#1462 Small Sips: More Insulin
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A longer-acting insulin strategy helps manage high-fat and high-protein meals more effectively.
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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.
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#1461 Cold Wind: C.D.E.C.S
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
"Myla", in her 30s and a certified diabetes care specialist in a GP’s office, shares her story and clinical insights in this candid episode.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Welcome back, friends. You are listening to the Juicebox Podcast.
"Maya" 0:13
I have had type one diabetes for most of my life. I am going to talk about my experience working as a diabetes care and education specialist in a family practice,
Scott Benner 0:27
nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout. That's Juicebox at checkout to save 40% at cozy earth.com 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. Are you an adult living with type one or the caregiver of someone who is if you are, I'd love it if you would go to T 1d, exchange.org/juice box 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 and you want to do something right there from your sofa, this is the way the show you're about to listen to is sponsored by the Eversense 365 the ever since 365 has exceptional accuracy over one year, and is the most accurate CGM in the low range that you can get ever since cgm.com/juice box. This episode of the juice box podcast is sponsored by us Med, us, med.com/juice box, or call 888-721-1514, US med is where my daughter gets her diabetes supplies from, and you could too use the link or number to get your free benefits check and get started today with us. Med, hi, Myla, how are you good? How are you? Scott, awesome. Thank you. I will thank you in the recording. I slept through our time this morning, and you were nice enough to re reschedule later in the day. I told you privately, but I'll tell people here is my first time that ever happened to me, so I appreciate you being flexible. Sorry about that. You are anonymous today because you're going to talk about what
"Maya" 2:37
I am going to talk about my experience working as a diabetes care and education specialist in a family practice.
Scott Benner 2:45
Awesome. So you are what we used to call a CDE, right? All right. Tell me a little bit about yourself first. Obviously, let's not talk about things that are so specific that will out you. But you know, what's your background? How are you attached to type one How did you end up in that line of work? Etc.
"Maya" 3:05
I have had type one diabetes for most of my life. I took a very long and strange journey to get to the point of becoming a diabetes care and education specialist. I eventually became an RN worked in the hospital for a little while, and then figured, I'm pretty doggone good at diabetes, and I really like talking to people about diabetes, and there was an opening and a very dire need that I came to learn. So I was basically pulled away from my hospital position and asked to step into this diabetes education role.
Scott Benner 3:44
Okay, so you become a nurse at what age? 2829 How old are you now? About 30s. Okay. And how old were you when you were diagnosed? 14? Oh, okay, so you grew up with type one diabetes over the last 20 years, basically, yes, so in the early 2000s these you were diagnosed, and you became a an RN, you worked in a, you know, a pretty, like, basic setting, like people expect in a hospital, whatnot. You've got diabetes. What? What happens there that makes you think, CDE, like, are you just seeing how people are cared for? And you think I could put my talents to use in this
"Maya" 4:21
space. Well, honestly, in the area that I grew up, healthcare isn't great. There's not a lot of options. We're pretty limited in access to resources, knowledgeable access to resources. I kind of think of myself as like the opposite side of a coin, as Jenny, okay, Jenny had great CDEs. Growing up, I did not. I had horrible, horrible guidance, advice kind of left just a founder, and in my mid 20s, I finally decided to figure it out for myself and realize, oh, diabetes isn't actually. That hard. It doesn't have to suck. And I'm pretty good at talking to people, explaining things to people, yeah, in a very personable way that matters to them. And it just seemed like a very obvious fit. Do you have
Scott Benner 5:14
a particular remembrance of your CDs growing up that sticks with you? One
"Maya" 5:19
that comes to mind is when my endocrinologist approached the subject of starting an insulin pump about a year after diagnosis. I'm like, Oh, heck, yeah, that seems cool technology. I'm all about that. That clinic, apparently, I don't know if they were, like, funded by Medtronic, or what the situation was, but my CDE, she showed me a whole bunch of pump options, and, like, really, kind of pushed towards the Medtronic pump. But I was a swimmer, and I really, really wanted an Omnipod. I'm like, That seemed like it would work a lot better for my lifestyle. And they were just kind of like, oh yeah. I mean, that tubeless thing is nice, but your insurance probably wouldn't cover it. I had fantastic insurance. They definitely would have covered it, but they just didn't want to do the work and find out, look into it, didn't want to, I don't know if they were getting paid off by a mentor clinic or
Scott Benner 6:19
what we won't want to say that. What you're saying is like you felt like you were being pushed in a direction. Yes, you were being sold to Okay, yeah, I know we're being a little vague with your dates, but omnipot was pretty new back then. I had a very similar experience to yours, by the way, when Arden was diagnosed and we looked for a pump in, gosh, it was later than that. Even we were looking for pumps in 2000 and she was diagnosed 2006 I think we started looking at pumps maybe three, four years later, and we were already getting that pressure to like, Oh, you want this one back then. It was the anim. You should get the Animus ping. That's what they wanted us to have. And I said the same thing. I'm like, I really would like this to be tubeless. And then we got the sales pressure too. But it was weird, because it's sales pressure from medical people who don't have sales training, so they just say things like, Oh, you're too lean for that, or your insurance won't cover it, or like, that kind of thing. It's how it felt at the very least. And this is what you got. Like, were they helpful with settings, understanding what was happening, making adjustments, anything about that, not
"Maya" 7:24
really. They just kind of like set it. The endocrinologist would make recommendations every time I'd see him every three months. I don't remember the diabetes educator being particularly helpful. And I think probably the biggest issue overall was because I was a swimmer, you know, I had to take that pump off every day for two, three hours, do intense, intense workouts, and I would be four or 500 by the evening time, and then put my pump back on. I was probably way over basal eyes, and so I was just riding this blood sugar roller coaster constantly, and it was brutal on my teenage years.
Scott Benner 8:07
Yeah, and there's no concern from the physicians that this isn't the way to go, like, it's just like, oh, this is fine. If you take it off, you put it back on, and you're okay again. Is that how they acted?
"Maya" 8:16
Yeah, basically. And I remember one time my endocrinologist talking about how my a, 1c was not consistent with my blood glucose readings and my logs. And I'm like, Well, I know how averages work, and these are only pre meal numbers. You're not having me test after meals. You're not you don't see those numbers from that time that I'm swimming for three hours you don't see what's going on in the evening. The math is math. And yeah,
Scott Benner 8:44
so you were math is math. And so you were putting the work in, doing what you could. But then there were large gaps of times, almost every day, where you weren't getting insulin, and then they acted like that. That was more like you're doing than the doing of not wearing the pump. Yeah. Oh, awesome. So what's the impact of that? When you grow up with that kind of health care? I have always disliked ordering diabetes supplies. I'm guessing you have as well. It hasn't been a problem for us for the last few years, though, because we began using us Med, you can too us med.com/juice, box or call 888-721-1514, to get your free benefits. Check us med has served over 1 million people living with diabetes since 1996 they carry everything you need, from CGM to insulin pumps and diabetes testing supplies and more. I'm talking about all the good ones. All your favorites, libre three, Dexcom, g7 and pumps like Omnipod five, Omnipod tandem, and most recently, the I let pump from beta bionics, the stuff you're looking for, they have it at us. Med, 88887211514, or go to us. Med.com, Last juice box to get started now use my link to support the podcast. That's us, med.com/juice, box, or call 888-721-1514, when you think of a CGM and all the good that it brings in your life, it's the first thing you think about. I love that I have to change it all the time. I love the warm up period every time I have to change it. I love that when I bump into a door frame, sometimes it gets ripped off. I love that the adhesive kind of gets mushy sometimes when I sweat and falls off. No, these are not the things that you love about a CGM. Today's episode of The Juicebox Podcast is sponsored by the ever since 365 the only CGM that you only have to put on once a year, and the only CGM that won't give you any of those problems, the Eversense 365 is the only one year CGM designed to minimize device frustration. It has exceptional accuracy for one year with almost no false alarms from compression lows while you're sleeping. You can manage your diabetes instead of your CGM with the ever since 365 learn more and get started today at Eversense cgm.com/juicebox, one year, one CGM. I didn't expect to live long. Oh, Jesus. Okay, I didn't think you were gonna say that. Also, it's later in the day, I could easily cry, so be careful. You grew up feeling like I'm not long for the world. Yeah, and I didn't care. Why do you think? Because you just get so
"Maya" 11:30
apathetic when you're high and then low, and then high and then low, and you get burnout, and you're just done with it. And so if you're not gonna live long and you're feeling terrible, anyways, who cares? Yeah,
Scott Benner 11:41
just I'll ride this out and see where it goes and when it ends, whatever. Yeah, Jesus. How long do you think you felt
"Maya" 11:47
like that for? Oh, probably into my early 20s. Oh, god. What helped you get rid of that feeling? I went to the doctor one day out of necessity, because the doctor I had before stopped prescribing my insulin because I hadn't seen them in like, two years. So I got a new provider, and I'm telling her, you know, I probably got, you know, kidney damage or heart damage, I probably got all sorts of things going on. And she goes, Well, let's just run labs and see. And everything was fine, other than my a 1c being a high. I'm like, Oh, maybe I will live long, so we might as well feel
Scott Benner 12:21
good. We're happy. You're okay. But the reverse message we're hoping people get too because, because you could have very easily, like, the way your body's built, your physiology, whatever, like, you also could have gotten those tests, and people could have been like, oh geez, it's lied in the wrong way, you know. So you got you feel like you got lucky. Or am I putting words in your mouth by saying that? No, I think that's accurate. The pressure goes away because you feel like, okay, I don't feel like I'm gonna live long anymore. Do you have a feeling of like, but I'd still like to do better? Or is like, because I'm imagining that's not your situation now, like, blood sugars, a one, CS, etc. So how do you get Yeah,
"Maya" 12:59
once I realized my body is doing okay. I am actually gonna probably live a while, good, long while, so I might as well really figure diabetes out, because it's gotta be achievable. So I just poured myself into it. I read so many books, started dabbling in the internets and reading everything I could absorb. I even pulled out my textbooks from college, from when I was young, just reading up on physiology and nutrition and all of that stuff. And just like, really dug deep into it. And then it's like, Okay, I'm gonna start with the basics and just break it down very simply, and when you understand it, it's not that hard. Yeah.
Scott Benner 13:45
What was the difference between you then and you when you were is it just that you were younger before and now you or did you understand better about how to learn and make and apply things once you figured them out?
"Maya" 13:56
It was just kind of a mindset. Well, part of it was just like mental health stuff as a teenager, early 20s, and then, like, becoming okay with myself, and then also just my endocrinologist not having super high expectations of me succeeding with diabetes management. And so that kind of weighed on me. I'm like, well, what's the point? And then, after going through, I would say, some mental healing, becoming okay with myself, and realizing I can do anything that I want to, and I can be good at anything that I want to. So I'm going to be good at diabetes. Can you tell
Scott Benner 14:36
me a little bit about what the mental health stuff is in your teens, early 20s,
"Maya" 14:40
I can I was molested frequently.
Scott Benner 14:45
Oh my as a teenager, Jesus, welcome and super happy. I'm
"Maya" 14:51
sorry. Welcome aboard, Scott.
Scott Benner 14:55
I'm obviously not laughing at that, but I was like, Oh, Jesus. I just thought maybe it was like, regular. Off, family member, a neighbor,
"Maya" 15:02
uh, no, but someone that I would have considered like a brother.
Scott Benner 15:05
Oh, I'm sorry. Oh, geez, you had this experience when you were super young, and then you blocked it out, or you had it when you were older, and chose to try to ignore it. So the messed up thing. Wait, that wasn't the messed up thing. Okay, hold on a second. I gotta get myself ready. I told you 10 minutes ago I could cry today. Go ahead. I don't want
"Maya" 15:23
to freak people out. This might freak people out. It would happen when my blood sugar was low and I was vulnerable. Oh, and my body, or my brain, I guess, would just kind of block it all out. So it was as a teenager, while I had diabetes, and so for the longest time, anytime I had a low blood sugar, my brain would just shut off. Honestly, there's periods of time, like month, long periods of time where I have very little memory, just because my blood sugar was low so frequently that I guess my brain just stopped
Scott Benner 15:55
recording. Gosh, that sucks. And then this person saw your situation it was like, this is the time to pounce. That was the vibe, basically, how did you figure out that this had happened to you? And how did you figure out, like, how did you work your way through all that process? It
"Maya" 16:10
going into, like, my early 20s, I was at a university involved in, like, some campus ministry oriented, like, young women going through struggles and whatnot. And one evening, a girl showed up at my apartment, and she's just bawling. She's hysterical. Turns out she had nearly been raped, and so I just took her in and took her aside, and just spent time with her, and like gave her the space to be upset, obviously, to grieve, and also give her the opportunity to talk and vent in anything she needed. But I didn't expect it to affect me so deeply, and I didn't understand why, until I started having, like little, little flashes of memory, and that just crushed me. And then it do
Scott Benner 17:01
seek therapy. How do you get help for something like that? Yeah, I
"Maya" 17:05
did end up going to counseling, kind of pushed into counseling by friends and family, which was good. I'd never been someone who would have been comfortable talking about anything personal, anything private. Always grew up kind of stone cold, stoic, I guess, learned to talk about my feelings, which was a very strange experience, yeah,
Scott Benner 17:29
but it was helpful and worth the pain to go through it.
"Maya" 17:33
Oh, absolutely. I think I cried every day for two years, and I feel like that was making up from last time.
Scott Benner 17:43
No kidding. Wow. Okay, so you, well, I appreciate you sharing that. That's really something, you know, process all this your nursing, because that's happening at the same time, right? Like you're an adult, you're in the nursing field. You're going through this, this journey. No nursing came later. Nursing was after that. Okay, all right, so you go through the journey, then you start with your nursing career. How long are you in, like a hospital setting, before you end up in in the doctor's office that we're gonna talk about? It was less than a year. Oh, gosh, so did they scoop you up? Or did you move? How did you make the transition from the hospital to the office?
