Scott Benner 7/23/24 Scott Benner 7/23/24

#1260 After Dark: Anonymous Return

A returning guest shares her progress since episode 336, discussing her journey through depression, diabetes management, and raising children.

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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 1260 of the Juicebox Podcast.

Today I'll be speaking with a returning guest. This anonymous female was initially on Episode 336, after dark depression and self harm, and today, we're going to get a follow up from her. 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. To save 30% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout. I just got a package from cozy earth this morning and I am super excited to put on my new shorts. Tickets for the 2025 Juice cruise are limited. I'm not just saying that they actually are limited. We have a certain window to sell them in. And then that's it juicebox podcast.com Scroll down to the juice cruise banner, click on it. Find a cabin that works for you and register right now. You are absolutely limited by time on this one. I'm so sorry to say that it sounds pushy, but it's the absolute truth. Juice Cruz 2025 I hope to see you there. We're gonna get a tan talk about diabetes and meet a ton of great people who are living with diabetes. It's kind of going to be like floating diabetes camp. But you won't have to sleep in a log cabin, you'll get a tan. And it's not just for adults or kids. It's for everybody. This episode of The Juicebox Podcast is sponsored by ag one drink ag one.com/juice box. head there now to learn more about ag one. It's vegan friendly, gluten free, dairy free, non GMO, no sugar added no artificial sweeteners. And when you make your first order with my link, you're going to get a G one and a welcome kit that includes a shaker scoop and canister. You're also going to get five free travel packs in a year supply of vitamin D with that first order at drink a G one.com/juice box. The episode you're listening to is sponsored by us med us med.com/juice box or call 888-721-1514 You can get your diabetes testing supplies the same way we do from us med this show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. Everyone I'm back with a returning guest who will be remaining anonymous as they were in their first episode, which was called it was episode 336. It was in one of the first after darks it's called depression and self harm. We had to call you something though. or Now do you just do want to make up a name? Do we make up a name last time?

Anonymous Female Speaker 2:53
We didn't make up the name. Alright, well

Scott Benner 2:55
then let's not make up let's stay consistent. Don't make up a name. So you were 24 Then, and I really suggest to people to go listen to the episode, you were one of the first people to be that incredibly honest with me that and it was really eye opening for me taught me a lot. But then afterwards, you and I maintained contact for quite some time. So yes. Can we start with that? Why did that happen? And was it valuable to you? Etc?

Anonymous Female Speaker 3:26
Yeah. So after I reached out to you, I was in a really, I feel just I guess lost spot. You and I kept having our conversations and you really wanted me to reach out to a therapist or just somebody, not you that could help me truly helped me and not just be like a sound support. I feel right. And so I started doing that. And and that was really helpful it you know, I have more than just like depression issues and self harm issues, since she was really able to help me dive deeper into, you know, what's the root of my issues, I guess. And then I thought I was doing really good being in a better place. And then COVID hip. And that wasn't Yeah. And then it pretty much took me back to square one because you know, the media tells you diabetics are high risk in and all of that stuff and it just scared me. Okay, so then I went into a major depression like I would shower 10 to 15 times a day, because it was something I could control.

Scott Benner 4:42
Wow. Let me ask you a question. Because if you asked me to recall that time, I would say that beyond last. I couldn't tell how much I didn't know what you were in control of for yourself. Like the important like the important thing is not like you know pretend control where you're pretending to control something but like, do you recall, for example, that I researched and called a mental health facility for you? See? No, you don't know you don't know that to you. Hmm. That that is exactly what I've always been wondering, because I don't know the word to describe your state at that point when we were talking. But I remember saying, like, hey, I really want you to get in touch with somebody. And then you sent me a lot of messages. Some of them were disjointed. And at some points, my wife would say, Oh, you're not ever going to be free of this puppy. And, and, and I was like, no, no, no, I'm like, I'm gonna, I'm gonna help her. And at one point, I ended up online, I found, because you couldn't I forget why you couldn't figure out where to go. But I actually called a place I spoke with him. I remember starting the conversation by saying this is gonna sound incredibly odd. But I host the podcast, and someone who was a guest on my show recently needs help. And they're not going to get it without somebody, like setting it up for them. And I set that first meeting up for you. While you don't remember that at all, huh? Oh, wow. He's nuts. Is that odd for you to hear? Yes. Yeah, no kidding.

Anonymous Female Speaker 6:15
I'm in such a different mindset now. And just my whole life is so different from four years ago.

Scott Benner 6:23
Wow. Yeah. So okay, I'm sorry. So we're, we're in the shower and COVID I don't know when you're eating because 15 times is a lot every day. And can you walk through the COVID time without it like being triggering to you?

Anonymous Female Speaker 6:37
Yeah, yeah. And I was, I was a senior at my university. And so I was student teaching kindergarten. And all of a sudden, because I remember talking to you about the struggles of some of my kindergarteners and how it was really affecting me. And I couldn't figure out how to deal with that. But all of a sudden when COVID hit I never saw any of them again. And that was pretty traumatizing. And then when I thankfully my now he's my ex husband, him and I had a beautiful property that we just hunkered down and stayed there for a while. I never went out i i started well besides cigars I started smoking pot a lot more just to kind of take myself out of my inner body I guess and you know, change my mental state. So I wasn't so focused on everything around me. I

Scott Benner 7:41
do recall like your those little kids problems were getting imprinted onto you. And you were kind of suffering with them and unable to help them and then you're saying then then having them taken away from you was bad because then you didn't know if they were okay was that the problem? If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, G voc hypo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you store G vo Capo pen and how to use it. They need to know how to use G 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.

Anonymous Female Speaker 9:12
Yeah, and I still have never even seen feet like pictures faces. Nothing ever again in four years.

Scott Benner 9:21
They're okay trust me. They're in like third grade. Now they're balling out of control. No kidding. Living their best life. They're fine. So along the way, I didn't know that about the COVID thing. But I do remember you reaching out and saying like I'm getting married. And I remember thinking oh, I don't know if that's a good idea or not. But and it was only and it was only based on like what you had shared, obviously, all of this what based on what you shared in the podcast and you know, sometimes back and forth in writing, but I felt like and I guess you can tell I'm in hindsight. Now, my remembrance is that I don't, I don't feel like you're you had a very sexual relationship with him when you were just dating. Is that correct? That's, that's correct. Okay. And then how do you get past that and move to getting married?

Anonymous Female Speaker 10:16
Well, cuz we had been together, basically all through high school all through college. And I think it just made sense for both of us. And I, he was a year behind me at the university. And we get married in the summer. And I had graduated at that point, I found a job teaching while he was still getting his teaching license in school. And unfortunately, the job was, like, three hours away. Thankfully, I had family down by my teaching job, because I just kind of moved in with them. My husband and my ex husband, and I thought everything was going to be fine until he pretty much didn't want to be in my life. He I would I was the only one making a point to try in our relationship. Okay. And so I just was like, I'm not going to be in this, if I'm the only because he pretty much told me. I'm done trying.

Scott Benner 11:23
And in fairness to him, were you blocking his advances when he was trying? No, no, you are open to it at that point. Yeah, I gotcha. Okay.

Anonymous Female Speaker 11:33
And then we ended up getting a divorce. And I, my current husband, Tim, and I knew each other from school, he's a little older than me. And we just kind of reconnected after that. And now we have two kids, and he has a stuck, son. So it's been, it's been so much better just, I think finding a person that I connect with, but also knowing that my mental headspace is in a better place. But it has been rocky with postpartum and those type of things with both of my pregnancies.

Scott Benner 12:16
No, I want to know about that. But first, your first is with your ex. And the second is with your current. Is that right? No, they're both with my current. Oh, okay. Oh, this so his steps on is not with you. It's with somebody else I understand. Yeah. Okay. Yeah. Because that was, like, just hearing you now say that you were divorced. I thought that doesn't make sense. She has those kids. This has been such a short amount of time. I was like, How could that be? But now Now I got I'm completely like, square on what's going on? Before you had children? How much time was there between divorcing your ex and marrying your current husband? Like how how much time was in there?

Anonymous Female Speaker 12:56
My first child was more of a surprise. He was very fresh, almost divorced. And then my husband and I didn't get married until last August. And my husband, my son will be two in a couple of days.

Scott Benner 13:15
Okay, so maybe you had a baby together for a year and a half or so before you got married? Yeah, I gotcha. All right. Well,

Anonymous Female Speaker 13:22
then, and then our second. Our daughter was born this last summer in July just

Scott Benner 13:28
recently. Oh, congratulations. Very nice. It's lovely. You stop. Trust me stop there. One of each is perfect. You don't really need to do more.

Anonymous Female Speaker 13:35
Oh, i i There's no chance I can now. Why is that? Well, I'll back up with my boy. When I was pregnant with him. I ended up getting Bell's Palsy and occipital neuralgia. Did it go away? Yes. Eventually the Bell's palsy I got in September, had my baby boy in October, and it didn't go away until January. Oh,

Scott Benner 14:00
wow. That's a long time for something like that. Did he tell you why it happened?

Anonymous Female Speaker 14:05
No. I have no idea. I woke up the morning of my baby shower. And my mother being a very honest person going What's wrong with your face? I don't know mom. I'm just here. So then the next day I went to the hospital and

Scott Benner 14:22
Bell's Palsy. Were you preeclampsia by any chance?

Anonymous Female Speaker 14:26
So with with my son No, with my daughter this last pregnancy? Yes.

Scott Benner 14:33
I asked because I looked online and it says that Bell's Palsy is very uncommon during pregnancy, but if it occurs, it may be the primary sign of preeclampsia.

Anonymous Female Speaker 14:43
Yeah, so I was never diagnosed with preeclampsia with my son, but with my daughter this summer, I had preeclampsia with her and ended up getting trying to be induced at 37 weeks. She didn't take the Pitocin. And so I ended up having her via C section. And 37 weeks she was over nine pounds.

Scott Benner 15:10
Oh my gosh, how was your blood sugar's during the pregnancy? The

Anonymous Female Speaker 15:13
best in the I've been diabetic 16 years now. I had the best a onesies during that my two pregnancies. Okay, excellent. For my son my highest a one C was 6.6 in my third trimester. And that's when a lot of the insulin resistance happens. Yeah. And then with my daughter during my third trimester, the highest was 6.4.

Unknown Speaker 15:40
Okay.

Anonymous Female Speaker 15:43
Yeah, and then postpartum because my daughter ended up staying in the NICU for over a month. Sure blood sugar's weren't even registering on the machine or equipment, whatever, when she was born. And so she went straight to the NICU and I didn't see her for about five hours.

Scott Benner 16:02
She was born with low, like a low blood sugar. Yeah,

Anonymous Female Speaker 16:06
the my heart sugar wasn't even registering on the

Scott Benner 16:11
like when they took it. Oh, wow. Did they ever tell you what they thought that was?

Anonymous Female Speaker 16:15
They just kept referring to her as like IDM. Like, oh, this is really common with an IDM. And they're like, you know, an infant of a diabetic mother. And I was like, Well, none of this happened with my first so it's I guess it's not that common. It's all new to me.

Scott Benner 16:33
And scary. And thank you. Yeah. And

Anonymous Female Speaker 16:34
so while she and my husband went to the NICU, I opted for to get my tubes tied.

Scott Benner 16:42
Oh, I see. Gotcha. You're like we're done. That's good. Yeah.

Anonymous Female Speaker 16:45
Because I had a very difficult time with just my body with both pregnancies.

Scott Benner 16:52
How so? What What were some of the issues you had?

Anonymous Female Speaker 16:56
Just with like the Bell's Palsy and the occipital neuralgia. The local hospital is not the best hospital and so I ended up with my son getting delivering him three hours away. And then with my daughter, three hours a different way, in actually a different state.

Scott Benner 17:17
I looked up the occipital neuralgia because I didn't know condition in which the occipital nerves the nerves that run through the scalp are injured or inflamed, causing headaches that feel like severe piercing throbbing or shock like pain in the upper neck, back of head and behind the ears. That's what you had. Yeah, yeah, I don't want that either.

Anonymous Female Speaker 17:39
And I couldn't when I would go lay down at night. I couldn't sleep for longer than 10 minutes. Without that pain shooting up the back of my head and like dispersing throughout my whole head.

Scott Benner 17:55
Oh my gosh. Okay, I want to go backwards a little bit. So we're in COVID you're having a bad reaction and COVID Are you taking any kind of medication for them? And can you tell people what if any diagnosis you got through your mental health care since you've been on the show, you've probably heard me talk about us Med and how simple it is to reorder with us met using their email system but did you know that if you don't see the email and you're set up for this you have to settle up they don't just randomly call you but I'm set up to be called if I don't respond to the email because I don't trust myself. 100% So one time I didn't respond to the email, and the phone rings the house. That's like ring you know how it works. And I picked it up I was like Hello. And it was just the recording was like us med doesn't actually sound like that. But you know what I'm saying? It said hey, you're I don't remember exactly what it says. But it's basically like hey, your orders ready you want us to send it. Push this button if you want us to send it or if you'd like to wait I think let you put it off like a couple of weeks or push this button for that. That's pretty much it. I pushed the button to send it and a few days later, box right at my door. That's it us med.com/juice box or call 888-721-1514 Get your free benefits check now and get started with us med techs calm Omni pod tandem freestyle, they've got all your favorites, even that new eyelet pump. Check them out now at us med.com/juice box or by calling 888-721-1514 There are links in the show notes of your podcast player and links at juicebox podcast.com. To us Med and to all the sponsors. Ag one fits perfectly into my morning routine. I get out of bed, head downstairs, say hi to the dog let him outside while Basil is running around. I mix up my ag one drink it down, rinse out my container. And by the time he's done doing his business, ag one has me ready to do mine. Ag one posts online about their studies and here's some interesting stuff that they've learned at the 30 day A mark with a G one 80% of people in a research study noticed less gas and bloating at 60 days. 91% of people in that research study noticed that they needed less coffee. And it 90 days after just three months with ag 190 7% of people in a research study felt digestion has improved. If there's one product I trust to support my whole body health, it's ag one and that's why I've partnered with them for so long. It's easy and satisfying. To start your journey with ag one, just try ag one with my link. And you'll get a free one year supply of vitamin D 3k. two and five free ag one travel packs with your first purchase at drink ag one.com/juice box. That's drink ag one.com/juice box, check it out. Well,

Anonymous Female Speaker 20:47
I continue to take Prozac. They put me on that. And I feel like I've done really good on it. As I well in high school, I got Seasonal Depression was my tie, I guess the title of what I got my diagnosis. And of course living where I was in college. Seasonal Depression is very common, just because it's it does not in the winter. It does you never see the sun. You could not you don't, it just rains all day long, every day. And I even tried getting one of those like special lights that you put on, right, that just gives you the vitamin D or whatever. Just trying different combinations. I would say my drinking, and my pot smoking went up a lot. And so I think at that point, I was still needing some type of support. Where I didn't really have it from my ex husband. So I found it in drinking and smoking. Yeah.

Scott Benner 21:59
And that support really from from the alcohol and the weed that's just trying to get out of your own head. Right. Yeah, yeah. Because when that when you weren't doing those things, how are you feeling?

Anonymous Female Speaker 22:12
If I wasn't doing a project or like if I didn't have my mind, busy with something, I was sleeping. So I literally didn't have time to myself, I guess in my own head.

Scott Benner 22:25
Okay. Okay. Yeah. So just constant thinking, worrying. obsessing on stuff, that kind of thing. Yeah.

