Scott Benner 5/25/24 Scott Benner 5/25/24

#1207 Defining Diabetes: Amylin and Symlin

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode we define Amylin and Symlin.

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

Scott Benner 0:00
Hello friends and welcome to episode 1207 of the Juicebox Podcast.

Today on defining diabetes, Jenny Smith and I are going to define Amylin, and similar to 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, or are the caregiver of someone with type one and a US resident, please go to T one D exchange.org/juice. Box and complete the survey. Your answers will help to move type one diabetes research board that may help you to T one D exchange.org/juicebox. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are now 50,000 members who are sharing stories and ideas. Go check out this amazing private and free Facebook group. 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. Why don't we move right to? Let's do Amylin and sembalun now sembalun Not it's Amylin sembalun Am I saying it right, or amie?

Jennifer Smith, CDE 2:18
Lin? So it's a good question. So it's Amblin that's how you say it and sembalun Okay, and Amblin is actually truly the hormone that is comes from your own body. In fact, it actually is sort of CO secreted along with insulin from the beta cells. Okay. sembalun is the analog version that you can take as an injection to combat the loss of the amlan.

Scott Benner 2:51
Am I right to say that that's if you use simulate, it's three times a day,

Jennifer Smith, CDE 2:56
in a way. Yeah. It's mealtime specific. Okay, so it's not like some of our longer acting injectables we have now that you take a once a week or even once a day or whatever. sembalun is specific for a couple of really good reasons. One, it helps to slow gastric emptying. It provides satiety, and the other thing that it does it help to sort of suppress or reduce glucagon release in the aftermath of a meal where it can increase in create a rise in blood sugar, right. And so these are the biggest reasons that amarilla Amylin essentially is released, it's in response to a meal and caloric intake. So if somebody with diabetes type one diabetes, especially it is also used in type two diabetes, mainly from sort of a loss of insulin sensitivity. And so then those pancreatic beta cells kind of get taxed. And so somebody could benefit with type two using sembalun as well. But mostly, it's type one, in fact, I think it was the first specifically type one non insulin medicine, which is interesting, but it also needs to be taken with meals that have a specific amount of carbohydrate or was the original first thought, Okay, I believe it was about 30 grams of carb had to be taken in in order to utilize sembalun at that meal time.

Scott Benner 4:17
This episode is sponsored by Medtronic, diabetes, Medtronic diabetes.com/juice box. And now we're going to hear from Medtronic champion Jalen. I was

Speaker 1 4:27
going straight into high school, so it was a summer getting into high school was that particularly difficult, unimaginable, you know, I missed my entire summer. So I went to 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 work 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 5:00
Did you try to explain to people? Or did you find it easier just to stay private? I

Speaker 1 5:05
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. Did

Scott Benner 5:20
you eventually find people in real life that you could confide in.

Speaker 1 5:24
I 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

Scott Benner 5:45
hear Jay Lynn's entire conversation stay till the very end, Medtronic diabetes.com/juice box to hear more stories from the Medtronic champion community. So I'm reading here emmalin is a centrally acting neuro endocrine hormone synthesized with insulin in the beta cells of the pancreatic isolates, co six islets, thank you. CO secretion is provoked by nutrient in flux to the gastrointestinal tract signaling the need to restore blood glucose homeostasis. So when you are diagnosed with type one diabetes, like colloquially, some people always feel hungry. And it doesn't happen to everybody, I don't think but you'll hear from some type ones like, Oh, my God, I'm always hungry. And why is that? Like? What happens? That? Is it because this Amylin gets secreted from the beta cells? Correct?

Jennifer Smith, CDE 6:40
Okay, it's in response to meals, which is, again, the reason if you were to use its analog swimlane. That's why it would be taken only along with meal times, you wouldn't take it just because you think you need the right to take it. But yes, so satiety in the aftermath of a meal. I mean, there are a lot of factors, even even hunger hormones, things like ghrelin and leptin, all of those have relation to whether we are feeling hunger or feeling satisfied in the aftermath of a meal Amblin because it does slow gastric emptying, creating satisfaction in the aftermath of eating right. Oftentimes, we find that appetite kind of gets curbed, right, when we have the right Amblin secretion, or we're using swimlane. Now, most people say, Well, then why are why are we not prescribed both of these? Yeah, at the same time at diagnosis, right. And I will tell you that Similan is a it's a finicky, finicky hormone to work with, there are some baseline sort of use strategies. One is usually about 30 grams of carb has to be eaten at the meal time. If not, you don't use the sembalun, too. It also requires its own Pre-Bolus time. Okay. And we also typically start with an adjustment down in the Bolus dose of insulin for that meal, until we determine how well someone is actually impacting the post meal blood sugar. And then we can kind of titrate insulin to carb ratios and whatnot a little better.

Scott Benner 8:14
So is the simple answer. It's not prescribed that often because it adds another layer of difficulty at every meal. Okay,

Jennifer Smith, CDE 8:22
I would say that's, in a nutshell 100% The reason that it's not prescribed? In fact, I would say that most doctors don't even bring it up unless somebody is doing like a deep dive search for how can I navigate my post meal blood sugars, they might despite pop up, they go back to their doctor, and they're the one

Scott Benner 8:39
that brings it up. I interviewed a woman recently who is now using someone and she said the only reason she's using it is because she went off of her GLP to get pregnant. And you and I've talked about this in other episodes, the studies on GRPs and pregnancy are happening right now they look positive, but at the moment, your package insert is going to tell you if you're going to get pregnant, like get off your GLP medication. After she told me this. She waxed poetically for five minutes about how much a GLP is helping her. And she said it's not about weight. She's a fit person. It's not about insulin sensitivity. She's already plenty sensitive to her insulin. She said it is fully because I am hungry constantly. And she's like in this stop that. And so she was sad to have to stop it. And sure, yeah, and she said the same thing that she's shooting the sembalun at every meal. It's a hassle. It's not helping as much as the GLP did. And she was only using, I want to say a milligram of of ozempic a week. Oh, and it was helping her that much. That's not even that's just starting to get into like a therapeutic dose of it. And she was getting all this help from it and I And bouche through my daughter who uses a half a milligram a week, and that it works. It works for her. So, but anyway, okay, so Amazon's the thing that the pancreas makes, it stops making it when you have type one,

Jennifer Smith, CDE 10:14
or that it has to do with beta cell, right because it is made along with insulin in the beta cells. And in type one, we lose beta cells, not 100% of them, we know that some remain, but because it's so downplayed in what can come out, it's kind of, I mean, we don't need it the same way we need insulin, right, there's a, there's a definite different reason for it. Without insulin, or just assuming that we've got enough beta cells there, we're still going to have high blood. Right? Whereas Amblin is is different, it doesn't regulate the blood sugar directly. It does help with regulation, indirectly, because of some of the way it delays the absorption. And then other ways in which like I said earlier, it it does some suppression of glucagon, which often comes in right after you eat. And unfortunately, with diabetes, we see the impact of that, that we can't really control outside of adjusting insulin doses. So

Scott Benner 11:22
just the loss of amlan effectiveness, do you think that could have something to do with people not absorbing nutrition as well, too? Could it have stuff to do with digestion, because if, if Amazon slows gastric emptying, then your body has time to pull out the nutrients. And my, my personal experience is my you know, you know, everybody knows, like, I've needed like iron infusions forever, right. And now that I've been on a GLP, for a year, I just got my bloodwork done the other day, you know, my heart is 181, I haven't had an infusion like 18 months. So now that my digestion is slower, my body is having luck pulling the nutrients out of what I eat,

Jennifer Smith, CDE 12:04
that could be a good way to think about it.

Scott Benner 12:09
I'm trying to think about all this journey. I've tried to fix everybody's problems before I get sick of making this podcast. So

Jennifer Smith, CDE 12:15
ya know, and that's it. I think in terms of that, too, it brings in another piece to that slower digestion, you know, the biggest thing that you really talk about all the time, regardless of what the topic is, is that insulin, you need to learn about how insulin works, right. And because of that, with something like adding sembalun, we do have to be really concerned about hypoglycemia with it. Because if insulin dose is not adjusted accordingly, because of the way that gastric sort of slowing happens, you're much more at risk for lower blood sugars, unless somebody has really directed you well, in how to include sembalun, along with insulin along with your meals. Yeah, like I said, it's a it's a finicky medication. And if you don't have somebody who's really willing to hand in hand kind of work with you. It can be kind of hard to figure out,

Scott Benner 13:16
right? So maybe this problem, generally speaking, dissipates in the type one community if and when g LPs are made available to people with type one, maybe a lot of this would go away, then

Jennifer Smith, CDE 13:28
possibly it's not because it's replacing what's lost. It's just masking it. It's kind of masking it, but for a different reason. That is still replacing something that's not really working the right way in the Yeah, no,

Scott Benner 13:43
it's a patch on a patch, really. But yeah, like, I mean, it's not like Yeah, I mean, at the moment, you're not just going to make your pancreas start working again. So alright, cool. Well, listen, I'm happy to have gone over this because it's been in my head forever, because I've heard some, like old timey type ones talk about it, like they used to give us this or one of the insolence used to have it in it. Is that what Um, no, that's not it. They used to, they used to give it to people. Right. Okay. Yeah.

Jennifer Smith, CDE 14:09
I mean, it's still available, you can still absolutely ask for it. It is just not highly prescribed prescribe.

Scott Benner 14:16
Okay. All right. Thank you. I appreciate it. Yeah. No, that

Jennifer Smith, CDE 14:18
was a great. It's a clever ask. That's a great question.

Scott Benner 14:21
Absolutely. All right, what else we got here? Let's see. Let's see, let's say, well, since we're going down this road

Jalen is an incredible example of what so many experienced 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. On 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 diabetes diagnosis comes with a lot of new terms, and you're not going to understand most of them. That's why we made defining diabetes. Go to juicebox podcast.com up into the menu and click on defining diabetes, to find the series that will tell you what all of those words mean. Short, fun and informative. That's the finding diabetes. 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 the hydration and even trampolines juicebox podcast.com, go up in the menu and click on diabetes variables. If you're living with type one diabetes, the afterdark collection from the Juicebox Podcast is the only place to hear the stories that no one else talks about. From drugs to depression, self harm, trauma, addiction, and so much more. Go to juicebox podcast.com up in the menu and click on after dark. There you'll see a full list of all of the after dark episodes. 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. The episode you just heard was professionally edited by wrong way recording. Wrong way. recording.com Thanks for hanging out until the end. Now you're going to hear my entire conversation with Jalen don't forget Medtronic diabetes.com/juice box or the hashtag Medtronic champion on your favorite social media platform.

Speaker 1 16:55
My name is Jalen Mayfield. I am 29 years old. I live in Milwaukee, Wisconsin, where I am originally from Waynesboro, Mississippi. So I've kind of traveled all over. I've just landed here in the Midwest and haven't left since

Scott Benner 17:10
ice. How old were you when you were diagnosed with type one diabetes?

Speaker 1 17:13
I was 14 years old when I was diagnosed with type one diabetes

Scott Benner 17:17
15 years ago. Wow. Yes. Okay. 14 years old. What are you like? Do you remember what grade you were in?

Speaker 1 17:22
I actually do because we we have like an eighth grade promotion. So I had just had a great promotion. So I was going straight into high school. So it was a summer, heading into high school

Scott Benner 17:32
was that particularly difficult going into high school with this new thing?

Speaker 1 17:35
I was unimaginable. You know, I missed my entire summer. So I went to I was going to a brand new school with, you know, our community, we brought three different schools together. So 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 work type one diabetes was

Scott Benner 17:55
did you even know? Or were you just learning at the same time? I

Speaker 1 17:59
honestly was learning at the same time, my hometown did not have an endocrinologist. So I was traveling almost over an hour to the nearest you know, pediatrician, like endocrinologist for children. So you know, I outside of that I didn't have any type of support in my hometown.

Scott Benner 18:16
Was there any expectation of diabetes that somebody else in your family have type one? No, I

Unknown Speaker 18:21
was the first one to have type one of my family.

Scott Benner 18:23
And do you have children? Now? I do not know. Do you think you will one day, still thinking

Speaker 1 18:28
about it? But right now, I've just been traveling books at all my career myself. So

Scott Benner 18:33
what do you do? What's your career? Yeah, so

Speaker 1 18:35
I am a marketing leasing specialist for a student housing company. So we oversee about 90 properties throughout the US. So I've been working for them for about

Scott Benner 18:43
eight years now. And you get to travel a lot in that job. Yes,

Speaker 1 18:47
I experienced a lot of travel. It's fun, but also difficult, especially with all your type one diabetes supplies, and all your electronics. So it's a bit of a hassle sometimes. What

Scott Benner 18:58
do you find that you absolutely need with you while you're traveling? diabetes wise,

Speaker 1 19:02
I have learned my biggest thing I need is some type of glucose. I have experienced lows, whether that's on a flight traveling, walking through the airport, and I used to always experience just being nervous to ask for some type of snack or anything. So I just felt, I felt like I needed to always have something on me. And that has made it my travel a lot easier.

Scott Benner 19:23
So growing up in the small town. What was your initial challenge during diagnosis? And what other challenges did you find along the way? Yeah,

Speaker 1 19:34
I think the initial one I felt isolated. I had no one to talk to that it was experiencing what I was going through. You know, they were people would say, Oh, I know this is like hard for you. But I was like you really don't like I just felt lonely. I didn't know you know, people were watching everything I did. He was like, You can't eat this. You can't eat that. I felt like all of my childhood had been you know, I don't even I remember what it was like for life before diabetes at this point, because I felt like that's the only thing I could focus on was trying to do a life with type one diabetes,

Scott Benner 20:08
when you found yourself misunderstood? Did you try to explain to people? Or did you find it easier just to stay private?

Speaker 1 20:15
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, you know, kept it to myself didn't really talk about it was I absolutely had to,

Scott Benner 20:33
did you eventually find people in real life that you could confide in. I think

Speaker 1 20:38
I never really got the experience until after getting to college. And then once I graduated college, and moving to an even bigger town, that's what I finally found out was people were I was like, Okay, there's a lot of other people that have type one diabetes. And you know, there's a community out there, which I had never experienced before, is

Scott Benner 20:59
college where you met somebody with diabetes for the first time, or just where you met more people with different ways of thinking. So

Speaker 1 21:05
I met my first person with diabetes, actually, my freshman year of high school, there was only one other person. And he had had it since he was a kid like young once this was like, maybe born, or like, right after that timeframe. So that was the only other person I knew until I got to college. And I started meeting other people, I was a member of the band, and I was an RA. So I was like, Okay, there's, you know, there's a small handful of people also at my university. But then, once I moved to, I moved to St. Louis. And a lot of my friends I met were like med students, and they were young professionals. And that's where I started really getting involved with one of my really close friends to this day. He was also type one diabetic. And I was like, that's who introduced me to all these different types of communities and technologies, and which is really what helped jumpstart my learning more in depth with type one diabetes.

Scott Benner 21:56
Do you think I mean, there was that one person in high school, but you were young? Do you really think you were ready to build a relationship and around diabetes? Or did you even know the reason why that would be important at the time?

Speaker 1 22:07
I didn't, uh, you know, I honestly didn't think about it, I just was i Oh, there's another person in my class that's kind of going through the same thing as I am. But they've also had it a lot longer than I have. So they kind of got it down. They don't really talk about it. And I was like, Well, I don't really have much too late connect with him. So sorry, connect with him. Oh, yeah,

Scott Benner 22:27
no. So now once your world expands as far as different people, different backgrounds, different places in college, you see the need to connect in real life, but there's still only a few people. But there's still value in that. Right?

Unknown Speaker 22:39
Correct.

Scott Benner 22:40
What do you think that value was at the time?

Speaker 1 22:43
I think it was just what making me feel like I was just a normal person. I just wanted that. And I just, I needed to know that. Like, you know, there was other people out there with type one diabetes experiencing the same type of, you know, thoughts that I was having.

Scott Benner 22:58
When were you first introduced to the Medtronic champions community? Yeah.

Speaker 1 23:02
So about two years ago, I was, you know, becoming more I was looking around and I noticed stumbled upon the Medtronic community. And I was like, this is something I really, really, I kind of need, you know, I said, I, all throughout these years, I was, you know, afraid to show my pump. You couldn't, I would wear long sleeves, like, didn't want people to see my CGM, because I didn't want people to ask me questions. And you know, I just felt so uncomfortable. And then I noticed seeing these people really, in the Medtronic community, just, they embraced it, you could see and they weren't afraid to show it. And that was something I was really looking forward to.

Scott Benner 23:38
How is it knowing that your diabetes technology is such an important part of your health and your care? And having to hide it? What did it feel like to have to hide that diabetes technology? And how did it feel to be able to kind of let it go,

Speaker 1 23:51
I will refuse to go anywhere, like, I would run to the bathroom. I just didn't want to do it in public, because I felt like people were watching me. And that was just one of the hardest things I was trying to overcome. You know, I was fresh out of college, going into a young professional world. So you know, going out on work events and things like that. I just, I just didn't think I just didn't think to have it out. Because I was so afraid. But then, once I did start, you know, embracing again and showing it that's when the curiosity came and it was actually genuine questions and people wanting to know more about the equipment that I'm on and how does this work? And what does this mean and things like that, which made it kind of inspired me because I was like, Okay, people actually do want to understand what I'm experiencing with type one diabetes.

Scott Benner 24:36
What did you experience when, when the internet came into play? And now suddenly as easy as a hashtag and you can meet all these other people who are living with diabetes as well. Can you tell me how that is? Either different or valuable? I guess compared to meeting a few people in real life?

Speaker 1 24:53
Absolutely. I think if you look back from when I was first diagnosed to now, you I would have never thought of like, you know Oh, searching anything for someone with, you know, type one diabetes. And now it's like, it's all I see, you know, you can easily search Medtronic champions, and you see people that pop up and you're like, wow, look at all this content. And I think that's something that that kind of just motivates me and which is how I've kind of came out of my shell and started embracing more and posting more on my social media with about, you know, how I'm able to type one diabetes. And I think that's something that I hope can inspire everyone else. What

Scott Benner 25:27
was it like having more personal intimate relationships in college with type one,

Speaker 1 25:32
I think it was kind of hard to explain, you know, just, for example, like, no one really knows and understands, like what alo is. And I think that was a very hard thing for me to explain, like I, you know, it can happen in any moment. And I'm sweating. I'm just really like, not all there. And I'm trying to explain, like, Hey, this is what's going on, I need your help. And I think that was something that was hard for me to, you know, I did talk to people about it. So when this happened, they were like, oh, you know, what's going on with your mate? I'm actually a type one diabetic. This is what's going on? I need your help. What about?

