#1408 Yeah, Yeah, Yeah

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Ashley's son wa diagnosed a year ago. He uses an iLet pump. 

• Diagnosed unexpectedly at a well visit, now using the iLet pump without doctor guidance.

• Managing puberty, sports, and challenges with consistent bolusing.

• Support from unexpected places has made a big impact.

+ Click for EPISODE TRANSCRIPT

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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
Ashley's son was diagnosed about a year ago. He's 12 years old. We're going to talk a little bit about their diagnosis, and a lot of talk actually about their new eyelet pump, which was given to them with no help from the doctor. Surprise

me, music, Hello friends, and welcome back to the Juicebox Podcast. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout. That's Juicebox at checkout to save 40% at cozy earth.com and if you're a US resident who has type one, or is the caregiver of someone with type one, visit T, 1d exchange.org/juice box right now and complete that survey. It will take you 10 minutes to complete the survey, and that effort alone will help to move type one diabetes research forward. It will cost you nothing to help the diabetes variables. Series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about, travel and exercise to hydration and even trampolines. Juicebox podcast.com, go up in the menu and click on diabetes variables if you're looking for community around type one diabetes. Check out the Juicebox Podcast. Private Facebook group. Juicebox Podcast, type one diabetes. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate, and waiting for you at contour next.com/juice box. I'm having an on body vibe alert. This episode of the juice box podcast is sponsored by ever since 365 the only one year where CGM, that's one insertion and one CGM a year, one CGM one year, not every 10 or 14 days Ever since cgm.com/juicebox.

Ashley 2:18
Okay, hello world. I'm Ashley, and I'm here talking about my son who got diagnosed a year ago. Okay, unexpectedly, very unexpectedly. So I'm here to talk about that with you. Scott master Jedi,

Scott Benner 2:33
unlike Oh, I didn't know you're gonna say something nice about me. I wouldn't have talked over you. I'm so nice, so so nice. Yeah, I mean, I do you think most people are like, get diagnosed with things? They're like, I knew this was coming. I've got lambago. Like, or, you know what I mean, what is lambago?

Speaker 1 2:47
Well, I didn't know what lambago I I knew as much as what you just said, as I knew what type one diabetes was when he got diagnosed. Let's just go with

Scott Benner 2:57
that. Yeah, you just didn't have any knowledge of it. It wasn't in your life. It was not

Speaker 1 3:01
in my life. It was not in my family history. It type two was in my husband's family history. His grandfather had it so he had the sugars, as some would say, but he was in his 80s, and didn't really take that great of care, but at the same time, he did the best he could. But yeah, I didn't, I didn't really even know the difference between type one and type two. We went in for a well visit for Trevor. It's my son's name, and we had no idea, virtually no symptoms, besides being a angsty tween. Gotcha

Scott Benner 3:38
Wait, listen, let's go backwards for a second. First of all, lumbago is a general term used to describe pain in the lower back it can be caused by various factors such as muscle strain, etc. Anyway, it's lower back pain. There you go. There you go. Okay, that makes sense. It's got to be something I've heard like on an old TV show, because that seems like a word from like, like, hold on, when in time? Would this word be used frequently? Okay, it's got to be, like a, like an old timey word on a second. Also you said you're nervous. So I'm going to try to, like, figure it out the late 19th and early 20th century. Well, guess what? I don't know what that means, because I grew up in American my schooling was terrible. Well, wait a minute, when did the 20th century start? I just realized that nobody knows 1901

Speaker 1 4:28
really, I don't know. I think it was on Jeopardy some point,

Scott Benner 4:31
1901 god damn Ashley, get out of here.

Unknown Speaker 4:35
You know, well

Scott Benner 4:36
done. All right. Now people are like, Oh, wait, he doesn't know general knowledge. I'm making my meal bonuses off of something. He said, Okay, so you're not expecting it. You go in for a well visit. You said he was being a little cranky. How old was he then I'm sorry he

Speaker 1 4:54
was oh, let's see. Well, he his birthday wasn't. Year

Scott Benner 5:00
ago, how old was he now he's 12. So was he like, 11?

Speaker 1 5:04
Yeah, he was 11. We had the well, visit a little later than his birthday. So yes, he was 11. I

Scott Benner 5:10
want people listening to know before we go any farther, Ashley, that you and I have had a brisk half an hour to get to know each other while you're figuring out how headphones work. And so this isn't just me, like, jumping in and being snarky with a person who I met six seconds ago, like you and I, yeah, you and I are basically, like dating now. You know, we've been through like, a number, honestly, that's true. She did. She heated up, took off a layer of clothing, and I thought this is going great, actually. But what I said was, turn your camera off. I don't need to see this, although now I feel weird, Ashley, anyone would be lucky to see you take your shirt off. Okay,

Speaker 1 5:48
so I do, I do have multiple layers on. I just want to be clear. Yes, in

Scott Benner 5:52
fairness, she wasn't down to an undergarment. No, but, but nevertheless, why are you nervous? Do you think

Speaker 1 5:57
I just want to make sure that I'm emulating the right message, and I'm not going to say something that's going to offend or upset my spouse or my son. Should he care to listen to this? Because, you know, the internet's forever,

Scott Benner 6:14
right? I mean, I hope so for me. I mean, I put Can you imagine, like, if who painted the Mona Lisa? What was that guy? He's an Italian guy, right? Uh, fairly certain. Yeah. Okay. Anyway, if somebody paints the Mona Lisa and they put it online, it would have disappeared eventually, because people would be like, Oh, that's not a hot new thing anymore. I don't look at that anymore, thank God. Like, so I need the Internet to stay forever, or this will all just disappear one

Speaker 1 6:40
day. Do you really not know who painted the Mona Lisa. I just need to. I

Scott Benner 6:44
can't think of it off the top. It's playing art at Da Vinci. Da Vinci. It's very early in the morning. For me, I want to I am two for two. First of all, your general knowledge is rock solid. Well, I did go

Speaker 1 6:55
to school for art. Oh, wait, you did. Yeah, I have a sculpture degree.

Scott Benner 7:00
Oh, tell me about how handy that's come in paying the electric bill over the years. Well,

Speaker 1 7:04
you know, my husband's in healthcare, and I am the complete opposite, so, but I do dabble. I I am a floral designer. So, yeah, I I see now I am very handy with my hands.

Scott Benner 7:22
Is that why wait? I'm sorry. We haven't believe that. Okay, yeah, you're like, Oh, my son might listen to this. So are you saying being a sculpture, a sculpting major, yeah, got you a doctor? Is that what you're saying?

Speaker 1 7:38
No, he's not a doctor. He's an IT guy, but he just landed in healthcare. I'm just saying like he is one side of the brain and I'm the opposite. And, you know, opposites attract that way.

Scott Benner 7:49
Very true. Also you and I have something in common, although I have never arranged flowers professionally. I boy, I know for sure. I haven't said this on the podcast. I do very much enjoy doing it. Oh, very nice. Yeah, I do it like low rent. I go to the grocery store where they sell, like, bunches of flowers for like, no money, and I stand there very thoughtfully and grab things, and I'm like this, and this, this will go here. And then I go home and trim them up and arrange them in a vase. I give them to my wife, who seems completely unimpressed, because she's, you know, Irish and English, and she has no real heart inside of her, and so like, I'm like, hey, look, I did this for you. And she goes, they're nice. And then that's the end of it. But I sometimes think if I should have gone with a more Mediterranean background, because I feel like those girls would be, like, more passionate about stuff like that. I think you did a good job. I don't know. She's fine. I'm not saying anything like that. You're pretty Caucasian. Would you be excited if I brought you flowers? Or no

Speaker 1 8:54
actually knowing my profession, you should never buy me flowers. That's the last thing I want to see after I design flowers all day. Oh,

Scott Benner 9:04
I thought it would be because you'd look at me and be like, you did it wrong, or you shouldn't have put that red with that yellow, or something

Speaker 1 9:09
like that. Well, I mean, I have an appreciation for flowers for sure. No, I can appreciate flowers for what they are, but it's the end of the day when you work with flowers and then you come home, I

Scott Benner 9:21
understand, yeah. People used to ask, like, I worked in a bakery for a little while, and they were like, don't eat all the food. I'm like, Oh, that. That idea goes away pretty quickly. So can't do the same thing over and over again all day long. Yeah, yeah.

Speaker 1 9:33
So okay, oh, I just did a Scott. We did the Yeah, yeah, yeah. Do I

Scott Benner 9:38
do that? Oh, I do that, yeah, yeah. You do? Yeah. I don't know what I do. This episode of The Juicebox Podcast is sponsored by the ever since 365 get 365 days of comfortable wear without having to change a sensor. When you think of a continuous glucose monitor, you think of a CGM that lasts 10 or 14 days or. But the ever since 365 it lives up to its name, lasting 365 days. That's one year without having to change your CGM. With the ever since 365 you can count on comfort and consistency. 365 days a year, because the ever since silicon based adhesive is designed for your skin to be gentle and to allow you to take the transmitter on and off, to enjoy your shower, a trip to the pool or an activity where you don't want your CGM on your body, if you're looking for comfort, accuracy, and a one year wear you are looking for ever since 365 go to Eversense, cgm.com/juicebox, to learn more. The contour next gen blood glucose meter is the meter that we use here. Arden has one with her at all times. I have one downstairs in the kitchen, just in case I want to check my blood sugar. And Arden has them at school. They're everywhere that she is. Contour, next.com/juice, box. Test strips and the meters themselves may be less expensive for you in cash out of your pocket than you're paying currently through your insurance. For another meter, you can find out about that and much more at my link. Contour, next.com/juice, box. Contour, makes a number of fantastic and accurate meters, and their second chance test strips are absolutely my favorite part. What does that mean, if you go to get some blood and maybe you touch it, and, I don't know, stumble with your hand and, like, slip off and go back, it doesn't impact the quality or accuracy of the test. So you can hit the blood, not get enough, come back, get the rest without impacting the accuracy of the test. That's right, you can touch the blood, come back and get the rest, and you're going to get an absolutely accurate test. I think that's important, because we all stumble and fumble at times. That's not a good reason to have to waste a test strip. And with a contour next gen, you won't have to contour next.com forward slash Juicebox, you're going to get a great reading without having to be perfect like that's very important to go over right now. I don't know what I'm saying or why I'm saying it, or anything like that. This is just I am so unaware of,

Speaker 1 12:22
well, I'm sorry to have knowledge that that's one of the things you say, then just keep doing you. No,

Scott Benner 12:27
no, no, I'm okay with all that. Don't worry. I like, I like, knowing it's just, by the way, I'll forget, like, a week from now, somebody will be like, do you say? Yeah, I don't think, no, I don't think. So. Okay, so how many kids you got?

Speaker 1 12:39
I have two, I have a almost nine year old girl, and then I have a 12 year old boy, and he is the only type one that we know of in our family. How long have you been married? Oh, the married since. Oh, eight. So what is that going on? 17 years?

Scott Benner 12:58
Oh, congratulations. That's nice. You've gotten through all the difficult parts. There's one more coming up, and then it's just smooth sailing to death. All right, I don't know, yeah, right around 20 years. Oh, okay, you'll reassess in your brain. You'll be like, Am I really gonna do this till I die? And then you'll make that decision, and then it'll just be then it just goes, fantastic. This is the cruising part, right here, yeah, without all that pressure to have sex and do other stuff, it really gets easy.

Speaker 1 13:23
I love that. Looking forward to it. Oh

Scott Benner 13:27
yeah, it's gonna be great. It's also less expensive, because the kids get older and you stop paying for stuff that they do.

Speaker 1 13:33
Well, until the 26 year mark, I guess from Trevor. We'll we'll see how that less expensive part goes. Oh, I see. Do you worry about that? Yeah, I guess I do worry about, not on our end, but on when the transition happens. I I've already looked up jobs, you know, transitioning, you know, what kind of jobs he should maybe look into that has better health care, that kind of thing,

Scott Benner 14:01
yeah, well, don't work at a hospital that apparently doesn't do they, for some reason, they don't have great health care. Yeah, yes, and no. People in pharma have really good health care. You know what I find, generally speaking, if you work for a company that makes a lot of money, then they spend more money on health care. It's pretty much it, yeah? I mean, yeah, if you're gonna work for like, the lady up the street, who's, you know, you're, you're screwed. Definitely

Speaker 1 14:26
not a florist. That's not, don't be self employed.

Scott Benner 14:29
Yeah, no, that's horrible. I don't I mean, I get all my health care from my wife, and if I had to, I'm sure whatever. I mean, God, what could I do? You know what I mean, I'd be buying out of, I don't even know how that works, right? Like, how does a, how does a self employed person get health care?

Speaker 1 14:47
How does anything really work? I mean, somebody just says, This is how it works. So,

Scott Benner 14:53
you know, it's interesting. You say that because you're going to be the only person who knows this. If I see this out in public and. Next couple of months, I am going to know you gave it away. Ashley, okay, Arden and I are making a series for the podcast called I don't understand. And we just have this never ending list of things we do not understand, and we sit down and figure them out together. It's pretty fun. Yeah, it's gonna be good. Sounds great?

Unknown Speaker 15:17
What a great way to bond, too. Well, yeah, also,

Scott Benner 15:20
I figure most people don't understand those things, so might be interesting to listen to it get figured out. We'll find out. Nevertheless, yeah, you said earlier that I am like, fantastic. I forget the word you used. You were wonderful, fantastic. Something like that, a Jedi, I think I said, like, a Jedi Master or something masterful. I hear, heard you say. So what does that mean? How did you come to that? Why did you find the podcast? How's it helped you?

Speaker 1 15:49
Oh, um, so right after Trevor's mystery diagnosis, we were in the hospital. And, well, he was, like, barely in the hospital, because he wasn't in DK or anything. And I was completely overwhelmed, because not only did I not understand the differences between the types of diabetes, but I just was trying to just open any door and window and anything of trying to get education. And my husband is very much. He buys books on Amazon, and he just loves to just page turn everything. So he's doing that. And I went to Facebook groups and podcasts, and I found yours. I happen to come across yours, and got into just the you and Jenny, and listening to all of those pro tips. And it was really, really helpful. We did a lot of troubleshooting, a lot of I would listen to a couple get super overwhelmed, and then I would just stop and say, You know what? We'll figure this out. I'll let my husband take the wheel, and he seems pretty good. Get a good handle on what the books are saying. So let's just go that route. And then it was, Oh, let the doctors, you know, split that. And then that would kind of crumble. And I'm like, You know what, I'm going back to Scott and Jenny. Then I'll listen to those some more. And then I feel like I'd, you know, get some traction. And then I'd say, You know what, let's try this. And then that would work. And then I'd feel like, get some more confidence, and then a little bit more, a little bit more. And I'd listen to yours a little bit more and figure out glycemic load index and all the variables and fat, protein. And it was just and then you just kept saying, like, eventually it's just going to click. You just have to try and it'll click. You. So try it. It'll click. And I knew, like, I just needed to get over that hump. But you know, like you always say, we got to be bold with insulin. And of course, I thought I killed my kid a couple times, but we didn't. He's still here an event. You know, we're only a year in, so we still have a lot of learning to do. But I definitely feel like it's it's getting better, good. It's not getting easier. It's getting better. If

Scott Benner 18:00
you don't find yourself running through the house in the first 18 months going then you're not trying hard enough. You know, like things go wrong. And you know, that's why I would repeat over and over again to people like, you know, it's experiences, and then learning from the experiences, like so many people do the hair on fire thing, and then they lose the moment Right? Like, you like, yeah, it went wrong, but just step back and examine what's happening right now, because this is your answer to the next time and keeping it from going wrong again. Like, you have to have the experience. It almost has to go wrong, so you can understand what right would have looked like. And, you know, and that's a hard thing to like. How do you explain that to someone who, a couple of months prior, never thought anything like this was going to happen to them? You know what I mean? It's a big leap. And so I would imagine that what happened to you is pretty common. Like you listen, you go, this is a lot. And then something I said rings true, and you go, That guy might have known something, or that lady said something, let me go, like, find out again, because your husband was never going to get it out of those books. I don't think anybody I listen. No disrespect to people who read. There's so much right when you when you say something out loud, you have takeaways when you leave the conversation. And yes, that can happen with reading, but there's also so much information, it's so static, and it even if it was rock solid, you know, when it was written two years ago, now suddenly there's like, maybe you're using an algorithm pump and reading a book that was written before those existed, and then it's not apples to apples anymore. And you know, it's just, I don't know. I think this is the best way talking, you know, for me, I'm sure there are plenty of people are like, look, I read fine. I know there are people who read the transcripts of the podcast and don't listen to it. And actually, I

Speaker 1 19:53
do both. I do both. So I I think that's really helpful. Sometimes I do both.

Scott Benner 19:58
I'm glad to hear that, because. Is making those transcripts is a huge and utter pain in my ass, eats up a ton of my time. And I because I have to type each word out as I listen back, that's not really what happens. I just drop it in, AI, it's AI, but it's still, it's like, very time consuming, and like, in my heart, I'm like, nobody uses these. Like, that's how I I felt in the beginning. I was like, I'm going to do this, because three people asked me, but nobody's going to use these. And then I hear back from people all the time how valuable they are. So maybe I'm wrong about reading. I don't I don't know. How do you use them? Can you explain to me how you incorporate a transcript? Well, I used

Speaker 1 20:37
it yesterday, actually, when I was listening to a podcast, and I didn't have enough time to listen to the whole thing, so I read some of it, and I was like, okay, skip, skip, and read a little bit more. And then I got to what I thought was a juicy part, and then I skipped to that part. And then I was like, I don't have time to listen to listen to all this, so I'm just going to read it. And I was able to read faster than what you guys were talking and so I was able to read through it, and I went and then I was like, oh, man, I skipped this. I need to go back. So then I was able to go back and read. It's kind of like my, I don't know, I probably have dyslexia of some sort. So then I was able to get, I'm

Scott Benner 21:20
worried that you don't even know, like reading a book, and

Speaker 1 21:22
you're like, I need to get to the end and see what what happens, what happens? And then I go back and I read the whole thing.

Scott Benner 21:28
Do you mean dyslexia? Isn't dyslexia when you read? See things backwards? Yeah, I

Speaker 1 21:34
probably messed that up. Yeah, there's one point for you. Two for me, one for you. Scott, no, not that we're keeping track,

Scott Benner 21:41
you're gonna really enjoy the episode where Arden and I try to figure out what a blind person sees, color, blind or blind, no. Blind like a person who's completely blind, right at what percentage? What are they experiencing? If they're completely and totally blind, what is it they're experiencing? And is there context where we like we went through it. We tried to figure it out. We got, like, first hand accounts from people who were blind, like it was, that was us trying to figure out. Anyway, dyslexia is a specific learning disability that affects an individual's ability to read, spell, write and sometimes speak. Do you have dyslexia?

Speaker 1 22:15
No, I don't. I just, I guess I'm I can't focus.

Scott Benner 22:22
Do you have ADHD?

Speaker 1 22:23
Probably, yeah, I was the kid that got in second or third grade that got put in the gifted program, and then couldn't focus, and got all their work done super early, and then wanted just to, like, play around with all the kids got in trouble, and then they're like, put her in gifted program, and then they just always on stage, made my own, produced and wrote things and got on stage and got bored of that, then went back and became like a a B student.

Scott Benner 22:51
I couldn't get a B on purpose, that's for sure. I'd have to have a really bad teacher to get a B like that person would have to really not care that I was cheating, and then then I could pull a B, but of my own accord, a C, if I was lucky. Yeah,

Speaker 1 23:06
you're pretty smart that. I think you got it. You think you did pretty well for

Scott Benner 23:10
yourself there? I don't know. Usually, in a schooling situation, I look like a lead balloon underwater, just like that thing's never getting out of this, you know? I mean, like he's he's not getting out of here. He live here until he's 90. They're not even gonna let him out. I was terrible at school, like, really, genuinely bad at it. Hospital stay, not too long even.

Speaker 1 23:31
No, we were, well, like I said, we were, like, blindsided, like completely blindsided, by this diagnosis. He went in for the well visit. And honestly, I thought he had ADHD. I thought my son was, he was starting to get in trouble at school in fifth grade, and he was starting to get in trouble for, like, little things, you know, like someone, he took somebody's pencil through it, or did something. And I was like, You need to write an apology for that. And you know, they're like, Well, maybe he'll turn around after winter break or something, and then something else happened after winter break. And so I was like, Well, I don't know. So we did the whole had the teachers fill out the Vanderbilts and kind of like the first step on seeing if there's something there, okay, and we kind of piggybacked that doctor's appointment for the Vanderbilt with his pediatrician to go over those with his will visit. And when they went in with that for the well visit, they just happened to say, Oh, we also between ages nine and 11, somewhere between there, we'll do a finger stick. I didn't think anything of it, because he's my first born, and I never, never, we've never done that before. We never done it before. So I was like, Okay, go ahead. They finger stuck him, and it came back a little high. They, well, they weren't sure at first night. And I did understand what that was for. And I did mention, like, Well, he did just eat cereal about an hour and a half. Go about an hour ago. So just to let you know, like you did just have something sugary, like, okay, no worries. That came back and it was pretty high. I It wasn't astronomically high, but it was high enough that they said, Hey, this is concerning, but it could be a lab error. What do you want to do? And that's what I would say, what you want to do? What they asked me, what I wanted to do.

Scott Benner 25:22
What do you want to do? Like, Well, I I like to talk to somebody who went to medical school. What do you want to do? Jesus Christ, what do you want to do? You're like, like, I thought I was coming here to get a lollipop. Like, I'm making medical decisions now. Anyway, I'm sorry. What did you want to do?

Speaker 1 25:37
Well, I said, let's get a they, well, they gave me options. This is what they did. They didn't say, like, completely blindly, what do you want to do? They're like, you can either, you know, come back in and get a finger stick again, or you can maybe get lab tests. And I was like, let's just go ahead and get lab tests. We have no baseline of anything. Like, I don't even know those white blood cell red blood we don't have anything. So we had this scheduled. It just so happened that that was the same week that he had state testing for a school. And the school system, as you know, are pretty rigid about these schedules for their state testing, and I didn't want him to have to, like, go in for a makeup test for these he wasn't thirsty, he wasn't Bedwetting, not that I knew any of these telltale signs, but there

Scott Benner 26:20
was nothing extra. What was the finger stick? Do you remember what it read?

Speaker 1 26:23
I think it was like in the 160s okay, maybe somewhere around one I think it was around 160 I remember they were like, not overly concerned, but they were like, wow. So little high. So anyway, they had scheduled a lab testing, and it was right up the street from where we lived, and that it was the same morning he had to be fasting, obviously, but obviously we we're supposed to have a great morning breakfast and then send your kid to school for state testing the next day. And I was like, Oh crap. I forgot about that. So I'm like, well, we're not going to do the lab testing today, because we have state testing, we'll just skip that. We'll do that another day. We'll do that on Friday instead. So the next afternoon, when he's supposed to have his lab results, the pediatrician called him, like, hey, we never got those results. What's going on? I explained the testing, and they're like, actually, you really needed to get those we really need those results. We really, really, really need those like, it's Pam. Was like, I just didn't understand why they were what was, what was so important, big deal, yeah. And then they were like, explaining the dka and all this and that, I'm like, really, is that that big of a deal? And he has, he's never went and then they were explaining what that meant, and then I pushed back, saying he doesn't even drink water, like he doesn't even go to the bathroom. He's never wet the bed. You

Scott Benner 27:50
guys are screwing this up. I brought him in for ADHD, okay, so you're getting this all wrong. Yeah.