"Maya" 18:18
They scooped me up. They snatched me right away. Because why? Why do you think the lady who used to hold my position really wanted to retire? She didn't want to leave the doctor's office high and dry, and so she's like, I gotta find somebody who can, who can carry on. And she was just telling a friend about this, and her friend, who is also a friend of mine, was like, Oh, I know a girl, yeah. And so she just, like, randomly hit me up, and was like, will you please take my job? Wow. And
Scott Benner 18:51
this is, like, fairly local to where you grew up. And you said you grew up in a place where healthcare wasn't awesome, is that right? Yes. Okay, so now you're in a regular office, like, what kind of position do you have there? Are you making decisions? Are you setting up the way things work? Are you working under somebody else? The
"Maya" 19:08
way it works is the way I structure it is. I like to replicate how my endocrinology office work, but I do everything I I play the role of the LPN, who takes you in, the endocrinologist, the CDE, the nutritionist, sometimes the social worker. So I kind of wear all of those hats. I do all the decision making. And the only way we can technically bill for that is if I, at some point during the appointment, say, Okay, I'm gonna go get your provider now, who is just gonna come in here and say, Yes, I approve of this plan. And then it gets billed under that provider's credentials, so I do all the work, and then they bill it.
Scott Benner 19:51
I've always known that's what was happening. You've heard me say on the podcast, I imagine, like, Arden's endo would like physically touch her once a year. And. Was always like, why is this happening? Like, we never see this person. It's always the CDE, it's always the nurse practitioner. It's always those people, right? And then once a year, this person would come in, and she'd be like, hello, Arden. Like reading it from the thing. Let me how are you? Let me touch your sights. You look great. Thank you. Goodbye. And I would always think, like, that's gotta be for billing. Yes, it is, Oh, okay. Oh, I was right, excellent. Finally, I'm right about something. So you are basically like the diabetes life coach in the place, and doctor, you know, chief cook and bottle washer, it sounds like everything else. And then once in a while you say a thing, the provider comes through. I mean, you guys have to Bill somehow. So there is a little bit about how the insurance is set up, right? Like, so they think that the best way to give care to people is through the certified diabetes education care specialist, right? That person is going to give the care, but because of the way the insurance is set up, we have to bring the doctor in once in a while. So that's not, that's not really dirty play. It's just kind of like getting paid based on how the system is set up, is that right? Or am I missing something? No,
"Maya" 21:03
that's pretty accurate. Because otherwise, if we did it the way, just like traditional diabetes education places do it, it doesn't make money, and so they wouldn't be able to support having me in this role. They wouldn't be able to afford that and trying to have the providers do it, they don't have time for it, and they also just don't have the knowledge and the expertise. And so it works out to let me be the expert that just has delegation under each of the providers. It's the ideal situation for me, because I don't have to go get my NP or an ND, or those higher credentials, I can do it as an RN. And you know, if someone calls my office and says, Hey, we had talked about changing my insulin or trying a different medication or something like that, normally, when you call the office, it has to go to that provider's nurse, and then that nurse has to create a case, and then send it off to the doctor and say, What do you want to do with this? And then the doctor takes two days to look at it and says, Oh yeah, why don't we do this? And then he communicates it back to the LPN, and then the LPN puts the order in. Then it gets to the pharmacy. I eliminate all that. Okay, the patient calls me and says, Can we do this? And I say, Heck, yeah, let's do that. I put in the prescription under that doctor's name. Are you telling
Scott Benner 22:26
me that some of the rigmarole that goes on for people when they come on and talk about their experience with their doctors, it's so much more about the functionality and the pecking order and the insurance and not like so that's why they get slow responses, no responses, less than helpful, comments like that kind of stuff. That that's part of it. But you say the other part of it is some of the providers wouldn't know what to say, even if they had the time to say it. Is that? Right? Yes. Oh, okay. Oh, okay. And then when you told me that you had a cold wind story, like, this isn't the story, right? Like, what was your experience there that made you think, like, I'd like to come on and tell people about what happened in this office.
"Maya" 23:10
Well, there's probably a lot, I think probably my first jaw dropping moment there was, I started working with a patient coming in and got him set up on a continuous glucose monitor. He was put on insulin, I think nine months before I started seeing him, and his a one, Cs were consistently like 1213, not coming down. He's on these outrageous doses of basal insulin and is not doing anything. And I'm looking back through his past history and seeing that, you know, he's seen the provider, he's seen the previous educator. And every time they see him, they're like, numbers aren't at goal. He did CGM trials not at goal. And so they just kept upping the insulin, up in the insulin after, like, seeing him twice, I'm like, something's not right. What in the world is the problem? So I'm just racking my brain, what could it possibly be? And then he starts telling me, hey, when I inject my insulin, like my fingers get wet. And I looked at him like, What are you talking about? And he goes, I go to put it in, and my hands get all wet and they smell weird. I'm like, so I pulled a demo pen and needle out of the cupboard and said, show me exactly what you do. And he puts his needle on his demo pen and does not take the cap off, pokes his stomach with it and tries to give the insulin. Oh my god. And I thought he was joking. I chuckled. I'm like, that's funny. And he's like, what's funny? You're
Scott Benner 24:48
like, hey, Henny Youngman, what's going on here? And for nine months,
"Maya" 24:52
he was just leaking his insulin on his skin. Oh my god. And nobody thought. Got to ask him if he was injecting properly,
Scott Benner 25:01
but just kept telling him more and more and
"Maya" 25:05
more and more every single time they saw him, what kind of diabetes does this person
Scott Benner 25:09
have? Type Two? Type I was gonna say type two. Okay, so, oh my gosh. And so an adult, right? Okay, like so people have clarity, an older person, or a person who you might not think they wouldn't take the cap off the needle,
"Maya" 25:26
not like old that I would think that you wouldn't know, but you
Scott Benner 25:31
immediately just said, Look, you get lucky when they say, my fingers get wet. Yeah, right. But then you think it through, and you go, Okay, show me the whole thing. Yeah? Like, how long did that go on for that person? Do you think? Well,
"Maya" 25:43
he had started insulin nine months beforehand and never got any of it. Oh, my
Scott Benner 25:48
God. I know that. You probably just like, I mean, it happened right in front of you, so you had to say it. Were you Was it hard for you to say to them, Hey, you're not taking the cap off. And did they take it well? Or were they embarrassed? No,
"Maya" 25:59
no, he wasn't embarrassed at all. He's like, how would I know? Why would I know that nobody showed me anything? And I'm like, I'm sorry that happened to you, and I believe you that no one showed it to you, because they're done that. I marched down to his provider's office and said, Are you kidding me? Yeah. So I went to every provider in that office. There was like 10 of them at the time, and told them, hey, just because you think it's obvious does not mean that it's obvious, right?
Scott Benner 26:29
I think that that's how people speak. I believe that when people think of a thing that that they know, right, and they're regurgitating it back to someone else, they skip the parts that seem obvious to them. Yes, people are not great teachers, like in that situation, that's just it's very common. Honestly. Was this happening with any other things like, did it make you step back and go, What else aren't we telling people, oh yeah, oh
"Maya" 26:56
yeah, because he's not the only one that I found doing that. Well, are you kidding me? Probably within a couple of months, I think, like after that experience, I I kind of, like made it a little joke with patients when I was teaching them insulin or, like, their GLP injections, anything like that. I'll tell them, Okay, now we're gonna put the needle on the pen and twist it on, and you'll pull the first cap off and look, there's a second cap. You gotta make sure you see that tiny little needle there. And when I was doing that with one patient, there was a lady coming in, and she was starting ozempic, I think it was and her husband was with her. And her husband had, I think, a few months, been started on insulin, and so I'm telling them, Okay, gotta make sure you take both caps off and you see that tiny little needle. And his jaw dropped. Oh,
Scott Benner 27:57
no, I'm not on this epic, honey, I figured out why I'm not losing weight.
"Maya" 28:05
Now I know why it's not working. They say it takes your,
Scott Benner 28:08
your your appetite away. But I just, I don't notice that at all. It's crazy. Wow. So this is an incredibly I mean, that makes this thing reasonably common, like for people just to have that confusion, and it does make you wonder. Well, it makes me wonder, like, you extrapolate it out. Like, take it away from type two, bring it on to type one. Like, how many things get said that people are just like, I don't really know what that means, but I'm just going to keep going. I have to tell you something. I was sent a document to sign today, and I was in a rush, and I didn't read it, and as I was going through, I was it was a thing. I knew what I was signing. And I want to be clear, I didn't read the directions about where to fill in my information, I guess I should say. And I click on the place, and I am like, why? And I am typing, and I am typing Windows. Well, not take this typing. And it was very irritated. Then it took me a while, and I was like, Oh, it's a drop down box. And then I looked again, I was like, Oh, that's not even where the answer goes, I think that things are so well set up for us now that everything's just click to next click. You don't have to sign your name anymore. Like, click to adopt a signature. Like, I think in a world where that's what people are accustomed to, you start giving people something that's new and scary, that they're unsure of, and it has 17 steps in it. It sucks. And I do think people should take responsibility and read. And read. And I obviously stopped and read eventually, but like, I understand how they get through that process, I made that entire defining diabetes series because it became obvious to me that people were being inundated with language that they did not understand, and the language was very important to the decisions they were making. So I think it happens constantly. All right, what else besides people injecting into their caps? What else have you
"Maya" 29:46
seen? Well, when I was telling all my providers about that, one of the providers informed me that she had a patient who was that she discovered was injecting the insulin into his food.
Scott Benner 29:58
What can I tell you? Myla? That's awesome. I wish that worked. That'd be great, wouldn't it, wouldn't
"Maya" 30:03
it? Well, it tastes nasty, but, you know, I mean, six
Scott Benner 30:06
to one, that would really be like, that'd be awesome, maybe. Oh, for how long do you think? I think it was just a couple of weeks. Oh, my God, you just inject this when you eat. I'm
"Maya" 30:18
guessing that when it was demonstrated for that patient. They probably demonstrated on like an orange or something.
Scott Benner 30:24
Oh, yeah. Oh, no kidding. Oh, that makes sense, yeah.
"Maya" 30:27
And so they think, instead of this replicating skin, we're actually just injecting it into
Scott Benner 30:32
our food. I would love to talk to that person. If that person is out there and here's this, please contact me. I want a full accounting of what everything tastes like when you inject insulin into it. That's really something. And I have to ask this question, I guess, because I think people are probably wondering at this point. The cynical of you out there are thinking, okay, she's telling stories about stupid people, but I'm guessing that's not true. You would be surprised right at the level of intelligence and understanding of the people who are confused by these things that people who understand would think are simple, but aren't that simple to somebody who doesn't, hasn't ever seen it before. Yes,
"Maya" 31:07
that, but also understand, this is going to sound mean, but a lot of people are stupid in certain things. Oops.
Scott Benner 31:15
Day is how we like to say it here. Yeah, right. Listen in kindness. There are all kinds of levels of understanding and all kinds of things, and we all fall into different categories. There are things I couldn't possibly understand. I've gone over a number of them here on the podcast over the years, but one of them I'm still to this day, like, baffled by is, like, I can't do simple algebra, like, I just can't, like, you start telling me numbers or letters, and this means that, and my brain just goes, no, that's not right. And there's plenty of other things in the world I can't do, and, you know, just because someone has had a limited education or, you know, or whatever, leads into that situation, even if that's just who they are, the idea of like meeting people where they are is very you know, I used to think it was cliched. I'd hear people say that you have to meet people where they are, but after doing this for so long, I think it's maybe one of the more honest and accurate, so true statements you could make. Yeah, and it's not about a judgment, like, if you don't understand, then the person helping you should find a way to explain it to you in a way that you can understand, because I have seen people at every one of those levels have success. It's about how you teach it to them, not about their ability to understand it. Yeah, yeah. Oh, geez. I have it in my head that people out there are like, Oh well, she's telling stories about people who are like, you know, big dummies. But I don't think a, I don't think that's fair. And B, I don't think that's the way we should be thinking about this stuff. Okay, what else? Any stuff where you're like, do you still work there? You do you do? Okay, I feel like the place would burn to the ground without me. Oh, that's interesting, because there's no one else there that understands diabetes. Yeah. Basically, how do you guys make out helping type ones?
"Maya" 33:02
A lot of them get referred out, but a lot of them will see very specific providers who are actually good at type one. We do have a bigger hospital system not too far from us, so I think a lot of them just get referred out there.
Scott Benner 33:18
There are people in the practice that can help, but generally speaking, it's not a great idea where it is. I've
"Maya" 33:26
told my husband that If I am ever hospitalized in our hospital and am unable to make decisions regarding my diabetes, there are very specific providers that I will allow to basically take charge of managing my diabetes, while I cannot and very specific ones who are not to come near me.
Scott Benner 33:49
What else have you seen happen to people? Well, one time I had a guy have a seizure
"Maya" 33:53
on the floor in front of me. When I started investigating as to how we got here, it made me want to tear my hair out. So this patient came in, and his blood sugar at the start of the visit was kind of low. And so I gave him some juice, and we're having a nice talk and going over stuff, and then his blood sugar starts coming up a little bit, and then it started dipping again. So I gave him some more juice, and he's wearing an insulin pump, not on an automated system, and a continuous glucose monitor, and his blood sugar just keeps dropping and dropping. Like, what the heck? I made sure that his pump was suspended and it was I'm just like asking about his basal rates, car ratio sensitivity and all that. And trying to make sense of what's going on with his blood sugar and comparing it with his CGM graph, and I'd seen earlier in the day, around lunchtime, he Bolus is for his meal. He has a big spike up. He. And then I see, like, several more boluses after that, and then it's a major crash, and I'm asking them, okay, what did you whatcha for lunch? And he's telling me, and like, best I could figure it added up to about, like, maybe 28 grams of carbohydrate. And I'm working in this pump, and I'm like, so how does that add up to 192 grams of carbohydrate. And he just kind of gives me the slice while I'm like, what I think happened is you took insulin for your lunch, but you took it late, and you ended up getting really high. And so instead of just letting your insulin, do its work and bring you back down. You got frustrated with it knowing that you're coming to the doctor's office later, and you don't want to be here with a high blood sugar. So you told your pump that you're having 100 grams of carbohydrate and when you're actually not, and he had ended up bulleting like 52 units over the course of 45 minutes,
Scott Benner 36:04
he's stacking his insulin off.