Scott Benner 26:10
Once you've had an experience like that in front of someone? Was it always bonding? Or did it ever have people kind of step back and be maybe more leery of your relationship?

Speaker 1 26:22
After I would tell someone I had type one diabetes after subtype of regenerate DNA, they were kind of more upset with me that I didn't tell them up front. Because they were like, you know, I care about you, as a person I would have loved to knowing this about you. It's not anything you should have to hide from me. And that was a lot of the realization that I was going through with a lot of people.

Scott Benner 26:40
Okay, let me ask you this. So now we talked about what it was like to be low, and to have that more kind of emergent situation. But what about when your blood sugar has been high or stubborn? And you're not thinking correctly, but it's not as obvious maybe to you or to them? Yeah.

Speaker 1 26:54
So I also I go through my same experiences when I have high blood sugars, you know, I can tell like, from my co workers, for example, I didn't really talk to you know, when I go out backtrack, when I visit multiple sites for work, I usually don't announce it. And so sometimes, I'm working throughout the day, I might have smacked forgot to take some insulin, and my blood sugar's running high, and I'm a little bit more irritable, I'm all over the place. And I'm like, let me stop. Hey, guys, I need to like take some insulin, and I'm sorry, I'm not I didn't tell you guys. I'm a diabetic. So you may be wondering why I'm kind of just a little bit snippy, you know, so I like to make sure I do that now going forward, because that's something I noticed. And it was kind of hindering me in my career, because I was, you know, getting irritable, because I'm working nonstop. And I'm forgetting to take a step back and focus on my diabetes, right?

Scott Benner 27:46
Hey, with the advent of new technologies, like Medtronic, CGM, and other diabetes technology, can you tell me how that's improved your life and those interactions with people?

Speaker 1 27:56
Yeah, I can. I feel confident knowing that it's working in the background, as someone and I've always at least said it, I have been someone that's really bad with counting my carbs. So sometimes I kind of undershoot it because I'm scared. But it allows me to just know that, hey, it's gonna it's got my back if I forget something, and I think that allows me to have a quick, have a quick lunch. And then I'm able to get back into the work day because it's such a fast paced industry that I work in. So sometimes it is easy to forget. And so I love that I have that system that's keeping track of everything for me.

Scott Benner 28:30
Let me ask you one last question. When you have interactions online with other people who have type one diabetes, what social media do you find the most valuable for you personally? Like? What platforms do you see the most people and have the most good interactions on?

Speaker 1 28:46
Yeah, I've honestly, I've had tremendous interactions on Instagram. That's where I've kind of seen a lot of other diabetics reach out to me and ask me questions or comment and be like, Hey, you're experiencing this too. But I've recently also been seeing tic TOCs. And, you know, finding on that side of it, I didn't, you know, see the videos in different videos. And I'm like, I would love to do stuff like that, but I just never had the courage. So I'm seeing people make, like, just the fun engagement videos now, which I love, you know, really bringing that awareness to diabetes. Yeah.

Scott Benner 29:16
Isn't it interesting? Maybe you don't know this, but there's some sort of an age cut off somewhere where there is an entire world of people with type one diabetes existing on Facebook, that don't go into Tik Tok or Instagram and vice versa. Yeah. And I do think it's pretty broken down by, you know, when that platform was most popular for those people by age, but your younger people, I'm acting like I'm 100 years old, but younger people seem to enjoy video more. Yes,

Speaker 1 29:43
I think it's just because it's something you see. And so it's like, and I think the one thing and obviously, it's a big stereotype of our diabetes is you don't like you have diabetes, and that's something I always face. And so when I see other people that are just, you know, normal, everyday people and I'm like, they have type one diabetes just like me, they're literally living their life having fun. That's just something you want to see it because you don't get to see people living their everyday lives with diabetes. I think that's something I've really enjoyed.

Scott Benner 30:11
What are your health goals? When you go to the endocrinologist and you make a plan for the next few months? What are you hoping to achieve? And where do you struggle? And where do you see your successes, I'll

Speaker 1 30:22
be honest, I was not someone who is, you know, involved with my diabetes, I wasn't really focused on my health. And that was something that, you know, you go into an endocrinologist and you get these results back. And it's not what you want to hear. It gets, it makes you nervous, it makes you scared. And so I have personally for myself, you know, I was like, This is my chance, this is my chance to change. I know, there's people that are living just like me, everyday lives, and they can keep their agencies and their blood sugar's under control. How can I do this? So I go in with it, you know, I would like to see it down a certain number of points each time I would love for my doctor to be like, Hey, I see you're entering your carbs. I see. You're, you know, you're not having lows. You're not running high, too often. That's my goal. And I've been seeing that. And that's what motivates me, every time I go to the endocrinologist where I don't dread going. It's like a an exciting visit for me. So

Scott Benner 31:10
you'd like to set a goal for yourself and then for someone to acknowledge it to give you kind of that energy to keep going for the next goal.

Speaker 1 31:18
Yeah, I feel as a type one diabetic for me, and it's just a lot to balance. It's a hard, hard journey. And so I want someone when I go in, I want to be able to know like, Hey, I see what you're doing. Let's work together to do this. Let's you don't want to be put down like you know, you're doing horrible you're doing it's just, it's not going to motivate you because it's you're you're already fighting a tough battle. So just having that motivation and acknowledging the goods and also how we can improve. That's what really has been the game changer for me in the past two years. Jalen,

Scott Benner 31:55
I appreciate you spending this time with me. This was terrific. Thank you very much.

Unknown Speaker 31:59
Absolutely. Thank you.

Scott Benner 32:01
If you enjoy Jalen story, check out Medtronic diabetes.com/juice box

#1206 Not Evidence Based

Elise has type 1 diabetes and a lot of drive!

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 1206 of the Juicebox Podcast.

28 year old Elise was diagnosed just seven months before our recording. She knew she was antibody positive and so she expected a type one diagnosis. Elise has a PhD and is getting her MD right now, I think at least knows how to multitask. We're also going to talk about a pelvic reconstructive operation that she's had and the long recovery process. While you're listening today. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. Speaking of being bold, do you want to help with type one diabetes research? Yeah, do well, if you're a US resident who has type one or is the caregiver of someone with type one, you can do that from the comfort of your home. T one D exchange.org/juicebox. complete the survey and just like that you've helped, you're also supporting the podcast and you're just being a nice person. Also, you might get something out of it to go check it out T one D exchange.org/juicebox. And don't forget to check out the private Facebook group Juicebox Podcast type one diabetes, we're up to 50,000 active members there is a conversation happening right now that you would love 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. 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 episode of The Juicebox Podcast is sponsored by us med you 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. My

Elise 2:43
name is Elise and I'm 27 Or I just turned 20 Actually, and I was diagnosed with type one this past June. So it's been about six or seven months now. But I kind of knew that I was headed down that pathway because I was antibody positive and worked in type one research beforehand.

Scott Benner 3:00
How did you know you were positive.

Elise 3:02
So I found out by accident. I was doing research after I graduated from undergrad in a lab at a major medical institution that was doing research in type one, I had no connection to type one previously. And we use our own blood to like practice tests to make sure that we weren't wasting patient samples and whatnot. We just had to like basically QC them. And I was doing that. And I was using my own blood. And this one test that I was running kept coming back positive in a way that was not anticipated. For what I thought I was running, which was my own blood, which should be negative. So I discovered that I had gad 65 antibodies kind of by happenstance, in that way, happenstance

Scott Benner 3:43
that's random. Yeah. Yeah. Yeah. Oh my god, we're gonna teach you guys how to use this test today. Oh, use your own blood. We don't want to waste the samples. I have why Yeah. Oh, wow. Yeah.

Elise 3:55
So then I went to an endocrinologist that had all of my antibodies tested. And I've had between two and three positive at any one given time. That was probably about six or seven years ago that that happened. What

Scott Benner 4:09
understanding that they give you at that moment, did they say This means you're going to get type one diabetes at some point, or you have a chance of it? Or what are they? How do they present it to you? At

Elise 4:18
that time, all of the trial, that research hadn't been published yet. So we didn't really have a great idea. I think there were a couple of studies that had come out of Europe that had an idea of what it looks like if you had two or three positive basically they said in your lifetime that you will end up with type one unless you get hit by a bus first. It's just we don't know when did it didn't take too long. What

Scott Benner 4:42
do you 2021 At that point, somewhere around there? Yeah, I

Elise 4:45
was about 21 at that point. And now I'm 28. So Wow.

Scott Benner 4:49
And so how did you notice it coming? I guess because if you were on the lookout, yeah,

Elise 4:55
well, so I hadn't measured I definitely had a lot of issues with My blood sugar at that time around when I found out that I had antibodies, but I was having reactive hypoglycemia. So I was like dropping into like the 30s and 40s, like an hour or two after eating anything for no apparent reason, which was a wild experience. So I wore a G for I think it would have been at that point in time for a while. But then this thing would happen, where if I would try and like treat a low, I would just like spike and then drop again. And it was just easier to not do anything so that I stopped wearing a Dexcom. Because it wasn't actually changing what I was doing.

Scott Benner 5:33
How long did the lows last for?

Elise 5:34
I stopped caring about them after like two years, they probably kept going. And I just wasn't aware of them.

Scott Benner 5:40
What did they feel like versus what does it feel like to be low now?

Elise 5:44
I didn't feel it at all. Because I wasn't dropping quickly. Like my, I was just kind of sitting in like the 30s or 40s. And so I had no idea that I was low.

Scott Benner 5:58
So a low with manmade insulin versus a low with your natural insulin. Completely different experiences.

Elise 6:06
I don't know that they feel different. I think it's the rate of change. That makes me feel dumb. Okay. Okay. Yeah, I think the rate at which I'm dropping depends on whether or not I feel below. What

Scott Benner 6:19
did you do when you were in the 30s? Before you had diabetes before you're using insulin, but would you just sit around and be like this will pass or

Elise 6:26
so at first, I would try to like have like, short acting carbohydrate, but then I would just like come up into the 80s and then drop right back down into the 30s. So I had to be like really specific about the way that I like timed protein and fat like with my carbohydrate intake as to not like, like in a ball. And anecdotally, I've heard that this is a thing for people that later down the line and up with type one. But there's no clinical evidence or like published data to support that. Interesting.

Scott Benner 6:55
That's really something. Okay, so you are eventually diagnosed at that point. Are you in practice? Are you like, well tell people what you do, I guess first.

Elise 7:05
So I am in my third year of an eight year program. I'm in which I'm getting both my MD and my PhD. Third

Scott Benner 7:14
year of an eight year.

Elise 7:17
Yeah. Yes. So the way that that works is you do the first two years of med school, and then you take a break from med school and you do four years of a PhD. And then you go back and do the last two years of med school and then you do residency and fellowship, etc, etc.

Scott Benner 7:33
Oh my God, will you be a physician in your mid 30s? Working? Yes,

Elise 7:36
yes. Yeah, I graduated from this program in 2029. was

Scott Benner 7:41
very nice of you to keep the country afloat with all the loans you're taking out. Thank you.

Elise 7:45
Actually, no, that's the benefit of the it's called the medical scientist training program. So it's completely NIH funded i You don't have to pay for any of medical school and you get a stipend for all eight years. diabetes

Scott Benner 7:57
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 to big button it 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 888-721-1514 or go to my link us med.com/juice box using that number or my link helps to support the production of the Juicebox Podcast. 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 vo Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you storage evoke hype moped and how to use it. They need to know how to use G Bo 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. Yeah, how'd you find out about that? Did you win a lottery and somebody told you about?

Elise 10:36
I mean, it's very there are about 50 programs in the US they take between like two and like 10 students each. So they're very, very competitive.

Scott Benner 10:45
Am I talking to are you brilliant or something? What's going on?

Elise 10:48
I wouldn't say so necessarily. But it's just a it's a niche topic because you have to be in it for the long haul. With eight years of education,

Scott Benner 11:00
also be willing not to make money into your mid 30s.

Elise 11:02
Yes, this is true. I do have an engineering degree. And I think sometimes about what I could be making an industry versus what I'm making eight years when a grad student stipends and I waited hurts my soul.

Scott Benner 11:13
Right. You got an engineering degree and then you went back to school to do this. Yeah, yeah, I did. With you. Go ahead. Yeah. Really? No,

Elise 11:23
I don't really know what I was thinking. So I started med school at that point. I this was three years ago, I had checked my agency probably every year or so I also have Hashimotos and Crohn's disease. So I'm just kind of an autoimmune nightmare. And so at that point, I was testing my agency every year. So my agency was typically running in like the mid fours. We didn't worry about it whatsoever. I then this past spring had to go through I had a really like large orthopedic surgery in which they had to, basically like break my pelvis and reconstruct it. Okay. And so, pre op, I had labs done, and they ran an agency, which I hadn't done had done probably in three or four years at that point. And my agency came back at five, nine, at which point I was like, That's not where it was the last time I looked at that. So I had eaten a pair probably like 45 minutes an hour earlier. And I was like, You know what, let me just test let me just see. And I was like, 330, I was like, Well, I think I think I have the diabetes now. I think it has happened, Lisa.

Scott Benner 12:33
I like the way you tell stories you like I robbed a train but I got a splinter on the train that you told me about the splinter. I want to know how about like, what your pelvis, what happened to your pelvis,

Elise 12:43
I have hip dysplasia. So essentially, like the socket of my hip is shallow, and my femur was not, like seated well in that socket. And so I had been a competitive athlete throughout my entire life. And over that time, I had shredded through the cartilage and muscles that were doing the job that bone was really meant to be doing. And so I had a very uncommon orthopedic procedure called a Peri acid tabular osteotomy where they rake all the way around your hip socket, and then reorient it over top of the top of the femur and screw it back into place. So I have for four and a half inch screws in my pelvis.

Scott Benner 13:32
How long did it take to recover from that?

Elise 13:33
I'm at six months post op now, I would say I'm just getting to a point where I'm fully back to my normal life. What was the pain like? Well, you have to it was an inpatient surgery. So I was in the hospital for about five or six days. And then because nothing can apparently go right in my life, I see pneumonia while I was in the hospital, and then my incision to hissed and I had to have a second surgery to re close it. Yeah,

Scott Benner 14:01
I'm not getting in a car with you. That's for sure. Yeah,

Elise 14:04
I really I didn't get great luck in the body department. Yeah, at this point now, like my pain is better than it was pre op and I can run again. I've started horseback riding, again, all of that type of thing, but it was definitely a big recovery.

Scott Benner 14:21
Did you need more effort with your insulin through the recovery?

Elise 14:23
I was so new. So I was diagnosed on June like ninth or 10th and I had my surgery on July 5.

Scott Benner 14:30
Did you reach out to me on the podcast eight minutes after you got diabetes or something? Yes.

Elise 14:34
Yeah, I did. Because I've been listening to the podcast, probably since like you started because I had this weird special interest in type one, which is why I was working at a type one diabetes lab at the time. So like I listened to the podcast in like 2015 I don't think

Scott Benner 14:52
this is possible this but maybe you gave yourself diabetes by being around as much

Elise 14:56
I might have. Yeah, so I had lived Send to like, all of your pro tips all of your episodes, basically ever before I was even diagnosed.

Scott Benner 15:07
This is very interesting. Okay. Also, just quickly before the surgery, if you tried to run the straight line, would you go in a circle? Or was it not that bad?

Elise 15:14
I couldn't really run

Scott Benner 15:18
that dumb joke. I'm done now. Wait. So this is super interesting. Okay, so you as a former engineer, med student, you decided you were gonna get involved with diabetes? Yeah, you start listening to my podcast. And then while you're at med school, learning how to do a blood test, learn that you have get antibodies and are likely going to get type one diabetes at some point. And so you basically listen to the podcast for years, almost nine years before? Before? Not that long, but a long time before you got type one. How much did that help you when you were actually diagnosed, started using insulin

Elise 15:59
so much? Because the amount of education I got was 00. Wait

Scott Benner 16:05
a minute, so you would have you probably, oh, this is so crazy. You were like, I got diabetes. I'm gonna go on that podcast. And tell them the story. That's what

Elise 16:13
we're doing because I taught myself how to manage my diabetes exclusively from what I knew basically from those podcasts. So

Scott Benner 16:20
I'm taking care of you basically, basically, your brain and your fingers. Yeah. Okay. I'll accept that.

Elise 16:28
Yeah. So at that point, that was in like, April, right. I messaged my primary care. And I was like, Hello, I've done an oral glucose tolerance test in my living room, and I have diabetes. Now. Here's the results of my antibody tests proving it's type one. Can you please refer me to Endo? And then I went to endo a month later, which in hindsight, I really probably should have gone somewhere before that, but I just didn't.

Scott Benner 16:51
Are you married? No, no. dating someone? I

Elise 16:55
have a partner of three years.

Scott Benner 16:56
You're with somebody? Okay. I'm worried for your safety. I just wanted to make sure someone wanted to make sure someone was with you. Yeah,

Elise 17:04
no, I'm well taking a ticket. So because at that point, so after I tested my blood sugar, the one time after eating the payer, and I was like, 330, something I like, started testing it more, because now I'm my own science experiment. And my fasting blood sugars were like 80s. So then I was just confused. And didn't think like, I didn't have ketones. I was like, I'm fine waiting a month to get into Endo. Um, at that point, I also just confused the Endo. So she slapped a Dexcom on me. And then ironically, I was going to be like National endocrinology conference that week that I had the Dexcom on me, like, because I was presenting research about peds. diabetes stuff. Like the week I was being diagnosed with diabetes, which I feel like just made the whole thing even more meta.

Scott Benner 17:47
Jesus, this is weird. Yeah.

