#1230 Off Insulin with Mounjaro

Jim, an 8-year Type 1, has discontinued insulin use since incorporating Mounjaro into his regimen. 

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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 1230 of the Juicebox Podcast

Well, I think today some of you are going to be mad at this episode might even get a little pissed off, but some of you are going to be amazed and some of you are going to think this is a miracle, it's probably not one way or the other. 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. guys seriously, why don't you hear Jim's story? It's bananas. And I'm talking to like be a Na Na S that is bananas. 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. And if you'd like to help with T one D research go to T one D exchange.org/juicebox. complete the survey and just like that you'll be helping they're looking for US residents who have type one or are the caregiver of someone who does. I got the opening done so quickly. I ran out of things to say so I'll just wait with you quietly told musicans Dun dun dun BUM BUM BUM BUM BUM BUM BUM BUM here humps nice guys. Today's episode of The Juicebox Podcast is sponsored by Omni pod and the Omni pod five. Learn more and get started today at Omni pod.com/juice box. This episode of The Juicebox Podcast is sponsored by ag one drink ag one.com/juice box. When you use my link and place your first order, you're gonna get a welcome kit, a year supply of vitamin D and five free travel packs. This episode of The Juicebox Podcast is sponsored by cozy Earth cozy earth.com use the offer code juicebox at checkout to save 30% off of the clothing, towels sheets off of everything they have at cozy earth.com.

Jim 2:16
So Hi, I'm Jim D from Boston mass. I'm a type one diabetic.

Scott Benner 2:22
Tim, I appreciate you doing this. You don't know this because you're completely new to the podcast and everything. But you're probably the quickest person to ever book and get on that I've ever talked with. Usually it takes six months to get on to the podcast. Wow, I

Jim 2:34
feel like an Olympic champion and I'm just sitting here at my job. Well,

Scott Benner 2:38
you should, because you have a very specific story that is, I think significant. I'll tell people that you appeared as a new Facebook group member and put up this kind of like not long but detailed thoughtful post about your situation. And it became instantly the most popular, almost polarizing posts that I've seen in a while. I want to work backwards and get back to that post at some point. So before we get to that, tell me how old are you? How old were you when you were diagnosed with type one? I want to hear that bit first.

Jim 3:13
Sure. So first of all, Scott, thank you for having me. I'm glad I was able to bring some topic to the table that people seem to be excited about. So I'm happy to share my story. And so I am about to turn 58 In two weeks, and I was diagnosed as a type one. When I was 50 years old on Valentine's Day of 2020 diabetes doesn't run in my family at all. There's no history of it. I wasn't pre diabetic. This literally came out of thin air for me and I live a relatively healthy lifestyle. I was not a huge snacker not a regular Coke drinker. It just literally hit me like, like a bag of sand to the side of the head out of nowhere.

Scott Benner 3:56
Tim, tell me Jim's Okay, right. Yes, absolutely. 2020 Or did you get the date wrong? Dustin was

Jim 4:03
eight years ago. And so it was 2016 I'm sorry, my room. My bad math?

Scott Benner 4:08
No, no, that's fine. Because I'm like, had it my head. I'm like he's had type one for eight years. Then he said 2020 Oh my god. Did I misunderstand. I'm sorry. Okay. Don't be don't be sorry.

Jim 4:15
So it did happen to people at my age. Listen, I'm

Scott Benner 4:19
52 and I'm not doing the like walk into the room and forget that I came to pee thing yet but I'm getting closer. So you said came out of nowhere. So let's go through it first. Sure in your family, any other type one diabetes, and

Jim 4:35
not nobody who has a close close relative I have some second cousins but their their diabetes runs in the other other side of the family. So you could really argue that there is no biological connection to anybody in my family who had it. I'll explain to you sort of how I was diagnosed. My wife and I were away on vacation. And I've always been somebody I ran cross country in high school. My legs have always had a lot of muscle on them. And I opened up the window curtains one morning and my wife said, Oh my gosh, your legs are so skinny what what's happened? And I burst into tears and said, I don't know what's wrong, but I can't stop drinking water. I'm thirsty all the time. I feel like I have sand in my mouth. I'm sure there's something wrong. And I hope this vacation isn't our last hurrah, but I'm not really sure what's happening. And my wife, who is my non clinical medical adviser, said to me, well, let's call your doctor right now. And we call them we set up an appointment for when we got home. And we got home on a Monday, Tuesday morning, I was in my doctor's office at 830. And by 915, that morning, I was diagnosed with diabetes. They believed it was going to be type one at the time because my a one C was 13.7. I had some other factors. And so they run ran a panel of tests. And lo and behold, I already had the type one antibodies present. So they could confirm that in fact, I was a type one. And starting that afternoon, I was learning how to prick my finger and use a glucose monitor and starting both short term and long term insulin and it just turned my whole life upside down on that. That Valentine's Day.

Scott Benner 6:12
Jim, were you also in the drama club in high school or Turkish humans made me cry? Did you go off on that vacation thinking I'm dying? This episode of the podcast is sponsored by Omni pod five. A lot of people in my private Facebook group talk about their love for Omni pod five. Have you seen those posts and thought, Oh, I wish I could have that experience with an insulin pump too.

Lija Greenseid 6:37
If you have and you answered yes to that question.

Scott Benner 6:39
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Scott Benner 9:08
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Unknown Speaker 10:32
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Scott Benner 10:35
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Jim 11:38
I actually did, I truly in my heart thought there's something terrible going on. And this will be the last wonderful vacation I have with my beautiful wife before you know the hits the fan and whatever we're about to have to deal with, we're gonna have to deal with together. And although I don't keep really secrets from my wife, I felt like this was so potentially devastating that it was important for the two of us to have a nice romantic three day weekend in Miami.

Scott Benner 12:04
How long had you been hiding your symptoms? Probably about

Jim 12:07
three weeks to a month is what I can recall. Now there is Scott a story that I'll share with you briefly that happened about eight months before that, which is I was running a conference in Chicago. And I got the flu the day before the conference started. And I was very, very, very sick with the flu like I had never been sick before. But I didn't realize because I was alone in my hotel room that I was getting very dehydrated and how sick I really was. And so after four days of being stuck in a hotel room, I was talking on the phone with my wife who was in Boston and said either I'm flying to Chicago, or you need to go to the ER and figure out what's going on. And so I took an ambulance to the ER, and they checked me and they told me that I was extremely dehydrated. And that in fact, some of my my core body functions were either on the verge or about to start shutting down because I was so dehydrated. So that experience was in my mind at the time totally unrelated to paying diagnosis. My endocrinologist has a theory. And it's only a theory, of course, but that I was so dehydrated that my body started to become compromised. And your pancreas apparently in your beta cells in particular, are very susceptible to sort of stop working from dehydration, and they don't always come back to life the full way. I never like to say that's what gave me diabetes, because we don't really know. Sure, but they thought that maybe I had a predisposition to it. And then this may have been the trigger for it. Did

Scott Benner 13:32
you have once the testing happened? Did you have auto antibodies for type one? Yes, I don't. Yeah. And are there any other autoimmune issues with you or in your close family like celiac, hypothyroidism, fit a Lago? Anything like that? No,

Jim 13:48
nothing like that. The only thing that that I carry is on a cystic fibrosis carrier. That's the only sort of interesting medical piece about me otherwise I am as plain Jim as you can get. run of the mill. Absolutely. Just normal average run of the mill kind of person. Your mom

Scott Benner 14:06
have arthritis. Ra No,

Jim 14:09
she did not have that. That.

Scott Benner 14:10
Okay. You get the flu?

Jim 14:11
I said she did not. She does not she's still with us.

Scott Benner 14:15
Jim didn't want to write his mom off too soon. No, now she's gone. No way. You know what she's not but when the last time you saw your mom, geez. How old is she?

Jim 14:26
My mother is a very Spry 84 year old. Good

Scott Benner 14:30
fair. That's excellent. Okay, so you go to the hospital, they pump you full of fluids. Is that enough to get you on your feet then that

Jim 14:36
it was so I spent about 12 hours getting pumped full of fluids. They sent me back to the hotel. And then two days later, I was finally well enough to fly home and spent another probably five days of recovery at home, getting stronger and sort of rehydrating getting my energy back. But when I felt better, I thought it was a one and done. I never thought it would potentially have any long term impact. And that's why I say you know, we can't ask absolutely say yes this cause that it's a belief that I have in my life that I was apparently so sick that could have potentially triggered this. Yeah,

Scott Benner 15:07
well, you've never been around autoimmune or type one either. But you know, my daughter had Coxsackie virus before she was diagnosed. Having a virus for instance before diagnosis with type one is incredibly common. Sometimes even stress. I've talked to people who have gone through like traumatic things, then they're type ones come on. But you know, in the end, like you You alluded to, you had auto immune antibodies, they just hadn't been triggered to cause your type one yet. Then after that you have type one diabetes. There's a reason I'm skipping through all this. You have type one diabetes, how are you managing then, like, what did they give you to to deal with this? So

Jim 15:42
I immediately on the day that I was diagnosed, started taking both short term or mealtime insulin and longtime, longtime insulin. So I was taking three shots a day with my meals for about half an hour before I would eat a meal. And then and they put me on a straight flatlined dose. So I was starting with four units of mealtime, insulin. And then I started with six units of long term insulin or over, you know what I would take it right before bed at night, or sometime early in the evening, as well as I also started Metformin at the time, okay.

Scott Benner 16:14
And they told you, you had type one diabetes, nobody misdiagnosed you as type two or anything like that. At

Jim 16:21
the very beginning, like for the first maybe 10 minutes that I was talking to the doctor, in on that fateful day, he said, you know, maybe it's type two, but based on your a one C, which at the time was 13.7, when I had some blood drawn in the office that day, you're presenting as a type one, but let's do the lab work. And so it took a few days, obviously, to get the antibody test back and a few other things, but within short, a very short term. We knew I was a type one. Yeah,

Scott Benner 16:46
lab work, confirmed it. Okay. So now you live, how many years with type one diabetes before you intersected GLP. medication?

Jim 16:59
It was about six and a half years. Okay, so I started Manjaro in October of 2022.

Scott Benner 17:06
Why was it given to you? Or why did you ask for it? So

Jim 17:09
I didn't ask for it. It was nowhere on my radar screen. But I'm lucky enough to live in Greater Boston where we have some of the strongest and best medical facilities in the country. And my endocrinologist who I see quarterly, I would say is appropriately aggressive with both technology and medicine. And she said, You know, there's this new medicine that's come out, it's really designed for type two, she said, but we're seeing some success with type ones. And if you're open to trying it for probably two or three months to see what it could potentially do for you, I think you might be a good candidate for it. And because I trust my endocrinologist implicitly, till the end of the day, I listen to anything that she tells me to do. Follow her guidance. I said sure. I'm happy to try it. And so that's what triggered the initial 2.5 Manjaro shock.

Scott Benner 18:01
Okay, now, let me just go backwards for a second because I really want to hammer this home before we move forward. Every day six and a half years Basal insulin covered every carb that you ate if you didn't your blood sugar went up the whole thing, right? Oh, yes,

Jim 18:15
absolutely. And I would even sometimes think let's say I was going to have a heavy carb meal so maybe I would take six or eight units of insulin before meal and then I would have you know, What would surprise me to be less than carb or someone would serve me whole wheat when I wasn't expecting and so I sometimes you know, would go down based on my insulin into the 50s and even once down as low as the high 40s which was very scary. But yes, I was absolutely taking my excellent as I should my Metformin as I should every meal looking because they had me on because I was in what what we thought was our what was could be described as my honeymoon period. I didn't have to go through the whole calculation of how many carbs Am I gonna eating? And how many does my body need for that yet, it was still kind of a flatline helpful dosage. Do

Scott Benner 19:02
you think that you ever experienced what people call a honeymoon?

Jim 19:05
Yes, I do. And in fact, I think that I was in my honeymoon period for at least a good four to four and a half years before I started to need more insulin, both at mealtime and at night for the long term.

Scott Benner 19:22
Okay, so you probably had, I don't want to call it a lot of light, but you were using a fair amount of insulin already. But it went up about four, four and a half years into it. Then you lived a couple of more years like that with the increased need. Then the Manjaro came on. Exactly. Okay. Did you have any weight issues at the time? As

Jim 19:39
a youth I was always skinny. I was a college kid. I enjoyed donuts and ice cream and cheese burgers. When I hit my late 20s I would say I started to put on weight. But I'm 511 with medium sort of build so I should be around 180 And I got up to as the when I was taking the insulin before I start To the Manjaro, my weight went up almost to 220 pounds. And some of that was because I could eat more with more insulin. And I was trying to live what I quote unquote normally would eat. And so I was probably not quite as self aware of where my weight was going as it should have been. However, I also think that the insulin helped me gain weight. Did you get

Scott Benner 20:23
caught up in that? That feeling of wow, I learned how to Bolus for all this, I can eat whatever I want, and then forget about food as nutrition and calories.

Jim 20:32
It's as if you just read my mind. That's exactly right. Yeah,

Scott Benner 20:34
that's a pretty common jump. So this podcast, which I know you don't listen to talks, you know, when we talk about management stuff, we talk about using the right amount of insulin at the right time and keeping your a one season your variability low by understanding the timing and amount of insulin. But at some point, there are people who lose the you start seeing food so much as this like thing you conquer with insulin that you stopped seeing it the way other people think about it, which is calories that could if I eat too many of them caused me to gain weight. Exactly. Yeah, it's really interesting how it happens. So okay, so you are a couple of years, hot and heavy using insulin, you're gaining weight, etc. and so on. Your life's moving on, doctor comes over and says, Hey, we're hearing about how this drug is helping people. Why don't you give it a whirl? They don't have any problems with insurance, because back then insurance wasn't hassling people about it. Isn't it interesting. And I want to point this out to him, I don't want to make your your episode a political statement. But if Jim would have had this experience two years later, than the rest of the story you're about to hear it never happens, because Jim's doctor would have said, hey, I want you to try 2.5 of a GLP. And his insurance would have said no, he has type one diabetes. And that's not what this is for. So you get the two, five, you start to inject it. What do you notice in the first week,

Jim 21:55
like probably many of the listeners, not only did I start the injection, but I found a Facebook group, I did some research online. And I thought I was going to take the shot and sort of wake up the next morning and not be hungry and maybe be down five pounds, like I had no expectations of what to expect, other than what I was reading about. So I started the shot on a Friday because I did read that people said that the side effects seem to be worse in the first 24 to 48 hours after taking a shot. And so I thought, well, that will give me the weekend to sort of figure out how I'm feeling and what's going on. And I took the first shot with both a level of excitement that thinking wow, I wonder what this is going to do for me. And could this change the my trajectory of how I have to be you as a diabetic, but I was also nervous. And I would say the first week I had 00 impact on me zero, I ate the same I felt the same my body process food the same. My glucose numbers were the same. I didn't see anything. And I thought okay, well, one weekend, we'll see, you know, maybe the second week, something will happen. And so next Friday, again, I took a 2.5 milligram shot. And probably within about 12 hours, I started to feel this slight sense of nausea. And I am not somebody that generally I don't get seasick. I don't get motion sick, I don't generally get nauseous. And I thought oh, this is kind of an interesting feeling in my stomach, I wonder if I maybe ate too much. And now the medicine is telling me Hey, slow down, you know, your digestive tract is slowing down. And so your stomach is giving you a signal. And within another 24 hours, I had lost interest mentally in most foods. And the best way that I describe it, when I've talked to my friends and colleagues about it is it went from like always being hungry and always thinking about what's my next meal? What am I going to have for a snack, but am I going to drink? What am I doing to the flip switch went off. And food just evaporated from my stream of consciousness as always being that number one topic in my brain. And instead, it flipped to everything else that was going on me I felt like it was as if I had foggy glasses on. And then one day I used a little lens cleaner and everything became sharper and crisper. Because the noise from the food and thinking about what my next meal would be what would my snack be? Just went away and everything else came clear into picture in my life. It was just unbelievable.

Scott Benner 24:23
How did you find the experience because you don't know this, but I don't have diabetes. But I began using GLP. April last year. So I've been major and I've been on it like 14 months and I've lost 47 pounds. I would go as far as to say that there was some time where I had to reevaluate how I spent my days because I was suddenly met with extra time in my mind and extra time physically because I wasn't constantly with food. Does that make sense? Like I actually woke up one day and I'm like it almost felt like boredom or loneliness because I suddenly there was more than 24 hours in the day for me.

Jim 25:04
Yeah, I totally agree with you, Scott in the way that I frequently have described it as I felt like I got more bandwidth in my day, that it was as if a piece of the pie of what used to fill up my week or my day was removed. And now I could start to focus on other things and do them in a deeper, more meaningful way.

Scott Benner 25:21
I'm able to better do that thing that that fit. People always tell other people all the time that like foods, just, you know, fuel for your body, and you're like, okay, like, that sounds good. And then I look at them, and they're all jacked up, and they've got abs and stuff. And I go, obviously, it's working for you. So I'll try. And then I tried to think of food as fuel. And I'm like, I mean, that's nice, but I would like a cookie. Now, it's not like that. Now, like when you and I get done recording today, I'm gonna go downstairs, take a piece of steak, probably two ounces, I'm going to slice it thin. Throw it in a pan with two eggs, scrambled it together and eat it for protein. And I don't know, I might put something else with it. I'm not sure exactly what. But I'm going to eat it because I know I have to for nutrition. But it's 1030 in the morning right now. And I am not hungry. I haven't eaten anything today. I got up. But my dog because I did the thing. I got a shout or it's freeing in a way that I think some people would hear that and go, Oh my God, that sounds horrible. And I think if you were to fight it when it happened, it probably would be horrible. If you started lamenting the loss of something, I can see where you could get into like a psychological battle with it. But I just gave myself over to it because I was like, I am healthier than I was yesterday. I want to keep doing this. You know, interesting to hear other people talk about it like that. So yeah,

Jim 26:40
Scott, I'll tell you another interesting nuance for me, which is I used to find cooking, very relaxing. So it would not be uncommon for me to cook, maybe four out of seven dinners for my family, or for my wife or kids are older and moved out. But my wife and I had to sit down and have a relatively nice meal that would be somewhat complicated to make. But I enjoyed that process. To me that cooking was a relaxing process, I would turn on music, and I would enjoy the whole piece of it. And one of the things that really changed for me is that even the preparation of food lost interest to me. And so really anything related to food and nutrition just sort of moved to the back of my mind because it was no longer the joyful experience of eating or the joyful experience of cooking. Yeah, and the other piece, I would say to your steak and eggs breakfast, by the way, if we would look closer, I'd be there for your leftovers. So it sounds delicious, is that I realized that I can't eat salad anymore. I used to enjoy salad quite a bit. But now it doesn't have enough nutritional value in it for me to eat, even when I add some protein because I do still need carbs. Of course, like we all need carbs to survive. And so you know, I'm not a doctor, I'm not giving you medical advice. But to me, I feel like I need carbs to survive. For me, I've had to really think about what is the nutritional value of everything that goes in my mouth. So before it used to be How sweet is it? And how salty is it? Because those are the two flavor profiles that I would sort of lean towards. And now it's all about how much is it going to feed? What I need to keep my engine going.

Scott Benner 28:17
I have the same thoughts. It's really it actually put me where those health nuts wanted me to be when they were saying it to me, you know, and everybody else is Food is fuel. You know, and only so much fits in here. So put in good fuel. Exactly. And yeah, no, it's fantastic. Okay, so, but this isn't even while you're on the podcast, although we'll jump ahead and jump back again. In the how many years have you been on Manjaro?

Jim 28:41
It'll be two years in October October 1 of 2024. So I'm about 18 months or so into it now.

Scott Benner 28:48
How much weight have you lost?

Jim 28:49
I've lost almost 60 pounds good for you. 60 pounds. It's a life changing amount of weight. Yeah,

Scott Benner 28:57
somebody in my family started using it. And they started to they went the other way they started lamenting Oh, I don't like the food doesn't bring me joy. And I'm like, it's funny. It's like I don't think Food shouldn't bring you joy. But we've gotten to a weird place now where the food's so supercharged was salt and sugar and all that other stuff and you know they probably bringing you more joy than it's supposed to, you know, they're having that thing and I said I'm gonna say something I think they used to say in the 70s around like the dieting phase and I don't want to trigger anybody but nothing tastes as good as skinny feels is how I think of how things now I'm like, because the visuals nice. Like looking better. Is nice putting on a t shirt that doesn't grab me as nice not you know, having fat like in places that I shouldn't that's all nice. Like don't get me wrong, but it's the knees don't hurt more energy better sleep, feel healthier skin looks better. Like it's the other stuff that I that I'm happy to have. The vintage part

Jim 29:53
is a bonus. I wonder how you feel. I love that I feel generally more like I have more energy See, I will say, however, sometimes I struggle to eat enough calories to keep my energy level. Okay, so that's the one thing for me, I absolutely agree with you like the whole idea that I'm healthier, I'm lighter, my clothes are tight on me all feels good to me. The thing that feels best to me though, is when I look at my blood work numbers, and know that not only do I physically look better, that I'm healthier now than I was before. And that's going to lead to, hopefully a long life of being a parent, maybe God willing, someday a grandparent and the life that it is giving me too. And the ability to look long term forward, as opposed to short term forward has been a game changer. Because if you're diagnosed with diabetes, and you're in your 50s, or 50, like I was, you know, you tend to read about the bad stuff, because people don't tend to talk about it or write articles about, oh, I have diabetes, look at these wonderful things that are happening to me to me. So I read all the negatives and was preparing for those. And now I feel like this medicine has given me a new a new outlook on life blast time, my agency I don't I don't know, I don't think I mentioned this before. But my last day when Soucek was 5.7. Like, right, it doesn't get much better than that for a type one diabetic. I couldn't hope for more than that.

Unknown Speaker 31:16
Yeah. How were they

Scott Benner 31:18
throughout the six and a half years? Did they vacillate? Were they pretty stable? They onesies?

Jim 31:23
I generally was somewhere in the sixes for most of the time. Okay. Yes. All right.

Scott Benner 31:29
Here's the real reason you're on the podcast, you start doing the 2.5, did you stay at 2.5? Or did you ever go to five milligrams. So

Jim 31:36
I did 2.5 for a month. And then I moved up to five, and then I kept going up, and I've gone up to as high as 15. And now I've gone back down. So we can talk about that, too.

Scott Benner 31:48
What number did you get your most weight loss at? A combination

Jim 31:51
of 10.0 and 12.5?

Scott Benner 31:55
Okay, because I'm on 10. Right now I use that bounce. So same drug. And I know the name is different, but same drug, my doctor is like, I think we gonna try the 12 next. And she keeps saying like you really see a 1012 even up to the highest dose and said the same thing. Like once we get the fat off of you, we'll we'll go back and find a maintenance level. So how high did you you made it all the way to 15.

Jim 32:18
So I went all the way to 15, I will say that I was only on 15 for a month, and I had significant side effects much worse than I had had on any of the other doses. And so we decided to go back down to the 12.5. And so I was on 12.5 for probably about 10 months straight. And I also feel very lucky. Although I know a lot of people have trouble finding the medicine locally, I was able within a 30 minute drive of my house, I was never out of the medicine at any time, I did have to drive half an hour to get it to me, you know, half an hour of my life, I was well worth some time spent to pick up the medicine. So I I did do 12. And now I'm back. So I stayed on 12 for a long time. And then I started having some additional lows. And so my blood glucose was going down to 60 Sometimes at night. And so we thought I should go down. So I've been back on 10.0 for the last just two weeks. Okay. And so we think that maybe 10 is going to be my maintenance dose, but we're not sure yeah, we have to wait and see, you

Scott Benner 33:22
would have laughed extra hard more than other people on Friday afternoon. If you were at my house, when you saw me come out of here after working all day, and I looked at my wife, I was like, I gotta go, I gotta get my medicine. And then I drove, I drove like 45 minutes in traffic to this little pharmacy that I know, carries it all the time. Go in pleasantries, get it taken care of, look at the guy go, I will be back in a month. Remember me? Like you're actually you're actually working out a little system with them where you're like, look, you can trust me, I'm gonna buy a box of this every month. And therefore they kind of hold it for you. There's like a whole back end thing that's going on around this. It's not I'm not doing anything wrong. I've just I've literally had to build a rapport with a pharmacist to make sure that my medications, they're covered by my insurance lovely like, and again, just say you feel lucky is crazy. I paid $25 for it. But here's the big part of your story, though. How much insulin are you using?

