than that now. And my toe hurt a lot. And I know, in my mind, I was like Kelly's like, Did you stop it? Did you I have no recollection of anything happening to my till I went to bed, it was fine. I woke up and felt like somebody was stabbing my toe. And I'm like, this will go away, then it didn't, then it got worse. And then there'd be good days and bad days. And I was like maybe there's a bone chip in there. And like someday, like, you know, I'm like telling myself all kinds of stories. Then I get into the position where I have to fly unexpectedly, to go say goodbye to my mother. And as me and my youngest brother Rob are like trying to get through like the Chicago airport. He's like, dude, do you need a walker or something? And I couldn't like I couldn't walk. I was like walking on my heel, like running through the airport on my heel. I was like, Oh, crap, I'll go to the doctor. So I went to urgent care because I was like, just do an x ray. And it'll probably show like a bone ship or something. And then I can take it to a real doctor and get it taken care of. Like, that's what I thought. And so sure enough, she actually isn't she goes, Oh, it looks like a little bone shipped off here. I was like, and then I felt like a genius. I was like, I knew this is what happened. And she goes looks like it's settled in the knuckle here. Blah, blah. I took the film to a doctor. He goes, Oh, yeah, it looks like you have some arthritis in this knuckle. We'll clean that out and we'll be fine. I was like, great. I woke up from the surgery he goes wasn't arthritis. I was like, wait, what he was, like, takes a lot of fraying in there. And I'm like, what? And he goes the ligament not the ligament. The other thing. Crap. Fiber says something doesn't matter. That something was all frayed away. He goes anyway, I had to give you microfracture surgery. And I was like, why? And he's like, Yeah, we poked like, countless holes in the bone, a cartilage. He's like, so that hopefully the cartilage will grow into the holes and kind of reattach your toe. And I was like, seriously, then he's like, Yeah, I'm like, Okay. Like, I thought he was cleaning out a knuckle and taking out like a bone chip. And I'm like, how does that happen? He goes, No, no, you probably heard it. At some point. I was like, okay, so yeah, the cartilage was just fraying in my toe. And it was my big toe and it wouldn't bend and I couldn't drive off it. So I couldn't walk Okay. And boy, I'll tell you, that writes your brain about what you're in control of, you know what I mean? Like that little thing in there is broken like I'm now hobbled, like legitimately hobbled and in a significant amount of pain, I took a fistful of over the counter drugs to get through that flight. Anyway, it actually seems to be working, it's getting better all the time. And the pain is very minimal. So hopefully this works, because if not Scott, they're going to fuse my toe. And I'm like, they're gonna want now it's okay, we just go to the knuckle, we fuse the bone together. I was like, that's the fix? Like, where the hell are we? Anyway, that's where medicine is for your toe. for yourself. You don't use medication for asthma symptoms, or just an inhaler? Or is it and is that prescribers over the counter? It's

Scott 45:52
it's a theater, although it's a script, and I haven't used it. I haven't used it at all this summer. Like I said, we had a very, very low smoky summer here, and I'm really happy with

Scott Benner 46:03
it. You don't need it to run. No, no,

Scott 46:07
I, it's kind of funny. I ran a small race down and done by Colorado Springs. This weekend. It was only a 10th of a mile for 24 hours. And the dust was really bad down there. And I thought, Oh, I didn't bring my inhaler. This is going to stink really badly. But I had no problems whatsoever. Thank goodness.

Scott Benner 46:30
Hold on one second. I am looking at. I'm getting a live. I'm moderating my Facebook group live. So somebody looks like they've jumped into the group. And they're trying to scam people. And Isabelle knows I'm recording. And she wants to make sure I want to do what she wants to do.

Scott 46:52
Yeah, so it's just one of those. I trust her judgment. Yes.

Scott Benner 46:55
Yeah, I think she's just because she's gonna have to ban the account. And she's like, I want to be sure before I do this. Okay. That's what we're gonna do. I have a whole life that no one knows about. She just, she just typed by to me about the account, not to me. So I'll say thank you still recording? Yeah, it's, it's a real world, like a whole job moderating that group. It's so big. You're in it. I know, I work because I recognize name from it. But there's this thing, like, the bigger the group gets, I think the more valuable it gets. It's amazing how well it works for people, there's no time of day in a 24 hour day, you can ask a question and not get responses, which is amazing. But once there's that many people, and it's that active, then the members look like fish in a barrel to people who are either scamming or selling. And they'll very artfully try to make what they're doing seem legitimate, or caring or whatever. And then they get you then they DM with you, and then they take your money. So it's hard to

Scott 48:05
work in a space that does content moderation, not what you're doing. But on a similar vein, and I see it all the time in all of these groups where someone comes in and goes, Look at the shirt I just bought, or look at this thing I just bought. And you look, you click on their profile, and they they joined five minutes ago. Yeah.

Scott Benner 48:24
Oh, there was a I've said this before. But it's worth saying, again, a coordinated effort to sell shoes. And it was fascinating how well it was coordinated. One account, by the way, could all be the same person like I would have. Like, there's no way to know what you're dealing with. But one account says, I have diabetes, and I'm having foot pain. And I'm looking for a shoe. That's all it asks for. It needs help. And then real people come in and give help, while along the way. And other accounts will come in and say, Oh, my doctor gave me these and check them out because they really worked. And then they'll have a third account, come in and say I use those two. Then the first account says, I'm going to give these a try. And then they appear to be having a real conversation. And then before you know it, other people in the thread start buying the shoes too. By the time that all got broken down by one of my moderators who figured the whole thing out Stephanie, she like, sniff the whole thing out like Columbo. I think we learned that there were like six accounts that were all on this one shoe scam, just to make everybody feel like it was a real conversation. It's good business to like, I mean they're making money off of it. And

Scott 49:39
it's chose the wrong side of this. I sit in much spammers all day long. Constantly 24/7 I think these people are idiots I could I could get around me.

Scott Benner 49:48
I could do a much better yet. Well that is the other problem is often where they're easy to catch is there. They don't have a grasp of the English language usually, which is what makes it easier to like you know, like I'm a pirate like that kind of thing. And like it's easier, but when they, when they do when they can speak English well and use phrasing correctly and stuff like that. It's hard to find sometimes, I've often thought the world is lucky, and I'm a good person. I don't know if you've ever had this feeling. Because I could, I could definitely rip people off if I needed to, like I would, I could see how it could be done. Like, that's what you're saying, like, I could get around this if I needed to. I don't have any, like ill intentions for people. But if I did, I mean, my God, like there's, you could, you could do this all day long. Just little little, like scammy things all day long. You could you could do nothing but print money doing that. And that's what's happening. It's everywhere. So anyway, we keep it out. And it's a lot of work. And I hope people appreciate it. Because there's times it's like, one o'clock in the morning and I'm getting texts, like we have to do something about this. We can't leave this set, like I want to sleep, and you kind of can't. So anyway, alright, Scott, why did you want to come on the podcast? I mean, we've only been talking for 45 minutes, so now's probably the time to ask you.

Scott 51:07
Mostly I just You had reached out about people who are diagnosed as adults. find it fascinating watching basically the just found out crowd or the community. Oh, yeah, I was diagnosed, I've been in the hospital for a week, what do I do? It pains me to know and that these people were getting out of the hospital and asking what to do, because I think I mentioned I was actually mountain biking when my doctor called to tell me I had diabetes. So I wasn't in the hospital. But I came back. It took a little bit to find an endocrinologist, like a week. And I basically just ate salads for a week because I didn't know what else to do. And that's what my wife said to do. So I did that. Yeah, I got him with the Endo. They gave me some information. But, and she's a great fit. Don't get me wrong, I loved her. She was the best endocrinologist I've ever met. Then she moved, and they got another one. And she's just as good. So I have this really great care team, I have an RD. And I see these people jumping in the group like, what's the carb? What? How do I take insulin like these, these, these supremely basic questions seem to be not covered well by the medical staff. And that's, that's what led me to, that's actually how I found your podcast was one of the other, you know, just the typical type one groups on Facebook, or were just driving me nuts with the sheer volume of this and misinformation.

Scott Benner 52:29
It's it's tough. Jenny and I are prepping a series right now that's aimed at doctors. And so the the idea behind it is, we're going to talk to doctors about what they should understand and what they should be telling people. And at the same time, we think the information will serve as education for the patients about what they should be expecting from their doctors, right. So it should, it should serve two groups, you should see like the massive amount of information we've pulled together from, from patients from people listening to the podcast are like, here's what my doctor doesn't know, or here's what I wish they understood. And we pulled that all together. And then we're going to kind of reverse engineer it and try to basically teach doctors how to take care of diabetes through a podcast, because I'm out of ideas about how to like, I'm, I'm past hoping it's gonna get better. Because it just isn't like the way the medical system is set up. And the way they're taught in school, they just don't know. And they're never going to and no one's going to change it. So I figured if this podcast helped people to live better with diabetes, maybe we could help doctors to understand it better. And I think it's big enough now that it's time to take a swing at that. So anyway, it's something we're going to be working on through the end of the year and the beginning of next year.