Elise 17:52
So when I had the Dexcom on and I, unbeknownst to me, was apparently still having crazy low blood sugars. It's just that now I was spiking. So anytime I A, I would spike into the two three hundreds and then crash into the 40s. Yeah, like just by myself with my own no insulin like added. That's just what my pancreas was choosing to do at that moment, which, in theory, this is not evidence based medicine, this is just a spitballing, kind of similar to the process of what you might think would happen in Hashimotos, where you have hyperthyroid before you end up hypo thyroid, kind of like as the beta cells are being killed, they are releasing insulin more aggressively than they may have.

Scott Benner 18:38
Otherwise. Yeah, they have some left and it's trying too hard. Yes. Yeah. Yeah. By the way, everything about this podcast is, you know, softball.

Elise 18:48
Yeah, I just I just like to make it clear, because I

Scott Benner 18:50
thought there's nothing like evidence based here. I was like, oh, was I supposed to do that?

Elise 18:56
No, I just I like to be very clear when I when I say things because most of like as a PhD student, everything I do is evidence based most of the time except for things having to do with my own health. I just fly by the seat of my pants. That's

Scott Benner 19:08
funny. Well, I'm, I'm basically I'm just a podcaster. So I have a, you know, I just say at the beginning of the podcast that this isn't medical advice, and then yeah, do what I say the things that I noticed and you guys can take what you want from it. It was just fine. Okay, okay. I'm sorry, keep going. She

Elise 19:26
threw me on some Metformin, which I'm not really quite sure why she did that. I didn't actually end up taking it I don't think I don't think I even filled the prescription because I was like, she doesn't know what she's talking about. She was fine letting me have my blood sugar's be doing that because my agency was still like, five, nine or whatever it was at the time, okay, but I was like, I'm not particularly comfortable with my blood sugar being in the two, three hundreds for like any period of time, and I would like to start insulin. At that point. She wrote me a script for Humalog I didn't take any Lantis I've actually never We're taking Lantus ever before for any long acting insulin. And so I, she, she wrote me a script for like the junior pen. So I could do half the units because I'm really insulin sensitive. And she said, Just give yourself two units and see what happens. And that was it.

Scott Benner 20:18
Good luck. Yeah, that was the whole thing. Just jam it in there and see what goes on. And then you probably you don't seem like you were ever daunted by this. Is that fair?

Elise 20:28
I mean, I wasn't. No, but I could see someone being quite overwhelmed. Why not?

Scott Benner 20:35
Do you think I mean, I guess cuz you listen to the podcast all the time. You probably felt like you knew what to do already. Yeah,

Elise 20:39
I mean, I knew exactly what I was doing. I was very prepared. I'd had a couple of roommates that had type one before, because of this weird, special interest. This

Scott Benner 20:48
special. You just put you on like, you guys need an apartment, you have diabetes, I'd prefer someone with diabetes, if you don't mind. Well, because what

Elise 20:56
happened? Okay, so when I discovered the special interest, I did an internship at Vanderbilt, specifically in like diabetes research, and the other people in that program. Were interested in diabetes because they had diabetes. And I was just the random person with a regular pancreas at the time.

Scott Benner 21:13
I like how you like slipped in the name of the college there. I was nice.

Elise 21:18
But, so that was a chaotic time. So at that point, I started insulin, I very quickly realized that just giving myself two units anytime I ate was not doing anything. And I made myself carb ratios. And at that point, I pretty much stopped talking to my Endo. I didn't I didn't really ask her anything, because I knew pretty much everything I needed to know, from essentially listening to the podcast for as many years as I had been. That's such

Scott Benner 21:49
an odd thing. Does it strike you that way? As you're saying, even

Elise 21:55
saying it out loud. Yeah, I was just very confident in the fact that like, I don't know the first time I gave myself insulin, I was definitely a little bit weirded out. Because I just had no idea how my body was going to respond to exogenous insulin. But once I did like the first injection and realized I wasn't going to be like, 16 in an hour. I was fine. You're on your way. Yeah, it

Scott Benner 22:21
honestly it feels like if I was walking outside. And someone said, here's an obstacle course I need you to run through. I'd be like, Oh my god, this is great. I've been watching Mr. Beast videos for years. I'm all ready for this. Like, like, really? Such a strange? Yeah, it was

Elise 22:34
like, I know how to Pre-Bolus. I know, like, I got, I've got this, I can do this.

Scott Benner 22:39
Oh, my gosh. And so you're never going to know, a lot of the difficulty that people often have to experience?

Elise 22:48
I would say so probably. Yeah.

Scott Benner 22:50
Interesting. Oh, okay. Can you tell people a little bit about what you're doing for your PhD? 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.

David 23:07
I use injections for about six months. And then my endocrinologist at a navy recommended a pump.

Scott Benner 23:13
How 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 23:23
I was medically discharged. Yeah, six months after my diagnosis. Was

Scott Benner 23:27
it your goal to stay in the Navy for your whole life? Your career? It was? Yeah,

David 23:31
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 23:44
most. Was the Navy, like a lifetime goal of yours? lifetime

David 23:48
goal. I mean, as my earliest childhood memories were flying, being a fighter pilot, how

Scott Benner 23:53
did your diagnosis impact your lifelong dream?

David 23:56
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 and help guide away 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. Stick

Scott Benner 24:22
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.

Elise 24:36
So my PhD is in immunology. So I'm looking at the way that our immune system responds to infection for my PhD, but for like longer term things I'm interested in autoimmune disease and malignancy. Kind of the way that our body identifies things that are self and not self. Okay.

Scott Benner 24:56
And what it does once it realizes later why It gets confused about what is what? Yes, yeah. That's interesting. I want somebody to start researching how GLP is are going to help people with type one and autoimmune to. It's

Elise 25:11
very interesting. There are a couple of groups that are doing a lot of work on G LPS in addiction medicine. And that's fascinating also, but I think the the type one world is definitely up and coming.

Scott Benner 25:24
I keep talking to people over and over again, I've got them some lined up to come on the show, using just significantly less insulin. Yeah,

Elise 25:35
I take basically no insulin, and I want to make that pretty clear. I caught my type one, at a point where I probably wouldn't have been diagnosed for another year to three years. Had STI Nanos? Yeah,

Scott Benner 25:51
yeah, no, I understand. I know you're not using a ton. But I'll say this. I've been slipping it into some episodes here and there. I've got Arden using a point two, five of ozempic every week. So what they don't even consider to be a therapeutic dose for weight loss. My best guess is that she's going to use 11,000 fewer units of insulin in the next year. Wow. That's the reduction we've seen already. That's crazy. This is absolutely not. And she's lost some weight, which I mean, I didn't look at her and think she had to but now that she's lost weight, I'm like, Oh, okay. I see that. That's yeah, you know, you look healthy. It's really fascinating. It really, really fascinating. I can't say enough about it right now. Anyway, Jesus. So what made you want to come on the pot? Like, like, really? Did you have like this moment where like, I was diagnosed, now I can go on the podcast.

Elise 26:43
Yeah, I think like many years ago, I remember like almost sending you a message being like, I should go on. And I was like, What am I doing? I have actually nothing to say about this.

Scott Benner 26:53
I Scott, I'm an engineering student who? Did you ever work with your engineering degree? No,

Elise 27:00
no. Yeah.

Scott Benner 27:03
So you went to college for four years? Yes. You completed a degree? Yeah. You got out. And you were like, I don't want to do that.

Elise 27:10
Well, so I double majored in engineering and biochemistry.

Scott Benner 27:15
All right, hold on. Let me get back to my initial question. How smart are you? Exactly?

Elise 27:21
I don't have any I don't think that I'm any smarter than any other person. No, no.

Scott Benner 27:27
Don't do that. Do you know your IQ?

Elise 27:29
I do not know. Really?

Scott Benner 27:33
Do you find yourself juggling ideas on multi levels, all at the same time? Seeing all different perspectives of something and thinking about more than one thing at once? Definitely.

Elise 27:44
But I also think that might have to do something, have something to do with the fact that I definitely have undiagnosed ADHD.

Scott Benner 27:50
Listen, I'm tired of people saying that, just because you can couple things at once. That's, that's nothing. I mean, you you finished a degree that takes a level of persistence. And like, Were you on the Adderall during college? Are you okay? No. Well, then, how many kids are using Adderall in college? By the way? So

Elise 28:06
many, but honestly, it's way worse in med school? Oh, I bet. Yeah, it's crazy. We have to take this board exam at like second year. And there Yeah, people are crazy.

Scott Benner 28:18
To get it from a doctor, or do they buy it another way? All

Elise 28:22
of the above? Something?

Scott Benner 28:26
Yeah, I'm not a fan of obviously using it recreationally to? Yeah, to do that kind of

Elise 28:32
I mean, it certainly has its place. And also, I don't I don't really get the appeal to be quite honest. I don't know that I need to be any more focused and driven. Yeah.

Scott Benner 28:42
Why do you think you have ADHD, it's undiagnosed. I

Elise 28:45
just have a lot of trouble, like narrowing in what is going on in my brain when there's a lot of stimulus happening. And my thoughts happen, like in silos that are running parallel to each other, but in a way that they all connect to me, but probably make literally no sense to anyone else. And so I flip flop from ideas pretty quickly in a way that if I don't sign post them very consciously, no one has any idea what I'm talking about. This

Scott Benner 29:22
is a problem for you. Where do you live? It's how does it present as a problem?

Elise 29:29
I have to very consciously think about the way that I phrase things and how I convey information to people and I have like formulae that I use to convey information in a way that I think it will be best digested by any given individual at any time.

Scott Benner 29:47
And what happens if you don't do that? Do people treat you oddly

Elise 29:52
think they just don't understand what I'm trying to convey

Scott Benner 29:55
is that possibly because you're smarter than they are?

Elise 29:57
I don't necessarily think that That's true, because there are also a lot of areas in which I am very unintelligent, I have probably the worst common sense you may have ever experienced in your life.

Scott Benner 30:10
You lack common sense.

Unknown Speaker 30:12
Yeah. All right.

Scott Benner 30:14
Well, I'm not great at everything. There's things I'm very bad at, as well. Like, but my brain works. I mean, I have a note in front of me here about a series that you're going to hear on the podcast six months from now, probably, if I can pull it together quickly enough. I already know what the content is, combine to format it, how I'm going to deliver it. I think that there are two companies that would be interested in buying advertising on it. I have a plan set up to record it, and to pull it all together. And then to send it out to them to see if they're interested in advertising. And I thought of that one night at four o'clock in the morning when I woke up to go to the bathroom. But does that make me weird?

Elise 31:01
No, I don't think so. All right. And

Scott Benner 31:03
it's going to work. It's really going to help people, like I think, consciously and sometimes subconsciously, about how to help people with diabetes. Yeah, most of my good ideas come in the shower. This one came in the middle of the night, when I'm not gonna lie to you. I was a little cold, and I was paying. And then I got back in bed. And I was like, trying to warm back up again. You know that like back in the covers thing? Yeah, come on, get warm, get warm, get warm. And my brain goes, what are we going to do with that idea you had about like the micro content, the shorts, we should do something with that. And I'm like, Alright,

Elise 31:34
do that. And then I text myself. It's on a whiteboard behind

Scott Benner 31:37
me. I have a giant, I have a giant whiteboard with all of my ideas for the podcast. And I stare at them for weeks and months and walk past them until one of them like smacks me in the face and says, do this. And here's how to do this. And, but, but while I was sitting there, thinking about it, at four o'clock in the morning, really knowing full well, I was gonna go back to sleep. As soon as I got warm again, I started walking through all the different arms of it, like how I was going to record it, how it was going to present it to people where I get the information from, what companies that I think might be interested in putting ads on it. And then while I was thinking about that, it also occurred to me that I've got this company, it's reached out to me about translating my stuff into Spanish, through AI, but audio, like not like text, like they would actually take mp3 files from the podcast and just turn them into Spanish speaking. And I was like, if that works, then I could do the bold beginnings and the pro tips in Spanish, it's going to be expensive. I'll have to get somebody to offset that with ads. And like so then I was thinking about two different projects at the same time.

Elise 32:49
But I don't have ADHD. Yeah, but those are still related in a way that like, I can see how you logically got between those two concepts. So

Scott Benner 32:59
you're saying that in that conversation with yourself, you start wondering if Andrew Garfield or Tom Holland was a better Spider Man,

Elise 33:07
or something completely discussed something completely unrelated? Yeah.

Scott Benner 33:10
Like I don't give a about Spider Man Scott. But by the way, is it Tom Holland or Andrew Garfield? Or do you have no idea?

Elise 33:18
I have no idea. I'm not particularly plugged into pop culture. I don't have a lot of time for that. Yeah.

Scott Benner 33:25
You don't sound like a personal a lot of time between diabetes we When did when? Hashimotos. When were you diagnosed with that?

Elise 33:32
I was diagnosed at eight about the Crohn's guy was like 1819.

Scott Benner 33:39
Is that persistent? Something you deal with constantly?

Elise 33:42
Yeah, actually, it's very interesting. I was on a medication and an immunosuppressant for Crohn's. It's an TVO. You probably see like a bajillion ads word every day. Okay, that a lism ab. And it is a drug that blocks the ability of lymphocytes or immune cells from trafficking through the walls of your certain organs. And this case, they use it to prevent lymphocytes from going into the gut. And so it can be a really specific way to decrease your immune system with respect to an autoimmune disease without completely tamping down your whole immune system. So this is a drug that I was on for about four years, I had a weird like random insurance thing happen where I got pulled off of it last January, about a year ago, because of a coding issue was the whole thing. But I stopped the drug. And about six months after that, I started having my dysglycemia that I hadn't noticed before, aka like I had diabetes now. And very recently, I have learned that that drug is actually currently in clinical trials as a drug to prevent the onset of type 102

Scott Benner 34:52
Like tz old, one of the like that idea, but less

Elise 34:57
immunosuppressive than tz Okay, I'm not, unfortunately not eligible for T Ziele. Otherwise, I probably would have taken it but I yeah, I am not eligible.

Scott Benner 35:08
So your insurance company gave you diabetes, that what you're saying, basically, yeah, we should come down on them. Yeah.

Elise 35:15
I have health care. They're going out.

Scott Benner 35:19
I like that you were willing to call them out. Oh, I will. This girl struggling she got type one. Yeah, happy. Yeah, now you're buying her insulin. Right? I mean, what the hell? And what about the Crohn's? How does that present? My

Elise 35:33
Crohn's disease is mostly in my colon, but I also have a little bit in my small intestine, so I don't absorb vitamins minerals, particularly well. So I'm anemic. Most of the time I get iron infusions. I'm low and all of like my B vitamins. D vitamins. So that the UK supplement of those, but yeah, when I'm on medication I'm I do very well.

Scott Benner 35:55
Okay. Interesting. I'm starting to think my irons a little low. I'm trying to get ahead of it with supplements, but my my fingernails feel a little wavy. Do you know what I mean? Yeah. And I'm a little getting tired. In the afternoon a little bit. Yeah,

Elise 36:10
I can't, like I can take so much iron orally, and I will not absorb it ever. So when

Scott Benner 36:18
I mix it with vitamin C, at the same time, I get a little better pickup with it.

Elise 36:22
I've done all of the things. I'm taking, like 80 times the recommended dose at one point like, yeah,

Scott Benner 36:30
see if it would stick to you. So yeah, no, it sounds like you're experiencing something a lot more significant than I am. But I still like, you know, I can get about every six, nine months and like my is my iron low.

Elise 36:41
Yeah. Once I have the infusion I hold it for like a year or two. It's just getting it into my body is hard

Scott Benner 36:47
and drifts down. Yeah. The infusions are crazy. I don't fantastic. They're fantastic. They changed my life actually. Yeah. Well, Jesus, sorry. So you've had Hashimotos taken just before for that?

Elise 37:01
I don't I'm not I'm medicated for it at this moment.

Scott Benner 37:04
What's your TSH?

Elise 37:05
I think my last TSH was like 1.2.

Scott Benner 37:09
Yeah, that's good. Okay, yeah. You're not taking anything for that. krones you were doing an injectable they took the injectable from you. Do you think you'll get it back? Yes,

Elise 37:19
at the moment, I'm completely off of drug because I'm going to have a scope in like 14 days or so. And then they're going to take biopsies and try to petition to my insurance company that I do, in fact, need some medication, which will be very interesting. Maybe I suddenly won't need insulin anymore. If I go back on it.

Scott Benner 37:38
I would be, you know, whatever. That wouldn't be as nice as i Are you which way did they go for that? They go down? Both ways. Yeah, good times.

Elise 37:49
Yeah. I mean, honestly, people people lament that and a lot. I don't think it's that bad. But also I have Crohn's to start with. So it's really just like a Tuesday for me.

Scott Benner 38:00
Sketchy on both sides. That's okay. All right. Yeah. Well, good luck, I hope you are able to tuck the insurance company into giving you what you need. Thank

Elise 38:06
you. Thank you. Yeah, that's quite so then I also I very forcibly forced my endo into putting me on a pump. Probably about three months after I was diagnosed. Why did you I never went off on any long acting. So I just started with like, playing around with my basals. Right. I also never good training. I just put in whatever I felt like was that all worked out? Yeah, it worked out great.

Scott Benner 38:35
The doctor doesn't argue with you at all at this point. Not really.

Elise 38:39
I think I think the results like speak for themselves. So she's less she's less worried about it. But very interestingly, when I started I was saying that how I was spiking really high and then dropping really low before I started on insulin, right? When I take insulin, the drop is completely gone.

Scott Benner 38:56
It's because your body's your body's not trying. Yeah, so if I

Elise 38:59
give myself insulin and I even if I do spike a little bit, I will not. I have far fewer lows on insulin than off which I find fascinating. Okay.

Scott Benner 39:10
No, I did too. It's a little strange. Because why would your body know that you've put in insulin unless your Pre-Bolus thing so much that your blood sugar is not changing so your body never tries to impact it?

Elise 39:21
Yeah, I mean, I don't really I have pretty high standards for where I like to keep my glucose so I don't spike enough I don't think in order to trigger that insulin release from my remaining beta cells because I do have a measurable C peptide still.