Speaker 1 27:56
No, I understand. So, yeah. So Friday is when he had his blood test, and that came back on my chart pretty quickly, but they also ran as a 1c that didn't come back until Monday. So all the results over the weekend came back fasting glucose was, I think, 109, his white blood cells were really low, I believe, and is late. Let's I think we're really high. He caught it really early, right?

Scott Benner 28:29
Super early. Yeah. I mean, a fasting 109, is still high, right? You shouldn't, like, if you're you don't have diabetes, your fasting blood sugar should probably be like 80, in the 80s, right? So especially for a kid and but still, that seems really early, so you didn't see no offense, like you weren't like, there's something wrong with my kid. He just, he threw some of the kids pencil one time, which, by the way, I don't know if that's getting to do with diabetes or not. Like we used to take pencils from people and throw them all over the place. I realized it's a different world. Now. People are like, nice to each other, but I think that's just what they say. I'm sure the same stuff still happens. Yeah, yeah. And you're like, hey, let's do the Vanderbilt test and see if he has ADHD. My dad would have just hit me. The 70s were so much different. You're like, let's get some testing to make sure he's okay. And my dad would have been like, Hey, did you throw that kid's pencil? Don't do that again. I would have been like, Oh, you're making a lot of sense, and that would have been the end. You're not supposed to hit children. I just want to say that out loud, no, and I'm not advocating it. I'm just telling you a story about 1978 when somebody would have just beat your ass for that, and then you would have never done it again. But it's okay. I know you said your husband grabbed the books and you went to online and everything to try to get your information, which is terrific, but like, can you dig down deeper into the actual like, in your gut feeling about all this? Do you feel like somebody shook up your snow globe? Are you in denial? Like, where's the deeper

Speaker 1 29:53
emotion? Deeper emotion I was I was grieving. I was. Grieving, but I was also thankful at the same time, it was like a weird juxtaposition of I was mourning that for Trevor, that he was no longer gonna be living a life with food that was gonna be free of just no longer after I understood what type one was like that. Yeah, he could live a normal, healthy life, but he has this relationship with food that I have, that he doesn't have, that he can no longer eat things without thinking about what it's going to do to his body, like I obviously have to do that too, but not in the way that he does not a life or death. He has to wake up every day and choose to live like that's just mind boggling. Yeah, no, I understand. I didn't mean to make you cry like I mean. And another thing that I I, I feel like it's important to say like he was, we were also shell shocked to this, like he was not in DKA, obviously. But when we got home from the hospital, his a 1c was eight, was 7.8 and they called on Monday and told us I did have the ADHD medicine and I was gonna go. And by this point, like on Monday anyway, I was gonna go. And so everything was, like, seemingly normal after that first result, or after the blood test, and everything the a 1c came back on Monday. By that point, I was just going off of the original blood, blood results, not even knowing what the a 1c was. And I my husband and I had just said, you know, let's just go ahead and try this ADHD medicine. Because they said, Yeah, we he might actually have a little bit of that. So I was walking into the pharmacy to just go ahead and try that medicine to see what that said. And that's when they called and said, Hey, a 1c came back. You need to get over here. Get over here now. Yeah, and he's going to be admitted to the hospital. What did you tell him? What do we tell Trevor? Yeah, I mean, we were honest with him. We told him what it was. We told him that we there's many, many, like millions of people that have it, infants, older people, you can live a long, healthy life. He's a soccer player. He plays competitive soccer. We told him about Jordan Morris, we told him about, you know, Nacho we told him about a whole bunch of athletes in a whole bunch of other fields, right? So he wasn't discouraged about that. You feel like that helped him? He thought, No, he didn't. It didn't help him at all. He felt like he didn't have it. We felt like he didn't have it. I mean, so, like, that's another thing that was, that's a huge thing with this whole whole thing. And I think we're still, he's still kind of in that little bit of a rut, even a year into this denial. Yeah, I think, Well, I think he's in acceptance now, but I feel like he kind of slips back into denial. He's always been the kid that's he's telling the stoves hat, and he's just has to put his hand on it, just to double check. So he just doesn't and also he just doesn't care. I think it's, I don't know if it's the age, I don't know. Listen,

Scott Benner 33:16
first of all, I don't think anybody cares. You don't even mean like, they don't want to, like nobody wants to think about this stuff. And we listen, you say the right thing, and it is the right thing to say, and I believe it, which is, you can live a completely normal life for this. Obviously, I think that right, but it doesn't make it go away. Now you're just doing more things to live normally, which, by definition, is not normal, and that's when it becomes attitude. That's the decision right there. Like, am I going to just accept this as part of my life so that I don't fight against it constantly, and I'm not always feeling like I got the short end of this stick somehow? Or am I going to decide to be ultra literal and say, No, this isn't normal, and I am getting screwed compared to people who are not going through something like this. That's where it's mindset. And I don't know how you get somebody to the right mindset like I think that. I mean, you can do the right things and as the parent and say the right things, and hopefully they end up there. But I don't know if you can force it, you know what I mean? Like, you mean, like, you're like, look, Jordan Morris, he plays soccer and has type one diabetes, and the kids probably like, yeah, that's good for him. Like, I don't want that though, you know, like, so, like, and he's too, yeah, he's young, so he's also going to start hitting puberty. He already has. He's like, nine feet tall or something. You know what I mean? How tall are you? By the way, I'm sorry I fairly know your kids, six feet tall. How tall are you?

Speaker 1 34:48
Yeah, I'm five seven. Okay, seven tall for a girl, as they say, is it? That's what they always want to be, five nine. So I didn't hit my goal.

Scott Benner 34:58
Yeah, listen, go ahead. A five three girl, if you're tall, so And how about your husband? Was he like a giant? No,

Speaker 1 35:06
he had potential to be. He's six one. People always think he looks really tall, though, but he's six one, yeah.

Scott Benner 35:12
How about tall? People in his family like, where's Where does a six foot? Girl was

Speaker 1 35:17
six four. My cousins are 6566, okay, my father in law is six four. I think 636

Scott Benner 35:24
they have any autoimmune stuff, those guys like, maybe, okay, I

Speaker 1 35:31
have Raynauds or raynoids. Look at you. Maurice, overachiever. Yeah,

Scott Benner 35:36
your hands cold. Do they turn your fingers turn blue?

Speaker 1 35:39
Oh yeah, they're getting pretty purpley right now.

Scott Benner 35:44
How come are you sitting a certain way? Is it? Do you know what brings it on? Oh, gosh, it could. Tuesdays, days it ends in y, stuff like

Speaker 1 35:54
that, yeah. Days, it ends in y. That's it. Yeah. Okay, so

Scott Benner 35:58
you have uncles with eczema, and you have Ray nods.

Speaker 1 36:02
My No, the eczema comes on my husband's side, on the

Scott Benner 36:06
husband's side. Oh, there it is. They should give a test when you're dating. I'm telling you, this is we could avoid these auto immune things if we just did a quick questionnaire before it got too serious. Darn here's a crazy question, how long you've been married?

Speaker 1 36:23
I think I said 1716, or 17? Yeah, I don't know something like that. I'm bad at math. Don't worry about I'm an art major. I didn't I didn't have to take math in college. That's one of the perks. I

Scott Benner 36:33
don't think that's math. I just think that's counting. But nevertheless, like, go back to dating. Okay, 20 years ago, whenever you were dating,

Speaker 1 36:39
and was 18 when I met him. I know that you were 18

Scott Benner 36:43
when you met your How old are you now? Oh,

Speaker 1 36:46
where I just I this was part of the podcast interview. Oh, wait, you don't want to I just turned 40.

Scott Benner 36:53
Oh, my God, you're almost gonna die. That's horrible. You shouldn't told anybody about that. So you're 18. You meet this guy, told the world, it's okay. You know what I tell people all the time, and I genuinely mean this, I'm old because I'm alive, the alternative not as good. You

Speaker 1 37:09
understand like, you know what I mean? Yeah, thank you for that perspective.

Scott Benner 37:13
Also, I saw you for a couple minutes. You're looking you're doing fine. Don't worry about it. Okay? Thank you. Arden asked me the other day, it's now on our list of I don't understand. Why do older people look younger than they did in previous generations? And we were in a restaurant the other day where the waiter guessed my age as 40. And I was like, oh, no, I just had a birthday. And he goes, Oh, happy birthday. How old are you? And I said, 53 and he was genuinely knocked over. And I was like, oh, is my hair is dark, and I act like a child. That's pretty much probably why. But the point is, is that when my dad was 53 he looked like he fought a war, you know what I mean. And his father, when he was probably died before he was 53 and probably did fight a war, you know. So no Stolen Valor here. I don't know if he was actually in a war or not, but point being that you look fine. You're don't argue about your age. But my question is, is, if I go back to you dating 18, Jesus, what did you know when you were 18? Nothing. Not diabetes, yeah. And I say to you, listen to me, Ashley, I'm from the future. Okay? And if you marry this guy, you're gonna have two kids. They're gonna be great. Here's all the great things are gonna happen to you, but your son, when he's like, 11, he's gonna get type one diabetes. And here's what type one diabetes is. So if you want to, just like, you know, you can date this guy if you want, but like, let's make sure we use a condom and then break up with him. You start loving him. See if you want to get out of this, would you have done that? Oh, 100% I would. You would have bailed on him when you were 18. If this, no, no. I mean, I would do it. I would do it. You still as at 18. You can look back and say, It's okay. I would, I wouldn't leave this situation.

Speaker 1 38:54
Yeah, yeah. I know what my husband looked like when I was 18. Yeah,

Scott Benner 38:58
of course. Oh, he was super handsome, is what you're trying to tell me he still is? Yeah, I would totally I love where that's so honest. Ashley's like, listen, I was 18 and he was hot. I'm not going anywhere.

Speaker 1 39:09
I'm not going anywhere. I'm locked in. Is

Scott Benner 39:12
that really what you meant? Yeah, that's fantastic. Thank you for being honest. I appreciate that. Are you still nervous?

Speaker 1 39:20
No, no, I really was, I mean, I was nervous, but I'm not, like, too, too nervous. Okay. Why'd you

Scott Benner 39:25
want to come on the podcast? Obviously, to meet me. I'm fantastic. Skip over that. What did you want to tell people? Yeah,

Speaker 1 39:31
I just wanted to let people know that screening, you know, I know, like screening super big right now, and that it really is important, because it truly. I feel like it saved our family. My son from going into DKA, which obviously he did not, although we're going through the psychological part of what type one can do to a family, I feel like that goes especially from listening to your pod. I feel like that is true in any regard, like what you just mentioned, like you just, you don't know, really, what your journey is going to be, as far as after diagnosis, but knowing is half the battle. So after you get that, you just, it's just what you do with it, what you do with the knowledge, what you can do with knowing what you know. Yeah, so I just, I wanted to come on the podcast to share our story, and then also to share how we're doing a year in we're on the islet pump, and to kind of answer any questions about how that's going with the kid on puberty. Because, shoot, I mean, you mentioned it before. He's six six feet. And I mean, he started this with he was my height, he was five seven, and now he's almost six feet. Wow, just shade under six feet tall.

Scott Benner 40:52
Well, let's talk about the eyelet pump. But before I do let me say this screened for type one.com. Is a sponsor right now, if you go into the show notes to the podcast player, there should be a link there, or you can type into a browser. I think there's links at Juicebox podcast.com now, that's if they're still sponsors six months from now. If they're not still sponsors six months from now, then scroll, don't. No, I'm just kidding. Do you know why it's because you said screening is like, is like, all the rage right now? Do you know why that is? I would think

Speaker 1 41:22
it's because of the the medicine that they can take to help prolong the Plymouth. Yes, there you go. Yeah, which is called, know what that was now called, you go ahead, you know what it is?

Scott Benner 41:36
It's because there's a push. Because, you know, I don't know if I'm supposed to say all this, but I mean, what are they gonna do? Sanafi bought tea sealed from a company called prevention bio, and this medication seems like it might be kind of revolutionary, like, at this point you take the infusions. I don't have all the details, so I don't want to, like misspeak, but there's these infusions that you get every day for a certain amount of days, and what they're seeing is it's pushing off people's diagnosis if you take the infusion early enough. My expectation is, is that they they think that it's possible that in the future, they're going to learn more about it, because that company paid a lot of money for that drug and so And honestly, you know how much they paid for it actually

Speaker 1 42:23
three. Dare I say $3 billion bill, oh, I was gonna say 1 billion. 1 billion.

Scott Benner 42:30
No, no. They bought prevention bio for $3 billion so I'm like, listen, they either think they know something, or, you know, somebody with an ego trip had the checkbook that day. I don't know which one it is, but like, point being that you know, if you get screened early enough and find out that this is in your future, and do this infusion, they're seeing it put off people's diagnoses for a year or more. And I think if you read between the lines in a lot of the interviews I did with prevention bio back in the day, I think they're hopeful that it one day might stop it from happening, or maybe modified somehow, might be that. So anyway, then when you think about that, like, how do you get people to screen for type one diabetes if they don't think they're going to get it and they're not showing any signs, because you really have to find out early. Yeah, that's a Herculean problem to get people to screen for something like that. So that's why you're hearing about screening so much. Anyway, screen for type one.com now that was not an ad, because I'm sure I said stuff in there that I'm pretty sure I'm not supposed to say if it's an ad. So anyway, that wasn't an ad. That's okay. No, it's okay for you, but I don't know if it's okay for them or not. But well, we'll find out. Well,

Speaker 1 43:43
it's really important. I feel like, I mean, the, I mean, listen, we go to a really great number one in the country, pediatric Children's Hospital for endocrinology. So the fact that, when we were there, they kept saying they we had multiple doctors coming in in the two day span asking, Hey, were you the kid? Was this the kid that got diagnosed with a they just a well visit or a finger stick. You give your pediatrician a gold like they that's an I just cannot believe it just to hear that that is unprecedented. I

Scott Benner 44:20
should stick on that for a second, Ashley, because I'm, I'm obviously quick to give doctors crap when they don't do something right. That was really well done by your pediatrician.

Speaker 1 44:27
Yeah, seriously, yeah. And probably I'm so thankful, yeah,

Scott Benner 44:32
saved your kid from being in DKA and saving him from, you know, but I mean, that could kill a person. First of all, is very serious, and you know, all the trouble that that goes through, plus you get a slower, you know, you're the onset still happening. You get a little time to figure things out before it gets wonky. Do you think he's honeymooning now, still? Or do you,

Speaker 1 44:51
oh, no, no, no, I feel like honeymooning ended in the summer. That was when I was saying. I was listening, dabbling. In your podcast, my husband was reading books. We were doing our first vacation. I think that's when we crashed and burned. It was

Scott Benner 45:08
all of a sudden, the need rose significantly. Yeah,

Speaker 1 45:12
we were insulin it was like, ours is insulin resistance was going on. It was just nothing was happening. That's when I learned about combo bolusing. That's when I learned about all sorts of things, all fat, protein rises. That's when I learned all the things. But that also that's when his honeymoon left.

Scott Benner 45:30
Did you sort of take over? Because it You made it sound earlier, like you're like, my husband's got a book. I'm gonna let him handle this. But are you that really is what you said? You're like, he's good with books. He'll probably take care of the diabetes. But, like, is it mainly you now, or do you guys do it together? No,

Speaker 1 45:47
no, I really feel like it's, it's a great teeter totter combo. You know, like, some days he's really great, some days I'm really great. It's a really good teamwork, nice. Yeah, and he's, like, I said he's, he's, my son is really into competitive sports, with mostly soccer, and he trains a lot and off seasons and does Futsal, and so, you know, we are really good at tag teaming and figuring it all out. It's just kind of like a little dance. It's

Scott Benner 46:19
excellent. Good for you. I didn't mean good for you. Like, shut up. Good for you. I want to move on. I just, I'm looking at the clock, and you did take 25 minutes to get your headphones on.

Speaker 1 46:27
So I'm trying to, like, talk about beta eyelet or something. We can do

Scott Benner 46:31
that. I have a phone call in a half an hour. So, yeah, go ahead. Somebody's inviting me next. What questions you got considering speaking in Canada next year? So I have to have a phone call to find out what they want from me. But my question is, once he has diabetes, is it syringes? Is it pens? Is it a pump? What do they give you? Do you

Speaker 1 46:50
an MDI? We got a g7 we were thankful that we had a one of our good friends is a an adult endocrinologist, and she had a sample g7 because he was diagnosed in April, and I think that was right around the time that it was available in the US, is that, if I'm wrong, I'm sorry. So she had a sample g7 and she gave one to us and said, Hey, try this. This works pretty well, from what I've heard, interesting. And we plugged that one on we plugged one of those on them. And at the time, I don't think it was on the formulary on insurance, but it quickly became on the formulary. And so we were able to get that for Trevor, so he's always been on the g7 and we are also doing that with MDI up until December, when the beginning of December is when islet became compatible with g7 and you've

Scott Benner 47:44
had it for almost eight months,

Speaker 1 47:47
islet, yeah, oh, yeah. We got the eyelet in January, January 7. So this

Scott Benner 47:52
is interesting, because you have no other experience with another pump. No. So what was his a 1c on MDI, but he was probably honeymooning.

Unknown Speaker 48:01
Um, he's always been in the sixes, sixes,

Scott Benner 48:03
okay? And he he wanted a pump. You wanted him to have a pump. He was

Speaker 1 48:09
always apprehensive to do pretty much anything so. But when the pump became available, we went through pump. We went through pump training in November, and there was like, nothing's available for g7 you can go back to g6 and we're like, we never run g6 and he was like, I am not doing anything other than g7 so we're like, well, we gotta figure out what's compatible with that. And so when the islet became available, we were like, Hey, let's go time if you want this and try. You ended

Scott Benner 48:36
up with an eyelet because it was g7 compatible, or because you liked the function of it and how it worked both we

Speaker 1 48:43
liked the function of it. During the pump training at the hospital, I had asked specifically to get a representative for Ilet to get more information about it. Again, the adult endocrinologist, my friend, had mentioned that this was going to be available and just kind of the ins and outs of the ease of what it did. I had also had you had also had somebody on talking about it, so I had listened to that in conjunction to, like YouTube influencers and things like that. Kind of like listening to other pumps and Trevor's endocrinologist at his three month appointments. Had also said, you know, asked him about like, Hey, are you guys interested in pumps? And Trevor had always been like, No, I think I'm okay with where I am, because he just got steady with something. And was like, This is it, it's working. This is it. This is working. This is it. And his endocrinologist point was like, let's get a goal of looking on YouTube and trying to see what pumps are available, what pumps you might be considering what pumps you're not like, just baseline. Just try and get try and get options. And so that was one of the options, was islet, because he liked the ease and the functionality of it, of like, not having to carb count. Okay, when that became available in December, I was like, hey, this one's available. Do you like this? Option. I mean, it's tubed, but, and he's like, Well, yeah, let's try it. And I was like, what's the harm of trying it? And then the summer, if you wanted to do Omnipod, there was no contract on that, you could always jump to that one for the summer time and then go back. I mean, there's options, right? So that's why we did that.

Scott Benner 50:18
Excellent. What was your finding like you, you started using this pump which explain to people, in your words, how do you announce a meal on an island, for example,

Speaker 1 50:27
depending on what his initial number is. Let's just look at what His number is right now, for example. Oh, well, let's not use this number for right now. Well, let's just say from when he woke up, his number when he woke up was like 140 if he is going to eat breakfast, I would have him announce a breakfast usual, because he usually eats his usual breakfast. And then I would have him wait about 15 minutes, and then he would eat so you are still pre bullish thing, and then he would eat his usual breakfast.

Scott Benner 51:03
They'll tell you not to do that. You know that, right? Like eyelet says don't Pre Bolus. The company

Speaker 1 51:08
beta biotics. Well, certain individuals at the eyelet will tell you not to do that. Other representatives will tell you it's okay,

Scott Benner 51:16
okay, gotcha. And that's all I just wanted to say. Then what happens? Like, like, just now, you're like, oh, let's not talk about this.

Speaker 1 51:24
I think he just ate. He might not have announced but

Scott Benner 51:27
so you think he ate without eating or without using insulin? Oh, yeah, yeah.

Speaker 1 51:32
So this is also what it is about him. When I said earlier, like, oh, he just doesn't care. And but also, he's a tween boy, so he could just be downstairs, just watching a show, and he might have gotten excited about whatever Lego build he's watching on YouTube, or whatever it is. I got some adrenaline. Yeah, adrenaline. And it just might have kicked it up a little bit, okay, and so. But what happens is, if you don't eat and your numbers shoot up a little higher out of range, it will, the algorithm will see that after a little bit of time, and will give you a little shoot of insulin, like a little herbs, a little bit, a little bit.

Scott Benner 52:21
Where is his a 1c, on islet, he's still in the sixes. And what about excursions at meals, like, what are high blood sugars look like, and how long do they take to come back?

Speaker 1 52:31
It just depends, uh, he can be in the two hundreds, or he could stay level. It just depends on what he's eating and the what if, is it raining outside? I mean, I don't know. So

Scott Benner 52:44
if he hits a 200 for example, off of like, say, a fatty meal, like something with, like french fries or something like that with some grease in it, how long do I expect him to be in the two hundreds? Does he get low when it comes back down? Honestly,

Speaker 1 52:56
it really just depends on the day. Is it a Saturday? Is it a Tuesday? Did he just work out? These are the things that I need to know. Right going he is going through puberty right now, so it is a crap shoot whether or not he's going to go high or low. Was he dehydrated? Did he have a soccer match? Is he going to a soccer match? Is he going to burn that off? I need to know what the fat, protein rise is going to be in that because if, if he's going to be high and he has a soccer match later, it's not that big of a deal, because he's going to burn it all off, in my opinion.

Scott Benner 53:26
Does a high blood sugar affect his ability to be athletic? No, he doesn't slow down, get tired, easier, stuff like that. No,

Speaker 1 53:36
a low blood sugar, for sure, does okay. He gets really weak in the legs. He gets like tingling, tingly in his leg. How low does that have to be for that to happen? He usually feels that around like 70, really, 6870

Scott Benner 53:52
okay. Is he generally higher than lower?

Speaker 1 53:55
No, he's usually around 161, 70. Okay. And do you know you would probably consider that very high?

Scott Benner 54:04
Well, I don't consider, I listen, I don't judge people. Okay, so, but I mean, I know, all I know is that I'm sitting here right now my blood sugar is probably 85 and 160 sounds like it's twice as high as 85 and so if my kid's blood sugar was 160 I'd be like, we need more insulin. But does the pump bring him from 160 down to a lower number? Or does he live at 160 like I'm trying to figure out, like, does his graph look generally lower, 80s, 90s, 100 and then big pop it food, and then back down again. Or is he always like, 121, 3160, with some pops to 200 and come back again,

Speaker 1 54:46
again. It kind of just depends on the day, I would say, like on his good days. Like, meaning, like he doesn't have a really strong or a really heavy, you. Athletic soccer, or a heavy training day where there would be like adrenaline spike, or what I call a false high, he would be somewhere around, like the 130s Okay, mostly, okay. And then the after he eats, he would go around highest would be around one, or would be around 190 200 and then he bought back down and like the 160s maybe, or back down to 120 and then that'd

Scott Benner 55:27
be like a good day. How does this reality compare to MDI?