Anonymous Female Speaker 22:33
And then, when I started teaching, by then I had my own classroom and stuff. My family also has a ranch. And so on the weekends, I would just go help my family on the ranch. Just to get you know, get so tired that I would go home, take a shower and be out by seven o'clock at night.

Scott Benner 22:59
Just the day just ruined you almost just took everything out. Yeah. Okay. Cool. Jason. So is your is your regimen pretty much the same? And then what do you do when you're pregnant? You came to you can't take Prozac when you're pregnant, can you?

Anonymous Female Speaker 23:14
Well, I was I did. You did? Oh, no, let me let me change that. I was supposed to the only thing I ended up just taking because with both pregnancies, I was extremely nauseous. The morning sickness was not very kind to me. So I stopped taking all medication for everything but like my Omni pod, and my Dexcom. Like those were just easy. But I also take thyroid, I take levothyroxine. And, and my Prozac and I and at the time prenatal? I couldn't take any of that.

Scott Benner 23:50
They just all made you feel nauseous. Yeah,

Anonymous Female Speaker 23:53
more than the baby.

Scott Benner 23:56
Did the thyroid not having the thyroid medication. Does that get things out of whack for you? Yeah, it did. Yeah. Right. You can't be without that law. And that stuff has a very short shelf life and your body like it doesn't last long if you're not taking it. So

Anonymous Female Speaker 24:13
yeah. And then with my second pregnancy, I ended up having to like almost triple my thyroid medication. But and I was also seeing a doctor like literally every other week, whether it was here or my endocrinologist three hours away.

Scott Benner 24:31
And you were able to tolerate it with a second pregnancy just not the first. Yeah, the medication. Oh, that's interesting, too. Yeah, bodies are weird. That's uh, did that noise just stay with you for nine months or did it leave at some point?

Anonymous Female Speaker 24:48
Nausea. It left. Eventually, like by the halfway through my second trimester it was gone. But then it was kind of when not enough. sort of the preeclampsia started, I found out about a month before I had her. I was at a maternal fetal medicine appointment. And they had done bloodwork and the doctor came in and goes, What is your blood sugar right now? And I mean, it was under 130. And he goes, I don't think you're in DKA. But your blood work is showing me that you're in DKA. And I was like, my last day when see was 6.2. My blood sugar rarely gets above 150 Right now, and I ended up getting hospitalized for the night. Because after running more tests, they realized that I, I was eating so little, just because I wasn't hungry. I was eating so little that the food that I was eating was going straight to the baby and leaving my body in like a ketosis state.

Scott Benner 26:02
Yeah, I was gonna say you're in ketosis, which can be confusing when they look at at some basic testing. Oh, okay. So you weren't in. You didn't have ketones from high blood sugars. You have ketones from like, starvation, almost?

Anonymous Female Speaker 26:15
Yeah, yeah. Because I never. Because with my first child, my starting base weight was 160. And well, and I'll tell you, I kind of skipped this in between my son and my daughter, we experienced a miscarriage. And that really played a toll on my depression. Just because it was, you know, very early. We just never, there was never a heartbeat. But of course, that, you know, plays a big toll because I my body missed it. Like I never exceed, like, naturally had the miscarriage. I had to go get a DNC.

Scott Benner 26:59
Oh, geez. Yeah, that's a lot. Yeah. And so how soon after your son's birth was that? Well, it

Anonymous Female Speaker 27:07
was June of last year. So 22.

Scott Benner 27:13
Okay, Jesus, what is it look like when you're depressed now? So like day to day, how would you describe your, like the lightness or lack of lightness in your mind,

Anonymous Female Speaker 27:25
I would say, it's gotten better in the sense of, since my daughter was born, she spent 33 days in the NICU. And I was there the whole time. With my job, I was, well, I was on maternity leave. But with my job I was able to work from remotely. So my husband had to come back home. And thankfully, we live in a small enough area that my in laws and my my parents helped with my son and my step son, and just trying to make sure somebody could stay with my daughter, or our daughter, those over a month. And so being three hours away from home, being alone, being in a very depressing place. I mean, I was very thankful that my daughter was a chunk. And I could she was at the point that I could hold her, like in her crib. They have different stages of cribs, and I was she was at a point that I could hold her. She wasn't fragile, like some of her neighbors and, you know, in boxes, but it played a toll on me. And it got to the point that I would get there go later. And later in the day, all I wanted to do was sleep, because I thought this is such a depressing place. And then I would hold her for six or seven hours solid, put her down. Because I knew she was getting taken care of I knew they were feeding her. She was the biggest baby in the NICU. So people loved holding her. And I would just go to the bar and drink.

Scott Benner 29:08
Oh my gosh, how long was she there for 33 days? You drink while you were pregnant? No, no. And how did you stop yourself from smoking weed and drinking while you were pregnant?

Anonymous Female Speaker 29:20
The drinking was easy, because I didn't want to do anything. In the beginning of my pregnancy, when I was nauseous, I would smoke just enough to like curb the nausea feeling. So it wasn't like I was smoking blunt after blunt or you know, those types of things. It was literally maybe one or two hits and it curbed it. So then I could go take a shower or go do something and not feel like crap. Yeah,

Scott Benner 29:54
I understand. So but as soon as she's there, you the alcohol kind of holds you back. likely,

Anonymous Female Speaker 30:00
yes. Well, and especially because we live in a row marijuana state, that where it's legal, and we had her in a state that it wasn't legal. Do you

Scott Benner 30:12
think if you were at a hospital where it was legal, you would have smoked instead of drank? Yo, yes. Yeah. You're just going for what was available? Yes.

Anonymous Female Speaker 30:21
And I realized, like I realized very quickly, I remember why I slowed down on the drinking is I hate the feeling that gives me but it didn't stop me I would go every night. Because it took me a long time to get out of the hospital once I had her because my preeclampsia stayed for like two more weeks. And I ended up having to get a magnesium drip line. And it was just a very traumatizing for

Scott Benner 30:54
me, where's your husband and your son while you're at the bar?

Anonymous Female Speaker 30:58
They were back home because my husband continued to work.

Scott Benner 31:03
Oh, so you were you were by yourself at this hospital?

Anonymous Female Speaker 31:08
Yeah, I was by like, I stayed at the Ronald McDonald House, by myself, would walk over to the hospital and be with our daughter, by myself. And my husband would come over like on his weekends.

Scott Benner 31:24
When you're in a bar in the evening, in that scenario, Does your husband know that? Yeah, yeah. And what is were you managing with alcohol? Have you been managing with alcohol all the way through just not during your pregnancies?

Anonymous Female Speaker 31:37
I really, my husband's family doesn't really drink. And so like, my mother in law might have like an occasional cocktail, like if we go out for something special, otherwise, they don't drink. And so I just like, I'm not going to buy. At this point in my life, I'm not going to buy a 12 pack of something, and be the only one to drink. So

Scott Benner 32:02
you weren't drinking much at all, for those couple of years there. But once you were, what would you tell me was driving you to go to the bar after the baby? Like was it anxiety or depression? Or what did you What do you have going on as soon as she was born?

Anonymous Female Speaker 32:20
I feel a lot of it was like, what you said anxiety and depression trying to figure out, like, just how to escape my mind, because they couldn't give us a timeframe. You know, it's all up to her when, because she her blood sugar's she had so much fluid in her lungs, and she came out like purple. And so she just instantly got a feeding to put in her nose, and a CPAP machine. And she was on those for at least four or five days. And then nobody could, you know, she was struggling eating in general. And that's what kept her in there. Because she couldn't figure out how to take milk from a bottle. Why? Because with both of my pregnancies, I wasn't able to produce milk.

Scott Benner 33:11
So you knew you knew you weren't gonna breastfeed immediately when she was born? Yeah.

Anonymous Female Speaker 33:15
And so that was also one thing I knew I could go and have a couple drinks and not affect her.

Scott Benner 33:25
Well, that's a lot. I saw her being sick. Was that a driver for you? Was that upsetting for you? Was it just that you were by yourself? Or that you were far from home? Do you think it was all those things together?

Anonymous Female Speaker 33:36
Oh, definitely a combination. Because then I was trying to figure out, you know, my, I was talking to maternal fetal medicine once a week because they wanted to do like checkups on my blood pressure and my C section incision. So they always said, you know, postpartum depression can be very real when, especially with when your babies in the NICU. So please don't, don't feel like you're a burden to reach out to us, because we will find somebody for you to talk to. I never reached out. But I, my husband was, you know, him. And I talked a lot and every time the doctors made their rounds, I'd call him and give him the updates and, and all of those things. And so I think as the weeks went on, that it, you know, she wasn't leaving there. That's when you could just I could just feel the shadow or the darkness. Just continue to, like spread inside me. And because there were days like at the beginning, I would go see her at 7am and by the end of it I was seeing or oh one two in the afternoon. I'd stay until four I arrive, and then I'd go to the bar

Scott Benner 35:02
when you get home. Does all that just stop?

Anonymous Female Speaker 35:07
Or do you continue? Like when we like when we finally came back home with her out of the hospital? Yeah,

Scott Benner 35:14
yeah. Are you drinking again? Are you like, well, I drink now again? Or is it just go away?

Anonymous Female Speaker 35:19
I might have an occasional like hard cider. But I only limit myself to one. And it has to be after six o'clock. But I smoke a lot more weed

Scott Benner 35:34
to try to maintain it. What's your diagnosis? Again? Can you remind me? For what for?

Anonymous Female Speaker 35:39
Why you taking the Prozac? Anxiety and depression? Okay,

Scott Benner 35:43
there's no talk of like bipolar or personalities? Not just okay. If you didn't smoke, we see you smoke weed daily. Is that right? Yes, yeah. If you didn't, what

Anonymous Female Speaker 35:56
would happen? I don't I try not, I don't do it. When I'm alone with our kids, because it gives me paranoia. Okay, because I'm scared that I'm gonna fall asleep or something. And so usually I just do it at night to go to bed. Because that's the hardest time for me is at night, going

Scott Benner 36:19
to sleep is hard. Yeah, your mind races can't stop thinking about things, that kind of stuff.

Anonymous Female Speaker 36:24
Yes, because I feel like I have, like, with my job and my, my master's program and our children and just, I feel like I'm going nonstop. And that's really the only thing that kind of just resets me, and I'm able to fall asleep within minutes,

Scott Benner 36:41
I see. But the rest of the day, you do well with the kids,

Anonymous Female Speaker 36:44
if they're not driving me crazy, because my son is in the terrible twos. So

Scott Benner 36:51
just running around screaming and throwing things. Pretty

Anonymous Female Speaker 36:55
much. And so a lot of the time, like, when they're both sleeping, like I'll take it that my shower about like midday, to try to recenter myself, because that's always worked for me, like during COVID. And when I was younger, so that helps me a lot through like the rest of the day. And

Scott Benner 37:15
none of this is hidden, like your husband knows all about all of this. Yep. Is he involved in helping you at all? Are there things that you need from him,

Anonymous Female Speaker 37:23
him and I every evening, like before I actively try to go to bed. And then I sit and talk like, after we put our kids to bed, we talk just about our day and and when I'm struggling, I don't wait to text or like if he's at work, I don't wait to tell him about how I'm doing that night. Usually, I will text him or call him if I am like really struggling. And he is able to just help me. You know, you're a great mom, just affirmations that I know, I try really hard to be a great mom. And so I there are times that I might smoke just a little bit just to have the edge off. And then I can really focus on being present with my children, because, you know, they from zero to two is so developmentally important. Yeah, they need a lot, that's for sure. And so just by taking that edge off, I sit with my like, I'll hold my little girl and play with my two year old and, and we go on walks, and it's just I don't have the mental load on anymore. And which is very comforting. And and I think my children are benefiting, you know, from me not having to deal with everything going on in my head. Right?

Scott Benner 39:04
Do you have any issues, any intimacy issues with your husband, like you did with your, the previous person?

Anonymous Female Speaker 39:11
No, it's completely like, different 180 Okay.

Scott Benner 39:16
And you don't have any intimacy issues with the kids. It doesn't sound like so it sounds like you're, you're close with them and loving with them and all that stuff. But it's just it's one of the things that stuck out from the conversation last time with me. It's interesting. So my next question is, Are you actively cutting yourself? No. Oh, good.

Anonymous Female Speaker 39:38
But the but the thought is always there. Okay. I haven't taught myself since. Well, the beginning of COVID. That's a long time but yeah, but I would say I probably think about that doing it like the act of When it Oh, at least once a month, okay, but I never go, i never go through with it. But I'm like that I know that something I can control. I control how deep it goes, I control how many times I do it. And to me that was like one of the biggest satisfactions

Scott Benner 40:22
of the of actually the process of doing it. Yeah, all the control that was involved. Yeah, yeah, no, I remember you trust me. I remember you explaining it to me. My conversation with you last time is it helped shape a lot of things that I didn't understand previously. Yeah. And I just you, you would, you would expose me to so many ideas that I didn't know about. And you were just so clear, and, like honest about them, that he taught me a lot. But I'm, I'm thrilled for you. That's really exciting.

Anonymous Female Speaker 40:54
Yeah, I feel I mean, in such a better place overall, right now. Your

Scott Benner 41:01
speech patterns even different? Really? Yeah. Yeah. It's really something it was. I remember talking to you and thinking that at the at the end of every one of your sentences, it almost felt like, there was a voice that wanted to go, Oh, my God, everything's terrible. What was me Help me please? Like, like, every at the end of everything you said it felt like that was gonna keep coming. And you don't sound like that now. It's really, really interesting to talk to you again. It'll

Anonymous Female Speaker 41:29
be interesting to hear my first episode, because I have because I remember, one of the things I remember you telling me was, don't listen to your episode. Don't do it. Right. Did you ever and I listened to it, like, probably a month after it came out. And I listened. Probably not the best, like situation. But I was alone in like, my bedroom. And it was completely pitch black. And I just sat there with my eyes closed.

Scott Benner 42:01
What was your takeaway while you were listening?

Anonymous Female Speaker 42:05
Well, part of me thought, and I've haven't listened to it reasonably sure. Because I probably think differently. But I remember thinking, like just the honesty, and not on my own, almost not thinking it was me. Because of I don't know, just because I, when I remember listened to it, I was like, that doesn't sound like me, that that could be anybody. But it's not me. And then as it kept going, I was like, Oh, my gosh, this is my story. This is this is what's happening, and what has happened to me. And so I, I probably listened to it three times of like, one after another. And I've listened to it over again.

Scott Benner 42:51
I well, I

Anonymous Female Speaker 42:52
can tell you this, but then I would like

Scott Benner 42:56
go ahead. No, I was just gonna tell you that, you know, I've recorded well over 1000 interviews, you're the only person I've stayed in contact with afterwards. Really. I mean, there's just there would literally be no way to do it. I get done talking to some people, I think I can be friends with these people, you know, but I can't, I can't add a new person in my life every day. You don't I mean, but for me, like, from my perspective, what I thought was, you're not going to be okay, if somebody doesn't help, because there was no help coming from your extended family. You had a very strange relationship with your boyfriend at that point. In my estimation, I didn't see how he was going to be helpful. He was too young, you were young. And I thought, I actually thought If I don't help her, this isn't going to end well. And I'm gonna feel like I was responsible. And I don't I don't want that for me. And I don't want that for you. So why not? Like, let's just keep talking and see what, see what happens. I'm very excited for you, honestly, like, I don't know if I sound like that. But it would have been easy to record with you and think, Oh, that girl is not going to make it. You know, and just and just be done. Like when you told me you were pregnant the first time I thought that's absolutely out of this world. Like I couldn't imagine that happening. Like I don't even mean just in no way shape or form that you were like, having a baby and thoughtful about it in your email, like your note changed, like the tones of your note changed and just seem so much more together for the lack of a better word. I was like, Well, I think she's doing it. You know, that's pretty cool. Because it would have again, if I had to bet after I talked to you, like if he took my hard earned money and said, How's this gonna go? I'd be like, I don't think it was gonna go well. Why haven't you given up? Like given it?