Scott Benner 39:40
Yeah, you do. All right. Any other autoimmune in your family feels like there has to be Yeah,

Elise 39:48
yeah, my mom has like vitiligo Hashimotos, many many and autoimmune.

Scott Benner 39:53
Any Raynaud's? I don't think so. cold fingers. What are we talking about? Seriously? joints.

Elise 39:59
No, no. All right. I'm aware of I think I have a couple of people with RA and my family history, some celiac disease.

Scott Benner 40:05
Oh, how Caucasian Are you guys? Irish? Barry? Are we talking about Italian? Okay. Okay. It runs through your mom's Italian.

Elise 40:14
No, my dad's side is Italian. My mom's side I think is? I don't know, actually, my dad would be very annoyed

Scott Benner 40:22
to you. You don't know your your mom's lineage is.

Elise 40:24
My dad wrote a book on our ancestry too. This is really embarrassing. I think she's Scottish.

Scott Benner 40:31
Oh, that makes a lot of sense. Yeah, yeah. The Italian is not where you got the autoimmune. My again. Yeah, I'm not being very specific. I'm being like, what I've learned talking about evidence is not evidence based. By the way, that'd be a great title for your episode. This is not evidence based. But that Scottish thing. I get that, like, stay away from the pasty people if you don't want autoimmune in your life. Yeah,

Elise 40:55
so. So we have a lot of the autoimmune but so I, I just kind of put myself on to the Omnipod. I was really trying, I wanted to loop because I thought that was just the coolest mesh ever of being able to use my engineering degree and like write some code. But my insurance for whatever reason would not approve a dash. And like I tried for like four months to get them to approve it. And then the first time we tried with Omnipod, five it went through. So I've been using Omnipod, five and manual.

Scott Benner 41:23
Where do you get your insurance from through the program? You're in? Yes. Yeah. I wish I should have been a doctor, I'll take eight years to do something. I mean, how's the house? There's no bugs.

Elise 41:34
They don't they don't provide our housing. Oh, but

Scott Benner 41:38
the stipend I mean, are you able to like, like, are you living? Okay.

Elise 41:42
I mean, I worked for several years prior to starting the program. So I was in a position where I was able to be financially comfortable. But I think if you came straight from undergrad, you might have a hard time

Scott Benner 41:54
I say it's not that much money. No, I was thinking of trying it just to take a break. This real world stuff in the Navy. Yeah. So it's a forever student. Yeah, I get somebody to flip the bill. I pretend I want to be a doctor for a little bit, you know, then I go, Oh, nevermind, I gotta go. Well, I swear to you, that's a lot of any chance you're going to change your mind seven years into it.

Elise 42:17
I really hope not. I am a person that is more on the research side than the clinical side, which is, I think, more in the minority of physician scientists, which is kind of like what our field is called. Yeah, I generally like the ideal when they talk about like, what are physician scientists? Like 80%, research 20% Clinical to like a day in clinic per week. And then the rest doing research is like what they like, forecast is optimal. But not everyone goes that path. People end up in industry, people completely ditch the PhD and just work clinically because they get paid more. Some people go into specialties that make it more difficult to maintain research. Yeah.

Scott Benner 43:05
So you kind of have to just let everybody find their way to fill all the needs that exists. Yeah. That's I'm just saying you, me, you bailed on that engineering thing. I'm just wondering if you just

Elise 43:15
know, I still I'm glad. I'm glad that I majored in engineering because I do have a bit of an engineering flavor to my immunology, PhD. I guess you could say, I'm interested in like, high throughput machinery to look at cells on a single basis, and like how we create those machines, and also how we analyze huge amounts of data with computer programming. So it's all related. I didn't just completely drop it.

Scott Benner 43:44
I'm just teasing you. It's fine. Don't get upset. You're not upset.

Elise 43:48
No, I'm not sad. I would never i If I could go back and not do a degree in engineering, I would absolutely not do it again.

Scott Benner 43:56
You went two years into your med school before you switch back to the PhD for this gap here. Did you guys cover diabetes yet in med school?

Elise 44:05
Yes, yeah, I had finished my second. So my school does a one and a half year pre clinical curriculum. So you learn everything about all of the organ systems in a year and a half, and then you go into clinic and like keep learning, like practical skills essentially after that. So I had finished all of my pre clinical coursework. When I was diagnosed,

Scott Benner 44:27
did you learn enough in med school to help people with somebody there diabetes?

Elise 44:31
We did do a simulation one time on someone in DKA. So I think I had a pretty decent idea of like, how to manage acute DKA. Like certainly not by myself as a second year med student.

Scott Benner 44:43
You know what I'm saying though, at least I'm trying to figure out like, what's the amount of information people get about diabetes? Three,

Elise 44:49
we were taught more about how to handle diabetes in an acute setting with respect to type one in DKA. And that was pretty much it except for the fact that like, type ones have to be on insulin. But there was no, like further education. I mean, I guess they kind of go into like sliding scales and that kind of thing, but it's

Scott Benner 45:13
about where it ends. Yeah. Define acute for people.

Elise 45:16
Acute as far as like you show up at the IDI, you know, have new onset type one diabetes, like or are in DKA. That type of management setting I would say is what med school like prepared us more for. But then I also will say that when I was diagnosed, so I'm 28. I was 27, when I was diagnosed, the number of my peers and also physicians that were like, aren't you old for? Like, okay.

Scott Benner 45:49
They don't really know anything. You're saying? No, no idea. Yeah, no, I don't think anybody does. That's okay. I'm not blaming you or them or like anybody else. I just don't think it's I mean, I think medical school is what it is, right? It's yeah, they

Elise 46:01
teach you how to save someone from dying, not necessarily how to manage them in everyday life, which is like, also, when I was in the hospital, like I signed a thing to be like, I am in charge of my insulin and will like, take care of that, which they didn't really care about. Because I was on the orthopedic ward. Honestly, they were just thrilled to not have to deal with it themselves. Yeah. But

Scott Benner 46:21
that's my finding is that mostly they, if you can do it, they're like, Oh, good, because I don't know what I'm doing. Yeah,

Elise 46:27
they did try to fight me one time, I was like to add something because they'd given me a bunch of steroids in the car. And I was like, I'm giving myself insulin now. And they're like, No, you can't, you just ate. And I was like, what you I don't think you understand.

Scott Benner 46:39
So a person saw that you had recently given yourself insulin for food. So they thought that meant you could not have any more. First

Elise 46:46
of all, he told me, I shouldn't have tested my blood sugar, because it wasn't four hours after the meal. And that even though my blood sugar was 283, and I knew that, like I missed and I needed more insulin, he was like, You can't give yourself more insulin.

Scott Benner 47:00
I think it's incumbent upon me to say that a lot of times the medical people you're running into in your life, are regurgitating stuff off of a one sheet, you know, bullet pointed list that they learned in med school years ago, they don't know why there's what that

Elise 47:19
was that was an RN? To be fair, yeah. I

Scott Benner 47:22
don't know, Well, who else should I expect to understand diabetes, if I don't expect a nurse to do it? I

Elise 47:27
mean, I think that it is a very unique disease, and the fact that the individuals who have it are more experts than the people that treat them, because of the learning curve, of having to deal with it day to day. And personally, like, from my perspective, I think that that's true of nearly every human condition. And that, like, our patients are the people that are living this life every day, and like they are really the ones that like, like you get to make the plan and like I'm just going to support you in whatever way I can do by giving you the information and helping you make the best decision that you feel is right for you. It's about your experience your lived experience with it. So I I don't know how much like they can actually teach you about what it's like to live with any disease.

Scott Benner 48:18
I agree. I mean, I've been doing these series now for a while with doctors and talking to doctors and listening to what doctors know about what they see at their jobs. And I just got done interviewing this endocrinologist the other day, who's a young guy and has type one for you know, since he was like, I think 18. And I'm like, so what's the answer? And his answer was a lot like yours like, well, it's, it's kind of on them, you know, after a while, and I'm like, gotcha, get just no one if there's a bigger answer. It doesn't exist right now in the minds of the people who are doing the work, or they can't get into practice or anything. Can you talk about the thing that you told me before we started recording or can you not talk about that? I

Elise 49:01
can talk about it more vaguely Go ahead. So as a part of my time during med school, I have done some work looking at basically case reviews and chart reviews of every individual with a type one diabetes diagnosis under the age of 18. That was admitted to our major academic institution over the course of two years. And in this analysis, we are looking at the amount of time between a hypoglycemic, blood glucose coming through and the time to recheck going off of ADA guidelines seeing how close to standard that is looking at individuals that were admitted with DKA. And looking at how quickly they were switched from IV back to sub q insulin and whether or not that was done in the appropriate manner. And just in general errors of insulin dosing, hypoglycemic management that may lead to further DKA or A longer admission over the course of any of those individuals time. And then we stratify that by a whole bunch of things like, you know, what was their agency when they came in? Like, is this a person that has had multiple admissions over the course of that period of time? Was this their first onset? etc? And can we stratify? What is making those errors or incidences more frequent? And how can we work to prevent them?

Scott Benner 50:25
What do you think you're going to learn? And what do you think you can present that would offer another idea?

Elise 50:31
I don't know that I have a great solution. But I can tell you that there are problems. What which I think we all know, but has not actually been published, right? Every person that has type one in their lives knows that when you are in an acute care medical situation in the hospital, your type one is not necessarily being managed, as well as you might want it to be managed. When you're at home, depending on the person, right, every person manages very different. The type of person that's typically the audience for your podcast, I would say, would have that feeling. But there actually is no evidence base to confirm that. So a lot of this research that we are trying to put forth right now is to demonstrate that that is, in fact a problem, because we can't lobby for change unless we demonstrate that it's a problem. So that's the first step is just proving to academia at large that we are bad at this. And this is proof of that

Scott Benner 51:32
people's outcomes aren't enough proof.

Elise 51:34
I mean, I think that like an individual case report, here and there have been done, and it has been well studied in the adult population. And of course, patient stories are the most important. But as far as getting funding for change to be made in a way that is actually like, going to make improvement, you need to demonstrate on a larger scale, like proof that this is a recurring problem.

Scott Benner 52:02
Okay. They should ask me, I talked to a lot of people. Yeah, I think we don't hear from most of the people who are not doing well. Yeah,

Elise 52:12
I mean, I think to the point of this particular study is looking at it from more of an unbiased situation. So we have pulled every single chart of every single type one that was at this hospital, and every single data point from the entire time they were admitted, whether or not the bad admission was related to their type one or not, and have very clear set algorithms that pull out data that don't match with what should have happened, an individual might not even know that certain mistakes or differences to what is like the standard of care might not have happened. And so this enables us to pull that in a way that is a little bit more unbiased. Wish you

Scott Benner 52:58
luck with it. It's my contention that when you set expectations, at higher numbers, or with more variability, especially in a setting that's medical, you then are programming people at home to be accepting of those limitations and variables, instead of thinking that maybe they're impactful. Yeah. And so yeah, that's a shame, really, because you don't realize it in that setting. You know, you're in the hospital for a couple of days, and somebody says, Oh, we're gonna leave your blood sugar at 230. It's okay. Well, then you go home thinking 230 was okay, like the nurse said, so? Yeah, you know,

Elise 53:33
I mean, even for myself, I obviously have very frank conversations. I've switched on the providers now. And then I do really enjoy my Endo, but she definitely thinks that I have more stringent glucose, like management guidelines than are necessary. We do. I wouldn't say arguments, but points of contention over that, because I'm a person that I really don't want myself over 130 ever if possible. That's not to say I don't go through 130 I do I have diabetes. But I am not going to let myself sit in the 130s. And if I see a blood sugar that's in the 140s 150s I don't entertain that. Yeah. Like since I've started insulin, I have never been over 180

Scott Benner 54:20
We give you a doctor that endocrinologist diabetes, and I bet you they'll all of a sudden think does

Elise 54:26
have diabetes.

Scott Benner 54:29
Yeah. Oh, how old? I

Elise 54:31
don't know. I would say she's in her 30s. Hmm. Interesting.

Scott Benner 54:34
And when you come to her, doing what I'm assuming is better than she's doing for herself personally.

Elise 54:42
Well, I will say to I am honeymooning very aggressively. So I have a little bit of an edge. You're very

Scott Benner 54:47
nice to like to make sure we keep saying that. But but that's not my point. My point is is when you come to her

Elise 54:52
I have no Basal half the day level of honeymooning. Yeah, that's the

Scott Benner 54:57
same but she doesn't look and go I wonder what this person and knows that I don't know, she just thinks you're putting too much effort into it.

Elise 55:03
I mean, I do think that like, I am a very type a high strung person. And I think that there's a part of her that thinks that I'm putting too much time and effort into this.

Scott Benner 55:15
Do you think that's happening?

Elise 55:16
I think at times, I think that there are certainly times where the amount of brain space that I put towards my diabetes when like, at the end of the day, are those 15 minutes at 160 really gonna be the kicker, like, No, you know, the kicker.

Scott Benner 55:31
To me, the thing that makes you kick the bucket, is that what you're Yes, yeah. Yeah, I'm not saying your blood sugar can't go to 160. And that, you know, that's not what I'm saying.

Elise 55:41
I do i per separate on that. So I think that like she is legitimate and some of her concerns,

Scott Benner 55:47
okay. Is there a way for you to accomplish your goals without over focusing?

Elise 55:53
I mean, I think that's just kind of my nature in general. I'm working on trying to like find a little bit more of a balance with it, especially because I know as time progresses, it will become probably more and more difficult to manage my blood sugar's as I thought honeymooning. Alright.

Scott Benner 56:11
You're the first thing to say, per separate on the podcast, in case you're wondering. I use a lot. I try not to whip out my big words, but that was good. I like that.

Elise 56:22
Yeah, no, I sit with it a lot. I don't know. But yeah, I take I take tiny amounts of insulin, Tiny.

Scott Benner 56:29
Well, are you fearful that when your honeymoon ends, that you won't be as good at this as you hoped to be?

Elise 56:35
Definitely. I think that a large part of me thinks that I'm only as good at it quote, unquote, as I am because like, I call it diabetes light, like li te. Or like, I have one. One individual that has diabetes that causes diabetes. It's just like, the the easy version. Like I have like the bumpers on while I'm playing but like, well, I'm bowling.

Scott Benner 57:00
Yeah, give me your honeymooning. So it's not. It's yeah, what it is. Yeah. But I'm wondering if like, psychologically, you're concerned that when the honeymoon ends, that you're going to overwhelm yourself with worrying? Or is that your doctor's concern?

Elise 57:15
I think that she that's probably her concern. I mean, I'm worried that I won't be able to maintain as tight of control as I have now, which is probably true. To be quite honest. I would think so. Yeah, yeah. But I also think that I'm probably underplaying the amount of tools that I have, and that at the end of the day, it's the same, like my brain is using the same algorithm, just with different volumes of insulin. I agree. That's not going to change the way that insulin works. And the way that my body responds is not going to change. It's just the amount of insulin at each of those encounters that will Yeah, no, I agree, which already happens. Like my, the amount of insulin that I need, day to day varies between like, two units and like 20 units at any given time. So part of me also thinks about that, because I think most of me thinks that it's gonna get harder. But then part of me is like, maybe if there was just an ounce of consistency, like if all of my beta cells were gone, that would be a little easier. Yeah. Because I never know,

Scott Benner 58:13
perhaps you'd be able to show yourself that you do know what you're doing. Yeah, I think you're gonna be more experiences. And they'll come obviously, as the honeymoon wanes. But it sounds to me like you'll be okay. I mean, I would hope so. So you're not overwhelmed by it? Or you?

Elise 58:29
I wouldn't say I'm overwhelmed by it. I think that there are there's an appropriate amount of concern over managing it. Yeah. But

Scott Benner 58:37
if I find you in a quiet moment, you're not staring at a wall going. I'm gonna kill myself with a diabetes like nothing bad's. Right. No,

Elise 58:43
no. And I also, I do think there are things too, that I like, because I have more chill vibes, diabetes at the moment, I'm probably not as concerned about as I should be, for example, low blood sugars really don't concern me. And they probably should. It's very different. Like for people that I'm caring for, like interacting with, I have very different expectations and standards than I do for myself, because I know my body very well. And I know that like at this moment in time, my alpha cells, which are the, like, Sister cells, the beta cells in the pancreas, which produce glucagon, that helps you raise your blood sugar when your blood sugar is low, that's mine are still functioning really well. So I don't need to catch my lows as aggressively like I can sit with a 70 double arrow down and know that I'm probably not going to need to treat that which I think scares the hell out of my partner.

Scott Benner 59:35
I beg it does all that beep beep beep and you're like, that'd be probably gonna be fun. Yeah. Like, are you sure? Okay. All right. I'm good with all this good talk a little bit about you said to me before we started recording. you babysit a type one?

Elise 59:51
I do. Yes.

Scott Benner 59:53
How did that go? Yeah.

Elise 59:54
So he's two and he was diagnosed, I would say about A year ago, so he was just like 1214 months, I think when he was diagnosed, it's helpful that we both actually I babysat him last night and he put my Omnipod on for me in the most uncomfortable position on my arm that ever could possibly exist. But I'm just vibing with it for three days, because he wanted it there. And I was okay with that. But yeah, it's very interesting. We actually the two year old and I take very similar amounts of insulin and have very similar, almost all of our settings, like our pump settings are the same, except for my correction factor is a lot more aggressive. But like our insulin to carb ratios, and our bagels are very similar. But his like, correction factor is like one to 200. And mine's like one to 50. Okay.

Scott Benner 1:00:46
One to 50 is one to 100. Yeah. Oh, that makes sense. Do you make decisions for that kid while you're babysitting about their insulin? Are you following rules from parents?

Elise 1:00:57
It's a little bit of both. So they have I set up with them, like, you know, where do you feel comfortable having his blood sugar being also knowing that he's two, he doesn't know when he's low or high. And you can't always reliably get him to consume something. So running a little bit on the higher end is what they're more comfortable with. And I'm plenty happy to abide by whatever they're comfortable with. Yeah, he actually he just recently in the last, like, month or so switched into auto mode. And that's made a huge, huge, huge, huge difference for him.