"Maya" 36:07
Oh, you're stacking. Did
Scott Benner 36:09
he reply to your assertion that he just didn't want to be high at the doctor's visit?
"Maya" 36:13
Yeah, yeah. He's like, Yeah, that's accurate. I'm like, Okay, fair enough. And so I'm like, Okay, well, you got to keep eating, because you got to make up for this insulin. And,
Scott Benner 36:24
you know, we're having lunch now, it's not an appointment anymore, right, right? And I'm,
"Maya" 36:28
I'm going through his history, his Bolus history, his basal rates, which didn't make any sense. So then I start looking back through his chart. You know, it's business with his provider before, and it looked like every single time he came in to see his provider, his blood sugar happened to be low. I'm like, You do this every time, don't you? And he goes, Yeah, I do. And so his provider, instead of actually investigating why he's low, just assumes, Oh, it must be too much basal. And so he would just cut back the basal rate way down low, inappropriately, which then would make the problem worse with his spikes after his meals. Of course,
Scott Benner 37:10
I feel may i Myla, yeah, I feel vindicated by this story, because I have been saying for so long I have a weird job, right? Like, you know, this whole thing starts because I'm Arden's dad, and I, you know, I figure it's my job to figure out how to take care of her. And, you know, I start writing a blog about it at some point, and then that blog makes its way to this. And I somehow, you know, become a person who's interviewed 1000s of people with diabetes. And so I have my opinions about what I see when I talk to people. I don't live with diabetes type one myself. I don't have type two diabetes myself. I am the caregiver, you know, which is, you know, she's 20. I'm not exactly her caregiver anymore. I've been the caregiver for a child who's gone from two years old to 20 years old, still going hopefully, with type one diabetes. I have this experience talking to people and hearing them tell stories over and over again, and hearing what they say, and I have my opinions about why they do things, but it's no different than, like, you know, a researcher like, if you'd send me out into the, you know, into the forest to watch birds, I'd be like, This is what I think is happening, or this is my this is my perspective on what I'm seeing. I'll say that, and then, you know, I think well meaning people, but like, some people would type, one would be like, you're wrong about that. I'm like, Well, you know, maybe I am for you, maybe I'm not for someone else, but in the end, it's just the thing I saw. Like, I'm just reporting back to you what I think I'm seeing. And I'm gonna do that here, because it took me a while to figure out that when doctors look at graphs, or you go in and tell them, I'm low allotted 1pm I'm low allotted 2am whatever you end up saying to them, all they do is reflexively turn your basal down at that time. That's all they do. They go, Oh, you get low at two. Let's turn your basal down at two. They don't even do the like, let's turn your basal down at one. Or, you know, 12. Like, let's actually see if it'll work. Like, if that actually was the problem, that you were magically getting low at 2pm or something like that. But they never say, what'd you have the meal before? What happened prior to that? Like, it's just always, like, this reflexive like, Oh, if you're getting low there, then we'll stop that by turning down insulin, which just puts them in the exact situation that you're talking about. This person was in which he's got super high blood sugars all the time because he doesn't have enough insulin going. He doesn't know what he's doing anymore. None of his settings mean at this point. So he just is, like, up, bunch of insulin down bunch of food, and here we go. That's it. That's how it happens. Yeah.
"Maya" 39:46
So as I'm investigating this, his blood sugar just keeps crashing, and I run out of juice in my room, so I open up the door and tell my reception is, hey, get more juice. And so she runs off to get some. And as I turn around, he's down on the floor trying to crawl for the door. And I'm like, What are you doing? He goes, I need to go home. I'm like, No, I don't think you're gonna do that. And so I just kind of redirected him to a corner, and he's like, where's my keys? I need to get going. I'm like, I think we need to drink some more juice. And so the receptionist brings the juice, and she goes, You want me to get one of the nurses? I'm like, yeah, probably should. And so he drinks the juice, and then he just kind of like, slumps into the corner, gets real sleepy, and then starts, starts seizure activity. I'm like, Oh heck no. So I without my own glucagon and administer it. And he's just, oh, screaming in there. And then one of the nurses shows up and he's like, what's going on? Like, he took 52 units of insulin. Is what's going on? I just gave him glucagon. And so she runs and grabs another glucagon as a follow up. And one of the providers shows up and he's like, Yeah, we should probably give him another glucagon and then call the rapid response.
Scott Benner 41:06
First of all, I want to tell you that I'm very proud of myself for being an adult. Because when you said you directed him back into a corner, I felt like you like, had a turtle that was like, leaving the room, and you just, like, spun him in the shell. You're like, here. That's what it felt like. And I didn't joke about it then I was real proud of myself. But now here I am doing it anyway. The rest of it is, is when the nurse says, what's going on? You know, I know you're in an emergency situation, but the appropriate response would have been, we've done such a poor job of helping this person that this is what's going on. Because that's the truth. Like he's got such terrible help that his blood sugars are bouncing all over the place, probably mostly high and then and he doesn't have it. I don't know why. Like, I can't sit here and diagnose a person like, I obviously don't know. But like, does not want to show up at the doctor's office and look like he doesn't know what he's doing, yeah, but he literally doesn't know what he's doing exactly. And I'm not wrong, am I Myla to say that it wasn't that difficult to figure out, right? No, it took me four minutes. Yeah. Okay, so why does that happen over and over again? Like, you work with a lot of people. Like, how come you have this unfair feeling that if you were to leave this job, everyone would be lost? Like, what do you see in other people, other professionals, standards, practices, intellect, understanding, all that stuff, like, why is a simple thing? Like you figured out? Not simple for everyone to figure out. That's
"Maya" 42:35
the baffling thing. Because I do not consider diabetes, like the concepts tremendously hard. And I'm wondering, if you know, when providers are going through school, they're told that it is and so then it's just in their brain. Hey, this is hard stuff for people to do. We should always refer out to endocrinology. Well, guess what? We don't have endocrinology. It's on us. Most of the patients in this area are managed by their PCPs and
Scott Benner 43:03
doing poorly. Is it apathy? Like, why would someone not be like, Hey, we're not doing a good job? Like, how is it possible that people have such terrible outcomes, but that the response is always the same, like, oh, they don't know what they're doing, so I guess it's a screw them. Like that kind of not screw them, but like, you don't even like, oh, we can't we can't help them. Or they, what do they write them off as non compliant, or something like that. Like, it's a
"Maya" 43:28
lot of things. Go ahead and it's also many different things for different providers. You know, apathy definitely is part of it. I've heard one of the providers was asking another, hey, what do you do with your pump patients? And he says, I don't take pump patients. I send them to so and so, like, I won't deal with that because I can't figure it out. I think a lot of it is that family medicine is swamped. They do not have the time to devote to it. One of our providers left our practice for a private practice, and he left behind 1200 patients, really just him, and he took many patients with him. So
Scott Benner 44:08
one provider in a GPS office can be seeing up to 1200 people, yeah, or more, maybe yeah. And so when you hear a provider say, I don't even help people who use a pump, that's because he doesn't understand the pump and he does not have the bandwidth to figure it out. It just, there's just literally not enough time. Yeah, do you think if they had the time, they'd want to
"Maya" 44:32
depending on the provider? Like I said, there's one or two who are pretty good at it that I would trust, okay, you know, one who just goes above and beyond. And I'm regularly seeing him working at like, 8pm on a Friday night. I'm like, why are you still here? Why am I still there? Is the question, but he's
Scott Benner 44:53
at least making a doctor's salary, right? I don't know how. I don't know what that is at this point. I don't know how, how that works out. Works out for people, but so too many people, not enough providers. When you do have enough providers, they sometimes don't have all the information. They don't have the information, they don't have time to collect it and to disperse it. And so, like in a real world setting, like, if I gave you that magic wand, Milo, like, how do you fix this? And it doesn't have to be within the parameters of how things go now. Like, what would fix this? I think if people
"Maya" 45:30
really buckled down as the patient and just became as knowledgeable as they possibly could be, because realistically, diabetes is on you. You're the one who has to live with it. You should be the expert in it, you know, like I go see my PCP. He probably doesn't know anything about diabetes, and I don't expect him to, because I'm comfortable with I what I understand, and he's comfortable letting me make decisions and take charge in all of that.
Scott Benner 45:59
So if people people cared more, I feel like you just told me the answer is the answer to tell people the truth. Because I dropped off a vehicle to get repaired the other day, and the person who was taking the vehicle in said to me, you can have it back on Wednesday. And when I was dropping it off. It was Monday, and I was like, two days, and he goes, No, no, next Wednesday. And I'm like, wait, what? Because, yeah, yeah. And he starts talking about, like, it's gonna have to go over to the body shop to have this one thing adjusted and everything, and, you know? And I was like, Okay, now my I grew up, I had a real job, like, I didn't always used to make a podcast, right? Like, I used to do real hard, difficult things, in dirty, cold, hot climates, right? So I've worked hard in my life, and I know what has to be done. And I said, There's no way it's going to take that long to fix this problem. And he starts to tell me a story, what I now recognize, what your Jewish grandmother might have called a Bucha Meister. Okay? He was making up a story that would shut me up. Okay, well, you have to see, like, they're gonna have to take these bolts out, and this is gonna have to come off, and that's gonna have to do this, and it's gonna add, it's just very difficult. I'm like, in no world is what you're describing going to take 12345678, days. I'm not even giving you the weekend. Like, let's take the weekend out of it. It's not possible. And he just kept doubling down that it was yes, it's definitely going to take that long. This is difficult work. You don't understand how hard this is. Like, you're you don't know cars, and I'm like, I don't know cars, but I know working, and I know about what's got to happen here. And so I just stopped him and I said, Listen to me, if what you're telling me is that the shop is backed up or that your schedule is completely screwed and my car is just going to sit here for two days before you even touch it, or whatever it is you really are trying to tell me, just tell me that. And he said, No, the work's really hard. It's going to take a while. I went to another advisor. I actually got assigned to a different service advisor, and I spoke to him differently because that we didn't start with the same like conversation. And I just, you know, I said, like, hey, look, I need the vehicle back for the weekend. Here's why. I openly told him why and everything. And he said to me, yeah, yeah. Man, this is kind of a newer process for us. We don't usually use this shop that it has to go to, so I don't even know how to get it into their schedule yet, like I'm still figuring that out. By the way, I'm not happy that it's going to take till Wednesday. Don't get the don't get me wrong, but now that I understand that that's the situation, I'm fine, and I was free to look for a way to work around that fact. And I think this is the same thing that's happening, right? You walk into a doctor's office and that person presents as you know, I might as well just keep going with my Yiddish today, with the Mashiach. I'm not Jewish, by the way. I just love Yiddish, and I know I'm using it wrong. So those of you who know it well, cut me a break. You go in and you look at that person like, they must know they're the guy, they're the girl. They got the coat, they got the stethoscope, they went to school. They know what's happening. And in the back of their head, they're thinking things like, I can't help this person with a pump. I don't even understand a pump. Or don't understand like, I don't know education well enough to tell somebody at the end, like, don't forget to take the needle cap off, like, or whatever else goes with it. So you think they're the end all be all they are at best, pretending. And they know they're pretending, but they tell you back, oh yeah, I got this, don't worry. And then that, I think, is just it. Like, I think if the doctor just said, what you just said, like, look in the end, this is yours. Like, I can't possibly give you all of the advice or the direction that you're going to need. Here are the basics, but you should continue to try to figure this out. This is a complex, deep, you know, multi fingered spider web of an issue. Is that what you're telling me?
"Maya" 49:57
Yeah, and I've been seeing it. Change in my clinic, because, like you said, people just say stuff to shut patients up, and I just tell it to people straight. I tell them exactly how it is. Hey, it might take longer than expected, because I got to do this, this and this, and talking to your insurance company, and I don't know what's going on with your DME supplier. And so I keep people very informed on all the processes and why there's delays, and, you know, very honest about what's going on, or just like, hey, I'm sorry I forgot to do this. If I didn't write it down, I'm not gonna remember it. Yeah, and people appreciate that level of honesty, and I've kind of seen it trickle into the provider's attitudes a little bit good, like they're very comfortable now, saying, Hey, I don't know about this. Go talk to my luck.
Scott Benner 50:53
Yeah. And if she doesn't know, by the way, get yourself the internet or something. Because, yeah, exactly, don't just stop. Don't go, oh, I don't know. Like, this is a complicated thing. This system we have set up, it's not right to handle your issue. It just isn't, like, it's barely right to handle much simpler issues, truthfully, right? Like, let alone, you know, the administration of insulin for type one or type two, or these GLP medications. Like, I hear people all the time like, oh, I started GOP medication. I've got diarrhea. Now I'm gonna stop it. I'm like, stop it. I think that's expected. Did no one tell you that you didn't go over the package insert, at the very least and say, Hey, this might happen. That might happen. Nothing. People are left on their own. I saw a guy the other day that couldn't get out of the right lane into the left lane, and now I'm worried someone also gave him a bunch of medication and didn't tell him how to use it, like, you know what I mean, like, but I'm also trying to remember that the person who gave him the medication probably can't get from the right lane to the left lane either. So what do you do when there's these complicated issues that people aren't there to help you with and that you're maybe not qualified to figure out either? I have to tell you, like, all I hear after 55 minutes is listen to the bold beginning series from this podcast. If you get type one diabetes. Oh yeah, yeah,
"Maya" 52:09
all my type ones that I'm seeing coming through. Like, you listen to podcasts. No. Well you do now, here's your homework. It's the
Scott Benner 52:18
only way I've been able to like I'm sure there's other ways, but the only way I've been able to put into practice in the world is here is this information. It's in shortest form possible. It's friendly, it's not it's not overly like academic. And I think it puts you in a in a place that you'll at least understand enough that you can step back, refocus, and then make a decision, like, Is this okay for me? Is this my level of like, is this stasis for me? Am I going to be happy here, or do I want to look farther into other ideas and maybe fine tune this machine a little bit and make this diabetes different? But I do not see a path or a world where the way we're doing it in a doctor's office. Is all that valuable? I now, I've been doing this for more than a decade, and there are people who come on and say, Oh, my my doctor is awesome. It's great. I'm fine. Here's my a, 1c, I'm good. My variability is good. Like, you know, I'm fine. I'm just chugging along. Even sometimes people will say, Oh, I love my doctor. They're talking to me with, like, an eight, A, 1c and I'm like, I'm sorry, you're Why is your doctor great if your a 1c is eight, I don't understand. I mean, I understand if you like them, or if they're kind or whatever they lollipops or, like, whatever the hell it is, you know. I mean, you talk about sports and you just, you're comfortable, but you're shooting for an A 1c as close to, I mean, what's the ADA saying now seven, I'm telling you six. A lot of people listening are like, oh, and the fives would be more of what I'm shooting for. And you're at eight or nine, and you're telling me how great the doctor is. I'm sorry, the doctor's not great. Like, if the doctor was great, you're a one CD in the sixes. That's how I see it. So, yeah, it's something, really is, I don't know. All right, give me another story. What else
"Maya" 54:01
another story? Let's see. I had a little old lady who we would do regular follow ups, and she started having this pattern where certain days of the week, at certain times in the afternoon, her blood sugar would crash. And so I'm like, Okay, well, what's happening prior to this crash. And it turns out she would have an afternoon snack, take her insulin, and then have a that was her shower day. Okay, so the other days that you have your afternoon snack and take your insulin, you don't crash. So it's clearly the shower causing that vasodilation and the uptake of insulin quickly into the bloodstream. But explain that to her and her caretaker, and they're like, Okay, yeah, that makes that makes sense. I'm like, so let's just either wait on the shower or maybe we take less on the insulin on the shower days. And they're like, Okay, yeah, great. And so, as I said, part of my job is go get one. Of the providers to sign off on the plan and pop in and approve everything. So I went and grabbed whoever was available, just one of the providers, and I was letting him know, yeah, so she's having crashes when she takes her insulin and then has a shower. It's causing lows. And it's like, Oh, I wonder why that is just like the insulin, just like, wash off in the shower.