Speaker 1 55:31
So much better. But the same time, we were at the very beginning of diagnosis, and he was binge eating because you were newly diagnosed, and he was finally, maybe, you know, getting the insulin he needed, hungry his body needed, so he was hungry, ravish Lee, eating. Who knows? I mean, there's so many different, like, so many different variables, that it's hard to see, yeah, and so I'm not quite sure. And now we're going through puberty, and he is an athlete, and it's also kind of challenging to really see a grand picture of, like, a great steady line all the time, because he gets these, I like to, like, I said, I like to call them false highs, because he gets huge bursts of adrenaline when he's working out. And, you know, he's starting to, like lift weights, pseudo kind of lift weights. And the liver is really shooting out that glucose, and then the muscles are really, you know, getting ripped apart. And then afterwards he drops because, you know, the recovery, because he's getting the muscles now. So,

Scott Benner 56:38
like weight lifters type one would tell you you have the Bolus to do anaerobic exercise so, but you can't do that with the eyelet, right? You can't say, Hey, I'm getting ready to lift weights now, Bolus. It's only for me. It's

Speaker 1 56:51
not really lifting weight. He's doing more like plyo stuff. And I'm not sure exactly what he's gonna do when he goes in for these training sessions. So I'm like, sometimes he's just running around in circles, and then he's, like, trying to do splits and stuff, and he's mostly a soccer training so I'm like, oh, a lot

Scott Benner 57:08
of running, yeah, a lot of running, yeah. Cuz, not really a sport. You can't use your hands and everything. I

Speaker 1 57:13
understand we really like the pause feature. That's really helpful. What is that? It's a new feature on the islet. It just rolled out about a month, a month and a half ago, maybe where, when he is disconnecting. So when he is playing soccer or on the pitch for a game or a match, sorry, on the pitch for a match, in his boots, um, he'll Disconnect his eyelet, and we will pause it so it's not spitting out anymore, basal or trying to adjust his numbers, and then you can pause it for up to two hours. And then once he gets done with his soccer match, we'll unpause the islet, and then it'll plug back in or reconnect.

Scott Benner 57:56
Is he high after he gets done playing? Um,

Speaker 1 57:59
he can be, but sometimes not generally, he usually is, but it's a then he comes straight back down, because that's an adrenaline high, and then he comes right back down. And usually we have to give him stuff. We usually have to give him a jerky or trail mix and stuff uncovered. Well, usually that's low carb stuff anyway, but we usually give him, you know, things uncovered in addition to protein, things

Scott Benner 58:24
to hold him steady after the exercise. Yeah,

Speaker 1 58:27
and we do that, we usually give him that kind of snack before he he goes in as well to work out, too. Okay, nice. And you're finding it's working for you some days, yes, some days no. I mean, sometimes we nail it just like pizza. Sometimes it's like, yes, we killed it, we did it. And other days, we're like, you know, what

Scott Benner 58:48
is it fair to say? You don't when it goes right, you don't exactly know why it went right.

Speaker 1 58:54
Are you at that point right? You're like, yes, we knew it. We rocked it. Rocked it hard. And other days, when it goes wrong, you're like, what happened? Are you

Scott Benner 59:02
ever able to, like, figure out what happened?

Speaker 1 59:06
Some days, some days we find the the candy wrappers. Some days we don't, you know, I mean, some days, some days it's that. Some days there's nothing.

Scott Benner 59:15
So your biggest concern right now is to get him to consistently Bolus for food. Mostly, yeah,

Speaker 1 59:21
mostly, if, I mean, yeah, I would say yes, we want him to learn how to manage, obviously, on his own accord, but also the right balance of pushing him to start to care. But as you well know, if you've done this so many years, you have to people care about what they want to care about. Yes, exactly right. So there's a right balance there.

Scott Benner 59:46
The goal is to, like, get them to care about it, or see the value in it, and, you know, etc, like, that's the kind of stuff it's that's where all the parenting comes in and not freaking out. And, you know, because you can't just yell at somebody. To do is like, despite what 1978 would tell you, hitting somebody is probably not a good way to get them to do what you want to do in the moment, doing that right, right? Yeah. My point is you can't force people to do things, right, yeah. Often when you try to force them, it just goes the opposite direction anyway, yeah, yeah. So that's pretty much the hill you're going to be climbing for the next couple of years. Yeah.

Speaker 1 1:00:20
I mean, the goal, obviously, is to get him to do this sooner. I would say, by high school. You think you will? I mean, if not, then I would hope girls would probably, or whatever he's into, would help the situation. I don't want to shadowing his dates. But if it comes to that, I think, hopefully that'll help. I don't know. So

Scott Benner 1:00:44
your expectation is, is that once he starts dating, he won't want people to see what's going on, so he'll take care of it, so it doesn't happen. I

Speaker 1 1:00:51
mean, he doesn't want anybody to know that he has his diagnosis. That's another hurdle we're trying to jump right now, is just trying to have him be open and honest with people, but at the same time, it's a heck of a difficult age to be diagnosed. So why do you think he

Scott Benner 1:01:08
doesn't want people to know? I mean, he's

Speaker 1 1:01:09
already standing out at a six feet tall person, six foot tall boy, so he's already that going for him, but I don't know. I think he's just, it's just his personality. I don't, I don't know. I can't answer that for him. I He just does not want anybody to know, to the point where he doesn't want to go swimming, he doesn't want to do things. Says he doesn't care. But we know that's just a 12 year old mindset right now. I don't know.

Scott Benner 1:01:35
Do you do therapy for that? Do you just keep working? We do? Yeah,

Speaker 1 1:01:39
he goes to and I love having that outside person that also has diabetes to help him and help nudge him. And we always see a great, great turn around after seeing that that's also with the hospital, you were able

Scott Benner 1:01:54
to find a therapist with type one. Yep, nice. So, oh, that's excellent. Yeah. See it is personality. Because if I was six feet tall and 12, I'd just be walking be walking around going, I'm so much taller than you like, I'd be so thrilled, you know what I mean. And then you see people who it happens to them. They're they're, they try to shrink. You know what I mean? Like, they don't want to stand out, or, like, I don't want to stand out. But I would definitely take that as a dominant thing and run with it. I'd be like, Oh my God, you're all so short and, you know, just like, live in the moment. But that's not how he feels about it. Yeah,

Speaker 1 1:02:22
yeah. Again, I don't, I can't get into the mind of of my son, but yeah, I don't know. Does

Scott Benner 1:02:27
he take after you or your husband with his personality? Me, okay,

Speaker 1 1:02:33
we are like oil and water when we get together. I see it very

Scott Benner 1:02:37
much. So because you're so similar, it's hard to get along. Yes. How would you manage if you had diabetes? Would you think you'd hide it from people? Probably, yeah, I think I would. Why? I think back in when I was his age, I would be in the blame and shame game for some reason or another. Yeah, just to but do you think that's what he's doing? Probably, in some regard. Yeah, I mean, I touched on this earlier, and I don't want to bum people out, generally speaking, but whatever, it's just, it's the end of the podcast at this point. So they're still listening. They'll go with it. It's the mindset you're going to need if you're going to be successful, which is, like, you know, I really don't care if I have diabetes. These are the things I do. It's normal. I can't sit around and belabor it and, you know, be like, Oh my god, Woe is me. Or like, want to blame somebody, but if you are doing that, I mean, I get it, you know what? I mean, like, you can live a normal life even you have diabetes, yeah, but it's not really a normal life. It's a normal life with diabetes. You know, like, no matter what would it? Forget diabetes. If you were born with nine fingers. You could live a normal life with nine fingers, but it's not exactly normal. You have nine fingers. You know what I mean? Like, it's that feeling in there. Again. I think some people get stuck on it and some people don't care about it, and I think you're gonna do better if you don't care. But how do you get people who are stuck not to care? That's like the million dollar question, or the $3 billion question, you know, if you're sanafi, but like, seriously, like, how do you, how do you make that leap to understanding that if you just accept it, it's better, you know what I mean? Like, there's that, um, I don't know how I haven't talked about this in a long time, but it came up in my life recently I was talking to, I shouldn't say who I was talking to. I was talking to a younger person in my life that isn't my kids. And I was explaining this, this commencement speech called This is water that was given like, I forget when by by an author who has since taken his own life. So, I mean, I don't know how much of his insight you're interested in hearing or not, but,

Speaker 1 1:04:41
well, I bought the book after I heard you on your podcast, so I'm sorry to hear that he's since deceased. He's long

Scott Benner 1:04:48
deceased, and not that. That makes it better. But nevertheless, this is not we're talking about. We're talking about it's this one idea in his commencement speech that I find to be like at the core of living. Happily. And, you know, I won't paraphrase him, I'll just tell you the way I think of it, which is, if you're driving down the road and someone drives past you like an absolute lunatic, they're probably an asshole, right? They're probably just driving unsafely, but they also might have a great reason for it. Their kids at home and sick, or their house is on fire, or they gotta take a okay, like there's a reason why they're doing this. They're not an asshole. They're just they're in a bad situation. My point is, is that you're in your car, they're in their car. They've just sped by you. You're never gonna see them again. You don't really know why they're doing what they're doing, and it benefits you to assume the best, because if you assume the worst, you're just going to have this anger, you're going to it's going to live inside of you. You're going to distrust people, you're going to have a bad experience. You know, the all these reasons why, if you decide to guess that they're just an asshole, it's bad for you. And if you just say, You know what, I hope they're okay, you know, and that whatever's happening is happening for a good reason. That's it. It's nice and light and airy, and you let it go. And I see the connection with diabetes there, which is you can decide to say, hey, you know what? You can tell me, I'm normal, all you want, but I'm wearing a thing on me that's giving me insulin, because my pancreas doesn't make insulin, and my blood sugar gets low, and my legs get tingly and etc and so on. And there's 1000 things about this that aren't normal, but if you just accept it, it just is easier on you. Like, I just that's, that's it really, like, just let it be easier on you, because life's already hard enough, and now it's harder. So give away as much of that anger as you can, because it's just better for you, like you're doing yourself a favor by just assuming that that person drove past you for a really good reason. And don't think about it anymore. I know that's probably overly simplified for people, but I just gave that book to two college graduates in my life, I was like, here. I read this a couple of times a year. It really helps me keep perspective, and it helps me be kind, and I hope you, you know, enjoy it now. Will they ever read it? I don't know. I mean, they're like, 20 some years old. They probably are just like, Man, I just want to smoke weed. Leave me alone. But who knows. Anyway, everyone smokes weed now it's a big thing. Ashley, as you know, all right, what did we not talk about that we should have?

Speaker 1 1:07:26
I don't I think we cut mostly. Did we do it? I think we pretty much did it. You

Scott Benner 1:07:32
sent me, like, two emails and the thing that you put in here, so I'm hoping I got to the stuff that you wanted to

Speaker 1 1:07:38
talk about. Yeah, I mean, I think that's pretty much it, unless you wanted to talk about Steve Logan, that's pretty much all. Wait,

Scott Benner 1:07:46
Steve Logan, what is that? Who is Steve Logan, yeah, I have no idea who that is.

Speaker 1 1:07:50
Oh, he is, like, arguably one of the best UC bear, cat basal players that's ever lived.

Scott Benner 1:07:57
What is that? Is that, like, a college,

Speaker 1 1:08:01
college? Yeah, University of Cincinnati. Oh, my God, you don't know who that is. No, of course not. Oh, Steve, okay. Steve

Scott Benner 1:08:10
Logan is an American former professional basketball player. He played college basketball for the Cincinnati bear cats. He's 44 years old now. He's 510 How do you play basketball in your 510 he must be like a super person. He was drafted in the second round in 2002 but it doesn't seem like he played professionally anywhere, because I don't see a listing for that. What does he do? Does he teach in the area now? Well,

Speaker 1 1:08:32
he was at a basketball camp that Trevor was signed up for. He did play professionally. He got drafted. Thank you. Oh, drafted for Golden

Scott Benner 1:08:41
State Warriors. He's a hands on man. Good for you. Steve, nice and hands

Speaker 1 1:08:45
Yeah, no, he's, he's really good. Well, anyway, it was so we had already had Trevor diagnosed. And so we had already had all these camps for Trevor, because you had to sign up for camps in February. Had diagnosed in April, and so we had all these basketball camps sign up. That's when Trevor still played basketball. He'd sent he has since quit basketball. He doesn't think he's good enough at six feet. I'm like, how do you I don't think you're good enough. But anyway, so we were still an MD guy and super nervous, and he had a whole week, all day long, all week at this University of Cincinnati camp spoiler. We live in the Cincinnati area.

Scott Benner 1:09:19
Come meet us. No, I'm just getting good. That's fine. As

Speaker 1 1:09:24
we're going to this camp, we're really nervous. The staff there is the trainers are wonderful. They supply lunch. They're all sponsored every, every day for lunch. So we're trying to figure out the combo, or the trying to figure out the Bolus is for every day. They're they're even able to give him the the injections for his lunches, which is great. So the last day, I gave thank you cards and gift cards to the trainers. And as I was there for the last day, I ran into Steve Logan, and as I was because I was one of the only parents that was kind of walking around. Uh, during lunch time, and he stopped me and was like, Hey, how's going? And just kind of chatted with them a teeny bit, and kind of explained, like, why I was there, just kind of handing out these thank you cards. And he was like, hey, you know your kid. He's the one with pink shoes, and Trevor had, like, neon bright pink shoes, like he couldn't miss them. And I was just blown away that he even knew that my kid was because there's hundreds of kids at this camp, yeah. And he's like, Ah. I was like, is he in your group? He goes, Oh, no, no, no. Some of the beginning of the week had mentioned that your son had type one, and I actually know the signs. So I decided right then that I was going to keep an eye on your kid, because I I have, I have type two, and I know it's not the same, but I know what to look for. So I've been keeping an eye on your kid all week, if any, if he needed anything, I just wanted to let you know that I had him covered. And also he's been, he's been doing pretty good. He's been working hard. And I was like, Oh my gosh. I just like, my heart dropped. And I just like, can I give you a hug? I know I don't know you, but I just also want to give you a hug. And he's like, yeah, yeah, sure, of course. And I looked at him, and I was like, my husband has always told me that you were his favorite basketball player, and I just want to let you know you are now mine, and I'll just never forget that. I just thought that was beautiful, so, so nice, unless

Scott Benner 1:11:30
that's how he gets the moms to hug him and then it's crazy. No, I'm just kidding. That's wonderful, though, and I can see why that's so touching to you. Yeah. Did you see I got uncomfortable with your emotion, and I tried to change direction. I know, I know. I was like, Oh, you're crying. Like he's probably just being creepy. No, I'm just kidding. He probably was not totally joking. That's really wonderful. It was so, so nice. And he has tight he told you, as type two. Yeah, that's something. Well, good for man. See, see, there's decent people all over the place.

Speaker 1 1:12:00
Yes, I feel like throughout this whole year, there's just been dabbles of that, just here and there. It's like, right when we needed it, things happen, someone you know, like the doctor, our friend who had the g7 I had no idea even which CGM to go for, look for, or even how to insert it, and all of a sudden, bam, there. It was wonderful. We had a neighbor down the street. She was the nurse. I had no idea what a 1c was. When that test result came back, she's like, did they check his a 1c I was like, I have no idea that came back. She knew exactly what to help me with. I mean, there's all these little steps all along the way. Ever since it's just been

Scott Benner 1:12:38
solid pieces together. You find a podcast, you read a book, you meet a person. No, no, no, I don't I didn't sound like I was trying to lump me something. I'm sorry. I didn't mean No, no, no, of course, you're lumped in there. No. But like, you know, these little things happen along the way, and you ascend and get better, and it gets easier and etc, and that's going to keep happening for him. You You understand right now. And by the way, if my phone rings, I gotta go. But like, I'm so sorry. No, don't be sorry. It's your fault for not knowing how to plug in your headset earlier. But that's Don't be sorry about it. It's no one's fault. It happens all the time. Seriously, please don't worry. But you know, like you're on a journey, he's on a journey. Your husband's on a journey. You got another kid who, trust me, is being impacted by this. You might not even notice it, yet. You're on a journey together, separately, and everybody's on a different timeline. So you just keep supporting each other, and it eventually, hopefully, people have the experiences they need to have the tools that they require, and they accept what's going on. And yeah, there you go. You know, yeah, that's what I'm calling the episode, by the way, yeah, yeah, yeah, yeah. So that people can incessantly listen for like, maybe they'll turn into a drinking game. Scott says, yeah, yeah, take a

Speaker 1 1:13:47
shot. I think it should. Let's put one right there. What do you think I mean

Scott Benner 1:13:50
by Yeah, yeah? Do I mean I hear you shut up. We're moving on. Do I what is I

Speaker 1 1:13:55
think it's your Matthew McConaughey is all right, all right. All right.

Scott Benner 1:13:59
He sounds much cooler when he's doing it. Yeah, I did not do it justice. I know, no, not than you, than, I mean, than me. I wasn't saying your Matthew McConaughey was terrible. I was saying, Oh, it is. No, it is. But that's not what I was saying. What I was saying was that I my, yeah, it's not as cool as his. All right. All right. All right. Don't you think? Do you think he gets tired of it? Do you think once in a while he's like, oh, people are waiting for it. I'll whip it out here.

Speaker 1 1:14:22
No, absolutely not. He's Matthew McConaughey. He doesn't know. His ego thrives on that. Oh, you think he loves it 100% okay, all

Scott Benner 1:14:33
I know about Matthew McConaughey is, I think his wife is hot. That might not even be true. That's just the thing. I think. Also, I'm a man, so this is pretty much how I judge the world. It's something I'm so sorry. Oh, she is, I'm looking, yeah, okay, very beautiful. Yeah. Certainly is. What are the man? There's a reason to be famous. That lady will talk to you. Goodness gracious, yeah, I should have, I mean, it wouldn't have helped. Anyway. Oh, here comes my call. I gotta go. All right. Well, have a good one. Thank you. It's nice to do this with you. Hold on one

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#1407 Talking Afrezza with Paul Hanson, RN, BSN, CDE, T1D

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Paul shares his extensive Afrezza knowledge. 

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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
Have you ever wondered about inhalable insulin? Well, Paul's here today. He's a nurse, diabetes educator, a type one and an a fressa user. We're going to talk all about it.

Here we are back together again, friends for another episode of The Juicebox Podcast. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. 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 to check out, you're going to save 30% off of your entire order. Are you starting to see patterns, but you can't quite make sense of them? You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, if you're starting to think this isn't going the way the doctor said it would. I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group, just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 this episode of The Juicebox Podcast is sponsored by us Med, usmed.com/juice box, or call 888-721-1514, get your supplies the same way we do from us. Med, the show you're about to listen to is sponsored by the ever since 365 the ever since 365 has exceptional accuracy over one year and is the most accurate CGM in the low range that you can get ever since cgm.com/juicebox

Paul Hanson, RN, BSN, CDE 2:05
Hey, Scott. This is Paul Hanson. I'm a nurse diabetes educator. Was diagnosed with type one diabetes in January 2 of 1977 so you know, do the math. I'm coming up on 53 years. What is the math? 48 years? Good lord, I should check my blood sugar, huh? Pun intended. Honestly, I've been a supporter and follower of you and your daughter for quite some time, so really looking forward to the opportunity to connect with you today. And oh,

Scott Benner 2:32
that's crazy. I didn't realize that. I thought somebody put me in touch with you, and I didn't realize you knew who I was, honestly,

Paul Hanson, RN, BSN, CDE 2:39
absolutely I knew who you were, in fact. Little short story about us. You and I met at an insulate talk, I want to say, a national sales meeting when I worked with insulate, when I went to work for the corporate dark side and left, you know, clinical side of things. Yeah, you were there to give a talk, and I was in the audience, and I totally stalked you as you were coming out of the bathroom because I wanted to introduce myself, because was really a big supporter of you and your podcast. So I'm glad I didn't scar you, and that wasn't something that makes you stay up at night and not sleep, but that's how we first met. Yeah, I do

Scott Benner 3:15
have a scar from that day, if you want to know what it is. So I have a two fold scar from that day. I guess the first thing is, I had never given a talk to that many people before. Yeah, and I got it into my head, initially, to write out what I was going to say. And then, like, the day before, I was up in my hotel room, because this was, it was a national sales meeting. There were hundreds and hundreds and hundreds of people in that room, you know, because insult brings in. I mean, a lot of companies do this, but they'll bring their sales people all together once a year. And so I stood in my hotel room and I looked at what I wrote, and I thought, This is stupid. I can't, like, I can't do this like this, like, I just have to talk the way I normally do. I pivoted very late, and which made me nervous, because I was like, I had never really done nowadays. I just honestly, I just go up there. I'm like, huh, diabetes and go. But back then I was super nervous, and I got up there, and I was probably putting my whole heart into it, I would imagine. And at some point I recognized that was my first scar. Was being scared. My second one was when I recognized that a group of women and men, a mix of people in the front at the stage were crying while I was talking, and I didn't like it was the first time Paul I used to I get notes where people are like, Oh, I listen to the podcast, and it kind of makes me cry, or I feel emotional, and it's all like, nice, but I never had seen it in person before, and I almost felt like, sorry. Do you know what I mean? Like? I was like, Oh, I'm I'm like, I didn't mean to make you feel like this. And they were like, No, it's okay. And it just turned out that, you know, as in a lot of places, there are people working for companies that help people with diabetes that don't have diabetes, and some. Of them, don't. They're just selling a widget in their mind. You know what? I mean, like, it's the thing we make. And they're, they're moving along. But you have type one and, and I think this maybe is going to be why you're, you might be the right person to talk to today about Fresno. So how long? I guess? Let's give people just a high level overview. You've had type one since 77

Paul Hanson, RN, BSN, CDE 5:18
Yeah, January 2 of 1977 so, you know, that was, that was a long time ago. You know, that was when the cavemen were still around, and I had to, you know, dodge dinosaurs and hunt Willie mammoth to get my insulin. So how old were you then, Paul, I was four and a half. Yeah, okay. And truly, my first memory Scott is waking up in a hospital cold peanut butter sandwiches, because that was the snack that I was allowed to have, a mix of carbs and and terribly cold peanut butter. And watching my mom give injections with a at the time, monster sized needles into oranges, and that was my introduction into diabetes. Wow, to this day, I still love cold peanut butter sandwiches. That was a different reason why I was having it back in the day. Yeah. How Where are you on big needles? I'm not a big fan of big needles. I was right at that edge where they were getting into you know, I didn't have to boil my needles, luckily. But the needles back then were, I wish I could remember how big they were, but when I look, I swear I was like, it looked like an 18 gage needle. Holy cow. But I love the micro fine needles now and I, and actually, I do this every day with an ultra fine needle, with my long acting insulin trace needle, so needles don't bother me. I've given a gazillion injections, but it's not something I signed up for, yeah. So all

Scott Benner 6:33
right, so you managed back then. I mean, four years old, your mom, your your parents managed back then with what I mean, are you, oh gosh,

Paul Hanson, RN, BSN, CDE 6:43
ultra lente. Then, yeah, ultra lente and I was using porcine insulin back in the day. So insulin made from, you know, pigs, eventually, there might have been a mix of bovine in there. I, I'm not super clear on that, as you can as you can imagine. Then eventually NPH came out, and regular insulin was pretty amazing. So I was doing that, and I was injecting just once a day. Believe it or not, for years, I had a really And this speaks to the uniqueness of diabetes. But my MPH lasted for an abnormally long time, to the point where I would actually get nocturnal hypoglycemia quite a bit at night, and so they mph in regular in the morning, and then a little dose of regular in the evening. And that's what I managed for Honestly, all the way through college, really. Yeah, it's crazy. And then Lantis came out for me, and that was such a game changer, because you have diabetes, she's like, oh my goodness, I wish there was something more physiologic, more physiologic. And so when that came out, I got to go through the amazing fight with my insurance company, which I won't mention which one it was, about how I needed to have it. Long story short, I just said, Hey, no, no worries, man, just look forward to an ambulance call in the near future, you know, with the mph, you know, giving me issues in the middle of the night, and it'll be a good time. And you can pay for that, or you can pay for my Lantus. Yeah. They were happy to move along. Then, yeah, and then they paid for the Atlantis.