Scott Benner 1:01:33
Well, there's a lot going on here.

Elise 1:01:35
I would love to do auto mode, but I really don't want to deal with well, actually, technically, I talked with the Omnipod reps. And they said that I should not do auto mode, at least not yet.

Scott Benner 1:01:44
Because you have time. So you absolutely don't need basil. Well,

Elise 1:01:49
yes, there's times that I absolutely don't need basil. And also the amount of insulin that I get from basil, versus the amount of insulin that I get from boluses is like 10 to 90%. So like compared to like a one to nine ratio, essentially. And because the algorithm is built in a way that it's estimated on a 5050 split, they basically said I would break the algorithm to try with it trying to figure out how because my TDI would be so much higher than my basil are requiring.

Scott Benner 1:02:22
I actually don't see how it could possibly work for someone in your situation. Yeah,

Elise 1:02:25
so I'm just vibing in manual mode, which works for me anyways, because I have a g7

Scott Benner 1:02:30
Yeah, that sounds good to me. You're doing great. So what do you do? Do you get like zero basil for a while?

Elise 1:02:35
Yeah, my basil will have like three basil programs, one for when I like suddenly don't have diabetes anymore, which is like I think a whole two units a day. And then I have one Basal program that's like my normal, which is two and a half units a day. And then I have a high Basal program, which is like five units a

Scott Benner 1:02:55
day. How often do you find yourself not needing anything? My

Elise 1:02:59
Basal is zero overnight, always. I need no basil overnight. Where's your blood sugar sit then? It depends. I would say most of the time unless I have like a high fat high protein meal for dinner. I will sit in the 80s or 90s overnight, but I do have a high fat high protein meal and I don't do an extended Bolus or I missed the Bolus a little bit then I might sit and like the one hundreds 110s But nothing higher than that pretty much ever

Scott Benner 1:03:26
wonder how long it'll go on for? Yeah,

Elise 1:03:29
so I have no Basal overnight always. And then my my basil just kind of like increases throughout the day. I need the most basil like in the evening.

Scott Benner 1:03:38
I see. That's really interesting. But

Elise 1:03:41
again, I've never been on Lantus. So I like Randy long acting, so I have no idea what that is in comparison.

Scott Benner 1:03:47
Yeah, I don't know if that matters. I'm just it's just super interesting that, you know, no need overnight. 110. I mean, obviously you do have, let's be clear, you obviously have a Basal need overnight, because your blood sugar's Well, my body is just creating it. Yeah. You know, if you didn't have diabetes, I mean, your overnight blood sugars would be in the 80s. Probably. Yeah. Yeah. So there's 30 points there. You can maybe get away with some basil overnight, on

Elise 1:04:12
certain nights. Yeah, I would say on most nights I run milk when I was last night

Scott Benner 1:04:17
because you could get low overnight with basil. Yeah, gotcha.

Elise 1:04:21
Last night, I was running mostly in the 90s. Okay, but then I occasionally like will go into like this 70s 80s and then pop back up. And

Scott Benner 1:04:32
I understand. Okay, listen, is there anything we haven't talked about that we should have? I

Elise 1:04:37
don't think so. One thing I think is very interesting, just from like, I'm a numbers person you may have gathered, I had my endo do a little experiment for me, because I wanted to know how accurate GMI percent was. So I did. I had my GMI from my Dexcom data. And then I had our poll and agency which is an average from the last Three months approximately. And then I also had her do a fructose Amin, which does an average from approximately the last three weeks. And the difference between all three of them just kind of blew my mind a little bit. And then that just makes me think do we actually like do we does anyone know what their blood sugar is ever? Because I don't think so like we're just all doing our best with like what we have? And because all of the forms of measurement have some amount of error and or are not the best measures, and we were just doing our best, but I find it interesting like how much again, we per separate over this one number, when in reality that's probably not even your blood sugar. Probably close. Yeah, I've

Scott Benner 1:05:42
had that thought I've had that thought since day three with diabetes. When the first time the they came in with the meter that they gave Arden and the meter that the hospital had. And they were so far off from each other. I was like which ones right? Yeah, she's like, go with the one we get. We're giving you I'm like, but that one says something different? No,

Elise 1:06:03
yeah, but my CGM, I think was five, seven. And then if you might be one C was five one. And then my fructose. I mean, it's like a weird number in the two hundreds, but like equivalents to the A one C of like, five six, I think. Yeah. So I don't know. I thought that was interesting. The other thing is, too, I this week had this weird thing happened and thinking about like, what is accurate? Who knows? My G seven refused to calibrate I've never had like, I've never put in a calibration before. And it's just like, No, you can't, doesn't want you to do that. Yeah, so I was reading like 110. And I felt like I was dropping. So I did a finger stick and I was 47. So I went to calibrate it. And I it was the first time I had calibrated it. It was like day three of the sensor. And it rejected my calibration. It just said no.

Scott Benner 1:07:00
No, thank you. I don't know that that's ever happened before. To me.

Elise 1:07:03
It was the first time it's happened to me. It was very surprising. But yeah, this I still have the sensor on now this happened like a couple of days ago. They got itself together. And it was like accurate again the next morning. But weirdly ever since then, it's had like breach sensor errors every, like 20 minutes. I just have like gaps of data. So it's it's on its way out.

Scott Benner 1:07:24
Is this sensor like the one that's on oddly, because the kid pick this spot or no is that? No,

Elise 1:07:29
that's my Ami. Like in a weird spot underneath my arm right now.

Scott Benner 1:07:36
You didn't look at the end of what about over here?

Elise 1:07:41
I don't know I was trying to,

Scott Benner 1:07:43
you'd be like, No, that's not where it's going. Let's do it.

Elise 1:07:46
I didn't really I don't put like pads on my arms that often. I'm not really into it. So I hadn't tried many locations on my arms. And I was not aware that this was going to be as uncomfortable as it is. But it's only three days and I can survive.

Scott Benner 1:08:02
Barton is very specific about where she puts her stuff. Yeah, I

Elise 1:08:06
am also very specific about it because I tried for the first time last week putting an Omnipod on my thigh. But I am I'm a track athlete and a horseback rider and I really really like muscular thighs and I don't think I can use my thighs from the pods they Yeah, I don't think it'll work out.

Scott Benner 1:08:28
I've heard you call out your your muscular thighs. What college you went to a lot of a lot of like quiet like primping from you I hear it.

Elise 1:08:39
Oh goodness. No. Supposedly though, the the muscular thighs are why my incision opened when I had my surgery on your hip pelvis on my hip. Yeah, my my surgeon goes you know, this is a complication. I usually only see a young buff boys and I was like, Is that a compliment?

Scott Benner 1:08:57
Please don't use the word buff boys with me. Yeah,

Elise 1:09:01
I don't know what you're going for here, bro.

Scott Benner 1:09:04
Anyway, I can call this episode young buff boys where when people just be so disappointed when they get to it. They're like, Oh, you tricked us. So a lot of moms that listen to this show. I might be maybe I should do

Elise 1:09:18
your titles or one of my favorite parts of the episode.

Scott Benner 1:09:21
Thank you. I appreciate that very much. I've got that jotted down for you here not even kidding.

Elise 1:09:27
Oh my gosh. What evidence base was a good one? All

Scott Benner 1:09:29
right. Probably what it's gonna be though.

Elise 1:09:33
Yeah, young boys came in too late there. Yeah, I'm gonna

Scott Benner 1:09:36
go with not evidence based. That's what I'm going with that that's what I'm doing. Nevermind, but non. Yeah, the buff boys things for me. All right. Well, I wish you a ton of luck, Elise. I thank you so much for being a person who listened to the show didn't have diabetes. That was really nice of you. Yeah, well, it helped me out clearly. Who knew? I said before we started recording. I think you just surrounded yourself with so much diabetes you had no choice but to get it.

Elise 1:10:00
Yeah, exactly. Yeah. Apparently I did have a great aunt or something that had type one. No one ever told me until after I got type one. But

Scott Benner 1:10:09
what is a great aunt? I don't know the distinction. My grandmother's

Elise 1:10:12
sister, right?

Scott Benner 1:10:14
Is that a great aunt?

Elise 1:10:15
I'm pretty sure.

Scott Benner 1:10:16
I'm looking at the aunt of one's father or mother. Either side. Really? the aunt of a father? Yeah,

Elise 1:10:27
so my grandmother, sister. You don't know them? Right. I know. She died. Apparently when she was like 11 of type one. Supposedly.

Scott Benner 1:10:34
Look at you bumming us out the end. What the hell? I didn't know her. Oh, well, if you didn't know her, then it's fine if she's dead. I mean, as long as you didn't know her, I guess. Oh my gosh, how did I not know what a great aunt was? Is it Aunt aunt?

Elise 1:10:54
I think either. We didn't even get I did live in Australia for most of high school. We didn't even get there. Wait, how we got transferred there for my dad's job.

Scott Benner 1:11:04
That's your dad's job was writing books about something?

Elise 1:11:09
No, no, it was government contracting. But he wrote a book. No, he did that in his like, free time.

Scott Benner 1:11:15
Yeah, that's how people do it. They just write books for free times

Elise 1:11:19
ancestry. Are you and he's similar? I would say so. Yeah,

Scott Benner 1:11:24
I'm thinking so people don't write books. And if I've written a book and not one nearly, I'm assuming detailed as your father's was. And it's a lot of work. It takes up a ton of time.

Elise 1:11:34
Yeah, I don't know. He imports some cheese from like the town in Italy that like our relatives like came from and like he has to get special. Like you can only get it if you're a descendant of these people. I don't know. It's really into it.

Scott Benner 1:11:46
What's happening here? No idea. Actually, I'm letting you go now. Because that I do think that you're going to be wildly successful, and it's making me upset?

Elise 1:11:59
No, I hope so. I think I do want to go into peds and I'm contemplating endocrinology, just the only problem is, insulin is the only hormone I actually care about. So gosh,

Scott Benner 1:12:10
I don't know, I people talk about smart insulin and coming up with that kind of stuff. And I mean, it would mean so much to people, if they just didn't get low blood sugars, you know, like that. One thing would be such a big deal for everybody. So I'm hopefully one of you smart kids will figure it out. Hopefully, yeah. Is there gonna be you? I mean, I don't want to pressure you. I don't

Elise 1:12:30
know. I don't know, I probably. To be honest, I probably won't state now that I have type one, I probably won't stay in the type one arena. Just because it's a little too close to home. I'll probably end up in oncology. Maybe rheumatology,

Scott Benner 1:12:44
that's fine. abandon us at least that's fine.

Elise 1:12:48
I'll still stay connected. adjacently I completely

Scott Benner 1:12:50
understand. I don't know how you would want to be involved with diabetes 24 hours a day. It's gotta be really difficult. No, I

Elise 1:12:56
think it's fascinating. I like it. It's just mainly the thing is that like, endocrinology is a lot more than just diabetes. If it was only diabetes, I think I'd be more into it. Really? Yeah.

Scott Benner 1:13:07
Just I'd be I'm going through what you just said there. If it was just diabetes, you can't you can be an endocrinologist. But you don't want to be in practice, though. Right?

Elise 1:13:17
Well, so I do I want to be somewhat in practice, just not full time in five

Scott Benner 1:13:20
days a week. Yeah, yeah. Yeah. Cuz then. Okay, so then endocrinology is too broad for you. Is that right?

Elise 1:13:27
I mean, it's not necessarily that it's too broad. It's just that its breadth doesn't perfectly overlap with my interests.

Scott Benner 1:13:33
We want you to be interested, we want you working hard, not just showing up at work all half assed and just tripping through it. You don't I mean,

Elise 1:13:40
I just I want I want something that I really care about. And like, I think endocrinology is interesting, but I think I care mostly about insulin, and that's pretty apparent, and the other hormones would definitely not get their attention that's needed.

Scott Benner 1:13:56
All right. Well, I wish you a ton of success. And I hope one day you're able to pay your bills. Thank you very much for doing this with me.

Elise 1:14:04
Yeah, of course, hold on one second.

Scott Benner 1:14:14
Mark has 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/juice box. 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. A huge thanks to us, Matt 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 Ford slash juicebox. you spell that GVOKEGLUC AG o n.com Ford slash juice box. A diabetes diagnosis comes with a lot of new terms and you're not going to understand most of them. That's why we made defining diabetes. Go to juicebox podcast.com up into the menu and click on defining diabetes to find the series that will tell you what all of those words mean. Short, fun and informative. That's the finding diabetes. 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. 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. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

#1205 Pocket Underwear

Diane was diagnosed in her late fifties, her father also had type 1 diabetes.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 1205 of the Juicebox Podcast

Diane's father had type one diabetes, and she thought that she had, quote, dodged that bullet when she wasn't diagnosed at all through her 20s 30s 40s. But in her late 50s, she got type one. Today we're going to talk about her story and some other autoimmune issues that she has. 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. 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/juicebox If you're a US resident and you have type one diabetes, where you care for someone with type one, I need your help to help. How will you help help? Let me tell you, you go to T one D exchange.org/juice. Box you complete the survey it takes about 10 minutes, and then the answers that you give to the questions in the survey. They help type one diabetes research. So you don't have to go to a doctor's office. If you want to help with research. You don't even have to leave your home. T one D exchange.org/juicebox help others help yourself. This show is sponsored today by the glucagon that my daughter carries G voc hypo pen. Find out more at G voc glucagon.com. Forward slash Juicebox Podcast and started using a contour meter because of its accuracy. But she continues to use it because it's adorable and trustworthy. If you have diabetes, you want the contour next gen blood glucose meter. There's already so many decisions. Let me take this one off your plate. Contour next one.com/juicebox I am quite literally covered in cozy, cozy Earth. I use their towels. I use their sheets. I use their sweatpants and their sweatshirts. And I just got a pair of shorts in the mail, which I haven't even opened up yet. Maybe I'll do that during the ad later. Cozy earth.com use the offer code juice box at checkout to save big on everything in your cart. Cozy earth.com use the offer code juice box.

Diane 2:28
My name is Diane, I am 59 years old. I'll be 60 in December. I'm a registered nurse. I was diagnosed during COVID. May 29 2020. I am the daughter of a type one diabetic.

Scott Benner 2:47
Okay, your father with a still mother? No,

Diane 2:51
he passed away from a heart attack in 2013 2013.

Scott Benner 2:53
How old was he? Do you remember?

Diane 2:58
He was I've been the 171 or maybe 72? I think he was 72 because he was born in 1941. So he was somewhere in their early 70s.

Scott Benner 3:13
How long have he had type one?

Diane 3:14
He was diagnosed at the age of 14.

Scott Benner 3:17
Oh wow. And you were diagnosed like in your late 50s 56. And that interesting. Okay, any other type one in the family?

Diane 3:28
No type ones but lots of other autoimmune disorders, for instance. So my dad's father and his brother marry two sisters. So all of our cousins are once removed. I have two cousins that had vitiligo pretty significantly. And then my dad's sisters have some autoimmune disorders. I'm not quite sure what they are. One of them is the type two diabetic, but they have some autoimmune disorders to that I found out later was after I was diagnosed. Do

Scott Benner 4:04
you have any others? Oh, yes. Well,

Diane 4:07
so I was diagnosed with a goiter when I was nine years old. So I've been on. I've had hypothyroidism since I was nine. So I've been on medication for that. I had no other autoimmune disorders until I was diagnosed with the type one diabetes. I actually had Pernicious anemia going on at the same exact time. And it was noted that I was macrocytic meaning my red blood cells were enlarged. When I was diagnosed with the type one, and the hospitalist that was admitting me she noticed that I was anemic. And I mentioned that I was anemic but didn't follow up. She didn't she just asked me if I'd had any abnormal bleeding or anything like that. And I I said no. And that left it at that. So um, then I also have autoimmune hepatitis, but I, which I got later diagnosed with. That was the Oh, and then I have some vitiligo as well, that's going on to

Scott Benner 5:15
when did the pernicious anemia start?

Diane 5:19
So the pernicious anemia actually was occurring at the same time I my type one diabetes was occurring, but it didn't get diagnosed until I started having significant neurological symptoms. The type one diabetes hit me hard, but I was prepared because I'm a registered nurse and I grew up living with a type one diabetic and saw the trials and tribulations that you went through. And so I was familiar with the type one diabetes and I was fine. I mean, I wasn't fine with it. But I mean, I, I had come to grips with it. But the pernicious anemia really scared me a lot. Tell me why. I started with having balance problems. And I My balance is as I've gotten older, my balance isn't always been that great. But I noticed that my balance was really bad. I could hardly even walk straight. I developed a small tremor in my left hand and I thought maybe it was just, you know, like, my blood sugar's if they got low, maybe it was that I became so depressed and anxious. I, I was crying every night. And unfortunately, too, we had a dog that passed away during COVID as well. I've always been a nurturer. And we've always had a dog and I didn't have a dog and my husband was like, let's not get a dog for a while because we you know, we're older and we have a travel trailer and motorcycle and he's like, got like to enjoy some of these things first, before we get another dog. And I was crying every night. And he's like, okay, we can get a dog. Oh,

Scott Benner 7:09
you got one cast iron. You can have mine, either of them or both. It doesn't matter to me. I'll bring them to you even.

Diane 7:15
I would if I could. I would I would have a dog rescue. Oh, my husband's like, no, no, no, no,

Scott Benner 7:24
I have a brand new bag of dog food and $50. I'll give you along with us dogs. What do you think of that? get you going? Oh,

Diane 7:30
that sounds? That sounds wonderful. Yeah, sorry. Yeah. All these neurological problems. And I couldn't even got to the point where I couldn't even share. I couldn't take a shower with the shower door closed. I was so anxious. I went for a routine eye exam. And my eye doctor said you have nystagmus and that's where your eyes your huh. And I said, Oh, I do. And he said, Well, you don't seem surprised by that. I said, Well, you know, I'm a neuro nurse. I know it's Nystagmus is

Scott Benner 8:00
Oh, yeah, they didn't show.