Jim 34:17
So I am very proud and happy to say that I am off all insulin, zero insulin. Let me say that again. No long term, no short term. I now take zero insulin on a daily basis, weekly basis, monthly basis and basically annual basis. And that happened. After about six weeks of being on the Manjaro. I started to titrate down. And I'm sorry, sorry, sorry. It started after two weeks, I started to titrate down and by about five or six weeks, I was fully off of all of my insulin.

Scott Benner 34:53
So does your brain explode like you're only you're halfway into a five milligram shot and you're I'm assuming you're on the phone When was your endo going? I mean, we've been moving my insulin down the way I expected. But how, how much further down? Could this go?

Jim 35:06
Well, it was a, it was a great question. And I when I first called and spoke to my endocrinologist and said, I don't think I need this month's insulin and what this is what's going on? She said, okay, you know, maybe you'll have to go back up. But let's, let's start to move you down. And so we moved down two units at a time of both the long acting and mealtime insulin. And because I was on relatively low doses, it happened pretty quickly. And so I was able to get off of all of my insulin. And I have to say that when I meet diabetics, quote, unquote, out in the wild, and you know, I, if I see somebody with a Dexcom on I am just one of those people, I just go and start talking to them. And it happened on Saturday night, I was out poor Friday night, we were out for dinner at a Mexican restaurant. And I saw somebody wearing a G six and went over and said, What did you eat for dinner tonight? I'm just curious. And then we started talking, and she asked how much insulin I take. And I told her my story briefly. And that the look on this woman's face was I have to call my endocrinologist. And if it wasn't a Friday night at nine o'clock, I'd probably call her right now, because it is so unbelievable that I have proven through antibody testing that I'm a type one. And yet, I do not currently take any insulin. Here.

Scott Benner 36:14
I don't know how many people you know, with type one diabetes, but have you been met with like skepticism when you say this to people say things like you don't have type one, you had type two, like that kind of stuff?

Jim 36:23
All the time? Yeah. All the time. I hear that. And what I say is, you know, first of all, you know, you don't know me, you know, I don't know you to the to the stranger that I'm having a conversation with. But I can assure you that in fact, you know, I have the testing to prove that I'm a type one. And we have to live in a world where we, we allow for the evolution of medicines and treatments to take place without punishing the patient. And when you tell me that, you know, Oh, I must have been misdiagnosed or you don't know what you're talking about. You're a type two, I just look at them and say, you know, you can believe what you want. But let me tell you my experience I haven't testing done. I know that I'm a type one diabetic. And yet here I sit in front of you today alive without insulin.

Scott Benner 37:08
And a five seven fair in fairness, you're a once he didn't go back into the like high force or something like that. But are you? Are you wearing a CGM still or do you periodically?

Jim 37:17
I do I wear it every day. So I'm somebody that wants to make sure that I'm doing everything I can for my health. And so to me, a CGM is just part of my life that I accept and willingly wear one. Because it helps me there are times where sometimes I won't realize that I'm going low, and it will tell me oh, you know, you're you're in the low 80s. You're heading towards 70. You know, now's the time to have something because Scott, as you probably know, even though you're not diabetic, sometimes you can when you're on these medicines, and totally forget to eat even sometimes drink. And I tend to try to drink a lot of water. But, but I have gotten an entire from waking up until dinnertime without thinking about food like it is that removed from my brain, that I will just keep working all day long. And even though it's lunchtime, and I see people getting up, like, Oh, I'll go to go in five minutes and five minutes becomes an hour. And then I'm on to my next meeting. And it literally as is as if my brain has said, Oh, you must have eaten already, because we're not telling you you're hungry, but I haven't eaten. And so I'll go a whole long time without eating anything. And then of course, there's a you and probably many of the listeners know, that will drive your blood sugar levels down and so that so that my CGM reminds me Oh, I have to eat. Yeah,

Scott Benner 38:33
it's fascinating. That thing that you that you describe, I still don't know how to completely convey it to people. It's so significant that it's caused me to, like, existentially think about food. And, like wonder, like, how do I spend so much of my life? Just captured by the idea that like, I have to, like plan for my next meal? And what am I going to eat now and I haven't eaten in a couple of hours, I have a snack and I feel hungry and you're feeding the hunger all the time. And your body's getting my body was getting like bigger, you know, slowly bigger and bigger, and I was less than less healthy, healthy. And yet, there's no way like you can say have willpower. It's it's a nice thought. But I did not have willpower. I wasn't like gorging myself or anything like that I just ate when I was hungry. I was pretty reasonable about it. I don't eat like a lot of crazy stuff throughout my life, my body was just going the wrong way. And it's almost like the only way I can describe it and I don't think this is technically sound but like, it feels like I have a GLP deficiency. And and now that I have more, my body appears to work the way I think it's supposed to the one thing that I will tell people and I've talked more about this on the podcast, but you have to teach yourself how to eat again, like how to like say to yourself, I know I'm not hungry, but there's an amount of calories today in nutrition today that I need and I'm going to go take it in and there's an amount of water that I need. I'm gonna go take it in, not because I'm being told by some unseen force, but because I know it's necessary, that's a leap you have to make. And it's not going to be the same for everybody, right? Because everybody's digestion is going to be different. And you know, especially with diabetes, you could, we could run into people who have gastroparesis. And I don't just mean like slow digestion, but they could have damage to the nerve that that, you know, handles digestion. And, you know, that would obviously change things. It's not for everybody, but you have to teach yourself how to eat again on it. I'm in the middle of so my daughter uses that. And she's type one. And her her uses, how much her insulin is gone down. It's not going to stop it like it did for you. But significant decrease, I think 16,000 fewer units of insulin this year, because of the GLP.

Jim 40:41
Oh, that's fantastic. Yeah, I'll tell you going back to that, training your brain that you need to eat. The way that I think about it is I used to eat because I loved food. And now I have to eat because my body is an engine and it needs fuel. Yeah. And so that switch to fun to fuel helps me eat. However, it will sometimes take me two and a half hours to eat a small turkey sandwich for lunch. Because it just won't go down easily. My brain is saying you're not hungry. But my brain is also telling me Hey, Jim, you need to eat you need these calories. You need this protein. This is the thing to do. And so it's a little bit like that Ying and Yang and your brain saying yes, no, yes. No. Yes, no. And your rational self saying, Yeah, I know I need to eat something. I know I need this fuel. But it's sometimes hard to to get get it all get all in what you need. In a reasonable time.

Scott Benner 41:38
You don't you don't stop at the gas station. For fun. You stop because you need gas. So exactly. Right now it's something else. So like I asked you about the CGM. For recent Do you see a spike in a meal?

Jim 41:49
I do. So I'll give you an example. I mentioned Friday night, we went up to a Mexican restaurant, I had multiple blamo, or chicken mole a sauce, rice, cabbage and black beans. And so I estimated that that meal probably had based on my portion size, somewhere between 60 and 70 carbs, because there was a lot of a lot of stuff in that. And about an hour after the meal, my blood glucose was up around 180. And it stayed there for about 30 minutes. And then it came back down to about 115. Within the next, I would say 90 minutes or so. And so I was back at my baseline, I tend to be between 100 and 105 to 115. That's sort of my norm. And I was back in my normal baseline sort of range within, you know, two hours or so of eating the meal. Like it was just, it's amazing.

Scott Benner 42:46
I can't imagine that if you had that CGM on your wife, it would have looked much different if she ate the same thing. I

Jim 42:50
totally agree. And that's actually part of what my endocrinologist said, which is look at these charts, like when you mark that you're eating something and you're estimating your carbs, yes, you're getting that spike, but you're coming back down as if your body was functioning like a quote unquote, traditional pancreas normal person.

Scott Benner 43:07
And if you don't eat Mexican, if you have a more normal that turkey sandwich, do you see any kind of rise at all, as

Jim 43:15
much smaller, so maybe I'll go to 131 40, something like that. If you ever said to me that in my lifetime, I was going to go from taking four shots a day, to no shots a day, or one shot a week. And my eight one C is going to be lower. I'm gonna feel better. You're gonna look better. I would have said, you know, Scott, nice to meet you, but go sell it to somebody else because I'm not buying

Scott Benner 43:38
Oh, no, for sure. It would have sounded like I was like, Jim, do you know what happens? If you take cinnamon and put it on your food? It's gonna make your blood sugar better? Like no, it would have sounded like crazy. And that's see this is where we are right now. June 10 2024. We don't really know what this medication is going to do yet. Like right now out in the world, right, you're seeing it starts off as a type two medication. And by the way, it's been out for years longer than people think like just because the first time you saw that Mindy Kaling was thin. You heard the word ozempic doesn't mean that's when it started happening. Like there's before there's been rebel sis and other other stuff, you know, other like, there were daily shots of GLP s for for diabetes, you know, back in the day is the senza stuff like that. It's been out for a long time, right? They're obviously they've made some new molecules with the ozempic and the Manjaro. They're working better, but there's more coming. And right so now they go okay, type twos it worked for in the studies, they see weight loss, they make a weight loss drug, you said you know, you use Manjaro. I use that bound. It's they're both drugs that Lily make. They're the exact same molecule. They're just one was run through the FDA for type two diabetes one was run through the FDA for weight loss they give I have to give them different names. Now what we need is studies for people with type one like and we need it Fast and and we need to well, because your experience is insane like there's part of me gym that thinks that the government should come and get you and take you to a lab and you shouldn't even be able to say you don't want to go. Because we need to know why this is helping you. Like, why is this doing this for you? Why is my daughter gonna use 16,000 fewer units of insulin this year? She's had type one diabetes since she was two. She's 20.

Like, yeah, like what's believable? Yeah,

Jim 45:30
it is absolutely unbelievable. And for people that are listening to the podcast, you know, go go to the Facebook group and look at some of the comments from some of the people who reacted to my post. And, you know, there's dozens and dozens of people who are telling me I was misdiagnosed, or be that it's impossible, I must be doing something else. Or one person even said that, you know, I'm like a charlatan selling a witch potion, people on the street. What I want to say and if we if there's one message that anybody sort of takes away is, we're at the tip of an iceberg of understanding something new and different. So we can't let our belief system from the past impact our belief system for the future. And we need to accept that there are new medicines that open up new possibilities and seem to do different things in our body than we knew were always possible. And so I sit here, you know, as a type one, five years ago, if you said to a type one, you know, there's something coming out in a few years or something that's going to become more available next few years, that's going to take you off insulin, you know, they would have laughed at you and said, Oh, that poor guy. He's He's a nutcase. Because that's never gonna happen to him. It's

Scott Benner 46:35
possible that five years ago, you would have said that if I said it to you, oh, 100%, I think your point is just so worth, like, shining a light on, we don't know what this is. And we're still finding out. Like, I'm not saying if everyone goes out gets Manjaro and starts taking it, you're type one diabetes isn't going to need insulin anymore. I'm not saying that. I don't think that's true. I don't think that would happen for everybody. But you're the second person that I've interviewed that this has happened for. So

Jim 47:02
I will tell you, Scott, that I know somebody who is a type one diabetic, who it didn't work for. And so he's all upset, right? Like, you know, what, why is Jim getting all of these wonderful benefits? And I'm not. And so you're right, we do need to do more research, we need to understand what is it that makes it work in patient a but not in patient B, right. So that we can try to understand is it about when you were diagnosed? Is it about how far along you are in a honeymoon period? Is it something else that maybe I carry that helps the Manjaro do its job better? Or in a different way than it may for somebody else? Yeah, there's a lot of work to be done to try to understand this. The other thing that I would say is that Oprah did a special a couple of months ago on weight loss. It's available. Now, this is not a it's not a sponsorship plug. But I'll tell you it is available on Hulu, if you want to watch it because I recommend it to a lot of people. She also talks about how, you know, weight loss is very similar to the way we looked at alcoholism a few decades ago, which is, you know, we thought well, why can't you just put down the bottle it stopped Well, we realize it's a disease that your body has. And there are things that we can do to help you mitigate the condition. And weight loss is exactly the same, right? There's sort of three buckets of people. There's some people who diet and exercise work really well for, there's some people that only diet works really well for. And then there's this third bucket of people like myself who diet and exercise didn't work for me. And in fact, that's one of the frustrating things in my life is that for many years, I tried diet and exercise and it wouldn't work for me. And so I felt like I must be doing something wrong. And what a what is it that Jim has to do to apply more effort or more time or more commitment to make this happen, and now I realized it wasn't about my mindset or my energy that I put into it or my desire, but instead it was something genetically sort of miss programmed in my DNA that wasn't allowing that to happen. And now this new medicine is helping to fix whatever was broken in a way that is allowing me to live a more traditional, non diabetic lifestyle.

Scott Benner 49:09
You see people you know, famous people were like, it'll just work hard, you'll look like me, I'm like, well, a you have $9 billion. And your day isn't like mine is I don't you know, you don't get up at six o'clock in the morning and have to like take a shower and take out the dog and then drive an hour to work and then you know, work nine hours and then drive home and like you don't I mean like your life's not the same let's not like pretend that lives also. I've heard you in an interview say you use testosterone which by the way, if that's working for you, I think that's great, but I don't have access to that and I you know, and your body just happens to work with this process like this process that you choose of working out hard and and you know, taking your supplements and doing all the things that you do like it worked for you. Jim's points, right. You could take a different person and make them do those things. And it's still work. workout for them the same way, like everyone's body doesn't work exactly the same way. There's got to be different pathways for different people. Yeah, you're 100%.

Jim 50:07
Right. And not everybody is the same. What works for you may not work for me. And I also tell people don't believe everything you say, I tend to be a little bit of a disbeliever when it comes to some things. And when that person on TV that celebrity is saying, oh, you know, you just diet and exercise, you can look like me, well, I don't have a private chef, I don't have a gym in my house, I don't have a trainer that comes to my house. Oh, and by the way, I'm not having super plastic surgery on the side that I'm not talking

Scott Benner 50:34
likely cries at night, I get up with them. Like, again, all the other things that are happening that they don't tell you about, like 100,000,000%. Like, and moreover, I don't get Jinta. If I if I got preachy for five seconds, I don't I understand, like some of the responses you saw to your posts, like I really do. And at the same time, I don't understand them at all. Like, why wouldn't you look at this guy who's like, Hey, here's my story and go, Oh, my God, tell me everything you did write it down. Please send it to me. I want to go try to mimic this and see if this will work for me. But my big question for you is your insurance started to cover this. I imagine because it was back before they got the before they realized they could screw people with type on over and say no to it. But is it still covering it? Are you paying cash?

Jim 51:20
No. So it still is covering it? I fortunately have not run into my insurance coverage being an issue. Yeah. Now you're grandfathered in. I have no idea. I really don't know exactly how it works. But maybe maybe because it's a renewing prescription they figure you know, it's it is what it is I just, I can't speak to the back end part of it. What I can tell you is that every time I go and pick up my prescription, and it costs me, let's say $20 for a month or $30 for a month, I'm thankful that it's continuing to work. And I appreciate it very much that I live in a world where I have insurance, and I have access to medicine. And it is it. For me, it's life saving.

Scott Benner 52:08
My wife is the one who carries our insurance for our family. And she switched jobs recently. And I would say that one of the main forms of stress that came to us for this like process of when she was applying and looking like she was going to get the job, and is she going to take the job and all that stuff is happening in there, most of the stress was about their health care, versus the one we had. And when my zip bound, got moved over to the new insurance, and it went through. I felt like angels were singing, you know, and I was like, Oh, thank God, because I actually found myself thinking, I can't pay $25,000 a year for this, but I have to don't lie, like how am I gonna do that? Like, am I gonna have to rob a bank? Like, I'm seriously like, I started having that feeling like, like, you know, Jim, if somebody just came to you one day, they're like, hey, there's another $25,000 bill this year, I would have been like, I can't I don't know how to accomplish that. But I actually found myself thinking, but I would have to, like, I don't know how to like, I don't want to be 50 pounds heavier? Again. Yeah,

Jim 53:08
I think your experience is very normal. And I would only validate that I feel the same way. Like I I really feel like you know, every calendar year as the as the calendar moves from December to January, and my company's insurance rolls to the next year. I pray and hope that I don't have an issue. But you're 100% Right. It's, it's not an insignificant amount of money by any share by any stretch of the imagination. But at the same time, for people like me who, you know, you could argue it has changed my entire life of how I look at food, how much energy I have, when I can do what I want to do. I don't know how I would live without it. And so, you know, it's it's a scary proposition, but I figured some some way shape or form. I'm gonna have to figure this out. Listen,

Scott Benner 53:54
my situation aside, you're gonna get insulin dependent type one diabetes back without it. Like that's bonkers. Like, you cannot Yeah, yeah. Yeah. Have you ever missed an injection on the weekly? Yes,

Jim 54:07
I have. I missed one shot. On purpose. It wasn't a forget. Right. It was purposeful. Yeah. So so my son's in a band and my wife and I try to follow them when we can on tour. And so we knew that the travel schedule was going to just be a little bit crazy over a weekend. And so I decided to not take the medicine. And then when we got back, I decided I wanted to go for a week without it just to see sort of how quickly I the feelings would come back both the emotional and the physical and the need for insulin. And what I can tell you is after one week, I didn't see any change, and I wasn't willing to try for two weeks. There was no reason for me to sort of push it. But skipping one dose for one week seemed to have zero effect on me.

Scott Benner 54:49
You didn't need insulin. I did not Damn.

Again, I'm sending the government to your house. You have to I'm sorry, Jim. I know you love your wife. and everything, but you're not allowed to have real life anymore. We have to study you. I'm sending the aliens to get your gym, that's all. But I mean,

Jim 55:08
it is amazing Scott, your your, your reaction is not unique, like people will people who I tell the story to are like, it's hard to believe it's real, it's hard to believe that what you're telling me based on everything I know about diabetes is true. And I'm like, Look, you know, here's my refrigerator, I've got a whole drawer still filled with insulin. And every month, I have to check to make sure that if I need it, and it hasn't expired, but I don't need that. It's just amazing.

Scott Benner 55:33
Has a doctor approached you about a study yet? Not really

Jim 55:38
know that I was asked, my endocrinologist asked to make sure that I signed up for the type one registry and do the surveys that come out through them. So I do that. But otherwise, no, I haven't been asked her approach to do anything unique. Or somebody

Scott Benner 55:51
should figure out what the hell's special about you. So we can duplicate it?

Jim 55:54
Well, I'll tell you what I tell to anybody that's willing to listen, which is I'm happy to have any conversation. And if I can play some small role in helping others deal with their diabetes, I'm happy to do it. That's the whole reason I said, I'd be happy to talk to you today. Because maybe my experience will make someone else's life a little bit easier. And that you personally I would find that very fulfilling

Scott Benner 56:14
in the short term. I feel badly for all the people who are going to try this and not have the same experience. I don't think it's a dialed in experience, obviously yet clinically, I even I have a friend, just a friend who started it for weight loss. And I'd get the texts. When am I not going to be hungry? You know what I mean? Like, and it was weeks into a month, like, this isn't working for me. I've lost three pounds. I like you know, I'm still hungry and sucks. And no, I want I want what you got, like that kind of thing. And we're having this like real conversation back and forth. And one day, she just sends it to action. She's like, Well, that's it, I can't eat. I'm like, okay, she was I stopped thinking about food, it just magically happened for like two and a half months into it. But then she started seeing different issues, which was, it was slowing down the absorption of some of her pill form medications. And her doctor didn't know how to like, She then lost maybe 14 or 15 pounds, she was like on her way. And then her doctor kind of panicked and said, I don't know how to like fix this absorption problem for your medication. So you have to go off to though, off the GLP

Jim 57:17
you're 100% right, it's it's so new. And not a lot of doctors have a lot of training on it, they all focus on the weight loss part of it. But you know, my I'm lucky enough that my endocrinologist was willing to put me on it early and see how it worked and you know, the stars aligned and I wouldn't change anything for it.

Scott Benner 57:35
Yeah, a lot has to go

right for it to work out for you have to have a smart doctor who's on the kind of the bleeding edge of all this, you got to get lucky with insurance, you have to but I mean, hopefully I just did an interview Friday that hasn't come out yet talking about hopefully like some of these biosimilar companies that are going to make GRPs. And maybe they can become more plentiful and cheaper and stuff like that for people maybe get more insurance, but what we really need is for people to do clinical testing on type ones. Absolutely.

Jim 58:06
I couldn't agree more. And I would also say that if you try it, and it doesn't work, you know, it's upsetting. I fully understand how upsetting it could be. But it doesn't mean that there isn't another innovation coming around the corner. And so I think as particularly as diabetics, we really have to be thinking about tomorrow as much as we think about today, and hope, hope for recognize the reality of today and hope for something new tomorrow. Because whether it's Manjaro helping a larger swath of type one diabetics, or it's some new XYZ medicine, you know, there's so much research going on right now. And there's so many people trying desperately to help us type ones and type twos live the longest, most healthy, normal, traditional life that we can, that I have to believe that whether it's a non GLP GLP one or something else, that hopefully there's going to be something that's going to work for you, the person who is not working for today. And hopefully that will come sooner rather than later. Yeah,

Scott Benner 59:05
you also have to take whatever you can get out of it. Like for my daughter, for example, like she made it up to five milligrams, but it was too much. So she lost, like, her weight got too low. And so we're moving her back to 2.5. Hopefully that will continue to impact her insulin use the same way. It's like a science experiment. You're just trying to figure out what it is because her insulin usage was like way down. Fantastic. But then, you know, she's like, she was away at school and we didn't have as much contact with her. I would have been talking to her more about like, Look, you got to teach herself how to eat but she was just like, eating like once a day or something like that. Because it just, you know, her her she was during finals. And she's like that as you know, like, I'm just not hungry. And I'm like, I know but you need to eat something and we kept like, you know, giving her stuff that she would eat like don't get me wrong, she was eating but she wasn't eating consistently enough. But then the other side of The gym was like while she's beating through finals and these all nighters that were going on for weeks and weeks and weeks. Her blood sugar's were incredibly stable and she wasn't experiencing any lows and her spikes weren't bad. And like, you know, like, so it was allowing her not to think about type one diabetes management put more effort into college and like, you know, so there's kind of a now she's home for summer, of course, and we're going to change the dose and try to get it back in I'm hearing about people online. I haven't I haven't heard one doctor yet say this is okay. But there are people online are starting to microdose it to like, just try to like, like, make a dent into their insulin needs without the other stuff because they can't handle the side effects of some of the bigger doses. And I just don't know where this is gonna go.