Anonymous Female Speaker 44:45
Well, I think once before the pregnancy, I'm not sure. But once I was pregnant with her son, that's when I completely like that's probably when I started caring In about my diabetes the most in my life, because I did want to be obese in my, in the future suffers. And so I just had that in my mind the whole time and, and thinking, you know, it's not about me anymore, so I have to keep it together for this innocent human thought, you know, they never asked to be in the world. Yeah. And then every day since, because with him, I had him naturally, probably not the best decision. But with her, I had her C section. And my two recoveries have been so different. I think if just with everything, if I would have had the same stuff happened with my first pregnancy, I don't think I would have made it just because I really experienced postpartum depression. With my first child.

Scott Benner 46:03
You did not know, okay.

Anonymous Female Speaker 46:07
With her, I feel like it's not this huge, dark cloud over me every single day. But there's, there's a cloud. And sometimes it's, it's hard. And I started going back to work. And so I'm working from home a little bit. And just really just trying to take in having children and trying to be like the best mom I can be. And that's I feel like kind of my new goal. When I started having children, like everybody wants to be the best parent. But it just gave me a sense of purpose that I feel like, four, five years ago, I had never dreamed of having. So there was no goal with that.

Scott Benner 46:54
It's easier to take care of yourself knowing that if you don't, you won't be able to help them. Yeah. And with the diabetes, especially if I'm remembering right, you are not exactly on top of things when I talked to you the first time. So yeah, it was one of the it was a I remember your diabetes being an afterthought. Is that about Correct? Like you give yourself insulin if you had to like that kind of stuff? Like when, like your blood sugar's got high. Was that the vibe before?

Anonymous Female Speaker 47:22
Yeah. Or, like, when I was younger, in high school, I would just like stick it empty Omnipod on me. So it would suffice my mom. Yeah, but because I could I didn't care.

Scott Benner 47:35
Yeah, well, the depression and the mixed with, I mean, with the pressure from the diabetes, and you weren't, you weren't even trying to stay alive. Really? Right. Like, there was no feeling of like, it's imperative that I go on. You were you were that depressed. Yeah. And that was for a long time in your life. Oh, my God. I'm right about that. Right from How old do you think you were when you started feeling depressed? Probably

Anonymous Female Speaker 48:02
a sophomore in high school. So at least well, that was over 10 years ago. Because I'm, I'm 28. Now.

Scott Benner 48:11
Wow, that's even weird. I'm getting older. You guys are just you're aging nicely, and I'm getting old. How old? Were you were diagnosed? Remind me 1212. Okay. 16 years ago? Yeah. And then five, six years later, in that range, you start feeling depressed and your mom has depression? No,

Anonymous Female Speaker 48:32
but she doesn't like acknowledge mental health or mental illnesses, like a normal like she, her thought process was, you have a good home. There's no reason for you to be depressed. Like, she didn't understand, you know, the underlying issues. And I think I remember telling you that I tried to go to therapy in high school. And the therapists that I saw, he ended up committing suicide.

Scott Benner 49:04
I do remember that. Yeah. That's a tough one. Yeah, that's yes. And so

Anonymous Female Speaker 49:09
it that really traumatized me as well. And so I still have, like, I feel really good opening up with my husband, even though he is no way licensed in any way. But it's just somebody that literally whenever I need to talk, he is there for me.

Scott Benner 49:29
Speaking with him is helpful to you. Yes, yeah. So you're not seeing anybody to talk to anybody right now.

Anonymous Female Speaker 49:35
No, I'm not. How long did you? Oh, probably four or five months of like, sometimes it was two or three times a week. And sometimes it was once a week or every other week.

Scott Benner 49:52
And you found it valuable overall.

Anonymous Female Speaker 49:54
Yeah, I there was a lot of things that I just let go I have in my life because I thought, you know, that is so much like, No wonder I'm constantly stressed and constantly having headaches it like all of these little backpack things off of my depression. And so I finally, like toxic people in my life, no longer talk to like, I could just instantly cut those ties. It helped me. And so I, I wouldn't say live like a very minimal life, but not a lot of things like get under my skin anymore. And that has helped tremendously well. So

Scott Benner 50:39
generally used to be you live with that, like kind of like drifting cloud that sometimes it's heavier, and sometimes it's lighter, but it's always pretty much there one way or the other. Yes, yeah. I mean, just the anxiety of raising children and the pressure of that, that doesn't bother you. You're you do okay with that?

Anonymous Female Speaker 50:56
Yeah, I will. We take I take a very, like natural consequences approach if my son is going to run. And like, eventually he's going to fall. He looks at me and I do not react. He doesn't react, he gets up and just keeps running. That kind of stuff that I'm like, if I don't react or have a big emotion, it'll be better for him. Because he doesn't need me to react like that.

Scott Benner 51:26
And by taking that tactic that helps you not to feel stressed. Yes. Interesting.

Anonymous Female Speaker 51:33
Oh, that's interesting. And we live in a very rural town, there's, I mean, not even a warning light or a stop sign, or a stoplight. And so he has no fear of the road as a two year old, he'll just like, we don't live on the main road. But he'll go and he grabs his like Toy pirate ship, and he'll just go, like, we just go play in our little cul de sac. And, and he is just fearless. Yeah. And so I think with him having that demeanor, I am able to, I never say like, be careful, or don't do that. Unless it's like a safety issue. Of course,

Scott Benner 52:17
do you find that his? I mean, that that feeling that he exudes? Are you able to kind of feed off of that a little bit off of that? Like, don't be scared feeling?

Anonymous Female Speaker 52:27
A little bit? I think that when you put it into words like that, yeah. Because I'm he's like a spitting image of me, and with red hair. But he just has this little personality where he just is an explorer and an adventurer and wants to go and do. And that at this point in my life, that's the complete opposite of me. And so I just go with it. We make messes we, we do so much, try to do so much experience stuff, that even though he's too he's probably not going to remember. But there's so much good with letting your child be messy and just doing those type of things.

Scott Benner 53:19
It's nice to it sounds like it might be freeing for you as well. I have a question. You've scheduled this recording and pushed it a number of times. I know. And what an I, every time it happens, I'm just like, that's cool. But there was a moment where I started to worry. I'm like, oh, maybe she's having like, like issues and they can't bring herself to do this. But do you remember? Was it just life stuff? Or did you have moments where you're like, I can't rerecord this right now.

Anonymous Female Speaker 53:48
It was never that I think it was more well, our time difference doesn't necessarily help. Not at all. That was kind of a struggle, because then I'd kind of you, I put you in the back of my mind. And then I'd be like, Oh my gosh, I I'm supposed to do this. But I'm working that day or, you know, different things or when I was pregnant. I just didn't want to I guess because and when I was pregnant, I really tried hard to listen to the pregnancy episodes. And I think I got through about 10 minutes of one. And I just sat and cried. Yeah, I because unfortunately, I should probably listen to the podcasts more. I really have to still pick and choose what episodes I listen to.

Scott Benner 54:41
I say they can have an impact on you too harshly.

Anonymous Female Speaker 54:46
Yes, yeah.

Scott Benner 54:49
Well, listen, I'm just glad to hear that you weren't like I you imagined from my perspective after the first second third time I was like, Oh, she might not be okay. Was my was my worry. I'm glad just to hear that. That That's not the case. Yeah, yeah. No, that's, that's good to go. So when you hear some people's stories, when are they hard to listen to? If they're too close to yours? Or if there's something you can't accomplish, or what? Where does it get to you?

Anonymous Female Speaker 55:14
I feel that like, any time, like one that really sticks out in my mind, is the mom that lost her diabetic son. I want to say in the car. Yes, yeah. Like, those type of things where I just feel like I'm not, I am mentally stable. But I just feel like my emotions are still pretty unstable. And now adding postpartum that doesn't help. Right. But those types that it's just kind of pulling at your heartstrings. Yeah, well, that's where I struggle,

Scott Benner 55:55
I have to tell you, if if it makes you feel any better, it's was hard for me to talk to her. And it's still one of the, like, conversations I've had that sticks inside of me. So I mean, I don't think that's, that might have nothing to do with your, your history, to be perfectly honest with you. It's just hard to listen to.

Anonymous Female Speaker 56:12
Yeah, well, and then I listened to a lot of like the after dark ones, because I know those just have a different tone. Usually, it can be a lot, a lot more heavy, right in the conversation. But I'm like, You know what I? Like? If this person can do live and do things, I sure as hell can. Oh,

Scott Benner 56:36
it does give you that feeling like, Gee, they're going through this, I can do my thing. Yeah. Oh, that's excellent. I'm glad to hear that. Those episodes, my hope with those episodes is sort of like, partly I think people coming from my perspective, can get some understanding for how other people's lives are. And then I also hope for people who are struggling to hear somebody tell a story of going through a similar struggle, and then getting out of it that that can feel hopeful. So I'm glad about all that. That's really interesting.

Anonymous Female Speaker 57:06
And everywhere I go. I like Have you listened to Juicebox? Podcast? It's phenomenal.

Scott Benner 57:13
Thank you. You're so nice. I think that your story will like stick with me for my whole life. It really well. It was one of the first times that somebody ever opened up like that. Talking to you really helped the podcast to grow. Because I mean, I think you're like the third after dark episode of fresh one. Yeah. So basically, my idea back then was like, well, like you smoke weed you drink, we'll talk to you people, right? And then I don't know where I thought it was gonna go from them, then I get this note from you. And I was like, alright, well, I guess I said I was doing this. So I'll do this. And then we have this conversation. And it's so like, eye opening for me. And at the same time frightening to me, like because I think there's no way you're going to be okay. Not because of you, but because you were isolated. Because from family because family wasn't that supportive of their mental health struggles to begin with, because the guy you were with was young. And I just I remember feeling like that kid doesn't have the tools for this, that you know what I mean? Like, I'm 30 years older than him, and I don't know what I would do. And then your notes. He just felt like you weren't okay, and that you really needed help. So, like, even just being involved in, like, I stepped over a line for myself calling a place for you. Like that was not that's not a thing I should have been doing. Like, you know what I mean? Like, but that was the situation the situation was so upside down. Like, you know what he mean? That it needed something that ridiculous to happen, a stranger to call across the country and try to help somebody? Yeah, you know, I don't know, it just it changed the way I look at some of this stuff. So, you know, like in the future, like, I can tell you that without without your conversation. The day I get an email from this woman who says, Listen, I was sexually assaulted in college, and it impacted my life with diabetes. And I want to tell that story. Had I not spoken to you? I don't know what I would have done when I got that email. because prior to that, I would have thought this has got nothing to do with this podcast, and I don't have the skills to have this conversation with her, you know, like, like that. By the way, I still didn't feel like I had the skills to have that conversation with her if I apologize to her before we started this, like, I'm not gonna do a good job. You know, like, I don't know what we're talking about here. And afterwards. I'm like, was this okay? And she's like, No, it was terrific. And, but I really think that the conversation I had with you opened a lot of that up for me. So yeah, I appreciate it.

Anonymous Female Speaker 59:49
Yeah, I mean, it's amazing how something like depression or anxiety even because I did not experience anxiety. I thought anxiety was like was a fluke, until COVID hit, and that's when my anxiety really ramped up. And I could understand like, oh, I, I understand why people have anxiety now. And so it's, it's amazing how an event or just something like that can trigger. And then I mean, diabetes is not simple by any means. But then how it trickles down to even that, or some, you know, an event like being sexually assaulted how that trickles down to your diabetes? Yeah.

Scott Benner 1:00:36
When she even said that when that person said that, in that note, I was thinking, I don't understand how that impacts that, you know, like, I don't know what she's talking about even but I figured, well, she knows. And I have enough dexterity conversationally to get through this. So I'll learn something that people listening will learn something and, you know, will add to the fabric of the podcast that way. But yeah, no, seriously, talking to you was a was really helpful for me. So, you know, a lot of what's come since then, is based in the what the word is. But the courage I have that to believe that I can do that. Have that conversation, you know, so anyway, I appreciate it. Thank you very much. So you have like, it's early in the morning. Your kids are still asleep? Yes, they

Anonymous Female Speaker 1:01:25
are. Yeah.

Scott Benner 1:01:26
Are you like we're doing it though, right. We're getting through this without them waking up. So that's pretty cool. Yes.

Anonymous Female Speaker 1:01:31
It's nice.

Scott Benner 1:01:32
I have to tell you your note yesterday, it was in two parts. The second part said, I just had a minor heart attack. Like, and right. So I'm trying to imagine I'm coming out of the grocery store yesterday. And I flipped my phone up. You know how the iPhone does the thing. Now we're like, you get like, you're like there's a bunch of stuff on the main screen, they start to stack up a little bit, and the most recent one is on top. So yeah, I look and it's from you. And it says, I just had a mild heart attack. And I thought, oh my god, you had a heart attack, like so I like sit in my car and I whip it open. And I'm like, I'm getting rid of let's say like, all I can think is like wow, the people love this podcast so much that even after they have a heart attack, they still think the message. And instead I realized that it was the extension of your first message, which is hey, my kids are sick and like blah, blah, blah. And I just realized I have this recording with you tomorrow. I just had a mild heart attack like you were being you know, you were joking. Yeah, for but for 35 seconds. I thought you had like a health issue. And I was like, oh my god, like it was like so stunned. Like when I got I got in the car at the grocery store. Anyway, I'm glad you did I have a heart attack.

Anonymous Female Speaker 1:02:46
Me. Yeah, me too.

Scott Benner 1:02:48
Right. easy thing to be glad about. Is there anything that we haven't talked about that we should have?

Anonymous Female Speaker 1:02:53
I don't think so. I feel like just the first time like the tones in my mental load. Obviously, it's different now. But it's night and day different I feel. And I feel like even listening, like and you listening to me right now, while we record this. I just feel like it could almost be two different people. Oh,

Scott Benner 1:03:22
anybody who hasn't heard your episode goes back and listens to this. They're gonna think I can't believe that girl's alive to have that second conversation. Seriously? Yeah, for certain episode 336. After dark depression and self harm. It was back. It went up on May 14 2020. We're recording now in October 2023. So this is over three years ago.

Anonymous Female Speaker 1:03:47
Yeah. And I think at first I was trying to do like a year after Yeah.

Scott Benner 1:03:53
Now you've rescheduled more times than I have fingers on one of my hands. I think so. And I'll be honest with you, I once said to my wife, so I'm like, Hey, I gotta go record. And I went upstairs, and then I realized that you'd canceled it. And I came back down and my wife goes, what happened? And I said, Oh, the they rescheduled. And she goes, okay, and it happens. I don't want to give people the freedom to like do this all the time. But I'd say three or four times a year, somebody rescheduled the last moment, and a couple times a year, people just canceled the last moment. It's part of the it's just part of it. It's how it goes right? Sometimes I'll come downstairs and my wife will be like, what just happened? I said how they flaked, you know, like, just forgot the day or something like that. So my wife goes to the person flake, she's using my words. And I said, Oh, no, no, it's and I told her your name. I said, you remember her from this conversation? I was like, oh my god, do your pen pal. And I was like, Yes, her and and I said, I honestly don't think I'll ever record with her again. Like so that we're doing this today is even a little shocking to me, because I thought for sure this was going to just be a thing. We'd Did where you take up a day on my schedule, but we never get back together again. I actually, I really did think that's what was gonna happen. I'm thrilled. It's not. That's why I asked you about it. Yeah,

Anonymous Female Speaker 1:05:11
well, and I feel part of it maybe, maybe was the anxiety of like, not necessarily reliving that time in my life, but just

Scott Benner 1:05:21
having to remember that that was you.