Scott Benner 8:08
Sometimes you have to say things on phone calls to get your get your meds, that's for sure. I've done it a number of times in my life, yeah, but you did regular and mph through college,

Paul Hanson, RN, BSN, CDE 8:17
yeah, yeah. I mean, remember I was, I was born in 1972 so we'll date me. Yeah. Awesome, yeah.

Scott Benner 8:24
So do you remember what your your outcomes were like then, like going back to college, for example, I

Paul Hanson, RN, BSN, CDE 8:32
do. I do. You had to be very regimented when you were on mph. And even with that regimentation, there was still going to be variation, just because, you know, the human body does what it wants to do based upon all the things that you're doing. So I would have to make sure that I had a snack with me in between, as I was walking through what's called the quad, I went to case, Western Reserve University in Cleveland, Ohio. And if I didn't have a snack, I would actually start to tank and get low in the middle of my walks. And of course, there are times where you're running late in one class and you're trying to get to the other because attendance in college for some reason in certain classes. In this case, I think it was statistics at the time, nursing statistics, you had to be in your butts and seat before the class started. So there were times where I would walk into a class and I'd be breaking out into a sweat. And it wasn't because I had had to run to class. It was because I was now having to fight off a low Yeah. Next thing you know, I'm I'm guzzling down a can of soda because that's what it was back in the day for me.

Scott Benner 9:33
Yeah? Jesus. Well, okay, so when you go to Lantis, I want to kind of jump through. I want to understand the different stops you've made management along the way, so Lantis is still your MDI there. I imagine diabetes comes with a lot of things to remember, so it's nice when someone takes something off of your plate. US med has done that for us. When it's time for art and supplies to be refreshed, we get an email rolls up and. In your inbox says, Hi, Arden, this is your friendly reorder email from us. Med. You open up the email. It's a big button that says, Click here to reorder, and you're done. Finally, somebody taking away a responsibility instead of adding one us. Med has done that for us. An email arrives. We click on a link, and the next thing you know, your products are at the front door. That simple, us, med.com/juice, box, or call 888-721-1514, I never have to wonder if Arden has enough supplies. I click on one link, I open up a box, I put the stuff in the drawer, and we're done. Us. Med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and the Dexcom g7 they accept Medicare nationwide over 800 private insurers, and all you have to do to get started is call 888-721-1514. Or go to my link, us, med.com/juicebox, using that number or my link helps to support the production of the Juicebox Podcast. Why would you settle for changing your CGM every few weeks when you can have 365 days of reliable glucose data? Today's episode is sponsored by the ever since 365 it is the only CGM with a tiny sensor that lasts a full year sitting comfortably under your skin with no more frequent sensor changes and essentially no compression lows. For one year, you'll get your CGM data in real time on your phone, smart watch, Android or iOS, even an Apple Watch predictive high and low alerts let you know where your glucose is headed before it gets there. So there's no surprises, just confidence, and you can instantly share that data with your healthcare provider or your family. You're going to get one year of reliable data without all those sensor changes. That's the ever sense. 365, gentle on your skin, strong for your life. One sensor a year. That gives you one less thing to worry about, head now to ever sense, cgm.com/juicebox,

Paul Hanson, RN, BSN, CDE 12:12
to get started. Yeah. So I changed Atlantis that was, I want to say that was 1991 to be honest, maybe 92 okay, I might be dating myself. Apologies, yeah, so I was on regular still for a little bit, and I would give it to myself, because they would cover the land just, but not the rapid acting insulin yet, but then, like, honestly, within a month, I just let them know that that wasn't going to work, because I wasn't having coverage in the middle of the day, and the last thing you wanted to do was take an insulin that might work, you know, eight hours or more with the regular insulin, and give it in the middle of the day. And so I was having issues. And then at that time, right? I was studying to, you know, be a nurse, and I really paid attention to the insulin action times. And I was like, Look, here's a map, or not a map, here's a here's a graph of how my insulin is working. I need to have this rapid acting insulin. And so eventually I was able to get that covered, too. And so then I began multiple daily inject, I would say, probably 92

Scott Benner 13:09
there. Okay, 92 you're doing. MDI, now. Do you ever go to a pump

Paul Hanson, RN, BSN, CDE 13:14
I did? I worked at Seattle Children's, you know, an incredible institution there, and I was blessed to work with all the different reps there and be introduced to all the different devices, including an old one, which I was really, I was a big fan of the Smith Del Tech Cosmo back in the day. It was that introduction into the different pumps, seeing the results that other children were having, and hearing what the reps were saying at the time, actually, and just my own personal need to make adjustments for basal based upon at the time I was a collegiate athlete, to plan soccer having to adjust my basal rates. I wanted to have more precision over the dosing of my insulin. So I did. I started on pump therapy. Gosh, when was that?

Scott Benner 14:02
The Cosmo? Was that your first pump? No,

Paul Hanson, RN, BSN, CDE 14:07
actually, the the Smith first pump was gonna be a decent Tronic, but that wasn't gonna be covered. And then decent Tronic was purchased by Roche diagnostics. So I then waited a couple years, actually, because when I first wanted to go onto a pump, I wanted to do something unique. I was seeing, I was being seen by my Endo, Swedish Endocrinology at the time, and I said, Hey, look, this is what I have to do. I'm an athlete, and I was pursuing professional soccer at the time. I was like, Look, I need to make sure that I can simulate as close to possible a decrease in the phase the basal insulin. So I want to start on my pump with 50% of my basal daily being given by Lantis, and then the rest of the basal rate being figured out based upon that daily Lantis. And so I had to sell them on the clinical benefits of that. And I said, Well, look, you know, one of the things that you teach is. If you have a site failure, there's a chance that you can go into DKA faster I go. Wouldn't you think that it would be better if I have this 50% basal to minimize that risk? And that was actually what allowed me to go onto a pump with 50% of my basal being given with Lantis insulin. At the time, that was probably 1990 or no, not 1990 that was probably 2000 and which is crazy, 2006

Scott Benner 15:27
well, 2006 Yeah, I'm wondering, like, you know, you're making charts to tell people, like, hey, I need this. Like that. Do you think it was the fact that you were in nursing school, or is it more about how your brain worked? Like, why were you tracking it? I mean, I've talked to so many people are like, look, they told me how to use the instant I put it in. It didn't work. Well, I didn't do anything about it. Like, why were you so on top of it, why were you the one suggesting bigger ideas?

Paul Hanson, RN, BSN, CDE 15:52
Yes, this is actually part of my story, Scott. I think a large part of it is, yes, I was a nursing student. But I think I was a nursing student because at a very early age, on my eighth birthday, or my mom asked my endocrinologist, not the most healthy individual, I'll save the specifics, but asked if she would have risk of having grandchildren with diabetes. And in an effort to try to minimize her angst, he actually said something that was pretty crass, and you said, if you have other children, you won't have to worry as much about it, but you won't have to worry about it with Paul either. A, there's a small chance in B, he'll probably have passed by the time he's around 30 years old. So now this is, this is on my eighth birthday, and you know you're, you're a kid, yeah, and you're sitting on the doctor's table and your legs are swinging, Scott, and you're just like, don't, don't, I'm gonna get a sticker. It's my birthday, and everything just stopped. And to be transparent, I was a meek little kid at the time then, because I went from being the tallest, most rambunctious kid prior to diagnosis, according to photos and and stories from family to being told that I couldn't participate in gym class, I was on a calorie restricted diet, and I went from being about head size, taller than everybody, to up until I was, gosh, 12, whatever, having calorie restrictions, and clearly, like being the shortest kid and not being able to participate in anything. And so I became very meek because I was told, I can't, I can't, I can't, I can't, you're sick. You're sick, you're sick. And so that was pretty tough. So on this eighth birthday, I got that note from the doc, as my mom is now crying, yeah, and she just wanted to know about the risks of grandchildren, and he, he said, the bus, get the bus stuff.

Scott Benner 17:44
Make some more babies. This one's gonna die soon. Yeah, yeah, yeah. It's really,

Paul Hanson, RN, BSN, CDE 17:48
it was really happy birthday. So I got up, I hopped off the table, and I walked out. My mom kind of lost her at me, because he didn't understand why I was leaving. And I was in in the lobby, and she came back. She's like, you need to come back and apologize to Dr blank. I'll leave his name out of this. And, Doctor, how's that sound? Yeah? Doctor, I said, Mom, I'm not, I'm not going to apologize to Dr butthead. I'm going to say butt heads, whatever you're good with. Yeah. Yeah. And I was like, I don't want to see him anymore. She's like, you will get back in there and you will apologize now where you're grounded. So I feel like that's kind of when I just woke up, not the conversation with my mom, but that day. So I walked back in to see Dr Butthead, and I let him know. I said, Look, Dr Butthead, you're fired. I don't want to see you anymore. You're not my endocrinologist. You're gonna die a whole hell of a lot sooner. I didn't say, Hell if I was an eight year old, but you're gonna, you know you're gonna die a lot sooner than I will have a good life. And I looked at my mom, and I said, Happy Birthday to me. You can ground me. And I walked back out, and that night, I gave myself my first injection. Oh, wow. It took about a half an hour because I had to overcome the fear of jabbing myself with this needle. And it lasted that fear for for quite some time. And I've got a funny story afterwards about, you know what the solution was? Yeah, I think that's getting back to your original question. I think that's why I became so focused on not being limited because of my diabetes like so I truly believe no limits. You know, I no limits. I

Scott Benner 19:25
mean, that's first of all astonishing, that at eight years old, you're like, I'm drawing a line in the sand right here. How did your mom respond? Did she relent on the grounding thing? Did she see your side of it ever? Because it's 1985 she also could have taken you out of the car, beat you amongst your head and shoulders. So I'm not sure what happened exactly. Oh well. So

Paul Hanson, RN, BSN, CDE 19:41
actually, it was, it was 1980 at the time, when on my eighth birthday, she did not relent. You don't know my mom, I was definitely grounded. I still gave myself my shot that night, and what I decided that day, it was something I felt. Got like this guy couldn't even take care. Of himself, and he's gonna put this diagnosis in on me. And I had been limited already so much that I said, No, no, no more. And I started to learn about the insulin even more the next weekend, I forged my my my parents signature. I'm really kind of speaking a lot to my character right now, so I apologize.

Scott Benner 20:17
What were you doing? No to play

Paul Hanson, RN, BSN, CDE 20:21
soccer. Oh, okay, yeah, because I wanted to play, I wanted to go be a kid, and I knew, if I could have, you know, my mom was and dad were excellent about making sure I always had snacks around because hypoglycemia was, it was nasty back in the day, and I've got some really scary stories about just paramedics being called in. You know that the course of adrenaline that's running through your body and them having to call in two sets of medics because you're just whooping everyone's ass as an eight year old, you know, kid, you know, weighing nothing. And so it's, it's just, it's not a great thing. It wasn't a great feeling. I decided that with this, you know, with sodas and juices and other things. I was going to go play soccer. And when I was found out that I did that, of course, I was grounded for that as well, but I just said, Look, I'm going to be dead by the time I'm 30, so I'm going to have died playing soccer.

Scott Benner 21:12
Yeah. Why not soccer? I don't even think I might get the women. So I got over, yeah, yeah. I got limited, limited horizons. Here it feels like, how long did you go along thinking you were gonna die in your 30s?

Paul Hanson, RN, BSN, CDE 21:23
Not long it was after soccer. Basically, I put that out of my mind as like, Okay, you proved

Scott Benner 21:27
it to yourself. You're like, oh, I if I did the Yeah. Here's another thing they told me I couldn't do. I did that. So they might have been wrong about all this stuff. It wasn't even

Paul Hanson, RN, BSN, CDE 21:34
that I just I was gonna do everything to spite Dr Butthead, and I was going to learn everything I could and try to do the best that I could. And I knew at a very young age, I you can see and feel, if you think about it, we didn't have sensors. We had, you know, test strips, that you're checking your blood sugar, but you were limited on how many times you can check your blood sugar. But as a person with diabetes, you can feel when your blood sugar is high. You can feel when it's lower, it's coming on. You know, others without diabetes might not understand this. There would be times where I would sneak something. I would sneak a donut, because I was done being told I couldn't have a donut, or this, that, or whatever. And all of a sudden, my muscles would ache, and I would go and pee on the ketone strip and make sure it wasn't getting too high. But it would show that, you know, you're spilling glucose and all that stuff. And so I saw the cause and effect, and I was like, Well, if that's the case, if I want to have a donut, and my insulin is working this much, but my blood sugar is going to this high after I have a donut, means I can't have a donut, or I have to give some insulin for that donut, which honestly, at the time, was probably a little silly, because for quite some time, I was doing that with regular insulin, but I was not allowed to go to birthday parties or anything like that until I was around 1314, years old, because of those challenges and not being able to have cake. And my mom was worried that I was going to eat cake because I would pack my insulin. And she's like, you can't go to the party. I don't want you giving insulin there. You might get low, and I would and I would tell her, I go, No, I'm not this. Insulin is not going to kick in for the next two, three hours. I'm going to take one, one unit so I can have a piece of cake. Let's not prescribe like that. You can't I go, Yes, I can. This is how it acts.

Scott Benner 23:13
Yeah, I've been doing this. I'm paying attention. This is how you know, it's funny, Paul, your story. So mimics a situation that I had where I think a well meaning medical professional told me that I shouldn't worry about Arden's blood sugars going up and down, because it takes like, 30 years for diabetes complications to happen, except when she was telling me Arden was two, right? And so I stopped her, and I said, So you're telling me that when my daughter's 30, she's gonna have complications, and then there's that dead look, you know, that's there. And I go, that's not comforting, you know, in case, in case, she thought it was, and I think that might have been about the time that I thought I'm gonna have to figure this out, because I don't think anyone else is gonna help me. Yeah,

Paul Hanson, RN, BSN, CDE 24:00
yeah. Gosh, this could be an entirely other call, and it speaks to the challenges within, you know, endocrinology itself, and the support and all that stuff. But I do think we're still blessed within the pediatric space to have the support that we have. I've met

Scott Benner 24:13
a ton of good people along the way, and that person, by the way, was valuable to us throughout the it was just that one moment where they, I think, people don't think or Well, I mean, Dr butthead seemed a little more unnecessarily direct. Like, maybe, hey, why don't we let Paul go outside for a second while? I let you know that you should keep procreating if you want grandchildren without diabetes. Like, exactly, by the way, do you have brothers or sisters?

Paul Hanson, RN, BSN, CDE 24:35
I do. I'm the oldest of six, and none of them have diabetes. Wait. Your mom listened, though, huh? Yeah, man, she cranked him out, and I didn't even get a sticker that day. Scott, well, you

Scott Benner 24:50
know the downside of this is your dad probably loves the doctor,

Paul Hanson, RN, BSN, CDE 24:55
or does he? She also has six i.

Scott Benner 25:00
So I think what we're highlighting here, and I'm glad you know that you were able to share this, because I'm trying to figure out how you get to inhaling insulin, because it's a leap, but now it's not a leap for a person like you, and so now that makes more sense to me. So you did pumps. You did i I'm gonna jump ahead now to for us, if you don't mind, I'm sure you tried pumps along the way. Everything else. Where do you first hear about inhaled insulin? What makes you start trying it? What did you experience early on that kept you going? Yep,

Paul Hanson, RN, BSN, CDE 25:30
I met Al Mann at an ADA event. I want to say it was, might have been the one in Washington, DC. It was some famous anniversary for the ADA. I can't remember what year it was. Al Mann himself was there in front of a video screen talking about this insulin. And for anybody who doesn't know Al man he's behind the creation of this inhaled insulin of Fresa. He created the company mankind. And I was so enamored by what he was discussing and the implications that it could mean in the diabetes space. Let's step back a little bit selfishly, just for me as a person that wanted to have something that was more physiologic, I would still, at the time, have challenges with my pump, and it was always centered around meals as a result, you know, I would know certain holidays or whatever, my blood sugars were going to be a little caddy Wampus for a while, and that's just what you did. Or at least that's what I did. What this meant for me was there was an opportunity and see if it could help with those challenges. Like, honestly, Scott, I I suddenly would have cereal until I started on a Fresa, because it was going to be a show, I could guarantee I was going to shoot up into the three hundreds. And then I was definitely going to stack my insulin. Because, you know, you try to get on top of that. It doesn't matter if you give it 30 minutes beforehand, at least in my case, because everybody with diabetes is different, I would still go up, and that was just based on, you know, the cereals. And so I was like, Man, this is a physiologic mimicking insulin that's getting into the lungs, which means it's getting right into the bloodstream. They differentiated it from the inhaled insulin exuber Which, you know, came out when I was working at Seattle Children's. And I was like, this, this could be a game changer in the diabetes space. So I watched it for a while. I kept watching it. Unfortunately, Al man passed mankind and Sanofi Aventis kind of partnered early on, and my perspective was that they took more of a type two route versus a type one route, where I was surprised by that choice. And this is just Paul Hanson as an n of one making that decision, because I saw in the type one space, the fact that we are so impacted by the need of insulin at all times, versus, you know, the

Scott Benner 27:54
type two space, and the speed of it being so important too, yeah, and

Paul Hanson, RN, BSN, CDE 27:58
the speed of it being so important and the fact that it cleared so fast, so honestly, I started on it about five years ago, okay, and the first thing I did was I was with a friend. I didn't get their permission, but he's in the diabetes space, and I can ask for forgiveness, but I was with two friends, and I'm going to share their names, and I'm going to let them know, Scott, unless you don't want me to, but it was Brian Lee and Gary Yamada, two very close personal friends of mine. Brian was actually working for mankind at the time, and he had been telling me about it. And so I ended up getting some of, you know, my own a Fresa, and we met, and I was like, Yo, I'm so excited about this. I want to get an obnoxious meal, and I want to test this. So we, we all met down in Southern California. I had chicken and waffles with regular gravy, knowing that it would it would have devastated me on my pump, yeah, and so what I did was I had my pump for basal and increased it, and then dosed for that meal. And honestly, I didn't get above, like, 180 200 and I was like, wow. What I noticed, though, is I needed to dose a little a little bit more later, you know, probably about two hours later. Okay, I recognize that this was going to be some learning for me, but I did not go into the three hundreds. Yeah, and I don't feel like for me, my muscles ache. I get cloudy a thought. I just don't feel great, dry mouth, all the fun things. So the next thing I did was I hadn't had a bowl of cereal. I sat down. This is when I came home and I asked my wife to pick up some cinnamon toast crunch. So of course, my kids, who were younger at the time, were like, sweet. I'm like, Look, Dad's getting the first bowl. And I had a college size bowl of Cinnamon Toast Crunch. And again, I dosed with more confidence, with a little bit more of the and I didn't shoot above 180 and, you know, I came back down like, probably. Just finished up at around 150 that That, to me, was such a game changer. To be clear, it's it was a process for me because of the fear of hypoglycemia, I

Scott Benner 30:09
would imagine, yeah, because you'd had diabetes for such a long time, and it's so ingrained in your head about, you know, mph and how long it lasts, and you got to eat at the right times and all that stuff. But that probably makes you a better, you know, navigator of learning this new thing too, yeah.

Paul Hanson, RN, BSN, CDE 30:27
And honestly, if you think about it, hypoglycemia dictates the actions of anybody with diabetes, of parents with children with diabetes, it's, you know, we want to prevent that, I mean, for obvious reasons. And so I was slow in my uptake of utilizing it all the time. I would probably use it for one or two meals a day, probably about three years ago, I went to it full time. I went to traceba, because for me, that insulin worked really well as far as basal control, as well as being able to exercise and not having the basal insulin itself drive me low as a result. And again, I'm an n of one. That was my result. And then with the ephraza and I've been for the last three years on a Fresa and placebo, the best I can get, my ANCs were around six three to six one, and they dropped to a five nine to a five seven. And I've actually had a five three, and that's with hypoglycemia ranging one to 3% only, wow, and, and that's a big

Scott Benner 31:28
change. No, that's huge. How would you describe your eating style? I'm still lower

Paul Hanson, RN, BSN, CDE 31:33
carb to be honest. I just, that's just my choice. But come holidays and stuff like that, I'm not limited anymore to having these desserts and worrying about my blood sugars. Early on, I put on a little weight because I was a little too excited. I was

Scott Benner 31:48
gonna say you were just like chicken waffles. Great, by the way, chicken waffles and gravy. Way to go. You're like cereal. What else I bet you were? I actually you know what I thought to say earlier. I bet you, Dr butthead and you had more in common by the time you figured out a phrase.

Paul Hanson, RN, BSN, CDE 32:05
It didn't get that bad, Scott, but honestly, you think about all those years of not being able to do things, and I probably put on eight pounds, okay, that was also after a knee surgery. So there's a combination of things, but that all being said now, exercising, you know, ex pro soccer player, I eat what I want, and I don't have to worry about it. My wife is Cambodian sticky rice, all the yummy things. I eat what I want, and I don't have to worry about the crazy spikes.

Scott Benner 32:35
Yeah, no, it certainly is. You're not a high carb all day person. But no, if you run into something now you would have ignored it in the past, and now you say, Oh, I'm going to give this a shot, because I feel like I can kind of crush this spike and stop it from happening, and I'm going to get a rise still, but not something that makes me feel terrible, or that lasts for four hours, or that ends with me crushing it and then having To catch it on the back end

Paul Hanson, RN, BSN, CDE 33:00
Exactly. This is the thing for me. And I shared this early on, because of the fears of lows. There'll be time when i times when I had dosed incorrectly, I had to give myself more, you know, an hour later, because there were times where I did estimate wrong, right? You know, you're carb counting, and you're doing all these things based upon in the past, I had an insulin to carb ratio and insulin sensitivity and and all that stuff. You know, you're putting together your best guesstimates. There are times because there is no perfect science with diabetes. I feel or it's very hard to get there. I did have to. I definitely missed dosed. But again, that was my my fear of lows, right? And so part of my journey with dosing of a fraza was the embracing of the fact that you had to always take about one and a half times the amount of the insulin that you would normally give with an injectable insulin. And in all honesty, you know, it's, it's kind of out there with mankind's peds trials, they're testing it at two times the dosing. And that's actually what I ended up finding myself is that I had to, I had to take around two times as much insulin, and so that that can scare a lot of people because of the fear of hypoglycemia. I want

Scott Benner 34:09
to dig into how the dosing works and everything. How long do you think it took you to figure out the dosing? I

Paul Hanson, RN, BSN, CDE 34:16
want to get this out for everybody so they know this. Again, diabetes educator, nurse. For a while. I did work for mankind, so I need to get that out there. Yeah, please. And even with that, though, because of my own personal experience with hypoglycemia, it probably took me nine months, okay, to a year, truly just me, because of my own you know, I, I don't, because you took to it because of the path, because I don't want to be a burden on my family. I don't want my wife. She has never had to call the paramedics, never had to deal with glucagon. She's never had to do that. My kids haven't had to see that. That's a driver for me, yeah, and so in those instances, I would probably run the risk of being a little bit higher because I knew that you could. Correct sooner, because it clears so fast, and that was the route that I took. That was my route.