Scott 53:45
Is it going to be on the different podcast format? Or is it going to be part of the Juicebox? Podcast?

Scott Benner 53:50
Oh, no, it'll be it'll be right here. But I also have toyed with the idea of launching it as a separate podcast, too. But the problem there is is that is that making anything popular is is actually it's impossible. It just it is. And when something becomes popular, it's as much luck as it is anything else. So I've got the IRS already. I figured we put it here and let people the only thing I can't decide is are people going to be have the nerve to give something like that to a doctor. Oh, I did. Yeah. Yeah. So I think maybe yes, and I think a lot of doctors listen to this too. So hopefully, that'll be a way that it can happen. But I can't I can't take it anymore. Either. Like it's just frustrating for an adult or a child or a parent to like be put into a situation where they have this difficult to manage thing that could be explained to them and nobody explains it to them. And then you learn that they're not explaining it to them because they don't understand that either. Then you have these conversations with people and see how their lives unfold when they don't have that information. It's unconscionable. So, I mean, somebody's got to try to do something And I tried for a couple of years, and I'm sure this will pop up. When Jenny and I talked about it, I tried to get speaking engagements, you know, there are organizations that, you know, have the ear of the medical community. And every time they contact me, they want me to come on, and they want me to come to their thing and speak. But they want me to be like, you know, the famous guy from the podcast, like, give some light hearted, like, they just want to draw people in. And I want to say something, and I tell them, here's what I'd like to talk about. And they go, yo, we can't have you out to talk about that

Scott 55:30
over and over. And they would, would lose their minds. Well, you're not

Scott Benner 55:34
a doctor, and you're not going to come here and tell everybody they're doing it wrong, is what I was told once, one time, a more reasonable person said, I wish I could have you come do that I would get fired if you showed up and spoke about that. So that's when I was like, this isn't gonna they're not gonna fix this. So like, maybe I'll take a shot at it. I mean, the podcast is spread, right? It helps people with diabetes, they find each other, maybe that'll work the same way. I don't know. But it's worth a shot. And at the very least, even if doctors ignore it, it will teach people listening, what to expect. And so it'll still be really valuable for listeners. Anyway, that's my idea popped in my head in the shower about six months ago.

Scott 56:14
I think it's a great idea.

Scott Benner 56:16
Thank you, I have all my best thoughts in the shower.

Scott 56:18
I see people jumping in all the time, like, Hey, I saw my doctor said, you know, take this many units for this many carbs. And it's not working, what should I do? And the number of people who simply don't understand that this is their life, that if they, if it's not working, fix it, you know,

Scott Benner 56:36
try something would be a good first step. And then well, then the other problem is, there's there's factions, oh, yeah, different than any other life, right. But we had it the other day in the Facebook group. This woman's kids had diabetes for three weeks, you know? And she's like, Hey, rice, what's the deal with rice? You know, and she's like, you know, how do I do this. And they're, you know, overwhelmingly in my group, like, genuinely, overwhelmingly, it was a very popular thread where people came in and gave all kinds of different great thoughts about how to Pre-Bolus or how to, you know, change to a different rice. We do that we basmati rice here, because it's easier to Bolus for, or how to do extended boluses how to cook. Like, people started talking about cooking things, then cooling it and reheating it. So it doesn't have the same impact, like just tons of great information. But it only takes one person who's got a, you know, something they want to say. And they're like, don't eat it. That's what you do. Don't eat it. And I'm like, That poor lady's kid has had diabetes for three weeks. Even if don't eat it ends up being the right thing for her. That's where you want to start by scaring the hell out of her and her kid. Like you don't you mean? Like, why? Why is then there's the older people have type one diabetes, I just, I don't eat those things. And I'm like, Have you tried the Pro Tip series? It won't help? No, it will. But okay, so okay, you're old enough, you decided you can't eat rice, that's fine, then you have to kind of like moderate the conversation so that it's clear that there would be another way, just and not offend that person, which I had to do with a couple of older women that were in the group. I was like, Look, you should try this. I think maybe you'd find that if you timed your insulin differently. I don't have time for that. Okay, good. But at least now the people reading it can see that there. They might have been wrong. And there might have been another way. But if that's the decision they make, by the way, Scott, I don't care if you decide just to cut out rice, like God bless whatever. I don't really care how people eat at all. But then it's just It's always, it's always one person. One. Like, bro, sciency I only eat elk meat that I kill myself. You know, like that vibe. And you're killing yourself and the insulin is killing you and carbs are killing you. And I'm like, Oh, my God, man, calm down, like go live like that if you want to, but don't What are you doing to this woman? So then I tried to have a conversation with that person knowing by the way, when it starts Scott, I'm going to be as thoughtful and open to this man's ideas about how to eat as I can. But I know that by the time this day ends, he's going to leave this group. But I still have the conversation because it's worth letting people watch the conversation happen. And in the end, it works. The lady says I'm going to go try the Pro Tip series. I'll be back. I'll switch to basmati rice. I'm going to try the cooking and cooling process for you know, I think some people do it with potatoes and stuff like that. So we got all the good information to her. And I told her and if you one day, you just want to eat low carb because you can't figure all this out, then that's up to you. You should do that. But don't not understand how insulin works and just give up on the third day. You know what I mean? Like because that's going to lead to something bad because you know, pizzas really good and it's Gonna be a problem at some point. And if that kid goes to college man, good luck being low carb and a college on a college campus. I don't know how the hell you're gonna do that.

Scott 1:00:07
I can't even imagine it. I can't. I think that we we push people into disordered eating habits. We being diabetics push others into disordered eating habits instead of fixing the problem of good eye cream balls too early, too late, too little too much. Should I have extended Bolus? What do I do versus I'm just not going

Scott Benner 1:00:26
to eat? Yeah, I think it's a 10% greater risk of having an eating disorder if you have type one diabetes, and it doesn't matter if you're going to forget the science behind it. I've talked to a lot of people with diabetes, a lot of them have eating disorders like so. And it's, in my opinion, based on my experience, it's because of this. It's because they don't want their blood sugars to get high. And of course, they don't want to and they don't want to use insulin in a way that makes them low later. And of course, you don't want to do that. And they have no like we've discussed for the last hour, nobody's taught them how to do it. So they're doing it all wrong, their blood sugars are ping ponging all over the place. And yes, eating no carbs will put an end to that, it'll cause you to use less insulin, less insulin will mean fewer spikes, fewer lows. 100%. Right. It also means you're eating steak every day, or something like that, you know, or for the rest of your life. And I'm sure there are low carb people that will hear this and I go, there's plenty of good. So I'm sure there is there's plenty of great stuff you can eat. It's lovely. It's also expensive. Some people can't afford it. It's also a big idea some people can understand. And whether you're eating carnivore or keto or somewhere in between, you still need to understand how your insulin works. So let them understand the insulin, then they can apply it to whatever eating style they want. Because this is America, and I'm not their mommy, and they can eat whatever they want. There are plenty of people who eat stuff that I'm like, Hey, here's how you Bolus for this, that I also think I wouldn't need that. If I was you, that does not look good for you. You know, I'm not them. To act like you can make people do anything, because it's what's right, or what's good for them is ridiculous. Like, I don't know how long you have to be alive before you can figure that out. You know, if it was as easy as telling people the right way. First of all, that would infer that we know the right way. But if it was that easy, then the whole world would work great. Because we would just tell everybody what to do. And it would all be fine. Except that's not how it works. So you're going to ignore that. And then let them have poor health for their whole life. Like, why? Cuz you know what I mean? Because you think eating a carnivore is the way to go, like, or whatever, like I don't, I just don't get that whole thing. I don't understand that feeling that you can bend the world to your will. It's just because it's quote unquote, right? It doesn't make any sense to me at all. But anyway, apparently, it makes sense to a few people. And then I get into a, you know, I get into a thing with those people, because they're just attacking and defending their position. And I, I try very hard to stay open minded to see their position, explain what I think the bigger picture is. And then eventually, at the end of the day, they think I'm tall, and then they leave. So it's, but every time it happens, Scott, I think, Oh, this is my day. I don't want this to be my day. But it's gonna be and and then there we are. I'm sorry. I went off on the thing that I apologize when

Scott 1:03:15
I was diagnosed with celiac. And I came home from the doctor and we lived in this this town of like 600 people in the middle of the Allegheny Mountains. And I went to the grocery store, which you know, small town grocery store you've been, you can look up and go in and I'm trying to find something to eat that's gluten free. And I mean, I had done some research on the internet. I knew, you know, certain things. And I went and I'm like, Well, I'm getting ice cream because I deserve ice cream. And I pick it up and they look at the label and one of the ingredients is way and I hadn't stuck it like it's stuck in my head that I couldn't have way that way was a wheat product. I don't know what made that connection, but it did. Threw the ice cream back in I grabbed a bag of Fritos and went home and I'm sitting on the couch pouting and my wife comes in she goes What's the matter? I go, I can have ice cream it has way and my whole family to this day mocks me for that.

