#1448 Small Sips: Stop The Arrows

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Acting early on CGM trends prevents major highs and lows and leads to more stable control.

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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 00:00 Hello friends, welcome to the sips series. These foundational strategies were nominated by listeners. They told me, these are the ideas in the podcast that truly made a difference for them. So I distilled them down into short, actionable insights. There's not going to be any fluff or complex jargon, just practical, real world diabetes management that you can start applying today. And I know your time is valuable, so we're keeping these short. Another small sip will come out once a week for the foreseeable future. If you like what you hear, check out the Pro Tip series or the bold beginning series for more. Those series are available in the menu at Juicebox podcast.com and you can find complete lists of all of the series in the featured tab on the private Facebook group. Please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. The questions you have, I guarantee you there's answers to them in the Juicebox Podcast, and it's all free. You all right, Jenny, I appreciate you doing this with me again. We are going to talk about stopping the arrows today. Oh, fun. So this came up originally in defining diabetes that we did in 286 where I think we were just talking about visual cues that we were using in Dexcom or any CGM, really, to make decisions about diabetes. So I'd like to hear from you first, how do you utilize arrows on CGM? Do you pay attention to them? Is the number more important to you? How do you think about it? I think

Jennifer Smith, CDE 02:03 the arrows can actually be more beneficial than the number value itself, because we know that CGM is going to be a little bit off of a finger stick in general. And when your number is changing, or you've got that arrow or the directional line of the dots on your on your system, showing you that things are shifting and changing, whether it's a rise or a fall in your glucose value. But the number isn't exactly a finger stick value. It is giving you information about what's happening right now, though, and so when I look at, you know, my arrows, for example, I expect a little bit of a trend up in the aftermath of eating something, but I also know enough about the types of things that I eat that I could expect based on timing, knowledge and everything else, That arrows shouldn't be dramatic, like I should not get. In fact, I don't know the last time I actually got, like, a double arrow up, kind of, or even a single arrow up, but in general, a nice, stable sort of course, up in the aftermath of eating something. You might get a little bit of that angled arrow trend up in the aftermath of a meal. But you also have to think in that scenario, again, not based on the number, but based on the trend that's happening. Okay, I just ate. I expect a little bit of a shift in my blood sugar. It's not going to stay flat in most cases, some eating sales, sure. But in general, it's going to coast up a bit at a certain point. However, after the meal and the Bolus, it should plateau. It should stabilize. You shouldn't any longer have that trend Up Arrow or that angled arrow up, it should plateau. And then eventually, over not a terribly long period of time, maybe 30 minutes, it should actually start to kind of come back down. So we're looking for a bell curve when we're looking at data around meal times in times that aren't around meals. Though, those arrows can give you more information about what you might need to do too, because if you're in a fasting time like overnight, and you just so happened to wake to an alarm that you've got set for a higher low blood sugar, and you have a trend arrow happening there, it might actually cue you into doing a finger stick to evaluate whether that's true or not, and to take a course of action, because now, assuming there's not any food or anything else happening, the trend up might actually need some assistance. You might need to do something about it, or the trend down, you may need to do something about it to stop it, because clearly, you have nothing else impacting the change right now.

Scott Benner 04:50 So I think when I said originally, like, I think about stopping the arrows, it was when I was trying to figure out how to use the insulin. Right? Like, so, to your point, I like that you said after math, after after a meal. Like it was, like a car accident, and everybody's just, like, dazed out in the

Jennifer Smith, CDE 05:10 streets. People talk about it, it seems like I don't like it is, like a whole, like, atrocious situation. That sounds like you ate, you know,

Scott Benner 05:17 just wandering around and there's smoke in the air, like, what happened? You ate? Yeah, it's so I just love that when you said aftermath, that was so what I was trying to get at back then in these episodes where, by the way, comes up again in episode 327, episode 125, like, it's a thing I've talked about a lot, but before algorithms and before really understanding firmly how insulin was working. I was teaching myself about the value of my Bolus by what the arrow was doing afterwards, right? Like, and, to your point, like nowadays. I mean, if I saw a double arrow in either direction nowadays, I don't even think I'd, I'd be like, what just I don't understand. But back then, they were happening constantly, right, sure, but back then, I didn't understand Pre Bolus thing. If you listen back, you can hear that as Arden was growing, because Arden was diagnosed when she was so small, as she was growing, her office never changed her insulin to carb ratio. Oh, her endo office, really, and her also the insulin sensitivity. Like, I looked one day, and it was like, one unit moves her 300 points. And I was like, that's not true at all, you know, like, and then I realized, like, these settings are being ignored by people, and they're important. She's grown, she's gotten bigger. Her basal doesn't change. She's grown, she's gotten bigger. Nobody changed her insulin sensitivity. I'm like,

Jennifer Smith, CDE 06:40 which is one that drives me crazy, that sensitivity factor, correction factor, it is the least adjusted of all the three knobs, so to speak, that you can kind of turn right. We've got basal insulin to carb correction factor. It's the one that gets left in the corner by itself and nobody fixes

Scott Benner 06:59 it. Yeah, I was stunned. I mean, once I mean, once I figured everything out, I was stunned what was happening. I didn't even think twice about it. I wasn't pre bolusing. Her settings were way off. She'd eat something, her blood sugar would definitely two hours. Were happening all the time. I even think back then I was blaming the insulin at one point, like probably, I actually think that I love a Pedro. Arden. Been using it forever. I find it very smooth for her. But I think I made the switch because I thought it was Nova logs. Fault that we were seeing these double arrows because I was out of ideas about, like, what to do, what to do. But anyway, like, what I this, this kind of fundamental idea I had back before the settings were right and I knew what I was doing is I would think I have to stop the arrows, right? So, like before, I understood that I wasn't using enough insulin, I at least knew I should not be seeing this arrow up, and I kind of set these lines in my head, like if you know, in the first 30 minutes after she ate, she was rising quickly, or she got over 140 and it looked like she was gonna go to 160 I assumed I didn't use enough insulin. I put more insulin in. Nowadays. I still use that, but it just doesn't come up as much. But what really ended up happening was the people listening to the podcast who also were in a situation where they didn't understand that there were three settings they needed to be looking at, that they were probably all wrong, that they were timing their insulin incorrectly, etc, they found that phrase stop the arrows to be really helpful in the beginning, while they're learning, you know, while

Jennifer Smith, CDE 08:30 you were saying that, learning about how to stop the arrow, as I imagined you like, in my head, the scenario of like, packing your backpack Full of whatever you're going to leave the house with to take care of whatever force was invading your home at that point. Imagine it's like you're in this war against, oh, something

Scott Benner 08:51 against the arrows, like, like, really, because that's what is. Because the number to your point, listen, CGM are fantastic, but the speed direction that information is super, super helpful, maybe more so than the number, right? But, yeah, that's exactly what it felt like. I was like, oh, it's everything. Felt like it's coming for you all the time, like you don't I mean, like, here comes the arrows coming. I don't know how it got here. I don't know how to kill it. I don't know how to stop it without it turning into a different arrow that I don't want to see. Right? Anyway, as a general management idea, I think when you see straight arrows in either direction, they need intervention. So it's obvious when you're dropping fast that you need intervention, but I don't think it's so obvious, at least in the beginning, to people, that those straight arrows up mean I've significantly mistimed and miscalculated my insulin, right? Yeah, right. And

Jennifer Smith, CDE 09:44 those, I think those straight arrows are definitely, I mean, angled arrows you're likely to see more often, especially angled arrows that are coasting up slightly again in the, I was going to say it again the aftermath of a meal,

Scott Benner 09:57 it is. I mean, if it's going like this. Yes

Jennifer Smith, CDE 10:00 and to not be too again, this is where the understanding of insulin and how insulin works, along with food, becomes really valuable. Because if you're just trying to stop the arrow and it's 20 minutes after you've eaten a meal, you haven't really given that insulin enough time to do justice, right? So I think there is a timing or an evaluation time to look for that arrow and say, Okay, I know I still have insulin working here. I'm going to wait 30 minutes and hope for that plateau, hope for the the turning point that it's not going up anymore, that insulin really is taking action. And they're kind of that tug of war idea that you, that you created. They're working together, the insulin, the carbs, they're working together, and now it's going to coast back down the up and down arrows, like you said, those straight arrows, those are the ones that usually indicate either something is amiss with the insulin site that the pump site, right? Is it leaking? Has it been pulled loose? Is it disconnected? Because if this is a normal meal for you, that shouldn't be happening, right? But the other piece would be, if you got a straight arrow up or a straight arrow down, it's probably timing that was the best.

Scott Benner 11:17 Yeah, right. If you're using the right amount of insulin and you're still seeing a straight up arrow, you may have just let the food get ahead of the the insulin by not Pre Bolus thing enough. I kind of think there's two different ways to think about this. Like, there's the way to think about it once you're in my position and your position where you know your settings are good, right? Like, once you know your settings are good, if you see those drastic arrows, you're like, Oh, this is timing, or I didn't use enough insulin, or I've miscalculated the impact this food's going to have. Something like that back when you don't know what you're doing, and it's just starting out like to your point, you don't want to Bolus for a meal. 15 minutes later, see an up arrow and just start pouring in more insulin, because correct you don't know what's going on. Like that. Might be a time to sit back and evaluate and say to yourself, you know, for next time, I'm going to try to get the insulin in in enough time that this doesn't happen, that this food doesn't come in and just crush and overtake the insulin, because it's not working yet. If this makes sense to you and you want to learn more, go to the Pro Tip series to try to learn more about how to get your insulin setting set up. Thank you. Perfect. That's awesome. Yes, 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 if you or a loved one, was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The Bowl 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. 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. You.

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#1447 Diabetes Pro Tip: Insulin Resistance

Jenny and Scott break down what insulin resistance and diabetes.

You can listen online to the entire series at DiabetesProTip.com or in your fav audio app.

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

+ 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 00:00 Here we are back together again, friends for another episode of The Juicebox Podcast. Today I'm adding to the Pro Tip series. The rest of the series runs from episode 1000 to Episode 1025 it's also available at Juicebox podcast.com, up top in the menu, look for diabetes. Pro tip, please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. When you place your first order for ag one, with my link, you'll get five free travel packs and a free year supply of vitamin D drink. Ag one.com/juicebox, 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. Are you an adult living with type one or the caregiver of someone who is and a US resident? If you are, I'd love it if you would go to T 1d, exchange.org/juice box. And take the survey. So if you'd like to help with type one research, but don't have time to go to a doctor or an investigation and you want to do something right there from your sofa. This is the way this episode of The Juicebox Podcast is sponsored by Medtronic diabetes and their mini med 780 G system designed to help ease the burden of diabetes management. Imagine fewer worries about mis Bolus is or miscalculated carbs thanks to meal detection technology and automatic correction doses. Learn more and get started today at Medtronic diabetes.com/juicebox the episode you're listening to is sponsored by us. Med, us. Med.com/juice, box, or call 888-721-1514, you can get your diabetes testing supplies the same way we do from us. Med, Jenny, we're going to do something that we don't do that often. We are going to add to the Pro Tip series today. Yay. Right? We are gonna talk about insulin resistance.

Jennifer Smith, CDE 02:23 Oh, the fun of insulin resistance. Did you hear all

Scott Benner 02:27 the clicking? Everyone's like, reaching for their phone. They're like, Oh, I don't notice this.

Jennifer Smith, CDE 02:32 Turn this off. Let's fast forward and see if they talk about something. Guys

Scott Benner 02:34 say, insulin resistance. Did she pretend to be excited about it? What's happening right now? But we think this is very important and very important to add to the Pro Tip series. So we're just going to jump in with, you know, starting at one, what is insulin resistance in type one and what drives it? Let's talk about that first, make sure we understand awesome.

Jennifer Smith, CDE 02:54 So I think it's important to again, define kind of insulin resistance as what's happening in the body? Like, why are you using a ton of insulin? That's what I think most people on a very like, just low statement level, I use a lot of insulin. I must have insulin resistance. That's not necessarily true, and I think that begs definition as well. Overall, the definition of insulin resistance is the body is impaired in response by some specific tissues in the body to actually using insulin, well, which then decreases glucose uptake or movement of glucose out of your bloodstream into those cells, right? And the main sort of tissue receptors for insulin that become resistant are your liver cells, your skeletal cells, and then your fat cells. You might also see them called adipose tissue, but it's just fat cells, essentially, and it really means that your body just isn't it's not allowing the insulin to open the doors on those cells and allow the glucose to come in so our body doesn't essentially dispose of glucose the right way. I mean, it's the defining piece of type two diabetes. And while we really want to talk about type one, I think that's the piece that is misunderstood, because it's happening in type one and type two in a in the same way, but potentially and potentially for some of the similar reasons, right? But type two, we may eventually get to insulin resistance by not really seeing blood sugar changes, right? Because the body is actually trying to compensate for those cells not using insulin. Well, the beta cells just put out more and put out more and put out more insulin, and eventually they kind of get pooped out, right? So in type one, I think it's important to then define we can have insulin resistance in type one, but there might also be times where insulin. Needs are very high. And that doesn't mean you have insulin resistance that is long term a problem, right? So to defining those time periods really insulin resistance for time specific could be puberty, your child or teenager may use an excessive amount of insulin because there is a lot of growth and a lot of stuff happening. But unless your child is also obese, has elevated blood pressure issues, has issues which with low HDL levels, kind of the metabolic pieces that we're looking for that coincide with insulin resistance or metabolic syndrome, right? You may just need more insulin steroid use. You need a lot of insulin for using steroids and some other medications or other medical treatments. You may have excessive use of insulin, but there's the resistance in the picture, then, because of something that will not be long term, okay? Does that make sense? And you type, you know, pregnancy with diabetes as well, gestational diabetes, those are all instances of insulin resistance that they can be managed. And once those hormonal shifts are out of the picture, the resistance typically isn't as excessive or and, or just goes away, right? It

Scott Benner 06:19 could be language with type ones too, because, like you said, insulin resistance is a very specific thing, but you could be at times resistant to insulin. That's the feeling right, like it doesn't matter how much insulin I give myself, it's not moving. I'm resistant to the insulin. I'm insulin resistance. And then those two things just get blended right together, correct? That's just Yeah. And now it all means the same thing, but it doesn't mean the same thing. Does not again, weight gain, sedentary lifestyle, hormonal changes, medications, illness or stress, lack of sleep. These are all reasons why you might find yourself requiring more insulin than you normally do, right? Doesn't necessarily mean well, the weight gain does, though, right now weight gain is that would be insulin resistance.

Jennifer Smith, CDE 07:04 It would be especially if it's weight gain that goes well outside of a growth parameter, or expected growth, right? Kids, teenagers, we expect them to grow, and usually growth happens in weight and then height, and then weight and then height, right? It doesn't typically all happen at the same time, give or take the kid, right? But we wouldn't expect a child to grow really, really slow or not much in height, but continue to pack on the pounds. That's not what we would want to be happening. That's not normal growth. And so then if other parameters are in the picture, especially, you know, more sedentary lifestyle. I there is, you know, one of the potential risk factors when we talk about type one with insulin resistance is a family history of type two. So there's the potential, then, that the body is more from a genetic predisposition to have the potential for problems with weight management and whatever. And again, there are people that would beg to differ with that, but there's enough research out there. I've

Scott Benner 08:07 had a doctor on from Joslyn. He's also on staff at Harvard, and he said that, you know, the term double diabetes is just, you know, going to take on more and more prevalence, maybe in the zeitgeist coming up, probably because of how glps are working. For some people with type one, which then, you know, you ever see somebody with type one, go, I tried a GLP. It didn't do anything for me. And I thought, oh, yeah, you don't have any insulin resistance, you know what I mean?

Jennifer Smith, CDE 08:33 And or the other factors that the GLP ones, I mean, they're, they've been used for a long time. The newer versions now are definitely like the steroid version of what we had years ago that really didn't do what the new ones are doing.