Diane 8:03
Yeah. And so he said, Oh, I'm just gonna send a little email to your, your primary doctor. And I said, Okay. And so then my primary doctor called me and said, You know, I got this email from your eye doctor, and I'd like you to come in and get checked out. My primary doctor wasn't able to see me right away. So I went and saw one of her colleagues who's a wonderful doctor, and he, you know, was doing a physical exam and I had no reflexes. And that's one of the symptoms of B 12 deficiency is you lose you're like, when they hit the hammer with your knee you lose your reflex. Yeah. And he listened to my heart and he goes you have a heart murmur. Have you ever been told that before? And I said absolutely not. I religiously workout three days a week I've never had a heart murmur he goes yeah, you have a pretty significant heart murmur I'm really upset me

Scott Benner 9:01
Yeah, no kidding.

Diane 9:01
You're out I'm gonna have him drop a bunch of labs and I'm I'm gonna it was like a Thursday that he saw me goes I'm gonna have them draw some labs and we'll go from there.

Scott Benner 9:12
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 storage evoke hypo pen and how to use it. They need to know how to use Tchibo Capo pen before an emergency situation happens Learn more about why G vo Kibo pan is in Arden's 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 GE Volk glucagon.com/risk For safety information. That contour next gen blood glucose meter is the meter that we use here. Arden has one with her at all times, I have one downstairs in the kitchen, just in case I want to check my blood sugar. And Arden has them at school, they're everywhere that she is contour next one.com/juicebox test strips. And the meters themselves may be less expensive for you in cash out of your pocket than you're paying currently through your insurance for another meter, you can find out about that and much more of my link contour next one.com/juicebox Contour makes a number of fantastic and accurate meters. And their second chance test strips are absolutely my favorite part. What does that mean? If you go to get some blood, and maybe you touch it and I don't know, stumble with your hand and like slip off and go back, it doesn't impact the quality or accuracy of the test. So you can hit the blood not good enough, come back, get the rest without impacting the accuracy of the test. That's right, you can touch the blood come back and get the rest. And you're gonna get an absolutely accurate test. I think that's important because we all stumble and fumble at times, that's not a good reason to have to waste a test trip. And with a contour. Next Gen. You won't have to contour next one.com forward slash juicebox you're gonna get a great reading without having to be perfect.

Diane 11:49
So my labs started trickling in, and I have, you know, my chart through Providence, which I work for. I started seeing my labs and I saw that my V 12 was really low. I would think I was what I was seven and low normal in the United States is I think 200 or 300. And I was like oh, so I sent him a text. I said, Hey, I see my be 12 Slow. Do you think I could get smoothie? 12 shots deals. Yeah, I'll make arrangements with my office staff. And then more of my labs were trickling in. And I still saw that I was macrocytic meaning my red blood cells were very large and immature. He by Sunday evening, he texts me and he says I think you have Pernicious anemia. And I thought Pernicious anemia. I can remember something from nursing schools that have to do with vegetarians.

Scott Benner 12:50
So I'm looking here just so people can catch up a little bit. Typical presentation of Pernicious anemia includes fatigue, parallel appearance, tingling sensations, depression, alterations and visions and smelling urinary incontinence. psychotic episodes, weak this involuntary movements due to the beats while deficiency. You had all that like you had a lot of that stuff going on.

Diane 13:10
I had a lot of that stuff going on. Yeah, crazy. Yeah. So I had all these neurological symptoms. And then when he came back, I think you have Vitol deficiency, pernicious anemia. I started doing research and I saw one of the number one symptoms was a heart murmur. So and then all the stuff that I was read, of course, you know, I'm a nurse, so I immediately start educating myself on everything. Even when I became a type one diabetic. I, I did so much research and that's how I found your podcast. Cool. I never listened to podcasts before. I mean, I've had lots of people talk, I hear people talk about them. During the pandemic, especially a lot of people were, you know, listening to podcasts. Especially when it comes to my house I've always in because I'm a nurse. I always when I come across something I don't know I dive right into it and become educated familiar with what's going on. Are

Scott Benner 14:16
we just Googling type one diabetes? Or how did you? What was the way you thought to figure it out?

Diane 14:21
I don't know. Exactly. I found your podcast. I think I was just trying to find things to keep me busy during the pandemic. You know, everybody was on lockdown. There was a couple of podcasts that I was listening to. And I came across your podcast and I started listening to it and I was just like, oh my gosh, this is amazing. I love this. And I started telling everybody about it. When I was having all the depression problems before I was diagnosed with the B 12. And I started having all these depression problems and anxiety and then of course being a health worker trying to wrap my head around doing the whole pandemic stuff. I work where I work was saying how we have counseling, you know, for health care workers we have for employees, we have counseling, you can do it all online. And so I tried to find somebody to talk to you. And I found somebody I, you know, I kind of wanted to find an older woman my age, and I couldn't seem to find anybody. So but I did find a young woman, and she talked to me one session, and she was just like, well, I don't really kind of like, I don't know what I really would do for you. We just didn't connect. So when I was in the hospital, and I got diagnosed with the diabetes, of course, being in my 50s, and I was I was overweight. The hospitalist immediately started talking to me about type two diabetes, and how my primary doctor would follow up with me and talk to me about that foreman. And I, in my mind, I said, No, no, I am not a type. I'm not a type two, my fasting blood sugars that have always been, you know, high 90s, maybe 101, but never higher than that. And I had just had a physical. About two months prior to being diagnosed. I spent two nights in the hospital, you know, teaching me how to give injections, which I already knew how to do course, mostly, I was just visiting with my friends, the nurses that were my nurses, were people I already knew. And I spent two days in the hospital during COVID. And then I got discharged on a Sunday. And then the following Monday or Tuesday, I had a virtual appointment with my primary doctor. And she immediately said the same thing. He said, You don't just go from normal to having all these symptoms. I'm gonna test you for type one diabetes. Diane,

Scott Benner 17:04
is that what got you was just the medical background. It wasn't that your dad had type one and that you guys had all this autoimmune that made you think you don't I mean, I

Diane 17:13
hear what you're saying. But I had been tested numerous numerous times as a child. And even during my pregnancies, I have two kids. And during my pregnancies, I never had any gestational diabetes. Nothing ever presented itself before then. Okay. And my mom did say I had a glucose tolerance test when I was was 12. It was an eight hour test. And I had to do I had to drink the, you know, the syrup stuff, and to drink that every hour. And then I had to do it, urine and blood test every hour. And my mom said that I had an abnormal curve, but that I was not a diabetic. And my I remember my brother had the test too. I have a brother, it's 18 months younger than and he had that test done as well. And neither one of us feedback is, you know, having anything abnormal.

Scott Benner 18:16
Does he have diabetes now or No? He doesn't know.

Diane 18:21
He does have heart conditions like my dad did. You had a heart valve replaced? In 2019? I think it was. Your

Scott Benner 18:30
father's heart stuff was not from the type one it was. It was a complication. It was

Diane 18:36
a complication of type one. He had two open heart surgeries and he had atherosclerosis. I'm sure you know, he grew up in the age of, you know, testing your urine and oily needles and I remember him sitting and sharpening his needles with the whetstone. Really, I grew up with all of that. Oh, yeah. Grew up with the smell of insulin in the morning my dad and I would share the bathroom in the morning when I was getting ready for school I would smell not I love the smell of insulin. I know some people say they don't like that smell but I it was before the insulin that we have now or she you know was equine and pork insulin.

Scott Benner 19:19
That didn't smell like band aids.

Diane 19:21
Yeah, has that smell I liked Oh, even back then. It did.

Scott Benner 19:25
I was gonna ask you. Yeah, okay. Oh, yes, yes,

Diane 19:27
yes, yes, yes. I was struggling with all the depression and anxiety. And so I reached out to my endocrinology team, and when I finally did get to see an endocrinology, it was a nurse practitioner. And she's also type one. I really liked her a lot. He's more of a manager, you know, like managing. It didn't really give me a lot of information. And I think partly part of That was that was a hindrance that I was the nurse and that she figured I already knew maybe or I was doing MDI. When I was diagnosed I was 9.3 was my HPA once the I did not have ketoacidosis because I think partly because I caught my symptoms fairly early.

Scott Benner 20:22
So we went to the movies yesterday and I wore my cozy Earth joggers, but I was missing my cozy Earth pullover because I've lost some weight and it was so big it didn't fit anymore, but luckily for me, I ordered another one and double Lucky for me, it arrived today. Let's take a look. What did I get here from cozier first of all, simple packaging but once you opened it up, beautiful bag that this comes in here. Definitely reusable and lovely. What's in Oh, this is the this is Oh, I got new. I got shorts, guys. Oh, look at this. These are gray. Beautiful, soft. Love it. Huh? Great shorts for summertime. And what else did I get? Here? It is. My pullover. It's what I needed at the movie theater. But I didn't have but you can't feel it. But I can. You want quality. You want to be just warm enough. Without being hot. Just cool enough without being cold. You want cozy Earth products, their towels, their sheets, their clothing. I'm rubbing it against my first enrollment. Okay. Cozy earth.com use the offer code juice box at checkout to save big on your entire order. And just you'll just be as happy as I am right now when you buy stuff for yourself. Oh, I'm gonna hug it again. I'm hugging. Oh, there's links in the show notes and links at juicebox podcast.com. To what is this? What is this here? I'm gonna put it in this bag. Get How nice is that? What else can I use this bag for? Cozy earth.com baby sleep bave live comfortable quality. You deserve it.

Diane 22:07
It was my vision that got really bad. My vision was so blurry, I couldn't even see we write the patient's names on our unit on a big dry erase board. And from my from my charge nurse says I could not see the patient's names on the board. And I was telling my coworkers man, my patient is so bad. And I just had my vision check. My husband and I had been fishing had been like going on for two weeks, I noticed I was having polyuria polydipsia. But I avidly exercise three days a week was you know, weight training. And I thought oh, I'm just more thirsty. You know, I just started poopoo in all the right. Yeah, and I noticed my urine was dilute. I was going to the bathroom like I don't know, every 45 minutes an hour. I was like This is crazy. And then my vision was blurry, European

Scott Benner 23:00
yourself blind. Pretty much. I feel like this is interesting for people because even you know as a having a career as a nurse, and growing up with someone who's a parent that has type one diabetes, you still were just like, well, this, you know, I mean, like just the ability to write things off is so common like for people? Oh,

Diane 23:18
for sure. Yeah.

Scott Benner 23:20
Oh, for sure. Yeah. And

Diane 23:21
especially at my age of 56. I was like, Well, I think I this is ridiculous that I would be a type one at 56. I mean, why wouldn't it have caught me sooner?

Scott Benner 23:30
Right? You felt like that was gotten past that.

Diane 23:33
I thought I'd you know, I'm like dodged the bullet. I thought, Oh, I've dodged the bullet. It's not going to happen to me. No, we my husband and I were we like to salmon fish. We'd been fishing. My husband, I couldn't even see the leaves on the trees. Everything was so blurry. And my husband's like, you need to go to the doctor. And so I went and saw my doctor and he said, Well, I don't see any diabetic damage, you know, your eyes, your prescriptions a little bit different than the last time I saw you, you know, three months ago, and I thought something's wrong. I've got to go to urgent care. And I thought, urgent care during 2020. Right? Who knows how long I'll wait. Well, lucky for me Saturday afternoon. I get there and there's only two people in the waiting area. When the nurse calls me back. I said, Can you check my blood sugar? Absolutely. And he checks my blood sugar and his meter says high and I said How high does your meter go to? He says 600 And I was like, Oh great. I guess I bought my tests off a golden ticket to the ER and he said as a matter of fact you have and he brings out this golden piece of paper and writes all my vital signs on it. I was like This is crazy. And I come home and I get out of the car and I just start bawling my head off in the driveway and my husband's putting the boat away. And I said, I have to go to the emergency room. And he's like, Okay, I packed a bag and went to the emergency room.

Scott Benner 25:06
Did you ever get COVID? By the way?

Diane 25:09
No, I never had COVID

Scott Benner 25:11
Even I was just going to go into the hospital in the middle of it. I was just wondering if it found you that way.

Diane 25:16
Yeah. And I was concerned about getting COVID at work. Of course, we were doing all the PPE and all that jazz. But I worked on a unit. I didn't work in critical care, I work on a neurovascular unit. I was concerned about getting COVID to so but I'm, I always wash my hands and wear a mask. And we were quarantine and then a whole bit, you know, after I got diagnosed with the type one diabetes, and I was having all problems with the depression and anxiety. And I tried to get a counselor and it didn't work out. And so then I reached out to my endos office, and I said, Is there a counselor that works with your patients? You know, could you refer me to a name or something? They gave me a name of this psychologist. His name's Michael Phillip. And he is amazing. He's also type one diabetic II was latent onset diabetic. He was in his 30s. I started just seeing him and I would sit down and chat with him. We would just chat like professionals it was I really enjoyed seeing him. It wasn't like counseling so much. It was just, I didn't have any other type ones around me. And I was listening to podcast. And, you know, trying to educate myself. I saw him a few times. And then that's when I got diagnosed with the beetle deficiency. And then I had more problems, trying to get my team to listen to me. Because once I started until I got the big 12 shots, and I educated myself about Pernicious anemia, and learned that I would need the 12 shots for the rest of my life. My primary doctor was not on board with that. She said, Well, your numbers are normal. And I said, but I have a mallet Norte malabsorption problem, right? I will need this the rest of my life. And nobody was listening to me. It was crazy. And I got this wonderful book written by an ER nurse and her er husband, who's the doctor. And it's about the child's deficiency and their trials and tribulations. She was the 12 deficient as well. And they started seeing patients in their ers with symptoms, you know, older people, you know, little old lady was gonna come in confused or falling. And they're in there saying, Oh, they just have dementia. They're getting old. And nobody was nobody was testing them for B 12. And it was, it was an amazing book. It was an eye opener for me. I felt bad for my poor husband, because we went on a fishing trip. mid June while I was dealing with all of this educating myself reading this book, trying to get my team to listen to me. I would read Stephen the book and when we were fishing in the boat, and then I would start crying and then I was yelling. They're going Yes, yes, I hear you

Scott Benner 28:28
saying you know he loves you because you didn't, you know, fall in the water by mistake.

Diane 28:35
He loves me so much. And he totally has been so supportive through all of this. It's amazing. And he's listened to the podcast a few times, too. That's excellent. So once I got diagnosed with Pernicious anemia, and I had all this movement disorder, gait problems, balance problems. I had all these fancy tests or my vision, my nystagmus like, I couldn't see in the dark. I finally had to plead with my neurologist to get to prescribe me the big 12. He said, Well, your primary doctor should be taking this over and I said she's not listening to me. She says that my levels are normal and I need this for the rest of my life. So he prescribed a one one month one time dose. I thought Well, thank God somebody's listening to me. In the meantime, I I adopted a dog and I was going to see my psychologist and he was helping me and he was I was telling him about the podcast and how much I enjoyed it. He started listening to a two. He does a lot of not a lot of research but he helps us helps in some diabetic research. He does stuff with Dexcom also, and I was doing MDI, in 2021, I got diagnosed with Pernicious anemia. And then in 2022, I had lab worked and I was they put me on a statin right away the endocrinology office, but be honest that and because the being a diabetic, you know, they worry about your cholesterol, even though my my numbers were okay, they still put me on a low dose of Lipitor for cholesterol. Yes, my cholesterol. I saw my nurse practitioner for you know, routine, endo office is there and she did some lab work. And she noticed that my liver enzymes were just slightly elevated. So the next appointment I had with her she brought it up that she said I saw I see that your your liver values were slightly elevated. I'm gonna have your or she I don't think she actually said it to me. But she might have sent it in an email or something saying that she went my primary doctor know about it. Well, nobody ever follow it up. And then when I saw her in June of 2022, might have been like September, and oh my gosh, I was so sick. I was so fatigue. I almost passed out in the shower, and my husband had just left for work. And I thought, man, I've got to make it to this endo appointment. And so I got to my appointment. And when my nurse practitioner came in, she goes, how are you? And I said, I am horrible. I feel horrible. I still fatigue. I almost passed out in the shower today. And she said, Oh, that's That's unfortunate. You know, he was concerned. She was concerned. He sent me to the lab, managed to make it home and I hadn't had much of an appetite and it started having some nausea, intermittent nausea like that, that week. And so then I came home and I was hungry. And I stopped and got some tacos from Taco Bell. At one taco and then I lay down on the couch and was taking a nap. And then my phone rang. And it was my endocrinologist office and they said, your liver enzymes are elevated, and you need to go to the emergency room. And I was like, oh, that's, that's not good. I packed a bag. And my husband, unfortunately, was home. So he took me to a hospital. And of course, they were still doing the whole nasty thing at work. They redo my labs because they couldn't see their labs. And my liver enzymes were through the roof. Like I was a raging alcoholic. And of course, the first thing they asked me was, Do you drink alcohol? I said absolutely not. You know, I don't drink any alcohol. And so they admitted me. They tried to give me some medicine to call me a chemist. It's an IV medication that binds the, like toxins in your blood, it helps your liver help your liver recover. Oh, that just made me horribly sick. And the hospital is. I told them I don't want to take I don't want to take any more of that. And it was just because I asked him if we if I could use if I could take that. He said sure we can try that. And you know, being a nurse I you know, I know some things, you know, I know quite a bit of things. They did an autoimmune test on me for autoimmune hepatitis, I saw a GI doctor while I was there. And of course, it was a standout test. So I spent two nights in the hospital on my unit with nurses that I know that I work with took care of me, which was I asked I asked for that actually, I thought I'd never asked for that. But I wanted to be where people I knew and that I loved and that I knew love me. I spent two nights there and I started feeling you know a little better because they'd give me some IV fluids too. It took quite a while for that test to come back. But about a week after I was in the hospital. My test came back autoimmune hepatitis A week. It took a week for the lab to come back. Yeah, yeah.

Scott Benner 34:20
When you get those B 12 shots, how long does it take for those symptoms to start dissipating?

Diane 34:26
Well, everybody's different, but pretty probably about a sprint. So initially, when you are diagnosed with the 12 deficiency, they give you four weekly shots. And then after those four weekly shots, they may they may retest you, they may not retest you. You have to be off the 12 any kind of Eatwell supplementation for four months before you can get a through the 12 level reading because it doors in your liver. And so your body holds on to it for quite a while.