Scott Benner 1:04:08
I can see you eating the Fritos I don't want these freedom. Exactly what it was stupid freedom's stupid.

Scott 1:04:18
But I think I think that happens to a lot of people is they get something that's factually wrong in their head and they run with it. They it's like instead of shopping to look at the flag, they're caring and to see if it's right, they just take it as a standard barrier and run down the field.

Scott Benner 1:04:35
I want to be completely clear, a lower or low carb diet will make type one diabetes management easier. It will 100% Eating cleaner foods will stay away from processed foods will cause more complex carbs are going to be more difficult. Like I'm not telling you that but it's not impossible. It's just the thing you need to understand. You deserve the opportunity to understand it before you make a decision about a thing. You're never going to eat again for the rest of your life. And it that's just, that's my take on it is that everybody should understand how to use insulin, and then take that knowledge out into the world and do whatever you want with it. I don't care, like you just but you should have a basic education before you start making lifelong decisions. That's all. And I think that for some reason, the way people eat becomes very tribal. And they very much defend it. I've talked about it before I understand if you're, you know, a person who has diabetes, who struggled and went low carb, and it feels like it saved your life. Like I understand that completely. And I would probably proselytize about it too, if I if I had that feeling. But I'm going to tell you that if you would have met me before that and tried those pro tip episodes, you might not have done that. And you still could have, but it might not have been your only decision at the time. So that that's all that's all I'm saying. But trust me that gets bent all the time, like I see online, like he's a carb pusher, like, oh my god, I'm a carb butcher. I don't give a crap what people eat. As a matter of fact, I don't think you should have that many carbs. It's, you know, a reasonable amount, that's fine. But you find yourself in a day where you're having 300 carbs, 500 carbs. I don't I don't know. I wouldn't do that if I was you. But I'm not you. So I don't care what you do. I don't know why more people. What's that?

Scott 1:06:20
Somebody posted the loop graph the other day asking your question about something and the 135 carbs on board and I went, I have not eaten 135 carbs in a day. In 10 years.

Scott Benner 1:06:35
Oh, there are days where Arden's just like, I'm stunned by how much insulin she like needs for some times. Like it's usually around her period, that kind of stuff. When she gets I think cravings for things aren't and could have like three meals a day, and each meal could be 50 or 60 carbs. And well, yeah. And then that's, that's

Scott 1:06:53
not that much. I mean, my wife goes to Starbucks and comes back with a drink. And I think it's probably 150 carbs. Yeah. All the time.

Scott Benner 1:07:02
But that's a great example. Like Scott asked me if I think your wife should drink that. I do not believe she should know, I think that's probably a mistake for her overall general health. But if she's going to and she has diabetes, I'd like her to be able to do it without a 350 blood sugar that lasts for two hours and ends up with a low.

Scott 1:07:20
I tell people this all the time. I don't I eat low carb, low ish carb. Like, if we go out to we I was out with some friends a couple of weeks ago, and I got a burger with no bun. Because celiac and french fries and they were making fun of my my halfway keto halfway, not keto dinner, but I don't eat carbs in the morning, very rarely, because we get up and get moving, I get a few hours of work done. And then I go run. And I know if I have more than a half unit of insulin on board, when I go for a run, I'm going to have to do drastic things like I'm going to have to like eat 20 or 30 grams of carbs. So I don't crash because it might go from about 10 to one or 10 cars per unit to about 100 carbs per unit.

Scott Benner 1:08:08
When you're exercising. Yeah, yeah. It's

Scott 1:08:12
so funny. My own that that. So I ran 30, almost 34 miles on Saturday. At that race, my g7 freaked out in the middle of it. And I was running this perfectly flatline at number for like an hour and a half and all of a sudden it beeps and says hey, you're too 20. And I'm like, No, I'm not to 20. I know this, I fooled around with it, tried correcting it a couple times. It didn't work her place that which the warm up on the new sensors is everything. To me. It's beautiful. So I've eaten a whole lot of carbs to correct the insulin that that was given to me when it thought it was 200 but wasn't. But at the end of the day, after 10 hours, I had used less than 40 units of insulin total.

Scott Benner 1:08:52
It's over on that. Yeah,

Scott 1:08:53
yeah. And I eat a lot of bananas.

Scott Benner 1:08:56
The way the variables impact is fascinating. I mean that. I mean, obviously that's a lot of running. But Arden has been doing a couple of all nighters in a row. And like clockwork, she's getting low at like four o'clock in the morning. And it's just it's from her sleep being off. Yeah. Oh, yeah. That'll kill me. Yeah. And so it's an it's fascinating. And then of course, you're exhausted and your sleeps off, and you're low. So like, last night, I had to wake her up. I had a hard time waking her up last night. And like, I was sending, like, find my iPhones, like I left my bedroom, so I wouldn't wake my wife up because I was like calling. And I got to the point where I was looking at her blood sugar, and I'm like, I'm gonna have to call her roommates. And I'm like, she's gonna be pissed about that. But I tried not to and I but I, as long as I could, but with Nightscout I could see she still had enough insulin on board. This was going to be problematic. She wasn't going to float at 60 and she didn't she went down to 50. And then it was like 48 And I'm like, okay, like, that's it. Like, here we go. And I woke everybody up and she sent me an angry text, you know, don't bother my roommates and I just sent her a text back. I said, Arden, I waited as absolutely long as I could this was necessary. You know, you need to drink a juice. And that's it. And actually remotely, I changed her target from where it is to like 110 for the rest of the night, so it wouldn't happen again. And oh, people are like, how do you do that? I did it with Nightscout. She's using Iaps. I don't have time to explain it all to you right now. Actually, I don't have time, Scott, because I have to go to a lunch thing soon. But I did all that. And she woke up this morning, and I got a text from her at like 10 o'clock, she should have been in class. She goes, Dad, I slept through my class. I'm so sorry. Like, you know, I'm gonna have to do a couple of things. Because I'm behind and I'm exhausted and I need to catch up. And I just told her, like we even talked about last night, like she's not mad about last night. She wasn't mad, then she just shut her blood sugar was low. It's four o'clock in the morning, and she was frustrated. And I just told her one of those things that like, you know, I've learned like, through being old, I just told her. I said, like, just remember, be flexible. Like, rearrange your to do list so that it reflects what's you know, most important now? Don't look backwards. Don't worry about anything that you feel like you're putting off. I said, You're a smart person. You'll do the right thing. Just keep going. That's it. And I hopefully that's what she'll end up doing. But yeah, she tried to burn the candle at both ends for a couple of days. And it just, it made everything hard for so yeah, anyway, those variables like running or not getting enough sleep or whatever. They're, they're tough on you, Scott, I apologize for doing this. But I gotta ask if there's anything else that we missed, because I have to

Scott 1:11:36
go in a minute. Oh, no problem. No, I had a great time. Thank you. Oh,

Scott Benner 1:11:39
me too. We're definitely calling this to old Scots. Yeah, is a perfect name. Although I imagine you're like, you know, in amazing shape. And I'm just still trying to get there. And I'm using medication. It sounds like you're running to do it, but good for you. If it's therapy. Well, you know, I didn't want to say because you seem like such a nice person. But I believe anybody that runs this much is is exercising their their thoughts. Oh,

Scott 1:12:06
my, my shrink look. Well, I would agree with you all day long.

Scott Benner 1:12:10
That's all fine with me. I don't know where you were, however you think comes out. Listen, if you think comes out with extra healthy. Fantastic. You know, one

Scott 1:12:19
quick story, please. You got all these please, please. So it was at the grocery store yesterday, I just had like three or four errands to run. But I'm like trying to do between meetings and stuff. And I got run into the grocery store. And I'm grabbing the things and for whatever reason my blood sugar goes from 116 to 50. In the 10 minutes, I'm in the grocery store. I've had tumbling issues, that's probably what it is. But I get up to the camera and I'm standing there and I'm like I because my blood sugar was so low. I forgotten everything that I needed. I'm standing there with two six packs of Diet Pepsi. I can't operate the machine. I can't do anything. So I grabbed a package of gummy lifesavers, and I'm not talking a small package. I'm talking like, you know, the big roll by my cigar. Yeah. And I'm shoving them into my mouth while waiting in line at the checkout. And the woman comes over she goes, Are you okay? And I'm like, why? She goes, You're sweating really bad. I'll be fine in a minute. I couldn't she had to ring me out at the self checkout. I couldn't do it. Yeah,

Scott Benner 1:13:09
that's crazy. How quick did it come over? Get 10 minutes? Oh,

Scott 1:13:13
yeah, if even I mean, I literally walked in the store and was was suddenly confused.