Jim 1:00:39
It feels like we're just at the very tip of the iceberg of understanding what it can do and how it does it. And I'm sure as that learning happens, they'll make tweaks to it and right you could I make made this joke, but it's true, like you could almost envision a lineup of are you taking it for weight loss? Are you taking it for type two? Are you taking it for type one, and each one being slightly different to kit the right receptors that our body needs? In a way that makes it very meaningful and results focused? Yeah,

Scott Benner 1:01:09
and you and I, because we don't have any real like, idea of what we'd be talking about. Don't don't aren't talking about what you're seeing for women with PCOS and GRPs, which is starting to look like it might be significant inflammation in general. And I've seen some people without ears Danlos Syndrome, talk about their joint pain going away on GLP is now maybe that's because they lost weight. But maybe it's also because of inflammation loss. Maybe your beta cells are working better because of reduced inflammation. It's

Jim 1:01:37
anything is possible, right? We just don't know. I've also seen on some of the Manjaro Facebook groups, I've read some people who say that they've had drug and alcohol problems that this has helped them break that need and that obsession with whenever they're they're viewed was there. They're gambling as well, there. Yeah. I mean, there's there's just it seems like there's sort of no end to seemingly there's no end to the possibilities of this medicine. I'm sure there are, of course, but But for today, it's it seems to be doing magical things for people in magical ways.

Scott Benner 1:02:11
And we don't seem to know what they are exactly. Like so. So this is a time of discovery. And I hope that Listen, I've been talking about it more frequently a because I'm using it be because I saw what it did for my daughter. But then because I had a mom of a 15 year old type one Come on, who is like, almost completely done with insulin went from like 70 units a day. I think she's down to like four units of basil now. And like, that's insane. Like, and she has the same kind of graphs as you're talking about.

Jim 1:02:41
Yeah, it's it's amazing. It's it's a game changer. It's, it's just unbelievable.

Scott Benner 1:02:47
No, I couldn't possibly agree more. But Jim, I appreciate you doing this with me is there anything I didn't ask you about that I should have or anything you wanted to say that we didn't get to,

Jim 1:02:55
I would only say that I encourage everybody to have an endocrinologist that they really trust and love. Because to me when that relationship right now is one of the most important relationships in my entire life. And so my endocrinologist is, you know, core to my, my well being, and somebody I look to for all kinds of support, and ask help questions too. And so if you're unhappy with your provider, find somebody that that's helpful and that you feel like is going to be able to give you what you need. So if you're a traditionalist and you want someone who's more old school, that's great. If you're looking for somebody who's maybe thinking about more cutting edge technology, that's great. Some people focus on the medicine, whatever it is that you think is going to be the right sort of match for you is what you should go and do. Because there are so many possible scenarios by which you may be able to get help, but you can't do it alone. And you certainly can't do it by doing your own research, you really need to partner with a professional.

Scott Benner 1:03:54
Yeah, especially with the landscape of the insurance right now. Like the way it sits right now around GLP. Specifically, like insurance and just getting a doctor to like, consider a medication that's not labeled for your need right now. I mean, you're looking for special people, you know, you really are, I'm glad and lucky to have found a doctor like that for my family. And it sounds like you have a similar situation, because there are plenty of people who will are gonna go to their endos after this and say, Hey, listen, I just heard a guy's story blah, blah, blah, this guy Jim going to tell them the whole thing and a doctor is gonna go, it's not for type ones. And that's gonna be the end of it. Like they won't, they won't talk to you about it anymore. But you think that that's because it's a rule and they can't but it's because they don't have the balls or the imagination or the knowledge or or that kind of a thing. So exactly,

Jim 1:04:43
or they don't have the bandwidth to really learn for the for the medical professional, right? Because our medical professionals are now so taxed with the patient, patient after patient that they don't even have the professional learning opportunity to say, wait a minute, what happens if I do put a type two on it? Excuse me a type one. On this and it's not you know, that's that's writing sort of off script. I forget what they call that but awful

Scott Benner 1:05:05
Yeah, label. Yeah. And you're right, they might not even know like, they might think you're wrong. Like when you say, Oh, you misunderstood Jim story, or he probably has, like, you know, they could genuinely not be turning you down because they're like, No, I'm not doing that they could be thinking like, that's not right. But you know, I don't know I'm in here all day seeing patients I'm not out there listening to the podcasts and reading, reading, you know, NIH articles and that kind of thing. Yeah, yeah, they're busy being clinicians.

Jim 1:05:32
There's one other thought that I'll share with you, which is someone told me when I was first diagnosed, that I had to find an endocrinologist who is a type one diabetic, because they're the only ones who really understand the struggle. My and I've had to endocrinologists in the last eight years, neither one of them are type one. And they're both incredibly passionate and understand my condition and what it's like. And so to me, whether your endocrinologist does or doesn't have type one, diabetes is inconsequential to the care that you can get. What's most important is you find somebody that you trust, who's an expert in the area that you want to be, and

Scott Benner 1:06:06
you can get a good end of that doesn't have type one, if they're Listen, it's just like everything else. There's good ones, and there's bad ones. And some of the good ones have type one, and then you kind of go, oh, it's because they have type one they understand. But that's not a prerequisite. I've met a lot of NGOs that don't have type one, they're astonishingly good at helping people with it. Exactly. I've also met heard stories that are, you know, curl your toes about people who don't understand that at all, and are still, you know, directing people about how to take care of type one diabetes, so it but it's no different than anything else in the world. It's just exactly right. Well, I mean, I can't I can't thank you enough for doing this. And congratulations on, on what's happened to you. It's just wonderful. I didn't ask you. But let me ask you here at the very end, like, what was it like to functionally not have to use insulin anymore?

Jim 1:06:53
To describe it as emotionally freeing is an intense understatement. I used to carry a backpack around with me a little backpack that I would always have sugar pills in and my insulin in and you know, I'm sort of prepared for the crisis at any moment. And I don't carry that bag anymore. Like that is mind blowing to me that I am able to just seemingly live a traditional, quote unquote, normal lifestyle as a type one diabetic and eat what I want to eat. And my birthday is coming up in two weeks, and I used to love to go to the beach on my birthday, and have a salty bag of pretzels and a full sugar coke. And I haven't had it for many years. But this birthday, I was actually thinking, you know, it might be time to do a little celebration, and recognize what I've been able to accomplish and go and have that full coke and those pretzels on the beach and celebrate my birthday. That's excellent.

Scott Benner 1:07:45
Of course, Jim is going to be for pretzels and three sips of the coat before you go. It's enough.

Jim 1:07:49
Exactly. That's exactly right. I can barely finish anything anymore. So you're 100% on the spot. I

Scott Benner 1:07:55
was driving home from the grocery store the other day, and I had bought a bag of like, pretzels. And I was I was hungry. I'm actually I'm hungry right now. But like I don't want people to think I don't get hungry. But I was hungry on the way home and I opened up that bag of hard pretzels. And I might have eaten like they weren't that big. You know, they were maybe like two or three inches across. And I got to like the third one. And I was like woof. Like, that's enough. I gotta stop. Yeah, like I actually I was like I Oh, I feel full. And I think it's completely possible that prior to a GOP GLP I could have eaten half of that bag of those pretzels.

Yeah,

Jim 1:08:32
I think you're you're 100% right, what used to take me an entire slice of cake to satisfy a craving that was a bite or two.

Scott Benner 1:08:40
Yeah, I have this some I have this pint of Mango Sorbet in my refrigerator, that I now eat a half a teaspoon at a time or a teaspoon at a time. Whereas I would have prior opened it up and been like, oh my god, this is good and had to stop myself from like eating half of it. And I get the same satisfaction out of it. Which is really exactly lovely.

Jim 1:08:58
And I don't know about you, but I don't feel like I'm missing anything. It's not. I mean, I miss cooking. But otherwise, the benefits for this just far outweigh any of those kinds of negative side effects that you might suffer with. It's just, it's just so worth it.

Scott Benner 1:09:12
I can freely agree with that. 100% Yeah, no, I mean, like, Listen, I'm sure people are gonna, like I've had people come at me online and say things like, Oh, you're pushing the GLP agenda. I actually had somebody say that to me. And I'm like, Listen, I'm just sharing with you what's happening to me? Like I'm not like I don't have a GLP sponsorship. Although I want to say something right now. Eli Lilly, I would happily I would happily be exempt bound sponsor, but I don't think they need I don't think they need the marketing. It's something that the word is spreading out on its own but I was interested because that person's perspective. To me seemed like this is not a real answer. This isn't how it should be done. Whatever their their, you know, political line of thinking is around Weight Loss. serve whatever, they you know, maybe I should be dieting and running or something like that, or you know, like, and they don't know, I already tried all those things, that's fine. The anger there about like, You're cheating. And don't tell other people that cheating works. Like I was like, Oh, wow, is that how you think about this? I just think about people being healthier and less encumbered. And what a joy that is for them.

Exactly. Right. So okay, exactly.

Jim 1:10:26
Well, Scott, I, before we close, I think that it's important for me just to say thank you to you, I've even in the few episodes of your podcasts that I've listened to, I feel like I've learned a lot, you are a voice for those who need education and are interested in learning more and hearing these stories and sharing. And so behalf of you know, all the type ones that I know, and I'm sure 1000s and 1000s of others, thank you for doing such a great job and keep up the good work. Oh,

Scott Benner 1:10:54
you're very kind. Thank you, I appreciate that very much. I will, I will, indeed, I have nothing else I could do, Jim, I will end up being a cashier, literally at target if I don't do this. So I don't know what else I'm qualified for, except to make a podcast about diabetes and talk to people about their lives. It's been a real pleasure helping everyone so far, and I sincerely look forward to continuing to do it. And I'm trying to morph along with where things are going. And that is why I'm covering more GLP stories, because I've tried to take a thoughtful step back and look at it. And this really looks like it's going to be a large part of how people with type one type two diabetes are going to manage their lives. So I'm just trying to make sure that people understand it. Because as it unfolds, in all the ways that's going to unfold clinically, insurance, you know, all those different ways. I want people to be ready for it when it's their time not have a drop in their lap and do the like Why are you pushing this GLP agenda on me and then miss out on what my daughter is experiencing what I'm experiencing what you're experiencing, etc. So anyway, I appreciate it. Don't worry, I'm not stopping the thank you so much.

Jim 1:12:02
Keep up the great work. And I hope maybe this conversation helped some people understand that you can be a type one and not be on insulin in the new world that we live in. I

Scott Benner 1:12:11
appreciate your story. I really do. Jim, thank you. Hold on one second for me. Okay. Yes, sir.

I was sent back and I realized you might not be able to hear the crickets. So you might actually think I'm crazy. But I swear Can you listen? It's here, I promise you. Listen, if you're in the private Facebook group, there's going to be a post about this episode. And Jim said he check in and answer questions. So if you have questions for Jim, go ask him. If you'd like to wear the same insulin pump that Arden does, all you have to do is go to Omni pod.com/juice box. That's it. Head over now and get started today. And you'll be wearing the same tubeless insulin pump that Arden has been wearing since she was four years old. I'd like to thank ag one for sponsoring this episode of The Juicebox Podcast and remind you that with your first order, you're going to get a free welcome kit. Five free travel packs in a year supply of vitamin D. That's at AG one.com/juice box. And if you like rubbing comfortable, high quality things on your body, cozy earth.com Go there, fill up your cart with towels and sheets and everything they have. And then save 30% using the offer code juice box at checkout at cozy earth.com. I know that Facebook has a bad reputation. But please give the private Facebook group for the Juicebox Podcast. A healthy once over Juicebox Podcast type one diabetes. The group now has 47,000 members in it, it gets 150 new members a day. It is completely free. And at the very least you can watch other people talk about diabetes, and everybody is welcome type one type two gestational loved ones, everyone is welcome. Go up into the feature tab of the private Facebook group. And there you'll see lists upon lists of all of the management series that are available to you for free in the Juicebox Podcast, becoming a member of that group. I really think it will help you it will at least give you a community. You'll be able to kind of lurk around see what people are talking about. Pick up some tips and tricks. Maybe you can ask a question or offer some help 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

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#1229 Resilience: The Concept and Definitions of Resilience

Scott and Erika break down and discuss resilience. Part 1 of 4

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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 welcome to episode 1229 of the Juicebox Podcast.

On today's episode, Erica Forsythe and I will launch a brand new four part series on resilience. This is episode one, there'll be three more. While you're listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise and Always consult a physician before making any changes to your healthcare plan. If you'd like to hire Erica, she can be found at Erica forsythe.com. When you place your first order for ag one with my link, you'll get five free travel packs and a free year's supply of vitamin D. Drink ag one.com/juice box. If you'd like to help with type one diabetes research and you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org/juicebox. and complete the survey. That's all you have to do. And you're helping you can do it right from your phone or your couch or wherever it takes about 10 minutes. T one D exchange.org/juicebox. I know that Facebook has a bad reputation. But please give the private Facebook group for the Juicebox Podcast a healthy once over Juicebox Podcast type one diabetes. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us met. This episode of The Juicebox Podcast is sponsored by ever since the ever since CGM is more convenient requiring only one sensor every six months. It offers more flexibility with its easy on Easy Off smart transmitter and allows you to take a break when needed. Ever since cgm.com/juice box this show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at je voc glucagon.com forward slash juicebox. Erica I, after one of my fever dream showers sent you a text message where I was like I want to talk about resilience on the podcast. And you were excited. I was excited that you were excited. But today's the day we're going to actually pick through maybe what a series is going to look like I didn't know honestly, like I didn't know is this a conversation takes an hour or is it? You know, take a week and and I want you to kind of talk to people about the steps you took after I proposed the idea.

Erika Forsyth, MFT, LMFT 2:59
Yes. So I think it will probably morph into a lot of different topics and themes as we discuss resilience because what I have found as kind of like when we were talking about ambivalence is that we might all have a certain kind of understanding. And we know the word we know the term, we heard a lot around the pandemic that this is you know, developing, everyone's becoming more resilient. And what I've learned is that even in the experts in the field, all the researchers, they have different ways to define and understand resilience and even how one can become more resilient. And is it innate? Is it something that everyone can develop? Is there is it a privilege? So I think it'd be really exciting and interesting conversation. Cool.

Scott Benner 3:52
I won't tell people that you said you wish you wouldn't have to see any of your clients this week. So you could just read more about resilience. I'm sure that's not a reflection on them, but your excitement about the topic. So yes, I

Erika Forsyth, MFT, LMFT 4:03
just I found when you proposed the idea. I think I went through my own process of thinking like I knew I knew what it was. I know how I can help people and myself become more resilient. And then I realized, gosh, there's so many wonderful books and papers and research out there on it that I didn't even really understand a lot of which I will quote and reference throughout our conversation. So I am grateful for the suggestion and I am curious as to what made you think about it, the topic of resilience. As

Scott Benner 4:39
we may have talked about in the past, when the hot water hits the back of my neck, my brain seems to work better, and mind to Okay, and I feel 15 to 20 IQ points smarter in the shower than I do anywhere else. And I don't I have to be honest with you. I don't recall what happened that made me Say this out loud to myself think it through and then pose it to you, other than to say that it's interesting. Like there are times that people asked me, how did you build this podcast in a way that helps people. And you know, so it's a functional document, you know what I mean that that appears to work in a timeline. And you might think that that's been some like Machiavellian plan that I've been putting together for some time, or that I went to college about, you know, planning things, or the truth is, I just fall on my nose on this stuff. So I'm making my way through Arden's life with diabetes, which is making my way through my life with a daughter who has type one and all that comes with it. And as things I don't know, present themselves to me, and I work through them. I feel like my understanding of the world is building. And at the same time, because of the podcast, and my connection to so many people, and then the Facebook group with now 50,000 members in it, and I get to watch people have conversations and see these sort of like psychosocial things happen in real time. It just seemed to me like it was time to talk about this. So I don't really have another answer, other than to say that maybe I'm in the part of my life where I want to understand this better. You know, because do I have it be just because I grew up poorly. You know, what I mean? Like, did somebody like imbue me with it? When I was born? Like, did I get like, the God go hairs, two arms, two legs, and give him some extra resilience? Or did I just get put in situations over and over again, that required it. But those situations weren't overwhelming enough, that I was able to be resilient didn't really mean like, they didn't break me instead, like, it all seems very lucky to me, you know, the entirety of it, I think, who I am is lucky. And I think there are people who are struggling with things. And it's not because they're not resilient. And it's not because they're not smart, or don't understand the world, I just think that you get put in things in the wrong order. Or you get a little too much of something, and it overwhelms you with the wrong age or whatever, it could put you in a hole that you can't get back out of again, or at least maybe can't get back out of on your own. Anyway, I wondered if I was resilient on purpose, or by mistake, I guess, you know, those are

Erika Forsyth, MFT, LMFT 7:18
great all evidence, even as you are throwing out all those kinds of wonderings. A lot of the research explores all of those things, how why when? What are the risk factors? What are the predictive factor protective factors in developing resilience? And I know we even talked about this throughout all of our time together recording various episodes, your story, and I thought about that if like, how did you not break? Right? Like a lot of when you hear the concept resilience, a lot of people use the analogy of like, when a blade of grass has stepped on, it doesn't break, it might lay there for a while. But surely, it'll it'll stand back up. So like the bending instead of breaking concept, but

Scott Benner 8:02
if a mower comes along, you're not putting it back together again. And, and right, like, so. I mean, I've told a number of stories. But I've said so much on this podcast, I probably I will look back one day and think I shouldn't have told anybody that. But like, you know, I've told stories about things like, you know, being a kid and my dad wanting me to agree with him, and starting off by hitting me with his hand. And then I went to the floor to try to avoid his hand. And then he, I guess, in a desire not to bend over just kicked me instead. And while that was happening, I consciously remember thinking, I could just agree with him in this would stop. And then I thought, but he's not right now. In fairness, Erica, I don't know if he was right or not. And I don't know what the hell we were arguing about. Like, I have no remembrance of any of that. I just remember thinking I'm gonna stand my ground. That's all. And it didn't matter if I was gonna get hurt. He obviously wasn't hurting me too badly. Because I imagine as a child, I would have, I would have given in general, I mean, like it might be. So first of all, I want to say that I'm not saying that there's levels of kicking somebody, but like, you know what I mean? Like, I don't think it was hard enough that it made me go Oh, okay. Like, you know, but so I was able to kind of like stay in the game. I also remember being totaled up and thinking that my mom's not helping me. And then later, I thought, gosh, she must have been really scared if she didn't step in, like that whole thing. I didn't put it all together right away, but it was it's this one memory now. My point is, is that, did I stick up to him? Because I'm a resilient person, or did that experience make me that way? Or did the other little experiences make me that way? Along the way, and does that start right away with being adopted? Like I'm being told when you're like, I've known I'm adopted for my entire life. Like I do not know a moment I didn't I wasn't aware of it. But that's somebody telling you. Hey, you had parents who said, someone else take this You have to make your peace with that right away like somebody gave me away and yes all the other parts really nice somebody stuck up for me somebody made me there their son and I have a mother and a father and all that stuff. But man someone just gave me away. Now I know adopted people that crushes them. I didn't really care that much. Why is that? You don't mean like it's not because I can't take credit for it. That's for certain. Are you going to help me figure out why I'm well

Erika Forsyth, MFT, LMFT 10:29
I don't know. But I think all of your all of these points are definitely explored. Even you know, trauma as an infant, we'll talk about what when is trauma it does matter right when when you learn about or experience a trauma, even trauma that you don't even remember like when you were a newborn and and you know, adopted, how

Scott Benner 10:54
do we know that 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 Jeeva Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you store Chivo Capo pen 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. diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi origin. This is your friendly reorder email from us med. You open up the email. It's a big button that says click here to reorder. And you're done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives, we click on a link and the next thing you know your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three, and the Dexcom G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is call 888-721-1514 or go to my link us med.com/juicebox using that number or my link helps to support the production of the Juicebox Podcast. Like how can we say for sure that something that happened to me when I was three somehow sticks to me or like now they talk about generational trauma? Right? Like, you know, something could have happened to your parents that imprints on you somehow genetically, like where's the research that makes us comfortable saying that that's the thing.

Erika Forsyth, MFT, LMFT 13:49
I would suspect within neurobiology, you know, scientists who are literally studying people's brains in conjunction with their story, and in conjunction with their presenting symptoms and behaviors and their new measures that they have, that we'll talk about. Also, I feel like now we're kind of doing an intro here, like the ACE measures, the adverse childhood experiences where we'll want to talk about that a little bit. That came out about 25 years ago, but became really kind of hot, about three to five years ago. That that is I am not an expert in the neurobiology brain research fields. But from what I from what I've learned and gathered, my understanding is that they can track that based on those things I just said, Well,

Scott Benner 14:39
I mean, it seems common sense it right. Like, I don't know you've Jewish people have been through the Holocaust. And then you get a generation of fearful people who think they're gonna come and get us, you know, and then that doesn't happen but they still have that fear then that imprints on their kids, and then their kids move forward in that in that kind of nervous, like, you know, that kind of thing, like I'm not I know. Sounds like I'm generalizing but I mean, that's, I think that's pretty obvious that that impacts a lot of people. It's not everybody. I've heard people talk about the potato famine, and how you might be able to trace Irish, like people having more. What's the word when you don't feel happy? It's such a simple word. I can't believe it's fall out of my head. No. People take medications depressed, oh my god, it's late in the day. Now people are gonna be like, he couldn't remember depressed, how are you gonna listen to anything else? He said, sorry. But like, I've heard people come up with a fairly, you're a professional. So I'm just a dummy, who learned how to use this microphone. So like, this is your fault. But yeah, like the there can be depression through Irish lineage and, and that they talked about, like those years where those people just didn't have any food. Maybe it's imprinted in your wiring. But maybe also, it's just the way it makes people feel like, you know, you even talked about, like generational issues with money. You know, like, I remember, years and years ago, when the hurricane was in New Orleans very long time ago. And I had a neighbor who said to me, Well, why don't they just leave. And I said, because they have generational issues with money, they, I said, they might not be able to afford to leave. And I said to him was like, try to imagine that for the love of owning an automobile, you can't save your own life. And you know, it's not, oh, they should work harder. Or it's you grow up with the expectation that this is your life. And you see that and diabetes, by the way, from people who say, like, oh, I have the sugars, it's going to come and get me just like it comes and got my grandmother. They believe they have a path that they're already set on. And I you know, anyway, it's just it's, it's kind of fascinating. So it is yeah.

Erika Forsyth, MFT, LMFT 16:59
Yeah, well, we could come up with love different examples, like, you know, people who were raised in the after the Great Depression, or during during the Great Depression, and after lots of studies on the fear of not having enough, right, and all those things, and is that as with the question, I think that you're asking, Is that something that is learned? Is it within their genes? Is it through stories, that then you kind of absorb that? Those thoughts and feelings and symptoms? It's probably probably a little bit of everything? Is that

Scott Benner 17:29
a part of us like a psychosis that just befalls all of us? Did you know that there's very little history of people complaining of lower back pain prior to World War Two, people say that we came home and built nice houses and put lawns around them, and everybody's life got easier. And you had more time to think about yourself, I did not have that simple idea that like, you know, you weren't as focused on like, I gotta make money today, because I gotta buy food, or we're all gonna die. Good Life became easier for people. And that gave them more time to consider themselves. I mean, there's arguments being made right now in public that, and I don't know, even I don't have a stance on it. But that maybe even too much therapy could give you too much time to think too much about yourself. You know, like, that kind of an idea? Yes.

Erika Forsyth, MFT, LMFT 18:18
And we will, we will talk about that, too. I'm like, so I'm so excited. You go,

Scott Benner 18:23
you, you, you paste me through this? What really caught your eye? What do you think this conversation is gonna end up being about?