Anonymous Female Speaker 1:05:25
Yeah, because I tried very actively, to not remember, like our converse, like, you helping me, I remember that, sure, to a point. But like our conversation where I was in my life, I try really hard to not remember that. So it's kind of, you know, hard to go back three years, when I've grown so much.

Scott Benner 1:05:52
I know, I don't blame you at all. Like, there's part of me that just thought, like, if you and I ever talk, it'll be an amazing sign of like progress for you a second time. And that is how I feel now talking to you. I'm so thrilled that it kind of went the way I expected it to. But yeah, part of me just thought like, letting you keep that date on the calendar, maybe. I don't know what's good for you somehow. So I just because my wife would say, you know, you can't give these dates away all the time. You're gonna, you'll get behind and I was like, now for her. It's okay. This is special. It's alright. Because there are other people, by the way that after, like, they'll like if they cancel once. I'll be like, it's fine. You can reschedule it. And if they cancel a second time, I don't say that's fine. You can reschedule. I just go okay, well, I'm sorry, this didn't work out. Because they're gonna be habitually flaky. I just didn't feel that way about you. I was like, I'm happy if this stays on my schedule forever. So

Anonymous Female Speaker 1:06:44
yeah. Well, and then one thing I tried to do, like, I will not actively because I, you know, ebb and flow of you, filling my mind, or like your podcast or talking to you or whatever. And so then I was like, every now and again, maybe I should message him and give him a little update on how I am and what I'm doing. So he doesn't think I'm dead. Or

Scott Benner 1:07:11
I like don't worry. Yeah.

Anonymous Female Speaker 1:07:15
You know, yeah, well, I I'm still a functioning person, I guess. Yeah. Listen,

Scott Benner 1:07:22
it all very, it's very helpful to me at times to like, I'm, I get a lot of messages. So I'm not the most communicative like quickly when I get messages sometimes. But do you remember the after dark? Did you listen to the after dark with the girl who was the stripper? No, you didn't hear that one. So she said something like, I mean, a couple of things that were really worrisome while I was talking to her. And she's another person who like I think about sometimes like, I hope she's okay. And she sent me a note a couple of months ago, about some like pretty big changes and improvements she made in her life and things that I'm that she realized. It took, like a long time after she recorded the podcast, but she realized like that what I said there was like, That's not okay. I don't want to live like that. I was thrilled to hear from her. Like, just that she had made an adjustment and a change and that things were going good for her. Yeah, I like that. I think there trust me there's people in my head I'll never speak to again that I think about a lot from the show.

Anonymous Female Speaker 1:08:23
Yeah, well, and and I never expected like for you to respond or even like a, you know, a thumbs up. I would have been fine with from you just cuz I was like, he needs to know that I'm mental. Like I'm just in a better place. Yeah,

Scott Benner 1:08:42
no, I appreciate it. I really do. Thank you, man. Thanks for doing this again. And thanks for taking good care of yourself. Do you ever consider dry vaping your weed instead of smoking it?

Anonymous Female Speaker 1:08:55
No, no. I've thought about I've thought about tinctures and like RSO oil. And so I have like a tincture that I'll put in like my coffee in the mornings just to mix it up. But I stay away from edibles because they do a number on my blood sugars and it's not worth it to me,

Scott Benner 1:09:18
right. I was talking to somebody recently I don't think her episodes up yet but she has a number of different autoimmune issues. And she's like smoking CBD and, and like a whole bunch of different stuff trying to like help it and it's interesting what people are doing to try to try to help themselves honestly. Anyway, I'm just happy for you that you know, you found I don't I don't even think that you found like where you're going to be it sounds like you're still moving in the right direction. Like you haven't leveled off. It sounds like you're still moving.

Anonymous Female Speaker 1:09:50
You know what I mean? Yeah, I feel like I feel as long as like my kids are growing up, which I guess they'll always grow up but be and children, specifically, I think, as long as their children and like, need me that like I will always be moving in a forward direction, because they give me purpose, and they give me a reason to manage my blood sugars and make sure that, you know, in 20 years, I don't go blind or you know, all of those complications that could happen. I, and I, you know, there are most most days, I do not want to do anything, but my son loves to be outside, it could be 10 feet of snow outside. And he wants to be outside. And so he gets me out of my comfort zone and going and doing and just living. And so I think he doesn't know that I think him for it. But I thank Him every day for just getting me out of bed.

Scott Benner 1:10:58
Well, and then do you think long term, you'll be able to find a reason that doesn't involve another person that hopefully when they get older, you can, you know, find some happiness for yourself and then still be there for them as an, you know, a mom who's not with him every day?

Anonymous Female Speaker 1:11:15
I hope so. And maybe as I get older, or you know, since I'm only 28. And so maybe in my 30s I'll like I don't know, if it's a light bulb or just working in that forward direction of life, I guess and not going backwards. Yeah. Maybe I'll figure something that gives me inner peace. And I don't need to rely on a force outside of me. I guess. I

Scott Benner 1:11:48
wonder too, if they won't make if they won't make some more advancements in that use of psilocybin for depression. Because there are a lot of there are a lot of trials going on. Now that say that. People report that they do these, I don't know how, listen, I don't know how they do it, right? This mushrooms and basically low dose mushrooms or something like that. And they I don't know exactly what they do along with therapy, but people then they're doing it with a lot with military people and PTSD and depression and things like that. And people report really like astonishing changes for themselves.

Anonymous Female Speaker 1:12:25
Yeah, I know, I know a couple people that go on mushroom retreats, where they are paired with like a therapist, and then they micro dose on mushrooms. And they just sit with the therapist. So it's a controlled environment, right. And whatever happens happens.

Scott Benner 1:12:47
And a lot of people describe like rewiring and like a loss of their depression and things like that. Actually, there's a lot of work at Johns Hopkins University with this. I mean, they're really yeah, they're doing like, if you Google Johns Hopkins psilocybin, you'll, you'll see they're doing looking at treatments for major depression. They say that the I remember an article from a year or so ago, I could probably find it. But they were saying that for up to a year after this the therapy that people were still doing well. So wow, it's really crazy. Anyway, I feel like something will happen there. You know, and eventually, eventually, drug companies are going to figure out a way to monetize weed and mushrooms and stuff like that. So No kidding. Yeah, once they once they decide they can make money with it, then they'll figure it out pretty quickly. Yeah. So anyway, I'm really I'm so happy for him. So I can't use your name. I a couple of times. I've wanted to call you by your name, but I'm really thrilled for you.

Anonymous Female Speaker 1:13:49
Thank you, I It's been a long, three or four years, however long it's been but I feel like you're our first conversation. And what you did for me really cooked like, projected, not necessarily like where I am now. But it felt so much I think because, you know, my ex husband didn't know what to do. My family didn't know what to do. And just you going out on that limb. I think I realized like there are people in the world that truly care about me. Oh, and so and like three timezones away. I'm

Scott Benner 1:14:33
sure everybody listening cares to you just never you'll never meet them, you know? Well, that's really lovely for you to say, I appreciate it. I was it was my pleasure. And it was uncomfortable for me. I mean, I can tell you that, but it just felt not just necessary, but I don't know how a person would have met you and walked away from you that situation. Like I can't imagine that. So yeah, seemed odd. Yeah, and

Anonymous Female Speaker 1:14:59
and it's been, you know, like, when my episode came out I, because you shared it on the, I'm assuming if I remember correctly, like the Facebook group and that and, and just reading some of the comments. That's where it got, like where I started to get affected like, oh my gosh, these people listen to me and just them I guess, the community that you unknowingly, we're going to we're, you know, building. It's such a strong community I feel and it's people from all different backgrounds. And so it's nice to just because I've pretty much put taken like the Juicebox Podcast and like, put it on the backburner right now, just with my master's program, and two children under two. Life, yeah, I don't commute as long as I do, or as long as I did, and I had that time. And so I'm, unfortunately not as up as I should be. But definitely, I probably go to your, like the Facebook group, oh, four or five times a week. And that's kind of how I have stayed connected. Not with you, but just with the community, because it is a very close knit community. And that, even though I will never meet any of these people, it's just nice to know. Like, there's other people in the after dark series, I reached out to one of the after dark people, and we messaged a little bit, and I followed him on Instagram and that stuff. And so I just played I kind of am like a shadow in this world. In the sense of, you know, yeah,

Scott Benner 1:16:53
I get my mentions, and there are times I'll see your name, like your message. And I'll think, Oh, good. She's out there. You don't I mean, like, it just, it's a nice little, it's a split second, you know, I see your name roll by on my, my mentions, or I'm not bragging, but my mentions are like, hellacious they're just, they don't stop all day long. And it just to see your name, like pop up in that list sometimes like, Oh, good. You know, like, that's great. And to your point about the group, being kind and diverse. I'm never not amazed by it. You know, like, you'll watch somebody, literally from Australia, ask a question that's answered by somebody living in India. And then you know, it and before you know it, you realize years, people from Mexico and Canada and the EU, all over the US and Germany, France, like the UK, they're all talking to each other. And they all have something to add. And even just hearing you now talk about how it even felt supportive, just to hear people like conversate, about you, and your episode to say like, Oh, I heard that and, you know, have feedback and how that feels supportive to you. I mean, even those are things that I mean, I can imagine them if I stop and think about it, but day to day, as the minutes are clicking by and I'm doing all the things I'm doing. I don't stop the thing. Like, oh, that really helps them that post actually supported you like that. That's really cool to hear. So I'm glad you said that. It

Anonymous Female Speaker 1:18:23
was really like hard to a listen to my first episode. And then let's like, read those comments. I think just because being you know, slightly in a, you know, a different mindset then. And not, you know, none of them, obviously could reach out because of the me being anonymous and staying anonymous. But just knowing that there are people out there, that's more than like my husband or my family. Yeah. It's, it's been very, it's really great to have just this outlet of, and I don't really post in it or anything, I might tag the Juicebox Podcast every now and again or whatever. But just knowing that when it comes to such a large part of my life of the diabetes, I know exactly where I can go to have 100% support from people. Literally, like you said, literally 1000 miles away, right.

Scott Benner 1:19:26
And you get to be yourself and the person from the episode, but you don't have to tell anybody that that's me. And I would imagine there's some freedom in that as well.

Anonymous Female Speaker 1:19:38
Yeah, yeah, for sure. Yeah.

Scott Benner 1:19:39
I've seen people do it both ways. And doesn't seem like there's a right way. It's, you know, whatever makes the most sense to you and what's most comfortable for you, but I've seen people be like, That's me, and you know, talk to them and but just to know that you could see it and they they were talking to you and they didn't know it like it's all very good. And by the way that they were kind and, and generous and lovely and not, you know, I mean, you could have easily clicked on that link and somebody could have said something off the wall and it might have been bad for you. So that's great. All right. Okay, good. I'm gonna let you go. You got to at what, by the way, what's wrong with your kids? Right, what kind of illness they have?

Anonymous Female Speaker 1:20:16
Well, I'm currently being treated for pneumonia. Oh my God. And the littles just have, like, stuffy nose, runny nose, cough, just cred. Yeah. And so it's not a very happy place in our home right now.

Scott Benner 1:20:37
Yes. Nobody wants to be sick, that's for sure. But I hope everybody feels better quickly. And seriously. Thank you so much for doing this with me.

Anonymous Female Speaker 1:20:46
Yeah, no problem. I'm so glad we were finally able to connect.

Scott Benner 1:20:49
Yeah, let's get you back on the schedule now so we can record again in five years. Okay. Hold on one second for me.

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 gonna get a free welcome kit. Five free travel packs in a year supply of vitamin D. That's at AG one.com/juice box. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juice box. you spell that GVOKEGL You see ag o n.com. Forward slash 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 the sponsors. I was looking for a way that we could all get nice and tan and meet each other and spend some time talking about diabetes. How are we going to do that on a juice cruise? Juice cruise 2025 departs Galveston, Texas on Monday, June 23 2025. It's a five night trip through the Western Caribbean visiting of course Galveston, Costa Maya and Cozumel. I'm going to be there. Eric is going to be there. And we're working on some other special guests. Now, why do we need to be there? Because during the days at sea, we're going to be holding conferences. You can get involved in these talks around type one diabetes, and they're going to be Q and A's. Plenty of time for everyone to get to talk, ask their questions and get their questions answered. So if you're looking for a nice adult or family vacation, you want to meet your favorite podcast host but you can't figure out where Jason Bateman lives. So you'll settle for me. If you want to talk about diabetes, or you know what, maybe you want to meet some people living with type one, or just get a tan with a bunch of cool people. You can do that on juice cruise 2025 spaces limited. Head now to juicebox podcast.com and click on that banner. You can find out all about the different cabins that are available to you. and register today. links in the show notes links at juicebox podcast.com. I hope to see you onboard. 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

#1259 Grand Rounds: Gas Passer

Diagnosed with type 1 diabetes at 41, Courtney, a nurse anesthetist, discusses the impact of her diagnosis and managing her condition alongside her career.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 1259 of the Juicebox Podcast

Courtney is a nurse anesthetist anesthetist enough for her boy, she's a gas passer. She's also, she also has type one diabetes, and she was diagnosed at 41 years old. She's now 46. She has Graves disease, and antibodies for Hashimotos and today we're going to find out what she sees that her job. 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. Don't forget, if you use my link drink ag one.com/juice box you'll get a free year supply of vitamin D and five free travel packs with your first order. And if you go to cozy earth.com and use the offer code juice box at checkout, you're gonna save 30% off of your entire order. Subscribing to the Juicebox Podcast newsletter is this easy. You type juicebox podcast.com into a browser. Scroll to the bottom put in your email address, click sign up. I was looking for a way that we could all get nice and tanned and meet each other and spend some time talking about diabetes. How are we going to do that on a juice cruise? Hang out at the end of this episode to learn more.

This episode of The Juicebox Podcast is sponsored by touched by type one. This is my favorite diabetes organization. And I'm just asking you to check them out at touch by type one.org on Facebook and Instagram. This episode of The Juicebox Podcast is sponsored by the Dexcom G seven, the same CGM that my daughter wears. Check it out now at dexcom.com/juicebox. Today's episode is sponsored by Medtronic diabetes, a company that's bringing together people who are redefining what it means to live with diabetes. Later in this episode, I'll be speaking with Mark, he was diagnosed with type one diabetes at 28. He's 47. Now he's going to tell you a little bit about his story. To hear more stories from the Medtronic champion community or to share your own story, visit Medtronic diabetes.com/juice box and check out the Medtronic champion hashtag on social media.

Courtney 2:26
I'm Courtney, I'm a nurse anesthetist, which is an anesthesia provider. And I was diagnosed with type one diabetes about 15 years into my career. And I think there's a lot patients can learn to advocate for themselves. And I think as health care providers, especially in the perioperative period, there's a lot of finesse to be learned as well. So that's why I'm here.