Scott Benner 55:25
I thought he was joking. No, come on, stop. Are you with me?
Speaker 1 55:32
Like, I just stared at him. I i had so many things to say, just like, Um, no, it's because of vasodilation, and the insulin just gets taken up too quickly. What you said is just wrong on so many levels. And I don't even know where to start, but I was just like, not today. Seriously. There's no way they were kidding. No, he was not joking. Does the insulin wash off in the shower like that would cause a low. Oh, yeah, even that, if it washed off, wouldn't it get higher, right? Oh, I got so lost on the washed off part. I forgot the part where exactly needed to make even sense in that multi level stupidity, I had
Scott Benner 56:13
a physician, like an, MD, yes, okay, all right. I could have been a doctor. I'm thinking it now. I just couldn't do the school Exactly, exactly. Okay, all right. It should be shared with people that your intake form. You had a couple of options for the kind of episode you could have done today. I was the one that said, let's go the cold wind route. So the stories that you are just like pulling out of your ass left and right, you didn't show up prepared with I want people to know that, like, you don't have a list in front of you, like, tell the old lady in the shower story, tell the needle cap store. Like you don't have that in front of you. I'm just saying, Tell me another one, and you're going, Oh well, here's the one where the doctor thought insulin could wash off in the shower and that that would make your blood sugar go down, not up. I'm guessing if I said, Tell me another one, you could just reach back into your head and just do it again and again and again. So my question here is, is, like, I guess before the question, let's make sure people understand that you're doing this in a general practitioner's office. Yes, it's not an endocrinologist office, but you're in a setting where this is what people need. Like, they don't, some of them don't go to endos. They still have type one, type two diabetes. Yes, right. So do you agree? I don't know if you heard this episode where I was talking to someone from beta bionics about their eye, let pump. And I said, if you want this pump to take off, I think you should go to GPS offices and sell them there. Do you think that would work? Do you think if, if a, if a salesman came to your office and said, Hey, listen, I know you're helping people type two or using insulin. I know you're helping people type one or using insulin they can't get to endocrinologist office. I know you're overwhelmed. Let me show you this pump where you just choose breakfast, lunch, dinner, normal, you know, bigger, smaller. Do you think that the doctor's office would be receptive to that? Depending
"Maya" 57:59
on the office? My office is, like, scared of reps, and so I basically have to filter them all, yeah, like the the idea of the eyelet is just very lovely, but again, it's also a little bit dependent on the patient's ability to comply and do things properly. I've put in several patients on an eyelet and some of them have done fantastic, because they use it the way I tell them. To one lady, I told her, You know what? I just want you to wear it. You do not interact with it, you don't even announce meals. And she's doing great. Another patient, you know, because I'm
Scott Benner 58:38
sorry, because that is such an upgrade from what they were experiencing that just letting the blood sugar go up and the pump to push it back down again was a significant Betterment for them. Significant improvement.
"Maya" 58:49
Wow. Yeah, I gotcha. Okay, but then you always have that patient who thinks that they can trick the system and, you know, announce a large meal for something that isn't necessarily large in order to get more insulin or a smaller meal, because, oh, it's gonna crash me. You know, I explained to him many times, that's not how that works. You're actually making it worse over time. It might work the first time, but the next time, it won't. And then the time after that, it'll be worse. And then when you announce it as a normal meal, it's gonna crash you anyways. So there's always people who try to fight it, or people who just don't understand it, but a lot of people who do, who can do what they're told do well,
Scott Benner 59:31
right? So like with everything else, at some point in the process, people are the problem. Yes, right? They can't listen, they don't learn, they don't understand, they can't teach. Like it's the interactions we're having with each other and with ourself, and the diabetes that is in some way, shape or form, stopping something from working. And the answer for one person is not the answer for the next person, right? So you think. Think through your experience having type one, and from helping these people in this situation, your experience is you give people the information, give it to them as simply as possible, so they can get a foundational understanding. And then is the rest really just hope, like, are some people just support
"Maya" 1:00:18
involved in that? Okay, when people want more, we can give them more, but just going at the pace that they can handle, and then yeah, a lot of hoping that they're going to
Scott Benner 1:00:30
do what you told them, yeah, okay, well, that's upset. I mean, I I have to be honest, like, I think that's what I expect that it very sadly, not everybody can have the same outcome for a myriad of reasons. It's not a reason that you shouldn't keep trying. But then, like you talked about in your own personal story, if you keep hitting the same brick wall over and over again, you stop trying. So if you're not well set up by a physician, or if you're not well suited to make these decisions and understand this situation, you are going to run into an apathetic moment in your life, and then you very well go down that road until you're either shocked into doing something, or you mature into doing something, or somebody comes along and tells you something that clicks In your head, but that for most people, not most people, but for a lot of people like these, more you know, less desirable outcomes are maybe what's going to happen if all of these different variables in your life line up and put you in these certain buckets? I guess, no,
"Maya" 1:01:38
and it doesn't help the level of apathy that develops on the providers side. I've read so many chart notes where they say that this patient's diabetes is well controlled, and their a 1c is like anywhere from 7.5 to 8.5 I'm like, why? No, just no, we're not happy with that, right?
Scott Benner 1:01:57
So then you have a person out there who's doing the work, and would maybe understand better if you explain to them, Hey, if your basal was a little stronger here, if this was this, if maybe a bowl was 10 minutes before your meal, like, if you did those little things, like, maybe this six and a half seven would be more like six, like, that kind of thing. But they don't even know to, like Wonder, because somebody tells them, this is awesome. You're doing great. Yeah, yeah. Yeah. All right. I think I understand you want to tell another story. Do you have one that's in your head that you're like, oh, no, wait, I can't go without telling this one. Or are you good?
"Maya" 1:02:28
Oh, let's see. Oh, you know, sorry
Scott Benner 1:02:31
that the way that happened was just awesome. You're like, oh yeah, hold on, here's one.
"Maya" 1:02:35
So I met a gentleman who, when I first met him. He's telling me that he's had type two diabetes for well over 15 years, and it's never been well controlled. He's been on all these medications. Nothing's working. He's best day one, see, he's ever been able to attain was like high Saturns. And I think I know this one go ahead, though I spent five minutes with him. I said, you don't have type two diabetes. He is lean. He spends hours working out daily. He eats a low carb diet. And I'm like, Honey, you do not have type two diabetes. I bet you. We put you on a tiny bit of basal insulin, maybe a GLP, because you certainly have some C peptide production. And I bet you, or anyone sees probably in the sixes in a couple of months, you catch
Scott Benner 1:03:27
somebody in like, a really long, like Lata situation, you think, yeah,
"Maya" 1:03:32
yeah. And I looked at him and, like, I asked him his heritage, I confirmed his heritage. I could tell what it was. And I'm like, oh, yeah, that's almost certainly type one diabetes, I told him. So we can test C peptide. We can test auto antibodies, if you want. Let's just start some insulin, even just a little bit to start with, and maybe like low dose menjaro and see if you get that postprandial effect too. Because, like, anytime he ate, just like the tiniest of adult carbohydrate, his blood sugar's 250 300 easy. And sure enough, within a week, he's calling me. He's like, this is awesome. My blood sugars are so good. And I'm like, yeah, yeah,
Scott Benner 1:04:11
wow. How long was it that that 15 years. Holy crap. Do you think that that person is type one, but still had a fair amount of insulin production going on. Yeah? How old? By the way, 60s. Interesting? Yeah. I mean, I think we're gonna see more people. Think we're gonna see more stories like that now with the glps too. I
"Maya" 1:04:36
think there's a lot of that actually people misdiagnosed as one or the other, and just not being treated appropriately, like I have so so many patients, so many type two patients, genuine type two patients, who believe they have type one because they're they've been told that they're insulin dependent, and they've been on insulin for 25 years and low and low. Like, get them completely off of their insulin. Said your provider before you just didn't know what they were doing. And that's okay, because I do, but that
Scott Benner 1:05:08
happens a lot as well. Tell people what the heritage of the gentleman like, told you, uh, Finnish. Why did that mean something to you that he was like,
"Maya" 1:05:17
because Finnish people have the highest propensity of diabetes in the world, particularly type one. It's like 10 times the average. There's entire communities in Finland where everybody has diabetes, yeah.
Scott Benner 1:05:35
I mean, I see it on here too. Like Scandinavian countries, like sometimes the Irish Nordic people, like, you know what I mean? And then when you look into America, I started realizing that, you know, the Minnesota Vikings aren't called the Minnesota Vikings, just for no reason at all, like a lot of Nordic people landed in that part of the country. So then you get communities again, that might seem more type one, yeah, it's interesting. I mean, I've seen the same thing having conversations for so long. It's just, you know, interesting to hear somebody else say it. So, okay, all right. Well, Mila, thank you so much for this. Did I say Milo? Mila, what did we just what did we land on? Myla? Myla? Mila, maybe whatever. I really appreciate you doing this. For anybody who is listening to this and thinks I know who that is. She works at my doctor's office. I got a guy who changed her voice so much, trust me, she won't even recognize herself when she's listening to this so if you think you recognize the voice, it has been changed significantly, and it's not the person you think it is. So leave that person alone. That person just sounds like this person changed digitally to sound like a different person. Is that it cool that they can do that the world, huh? Awesome. Anything else you want to tell me before we go? I
"Maya" 1:06:46
think we could probably go on for a long time. So we better just button it up. That's
Scott Benner 1:06:50
crazy. Okay, ready? Without the story, rapid fire as many one sentence descriptions of weird things that you've seen that you
"Maya" 1:06:59
can recently someone who's on a put himself on a sliding scale for his Lantis and would take anywhere from zero to 40 units, depending on what his blood sugar was at the time when he would take the Lantis,
Scott Benner 1:07:12
where'd they make that this, I know I said I was gonna ask this. How'd they make that decision? He
"Maya" 1:07:16
wasn't giving good guidance, and he was scared that if his blood sugar is 80 when he's about to take 40 units Atlantis, he's going to die.
Scott Benner 1:07:24
Okay. Next one. Go ahead. Keep going. This is awesome. I frequently see
"Maya" 1:07:29
patients on sliding scale plus fixed meal doses of insulin without the providers specifying that if you're going to do fixed doses for meals, you should probably also do fixed carb counts for those meals, because there's going to be a huge difference when that patient, who normally has, I don't know, pancakes for breakfast, decides to eat bacon and eggs, but still takes that 15 units of Humalog, right? Gene. Never seen that before. Gotcha, yeah, that's when they end up in the hospital. All right. What else? There is an alarming lack of glucagon prescribed for people who are insulin dependent. Yes, even type ones, yes,
Scott Benner 1:08:14
yes. Oh, I know this directly from the people who make the glucagon. By the way, it's a significant issue that you can't get doctor's offices to prescribe glucagon to people. Yeah, I mean,
"Maya" 1:08:24
it's what, like, 7% of people who take insulin get a glucagon prescription and like, Gee, that seems a little bit
Scott Benner 1:08:33
crazy. Yeah, that's insane. That one really strikes me. Like, just, I mean, you're writing out all the scripts say, Here's glucagon. Here's why it's important. Let me, let me tell
"Maya" 1:08:43
you what I've tried pushing in my clinic that like for it to just be fixed in our EMR, that, hey, when you prescribe insulin, can we have it so that it triggers the system? Hey, you're prescribing insulin, you should also prescribe glucagon, because that sounds very simple. Yeah, you'd think that it could be programmed, but because, like when we prescribe anything, it'll pop up with a list of possible interactions or things to be cautious about. But gluco conscious doesn't get addressed. I don't know.
Scott Benner 1:09:18
I gotcha. Okay, all right. Well, these conversations are always enlightening, and at the same time, leave me with the same feeling of, like, I don't really know how to fix any of this. Nothing's like a switch. Like, you know what I mean? You don't just go, just say this and it'll work out. Or there's too many people, they have too many varied understandings and backgrounds and focuses, and you really can't just nothing's gonna work the way you want it to. So anyway, from my perspective, if you've, you know, I really do think it's that bull beginning series. If I could, I'd spend six months calling doctors offices and just trying to, like, explain to them what it is, but I think it would be fruitless if I did that as well. Yeah. Yeah, it's frustrating. Yeah, okay. All right. Uh, everybody, go have a nice day now. Bye. All right, hold on a second. Myla,
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#1460 Jakob Blow
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Jakob has T1D, is 29 years old, a paramedic firefighter. Has only recently been on a pump and CGM since 2 years ago. He’s married and has 1 kid. He’s had diabetes since he was 7-8 years old.