Scott Benner 1:13:17
And that's you wearing a fairly adept algorithm that is taking you're taking away insulin trying to stop that from happening to you like that. And it still can happen after I managed Arden last night, got her awake and got her to do everything. I looked back at how long that algorithm had been trying to stop this low from happening. It had been trying for like four hours to avoid this moment. You just stop and think if that's not an algorithm then for the last four hours, she's getting a unit of insulin an hour as her basil on a on like a standard pumping system. And she would have needed I mean, instead of like a small little quick 15 gram juice box that took a 50 and turned it into a 95 for the rest of the night. I mean four units. I mean, she would have needed like 40 carbs to fix that maybe more and something more substantial than juice. So anyway, this stuff's amazing. We're lucky to have it I got to jump off scot I'm so sorry. Oh, no

Scott 1:14:16
problem. Thank you.

Scott Benner 1:14:17
Of course Hold on one second for me. A huge thanks to us med for sponsoring this episode of The Juicebox Podcast. Don't forget us med.com/juice box this is where we get our diabetes supplies from you can as well use the link or call 888721151 for us the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. A huge thank you to one of today's sponsors. Ag one drink ag one.com/juice box. You can start your day the same way I do with a delicious drink of ag One thanks also to G voc glucagon. Find out more about Chivo Capo pen at G voc glucagon.com. Forward slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. If you're not already subscribed or following in your favorite audio app, please take the time now to do that it really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. That Juicebox Podcast is full of so many series that you want and need afterdark s gotten Jenny algorithm pumping bold beginnings defining diabetes the finding thyroid, the diabetes Pro Tip series for type one, the diabetes variable series mental wellness, type two diabetes pro tip, how we eat. Oh my goodness, there's so much at juicebox podcast.com. Add up into that menu and pick around. And if you're in the private Facebook group, just go to the feature tab for lists upon lists of all of the series. always free. Always helpful. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

#1177 Ask Scott And Jenny: Chapter Nineteen

Scott and Jenny Smith, CDE answer your diabetes questions.

• What should I do if I miss my MDI basal dose?

• What should I do if I inject the wrong insulin?

• What should my kid be doing in the event of a school lockdown?

• Of the latest advancements in diabetes ‘cures’, which one do you find the most intriguing?

• Should people be on statins if their lipids numbers are ok?

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

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 1177 of the Juicebox Podcast.

Today, Jenny and I will be answering listener questions in another episode of Ask Scott and Jenny. 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. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box. If you have type one diabetes, where are the caregiver of a type one and a US resident? I'd love it if you would please go fill out the survey AT T one D exchange.org/juice. Box this survey helps move type one diabetes research forward. It's very simple for you to do. You'll know all the answers to the questions. It won't take you much time and you'll be helping T one D exchange.org/juice box. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes. Don't forget when you use my links you're supporting the show. So look right there in the show notes of your podcast player or at juicebox podcast.com and make the clicky. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us met. Today's episode is sponsored by Medtronic diabetes, a company that's bringing together people who are redefining what it means to live with diabetes. Later in this episode, I'll be speaking with Mark, he was diagnosed with type one diabetes at 28. He's 47. Now he's going to tell you a little bit about his story. And then at the very end of the episode, you can hear my entire mini interview with Mark. To hear more stories from the Medtronic champion community or to share your own story. Visit Medtronic diabetes.com/juice box and check out the Medtronic champion hashtag on social media. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox. Jenny and I have recorded an entire episode before we hit record. So we should there's part of me that thinks that one day I should just like wine Jenny up and want to let her talk. And then we should just record that. But

Jennifer Smith, CDE 2:55
we're back. Katherine caffeinated me,

Scott Benner 2:58
Danny, we are back to do an ask Scott and Jenny episode which we have not done in a hot minute. Let me see if I can tell you when the last one happened. But while I'm looking you consider this. What should I do if I miss my MDI Basal dose?

Jennifer Smith, CDE 3:19
Oh, that's a really good question. And I like that that's actually an injection question. We don't get a lot of No, we don't we don't get a lot of them. And I think that there are definitely a lot of people still doing MDI that have great questions. I wish more people would ask them. Yeah. But yeah, so I mean, it does depend. So you know, if you miss, let's say, you're taking your Basal insulin in the evening, you wake up in the morning, you're like, Oh, my goodness, I missed my Basal insulin, right? Me You could down dose your Basal insulin by taking some in the next morning when you wake up, right? Okay, if it's well beyond it, let's say you take your Basal insulin in the evening, and you realize at one o'clock in the afternoon that you missed your Basal insulin. And that's why blood sugars look strange, right? At that point, you are beyond taking that Basal dose, even a portion of it. And what you may end up needing to do is just manage with more rapid acting insulin, right, we're gonna need to cover correct, you may need to even increase a slight amount the amount of insulin that you give, or your carbohydrate or your mealtime coverage, because you're missing that baseline. So you could expect your rapid acting insulin doses to try to be making up for that missing background. You can even see this when you're when you're trying to do Basal testing. Yeah, and you're evaluating and you're seeing well, when I don't eat a meal, my basil causes my blood sugar to go up where it shouldn't. That is a basil deficit. But when you do eat a meal, it looks like everything is perfect. That means that your rapid is covering some of what the Basal should actually be covering.

Scott Benner 5:04
I have a couple of thoughts here in questions too. So there are older and newer infill Basal insulins too so like older like love Amir Lantis, newer like Joseba and what's the other one to

Jennifer Smith, CDE 5:17
jail basic lar. Okay.

Scott Benner 5:19
So they work on so that the knock on the older ones love Amir Atlantis are that they don't really last 24 hours sometimes so you'll even get he'll hear people splitting insulin so I can say that Arden us love Amir, but I'm out of okay, I'm out of the old ass basil game at this point. But if I missed Arden's love Amir at 8pm. And she woke up at 8am. And I was like, oh, hell, I missed it. That's too long at that point you think?

Jennifer Smith, CDE 5:50
Or something like and that's, that's great that you brought up the kinds of insulin for love Amir Yes, it's too long, essentially. Love Amir, for the most part who you those who used it found essentially that they did need to dose it twice a day. Yeah, we thought it was a you split it too. Yeah. So you know, have you missed it at 8pm by then you've missed the window of its most beneficial time period. So if you're going to dose again at 8am, go ahead and just dose with what you dose normally,

Scott Benner 6:17
and just start over like now we just do it at 8am. Now,

Jennifer Smith, CDE 6:21
well, if you just said you were dosing twice a day? Well, we wouldn't. That's why it was yeah, my

Scott Benner 6:25
scenario, I would, I would have just given her half at 8am. And then back again at half at 8pm. But for people who were doing it every 12 hours, or every 24 hours, excuse me, now they're 12 hours behind, and it probably didn't work up to the to the 24 hour mark to begin with. So, I mean, you could if it was live from your Lantus, you could just say, Oh, I guess we do our basil in the morning now and do it right like and start in the morning? Or would you have lows that day from that

Jennifer Smith, CDE 6:51
deal? With love Amir with love Amir, I think that that would have definitely been okay to navigate that way again, because for for most people who had been using it, it was definitely a 12 hour. So they took it and then they took it again, within 12 hour time periods, you miss one dose, you're kind of like over it, you just wait until the next 12 hour dose. If you were more of a Lantus user, though, which is definitely longer lasting, and most people got at least 20 hours of action out of their Lantis, or saw it start to sort of peter out by 18 to 20 hours, right? Yeah. So therein lies the question, you know, you miss it into the next morning, now you're 12 hours into missing your Basal insulin, you could take some how much you could take a quarter, you could take a third of what your total dose had kind of been a helping hand in a helping hand and then essentially take it again at the next you know, the next time period or downplay that a little bit to kind of just coast you through the overnight without being too low. Yeah.