Scott Benner 2:52
Cool. So 100% This episode is going to be called gas pastor just so you know. And

Courtney 3:00
love it. Yeah, it's gotta wear it proudly. My coworker actually has a hat that says I have gas. Yes,

Scott Benner 3:06
Pastor, by the way, a phrase I know from the TV show mash. I love that show me where I know that that phrase. How old were you when you're diagnosed with type 141

Courtney 3:17
or 2912? Tightens I like this

Scott Benner 3:22
nice track. How old are you now

Courtney 3:24
46

Scott Benner 3:26
years ago, any type one or other autoimmune issues in your family line.

Courtney 3:31
I personally have both that I had Graves disease and the antibodies for Hashimotos as well. So me and I have a cousin with graves but nobody else with type one or other autoimmune that we know. No celiac. No celiac. Here's a weird one for you. Bipolar disorder. No, not that we not that I know of nothing. Anybody claims

Scott Benner 3:55
out loud out here. You know, okay, great. That's what I want to know. So

Courtney 3:59
And guys, both my kids have done the trial net, which is great and currently negative. And then I just got my sister and all my nieces and nephews to test as well.

Scott Benner 4:07
So oh, you're a bit of anomaly about that. Okay, I know so safe to say you were shocked.

Courtney 4:14
Absolutely blown away. So I graduated nursing school. So for those who don't know, a nurse anesthetist has to be a registered nurse first and then you do ICU experience for a few years and then you can apply to go back and get your Masters now it's current when I went to school is a master's it's a doctorate now. I was an ICU nurse for three years and then a recovery room nurse for a year before I went back to school. And I remember sitting in lecture about our endocrine lecture thinking back in, you know, 99 2000 thinking I really don't ever want type one diabetes like that would be really a nightmare. And granted the improvement is shocking compared to how we used to treat type one but it's Yes, I had had knee surgery and got the flu and went into the ER and was shocked to spend a few days in the ICU with a type one diagnosis. No idea.

Scott Benner 5:13
Wow, knee surgery brought on by an injury or degradation of your knee. Yeah,

Courtney 5:18
just trying to avoid a knee replacement. I've been really hard on my knees in my lifetime. And at the time when I went to the ER, my agency was 9.8. So I'd probably been limping towards that diagnosis for at least several months, I'd had a fasting sugar. I got diagnosed in March and October as part of my annual with a fasting sugar of like, 105. So not great, but obviously I wasn't severely impaired at that time. But at diagnosis in full blown DKA my blood sugar was only 262. So I think it was the flu just made me so insulin resistant, and I wasn't really eating, because it was on crutches like I was

Scott Benner 5:57
asked your question before we get too far past that. Are you some sort of a like, comic genius? No. Did you hear yourself say I limped towards diagnosis? I did now. Yeah, I've been You mean after telling me about your knee? And then I was like, Oh my God, she's so deadpan when she's doing this. She's either a genius or doesn't know. She just said that. Oh, my gosh, I would have stopped to congratulate myself for making that joke. If I would have said it. I would have been like, Hey, did everyone hear that? I'm so good at this. My god. I'm so good at this. Did anyone hear? No, no? Wow. Okay. So that diagnosis, are you. You're married at that point? I imagine. What two kids two kids already? What's your remembrance of the diagnosis time in the hospital stay.

Courtney 6:46
I mean, the first night was a blur. I was. I mean, everybody in DKA sick I was, you know, I was right along with everybody extremely sick. Ended up in the ICU for five days, I got pneumonia. I had pneumonia flew a and I was in this locked knee brace. I was pretty pathetic, like on the unit like jumping around. I actually missed my son's sixth birthday party because it happened. The second day, I was in the ICU. And I was like, I can't imagine rescheduling this with everything that is on my plate. So just the grandparents came down and ran the birthday party. But it's all it was all a complete blur. Yeah. And I was at the hospital that I work at. So people were coming and going because they were worried and I really appreciated the visits. But I can't say that I remember who.

Scott Benner 7:38
You know, there was a diabetes educator here once who told me they were diagnosed as a child, and had a big birthday party planned for themselves. And the parents didn't have the heart to cancel it because of all the other kids so he was the only one that didn't go to the birthday party. He felt it's a nice memory for him. He's like, I thought it was nice to my parents not to ruin it for everybody else. True, but my response was your recording. I was like, Oh, that's cold. Yeah, but apparently not. He doesn't remember it that way. Anyway. Okay, so people were in to visit with you. You don't have a lot of memory of it. Do you think it's a blur? A blender blur of the flu and the diagnosis at the same time?

Courtney 8:18
Yeah, I mean, I'm sure I got you know, the typical insulin resistance and needed more, you know, I'm sure I have some degree of plateau. Right. So that's just a slower onset of type one. So I'm sure I had some pancreatic function that was keeping me out of DKA until I got the flu, and then it just couldn't

Scott Benner 8:36
the rest of the game. Yeah. Well, I'm glad your kids don't have markers. That's, that's terrific news.

Courtney 8:40
Yes. And my sister was super my sister is a PCR nurse. And she's amazing. And I was calling her from the ER being like, I'm getting sicker. And I don't know what's happening. And so she drove down in the middle of the night and was kind of instrumental in in helping us through that. Since she sees a lot of DKA

Scott Benner 8:57
how many nurses did your parents make? Just to just 200%

Courtney 9:01
of their children, but to

Scott Benner 9:05
say helvar ratio? All right, so So you come out of the hospital. And you know, you're now I'm we're gonna jump around a little differently than we usually do in these episodes. Because of your background, we're going to talk a lot about what you see, you know, as a gas passer. So you learn about type one I heard you say like in school, I was like, I don't want that for sure. It's not weird that you chose that to like, say, I don't want that of all the things you were learning about. Right now we're going to hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is Mark.

David 9:40
I use injections for about six months. And then my endocrinologist at a navy recommended a pump.

Scott Benner 9:46
How long had you been in the Navy? Eight years up to that point? I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

David 9:56
I was medically discharged. Yeah, six months after my diagnosis. Was it

Scott Benner 10:00
your goal to stay in the Navy for your whole life? Your career? It was, yeah,

David 10:03
yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we made the decision despite all the hardships and time away from home, that was what we loved the most.

Scott Benner 10:17
Was the Navy, like a lifetime goal of yours. lifetime

David 10:21
goal. I mean, as my earliest childhood memories were flying, being a fighter pilot,

Scott Benner 10:26
how did your diagnosis impact your lifelong dream?

David 10:29
It was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant. I was not

Scott Benner 10:37
prepared for that at all. What does your support system look like?

David 10:41
friends, your family caregivers, you know, for me to Medtronic, champions, community, you know, all those resources that are out there to help guide away but then help keep abreast on you know, the new things that are coming down the pike and to give you hope for eventually that we can find a cure, and you

Scott Benner 10:55
can hear more stories from Medtronic champions, and share your own story at Medtronic diabetes.com/juice box. You can manage diabetes confidently with the powerfully simple Dexcom G seven dexcom.com/juice. Box. The Dex Dexcom G seven is the CGM that my daughter is wearing. The G seven is a simple CGM system that delivers real time glucose numbers to your smartphone or smartwatch. The G seven is made for all types of diabetes, type one and type two, but also people experiencing gestational diabetes, the Dexcom G seven can help you spend more time and range which is proven to lower a one C, the more time you spend in range, the better and healthier you feel. And with the Dexcom clarity app, you can track your glucose trends. And the app will also provide you with a projected a one seen as little as two weeks. If you're looking for clarity around your diabetes, you're looking for Dexcom dexcom.com/juicebox. When you use my link, you're supporting the podcast dexcom.com/juicebox head over there now.

Courtney 12:07
Absolutely. I think about it a lot. Because sometimes I'll see like our ad on Craigslist, and I'm like, I don't want to do that. And it's the second it enters your mind. You're like, yep, that's going to be my case. So now in hindsight, I'm like, I should have never thought that I should have just embraced the knowledge,

Scott Benner 12:22
you should have just picked up the Daily News looked at the lottery winners and said, I don't want to be like that, I would have definitely I definitely would have been the way to go. If you were gonna Jinx yourself, I guess. But now you've got this different understanding right now you're five years into it? Um, well, let's figure out what your understanding is right now. Like, where's your agency?

Courtney 12:38
Since diagnosis, the highest agency I've had is 5.20.

Scott Benner 12:43
My goodness, are you eating low carb? Or are you just very good at diabetes? Yeah,

Courtney 12:46
I mean, I tend to eat lower carb when I'm at work, just because I have no time for Pre-Bolus. Like my break is when my break is. And so I tend to eat a little more low carb there just to try and maintain but no, we don't adhere to a low carb. Okay, I have just really tried to embrace what you teach on the podcast. And I actually have a friend who's, you know, likely going to get a diagnosis in the next few days. And he's started listening as well, I recommend that as I said, there's just so much they're not going to teach you in class, there's not time. But there's also just you have to teach to the very minimal, you know, the lowest, the person coming in with the least amount of knowledge, and you're starting with a much higher knowledge. So just embracing, trying to do better on your own.

Scott Benner 13:38
I didn't know this was going to be a story about how terrific I was or I would have gotten to it sooner. Yeah, no. How long? Have you been listening to the podcast?

Courtney 13:45
Somebody recommended it pretty quickly in to diagnosis, I would say within the first four months. And so I tend to focus more on the episodes of management versus storytelling, I guess. But I mean, nobody taught me about Pre-Bolus, or protein or any of those things in, in education, it was carb counting, and which is a great foundation, a great place to start.

Scott Benner 14:13
I'm thrilled I and listen, if you aren't the kind of person who likes to podcasts for the chatting, like I get that I support both sides of that coin with the other. I put all that like, I think great management content in there. Because everybody wants that, you know, on one level or another. But there are plenty of people who love the stories and they get a lot of community out of it and a lot of good feeling out of it. So I figure if we order, you know, offer a kind of a 5050 of that. You kind of make both sides of that coin happy. I love it. Yeah, so yeah, I'm thrilled about it. I mean, before we started recording, I mentioned something from another episode and you were like, Oh, I haven't heard that. But be honest. You wish you did, don't you?

Courtney 14:53
Oh, absolutely. I'm gonna go find it. Well, no, no,

Scott Benner 14:57
you're not allowed. You can only listen to the management stuff. I seriously didn't know that the podcast was valuable for you and had been. So that's fantastic. So Pro Tip series, that kind of stuff. real helpful. Yeah,

Courtney 15:08
exactly the bold beginnings. You know, the one episode that really rang true was just being that being diagnosed as an adult. And while there weren't tons of management tips that I went away with, I remember being like, it is my life was flipped, I felt seen. My life has been completely flipped upside down. And I remember just feeling part of it community and seen at that moment. Like, yeah, this is hard, and no one really understands it. Yeah,

Scott Benner 15:38
see, now I could call this episode Princess of Bel Air. I love gas pasture, though. It's gonna be hard to get away from it for me. Yeah, I'll take it. Yeah. So all this, this knowledge that you have about diabetes has informed your work. And that's why you're really here. I want to talk about that. So can you just kind of open up about that for me and fill me in?

Courtney 15:59
Sure, feel free to like, slow me down. If I get going too fast. I'm gonna touch quick, quickly back to like, when I talked about nursing school when I went to nursing school, which, you know, like I said, was late 90s. You know, the fast acting is the Nova log and humor log had just been patented, and they were not part of education at all, they weren't even rapidly adopted. So we were learning about mph and 7030 and regular insulin, and managing diabetes from a you take this insulin here, and you eat exactly four hours later, because that's the peak that we're talking about. Glargine was barely being adopted into practice. And so that's part of being like, Oh, you really had no freedom to eat, then because you were trying to match an insulin profile that had nowhere close to a carb uptake profile. So moving forward, a lot of people my age, which make up a huge chunk of medical providers, right, the the 40 crowd, you've graduated residency, or you've gotten your masters or you're a nurse at the bedside, but you haven't yet retired, or part of this group that went through education that didn't ever even learn about human laga Novolog as part of our basic education, let alone clergy. So now you come to today were upwards of 60, like so. And then 96, less than 1% of patients were using an insulin pump, we didn't I mean, we knew they existed, they were like the Zack Morris cell phone attached to your waistband, but people weren't using them, because what's the point and continuous infusion of regular insulin sub q. So now we fast forward to upwards of 60% of type one patients are using insulin pumps, and none of us ever learned about these devices, let alone that they only have rapid acting insulin. We don't We never talked about Basal Bolus insulin, because that wasn't really how insulin was given back. Back in the day, you had sort of insulin that you had to eat to protect the peak, so that you didn't bottom out. So when you come in with an insulin pump that someone's unfamiliar with their gut is sort of like I don't want to deal with that. What they're not recognizing is if you take an insulin pump from a tape, one patient, you have removed all basil or background insulin. And it's not the standard of care. But I think it's hard to re educate everyone on on the technology today. In one mass.

Scott Benner 18:36
I mean, I guess the basic problem is, is that people are where they were taught to these positions, like in med school got one level on one idea, then they moved out into the world, and the world changed, and nobody came along and told them. So they're just doing everything they do, right.

Courtney 18:53
And so specifically, like I don't want to like toot my own horn or my professions own horn. But if you think about any anesthesia provider in any sense, they have to be so knowledgeable on hundreds, if not 1000s of surgeries and what's going to happen during that time. They have to be knowledgeable on hundreds and 1000s of different medical problems and medical history and how anesthesia drugs affect them. And for instance, like the top drawer of my anesthesia machine has 25 different drugs just in it with that doesn't even talk about the you know machine that I can go get almost any drug I want out of in the hallway. So it's just the knowledge base is vast and trying to keep up on every knowledge. You know, every disease process is difficult. And then you talk about type one whose management has drastically changed in the last 30 years. Yeah, it's it's crazy. You

Scott Benner 19:52
have those drugs because there could be drug interactions that you have to counteract and that's what they're there for. Is that right?

Courtney 19:57
Yeah, so almost every anesthetic If drug is what's called a cardiac depressant, so your blood pressure drops, you're you may have those things that we have to have counteract or your heart rate may be fast, or it may be slow, or you may need pain medicine, or you may need pain medicines that not narcotic, or this particular surgical procedure, you know, causes less blood to come back to the heart. So we need to supplement that with a different type of IV fluid. It's, you know, it's just a complex thing. So then you have someone who for years came in with either this background of regular insulin or mph is their Basal, then we moved to Glar gene, which is beautiful for a MDI. Because it really does have almost 24 hours, so you didn't have to do anything, you were like, you took that check, okay, I don't need to give you insulin it's taken care of. And so now we have to come back to many hospital policies, say your insulin pump is not allowed in the O R. And while patients are advocating for themselves to take to their pump to the O R, it would be against policy. So then it becomes removed at some point in the beginning in the in the pre op area. But are we replacing that with? The big question is are we replacing your Basal insulin and we need to be that's the standard of care. So how do we do that in the perioperative period, there's really only two ways to do it. And that is to allow the insulin pump to run if it's within hospital policy, or you need to start an IV insulin infusion,

Scott Benner 21:30
why would they not want the pump to stay on? Well, a turns

Courtney 21:34
out anesthesia providers know nothing about an insulin pump. Like I could hand my insulin pump to my friend. And there's, it'd be difficult for them to figure out. Maybe not difficult, it would make them uncomfortable to try and Bolus from a pump. Also, during surgery, you tend to get steroids, there's a stress response, fasting in and of itself can make so the risk of hyperglycemia is actually higher during surgery than hypoglycemia. So to have to Bolus from that with a not be something in the wheelhouse of any anesthesia provider, they've probably never done it, it's not to say they can't learn I'm just the reality is it's unlikely that they've ever done that. And two, it's a very dynamic period, so your blood sugar could change rapidly up or down. More often than not, it's up. And when you Bolus from a pump, as we all know it takes time, right? So it's sort of behind and then you have a change in blood pressure and perfusion to your subdue tissue. If your blood pressure's low if you're cold if you're warm, so it's a lot less predictable to give sub q insulin in the perioperative period, versus IV insulin. If that makes sense. Though, we are starting to see studies come out with very good results for insulin pumps in especially like your smaller everyday run of the middle of surgeries versus your bigger surgeries that have high dose steroids or dramatic fluid shifts, the data doesn't exist. So adopting a pump to is like, I think it'll work fine. But there's very few controlled studies on insulin pumps, because we're not a very populous group of humans.