+ Click for EPISODE TRANSCRIPT
DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Friends, we're all back together for the next episode of The Juicebox Podcast. Welcome.
Jakob 0:14
My name is Jacob. I'm a type one diabetes. Have been for well over 20 years now, and decided to come on and hang out with Scott for a little bit and see if we can't get to an interesting conversation today.
Scott Benner 0:26
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. I know this is gonna sound crazy, but blue circle health is a non profit that's offering a totally free virtual type one diabetes clinical care, education and support program for adults 18 and up. You heard me right, free. No strings attached, just free. Currently, if you live in Florida, Maine, Vermont, Ohio, Delaware, Alabama or Missouri, you're eligible for blue circle health right now, but they are adding states quickly in 2025 so make sure to follow them at Blue circle health on social media and make yourself familiar with blue circle health.org. Blue circle health is free. It is without cost. There are no strings attached. I am not hiding anything from you. Blue circle health.org, you know why they had to buy an ad. No one believes it's free. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now it is incredibly accurate, and waiting for you at contour next.com/juice box. 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.
Jakob 2:04
My name is Jacob. I'm a type one diabetic. Have been for well over 20 years now, and decided to come on and hang out with Scott for a little bit and see if we can't get to an interesting conversation today. That would be awesome. How old are you now? I am 29 so I was diagnosed when I was seven years old, and actually right around this time of year, because the only thing I remember from my diagnosis is it was a couple weeks before Halloween, and I was pissed.
Scott Benner 2:31
People are talking about sugar, and you're like, Whoa, slow down. I've been waiting for this all year. What are you talking about? Yeah, yeah, pretty much. What do you remember about being diagnosed beyond that. I don't know what
Jakob 2:42
it was about Mondays, but every Monday I would throw up at exactly 10am for like, the two weeks prior at school. I think my mom made pancakes and syrup every morning, Monday morning when I went to school, and that might have been it just spiked my blood sugar like you wouldn't believe, threw up on the girl that sat next to me twice during that process in what was that second or third grade? So she wasn't super fond of me.
Scott Benner 3:04
Jacob, the first one was on purpose. The second one, did you think we know she can take it so we'll go this direction? What do you mean?
Jakob 3:10
I'm not really sure. I think I always kind of tried to wait till the last minute, like, oh, this will pass, this will pass, this will pass, this isn't going to pass.
Scott Benner 3:17
And too late, Yep, yeah. So
Jakob 3:21
as my parents put it, I was all of, like, 40 pounds at seven years old, I was like a skin and bone they said, when we were finally got diagnosed and were in the hospital, they saw me walk out of the bathroom and, like, just my boxers one day, and they're like, oh my god, he looks like a Holocaust survivor. Like, really, really,
Scott Benner 3:37
just thin. And were you thin to begin with, and then obviously you lost more weight around the diagnosis, or were you not than you were? I
Jakob 3:46
don't know. I'm I'm a thicker, I don't like, I'm not really thicker. I'm just a big, kind of, like, not big. I don't what's the word I'm looking for here. I
Scott Benner 3:55
love it. Like, this is awesome. Wait a minute. I know I'm not,
Jakob 3:59
like, a skinny rail. But I've, other than when I let myself go a couple years ago, I've never been like, fat right
Scott Benner 4:08
to let yourself go on purpose. Was it like a decision? Were you like, Hey, let me try this now? Or no,
Jakob 4:12
it was honestly just I let myself go for a while there right after my wife and I got married, and then
Scott Benner 4:21
Jacob's, like, got one I'm done, yeah,
Jakob 4:24
lower physical activity just wasn't doing as much. Sat around the house a lot more and, like, it was, like, two years ago, I looked at myself and I'm like, holy crap. I'm 220 pounds. Like, could
Scott Benner 4:35
I get this lady to go out with me again, if she wasn't already, like, pot committed? Yeah, so I see, did you ever hear her go, oh God, like, or anything like that? Like, did you like,
Jakob 4:47
No, we never. We were actually going through. We were cleaning a bunch of stuff out yesterday or the day before, and we found some old pictures from right around right after our wedding. And I was like, Oh no, no, no, no. Oh no.
Scott Benner 5:00
Did not know what happened.
Jakob 5:03
I No, I didn't realize it, honestly at the time, yeah, and then I started the job I'm working now. And when that happened, I was like, hey, hey. First off, I was like, Hey, I gotta get my diabetes under better control, because it's, you know, a requirement of the job. Even though I've been doing it for a long time, I went from a small department that didn't really care about, you know, if I was taking care of myself or not, to a big department that, literally, I would probably get let go if my diabetes wasn't within the specs that it was supposed to be in. What kind
Scott Benner 5:36
of work do you do? I'm a firefighter, paramedic. Oh, okay, and they were, they were paying attention to your ability to, like, say, walk up some stairs and hold something at the same time. Yeah,
Jakob 5:46
exactly. So I got hired at the job I'm working now in 20 what is it? 2024 so 2022 into 21 I think so. I'm coming up on two years with my department I work at now. And when I got hired, I was heavier, but like, my a 1c at the time I got hired was also like, 8.6 and my last a 1c I had drawn two weeks ago was a 5.80 wow. Well,
Scott Benner 6:11
we'll get to how that happened. And you're bringing back bad memories of me, like running hose up and down stairs and, like, fold gear, and it's no wonder I can keep doing that. Geez, a lot of work. Yeah,
Jakob 6:24
trust me, we had, we had a training the other day where they blacked us out and basically threw us inside of a large warehouse with just us and our crew and a bag of rope, and said, find your way back out. And by the way, there's someone in there. Go find them.
Scott Benner 6:39
Nothing like it. So you've crawled on your hands and knees just following a wall on your right side, hoping it led to something. It's a not a not a great feeling. We're gonna do a right hand search today with your eyes closed. Great. It's awesome. Well, yeah, I'm telling you too, for anybody who's wondering about it, like just go somewhere in your house, put your right hand on a wall, go down on your knees, and then try to get to something. And then imagine wearing boots and pants and a coat and a bottle on your back and breathing through a tube and the pressure of the place is on fire. And see if you it's just really, it's crazy fire. School is something I will never forget. Honestly,
Jakob 7:20
don't forget, you're doing it in a house you've never been in before. You can do it in your house. You know where everything is, yeah,
Scott Benner 7:24
yeah, yeah, right. Well, I didn't want to tell people to walk into their neighbor's house and say, Hey, I gotta try something real quick. Don't bother Don't Don't mind me. I'm gonna go try to find the bathroom. Damn. Yeah, exactly. So, okay, so you're diagnosed young. You vomit on some kids. She don't like you anymore. You move through your life. How like, what is your care? Like? Who's helping you, who's not helping you? What are your outcomes?
Jakob 7:48
So for the longest time, I was MDI, I would say almost all of my diabetes life, until a year and a half ago, MDI, long acting, short acting, and like cuma log in Lantis. So even two years ago, when I finally decided to switch to a pump, I was cum log in Lantis, no, CGM, no. Just finger sticks if I even really ever did that, I did a lot of how I felt and not how I actually was.
Scott Benner 8:18
You know, what I tell my daughter about that? Right? No, what if how you felt was a good way to manage this, I wouldn't have to buy all this stuff for you. So,
Jakob 8:27
yeah, yeah, yeah, I realize that now.
Scott Benner 8:31
But see, you didn't start regular, mph, though, right? You started with humologue The
Jakob 8:35
first couple years. I might have been regular, and I remember having like there was a cloudy vial that we had to roll. You had to mix one at bedtime or meal time. I don't really remember. It was so long ago, okay,
Scott Benner 8:48
but you did so you did start there, though, yeah. And my point about that is, is that that sets expectations, and it sets up your your care guide. So at some point, your mom was probably told, eat at certain times, inject at certain times, like that kind of stuff,
Jakob 9:04
yeah, and I vaguely remember that, but I also went to probably the largest children's hospital in the area that I'm in. So I felt like it was pretty progressive, pretty quickly, of like, okay, hey, we've gone from you eat 30 carbs at dinner, and 1515, gram snack here, and a snack here. And, you know, we went from that to a, hey, here's a carb ratio fairly quickly. I want to say it was within, like, a year or two of diagnosis. Jacob,
Scott Benner 9:35
I was trying to bail you out here, but apparently you knew what you're doing. And,
Jakob 9:40
yeah, no, no. 100% I knew what I was doing, and I just didn't care for a while. I will say, I mean, I love my parents. One of the things I will say, though, is I think they let the reins go a little early on me and let me manage myself. And I think some of that was me pushing for that, when maybe they should have tried to be a little more involved with that. Still, but you have kids? I yeah, I got a three year old.
Scott Benner 10:03
Yeah, okay, well, on the way, yeah. Wait, wait, do you see is all I'm gonna tell you? Oh yeah, I know. First of all, I have to tell you, I never have more fun when I'm talking to an adult who has had type one, when they start with, listen, I love my parents. And then there's a pause, then I'm like, oh, here it comes. Parents are flying right under the bus now. So what you think is you were like, I can do it. And they said, he said he can do it. And then that was the end of it. They never thought about it again. 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 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/juicebox, using that number or my link helps to support the production of the Juicebox Podcast, 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/juice box, 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 in 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/juicebox 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.
Jakob 13:09
Yeah. I mean, they were pretty involved through like, middle school, but then as soon as I got to high school, it was all over. You know, I was, I was eating whatever I wanted. I think the big thing that kept me not into like, A, 10, a, 1c, is I've always been into sports. I've always been super active. So even if I was hitting the two or three hundreds, I'd jump in the pool at water polo practice, and I'd probably be 30 by the end of practice. Yeah,
Scott Benner 13:34
but this was a lot about numbers and not a lot about health. Is that right? Exactly? Okay, yeah, that's tough. Like, I mean, listen, Arden's 20 now, and you know, you are constantly walking a line between, you know, helping, where help is needed, staying out of it when you know you want to, obviously give her space to grow, right? Also, you know you'll see like, you know, 15 years from now, like kids pushing back and finding, you know, like setting boundaries between their parents is really healthy. So you want that to happen, but you don't want that to happen in exchange for a 350 blood sugar the last six days. How do you tell somebody I trust you and Jacob, I know you're, I know you're a good kid, and I know you care. And blah, blah, but you're also, you know, this old, and you're not bolusing all the time or whatever. So it's such a weird balance to try to walk. And I was, I was talking about it with a much older person than I, which is to say something, because I'm pretty old. They don't have a kid with diabetes, but they are an endocrinologist, this person I was talking to and they were talking about just parenting their own children, and like saying, like, look, my kids don't have diabetes. They're in their 30s, and they still sometimes call us and ask questions, and you're still, I'm like, oh my god, is this never gonna stop? Like that. That's what I took away from that. I was like, Wait, this is gonna happen forever. I was like, Okay, I don't know. Art and I are finding our way through it. It's not smooth, you know what I mean? Like? Because she sees it from her perspective. Doesn't give a shit about my perspective, and I'm trying to take her perspective into account, and she doesn't think I am. So it's a classic parenting situation, diabetes or not. But then you you know, you mix in the health outcomes into it, and it just feels dire. You don't want something untoward to happen, and you don't want to ruin your relationship, because then something definitely is going to go wrong. Yeah, good luck as well. I'm saying it's a lot Okay, so you screwed with your family. You told them you were okay, you weren't. And then how long does that go on for? Oh,
Jakob 15:42
like, literally, until probably two years ago. And I started finally looking into like, Hey, how can I get better control over this? And I think part of it was, you know, I got this, this newer job at a bigger department that actually pays attention to, like, your health metrics and all this other stuff. And I think some of that was also my kid, like my kid was getting to that nine months to a year age, and I'm like, Gosh, I really gotta do something so that I'm here for this kid in 2030, years, like my old man is for me right now, when I call him at two o'clock in the morning or eight o'clock in the morning and I haven't slept all night, and I'm like, hey, could Can you help me with this kid
Scott Benner 16:20
that I made a mistake, and it's looking at me and it seems hungry, and I'm I'm tired. I don't know if you know I got this job, it goes overnight sometimes, and I think that putting her in a closet is illegal, so I need you to come over. Is that about
Jakob 16:36
it? Yeah, pretty much. I mean, he's, he's a really good kid, I will say, even when I have those nights at work, which I have, often I work the second busiest engine company in my city. It's not uncommon to run 20 calls in 24 hours and just not sleep much.
Scott Benner 16:54
Real fires are just a mix of everything. I
Jakob 16:57
work downtown. So if you can imagine the kind of clientele we run into downtown, it's a lot of homeless, drug addicts. Oh,
Scott Benner 17:09
you're running those calls all day long, all day long, and then, and then it's to the hospital, and then back, and then again, like that cycle,
Jakob 17:16
yeah, I mean, we're, I work off an engine. Mostly we don't. The department I work for has one ambulance that we transport off of, but we, as of right now, we have a private entity that transports for us, but that changes in July of next year, and we will take it back over, but we're riding in on the engine quite a bit, because, I mean, you get some of those people that are strung out and they're unpredictable. You never know what they're going to do. So it's like, hey, let's get some extra people back here. And I say, keep you safe and the patient
Scott Benner 17:46
safe. At the end of a 24 hour shift, you're pretty beat. Yeah.
Jakob 17:49
And my son's pretty good about like, I'll come home and I'll sit in my recliner and he'll kind of curl up on my lap with a hand me the remote and tell me to put bluey on and his juice cup and be like, I'll slap you in the face when I'm ready to go play with my toys. You take naps. I'll wake
Scott Benner 18:03
you up, buddy. Don't worry about it. Yeah, I'm talking to you. Seem like a bright guy, Jacob. So like, how do you go that long? I want to say it's not a condemnation. I'm not being like, how did you do this wrong? Like, I'm just trying to understand, how does a day turn into a week and a week turn into a month? A month turn into 10 years? Like, how does that happen?