Scott Benner 08:46 Glps on steroids, right? I mean that inflammation, weight loss, it tamps down hormonal issues for some people, also just constantly high blood glucose, just chronic hyperglycemia, can increase your insulin sensitivity. You've probably heard me talk about us Med and how simple it is to reorder with us med using their email system. But did you know that if you don't see the email and you're set up for this, you have to set it up. They don't just randomly call you, but I'm set up to be called if I don't respond to the email, because I don't trust myself 100% so one time I didn't respond to the email, and the phone rings the house. It's like, ring. You know how it works. And I picked it up. I was like, hello, and it was just the recording was like, us. Med doesn't actually sound like that, but you know what I'm saying. It said, Hey, you're I don't remember exactly what it says, but it's basically like, Hey, your order's ready. You want us to send it? Push this button if you want us to send it, or if you'd like to wait, I think it lets you put it off, like a couple of weeks, or push this button for that, that's pretty much it. I push the button to send it, and a few days later, box right at my door. That's it. Us, med.com/juice, box, or call 888-721-1514, get your free benefits check now and get. Started with us, med, Dexcom, Omnipod, tandem freestyle, they've got all your favorites, even that new eyelet pump. Check them out now at us, med.com/juice, box, or by calling 888-721-1514, there are links in the show notes of your podcast player and links at Juicebox podcast.com to us Med and to all the sponsors. Today's episode is sponsored by Medtronic diabetes, who is making life with diabetes easier with the mini med 780 G system. The mini med 780 G automated insulin delivery system anticipates, adjusts and corrects every five minutes. Real world results show people achieving up to 80% time and range with recommended settings, without increasing lows. But of course, Individual results may vary. The 780 G works around the clock, so you can focus on what matters. Have you heard about Medtronic extended infusion set? It's the first and only infusion set labeled for up to a seven day wear. This feature is repeatedly asked for, and Medtronic has delivered. 97% of people using the 780 G reported that they could manage their diabetes without major disruptions of sleep. They felt more free to eat what they wanted, and they felt less stress with fewer alarms and alerts you can't beat that. Learn more about how you can spend less time and effort managing your diabetes by visiting Medtronic diabetes.com/juicebox

Jennifer Smith, CDE 11:31 it can actually, yeah, it can increase high blood sugars. Can increase your insulin needs, not your sensitivity, but yeah, exactly, it can

Scott Benner 11:39 give you increased insulin resistance, is what I meant,

Jennifer Smith, CDE 11:41 right? Absolutely. And what, what does that boil down to? It boils down to an inflammatory, you know, nature. I mean, we've talked before when we've talked about the different things that high blood sugars do in the body, right? And it is. It's kind of like, I think you've said, like a sand blaster to the outside of a painted building, right? The more sugar you have circulating, the more damage it creates inside your vessels and your tissues, thus all of the complications that we know about and have been told about, but if we leave that high, it's just chronic inflammation, and that's really hard for the body to get over. I think it's interesting that the doctor you talked to actually commented on what we kind of call now we're really aiming for the ability to have a dual diagnosis. And there is now in the ADAs, I think I brought this up before too, like an 88 standard changeover, the 2025 standards of care in diabetes does have a specific kind of statement within their document that notes that although type one is the diagnosis, some people with type mate one may have features that are associated with type two, things like insulin resistance, the obesity factor, metabolic abnormalities, inclusive of things like PCOS and all of those, and in terms of managing their life the best that we can, we're going to need to create a category for those people who have features of both type one and type two, almost a new diagnostic code or a new not just type one or type two or Lata or type 3c, or, You know, any of those things, but it translates then into the ability to access medications that can be an advantage. And as of yet, we still don't have any. We don't really have anything that's type one outside of insulin. And maybe, you know,

Scott Benner 13:36 my daughter's endocrinologist gave her a double diagnosis, and it was accepted by our insurance the first time. She didn't have to argue about it.

Jennifer Smith, CDE 13:44 And there are some specific parameters, like, if you're looking at that dual diagnosis, because you've gone through it with your doctor, it's not just your, you know, Google searching, or whatever it's you've gone through it with your doctor, and you've got at least, I think it, think it requires at least three specific areas to be check off points of determining insulin resistance. It it's based on how many units of insulin per kilogram of body weight you're using in a total daily amount of insulin. If it's over that amount, check box, right? Obesity is another indicator, right? So if you're looking at BMI from that indication, the threshold for the GLP ones is at least a BMI of 27 and above, right? So if you've got those factors, blood pressure that's elevated more than 130 over 80, I think it's a HDL that's low, especially for for men and for women, you've got high triglycerides higher than 150 all of these are their check offs to proving that there's a metabolic condition or a metabolic piece despite the initial diagnosis of type one, that dual diagnosis can be really beneficial.

Scott Benner 14:55 I know for sure, after talking to Dr Hamdy, I'm gonna have to be digging more into what a cytokine is, because. Because he kept bringing it up a lot. He also talked about a oral GLP medication that's in the pipeline that will not only help you with weight loss, but minimize muscle loss. So very he was very excited about that, I will say, he seemed very sure that injectable glps are a flash in the pan, and that the oral ones will be the way it happens much sooner than you expect. So I have my fingers crossed for that. I wonder,

Jennifer Smith, CDE 15:27 did he comment anything about the reasoning? I know a lot of people have asked for a long time about, why can't we just take an insulin pill? Right? And it has relevance to what the digestive system does to that it just breaks it down, and it digests it, and you really get nothing out of it. Then, right? So either it's an injectable or it's an inhalable and then the body doesn't break it down too quickly, and you get nothing out of it, right? He

Scott Benner 15:53 didn't mention how it's getting accomplished at this point, but if people are interested, it's episode 1411 it's called GLP essentials, with Dr Hamdy is very thoughtful on the subject. I'll have to listen to that too. Yeah, very involved for a long time. Hey, I just want to say that if you have type one and you're not experiencing what seems like actual insulin resistance, some reasons might be genetics. You may have, like Jenny said, not be in one of those hormonal impact signs. You could be younger because, for reasons, you know, younger people don't experience it always as as frequently as older people, and you might just be more active, like, you know, we talk about that all the time the Pro Tip series and other places. Why do people struggle with a ID systems? Sometimes, because I'm super active on the weekend, but not during the week or vice versa. And you're like, oh, this thing can't keep up with me. But the truth is, is that your lifestyle is greatly impacting your insulin needs, correct? Yeah. So that's another way to think about it,

Jennifer Smith, CDE 16:50 and therein lies a you then don't really, you're not really classifying that as insulin resistance. That's a lifestyle impact or unlike chronic inflammation, which can also come from other health conditions, they could be impacting your body's ability to use insulin the right way or efficiently. And so then inflammation is more of a long duration, and you are likely to then have true insulin resistance, whereas high blood sugar is from a really stressful job. I have so many you know now working with a lot of women who are kind of moving past menopause, moving into sort of retirement stages, right? What we see is really high stress, high energy jobs. They retire, and come January, they're like, I don't know, I'm low all the time, like, well, let's take a look.

Scott Benner 17:41 I would curse right now and tell you that Arden's been off of school for a number of weeks. Might be six, eight weeks, she takes a GLP medication that helps with her insulin. You know, resistance, because she probably has PCOS. And you know, her settings are much lower right now than they were back in college. And today, she went back for just a day, like, to go back for a day to do this thing. And since she woke up, and now three hours later, her blood sugar is 175 like the algorithm, can't it. Can't get her down, like, because now our settings are for Arden at home, not stressed out. Arden, not Arden's at school, thinking about all the things she has to do art. And knowing

Jennifer Smith, CDE 18:21 the algorithm you're using, I know that it takes a little bit of adapting to actually, yeah, nudge it back, yeah.

Scott Benner 18:27 It'll keep up a little bit eventually. But the truth is, is that the person she was on her graph yesterday and for eight weeks prior to that is not the person she is today. So, and I'm telling you, that's exactly what it's from anxiety life, you know, foot on the floor, that doesn't go away. Basically,

Jennifer Smith, CDE 18:45 kind of going back to the doctor's comments about the cytokines you're like, I have to look that up. There's a lot of really good cellular investigation as to insulin resistance and what's not happening right in the body, and what are some of the lifestyle things that we can get to beyond adding extra medications that could, you know, again, help. So I don't

Scott Benner 19:15 want to get into it now, because we'll get off track. But he had an interesting take that I'll share with you privately, and people can go check on it, the livers role in insulin resistance. So how could the liver be impacting people? Yeah, I mean,

Jennifer Smith, CDE 19:31 you know, your liver is a really interesting organ, right? What the liver does a lot of things. It's a detoxifier. It helps with management, not only of blood sugar, but a lot of other systems in the body. And so if your body isn't using insulin the right way, there's a disconnect to the liver. For you know, ease of explanation, there's a disconnect to the liver, then about what it's supposed to do for. You and it gets off balance. That's the best way to really, you know, simplify it overall.

Scott Benner 20:04 So I have a little bit of language here. I want to know how you feel about this. Under normal circumstances, insulin suppresses the liver release of glucose. When there's insulin resistance, the liver doesn't always receive the stop message, effectively Correct. That's what I said. It gets what you said, Okay? Because I was like, Oh God, I'm not sure if I'm understanding, nope. So I just wanted to make sure. Okay, awesome. Moving on. Because these are also, I should point out, these are questions that were sent in by listeners specifically about insulin resistance. Oh,

Jennifer Smith, CDE 20:33 awesome. Well, they were very well thought questions, honestly, very well worded and well put together. If you really wanted to get into the science of the liver and all the things we could use big, fancy words, you know that talk all about glucose uptake and fatty acid oxidation and like all of these. But right? People are gonna be like, I don't know what that word means. Like, what does that have? I don't understand. Just tell me why my liver isn't doing the right thing,

Scott Benner 21:00 doing the right thing. How does insulin resistance impact long term diabetes management beyond just needing more insulin? Are there complications that are associated with it? That was the question that we got from a person. What do you think? I think

Jennifer Smith, CDE 21:15 the deeper question is, with insulin resistance, it creates a problem with overall glucose management, that's the bottom line. And so really the question there is, if I don't get on top of the resistance, meaning really, I'm not managing my blood sugars because I'm not able to get my insulin to work, well, down the road, you have all of those long term complications that we're really trying to prevent, right? And the biggest ones really being heart conditions and those micro vascular things like in your eyes and the nerve cells and all of those things are relative to the bottom line being your blood sugar management. But if you're doing the best that you can, and you're using a lot of insulin, it's not quite controlling everything yet, then the real issues with resistance are the downline of what does that mean with blood sugar?

Scott Benner 22:12 It's funny, as I thought about this one, what popped into my head was a well maintained classic car. It's gonna sound strange for a second. But I have a friend who drove a Camaro, you know, built in the 60s. Not just beautiful car, but like original three speed transmission, 326 motor. It was convertible, had the headlights that uncovered and like the covers, came off and slid into the car, all run by air. And 4050, years later, the car looked brand new and worked brand new, and it made me think about people who say, I'm fine. Like, look at me. I have type one diabetes. But, like, I know you're saying my a 1c should be this, or my variability should be more like this, or maybe I should eat like this or that, but I'm okay. And to them, I would say that in 1965 that car looked brand new, and the reason it still looks brand new is because of the meticulous way he took care of all the little parts and features of it that you don't recognize are even happening day to day. Like, yeah, I know this is an old timey idea, but there's a big piece of plastic that like, flipped out and slid into the car, all off of air pressure that still worked. 50 years later, you have little functions inside of your body like that, and they're just really important to keep up. And so if you're wondering why, sometimes you buy a car, and 15 years later, it's garbage and you basically throw it away, it's because you ignored some of the little things that day to day seemed like they were okay, but could have used a little tender, loving care. So

Jennifer Smith, CDE 23:40 you made me think of my dad. He and honestly, I It's like you were talking about him truly, because he had a 68 Camaro. Oh, no kidding, dad. I should say it's actually my brothers now. I mean, my dad's been passed away for a number of years already, but he willed it to my brother, so my brother now is the one who maintains it. And you're right. I mean, my dad, if anything I learned from him beyond just exercise, it was you take meticulous care of the things that you really want to last. That was his bottom line. I mean, he waxed our bicycles. Scott, so it sounds like the same guy you're talking about, like all the care that you give, but you have to think about yourself. It's like the advice that's often given to parents. If you have a child you're taking care of you have to take care of yourself too, or you're not going to be there to take care of those who need you, right?

Scott Benner 24:31 My friend eventually sold his car. Oh, that he bought from the first owner, which was an old lady who literally, just like the story goes, like, put it in the paper. And he got there, and she's like, I can't handle this thing anymore. And he bought it for $2,000 and sold it many decades later for $60,000 and I think if you want to still be valuable many decades from now, you gotta polish the chrome a little bit. You know what I mean. And that's not a euphemism. Yeah. But no, not

Jennifer Smith, CDE 25:00 at all. If you want yourselves to be as healthy and lovely and at 90, you want to grocery shop and carry your bags in the house and all of the things there's maintenance to your body, you have to do, right?

Scott Benner 25:11 Yeah. I mean, it's the difference between whether you go to the junkyard at the end or you gracefully, you know, drift off. Here's another question for people, many type one struggle with unexplained high blood sugars despite pre bolusing and adjusting insulin. How can someone tell if this is insulin resistance playing a role? I think this gets into management. I think this is more about settings, right?

Jennifer Smith, CDE 25:34 I do and because I think the question just begs more discussion, really, it does, because it's not defining all the time. I sit high. No matter how much insulin I dump in, I sit high. It's specifically around meals and going high. And so with the idea that this person feels like their Pre Bolus has been worked on, and that that's potentially not the issue, then maybe there are there some some other components within the meal time and or maybe the ratio has changed, right? Maybe they've grown. Maybe they've gone through a life change of some kind, and so maybe the ratio has changed, but they haven't changed that. They've just been playing with the Pre Bolus.

Scott Benner 26:13 I tell people all the time, because people all the time say, I don't know what's going on. My Pre Bolus time is 30 minutes. I have to Pre Bolus an hour before I eat. I'm like, well, that's not a Pre Bolus issue. Like, that's something else. So I always tell them to go back to the beginning make sure the basal is okay. Yep. You know, has anything huge changed in your life about your activity? You know, the things you're eating, right? That kind of stuff, you're sleeping, etc, essentially,

Jennifer Smith, CDE 26:36 the variables, that's what you're you know, I mean, looking at at those variables. Maybe the person was used to walking their dog three miles in the morning before they actually got to breakfast, and that was a benefit, and now all of a sudden, they're not doing that. Or you know what I mean? So absolutely. So

Scott Benner 26:54 I'm going to read now five questions in a row that are all part of a bigger conversation. Okay, there seems to be two schools of thought, one focusing on low fat, high carb diets, like the mastering diabetes diet, and another one, low carb approach. What does the research say about the best dietary approaches to improve insulin sensitivity in type ones? The next question is, are there specific foods or micronutrient ratios that have been shown to improve insulin sensitivity. The next one is for someone who's insulin resistant. Should they be focusing on cutting carbs, reducing fats, or prioritizing protein? And there are mixed opinions on intermittent fasting. Can fasting improve insulin sensitivity type one diabetes, or does it pose a risk? I'm going to throw in this one as well. Some people say that processed foods contribute to insulin resistance, what specifically in processed foods makes them problematic for blood sugar control. So we'll go through them one at a time, but I think they're all part of this conversation. They are,

Jennifer Smith, CDE 27:54 and I think we'll, we'll kind of mush them together, even though trying to kind of go through them separately, it's probably going to answer

Scott Benner 28:02 a lap, yeah, they're gonna go for a lap, yeah, yeah. The first one is the tough one, because, you know, people who are very strictly low carb, that have a lot of success with it are just going to tell you, you know, love, like, what do they say? Low numbers, right? You know, little bit of

Jennifer Smith, CDE 28:18 car, the rule of the rule of small numbers, right? A little bit of carb, a tiny amount of insulin, you've got an easier, kind of a little easier control mechanism, because there's not as much overage there from an insulin, but you also don't have a heavy hitting macro nutrient being carbohydrate that you're really trying to step on top of and keep managed. Right? The big thing behind this main question of the two schools of thought from a dietary standpoint, or like my background, it really boils down to looking at what each of these fueling plans provides. Has science that does suggest it can work. They both do the vegan, low fat diet, plant based absolutely has research that suggests you can reduce insulin resistance, you can bring your medications down, you can help to control the heart issues, even things like PCOS end up being better managed and navigated. Weight loss is something that happens in the picture. Those are 100% the same thing that the low carb approach also is able to prove that they can achieve, you know. But the bottom line is, you decide on it, and you don't falter from the plan. That is it in a bottom line picture. If you're going to do something like all plant based, low fat, then do it. Figure out. But you have to stick with it. It doesn't mean every week you will go out for your 16 ounce steak, because you can't 100% give that up. This is a plan, right? You choose it, you follow it, and 100% Your metabolic things, they clear up. They do the cholesterol levels, the blood pressure issues, again, even the metabolic things, the way that your body cells use food, they are changed. Yeah,

Scott Benner 30:12 I think it's, it's such an important thing to say, because I think that's probably where people go wrong. They're like, they dive in, like, you know, I'll eat super low carb. But then on Saturday, you have a slice of pizza with a bag of Cheetos, and forget, right? Two steps forward, one step back. It was probably two steps forward, 10 steps back, right? It's about whether or not you can really commit to it. You think I

Jennifer Smith, CDE 30:33 really do? Because there is when I look at the data, and people ask me the questions all the time, well, should I should I go this way? Should I go that way? I have to say. But what? What do you know about both of those plans? They're almost like opposite ends of the spectrum. Yeah, which one are you most likely to be able to stick with long term? Because if you can, here are the 10 different research articles I can give you. They're not even based in, like, the big ones that a lot of people have problems, like believing in, right? These are really good, defined references that suggest it can work. And we've got communities that are centered on both of them with discussion about why they work, and all the people that that they definitely help. Right?