Erika Forsyth, MFT, LMFT 18:30
I think today, I mean, it was we're already kind of, even in your questions, you know, you're reflecting on all the different themes that could come out of the conversation of resilience, and even, even just the concept of resilience is a natural human phenomenon. That's why, you know, some researchers say, that's why we're still alive as we evolve, because we are a resilient species. And I think if we just started off with trying to talk about resilience, I might, I might understand resilience different from you, just like, right, so we want to just understand and acknowledge that resilience, which in general, the I think the easiest definition of resilience is one of my favorites. And I will, quote Brene, Dr. Brene. Brown, as well as Dr. Bruce Perry throughout our conversations, and Oprah as well. They wrote a book recently, Dr. Bruce Perry and Oprah on what happened to you. And then Brene Brown has lots of different books on on resilience and vulnerability. And she Dr. Brene. Brown defines resilience as the ability to overcome adversity. I think it's a very simple definition. But even in that is the word adversity that I want to get into later, whether it's today or another episode, because adversity will look and feel different to all of us. And so I want to define and talk about that along with trauma. The other Dr. Ann Masten, who created the resilience theory, she talks about what's in innate human capacity. So something that you were just kind of wondering, Scott is, are we We're all born with the ability to become resilient. But at what point? Is it a skill? What point? Is it something that that you've mastered? At what point do you need to work on it? That's what we want to talk about. It's it's just she really focuses on the adaptation part. When we think about resilience and positive psychology, which we'll talk about also, I wanted to define it through Dr. Ann Masten, the capacity of a system to withstand or recover from significant disturbances, whether that's trauma, adversity, that threaten its adaptive function, viability or development. So she really looks at resilience, as this kind of interruption you we have all these different systems in our body, when it's interrupted, then do you have the ability to keep functioning to even just survive and even thrive and grow through that? Strike, pause or keep going?

Scott Benner 21:03
I just wanted to add that when I think of being resilient, I don't necessarily think of it always as me overcoming the adversity, but more as just not giving up because of the adversity. So I don't have to win to be resilient. Like in my mind, correct. Yeah. I mean, yeah. And that's, that's just what that's my one thought after listening to that.

Erika Forsyth, MFT, LMFT 21:28
Yes, winning. So that's interesting. So that resilience, as I was describing, it felt like overcoming it, meaning like you, you had the adversity, you had the trauma. And then you're on the other side of

Scott Benner 21:40
it. Like there's triumph at the end. There's triumph. Yeah. Okay. I mean, I have a weird way I think about the timeline of life, like, I'm not looking to win every second of the day, right. So if a couple of days turn into a couple of bad weeks, turn into a bad month, I'm alright. Like, you know, like, my basic needs are covered, and I haven't given up in my heart and in my mind, then I'm being resilient. There's a way to be killed by the thing, a how to kill the thing, or to stay in the fight. It feels to me. And I think as long as you're in the fight, that's not bad. You know, if you can come on the other side of it eventually. I think that's obviously optimal, and what you're shooting for. But I wonder sometimes if people give up too soon, that's all because they think I've already tried. How come I haven't won? Does that make sense? Yes.

Erika Forsyth, MFT, LMFT 22:32
Because one of the key markers of our factors of someone who's resilient is something that you the concept, you've talked about a lot that you are perpetually hopeful, yeah, person, and the ability to, to have hope in these harder, more challenging situations. That's part of being and becoming resilient. Okay? That even when you're down and out, you you're going to keep looking, you're going to problem solve, you're going to look for other resources, you're going to look for help, you're going to ask for help.

Scott Benner 23:06
Yeah, it's interesting, too, because I can easily like, if I wanted to be bombastic, I could say I don't give up. But I could also tell you that my problems were lower middle class, white people problems. The attorney mean, like, my parents were divorced, and the guy hit me some and we didn't have any money, like, but I didn't have any money. But I still was like, sheltered. Like, we didn't have any money, but we ate like, you don't I mean, like, it wasn't, I wasn't homeless, I wasn't without food. I wasn't being molested, like, you know, me, like, there were plenty of levels of worse, under where I was standing. So it's easy for me to say I was resilient. But I don't know. If you put me in one of those other situations, I might be dead. And and maybe on my last breath, I would have told you I fought as hard as I could off. Like, I'm not saying that everybody's got the same fight, obviously. But it is interesting to watch people in a fight that you fought and won Give up. Does that make sense? Yes.

Erika Forsyth, MFT, LMFT 24:07
Okay. And that is because of all these other different factors about who you are. Your personality, the protective factors, the community, right, like, did you have one of the things that we will talk about also extensively? Is this the support system did you have while maybe your father wasn't a safe place for you? Perhaps did you have other places of connection where you felt like you were seen and you were your life mattered?

Scott Benner 24:38
Yeah, it's so funny. You say that because I felt very safe with my dad. Yeah. Okay. Yeah. He's a big, like, protective person for me. I mean, even as we're talking about, like your perspective to judge something like my perspective about my resilience based on my experience, yeah. Also, I think your perspective about getting your ass kicked by your dad in the 70s is different than trying to think about it and 2024 two, that's right, right. So my expectation, I have to be honest with you through my life was that if I didn't listen like someone was going to smack me. So I don't know that it was as shocking as it would be now as if I like just backhanded art and out of nowhere, if she said something crossed to me, like I literally like we try very hard not to say it out loud. But my wife and I later will be like, Yo, you would have got your ass kicked for that. Right? And. And I'm like, No. 100% is a lot of perspective. Like, I like the way we're moving. Don't get me wrong. But I think if we all were magically woken up in 1971, you wouldn't think as much about things as we do. Now, when we look in hindsight, if that

Erika Forsyth, MFT, LMFT 25:44
makes sense. Yes, but I would also want to highlight that as we are looking at these childhood adversities, like through the ACE tool, they have done a lot of research noting that people who have had three or more adverse childhood experiences and that's kind of like the conflict, divorce, neglect, abuse. They've made these links to that there's a higher predictability of having chronic illness. Mental health problems, alcoholism.

Scott Benner 26:18
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Erika Forsyth, MFT, LMFT 28:08
Yes. Yeah, we'll get into that. Yeah. Okay. Good. So and some people might see resilience as getting through making it. Some people see it as getting through overcoming and thoroughly thriving. I love the one thing that Oprah talks about in this book with Dr. Bruce Perry is there's the post traumatic stress, but then there's post traumatic wisdom, I think is really significant to if

Scott Benner 28:38
I'm not mistaken. I'm not 100% Sure. But Oprah has suffered some sexual trauma, right? Yes. Okay. Yes. Okay. Yes.

Erika Forsyth, MFT, LMFT 28:44
Yeah. So she and she, I haven't read that their book cover to cover, but I'm planning on it as we continue to talk through this the series. She does I know, she talks about that in her book as

Scott Benner 28:55
well. Yeah. This is my remembrance from the Yes. And daytime television.

Erika Forsyth, MFT, LMFT 28:58
Yes. And she was one of the first people really to be, you know, vulnerable in that way and make it okay to talk about so it was really significant.

Scott Benner 29:05
Yeah. Okay, good. So I'm happy. I'm excited. So

Erika Forsyth, MFT, LMFT 29:09
yes, good. So I think just one, there's this cultural piece to I think, is significant. When we talk about resilience. Michael Unger, who was part of the resilience research center defines it as the human capacity to navigate and negotiate culturally meaningful resources to sustain their well being. So when we we think about it, resilience, there's kind of these internal skills that can can grow and you can adapt. There's also really significant external source of support, whether it be through your immediate family, through community members through through other cultural factors that are significant your faith, your spirituality, your church. So I think that's important to note too. The research really focuses on and the significance of being in connection and community with people is that is a key factor of being able to be resilient. Yeah.

Scott Benner 30:07
So cultural, cultural importance is big. Yes. I also, as you were talking about that, it occurred to me that I'm adopted, I have two brothers, and a mom and a dad who are all related to each other. And they handled things very similarly, the four of them, and I was very much different, I would have different reactions to problems that would arise. Like they'd all think, like, do this. And I'd be like, that doesn't make any sense. We should be doing this. And I would say, probably not that my brothers aren't resilient. But I have literally no give up on me. Like none. Like if I murdered somebody, Erica, I would say I didn't do it right up until the very end, okay, like, as you were pulling the switch, I'd be like, it wasn't me, you're making a mistake. Right? Like, it would be my last words, you mess it up. I didn't know it. And like, I don't like I don't see barriers. I just something happens. And I pivot. Like, every time I never end. And if somebody says to me, you I go, Oh, no kill, like leg, right leg. Like, I don't sit and take that. Like, if you put something on me like that, I will gather myself and come back at you 10 times as hard as you came at me. That's a thing that on a personal level, I had to learn to modulate. Obviously, as I got older, on even like a business level, like if people would mean I do not take it. I can't tell you how many times I've said to somebody, I'd be happy to die on this hill, even though I know this hill is completely unimportant. And so like, you know, like, seriously, like I am, I am not even I'm not an aggressive person in public. But if somebody approached me, I would think to myself, Well, okay, then I guess this is what I have to die for, like, right here and now. And I have that feeling. intellectually. I have it in my business practices. I said to somebody recently in a business practices, like, if you're not happy, I'd be happy to give your money back. And they were like, no, no, what are you talking about? I was like, No, I mean, I'm like, I'm not doing this with you. But you don't own me, like, we're not doing this like this. And it would have been a significant detriment to me financially, and I did not care. Like, and that's just, I have that feeling about everything, my brothers at some point, they'll give in, like, this is as good as it's gonna be. I'm gonna stop fighting now. Like that kind of thing. My mom was exactly the same way. So anyway, I'm sorry. And so I'm hoping people hear something about their life and the conversation, which is why I'm telling so many stories. But yeah,

Erika Forsyth, MFT, LMFT 32:41
it's hope. It's hope, and the problem solving and the conviction. There's like a conviction and belief system there that has, who know, we don't know, because I haven't I'm not your therapist, but I also don't do brain scans. But somewhere in there, it'd be it became a core. Like those neuro pathways when they were formed as an infant, you were like, your fighter

Scott Benner 33:03
is some of the capacity. I tried to say the word IQ out loud a lot. But like, think of it more as like memory and a computer, like just computing space, right? Like it's some of it capacity is, is some of it a male, female thing sometimes, like, Do women get more protective, where men get more attacking? Like, generally speaking,

Erika Forsyth, MFT, LMFT 33:22
I don't know about the male female data in the written resilient research I have, I can't remember. And I have to find it. I think there is a capacity kind of ability. But I don't want to say that for sure. Because I can't remember, I can't recall, I don't have my notes, but I'm gonna look for it. But it also

Scott Benner 33:41
looks different with other because like, you can, like a mother's a good example, right? Like, how many marriages end when a woman decides I can't let my child be around this anymore. Like, I'll stop being happy. I'll stop feeling fulfilled, I'll stop on the path that I wanted my life to be on to protect this kid like, mothers do those things. I don't know that men do that as much. Generally me like, it just it seems to me like men do more of like what I just talked about, like, I'm just gonna, I'll just kill everything and make it better. They generally mean like, I'll just win. And that'll be better, where women might be like, Look, there's no protected spot here. And their resilience might look like giving up when I think it's just a different kind of resilience. I actually think it's a bigger resilience, if that makes any sense. Like did like the ability to say, I'm gonna walk away from a husband that I love but is maybe just not a good father or, I don't know, uses drugs and is a bad example for my kids or something like that. I'm gonna walk away from that, like, I think that's resilient. I think some people could see that as quitting, but I can see where that's resilience to, you know,

Erika Forsyth, MFT, LMFT 34:51
yes, but and you know, I don't I will, I will stop generalizing, resistant and written generalizing gender men. Hoover's but yes, I think resilience is exactly that is defined differently as you as you kind of receive and narrate that story, right? Is that resilience is you're overcoming the adversity of whatever's happening in that marriage, or family system. But someone else might look at that and say, well, she's quitting on the marriage or quitting on the family. But she's, or he is looking at it as no, I'm overcoming this adversity, and we're gonna move on and grow in this other way.

Scott Benner 35:31
There's bravery in doing that. Right. Like, they're just there is and it could be obviously, it could be a male or a female. I just, I've talked to a lot of people. I've heard that story from three guys and from 50 women, like, you know, like, when someone reaches out to me privately and says, Hey, you know, I don't know what to do. My husband or my wife doesn't take my kids diabetes as seriously as I do. I mean, 99% of the time, that's a woman telling me that her husband doesn't take it seriously. It's very uncommon. It's it's infrequent, but it happens in the other direction. Anyway, it is an overgeneralization based on my experiences, not based on my opinion. I hope that's clear. Whatever. Yes, yes,

Unknown Speaker 36:07
I hear that. Okay. So

Scott Benner 36:09
positive psychology is that we're moving to a fell. Yeah, so

Erika Forsyth, MFT, LMFT 36:12
we kind of understood and we will always I always want to go, we'll go back to this definition, evolution of the definition of resilience throughout. But I think just holding this kind of growing, the right kind of sustaining, surviving, and overcoming adversity, in general is kind of what I'm operating out of, but even though we, you know, that like, leaves different thoughts. So in that, I think, in around the late 1990s, early 2000s, kind of resilience was becoming more of a discussion. That's when the ACES were, I think, originally created, even though as I said, they didn't become kind of hot. Until a few years ago, the President of the APA, which is the American Psychological Association, his name is Martin sell, like, see, like, then I'm not sure if I'm saying that correctly, he kind of made this observation that for the past, you know, 50 years or so, psychology was really focused on the psychopathology of people. And you know, that through the DSM through diagnosis, creating the focus and emphasis on on psychology, was trying to heal from this past damage, right. So you're in that focus of trying to heal from your past trauma, you at the same time, he was noticing that we were neglecting and not focusing on people's strengths, their ability to overcome these hard things. It was just kind of like, let's, let's replay let's and I think there's a really important aspect to that to understand what happened to you, which informs why you're feeling a certain way today, and then heal and move forward. But it was so much focused on just the psychopathology, okay, that that's kind of what positive psychology was, the inception of that was created, which is, the definition is the study of human flourishing, and an applied approach to optimal functioning. So it's, it's also defined as the study of strengths and virtues that enable individuals, communities and organizations to thrive. And so people hear positive psychology, it's not just like, positive mindset, like be happy. There's really an emphasis on understanding someone's strengths, even as they've gone through the adversity. Yeah, focusing

Scott Benner 38:40
on what they are and what they could be, again, not what they aren't and where they're falling short, or what they've had taken from them. Yes, okay. Yes,

Erika Forsyth, MFT, LMFT 38:49
taken from them or not been given to. So that it is a focus on the positive emotions and experiences and virtues and strengths, which is kind of connected to some of the resilience a theme of, of understanding your, like, even even in the midst of that the university knowing like, as you've already referenced, like your ability to keep going the OP, like the hope and the positivity that you can make it through. That's kind of the focus of the positive psychology, and we can get into that now or even in further episodes.

Scott Benner 39:28
Well, let me let me just say this, I remember, I don't know how old I was. But I remember coming to the conclusion that I didn't start on level ground. And that part of my life was going to be getting back to what was equitable and fair. Like I wasn't even at my starting point yet. And I wonder how many people either a don't recognize that they were poorly parented or grew up in a bad situation and that they've been putting a hole We'll just start out, it's almost like taking two flowers and planning one in the sun and one in the shade. And just, you know, one of the shade just doesn't do as well. And but one day you realize it, you walk out into the sun and you're, you're two years behind the other flower, and you got to catch up. Like, I just remember thinking, Oh, geez, like, I have all these thoughts about the world, my head and my ideas about myself and what I want to do, but I don't just get to wander outside, go to college, and then take a vacation and start working and find my way through the world. Like I have a lot of other things to conquer, just to even get back to that space. And then once I got to that space, it was too late, like, chronologically. My wife was like, Are you gonna go to college? And I was like, no, like, we don't have time for that now. Like, it took me all this time to be a person. Like, like, now I've got it. I can't, I took one college class, I got an A. And my wife said, See, you can do it, go get a degree. And I said, No, I can do it. I don't need the degree. And I it's funny because her personality was like, Oh, my God, I didn't even know if you could do this. But you obviously can. So go do it. And I thought no, that was enough. I proved to myself, I'm good. Like, I can make my way on my own. I don't need to go to college. But the point there is, is that recognition of oh my god, some people start on a cleaner slate than I do. And I can either sit around and I guess complained about that. Or I can work to clean the slate off. So I get going. But it's tough once you start seeing how long it takes it. I mean, it was for me at least Yes. But where do you want to move to? It's only ask me what we should talk. You should tell me I

Erika Forsyth, MFT, LMFT 41:36
think let's keep it kind of just kind of doing I think it's feeling where you can do a brief overview. And then because I I feel myself wanting to go deeper into all these things. But then we're not going to just dig into it. I just to brief overview. Yeah,

Scott Benner 41:50
so we're so so far, we've talked about what resilience is positive psychology. And we're going to just in these last 20 minutes or so we'll go over the other kind of big topics that Erica and I are going to come back around and dig deeper in in coming episodes. Yes. Okay. Sounds

Erika Forsyth, MFT, LMFT 42:06
good. Sounds great. Go ahead. So in our next topic, I think it would be important for us to really dig deep into understanding what is adversity and connected to that trauma. Because there's been a lot of it's very common today for us to define like we have had a traumatic background is being diagnosed with diabetes and living with diabetes, a traumatic event, I would say yes. Is it you know, is it a chronic trauma. And so I would love to spend some time understanding, Dr. Bruce Perry differentiates between capital T trauma, kind of like a one time incident versus a little T trauma and how that can become the way it's presented in your body. And then how you present externally a big T trauma. Okay. In that discussion, I think we could go further into PTSD, there's been some, a little bit of research and PTSD and chronic illness. And the I'm gonna go find the person who created that Dr. Donald Edmondson, created the enduring somatic threat model of PTSD. And I think that could be a really interesting conversation around that specifically around the diabetes. Yeah, for sure. So kind of looking at what is what is trauma and adversity? How can we understand that concept? In connecting that to PTSD and we can talk about the in chronic illness there isn't a lot of there's I could not find any research around PTSD and type one, there is some more links around PTSD and type two, but then also, conversely, chronic illness leading to PTSD.

Scott Benner 43:53
Yes, go ahead. I just was doing that math in my head, the chronic illness leading to the PTSD and then thinking of and but PTSD could also lead to some chronic illness.

Erika Forsyth, MFT, LMFT 44:03
Correct? Because of inflammation. Yeah, there's a lot more research on that.

Scott Benner 44:08
Okay, about about inflammation and how it starts to impact your body and everything. Your morphology. Yes, yeah. Okay.

Erika Forsyth, MFT, LMFT 44:15
Yes, in in this discussion, though, I would love for us to spend some time on the concept of of privilege, which is connected to resilience. And this is where Dr. Bruce Perry and Oprah and also Brene Brown and in one of her podcast episodes, they they go into this idea that people who develop PTSD in the end they don't give anything we talk about like kind of combat PTSD, but people who develop traumatic symptoms and behaviors have a higher probability that earlier in life they experienced, what are some of the aces, right? The chaos, threat, neglect, abuse, and so because of that, there's So I want to make sure I'm explaining this clearly, when when you experience chaos or trauma, your stress response system is activated in a kind of a privileged upbringing, where stress is more kind of regulated and kind of expected, your stress response response system has time to respond and adapt, thus creating more resilience, or your ability to become resilient.

Scott Benner 45:28
Because you're not trapped in the in that initial traumatic situation. Or you might even have parents or support system who can help coach you through it or like there's a lot because privilege can mean a lot of things in this space. Right?

Erika Forsyth, MFT, LMFT 45:42
That's right, yeah. And so when I'm talking about privilege is the privilege of feeling safe and secure. And when you're a child, or an even an infant, when there's any activation of the your stress response, if it's uncontrollable, unpredictable, prolonged or extreme, the research and data shows that leads to traumatic changes in your brain and functioning, thus making it more challenging to develop the resilience. And so that's why will they talk about that? How resilience can be defined as a privilege because of because of this data and responsive to kind of pre and post trauma? It's interesting, it is,

Scott Benner 46:32
can those brain changes be reversed? Or are they are you stuck with them? Yes,

Erika Forsyth, MFT, LMFT 46:39
absolutely. I mean, that's where there is hope. It is harder. For example, I'll just I'll just talk about the combat. I think it's a really interesting example. They talk they talk about people who developed combat related PTSD. So like, you go to war, and everyone's exposed to the same MC I'm talking about if you're in military, yeah, you everyone's exposed to the same type of war. But the people who developed combat related PTSD have a probability of an earlier life. This is the Dr. Bruce Perry says an earlier life that's permitted with all of that chaos, threat, neglect and abuse than individuals who have that same combat exposure. Okay, who don't develop combat related PTSD. That's what the data is saying. So there is this because of this early early childhood exposure to prolonged and extreme trauma, they had a higher chance of developing the combat related PTSD, because their stress response system was already sensitized to it.

Scott Benner 47:43
Does that have anything to do with them choosing the military? Oh, I don't know. Interesting question, though. Because, I mean, I don't want to use an offensive word America, but I'm a big policy. And I there's no way I would say, I'll do that. But I've been through so much. So I can see where I mean, like, you're just being generalized. And you think, Oh, I could see maybe where people who have been through something might be, but I see both sides of it. Maybe they'd be drawn to violence, and maybe they'd be drawn to stay away from it to do you, Don't you mean, like, i That's why I ask because I wonder what it is? Or if it's different for everybody?

Erika Forsyth, MFT, LMFT 48:18
Yes. And I think that, I love that, because that kind of goes into this, this concept of the privilege of regulation. This is Brene, brown stuff, where she talks about, can you apply that same thing to vulnerability and curiosity. And if you're feeling safe, if you have a history of feeling safe and secure, you might be be more apt to go out and be curious, and try new things. Try risky things, versus children who were raised in an environment in which they felt not safe or secure, they are often less apt to go out and be vulnerable and curious and try risky things. So that's an interesting question about Yeah, I'm sure there's research out there, but who goes into the military based on their prior experience, because

Scott Benner 49:02
I can definitely see the I can see the desire to want to say if I hit a kid, they'd be prone to violence, but I could also, I could more see, if you hit a kid, they'd want to avoid it. Like that. Or, you know, who knows? Probably no different than you hear people all the time, say, you know, you you see your parents when you're growing up, and you either decide to become them or, or fight against what they are right, like so maybe there's maybe that's just a coin flip in there. But anyway, okay. I didn't mean to get stuck on that, but okay. No,

Erika Forsyth, MFT, LMFT 49:30
I think it's a good question. I think it's really important for us to, to kind of dig into that question, because ultimately, we're still kind of trying to talk about understand this resilience concept about how do you doesn't matter? Does your story matter? Does your history matter based on how you can become resilient right

Scott Benner 49:48
I mean, we'll talk about it more when we get to that that episode, but like what I'm hoping people are hearing I hope they're not hearing the war like example. I hope they're hearing like, am I respond? Finding something to do with my diabetes, because of something that happened to me when I was a kid, or the way I grew up around, I don't know, blah, blah, blah, that when I get to my doctor's office, and I've got my grade A one C, I listen to the podcast, and I got my grade one C, and I'm super happy and excited. And I'm confident I know what I'm doing. And the doctor says, I want you to move your agency up. I don't like this, and they'll go, okay. Like, what is that? Like? How does that happen? If someone said that to me, I don't know that I could stop from laughing at them. But more people I hear from just put their head down and do it. And like, then when I talk to them, they say, I don't know, I don't like confrontation. But maybe there's a reason for that. You know what I mean?