Scott Benner 7:55
And then I guess, be careful for like that 36 hour period that you're not seeing. By the way, I'll point out that in episodes about splitting and so on, you very firmly came down on the side of not splitting Lantis

Jennifer Smith, CDE 8:07
for the most part. Yeah, I Lantis is it's definitely longer than a 12 hour action. So if you're going to split it, you really have to be kind of cautious. I've seen some people with tinier doses, do well potentially splitting it because they get the heavier dose in a time of day where they really need that background insulin for whatever the reason, and then maybe they just need a hint more to nudge them over into that. Let's say you can take it at breakfast and at dinnertime right? heavy dose in the morning, it covers behind the majority of the activity and the variables of the day. But the overnight, they need just a hint more of it in order to not run high overnight or to graze up before they take their morning dose. So you might see something like, you know, eight units in the morning and maybe a unit and a half in the afternoon or the evening time. Right. But that's not the typical for

Scott Benner 9:02
that. And to go to the more modern insolence, they actually seem to lap that 24 hour period, right. So

Jennifer Smith, CDE 9:09
ya know, yeah, and I think you're just gonna say essentially that if you take it and you missed your dose, you may have up to about 36 hours.

Scott Benner 9:19
You might get some coverage in there. Yeah, you might. Yeah, if you did that, say you Mr. CBOE and you waited the whole 24 hours to shoot it again and you just managed on the you know, with fast acting until you got back to your tear tear injection time. Do you think the next day would look a little resistant to or do you think you'd be back to good after you injected it? If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G vo Capo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue You pay for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily jeuveau Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you storage evoke hypo pen and how to use it. They need to know how to use Chivo Capo pen before an emergency situation happens. Learn more about why G vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma. Visit G voc glucagon.com/risk. For safety information.

Jennifer Smith, CDE 10:52
You should be back to fairly good after you injected it assuming that the dose that you had been using before missing a dose was pretty good. Okay. Yeah.

Scott Benner 11:03
All right. So the first thing that came to your mind, it's a good conversation, but the first thing that came to your mind was manage it to your next injection time with fast acting insulin. Okay, so is there a one to one thing they're like if I like if I'm injecting? I don't know. 10 units of true SIBO? Is there an amount of fast acting every couple of hours that would like kind of keep me in the game? Not really

Jennifer Smith, CDE 11:30
not really we would what we would usually recommend is with mealtimes depending on where your blood sugar is, right? And possibly where it's trending again, the beautiful thing about having CGM now is you can actually tell how things have been being held without a piece, you know, behind that would normally be there. Okay? So if you're rising, coming even into a mealtime, you can think ahead and say, well, the rise means I'm probably missing at least half a unit of insulin, give or take person, you know, sensitivity versus resistance. And I've not even like eaten or Bolus for my meal time yet. I need to nudge this up minimally. And I'm going to be conservative about it because I'm not quite sure how much more I need behind this. Okay, right.

Scott Benner 12:13
What's your timeframe for I forgot my 6pm You know, Basal insulin injection, but it's only 730. Just throw it in then. Right? Absolutely. How far away from that six before you can just go hell and just do it. I mean, I know. Three, four hours, maybe I would

Jennifer Smith, CDE 12:30
say four hours, quite honestly, like if you're normally dosing 6pm. I mean, a lot of people take evening Basal insulin, it's like eight to 10pm. Typically, unless they've been told to take it with dinner or around dinnertime. It's usually like

Scott Benner 12:43
more why I think of it that way. Because it was because Arden was so small, it was part of the safety like oh, shoot it near a meal. Plus, you're giving her a needle than anyway. So it's not as that's kind of how we used to think about it.

Jennifer Smith, CDE 12:55
Yeah. Okay. But yeah, if you are normally dosing it at 6pm, and you remember at bedtime at 1030. Darren I missed, you know, go ahead and take it at that point. Absolutely. And then just back it up the next day,

Scott Benner 13:09
where your thought is that because if you forget it at 10, if you remember to you're not awake at 2am to remember it. So unless you wake up in a cold sweat and go oh my god. Right. Yeah. All right. That's okay. I appreciate that. And that was good. Yeah. Well, let's stick with this theme for a second in the inside of the theme a little bit. What should I do if I inject the wrong insulin? So I've seen

Jennifer Smith, CDE 13:32
this so many times. And you know what, it seems to be more of an err on the side of I was supposed to take Basal insulin. And I injected 30 units of rapid insulin, instead of taking my 30 units of Basal insulin. That's the one that I see. 99% of the time

Scott Benner 13:51
never goes the other way. I was making a two unit correction. And I use basil instead of my fast acting. Right, right. It's almost like you just said like this giant dose, even if you're a little kid, you don't you mean like, you know, three units of you know, is is a giant though. So in case this isn't clear to everybody, some of the most, I find interesting and heartfelt posts I've seen on Facebook, or somebody who jumps on and says, Hey, I just shot 20 units of Novolog instead of 20 units of Lantis. And I'm MDI and it's in and what do I do? And I always think what a great opportunity to understand how insulin works. I never say that out loud. Right? Because they're usually running in circles like a chicken without their head.

Jennifer Smith, CDE 14:41
You're not just like, hey, just sit watch what happened.

Scott Benner 14:46
wonder like, you know, like, so for my money. I do the math. I just say, you know, I shot 20 units of insulin. My insulin to carb ratio was one per this. That's how much food get to eat now, maybe add some fat, some ice cream, what a great time for a milkshake to, like, you know, that kind of stuff.

Jennifer Smith, CDE 15:06
Ya know, and that's it depends, you know, if you have a fairly aggressive insulin to carb ratio 20 units might not be a terrible amount, despite not necessarily wanting to add extra food. Yeah, 20 units might be something you can clearly take care of and navigate and manage that problem, right? If you however, usually take one or two units to cover a meal of 30 grams worth of carb, why units is a whopping dose

Scott Benner 15:34
your insulin glucagon time, then, yes,

Jennifer Smith, CDE 15:37
that's that's glucagon time. Or it may even be potentially that with enough sensitivity, you may end up actually just needing to go to the emergency department to be able to say, You know what, this is what I did. I definitely know that I'm going to need a glucose drip, I know that you're going to need to navigate this because I can't eat enough that I see often with kids, where they just their tummy is so little. They can only take so much juice. Sure.

Scott Benner 16:04
Yeah, there's there's no yeah. And yeah, I actually it wasn't making light of it. It's usually it's usually adults, but like, you know, that I see are like, ah, but I've actually managed one of these through, personally. So a girl, I don't remember her name anymore, came on the Facebook group and said, I just did this and she was in a panic. Yeah. And she's home by herself. She was in her early 20s. Right. And then the first comment that came to the Facebook group was call 911, which I think sent her spiraling. By the way that's, that's always like, you know, you always get one or two people are like, Oh, I know, you asked for what color is the sky, but I'm going to call it tell you to call 911 instead, and like, you know, like, so she starts panicking. I can see her panicking. And I just said, Give me your phone number. And I called her and I was like, Hey, what's up? And she was she was upset, or Yeah, I mean, she was panicked. And with good reason. What I did was I said, Alright, look, you know, what's your insulin to carb ratio? It's interesting that she went, I don't know. Oh, so I was like, you know, many people don't know stuff like that. They're like, I just usually do about this much for dinner and like, blah, blah, blah. So I said, Okay, I picked something that I knew how many carbs are in it. I was like, how much would you have Bolus for this? Yeah, that you really like firmly understood. And I said, Okay, so we're gonna put your like insulin to carb ratio at like, one unit for 15 carbs. And she's like, okay, and I said, Well, how many units did you shoot? And then she told me, and then we did the math. And I said, alright, well, you get to eat 125 carbs right now. Like, you know, and then I was like, let's but then she was like a healthy eater. So then that wasn't that easy. You don't I mean, I was like,

Jennifer Smith, CDE 17:40
I might get the honey nut cheerios out.

Scott Benner 17:43
That crap. And I'm like, Oh, God. Okay. So like, I was like, I might Hi, header, open the refrigerator. And we just went through it. Like, yeah, shelf by shelf, line by line, we open cabinets, we found enough stuff. At one point. I said, even if we don't find anything, don't worry. I was like, there's a five pound bag of sugar in the house somewhere, we'll start eating that, don't worry, we'll have it's gonna happen. We're gonna be okay. You know, I said, well mix sugar with water. There's all kinds of things we can because they didn't keep a lot of juice now, so she didn't have a lot of stuff. And she got through it. She was okay. Yeah. So

Jennifer Smith, CDE 18:13
in that instance, in terms of the portion that it might need to take somebody, again, with a stomach capacity to handle sometimes small, heavily packed carb types of foods are often a little bit better, you know, people think juice first, right? But it was also think despite being kind of panicked at that point, you have to say, well, am I like pretty stable right now or where is my blood sugar, you know, my sitting already at like 72. And if you are, okay, we need to get some quick something because it's a rapid acting insulin, and it is going to start working pretty quick, right? Whereas if you're sitting at 180, you've got a little bit of wiggle room there to navigate. And you may actually progress through rather than sitting down to the bowl of 125 grams of whatever it is gonna be, you