Scott Benner 31:19 Is there any scenario where following any of these ideas strictly won't work for somebody? Is there somebody who's just genetically it doesn't work for is that not a thing? Because it's part of the little questions? Question, yeah, like, I mean, is there someone out there just eating low carb exactly the right way? And they're like, how come this isn't working for me or vice because I've heard it for the more the vegetable, like fat one. I've heard people say I've done it specifically well, and it hasn't worked for me, but I'm watching other people do it, and there's got to be something there that's, I'm

Jennifer Smith, CDE 31:49 sure that there is. And so that also suggests that maybe either you're not following it to a T so really, get the reference materials. Get the books. I mean, there's, there are books on, you know, the mastering diabetes and also on the low carb end of every their books that definitely give you very well defined this is your plan of action. Yeah, you haven't quite done and you've really only been following with some online person who tells you what they're doing. Maybe there's a little piece in there that's not quite what your body is working with. The best way

Scott Benner 32:19 that takes me to the micronutrient idea. Like, how would an average person who's like, I'm going to make sure I'm giving my body exactly what my body needs? Like, how do they figure that out and put that into play? Yeah? I mean,

Jennifer Smith, CDE 32:30 it also goes into lifestyle, right? If you are somebody who has a really excessive amount of movement in your life compared to somebody who is more sedentary, we would look at what is your overall need to be able to break down macronutrients. And then the lovely thing about the macronutrients is that if you are getting a fair variety of foods, you're going to take in all the micronutrients that you need, both the fat soluble and the water soluble vitamins, the antioxidants, all those things that help on a cellular level, change things like inflammation. It's not as simple as people often think, cleaning up the diet, yeah, just

Scott Benner 33:11 pouring in the right stuff, yeah. I mean,

Jennifer Smith, CDE 33:13 it really does behoove people to sit down with somebody knowledgeable, and I'm not going to say that, you know, find the right person right away. It might take, just like looking for the right endocrinologist. It might take a little bit of navigating through some people to find somebody who kind of fits with you and that you can work really well with, but they should be evaluating your life, what type of stressors you have, what kind of energy level or exercise plan do you have, and then building into that well to meet your need as well as address this insulin resistance and overall help with insulin sensitivity. Let's play with adding this, taking this away, cutting back here, adding this in. You know, somebody who is an endurance athlete is going to have a different macronutrient need profile than somebody who is in the lifting gym three hours every single day and they're bench pressing. I don't know a large amount of weight that I can't even probably live. Does that make sense, though it

Scott Benner 34:19 does. I want to go to intermittent fasting and then go back to processed foods. So the intermittent fasting, what I have here says that, you know, for some people, it might improve insulin sensitivity, but then it warns against hypoglycemia. But what I would say is, from my own personal experience with Arden, is Arden can fast almost for freaking ever, but she's also on an algorithm that's taking away your insulin at times. So if you're using, like, jacked up, heavy settings, and then all of a sudden, like, I'm gonna start intermittent fasting. I mean, you're probably gonna get low. But if your settings are there, and your system can bob and weave with the fact that there's nothing in there, I've seen art at night eat for 1824, hours. To not get low, like, as a matter of fact, like, I would tell you, if you can get all that straight, and you're a person who's like, oh, I can't exercise without getting low. Wake up in the morning, don't eat with great settings and single move workout in the morning. Yeah, so

Jennifer Smith, CDE 35:13 no, it's a, I think it's a quality question. Whoever asked about intermittent fasting, the risks, as you just said, can be minimized, especially with the type of technology that we have today. At it at our disposal, right? Not everybody, but a lot of, a lot of people have access to at least a CGM, great, right? If you have access to an A I D pump system, fantastic. That moves you up the mark to avoid risks if you're trying to do some fasting, but even those who do multiple daily injections, you can strategize your insulin and your dosing in order to be able to do intermittent fasting. And there are, you know, by definition, there are a lot of different kind of ways you can intermittently fast. Some people do fasting two days in a row, then they eat for two days and they fast for two days, right? Then there are people who do what's more common, and I think in terms of navigating the real metabolic reason, which I would encourage people to really look up, because it's quite fascinating the cellular level and the reasoning behind intermittent fasting and how it really benefits insulin sensitivity and weight management and everything. Is the idea of time periods of the day where you will designate, this is my eating time, yeah, and then time periods of the day where you will be done eating, let's say by 7pm and then you don't eat again until 10am the next day, right? Or noon the next day, and there are a lot, especially from a women's health perspective, there are a lot of good referenced research in what that does from a hormonal level in women's health. Not enough of it. I think that goes into real type one diabetes. But if you can read into the research, you can understand how it could impact your diabetes management, because most women complain about the fluctuations around their monthly cycle or moving into perimenopause or even menopause, right? And if we can harness that energy burning piece of our cells in the right way, and also clean up our intake with the food that we are eating. It makes an enormous difference on our overall ability to use insulin the way that we're supposed to. I'm going

Scott Benner 37:33 to jump to this last piece here, processed foods. You know, can processed foods really blah, blah, blah, like, I think, I think in the information age, we're very used to people saying things, and we just accept them, right? We don't really dig deeper into them. And so some people can also hear that in just this recording, like, oh, processed foods are bad for you. Like, ah, I've been eating it all my life. I'm fine. Like, it's great. Yeah, you're because your car is not 50 years old. Yeah, your body's still able to make it through a ho ho without you dying. But one day, you'll put the wrong gas in and it's just gonna shut off. But I'm gonna keep a lot of this for the nutrition series that you and I are gonna do, because I think we should do an entire episode on why exactly processed foods are doing what they're doing to you.

Jennifer Smith, CDE 38:14 Yes, it's on my list, and I have not organized for us yet, sorry. Give

Scott Benner 38:19 me a high level overview of processed foods and how they can, you know, make insulin resistance their car make it worse.

Jennifer Smith, CDE 38:26 Yeah, and actually, it ties into that first question in this little kind of segment that we're talking about is the focusing on either the really low fat high carb intake or the more low carb or ketogenic type of plan. One thing that's missing from both of those plans, for the most part, if you're doing the plans the right way, you are eating food that looks like food, what has that done then, behind the scenes, whether you're low carb, high carb, whatever you've cleaned out. I mean, the question here, what specifically in processed foods makes them problematic. Have you ever read the back of most of the packaged things that you buy? I mean, outside of maybe you bribe brown rice. It's brown rice, right? There's nothing problematic in that unless you're low carb, then you won't eat it. When you look at the back of many packaged items, they are full of things that I guarantee you can't pronounce, nor do you know where they came from. Why are they in there? Outside of things that have parentheses after them, since this anti caking agent or you're like, great, but why does it have to be in my food? Then, yes,

Scott Benner 39:35 it went your mouth and came out your butt. But it does. You don't know what it was doing. What was in there. Maybe you could swallow stuck. You could swallow a nickel and it can come back out again. It doesn't mean you want it there. I'm just high level, rapid breakdown of refined carbohydrates, added sugars and metabolic overload, inflammation, oxidative stress, unhealthy fats interfering with insulin signaling, nutrient deficiencies and lack of fiber, chronic overeating and weight gain. Because of calorie density and hormonal dysregulation, on and on and on. Like, yes, processed foods are bad for you, but we'll dig in later about why. And yes, they can listen, if you just ate food that you, like, Jenny just said, like, you lift it up and go, this is broccoli. I see chicken like, you know, and yeah, then eat it right. Don't take the chicken and dump some sauce on it that you bought from somewhere and go look. It's orange chicken now. Now it's chicken with nickels all over it. Think of it that way.

Jennifer Smith, CDE 40:29 It's a good brain, like you're eating

Scott Benner 40:32 aluminum foil or whatever. Like, maybe it'll make it out. Maybe it won't. Right? Can we jump to how are you on time? You good? I have about five minutes. Okay, let's go to medication, supplements, options. What can people take? Type one to help with insulin resistance, if they've changed their diet, if they change their exercise, and it's just not working,

Jennifer Smith, CDE 40:54 sure? I mean, there are prescription meds, and again, early on, I talked about how you can potentially get that dual diagnosis to improve the ability to get these covered with really good, well written letters from your doctor, things like the GLP ones. GLP one gi P is things even like old school Metformin is another potential one that you do not need a prescription for, and I can definitely say is visibly beneficial, not to the impact of things like a GLP one, but definitely beneficial in the here and now, because it gets used up pretty quick, is the Berberine that is definitely one that is beneficial. It helps attack kind of around that meal, but not necessarily long term, okay, right? Thank

Scott Benner 41:38 you for doing this with me. That's a great topic. Now it's awesome. I'm going to send all the information over to you, and we'll you know, so we have everything for next time. But before we go, how does hydration impact insulin sensitivity?

Jennifer Smith, CDE 41:52 That's a really simple one, right? Because if you are not well hydrated, all the things that are circulating in your system that are supposed to get to the cells to allow them to work the right way, one of them being hydration. If you are dehydrated, it's like moving mud or molasses through your system instead of like water out of a faucet, right? It's supposed to fluidly flow at your cells are supposed to have access float around in your body, kind of like, you know, really low leveling biology explanation. But hydration is huge, and hydration, along with which, I think often gets missed, people say, okay, they told me to drink more water. I'm drinking more water. I'm drinking like, two gallons of water a day, great, but now you're probably flushing out a lot of good electrolytes. So there is a fine balance, I say, you know, easy, simple electrolytes on a day to day basis with your water intake, are also very valuable from a balance of things in your body, you know, and the eight cups a day, give or take the person, it's probably more. If you're an athlete, it's probably more. If you're sitting in sauna for three hours a day, right? Based on size person athletics, you can kind of go up and down from there, but if you're going to try a baseline, great, stick with the eight.

Scott Benner 43:13 And what about anybody who's going to say, I'm incredibly well hydrated. I had two liters of Diet Coke today, same thing as two liters. No, okay, not at all. No, not, not at all. There is drink juice boxes all day. No, no,

Jennifer Smith, CDE 43:28 not. Hydration. Okay, are you sure? Let's look at let's look at water. Water is hydrating. There's nothing wrong with it. Just

Scott Benner 43:38 drink some water. Okay, what if I take water and I put something in it back in the day when I was a kid, but Crystal Light, I don't even that exists anymore. Now I put Crystal Light in it. Am I still drinking water? Or am I am I negating the benefits you're still

Jennifer Smith, CDE 43:50 definitely drinking water? Again, that goes back to processed foods, and what is in the thing that you're adding to your water to make it taste like you want to be able to actually drink the two gallons of water a day,

Scott Benner 44:02 Crystal Light Water with three nickels, yes, at least you're getting water. Hopefully they won't grab onto an artery on their way through, or whatever. I know arteries are not in your digestive system. I'm just saying no. Okay. What are your thoughts on supplements like Berberine, Metformin or a GLP like ozempic or Manjaro for addressing insulin resistance in type ones. That's a question right from a listener.

Jennifer Smith, CDE 44:24 No, I think it's great. I also think it needs to be differentiated, right? Because a supplement is something that isn't technically regulated, at least not most of the time, versus a medication that has approval, is on the market, is available through prescription. Like, you can't get it otherwise, right? So when you talk about things like Metformin or the GLP ones, GLP one Gi, P, the Metformin is a little bit different, but all of those are prescription you talk about Berberine or some of the other ones. Like, I mean, there are a whole list. Of things that help, from the standpoint of even optimizing your own GLP one system output, right? Your gut output which isn't working, which is why the GLP one meds do work in people with diabetes. So there are a whole host of those. I once

Scott Benner 45:16 got listeners to send me all the supplements that they take. And I thought just like, tell every like, let them just tell me everything that they take, and I'll weed through it. Maybe I'll find some like thing, and I can't figure out a way to be certain about any of it. And so like, you know, it's hard to just jump on here and start saying, like, you should try this or that, or this lady said this helped her. And part of me wants to put it out there so people can decide for themselves. And part of me is like, God, stuff could be expensive and maybe not do anything. And, you know, and many

Jennifer Smith, CDE 45:44 of them are, many of the supplements are, but you also with anything, I think, even with the prescription meds, you should be doing a little bit of your own research. Yeah, you should be doing information searching, because many of the supplements do have good research backing to them, but the information is important to look at, what was the population that was tested most often for some of the supplements we're looking at tests being done mostly in type two diabetes. Does that mean it's not relevant to type one? Not at all, but they're really only doing most of this stuff in type two, and then what's the concentration that's being used? What's the healthy concentration to use that you can get on the market? You already said, what's the cost of using that? What impact should I see? And a lot of people, I think, with supplements, to go down that kind of road, first is you end up getting a list of six things. And you think, Well, great. All of these are supposed to be wonderful for my weight and for my blood sugar and for my my gut health. I'm just going to throw them all together and see what works. Well, if it does, fantastic. But some of them may not be doing much at all, purple, right?

Scott Benner 46:59 Five at once, if they all so then I think the problem becomes then, because I've gone through this myself or with people in my family, you say to somebody like, look, we're just going to take one of these a day for three months and like, and people are just like, What are you kidding me? And if you don't see a pretty instantaneous like, change or value, it's hard to remember to even do it. It's hard to Shell out the money. And then people tell you what's got to be a quality, you know. And then you look and quality means $40 for a jug of them, and you're like, oh, you know. And so I don't know how to talk about, I wish there was, like, an easier way now what I can tell you about, what I've learned about glps Over the last couple of years, taking them for myself, using them for my daughter with type one. Listen, I'm not obviously a doctor or researcher anything like that, but I know a few things to be true after the last couple of years, if you're using a GLP medication, as Dr Hamdy said in Episode 1411 and you are not doing muscle training and taking in enough protein, he says you should not even be using them. It's just too dangerous to lose muscle, especially as you get older, and it's just something you don't get back. So you have to maintain and build muscle while you're using a GLP. It's very important. The other thing I've learned is some type ones are like, Oh my god, I jumped on a GLP and it changed my life. Like, I use significantly less insulin. I like, you know, my spikes are lower. Like, oh, all these good things are coming. Then another type one will say, I tried it, and honestly, I tolerated it well, but nothing happened to my insulin needs. And I guess I've come to believe that some people can have, you know, what I've heard called, like, double diabetes, like they have type one diabetes, but they also have insulin resistance. Correct the dual diagnosis, yeah, without type one, they'd still have insulin resistance. And I don't know if I'm right about that or not, but just watching people, it's the only like explanation I can come up with why some type ones would take it and have such a reduction in someone, and some type ones don't have any So, right? Yeah. I

Jennifer Smith, CDE 48:56 mean, this actually gets into, I think, another, another question somebody had asked within the same line of questions, it's about like lab values and testing for insulin resistance. So again, if you're looking at supplementation or pharmaceutical type of prescription, it would behoove you to know is what I'm seeing growth in my teenager and they just need more insulin? Or is this truly insulin resistance? Because there are some markers that you could look at that could move you to a diagnosis and again, now with ADA standards, suggesting that people with type one could have these other pieces that are more type two, and so you could have a dual diagnosis, making it quote, unquote easier to potentially get the prescription option

Scott Benner 49:48 right, right. I'll mention too in that episode that Dr Hamdy, who is, I think, on the the arrows tip on this stuff, says that he thinks double diagnoses will be actually common. And acceptable very soon. So I it sounds like behind the scenes, the people who push for this stuff are pushing for that.