Scott Benner 23:19
So I get it, I understand how we get to where we are. What are people need to do to use them? Like what what can I do going into a surgery to say to someone look, this pump, I'll make sure that it's new, that it won't run out. But it's not so new that it's not working? I'll put it on 12 hours before the surgery, make sure it's nice and settled in and it's working? Well. I'll come in, show you where you can push the buttons if you have to shut it off. But in the end, I mean, it's just the insulin pump. Like if if it was really I mean, I don't know what they're concerned about. But if you weren't getting really low, they could just rip it off you. It's not like you don't I mean, it's not like not knowing how to push the buttons would stop you from stopping it if you needed to. It's just it's really, yeah, it couldn't it feels like there's a lot of not thinking that happens around stuff like this.

Courtney 24:05
Sometimes, and I you know, I feel strongly that we're missing an opportunity to embrace more insulin pump usage. And in fact, like the anesthesia Patient Safety Foundation, put out a piece a couple of years ago advocating for more use, and there's some interesting studies coming. There was a really fascinating one out of Switzerland that they put insulin pumps on a large group of type two patients that utilized insulin, and they had far better control with less hypoglycemia, shocking, they put it on in pre op and they were at their entire hospital stay so the data is starting to leak out. I guess my concern is, I think if an anesthesia provider feels good about the insulin pump, the surgical site is far from the insulin pump site. So if you're having an operation on your belly You really should probably have your insulin pump on your leg if you want to have any hope of it standing. Yeah,

Scott Benner 25:04
yeah, I mean, she's do people not think about stuff like that would

Courtney 25:08
be so surprised at the things sometimes you see. And I think that's the other reason you have somebody who comes in and rides their pump in a way that is probably, you know, they're a one sees still 11 And you're like, this really isn't doing a great job for you. And then you have someone like me and lots of your listeners who come in with super tight control and are very knowledgeable. But you don't know who you have in a 10 minute interaction, necessarily. I

Scott Benner 25:35
understand. Also, it wouldn't take that much more insulin to turn an 11 a one c into an eight, a one C and you still wouldn't be really tightly controlled, but it's you know, yeah. Well, that mean, listen, that goes to show, what it shines a light on is the vicious circle, there is just no reason in the world that a person should have an insulin pump, and an A one C of 11. That somebody's not understanding fundamentally how to use their insulin. And a doctor should be able to like step in and give them the information that they need. Yes, you know, it's not just it's not that hard. So then what it points to is either a person who doesn't understand or is unmotivated, or some, you know, somewhere in between that scale, having diabetes showing up in a hospital where another doctor looks and says, Oh, an 11 a one C, you don't even try, you don't even care. So then you kind of get written off at that point. You don't mean like, you shouldn't have to be you coming in going, I have a 5.2 I want to see and I really know what I'm doing. It's okay, if we take good care of me here. Yeah. You know, I'm saying like, take, why don't we take good care of everybody? Crazy thought, like, some people just aren't going to know, like, you've just explained why. You know, long time ago, there's not really that long ago, there weren't insulins that worked, as well as the ones to do today, the standard of care was much different. There are still people out in the space, who grew up with that. And there are people who are learning from those people. So that's why you can't get rid of it, if you would just think of a generation of doctors would just retire would be okay. But that's not so that's not the that's not going to work, you know, not completely. Yeah. So I don't know it's a it's hard to, it's hard to hear about. Yeah,

Courtney 27:10
I mean, I guess at the end of the day, I think if we want to provide safe care in the perioperative period, I want people to understand that Basal insulin is not an option. It is a requirement. And so for patients on MDI who took their long acting insulin, it's often simpler for us anesthesia people, Basal insulin requirements are met, right, we should be checking blood sugar every hour and treating hyperglycemia and hypoglycemia appropriately. If a patient comes in with an insulin pump, I think I have to say you need to work within your hospitals policy. My hospital allows patients to keep their insulin pumps for day surgeries. But those surgeries that are going to the ICU or bigger surgeries, they want their insulin pumps removed until the patient is awake and can restart them. And in those cases, our hospital dictates that you start an IV insulin infusion at the Basal rate that set in the pump. So we are meeting Basal insulin requirements. And then our life we have a glycemic team meets with the patient postoperatively. And some patients are NPO, or they're going to be on high dose steroids. And it's just easier to stay on an IV insulin infusion for a few days. And sometimes they move them right back to the pump and patient. Does

Scott Benner 28:27
the IV insulin give you like insane control.

Courtney 28:32
So the difference with IV insulin versus like a sub q, insulin is a is IV. So all IV insulin is regular insulin. So the same regular that people sometimes inject back in the day, but some of the low carb people, I think advocate for that still. But it is a completely different profile when you injected IV, so it's half life is seven minutes. So if you're running high, I can give you a Bolus of insulin and it is acting within seven to 15 minutes. And so then it's also completely gone. We say things about seven half lives, you can consider a drug kind of out of your system. So if you were hypoglycemic on an IV insulin infusion and I turned it off or cut it in half, it would be gone within an hour. So we're dealing with things that can we're dealing with a drug that can react or faster to the changing glycemic environment of surgery. So while I think we're missing opportunities to move forward with insulin pumps in multiple cases, I don't think every case can be done with an insulin pump. And I think we can safely use IV insulin. My big thing is we need to start IV insulin and so some patients unfortunately do get removed from their insulin pump and you hear horror stories. And then they gave me a Bolus of insulin through the IV because I got high Poor glycemic Well, no. Yeah, you had no basil. It'd be like a site going bad or whatever. And then they see your blood sugar at 200. So they give you a unit IV. Well, it works to drop you down to 180. But it's gone. Again, in less than, you know, it's affected this site, it was probably even less than that. So then they recheck and they're like, Oh, you're 200 again? And you're like, Well, yeah,

Scott Benner 30:25
I don't have any. And so my pancreas doesn't do anything. I mean, it does some stuff. It doesn't do insulin anymore. So

Courtney 30:31
the patient comes out, and it's like, what the hell? And I'm like, exactly. And so I've given a couple of lectures on this topic. And my girlfriend the other day was like, You should change it from type one diabetes in the perioperative period to its Basal baby. And like, that's just your mission. Does the patient have Basal insulin? Does the patient have Basal insulin? Like that should be what my hat says not gas passer. But does your patient have Basal insulin? But Courtney,

Scott Benner 30:57
is is the way you're talking about this right now, from a professional perspective? Is that only because you got type one diabetes five years ago? Like how would you have talked about this seven years ago?

Courtney 31:09
Totally different. So what there's about 5% of all patients with diabetes have type one. So I like to look at the flip side of that meaning 95% of patients with diabetes do not have type one. And so I think that's a common thing is people get diabetes, which I really want them to have two different names, but so that the confusion is less, but patients come in with type two, and we think about that different, right, they have insulin production, their risk of DKA and acidosis is far lower during the surgical period than somebody with type one. And I absolutely would like if an insulin pump came in, it gave me like a quiver in my gut. I'm like, I don't like I don't know what to do with that. And and every time it was like, Okay, I have to look it up. Do I keep it? What do I do? And so I think people, I really, really think many professionals don't realize that the insulin pump has only rapid acting insulin and that they're taking no Basal insulin. So that's where the mistake happens. I think I fell into that idea of like, oh, it's not regular insulin. Oh, that's weird. And then learning that, once I, I was just like, the second I was diagnosed, I'm like, I want to pump and I want to CGM. And they're like, well, your insurance is gonna make you wait for your pump, but you can get a CGM tomorrow. And I remember learning about my pump in the six months, I had to wait. And I was like, Oh, I like it's not. I get rid of clergy. I'm like, holy cow. Like, that was a moment for me. And it's sort of embarrassing to admit that I didn't even recognize that. And so I think that's a big part of why I'm here. Like, it's embarrassing. What I didn't know. And I also watch other people not know that, I

Scott Benner 33:01
think that it's the most disappointing thing I'm going to hear in the next four days. Honestly, just the idea that that a medical professional might not understand that basic idea about how an insulin pump functions. That's really like BS, you have to put yourself in a position of someone who's just going to the hospital to have their you know, I don't know, have their

Courtney 33:23
super Yeah, important conversation is that I do think that knowledge deficit exists. I'm unfortunately, and I think someone coming in to have surgery and has been told that their insulin pump needs to be removed, I want them to have the words to be like, That's my only Basal insulin. So what are you going to do to provide me Basal insulin while I'm in surgery? But don't

Scott Benner 33:49
you think that people have an X of reasonable expectation that that's not a thing they have to say? They should? Yeah, if you couldn't eat if you went to take your car to get four new tires on it? Do you think the last thing you should say to the guy at the counter when you hand them the keys is please tighten the lug nuts back up when you're done?

Courtney 34:07
I mean, yes, but I'm, I'm not. No, I

Scott Benner 34:11
know you're not. I'm not calling you. I'm just saying I'm just having a conversation with you. But like, I'm trying to put the conversation not you in the perspective of everyone else. Who has no reason in the world to expect that a medical professional wouldn't understand how an insulin pump work. You don't I mean, like I understand your description of why that's the case and I'm not even arguing with it. It makes complete sense to me I'm just saying that if you're just like I was gonna say Joe Blow do people say that anymore if you just the average guy on the street but his Joe Blow even mean we'll look into it later, Courtney, if you're just an average guy on the street, going in for a procedure a you're probably not thinking about it because you're probably worried about having your appendix out or something like that. But at the same time, like, I'm at the doctor building now, with all the doctor people in it. This is a medical thing. My device is a medical thing. They'll know like I don't even think it gets up Well, no, I don't think you even think about it. That's what I'm that's my point like, so I know people have to that's why it's important to talk about this. For people with diabetes, they need to go in there without acting like a lunatic or seeming strange and say, Hey, who do I talk to and explain this insulin pump? And then you know what happens when you say that somebody is going to want to reassure you? That's a famous thing in all professions. Oh, absolutely. Oh, no, we know what we're doing. Sure you do. I don't know. 10. Let me just say this. Now, I want to be clear. I don't know 10. People that know what they're doing. Okay. Like, forget about it. Forget about medicine in my life. I read I know, a few people who've got everything together. But I know way more people who would say, oh, no, don't worry, don't worry, don't worry, I got it. I got it. I got it. But what their brain is thinking is I don't know what I'm doing. So it's human nature. You don't I mean?

Courtney 35:52
No, I agree. But I also think I'm not. Yes, I think people come in and expect people to be knowledgeable, and I want them to be knowledgeable. And I believe that they should be how do we do that? Yes. I mean, I'm doing my best. I'm talking to you multiple times. And I, you know, I don't have a great answer.

Scott Benner 36:16
Is there not continuing education in the, in the facility? The like, all the, you know, do all the gas pastors not get together once a week for a 15 minute lecture on something? Or is there not an email that goes around and says, hey, don't forget, insulin pumps work like this? And then like, why is that not a thing? Would that be so simple? It

Courtney 36:37
is a thing? Oh, it is a thing? You told me that I work at a huge academic institution. Right. So we are very geared towards education. So I lecture at my own institution to our residents, once a year. So their first year, here's this, I give, I've given Grand Rounds, a full grand rounds where I just went through everything type one related including CGM and insulin pumps. And then I talked about insulin pumps, usually about for 15 minutes on what we call a CQ AI meeting, which is also Grand Rounds, but it we go through like, Hey, we're not doing this great. You need to do this every time. Here's our policy, this is what you need to be doing. So that exists in my institution. It does not exist throughout, you know, we have places that you know, are tiny, they're one anesthesia provider, and to try and stay up on every last detail in medicine is difficult, because anesthesia touches in every you know, high blood pressure stroke, blood clots, cancer, you know, and then the surgeries that go along with it. I'm not justifying not having the knowledge base but staying on top of every single change in medicine is is not I want

Scott Benner 37:56
to do an exercise with the coordinate Tell me Tell me again. What is your actual like job title?

Courtney 38:01
I must CRNA or a nurse anesthetist?

Scott Benner 38:04
Right? Spell anesthetists for me.

Courtney 38:08
My my Dexcom is going off. Did

Unknown Speaker 38:10
you hear it? Don't, sir.

Courtney 38:12
It's a n e t h i s t. Okay.

Scott Benner 38:20
Here's what I'm gonna do. Because I think the world's simpler than we make it. Okay, I'm gonna ask Chad GPT explain how an insulin pump works to an N S. Say that again. We How come it spelled like that? Why does nothing like me today, anesthetist? Or

Courtney 38:36
you could say anesthesiologist, it's all I have it. I have a different path to education, but we both provide the anesthesia.

Scott Benner 38:43
Let's do that. Because that I can spell include what they need to know about help about managing

Unknown Speaker 38:55
a person

Scott Benner 38:57
with type one diabetes, I've never done this before my wife. Okay. insulin pump is a medical device used to manage diabetes specifically type one diabetes, which is characterized by the body's inability to produce insulin. Insulin is a hormone almost second it is not stopping Insulin is a hormone that regulates blood sugar levels by allowing cells to absorb glucose for energy and type one diabetes the pancreas does not produce enough or any insulin requiring external insulin administration to maintain proper blood sugar levels. Here's how an insulin pump works and what an anesthesiologist should know about managing a person with type one diabetes, and the LIS function of the insulin pump continuous insulin delivery Bolus dosing adjustments during surgery and monitoring adjustments during surgery during surgery or any medical procedure requiring anesthesia. It is important for the anesthesiologist to communicate with the patient about their insulin pump. Depending on the duration and type of procedure adjustments may be may need to be made to the pump settings for instance, the Basal rate may need to be temporarily reduced or suspended prevent hypoglycemia, or low blood sugar. Okay, that's a browser window My computer coordinate, like, how come someone can't do that? And go, Oh, I'll be in charge of sending out the daily reminders to everybody. Like, I mean, did I just fix the whole world? You see no saying like, I love how everybody says, Oh, this is how it is, or here's how we got here, or it's so hard to fix. It's not that hard to fix. One focused person could fix this in every hospital. Do you really mean? Like, am I being pity? I don't know, if I am,

Courtney 40:28
you're not here today. What I'm gonna say is, I tend to be that person a little bit, you know, people

Scott Benner 40:35
know who you are, I have a document because we all got lucky and you got type one diabetes. But what I'm saying is,

Courtney 40:41
even as somebody who tirelessly advocates, I can't force someone to absorb that information.