Scott Benner 35:05
But for you, you started the injections. And when did you notice? Like the symptoms going away? How long after

Diane 35:13
got the second injection? I started feeling better. That fast. Yep. Yeah, you fill up pretty quickly and it be 12 is very cheap, very inexpensive. The only type of B 12. Injection injectable in the United States three prescription is a synthetic b 12, which is no Kabbalah mean. And I was doing the sino injections. And then I had to be 12 or the I have the autoimmune hepatitis. And I had been educating myself about B 12 injections and the types that you could get. I was getting some methyl cobalamin from a pharmacy in Florida. And I had just started injecting myself with that with the methyl cobalamin, which is more like what's your body actually uses for synthesizes? Right? I don't feel that the synthetic was working well for me interesting. Can

Scott Benner 36:24
I ask a question about the autoimmune hepatitis? Like what's the treatment for that?

Diane 36:28
So they put me on high doses of steroids, which was oh, so

Scott Benner 36:34
horrible on your blood sugar, right?

Diane 36:37
Oh, my gosh, my blood sugar was crazy. Oh, and in the meantime, when I was seeing my psychologist, he kept asking me who's your endocrinologist, I said, I have not seen an endocrinologist. And I've said, all I've been seen is the nurse practitioner. And he said, Well, you should be seeing a doctor at least once. And so he sent a referral to my Windows Office. Or, you know, saying, you know, please, please proceed by an actual MD. I never heard anything from the office ever. And then after when I came in with the so then when I got came in with the high liver enzymes, my endocrinologist who are now seeing II saw my lab values and decided to take on my case, because of that. Not because that I was a type one diabetic, but because my liver enzymes were elevated. That's when he decided to take me on

Scott Benner 37:38
notice of that. So so it's so crazy. Yeah, so the steroids, they hit you with them. It's not over then Right? Is there maintenance that has to be done?

Diane 37:46
Yes. So I was on the large doses of steroids for like two months. Then I went on a taper and then they put me on a medication called is this refrain. I take that daily. And then I have to have lab values drawn every three months to make sure that it's working and doing his job and not not creating other problems, because there's a lot of serious side effects with this medication too. And

Scott Benner 38:17
this is a thing you only knew about because of lab values. You weren't having an issue that you were concerned

Diane 38:23
with. I was having fatigue, and I did have some jaundice going on. But it was very mild. You can really tell unless you really look close. But no, I had no like enlarge. My liver wasn't enlarged. I had no pain. I just had some mild nausea. I did notice my stool coloring did change. But mostly it was just the fatigue. I was so fatigued,

Scott Benner 38:48
no amount of sleep made you feel rested. No, but

Diane 38:51
I am a night shift worker too. So that, you know, all kinds of You always cause all kinds of problems. And it's funny because like a few months after I was diagnosed with autoimmune hepatitis, I listened to an episode of a young man who was type one diabetic in South America. Yeah, also. Yeah, had also been he was on your show, right? And he had also been diagnosed with autoimmune hepatitis, but he could not take maintenance medications and has to stay on steroids. And he talked about how difficult it was for his insulin, you know, and all that stuff. Oh, yeah. And they put me on this like, I don't even remember the name of the insulin. They put me on some high concentration of insulin. And then when I did the taper, I actually had to taper myself. Nobody followed up with me from the Windows Office, like, Okay, you're on these high doses of insulin. So when they start tapering you off the steroids then you know we'll need to start tapering off the insulin I was the one add to taper myself

Scott Benner 39:56
off the insulin you at least knew to do it though.

Diane 39:59
Oh yeah, I knew that I had to do that. Because if I didn't my gosh, my blood sugar's within. Yeah, ridiculous. I would have been in the toilet. You know, so low, it would have been ridiculous. But it really frustrated me that nobody on my team was following up with me at all.

Scott Benner 40:19
Damn, my daughter is in the ER this past week, twice. And she checked into the ER twice two different days was pretty much like, kept there for 12 hours at a shot. And in two separate visits 12 hours at a time. I'm gonna let you guess how many times somebody asked her about her blood sugar or tested her blood sugar? Probably one. Never. They never brought it up. Oh, that's crazy. That horrible 19 by herself in a hospital room with roommates. She comes in I have type one diabetes, blah, blah. Here's what I'm here for. And no one ever mentioned it to her ever once ever again. That was it as if she wasn't passing out. It wasn't worth talking

Diane 41:05
to up to her about right because that's not why she was there.

Scott Benner 41:10
It's yeah, absolutely. Like, just I was like really floored by that. Honestly. No follow up. No concern. Nothing

Diane 41:18
is crazy. It's so crazy hospitals. They don't we're so our staffing is crazy. I can't even tell you on my unit. We have so many travelers. We have hired a quite a lot of new nurses. But they don't you know, they don't know a lot of things too. It's just crazy. The ers. You know, it's just unbelievable. The ers. I always tell people if you don't have to go to the emergency room, go to urgent care. Just go to urgent care first. I've sent my employees I've sent my co workers down to the ER, I have just one gal, her blood sugar. She came to me one night and she said my blood sugar's over 300 and I can't get it to come down and I was just feeling horrible. And I said, okay, just go to the emergency room. This was like three o'clock in the morning. She called back up to the unit at like 715 She says I'm still down in the ER waiting to be seen. And I said just go to urgent care. I just told her go to urgent care. They can give you some IV insulin. And then you know, then you can go from there. Off with your doctor or whatever. Yeah.

Scott Benner 42:23
There were things that only took a few minutes, but they wouldn't get back to her for two hours. Yeah. And yeah, I was on the phone with people. I was her roommate. I said you have to go stand in the hallway and stare people in the face till they come help you. Yeah, and you know, walk over to the doctor ask this question. Don't wait for them to come back. Yeah, Arden said it wasn't just her. She said the second day she was there. A woman came in who had had her gallbladder removed already. And she was having some sort of an attack where I don't know she ate something or whatever their body couldn't deal with. And she was just vomiting, like uncontrollably. And my daughter said she vomited for two and a half hours before somebody gave her nausea medication. And she just sat in there yelling, I need help. I need this medication and people would go we'll be right back. We'll be right back. We'll be right back. But the funny thing was, is that I finally had to get on an airplane to go make sure she was okay. And I was in the ER, they weren't busy. It wasn't because they were overwhelmed. I would probably need a month and a lot of clipboards, to sit there and really figure out what was going on. But bare bones didn't quite know what they were talking about. No sense of urgency, no desire to really be helpful, just checking boxes, and then kicking you like that's what they wanted. Like when I arrived. The floor manager was aggressively trying to kick Arden out of the hospital without answering any of her concerns. And I said you haven't tested for this one thing yet? And he said yes. By the way. I think we've gone through a number of things. Arden had lower abdomen pain, and it got worse turned into stabbing. The stabbing went up into her sternum. We thought appendix right. And you know, she had pretty much every appendix sign, senator to the hospital. They do a CAT scan. They tell her it's not your appendix. Now listen to this though. They tell her it's not her appendix but you have cysts all over your ovary. We have to do an ultrasound right now to make sure they're not torsion or twisted and Arden's like, okay, you don't like I don't like okay like that or morphine. At that point. She was just agreeing to whatever was going on, and they take her to the ultrasound. Two hours later, someone walks in the room, the same person that told her I saw your CAT scan and you have cysts all over your ovary came back in the room and she goes there are no cysts on your ovaries. What but then did not explain that any farther. And she goes she goes I wait You came in here a few hours ago and said they were. And he goes, Yeah, what CAT scans aren't the right way to diagnose that? And she goes, what? And he goes, it's not that we're going to discharge you. She goes, I'm still in pain. And he said, Well, yeah, you have to follow up with your OB, and then didn't tell her anything else. She's 19. She's with roommates from college. They, they're roommates. But they're not like lifelong friends or anything like that, you know, and they're good people and all but they don't do the hell they're doing. And at one point, Arden said to me, I realized, these the two roommates I was with, they'd never even been in the hospital before. They weren't people who grew up with any kind of medical issues. They don't go to the doctor, they've never been to a hospital, they were scared out of their goddamn mind. And she's aren't like I'm high on morphine. And like trying to make sense of what's going on. No one's checking on her. Like if I couldn't monitor her blood sugar, I was basically keeping her blood sugar stable from New Jersey. When I sent her to the hospital, I started putting her I put her algorithm into a higher target, so that she would ride a little higher in the hospital because I knew she was going to get there. They were going to hit her with pain meds, and then nobody was going to help her. So I kind of was the head of the whole situation. But anyway, they sent her home. And you know, not surprisingly, she woke up the next day not doing any better. And she struggled through the day. At around midnight, she calls me and says, I think this is getting worse. And she starts describing that the stabbing pain has gone from the she still has the cramping lower stabbing lower stabbing sternum. Now the stabbings in her left chest going through to her shoulder. And so I'm looking at everything and I'm like, This feels like gallbladder maybe, like you don't mean like so I can see how it could get misconstrued early on blah, blah, blah, Now the pain is moving up into her chest that could be gone. i Okay, so I send her off to the hospital again, in the middle of the night, like three in the morning, and I get right on an airplane, like I'm on a plane by 7am. And by the time I get there, I'm literally walking into this guy telling her, you gotta leave your word we've discharged, you get out. And there's nothing wrong with you that we can find. She's sitting there and she's in all this pain. She's like, I started looking at my chart, they start talking about like, it's like a logical Arden's like, I'm not crazy, like I'm in pain, you know. And so I come in and I say, listen, hey, everybody calmed down, like Hi. Like, I'm here, like, I have now been awake. By the way, I've now been awake for 27 hours as I walk into that hospital, because I wasn't planning on going somewhere in the middle of the night. And so I go walk in, I orient myself with what's going on. I said, What tests have you done? And he goes through everything. And I said, your shorts, not our gallbladder. I'm like, it's a pretty classic presentation at this point for gall bladder. And he said, Yeah, it's not I said, How do you know? And he goes, Why don't I said, What did you test? Because I asked him when I got there, have you been imaged? And he said, she said, No. And he goes, we tested her bilirubin. And I was like, that's not a way to rule out gall stones. And by the way, diet, he says to me, how do you know? And I said, Well, I have a podcast and the internet. Why don't you know? So he's like, Well, that's that's not a classic presentation. I said, No, it's a word for word presentation. It doesn't mean it's going to be that, but you need to alter it, by the minimum give her an ultrasound, right. And now at this point, not only am I aware of this, I've educated myself on it on the airplane. But I'm in contact with an endocrinologist who listens to the podcast, who I'm bouncing things off of Thank you very much if you're listening, and she's telling me the same thing, like backing up what I'm thinking. So I said, Listen, she's here, give her the ultrasound. If it's not that, then God bless them. We'll go, he says, he tried to scare us into leaving. He said, she's already been discharged. If you want her to have an ultrasound, you have to walk back out of this, er, walk back in, check back in, go through the intake again, and then make your complaint and we'll see if we went to ultrasound. Oh, my God. Yeah. I giggled and I said, Well, that's not what's going to happen. I'd like to speak with the physician on on call right now. If he goes, he won't talk to you. And I said, Yes, he will. Go tell the physician what I said. And he goes, this is not gallbladder. I said, may not be, but we've gone through everything else. This is the next reasonable step. You haven't tested her for it. We have we tested her bilirubin. I said that is not a test for that. You should know that. If you don't know that. You might want to go Google it, or look it up or go back to school or whatever. And now we staring through me. And I said, Let's be real clear. If you put her back out on the street and she has a real medical emergency. I'm going to sue you. And he goes, hold on. And then he leaves and he goes and talks to the doctor. And he's like glaring back in to the room. So I I stepped out into the hall and I glared at him while he was talking to the doctor. And so I just stared him in the face the entire time he was doing it. He comes over and says, this last day to me, he goes, even No, there's no presentation for gallbladder, the doctors gonna do the test for you to make you happen. I said, and you know what I did? You'd be very proud of me very well, I was proud of myself. I'm happy to share it here with everybody else. I de escalated. I thanked him, I put my hand on his shoulder. I said, I really appreciate this. I'm just worried about her. And I just want her to have like, you know, as much coverage as possible. She's here by herself. I can't stay here in the state for long. I need to make sure she's okay. But like I started thinking he was full of, by the way. Yes. Oh, yeah. And he came back in with his head when he didn't want to have his hat in his hand. So he came back and re attacked me. You know, you're wrong, but we're still going to help you because, by the way, dying because that because hospitals are always run tests that they think aren't necessary. Right? Like, like, that happens constantly. I just shut the whole thing down. I thanked him. I treated him like he was Jesus Christ Himself. Thank you so much for your wonderful blah, blah, blah. He left the room. I looked at my daughter and went, what a hassle. And like so. And she goes, she goes, You were so nice. This time. I said, Well, we got what we needed. Yeah, that's right. Yeah, I'm not looking

Diane 51:25
to get what you need. Yep. Exactly. Why Kevin with kindness. Yeah, because you kill you. I'm

Scott Benner 51:31
not here to like fight. I don't fighting with him. By the way. Me being right or him being rights meaningless. I don't care. Right. So a few minutes later, finally, the doctor comes in. My daughter goes first time I'm seeing this guy been here, nine hours at this point. And he comes in nicest can be he goes, Listen, I agree with what you're saying. gallbladder is the last thing we should definitely image it blah, blah. Did I get the nurse in trouble that I complained. I didn't do anything. I said thank you very much. I really appreciate this. That's all I've just thank you so much. They run out and give her the the ultrasound she comes back. And that's it. Now it's okay. It's all good. You're gonna have to go to an OB maybe and like so now we're down to like, I mean, we don't even know honestly, like, we've eliminated so many things. Like endometriosis. Like is like one of the last things I can think of, you know, so she's gonna go see an OB when she gets home. But that hospital stay was I don't even know another way to put it. It was horrible. Yeah. And if she would have been by herself, they would have hit her with morphine kicked her out. When she came back, they would have hit her with morphine and kicked her out again, they weren't really trying to help her. And then they would say things to her, like, make a follow up appointment with with an OB and she goes, I'm at college, I don't live here. And they'd say, Well, you should call your doctor. So no direction no like, vibe, even you don't even not even like, hey, look, maybe it's this or try to check in this direction. Just like we you came here and asked us the question. The question has been answered. And the answer is we don't know. But you're not about to die. So get out. So terrible. Yeah, yeah, that's America. Majan. somewhere else.

Diane 53:12
I will have to say I'm I. I'm glad I'm a nurse. I'm glad I'm a nurse. And I'm glad I'm a nurse at the hospital I went to because I probably I probably wouldn't have gotten. I mean, even though I had problems with my care team listening to me, I probably still wouldn't have gotten the care that I get. No, of course not. And I think it was only right. Yeah. I say that all the time. You're

Scott Benner 53:38
dying. This is the world now you need to know what's wrong with you. And they're just the ones standing between you and the legal need for a prescription or a test or something like that. And I'm not saying it's everybody, I'm sure there's other places I could have sent my daughter in that situation, they would have handled her very well, but didn't happen this time. And we didn't start off poorly. Like she just went in there like, you know very kindly I'm in pain. This is what's going on. Can you help me? You know, and, you know, they they agreed they were like it sounds like your appendix and then they came back and like it's not your appendix. It's your ovary. It's not your ovary. It's we don't know. Well, leave now. Thanks. Why I'm still in pain, the stabbing pain still here. Like and so. Yeah, it's fascinating. I mean, I don't know what people who aren't me. Like, listen, Arden's really like a She's a tough person. And but she's still 19 and they had her they hit her. They hit her twice with morphine in 48 hours. She'd been in pain for a couple of days. I got to that hospital. There were tears collected in her clavicle. She was crying so much. And then while she's standing there crying, and her roommate is distraught, because this poor girl has never even seen a hospital before. This grown man. By the way, his name was Russell and if anyone ever tells him About this, please let them know I said he's a prick. He's standing in front of them, like aggressively kicking them out of the hospital. Like he's being aggressive with these girls. And like, unnecessarily. And he just, he's pushing them and using harsh language with them and being Curt with them and not answering their questions and denying anything. So what Arden finally did was Arden. Arden said, even through the tears, she said, I'm not leaving here. I demand you admit me. Good for her. And so like that frozen because he couldn't like I think he couldn't straight or when she asked, and so like it frozen. And then she said, my dad's on his way, he just got off of a plane. I'm not moving until I speak to him. And if you don't like it, you have to admit me, I'm not leaving. And that's the only thing that stopped it. Yeah. So he was literally like aggressively badgering to 19 year old crying girls, one of them had been in pain for three days, and was half loaded on morphine. And he was just trying to get them to walk out of the place he didn't give.

Diane 56:04
So yeah, that's Yeah, unfortunately, my husband has met some of that too, because he's not, you know, he's not medically savvy. He doesn't know how to advocate for himself very well. And he's met some doctors that were like that. And so now it's, it's a struggle to get him to even just go get a routine checkup? Because he didn't, he doesn't think that they're gonna listen to him or they're going to, it's just frustrating. Yeah, it's frustrating. And that's one thing about, I was always empathetic to the patients, but I'm even more. So now that I've had to go through all of this. Yeah. It's crazy. It's just crazy.

Scott Benner 56:44
Everybody's not good at their job, I understand that. And some people just do things for a paycheck, or maybe they're just tired or whatever. I mean, any number of things could be happening. But there are very few jobs where that can't matter. Like you have to still follow through. And, you know, just once I got there, and you know, I got to the doctor, now he was the nurse guy, he's gone. Now he will I don't see him again. And now it's a different nurse. And she's just like, you know, pleasant, but literally no help. And in no hurry to speak of, like, you know, finally walked in and said, you know, we're just charging you now. And I, so I got them to what I ended up saying was, look, we have no answers whatsoever. None. And I said, Is it possible she has an infection somewhere we can't see. And they said, Yes, that's possible. I said, Okay, once you hit her with one course of an IV, IV antibiotic, just and then let her leave with something like a pill for a few days, like just just in case, not going to hurt her. And maybe maybe we'll catch something by mistake. And the doctor goes, Sure, no problem. Like it just does it. And so I'm like she you have opinions, and then you don't have opinions. And then I say something and you say no, but then I say something you go sure whatever. There's no consistency to it. First of all, if the IV antibiotics were a good idea, why didn't you think of it? And you know, and and if they're a bad idea, why did you do it? If the whole thing is just confusing? And there's no answer, except no one knows what they're doing. And if they do, they don't care enough to make sure they're doing it? Well, because my point was with all that is she comes in at the checkout, and she says here, you know, all of your prescriptions are waiting for you at this pharmacy. It's up the street and I said, I we don't have a car. And she goes what I said, I just flew here from New Jersey. I do not have a car. She doesn't have a car, her roommates, broader and left when I got here, we have to Uber back to her apartment, can you please send these to a pharmacy near where she lives? And she looked at me, like I asked her to wreck the Chrysler Building by hand. And I said, I just need you to resend the scripts to a different pharmacy. And she stared at me like, are you? Are you kidding me? You're asking me to do this. Just go and then she says it's only up the street. And I said, I don't have a car.