Scott Benner 19:02
know, that's not as clear thought to some people as you might think, because a lot of people see 180 and pick almond range. Like, you know, they don't think about the way you and I think about I'd be like, well, we've got 100 points to play with here. And yeah, also, the thing you said about juice, you can get you sick, really easy like that, like that nauseous feeling in your stomach, really, I can't do this anymore. And a big Bolus will burn through a fast acting carbs very quickly to like if you put in, you know, 10 units that aren't for anything and like you said, you've only ever put in two units for your biggest meal in your whole life. drinking juice isn't going to do crap it's going to be it's going to be like Jenny and I tried to stop like a NFL running back. We're gonna be like, Hey, don't don't do this. You know, that's gonna be the end of it. Right? Yeah. For two seconds. dense foods slowly digesting stuff. That's the kind of like, think about those foods that when you eat you always end up bolusing more for have a little of that at this point. Yeah. Oh my gosh. And then, but you said go to the moon. Wanna see room if you're, and I agree with that. But you can't just get in the car and drive to the emergency room. Because before you get there, it's me you in about 15 minutes. If you're lucky, I would imagine it

Jennifer Smith, CDE 20:10
right. If you are the one and you're alone, as this young woman that you are helping was clearly, that's probably not the best idea, especially considering she was very worried about what was going on. It's better to actually get to at least a stable enough place with enough carbs to be able to get to the potential of an emergency department to be able to help again, only as the last and kind of need. And, again, what's the goal between in there? It's glucagon. Yeah, we have glucagon that absolutely can be used in the case of need, you

Scott Benner 20:45
gotta have it with you. By the way, she did not have that either. She didn't have that she couldn't reach her parents. Like it was like a dumpster fire of like, bed, you know, variables for Oh, lo food in the house. Like the whole I don't know, I'll never forget, like, also never forget feeling panicked about it, because everybody was like, just do this. And I'm like, somebody's got to actually help her. Right? Like, you know what I mean? Like, she can't, she was panicking. And she was young. And she was by herself. And I was like, I'm gonna, like, just call me or I'll call you or whatever.

Jennifer Smith, CDE 21:12
And that's what she needed. Rather than reading and reading and reading the 50 comments that came in, I got worried about that. Yeah, you start to go down this and instead of doing your reading, start

Scott Benner 21:24
wondering which one of these is the right thing to do? Yeah, correct. Yeah, so just

Jennifer Smith, CDE 21:28
like one person to take into you need that verbal, that human connection, which is by the

Scott Benner 21:33
time we were done, she was eating bread, obviously, keep bread, that's good. Some bread? We're gonna I that's what I did I mix bread jam on their bread was sugar and peanut butter. And like, anything like that, like I kind of I kept hitting her like fast and slow digesting carbs at the same time. Anyway, honey is

Jennifer Smith, CDE 21:49
a pretty packed one to honey and maple syrup. From the standpoint of the content of car, I mean, a tablespoon of honey is like 17 grams of carb. And maple syrup is even heavier. Yeah,

Scott Benner 21:59
that's a consideration to like bulk of food. Like, I feel like this has been said, but it's worth saying, again, you can't just start with like, I'll eat grapes, like because you're gonna fill up before you get to the car number you don't I mean, like, you need some that's gonna hit you really? Like. And by the way, once you get through that, three hours after you've injected it, let's start over again. You know what I mean? So, right, yeah, just trying to stay alive at that point. diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email. It's a big button that says click here to reorder. And you're done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives, we click on a link and the next thing you know, your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and the Dexcom G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 8887 to 11514 or go to my link us med.com/juicebox. Using that number or my link helps to support the production of the Juicebox Podcast. Right now we're going to hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is

David 23:57
Mark. I use injections for about six months. And then my endocrinologist at a navy recommended a pump. How

Scott Benner 24:04
long had you been in the Navy? Eight years up to that point? I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

David 24:13
I was medically discharged. Yeah, six months after my diagnosis.

Scott Benner 24:17
Was it your goal to stay in the Navy for your whole life? Your career was Yeah,

David 24:21
yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we made the decision despite all the hardships and time away from home, that was what we loved

Scott Benner 24:34
the most. Was the Navy, like a lifetime goal of yours. lifetime goal.

David 24:39
I mean, as my earliest childhood memories were flying being a fighter pilot, how

Scott Benner 24:44
did your diagnosis impact your lifelong dream?

David 24:46
It was devastating. Everything I've done in life, everything I've worked up to up to that point was just taken away in an instant. I was not prepared for that at all. What does your support system look like? friends, your family care givers you know, for me to Medtronic champions community, you know all those resources that are out there to help guide the way but then to help keep abreast on you know, the new things that are coming down the pipe and to give you hope for eventually that we can find a cure. Stick

Scott Benner 25:12
around at the end of this episode to hear my entire conversation with Mark. And you can hear more stories from Medtronic champions and share your own story at Medtronic. diabetes.com/juicebox. Jenny, this one's interesting. I always have a weird feeling when I see people worried about this, but it happens all the time. So let's talk about it from a technical standpoint. Oh, okay. What should my what should I be doing? What should my kid be doing in the event of a school lockdown? My first thought is always what I told Arden was turn off all your alarms first. I was like, because you're gonna get upset, your budget is going to shoot up and we don't need a beacon going off over your head if there is actually a person wandering around your school with a gun. I mean, I guess that is part of it hot like you got to quiet your stuff. Your technology? Yeah, I

Jennifer Smith, CDE 26:03
I was actually going more from the what should you have on your person was

Scott Benner 26:07
thinking you'd go that way. So I went this way? Yeah, yeah, no, or the easy

Jennifer Smith, CDE 26:10
to grab bag, right? It's almost like the the T one D to go kind of bag that you have next to your, you know, garage door or in the back of your car or whatever. It's got packed with like everything. And I think at school for any age kid, especially maybe the the high school age, even middle school where they're probably more so taking care of themselves. They don't have a checkpoint really, right. And so they need to be ready to grab something and run and go wherever they're being told to kind of come together. Right? Yeah. But the alarms that's a that's a great one.

Scott Benner 26:46
I mean, so what we did for Arden was like you said in younger ages, they don't leave a room, usually they stay in a room, they do everything in the room. But once she started moving around room to room, we stocked every room with a few juice boxes, and some snacks fast acting, you know, sugar and something a little more substantial. Something that was you know, is all, like wrapped in a package wasn't gonna go bad the whole year, like that kind of thing. Right? We also started to notice, there were times of day she was low and times a day she wasn't. So we would ever more heavily stock some classrooms than other classrooms. But that's my first thought is, this isn't something you do in the event of this is something you do ahead of time. You know, my pain? Yeah. So I would have each classroom have some stuff in it. Now the the insulin part, I hear what people are saying, because I've watched them have these conversations online. What if this goes 12 hours? What if this goes two days? Like, you know, that kind of thing? I mean, I don't know how you're supposed to plan for that. You can't have insulin in every room? You know what I mean? Like, no, I am a big fan of the kids carrying their stuff on them, right? You know, your controller for your fear pumps, you know, glucagon should be with you not in the nurse's office, you should be in the nurse's office too. But with you, I think you will also start going into like survival mode. Yes. Maybe, you know, dial back your Basal a little bit. If you're on a pump, like, keep out of a low situation, you know, like nothing wrong with 150 blood sugar for 12 hours while you're sitting on the floor, if that's what's gonna happen. Correct. Do you have any other thoughts about that?

Jennifer Smith, CDE 28:19
No, I mean, it is it's a, it's a really, really good question. Honestly, I don't have any other thoughts, I guess, I would say to maybe in terms of what you're talking about, and how you had stocked your daughter's sort of school rooms accordingly. I wonder if also discussing with your school? Where is the place that in an emergency, you would bring the kids right? Or where does her grade go compared to the other grades? Evacuate the kids, if they evacuated them to a safe location or something like that? You need to know where to stack extra beyond the classrooms that she would normally be in she or he would normally be in?

Scott Benner 29:01
Yeah, this is not diabetes related. But I'm interested if you have you spoken to your boys about this, have you ever talked to him about something like this? They're pretty young, but

Jennifer Smith, CDE 29:09
they're pretty young, but they have their schools have done age appropriate education and about what it would mean, if there was somebody in the school that wasn't supposed to be there. That's kind of how it's addressed to be less scary, right. And they've done drills. I mean, that's the schools at least the ones that my boys have gone to, they've done drills, almost like a tornado drill or, you know, something like that to say, this is where we go, this is what we do. The all of those kinds of things are typically practiced Unfortunately, these days. I mean, the most that I had when I was little was like a tornado and a fire drill.