Scott Benner 40:50
Let me say this to those people do your job there. Okay, you're getting paid. You know what I mean? Like, just do the thing you're doing, I don't know, it makes I get very upset very. So you're even keeled, which is lovely for the conversation. But this seems so basic to me. And the fact that it has to be rehashed over and over and over again. And that a person like yourself has to get type one diabetes, and take it upon themselves to educate other people in a professional setting. None of that makes any worldly sense. It feels like to me that people see problems and then go, oh, problems instead of going, Oh, that's a problem. Why don't we make an adjustment, so it doesn't happen again, like because this is not a new story. You can put a whiteboard up in a room and say to the anesthesiologists, which I can spell, you could say to them, there's a marker in there, every speed bump, we hit for a month, we're going to write it down. And then we're going to create a list of things that happen most frequently. And then we're gonna go ask Chad GPT, to explain it to us all, and then we're gonna put it out into an email, and it is part of your job to read the email. And that's that, like, I mean, honestly, this is 45 days worth of effort, fix everything. I don't know, that's the part that confuses me all the time. Why do smart people not do smart things?

Courtney 42:05
I mean, those things happen, right? Those happen all over the country that we talk about these things, but then how

Scott Benner 42:14
does it keep happening, then you're just saying it's a it's a failing of human beings?

Courtney 42:18
So if you think about, I mean, yes, it's a feel of human beings, right? We all forget things day in and day out. I mean, half the time I forget my anniversary, right? Which it's not that long. You know, like these are, that's part of my job as a wife, I'm not saying it's acceptable. I'm saying we're human. And our brains, I will tell you in healthcare are bombarded constantly with emails of how we can do better what we did wrong. And I would tell you that failing on an insulin pump would not show up on that whiteboard. Why? Because they're extremely rare, even though we deal in this community, where they seem like every day, things, the fact that that person makes it to surgery with their insulin pump is we, you know, so rare for you. Extremely rare. So maybe we see one insulin pump through my institution that staffs 50 plus operating rooms a day, and anesthetizing. Say maybe we see one, and we have 167 people providing anesthesia, or more, you may see an insulin pump on a patient once every two or three years. Yeah.

Scott Benner 43:33
Well, listen, coordinate between you and I. Some you motherfuckers wouldn't want to work for me. That's all I'm saying. I'd fire you. That's never been. It'd be no one left. I'd be like you're gone. Did you read the email? No. Goodbye. And lay good. I just didn't. Go ahead. How are you going to improve people? Can I say something about people? Yeah, I don't think they really want to work.

Courtney 43:57
Oh, I mean, right. Yeah. When Powerball I'm out.

Scott Benner 44:00
I think everybody wants to, like, get up around 11. You know, move into the day slowly, maybe hit their Bong, have a little lunch. And I mean, maybe watching Netflix, who knows? And then he's into the evening and you're on your way. Like, I get it like it sucks. It's, it's a lot. I don't mean to be flippant about. It's a lot of it's a lot to remember. You know, there's a scarcity of how many times it happens, which makes it I imagined even more difficult to remember. It still happens. It does. It feels to me like there's a hole in my backyard. I only walk in my hole in my backyard every few weeks. But somehow I fall in the goddamn hole every time I go out there. And no one goes, Hey, we should put a sign next to that hole or Let's get crazy and fill it in. That to me is what it feels like. I know it's not often I know it's kind of silly. I know it feels like a thing you should be able to remember and it doesn't need to be addressed. But I don't know how long we have to live and watch the same thing happen over and over again before someone says hey, you know what? Why'd this is a problem? Listen, I'll ask you. Let's take diabetes out of it for a second. Are there other topics specific to your profession that reoccur all the time that are an issue?

Courtney 45:11
Well, let me just clarify. I want to say that this does not happen every single time. But I do think it does happen. I hear about all the mistakes because people ask me how to fix them. I never hear Hey, everyone. Use your provider. Yeah, nailed it. I

Scott Benner 45:31
was the I was put under six months ago, it went perfectly I. But that's not. I mean, listen, that's not a thing we have to talk about. Like, we're all adults, we don't need to be celebrated for doing it. Right? I hope not. Right. But I take your point, we're not saying everybody is in this situation, it's not going to happen every time. It's not going to happen. Every institution. I'm not saying that either. But we're just drilling down on the problem. So Okay, Let's lighten this up for a second. Okay, we have like 10 minutes left, I have a real serious interest here. First, let me ask you, do you think we got through everything you wanted to talk about?

Courtney 46:03
I mean, I think if I had to say one thing to any health provider, like anesthesia provider listening, if they're listening, they already know this, but they have to have Basal. You know, I'm not going to tell you to go against your hospital policy and leave an insulin pump running. If that's not in your hospital policy, start an IV insulin infusion. There are plenty of journal articles that talk about and I'm happy to send you a link. Scott, if you want to put it in the notes to the one that I think is the most comprehensive, please do. Insulin pumps have not been well studied in the anesthesia literature, there are studies that say I think you can use them safely. There's not one study that says this is the end all be all, what the literature does say is you have to provide Basal insulin, it's about the Basal insulin. And I would encourage any patient going into surgery to a know their pump settings so that you can communicate clearly. And know that if your pump is being removed to advocate for Basal insulin, you may be falling on, you know, repeating what somebody already knows, but just say, you know, my understanding is if you remove my pump, I should be started on IV insulin at my Basal rate. Yeah. Is that your plan that I think oftentimes patients a don't think to have that conversation. But there's still something intimidating about medical providers. They're the knowledgeable ones, and we're not, but I think it is perfectly acceptable to advocate for yourself in any way, shape, or form, especially in a way that's open to conversation in the sense that you're not attacking someone just say, right, everything I've ever read is if you remove me from my insulin pump, I should be started on IV insulin before you remove it. So is that our plan? And I can give you a copy of this for you know, bring it in with you. Um, you know, just if you avoid one time where you have a hiccup,

Scott Benner 48:07
it's valuable, for sure. It's, yeah, and know what you're talking about. Don't just go in and say, Hey, fix this for me, you have to have some information about what is working well for you as well. You know, because the doctor is not good. I mean, in that situation, like somebody in coordinates position is not going to sit down and help you figure out that your Basal is too strong or too weak or something to that effect. Yeah,

Courtney 48:25
I mean, our recommendation if we remove the pump, we were starting to use a tool called endo tool, which is sort of like control IQ or Omni pi five, insulin decision algorithm that doesn't, it relies on the provider to input the data, and then into a computer program and it tells us at what rate to run insulin and how often to check the blood sugar to make adjustments where

Scott Benner 48:49
this stuff is headed, right, Courtney? Like eventually, you'll be a technician and a computer will decide what to do. Yeah,

Courtney 48:55
so it tells me it's best guess and then we are we're moving towards that an algorithm that helps learn the patient and make decisions based on the patient. Yeah, anybody being removed from an insulin pump should have Basal insulin in some form, and that in the perioperative period, the most recommended by far is IV insulin infusion at the patient's Basal rate in the pump. And so Omni pipe five, you're probably going to have to you know, it's not a set rate, right, so that we run into that problem, even people doing it right. They're like, I have to remove your pump for this reason, and the patient's like, I don't know what my basil is. So maybe take a little time on an algorithm and figure out what kind of your pump is running at basil wise you're gonna have to do some calculations or dig a little bit deeper but that will really help your anesthesia provider as well to be like, you're removing that this is where I would start. And then sometimes we recommend like an exercise mode if you are keeping your pump especially for a short surgery because we as anesthesia, people are death li definitely definitely afraid of hypoglycemia. It's rare during surgery,

Scott Benner 50:04
is it a bigger problem because I'm unconscious already.

Courtney 50:07
It's not a bigger problem. It is not more common but it unrecognized hypoglycemia. So you would say I feel like and we would do something we check your blood sugar but no one's there to say I feel like so it relies on an anesthesia provider checking your blood sugar at a regular rate at very minimum is once an hour, literally with a finger stick. Yes, yeah. So

Scott Benner 50:33
what we really want is people to wear a CGM during a surgery that would be really valuable. So

Courtney 50:38
CGM are not validated in the hospital, any patient of mine that so they got an FDA approval during COVID. And emergency FDA approval, which was really fascinating some of the literature that came out of that like how they were used, and I think there's going to be a data spill that probably comes out. By hospitals policy on CGM is the patient may wear their CGM, and I may use it as a trending device. But at minimum, I have to use a finger stick machine in surgery at least once an hour.

Scott Benner 51:08
Yeah, that's fair enough. Plus, you really want to charge them the 50 bucks for the test strip. So

Courtney 51:13
true, true story. So in other the data is signal loss is common on CGM. And if they're not in the surgical field, you should ground away from them. They've never again been well studied in the operating room. So the Bovie pad in the grounding is always a question mark. Because you're putting metal you have metal in the patient's skin. And you know, it's coated in plastic, but sitting on top for the Dexcom. But I think you could advocate to leave it on even if your anesthesia provider chooses not to use it. I never make somebody remove it because they're expensive. And I know that and I've tried to educate people on that, but advocate for

Scott Benner 51:48
yourself. I have a story about what I did for art. And once that I'm not going to add here because I think it'll take away from people believing in me in this conversation. But I, I remotely managed artisans on during an exploratory surgery once so, and they didn't know I was doing that. But you know, Wi Fi, it's all magical. Now, here's my question, right? Because how I want to finish up because I really appreciate you doing this. First, I want to thank you very much for lending your expertise and your knowledge in this blend of you having type one with your years and years of service. As an anesthesiologist that's really valuable. And thank you I'm actually going to make this episode part of my grand rounds series. So now I can't collect maybe I'll just call it grand rounds. gasp passer. Probably gonna say anesthesiology. You know, normal. But But here's my question. I've been out a number of times, right? I had had a colonoscopy, they'd make you sleepy for that. Had my knee scoped and cleaned out. I've had enough surgery and my toe. They give me what they call the Jackson juice. That's propofol, right? Is that what that is? Yep. I want to understand the mechanics of that. And I'm going to start by asking if you get a bed. Bed is not the right word. But if you get an anesthesiologist that doesn't know it burns like a mother, you're going in. And it's the last thing you remember before you're gone is Why does my arm burn? Oh my God, my chest burns, then you wake up and it's over. But I had another anesthesiologist I told him I said hey, the last time I got this it burned really bad. My chest and he goes, Oh, don't worry, I can fix that. And then I think he tourniquets my arm and hold it there for like, tell me all about that. Like first of all, how do you get it in without a burning? Okay,

Courtney 53:26
so there's no guarantee, but propofol is very alkaline and so then it causes a pH change and it makes your vein really angry and it burns like mother. Like you said, it really does. So most anesthesia providers, especially for a general anaesthetic, so in the operating room, numb up your vein with lidocaine, IV lidocaine, so numbing medicine. Oh, that

Scott Benner 53:48
was all he did, okay. And then but he holds it there for a minute, right? That's how he he like the Lidocaine goes into the tourniquet my arm, I'm trying to remember what happened. So we

Courtney 53:58
we say there's a lot of science and a lot of art and anesthesia. And so that is one of the art things some people believe if you put a tourniquet and put lidocaine in there, it has a chance to numb longer because that blood is not moving away from the site. Other people just believe the act of giving lidocaine before and kind of with the propofol is enough. I gotta tell you sometimes, despite everything we do, well, I always tell people it's spicy. I'm sorry, I'm doing my best to make it not. Yeah. But that is completely normal. And it's going to be gone when you wake up. Yeah. So

Scott Benner 54:34
then okay, so that well, first of all, I want people to know that in case they ever kept can ask for it. But my book, the rest of my question is, what is the mechanics of it? Like how is it shutting me off like that because it happens. In US, it's less than 10 seconds.

Courtney 54:49
Light works on a GABA receptor in your brain, which is a receptor that can cause this sort of sedation and then it hyper debating it makes you go to sleep. But don't ask me how anesthesia gas works because we don't we don't really know we have theories, but we've never, we don't. And so that's usually you go to sleep with propofol and mostly anesthetics, your cap asleep with anesthesia gas once the propofol works, propofol just worked so fast, that that's how we call what we call the induction of anesthesia. So

Scott Benner 55:21
you put me out with the pro ball, then you keep me out with something else, typically, then you back it off, and I wake up, but this is why I asked the question because I know this and I was well, I just wanted you to I wanted to I wanted to know if I was right or not from what I had heard, but medicine doesn't actually know why it works, right? We

Courtney 55:39
have a much better idea on propofol but the anesthesia gas we do not know that fantastic.

Scott Benner 55:44
Like we can shut people off and turn them back on. And we don't really know how it's exactly happening. That's

Courtney 55:52
insane dose. We know what's appropriate. But yeah, we don't think

Scott Benner 55:56
crazy gortney is it's crazy. It's like mad. It's like, I

Courtney 56:01
love love, love my job. Yeah, it is the coolest job. I get to practice medicine edit, like cellular level, like I'm giving this drug that I know which receptor it works on. And I know what should happen when I give that. But bio bio hacking to some degree history in front of me too. And humans are medicine is you can do everything right and things go wrong, and you can do everything wrong. And things go right. I have a really cool job, but it is definitely stressful at times.

Scott Benner 56:30
Hey, have you ever? Um, so if this is something you'd want to talk about or not, but have you ever put somebody out that didn't come back

Courtney 56:37
and work at a trauma center? So yeah, that does happen. Yeah. No. I mean, it is extremely, extremely rare for somebody to die on the operating room table. You have some of the most experienced emergency managers in the hospital there. And we have a lot of drugs on hand. It's extremely rare to die in the operating room. But it happens.

Scott Benner 56:57
I tried to remind myself the last time I just had my toe fix, right. And before I went under I said to myself, like when you wake up blurt out, not today, Jesus, right. But I didn't remember to

Courtney 57:10
like on the way home and you're like crap I forgot

Scott Benner 57:12
to do because it's a room wins again. There's a room full of nurses there. And they're all sitting around charting and everything. And I was like, How great would it be if I just burst awake? And I was like not today Jesus. But I you know, you're very out of it when you first start waking up. So but yeah, also fascinating how quickly you're not out of it afterwards.

Courtney 57:33
I love it. I love it when it's a sign of a good anaesthetic when I'm wheeling into the recovery room and the patient's like, Wait, we're done. Yeah. It happened. And I'm like, yeah, they're like, but I'm awake.

Scott Benner 57:45
to It really is I wake up very relaxed afterwards, like, Oh, my God, but rest of my day is gonna be fantastic. Anyway, I see what happened to Michael Jackson, I honestly see how we could get hooked on and if you had trouble sleeping and had access to a shady doctor, like I get it. You don't I mean, like, Jesus, I really appreciate you talking about this. I appreciate you going over that with I am. Like, I'm not much of a geek about stuff like this, usually. But this one really is fascinating. Like we are shutting people off in a medical situation that we do not actually know why it's working. Like that's fascinating. You know,

Courtney 58:18
it's sort of Yeah, it's like one of those things that like, probably wouldn't get FDA cleared today. They'd be like, figure it out, but it's been around and use safely for so long that you're like, all right. Yeah,

Scott Benner 58:30
they say peanut butter is one of those things. You know that? No, I don't think peanut butter could get through the FDA today.

Courtney 58:39
I mean, that would be a sad day.

Scott Benner 58:41
I don't want to freak anybody out. But don't google why

Courtney 58:46
we actually like in our break room just we have peanut butter for like it when you're just running behind and you need a quick snack and I eat a lot of peanut butter. But they switched over to the natural little cups and I was where's the sugar? Really? It's the oils on top and I'm like I'm trying to eat quick. My cracker doesn't dip

Scott Benner 59:07
its own natural. Great, great, why don't we try to help I tried to live so I'm 100 right Courtney the peanut butter can be a little sweet but the hell

Courtney 59:17
are mixed like at least anyways landed

Scott Benner 59:20
so that oils not floating on top of it because you know you look at it like this is like sucking on a peanut for a whole day and just squeezing it my teeth slowly.