Diane 59:11
And she goes, Ah,

Scott Benner 59:14
and I said, Could I just have them in paper, please? And she goes, you just want them in paper? And I said, Yeah, can you just print them and hand me the prescriptions? Because by the way they were they were scribing a bunch of stuff where she didn't need Maalox, like all kinds of like for different like just throw stuff at the wall for stolen account. It was so clear. It wasn't her god damn stomach and like and they still tried to give her for other things. And I said just print me the scrubs. I'll go take care of it myself. And she goes, okay. 30 minutes later, I had to go hunt her down. I said, Can I get those scripts so we can leave, please? Oh, yeah, hold on. And then she went and got them. They were they were kicking her out five seconds before they couldn't we can't give up the space. She's got to go blah blah blah. Okay, put He describes him he describes 30 minutes later, she hadn't printed the scripts. You know what she was doing? I was watching her. She was stuffing food in her face on the internet, telling a friend next to her about her weekend. That's what she was doing. I was listening, and I was watching. So, and then she comes back. We're so busy. I'm sorry. We're so busy. I can see you playing Pong. I see you. I see you. I see you looking around to make sure that nobody sees you stuffing food in your mouth. Like, like, I'm watching you. And it just, it was mad. It was absolutely maddening. And I have to be honest, Arden is going to be fine. Like, we're going to figure out what this says she's gonna be okay. But thank God, she had this experience at a young enough age where she could like, like, process it and understand what her what her needs are for herself in this, but an old enough age where she can go like, this isn't going to get better. Like this is the norm if I ever end up in this situation again. Because like, I don't think she I don't even think she would have believed me if I told her you really have to take care of yourself. No one's going to help you. I mean, how in the hell are you supposed to believe that no one's going to help you in a hospital. It's It's fascinating. You know, anyway, it's,

Diane 1:01:10
it's crazy. Yeah. It's crazy. Ridiculous. And I worked at you,

Scott Benner 1:01:15
you know,

Diane 1:01:16
thank God. I don't work in the emergency room. But

Scott Benner 1:01:18
I've heard you talk around it three times already. Diane, I already I hear you trying not to be unkind. But you're like, don't go to the emergency room if you don't.

Diane 1:01:27
Right. I know. I tell people all the time. You're

Scott Benner 1:01:31
on the inside. And you're telling me Don't do it. So I don't know. The whole thing's crazy. Anyway, I'm sorry. Is there? Is there anything we didn't talk about that we should have? Did we leave anything out or anything you want to say that you didn't? I

Diane 1:01:43
will be happy to say that I work with two other type one diabetics on the night shift. When was diagnosed one month after I was and the other was diagnosed at the age of 19. He's now 3030 I think, okay. So I wouldn't the three of us are on together. I call us teen tandem. Because I eventually, once I finally did see an endocrinologist, he asked me about a pump. He was like, How come you're not on a pump? And I went through this feel about how I was used to vials and syringes. And that's what my dad did. And he's like, Well, you have good control. My agencies have been anywhere from 5.8 to six point. You Oh, good for you. I was diagnosed. Yes. And I owe a lot of it to Juicebox Podcast and to be involved with insulin. So eventually I got on a pump. I've been on a pump almost two years now. And I absolutely love it. And I at my last appointment when the g7 was going to be coming out. He said Well, once it starts talking with the T slim, you know, once they get that approved, and you will get the T the G seven. I'm looking forward to that. Yeah. One time here a couple of weeks ago, we had three type one patients. We've had several that are on there using their pumps. So when you come to the hospital and you get admitted, we have a contract that the patient can sign so that they can use their own CGM and use their own insulin pump. That's a great idea. And yeah, it's awesome. In fact, we had this one gal who was admitted for gastroparesis and was on her insulin pump and I was about three in the morning and nurse came out to the desk and she said my gals blood sugars like 300 And I was like, Oh, she needs to be doing corrected Bolus is she doing correct Bolus is a lot of my co workers, they educate I've educated them to I've shown them my stuff. And they, you know, I've educated a lot of people. And she's like, well, she says she's doing corrected boluses. So then I went in and talked to her. And she's like, Yeah, I've been doing corrective bonuses, and they had her on TPN because she wasn't able to eat. And because we're gastroparesis, and I told her you should reach out to your endocrinology team. And they can come up with a, you know, a profile for while you're on the TPN. You know, higher you know, they can change your profile. Yeah. And then the next day that that was in the middle of the night, and her mom was staying with her. She was young. And the next day she her and her mom are out walking in the hall. And she stopped and was talking to me and the mom was like, Yeah, we're gonna call the endo team tomorrow and talk to them about, you know. Oh, yeah, it's just so cool. Yeah, this is all Send it just, it just whenever I hear that somebody's using their pump, I always like to go in and say hi, my name is Dan. I'm also a type one and that's wonderful.

Scott Benner 1:05:11
Yeah, that's fantastic. I it's, it's a lovely just to open up and tell people and to share what you know with other people, so maybe they can help somebody else. That's really wonderful. Really, ya know, and needed. i

Diane 1:05:22
And I'm always looking on Amazon for ways to wear my pump without some iClip you know, with the T slim broke right away. And so then I got this other like a holster and it was huge and bulky. And whenever I wanted to adjust something, and it was hard getting off my clothes, so I found some pocket underwear on Amazon. It has two pockets in the front, and I wear my pump in my pocket. And I show all my co workers, my co workers my pockets. I just

Scott Benner 1:05:53
underwear with pockets in it. That's amazing. Yeah.

Diane 1:05:55
In fact, it was one day my husband and I were out to eat. And I heard I heard, I heard the pump go off. And I thought I thought it was my I heard this pump and I thought Oh my I'm going low. And I looked at my pump. And I was like, you know, it's not me. It was one of the waiters. And I said, Oh, my and my husband heard it too. And I said, Oh, it's tacky. I see your tubing. So when she walked by my husband said, Hey, your tubing is hanging out. And she's like, Oh, yeah. And I said, Yeah, I heard your alarm go off. I thought it was me. And she said, she said, Yeah, I'm gonna go over and get some juice, go get some juice. And then I was telling her about my pocket underwear. And another time I saw a gal It was summertime and this gal came in to the grocery store and was walking towards me and I saw her pump hanging on her. She had a little sundress with a little spaghetti strap. And I saw her pump and I said I like where you're where you're pump. I said, I'm also type one. Let me show you something. And I showed her the top of my underwear at the pockets and she goes, Oh my God, where did you get those? And I was like, I get I got him from Amazon. And she goes, Oh, I'm gonna have to check those out. I said they're, they're not that expensive. They're fairly inexpensive and I absolutely love them.

Scott Benner 1:07:17
Diane, you just named the episode pocket underwear. Congratulations.

Diane 1:07:20
Pocket underwear. That's right dance. Great. I love my pocket underwear. It's amazing. And I I'm always talking to my co workers about, you know, convenience and how you know how to wear it. We're always talking about where we put our CGM. I'll see sometimes I don't put mine on my arm very often. I don't really like people seeing it because there's always people saying, oh, oh, good for you. You're quitting smoking or you know. No, no.

Scott Benner 1:07:53
It's fine, Alex, thank you.

Diane 1:07:57
I started yelling at the farmers market and she had her CGM on our arm I think brave I whispered tourists and you share our brain wearing CGM on your arm. And she's like, Oh, yeah. She said that she had gestational diabetes and they prescribed it to her while she while she was pregnant. And I thought that is so amazing that they're doing that and my neighbor across the street, he's going through throat cancer. And they gave him a libre. My his wife messaged me one day I was out and about and she was like, hey, they just prescribed the libre. Are there any suggestions and I, I bought this, I buy this spray on adhesive. Skin adhesive, you know, it's like a skin prep. I said, Oh, I've got some bottles with that. I'll bring one over and we went over I went over and we talked about it and and just because they got him on here, he's type two diabetic and they got him on high doses of steroids while he's getting chemo and radiation. So yeah, it's just I'm always educating people about all the time. I think it's so important to talk about it. I wished I sometimes I'm sad because I wish that I could share this with my dad. Oh, yeah. Yeah. I'm sorry I missed him so much. I never realized sorry. never realize how much how much you went through. You know, how many cards and trying to keep his blood sugar's you know, straight. I remember one time he my mom had gone to the grocery store. I was about four years old. And my dad's blood sugar had been i and he's given himself several doses of insulin and they finally caught up with him and he went lay down to take a nap and my mom needed to talk to him and she Call the house. And, of course, you know, in the early 70s, late 60s, late 60s I Yes. And she was like, I need to talk to Dad, can you get him on the phone and I went into the bedroom and his eyes were wide open, but I could not wake him up. So I came back to the phone. I said, Oh, you know, he's awake, but he won't get up, he won't wake up. His eyes are open. And so my mom knew something was wrong. And she came home and he was, he was extremely low, low blood sugar. And I remember my grandparents coming to show us their new car, and we wrapped my dad in a bike and they got him out to the car and he took them to the hospital. I was just crazy. And, you know,

Scott Benner 1:10:47
I didn't think you're gonna make me cry. The end. Thanks.

Diane 1:10:51
Yeah, it just sucks. You know, you just you wish that you could share the technology. And yeah,

Scott Benner 1:10:59
no, I know, people who have that available to them now or are fortunate in ways they don't even understand. They may not even understand, you know?

Diane 1:11:08
Oh, yeah. I mean, I remember all of that stuff. My dad, I remember my dad was part of some kind of. He was some kind of guinea pig for a Good Samaritan Hospital in Portland. I remember going to Portland, my brother and I, and my mom. We stayed in like a boarding house while my dad was in the hospital. And he was they were doing some kind of I don't know, it's not experiments, but some kind of trial thing. And my dad was involved in that. Yeah. But dad managed to keep all his fingers and toes. His kidneys were you know, he was he had kidney, you know, chronic kidney disease from just all the years of high blood sugar's, but he wasn't in dialysis, but it was getting to that point. And his heart had been quite affected. He'd had his first open heart when he was 35. Oh, wow. And then about 17 years later, he had a second open heart surgery. And he had significant arrhythmia. And that's ultimately what killed him is his heart. You know, he had a regular heartbeat. He didn't have afib. You know, he just had all the other stuff. Well, yeah, I

Scott Benner 1:12:22
mean, it's, yeah, that's a long time ago. And if you weren't lucky enough to maybe even just, again, lucky enough to have a doctor who set your insulin about correctly for your activity and your food, you would just go along with high blood sugars and not know what are we bouncing all over the place and not know it? Know?

Diane 1:12:41
For sure. Yeah. Oh, yeah. It's interesting. Yeah. And my grandma, you know, my grandma was always very protective of him. They had a very close relationship. It was sometimes difficult. It was difficult for my my mom, my parents marriage, they got divorced when I was 21. And my dad, you know, he did manage himself that he really relied a lot on my grandma, you know, to help him too. And he, he tried to get my mom to, you know, have her take over his care? And she was like, No, you're an adult, you need to take care of yourself. Which is true. Yeah. But, you know, he had had all those years of being taken care of as a child. And, you know, he was in track. And he was very active. And then that, of course, as soon as he was diagnosed, and he wasn't allowed to do any of those kinds of things anymore, which was really, really hard for him. Yeah.

Scott Benner 1:13:41
I said that time of the time in the world, but he just you can't be active anyway. It's long enough ago, I've talked to people who one woman was told by a doctor to drop out of college because men wouldn't want to marry her. So she might as well just go would enjoy her life before it killed her. Like, that's a thing that God says. It's a thing that God said to somebody. So, so crazy.

Diane 1:14:03
I know. There's, there's so many that's one of the cool thing about the internet and multimedia, it's, you can listen to podcasts, there's groups that you can join. One of my co workers, that's the type one she or she started a like a support group where they get together and they have cocktails and these fun stuff like that. You can join you know, in your community and I belong to a couple of different groups on Facebook. I read a lot of people's stories, you know, that have been diabetics for as long as my dad was, it had been a diabetic, you know, and you know, it was long and I can relate to their stories because I remember my dad wheeling syringes on the stove and forgetting that they're on the stove and they have in Gloucester wrenches explode all over the kitchen. And I

Scott Benner 1:14:54
mean, the thing that grabbed me is sharpening his own needles on the whetstone.

Diane 1:14:59
Oh yeah, yeah, I remember I remember my dad had a nice good size. It was like a three by six inch Whetstone, and he would sit and sharpen his needles. And I was didn't watch him. Watch him sharpen his needles. And I remember, you know, when I was when I first saw him doing it, I was like, What are you doing? What are you doing that for? And he goes, Well, they get doll after I've used them a few times they get those, so I have to sharpen them so that they that I can get my shots without hurting me. It's like,

Scott Benner 1:15:31
now your stuff comes in the mail.

Diane 1:15:35
Yeah, totally. I just get on the phone, call him up

Scott Benner 1:15:38
and open your front door and they're sitting there. It's so cool. It is pretty great. Actually crazy. Dying. I'm a little out of time. So I have to say goodbye. But I really do appreciate this very much. And you coming on and sharing your story and, and letting me rant and rave about the hospital and everything else. So I appreciate your course.

Diane 1:15:57
That's that's the one beauty of of your podcasts that I love is that you. You you share as well. And I love I love it when you share I I just I'm always telling everybody about your podcast and thank you. Yeah, and when my psychologist when I was seeing him, and I was telling him about your podcast, he's like, he told me you should start a podcast, you should start a podcast. And then he would like think of names. For me, like, night shifts are in type one and

Scott Benner 1:16:32
nine. I'm against other people starting podcasts. I've already done it. And I've advertised as I need to satisfy and I don't need you all out there splitting up the course. Yes. In

Diane 1:16:42
fact, my co workers her endocrinologist, I guess has like a local podcast. And I went to she told me her doctor's name and I went to her podcast. And guess who her guest was on that show was Ginni. Oh, no. I was like, Oh my gosh, I was like, Oh my gosh, this is so crazy. I listen, I've listened to Jenny So many times on on juicebox. And he or she is talking to my co workers doctor. I was just like, that's just a small world, but not a small world. Yeah, no

Scott Benner 1:17:16
kidding. It's very funny. Well, Jenny's got a good microphone. I paid for it that other podcast and send me some money. She probably sounded fantastic on it. She did

Diane 1:17:24
sound fantastic. And I paid for that. Well, good for you. So you help people in so many ways. It's amazing.

Scott Benner 1:17:33
Oh my gosh, you're very nice. Okay, well, thank you very much. Hold on one second for me.

Arden started using a contour meter because of its accuracy. But she continues to use it because it's adorable and trustworthy. If you have diabetes, you want the contour next gen blood glucose meter. There's already so many decisions. Let me take this one off your plate. Contour next, Doc com slash juice box. 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 juice box. you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. I'm just I'm still rubbing my face on my new cozy Earth stuff. The the pullovers I don't know what it's made out of. I mean, I guess I could figure it out. But who cares? I think it's whatever is a cloud, like fat no. Beautiful, so soft. I'm gonna say this. And I've already done what I need to do for cozy Earth today. Like I've made my money. You know what I mean? Like, I don't have to keep talking. I don't know what it is about cozy Earth stuff. Put it whatever words to what you want once you get it when I wear it. I feel like I've upgraded myself. That's the best thing I can say. Like when I put on like cozy Earth joggers, like, yeah, they're sweat pants, right? But I put them on. I think this is what Drake must be wearing right now. Like when Drake puts on some sweats to go out and get like, you know, like coffee or something. He's whatever he's wearing. He's gotta feel like this. cozier.com use the offer code juice box at checkout. And you can be a Canadian rapper too. Or a podcaster I guess. Hey, if you have type one diabetes, or you're the caregiver of someone who is type one and you're a US resident, not so sorry, Drake, you can't do this. T one D exchange.org/juice. Box complete the survey, support the podcast support people with type one diabetes. You might really help yourself. T one D exchange.org/juicebox. Go fill out that survey. get logged on for me. Thank you. Lots of people with autoimmune seem to have trouble with their thyroid it and that's why I've made the defining thyroid series juicebox podcast.com. Click on defining thyroid the menu to find out more. Once there was a time when I just told people if you want a low and stable a one C, just listen to the Juicebox Podcast. But as the years went on, and the podcast episodes grew, it became more and more difficult for people to listen to everyone. So I made the diabetes Pro Tip series. This series is with me and Jenny Smith. Jenny is a Certified diabetes Care and Education Specialist. She's also a registered and licensed dietitian and a type one herself for over 30 years and I of course, am the father of a child who was diagnosed at age two in 2006. The Pro Tip series begins at episode 210 with an episode called newly diagnosed or starting over, and from there all about MDI Pre-Bolus Singh insulin pumping bumping and nudging variables exercise illness, injury surgeries glucagon long term health bumping and nudging how to explain type one to your family. Postpartum honeymoon transitioning all about insulin Temp, Basal. These are all different episodes, setting your Basal insulin, fat and protein pregnancy, the glycemic index and load and so much more like female hormones and weight loss. Head now to juicebox podcast.com. Go up in the menu at the top and click on diabetes pro tip. Or if you're in the private Facebook group, there's a list of these episodes right in the feature tab. Find out how I helped keep my daughter's a one C between five two and six two for the last 10 years without diet restrictions. juicebox podcast.com Start listening today. It's absolutely free. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com