Scott Benner 29:48
Yeah, stop, drop and roll and sit on your desk so that they'll find your body under the desk. And I'll tell you what, I've told my kids now they've both been through high school already. And I will say The caveat is they mostly were in a school with one level. Okay. But the high school did have two levels. I very clearly told them, run to a window, jump out the window, zigzag to the tree line find your way home. That's pretty much what I told him. I was like, Do not sit around waiting for Mrs. What's her name over here to save you? Like she don't know what to do. Okay, she barely understands English. And she's teaching it get out of the room. I says, I swear to God, if you're on the first floor, up on the countertop window, open out the window, zigzag into the trees, get the hell out of there. Like I that's probably not the right thing to do. But I swear to God, that's what I told both of them. And I wasn't kidding. Like, one time they looked at me like really? I'm like, Yes, run away. Run. The hell, you don't have to be faster than everybody just the bare. joking matter. But Jenny? Seriously, like, that's what I told him. I was like, get the hell out of the building and run. So

Jennifer Smith, CDE 30:58
if you can, I mean, in certain circumstances where you're not quite sure where the trouble is coming from? Is it still outside the school? Is it in the school already? Can you hear noises? What I mean? It's it's just a completely unknown. Yeah, yeah. Right. So I don't even know if all schools have windows that open? Well, listen,

Scott Benner 31:18
if it doesn't throw a desk out the window, then follow along, after I'm doing like Get the hell out of you, you know, in, but back to the diabetes portion of it. You can't have insulin everywhere. No, you just can't. So if you have a pump one, I think my my best thought is you go back to very low settings, so that you don't go into you know, you don't waste your insulin, Oh, yeah. And don't go low. And just try to stretch it out as best you can. Yeah, and have food and have food wherever you are. That's my thought. I would even say, if you got into a dire situation, and you didn't have food, and the time really started going on, you know, your kids should probably know how to like Temp Basal off for a while, let their blood sugar rise a little bit, put it back on again, like I mean, it all depends on how much you want to like, talk to them about this stuff, honestly, you know,

Jennifer Smith, CDE 32:10
correct and what and at what age, I guess an age appropriate way. And depending, as you just said, on what they know about their system, do they know enough to be able to go in and these should be things you've practiced ahead of time ahead of a very emergent situation, you should have practiced how to suspend a pump, or how to set a temporary rate or how to take the algorithm off and go back to manual mode so that you can actually do some of these manual kinds of considerations. And some of them, you know, you might have an eight year old who's really awesome and can do all of these things, understandably. And you might not.

Scott Benner 32:46
I also want to say I just did a quick googling. This is a number from November of 2023. I hate to say this, but the odds of a child in the US being killed in a school shooting are one in 614 million. So I mean, it's sad for the people that happens to of course, and obviously but I mean, I think if you're planning on this one, you're you've run out of things to plan for. He's kind of my opinion. But anyway, let's find something more upbeat of the Oh, Jenny. Oh, we're talking I just realized we were saying just realized we're talking about diabetes. When I said that I looked down. I see the word gastroparesis. I see LDL and I'm like, what upbeat things are gonna be here. I'm gonna pick the one up b thing. Okay. Have the latest advancements in diabetes cures, which is in quotes? Which one? Jenny, do you find the most intriguing? Oh,

Jennifer Smith, CDE 33:42
I think the most intriguing for me are the insulins that are the smart insulin type. That's very intriguing to me. Years ago, I attended a I attended a technologies and scientific advancement, sort of presentation in which a gentleman presented on something that he was calling smart insulin. And it worked almost like a thermostat. It was injected once a day, it covered basil and Bolus insulin needs. And it turned on and off based on the glucose level in circulation. So it was it was something that in terms of, you know, navigating, you don't necessarily need even a pump at that point, right. So that type of science is very interesting to me, because outside of a true a true cure for solving the issue. Something like this would, it would definitely take care of a lot of the variables that most people are trying to navigate around. It's not the baseline understanding. That's so difficult. Yeah, it's the navigating all the little individual day to day things that could impact what you know about insulin action for you All right. So that one definitely. And then I think the other one, it's similar, it has to do with insulin, but it's more the encapsulated beta cells. You know, the the, the person who receives them actually doesn't have to have the immunosuppressive drugs that are most typical when you get a transplant. of sorts. Yeah. Right, in order for the body to not get rid of them and see them as foreign. And that's the encapsulation component of it, is to prevent the body from seeing it as foreign. Yeah. That also,

Scott Benner 35:32
so that one was on my list of like bear attacks is one of the, like, one of the companies, but actual, like, beta cells, like inside of a pack of bubble wrap. Yeah, that they put under your skin and your, your immune system can't see through the package to see that there's somebody else's cells in there. So they're working, but they can't get attacked. That one's been they've been at that one for a while. And I have had someone on this podcast, who was in a double blind study. Oh, so they did not know if they were actually having it or not. But she said that by the time they removed it, she was sure she was actually she had it in her insulin needs were pretty much gone. Wow. So yeah. And isn't that crazy, though? She was in a study. So it was working. And they took it out of her and

Jennifer Smith, CDE 36:19
they took it out? You're like, no, no, I'd say that's where I'm like, I find my own island somewhere, you know, where I live, she

Scott Benner 36:25
she was lovely. She's like, I love helping research, I was like, I would have run away, I would have been like, you aren't not taking this back. For me. I wouldn't give you my TiVo back. Definitely not getting this cloud DVR, you can't have that back. You're not getting back my back. So I was gonna say that one as well. And again, I think it's important, we talked about this stuff to say I first started hearing about this, like 15 years ago. So like, don't, you know, don't start saving your nickels up for it just yet. And that is going to be the next part of it is and you can see what GLP is right now. The people with the best insurance are the people who are hooked up or the people of cash are going to go first. And he is going to be for the first week and a half. So just you know, don't get too excited. I will throw in tz yield. Because yes, I've interviewed people from that company a number of times, and they've never said it. And now Sanofi owns it. So I'm not talking about you, Sanofi, I'm talking about the people I spoke to spoke to before who worked at prevention bio, I could always hear in their voice. This is what we're using it for now, to kind of like hold off the diagnosis. But we really wonder if there's not more to it than that. The IG so that to me, was really interesting. In that same vein, one of the prevention bio, Francisco Leone, he said to me, I would love there to be a vaccine for hand Foot Mouth. I was like, what? And he goes, well, so many people are diagnosed with type one after getting Coxsackie virus. I wish there was a Coxsackie vaccine. Because I think if we could slow down people from getting coxsackievirus maybe we could put off people getting type one diabetes, the percentage that we're going to be affected made me cry, because my kid had coxsackievirus when she was two, and then she got type one diabetes. So I'm a he's talk and I'm crying. I'm like, it was a good idea. You know?

Jennifer Smith, CDE 38:15
That must have been the one that was it was a while ago you to him because he came up with the idea of its application in autoimmune disease not specific to type one initially. Yeah, he was looking at something else if I remember correctly, right. Yeah.

Scott Benner 38:30
So if you want to pick through my brain that to me, like it's nice that somebody's trying to stop type one or something like that. I think that if you want to push mankind forward, you got to figure out why our bodies react oddly to things and figure out how to stop that. Yeah, that's absolutely the bigger problem. There's a gentleman on the show today. sarcoidosis, which is an autoimmune coisas. Yeah, had to have his colon removed. And the sarcoidosis is still going after him in different places in his body. You know,

Jennifer Smith, CDE 38:58
quedo, Asus is one of those that affects each person who has it differently.

Scott Benner 39:04
Ya know, it's it's a, it's a hell of an interview. I think it's like, it's in the 1100s. Maybe. But my point is that that's an autoimmune issue. Yeah. Whether you have hay fever, or you get hives, and you don't know why, or your body's attacking your thyroid, or your pancreas or anything, that's the thing. I mean, I think we should be dropping everything and looking at that, because that fixes everything else, you know what I mean? Among

Jennifer Smith, CDE 39:28
many other things, what should we be looking at? And what should we be doing in our world? Rather than looking for aliens in the outer space? Listen,

Scott Benner 39:36
if we don't get hit by a comment, I think 500,000 years ago from now, we're gonna have all the answers we need. So I'm hoping a actually, I mean, you know, let me be serious here because we're kind of coming up on the end here. Yes. I think if you want to hope for something, hope that AI can get to the point where it can run these tests and get smart enough to break them down because much like everything else in the world, what slowing us down is us. We're only so smart, we only, you know, we only work nine to five, you might have to live a whole generation of people to get an idea weeded out of education to get back to somebody focused again, like you want a computer running and re running and running and re running and go and hear, hear hear, like, I think, you know, if you know, that would go much quicker, I'll use as an example. I don't know how many people track stuff like this, in a Tesla in a car, they have self driving, a lot of cars have self driving now, but Tesla's is pretty far ahead of the rest of them. And one thing that that company did was they built their own supercomputer, just to look at the data from self driving to teach self driving, how to get better, to get better. That's what you need for health care. You know what I mean? You need something smarter than us running and rerunning ideas over and over again, I think that's actually the thing you should be hoping for. Yeah.