Jennifer Smith, CDE 50:06 And it sounds correct, given all of the information that we have and some of the newer, like real research that we are looking at coming from use in type one specifically. And hopefully that's a turnaround for prescribing and not having to sit to get six letters of approval from your doctor stating this, this and this are the issues. Why won't you approve this? But

Scott Benner 50:31 if you saw a type one like you see type ones who use glps, right?

Jennifer Smith, CDE 50:36 100% yes, not 100% of them. But yes,

Scott Benner 50:39 absolutely so. If people are interested in learning more, they should talk to doctors. And if you can't, I'll tell you this, if you can find a doctor great that understands it, but if you find one that doesn't seem to understand it at all, like look around a little more, because they're just going to throw their hands up and go, I don't think you should do that, which I think is code for, I don't know what I'm talking about, and I don't want to get involved. So right, yeah. Speaking, yeah. Many people say that losing weight improves insulin resistance. Is this true even in a person with type one diabetes is not overweight, even if the person is not overweight. So if we have a person with type one who doesn't I don't know score as overweight, could losing some weight help their insulin resistance? It could. I want to say that I think there are a number of things happening. I'm going to go back to glps for a second, even though we're not talking about them when they first came out. And I had a bunch of conversations with a bunch of different doctors, they would all just harp on the idea that people are using less insulin because they've lost body weight. And they would just keep saying that, keep saying that. And I mean, after having enough conversations, even like with Arden who did not have like, you would never have looked at Arden and thought like, Oh, that girl should lose weight, but she did lose weight, and that's part of why her insulin needs went down. I believe they just are

Jennifer Smith, CDE 51:52 besides the true effect outside of weight loss, the true effect of GLP ones is it goes beyond just loss, and that's the reason that somebody who doesn't have a weight based issue but has high insulin needs, if something else hasn't been identified, such as a normal weight person, lifestyle doesn't suggest that they should be using as much insulin as they actually are. It's very difficult for them to control their blood sugars in the after meal time period, then we're looking for things like PCOS. Is there an undiagnosed thyroid disorder in the picture? Right? I mean, there are, there are pieces that I see over and over. They stand out to me. As soon as I talk to somebody, I'm like, have you had this checked? Did somebody ask you about this? Did you get No, nobody's what is that? Nobody's ever mentioned that. I'm like, let's get these checked first. So

Scott Benner 52:42 if you lost a lot of body fat and your insulin resistance didn't change, then look for other impactors. But in a lot of cases, losing that body fat should change your insulin resistance. It should. What about other body composition ideas like, what about adding muscle? Would that help? It should. Is that because you added muscle, or because adding muscle reduced fat? Well,

Jennifer Smith, CDE 53:04 you can add muscle and still retain fat, right? I mean, fat is stored energy, right? I mean, we have a lot of stored energy in our body.

Scott Benner 53:11 So if I'm like one of those guys that, like lifts tires and throws them over walls, like, for example, I was just that size, but not that strong, had insulin resistance, and added that muscle, I could see a reduced impact.

Jennifer Smith, CDE 53:23 You could see exactly because, again, muscle is it's harder for your body to keep healthy to maintain. So the more muscle you have on your body, the more revved up your metabolism is. And that's kind of the like the baseline explanation to that, right? But that's essentially what happens. And we know that when we move our body, even people with insulin resistance, can say, I can take a walk, and I can see the impact of that. I can move my body, and I can see that my insulin does start to work better, probably not as good as if they were a lower weight, brought their, you know, brought their body weight down, or somebody of the same height, but a leaner body type with more muscle on it, but they're still going to see impact. So if you now lose weight, add muscle, and you maintain a movement, you're definitely going to see an improved a lower amount of insulin that you need. So

Scott Benner 54:16 I'm looking at all of the questions that led us to this bigger idea, and I moved to say there's a person here asking, How much does walking after a meal impact insulin sensitivity? He's had this long conversation privately with somebody I've known for a long time who has type one, and he's in his 20s, and has recently put on a bunch of muscles, started doing like jiu jitsu and stuff like that, and and went to a little more of a lower carb lifestyle, but everything's a mess because his job is very active, right? And he's on Omnipod five, and he's like, I am getting low every day at work. Like, I'm low constantly, like, blah, blah, blah, like, on and on. And I we just kept talking and talking and talking and the the first two things I. Said to him, I ended up going, No, no, no, not that. And then eventually I said, here's what we're gonna do. And I figured out that he was getting low after meals, and that seemed to be the biggest problem, but he was so sure about his insulin to carb ratio, he said it was one to 10. And I said, Listen, let's just make it one to 20. And, like, see what happens. And I got a text the next day. I didn't go under 100 and my spike was only, like, 160 I said, Okay, make it one to 18 tomorrow. Like, keep changing that until we get there. I think that was your problem. But what he was seeing was, is that he was eating and then he was going to work and walking, walking, walking and tanking every time if he didn't walk after he ate, it wasn't nearly the same. So, right? What's the functionality there?

Jennifer Smith, CDE 55:46 Right? Any activity Walking is one of the best. In fact, years ago, during diabetes month, I can't remember what organization they used to have, something called the Big Blue Test, Manny. Would say, who was Manny? Yeah, it was Manny. It was essentially check your blood sugar. Go do 15 minutes of movement, come back and check your blood sugar. And 99.9% of the time, you're going to see movement down in your blood sugar. I don't care what body size or type you are, you're going to see why, because muscles require energy to move, and we know that exercise is, I call it free insulin, right? Your body needs the energy it's moving faster than it normally is. Your muscles are now primed. The doors on those muscles are now they're more free to open at will, and they don't need as much insulin to unlock the doors and let the glucose flow in.

Scott Benner 56:39 We know that works. You and I know that works. Is that actually impacting your insulin resistance, or is it just changing the function of the insulin that's inside of you over and

Jennifer Smith, CDE 56:49 over exercise is going to at some level, it's going to impact your resistance, right? It is okay, but in some people that exercise every day, it's basically holding you at a level. If you stop doing that, you're going to climb in insulin resistance. It's holding you out of stability. The insulin resistance is still there. And if you are the type who needs the GLP, one type, or the Metformin or something to assist further, then all you're doing is holding things where they are with your exercise. Don't stop doing it. Keep doing it. But if you're not finding you're not reaching your goals of weight loss or post meal blood sugars or as much as you really want to, then you're looking at needing to add something to help the lifestyle stuff that you're trying so hard to do. Follow

Scott Benner 57:39 up questions from people is, how does muscle mass influence insulin resistance, which I feel like we just talked about. But can lifting weights really make a difference? Yes, right,

Jennifer Smith, CDE 57:47 it can. And weight lifting is interesting. It actually many people who lift weights find no change immediately in their blood sugar. In fact, those who really go to some of the more the boxes, right, the gyms that are just all lifting, you have your workout of the day. It's very resistance based. You might actually see a rise in

Scott Benner 58:07 your blood sugar right during the lifting itself. During the

Jennifer Smith, CDE 58:10 lifting itself, right? It's an adrenaline based kind of thing, sort of like a sprint runner. You might see from the adrenaline of a sprint or hill repeats going up and down. You're going to see a rise in your blood sugar. But in the aftermath, just like weight training, you're going to see that your muscles are now recouping. And in weight training, you're building the muscle that you broke down during the workout right to build that back up, your body needs to use energy so you become more insulin sensitive in the aftermath, if you do enough weight training or resistance training, lightweight to high weight, whatever is good for your body, what kind of muscle you want, you're going to see that retained long term. Okay, that's the benefit of daily exercise.

Scott Benner 58:55 Okay, all right, let's move to like beyond diet and exercise, hormones, stress, sleep, steroids, that kind of stuff. When people see a greater insulin need because they haven't slept enough, they're under stress, the doctor gave them a steroid for an infection or they have a hormonal impact. Are they seeing an actual change in their insulin resistance?

Jennifer Smith, CDE 59:16 It's momentary. I think, yeah. I think it's momentary. I think it's more right, right now, this is what's impacting my insulin. Need hormones in females, obviously, that's more in the moment, or depending on where they are in a monthly cycle can go up and down, right? Somebody who has a big business presentation to do, they may be stressed for a couple of days while they prep for it, and they plan it, and they work with their team, and then they get to it, and as soon as it's done, if you've changed your insulin doses to accommodate and keep your blood sugar managed, you're likely to need to remember what your doses were before the stress, right? Because it should come back down. That's momentary insulin resistance, which isn't, I wouldn't even. Call it resistance. It's just the effect of a variable here and now.

Scott Benner 1:00:04 Do thyroid issues impact insulin resistance? Yes, they do. Okay, absolutely. Hyper, hypo doesn't matter. They both

Jennifer Smith, CDE 1:00:11 have impact on your overall insulin need. Yes, both to the extreme of needing a lot more, as well as a they're both a little bit opposite. We actually see in hyper that because your metabolic rate and the turnover of all different types of medications is a lot faster, you're ending up needing you're clearing that, and you're needing to use a lot more insulin, right? Whereas in hypo, you've got metabolic slowdown until it's regulated. And so you might actually find that while your weight isn't being managed well, and that you feel like you need more insulin, sometimes there is dysregulation in dosing, because you feel like you're taking more but you end up with a lot more lows because of the lagging effect of the amount of insulin that you're taking. So there is, I mean, thyroid is, it's huge to get optimized if you're having issues with your insulin.

Scott Benner 1:01:06 Okay. Do you know how sleep impacts insulin resistance, like lack of sleep? You know the function of it, or just that it does. It's

Jennifer Smith, CDE 1:01:14 just, I mean, baseline is, it's, it's a stress, right? Especially quality sleep. You might have something that tells you you're sleeping seven or eight hours a night, but we have enough watches and Rings and Things now to take care of. Looking at what was our sleep quality light, how many times did we roll over in bed? Even some of these devices measure what would be like sleep apnea, kind of dysregulation of oxygen intake during the overnight times. You might think you're sleeping, but you're really not getting quality sleep through all of the different cycles of sleep, deep sleep, REM sleep, all of those things, right? And in the end, it again, is just baseline. It's stress on the body.

Scott Benner 1:01:57 Since you mentioned stress at the end, there's these like sub questions under our headings here, how do I manage stress to improve blood sugar control? I'm going to assume that me telling you to calm down is not going to help. I mean, is it just one of those things, like, you got to figure out how to manage your stress, really? What are you going to

Jennifer Smith, CDE 1:02:12 That's right? I mean, it's like a it's like a blanket statement, because I think everybody needs something that's going to be a little bit different to manage stress. I manage stress by working out. I run. I do yoga several times a week. There are different types of yoga, some as meditative. Some is more active yoga. I use weights. So exercise is really my like stress reducer. I also like to cook. So, you know, find your thing, and if that helps you, and you have time to build it in. It might be enough to keep your stress levels at bay. Some people stress, though, is not only their own life stress, but it includes their family's stresses, right? So then you have to navigate it all. Yeah,

Scott Benner 1:02:54 I noticed a hot shower makes hardness, blood sugar go down, and I know that it's, it's like, people are like, Oh, hot or cold or this. I'm like, I honestly just think she gets in there and she chills out, she sings and she relaxes. The water hits her head, and I think she just relaxes a little bit. So, okay, identifying, let's see IR insulin resistance on lab work and early warning signs. What labs or markers should someone ask their doctor about if they suspect that they have insulin resistance, and for those who don't realize they have it, what are the early warning signs to look out for? Are there lab value? Can I get there

Jennifer Smith, CDE 1:03:32 are like somebody, and this goes the route of really talking about maybe somebody who has some of the physical identifying markers like you're overweight, you have a more sedentary lifestyle, you may not have the cleanest food intake, maybe you don't work out those kinds of things. Are there markers that someone could be looking at with not knowing that you have diabetes? There are, I mean, obviously one test would be an A, 1c right? It's going to give an overall evaluation of is your body not regulating your glucose like it should in people who don't have type one, something like an overnight fasting insulin level, can also be a method of managing your body's output, and it's a way To sometimes also identify pre diabetes, before type two diabetes, because, again, early stages of type two, your body is over producing insulin to make up for that insulin resistance that's there. So that is another piece that could be managed. Obviously, somebody with type one doesn't need a fasting insulin.

Scott Benner 1:04:38 I went to our friend online to ask this one so fasting insulin, Homa IR, homeostatic model assessment of insulin resistance, a fasting blood glucose, hemoglobin, a 1c triglycerides to HDL ratio, a ratio higher than 2.5 to one is linked to insulin resistance. Your C peptide, of course, postprandial blood glucose. Insulin, checking glucose and insulin one to two hours after a meal could let you know if you have form of glucose metabolism and liver enzymes. Elevated levels may indicate fatty liver disease, commonly associated with insulin resistance. It says uric acid. High levels correlate with insulin resistance and metabolic dysfunction. Some early warning signs could be frequent, fatigue, increased hunger and cravings, difficulty losing weight, dark patches on the skin, skin tags, high blood pressure, brain fog, PCOS, dizziness or shakiness between meals, increased waist circumference. There you go. That's from

Jennifer Smith, CDE 1:05:36 our most of what's on my list. So you you got to all of that. Jenny's

Scott Benner 1:05:40 like, am I going to get supplanted by a prompt? I hope,

Jennifer Smith, CDE 1:05:46 I think it was a valuable question, honestly, because while some of these may not necessarily be in the realm of type one looking, some of them are even things like your cholesterol levels. I mean, the LDL especially, is one that we end up looking at your triglyceride levels, the relevance of the liver enzymes. All of those, whether or not you have diabetes, can be Hallmark identifiers for yes. It's

Scott Benner 1:06:13 funny, because I just had this thing I wanted to say, and then I looked down at the next question, and the next question encompasses the thing I wanted to say. So I was like, Wow, this must be building to the right place. I, honest to God, didn't know that this was about to happen. So this next bit is misconceptions, reframing frustrations, vetting information, and the questions that came in from people are, what are some common misconceptions that you hear from people with type one regarding insulin resistance? And I'm going to tell you that my question was, do you think we talk about insulin resistance correctly? Or do you think it's a catch all phrase that we use in a bunch of different places?

Jennifer Smith, CDE 1:06:47 I'm going to say that that this about insulin resistance, what we're putting together. I think it's really valuable, because I think we're defining the difference. But I do feel like it can be a catch all. It can be a place where, my goodness, this is a lot of insulin. Like I see a lot of questions often, like, my child, is this this age and uses this much insulin? How old is your child? Who's this age? How much insulin do they use? Right? And again, our insulin needs are our own insulin needs. They are how to know if it's resistance, I think we've defined quite well here. And when it's not, is it a time in life that there's a variable happening that's not resistance? It is the hit of what's happening right now? Yeah,

Scott Benner 1:07:35 I feel like there are sometimes where there's variables at play. There's sometimes where it's, you know, a steroid, or sometimes it's you just became sedentary, like your kid used to play soccer, and now they don't anymore, or you've got a job, or you're walking around all the time. Then on the weekends, you sit and watch football like whatever that thing is, no matter what, when someone needs more insulin, they're gonna say, I have insulin resistance, right? And I think the GLP conversation has shown me that some people just need more insulin. They're not necessarily insulin resistant, but at the same time, is that just a heady conversation between you and I That's meaningless to the end user who just either needs it or doesn't need it, right?