Jakob 18:21
I think I just formed some really bad habits, young, not testing myself all the time. I never pre bullish my insulin. And I actually I post bullish because I used to graze all the time. So I'd give my insulin after I ate everything, I'd be like, Oh, I ate about 12 units worth of insulin. Get that. I just wasn't so, you know, you know how insulin works. My blood sugar is spiking up and then dropping down. I was on the roller coaster for years, and then I finally decided, like, just randomly one day, I was like, hey, I want to start trying to manage this better. I want to try and get ahead of this. And I think part of what it was is during my academy for this job, I had a doctor's appointment with one of my endos that I had at the time, and he was like, Hey, I got a sample of this Dexcom. Let's try it out. And I started seeing the roller coaster. And I was like, Oh, God, this isn't good. Yeah,
Scott Benner 19:19
you know, health wise, though, did you feel okay?
Jakob 19:24
You know, I look back now and I used to be a lot more of a loose skin, and I used to be a lot more maybe aggressive, or would come off angry more often than I do now. And I look back now and I'm like, I bet you most of those blow ups I had, I my blood sugar was probably like 400 and I didn't even realize it. Yeah,
Scott Benner 19:46
how long you've been married? We've
Jakob 19:47
been together. What married coming up on four years now, we've been together since 2011
Scott Benner 19:55
High School. Did she know that about you? Like, did she think you were just volatile? Or did she. It was diabetes. I had my moments,
Jakob 20:01
and she thought it was just kind of part of my personality and who I was, and anymore, like her and I almost never fight anymore, I'm just, I'm not as angry of a person as I used to be. And it wasn't all the time, right? But it was one of those, like, frequently I have a little meltdown or a blow up. And anymore, it's like, as she puts it, is, it takes you a long time to get back to that point now, but I don't ever want to see you back at that point, because something's gone terribly wrong if you're at that point again. That's
Scott Benner 20:32
interesting, man. I'm endlessly fascinated by that just slow drop off of health and how you don't notice it happening, and, like, how you could, like, like, like, have a personality that you look back on and go, that's not even really who I am. Yeah, it's fascinating. And, and if you don't get pushed by, God, I can't, I can't, like, I can't believe, how do I put this? Like, it's crazy that you had the I can't die. I got to be around for this kid feeling. But you never had that I can't die. Being alive is pretty great feeling.
Jakob 21:03
Yeah, no, I just, I think I was also in that kind of, you know, mid 20s, early 20s, you know, nothing, nothing's ever going to touch me. Yeah, thing and, but yet, the whole time, I'm working as a, you know, paramedic, firefighter, and I'm seeing people who are not taking care of themselves, that are close to the same age I am now, that are way worse off. And I'm like, Oh, crap, how did that never slap me in the face before? Well, yeah,
Scott Benner 21:31
I mean, it's, it's max of what they call hypocrisy, Jacob, because you're like, you know these people, the drug addicts, they don't. They can't keep it together, not like me. Yeah, right, exactly. It's interesting. So you decide to take a better care of yourself. Is it like a thing where you just go, I know what the dual just do it? Or did you have to go out and find out how to manage things?
Jakob 21:55
I started searching for some more information. Got, you know, like I said, I got on the CGM, I started seeing the data in front of me, and I'm like, Okay, how do we fix this? You know, you see that spike, okay, how do we fix this? Obviously, we missed something here. I started playing around with my carb ratio a little bit. I realized that my carb ratio was way more aggressive than it actually needed to be. As soon as I started pre bullishing my meals instead of giving my meals after, because it was, you know, I was a one to four when I started looking at all this, and I realized a lot of that was covering for the fact that I was given my insulin after I ate. You know, I was way over Bolus, I think I was, or basal. I was, think I was on like, 36 units of Lantis when I finally switched to the pump right before I remember, we had dialed my Atlantis down to, I think I was on like 26 units. I was giving 11 units in the morning and 11 units at night, because if I gave the whole thing at night, I'd wake up at 4am low. Wow,
Scott Benner 22:56
isn't it interesting, by misplacing the insulin throughout your day how much more you ended up needing because you weren't just covering food or body function, you were covering that plus high blood sugars with the settings, instead of using it in the right spot and having and mitigating those highs.
Jakob 23:12
Oh yeah. And then I think part of the whole, I think a lot of it was me putting insulin in at the right spot, obviously. But then, I think another part of the whole reduction of insulin needs during that whole time was that was around the same time I started losing a bunch of weight. You know, I went from 220 to in at the beginning of 2021 or 2022 to at the end of the year, I was probably 170 pounds.
Scott Benner 23:41
Okay, yeah, so what did you do there? Was that the way you ate? Or how did you Yeah,
Jakob 23:47
a lot of diet changes. I try not to eat the crap that I used to eat, like we used to eat out all the time. We don't do that anymore. I try and focus on, like, good old, like, lean foods. For a while I went, like, super low carb. Not going back there. I still, some people still say I eat low carb, but I'm like, No, I just don't indulge myself in carbs, you know. But, yeah,
Scott Benner 24:13
it's interesting, isn't it? The difference between, like, processed food and carbs, like, we all, we all say, like, you know, like, if you're eating crappy food that's processed and out of a box or a bag or whatever, you know, you know, and you're like, Oh, I'm eating, like, high carb. You don't mean, like, I'm eating a lot of, like, roots and, you know, broccoli and stuff like that. And so I think what people say should be saying is, I eat it's tough, because I hate talking about this, because there's, you know, no matter what phrasing you use, somebody thinks they know better about eating and like, somebody else gets pissed and all. But like, I just think that, generally speaking, staying away from processed foods. If it doesn't come in a bag or a box, that kind of a thing, if it's not over processed, if you're not drinking your your. Of your carbs. I mean, those are pretty quick ways to, you know, giving your body a chance. So you look at it as like your body was, like, overwhelmed every day by what you were asking from it. It just couldn't stay on the positive side. Yeah. Okay, yeah. So wow, that's not bad. Did you change your exercise habits through there, or was that just all eating? You did that with a lot
Jakob 25:21
of exercise habits too. I went from, you know, maybe working out every now and then when I was at work to, you know, I got a gym membership. I work out. Well, I typically, you know, three to four times a week I'm at the gym between work and when I'm at home, you know, trying to, you know, I dropped to a one, I think at the lowest, I was down to, like, 160 and I looked at myself, I was like, Oh, this is not healthy. I need to put some weight back on.
Scott Benner 25:45
How tall? 580 wow, you were 582 20 at one point. Yeah, yeah, that's, that's and
Jakob 25:51
I'm like, five eight with my shoes on. Like, that's probably me adding an edge.
Scott Benner 25:56
You're like, Tom Cruise. You're like, I'm five. You know, I'm tall. I it's in the fives, yeah. Oh, that's awesome, man, good for you. You know, you do all you need to do. You turn it around. That's awesome. Now we're gonna stay alive for our kids. That's nice, Yep, yeah. What keeps you doing it?
Jakob 26:14
I felt so much better. Had energy. I woke up every morning and I was like, Oh, hey. Like, I can, I can go for a full, you know, 1216, hour day of being awake and not need a nap and not, you know, just have the energy to keep going. I feel good about myself. You know, it sucks at first, right? When you're ever trying to do a lifestyle change, whether it's starting to exercise, changing your diet, you know, you miss the sweets or all that stuff is, I changed my diet and cut a lot of that stuff out, and anymore, I'm like, oh,
Scott Benner 26:44
cake, that doesn't sound good. Yeah, it's interesting. Because, I mean, I mean, if you listen, you know, like, right? I started, like, using GLP, like, a year and a half ago, and I'm down. I'm down 50 pounds and and I wonder all the time how much of that, how much of the benefit that I'm seeing in my life is just from weight loss and just not over taxing my body, and how much of it is, like the other stuff that we're not sure about, about glps, like, is it impacting inflammation and problems like that? And I think it's some of each, yeah, but it's hard to put into words like that medication is letting people lose weight at such a clip they don't have time to like, you know how you drift it into gaining weight? You're not drifting out of it. You're losing it so fast that if you're paying attention, like, I know it happened for me, like you can actually sit back and go, Well, this is weird. I can remember how this was, because it just was, and now I see how it is, and I feel like I have more of a perspective on both sides of it than if it would have taken me three years to lose the weight, like I would have drifted lower, lower, lower, and not seen the changes, maybe because they have, because they would happen more gracefully, I guess. But there's something there, like I know for sure that I am healthier and I feel better, like you said, Not tired, like that kind of stuff, because I'm just not taxing my body as much, both with food and weight. But at the same time, I think I'm getting something else from it. It's interesting to hear people talk about about this, because you started, not in that situation, got into that situation. Sounds like an Applebee's and then, and then you, and then you made your way back again. Yeah. Did your family support this? Like, how do you like, was it a thing you did quietly on your own, or did you have a cheerleader? How did you manage that part
Jakob 28:32
of it? It was honestly kind of quietly on my own. I kind of started making little adjustments. Like, I'd sit and talk to my wife about it at night and be like, hey. Like, I was kind of noticing this. And, you know, she understands the diabetes a little bit, just because she's been with me for what,
Scott Benner 28:48
since high school. You said, right, 14
Jakob 28:49
years. Yeah, 1314, years now. But she didn't understand all the intricacies of it at that point. And then I started, you know, listening to your podcast. You were, like, the third one I found, sorry, Scott, but you're the one I've stuck with.
Scott Benner 29:05
I'm not going to ask you the two that you bailed on, because that would be wrong. I prefer it this way, because now, you know, right? Yeah. And
Jakob 29:11
you know, all everyone that I found, you know, they they're all talking about pumps, they're all talking about CGM. So I was like, Okay, I'm on a CGM. I kind of want to try a pump. I've never tried it before. I was super resistant to it, like all the time. I had had endos bring up pumps to me throughout my entire life. And I was like, No, absolutely not. Don't want it. Don't want it. Don't want it. I don't think I really understood it at the time, but I was not going to do it. And then started here in the ads on your podcast for Omnipod five, and I did some research, and I'm like, oh, no, tubes, what? Yeah, I could do that. What you can do? You know? Yeah,
Scott Benner 29:46
yeah. So, you know what's interesting, Jacob, I'm going to take the tiniest little left turn, just to say a kind of behind the scenes thing. There's a little bit of a difference between I'm an influencer being paid by a company who has a. Podcast, and I have a podcast, and people buy ads on it, which means that, like my ads say what the companies who buy them want them to say, You know what I mean, like and if I have personal experience, then I can, you know, I can pepper my personal experience through the ads. That's no trouble. But somebody's not paying me and saying, Hey, you work for us. You're an influencer. Now, go make your podcast. Does that small difference make sense? Yeah, yeah, it does. Because I feel like I know who you're talking about. Is why I brought that up. It's a slight difference because I make the kind like this conversation you and I are having. I'm not thinking about my advertisers, and I'll like your episode will pop up. It'll get sent out to an editor, it'll come back, and we'll go in a folder, and when it's ready, and I get to it, it'll pop up, and I'll look at my list and say, Okay, well, this episode is going to go on Tuesday, and on this Tuesday, these are the ads that need to go on it. I don't move the ads around because of the conversation. I don't do anything like that, like so not that I'm better. It's just how I have it set up. Well, yeah, but you know,
Jakob 31:06
and I think listening to everyone's different experiences that you have on your podcast is, like, a big thing. It's not just you talking like there's, you know, there's episodes where you talk or you're talking to Erica or Jenny or anyone else, right? But then you have these conversations where you're talking to Joe Blow like me, you know, and they all talk about their experiences, and it's like, oh, these things have worked for these people. And you have multiple people coming on that are supporting different products, right? And you can go through your podcast and pick them out and figure out what might work for
Scott Benner 31:38
you, you know, you'll also noticed that the guests aren't comprised of a bunch of other influencers and other people trying to get their thing off the ground. So Exactly, yeah, right. Also, I really might call this episode Jacob blow
Jakob 31:53
awesome. I mean, thanks
Scott Benner 31:54
for doing that. I appreciate it. No. I mean, listen again. I think if anything helps people. It helps them. I genuinely, I really don't care what other people are doing, but I think that when you're listening or reading or watching their videos, like, you have to understand there's like, a slight difference, like, I make content that people want, and then I'm able to sell ads on it because it's popular. They're making content not everybody, but they're making content that they know the company wants, because that's what they're being paid to make.
Jakob 32:28
Well, and a lot of those other ones leave out the climax of what you're actually looking for, right? Because they want you to come and pay for them to tell you how to manage your blood sugar.
Scott Benner 32:39
Those are the health coaches. Yeah, that's that's another way people use podcasts like, so you're high all the time and you don't feel well. Oh, what a story. You know, if you guys just want to take it on, the first 30 days are free. Now, once you know, you just get in there, we'll really, we'll say the whole thing to you, like, I can tell you the whole thing now. It's between Episode 1001 1025, it's completely free. Go take it if you want to rile me up, I don't enjoy the idea of people selling you health information. Yeah, yeah. It feels weird to me that you're charging somebody to tell them to pre bolt their meal, because, yeah, it's really all they're saying. You know, I'm happy that the stuff is that the podcast is popular enough that it can carry ads and I can keep having conversations like this and listen. God bless them. They can't follow that model, probably because of their downloads. I'm sure they would if they could. You know what I mean, like, I'm sure if, like, if they had enough people listening, they'd probably just sell an ad too. But anyway, it's neither here nor there. Tell me about the changes you've made, the things you implement every day and and where you think the value is coming from.
Jakob 33:39
I think more than anything, is I actually carb count my foods when I can now, right? I'm actually like, I'm one of the guys that's got the scale, right? I weigh everything I eat. For the most part, I've figured out how to swag things. For the most part of if I'm out and about, kind of being like, yeah, that's about 45 carbs. Let's start there and see where we go. And then the big thing with the the CGM is just kind of watching how, how the blood sugar reacts after I eat, and it's like, Oh, hey, I missed that. Like I went from 102 when I Pre Bolus my meal to I'm 10 minutes, 20 minutes after I finished eating, and my blood sugar is 130 okay, we missed something here. Yeah, you know, let's, let's put some more insulin in or, Oh, we're out. You know, my wife and I are out. We're going to be walking four blocks to the next spot we're going, let's make a little extra jaunt and see if we can't just drive that that blood sugar down without having to Bolus a bunch of insulin and maybe go low. Yeah, are there foods you avoid now? Yes and no, I don't eat a lot of sweets anymore. That's just kind of my thing. I don't really eat like pastas or rices that much anymore. And my grandfather just rolled over in his grave because he's a hard was a hardcore Italian. And I just said, I don't eat pasta, but it's just kind of one of those ones where I'm like, is it worth is it worth it? Is it worth the excursion that I might get? Know, am I gonna cut some zucchini up into noodles and do that instead of pasta? Yeah, yeah, that sounds really good, actually. Yeah.