Erika Forsyth, MFT, LMFT 50:42
Yes, and maybe I mean, again, I wouldn't say this applies to all of the examples that you're maybe kind of summarizing, but I think maybe one of our themes could or episodes could be talking about behaviors that are adaptive, that keep you alive, as a child, is it is it people pleasing in this example, if if you are in an environment in which you have learned how to become a people pleaser, to stay alive, I'm thinking kind of in the extreme. Yeah. Or like a lot of people who've grown up in houses of addiction or abuse, many people develop that kind of sense of like, you just you kind of you know how to read the room, you're gonna predict outcomes, you know how to stay safe. And sometimes that can be people pleasing. But then, at some point in your life, that adaptive behavior that kept you alive as a kid is now becoming problematic as an adult. Yeah. And one question that I love that Oprah often talks about is, when is it time to let go of a behavior when it no longer serves you? Right? Because

Scott Benner 51:51
why not? kept you alive? Yeah. When people pleasing started, like, because like, if I was nice, then guy didn't hit me. Like, right, but now I'm an adult, and I'm getting walked all over. And by the way, it's possible. Sometimes you're being walked over by a person who doesn't know they're walking all over you. Because you're, you're people pleasing. So 1000 miles an hour, I think this is what you want. Me I'm like, she seems to like it. Like, you know what I mean? Or if she wants to go see that movie, like, you know what I mean? Like, and, and then you find out later, like, I didn't, I didn't want to do that, like you. Why didn't you say something like, you know, like that I listened. We bought a house. And years later, my wife's like, I didn't want that house. And it was like, You never said that. And we never got deeper into it than that. I was just like, Why didn't you tell me like i? i? Maybe this is it. Maybe she you know, I think back my wife grew up with alcoholic parents. Maybe she was just like, I don't want to rock the boat. You don't I mean, she's got no trouble rocking the boat. Now I just want you to know, so don't worry about it. She figured it out. boats going back and forth constantly.

Unknown Speaker 52:58
Oh, my goodness.

Scott Benner 53:03
So there's hope everybody

Erika Forsyth, MFT, LMFT 53:04
I don't know. I don't know, Kelly. I'm just laughing at this at the reference. Yeah,

Scott Benner 53:08
trust me. She laughed too, because she knows nothing. She didn't make anything easy for me. I like she's getting back at me maybe for the house thing. Who knows? By the way, the house is delightful. Everybody loves it. So whatever. Right? What do we move into? So that was chronic illness?

Erika Forsyth, MFT, LMFT 53:22
So we talked about that, or kind of earlier, the the PTSD and chronic illness? We talked about referencing the ACES the adverse childhood experiences? Yep. I think it'd be important for us to talk about, and I already alluded to it in the beginning and defining resilience, but what what are the common factors of resilient people. And in that conversation, I think it's really important to talk about the community aspect. A lot of the research, as I referenced, discusses and highlights that it's all about connection. I love this quote from Dr. Perry says the best predictor of your current functioning is your current connection. And I was thinking about this in reference to diabetes, and how in the beginning and even at any point in the stage, it can feel so isolating, even though you might have a good family, a good partner, good social support, just even the act of you're the only one that really gets it. If you're the one person living with type one, or you're the caregiver. Even that in itself can be really isolating. I wanted to throw that in there would dig deeper into that. Yeah. on that. Yeah. It's great. That's fantastic. I think it's would be really important for us to at the well at any point, how does one develop resilience? Let's say you you're as you go through and we discuss all these things, and you can you connect or relate to that you have either big T or little T trauma. You understand that you maybe have had moments of resilience and I think that's also important to say like you can have different seasons in your life. where you might feel more resilient than others, it doesn't mean you didn't lose the skill. It's just based on all these other factors that are at play in your life. But I think it'd be important to talk about kind of the re the reframing of trauma, they're kind of the restructuring of how you look at that. Trauma is important, whether it's through grief and loss, kind of processing, or the restructuring, and then tips on how to develop more of that resilience, right? If you are saying kasha, but I have I have all these aces. I've had major trauma in my life I'm living with with this chronic illness. And I feel like my resilience scores are low. How do I develop resilience? So I thought we could maybe talk about it's I mean, it's, it's easy to to name a, you know, a list off of things, but I thought maybe we could hopefully get into conversate about conversation deeper.

Scott Benner 55:52
That's fantastic. So Well, listen, I mean, I'm always gonna come from this perspective that I, I just don't see, with life being such a finite thing. I don't see the virtue and giving up ever. Like deanery mean, like no matter how bad things are getting, I think you should be fighting till the end. Because if a fair enough, if you get to the end, you're like, alright, I can't do it anymore, then go ahead and lay down and die. It's fine. But don't give up a day before or a week before or five years before. Just keep stay in it. Because I mean, what else is there? It's funny when I say things like that, I mean that in such a hopeful way. And I imagine it doesn't sound like that at all. But I really do mean that in a really like kind of bountiful way, like this is life. Like it might not be what you were hoping it was gonna be. But this is it. And so there's two decisions. There's lace them up and fight and there's later on die. That's sort of it to me like, and day to day that it's going to look different. You said there'll be seasons like there are days I don't feel like fighting. Like Trust me, I've worked I go home, make that call tomorrow. But you know, I'm I'm not looking to do that today. But when push comes to shove, Scotty chefs like so like, I wish I want to get everybody into that mindset of like I can I can fight for this thing for myself. I just have too many conversations with too many people who do well. And I don't see much difference between them and the people who are struggling. And this resilience thing to me is the piece of it that's either misunderstood or inequitably doled out or something, and I'd love to learn more about it so people can listen along. So I really appreciate you doing this. It's gonna be great.

Erika Forsyth, MFT, LMFT 57:29
Yes, yes. I look forward to it. Yeah,

Scott Benner 57:32
I know, my pleasure. How many so tell the like here in this last couple of like, how many episodes do you think this is gonna end up in?

Erika Forsyth, MFT, LMFT 57:38
We did already kind of defining resilience and positive psychology. I think next time we can go into the trauma, what is trauma and adversity? I think resilience and privilege could be one PTSD and chronic illness. The Aces, the community connection, peace piece. What makes up resilience? Maybe like, five or six more. That was great. Thank I, but don't quote me on that.

Scott Benner 58:12
Oh, if it's more, it's more if it's less, it's fewer. Yes. Yeah. Nice, right. Yeah. Thank you. I was just trying to like, a little right there with it's fewer by the way. By the way, there's a good example, my wife beat that into my head over years. I'd say less, she'd go. You mean fewer. And I go. Okay, thank you. And then one day, I just like now I say that anyway,

Erika Forsyth, MFT, LMFT 58:34
you learned you adapted? Oh, when I

Scott Benner 58:36
first met her, though she wouldn't have said anything. When she was younger. You know,

Erika Forsyth, MFT, LMFT 58:41
she she advocated and communicated. And then you had you received and adapted? I

Scott Benner 58:46
can't wait to talk about this. Because little things even like that. It's so much about your about the grace, you want to give somebody because I could absolutely see someone saying, oh, yeah, sure. Because she was pretending to be nice while she was trying to get you to marry her, which is a common thing you hear to people. But I don't think that I just think that the way she grew up, she was prone to just kind of acquiesce sometimes. And then as we got older, and she had more experiences and blossomed, she was able to say what she meant, not what she thought somebody else was willing to, you know, tolerate from her, you know. And so anyway, I hope people listen with an open mind, because you might hear things like that, that you have a knee jerk reaction about and then listen through and think, Okay, maybe not, because it's just very simple. Eric, and you see it all the time in popular culture, for people to just people who are succeeding to look at people who aren't succeeding and go, Well, they're just not resilient. That's all, you know, back in the day, you know, you go get, go get some guy from 1940 and bring him up here and see if he feels bullied. He would you know what I mean? Like, it's too easy for people to say that. And it's too complicated for that to be the real answer. That's right. Yeah, that's how I feel. And so I want to see If we can't shine some light on it, because I think if people saw it differently, not only would they maybe make more space for others in their life, but maybe they would do it for themselves too.

Erika Forsyth, MFT, LMFT 1:00:10
Yes and yes. And that's my hope is that we, as we discuss and learn about resilience together, we can we can understand that. It's not as easy as just saying, well just get more resilient and just do it because just do it.

Scott Benner 1:00:26
Her knights come in, why don't you just move? Yeah, it's not that easy. Okay,

Erika Forsyth, MFT, LMFT 1:00:30
I got it. Yes. Perfect. Thank

Scott Benner 1:00:32
you so much.

Erika Forsyth, MFT, LMFT 1:00:33
You're welcome. Thank you.

Scott Benner 1:00:42
A huge thank you to one of today's sponsors, G voc glucagon. Find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. You spell that? G v o KEGLUC. Ag o n.com. Forward slash juicebox. A huge thank you to ever since CGM for sponsoring this episode of the podcast. Are you tired of having to change your sensor every seven to 14 days? With the ever since CGM, you just replace it once every six months via a simple in office visit. Learn more and get started today at ever since cgm.com/juicebox. Arden has been getting her diabetes supplies from us med for three years, you can as well us med.com/juice box or call 888-721-1514 My thanks to us med for sponsoring this episode and for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links at juicebox podcast.com to us Med and all of the sponsors. 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. To learn more about Erica visit Erica forsythe.com 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

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#1228 Grand Rounds: Dr. Jessica Hutchins

Dr. Jessica Hutchins is a Pediatric Endo

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

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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, welcome to episode 1228 of the Juicebox Podcast.

Today, we're gonna be adding to the Grand Rounds series with Dr. Hutchins. She's a pediatric endocrinologist and a member of the private Facebook group for the Juicebox Podcast. 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. If you or a loved one has type one diabetes, and you and that loved one or a US resident, go to T one D exchange.org/juicebox. and complete the survey. This quick survey is going to help type one diabetes research move forward, it's going to help you it's going to help me it's going to help other people T one D exchange.org/juice. Box complete the survey. When you place your first order for ag one with my link you'll get five free travel packs and a free year's supply of vitamin D. Drink ag one.com/juice box. I know that Facebook has a bad reputation, but please give the private Facebook group for the Juicebox Podcast a healthy once over Juicebox Podcast type one diabetes

today's episode of The Juicebox Podcast is sponsored by Dexcom, makers of the Dexcom G seven and G six continuous glucose monitoring systems. dexcom.com/juicebox 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. 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. The touch by type one event live in Orlando is coming up fast. September 14. Tickets are available. They're free. I'm going to be there today I found out Jenny Smith is going to be there head now to touch by type one.org. Go to the program's tab and get yourself some absolutely free ticks. Ticks. That's short for tickets. It's free. Go register now.

Dr. Jessica Hutchins 2:37
Hello. I'm Dr. Jessica Hutchins. I am a pediatric endocrinologist in Georgia.

Scott Benner 2:44
Do I call you Jessica or Dr. Hodge?

Dr. Jessica Hutchins 2:46
You can call me Jessica. Thank

Scott Benner 2:48
you, Jessica. I feel like I know you even though I probably couldn't pick you out of a lineup if I had to. It's been like

Dr. Jessica Hutchins 2:54
over two years, I think at least two? Yeah, definitely. Well over two years that we've I've been on the Facebook group and sending patients to the podcast and the Facebook group. So yeah. Can I

Scott Benner 3:07
start there? How do you make your way to it?

Dr. Jessica Hutchins 3:10
I actually found out from a family a patient. One of my patients moms asked me one day, had you heard of the Juicebox Podcast? I was like no. And honestly, I think when she asked me I wasn't really like I had just kind of started getting into podcasts in general. And so I just had not been a podcast person before and then kind of started listening, dab dab dabbling in podcast listening. And then she mentioned that so then I was like, yeah, I gotta check that out. And then like, since then, was just kind of like, hooked to it. And I really liked a lot of the episodes like, I mean, I enjoyed the episodes of people telling their story, but I actually enjoy the education ones that you and Jenny do and like the series because it helps me have little fun ways to like explain things to patients like it just gives me like little tips and ways to think about stuff. When I'm trying to think of it through the lens of like a parent of a child with type one. So that's kind of the ones I actually listen to more I'll go back and sometimes listen to the story ones but actually like the educational ones best

Scott Benner 4:19
very touching because I think of you as a very tuned in thoughtful progressive Endo.

Dr. Jessica Hutchins 4:25
Yeah, I would consider myself that. Yes.

Scott Benner 4:29
So so you won't know this till I tell you. But you're one of my measurement points for me. Like when when I'm quietly trying to decide if I'm doing the right thing. If I'm, you know, making the best use of the platform. I have all that stuff. I think Jessica is in my Facebook group a lot. And she seems to agree with me. So yes. So I take that as like I'm doing okay. Yes,

Dr. Jessica Hutchins 4:54
no, you're doing great. I think you offer Yeah, it's just it's a All these families because I mean, I, I don't have type one nor do my children. But you know, I just think it's, I always tell families like I literally just saw a new onset diabetic today in the hospital, 14 year old girl. And, you know, no family history like this. And so, you know, they kind of blindsided. But I was telling him I'm like, the parents, I don't know if he listened to podcast, but there's a podcast. So we actually have it. All of our new onset skit like a folder with tons of you know, information, and I have one page is like, books, podcasts and Facebook groups to join and like Juicebox Podcast is on there. And then I have sugar surfing, and the doctor ponders like page, which you've had him on your show before. And we have like a Georgia type one diabetes, Facebook group for like, support group for Georgia. So I feel nice to jump in there. But just, I really think it just connecting families and I always, when I tell families about your podcast, I always say like, you know, his daughter was diagnosed as a toddler. She's now in college, like he's been doing this a long time. And you know, just kind of tell them, you know, there's the new onset to always say, hey, go find go on the Facebook group, they have a list of all the episodes to listen to, you know, for new onset, from the beginning, just that you can wrap your brain around, like, you know, what type one is and how insulin works. I said, because, you know, obviously, they get education in the hospital, but that's what like two days, and then they go home, and it's like, you just got this life changing diagnosis. And if they have no family history of type one, you know, it's it's a lot to take in in such a short period of time. And there's so many nuances and managing it that you can't, you know, like isn't going to be kind of explained in the very, you know, the very beginning, we're trying to just teach them like survival skills to get home safely. And then once they're home, then obviously, that's when they start learning, although, like more they want things that they'll they'll hopefully pick up on over over time.

Scott Benner 6:58
It's funny, the first question that pops up that you don't have an answer from from that hospital visit, and it hits you like a ton of bricks, like oh, I don't know anything about what I'm talking about?

Dr. Jessica Hutchins 7:06
Yes, yeah. And actually it so we have like a really cool setup here. So I'm in Georgia, I'm in like a smaller, like academic facility. And so we have, like residents and stuff like that. But we actually when patients go home, I have a nurse practitioner that works with us, virtually, she used to be works in the hospital. So she worked a lot with our diabetic families in the hospital, but then now she's all virtual. And so when they go home from the hospital, they usually see us in the office in about a month. But up until that appointment, they have virtual visits with this nurse practitioner, to that way, they literally kind of have her like almost at their disposal at first month to ask all the like, you know, silly questions that they can think of, you know, just like, just any little question they can think of, and then she'll review those numbers and adjust their doses and just like helps them kind of, by the time they get to my first appointment, I feel like they're all in a lot better place. Like, just understanding and just from a mental standpoint, just like a mental health standpoint, just they've, they've had that like hand holding for that first month, which has been really awesome. So, so it's been this

Scott Benner 8:13
setup you you like it? I love it. Yeah. And you're seeing, like, you're seeing dividends from it.

Dr. Jessica Hutchins 8:20
I know that parents, I mean, it's hard to, you know, one of the things initially the idea was like, oh, like, let's see if this like decreases like DKA I mean, the thing is, like, I mean, majority of my new onsets aren't like back in decay and a few months. I mean, hopefully not. But you know, we have obviously frequent flyer, you know, kids that come in and DK but for the new onset, I think it's more so the benefit I see is that the families feel more comfortable with the diagnosis, the first visit and the office post no discharge, I think goes by smoother and they've already gotten a lot of their questions answered. And they've aren't they just feel and like the our nurse practitioner that does the program like she's great with them. And you know, she again, she'd handholds a lot which is for people who are listening that are an adult diabetic versus a peds, diabetic, peds and adult world is very different in endocrinology. Like in feeds, we know we do a lot of hand holding and in the adult world sometimes I feel like it's sink or swim like you know, if you're not going to put the effort in then the provider may not put the effort in not everybody but in general when I talk you know to friends who go to adult endocrinologist versus like how I know we operate in peds. I do feel like in peds, we do a little bit more hand holding, because it's just it's a lot because you're not dealing with just the patient the child but it's also the parents and that adds in you know, another level of dynamics in addition to like, you know, puberty and all the stuff, the social, you know, stressors that these kids have at school and things like that. So, so

Scott Benner 9:56
when you Oh, I should ask this did you learn Listen to the Grand Rounds series. Did you bother you or did you like it? Did you not hear it? Today's episode of the podcast is sponsored by Dexcom. And I'd like to take this opportunity to tell you a little bit about the continuous glucose monitor that my daughter wears the Dexcom G seven, the Dexcom G seven is small, it is accurate and it is easy to use. And where Arden has been wearing a Dexcom G seven since almost day one when they came out, and she's having a fantastic experience with it. We love the G six but man is the G seven small the profile so much closer to your body, the weight, you can't really feel it and that's coming from me. And I've worn one. I've worn a G six I've worn a G seven. I found both of the experiences to be lovely. But my gosh is that g7 Tiny and the accuracy has been fantastic. Arden's a onesies are right where we expect them to be. And we actually use the Dexcom clarity app to keep track of those things. That app is built right in to Arden's Dexcom G seven app on her iPhone. Oh, did you not know about that? You can use an iPhone or an Android device to see your Dexcom data. If you have a compatible phone, your Dexcom goes right to the Dexcom app. You don't have to carry the receiver but if you don't want to use the phone, that's fine. Use the Dexcom receiver it's up to you. Choice is yours with Dexcom and now that choice includes direct to Apple Watch dexcom.com/juicebox

Dr. Jessica Hutchins 11:30
podcast have I listened the one that you did recently with another peds? Endo? I listened to that one which is after I listened to that one that's when I emailed him was like hey, let me let let's schedule something I've been meeting like I had been meeting I've been chatting for like two years, like hey, we're gonna do an episode so I've heard like, I haven't listened to like every episode but I have listened to quite a few of those. I don't really get bothered by you know, on the Facebook group or when y'all talk about it on the podcast when when people when people take like hits to the doctors like when my doctors stupid or say stupid things. I don't personally get very offended from that or even you and other people like stressing like advocating, you know parents or if they're an adult type one like advocating themselves like hey, if you want to pop or you want this like advocate for yourself, like I don't really get offended by that personally, the only thing I laugh at is when posts like, oh, you know, like I asked my doctor for whatever, an omni pod and they only want to prescribe a tandem like they must be getting paid from tandem. I'm like y'all are funny. Like, yeah, we don't get any kickbacks from anybody, like trust me, like, if you're in peds and David's because you like you enjoy pizza. No, because

Scott Benner 12:50
I'm not saying I take a kickback, but I've never been offered one.

Dr. Jessica Hutchins 12:53
I mean, the biggest kickback I'm getting is like I get like a free lunch, you know, every few months, when they come in, you know, like, tell us about whatever new thing is going on with their product and update us on what's going on. Like,

Scott Benner 13:05
can you imagine if someone was like, I want an omni pod? You're like, Nope, I'm giving you a T slim because I got a ham sandwich four months ago.

Dr. Jessica Hutchins 13:14
I mean, you know, I mean, we get like Olive Garden sometimes like, you know, it's you know, we're fancy over here.

Scott Benner 13:21
I didn't know. I didn't know they were handing out diarrhea. The doctors never. Exactly,

Dr. Jessica Hutchins 13:25
yeah. So there is no kickbacks, especially if he's in debt. And really, I mean, honestly, and in pharma and pharma. There is like that all got I mean, years ago, a long time ago, before my time as a physician, they there was a lot of probably shady stuff going on. But there's they can even give us free pens. And

Scott Benner 13:42
what is that called? That? Is it the Sunshine Act? Is that like,

Dr. Jessica Hutchins 13:47
they really and they actually keep track of all that. Like, I think you can actually look up like any provider and find out like how even like for me, I was like because every time we get a meal, we have to sign that we accepted the meal. And so I think there's like somewhere you can look up to see like how much any provider has like gotten, even if it's like meals, like just the money, the money value that they've gotten from like every different company or something like that. But yeah, I think for me, like when it comes to like that, so like the technology stuff, like pump type, I mean, for the most part, like how I'll give people what they want there. Sometimes I think there's some pumps because all the pumps are a little different. There's some pumps that work better, I think would work better for certain patients, but in general, but yeah, I don't really get I don't get upset when people talk about. I say bashing doctors to an extent like I mean, I think because I do know that there are some patients that are not listened to or not heard and I get why families get frustrated.

Scott Benner 14:46
Does it feel like bashing to you when you read it even though you're not upset by it? Where do you see their perspective?

Dr. Jessica Hutchins 14:53
I see I see their perspective but I could say I could understand where the other like other providers Just who maybe I think some providers are just very like, I'm a doctor, and I know everything. And you're just a normal person. And you know, don't know what you're talking about. Doctor

Scott Benner 15:11
voice. Hey, can I ask you a question? Are you nervous? Or do you just talk fast?

Dr. Jessica Hutchins 15:15
I just talk fast. Okay,

Scott Benner 15:16
I know, don't be sorry. I think this is the first episode, people might be able to turn the speed down on. Fascinating. When I think that you speak quickly. You speak quickly. It's like, when I hear somebody go, like, like, like, Scott talks a lot. I'm like, huh, I do. And then when I get into a conversation, I'm like, I can't even get into this conversation. I'm like, Oh, my God, these people are like, professionals. You can keep me out of talking, then you're doing something. But I love all your Don't. Don't Don't curb yourself. Like I like what you're saying. I just want to tell people real quickly. The Sunshine Act is officially known as the physicians payments, Sunshine Act in the US. It's a law that aims to increase transparency in the financial relationship between healthcare providers and pharmaceutical manufacturers and acted as part of the Affordable Care Act in 2010. It goes online, you can totally google it. If you want to understand how it works. Yes. But I think prior to that, though, a lot of those lunches happen on Waikiki. You know

Dr. Jessica Hutchins 16:12
what I mean? Oh, yeah, for sure. And like the golf like, I mean, I'm not a golfer, but like, yeah, like, oh, let's go play some round of golf. And you know, hear about, you know, whatever.

Scott Benner 16:22
This is a famous golfer, he's gonna play with us today. Can I tell you about our insulin pump? No, exactly. Yeah, that

Dr. Jessica Hutchins 16:28
doesn't. That doesn't happen. I did get I mean, this isn't like, this is not a kickback. This is, this was really cool. I my T slim and Dexcom. Rep. Both of them nominated me to go to their facilities out in California to go I get to go and tour both of the facility. Okay, because they're both really close to each other. And get to here, I guess, I don't know what they're going to tell me like, I guess here all the new stuff. I don't know. But let's have my reps nominated me. So I do get together that I am excited about that. But that's like, literally go there, see it and come back the next day? So

Scott Benner 17:06
yeah, oh, yeah. There's not gonna be you're not going to be luxuriating in San Diego for a couple of weeks. No, let me ask you a question. In the course of a year rough number, how many people diabetes or families do you talk to?

Dr. Jessica Hutchins 17:17
Gosh, like talk to?

Scott Benner 17:19
So I'm going to assume like one person you see a couple times a year, so don't don't count them four times count before?