Scott Benner 35:06
All right, so the reason I was am so excited to have you here is because I feel like I've talked to a handful of people using it at this point, and they've all done a great job of telling their story. And I'm certainly not, you know, saying otherwise. But I always end the conversations feeling like no one's been clear about how this works. Like, you know, you know what I mean, like, I know with like, you're using liquid insulin. It's insulin to carb ratio, it's insulin sensitivity, factor, it's, you know, it's your basal. Like, it's these, these things, right? And now there's algorithms that are that are moving, you know, dosing around for you within parameters, etc. And if you ask somebody to explain that, they can explain it, yeah, like, here's the formula I use to get to my insulin to carb ratio. And so when I count up 50 carbs, I take, I'm one for 10, so I take five units and, like, that kind of thing. I ask somebody on a pre to this, and they're like, oh, you know, a four and an EIGHT and a 12, and do you do two? And you wait one, and I'm like, I don't know what you just said. Like, like, so. And what's worse is I don't feel like they know what they just said. Sometimes, yeah, so please tell me I'm gonna

Paul Hanson, RN, BSN, CDE 36:17
try to expand upon it, okay, the way it would, and I had trained patients on it and stuff. Starting orders for this are, if you're taking up to four units of injectable insulin, four units of a fresn, but anticipate that your end dose is going to be an eight, okay, for that meal type, okay. Now there is a precision that we perceive that we have with injectable insulin based upon some crazy things, such as, we exactly know where we are, physiologically, we have absolutely crushed our insulin to carb count, in spite of the fact that, you know there is, I think, allowed up to 20 plus percent variability on the food labels, as far as carb count and all these things. And you know, you could, you've heard the story over and over that you could put a meal down in front of a bunch of registered dietitian dietitians and nurses who they do this for a living, and you're going to get such a wide variety of of carbohydrate estimates right. And so with that, we try to get as precise as possible. And I think we have tricked ourselves. If you take away the A I D component, automated insulin delivery, and you just go back to generic MDI and pump therapy, we have convinced ourselves that we've got a very precise algorithm, and it's exact. Yeah, I agree with you. That is just not true. Diabetes is complicated.

Scott Benner 37:40
When people say, I can do one thing one day, the same thing the next day, and two things that you know, like, You're not exactly are you dehydrated today? Were you less active yesterday than you were the day before? Like, you do your best you can right? Like, and so I assume the same is with a fresn. But like, just to start off by saying, like, Hey, if you're, you know, injecting insulin right now, and you're moving to a fresn, and normally this meal is four units. Well, it's probably going to be eight, but you also just said that the studies might indicate that it could be 16. So like, how do you figure it out?

Paul Hanson, RN, BSN, CDE 38:13
This is exactly what it is, right? You take what you would be given at that meal and one and a half times it, and you then round down, and that's for safety, for fear of hypoglycemia. You then check your trends one to two hours later, and if you're having to correct one to two hours later as a result, that then means that that dose was off probably by four units in that case. And just like anything, just like when you go onto a pump and you're having to call into the diabetes educator, and you're having to have basal rates adjusted, and you're having to have insulin to car races adjusted based upon two or three days data, and then you're having to do the same thing two weeks later, because now that data is incorrect and it's not working any longer. The same thing is happening with your friends. It's an if then statement from a safety standpoint, one and a half times round down if you then need to correct at that carb count with that meal type. Then next time, give yourself an example like this, an additional four units. It's really that simple and what, and I view it as simple, because I've done it, even though it took me a year. But my path, for me, it was year of lows. That was that reason, right? Not, not the precision. And what I have found is that I can look at a meal and it's more carb recognition versus carb precision, yeah,

Scott Benner 39:32
like this meal takes about this much. Yes, yeah. I mean, that's how I taught my daughter to do it as well, right?

Paul Hanson, RN, BSN, CDE 39:39
Yeah. And for anybody that is, how could I say this, at risk of underdosing and then later on stacking, or, let's talk in general, how hard is it to dose 15 minutes to a half an hour, depending on your blood sugar in advance, so that that insulin? Is ready to rock and roll as you're digesting your mixed meal with, you know, fat, protein, carbohydrates, etc, etc. It's not easy. And so the challenge that we see with a lot of patients, and I've faced this when I was in the clinical setting as well as, you know, on on, I say, the commercial dark side of things is that patients know so many times that if they sit down and they're giving their insulin at the start of a meal, the perception is, is that they're failing because of how hard it is? Oh sure, yeah, so that that kind of stinks. And so with for me, the reason I chose to go on a Fresno was I got to that point where I recognized carb recognition, and if I needed to, an hour later, I can give myself a correction, and I hear a lot of Doc saying, Oh, I can't even get them to give their insulin. How are you going to get them to, you know, to take it more insulin. An hour later, I would always just push back and be like, hey, just with all due respect, diabetes is hard, and this is an incredible option for those patients that and I'm going to push back even more doc that are taking their insulin, they're just taking it at the time that they eat, and that means they're not actually they're reducing their risk of success.

Scott Benner 41:08
It ignores how insulin timing works. You know, liquid insulin timing works, right? So I take all your points too. Like, you know, if you know you have to Pre Bolus and you don't, then the meal already started, when you're just like, Oh, I already screwed this up. Like, that feeling right? And then your blood sugar shoots up 1015, minutes later, and you're like, oh, here it comes. I do, like, not disagree, but like, I do think that it's okay to Bolus again. I'm not a person who says that. Like, oh, well, you know, the insulin action time is three hours, so you're gonna sit here and stare at this for three hours. My opinion is, if you missed on the dose, and your blood sugar shoots up, obviously you needed more insulin in there. Yeah, the sooner you put it in, the better, honestly, because at least then it's still working against the impact of the food, right? If you need it, I don't think you can stack if you need it,

Paul Hanson, RN, BSN, CDE 41:56
and I agree with you in that case, right? Because what happens is, A, you know, you messed up on the carb count. B, now your blood sugar is climbing. C, there's something called glucose toxicity, which then makes you insulin resistant to the quantity of insulin that you're taking in. Yeah. And so there's all these different factors that go into those, those times right, where it's really hard to say you're not going to stack, you know you're not going to give yourself more insulin. I don't

Scott Benner 42:22
have to Pre Bolus. Fresno, oh, you sit down

Paul Hanson, RN, BSN, CDE 42:26
and you eat and you take your insulin. And for for those with like, say, gastroparesis or others, they can actually wait until their CGMS are starting to trace up, and then they dose. They hit it there. This is the way it works. You inhale. It's in your lungs in less than a second. It's in your bloodstream in less than a minute. It's already an insulin monomer, which is the usable form of insulin, which the hexamer, or a monomer, bound upon itself six times, is actually breaking down into in the body to be in usable form. And now you're just you're inhaling it. It's a monomer. It's in your bloodstream in a minute. And you know, it's peaking and not peaking, it's starting to have a measurable effect in around 10 to 12 minutes. And this is all in the prescribing information the PI. It's mimicking a peak of physiologic insulin when you have a closed clamp study of around 45 minutes, right? And then the insulin response for somebody without diabetes. So it's pretty amazing, to be honest, there is the nuance of having to learn how to heck do I dose with this? And how do I overcome my fear of lows with this? I do want to say real quick, and we can put a pin in this. I also think the lows are different with an Ephrata than other insulin. My I'm not in front of the fridge inhaling because I know I might have three more hours worth of insulin in me if I, if I do get a low, instead of taking 15 grams, now I might take four to six grams. And I have these gels that I take that are, you know, around eight grams of carb, because it really just depends on, when are you having that low? If you're 45 minutes to an hour into your inhaled insulin, gosh, almost out of your system. So you don't need 1520, or a fridge full of food, because you've got hours of insulin, you know, sitting in your system. So there's that benefit as well. What

Scott Benner 44:10
number do you call low for me? 70? Okay, you would treat a 70. If it was falling, if I was

Paul Hanson, RN, BSN, CDE 44:17
falling at a 70, I would definitely treat that, I will tell you also something unique about amafreza. My understanding with the CGM is that their algorithms are based on 20 minute predictive values, right? And CGM technology is changing a ton, so I apologize if I'm Miss speaking slightly about any of the newer ones that have come out, but it's predicting where you're going to be. Well, the rate of change with the fresn, because it's so fast, is is different than injectable insulin. And so there are times where I've actually had a blood sugar that's been 100 and it's had a double arrow down, and I was like, Hey, when did I take my fressa? And I look in it, and it's like, oh, it's was 45 minutes ago. Up. I don't stress about it. I watch and I wait and I see how I feel, and 15 minutes later, my CGM will level out, and I might be 9295 but it thinks, because of that rate of change, that it's going to continue for that a long duration, because that's what happens with injectable

Scott Benner 45:20
insulin. Let me ask you a question. Uninjectable. You know, if I said the phrase, you can feel the fall, you know what I'm talking about, right? Oh, absolutely. It's Oh, yeah. Does that happen with a Fresa? I

Paul Hanson, RN, BSN, CDE 45:32
have not experienced that, okay, however. Well, now I want to back that up. I have experienced it, but it's not this anxiety ridden again. Have to get in front of the fridge. It's, it's the only, only thing I can describe is that it's different,

Scott Benner 45:49
yeah, because it feels physiologically different, or because you have a different feeling about what the outcome is going to be, combination

Paul Hanson, RN, BSN, CDE 45:55
of the of the of the two. Okay, right there. There are times where, if I've eaten a fattier meal, and it's slower to absorb, absorb, I have actually started to go low. It's made me nervous, especially if you know you're out and about with people. And so I will take an eight, you know, a quick eight, a hit of an eight gram gel, and I'll just continue to watch. And there are times where I've actually felt it and I started to sweat. That's another one of my physiologic things is I start to sweat. And it doesn't happen frequently, but when it does, those gels come out pretty quick. You know, they help me very quickly. And then what happens is, I know that that fatty meal is gonna drive me up later, so I just watch it. I was gonna say, dose again later. Do

Scott Benner 46:45
you use a Fresno, like, like, you know, like, thinking back to, like, an old square wave bowl, a certain extended bowl, the dual waves and all those, yeah. Do you put in some, like, you know, let's use, like, a real cheesy meat lovers pizza idea. Oh, 100% do you put a little bit in up front and then come in, what, 45 minutes an hour later, and hit it harder.

Paul Hanson, RN, BSN, CDE 47:04
I am so glad you asked me that question, because, man, pizza is such a pain in the butt. But, yeah, let's, let's, let's get even crazier. Let's go, you know, Dick crust, let's go, you know, Chicago style pizza.

Scott Benner 47:16
It's not really pizza, but go ahead. I'll, I'll allow this. Go ahead. Okay,

Paul Hanson, RN, BSN, CDE 47:20
I appreciate that.

Scott Benner 47:21
I know you're from Ohio and everything, but I don't think that counts. But go ahead,

Paul Hanson, RN, BSN, CDE 47:26
it doesn't. That's actually, yeah, that's a gut bomb. I hear you, but yeah, I'll dose more up front than I'll dose 45 minutes later, and I do dose every 45 minutes. Just to be clear with pizza is the concoction of the fat and the meat and everything, and the carbs I want to get on top of the carbs that are going to break down quickly. And so, you know, usually I'll take an eight there, and a pizza is going to be the dish that I take the most insulin with, for me, with my insulin needs. Yeah. So I'll usually take an eight, and then 45 minutes to an hour later, I'll take another eight, and then one hour later, I'll probably take another eight, and that's for, you know, two to three pieces of pizza. And I'm having to dose three, minimally three times for pizza. There are times when it's four, okay? There are some people say, just dose up front heavily for that. I have not had a good experience when you do that. The reality of it is, is this drug you down too far? Well, yeah, and this is a deal, and this is something I don't think is very commonly known. So at the smaller doses of friends of clear is super quick, right? Okay, but when you have larger doses, it does take a little bit longer to clear, okay? And so that might be some of the you know, the clinical rationale to just take more upfront if you're going to need that. I with hypoglycemia and the fear of hypoglycemia being with a driver, take a different approach as a person with diabetes, which is, I'm going to dose a good amount up front, and I am willing to dose, you know, three or four times so I can, a, enjoy that pizza, but B, avoid that risk of a low I

Scott Benner 48:53
think. Okay, we haven't gotten into this part yet, but you're inhaling it, right? So, and they're in little disposable like cartridges. Like cartridges, okay, how many of those do you think you use in a day? It depends, right?

Paul Hanson, RN, BSN, CDE 49:05
If, if it's a pizza day, then it's going to be significantly more standard day. I probably use between three to five.

Scott Benner 49:12
Okay. How do you carry them with you? They're in your pocket. Do you leave them in your car door? Like, how do you imagine

Paul Hanson, RN, BSN, CDE 49:18
an Altoid tin? Right? I went to training patients and when and for myself, I just went on to Amazon, and I found these black TINs that look like Altoid tins because I didn't, you know, want them to be minty fresh smelling as I inhaled them. And I get that the inhaler goes in there, and then I take out the cartridges that I need for the day. And I put them in there. I take them out of their foil wrapped and I put them in there, and they carry them with me. And so once you've taken them out from that little foil wrap, and they're and they're loose, they're good for three days.

Scott Benner 49:51
Okay, out of the like, refrigeration or not refrigeration, no,

Paul Hanson, RN, BSN, CDE 49:55
out of the foil wrap itself. So got a larger foil wrap. Package, and then in it, right? That's got rows of additionally foil wrapped containers, right? And each each row has three, so you'll have 30, and then an entire foil wrapped package. What I do is I usually take a row of five out, so five times three, so 15 cartridges, and I leave that in my my diabetes draw. And each day I'll go and I'll take section of fours. So I'll take three fours and and three eights, and I open up that portion, I put them into my little tin, and that's what I carry with me. And that's, you know, to me, this to me, that's not a big deal. Okay? I either have it my jacket pocket or my work bag. You know, in the past, I would carry it in my pocket. I've seen tons of people that actually will just take their inhaler, put it in their pocket, take their their crutches with them. That's just not a choice I made. Did

Scott Benner 50:53
it ever occur to you when you were making the switch, like, maybe I'll just stay, like, on an A I D pump and then use a phrase that a crush, like, big highs and stuff like that.

Paul Hanson, RN, BSN, CDE 51:01
Absolutely, it totally did. I was at this point where I had to make a choice. I started to have some abdominal irritation with with the pump sites and with Dexcom sites or sensor sites. And so I really had to prioritize, where is what skin space is going to be used, and what's going to be the priority? And so I decided to go off of a IDs, because the importance of the sensors is so important to me. Earl Hirsch has done a bunch of, you know, work on this, and does mention that, you know, with tan, yeah, you can have increased sensitivity and challenges with with using adhesive over long periods of time. And so I just went on a break. And what I found for me was that perceived and afreza is what I liked. However, I have considered going back onto an A I D, using a Fresa with it to overcome those because again, the A I D, S man Scott, were blessed in this time where we have all these incredible devices. Like, seriously, like, if I was eight, and Dr butthead was going to tell me that, and I had foresight, and I could say, Yeah, guess what? Dr Butthead, you know, we're going to have all this technology in the future. And, you know,

Scott Benner 52:13
yeah, what do you say? What's making you is it just how great the A IDs are, like, or what's making you think about going back that way.

Paul Hanson, RN, BSN, CDE 52:21
How great the A I D s continue to get. They continue to get better and better and better. And I don't want to really name systems, but like, they just, gosh, I, I'm so impressed with them, yeah, like, like, truly, you think about when they first came out, you know, we, you know, we had Medtronic and we had some, you know, we're doing their thing, and tandem and and Omnipod, and now you got PETA bionics, and you've got SQL med tech, and you've got all these options for all these different patients who have all these different needs. Yeah, man, it's, it's incredible, like, purely, no,

Scott Benner 52:55
really is. How about insulin sensitivity for, like, use a menstruating woman as an example, right? Like, my daughter's uh, needs change pretty consistently through the through the month. Does that change along with it? Or is a fressa insulin? And this is going to sound stupid, because I'm pretty sure I know the answer, but I'm still going to ask the question, because I think it helps people understand. Like, is there anything about a fresn that makes it insulin sensitivity proof. Or, do you know, I mean, like, my sensitivity rises, my Ephesian need rises as well.

Paul Hanson, RN, BSN, CDE 53:26
Yeah, if your sensitivity changes, your need rises. That's just, that's a physiologic thing, and so you just need to take more insulin. It's as simple as that. So if, if she's gonna be more resistant because of, you know, her menses, then she's gonna, she's probably, no, not. Probably she's gonna need to take more meal time no matter what. Just like, yeah, yeah, it is what it is, right? Physiologically, your body is saying, hey, the insulin you normally doesn't make isn't gonna do the job, so it would naturally just create more insulin. We now have to supplement that. So

Scott Benner 53:58
Paul, what would you do right now? Currently, the way you're managing if your blood sugar was 115 and it had been 115 for six hours and it was not going to change from 115 and you thought, I really want my blood sugar to be 95 Can you do that with a frozen or is a four gonna move you too far in a situation like that? I know it's just for you personally we're talking about. But like, I'm trying to figure out if you can be more precise with it, or if you need to work in bigger like, you know what? I mean, it's

Paul Hanson, RN, BSN, CDE 54:25
a good question. Is a good question. So, very, very good question. This is not FDA approved. Uh oh.

Scott Benner 54:30
Are you about to tell me? You go and then, like, spit the rest of it out. Let's go, no,

Paul Hanson, RN, BSN, CDE 54:35
no. But you know, I don't know if you've, like, seen the movie Serpico or anything like that where they have glass mirrors out. I've heard, let's just say I've heard rumors of multiple individuals, and I'll even say I've done it myself, or I've taken a four and I've opened up the contents and, again, not FDA approved. Do not do this at home. We're not giving medical advice. I know that that four is going to drop. Me, let's say 60 points. I will take a half of that, put it back in the container, put it back in the cartridge, and inhale half of it.

Scott Benner 55:08
Wait. How the hell do you do that? Like, by the way, I thought you were telling me you were snorting it, so I wasn't sure what was going because you were like, you're like, mirror Serpico. I'm like, is this like a an odd code reference? What's going on here? No, no, sorry. I mean, no, no, don't be sorry. Like, can you explain it? Like, listen 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. Now, Paul, what do you do? I

Paul Hanson, RN, BSN, CDE 55:33
will, in this case, let's say I'm 120 or whatever, and I want to be 90. I will take out a blue which is a four unit cartridge. I'll open up the cartridge, and I will put it on a I'll put it on a mirror, and I will take half of it, put it back into the cartridge, and I'll inhale it, and I'll end up at 90.

Scott Benner 55:50
I know I don't know what you're talking about, but I'm assuming somewhere online, someone is like you. You spray it onto the mirror.

Paul Hanson, RN, BSN, CDE 55:55
No. So the cartridge itself is broken up, so there's, there's blue tops, like a white bottom chamber that has the the powder in it, okay? And so what I will do is I will separate the two so you can access the powder. Okay, okay. And then I will take that powder, I will put it on the mirror. I will then take a half of it, and I will put it back into that cartridge, reconnected to the blue top, and then I will inhale it. And this is absolutely not something that don't

Scott Benner 56:29
do this, but like

Paul Hanson, RN, BSN, CDE 56:30
at all, but that is the only way, in that case, if I want to go to bed and be 90 and I'm at, say, 120 and I want to go through the night, because I'm one of those type A personalities. And so I have heard, let's just say that others do that. And I have tried it, and it has worked. Listen,

Scott Benner 56:51
I say, steal a 1c overnight all the time. Like, if you can be lower and stable, like, I don't mean low, but like, you know, if you're 130 and you could be 90, then let's go for it. You know what I mean, right? And

Paul Hanson, RN, BSN, CDE 57:01
if you can be 90 for eight hours, yeah, the impact on your A, 1c, and just, just everything, it's awesome.

Scott Benner 57:07
Actually. It feels to me like you like it, but it doesn't have as fine of control as you need. And that's understandable. What about breathing issues? Like, have you? Do you get a cough? He's like, I have to tell you when, when a Fresno first came out, and someone said to me, because people come to me and ask me, like, Hey, are you gonna do this? And they said, you know, are you gonna do this for Arden? I was like, Look, that seems like another step of complexity that I don't need, having my kid inhale something, and I don't, I could have been 1,000,000% wrong. I have no idea. It just was a knee jerk reaction. Some people do have issues. Right

Paul Hanson, RN, BSN, CDE 57:42
again, if you take a look at the prescribers information, or the PI again, it's not recommended for anybody with asthma or COPD, because there is a risk of bronchospasm. But if you think about inhaling, gosh, some type of NDI inhaler, or even, you know, some other inhalers that are preventative for asthma, and you're inhaling a powder, you run the risk of a cough. It's just, it is what it is. You're inhaling a powder. So at the larger doses, if you just start and you're somebody that has a larger insulin need. Yes, there is a risk of having a cough. A cough is non progressive, and it tends to dissipate with time. There are also strategies that you can use that, such as taking a sip of water before and after, to minimize that risk. When I started, did I get a cough? I did not with the four unit cartridges. Sometimes with the eight unit cartridges, you have to be aware of it. It's something that tends to go away pretty quickly, usually about about two, three weeks, if you get that, did I have throat irritation? I did. I had some throat irritation when I started to inhale. It did that go away as well? It totally did. Okay. You

Scott Benner 58:51
didn't panic. You didn't go, oh, great, I have throat cancer. You didn't like, you know what I mean, I didn't

Paul Hanson, RN, BSN, CDE 58:55
panic about, you know, do I have throat cancer or anything like that? Medically, if you go back to my earlier part of the conversation, I thought, I thought this through. I mean, this is not sitting in the body or in the lungs for a very long time. It's literally in the lungs in less than a second, in the bloodstream in less than a minute. So I don't have to worry about anything going on there in my lungs, broke cancer, or anything like that is dissipating. It's being broken down. I mean, it's, it's it's getting out of the body and the FB KP, which is the carrier particle. It's called femural day keto pipe pairs. It's in art. So I, being trained by mankind, when I worked for them, knew this. I didn't stress about it, but it was something that, as you know an athlete, I did worry about. They have you do an FEV one or force expiratory volume, which is part of a larger thing called a pulmonary function test. They have you do that at the start, and providers are able to follow that and see if you have any you know, change in FEV one, or you know your force exporatory volume. I do not some people you know can have a change. Of they say, if you have a 20% change from your baseline, then the you know, your doctor should consider whether or not you come off of therapy. Okay, you tend not to, you tend not to see that.

Scott Benner 1:00:12
Well, do you have any idea how many people actually use it?