Scott Benner 35:07
Has your palate changed as you've gotten older? Yeah? Oh, definitely two more whole foods. Yeah? Definitely
Jakob 35:14
like, I mean, this morning I got up, I cut up some onion, bell pepper, mushroom, spinach, some egg whites and a little bit of leftover ground turkey from last night, and made a scramble. And that was what I ate for breakfast, where, five years ago, I would have had biscuits, gravies, sausage, you know, all kinds of just heavy, dense, fatty foods that I just
Scott Benner 35:36
don't really I wonder about that too. Like, why is that? Is it just how you grew up? Is that what you thought of breakfast as I just spent
Jakob 35:42
a week with my dad hunting in the other side of the state. Every morning, he's like, Oh, I'm gonna make us breakfast burritos. I'll throw this in it. I'll throw this this in it. I'm like, hey, hey, Dad, can we just do like, there's some vegetables over there and some little bit of sausage and an egg, and I'll be good to go. Yeah,
Scott Benner 35:58
I probably eat more just eggs, like, scrambled up with a protein, than I do anything else in the morning, like, and not even and like, it's funny, like, not even eggs. Like an egg, like, you don't even mean like, it doesn't need to be all the eggs, like an egg. What I do this week, well, two, and also it seems expensive, but it's not, because, if that's really what you're eating, it lasts forever. Like, I'll go buy a couple of steaks and then make them up, and then slice them up, and then put them with the eggs in the morning for a few days, and then I'll maybe pivot to chicken, right? Like, you know, cook it ahead of time, slice it up, throw it in, rewarm it. The other day, I did, like, I went out. I was like, God, I've been wanting shrimp, and so I went out, I bought, like, I bought, like a pound and a half of shrimp, like, you know, from the from the seafood counter, like, it probably was frozen, like, wild caught, frozen shrimp, right? And, yeah, it cost, like 25 bucks, but I ate it for like, a week, you know what I mean, like, so every day I got up and I was like, Oh, I have some shrimp with eggs. And I know some people think, like, seafood in the morning is weird, but like, whatever, like, you know, I put it together, and once in a while, throw it in, like, a lower carb wrap and then, but most of the time, like, I don't need the wrap. But years ago, I would have been like, you know what? This needs toast. But now I don't think that way anymore. And if I want something crunchy to crunch with it I'll do like a thin, hard, like cracker, or like something like that, because I realized it's not the bread I wanted. It was the crunch I wanted. That makes sense. Everything
Jakob 37:30
used to go in a tortilla for me, right? Really, anything and everything and a tortilla
Scott Benner 37:34
has got to be 40 carbs. Oh,
Jakob 37:36
always, yeah, especially, I used to buy the big, massive tortillas they could make a burrito the size of a small baby. Oh,
Scott Benner 37:42
so it's 50, it's like, 50 carbs. And you don't think of it that way, because it's thin and flat and doesn't seem big, yeah,
Jakob 37:49
and then you're throwing hash browns in it. You're throwing, you know, everything else, sausage gravy. And you're like, Oh, God, that's, that's 120 carbs. I just put my body right.
Scott Benner 37:58
Also. It's grease and slowing down your digestion and extending that so you're going to get a big push right from all the carbs, blood sugar up, and then the great gravy. Jesus, you put gravy. It does sound good, doesn't it? You put gravy in there with all that fat, because gravy is not gravy. Gravy is fat, or you're frying everything in butter or oil or something like that, and then that holds up that blood sugar for three, four hours. Next thing you know, you're fighting with a 250 for, you know, until lunch, if you're lucky, yeah, exactly yeah. And your dad's, like, I did something good, like, yeah, yeah, literally shaving yours off my life. And that was nothing wrong with it. Once in a while, you know what I mean? Like I said earlier, like it becomes a ritual, and then it's what you it's just what you do. Yeah, yeah, no, man, it's, it's something Jenny and I are talking about right now, about making, um, I think we're going to do a list of processed foods that are really difficult to Bolus for, and describe to people why they're difficult to Bolus in real, shorter episodes and off try to offer an alternative to it at the same time. Because I just think that people don't, they don't know, like, if you said, like, what's gravy to somebody? And there's no world where most people would say it's fat, well, yeah, it's milk, heavy cream, butter, like, it's all fat, yeah? But in your mind, it's meat flavor. You know exactly, like, yeah. Now you could do a like a just like a thin that, then that's fine, right? But once you thicken it up, you're, you're asking for it. Oh, yeah, not that I don't listen. I can't. I'm super excited for Thanksgiving. Oh,
Jakob 39:36
trust me, like I kind of mentioned earlier, my wife's pregnant right now, and gravy has been like the craving, so I've been making a ton of it, Jacob,
Scott Benner 39:46
I'm gonna have to get a recipe from it's the one thing I'm not good at making at Thanksgiving.
Jakob 39:50
Yeah, you can't work at a firehouse and not be good at biscuits and
Scott Benner 39:54
gravy. Yeah, maybe I need a recipe from you. I think the cook, I don't know how to cook. It is my problem. Like, I don't. How to whisk it up and get it thick, and it's, I don't know why I'm not good at that, but I cheat with my gravy and pack it. I just buy it somewhere. And then I just then I thin it down with the drippings. And I go, look. It's almost, I almost made it. I just cheat on that one. Okay, like, it's interesting, isn't it? Like, just, you know, how food impacts and it's like, the last thing we think of, like, your weight goes up. You don't think about it, you know, your blood sugars are hard to deal with. It's the last thing you think about, like, it's, can't have Jenny on every day. But if I could you, and you really heard how she like, if I let Jenny come on and talk about, like, how she eats, you'd be like, Oh my God, no wonder she's so healthy. Yeah. Well, it's like,
Jakob 40:41
you know, we went to the grocery store yesterday where we did an online pickup at the grocery store yesterday because we were being lazy, you know, you looked at what we're unloading afterwards, I looked at it, and I was like, there is one thing in here that is frozen, and it is literally frozen potatoes that we'll throw in with some breakfast every now and then. And other than that, it's fruits, vegetables and meat. Yeah, yeah.
Scott Benner 41:02
Listen, it's bags, box frozen. You're asking for whatever that goes in it that keeps it from going bad. Yeah, yeah. So, yeah. Like, it's not World War Two, no. This isn't what we had to pack with us so that I don't die to starvation. You know what I mean? Like, there's, there's options here, but I it's just become, it's just become how food's made. I don't even hold people like, I would never even hold people responsible. There are people who say, like, just eat better. I'm like, I don't, I don't think people know. Like, how would I like, there's a whole food, a whole store. They call it the grocery store, right? And I go in there and it's full of groceries. How am I supposed to know that this aisles? Like, I mean, listen, it's some of it's obvious, right? Like, you know, potato chips, but I guess it's not, I guess it's not. To some people, it's just not obvious. Because I put up a post today about this, about food, and I asked people like, Hey, can you tell me the foods that you know, you, you know, struggle with. You can't, you know, tell me about the foods that you've given up trying to even cover. You can't figure out anymore. Like, it's just interesting. Like, I want to see what, what people are talking about. And boy, somebody comes on in five seconds and says, Yeah, I had to stop drinking soda because I couldn't Bolus for it. And I was like, oh God. People drink soda, like, like, and then, like, you know, you look and you realize, like it's so much, like so much people drink so much soda, like there's nothing, there's just nothing redeemable about it for you and you and I think it's the same as the tortillas, like it's liquid, so it doesn't feel like a thing that could actually hurt you. Does that make sense?
Jakob 42:39
Yeah, yeah, until you realize that you're drinking a 12 pack a day, well, right?
Scott Benner 42:44
And that it's got a bunch of stuff in it that you don't not food Exactly, yeah, and I'm not pick, listen, if you drink soda, like, I'm not coming down, or you can do whatever you want, right? Like, but that's one for me, that like, I'm thrown by that a little bit, like, when anybody drinks soda, I'm like, thrown by that. Or like, you know, fruit juice, or like, you know, it's like, really, it's like, just sugar and carbs and, yeah, I'm not saying it's just if you have diabetes. By the way,
Jakob 43:07
I've been wanting to throw a CGM on, like, my wife or someone else, and just watch how, like, even some of the other high carb sugar stuff impacts their blood sugar, even without diabetes. I think that would be fascinating just for myself.
Scott Benner 43:25
Listen, I sent my my son to like, you know, out in the world, we never drank anything that was sweet like that and like that's just one of the things now, is we've never, just never done right. And he goes off to college, and then goes down south to work for a year. When he comes home, he's, you know, Hey, can I get a sweet tea? I'm like, a sweet tea. Like, what do you what I was like, Am I what are we doing just to have unsweet tea? It's just tea. It's cold. You put lemon in it, you'll be fine. It's what he got accustomed to.
Jakob 43:56
That for. He went to the south, though, didn't he like? That's, that's kind of expected down there,
Scott Benner 43:59
he was in Georgia, and that's it. Listen, when you when you drive south on 95 you get to a certain point where you can't find a diet drink in a cooler when you stop to get gas anymore. Interesting? Yeah, it just like it generally doesn't exist. And also, for people are yelling into their they stop yelling at your car. First of all, while you're driving. It's ridiculous, but I know that artificial sweeteners aren't good for you. I'm not saying to have a bunch of artificially sweetened stuff either. I'm just saying that when you're drinking calories or drinking sugar, you are you're overloading your system in a way that it probably can't fight back from. So yeah, anyway, not that you can't have a sweet tea once in a while. I'm not saying that, but whatever do, whatever you want, I don't care. I'm trying Listen, I'm not perfect. Jacob over here isn't been feeding gravy to a pregnant woman. He might be committing a crime. As far as I know,
Jakob 44:55
it's between that or dealing with a very angry and emotion. Know
Scott Benner 45:02
they're giving her gravy, like, like someone would throw a steak in a lion, is what you're saying to
Jakob 45:07
me sometimes. And as she's eating it, she's looking at me she's had terrible morning sickness, or just sickness in general, this, this pregnancy, and she's like, I don't know why I'm eating this. I know I'm gonna throw it up in an hour.
Scott Benner 45:19
Okay, good times. You should have said, Hey, I know a little girl in third grade can catch that vomit for you. Hold on a second, right? Yeah, exactly. Do you have any other autoimmune issues?
Jakob 45:28
Me personally. No. You want to talk about my family. I do what else? Start naming some auto immune disorders. And my mom probably had some. Let's
Scott Benner 45:36
go RA for your mom. Yep, Hashimotos, probably celiac. No, no. Interesting. Does anybody have the one with the blotchy What's that called? Michael Jackson? No, where'd my brain just shoot i You made me lose it too. Wait a minute. I keep going. What else does she have? Lupus? Is the
Jakob 45:55
big one? Wow. Sclederma. I can't even name all the ones she's got. I mean, if you look up auto immune disorders here, I'm gonna do that.
Scott Benner 46:03
I once thought of doing this, by the way, on the podcast, and I have a list somewhere. I meant Viti, Lago. Ah, yeah, that's,
Jakob 46:13
I know, like. So the lupus is the main one that I always remember with her. Ra,
Scott Benner 46:17
people have eczema in the family. Yeah. Oh, I guess, yeah, yes, you have that. Yes, like, I don't really, I have nothing's got just diabetes. Then, uh, oh yeah, you know I do have, um, I have eggs, anything else,
Jakob 46:31
thyroid, I know she's got thyroid stuff. She doesn't have celiac. Do
Scott Benner 46:39
you have any complications? No
Jakob 46:41
for how much I didn't manage myself for so long, I've been lucky. I think I was kind of at that point when I decided to finally start really dialing in my diabetes, where it could have gone really bad, really quick, if I hadn't made that change. I was starting to notice, like, some stuff with my eyes where, like, they weren't, you know, I was things were blurry, or I'd start kind of having black dots every now and then. And I just recently had an eye doctor appointment. He's like, Yeah, everything looks great.
Scott Benner 47:11
Wow. Like, okay, you got you got there before it happened, like, as it was happening, yeah,
Jakob 47:16
there was some numbness in my feet every now and then I used to have, like, I don't have that anymore, you know,
Scott Benner 47:22
wow. How about, uh, how about Crohn's Colitis, stuff like that in your family? Yeah,
Jakob 47:27
a lot of that stuff. A lot of cancer as well,
Scott Benner 47:32
all on my mom's side. No kidding, yeah. So that sucks. I mean, listen, I think we could probably pivot the conversation if we wanted to, and and make some pretty valid arguments about all the processed food over the last five decades or so. And, you know, you know, some of the chemicals we're using in the world, and all this autoimmune stuff too.
Jakob 47:51
Yeah, well, and I think mom's whole family has a bunch of autoimmune stuff, but it's weird. They weren't like, they were pretty healthy people growing up from everything I've I've seen or learned from them, yeah, they were farmers. Like my grandmother lived off the farm, but, like her brother still runs the family ranch. He's like, 80 years old and still doing it. He's just some kind of man that never stops.
Scott Benner 48:19
He's a man that, the man that never stops.
Jakob 48:22
I remember what was it, probably 15 years ago now, because I was in middle school, or it was longer than that, probably 20, yeah, 1520, years ago now, dad and I went hunting, pig hunting with him, out in the out in the mountains, and I was, you know, middle school, high school, my dad's always been in good shape. This guy's probably like 7075, years old at this point in time, maybe 6570 and he is kicking my dad, me and my dad's ass up and down this mountain, packing way heavier anything than dad and I have, and we're 400 yards behind him. Suck and win, and he's turning around. Come on, hurry it up. Like he's just that big corn fed kid that that's that's what he does. Thank
Scott Benner 49:13
God we didn't count on you to stop Jerry. But there's a reference that young people are just like, what? Who's cherry?