Dr. Jessica Hutchins 17:26
Yeah. Okay. So in a given week, my like scheduled template for my clinic, I probably have about 15 to 20 diabetic patients, that's type two and type two, type one and type two a week. Well, I know last year, or we had a little over 80 new onset submitted to our admitted to our hospital, which we had met all of our new onset type ones, because of just the amount of education and then we admit any presumed type two that's going to need insulin. So if there a one c is greater than 10. So we had met all those just because of the amount of education and we serve a rural area. So a lot of patients live two and three hours away, and don't have, you know, like local hospitals or local hospitals that are mostly adult focused, and so we just feel safer admitting them. And that's Aedes that's type one and type two, you know, we have seen an increase in type two diabetics and in pediatric patients in the last few years, especially post COVID. We also get a lot of new onsets in the clinic, mostly type twos that are not on insulin that we see like as new patients. So we are the numbers have been, I think, I started where I'm at now. And 2019, right before six months before COVID hit. And I think at that point, it was about 16 Iwan sets a year admitted, so we've been like, slowly increasing. So

Scott Benner 18:57
tell me something, I'm trying to figure something out. I'm trying to figure out how much information that goes into people's heads ends up coming out in their management, like meaning, like, how many people take seriously what they heard, put more effort into it, because if you see 80 people a week, then just based off of you, my podcast should be bigger than it is. And you're not the only doctor out there whispering in people's ears if you put it in a on a pamphlet, which, by the way, I really appreciate but you know, what happens in the hallways, and a lot of the offices while they're walking in or out, the practitioner will grab you and go juicebox podcast.com. Yeah, like, right, like, right, like, Yeah, I know what the guy in there is about to say to you go find a Facebook group called like, you know what I mean? So, like, what's that like being a doctor knowing that you're going to talk to 80 people and only a small percentage of them are maybe going to elevate from what you've said to them? Yeah,

Dr. Jessica Hutchins 19:52
it's definitely and I think, I mean, I'm pretty sure on the adult world is very similar in the peds world. There so many dynamics. And also for me particular, the patient population I serve. You know, there's a lot of, for instance, a lot of my families, I, I'm talking to a mother who is a single mother with multiple children, working two jobs, and has, you know, grandma and aunts and uncles and friends and just older siblings that are caring for helping to care for their child with type one. And so whether it's diabetes, or say they're coming for pre diabetes, and obesity, sometimes I feel like, I try to be realistic and my, like, I want to give them the information, but just to be, you know, when I'm realistically thinking, like, when does this person have time to, like, sit down, and you know, like, so much of our family's life, like, they are living in a constant state of trauma and flight or flight mode, like 24/7. So and then you added on this, like, very, you know, big chronic illness on top of that. And so I think that's a lot of it. And so it can be, it can be frustrating, and it can be disheartening and sad when especially when we have the patients that come in, you know, multiple DK DK episodes a year. And you know, every time you see them, it's still like, you know, a once he's greater than 10. And you, you feel like you talk to you're blue in the face. And it just seems like nothing's getting through, you know, I tried to simplify management as much as much as possible for families, especially if, you know, like, either maybe education level isn't as high and or they just like, they just can't they just, there's too much going on in their life. And, you know, they're just worried about like, can I put food on the table and a roof over my kid's head. So it's just,

Scott Benner 21:51
it's hard to worry about 30 years from now, when you're not 100% sure that on Friday, the water is going to be hot. 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 22:07
going straight into high school. So it was a summer heading into high school was that particularly difficult and imaginable, 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 what type one diabetes was, my hometown did not have an endocrinologist. So I was traveling over an hour to the nearest endocrinologist for children. So you know, outside of that I didn't have any type of support in my hometown.

Scott Benner 22:40
Did you try to explain to people or did you find it easier just to stay private?

Speaker 1 22:45
I honestly I just held back I didn't really like talking about it. It was just it felt like it was just an repeating record where I was saying things and people weren't understanding it. And I also was still in the process of learning it. So I just kept it to myself didn't really talk about it. Did

Scott Benner 23:00
you eventually find people in real life that you could confide in, I

Speaker 1 23:04
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,

Scott Benner 23:26
Medtronic diabetes.com/juice box to hear more stories from the Medtronic champion community.

Dr. Jessica Hutchins 23:34
Exactly. And that, that, that adds a whole nother level of like, you know, just nuance to with patients. And I can't remember there was one episode, I can't remember what episode it was. And I was thinking about it. And even talking to my rep with tz old tz old is the newer infusion that recently got FDA approval, it's been over almost two years now, I guess. FDA approve that if you catch someone that has two antibodies or more for type one, and they're in that pre diabetes stage, you can give tz old which is a two week infusion to 30 minute infusion and the hope and what the clinical trial showed is that you can delay onset of type one. Yeah, so I have not personally been able to give this give it yet. One is finding the patients and two is like just logistics. Because it's every day for two weeks. So you know, and even talking to my rep. I was you know, saying really hard again, I serve like a rural part of Georgia. So when patients live two hours away, one I'm going to give this like in the hospital I'm not going to like do this infusion at home I don't feel comfortable doing that yet just because of the side effects I can have. Yeah, and they you know, again, if people live you know, really far from like, a decent you know, like a hospital that I would feel comfortable them comfortable than with them going to. So it's like then again, how do I if I have you know, A single parent that has other kids and then has like a job where she doesn't get PTO that it's like, Oh, hey, come to, you know, come here for two weeks straight for a 30 minute a day infusion it's like look like it just how is that going to work logistically like it just. And so I was telling my rep I said, I feel bad I said, because I feel like, it almost feels like it's an injustice of who can even have an opportunity to probably use this because of just the dynamics of like, their social situation. Like I just don't know how to do it. It's

Scott Benner 25:31
an inflammatory word. But this is where your privilege comes in. Yes, you're sure you have it? Yeah. Yeah. And I don't care. Listen, I don't mean privilege in the in the zeitgeist overtone that's gonna make half of you pissed one way and half, you piss the other way. I'm just talking about like the opportunity, or the, you know, like, I interviewed a white lady one time, I don't know that it's ever going to be on the podcasts. I'm trying to get along. She got a job. And the job is trying to block her from being on the podcast, but Oh, no, but you know, and she said, like, you know, the TZ old infusion, it was here, we got a hotel, we stayed for a week. And I'm like, Yeah, that's already more than most people can do. Oh, yeah. Yeah. And, you know, like, so that's the kind of stuff that you don't understand. The reason I'm asking you about it, is because you're in a unique situation, like, you know, good information to tell people, and you're willing to tell them about other stuff they can go find on their own. And yet, you're having the same frustrations, you and I have the exact same professional frustrations, like, unless I'm wrong, and I, I'd love to hear from you on it. But I think you go listen to that Pro Tip series, you'd have to really not understand it not to end up with an A one C and the six is in the next six months or a year after that. Do you think that's reasonable to say by me? Again,

Dr. Jessica Hutchins 26:46
I think if you if you have to use the word privilege, if you have the privilege to sit down and listen to a podcast for 24 hours, absorb the information, be able to apply it knowing again that like you may, it's not just you there's other caregivers involved, then yes, I think if like because I have patients who again, probably do have more privilege like that, they they have listened and they have been able to apply and you know, they're doing great. They can they can get these, you know, amazing AOCs, like in the fives and sixes. How do

Scott Benner 27:21
you make the time and the space for that if you're running from one job to another and then home? And then

Dr. Jessica Hutchins 27:26
yes, you know, I mean, even I mean, even for me personally, like, just in between, like, I have three, three kids, three young kids, I have three young kids full time physician and then like, amongst other things, and then you know, even trying to listen to like, you know, I'm in this like parenting coaching group that I like pay money for. And like it has all these lessons about, like, really like a gentle, gentle conscious parenting because I've been trying to like, adopt more of that and my parenting style. And like, I've been in this thing program for like, two years, and I barely get to listen to all the episodes and that I'm that I'm paying for because I just don't have to die. So like, I can't imagine

Scott Benner 28:06
like, what was your parenting style, like that got you to want to join the group. I

Dr. Jessica Hutchins 28:10
didn't really have one. But I was me and my husband were raised like very differently. So like it just immersive, that's like the gentle positive parenting is more about like connection, over like, the shame and guilt that we often do. And parents, and honestly, part of it, I felt I feel like a lot of times with my families with you know, parents, especially in the teenage years, and maybe you can speak to this with you and Arden, but the teenage years can get really rough. No, and when the kids are more independent, and they're more out on their own, but the parents still wants to control a lot. And you know, when I have families coming in and it's like, you know, the kid is like, you know, never Bolus saying you know, I give them all that later they have all the technology they have the pumps, they have the sensors, but they're just like not doing squat and you know, the parent and the kid are always fighting you know, and I hear you know, half the visit is the parent just like throwing the kid under the bus to me the whole time and like oh tell her Tell her how you like keep sneaking snacks and tell her you know whatever and say like I don't

Scott Benner 29:12
think Go is Oh my God listen to me you're all such terrible communicators

Dr. Jessica Hutchins 29:20
and so it's always this weird dynamic and are then touchy when you add driving into the mix it's like because I mean as a parent like if my child was type one like I would like you know really be worried about them being behind the wheel I mean obviously probably more for hypoglycemia than hyper but I mean sometimes when your blood sugar is really high you are not right the hit like you feel really you know affected by that too mentally, you know, between driving and just privileges and like, you know, are all struggle with like, oh, they get get they get things taken away because of they're not managing their diabetes. And when I compare that to like, the things I'm learning with like more like positive conscious parenting I'm like I don't know if that's gonna help, you know, like, but I don't know, like, it's hard because I'm like, I'm not the parent of a type one. And I just in my head I like I'm like, I just don't, I don't think that's going to work like taking things away from them or not letting them go out with friends. But then I still am personally still trying to figure out like, How can I help these parents, especially at the teens? Like, yeah, how can I help them get through this rough patch? Because I feel like it can be an I mean, it's frustrating for me as a provider, because I'm like, their agencies going up their parents, you know, the kids getting older, they're more independent. It's like, they want to be more independent, but they're not doing it. So then it's like, okay, well, where does that like, you know, sometimes I try to approach the kid and I'm like, Hey, like,

Scott Benner 30:39
your mom seems crazy. What?

Dr. Jessica Hutchins 30:43
Like, when you're home, like, why don't you just like, let your mom do it? Like, if you're on the pot, like if they're on the pot mom, like, you're home and you already either, like, let let your mom do it for you like, but it's like, again, one of those things where like the you know, mom is texting or asking the kid like, what's your sugar? Did you give your insulin, your blood sugar is going high? Or did you treat your low? And it's like, the kid is like, frustrated? And it is this like this battle back and forth. And sometimes I'm just like, I, I don't know what to tell this, this parent or this kid, like how can Hey,

Scott Benner 31:11
listen one time are in push back on me. And I sent her a number. And she goes, and it was like $1 number and she goes, What's that? I'm like, That's how much college is going to cost you if you don't change that pump right now. Because, um, but we also have like, a, we have a similar sense of humor. So I think it helps to, I mean, listen, if you're going in the doctor's office, and making Jessica, judge, jury and executioner for the things you can't get your kid to do. That is not going to be a winning formula.

Dr. Jessica Hutchins 31:39
No, it's usually not like, oh, like, and I try to make the kids feel better. And in the parents like, less than like, you're not the only one. Like, your kid isn't the only one that like eats food and doesn't Bolus and doesn't tell you they eat like, this is like this happens. This is

Scott Benner 31:57
regular kid stuff. But it's magnified because of health. Exact otherwise, you would ignore it. You'd be like, stop playing Call of Duty and they wouldn't stop and you go up. Yeah, he loves Call of Duty. Exactly. Yeah. And then that would be the end of it. Or I wish they'd stop looking at tick tock I told him not to but they're not going to and then 30 years from now, when something happens, you'll be like 70 unit, but like, I try my best.

Dr. Jessica Hutchins 32:18
Like, right? Yeah. When it's when it's their health, like you're hurting me. As a parent. I get it. You feel. Jessica,

Scott Benner 32:25
do you know the funniest thing you've said, so far? We've been talking for 28 minutes and 41 seconds.

Dr. Jessica Hutchins 32:31
What is the funniest thing I said?

Scott Benner 32:32
I'll slow down.

Dr. Jessica Hutchins 32:35
Slow down. I think I did slow down for like a few minutes. My favorite parts when I talked about I think when I talked about TV, all that slowed down. Because you

Scott Benner 32:44
were like, oh, there's things legally I have to say here. I think Well listen, let me say this because I tried to jump into that part of the conversation. It did not work for me. Screen it like you mean it by the time this episode comes out, there'll be sponsors on the podcast. And it's screened for type one.com SCR II N fo RT y p e one.com. Screen it like you mean it's for. I don't know how I'm like, allowed to explain it. But I think it's a public relations movement to talk about the importance of screening your extended family for type one diabetes, but you'll hear those ads throughout. Because they're on I think a completely almost impossible journey. Like they're gonna go tell you, Hey, listen, does your kid have type one diabetes, you should go tell your sister and her kids that they maybe should get screened for type one, which penalties is great advice. Right? And but man, how do you get people to do that? Like, based on your, on your conversation about how we can't even find time for people to go listen to a podcast? Like how are they? How are they going to go get screened for type one diabetes, when that doesn't seem like one of the top 100 things on their list today?

Dr. Jessica Hutchins 33:55
Yeah, well, and then honestly, even parents of some of my type ones, when I mentioned about screening the siblings, I have some that don't, they just don't want to know, right? They they would rather just watch for the symptoms, which, again, if you know if you have like an a parent who's paying attention and has the ability to pay attention, and recognize the symptoms early than you know, but even then by the time you're having symptoms, you're you're probably you're gonna probably be already past the point where you could get the TCL because you Yeah, you have to be like in that pre diabetes range. And so I mean, I get it for some parents, knowing that the other kid has an antibody is more nerve wracking and anxiety provoking. Then than not knowing again, everybody's personality is different.

Scott Benner 34:38
I think it's all about your level of anxiety and how it screws with you. Because the same because anxiety could make one person say I have to know and that same and anxiety touched the different persons slightly differently makes them go I can't know that this is coming. It's interesting.

Dr. Jessica Hutchins 34:56
I tested my son even though we have no history but he he had, he was set six or seven at the time, but he had like, wet the bed a couple times. And it was he had not done that, really since he had been potty trained. And I was like, what? What's going on? And so like, one day he was in my office and I, I checked as a onesie on our like pointed care machine in the office, and it was 5.7. And I was like, Why do you have a 5.7? A one C? Like, that makes no sense. So then I ordered the kit that at that time was I think it was an maybe enable sciences like you could order the kit. they mailed it to your house, you did a finger stick and you just had to put like three blots of blood on the little card and you mailed it back and they checked, I think three of the antibodies, and three in those three were negative. So I was like, okay, like, and I started out over, no, and actually, I repeated as a one C and it was like 5.6, which still I'm like, he shouldn't have a 5.6 I would see i One day he did something else that like even after I had the antibody results back I like, I can't remember he was like just being more drinking more has something about him just seemed too often I like, grabbed, I was at home and I like it was like the day before we were going on vacation somewhere and I grabbed his finger and like I had a meter at home and I just like no, let me just check your blood sugar. If I stupidly did not wash his hands before I did this. And I just like grabbed it and poked it and it was like 390 And I was like my heart like stop and my boss then I'm pretty sure like, walked into our bedroom. It was like praying. Like he like was that scared? And then I was like, no, let's go wash your hands. And anyway, he washed his hands and we rechecked it. It was like 94 I was like, Okay,

Scott Benner 36:42
could he be could he have anemia?

Dr. Jessica Hutchins 36:44
I'm trying to think when he if he would have checked that at his last day.

Scott Benner 36:49
Doctor? Well,

Dr. Jessica Hutchins 36:50
you know, like his primary care. Yeah.

Scott Benner 36:52
I mean, I heard you just slipped into the a onesie machine one day, so

Dr. Jessica Hutchins 36:58
I'll have to get I can probably check when he actually has a checkup coming up next week. So I asked

Scott Benner 37:03
our overlords check GPT forro. Can children have an elevated a one C and not be diabetic or pre diabetic? Yes, children can have an elevated a one C and not be diabetic or pre diabetic hemoglobin variants, iron deficiency anemia and chronic kidney disease stress and illness medication or laboratory error.

Dr. Jessica Hutchins 37:20
I mean, really like a one C? I mean, it really isn't like the best test really time and range is like a better, you know, a better

Scott Benner 37:31
CGM on him. Well, I

Dr. Jessica Hutchins 37:32
tried one on him, but he was not having it. He was, you know, he, they've seen me wear them because I've worn all of them just to like, you know, try them out. And so they've seen me wear it. But when I attempted to put it on on him, he ran, he ran circles around the house and was screaming, I was like, Okay, fine. Hey,

Scott Benner 37:50
when you said you and your husband were raised differently, can you give me context for that?

Dr. Jessica Hutchins 37:54
What just like he grew up more like in a Yeah, like his parents would use like spankings and my mom was not a spanker. At all, my mom was more like,

Scott Benner 38:07
I love you, Jessica, why are you doing this, she would just fuss at you. And then

Dr. Jessica Hutchins 38:11
like, she was just tired. Like, she worked and had three kids. I also am a lot older than all my siblings. And so honestly, I was a pretty good kid. And once my siblings came, I was like a little, another little mom, like I helped with the kids and babysat all the time. So my mom could just use like, a tone of voice with me and I would cry. So like, she didn't really have to, like do much, you know? I mean, maybe like once I was in high school, I think I got grounded a few times for like, going to a party when I said that I was going to be at a friend's house or something like that. But in general, like I was a pretty good kid. So

Scott Benner 38:48
not a lot to do for you. Okay, let's see some stuff you just said. I'm open to talking about anything looping pumping, diet, thyroid, working with families, etc. Okay, so let's pick through this list a little bit. How much time do you have for me today? Okay. Okay. Arden by the way, on her way home from college right now she's driving home from Georgia to here as we speak. That type of drive. Yeah, I think she just got into South Carolina because she just left about an hour and a half ago. She had to pack all her stuff like for her boyfriend flew down helped her move into her next place for next year. Yeah, and then he's gonna tandem drive with her on the way home she's exhausted. She's been doing all nighters for like, off and on for like a month and a half getting through her finals.

Dr. Jessica Hutchins 39:31
What does she want to do when she's done? Like what will be its what's her dream job?

Scott Benner 39:35
I think she wants to design her own line of clothing and manufacture and sell it herself in a in a like maybe a small setting. Cool. Yeah, that's your goal. But she's where you are right now is what I was just gonna say. Yeah, just a little East maybe. Yeah. Okay, so let's let's pick through your list. Let's go to pumping first. So do you put families on loop. Where do they come to you? And then you go, that's fine with me if you want to do that, but I have to tell you legally that I can't support it. Like, how does that all work?

Dr. Jessica Hutchins 40:07
My first Looper was that was actually the dad and his son both had type one. And they were both on Omni pod. This was pre Omnipod five, and he was getting ready to like he had another year before he was going to college. A mom was like, anxious because she wanted him to be on a closed loop system. For Omnipod five, you know, you know, in the beginning, it took forever for it to come on. I felt like there was like one as they kind of come and say she was just like, I don't like waiting anymore. And I had mentioned looping to them. The dad, the dad is an engineer and the patient like he also like, he's, he's at Georgia Tech, with doing engineering. So both very, very smart. And like, I was like, you know, there's this looping thing. And so they looked, they looked it up, they think the kid and the dad built, you know, built it themselves. And so he was my first looper. And then after that, I had another family who because they had really crappy insurance, they were using the libre, because the Dexcom was too expensive for them as for the out of pocket costs, they use the APS system and so they can they could live with the libre and they have this little thing called the bubble that they put like that the libre like goes around the libre and that would allow this was on the libre two that would allow the libre to to like talk to the APS app. De loop and his dad is like in the medical field, like he's a PA, I think. So he was you know, they're very, like the parents were like, they understand how insulin works. So like, and honestly, because the APS system and the looping like on the iPhone is a little bit different. And so honestly, like, I feel like they understand it better than I do. Because I can't go through, like all the pages and books and all the education they have to do to like, like, learn every little intricacy of the system. And then I have recently in the last few months, put a toddler on loop. And that was, again, I suggested it to mom. And then I have another family the mom, the mom is a math teacher, they were on op five. And she just she just wanted more control. So I was like, why don't you do looping? They actually ended up using T one pal, I think is the Yeah. Like help them? Yeah, they like put the they build the system for them. And like help them get set up. And then she ended up paying like extra money to do some sessions with somebody from Integrated diabetes. I think Virginie works, after she started looping. And so

Unknown Speaker 42:42
that's how she got four. Yeah, there you go.

Dr. Jessica Hutchins 42:45
Are leapers thinking

Scott Benner 42:46
about having like, you know, opportunity can afford to become an app developer can afford to, or to pay somebody to do it for you can afford the call Jenny and have her explain the whole thing to you. That's probably I mean, I'm guessing 1000 to $2,000 of you know, extra income to get set up on this thing? Yes, yeah. Yes. For sure. Yeah. So there's varying levels of people's abilities, right, varying levels of their effort, their understanding, etc. You have to assess those people? Do you put them on a pump based on that? Like, do you really mean like you look at somebody and go, you're not really going to be that involved with this, take the Omnipod five, or you're gonna probably want to be more aggressive. Why don't you try tandem? Or, or you're never going to count a carb right? Have you heard of the islet? Like, is it going? Is it going like that?

Dr. Jessica Hutchins 43:35
Yes. And then some people, you know, like, Well, some people, like I said, you know, come in and they already Googled for the kids but on tick tock or something, and they already have like, decided they want something. Usually it's probably the Omni pod because it's tubeless. But it depends on the family. Like if somebody basically just what you said, like I have patients who you know, now that Isla is out, I have a handful of patients on the island. Now, if they were already we're not carb counting like I already had them on like a set dosing regimen because they weren't carb counting and you know, they chronically have not controlled their diabetes. Well, then I've been like, kind of showing them the eyelet most patients I show, I like him I was like, Well, I don't I don't actually have anybody on Medtronic. I have not been a huge Medtronic fan. So far in my career. Have

Scott Benner 44:24
you seen the seven at GE?

Dr. Jessica Hutchins 44:25
I have not used it. I have seen it, but it's still

Scott Benner 44:28
in America. It's still using the old CGM, though, right. I

Dr. Jessica Hutchins 44:32
think it's Yeah, I don't think it's I don't like the CGM. I don't like that. You have to like, charge the transmitter and then it's like all that weird tape that you have to put on it. I mean, I know you don't have to, like calibrate it anymore. That you know, like you used to, but I think for me, even when Medtronic first came out, I felt like it was false advertisement because it was you start to calibrate and it really I just did. In the pediatric world of personally, people that were on it, they were very rarely in the like auto mode or whatever, I felt like they were getting kicked out all the time. And so they weren't really getting the benefits of an AI D pump anyway. And so I think

Scott Benner 45:15
when Medtronic gets when they're gonna really like blades back into this, it's going to be when they're newer CGM comes out in America and they pair it with the 780 G. I think that's when people will take it seriously. Again,

Dr. Jessica Hutchins 45:26
I mean, I've seen there's been some, some guy that's been posting in the in the Facebook group about the seven ad and how much he loves it. And I've seen pictures of his graph. And like, it looks promising, I think I mean, from my understanding their target goes down to 100, which is the lowest, you know, on the market outside of looping. I think just because I hadn't, hadn't really been working with it much. I just have steered away from it in general. But

Scott Benner 45:50
by the way, shout out to Bill whose name I know, because I know who you're talking about. Because he does post about it all the time. And I always say, Yeah,

Dr. Jessica Hutchins 45:58
and it looks good. Ooh, that looks good. Anyway, so but yeah, so usually, I would show patients, you know, showing the tandem show I'm Omni pod, like, Okay, which one do you want? Some patients? You know, I'll tell my diabetes educator like, hey, like, you know, just show them the island because like, there's no way they're carbs. There's no way they're carb counting. I do feel like, like, as far as like, the carb counting issue outside it before the islet came. I do feel like Omni pod five is a little more unforgiving for patients who struggle with doing that, because we've caught with carb counting. Once you're too hive. Well, like if you're not announcing meals are like really off on your carb counting. Because if you stay high for too long, it will make it will kind of force you into manual mode.