Courtney 59:28
I know I'm sure my patients appreciate the oil spill down the front of my scrubs when I go

Scott Benner 59:32
professional. Everything's gonna be fine. Anyway, good luck to all of you. We're all we're all live by a wing and a prayer. Just all things being held together by spit and duct tape. Good luck. The seriously this was really wonderful. I appreciate your time and you and your good natured about it and I got upset in the middle and you you stay deep.

Courtney 59:51
I mean, I I want everyone to be experts at everything. But if at the end of the day, if you're not an expert Just know a type one patient needs basil if they you take their insulin pump off, and I think, you know, it's it's pretty rare that that things go wrong. But I think that understanding is really an important, important piece. I could nerd out all day on it.

Scott Benner 1:00:15
I agree. Yeah. And currently Listen, I'm not a I'm not a Pollyanna person, like, I've been making this cold wind series, which is healthcare providers are coming on anonymously and talking about their jobs. And now I'm getting notes all the time from people like, Were you just shocked when they said that? I'm like, No, wait.

Courtney 1:00:30
You're like, wait, I started it on for a reason. Yeah, I

Scott Benner 1:00:33
started because I knew what they were gonna say. Like, I'm just giving them a platform to say that I'm like, You're shocked that this is how the world works. I'm like, oh, that's fascinating, then I'm not shocked. Yeah. So I will

Courtney 1:00:44
say, the vast majority of people in medicine want to do right. And if they don't do right by you, it is not intentional, I believe not saying it's not their mistake to own. It's just, I think, unless you're really like in it, like the the amount that you get bombarded and like the burnout rate is high. Yeah. But we do need to own our mistakes and own our knowledge deficits. But I do think and I do think there are people out there making the same mistake over and over, but the need to learn, but the vast majority of people really are here for the right reason why

Scott Benner 1:01:21
Yeah. Oh, Courtney, I believe wholeheartedly in what you just said, and that people's good intentions and their desires and everything like that. And when I even when I say like limitations of human beings, I don't mean that pejoratively. I just it's a limitation. Like we just can't keep it all straight, where we are thinking about going home and watching Netflix, like we are like worried about a fight we had with our girlfriend, people are still people. I'm just saying if you're Yeah, what happens is that when you come in from the other angle, when you're the patient, you get lulled into this sense that like it's all going to be fine. Because the Magic Man in the white coats there, it's going to be alright, this lady went to school like I mean, she got a master's degree for this. You said, right. And now it's

Courtney 1:02:02
a seizure. Yeah. And now it's a master's degree in anesthesia. Right. I'm not an endocrinologist. And so oftentimes, a type one patient that comes in to me, obviously, I'm worried about their type one and in a certain way, but we've heard about the side effects of type one, right? So often people who had poor management at some point in their life have kidney disease, or they have coronary artery disease are perfect. Oftentimes, your hypertension or your kidney disease is more concerning to me than your type one. And because that will affect my anaesthetic in that moment, right? Or more than your type one, even if I'm not treating your type one. Yeah,

Scott Benner 1:02:39
see, now my perspective, though, Courtney is because I get to have all these conversations and see all these things come full circle is back to the vicious circle I brought up before, like someone's got to step up and put a stop to this, like the idea that people with type one are going to have these problems. Not everybody but more of them than we hope. And that begins at diagnosis. That's where my grand rounds series comes from. It begins with diagnosis and having a learned person explaining this to you from step one. And so that you don't end up a person in an ER 30 years from now that you look at and go I'm more worried about her hypertension than I am about her diabetes. You know what I mean? Absolutely,

Courtney 1:03:16
yeah. Thanks. I mean, we have the tools now that we shouldn't we shouldn't be a living with a one season the nines. Like

Scott Benner 1:03:27
we're gonna agree with each other. You and I are this is a society of people who are like, probably wish medicine

Courtney 1:03:32
paid for, like, you know, every few months, like go home with the basics of carb counting, and then you have another, you know, education appointment, like how are we going to do better? Where do you feel like you're lacking? I noticed this, but our healthcare system is not designed for that. Yeah. Which is where you come in? Apparently,

Scott Benner 1:03:51
it's why. Hey, listen, here's the truth of it. All you shoddy doctors. You set me up with a nice life here. You know what I mean? Like I got this podcast that helps a lot of people pays my bills. I should thank you for being so bad away. I'm just joking. Am I joking, Courtney? A little bit. All right. I'm gonna go Hold on one second.

The conversation you just heard was sponsored by Dexcom. And the Dexcom G seven. Learn more and get started today at dexcom.com/juicebox touched by type one sponsored this episode of The Juicebox Podcast. Check them out at touched by type one.org on Instagram and Facebook, give them a follow, go check out what they're doing. They are helping people with type one diabetes in ways you just can't imagine. Mark is an incredible example of what so many experience living with diabetes is 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. I was looking for a way that we could all get nice and tanned and meet each other and spend some time talking about diabetes. How are we going to do that? On a juice cruise? Juice cruise 2025 departs Galveston, Texas on Monday, June 23 2025. It's a five night trip through the Western Caribbean visiting of course Galveston, Costa Maya and Cozumel. I'm going to be there. Eric is going to be there. And we're working on some other special guests. Now, why do we need to be there? Because during the days at sea, we're going to be holding conferences. You can get involved in these talks around type one diabetes, and they're going to be Q and A's. Plenty of time for everyone to get to talk, ask their questions and get their questions answered. So if you're looking for a nice adult or family vacation, you want to meet your favorite podcast host. But you can't figure out where Jason Bateman lives. So you'll settle for me. If you want to talk about diabetes, or you know what, maybe you want to meet some people living with type one, or just get a tan with a bunch of cool people. You can do that on juice cruise 2025 spaces limited. Head now to juicebox podcast.com and click on that banner, you can find out all about the different cabins that are available to you. and register today. Links the shownotes links at juicebox podcast.com. I hope to see you on board. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're not already subscribed, or following the podcast in your favorite audio app, like Spotify or Apple podcasts, please do that. Now. Seriously, just to hit follow or subscribe will really help the show. If you go a little further and Apple podcasts and set it up so that it downloads all new episodes. I'll be your best friend. And if you leave a five star review, oh, I'll probably send you a Christmas card. Would you like a Christmas card? Hey, what's up everybody? If you've noticed that the podcast sounds better, and you're thinking like how does that happen? What you're hearing is Rob at wrong way recording doing his magic to these files. So if you want him to do his magic to you, wrong way recording.com You got a podcast you want somebody to edit it. You want Rob

#1258 Weekly News 7/15/24

Weekly News 7/8/24

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 1258 of the Juicebox Podcast

Welcome back, everybody. This is all the diabetes news that I found interesting for this week. I hope you enjoy it. 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. I was looking for a way that we could all get nice and tan and meet each other and spend some time talking about diabetes. How are we going to do that? On a juice cruise? Juice cruise 2025 departs Galveston, Texas on Monday, June 23 2025. It's a five night trip through the Western Caribbean visiting of course Galveston, Costa Maya and Cozumel. I'm going to be there. Eric is going to be there. And we're working on some other special guests. Now, why do we need to be there? Because during the days at sea, we're going to be holding conferences. You can get involved in these talks around type one diabetes, and there are going to be Q and A's plenty of time for everyone to get to talk, ask their questions and get their questions answered. So if you're looking for a nice adult or family vacation, you want to meet your favorite podcast host but you can't figure out where Jason Bateman lives. So you'll settle for me. If you want to talk about diabetes, or you know what, maybe you want to meet some people living with type one, or just get a tan with a bunch of cool people. You can do that on juice cruise 2025 spaces limited. Head now to juicebox podcast.com and click on that banner. You can find out all about the different cabins that are available to you. and register today. Links the shownotes links at juicebox podcast.com. I hope to see you on board. sup everybody, it's July 19 It's time for the weekly news. I wish we have weekly news music, like old 50s music was I beat ePdP names like hey, there's gonna be news now like something like that. Anyway. I got for you. That wasn't fun at all. Okay, let's start with some mouse news, shall we? They're helping mice with diabetes again and that great. This is kind of interesting. Let's see. What do I got here? Well, I want to go back to what I wrote. Oh, here it is. Now this is from news atlas.com. Scientists Oh, scientists have developed a new drug therapy this significantly boosts insulin producing beta cells offering potential for reversing diabetes. Here's some key points from the article. Keep in mind this is work they're doing on mice. This involves harming inhibiting the D yr k one a enzyme and beta cells end a GLP one receptor agonist like ozempic in diabetes in diabetic mice, it says human beta cells increased by 700% Within three months reversing diabetes symptoms. Let's see future research. Combine beta cell regenerating drugs with immune system modulators to prevent immune attacks on new beta cells interesting. Harmon alone has undergone phase one clinical trials with more trials planned. I'm going to find out more about that a section a section in a second. The procedure involves a combination of two drugs hormone which inhibits the enzyme dy RK one a in beta cells and the GLP. One hormone stimulates the proliferation of beta cells while the GLP one receptor enhances this effect and supports beta cell functioning studies with diabetic mice. This combination lead was 700% increase in human beta cells within three months. Wow, that's pretty great. It says here our mind has undergone a phase one clinical trial. Tell me more about that. Tell me more. Tell me more Tell me more. phase one trial assesses the safety and dosage of the drug in small groups healthy volunteers or patients. Trials involve close monitoring to observe any adverse events, effects, excuse me and to establish a safe dose to drain for harm I and Phase One trials likely focused on its safety profile to determining how well it is tolerated in humans, and identifying any potential side effects. how our mind works by inhibiting the dy RK one a enzyme and beta cells we know that. Okay, current status and next steps. After successful phase one trials the next steps would involve phase two and three of course, that's how counting works. These phases will test the drug efficacy in larger groups. patient's further valuing its safety and impairment well, so there's like two more rounds of safety. And then then you're looking for regulatory approval if these trials demonstrate that hormone is safe and effective, that drug could eventually be submitted for regulatory approval, and if approved, become available for clinical use, which is how that works. Anyway, I thought that was interesting that they're mixing one thing with the GLP. That was kind of cool. Two bits of news from Novo Nordisk one good one not so good. Let's start with not so good. Novo Nordisk is working to address FDA requests regarding the approval of their once weekly Basal insulin insulin I codec. The FDA has delayed approval pending further information on the manufacturing process and the type one diabetes indication. Novo Nordisk is actively working to meet these requirements, but does not expect to complete them within 2024. But here's the good news side. This is very interesting. Novo Nordisk recently received FDA approval for an additional indication of their drug we go V at the 2.4 milligrams semaglutide. The new approval allows we go V to be used to reduce the risk of major adverse cardio vascular events mace such as cardiovascular death, nonfatal heart attack, and non fatal stroke in adults and established cardiovascular disease and either obesity or overweight. So there you go, kids. There's another way to get your we go V. Break that. We go V story down. A little more need details. Let's see what our overlords say about that and show me

there was a trial randomized, double blind placebo controlled trial participants 17,604 adults aged 45 years and older with a BMI greater than 27. The duration of this trial was over five years across 41 countries. The objective was to demonstrate the superiority of semaglutide 2.4 milligrams versus placebo in reducing mace, which includes cardiovascular death, nonfatal heart attack and non fatal stroke results significantly reducing may supporting the use of weego V for cardiovascular risk reduction. Hey, well, it's nice. We go V indications for this mace thing now and of course for chronic weight management for adults with obesity BMI greater than 30 or overweight greater than 27, with at least one weight related comorbidity condition and for pediatric patients ages 12 or older with obesity. All right, then that's another way to get you some wheat go V. Hopefully you don't have any of those problems. I wouldn't wish them on you. But anyway, new news. You don't I mean stuff that's new in the world. Now you know about it. Last thing for today, there is a significant legal battle is unfolding against Pharmacy Benefits managers, which are colloquially known as P VMs. Over their business practices and pricing schemes that allege inflate that allegedly inflate drug costs and negatively impact patients and pharmacies. multiple lawsuits have been filed aiming to address these issues and seek restitution. Keep in mind, I just said to Chet GPT tell me about the PBM lawsuits says here class action lawsuit has been filed by ncpa member Matt Astron house against CVS Health Care mark, and Aetna. The suit challenges the legality of direct and indirect remuneration, fees and other practices under federal antitrust laws and state contract laws. The lawsuit also contest the fairness of CVS is arbitration agreements. I feel like I said that word wrong. It should be remuneration. Okay, what she said, let's see the Oklahoma Attorney General getting her getting her what a name Drummond has filed a lawsuit against several major insulin manufacturers and PBMs alleging an unfair and deceptive pricing scheme. The lawsuit claims that despite the reduced production cost of insulin prices had been raised exorbitantly, causing significant financial strain on patients. This lawsuit seeks restitution and aims to bring transparency and fairness to insulin pricing the lawsuit. Both of them underscore the ongoing struggle between independent pharmacies and PBMs over practices like dir fees, which are often seen as unfair and harmful smaller pharmacies. These legal actions aimed to highlight and rectify these practices potentially leading to significant changes in how PBMs operate and improve conditions for both pharmacies and patients. Ah, well that would be nice if things got better for us. I'm going to end today shining a light on Australia. You say Australia, Scott, why? Well, they're doing something cool down there. So July 14 through the 20th is National diabetes week in Australia. And the theme is unite in the fight for tech, expanding subsidized access to continuous glucose monitoring, and ensuring equitable access to diabetes technology across the Australia. Good luck, everybody. I love that you're down there fighting that fight. There's some awareness campaigns highlighting disparities and access to diabetes technology and advocating for changes, launching events and discussions featuring health leaders and political figures to raise public awareness and support for policy change. Australia and diabetes society seems like they might be involved. Looks like diabetes Australia, along with Australian diabetes Educators Association, and the Australian diabetes society will engage in advocacy efforts aimed at implementing recommendations from the parliamentary inquiry into diabetes. This includes increased access to diabetes technology and support for credential diabetes educators Good. Good for you guys. Good. If those spiders don't kill you, I hope this works out. Tickets for the 2025 Juice crews are limited. I'm not just saying that they actually are limited. We have a certain window to sell them in. And then that's it. juicebox podcast.com Scroll down to the juice cruise banner, click on it. Find a cabin that works for you and register right now. You are absolutely limited by time on this one. I'm so sorry to say that it sounds pushy, but it's the absolute truth. Juice cruise 2025 I hope to see you there. We're gonna get a tan talk about diabetes and meet a ton of great people who are living with diabetes. It's kind of going to be like floating diabetes camp. But you won't have to sleep in a log cabin. You'll get a tan. And it's not just for adults or kids. It's for everybody. Hey, kids, listen up. You've made it to the end of the podcast. You must have enjoyed it. You know what else you might enjoy? The private Facebook group for the Juicebox Podcast. I know you're thinking Facebook's got please but no beautiful group, wonderful people a fantastic community Juicebox Podcast type one diabetes on Facebook. Of course, if you have type two, are you touched by diabetes in any way? You're absolutely welcome. It's a private group. So you'll have to answer a couple of questions before you come in. We'll make sure you're not a bot or an evildoer. Then you're on your way. You'll be part of the family. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're newly diagnosed, check out the bold beginnings series. Find it at juicebox podcast.com up in the menu in the The featured tab of the private Facebook group or go into the audio app you're listening in right now and search for Juicebox Podcast bold beginnings juice boxes one word Juicebox Podcast bold beginnings this series is perfect for newly diagnosed people