Paul Hanson, RN, BSN, CDE 1:00:16
I wish I had the exact numbers. I really do. I want it to be, and this is just me. I personally, as a person with diabetes, think this should be something that should be in everybody's tool kit, to be honest. You know, Scott, I get glucagon every single year, and I haven't used it, thank goodness, for 20 years, but I get that prescription. And so what I wonder is, is, are there are opportunities for individuals to get one or two of these prescriptions in a year. Practical, yeah, to deal with those circumstances, you know, where they've had a site failure, or they are going to go crazy, and they're not only going to have a Cinnabon, but they're going to get Carmel put on it, and they're going to have ice cream, and it's going to be one of those crazy days. I'm interested to see if that's an approach that is taken in the future, you know, by providers patients in their asks, for example, and will insurance companies allow it? I mean, that's just, that's another conversation altogether.

Scott Benner 1:01:11
That was my last question is, you know, is it covered by everyone's insurance? Even,

Paul Hanson, RN, BSN, CDE 1:01:16
yeah, great question with anything that is really beneficial to a person. Of course, it's not going to be covered by everybody.

Scott Benner 1:01:23
For you. No, probably not, yeah.

Paul Hanson, RN, BSN, CDE 1:01:26
So it's really, it's incredible for people with type one and type two diabetes. So of course, it's not going to be covered right away. As a first line, you have to do a prior authorization in most cases. Now, with the prior authorization, what I do know about, you know, mankind, they've done a ton of work. They've got a process where you can get it covered with that prior authorization. So that's not an issue, honestly, it's just, you know, you have to continue to fight. And it was the same thing with CGM and pumps, you know, honestly, for upwards of, like, 10 plus years, until the clinical, long term efficacy of these of this was shown. The thing

Scott Benner 1:02:04
that scares me about Fresa is I, first of all, I, generally speaking, I agree with you. I wish more people had access to us. They could try it. We could get a better understanding what people think, because you always end up talking to somebody who's just like, you know, all in because they know, but it's not growing. You know what I mean? Like, you know when you hear people talk about, like, I loop, and it makes it sound like everybody's looping, but really, there's not that many people doing it, compared to how many people have diabetes, right? Yeah. Like, that's the other idea. Like, I wonder if, like, is it going to get its day in the sun because it's been around for a while, it's past hands already. You know what I mean, from companies like, How long before somebody's just like, sing, catching on, yeah. And then we don't ever get a chance to really, as a community, absorb, you know, the knowledge that that comes with trying it to see if it's a thing that could, you know, spread. Does

Paul Hanson, RN, BSN, CDE 1:02:56
that make sense? Yeah, I know it totally does. And I'm gonna answer your question with a question. Oh, good, yeah. Do you think that overcoming clinical inertia is an easy thing to do?

Scott Benner 1:03:10
No, I think I actually have a job because nobody knows how to do it,

Paul Hanson, RN, BSN, CDE 1:03:16
right and so, you know, I think there's a lot of variables that go into this, into your question. One of them, I do think, is clinical inertia and comfort. Unfortunately, you've got providers now that are being forced to see more patients with less time and improve their outcomes, etc, etc, and they have got incredible staff that has done all this incredible learning to be certified on all these different devices. And now there's even more and more devices that then, when you bring in something that is as unique and is different than insulin to carb, ratio, correction factor, basal adjustments, X, Y and Z, it causes a reset. And sometimes that reset can be hard, yeah. So my hope is that it will be more commonplace and in more people's, you know, bags, so to speak. I wonder if newer prescribers are going to be more apt to take it up because they've been given access to that in college as far as their training, etc, etc. I don't have the answer to that. What I do know is that the mankind team is is continues to do an incredible job, as far as you know, really promoting it and working with younger prescribers, between you and I, I think this is something that was game changing for me, and so I hope that there are providers that want to seek The education and the understanding about what it is, so that they can offer it proactively versus reactively, because that's what I am seeing now. It's more reactive versus proactive. I think that is a place that would be really nice for, you know, the product itself. What

Scott Benner 1:04:58
did you do for the COVID? Company. When you work there,

Paul Hanson, RN, BSN, CDE 1:05:01
I was a Territory Business Manager, and I also trained patients sales training for a while as as well. Okay, so

Scott Benner 1:05:07
then, what have you seen work when you talk to a clinician and when it doesn't work, what do you think stops them?

Paul Hanson, RN, BSN, CDE 1:05:13
There is no magic bullet. I think it's persistence. I think it's getting that prescriber that has a few cases that are very successful, and then that's something that you can build upon. The challenges is getting those few cases. Other instances are you have a patient that comes in and and from a grassroots standpoint, they're very motivated and they want to have the product. And you have a prescriber that has either been resistant or you just haven't been able to get into right? Because that's that is a thing with a lot of healthcare systems, a lot of times these reps that are working their butts off, they can't even get in to have this conversation, because the faculty is is is protected, because they're seeing patients, seeing more patients, less time happy to get better outcomes, and so they can't be educated about it. So a lot of times it's the grassroots effort too. And so being able to support a patient, or support that provider, when they finally call and say, Hey, I need to know what the heck this is, I don't have the silver bullet golden, you know, whatever answer for that, I think it's going to take time, and I do think that it's continuing to grow. I've seen that in the space that I worked in and with the teams that I worked with, that it is continuing to grow, so I'm very optimistic about it. What have you heard

Scott Benner 1:06:28
as far as pushback? What's the doctor said to you? Like, the thing I said, right? Like, I don't know. I don't want them inhaling something. I'm sure somebody said that to you, even though a ton of medications are inhaled, you know, it's not, not an uncommon way for us to deliver medication. Yeah, what else have you heard people say that that have been pushed back?

Paul Hanson, RN, BSN, CDE 1:06:45
It's, it's basically lung safety. And then how are you going to get them the dose multiple times? If you know they need to take a follow up dose, I can't even get them to dose once. Yeah. And the reality right is, is what happens if we just, if you presented it as an option, and it was an insulin that this patient could take, and it can meet them where they're at, which is, you know, three out of or two out of three meals a day. They're not able to dose right away, or not right away 20 minutes in advance. So

Scott Benner 1:07:14
is that argument like, look, there's not enough people who are very motivated to take good care of themselves. And the ones who are already have an insulin pump, it's an A ID or something. They don't need another thing. And the people you're trying to get me to help, I can't get them to do anything. I can't possibly get them to do this. Like, is that? That kind of apathy from the doctor

Paul Hanson, RN, BSN, CDE 1:07:34
gotta I've got to be careful with this. I think that the reality is, is the A I D s are doing such an incredible job, like truly, the A I D s are incredible that I wonder if the systems themselves have a program set up within where the driving force is to get them to what appears to be the gold standard, which is an A I D

Scott Benner 1:07:58
Yeah, their sales is, is got a better story than yours does kind of idea, yeah, yeah, yeah,

Paul Hanson, RN, BSN, CDE 1:08:03
yeah, yeah. And so if you, if you spent all these years getting a system set up where your job, your job, but your goal is to get people on something that is improving safety and outcomes and and all that, and then you have resistance to that, you know, it kind of puts a little kink in your armor? Yeah,

Scott Benner 1:08:21
the doctor could be like, Look, we just got to this. I'm not going to start on something else.

Paul Hanson, RN, BSN, CDE 1:08:25
Yeah, so it's a really good question, Scott, I wish I had the answer that's, I wonder if that's the cause,

Scott Benner 1:08:31
yeah, it's just different enough that it feels too different. Yeah, is what I think can be like a stumbling block. I think the breathing part is a stumbling block too, that you inhale it in. But overall, it's just, it's the different thing. Yeah, it is different. And you they just spent the last decade trying to explain to people insulin pumps using insulin like, I know, insults been around for a long time, but adoption of insulin pumps is not as great as you would imagine among people who have type one diabetes. You're correct, right? And so you're working, working, working. And how do you even get that work? It's because you've got a company trying to sell a pump. Like somebody went out on a limb and was like, Here, we'll make the damn pump. Now we got to sell it. We're out of business. So now it's their job to go out there and and, you know, extol the virtues. And then you you know, you get moving in that direction. Then another insult company comes along. Does it again, and before you know it, it becomes Kleenex to the doctor, and they're all pumps. And, you know, like now you're hearing it from five different perspectives. And then someone comes along, goes, Hi, you know, this man named, you know, Al came up with this, and he's gone now, and sanafi had it, and they seem to not care. And and then they go, that's a big company. Though, if they didn't care, maybe there's a reason. And then it goes, reverts back to the company, and they're out there, small company, trying to push it, it just, it seems like a tough slog to me, like, I mean, it just, but it doesn't make it not a viable option. And that's why I'm I continue to have people on to talk about it, because I, I do think I have the ability to, like, get the i. A story out there, and I'd like people to hear about it, you know? I mean, there was a time, Paul that people came to me and said, and I'm certainly not taking credit for this, but, you know, I am probably one of the places where that is heard more than other places that came out. And today, look, I'll put my kid on this loop thing, you know what I mean? And, and it's like I said, again, still. I mean, if loops on 20,000 people, that'd be amazing, like, Forget 20,000 people, and there's no way that it is. But let's say loops on 100,000 people, that's still a very small percentage of people living with diabetes. Now it's nowhere near that number. I I asked the internet. The internet says that as of 2023, 30,000 patients with type one or type two diabetes have been treated with a fresn. It doesn't say they're using it currently, but they've tried it. This number is based on patient exposure analysis conducted between 2015 and 2021. A fresn developed by mankind Corporation, is the only Ultra rapid acting blah, blah, so you don't even that's a long time. Yeah, 30,000 people, not a lot of people. And no, there's no way to say that they're all on it. But I've also had people come on here and act like a Fresa is, you know, if you come like you can't pry it out of my cold, dead hands, kind of a vibe. So like the people who love it, love it, they should be able to talk about it, you know,

Paul Hanson, RN, BSN, CDE 1:11:19
well. And this is, I think this is where you're working for the company. And again, I'm no longer working for the company. But I think if you are right, the goal is, is to have your providers presenting that as a viable option because of the uniqueness, versus not talking about it because of its differences in uniqueness, right? And so I'm going back to what we said earlier, Scott, we are blessed being a very different time than when I was eight years old, sitting on the doctor's table with Dr butthead. We've got all these incredible algorithms. We've got these CGMS that are continuing to push the envelope. And now for you know, gosh, it's technically a phrase that came out in FDA approved on June 27 of 2014 so it's been out, yeah, for for 10 years. We've got an insulin now that's it mimics physiological activity. If you think about that, Banting and Best have to be doing cart, food, cart, you know, cartwheels and backflips.

Scott Benner 1:12:24
Yeah? No, no, they. I mean, there's part of you that wonders if it's not just, like, you know, the whole VHS beta max idea. Like, you know, those beta people were probably just like, wait, what's, I don't understand. Ours works. It's better. The quality is better. The tape is smaller. You're going with VHS, why? Like, how doing the wrong thing. But I mean that can, that can happen also. It begs saying that when, when I went to a large Children's Hospital, you know, a well respected large Children's Hospital, with my little kid and I was looking for an insulin pump, for the first time I saw this a long time ago. I saw an Omnipod, and no one wanted to support it, and so, like, I I've told this story in the podcast, but I'll tell it to you because you don't know it likely. It was basically like, you know, you go in this room, it's a conference room, and they had tables everywhere, and there were pumps. Like they were like, just laid all over the place, like they were just selling these pumps. Like, you know, like, like, oh my god, people are excited. And I walked the whole room is a big room. There are a lot of people in there, over in this corner, like, this cut out corner of the room was this small folding table, and there was something on it. So I walked over to see what it was. But as I got closer to it, it realized it just looked like somebody tossed the thing on it, like it almost looked like somebody was walking to the table, got about eight feet from it, and were like, I don't feel like going the whole way and like, just pitched it off the wall, and it landed on the table. Okay? And you know what that was on that table? It was an Omnipod. And I went, I picked it up, I went over to one of the people working there. I said, Hey, I don't know anything about this, but my kids little, and there's no tubing on this that's really attractive to me. It's also it's self contained. So it occurs to me that if the company should upgrade it, it's not like they're going to make 1000 different versions of it, like, you'll probably keep getting the upgraded version like, at least more quickly than I would with something else. I had all these reasons why I thought it might be a good idea. And the woman looked at me. She looked at the pump. She goes, you don't want that. Now, this very, very long time ago, okay, like before, right before omnipotent had its foot in the door. You don't want that. I said, why not? And she gestured to my daughter, and she said, she's too thin for that. Now, time after that, I heard people who were approached the same way and told, Oh no, your kid's too chunky for that. You're too chunky, you're too thin, you're too old, you're too young, you're too this, you're too that. What the hell like? How can there be so many reasons why this thing's not gonna work for me? And I, of course, said, you and I probably have a lot in common. I said, Well, I'm gonna get it anyway, and then. As soon as, as soon as I, I said, I'm going to get it anyway. Then the scare tactics came about the insurance Well, if you buy, if you get this and you don't like it, you're stuck with it for four years and, like, this whole thing, right? Which, it's not even the case anymore, one way or the other, because it's, you know, it's not adorable pharmacy benefit now, but, but anyway, that I was then it was your daughter's the wrong size. You don't want that. You're then the scare tactic about the insurance. Then two years later, Paul, after one of my daughter's appointments, the doctor asked me to stay behind. Said, can Arden go out in the hallway with the nurse? And I talked to you for a second, I was like, I know I did something wrong. This is coming. And, I mean, she don't want to say it in front like, Dr butthead would have just said it in front of me. Yeah, at least, yeah, you had a good doc. So it's scary what's going to be said, but it turned out to be a nice thing. And she said, We want you to know that based on how well Arden is doing on Omnipod, we are going to start prescribing OmniPods to children out of this practice. And I said, okay, like, I was like, whatever. And but I said, let me ask you a question. Why did you try to stop me all this, you know, a couple years ago? And she just gets very still and quiet, and she says, well, in honesty, it was new, and we didn't know anything about it, so we didn't want to try to support something that we didn't understand. And I said, maybe that would have been the best thing to tell me back when I asked about it. Yeah, yeah.

Paul Hanson, RN, BSN, CDE 1:16:24
And Scott, I think you hit the nail on the head is there is, there is pride and expertise that we go to when we walk into the institutions and they have it period. However, when there is something new, they might not have that same level of expertise, and that can cause a little bit of discomfort. Yep. And how do they then, whomever respond when there is excitement about something that they don't have a lot of information about, it can cause discomfort. And I'm wondering if that's what you you saw

Scott Benner 1:17:00
there. That's exactly what I saw there, and it's what I'm guessing is going to happen to people who go into a doctor's office and say, Hey, I'd like to try that. Inhaled insulin. Yeah, there's this, there's that. It's that. Don't do that. It's gonna It's scary. Boo, yeah, I

Paul Hanson, RN, BSN, CDE 1:17:13
heard you. I heard you cough five years ago. You might not want to try it. You know, you're not gonna be

Scott Benner 1:17:17
able to breathe if you take that, right? You want to breathe. Breathing is important to you, doesn't it? Like the world keeps changing and and I get it's funny. I get scared. Sometimes I think that what seemed like common sense 10 years ago now seems like bashing to people. Sometimes I'm certainly not bashing anybody, but I think what you just said is right, is that people are still people. I this is my job to teach you this. If I don't understand it, how am I going? I don't have time to understand it. I can't learn about it. Blah, blah, blah, like, you know, maybe it's a control thing. May I want the control here. I don't want you know more than me. I don't know what it is people are. You know, humans are fallible and delicate, and they make all kinds of decisions for all kinds of reasons. But if you're making a decision about what you're managing your diabetes with based on something that's being said to you by, you know, a person who you think you're supposed to listen to. I still think it's on you to do your diligence and find out if that's correct or not. I agree. I agree because Paul did it, and it worked out well for him. I did it for my kid. And you know, you're all welcome. Who lived in the Philadelphia and surrounding areas back then and got an Omnipod like, but you know what I mean? Like, sometimes you just gotta push on.

Paul Hanson, RN, BSN, CDE 1:18:27
I agree. I agree with you. And reality is, everybody is going into those, you know, pump nights or visits with a different type of energy and different things on their plate that day. And it might not be a great day for them to go in with that chutzpah that say you had, and I had, for example, that's hard, and as a result, they might not push for that thing when it's new, and they might take the advice from somebody who doesn't have the understanding about the new thing. Yeah,

Scott Benner 1:18:55
you always have to wonder if you're being offered something, because the salesperson is pretty and knows where the better bagels are.

Paul Hanson, RN, BSN, CDE 1:19:03
I'm not a good looking man, so I can't really speak to that. Oh, Paul,

Scott Benner 1:19:06
you're, you see, you're at fault on this for as the thing I see what's going on. But, but no, seriously, like, if I, if I'm a, if I'm the lady at the front desk at the doctor's office, and it's my job to blah blah, blah, and sales people come in and I like that sales person better, then I might be more likely to say the thing that they're selling. When you ask a question, oh, what's the best insulin pump? Oh, you know, the best insulin pump is, it's the tandem. Why so? Well, the answer being because, you know, the bagels from the tandem person are really awesome. And the, you know, the Omnipod lady brings in donuts, and they always seem a little not fresh, and whatever it ends up being, I don't even know where the law lies anyway. By the way, 20 years ago, you could take a doctor on vacation to Hawaii and call it a work meeting. I don't think that's legal anymore. That's not, yeah, no, that's not. But I still think you can bring a bagel or a pen or something, or stand there and be delightful for 20 minutes. You know, I'm not a salesperson, but I think if. I was, I could rule the world. Paul, somebody's rolling into your doctor's office turning on the charm. You know, forget the bagels and everything else. The person at the front desk likes them. And then they go back to the doctor and they say, I think we ought to take a harder look at this. They made some compelling arguments. Who knows what those compelling arguments were? You don't

Paul Hanson, RN, BSN, CDE 1:20:16
know. You kind of just really provided a really good summary, which first and foremost is the world is changing in so many different ways, but within the diabetes space, for example, B, humans are fallible, right? And so, you know, based on whatever influences, they might not always be at their best when they're trying to help. So what that then means is, C, as people with diabetes, or families with diabetes that are really wanting to learn the most about the options out there. The hope is, is that with all the information out there, that information is easily found, and then when you're in front of that team, you can have an audience to have a really good conversation and make the best you know choice for yourself. Yeah,

Scott Benner 1:21:00
I just don't care. I'm not just talking about a fresn, honestly. Like, if you want a GLP, go fight for a GLP. If, you know, if you're in there and you think I want an Omnipod five, and they're trying to give me a T slim x2 argue with them. If you're trying to get a T slim and they're trying to give you an Omnipod five, argue with them. Like, you know what I mean? Like, geez, if you're in Minnesota, they're gonna offer you a Medtronic, I guarantee you, like, you know what I mean? So, like, Paul's laughing. He knows the business a little bit. Yeah, stick up for yourself a little bit. And when somebody tells you no, don't just say, Okay, say, why? And if that reason doesn't make sense to you, then you got a little more work to do.

Paul Hanson, RN, BSN, CDE 1:21:35
I agree. And, and you can decide if you're going to keep this in here or not. But you mentioned, you know, the GOP ones. You're not going to be surprised about this at all. But as a type one, I fought like the dickens to get onto a GOP one IP combo, because I started to, as I got older, started to have a little bit of resistance, and I was not used to that. And this is after, you know, fifth knee surgery. It wasn't active, put on weight, all the all the things, right? And they just like, Well, no, you can't, because it's not for type one. I was like, might speak to somebody who's medical versus somebody who's just reading a check the box type thing, because type one diabetes is much more than just your beta cells being affected and like this is nonsense. Long story short, I have an incredible endocrinologist who helped go to battle with me, is able to help me get that I don't use it with the regularity of a weekly dosing or anything like that, but what it's done for me is it's helped with that sensitivity, and it's pretty incredible. And I am interested to see what's going to happen over the next, honestly, five years or so with, yeah, with the type one space and GLP ones,

Scott Benner 1:22:47
I've done a ton of content already. Listen, I got it for my daughter. I got it covered, by the way, you argue enough, you can do anything that's for all you're out there. It's tough because the lowest dose is, is too much for her. It's so robs her of her, like, hunger, that it's just, it's too much. So we were, you know, working with, like, trying different doses, different time frames, but, you know, like, and then we actually have, we don't talk about this very much. Arden has a pretty significant needle phobia that comes and goes once in a while, and so that's been a problem. I actually just got her a sample of rebellious to try that, to see if maybe we can make make some impact with that. But when she's on the GOP, her blood sugars are legit stable, and it is difficult to get her blood sugar over 140 when she eats. Isn't that crazy? Yeah, that's awesome. And so I am nativity is amazing. Yeah, I am going to figure it out for but I also don't want her walking around not hungry. I don't want her like, you know what I mean, like, I'm not looking for that, so we're working it out. But, yeah, no, I'll leave it in here. I have a ton of content about GLP. I'm a I'm a proponent. So, yeah, no, all right, Paul, I'm going to let you go, because if weeks goes any longer, my editor is going to charge me extra.

Paul Hanson, RN, BSN, CDE 1:24:00
It sounds good. Hey, it's been so great to connect again. I'm glad I didn't have to stalk you at the bathroom. It would have gotten a little awkward, actually. So I

Scott Benner 1:24:09
mean, here at the end, if you wanted me to go pee to make you feel better about it, I probably could go. I think we'll

Paul Hanson, RN, BSN, CDE 1:24:13
just pass on that.

Scott Benner 1:24:16
Thank you. No, no, it's my pleasure. You're really great. I'm glad. Hey, who helped me get you, Steven, it was Dave Akers. Dave Akers, oh, okay, well, oh, and Stephen went to Dave. Dave, go into you. That's right. Well, thank you everybody who behind the scenes puts in this kind of effort to make sure we talk to good people on the podcast. So, yeah, thank you so much. Hold on one second for me, Paul, I did a good job, right? We covered it all. Yeah,

Paul Hanson, RN, BSN, CDE 1:24:40
I think it was a great it was a conversation. It's organic, which is, again, one of the reasons why I listen to you. It's organic. I appreciate

Scott Benner 1:24:46
it. All right. Hold one second for me. Man,

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• Martin’s wife has lived with type 1 diabetes for decades. Now retired, he’s rethinking how to support her.

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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
Martin is 62, years old. His wife (type 1 30 years) asked him to come on in hopes that he might learn something about diabetes.

Friends, we're all back together for the next episode of The Juicebox Podcast. Welcome. 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 healthcare plan or becoming bold with insulin. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com if you or a loved one was just diagnosed with type one diabetes and you're looking for some fresh perspective, the bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginning series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu.

Touched by type one is excited to host their first ever walk steps to a cure. This is going to happen on March 8 at Lake Eola Park in Orlando, Florida. You can join touch by type one as they walk united with their community to elevate awareness of type one diabetes, to raise funds to find a cure and to inspire those with type one diabetes to thrive. Learn more at touched by type one.org Go to the Programs tab. This episode of The Juicebox Podcast is sponsored by touched by type one.

Martin 2:09
Hi, Scott, so my name is Martin. I'm from the UK, as maybe you can tell from my accent, and I'm married to a type one diabetic. You're married to, I'm married to, yes, excellent, excellent. So I don't have diabetes or anything like that. I My experience is purely second hand. Oh, this is

Scott Benner 2:32
gonna we don't get a lot of this. This is excellent. And I love your topic, by the way, that you that you included when you signed up. I can't wait to get to that. No, okay. Well, do you

Martin 2:41
have kids? We do have kids so they don't live with us anymore, because we are that old, we are both retired, and the kids have moved away and live in different parts of the country. One is married and has their own family, and one is just dating at the moment, but happily in relationships, happily working, going really well. Daughter did. She's pregnant again at the moment. Daughter did have gestational diabetes during her first pregnancy, but so far, that hasn't reared up during the second pregnancy.