Scott Benner 46:46
Just let me ask you a question. Because that fries my mind. People don't Bolus their meals regularly? No. Okay. Yeah, I'm so used to talking about the way that I know works and the way we do it. And I'm, I have to tell you that one of the things that I get shocked about more than anything, to put all this kind of high minded effort into this podcast and all this, like, there's, here's the variable series, the finding, if you understand the definitions, you're gonna be able to do it better, blah, blah, and people come to me, they go, Oh, my God, I'm doing so much better. I go, What did you do? They're like, yum, Pre-Bolus eating my food. I'm like, Wait, that's it. Like, yeah, they just, like, it feels like some days, it feels like the podcast could be three minutes long. One episode, and I'd reach just as many people and and yeah, but so that's that's not just me, this is what you see, too. Oh, yeah.

Dr. Jessica Hutchins 47:36
I mean, that's a lot. I mean, again, especially especially in the teenage years, I mean, whether it's the kid like a younger kid who just like gets into snacks and doesn't cover or like the teenagers who just, they just eat and don't Bolus, they just they weren't, they were the pump. And they just, they just let it ride and hope the basil covers it. And so the way that Omni pod fight is algorithm works with like the learning. And so, you know, they get kicked into manual mode. And the one thing I keep telling my rep is like, when you get when it forces them in the manual mode from a high, then it doesn't alert you that you're like, still in manual mode. So like, they'll I'll look at the report, and there'll be like a manual mode for days. And they're sitting there wondering like, why am I still high? Because the pump isn't, you know, obviously adjusting for the high, because they don't realize that they're in manual mode. And so, do

Scott Benner 48:32
people not know they're killing themselves? How do you stop yourself from saying,

Dr. Jessica Hutchins 48:37
I mean, we talk about the effects of uncontrolled diabetes, and honestly, like, with, especially with my teens, like, a lot of times the parents will be like, you know, they'll have you know, maybe family members that are like type two that have like, lost limbs and are on dialysis. And so sometimes the parent will be like, you know, like, oh, like, you're gonna, you're gonna die or you're gonna, like, you're gonna have dialysis and sometimes I'll use that but personally, like, again, like the teenage brain in particular, well, like all kids, but like teenagers in particular one, they're in that phase of like, thinking they're invincible, too. They're like frontal lobe is not developed enough to like, understand, like, future consequences. And so for the most part, to me, telling a teenager who's not controlling your diabetes about like, Oh, you're gonna die or you're gonna lose your, you know, lose your toes or whatever. Like, that probably is like, literally, like Charlie Brown, like, you know, wow, they don't, they're not hearing me. What I do try to bring up in kids is like, especially if they're athletes, like hey, like, if you want to be stronger if you want to be faster, especially like the boys like if you want to, you're trying to gain muscle, like you're, you know, in the weight room because you play football and you're like not picking up muscle mass. You need to take your insulin like the glucose cannot get into your muscle cells, unless you take the insulin, the insulin is the key to open that, you know, open that door. And so I tried to like focus on that. And then other the other thing I sometimes mentioned to Teenage boys has erectile dysfunction. Yeah, like hey, like, I mean, I'll like always preface that, like, I'm not condoning like, section your teenage years. But like if I'm

Scott Benner 50:12
trying to imagine me being like 16 in my office, and my doctor looks up at me, just because like, Hey, you want to Boehner? Is that deep? Because that ain't gonna happen? And you're like, oh, wait a minute, I didn't know what you're talking about important stuff here. Oh, yeah, I'm like, Would it be quicker to tell them that a high a one C makes their place? They should not work? Like, would that be fair? Because as you're sitting here talking, right, I know this, I understand the nature of man, I know the seasons of growth and understanding and your brain and your understanding of life and your desire. I mean, listen, you hear me, I tell people all the time, people help each other, help themselves normally, for other people before for themselves, like you have to go through these have experiences. So you understand. And hopefully, you'll be lucky enough to be, you know, like, still healthy to take advantage of these things you've learned. Knowing it. And then hearing you say it is two different things. For some reason to me like it just like it just flipped me out and made me upset. I was like, like,

Dr. Jessica Hutchins 51:10
I can have patient I have patients, I have patients that I mean, I've been like, I have been carrying them for years. And literally, they're a one c is greater than 14% on my machine every time I check it, kids, a kid Yes. Or their parents not involved. Sometimes, but sometimes again, like it's that the privilege thing, like, I mean, they're there, but

Scott Benner 51:34
privilege runs beyond your ability to do beyond your ability to afford something and it might run into like, do you have the privilege of having a parent who is interested enough intellectually minded enough, etc, to actually help you with this thing? Exactly. Exactly. Gotcha.

Dr. Jessica Hutchins 51:50
Yeah. And it's like if the kid you know, and it's not common, but you know, there have been times where like, kids have ended up in foster care, but that ends up not lending nest, usually any better. Yeah. Because they get put into homes where the person isn't always educated by diabetes, we, you know, we don't always know when they're gonna get moved to a new foster home to educate families ahead of time. And so it can end up being just as much of a hassle like conflict the kid just and then, you know, that adds the whole nother, like, social dynamic of now you're like, what this person that's like a stranger, and you're taken away from your family. So then you're not happy about that? How

Scott Benner 52:24
often do you see desire without intellect? Like, I want to help? I just can't I don't I can't do it. I can't think my way through it. Is that common? Or is it more common for them to have the ability but not the drive?

Dr. Jessica Hutchins 52:35
I think it's probably more like, they could have the ability, but not the draw, I say, I say the ability, like I think they're like, intellectually, they could do it. But I think not lack of drive. And just like our lack of like, again, like if you are literally like, again, like I said earlier, like just trying to feed your kid and provide a roof over their head, you know, you care about your kid, you love your kid, like, they'll come to the appointments. And they, I mean, like, you can ask them the questions and they can answer them, like, you know, even the kids like, what's your current ratio, which your correction factor, like they can rattle it off. They know how to do the math, like, it's not a lack of knowing is just like they just, you know,

Scott Benner 53:14
I always think like, what are we doing this for? If we haven't future proofed it? Like, like, why am I go into those jobs and exhausted and having these fights and standing in the grocery store at 730. And like, you know, arguing with these kids and living in a place like, you know, maybe I can't even afford and I have all these problems in my life. And you mean, I'm gonna fight through these things, to raise that kid to watch something terrible happened to it when it's 30? Like, what did we do it for them? Like, like, you get put is that not? I'm upset is that

Dr. Jessica Hutchins 53:49
it's maddening? And it's just it honestly, it's, it's sad, like, and I, you know, some providers, like, you know, may kind of like discharge patients, you know, they're just non compliant. I, in general, don't do that. Like, because I'm like, what does that date it's not gonna solve anything. I mean, I think sometimes, like, you may as a provider, you may recognize like, okay, me and this patient in this family are not like clicking, you know, like, we're not on you know, we just happen, right? Well, yeah. And like, do you think okay, that another provider may be able to, like, help them better in general like, I mean, unless you're unless the family you know, if somebody's like being disrespectful to like my staff or like, you know, whatever, then they may get discharged. But in general, like, just for like, you can't get your agency in control. I'm like, I'm like making you go somewhere else isn't gonna solve a problem probably either. I

Scott Benner 54:42
mean, kick a kid out of class for not being able to fly like you're trying to teach them something they're fundamentally not going to be able to do Yeah, and so you're then become what their, their guide through as good as we can get it.

Dr. Jessica Hutchins 54:55
Yeah, essentially, and I just hope like honestly, I have, I don't know If you follow there's a girl on social media her her Facebook is T one D chick, she, she's probably in her 20s or 30s. But she her and her brother, both type ones. And I follow her on social media and she talks about, like, when she was a teenager, she, you know, had like, greater than 10 A once he just had those years where she was just like, in a funk and just wasn't applying herself. I mean, and now she's, you know, like, actually now she's pregnant. And so, you know, obviously super tight control, but she's on a tandem and she like is like a diabetes influencer now, and you know, usually maintains an agency in the fives. And so like, sometimes I see her story, and I'm just like, I just in my head, just think, please, like, let that be all my patients that I

Scott Benner 55:41
have right now. That's where I want them to get. Yeah, like, hopefully one

Dr. Jessica Hutchins 55:45
day, like, just that frontal lobe develops, and you know, they just take care of them. And I think, and I think too, like, again, a lot of these patients again, if you're like living essentially, if you're like living in a lot of trauma and living, in some ways, sometimes like a hopeless state, I think even for the kid, like, it's hard for them to understand like that, like, life can be better like life. I mean, it's just, I think it's easy to get, you know, like, if you have like, Y'all struggle at home, and then you have diabetes, and you have people at school, like you know, teasing you or like you feel different because you're you're wearing all this technology,

Scott Benner 56:22
I've had my fair share of seeing some parents, like say like, I don't know why my kid won't do this. And I look at them. And I think God, if you were my mom, I'd give up to you don't no one ever sees themselves in these situations. Right? Like, yeah, I just think

Dr. Jessica Hutchins 56:33
it's just hard for some of these kids. And I mean, just the mental health aspect, you know, is, is a lot

Scott Benner 56:41
is the answer for people finding themselves in that situation. Islet? Is that the answer?

Dr. Jessica Hutchins 56:45
For some of them, I'm trying actually, like, I just ordered the eyelid on to my patients who are frequent flyer decay patients. And again, like a one c is greater than 14, like all the time, and I told my educate my diabetes educator, I'm like, You know what, let's just try the eyelet. Like, at this point, what do I have to lose? Like, you know, a lot of times, you know, as an endocrinologist, when we're like assessing is a patient pump ready. One of those things is like, well, they're always like, coming in DKA, you're hesitant to, you know, and not paying attention, you're hesitant to start a pump, because it's like, well, that could increase their risk of DKA. If they're not paying attention to their Dexcom. Like when they're running high and going through all like checking the ketones and changing your pumps, I thought it off, but they're not doing that anyway. Right? Exactly. They're not taking their long acting, they're always indicates and that's why I told my educator, like, at this point, like, what do I have to lose, like, they're gonna go in decay again, like that already happened. I had this one kid, I will like and actually still see him but he, like, always had anyone see above 10. And he was just like, really quiet, like, super introverted. And I was just like, the mom was a nurse, like, she's not a lack of education. And I just like want to ask the kid I'm like, like, dude, like, what's the deal? Like, he's like, I hate injecting myself in hurts. I don't want I he would take as long acting, but he just like, wouldn't take a short acting. He's just like, I hate injecting myself and I, but he would wear that he wore the next camo. I was like, You know what, let's just try. Let's try tandem. And he has been on a tandem now, I think for going on three years with an agency and the sexes ever since then went from above 10 to sixes. And it was just like he just needed. He just didn't like injecting was off. But once he got on the pump, I mean, it's like all business. Beautiful. Yeah,

Scott Benner 58:29
that's what you're looking for. I listen, I think that I think that's old timey backwards thinking about yes, if they're ready for a pump or not like, well, they're not doing this thing you're not going to just try doesn't make any sense. Or there's the stories of when people have their pumps taken from them. I'm always like, there's nothing about that story. That would make me think you shouldn't have this pump. It feels like knee jerk reactions from doctors sometimes.

Dr. Jessica Hutchins 58:54
I did actually, like about a year ago, I had one kid that I did tell him like, we're done because because we literally went from a onesies usually like, I mean, not stellar, but like, you know, eights and nines, but like, started the pump and had multiple decay episodes and a onesie went up to 14. So I was like, No, you were

Scott Benner 59:15
at least, at least you're injecting your long acting insulin.

Dr. Jessica Hutchins 59:19
Yeah. And so we ended up switching to the end pants. I was like, that way I could still get the data, you know, from the shots and the short acting.

Scott Benner 59:27
So is there a piece of your mind that says, Look, I just I can't save everybody.

Dr. Jessica Hutchins 59:31
I mean, yeah, I mean, I try but like, I mean, it's just, you know, again, I literally always just hope like, okay, maybe like, it's like, you plant I'm planting seeds now and the hope that like, they'll turn into that person who pulls it all together, that person that can figure it out and you know, and not someone who just, you know, continues down this path of just like, you know, and I think it's hard to take is the other thing I think about when I'm talking to my teenagers is like, Okay, what's your plan for life like kind of job are you gonna have like, like you have diabetes? Like you need a job that has like good insurance? Because this is an expensive disease? Yeah.

Scott Benner 1:00:07
Oh, you think a person who can't inject their insulin is planning for 10 years from now? Well,

Dr. Jessica Hutchins 1:00:13
no, but like, I've heard talking about her because I'm like, Okay, what's the plan? But like, you know, yeah, I mean, I do have those patients who like, or I have some, especially teenage girls sometimes are like this, like, they are stellar in school, like straight A student cheerleader, does all the things but then like, diabetes control, like they just like, they just can't put pull it together. Like they just don't Bolus and whatever. I have that sometimes, but more often than not, the kids who are not managing their diabetes, while are also not doing well in school and are also like struggling at home. You know, there's like family dynamics that are like, you know, yeah, not ideal at home. So it's usually like their whole life that's like, struggling, you

Scott Benner 1:00:53
know, what I've noticed, helping Arden the dynamic settings in the Iaps are really valuable, like adjusting her Basal. Her insulin sensitivity and her carb ratio based on like, perceived need based on like, the history of what's happening. I think that's taken another level of having to think about diabetes away from hard. Like, I think it's what got her through her finals. This this last time I see you're saying, Yeah, cuz you can adjust all that stuff. Yeah. Because it's easy to think like, oh, yeah, well, Scott's kid does it. It's easy for him to say, my kid won't do it. But there's plenty of times my kid doesn't do it. She Bolus is her food. That's a thing, right? And she Pre-Bolus is most of the time. So I'm happy. But if she's in the middle of a project in college, and she misses a Bolus, and her blood sugar goes to 200. She's not correcting. But the algorithm corrects. Exactly, yeah. And it hits hit and now Fair, fair, she believes it's going to do that now. So maybe she feels like I don't, I don't need to look, this is how this works. Yeah, there's probably been five times in the last six months, I've texted her and said, Please, Bolus, whatever suggested insulin there is, because this algorithm is never gotten ahead of this. But in keeping with what it's trying to do, and I won't even get, like, I don't even get a response. I just see on Nightscout at the Bolus that she does it. Yeah. And I'm like, okay, good. No, but she's also she's incredibly busy. Like, I do want to point out that she is really busy. But you know, there could be other kids who are going to be, you know, really drunk or really busy or studying or like, whatever. So like, there's always levels of why am I not looking at this? And all this is just because this whole conversation is just about the way humans minds work. Oh, yeah. It's all this is right. So

Dr. Jessica Hutchins 1:02:39
literally, I mean, you would probably cringe like, I mean, I can look like, I will have some, you know, I'll pull up a Dexcom clarity report. And literally, it will just be like, greater than 400 for like days in a row. And I'm like, I don't

Scott Benner 1:02:56
why not? It's what even once just for fun, like, yeah, the wonder what would have nothing, they're literally not looking at all? No. So

Dr. Jessica Hutchins 1:03:06
those are the patients sometimes, like as far as like, the pump candidates, like for people literally who I can tell, like, you're not even looking at your Dexcom. Like, I do sometimes get worried about putting them on a pump, because I'm like, oh, man, they were uncontrolled. But not in DKA a lot than those patients I do get worried about because I'm like, okay, they probably were at least taking their long acting, lease, like half the week, you know, or something, just enough to keep them out of decay. But like, if they're never looking at their Dexcom, I do worry, like, are you really going to change the pump and pay attention? And you know, troubleshoot it? If you know, if you're let

Scott Benner 1:03:38
me pivot here for a minute and ask you so obviously, what I'm hearing from you is that I have successfully found a way to reach certain people. Now, yes. Is there something that could be done for those other people? Like, am I just not creating the right content? Like, is there a thing I say that if I said it differently, or presented it differently? Where would they just never look? Even if it was there? Like how do you lead the horse to water? And and once they get there? Is the water that I have available the right water for them? Or do they need different?

Dr. Jessica Hutchins 1:04:11
I honestly feel like that like education, like the episodes like you and Jenny do. I mean, I feel like for the most part, those are very, I say, dumbed down. You know what I mean? Like in layman's terms, and like,

Scott Benner 1:04:27
Yeah, I know. Exactly. Yeah.

Dr. Jessica Hutchins 1:04:28
I mean, like, not in a derogatory way dumb, but it just is in layman's term. It's not doesn't feel like Doctor talk. And so, I mean, I feel like from that standpoint, that helps. That part is fine. Again, it's just it's just the broken healthcare system, you know, and just like, what is

Scott Benner 1:04:46
it or is it just there in a like, I mean, you're saying to me that these people would magically respond if the healthcare system was different.

Dr. Jessica Hutchins 1:04:53
Well, broken healthcare settlement, okay. Not just health care, broken health care, but also just like a broken I just have I have a broken system like, you know, again, when you talk about privilege and food deserts and racism, and all of the things like I think that's where a lot of that can come in. And just, that's not

Scott Benner 1:05:14
wrong, by the way, right? Like, even from a doctor to look at somebody go, I know you people don't do this. So I won't bother bringing it up. Like that kind of thing, where I know how your people eat or something like that.

Dr. Jessica Hutchins 1:05:24
I mean, you have to ask, you know, I mean, like, I mean, we shouldn't assume but like it happens, right? Not? Oh, yes, it happens. Yeah, that's even part of the issue. And that's where I even like, when I was talking to my tz old rep. That's what like, we were talking about that I said, I said, Honestly, there's some families who I probably wouldn't even mention it to them, because logistically, I don't see this. They don't know if they'd ever be able to use it. And that it's like, Is this even it feels like you're just dangling something in front of their face that they're never able to access. But then, but then I was telling him, I said, Then I was checking myself. And I said, Well, really, I should, should always I should be mentioning it to everyone. And then let them be the one to figure out if they can make it work or not, you know, but

Scott Benner 1:06:03
that's you making an assessment based on your knowledge and then saying, like, geez, well, maybe everybody wouldn't have that. But I also don't have a ton of time to go over every goddamn last thing. Like I gotta make decisions about what we're going to talk about. Yeah,

Dr. Jessica Hutchins 1:06:14
exactly. Yeah. And then I just, and sometimes it's again, just like finding resources. I do think sometimes I do feel like having community I think helps, even for the families like if you just having that community my nurse practitioner, we were talking she had a patient of hers, too. It was a type one and then I don't know if it's like the moms knew each other and somehow the kids met or something but the other the other girl that's also our patient was a type two but insulin dependent type two and always in very poor control. And then the moms ended up like linking up the girls and then all of a sudden like the type one who was very controlled like rubbed off on the tight on this little girl at type two and like literally that the girl with type two used to always have like a onesies yeah great but then 14 and has been in running in her agencies in the eights for like over a year now.

Scott Benner 1:07:12
That's why I love the Facebook group actually is because having that like positive peer push, it allows you to sit in the background and watch it happen without having to be involved in the conversation it just sort of like rubs on you a little bit you're like yeah, I mean all these people are doing this I could probably do this. I

Dr. Jessica Hutchins 1:07:28
do mention the Facebook, you know like I mean I'll mention the podcast but I know a lot people may not even they just don't do podcast but like I do notice like I have quite a few people in the Facebook group and again even if they're just like a fly on the wall watching it and like listening watching posts, I still think it they can learn from it and

Scott Benner 1:07:44
do you have that personal pain? I know what the podcast does for people like I've I've tons of feedback it's not it's not just one person or a couple of people that happen to you'll hear like varying levels of like I started episode one and I took me a year and I listened to the whole thing and hey Mia once he has five five Look at this. Like right like I see that I see people are like I listened to the Pro Tip series and I got my one seat down to a six and a half and I'm like god it's great or you know, newly diagnosed into bold beginnings which is basically kind of pro tip light for newer diagnosed people and like and it got me on the right path and two years later here we are like I know it works and when I can't get it into people's hands it feels like a like a personal failure. And when you see like the Facebook group is such a great example brings in 150 new people like every three days and I don't see those people one to one translate into listeners and and I think oh my god I got you I feel like I brought them like right to the finish line. And I couldn't I couldn't talk them into taking the last three steps and and do you feel like that and your job like oh my god I know what to do I could help you if you listened or if blah blah blah. Does it feel personally like forget all the business aside and like what you feel like as a doctor like when you're at home and it's quiet Do you think like I feel like I let people down? Do you ever feel like that?

Dr. Jessica Hutchins 1:09:10
I don't know if I felt I honestly feel like I let them down because I feel like I'm trying like I'm trying I mean I get frustrated and I get I get sad like I get it just that this is the state of it for many patients like I can educate till I'm blue in the face and it just it doesn't seem to be like getting in or whether there's a lack of understanding or a lack of ability or drive or whatever that is and more so I mean I think I get more like in my head I like Okay, what else could I do like what what else could we do as an office or you know as a health system like to better support these families it's probably more aware like not as like that I let them down but just more so like more of like okay, what what are we missing? What can we do? Yeah, to try to, like reach these people to try to help this person not, you know, come in and decay again or you know, to, to get that success of like, coming into our visit and their agency like coming down.

Scott Benner 1:10:13
I have an idea, but I'm going to share with you when we're not recording because people will rip me off and I can't have that seriously. The other day, I watched, like you said earlier about like a diabetes influencer. And I wanted to joke and say, like, I didn't know, there were other people doing this, I thought it was just me. But I do see people like, I'll put out an episode about something on Monday, and by Friday, they're talking about that topic. And they're, you know, on their channel stuff. And I'm like, you sons of bitches. Just damn idea and leave me alone place. But listen, the other side of that is, I feel like I'm having a positive influence on the noise that happens in the space, it helps people move towards good stuff. And so I am very happy about that. Like, but yeah, business side. I'm like, you know, have your because these are, trust me, those all those influencers? They're all making money. Oh, yeah. Or they're trying? Yeah. And God damn, trust me, because I've seen it, I see it happen every year. If they can't make money off it, they're gonna stop helping you with your diabetes. I'm the only one who was like, I'll do this for free. I think I can turn it into something. And I've turned it into something that's popular enough that I don't have to worry about my electric bill getting paid anymore. Just it happens now, right? So I can throw myself into the podcast. Most of those people are not in that situation. They are trying to make $100 from a pump company to say a pumps name out loud. Yeah, it's a hustle. Trust me. Yeah. You know, but I have an idea. And I think it'll work. I'm worried that I'm not the right one to face it. And then I don't know how to handle that. Yeah,

Dr. Jessica Hutchins 1:11:53
definitely. Yeah. Tell me your Yeah, we'll

Scott Benner 1:11:56
see. You can steal my idea. And I'm just getting like, no, because I do want to get your input just not when we're being recorded.

Dr. Jessica Hutchins 1:12:01
Yeah. Yeah. I think like I mentioned just the community aspect, I think I think there is some benefit to that, especially when I think as parents like raising

Scott Benner 1:12:10
is that where camp could come in for people who are struggling like that?

Dr. Jessica Hutchins 1:12:13
Yes. Yeah. So we actually last year I started. So in Georgia, we have camp kudzu, which is based out of Atlanta, the children's type one camp for children with type one diabetes, it's actually this is the 25th year. I've been involved with that camp since I was in my year off between undergrad and medical school when I worked at an adult endocrinology office, which is where I discovered my like love for endocrinology, and started volunteering at camp and had been kind of on and off throughout my training and whatnot. And so this past year, we started a new like session closer to in like the middle and South Georgia area to serve the patients that I serve. And so we started that session last summer, we do to the overnight summer camp, but we also do like little one day events, they can't cuz he doesn't all over Georgia and different cities, in just a chance for the family to come together. And they also do family camp on weekends, I think two or three times a year. So I'm hoping that I'll get a family camp session going at the location that I use for my camp session, again, just to pull people together. When we did one of our one day events, Dr. Ponder actually came and talked on it. And he gave a sugar surfing lecture to the parents while the kids were playing. And then then we all kind of came together and did games and stuff with the whole family and the kids. And I mean, just the parents like hearing his lecture lecture and then like getting some time just to like talk to each other. Like, from that it like spawned a whole like they made their own little Facebook group and they you know, like just being able to meet other families that are going through what they were going through was such a, you know, eye opener and the kids I mean, all loved it to the kids. One of my patients, he's type one and Down syndrome. He came to our overnight camp last year and we did an interview an interview about camp a few weeks ago and like literally, like the bright when he first saw me he was like Dr. Hutchins, like what's going to be the carb count for lunch on the first day of camp and I was like, I have no idea. But he was just so funny. Like he was like, literally could not stop talking to you by camp like he was so excited about camp and I've never been invited. I just want to say Oh, I would trust me like that is like something I yeah, that's in the works. Especially when I saw Arden was in Georgia. I was like okay, Scott's gonna be in Georgia so I gotta figure it out when he's here and I can get into something that is that is in the back of my head.