Jennifer Smith, CDE 1:08:12 Well, and I think to clarify, you need more insulin, what that says to me is without all of the other pieces that you think that you have insulin resistance. It really isn't. It boils down to have you looked at your setting, right if you're needing more around meals, but your overnight is sitting flat at 83 and you haven't really adjusted anything there, and there aren't any big pieces in the picture, and your hits are around meal times, probably not insulin resistant. You probably just need to navigate meal coverage. You

Scott Benner 1:08:43 might not be covering your carbs. Well, your ratio could be off, even if you are counting them correctly, or something like that. Yeah. In the end, I just want people to cover what they need, but I don't want them to ignore the other things that may be happening. Right? If it's as simple as taking an acetal to help with your PCOS and lowering your insulin needs. I don't want you just feeding the PCOS with a ton of insulin when this other thing could be valuable to you correct or something like that, or going for a walk or eating better, or that kind of thing, right? How does someone separate helpful advice from misinformation when it comes to insulin resistance? What do you think the misinformation is that they're getting like, maybe it's just the misunderstanding of the implications like we've been talking about. It's a vague question. It

Jennifer Smith, CDE 1:09:25 is a big question. Well, I think it boils down to you have to look at what your experiences are that's leading you to consider, is this resistance, or have I not considered what could be going on right now as a point in time adjustment that needs to be made, okay? Is it some of the things that we've already gone into? Are there lab values? Are there symptoms? Are there other things you know that you're looking at that are an issue that are leading you to consider some of the helpful advice? This is actually pointing you to think this is insulin resistance. I should get further checks or talk to somebody about this, or does none of the information that someone's bringing in fit what you're seeing? Does that right? Does that make sense?

Scott Benner 1:10:17 Yeah, yeah, it does. But I'm gonna ask another vague question though. I'm sorry, no, you ready for the last one? Yeah. Where should people start if they feel overwhelmed by trying to lower their resistance? Is there a simple first step that someone can take to put them on a path to figuring this out? Do you start with food? You start with your weight. Because you hear people talk all the time, like I can't lose weight. Type ones are going to say to you, all the time, I can't lose weight, because every time I try to exercise, my blood sugar falls and I end up eating to bring it back up again, and it feels like I'm just losing weight on one hand and eating it on the other hand. And I would tell you, if weight is your issue, then getting your your settings right so that you can work out would be step one. It wouldn't just be, hurry up and start working out, correct, you know? But also, if you don't start working out, you won't see that your needs are lesser. So it's, it's a chicken or egg thing, a little bit like, do you start working out and adjust your insulin as you go? Do you adjust your insulin? Get it really rock solid, and then start working out and keep adjusting I think maybe that's it, right? Yes, yeah, yeah. And

Jennifer Smith, CDE 1:11:24 I think in terms of resistance, let's say you've you've taken all of the advice, right, especially like from the podcast, let's say all the pro tips, you've applied them, you've tested and you've done the best that you possibly can, and with all the adjustments, you've actually found, gosh, my insulin needs are a lot higher than I actually thought they were, and it is, no matter what lifestyle piece I put into place, it is really hard to keep my blood sugar at the target that I'm aiming for. Great. Now you've got all this information to go to your physician, to your nurse practitioner, to your educator with and say, Look, I've done all this work, and I still feel like I'm using a lot of insulin to actually navigate despite all the things I'm trying to do. Yeah, great,

Scott Benner 1:12:13 Jenny, I get worried that the the actionable items all fight with each other. For example, we learned in this episode, that a sign of insulin resistance might be hunger. And then you're gonna go to your doctor, and they're gonna say, Well, if you lost some weight, your insulin resistance would get better. You should lose some weight. And you go, but I'm hungry all the time. And then they say, Don't be. And you go, but I can't not be because I got insulin like, you don't mean like, you get caught where? Like, hey, go work out. You're like, I work out. My blood sugar gets low. Everything seems to have it's like a bad cartoon, like superhero movie, like there's a bad guy for every moment that you have. And I can see how it would stop people from it gets frustrating. Yeah, right. I mean, listen, between I don't have type one diabetes, I don't have type two diabetes. I've never been I don't think I've ever been pre diabetic, but I have lost like 60 pounds on a GLP medication, and the hunger going away was a huge help. It just was like, you know, like it was such a big deal that helped me get over the hump. I will tell you,

Jennifer Smith, CDE 1:13:16 that's the biggest thing that I hear from most people who start using it, is the food fog. People call it the constant draw of I even have some people who have said, you know, I work from home. I leave my office and I have to walk through the kitchen. And since using the GLP one, I can walk through in the refrigerator or the cabinet the cupboard, I can pass it without even a thought of opening it at this point. You

Scott Benner 1:13:44 have no idea how well it works to the point where you have to remind yourself to eat. I had to remind myself to eat. Like I would get up and be like one two in the afternoon, but God, I feel lightheaded. And then I'd go over and I go, Oh, I didn't eat. I did no hunger whatsoever, like none I forgot to eat today. Easily. I could have gone 24 hours not eaten, and never would my brain have said you're hungry, or my stomach have grumbled. That's the crazy part, but it's also a huge boost. Now, I'm not saying run out and use a medication. I'm saying listen to this. Hear the ideas about what'll make it better, but then identify what's stopping you, because you may have to conquer that before doing the other thing that's all right. They're

Jennifer Smith, CDE 1:14:23 all really like valuable things to keep in mind. Because, as you said, people may go to the doctor and say, but I can't he says, stop eating, or don't eat many snacks. Or I can see how much you're in taking cut it back. And for those who really struggle with some mental stuff around food to begin with, that can be a road to nowhere to just tell them something that the doctor doesn't know. What they feel like, yeah, and it stinks.

Scott Benner 1:14:51 Well, the and the other side of it is too. And I have personal experience with this, with what happened to my wife is she went to an endocrinologist and said, like, Look, I'm just gaining weight. Eat for like, no reason, and lose weight, lose weight, lose weight. And they tested her thyroid, and her TSH was high, but in range, so they didn't give her medication. So for seven years, they yelled at her to lose weight as she gained weight. And then one day, it just took one of us to, like, you know, I guess you people call it advocating for yourself, but I basically just, like, said to the guy, like, just give her the medicine for God's sakes. Like, if it doesn't work, like, take her off of it. But like, what's the harm at this point, right? She starts taking Synthroid, and, boom, oh, what do you know? Look at that. Yeah. And so, like, even when you figure the problem out, sometimes there's another roadblock. And I see that with people all the time. They go through this horrible thing to figure out their problem. And they get to the person, they're like, hey, gatekeeper, give me the thing. And they go, No, you can't have the thing. And it's tough. You know, finding a doctor who understands what you figured out is a big deal, and I it's a whole other process to talk about how to explain that to a doctor. But, you know, I just don't give up. Is my is my message? I guess, yeah, yeah, no. All right, Jenny, this was awesome. Thank you very much. Of course, yes. Thanks for tuning in today, and thanks to Medtronic diabetes for sponsoring this episode. We've been talking about Medtronic mini med 780 G system today, an automated insulin delivery system that helps make diabetes management easier day and night, whether it's their meal detection technology or the Medtronic extended infusion set, it all comes together to simplify life with diabetes. Go find out more at my link, Medtronic diabetes.com/juice box. This episode of the juice box podcast was sponsored by us med. Us, med.com/juice box, or call 888-721-1514, get started today with us. Med, links in the show notes. Links at Juicebox Podcast com, if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bowl 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. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording, wrongway recording.com, you.

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Alisia, 20, with T1D since 8, rejected parental myths to lower A1C via an iLet pump amid weight, thyroid challenges.

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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 00:00 Welcome back friends to another episode of The Juicebox Podcast.

Alicia 00:15 I'm Alicia. I am 20. Been diabetic for about 12 years. It'll be 12 years in January,

Scott Benner 00:23 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. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D drink, AG, one.com/juice box. 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 I'd love it if you would go to T 1d exchange.org/juicebox and take the survey. When you complete that survey, your answers are used to move type one diabetes research of all kinds. So if you'd like to help with type one research, but don't have time to go to a doctor or an investigation and you want to do something right there from your sofa. This is the way t 1d exchange.org/juice, box. It should not take you more than about 10 minutes. This episode of the juice box podcast is sponsored by the contour next gen blood glucose meter. Learn more and get started today at contour. Next.com/juice, box. The episode you're listening to is sponsored by us. Med, us. Med.com/juice, box, or call 888-721-1514, you can get your diabetes testing supplies the same way we do from us. Med, I'm

Alicia 02:00 Alicia. Been diabetic for about 12 years. It'll be 12 years in January. How old are you? I am 20. Okay, all right. I've kind of dealt with diabetes practically on my own, because my family's more on the Hispanic side. They kind of are just trying to heal my diabetes with, like, the cinnamon tricks and medicine tricks, like herbal stuff. And I would take it. So, like,

Scott Benner 02:31 cultural stuff,

Alicia 02:33 yeah, so, like, they, they would tell me, you know, like, take, it's an herbal seed, and it's called Moringa. When they said that that cures diabetes and that it cured their friends diabetes, and most of their friends didn't specify that they were type two, right? So, like, my dad was like, No, take this and take that. And I took it, because I was a kid like, you know, they were mostly like, just trying to help me. So I I understood where they were coming from, until I hit the age of starting high school. Actually, I just kind of gave up on it. I really didn't take care of myself much. I was really frustrated. I want to be I wanted to be the teenager with hormones. I wanted to be, you know, like the, like, normal, like, without having to deal with diabetes. I wanted to eat a bag of chips with my friends because I would see them, you know, do it. Yeah, I was okay with it. And my mom didn't know half the time that I was doing it, until I got I had a cold. It usually started with, like, allergies and colds and headaches and stuff, and, um, freshman year, right before freshman year,

Scott Benner 03:43 Alicia, are you being attacked by a pack of hounds? What's going on?

Alicia 03:47 It's my dog. He barks at everything in the background. Oh,

Scott Benner 03:50 good. That'll be great for a podcast. That's good. Let me ask you a quick question before you keep going about this. I'm going back to you know, you're diagnosed the date, so you're pretty young. Obviously, you're alive still, so they gave you insulin, right? Yeah, but it was on you, though they weren't really paying any attention to it.

Alicia 04:08 It was more of they helped me with it until, kind of like they taught me to do it on my own. My mom would like send me to the bathroom. Hey, go take your insulin. So I kind of like, depend on myself to okay, they're sending me to do my insulin, but they're not really overseeing it, you know, oversee, yeah, overseeing the units. So there was a time where I would take, like, a few more units and stuff, and then my sugar would drop, and my mom didn't know why, okay? And then I would tell her, like, Hey, I did take a few more units than expected, because I, you know, we were with the family who was out of town, or whatever, so we would eat. We'd eat like out. Often, my parents really didn't consider the eating out affected my blood sugar more, because my, my family's from Mexico, so I. When eating out, we go to Mexican restaurants, and Mexican food doesn't have a lot of carbs. It has a lot of carbs, realizing, like, now I'm like, I should have spoken up about it, because I never, like, got the chance to explain, like, hey, maybe this is not a good choice for me. Yeah, I shouldn't be eating, like, a big plate of this, or a big plate of that,

Scott Benner 05:22 were you actually told that the food didn't have many carbs in it?

Alicia 05:25 Not really. When I was diagnosed in the hospital, they didn't really give a really well explanation, because my dad is not really fluent in English, okay? So to have a translator there, we really never had one. It was me trying to translate it. And

Scott Benner 05:43 as an eight year old for your parents, yeah, I barely really, as you're being diagnosed with Ivy, how long did they give you the cinnamon before they decided it wasn't going to work?

Alicia 05:52 They had me on my parents had me on cinnamon pills. Did cinnamon tea? Um, for about a few years. Actually, I was my godmother was trying to influence my mom to give me cinnamon pills and all these, you know, vitamins and Moringa pills and stuff. And Moringa pills, what is that? It's like a seed, but they would make it into powder and put it in pills for people who didn't like chewing the seed. Okay, you have to chew it. And it was a very bitter, bitter seed. And my dad was like, oh, you know, take this and take that, and it was never really a cure. So it's just like, no, like, I still have it. My

Scott Benner 06:32 question is, is, if your parents give you a Moringa pill, for example, which, by the way, is made from the leaves of the moringa tree, plant rich with nutrients, antioxidants and anti inflammatory compounds. It's often touted for its potential health benefits, including blood sugar regulation, anti inflammatory properties, high in antioxidants, lowers your cholesterol, rich in nutrients, and I think it's going to make you taller and prettier, too. It seems like it does a lot of things. They're giving this to you. You still need insulin. Like, is there a moment where somebody comes to you and goes, Hey, listen, the moringa pills are clearly not working, so we'll stop doing that now. Or do you

Alicia 07:05 know what I mean, it's so with me, I just kind of like I stopped them slowly on my own, because I was like, these are just not like, I still have to depend on so no matter what, these are not gonna work. They would sometimes regulate my sugar at the same time. I was taking it before a meal. So I was taking my insulin as well. So sometimes it would bring it a little bit lower, yeah,

Scott Benner 07:27 I was gonna ask you, do you not buy much? Instead of spiking to 300 Scott, I would spike to 275 it was a mirror, yeah? Like,

Alicia 07:35 like, it was, it was not by right, much,

Scott Benner 07:39 by the way, I don't doubt that there are, you know, supplements that people take that they see value from in a lot of different ways. But that's not type one diabetes. You see, you know, like, that's a different animal. You don't have type one diabetes. And just take a big dose of zinc and it goes away. But my confusion here is like, there's never once a moment where someone says to you, hey, I want to say out loud that the thing we told you to do is completely unnecessary, clearly not working. You don't have to do that. You just were left to regulate it on your own. The contour next gen blood glucose meter is sponsoring this episode of The Juicebox Podcast, and it's entirely possible that it is less expensive in cash than you're paying right now for your meter through your insurance company. That's right. If you go to my link, contour, next.com/juicebox, you're going to find links to Walmart, Amazon, Walgreens, CVS, Rite, aid, Kroger and Meyer. You could be paying more right now through your insurance for your test strips and meter than you would pay through my link for the contour next gen and contour next test strips in cash. What am I saying? My link may be cheaper out of your pocket than you're paying right now, even with your insurance, and I don't know what meter you have right now, I can't say that, but what I can say for sure is that the contour next gen meter is accurate. It is reliable, and it is the meter that we've been using for years. Contour next.com/juice box. And if you already have a contour meter and you're buying test strips, doing so through the Juicebox Podcast link will help to support the show. 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 Arden's 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 this 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/juice, box, using that number or my link helps to support the production of the Juicebox Podcast.

Alicia 10:49 Yeah. So my dad would kind of just like, keep on telling me, hey, you know, take this and take that, and my dad's stubborn. I'm stubborn, he would tell me, and I'm just like, it's not it's not it's not gonna work. It's not gonna go through. Sometimes, there was times where he was like, hey, you know, like, maybe you should try this instead. And I'm like, I've explained so many times I have to depend on insulin for the rest of my life. I've talked to my doctors. I've told them, you know, the things you you have me take. And even my mom was like, yeah, the doctor said, you know, that's just not gonna work. And my dad's like, well, how does this person I'm like, because that person probably has pre diabetes or type two diabetes to where they're able to reverse it, you know, like, for me, it's not reversible, yeah.

Scott Benner 11:36 Also, if you can find me one person that told me that they had pre diabetes or type two diabetes, took cinnamon and more ring appeals, and it just went away magically. I would love to talk to them, right?

Alicia 11:49 So, like, it was just, it was very confusing,

Scott Benner 11:54 yeah, yeah. And you're, you're your little kid too. Like, that's the thing that, like, throws me off. It's cultural to some point, right? Because it's just gonna sound like I made this up. But years ago, I'm not making this up, by the way. Years ago, in a, like, a Walmart parking lot, I don't know how I met a person in a parking lot who, like, looked at me and like, said, Excuse me. And I said, Excuse me. And then she was like, Are you the guy from the like, she heard my voice and knew I was from a podcast, which was freaking weird. But, like, we started talking, and then she started telling me she's, like, my son has diabetes, type on diabetes, and I have a real struggle. My mom doesn't want him to have insulin. And she started telling me the story about, like, you know, I keep fighting for him to have insulin, but my mom doesn't want him to have it, and my ex's parents don't want him to have it, my ex doesn't want him to have it. And I'm like, I don't understand what you're telling me. And she said, Oh, I think it's an Hispanic thing. And I was like, okay, like, I didn't know. I mean, she was just sharing her story with me in a parking lot, but that's what she said. She said everyone in my family, they were all Hispanic. She said, everyone in my family just believes that we can, like, just get rid of it some other way,

Alicia 13:07 with herbs, with herbs or some type of seed. Yeah,

Scott Benner 13:13 I can never, I'll never forget this girl, because she was the only thing standing in between that kid dying and not dying, like, because right everyone around him didn't want him to have the the insulin anyway. Okay, so this is your life. It's not it's not going great. Are you managing with injections, pens and insulin pump?