Scott Benner 3:23
Has there been conversation that that might mean diabetes in the future?

Martin 3:28
There has indeed been conversation around that, yeah, and the NHS here is keeping a close eye on it. She was, in fact, tested yesterday. She's at 24 weeks.

Scott Benner 3:40
Well, congratulations on being a grandfather again. Is that difficult that like you and your wife sitting down with your adult daughter and saying, hey, you know gestational could mean diabetes in the future, not so

Martin 3:53
far, no, she knows the sort of risks. Frankly, we don't come with just diabetes as a health background. I'm asthmatic, so that's something that the kids occasionally suffer from. I had eczema when I was younger. The kids both suffer from that now. So we come along with lots of health problems. They're used to that kind of inherited health danger, I suppose you could call it or or risk.

Scott Benner 4:23
So what about your wife? Besides the type one, does she have anything else? No, nothing, no thyroid or celiac or anything like,

Martin 4:30
oh, apologies. Yep. Good. Good. Prompt, nicely done. She does have if it or she's regularly taking stuff to keep the thyroid under control.

Scott Benner 4:39
Hypothyroidism, she takes, uh, Synthroid. Maybe

Martin 4:43
you're going into way more detail than I know. I'll be Martin. I'll be honest. Tell me. How long have you known her? So we are not now. You're really asking tricky questions that I hadn't expected and hadn't prepared for. We've been married over 30 years. Let's put it

Scott Benner 5:00
that way, 30 so you've been married over 30 years, and if I said to you, does she take a little white pill every morning? You're not 100%

Martin 5:06
certain he does take a little white pill that comes in a really nice cardboard box. But what the name is on the outside? I have no idea. I love that you said

Scott Benner 5:15
it's a very nice cardboard box

Martin 5:18
that's just keep them fresh, isn't it?

Scott Benner 5:21
That's listen. I only asked not to embarrass you, but to point out that, you know, you could live with somebody for 30 years and be like, I don't they do take a pill every morning. I mean, if I'm being honest, I'm asking you, because if people are listening who are just starting their journey with hypothyroidism, for example, I'd like them to know that 30 years from now, their kid, or they might be with a person who loves them very much, is like, yeah, it's not that big of an impact for them. You know,

Martin 5:46
agreed, now that it's under the control of the drugs, it doesn't actually impact her. She occasionally has to get assessed to get the dosage adjusted, sure. But actually, that is working out

Scott Benner 5:58
fine, excellent. No, that's great. Yeah, yeah, it's a big problem if you're not taking the medication. I agree. And I actually have a personal friend right now who's fighting with the doctor, you know, who wants to just point at everything except the obvious. They have a TSH that was five and a half. They tested it again. It was 2.6 it's bouncing all over the place. And the doctor is like, what could be your liver? It could be this, it could be that. And the person goes back and says, Well, elevated liver enzymes are common when TSH is elevated. And the doctor goes, yeah, it's not, it's not your thyroid, but it's just, like, but my hair is falling out and I'm tired and I have, like, like, just lists all these thyroid system the doctor goes, you know, maybe you have fatty liver. Maybe it's this, like, Can I try this generally harmless medication to see if, like, you know, it helps me doctors like, ah, we might want to test you for fatty liver. Like, oh my god. Like, just trying to make money, you know, like, I don't know. But anyway,

Martin 6:50
that sounds such a tricky situation when you're suggesting to the doctor based upon my symptoms. It could be this, but I suppose it does fit in with how the world works at the moment, we do a lot of diagnosis by Google. It's

Scott Benner 7:04
an interesting problem, you know, nevertheless, so your wife had diabetes when you met her, or was diagnosed during your relationship?

Martin 7:13
No, she'd had diabetes for quite a while. When I met her, she was at that point, because it was quite, quite such a while ago. She was obviously just injection controlled, but it's now become, as with all the technology, she now has a CGM on her arm, and she's still injection based, but it she's changed insulin several times during that

Scott Benner 7:40
so when you start dating, how prevalent is the idea that she has diabetes? You're really testing a memory now, a long time ago. But do you remember being like, I like this girl, but or do you remember not thinking about it? I remember not thinking about it frankly. Okay, it was an interesting aspect of her, but it wasn't a risk or a don't go there type flag, nothing like that. I have my daughter's dating a boy, and I resist every time I see him from asking questions that are meant to lead to are you judging my kid because of this? Are you worried about it. Like, are you scared? Would you flee if she had a problem? Like, like, I don't do any of I don't do any of that, and it doesn't overwhelm me when I'm seeing him, but I would be lying if I said I wasn't interested in where his mind was. And then there's part of me that thinks he probably doesn't even notice. Like, she barely you'd be hard pressed to know that Arden has diabetes if you were looking at her, you know what I mean? And interesting? Yeah, and she's, I mean, she wears her stuff out. But people get used to that very simply, like, I don't think it takes long for someone who's around you not to see your pump. For example, she's not overly involved in it. It goes very well. So there's not a lot to do, is what, I guess, is what I should be saying, not that she's she's involved in it. She's giving herself insulin every time she needs it, etc. But it's going so well that, you know, there's not, like, a lot of pit stops, I guess is my point. No, that's great. Good. Good for her, yeah. But I do wonder, what's that? I'm sorry I'm good for him as well. Actually, yeah, yeah, no, I hope so i It seems like that. I guess if I was worried, I'd probably open my mouth, but I must not be anyway. So you start dating, there's no notice of this or anything. But then through your life, like, what are the stories that stick out in your head that were diabetes related, maybe things that you were like, Oh, I didn't realize this was going to happen. Or, you know, that stuff like that. So

Martin 9:40
significant steps are definitely as you are changing your insulin regime as because as you move from one injection to another injection, that has always seemed to disrupt her and it takes several weeks to get through and. A new regime and to settle and to be under control again, pregnancy was, at times a little bit tricky. We always had to keep a set of chocolate biscuits on hand, as things would change quite rapidly when she was actually pregnant, those are probably the major things that that actually stick out now, she's obviously, most of the time, well controlled, looks after herself. At the moment, we're having a bit of a discussion, and I'm interested as to what your experience around this is, because I think you know a lot more about the the situation than me, obviously being my experience being second hand around a diabetic. I've not read through a lot of the background to diabetes, and I I'd be honest, I don't understand the dosage. And you quoted TSH at me earlier. I think your medical background is much deeper than mine, because I didn't actually understand that phrase. So I don't actually understand, I think, the mechanics of diabetes and the dependence upon the injections for the provision of insulin. And we're just having a discussion around that at the moment as to whether I should become more versed in that in order to understand what's going on with, you know, the amount that she's eating, the amount that she therefore needs to be dosing, the amount of exercise, and all those other factors that that come together to keep someone balanced with type one diabetes. What are your thoughts around that? Earlier,

Scott Benner 11:40
I told you about touched by type one and their steps to a cure walk, which is happening on March 8, 2025 you can go to the website touched by type one.org, and register now. But guess what? This weekend, there's a special steps to a cure kickoff event. You can join touch by type one for a light breakfast at their walk kickoff, come meet fellow participants, learn more about the walk and get excited for the big day. Then you can enjoy a complimentary day at the Orlando Science Center. Get out of here for free. What the heck? Touch by type one.org Go to the Programs tab, get registered. Now. This thing's happening on Saturday, January 18, at 8am you gotta go register right now on the website. Get going. I have to ask first, do you not know about it, because you were busy working, and she was raising a family, and you had two separate kind of lives around that, and now you're, are you guys retired now? We are indeed retired now, and now you're retired. Is she starting to think about, what happens when I get older? What if I can't do this for myself? Is that the concern? Or is she or did she look up and go, How did this jackass make it this far without understanding my diet? What's the um, the onus together? Think about, I'm gonna

Martin 12:47
go with the second one, frankly, that she really thinks I ought to be understanding some more of the situation in order to be under probably more of a sounding board as to whether she is actually going the correct way with the regime. Yeah.

Scott Benner 13:04
Can I ask you, like, a slightly personal question, did you when this came up? Did you have any hindsight? Did you think, wow, why didn't I think about this sooner? No,

Martin 13:14
that wasn't the thought that occurred to me. The thoughts that have occurred to me around this are, frankly, we have a relationship, which does work really well, but can be just a little bit prickly at times when we don't agree on something. And I just feel that if I knew more about the diabetes, then I would be saying, Why are you giving yourself three units at the moment, you've just run around the park. Shouldn't it be two? And I could see that creating more tension than actually providing the value that she feels. It might do

Scott Benner 13:54
is everyone hearing a wise man who's been married for 30 years, speaking very carefully. This is wonderful, Martin. Thank you. What Martin is saying is there were times over the years I thought to speak up, but I imagined it would end with the resolution of my marriage and me living above a donut shop, so I kept my mouth shut.

Martin 14:17
Maybe the donut shop is questionable, because we don't know many of those in the UK. But the general gist is there,

Scott Benner 14:23
yeah, of course. And by the way, I want everyone to know, my brain struggled for a more British centric food. It didn't find anything, and I just decided to move on the thing. Ah, have you not been to the UK? We said crumpets, fish and chips would be the one that would come out in the UK. Yeah, I don't know. I was looking for a baked good for some reason. Now the reason is, is that that joke here in America is that every guy I've ever known who ended up divorced lived above a pizza place for a while, while they were getting back on their feet, and I wasn't certain if pizza was a was a delicacy in England or not. Oh yeah, went off to come sometime and try it. But anyway. I hear what you listen, I get what you're saying. Like people don't want to be alone. They want someone to help, and they want support. But when that support comes from someone who's too close to you, a lot of times, your reaction is, leave me alone. I don't need your help, and nobody's looking to fight. So you guys probably settled into a space where you kept your distance on this, and she quietly resented that you weren't helping her. And had you helped her, she probably would have quietly resented that you were involved. But now you're now, you guys are together all day long. You're seeing the reasons why it would be helpful if everybody, if there was a sounding board, somebody to just run through it, I'll tell you, simply stated. I think the Pro Tip series in the podcast would be really helpful for you. Okay, yeah, no kidding. Episode 1000 to like, 1025 and there's even stuff in there about pregnancy, and just, I have a whole series about gestational stuff, and if your daughter should run into the problem, again, the diabetes part, you could figure out easily, right? Especially because she is she using a pump with an algorithm.

Martin 16:12
No, no. She was using the T slim, and that just completely didn't fit her lifestyle. It was making way too many assumptions about if this happens, I should do that, and it was either allowing her to go too high or pushing her too low. So that didn't last very long. At the moment, she is long term injecting once a day, and then since where I start become hazy and probably need to learn more, I think it's three times she injects on the rapid acting stuff. She's

Scott Benner 16:52
doing what they call MDI, multiple daily injections. And once a day she's using her her long lasting insulin, her basal insulin and Yeah. Then at meals, she's shooting for for carbs. Is that why it ends up being three times a day? Yeah? Does she ever shoot in between a meal to adjust down a high blood sugar? Occasionally? Occasionally, she does. Do you know what her a 1c is no, no. When she goes to the doctor, they give her that report about what her average blood, Yeah, agreed. Interesting. Have you ever gone to the doctor with her? Not about diabetes, because she doesn't want you there, or because you've just never thought to go. I've

Martin 17:34
just never thought to get. Been honest with you, how old are you?

Scott Benner 17:38
6262 Okay, so I have no medical background at all. Martin, I want to be clear. I barely got through high school, everything I know I know from I'm not kidding you, I didn't go I imagine I've said this on the podcast, but I missed 53 days of my senior year of high school, and I did that because I was poor, and I went to work instead. And, gosh, I look back on it now, and I realized I would work an eight hour day to make $40 before taxes. I'd skip school all the time to go to work. I got done with high school. There was no expectation of college. I grew up like in a very blue collar family, they just wanted me to go work, and I went off and did that. What I know I know because of having these conversations on the podcast, I know because of paying attention to my daughter's health and wanting better for her. And then my wife, who has hypothyroidism, you know, and she's 50 years old, she's had, you know, problems along the way, paying attention i My son has hypothyroidism. I couldn't process iron for a lot of my adult life. So my ferritin levels, my iron levels, were always very low. If you grab me right now and pointed at me, at one of my family members, and said, Tell me about their health background, I would know all about it. I have, like, a very deep caregivers mentality. I hate saying this out loud, because I think some people might hear it as sounding sad, but I don't think of it that way, I genuinely care more about the people around me than I do about myself, and if I'm not doing that, I'm not happy, generally speaking. So I'm very aware of everyone else's life and their situations, where they are the medications they take when they need to be doing it. And I'm going to tell you that for the most part, some people appreciate it, and some people are like, I don't want you involved that much. And there's like, a whole spectrum of the responses you get back from people. I understand that I'm unlike most people like in that regard, that if I interviewed 100 spouses, forget men or women, and asked them about their spouses medical stuff, I generally think they wouldn't know that much about it. I don't think that's uncommon the situation you're in, but I think it's really uncommon that you stand up and try to, like, figure it out. And I think this is, that's why this is a great conversation, because you're, I mean, you lived a long time not doing a thing, and now you're trying to figure out how to do it. The

Martin 19:59
fact. Myself just a little on that in the not doing anything. Obviously, I'm around whenever there is signs of a hypo or trying to help with a Hypo. But you're right. I've not got involved with the mechanics of how that hypo came on. About, yeah, so I didn't really know the background. I don't know the background. Yeah, my

Scott Benner 20:22
wording was poor there, like not being, yeah, yeah. But what I'm saying is that I don't think that's uncommon. I think the person with diabetes probably, like, if I got your wife on here and said, How come you didn't pin Martin down earlier on this, she might say, I didn't want to, I didn't want to burden somebody. I didn't want people to see me as sick. I didn't like she probably have her own reasons why she was more private about it, and allowing you to feel like, I don't need you to be involved in this, and then that's a pass for you. Then you're like, Okay, she's got it, and that's the end of it, you know what I mean? And then you go live your life and do all the other 8 million things you had to do with the last 30 years. This is so interesting, Martin, because I've never gotten to talk to somebody about it from this perspective. But I will tell you that I think the management of type one diabetes is at its core about the timing and amount of insulin, right? So whether that's the basal insulin or the meal time insulin, if you're making a correction to a high blood sugar, that's the timing and amount. You have to time it well. You have to measure it well. You can't measure it Well, if your settings aren't good, there are pretty reasonable ways to figure out what your basal should be, what your insulin to carb ratio should be, what your correction factor is, your insulin sensitivity, meaning, like, you know, a unit moves me exactly how far you know how many carbs are covered by a unit of insulin. These numbers are super important. If your wife got onto a pump, especially an algorithm based pump that was making decisions without her settings being pretty solid, that's why the pump probably felt like it wasn't working, because control IQ is a great algorithm, and if it was crashing or low or letting her get high all the time, you have to remember that that pump only knows what she told it or what her physician told it on the day they set it up. This is how much basal you need. This is your sensitivity factor. This is your carb ratio. And then beyond that, if no one's ever taught your wife that, for example, going off and having a salad, you know will, and let's say she has a salad and there's 20 carbs in it, that's different than having 20 carbs of French fries chips, because, yeah, the absorption, right? Is completely different. And you know why that happens? No, I wouldn't like to say, oh no. It's the fat in the fries slowing down your digestion and keeping the carbs impactful for a longer amount of time. It's not, yeah, that it's so it's so much about your digestion, because if you think about the timing of it, the timing is, whatever the carbs are, they go in. They're absorbed a couple of different ways, right beginning right away with the lining of your cheeks, which is why you would, if your wife was having a low blood sugar, put gel in her cheeks, or ask her to, you know, take one of those hard glucose tablets or something like that, because your body absorbs right through your that simple sugar, right through your cheeks lining, if you have, You know, I don't know a burger. That burger doesn't really get absorbed so much through your mouth. It goes down into your stomach and your body, for the lack of a better way of talking about it, your body kind of prioritizes things, and it breaks down. So if that burger went down there with cheese and bread, the bread is going to hold your blood sugar up. The fat in the in the ground meat will slow down digestion. The fat and the cheese will slow down digestion. And the entire time that digestion process is happening, that bread is kind of leeching off those carbs and it's and her body's picking that up in her bloodstream and raising her blood sugar if she eats that same burger and cheese without the bread. Well, there's not many carbs in there, so it doesn't really matter how long, although at some point, 45 minutes later, with this burger, this pretend burger with cheese, with no with no roll, your body starts to store the protein as glucose. So as it's breaking down the protein, it stores it as glucose. So you'll get even if you ate very low carb, you'd see some sort of a bump, 45 minutes an hour later, where your blood sugar would start to go up. And that's another thing. So my point is, is that if people don't understand how food is impacting their blood sugar, then they can't figure out where to put the insulin. That all makes sense. Yep,

Martin 24:38
understood. And yeah, I have come across aspects of that before. Because definitely, for example, when she eats a pizza, it hits several hours later, right?

Scott Benner 24:47
It's exactly why. And if the pizza has protein on it, like a sausage, for example, even longer. And so even a plain pizza versus a sausage pizza would be different. Yeah. And that all is just bonkers, because most people, no one tells them that. They tell them, count your carbs, push the button, you know, inject and go live your life, right? Yeah, that is not helpful when you're trying to make big decisions, and that puts your wife or and other people like her in that situation where they're making decisions which are driven by doctors. And, you know, Doctor says, Look, do this. And you get home and it doesn't work, and you're like, Well, I did the, you know, it was almost cursed. But it's like, yeah, yeah, I'm thinking I was told to do and it's not working. And then you're over their shoulder from the other room going, Honey, what's wrong? She's and she's probably thinking, I don't know. I you know, like, instead it turns into like, leave me alone. I'm trying to get this like, and I think that's how this gets sideways. Seriously. Yeah, that that fits the situation. So, what do you want to do? Like, what is your what is your goal? Like, what kind of a sounding board Do you want to be?

Martin 25:55
Oh, that's an interesting one. There are several ways I could play it. I could try and be a know it all, but I don't think that would actually work very well within our marriage, we don't tend to work like that and get on it would be much more a listener and then, in effect, an advice giver, as in, yep, That's the right way to do it, or no, have you thought of X, Y, yeah, whatever it is. So much more the gentle background sort of person, rather than the Oh, hey, it's time for you to three units,

Scott Benner 26:35
dear. Yeah, she's, she's not looking for you to, I mean, she's been doing a long time. I wouldn't, no,

Martin 26:39
she'd been doing it a long time. She's still alive. She's doing really well. Oh, by the way, I don't know how you think of it, but I don't think of diabetes as a sickness. You mentioned that earlier, and I was just wondering if that was your phrasing, or whether that was very interesting. Yeah,

Scott Benner 26:55
I don't think of it that way, either. But what I'm saying is that I've talked to enough people who say, I don't want to feel like I'm XYZ, like whatever the phrasing is that they use, yeah, I don't want people to see me as broken. I don't want people to see me as sick. I don't want it's not necessarily what they think of themselves. It's what they're worried other people will think that's kind of how it seems to me. Okay, understood is that, you know, and listen, fair enough, I've also spoken to people who see themselves as those things, and, you know, like so a lot of it is perspective. And you know, how people see the world. What I've heard from people is either don't see me as broken, or don't see me as a problem, or they're just frustrated that this thing is interfering with their day. Forget. They don't give a shit. You think about it. They don't want to be involved in it either. You know, like it's it's difficult to remember sometimes that this person who's doing this thing and making it seem so effortless is constantly thinking about it, burdened by it, doing their own work, mental gymnastics, to not be thinking about it. And they they very much wish none of this was happening, too. And that's an experience I've had to have with my daughter, where, like, not that you forget, but she just does such a good job that you're just like, Oh my God. You know, like, it feels effortless, and it's definitely not, you know, it's just definitely not. Yeah, agreed. Did you live at all any time worrying that your kids would get type one? Did your wife ever talk about it? Yeah, that's

Martin 28:34
been a conversation, and that's obviously a risk we're still aware of luckily, that hasn't happened so far. Yeah, could still happen, but hasn't happened so far. So

Scott Benner 28:47
it's interesting, because you're a generation B, I'm 50. I turned 53 a couple days ago. Okay, it does feel like a crazy thing, you know what I mean? Like, like, you're just like, I can't believe I'm this old, but I'm happy I made it. But my point is, is that you're, you're, you're a generation beyond me. So even this thing about like, being more involved, like, it's not common, it wouldn't be common for you, right? Like, this interlapping, like, you guys are kind of learning to be new people as you're retired, I guess is my my thought,

Martin 29:20
exactly, yeah, yeah. It's one of those new phases in life.

Scott Benner 29:24
Is that frightening? Is it something you're looking forward to, like getting away from the diabetes idea?

Martin 29:29
Yes, it is definitely something to look forward to and enjoy. We have plans for travel playing with the one existing grandson. That's great fun. So yeah, we have lots of good things to do. I mean, I'll I'll be honest, I also one of the reasons I retired was I wasn't actually very well. I had to have open heart surgery back in end of November. So things are a little bit different than they were. But yeah, we're enjoying. It so far. How did you come through the surgery that took a while to get back to feeling how it was before? I wouldn't like to say my stamina is back yet. And I wouldn't like to say that my stamina was back at those pre levels, because the even last year, I was skiing quite a bit, and that that was only sort of six or eight months before the actual surgery, but looking forward to getting back to it next winter. What

Scott Benner 30:30
did they tell you, like, what led to the need? Were you? Was it diet, weight, just genetic? I'll admit,

Martin 30:37
again, it shows my sort of disinterest in medical things, but I don't really know what the cause was. It was much more. I thought I was feeling ill. Started to go to talk to some doctors about it, and they said, Oh, it's not your breathing, it's your heart. That's what's slowing you down. And it just sort of snowballed from there through to you need to have some heart surgery. You need those three of those replaced. Okay,

Scott Benner 31:05
wow. Martin, that is so of your generation. It's fantastic. It really is,

Martin 31:13
in which way is that my,

Scott Benner 31:14
I don't know, man, like, I'm so involved in my own health. Like, if I like, if I get up and I'm like, Oh, what was that? I might do something about that? And you're just like, I don't know I was going along. And then Doctor told me my heart was falling apart.

Martin 31:28
But these things happen. You deal with them. When they happen. You get over it. No Inkling prior to that my breathing wasn't doing so well. But I've asked them anyway. So I was, I was used to that

Scott Benner 31:42
your breathing wasn't, well, yeah, and you had asthma. Oh, see, so there you go. So you had asthma. So you're like, Oh, this is something I'm accustomed to

Martin 31:50
exactly. So it was the symptoms didn't really push me down that heart route at all. And it was only when I started talking to some doctors, they said, Oh, by the way, this breathing thing may not be breathing at all. It, it may be your heart, and it's got a problem. Let's do some investigation along that route. And that was

Scott Benner 32:10
the right one. Interesting. That is very interesting.