Jennifer Smith, CDE 40:59
And then maybe it's interesting, because I, if you had something like that, pointing out exactly what some of the things we know about health care and longevity, and overall body systems and how to keep yourself healthy. Maybe people would take it better from a computer algorithm instead, in terms of pointing out, Hey, if you do step one, step two, step three, and do this in your life. You don't have to take XY and Z pills, because you can already solve this without putting money out of your pocket. Right? So maybe they would take it better.

Scott Benner 41:36
Yeah. Also, if you thought that at the end of 60 days of taking vitamin D, you'd actually feel better. But that's not what happens. You take it one day, you don't feel any better. Right?

Jennifer Smith, CDE 41:46
Right? Historical data that maybe would be compiled by a system like this, you would read it and you would say, Oh, I understand. I

Scott Benner 41:53
have to do this for 60 days. Jenny, listen, I'm now months and months and months into a better health regimen. Because of the GLP medication. I'm actually absorbing my nutrients now in my in my my vitamins and everything. Before I think I was taking them they were just like, kind of flushing right through.

Jennifer Smith, CDE 42:10
You had expensive poop essentially,

Scott Benner 42:12
I am expensive, not half the workforce. But But that's very funny, but I am. I'm gonna tell you now, my energy is such that sometimes at night, I think I'm not even tired. Like the end of the day comes and I'm like, I can keep going. Like, I'm like, I go to bed. But I lay there. I'm like, What could I be doing? Yeah, I'm gonna close my eyes and go to sleep. But if I wanted to get up, I could do something for two, three more hours. I'm like, Okay, it's crazy. Like, I know that some of that's weight loss, but I actually think I'm taking in these, you know, this stuff now. All right, we have like, a couple of minutes left, is that right? Yes. This might end up being with a called tickle your with a feather? I don't know if you know that phrase or not? Because I think this is a bigger, bigger thing than we can tack on a couple of minutes. But I am very interested in this conversation. Should people be on statins? If their lipids are okay. Oh, we can't do it now. Right? Maybe the next test Scott and Jenny. I

Jennifer Smith, CDE 43:11
like to tickle with a feather. It's called tickle my

Scott Benner 43:15
eyes of the feather because then you think oh, the next time this asks any chumps on they'll talk about lipids and then I'll go back to it. Yeah, it's like, it's my, it's my own who shot Jr. Which nobody understands? Yeah,

Jennifer Smith, CDE 43:26
I feel like I can be very honest, in terms of what my perception from a medical like physiology standpoint is with that, I hold nothing to any company or whatever. And if you have a healthy lifestyle, and you have healthy intake, and you have healthy lipid numbers, and all of those types of things, you are not the population that a lipid or that a statin is going to be beneficial for you. In fact, there are multiple reasons that you probably shouldn't. Now, I know somebody is going to beat me up about this. I don't care, quite honestly. But these are, these are medications that are to begin with their band aids. They're meant to fix something that isn't quite right in your body. Many times it's lifestyle. Truly, right. And there's a whole there's a whole like host of navigating things. And if you really do your research, and you really look at where funding comes from, you will find the reason

Scott Benner 44:37
Are you saying that if I manufacture a statin and I get insurance that covers that and if you have diabetes, then what's the phrase I'm looking for? Everything looks like a nail if you all you have is a hammer. So, so the doctor goes I was told to give people a diabetes statins.

Jennifer Smith, CDE 44:56
Thank you for saying it. Sure. Go 100% Like, I am not 100%. Like I said, there,

Scott Benner 45:04
you might need them. There are people who need them to get correct. Yeah, there are

Jennifer Smith, CDE 45:08
people who may need them. But the bulk of people, the bulk of people who are being prescribed them, they don't need them. They don't need them. And there are a whole host of reasons around the world of people who have diabetes, that they are 100% prescribed, even to those. And a lot of people question they say, Well, I told my doctor, I'm healthy. All my numbers are in range. I've never taken this before. Why are you prescribing it? Oh, but it's preventative. Those

Scott Benner 45:38
are the people I'm talking about, then to tell you listen, but it's preventing me from one from in case, this happens one day, maybe? Yeah, no, it's I think it's preventing you from being able to afford a cup of coffee because you're buying the statins. Now, listen, I have long not answered this question. Because I'm not a doctor. And I have no idea. And I know it's gonna get confused, because there are some people who need statins. Okay. Right. But yes, I think that what happened was, is they became prescribed bubble and covered by insurance if you have diabetes, and so it becomes whisper down the lane. And before you know it, we're five years into it and a doctor's handouts that it's like, like candy, and they don't even know why it's just what we do for people with diabetes. You know, and

Jennifer Smith, CDE 46:21
a lot of them do. I mean, a lot of them know the baseline of what they've been told about prescribing it, it is called preventative medicine, right? I mean, the other one that very similarly, our blood pressure meds for people who come in who again, healthy lifestyle, healthy intake, all of their, you know, their lipid panel looks lovely. Their blood pressure is nowhere near needing treatment, and they're taking it anyway because they have diabetes, and they've been told to take it because it's preventative. Yeah, just let's

Scott Benner 46:50
say Jenny's not walking around with her man wearing a condom 24/7 They put it on when they need it. Oh my god be so uncomfortable. That's so funny. We'll talk more about that in the next one. And here's a little highlight for people in the next one. We're going to answer this one and the next one, too. Hey, Scott, I've listened to your episodes on GLP and your diaries about your weight loss. Well done. Congratulations. I know you said that you think that GRPs or meds like them will become much more frequently used for people with type one can you please go into more detail about why you think that? Oh, and then this one I'm hearing rumblings about them potentially causing gastroparesis. They cause gastroparesis on purpose. They slow down your digestion on purpose, which is called guest or gastroparesis, just not in the way you're thinking of it if you have type one. Okay, so we'll do that when going down

Jennifer Smith, CDE 47:38
digestion definitely is different. In terms of what's happening right then having actual gastro paralysis

Scott Benner 47:46
caused by type one as a side effect of type one diabetes. Oh, look at this. I've heard Jenny competing in an Iron Man. Oh, there's gonna be plenty of stuff next time. All right. Thank you

Jennifer Smith, CDE 47:55
to half so I want to clear that to half Ironman. They were not full Ironman.

Scott Benner 48:01
Oh my god that you're more worried about than getting yelled out about the statins. Like I don't need to hear from those Iron Man people Jesus.

Jennifer Smith, CDE 48:10
I think

Scott Benner 48:15
a huge thanks to us med for sponsoring this episode of The Juicebox Podcast. Don't forget us med.com/juice box. This is where we get our diabetes supplies from you can as well use the link or call 888-721-1514 Use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. You spell that g VOKEGL. You see ag o n.com. Forward slash juicebox. Mark is an incredible example of what so many experience living with diabetes, you show up for yourself and others every day, never letting diabetes to find you. And that is what the Medtronic champion community is all about. Each of us is strong, and together, we're even stronger. To hear more stories from the Medtronic champion community where to share your own story, visit Medtronic diabetes.com/juicebox Don't forget, we still have Mark's conversation at the very end. It's a terrific kind of mini episode about 10 minutes long, that goes deeper into some of the things that you heard Mark talking about earlier in the show.

If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you. So So much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The diabetes variable series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about travel and exercise to hydration and even trampolines, juicebox podcast.com, go up in the menu and click on diabetes variables. Right now we're going to hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is Mark. I

David 50:34
use injections for about six months. And then my endocrinologist and a navy recommended a pump. How long had

Scott Benner 50:40
you been in the Navy? Eight years up to that point? I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

David 50:50
I was medically discharged. Yeah, six months after my diagnosis. Was

Scott Benner 50:53
it your goal to stay in the Navy for your whole life? Your career? It was Yeah,

David 50:57
yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we've made the decision despite all the hardships and time away from home, that was what we loved the

Scott Benner 51:10
most. Was the Navy, like a lifetime goal of yours? lifetime goal.

David 51:15
I mean, as my earliest childhood memories were flying, being a fighter pilot,

Scott Benner 51:20
how did your diagnosis impact your lifelong dream?

David 51:23
It was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant. I was not prepared for that at all. What does your support system look like? friends, your family caregivers, you know, for me, the Medtronic champions community, you know, all those resources that are out there to help guide the way but then help keep abreast on you know, the new things that are coming down the pike and to give you hope for eventually that we can find a cure.

Scott Benner 51:48
Stick around at the end of this episode to hear my entire conversation with Mark, and you can hear more stories from Medtronic champions and share your own story at Medtronic diabetes.com/juicebox. The episode you just heard was professionally edited by wrong way recording. Wrong way. recording.com