Alicia 13:34 So I was managing with pens, and because I wasn't, I just kind of like, gave up the hormones, puberty, everything hit. I did fall into diabetes coma once, and the paramedics thought it was a overdose, because I did take ibuprofen for a headache.

Scott Benner 13:53 You thought you OD on ibuprofen? Yeah, I gotta get you away from the adults you're around.

Alicia 13:59 They took they took it as an overdose. They did it give me Narcan, because that I was practically already in DKA. So they were, you know, giving me CPR. My mom was freaking out. And once they arrived to the hospital, the nurses and the doctors gave the paramedics hell. They gave them how? Like, no tomorrow, yeah, and we're yelling at them, because they were like, No, this is not an overdose. This is diabetic coma. She is in diabetic coma. How do you guys like, not see like, her body is in in shock. Her body's trying to, trying to wake up and not waking up. What are you guys not seeing?

Scott Benner 14:40 They come into your home, your parents, the first thing they say Isn't she has type one diabetes, yeah,

Alicia 14:44 so that's what my mom said. My mom told them she is diabetic. She took some medicine for a headache. I just got back from the store because I went to go get her some tea. She wasn't feeling good, but you

Scott Benner 14:55 had a headache because your blood sugar was 700 or whatever. Yeah. How? How do you get there? How did did you stop taking care of yourself? No,

Alicia 15:03 so I when I was sick, I was trying to give insulin, and from my with my body, I've noticed is when I am sick, I cannot control my blood sugars, trying to give insulin, and it wasn't going down. And I was sleeping more than half the time without alarms. Okay, so just kind of waking up, checking my blood sugar, seeing it was how I give insulin, go back to bed. What

Scott Benner 15:25 kind of illness like, like a flu or a head cold, or what did you have? It

Alicia 15:29 was a cold that I had, and it was, from what my mom told me is, it was like a cold that I guess went around the house, because everybody was sick that week. So it was a it was a strong cold. My body just wasn't able to fight I guess because COVID, same thing happened to me. I didn't fall into DK because I called the ambulance myself and I told them in type one diabetic, I can't control my blood sugars. COVID is really taking over my body. At the moment, I need to go to the ER, and my family has COVID as well, so the whole house was in COVID. So ambulance came and they saw my blood sugars were just going up. I wasn't even eating. I was trying to just control it, and I couldn't. So when I first fell into DK, it was a very traumatizing moment. That's when I kind of was like, Okay, I need to get a hold of this. I need to take care of myself. My mom noticed that. She was like, Okay, I need to start watching her. My dad's a very busy, busy person, so half the time he's not home, and we've had those arguments like, maybe you should have stepped in, because I tell them, like, I see so many families on the type one juice box group, be so involved. I was like, you have to understand that herbs and and seeds are not going to cure it, right? What's going to help is you being involved. You checking on my blood sugars the way my mom was, because after that, she would wake up in the middle of the night because she heard my thing go off a few times, and she's like, Hey, what's your blood sugar? Is it low? Is it high? Correct? If it needs to, she'd even open my phone, because she's like, I know you're not going to check your phone. She's like, I know you're not going to wake up, so I'll check it for you. There was times where she even tried to, okay, so we're going to go here and eat, take your insulin before we leave the house, because by the time we get there, you know you're you'll be able to eat comfortably.

Scott Benner 17:29 She was reminding you to do these things throughout your life.

Alicia 17:32 Yeah. So throughout I was I was on pens because high school, she was constantly checking on me. She was constantly, uh, texting me and stuff. So she, she became more involved until I was like, okay, but she would try to, like, over push it. Sometimes. I'm like, Mom, there is a point, you know, there's a boundary of like, okay, I got this like, I understand you're trying to make sure, because I'm your daughter, and I know we had a very traumatizing situation and stuff, but there is a boundary,

Scott Benner 18:01 yeah? So let me make sure I understand the timeline correctly. You get sick, you go into DKA. That freaks your mom out. She gets more involved. Yeah, okay. Are you taking care of yourself at that point? Because earlier you said you kind of burned out during high school and stopped taking care of it. When was that?

Alicia 18:16 So that was right before freshman year. Was DK, high school. I was, like, trying to give insulin, but then enjoy all the snacks with my friends, and I'm like, having to give insulin again. So, like, my sugars were kind of like a roller coaster, and my a 1c was still high. It was at, I believe, a 10, okay, at the time.

Scott Benner 18:38 Can I ask, did you go to doctor's appointments regularly. Did your parents go with you? Yeah.

Alicia 18:42 So my mom would take me with and go with me. She was kind of like my voice at the doctor's appointment. Okay? And it was very difficult to communicate with the like the doctor myself. How come we would tell her, like, what I'd eat. We'd let her know what's going on with my life, stuff like that. So it was very not helpful. Yeah, it was because my mom would try to, like, communicate with her more than I would and stuff. And my doctor did, kind of, like, was like, oh, okay, you know, because my mom was involved. But you know, she wasn't with me all the time. So yeah, for me, like, sneaking little snacks here and there, not

Scott Benner 19:22 Bolus, sing for them, stuff like that. Let me enjoy it. What was your understanding of a, 10, a, 1c and what was your mom's understanding of it? My mom

Alicia 19:30 was like, Okay, we need to work on it more. She was like, Okay, give insulin this time and this time and this time. I've always had a difficulty with my ANC, until about two years ago. Okay, my UNC skyrocketed really high because I had um, two losses in my family. So very important people give

Scott Benner 19:55 me a second, somebody, somebody, people passed away. And then, yeah. Tell me how that affects your a one thing

Alicia 20:03 that affected me really, really difficult, because it was two of the most important people who who were in my life, my grandmother, who taught me how to cook and how to make meals and stuff like that. I didn't want to do anything. I kind of, and I was in my technically second senior year, because I had to take another year to graduate. I fell behind. I kind of just slapped Do

Scott Benner 20:33 you think that you were depressed? Do you think that your blood sugars were just so all over the place and high that you were cloudy? Do you think there was a mix of that happening? I think

Alicia 20:41 it was a mix. For me, I didn't want to do nothing. And then two weeks after that, we found out that my godfather went missing. And in Mexico, it's, it's, it's a lot different. So in Mexico when, when, you know, somebody went missing, you know, like something happened to them. For me, it was, I was just like, done. I was kind of like,

Scott Benner 21:03 did you ever know you were sad? Did you ever think about hurting yourself during that time? There

Alicia 21:08 was times where I just wanted to kind of give up, not like, hurt myself, but like, because I knew I was diabetic, I was just like, okay, maybe if I just stop the insulin, um, that'll fix it for me. Yeah,

Scott Benner 21:23 it wasn't like you just needed a break and you need to give something away. So you gave away, thinking about the diabetes to lessen your burden. It was more than that.

Alicia 21:33 It was, yeah, it was, it was more. It was, I just kind of wanted to give, give up on life, okay, not just like life, just like, not worried about anything my health. It was more worried about my family. My family was hurting. I was hurting right?

Scott Benner 21:48 So you had more to think about than you had space for Yeah, okay, and you kind of gave the diabetes away. Then you're like, Okay, I'm not gonna pay attention to this. This will be one less thing for me to do,

Alicia 21:59 yeah, and because my body was really kind of what my endo only was, my body was kind of already immune to a high, A, 1c, that my body was just kind of used to it kind of used to being

Scott Benner 22:13 high. That's the wrong word. I hope he didn't say immune.

Alicia 22:16 Well, not immune, but like, just being used to it, yeah, your body

Scott Benner 22:19 tries to adjust to the bad things happening to it so that you can feel better. But you know, what it ends up doing is you feel normal when your body is in trouble. And so, yeah, right, okay, just as long as the doctor didn't say you your body's immune to high blood sugars. Now, because I would just like, I'm gonna come take you away and like, adopt you if that happened to you? Okay, right? But two years ago, things changed for you. You started doing better, like, what happened that shifted you? So

Alicia 22:47 I did meet my boyfriend, and I was still kind of in the dark stage, and I was telling him, You know, I am diabetic. I haven't been taking care of myself. Not gonna lie to you, I was like, I'm gonna be completely honest, because I've seen diabetes pass away from not taking care of themselves. My auntie passed away from type one diabetes because she wasn't taking care of herself. She had a really high one, A, 1c her whole life, she passed away at the age of 40.

Scott Benner 23:17 Oh my gosh, this your mom's mom or your dad's mom, it was my mom's cousin. Why didn't they give her cinnamon? Do you think

Alicia 23:25 my mom's side of the family is not really Hispanic? They're Philippine my dad's side is the more Hispanic side to where, okay, they would tell us, like, take cinnamon. I got it. Came to the realization, though, my auntie did tell my dad, like, my son's diabetic, you know, I've tried to tell him to take cinnamon in it. It doesn't it doesn't help. My dad's like, oh, but, you know, it could help. And my Auntie's older than him, like, that's his older sister. And she was just like, No, just give up on it. Let her focus on insulin, and you focus on just supporting her because you're not helping.

Scott Benner 24:04 Um, Alicia, are you crying when you talk about your your life, or are you just, it's

Alicia 24:09 just realizing that I didn't take care of myself, kind of like a hit in the face, like I should have.

Scott Benner 24:15 Oh, well, you know, though, like, listen, you're young, so you don't let me. Let me try to help you a little bit here. I don't know if you know the term. I'll give you a couple. You can tell me which one you know, dumpster fire show. Have you heard these things? Yeah, okay, I like to say you started out. You didn't start it in a hole. They went to the bottom of the hole, dug another hole, threw you down in the sub basement of the hole, then threw the dirt over top of you, then threw a lot of cinnamon on top of you, and then said, let's see if you can climb out of the hole. And then you got out from under all from under all the dirt. You're like, oh my god, I'm still in a hole. And they were like, Yeah, let's see if you can get out of that. Now listen, deference to your parents, like, you know, if they didn't know, they didn't know, and cultural stuff can really, I mean, can really, really manipulate people. No one was helping you. And eight years old is too young to figure out how to take care of yourself with type one diabetes. 80s by yourself. So

Alicia 25:01 yeah, it was, you know, go ahead and take your insulin. And I'm like, Okay, so like, like, Yeah, they did teach me how to poke myself with syringes and stuff and whatnot. But then I was like, Okay, I'm still young. I'm still trying to adjust to it. Sure,

Scott Benner 25:16 there's a lot more to it than that. Yeah, definitely,

Alicia 25:19 living in a Hispanic home, there's a lot of things. Like, if you went to bed as a kid, you know, like Something's just not okay, or whatever, well, I'd get in trouble for it. Realizing that they didn't know I was diabetic yet. I threw up in my grandpa truck. We were in California. They didn't know I was diabetic yet. There was so many symptoms that they missed. We kind of like realize it now, like you guys missed that, you know, high blood sugar, a pee constantly, and because I was a little kid in a bed, wetting the bed was, like, something that happened, and you guys didn't really realize it, I got in trouble for it, right? Like, a really difficult situation, because I kind of like, make fun of my friends. Now I'm like, you know, I got in trouble for, like, technically, being a diabetic without you guys knowing I was diabetic. Are you mad at them? No, it was just more of like, paying attention would have really helped, because I feel like I was type one diabetic before I got diagnosed, and realizing, like, now I was just like, wow, I was type one diabetic for a while without them realizing it. I was wetting the bed, like, constantly. So it was, like, kind of confused about because I was like, why? Like, I'm trying to get up and wake up and I can't. And then when I threw up, I was just like, Why do I constantly feel sick? I was going to the bathroom locked in, and my mom was questioning it, but kind of just like, like, she'd question it, but then just forget about it, if that makes sense, yeah,

Scott Benner 26:48 there's no follow through, yeah, yeah. Like, you'd leave the appointment. She'd say, we have to do better. But then nothing actually happened after that, right?

Alicia 26:55 There was times like, it'd be like, a week or two or three weeks, like, okay, constantly, take your insulin, take your insulin, take your insulin, and then just after a while, you know, just stops. She wouldn't push as much and stuff. But also,

Scott Benner 27:08 just take your insulin. That's not actually valuable. It's just somebody bugging you to take take your insulin,

Alicia 27:15 take your medicine. Yeah. It's like telling somebody to take their medicine, yeah.

Scott Benner 27:19 Like, did you know why you had to? Like, let's go back a little bit. Did you understand what the insulin was doing? Did you understand how it worked? Or was it just as simple as like, Please count this young

Alicia 27:29 kid. I just knew that it was just gonna help me. Okay, I just knew that it was gonna help me live. Because the way that the doctors kind of explained it like as an eight year old, you think, huh? Like, what? What do I have now? Like,

Scott Benner 27:45 yeah, you understand it as a child. You're like, what is

Alicia 27:50 my body doing to me? You know, because you don't know your body at a young age. So for me, it was like, what?

Scott Benner 27:57 What's your level of understanding right? Now, of it like, and where did you get that understanding from? You meet the guy, it sounds like you felt guilty almost. You're like, look, you're gonna, if you're gonna like me, I should let you know I might die. That's what you did, right

Alicia 28:10 as a diabetic, because I didn't really comprehend everything until I did more research, until, because my auntie would even be like, oh, you know, there's medicines on the black market. No, no. She, she tried so hard, and I love her to this day because, you know, she, she does worry about my diabetes, but not in the same way as, like, because she's like, anti government type. So it was just more of like, I'm like, You don't understand. Like, I have to live with it. So when I explained to my work, and I was like, it's something I have, something I have to take before I eat, to help my pancreas live do its work, because my pancreas is not producing, so I have to take an insulin for it. He actually kind of like, looked into it. He's like, okay, he goes. Now I understand the difference. He goes because I thought maybe it was because of eating. And I was like, No, that's type two. I'm like, type two is more of you kind of just screwed yourself

Scott Benner 29:12 up. Type Two is insulin resistance of some kind, right? Yeah. So some, yeah. Listen, there are plenty of people who you know, have type two diabetes that you'd look at and they don't look like they eat an extra calorie all day long, and they have type two diabetes, right? It runs a spectrum of people who have it. It was just helpful enough, because that's how he thought of it, right? Like what he thought was, if someone says they have diabetes, that means they ate too much food and now they need right insulin,

Alicia 29:40 right? So that's what he kind of understood. I was like, no for me, I was diagnosed with it at a young age, and it can happen to anybody. I was like, in I have to make sure my portioning is proper and stuff like that. Because that's when I was kind of, like, looking into it more he was, he was supporting me. Who's asking me, Hey, what's a normal blood sugar? What's a high blood sugar? What's a low blood sugar? So I know to this day, like, even he knows, like the sounds. He knows every sound of everything. He's

Scott Benner 30:12 paying attention. He's doing what you asked your dad to do. Yeah.

Alicia 30:15 So he he's like, Okay, I know your blood sugar is high use. What is it at? Let me help you. He's like, go ahead and take your insulin. We'll go for a walk or make sure to drink plenty of water. He's looking out for you. He constantly was doing it, and I just, I felt like, Okay, if he's gonna help me, I need to help myself too.

Scott Benner 30:36 Alicia, is it fair to say that you just felt alone, and once you didn't feel alone anymore, it felt more doable. Yeah, okay, definitely. Let me ask you a different question. You listen to the podcast, right? Yes, okay, you know Jenny, you listen to any of the pro tip stuff or any of that? Yes, okay, in your mind, just make a scale in your head and put Jenny somewhere on the scale of understanding diabetes. Right now, if Jenny, let's put Jenny to 100. Okay, and let's say the scale goes from zero to 100 Where are you on that scale? Where's your boyfriend on that scale?

Alicia 31:07 So that's a we'll

Scott Benner 31:11 make your dad zero. Your boyfriend 100 where do you fit?

Alicia 31:14 I put myself maybe at a 75 okay,

Scott Benner 31:18 by the way, people should know Alicia, and you should know too that for reasons that I can't quite understand, I'm holding my hands apart, making a scale, even though no one can see me. Why am I doing that? All right, I'm gonna stop. Don't stop doing that now. Okay, so you're just why it was I doing that? Are you at a 75 where

Alicia 31:36 do you put your boyfriend, like, right next to me? Probably, like a 74 so

Scott Benner 31:40 you and he kind of have a similar understanding of it at this point. Yeah, so Okay,

Alicia 31:44 he's gone to doctor's appointments with me. He sat there. He's asked questions. He's a Curious George. He's a Curious George definitely, because he's asked the doctors, like, what can I do to prevent her from going high, because stress has affected my blood sugars a lot. So he's like, What can I prevent her from, like, trying to stress out or trying to freak out, because I don't want her to go to a high blood sugar because I'm

Scott Benner 32:14 a mean diabetic. Because you're mean when your blood sugar gets high, I am so mean. Um, he's not curious, George. He's scared, George, actually, yeah, I just want to say, Alicia, had you said curious Jorge, we would have had a title for the episode. But no, it's okay.