Martin 32:14
See, whereas you would have been there with the I need to find out on this. I need to work out what could be causing this is that, oh

Scott Benner 32:21
my god, I would have Martin. I'd sit down in front of chat G P T and tell it a whole story about my health, and let it tell me what it thinks and and the whole thing. Oh yeah. I'd be like, I'd be like, first of all, I gotta tell you something. I've had some of the most thoughtful conversations with chat G P T in the last couple of months. So I know that sounds ridiculous, but you sit down in front of an AI thing, I do it over my phone, and so it actually talks back to me. I will literally say to it here, watch. I'll do it for you right now. Let me see if I can load it up for you. I'm having some medical issues, and I'd like to chat with you about it. If I sat down here now and talked you through some of the things I've experienced in the past, would you help me work it out? Listen to this, Martin. It's thinking, Okay, give it a second. Oh, now it's gonna let me down. Chat. GPT, what are you doing? You're always Martin, how embarrassing is this for chat. GPT, 4.0 hold on. A second. Let me start over again and not

Martin 33:22
they. These large language language models are not my fault. Hold on a second.

Scott Benner 33:30
I'd like to talk about some medical issues I've been having. If I went over some symptoms, would you help me figure out what might be going on? Absolutely, Scott, please tell me about the symptoms you've been experiencing. I'll do my best to help. Lately, when I eat greasy food, my bowel movements aren't firm and my stomach hurts. It sounds like your body might be having trouble digesting fats. Do you think that has anything to do with my previous problems not being able to absorb iron, because previously, I've been having trouble absorbing iron. Sorry about that. I got a text in the middle that messed it up. You're right, but so I now I've put on this big show about it, and I'm like, and now I'm it seemed like, but I'm swear to you, I had a 20 minute conversation with it, a 20 minute conversation where it actually helped me think about things that I hadn't considered before. Yeah, is so it is not it isn't crazy. I know just now it didn't go as well as I was hoping. It's not like that normally. So I literally just like talked it through, and it gave me this idea, and I thought, Oh, I hadn't considered that. And it led me down a road. I went and talked to my doctor about it, and my doctor was like, Yeah, that makes sense. And so then we worked on it, really crazy, but not just that. Like, seriously, I would think about all of that, but tell me why you wouldn't. Like, what is that idea like? Just that life is what it is. And it ends when it ends, and I'm not in that much control of it. I'm

Martin 35:04
intrigued that you think you do actually have that that much control life can be planned, but only to a certain degree. There are a lot of things that that happen that are completely out of your control, that you have to react to and do the best you can your health, I thought, and would still think, actually, is one of those factors. You don't know the DNA that you're born with, and therefore you can't, at any point say, Oh, well, 2025 I know I'm going to get that in growing toenail. Now, if I start to wear the right socks, I can deal with that. That sort of thing doesn't occur to me. Doesn't make me want to do the research. When I get the ingrown toenail, I'll get the right socks.

Scott Benner 35:53
It's so simple. So all right, so I'll tell you a story. Okay, okay. There have been a number of people on the podcast just recently. And those people are lot of they have lot of diabetes, so type one, but, you know, just getting going and okay, you know, they maybe had it for four or five years. They've been using insulin. They've got auto antibodies that indicate they are definitely type one. On their way to type one, but their body's probably still making some insulin. They have a very slow onset of type one, and they're taking one of those GLP medications that are for type two diabetes or for weight loss, like ozempic or Manjaro, that stuff you hear about all the time in the news, right? Some of them are almost either completely off or completely off insulin right now, now, like that's not a thing that anyone would consider in the past. That is a new idea. So because they were paying attention to the world and what was possible. Now, I interviewed a man who's literally, at this moment, not using insulin. Now, isn't that fantastic?

Martin 36:59
I agree that's tremendous. But isn't that the I have the in growing toenail and now founding, there are sock options. I could have a blue set. I could have a red set. I could have a pink set. And he works really well. His feet work really well with the pink set. Is it not that kind of situation? Rather

Scott Benner 37:17
than, I'm not following you, I'm not finding exactly like, so, like, he's paying it, he's paying attention to cutting edge technology, and it's working for him, yep. And so if he wasn't paying attention, he'd never find out. Like, never. A doctor wouldn't tell you about this. You know what I mean? Okay, yep, you're coming from restoring. A doctor wouldn't tell you about this. Never, ever. I promise you, by the time a doctor thinks to talk about this, it's going to be, it's going to be too late. It'll be 10 years from now. You know what I'm saying? It'll be 10 years from now, and they'll be like, You know what we're finding out, we're finding out, and like, and I'm going to be the guy running around going, is that what you're finding out right now? Because Scottie knew about that 10 years ago. And like, and that's the thing that I'm interested in. Like, I'm interested in, why not just do it like, you know what I mean? Do it? Do it right now. Pay attention to it. Get out there and and just like, try something. Like, I'm not talking about, like, bio hacking exactly, which is even probably a term you're not completely at ease with, but it is that simple. Like, you know what I mean? Like, it's if you're very low in vitamin D? Well, there might be a real reason for you to take extra vitamin D, like, why not try it? Like my my friend who, right now can't get a doctor to give them medication for a high thyroid stimulating hormone value, even though they have all the symptoms of it, my argument to the doctor is like, look, this medication is fairly benign, right? If I take it for a week or two and I didn't really need it, then you know, it's not going to kill me, but if I start seeing my symptoms go away, then can't we say, Wow, this is working. And would that really hurt to try it? Would a person that I'm seeing now who has type one diabetes, who's taken this GLP medication completely off label, and they're micro dosing it, giving themselves little bits of it every day, instead of the whole thing once a week. It's impacting their insulin needs and not causing them not to be hungry like that's a thing that I guarantee you Martin that five years from now, someone will say, we've done a study, and what we've learned is, and that woman will have lived the past five years of her life happy because she figured it out now and and so that makes me wonder, like, what else could I be paying attention to to benefit myself? Like, that's why, like, I'm not just saying to you, like you should have known something was going to happen to your heart. For it happened, but by staying kind of ahead of the curve, the opportunity is there. At the very least, that makes sense. Yep, that does indeed make sense. I see where you going. I'm just still a little bit nervous about that as an approach, because we are talking healthier and

Martin 40:22
trying, as you say, something new with your health doesn't feel to me a safe way forwards. Frankly, there haven't been a study if you don't know what those longer term effects can

Scott Benner 40:35
be, I take your point, and that is definitely a way that I would think you would think about it. But here's the thing, right? How much longer do you think you got? What do you think so? So if you try something like, like, I'll let you into my life a little bit. Okay, so it's interesting, because you, you don't listen to the podcast that much, I imagine, not at all. I'm afraid. How did you end up on it? I was volunteered by your wife?

Martin 41:01
Yeah? Oh, she listens. Send us to talk to you. I

Scott Benner 41:06
sit in front of you today virtually, yep. 53 years old. I weigh this morning. I weighed 184 pounds. Oh, my God. What is that in like, what do you got pounds? Like, that's fine. You understand what I'm saying? Yeah, I'm just understanding, okay, okay, a year and a half ago, I weighed 236 pounds. That's a bit much, right? It certainly was. I am not nine feet tall, Martin, so it wasn't working on me. Yeah, now I have a fairly sedentary job. I'm not gonna lie about that, but I do not eat poorly. I as I you and I talked before I started, I don't even I don't drink caffeine, I don't smoke, I don't drink alcohol. I've never had a cup of coffee like I'm a pretty clean eater. I'd made all these changes to my life over the years. No oils. I don't eat oil. I don't do all these things. None of it would impact my weight, nothing. No matter what I did, if I really, like, really starved myself, I could maybe lose like, 10 or 12 pounds, but generally speaking, I couldn't lose weight, and I was unhealthy. At times, my body would not absorb iron. I was at the in a position where, twice a year, twice a year, I had to go to the hospital, and I had to have them infuse me with iron, because my body was like shutting off. No lie, like I my ferritin level was nine at one point should have been a minimum of 70, and I would bend over to pick something up off the floor and almost pass out like I was that from this low iron, I said to myself, there are people losing weight on this GLP medication. I'm going to try it. And I tried it, and lo and behold. Now I'm, I mean, gosh, 3646 I'm laying like almost 50 pounds lighter than I was. My life is fundamentally changed. My knees don't hurt. I'm not creaky and achy. As crazy as it sounds, even though a doctor would never have told you this was going to happen, my body now absorbs the iron by itself through my nutrition that I take in. I don't have to take supplements for it just to keep me from dying. I don't have to go to the hospital and have interventions. And no one would have told me that that medication was going to do that okay, but now the research on just this medication alone in the last couple of years is saying that it is alleviating PCOS symptoms for women that a ton of women who for their whole life haven't been able to get pregnant, are suddenly getting pregnant because of this medication. Now a doctor will tell you, Well, yeah, well, they lost weight, but it feels like it's more than that, like I've seen plenty of overweight people pregnant. Do you know what I mean? Yeah, and and then now there's a study out that says that it might impact dementia and it might and there's on and on and on, because this medication, among other things, is eliminating inflammation in people's bodies like Fascinating, right? And people with type two diabetes are taking it, and some of them are not needing insulin anymore, or they're my brother is a type two is a one c1 from the mid sevens to the fives. He didn't change anything else, except he's taking ozempic once a week. My point is, they're even talking about heart health and ozempic and weight and etc and like, you don't know. Man, we're so close to figuring things out, and you're still you're young, 62 right? Yeah. So if you look at chat, GPT, 4.0 versus 3.0 3.0 was garbage, compared to 4.0 and 5.0 is going to be insane. And five years from now, I think what you describe is kind of scary, like, how am I just going to know if this is okay without a doctor? I think that's how people are going to interact with their health. I think they're going to pull their phone out of their pocket and tell the phone. Own. Hey, this is who I am. This is my weight, this is my height. Here's my medical history. Don't forget that. Keep that in memory, and then it's going to know all about you, just like you imagine your doctor does now, but they really don't. No, you know, the doctor stops outside the door, opens up, the chart, reads it, you know what I mean, like, uh, like, and meanwhile, you're in there with this, this warm feeling like of the last time you met, and the guy really likes me. He's a good guy. He knows that. He don't know anything about you, but that algorithm will. And then you can wake up one day and say, Hey, algorithm who remembers everything about my medical history that I've ever told it I woke up this morning, and on my lower right quadrant, I have a pain that feels like this, blah blah blah, and it might say, oh, Scott, you are having blah blah blah. That's where this is going. Now, there'll be a person on the other end to make sure, but I think that's what's going to happen. I think it's going to happen with diabetes and with health in general. That's my thought. And I think you could pay attention to that stuff and help yourself in little ways that would build up and be bigger ways eventually, it's an interesting future. What do you think, though, at your at your age, what do you think of all that? What

Martin 46:09
of all the the large language model stuff? Yeah, yeah. Oh, that's a absolute longer conversation at this point. Well, I can, I can summarize into it's a superb way of using the currently collected information that is available on the internet. However, I don't trust all of the information, or quite a lot of the information that's on the internet, and therefore, I'm not particularly trusting of those large language models. I

Scott Benner 46:42
don't disagree with you. You know, the question becomes like, how? How does it know what it should be paying attention to and what it shouldn't be? But when we're exactly, but when we're just talking about Martin, and it only knows about Martin, what we told it about Martin. Now you have a large language model for your health, and you're not going to and even if, even if you end up telling it something that's specious, something that you like, you know, was a ghost for you. You thought it was one thing, but it was actually another thing. Over time, you'll be able to weed that out and go back in and tell it, hey, you remember, like six weeks ago when I told you, I thought this was what was going on with me. I don't think that's what was happening. And just like that, it

Martin 47:20
won't think about that anymore, personalized, focused items, it could be very effective.

Scott Benner 47:24
I would agree. Yeah, it's going to do all the things that human beings can't do, keep, like, competing ideas in their head, but don't judge them based on bias. It's going to be able to remember things you told it six months ago about, like, you know, I got up in the morning and my toe really hurt. Just really, really hurt. Then it stopped hurting. But it'll remember six months later that your toe hurt six months ago, there in is where, like, you know, it might be able to put block, like puzzle pieces together and say, Oh, had you considered this? You know, if you said I was out of breath today, and it was after I went for a walk. And then you forget about that six weeks later, but it happens to you again. It would say, Hey, weren't you out of breath six weeks ago? I wonder if we shouldn't go to a cardiologist or maybe visit your pulmonologist, who would have then said, Oh, it doesn't look like it's this. Let's take a look at your heart, like that kind of stuff. Man, I'm super excited about that kind of stuff. You know, it's a good it's a good future, yeah, and imagine your wife even, like, as you guys get older, like, because this is the thing we don't talk about. Like, type one diabetes is just going to keep happening, like, for her, and she does if she does a, you know, a good job, and keeps her her stuff where it belongs to live a long, happy life and etc, but one day, it'll be harder to push the buttons, or it'll be harder to inject the medication or to do the math or that kind of stuff. But just imagine if you could, you know, say, you know, Alexa, can you tell me I'm about to eat a ham sandwich. I think you know about how many carbs you think are in this ham sandwich, and then it comes back and tells you, I think it's 23 carbs. And you go, great. I don't remember, but what does that mean for me? How much insulin do I need right now? And have it come back and say, Oh, that's two units for you. That might be very comforting as people get older, you know, agreed, hey, it might get you out of having to understand all this diabetes stuff. Martin, don't think that was gonna happen. No, no, no. So your wife sent you on here to learn something, to get schooled. What do you think her her onus was?

Martin 49:36
Oh, to talk about my experiences with her type one diabetes, to hear your opinion on that, because there are some parallels to our situations. You learned about diabetes because of your daughter, yep, but you're definitely getting it all secondhand. And frankly, would that persuade me that I should. Be more involved or not. What do you think? Do you think you should be? I did, actually, when you said expert series from Episode 1000 on, I did write that down. Good. I do need to start listening to you. Scott. Good, well,

Scott Benner 50:15
I'm glad, honestly, it that series is myself and Jenny Smith. Jenny is a nutritionist. She's a CDE, a certified diabetes educator, and she's had diabetes for over 35 years now. And I'll tell you what, what had happened. So I'll tell you what you're gonna get. Some background on me is that my daughter was diagnosed when she was two, but today she is 20. Actually, she's gonna be 20 in a couple of days. Couple of days. She's had an A, 1c between five, two and six, four for probably the better part of the last 10 years. And a long time ago, gosh, a very long time ago, after she was diagnosed, she was diagnosed in 22,006 and in 2007 about almost the exact year later, I started writing a blog about being the parent of a child with type one, and I was as lost as everybody else and her a 1c was, you know, in the mid eights, and I didn't know what I was doing, and just, you know, I was following what the doctor was saying, and it wasn't going well. But over time, I realized, like, if this is on me, like, if I don't figure this out, she's not going to live as good a life as she could have. And so I start, you know, putting pieces together and figuring things out. And one day I said to my wife, like, one day after I got her a 1c down into the fives, I was like, I said to my wife, I was like, I have a system. And she's like, What are you talking about? I'm like, it's not obvious. I don't call the steps that I take a thing. It's not written down like bullet points, but I know there are things, and if I do these things, Arden's a 1c. Is lower and stable. Her blood sugars are lower and stable. There's a system in here somewhere, and I started writing about it on the on the blog. But then one day, I launched this podcast, 2015 in January. I was making it for a while, couple 100 episodes, and people would get back to me all the time and say, I listened to the podcast, and my a 1c, goes down. I don't even know why. They'd say, like, I don't know. I'm just listening. I guess I'm doing the things I'm hearing you saying, because I don't like, most of my conversations are, like, the one I had with you, right? Like, it's not a lot of like, do this, then this and this, it's more big ideas. You pick out of the ideas and figure out for yourself. I would tell people all the time, listen, if you want your a 1c to go down, if you want your blood sugars to be more stable, just listen to the podcast. It'll happen. And people would have that experience. But then one day, I was like, God, there's 200 episodes. Like, How long am I? Like, how much should I expect these people to listen to, you know? And so I went to this girl, Jenny, who I know is now a very good friend of mine, and I said, I love the way you talk about diabetes. You have a more medical background, plus you have type one. I think I have a system. Would you sit down with me and talk about it one episode for one idea? And she was like, I'd love to so we did that. And then we could say to people, go listen to the Pro Tip series, if you don't have time to listen to the whole podcast. And then people would come back and say, I listen to the Pro Tip series. And a month later, my a 1c was down to six. Or I get notes all the time. My ANC went from eight and a half to six. It went from 12 to seven, and then it went to six and five and and, you know, all I did was listen to this. That's all you really need for your desire. You can keep listening if you want to. Yeah, you can go back and hear stories of God. I have after dark series where people will tell you anything from about their eating disorders to being bipolar and having type one. One girl came on here and told me she was diagnosed with type one on a heroin Benner, like, literally out on the town, scouring the town for heroin. She diagnosed with type one during that. And when you hear people's stories, you will pick things out of them. You'll hear little bits, and you'll think that's important, I should remember that. Or, my gosh, I didn't realize. Or you start to have, like, a community feeling, where you recognize you're not completely alone, and then other people have other ideas that are maybe even more valuable than the ones you have about an idea, and you can adapt and borrow from me and borrow from them until you have a, you know, a plan and a family that that kind of keeps you more shielded and protected. And that's that's how the podcast ends up working for people. No, that's really good, you know. And I'm not 62 but I'm 53 and I gotta tell you, this wasn't in my wheelhouse when I started doing this, and I was surprised by a lot of what happened. I really thought I know how to use insulin. I'll jump up on this microphone and tell people how I do it, and then hopefully they can get some success right. But instead, I learned about community, which is not a thing I really understood back then. I knew it was nice to know you weren't alone, but I didn't realize how important it was, and then to see that everyone basically has the. Same set of problems. You know what I mean? Like, basically has the other set of problems, and nevertheless, like, your story impacts my story impacts someone else's, and it makes your burden lighter as you go. And so it's not just about the nuts and bolts of diabetes and how you could have felt better, etc. It's really about a lot more than that. I hope you find some value in it, and that it's helpful, and that, you know, you and your wife can, uh, you'll have something else to talk about, and it'll be about me and my conversations I had with somebody the other day, that'd be crazy. That'd be that'd be insane, even literally, where are you at right now? You're in what I don't want you to tell me, like, what street you're on, but where do you live?

Martin 55:44
I live in Guildford, which is about 30 odd miles outside London, 3045,

Scott Benner 55:49
and I'm in New Jersey. Isn't that crazy? That's great, and I don't have diabetes, and your wife is finding value in a thing I'm saying in a spare bedroom in my house into a microphone. Yep, like the world's crazy. Now, I tell people all the time they have a private Facebook group I think has like 52,000 people in it now, and by the time somebody hears your conversation with me, it'll have 1000s more in it. And this podcast, which has now reached I'm getting close to 18 million downloads in the time that it's been recording and available for people in over 40 countries, the podcast charts like, well, like people listen to it in mass in 40 different countries. It's all because of the cell phone, because without the cell phone, people couldn't get podcasts. And people used to talk into microphones, and they'd sit down at browsers and try to listen through the internet. But it's not, really not, not a great way to take in audio, right, like until you could have it portable and with you and in your ears. It really blossomed at that point. So somehow, a guy in New Jersey who doesn't have diabetes is helping a lady in London who's had diabetes for 30 years because of cell phone technology in part. And I think it's going to keep happening like I think that as AI doubles on itself, and as technology gets faster and better, you're going to be able to get information to people in different ways. For example, I um allowed a company called Vision AI to absorb, absorb my podcast. So they took the transcripts from my podcast and absorbed it into their large language model for people with type one diabetes, and when you not only does it attach itself to your CGM data like I have it set up with my daughter's data. So if I go into this large language model right now and just say, what's my blood sugar, even though this thing is not attached at all, you know, to anything my daughter is wearing, it comes back and says, Your latest recorded glucose levels, 129 the trend is stable, and if I just asked it, what should I Bolus to get to 99 when it answers, it'll explain the whole thing to you, but it'll also break it down. Tells me what my insulin sensitivity is. It shows me the formulas and everything else. But then it just clearly says, you know, here's how much you should Bolus to do. That gives you like, you know, that kind of stuff. It also says tip from the Juicebox Podcast. And one of the Juicebox Podcast episodes, Scott mentions the importance of monitoring trends and making adjustments based on real time data. And Jennifer suggests using cautious approaches, starting with smaller adjustments and observing glucose responses for future fine tuning, and then it gives you follow up questions that would be smart to ask and that kind of stuff like, and that's just going to get better and better. You know, I don't know, man, like, I'm so interested in how to help people. I think all of this has something. It all has a place in it somewhere, because I've put so much information into this podcast that that idea of like, just go listen to it, you'll understand one day might be just go ask the prompt. It'll know, yeah, you know, super exciting. Anyway, I spoke way too much today. I apologize.

Martin 59:20
You're okay. No, no, no, no problem. Really

Scott Benner 59:22
good. When you leave today, what do you think you'll go tell your wife? We had a

Martin 59:27
good conversation. I thoroughly enjoyed the conversation with you that you are definitely passionate about the large language models and that that is a future approach, and the one thing that I will be doing is listening to some of your expert expert podcasts, which were 1000 on, I believe the episode number was,

Scott Benner 59:50
it's called the diabetes Pro Tip series. And okay, and that would be, and that's going to be dug down, but I'll tell you what to Martin, there's an app. There's a series called Bold beginning. Things that's for newly diagnosed people. So if you think I'd like a little more elementary lead into it, go bold beginnings first, and then go to pro tips. Okay? And there's also a series called defining diabetes that takes everyday terms around diabetes, in case people are, you know, throwing terms around and you're like, I don't know what that means. Those will help you understand Bolus basal, all the way up to things like feet on the floor, things you've never heard of before. But believe it or not, when people get up in the morning, when the world hits them that adrenaline, sometimes their blood

Martin 1:00:34
sugar goes up. Yeah, agreed. Now that one, that one on you, yeah. And

Scott Benner 1:00:38
so there's all kinds of different terminologies that I think get thrown around that stop people from understanding their diabetes well and all the rest, man, like there's a world of information. There's 10 years worth of conversations in there. I hope some of them help you and and your wife. And I really impressed with you guys, because I know some people who've retired and they don't talk to each other anymore, and so I am super impressed that you guys are so excited to to know each other like this. Yeah, new face, yeah, good for you. You excited to it? You excited about it? Yeah, yeah, yeah. How often you get to see your grandkids?

Martin 1:01:19
At least once a week. We look after him for a whole day once a week. Oh, that's really cool.

Scott Benner 1:01:25
That's lovely. Good for you. I bet you wait. I bet you wait for it every for the other six days, you're just waiting for him to come back, right? Oh, yeah, chatting about him. Don't you worry. That's wonderful. All right, man, it's really nice to talk to you. I appreciate it. Cracking to talk to you. Scott, yep. Hold on one second for me,

I'd like to thank touched by type one for sponsoring this episode of The Juicebox Podcast. And I have to remind you again about this steps to a cure kickoff event that's happening this weekend, january 18. Man, if you're in the Orlando area, I'm talking about a big day for you. Join touch by type one for a light breakfast at their walk. Kick off. You come meet fellow participants, learn more about the walk. You get excited, but then you're enjoying a complimentary day at the Orlando Science Center. I'm telling you, you're not going to get a better deal anywhere anyhow. Touched by type one.org Go to the Programs tab, head over there now. Man, you're lucky to be in Orlando. Are

you starting to see patterns, but you can't quite make sense of them. You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, you're starting to think this isn't going the way the doctor said it would. I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group. Just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 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. 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 you?

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