Jakob 49:24
Yeah, you'll ask me on that one
Scott Benner 49:25
the Germans. Sorry, I was making a world war one reference.
Jakob 49:29
There you go. Okay, now I get it.
Scott Benner 49:32
I interviewed this lady the other day, and she's like, she's young, you know? And she's like, I love the show. She goes, I gotta admit, sometimes you say things I don't know what the hell you're talking
Jakob 49:42
about? Well, I'll tell you this. You make a lot of movie references, and there was one that I heard you say, I'm pretty sure I heard you say in a podcast that you've never seen before, and I'm thoroughly disappointed. Oh
Scott Benner 49:53
God, do you want to list the movies I've never seen before? You'll get it's
Jakob 49:56
just one movie that I'm thoroughly disappointed that. I'm pretty sure you said you've never seen before, and it's the Goonies.
Scott Benner 50:03
Oh, I've never seen the Goonies. No,
Jakob 50:05
okay, Scott, that hurts me. Jacob, I've never seen the godfather. I haven't either. Okay, okay, my dad, my dad lives by it, and the theme song of The Godfather is his ringtone. But it's
Scott Benner 50:17
ridiculous. We used to have a list of movies that we wanted to see that we wanted to see that we've never seen. Like, I've never seen Gone With the Wind, like, stuff like, but I just, at this point now, it's so old, like, I just, I don't even think I would connect to it in any way.
Jakob 50:30
You know. See, maybe it's just because I'm, like, from Oregon, which is where Goonies was filmed, and that's just like, you, you're gonna be from Oregon, you have to watch the Goonies. I think it's an unwritten law, all right,
Scott Benner 50:41
well, let's keep going. I've never seen gremlins. I've never seen Oh God. I've never seen Animal House, wow, oh, I fell asleep while trying to watch it at a friend's house. Yeah, there's a lot of movies I've never seen that people would be like, stunned by, because I've seen a lot of movies. Yeah, you make a lot of movie references? Yeah, no, I we used to just, that's all we used to do. Like everybody we knew worked in a movie theater. We didn't pay to go to the movies. We saw everything. I'm going, I just bought tickets. We're going to a movie tonight. It's my son, who's, by the way, 24 and he might be older than that. No, he's 24 and I'm is he 24 he is. I'm glad that never stopped. Yeah, well, it's even crazier because he was born in 2000 so all I have to know is the year, and I know how old he is, because he was born at the beginning of the year. But so he's 24 I'm 53 my wife is 50, and we just bought tickets to the wild robot for tonight.
Jakob 51:36
Awesome. Yeah, super excited. I just
Scott Benner 51:38
there's something about going to a movie and sitting in a theater with a bunch of strangers that I know, if I met personally, I would hate we sit there, you know, with the same like, focus, same goal. Like, there's this one thing we all have in common, like, we like to go sit in dark places with a group of people and watch a movie, and doesn't matter, like, who they're voting for, or, you know, how they eat, or, you know, anything like, right? Like, the guy five over for me could be a giant racist, and I wouldn't know, because he loves Godzilla too. And, like, you know, so for like, two hours, you just a lot of parity. And I like that, yeah. So anyway, I love going to the movies. Oh, I can't,
Jakob 52:17
I can't sit there for that long. I'm too add for that,
Scott Benner 52:21
what's the longest movie you've ever sat through?
Jakob 52:25
I mean, I can sit and binge watch the entire Star Wars sagas and Harry Potter, no problem. No, not in a theater. Most of the movies I watch are at home. My wife tries to get me to go to the movies most the time, and I'm like, I'm gonna fall asleep.
Scott Benner 52:42
No kidding. I'm pretty sure the longest movie I've ever seen in the theater would be bitches, the hamlet, directed by Kenneth. How do you say it? Branagh, um, like, or late, mid 90s. It had to have been over four hours. Oh yeah, we saw it in the theater. There was a, there was a an intermission, but only because I'm old enough to have gone to movies when the movies were on film, like on, you know, they had to switch the film out. Yeah, they had to switch it because it wasn't like the the reel wasn't big enough to hold the whole film, yeah, but yeah. So a movie was awesome. I love that movie. My I remember my wife, we boy, we weren't either just about to get married or just gotten married. She was so sick, and I was like, we can leave, you know? And she's like, No, this movie's so good. She sat there with a box of tissues, and we watched it. Awesome. Awesome movie if you've never seen it, nevertheless, not the point. Yeah, your whole generation, like, You guys suck. I don't, you know, like, I can't just sit there. I'll watch it at home. It's not the same,
Jakob 53:51
yeah, trust me, it's I sit there, I coach high school sports, and I look at like, the kids that are in high school now, and I'm like, your generation sucks. I don't understand. So it's, yeah, it's every generation thinks that. Well, I
Scott Benner 54:05
also, I also keep up, listen, I'll tell you something. I don't pay for a lot of stuff, but I pay for the premium YouTube. I don't watch YouTube ads. I use YouTube enough that it's worth $20 a month for me not to watch ads. Yeah, yeah. So I think YouTube is awesome, like, for certain things. You know what I mean? Like, when you're trying to learn about stuff that's just outside of, like, you know what most people care about. So, you know, Netflix isn't gonna, you know, pony up for a series on or something like that, exactly. I think that's awesome. Like, you know, I'm looking at a very, very healthy chameleon staring at me. He's staring at me like, I don't know when this is over, buddy, but like, bring me a roach, and I know how to take care of him because of podcasts and YouTube. Yeah, that I learned a lifetime's worth of information in 30 days of trying.
Jakob 54:54
You can figure out anything on YouTube, if you I have found the end of YouTube a couple of times in my. Life,
Scott Benner 55:00
have you done that where you searched something you're interested in? You're like, I have seen all of this. Yep,
Jakob 55:06
everything's got the little red line at the bottom because you've watched it all already.
Scott Benner 55:10
Exactly. That's exactly, right? I had that feeling. I'm having that feeling right now because I don't want to say. I'm too I'm literally too embarrassed to say but I'm trying to, like, talk myself out of doing something by just, like, exhausting myself with it on YouTube. Does that make sense? Yeah, I've done that before. Like, if I just watch enough of it, I'll get sick of it, and then I won't do it, which I know I shouldn't do, but it really feels like I'm gonna do,
Jakob 55:39
yep, gotta. Gotta chase that. But
Scott Benner 55:42
then some of the similar like this, like simpler things, do I want to try to make sourdough bread one time? I do, but I don't want to figure out how to get a starter, and so I watched the videos, and I'm like, no good. I don't care. It's interesting.
Jakob 55:55
It's such a craze right now, the sourdough thing, I don't I don't know that I get it. Maybe it's because I've never enjoyed sourdough bread COVID. I think, yeah, every shift at work someone is bringing in sourdough bread that their wife was making. And I'm like, God, God, guys, can you stop? Can you Oh, you're just throw
Scott Benner 56:15
this away before you get to work. I mean, why do I push this on me constantly? Yeah, I listen, I started smoking meat because of COVID. Well, yeah,
Jakob 56:23
I think you get to a certain point as a father, and you either have to pick up smoking meats or World War Two history. So
Scott Benner 56:32
World War Two history, I'm not like, I'm not, I don't care about but submarine movies are awesome. I love a submarine movie I've seen. I think every movie that has a submarine, seriously, I haven't watched Das Boot on in German. I think every Oh, my God, like Crimson Tide. Have you ever seen Crimson Tide? No. Awesome movie. Awesome movie. Denzel Washington and Gene Hackman in his glory, ghost written by Quentin Tarantino. Like, okay, boy, it's good. And like, a I don't know, I don't know, what's wrong with you kids. You know, it's ridiculous. How old are you? 29
Jakob 57:19
I could be your father, yeah, yeah, yeah, I think, yeah, definitely good, yeah, that's
Scott Benner 57:25
insane. I mean, I would have been young, but, like, it definitely would have been a mistake. You immediately, 1,000,000% would have been, like, you know, made in the back seat of a car.
Jakob 57:39
Yeah, those are the best kids, though, right? Yeah,
Scott Benner 57:41
actually, I'm, I'm remembering that back seat and where I was and and the girl and I, you wouldn't have turned out. Well, I'm just gonna tell you that right
Jakob 57:50
now. Oh, god, okay, good. I'll stick with the parents I got. Would you 100%
Scott Benner 57:54
Yeah? No, no kidding. How about that? Oh, like, I just had a lovely memory. She was such a nice girl,
Jakob 57:59
yeah, but I wouldn't have had a great life. Okay, no, I don't think
Scott Benner 58:02
she was parenting the two. I want to be clear, she could have changed. She was great for other reasons. Yeah, she was, first of all, she was lovely and and she could have, I'm sure she could have shifted and had children, and they were probably very successful people. When I knew her, she was a little more focused on, you know, yeah, not serious adult things, which is, which is, yeah, yeah, exactly. She was a ton of fun. I'll tell you that. Okay, so that's pretty much it. What else, Jacob, have we not talked about? Anything we should have?
Jakob 58:35
I think we covered a lot of it. It's just, you know, I've made the big changes that have really impacted myself and made me better, healthier, more than anything, right? And learned a lot from myself and keep on. You know, it's never too late to reinvent yourself as a diabetic, right? Yeah, try and get that control back under you. I just want
Scott Benner 58:55
to say, Jacob, that that means a lot to me that you would come on here and share that. And I also think that I should say that if that girl ever hears this, I loved you so much, and I'm sorry you hate me. Whatever I did, I apologize. I'm sure an older me would not have done it, but I'm certain she probably still hates me. I'm assuming she hasn't thought about me in 30 years either, but probably not, yeah, just because it just popped into my head. Now, while you because, you know, because we went through that ridiculousness, and I was like, Oh, she was great. But I then I realized she's probably, if she heard this, she'd be like, Oh, well,
Jakob 59:25
I mean, it's like the girl that I threw up on multiple times in elementary school, she probably hasn't thought about me anymore, but she probably still has PTSD from that. Yeah, can
Scott Benner 59:34
you imagine? Wouldn't it be great if it's like a thing, like, not that she's upset by but that it's like, still a story for her, like she gets around people, and she's like, I don't know. Man, there was this kid, Jacob. He puked on me, like, twice in a week. I don't know what ever happened to him. You'd be like, I'm a fireman.
Jakob 59:53
The best part is, now that I'm thinking about it is after I came back to school, after being diagnosed, and I had, like, my. First low blood sugar during school, and they made someone walk with me down to the office. Was it her treat my yet my teacher made it be her. That's
Scott Benner 1:00:08
ridiculous. Did she not see what had happened? You guys are mortal. You're mortal, mortal, mortal enemies by that point, like just girls at home making like little dolls of you sticking pins at them, and probably you're lucky she didn't turn you down the wrong hallway and go, you'll be okay. Keep walking.
Jakob 1:00:29
No wonder she moved to Alabama the next year. What a
Scott Benner 1:00:32
little psychopath she would have been if she did that, by the way. You know what I mean? Yeah, I stuck him in a bathroom and I closed the door. I hope he's okay. He'll be fine. I just don't worry about it. She moved to Alabama. How do you remember that? I
Jakob 1:00:43
have one of those weird memories. Remember everything, the most ridiculous thing
Scott Benner 1:00:47
anyone's ever said on air. You're like, I remember with a girl in third grade moved to That's creepy, Jacob. I just want to say, Well, hey, what do we name in that next baby? Is it a boy or a girl? Do we know?
Jakob 1:01:01
We don't know yet. We she just did the blood test two days ago, so we should have results next week on gender and all of that stuff.
Scott Benner 1:01:09
Wow. May I suggest naming the baby ladder? Ladder? Yeah, because then it would be Jacob's Ladder, and that's a movie too. So that's all I got for you. There's no way you've seen Jacob's Ladder. No, the guy that was married to Susan Sarandon is in it for sure. You know, you're old when you Google something and it's not the first thing that comes up. It
Jakob 1:01:32
was the first thing that came up when I Googled it. It was filmed five years before I was born, 1990
Scott Benner 1:01:37
it says here, yeah, a psychological horror film. Yeah, yeah. Do I remember it right? Just who was in it? Tim Robbins. Tim Robbins was married, is right, married to Susan strand. Was married to Susan strand. Let's look. You don't know who either of those people are, so let me just look No, he was with her for a long time, but they were never married. 8898 they were together for like, 21 years. Isn't that interesting? You don't know who Tim Robbins is, do you? No, I don't have you seen Shawshank Redemption? No, oh, Jacob, I'm so sorry. Jacob, would you watch Shawshank Redemption for me this weekend,
Jakob 1:02:19
if only if you'll watch the Goonies. All
Scott Benner 1:02:22
right, I'll tell you what. Okay, damn it. I don't want to watch the Goonies so bad, but god damn it that. You know that movie sucks, right, doesn't it? No, it's a great movie. All right, I'm gonna, all right, listen to me. I'm not gonna check you on this, and I don't expect you to check me on this, but I promise to watch the Goonies if you watch Shawshank.
Jakob 1:02:43
Okay, well, I just googled it right here, and I'm looking at it, so it'll be on my list. It's gonna
Scott Benner 1:02:48
be one of the best movies you've ever seen. Okay, all right, I promise. All right, man, I'm gonna talk to you later. Hold on one second for me. Okay,
a huge thanks to us, med for sponsoring this episode of The Juicebox Podcast. Don't forget us, med.com/juice, box. This is where we get our diabetes supplies from. You can as well use the link or call 888-721-1514, use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us Med, 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 or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective, the bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginning series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're not already subscribed or following the podcast in your favorite audio app like Spotify or Apple podcasts, please do that now. Seriously, just to hit follow or subscribe will really help the show. If you go a little further in Apple podcast and set it up so that it downloads all new episodes, I'll be your best friend, and if you leave a five star review, ooh, I'll probably send you a Christmas card. Would you like a Christmas card? Hey, what's up, everybody? If you've noticed that the podcast sounds. Sounds better. And you're thinking like, how does that happen? What you're hearing is Rob at wrong way, recording doing his magic to these files. So if you want him to do his magic to you, wrong way, recording.com, you got a podcast. You want somebody to edit it. You want rob you.
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