Alicia 32:29 That even works too, because he's like, and when she's low, she is shaky and she feels lightheaded and stuff, and she feels like she's like a person I don't recognize. You've been with

Scott Benner 32:41 this guy two years now, right? Yeah, okay, in those last two years, you've gotten the eyelet though, when did that happen? So the

Alicia 32:48 eyelet happened about, I want to say, 10 months.

Scott Benner 32:52 Okay, let me make sure I understand. A couple of years ago, you start dating someone. You think I'm going to do better for myself. You go out, you try to learn more then, right? And you're at that point, your a 1c is in the 10s or greater. So

Alicia 33:04 it spiked, and then it went down to about a 12,

Scott Benner 33:08 okay, when over a 12 came back to a 12, you try to figure things out six months later. So 18 months ago, before the islet, where's your a 1c so

Alicia 33:17 before the islet, it was that 12 okay? Because it was, we were trying to work with it, with the just the insulin pen, and there was times where I was just because I was working in a very difficult area, where they didn't understand my diabetes either. My job was very questionable, like, why I'd go to the bathroom to go get my insulin often? Because I worked in a kitchen for two and a half years, it was very Why do you need to go constantly to the bathroom to go get insulin? Well, because, you know, my body depends on it. My blood sugar is running high, so I have to make sure that it is controlled. They weren't so supportive of, like, because I did the Omnipod for a little bit, they weren't supportive of it. They're like, um, why do you have that on and why are you so like, you got a lot like, customers about it. Because customers did ask. They were like, Oh, what's that on your arm? How is that working for you? They were curious about everything. So I'd explain to them, like, in the simplest way. And they were just like, Why do you have to explain to everybody what it is and and very difficult with me. So I was just like, you guys don't understand my health is more important than this job.

Scott Benner 34:33 Can I ask a question here? I know you're young still and everything, and it's you got a crappy start with all this, and you're you're getting it together. But how does a person forget you for a second? I can't wrap my head around having a 12, A, 1c, like, Were your settings wrong? Were you using not nearly enough basal insulin? Was your carb ratio way off? Like, How was that possible with

Alicia 34:55 mine, they had my carb ratio one unit per five carbs. Okay? And I would give the insulin, so I'd give it about 15 minutes earlier than when I would have to eat. Sometimes it was, like, right before I would eat, because we didn't have a lunch break half the time at work, okay, I didn't know, like, the next time I was gonna pretty much eat, it would still spike after I gave my insulin. How much basal were you taking then? For like the Lattis, it was 54 units. She had me up. You

Scott Benner 35:25 were using 54 at least. If I ask your weight, are you comfortable answering?

Alicia 35:30 Yes, go. So I was at a weight of one, 170, okay. When I was doing the 54 units, and I gained quite a bit of weight, trying to take care of myself, trying to get my ANC down. I tried to cut out, like, the carbs more, and try to just, you know, like, limit my carbs, because my sugar was still going high. Recently, about six months ago, I found out that I could be insulin resistant as well.

Scott Benner 36:05 Well, yeah, hey, Alicia, thank God I didn't have to bring this up, because, yeah, rough math on basal insulin at your weight puts you somewhere between like 31 and 39 units a day, and you're using way more than that, and having an A 1c in the twelves. And, I mean, and you're a one for five carb ratios. I mean, it's pretty heavy, you know what? I mean? So, like, it's not like they were way off on that. So somebody finally, I mean, listen, does this story end with you getting a GLP medication? Because it feels like this is where this is going, or no,

Alicia 36:35 right now, I'm on the pump. I've been on the pump for a little bit. My a 1c dropped from a 12 to a nine.

Scott Benner 36:41 That's on the the eyelet took you from a 12 to a nine. So what

Alicia 36:45 happened at first was the they put me on the islet, which, it works great. It works wonders. I'm a full time college student. I'm a full time worker. So both of those were just like, because I got a new Endo, and she completely changed everything for me. She's like, No, she's like, you're insulin resistant. She's like, for your insulin, you you take insulin and you're still high. Yeah, she was, and they had you at a 54 unit, the one that's that used to be my endo is now above her, and she's like, how do you let Alicia, you know, get to a high ANC like this, because I have her out of nine right now they, they kind of like, did comparison? Like, I dropped her for a 1c because I put her on a pump, and she's like, Oh, I tried putting her on her pump, and I was like, You pushed me to do an Omnipod, which obviously didn't work, because I'd have to switch out the pump within a day and a half, I was

Scott Benner 37:42 gonna say you were using up too much insulin. Yeah, did you say your mom's side is Peruvian? No, they are Filipino, Filipino. Okay. I mean, between that and Mexican, you can't be more than five 3am. I Right?

Alicia 37:53 Yeah, I am five. But exactly, yeah, it was good. Okay, all

Scott Benner 37:57 right. So, yeah, you didn't have, like, the hype gene on your side is what I was getting at. So you're using that amount of insulin. You're having that outcome. Something about getting on the eyelet, changing your your settings is making a dent in it for you, but it is not but you're also gaining weight using more insulin, right? So, yeah, is it fair to say that you are you taking in more calories a day than you need.

Alicia 38:21 Like, as a young kid, I didn't focus on that, and I just focused it on the car, focus on the carbs and the sugars. Now me and my boyfriend, are we? We kind of, like, realized this, like, a year in. We're like, wow, like, the calories kind of do make a because he would eat out a lot, yeah. Now he okay, maybe we should stay. And he goes, I don't want your blood sugar going high. So we kind of noticed, like, it is a big difference, because my boyfriend has gained weight as well. Yeah. He goes, it's because, you know, I'd eat out, and now that I'm like eating in with you, and we're cooking healthier meals, and sometimes we do, like lunch out on the weekends, we noticed the calorie difference, and we noticed the weight because we both got told, like, you guys have gained so much weight, and it's like, well, he gained weight because of relationship. I gained weight because the insulin.

Scott Benner 39:10 I'm making that boy happy, and that's why he's getting fat. Okay, yeah, it's

Alicia 39:15 a huge difference. So with the calories, we kind of just were like, we noticed, and we're like that. Like, damn. Like, this is, this is a lot.

Scott Benner 39:24 Are you excited to have figured out a thing that cult that that may be culturally but definitely familiarly You Didn't Know About right? Like, so,

Alicia 39:32 oh yeah. Definitely, it was like, Uh, I wish I could tell my parents. Like, Hey you. You guys know that y'all never really cured me.

Scott Benner 39:43 But like, Listen, I'm not cured, and you didn't teach me how to eat for damn sure. What did you guys do exactly? Also, I'm working full time while I'm in college. I don't feel like anybody's really covering my ass here. But no, seriously, like, now you have, you have a different idea of the world, like, you have a different idea of, like, how to fuel yourself and, like, what. Many calories. Listen, I'm going to tell you like I just looked online to get a window. If you're an active person at your height and weight, you need maybe 1800 2000 calories a day. And if you don't do much exercise, you're more like 1400 or 1500 and big difference. Oh, well, yeah. I mean, just track your calories for one day to get an idea of what's in what you're eating, right? It could be startling. It could be a lot different than you think. If you put yourself on some sort of a, I don't know, whatever, like you know, if you put yourself on some sort of a regimented system that got you around the caloric intake that you that you needed, I don't know what you actually need, you'll find out, but when you dial it back to a number where you start going backwards with your weight, you'll know that you're in a bit of a caloric deficit, and then you know you're gonna start losing weight for being in that deficit. Yeah, yeah. And then you will, like, Listen, you will 100% use less insulin as you lose weight.

Alicia 40:54 So I switched insurances currently, and now they're not wanting to cover so my my endo put me on trulicity right now, okay, to see how it affects my weight and affects my blood blood sugars, just like this week I found out that they don't want to cover it.

Scott Benner 41:15 Oh, I started getting so excited. I was like, Oh, this is good. We'll see how this goes. Like, yeah, so I want you on ozempic. Or, like, Well, they'd give you we go v, if your insurance covers GLP medication, you will qualify for your weight, right? You could go back to your doctor and say, Hey, I'd like to take step bound. Or we go V based on my body mass index. And can you please? Like, don't even mention my diabetes, just that. That's what I want to see. And if your insurance covers it, you're going to get it right. Yeah.

Alicia 41:44 So, because I was looking into it and stuff, and I noticed trulicity depends on your body weight, and it depends on because it said max weight you lose is 10 pounds. I was like, that's my time. You're like, much? You're like, Great, yeah, it's gonna help me a little bit, but it's not gonna help me, right, completely, like, I need it to, because right now, currently, I'm over 200 pounds, like, the pump, she was like, oh, you know, put in that, you have to take a meal, and it'll cover your insulin. And so when I was doing that, it, it would last me a day. And I was like, 160 something units is not gonna that's gonna make it worse for me. She was like, oh, you know, she said, explained it as, like, a small reset on my eyelet. And I was like, it's not a small reset, because it's gonna get used to giving me that 160 units a day. She wants

Scott Benner 42:39 you to push more insulin so that the pump starts to try to use more insulin, because she thinks that'll keep your blood sugar down. I'm going to tell you I I wouldn't think about it that way. I would think about it, yeah, like food. I mean, I would wonder, have you ever had your thyroid check too? Yeah.

Alicia 42:54 So she checked my thyroid right away when she first became my endo and my thyroids are abnormal, just by a bit. And they put me on medication for they gave you, like, Synthroid, yeah, okay, and then they were normalized. She said that everything was fine with my thyroid. You stayed

Scott Benner 43:15 on it, though, right. No, oh, hold on, if the medication fixed, it doesn't give in the medication away. Medication away, put it back again.

Alicia 43:24 She put it as like, 90 day supply, and just until my next appointment. Pretty much, because my my appointments are every three months. Okay? And this was my with my old Endo. This isn't the new doctor, yeah, okay. The new endo checked my thyroid again and it looked normal. Did you tell her? That's

Scott Benner 43:41 because you just got done taking the medication for 90 days? I

Alicia 43:43 told her. I was like, Well, I was on a medication before it, but she had me stop it because I guess it was not needed anymore. She's like, well, your thyroid came back normal, which I don't understand, because thyroid runs in my family. Yeah, quite bad.

Scott Benner 44:00 At least listen, here's what you need to do. Just scream and run in a different direction till you until you've gone as far as you can, and start over again in another place. I don't know what to say. I've

Alicia 44:10 been back and forth with because this is the general hospital in New Mexico. So it was very, very difficult, because now that I'm on the Blue Cross, they don't want to cover my sense. My sensor. They don't want to cover your CGM, yeah, so thank God I have, you know, test chips in a meter. But I'm like, where's this

Scott Benner 44:30 insurance coming from? Who you getting it through Blue Cross and Blue Shield? Yeah? But why? Like, through your job, or through someone else's job, or,

Alicia 44:37 no, my, my mom has me under her Medicaid.

Scott Benner 44:41 Okay? Well, Medicaid should definitely cover a CGM.

Alicia 44:45 So I was like, Wait, what

Scott Benner 44:49 the I'm almost cursed. Tracy. Hold on a second. Hold on a second. You gotta teach me. You gotta teach me some Spanish curse words so I can get away with them. Hold on a second here,

Alicia 44:59 because. Was, I was, I was with my boyfriend yesterday, and I was like, they're not covering so I opened the mails like, they're not covering the trula city anymore, because I'm supposedly not type two diabetic. They stopped covering the Dexcom g6 and I was like, This is my thing to monitor my blood sugars constantly for a reason, because we're

Scott Benner 45:20 not giving that away. Because, by the way, your CGM, your your your pump needs it

Alicia 45:25 exactly. So I was just like, what? So I tried calling yesterday, and they're like, Oh, I tried calling in the pharmacist yesterday, and she's like, your insurance is not wanting to cover it, so we're trying to talk to your doctor to see why it's not being covered and stuff. And I was like, this is something that I need. This is not like my pump relies on my Dexcom. Without my pump, I can't wear my pump, and then you guys can't kill my insulin. What's gonna happen then,

Scott Benner 45:56 yeah, you can't say my pump is covered. If the pump needs the CGM, if the pumps covered, then the CGM is covered. Like Boy, I'll tell you what thinking is not people's strong suit. Okay, so here's what I've learned using the internet a little bit. So Medicaid should cover CGMS. That shouldn't be an issue. Medicaid Part B covers therapeutic CGM like Dexcom g6 FreeStyle Libre under specific conditions, beneficiaries with type one or type two diabetes. Who have need for insulin dose daily and regular blood sugar testing requirements are often eligible. There's no way you shouldn't be able to get your CGM. And then Medicare Medicaid coverage for GLP medications for weight management such as ozempic and we go vary by state. I try to figure out if New Mexico was covered. It says Medicaid offers limited coverage for GLP medications, specifically for weight management, that's perfect. That's what you need. So however, this coverage often has conditions including prior authorization and verification of other weight loss efforts. Okay, well, we can get a doctor to say that there have been other weight loss effort like it should take one motivated physician with a pen and three brain cells to make sure that you have CGM and a GLP medication, right? Yeah. So

Alicia 47:04 with that, I was, I was very like, you guys are joking, right? Because this is ridiculous. I've had my sensors covered. I've never had an issue, and we just switched to Blue Cross and Blue Shield because they said that they cover more. I believe this is like a few to your face right now, because I've had this covered my whole life, so I shouldn't have an issue with it.

Scott Benner 47:28 I just want to be clear, you can't afford this stuff in cash, right? No, okay,

Alicia 47:32 it is I work at work at a Walmart. It is not. That's where I met that lady, and it's in and I'm in college, so paying for textbooks is already a struggle, yeah, and paying for other stuff, and to be driving to a far campus right now is is a struggle. What are you studying? I'm studying Pharmacy Tech, so, like, realizing, like, everything. I'm like, Okay, I'm not gonna, like, yell at the pharmacist, because it's not their fault, but it's also like, have this comfortable life, this not

Scott Benner 48:05 be an issue. Yeah, you need the doctor to come to your rescue here and to set this up for you properly, right?

Alicia 48:10 So I was just like, I was explaining, like, insulin by itself is so expensive. I've seen people struggle buying insulin here in New Mexico, the Dexcom alone is $300 where am I going to pull $300

Scott Benner 48:25 from? Would your parents be helpful or no, my mom

Alicia 48:29 told me, you know, for right now, if anything depend on on the the test strips and the meter, she goes, but we should be fighting this. We shouldn't be having to pay for something that, if

Scott Benner 48:41 it should be covered, it should be covered. Yeah, we

Alicia 48:44 were so just irritated this morning, because we're like, ridiculous, and then to be on the phone and wait and wait for somebody to answer. I was already irritated. I was like, You guys are just messing with my mind. And then for my endos office, it's more of we have to leave a message, and then they'll get back to us. I'm like, This is an emergency here. Yeah? Like, yeah, right. Just asking a question. This is more of my health at this point matters, because what if they don't even want to cover my insulin? Yeah? Because

Scott Benner 49:17 now you're worried that everything's going to go away. At least listen, between you and I, your doctor's office should see your weight as an emergency. It should see your insulin uses as an emergency. It should see that the CGM not being covered as an emergency. They should not be putting you on trulicity. They should be trying. There are clear medications in the world that work great for this. Or I've lost 52 pounds in the last year and a half, right? I know people who have lost 85 pounds. I know people who have lost 70 pounds. I know people have lost 100 pounds. Like, there's a world where, if you could get on this, this medication, it would listen, it's going to slow down your hunger, like, probably significantly, which is going to curb your it's going to curb your appetite. You. It's gonna you're gonna take in fewer calories, you take in fewer calories. You're gonna lose weight, you take in fewer calories, you're gonna take in fewer carbs. You're gonna need less insulin as you lose weight, you'll need less and less insulin. You keep it, you know, the eyelet, you know, hopefully can kind of keep up with that. You know that adjustment as you lose weight. And there's just no reason why. Literally, six months from now, you couldn't be, my God, you probably could be 40 pounds lighter six months from now, and on your way to doing something using a lot less insulin. Your a 1c would probably be down into this, you know, you would imagine the two sevens at that point, and you could be in a completely different situation.