Scott Benner 1:14:46
I would definitely come. So but there's no pressure obviously if you don't you don't want me and as far as like,

Dr. Jessica Hutchins 1:14:52
um, a lot of my patients listen to the podcast and like they would definitely I mean even Dr. Ponder coming was a big deal and but a lot of people didn't No ponder, like if they were like newer diabetics, just because it was I felt like some of the older diabetics, you know, are familiar with his stuff. But newer diabetics are familiar with you.

Scott Benner 1:15:09
This has got nothing to do with Dr. Ponder, but it's so hard to stay in the zeitgeist once you get into it. And like that, I tell people, like, I'll say it on here too, like, but I talked privately about all the time, like, like, you know, doing business and stuff like that. And people are like, what are you most proud of? And I was like, longevity. I was like, Yeah, keeping this train Moving is hard. And keeping it popular is hard. Like, you can say something really valuable. But how do you say it again, tomorrow without people gone? I heard you say that already? Yeah. And how do you stay in it long enough to get to the next group of people? And then how do you not get bored? Because you're like, Oh, I just said this to a bunch of people three months ago. Like there's that, like, that's hard. I'm good at it. Like so. Like, that's it, meaning I don't get bored by helping people in the early parts of their diabetes. Yeah. So it's just and it's so in the social media part of it. Like I listen, I I'm not begrudging anybody who's trying to knock out a couple 100 bucks at a time going, like if I weren't on the pod, like good for you. Like, I think that's terrific, right? But that's not a thing. You can keep going for long. Yeah, yeah, you have to, it's not a real job. It doesn't grow into the thing you think it's gonna grow into? And then how do you keep and it's content. People want content constantly. I laugh when I used to sit around, and I rang my hands for two years. Could I put two episodes out a week? Or would that make people upset? I don't know what I should do to I think they're going to stop listening. If I put two out. And then I put two out and people like, Oh, my God, this is great. Can you do more? And I was like, Sure. Here's three. And they were like, well, what do I suppose let's do on Thursday. And I was like, valid point. And then you know, like, and before I knew it, it was like five days a week. And then I like last weekend, I was like, I've got all this extra stuff, like I'm just gonna pull up on the week. And I thought, well, this is definitely gonna piss people off. Except this was a really popular week of the podcast, if there being two episodes on on Saturday and Sunday. That's too funny. Like, I was just downstairs right before you and I talked, right? My son is applying for a job. My wife is at home working. And I'm like, Hey, I gotta go work. And my son laughs because he's like, you're gonna go sit and talk to somebody? And I was like, Well, yeah, that's work. That's my job. Like, it's my job. And so I'm gonna go do that. And I sit down, I'm gonna take a quick break. And then I'm gonna do it again. I'm in a half an hour, Jessica. I'm recording with Erica, on a resilience series that we're putting together.

Dr. Jessica Hutchins 1:17:38
She's the site the site. Yeah, yeah. I've listened to some of hers. And

Scott Benner 1:17:43
then I'm getting to get done. And I'm gonna take a deep breath and eat something. And then I'm gonna come up here and put episodes together for you guys for next week. Yeah, if that's not actually your job, there's no way to keep it going. There just isn't. So these are the influencers, who you're thinking of right now. Like in your mind, you're like, Oh, I love this person on Instagram or something like that, write their name down, and then go into your phone and say, Hey, Siri, 12 months from now remind me to go look for this Instagram account.

Dr. Jessica Hutchins 1:18:12
The other group one of the things I mentioned on the list of things I would talk about diet. So the other group that I follow, and I guess that I'm quote unquote, popular and is the low, low carb group. And so I am low carb friendly. In your practice, in my practice, like a lot of peds endos are not low carb friendly. I have, you know, a few patients who come to me because, like, I'm familiar with, like Dr. Bernstein's method, and the like, type one, Greg, type, type one grid, and like, let me be 83. So I have some who like, just come to me for that, like with a new onset, I'm not like, Hey, you must do low carb, you know, if people asked me, you know, I did have a patient that when I first started, it was actually a friend, a person I met at church and then she found out I was a pediatric endocrinologist and then she was like, Hey, you like my son has like a pre diabetic agency and his pediatrician been watching it and I was like, Okay, check the antibodies he had like, all for like for the antibodies were positive and like, okay, he is going to get type one and like, at this point is a once he was like 6.2%, and I was like, and I didn't start work for like, another month. So I was like, Okay, so now until then, just like, try to go lower carb just, you can maybe delay this until I start working. And so they went lower carb he was actually able to go two years like he basically honeymoon with a completely normal agency in the low fives for two years. It was amazing. And he's still low carb because they at this point, they're used to it and he now is at the point where he needs injections pretty much every time he eats but they're like some of my low carb patients, they use the regular insulin for like the protein to match the like Rise of the protein. And so they use like long acting and they have to use are not not Every meal, mostly dinner because that's when he eats like a lot more protein is at dinner. So I am like, familiar with that. As far as like dosing with our and so yeah, in that way, like you mentioned earlier about me being progressive. So I feel like in that ways like with the looping and like being like low carb aware and friendly, it makes me a little bit more progressive,

Scott Benner 1:20:19
because that's who you are. Judge me on that? How am I with how people eat?

Dr. Jessica Hutchins 1:20:24
I think you're like me like you're like you do you like, because you'd like did the whole diet series where you like, and you had low carb people on there. Not yet. I think in the Facebook group, like some people, like can get back and forth about it, you know, whatever. But I mean, I think you're like me, I think you're like you do like, if that's what you want to do, then you can do that. At the end of the day, you just want to make sure like they know how to manage and so on. So

Scott Benner 1:20:49
that's exactly how I feel. But I every once in a while I'll get like, the somebody comes after me like a very like, zealous person will come after me and be like, you're stopping us from talking about this. I'm like, I'm not stalking you about anything. I'm like, you just can't come in here. And like, ring a bell and proselytize and tell people that if they eat a car, they're gonna die like or, and that's like, that's not what I said. I'm like, You should reread what you just wrote it because I don't have a horse in the race. I don't even care. Yeah, it's meaningless to me how you manage your your food, you should eat whatever you want, I really genuinely mean that. And but when I'm managing the group, it's a different scenario. Like I have to I have to protect everybody, not just some people, like there's a post that went up the other day, I'm actually going to get the record with the person soon. And I'm excited about that, because it's a really nice kind person who's trying to share what they figured out. And they put up this, this post, and I can't wait to ask them face to face. Like, what did you think the tone of this was? Right? Because I bet you they were excited and sharing good news. And if you read it, it feels a little like, if you just did what I did, you'd be healthier. Yeah, like, right. And and so I'm also not saying that's not true. Like I'm just saying like, yeah, I guess my point is, is that if just telling somebody what the right thing to do was than the last hour of our conversation wouldn't have sounded like it did? And the answer to those, those people's problems isn't eat low carb. Yeah, for

Dr. Jessica Hutchins 1:22:18
some people, that's not even, that isn't an option. Again, it goes back to like the privilege, like, it can be pretty, a little bit more expensive to eat lunch. Also,

Scott Benner 1:22:27
if just saying the right thing out loud made the world correct, then we wouldn't have any of the problems we have. You just go Oh, no, no, you know what, you can't do that. And people go, Oh, I didn't realize and that would be the end of it. That's not how it works, right? And so when these people come in with their super excitement, and I'll say, hey, look, you know, just please be keep in mind the tone of what you're saying here, it feels a little judgmental, blah, blah, blah. And then somebody will go, will you tell people they can eat a cupcake. And they come in here and ask how to dose for something on a restaurant that's obviously got 150 carbs in it. And that's not healthy for them, and blah, blah, blah, blah, blah, I'm like, what does that have to do with anything? I'm not telling them to eat that any more than I'm telling them not to eat. I'm not telling them not to be low carb. And I'm not telling them to go get a waffle with a pancake on top of it and a Sunday. Like I didn't say that either. You know what I mean? Like, all I'm saying is, whether it's the waffle with the pancake with the Sunday with the cupcake, or it's a steak, you got to know that there might be a protein rise from that steak. Exactly. And you got to know that the waffle with the Pig egg with the thing is gonna need like a half an hour Pre-Bolus And like, like a cartload of insulin, and you might get really low later. And you should pay attention to all that like, exactly. It's not my job to teach people how to eat. And by the way, it's no one's job. And if it was your job, it would be an absolute loser of a job that you would never all you you're gonna preach to the choir and think that you're converting people, but you're not you're just converting people who were up to be converted anyway. And I feel comfortable saying that, because there are times that I think my podcast maybe isn't as valuable as I think it is. It's just valuable for the people who is right for. And I would like it to be valuable for more people. That's what I'm trying to figure out. And I got them well guarantee that telling them what to do is not the way to get them to it. So I just mixed two issues together, but at the same time. Oh, yeah, they're the same thing. You're a doctor. I feel weird. And you go to church and I just cursed. bleep that out. Rob, please. Gosh, my. You're also from the south. I assume you're cursed all the time.

Dr. Jessica Hutchins 1:24:29
I laugh because like my husband, like petite, I did not grow up going to church. My husband did and so like, Oh, he's dry. I curse he like gives you the side eye and I'm like, like, you're fine. Like,

Scott Benner 1:24:41
isn't that interesting? The lady who got was brought up nicely didn't go to church, the guy who was getting backhanded did go to church. Well, I don't want to get into that right now. But

Dr. Jessica Hutchins 1:24:52
don't you know that that's what you know, the Bible says, well, the rod whatever.

Scott Benner 1:24:57
I don't know. Listen, I don't want to hit P before but every once in a while, it'd be nice if I gave him a five minute pass. Yeah, I'm sure we all feel like that. Anyway, ya

Dr. Jessica Hutchins 1:25:07
know, so I get I dropped a few curse words there every every now and again. So a person does not offend me.

Scott Benner 1:25:14
I love to curse. It's one of my favorite things. Alright, well listen, you have your own problems. You gotta go figure out how to parent small children, which it sounds like, if I'm being honest, you're struggling with and. And by the way, I want to thank you for coming on here. People know who you are. You're a physician. You're an endo. And you said a lot of things that sounded like Oh, no. And I thought that was really honest. And I appreciate that very much. Because I think it'll help people to hear you say, like, I can't get my kid to put on a CGM. And you know, like, he ran away from me like what do you want me to like? And you were just like, whatever. So chasing down right?

Dr. Jessica Hutchins 1:25:55
I chased a little bit but then it was like, was there currently then yeah, if he if I knew he was if he was actually did he actually had diabetes? His butt would be wearing a sensor like there wouldn't be an option.

Scott Benner 1:26:06
Did you consider money? I would have dropped money on the problem like nothing. Either been running away I've been like, can you smell this? 20 I'm waving in the air smells like Legos. American.

Dr. Jessica Hutchins 1:26:17
He responded to money he probably would he would probably respond to like Roblox, you know, like money on his Roblox sign pad game or something.

Scott Benner 1:26:25
I just gotta explain it to them correctly. That's all you got. Understand where the push and pull comes from? Yeah, you're great. I I'm sorry. It took us so many years to do this. Oh, no, you're fine. And at the very end here, let me thank you personally for the help you gave me when Arden wasn't feeling well, last year. I appreciate it. So

Dr. Jessica Hutchins 1:26:41
now, I know you've been on for a long time. But I do want to hear more about her GLP as you were talking about that, at our r&d, the GLP one

Scott Benner 1:26:49
you want five minutes. I'll give you five minutes. Yeah, you can. Yeah, give me give me. So I had Dr. Blevins on yesterday. And he'll be on again in a few weeks and on again a third time answering questions. He is another care ologists from Austin, Texas, who I found through YouTube. I was watching YouTube videos back when I was trying to understand what it was I was taking. I had that moment, a few minutes, a few weeks or into my use of a GLP medication for weight loss where I was like, I should probably know what this is. Well, I try to understand exactly what I'm injecting into myself. Right. And so I looked into it, I found him just doing a talking head video that I just found to be very clear and thoughtful and well sourced I thought and so I invited him on. Anyway, he's been on there's an episode about a 15 year old girl whose daily use if you haven't heard this one, Jessica, her daily use. She's a three year type one. She ended up on we go V because of what they thought was PCOS weight gain. And her daily insulin has gone from 70 down to six. Like daily. Yeah, she took her pump off. And she's only shooting Basal right now after having type one for three years and using 70 units a day. And so that's happening. I am almost to my absolute lowest weight right now since I started back in April of 2023. Is that when I started? That's awesome. Yeah. Arden is using it. We are like scraping it together any way we can. We're about to get our doctors about to take a different stab at getting it covered by insurance again. So we're getting ready for that. But she's doing five milligrams Manjaro right now. Actually last I would say weekly, but last week, she's like that I shot it like nine days after I shot it the next time she's like I just I was in class and I forgot. Yeah, she has forgotten but you can literally see the difference.

Dr. Jessica Hutchins 1:28:41
I remember yesterday, you were saying on the episode. Now excited. She wasn't really like overweight. Did she lose weight to or not really? Oh, she lost

Scott Benner 1:28:47
weight? Yeah, she did. Yeah, she looks. Now there are going to be some people. And Dr. Blevins and I are going to talk about this on one of the episodes where people just have this knee jerk reaction where they're like, You're too thin like that feeling. She's not too thin. She looks incredibly healthy, healthy. I'm not too thin. I think it's possible. We're all just used to seeing heavy people at this

Dr. Jessica Hutchins 1:29:06
point grade. Yeah, I mean, I mean, often, like we get referrals for like, obesity. And, you know, a lot of times I feel like the family will be like, I mean, they look normal to me. And I'm like, I mean, honestly, like compared to a lot of their peers, they probably do like about average. And it's like the kids who are like normal weight. The parents like they're so skinny. I'm like, Nope, they're 50 percentile. They're perfect.

Scott Benner 1:29:26
There are times that people put pictures of their overweight kids online eating really crappy food. And I think, oh, wow, this is an indication of what they feel is normal. Like, it really is interesting, right? Because even just from like in, I mean, I'll tell you from my personal perspective, if if when I was 45 pounds heavier, you weren't gonna catch a picture of me having a pancake somewhere. Like like you don't even because you're like, because you're self conscious about it. Oh, because I'd be like, I probably look like that because I eat this pancake. And so like but you know, like, but it's Interesting. I'm not judging people. I'm saying it's a very interesting look into popular culture and all that. Then my point being is that people will come up to me and go, Oh my God, you got to stop losing weight. And I'm like, I need to lose 20 more pounds. Yeah, you're like, I'm not at my ideal weight. Yeah. And forget ideal. Like, do you not see the fat right here? Like, this is right in the heart attack spot? Like, yeah, you know what I mean? And like, and they're like, oh, no, you look great. I'm like, I look better than I used to. And I And listen, I do look great. But I'm not healthy yet. And that I don't care how I look. I care about not dying. Like, right. Yeah. So are you with Arden

Dr. Jessica Hutchins 1:30:34
out of curiosity, so I know does she have to Windows JLC or regular Endo? And then also the one that's like, the lady that did the thyroid episode, she just sees her now. Okay, he's very curious. I was like, what her? I was wondering, did her other endo prescribe the GLP? One, or this is the one that's more like, functional medicine, naturopathic kind of, like sees it. And

Scott Benner 1:30:55
makes sense. Yeah. Because when when Arden turned the age, chop was like, Get out of here. And they were like, you know, she's in college right now. So we'll help her for another couple of months till you can get back. But then you gotta get out. And I'm like, Okay, I would think you'd want the guy from the podcast around, but that's fine. And so lols and insurance and everything. Exactly. One of the luckiest things that's ever happened to Arden is that Addy took her on as a type one patient, because it doesn't even take new patients type one, okay, and she doesn't manage type ones, for the most part. You manage her type one.

Dr. Jessica Hutchins 1:31:31
I mean, like, it was like she she just refilling your insulin and your pods and Dexcom. She's like,

Scott Benner 1:31:37
she's like, What am I supposed to be looking at here? And I'm like, Oh, don't forget to ask about her eyes every once in a while, like, you know, like, but But no, like, she's terrific doctor and looks into things. She's the one who was telling me two years ago, like, hey, maybe let's try putting it on Metformin and see what happens to her insulin sensitivity,

Dr. Jessica Hutchins 1:31:53
that it helps I use metformin and my type one we never did,

Scott Benner 1:31:57
we went right to the GLP. The GLP has happened so quickly that by the time we got our head wrapped around what we were going to do, she's like, let's just give her a GLP. Now, you're right. It's not covered by insurance. But we got a sample pen, and a couple of them. And then we hit her with the pen. And I was like, I will do anything for her to have this helped her so much. Yeah. Now, in fairness, it is not costing me $1,200 a month. We're buying a pen. We're using it more sparingly than that, like that kind of stuff. And we've we've relied on a couple of samples here and there. We're literally in a flux period where I have to find a way to get insurance to cover it. Yeah, like I can't keep doing I

Dr. Jessica Hutchins 1:32:37
have had I had one patient with type one. And now he aged out and he's in the adult world. But he was type one that weighed like 300 plus pounds. And not the most compliant teenage boy and I with lots of fighting with his insurance. And I think they had like anthem or something or one of those at the time. It was private insurance. We were able to get it covered. And this was actually like, three years ago. So that was a Victoza because that's what was like kind of out then

Scott Benner 1:33:07
what they're doing now is you're getting a double diagnosis. They're basically diagnosing you. You have type one and you have insulin resistance.

Dr. Jessica Hutchins 1:33:13
Yeah, well, and you're morbidly obese. Like, I mean, you're you need it for your well that Yeah, I mean, nowadays, when he was on it, he lost like 20 pounds, he'd never lost 20 pounds. And I mean, his a once he got it got a little better. I mean, again, he still wasn't very compliant with its insulin regimen. So but that

Scott Benner 1:33:29
person now could would be right for week over years that bound and it would probably be covered by their insurance for heart and like, you know, it's going to be it's going to be insulin resistance, like like, so does it meet the the BMI criteria? I'm assuming you didn't meet the criteria. When we started. Yeah, yeah. But what she does meet is her insulin needs significantly dropped. Her spikes are lesser her acne is cleared up, or periods are easier. They don't have studies yet on what it impacts. And yeah, but if you go to any reasonable OB, at this point, they're going to be like, Hey, if you have PCOS, try to get GLP if you can, that's literally how they talk about it to you. They're like, Hey, if you can talk to a doctor and given it to you, you should I've had a GYN tell RT and like I can't prescribe it, they'll turn it down. Like she's like, but if you went to your Endo, and like there are there are other reasons. And so we started off with like, like, this is just good. Try it. Now we're about to we just my wife just switched jobs. So we're about to put it back into the new job and try again. And I think ADDIE is going to just say, Look, you call it whatever you want, but this girl's got insulin resistance, and she's got type one. So if you want to say she's type two because of coding, I don't care. This is what's going on. Now. I don't know how long insurance companies are going to do that because right now they seem to be doing it, but they could change their but I

Dr. Jessica Hutchins 1:34:51
have a lot of Medicaid patients. So Medicaid like I mean, I can get my type twos on it but like obesity and Anything outside of a diagnosis of type two, like they're not good, they won't cover it. Yeah. And even then a lot of them, it's like, they'll cover trulicity, which I just did. Trulicity isn't really working.

Scott Benner 1:35:12
Like this stuff. This stuff's like, I don't want to call it magic. But holy crap, magic. Yeah, I upped my dose two and a half weeks ago, I've lost six pounds,

Dr. Jessica Hutchins 1:35:20
I need to get on it. I had gotten a sample of like, the logo V A long time ago, but it was like, the backorder was so bad. And so like, I got the sample the point two, five. And I didn't really feel anything on the point two, five. But then when it was time for me to like, get a refill on the next dose, like it was nowhere to be found. And then I just didn't go back and pursue it.

Scott Benner 1:35:41
You need it, do it. It's

Dr. Jessica Hutchins 1:35:44
worth it. Yeah, I have a two and a half year old and have yet to like lose that extra 30 pounds. Because baby,

Scott Benner 1:35:51
let me tell you something right now, I was out today. And this young girl comes to help me. And I looked at her and I thought, how is she like, it's the middle of the day, how she not in school. And then I thought, oh, high school is over. And so I said to her, I'm like, Oh, I was just about to say to you like, shouldn't you be in school? Like, you know, and she goes, I should but I'm in college. And so you can even say her like see her going? Like I know people think I look really young and everything, but I'm not in high school. I'm in college. And I said, Don't worry, looking young will really help you when you get older. And we were chatting for a second. And she goes, How old are you? And I said, Guess she goes you're in your? And she's like, I don't want to insult you. And so you just say what you think you know, and she goes mid late 30s. And I went, I'm 52 You're like, yeah, and I was like, This is great. And like, but no, but like, but she was really son. I'm like, even if you were being polite by 10 years, you were still off by seven years. Yeah, that's nice. And I said, this is my point to you. I was like, yes, it sucks now because everybody thinks you look like you're 12. But when you're 52 and someone goes already, you're 3540 years old. You're gonna love this. But the truth is Jessica, that a year ago, she would not have said that to me.

Dr. Jessica Hutchins 1:37:01
Because you looked old because you were Yeah, healthy. Exactly. Right.

Scott Benner 1:37:05
I am at a level of health now. Like forget, I don't care about how I look. It's fun to like joke about everything, except every once in awhile when somebody leaves me a review. And it's like, you're so privileged that you have this like, I know I am calm down. I feel better. I am better. Health wise. It's got I mean, if I still looked like I looked a year ago, and I felt like I felt today am I glad I came back like they came back recently. I would still tell you I'm taking this stuff. Yeah, I mean, so anyway, I have to go but I was gonna I wanted to ask you about low dose Naltrexone and auto immune Have you gotten involved in that at all? I have not. Okay, well, I'm gonna save that for another episode. I'm going to try to find somebody who has been using it or something like that. Apparently, apparently, you know what it is right. I have heard of it, but I've never used it. People are using it for like autoimmune issues now. And for like pain and swelling and stuff like that inflammation. Anyway, look into off to Google it. Yeah. Let's catch up to tell you about it. And then it'll tell you how to build a bomb that it will use on us one day. Thank you for doing this very much. I

Dr. Jessica Hutchins 1:38:13
appreciate it. Yes. All right. Have a good day.

Scott Benner 1:38:15
Yep, hold on a second.

A huge thanks to touched by type one. Don't forget to go to touched by type one.org and get your tickets for the big upcoming event in September. Jalen is an incredible example of what so many experience living with diabetes, you show up for yourself and others every day, never letting diabetes define you. And that is what the Medtronic champion community is all about. Each of us is strong and together, we're even stronger. To hear more stories from the Medtronic champion community or to share your own story visit Medtronic diabetes.com/juice box and look out online for the hashtag Medtronic champion. A huge thanks to Dexcom for supporting the podcast and for sponsoring this episode dexcom.com/juice box go get yourself a Dexcom g7 right now using my link, 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 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

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