Alicia 50:36 I've been dreaming of, like, yeah, since I realized, like, I really want to get to a seven. I've seen so many diabetes happy, more of like, a an excitement. For me, it's just like, Okay, I'm at a nine. I still gotta go down. Yeah,

Scott Benner 50:50 well, I want to say this, going from a 12 to a nine is pretty awesome, like, short term, if that is fantastic. I cried.

Alicia 50:57 I cried like a little girl, because I was like, finally. Like, I begged for this pretty much, I've, I fought for it, so, like, for me, like, even my boyfriend was like, Oh my gosh. Like, holy crap. Like, you, you did it yourself. Did you

Scott Benner 51:11 ever try, like, a low carb lifestyle?

Alicia 51:14 Yes, I've, uh, I went on pretty much the kind of like veggie, light protein type diet. So it was consist of, like, broccoli, carrots, small amount of carrots, because I realized I was like, Oh my gosh, like these even have carbs, like this is ridiculous, celery, brussel sprouts, stuff like that.

Scott Benner 51:37 What about protein like animal meat proteins like chicken, yeah, beef, fish.

Alicia 51:42 We're not too much on the, like, red meat side, because my mom did get diagnosed with heart failure last year, okay, and it was due to, like, smoking cigarettes, and she did have a high blood pressure, and it runs through the family, so she had that for quite some time. Well,

Scott Benner 52:00 that's even another reason to help you, because, I mean, we could easily pull together a couple of articles about GLP medications, lowering heart attacks, strokes. So

Alicia 52:10 that's what I explained to my end of because my mom went on the off brand of ozempic,

Scott Benner 52:20 okay, like she listened to your aunt, but on the black market, what are we talking about?

Alicia 52:24 No, so she she talked to a doctor because she was diagnosed with heart failure and she had high blood pressure, and it was very difficult for her to lose the weight. So when she spoke to the doctor about getting the weight loss medication, they gave it to her. But she does have to pay out of pocket. She has to pay, I'm not mistaken about 175 for the medication, and she's lost a ton of weight, good, okay, for her ton of weight, she's moving around more. She's, you know, she's healthier. Her appetite has gone down almost completely. So I was like, okay, you know, that's something I want to speak to my doctor. Because I tried the gym. I was working out about five times a week. I was on the treadmill. I was trying to, you know, try to just lose the weight somehow, some way, because I always struggled with it, but because I was taking care of myself, and the insulin just kept on going. The scale did not move. It moved like, maybe three pounds, and that was about it. And I was so irritated, because when I first got out of my doctor's appointment with the weight of about two something, I was like, Okay, let me go to the gym. I didn't weigh myself until another three months, and it only moved a few pounds down, yeah. So it's like, something is wrong. And that's when my new end was like, Yeah, you have insulin resistance. You need a medication. She's like, I'm not for sure gonna give that to you yet, because I want to see how your sugars are. And I'm your new Endo. I do have all your, like, old paperwork, but we need to see what's going on.

Scott Benner 54:02 Yeah, tell her I said, and I'm nobody, but tell her I said that, let's go. Okay,

Alicia 54:07 right? So I was kind of like, okay, you know, wait, my mom's like, No, you need to go on a weight loss injection, like, something that can help you forget the whole insulin resistance thing, because that's what your body's really like.

Scott Benner 54:21 You're fighting too many battles. At the moment, I don't think you're gonna over. You're not gonna be able to overcome all the things. Like, even if you work out like crazy, eat ultra low calorie, you know, low carb, like, on a line, you know, with a with a site on trying to lose weight and trying to get down. You know, your insulin needs. You know, insulin resistance comes with fat, like, it just that's part of it, like, so you're just, you're kind of behind the eight ball. Now you need something to kind of boost it, yeah, give you a little help. Yeah.

Alicia 54:49 So I was just like, this is not working. This is just, so when I went in for my last appointment, I told them, I need a weight loss. I need something, because this is not helping. Yeah? This is not helping at all. I was like, I've tried, tried losing weight. I've tried going on just like a no carb for like, constantly, like, like, I would do, like no carbs, pretty much I do, like, Max, maybe 15 carbs out of the day, right? My body, it felt great, but it felt still horrible, because my sugars are still moving like a roller coaster. And I was like, I haven't even eaten that many carbs today, like, so it was just a lot. And I was just like, I need something. And so she put me on the trulicity. And then instead of nowhere, I was like, where's my trulicity? It's not coming yet. And

Scott Benner 55:35 then they tell you, that's no good. Listen, the Trulicity is a nice idea, but it's not gonna, it's not gonna make a dent in your situation that big, yeah,

Alicia 55:42 when I realized, like, I looked it up, and I was like, What's side effects? Just to, like, kind of prepare myself, the max weight is, like, 10 pounds. Like they, they really put me on this, even if it

Scott Benner 55:52 would help me out. You need something to help you with a number of different things, like with the insulin resistance, hormonal stuff, you know, as you gain fat, excess fat, like that, visceral fat, around like they people get around their stomachs. Like it interferes with insulin signaling pathways. I'm not real good at all this like, but like, it increases, like, an inflammatory response. It increases insulin resistance in a number of different ways, and it's not something that's just gonna, like, magically go away. You're not like I mentioned it earlier, right? Like no one taught you how to eat growing up. They didn't teach you how to take care of your diabetes, right? And now this is what's happened, right? And now you're paying attention to it, and you're, you know, as an adult, you educated yourself, and you're trying to learn more. There's nothing wrong with giving you a boost here. Also, I don't understand the thyroid medication thing. Like, if your TSH was elevated enough that the bad doctor thought to give you the thyroid medication. Well, my God, you know what I mean, because that doctor didn't, didn't understand much, my guess is your TSH was really high, if they saw that and was like, Here, take medication. So then, great, the medication works. You need to stay on it to keep it down again. I'm gonna guess if you go back for blood work right now, your TSH is high again, and that's probably another reason why you're having trouble losing weight, right? Yeah, also, that makes using insulin more difficult, too, by the way, yeah,

Alicia 57:10 because I explained to them, like, the high blood pressure thyroids, type one diabetes does run in the family. Yeah. I explained to them, maybe I was like, could it be my thyroids? Because my mom's on thyroid medication, right? I was like, and she's been on thyroid medication for a year now, because they noticed her thyroids were high.

Scott Benner 57:30 Yeah, Alicia, can I say if I was you, or if you were my kid, I'd go with you to the doctor, and I'd be like, I know she's 20, but I'm here. And then that would be that. And then I would say, I want her labs redrawn. I need you to get her a GLP medication, not trulicity. I don't want a pill. I want an injectable. I would like munja. I would like the Z bound. If you can't give me the Z bound, I'll take the ozempic. I want to go on a schedule like I'm supposed to. I want to take it for a month. I want to make sure I'm okay. I want to move up for a month. I want to move I want to keep going. I'm trying to lose trying to lose weight here. Don't tell the doctor. It's, you know, don't tell the don't tell Medicaid. This is for my diabetes. This is for weight loss. I mean, my rough math says your BMI is, like, close to 40. So you qualify under any BMI that I know, as long as the insurance company covers the medication. You should qualify for it, right? I don't want to hear that. It's like, oh, it's not good for type ones, because that's not true. Like, you know what I mean? Like, so,

Alicia 58:29 so many times I'm like, No, you guys just don't want my

Scott Benner 58:33 Synthroid back. Okay? Like, go if you need to test me again, that's fine. But if my TSH is above two, I want my Synthroid back. And if you want to know why I'm saying all this to you, my mom has heart failure. That's going to be me. I don't want that. You know what I mean, like. So these things will stop that from happening. These are the things I need please make this happen right now. And I need your help. You might need to write a letter to the insurance company. They might say to you, has she tried exercise? Well, I have you might need to write that down. I went to a gym. I did all that. It didn't help. I tried trulicity. It didn't help. Like, now, like, let's go. I'm telling you, one motivated doctor should be able to set you right,

Alicia 59:12 right. Yeah. My last appointment was August 26 and with the whole, like, not covering my my stuff. I called this morning, and I specifically said, I just need to speak to my Endo. That's it. There's a concern. My medications aren't wanting to be covered because the islet communication wise with the beta bionic company is very, very stressful, very

Scott Benner 59:42 difficult, because I'm interviewing them. Soon, I'll tell them, tell me what you want me to tell them.

Alicia 59:47 Because my doctor tried to communicate with them to ask, because she could see my blood sugars and stuff, and like, the doses and all that on the Omnipod, but she could not see it in. Through the I let beta bionic she had so much trouble trying to reach out to someone in Colorado who was an educator on the islet beta bionics. She tried reaching out to the one here in New Mexico. Nobody reached out to her until, I want to say, a month after my appointment, and then that's when she called me. She's like, Hey, okay, so now we can communicate about this. But nobody reached out to her. She sent several emails, tried to call and nothing. She was having a very difficult time seeing, like everything that was happening on my island, until they called me, and they were like, I heard that you guys needed some help. Was like my Endo, she cannot see anything through my eyelet. It's only shared to one of you guys as the educators of eyelet, beta bionic, but it needs to be shared with my Endo, because my endo can't see it. I was like, my endo can only see my Dexcom blood sugars, but not my eyelet. So why is that like not happening? And she's like, let me going on.

Scott Benner 1:01:07 I'm not sure about that, but I mean, I can ask somebody to see if I can get an answer.

Alicia 1:01:11 After a while, she reached out, and my endo was like, after so long, though, and for you to have to be on a pump, because at first, my pump was lasting me a day and a half again, like the Omnipod. So I was like, it's only lasting me a day and a half. Like, this is just not like I I love it because it's changed my ANC, but it's making me gain the weight. It's only lasting a day and a half, not even two two half days.

Scott Benner 1:01:40 I'm gonna, I'm gonna say something here, like, I don't know, like, you have a lot of different implications, right? But the one thing that we can kind of control on our own here is the is the caloric intake. So insulin, letter of the law, insulin doesn't make you gain weight. Calories do so if you're able to eat a lot and keep your blood sugar down, because the pump is pumping so much insulin, that's not the insulin making you gain weight. It's, it's the it's the caloric intake, right? So do you have, I know you haven't looked at the calories in your food, but is there like, can you tell me, like, a genuinely, like, kind of average day of eating looks like for you,

Alicia 1:02:14 an average day would be like a really small, like, breakfast usually, which is about eggs. Sometimes they heated up sausages, because I'm usually running inside and out the house. So usually it's just a small breakfast lunch I usually eat, like at work. So usually it was like, pre made sandwiches right from Walmart, like they have, like the lunch box, I guess now, okay, so it comes with, like, a small sandwich, carrots, a cheese stick.

Scott Benner 1:02:50 I'm looking at it here, like an, like an All American half sub kind of thing.

Alicia 1:02:54 Okay, all right, like a simple, you know, like, lunch box, usually, or sometimes I'll eat like a fruit bowl because I'm, like, craving sweets, and that's like, my my go to if I don't want to eat a payday bar or something. Yeah.

Scott Benner 1:03:10 I mean, that sandwich is only 360 calories,

Alicia 1:03:13 like, the protein, which is like, the the meat, cheese and crackers, yeah. It just depends on all three of those. Or sometimes I'll get, like, the the chicken from the from the heated up area, and I'll take off, like the breading, because I don't know, crispy chicken tenders always have made my sugar go, just have it spike,

Scott Benner 1:03:33 yeah? So the bread and the breading, and then it's greasy, because it's deep fried, so it pushes up your blood sugar, then it holds it up, because the fat holds it up. Yeah? So

Alicia 1:03:43 I'll do those, yeah, keep going. And then dinner wise is usually a chicken with veggies, and then like a side, like rice or mashed potatoes or Yeah. So that shouldn't, like, carb Yeah,

Scott Benner 1:03:58 so Alicia, that shouldn't be the issue. Then the food, it's not the issue. You don't think, no,

Alicia 1:04:02 like, I feel like, because when I do eat, there is times where I do snack on, like a bag of chips or a bakes good, because in the cold, there's, there's quite a bit of sweets. Not

Scott Benner 1:04:16 gonna understand? No, I listen. I understand. I really do. I mean, listen, I know what I said, what I think already. I think if you could get those couple of items, they would make a big difference here. I think you'd come back on the show a year from now and be like, Oh my god, Scott, I weigh 125 pounds now. You know what I mean, like mine, I'm not using nearly as much insulin, and my a 1c is lower, and I feel amazing, and my thyroid is better. And I think that's very doable for you. You just got to get somebody that's willing to help

Alicia 1:04:42 you, right? Yeah, that's what I I've told because my endo was like, you know, it's technically still, because I'm 20, they still have it as, like, your like, the children's No, no, what are we doing? Well, they're focused on, like, just the diabetes. And I'm like, I'm 20 years old. You guys gotta understand, there's so. Much more with my body now that I understand that, that I know I need, yeah, so she's like, Okay, we'll move you to, you know, like the adult type one. This is, this is

Scott Benner 1:05:11 bull. This isn't going to help you. What I said earlier is what you got to do. You have to call the doctor and say, listen to me. I am in crisis. My mom has heart failure. How old your mom? My mom is 42 okay, my mom, who is 22 years older than me, is in heart failure, and I am following right along in her footsteps. I have Medicaid. I want you to get me this and like, stop asking them. Tell them what you want. Be nice, but tell them what you want. Tell them you need help getting through the system. This needs to happen immediately. You're gaining weight at an uncontrollable rate, and you don't know where this is going to go. Every day is dire. I need your help. I need you to help me save my life. That's what I would say to her and then, and I would say, Please, like, let's stay on the phone right now and work this out. I need a GLP medication. I would prefer Z bound, because I think it'll help me lose more weight, but if you can only get me, we go v, then that's fine, but let's start with Z bound, and then I want my labs redrawn. I want you to check my TSH again, and if it's above two, I want my Synthroid back, because I have hypothyroid symptoms I can't lose weight, like, but like, we probably have other ones too, right, right, yeah, right. And I have a familial issue with that. My mom is also on that, and you need to make sure I get me I'm keeping my CGM here because this pump brought my a 1c down three points. And if you help me lose this weight, my a 1c is going to come down three more points. But I need to stay on the CGM, and I need to keep this pump, and then just make sure that happened. Like, do not stop until that happens. I'm telling you those three things you're going to save your life definitely. Yeah, go get them. Okay, thank you. I'm sorry you're dealing with this when you're 20. My daughter's 20. If I told her I have to do all this, she'd be like, I'm I don't how am I gonna get this done? But like, you're a little you're a little more, I think you've been on your own a little longer. So if you need anything, write to me on the Facebook group. If you want me to outline this again or say it again, if you want to try to help, get people to help you, get language. There's a girl in the Facebook group that could write a great letter to your insurance company to help you with your GLP and your CGM. If you need help, like you, let me know through that Facebook group if you need help, okay, alrighty. Thank you so much. You're very welcome. Hold on one second for me. Don't hang up. Okay, the conversation you just enjoyed was brought to you by us, med, us, med.com/juice, box, or call, 888-721-1514, 887211514, get started today and get your supplies from us. Med, having an easy to use, an accurate blood glucose meter is just one click away. Contour, next.com/juicebox That's right. Today's episode is sponsored by the contour next gen blood glucose meter. If you're looking for community around type one diabetes, check out the Juicebox Podcast, private, Facebook group, juice box podcast, type one diabetes. But everybody is welcome type one type two. Gestational loved ones. It doesn't matter to me. If you're impacted by diabetes and you're looking for support, comfort or community, check out Juicebox Podcast. Type one diabetes on Facebook. Okay, well, here we are at the end of the episode. You're still with me. Thank you. I really do appreciate that. What else could you do for me? Uh, why don't you tell a friend about the show or leave a five star review? Maybe you could make sure you're following or subscribe in your podcast app, go to YouTube and follow me or Instagram. Tik, Tok. Oh gosh, here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page you don't want to miss. Please do not know about the private group. You have to join the private group as of this recording, it has 51,000 members in it. They're active, talking about diabetes, whatever you need to know. There's a conversation happening in there right now, and I'm there all the time. Tag me. I'll say hi. The episode you just heard was professionally edited by wrong way recording, wrongway recording.com, you.

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