Scott Benner 3/16/25 Scott Benner 3/16/25

#1463 Small Sips: Low Before High

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Preventing highs is easier than correcting them—catching small dips early leads to better control.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 00:00 Hello friends, welcome to the sips series. These foundational strategies were nominated by listeners. They told me, these are the ideas in the podcast that truly made a difference for them. So I distilled them down into short, actionable insights. There's not going to be any fluff or complex jargon, just practical, real world diabetes management that you can start applying today. And I know your time is valuable, so we're keeping these short. Another small sip will come out once a week for the foreseeable future. If you like what you hear, check out the Pro Tip series or the bold beginning series for more. Those series are available in the menu at Juicebox podcast.com and you can find complete lists of all of the series in the featured tab on the private Facebook group. Please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. The questions you have, I guarantee you there's answers to them in the Juicebox Podcast, and it's all free. You Jenny, we're doing what I think I'm going to be calling small sips in the titles, not sure yet. It's a kind of a fun way to think of it. I don't know what else to do. Honestly, sometimes I run out of ideas, but we're taking concepts from the podcast and talking about them in really, like small chunks. So this next one is low before high. It's easier to impact a low or falling blood sugar than it is to bring down a high blood sugar. Apparently, that was said in WoW episode 44 getting off the diabetes roller coaster. And then we did a defining diabetes at 269 called Low before high. But oh, now we've got some separation of about eight years between the first time it was said. And now it can't be that long ago, can it anyway? Long time? Yeah, let's just try not to think it was that long. I think

Jennifer Smith, CDE 02:22 it has been about eight years, because I think we started this when my youngest was first born, really, and he will be eight in January. No

Scott Benner 02:32 kidding, I'm sorry I've drugged me through this for so long.

Jennifer Smith, CDE 02:36 I'm glad you have

Scott Benner 02:38 Jenny and I both drank at the same time. We've been doing this together way too long, but so to me, I know I said it's easier to impact a lower falling blood sugar than to bring down a high. That's how I remember saying it. It's how I think about it. And I've said to people in the past, I'll say it here happily, like, if I'm in charge of your diabetes, I'm gonna come from that perspective, like, that's a daily and I want to be clear, like, even though that's a daily mantra for me, I'm not saying, I want you running around with your blood sugar under 70. I'm not saying, like, oh, we'd shoot for 60, and then we'll fix it. Like, I'm not saying that. I'm saying play down in the numbers 7080, 90, before erring on the side of caution, I guess is kind of how I think of it. Does that make sense to you?

Jennifer Smith, CDE 03:28 It does, and I don't think, as you just said, You're not encouraging, no, a roller coaster at all. What the goal is? Kind of a rule of small numbers, if you will, right? If your blood sugar is rising, and you know that there might not be enough there, you know is add a little bit extra so that it doesn't get as high, which is harder to bring down. And then on the back end of if it was a little bit too much, especially with our A I D systems that we have now, it's likely that it's going to catch it for you, or that you could easily catch it with a jelly bean or two. Yeah, right. Again, not the goal long term, because you don't want to constantly be catching lows or you're adding in calorie value that your body doesn't need.

Scott Benner 04:14 So given over proper respect to the idea that once your blood sugar gets elevated, it needs more insulin to bring down a number, just meaning that if there's an amount that brings you from 200 to 100 that same amount doubled isn't necessarily going to bring you from 300 to 100 right? I mean, people talk about in all different ways, but you experience some sort of insulin resistance when your blood sugar is higher, and so I just think better low than high, not meaning Low. Low meaning lower, better lower than high. It's also a term, like people are not confused by it. It's obviously a well understood idea in the podcast, but for somebody who's just tripping across this in like a clip somewhere, what I'm saying is, if you stay in. The lower numbers, things are easier. Now my expectation is that people hear that and think, oh, yeah, sure. Well, if I could do that, I would just do that. But you know, like, you know what I mean, like, that doesn't sound so easy. I'm not saying it's easy to keep your blood sugars 7080, 90, 100 110 in there, but there are tools within the podcast that will help you understand how to do that. About Pre Bolus thing, getting your settings right, how to impact certain foods that you may not recognize are requiring more insulin than your insulin to carb ratio might indicate things like that right. Adjustment for variables, all the things, yeah, and the other thing is, is that when you're higher and you make a big Bolus to bring it down, you are much more likely to experience a low later, which you very well may over treat, end up going back up again. And I think that's how this idea popped up in an episode called Getting off the diabetes roller coaster, because you know, over and over again, you're going to see people who are just living a life of up and down. And it is. And I'd like Jenny to speak about this for a minute, but stability is a much healthier place to live in than the roller coaster. Can you tell people why it

Jennifer Smith, CDE 06:09 is so long term? I always give the idea of an A 1c right. I see in the diabetes community online, especially the aim for these much, much lower a 1c is right. And I think the best explanation is you could have an A 1c that's 6.5 and have what we call standard deviation, which is the variance up and down from what that average a 1c suggests. And if your standard deviation is a low number, that means that that a 1c of 6.5 has stability. It means that you not having the roller coaster up down, like the Rocky Mountains, your more gentle rolling hills kind of up and down through the course of the day. That long term is better in terms of prevention for micro vascular, the small vessel, nerve eyes. You know, the vessels in the eyes preventing complications down the road. Stability is what we're aiming for, right? So the wider the variants, the more up and down again that roller coaster, which means that your body has to constantly move through a wide range of glucose values. And I see it very common in kids, and what their parents or their teachers suggest, it's not working, right? It's not working because their blood sugar might be 200 to start the day, and then they might Coast Way down into lunchtime. They can't Pre Bolus because their blood sugar is already at 60 at lunchtime, and then, without the Pre Bolus, then they're at 200 again an hour after lunch, and then they have recess, and it comes coasting back down that kid or that adult. You feel horrible when your blood sugar is coasting through such a wide range of blood sugar numbers. The more stability, the better you're going to mentally feel, the more, I guess, the better the learning capacity of a child or a teenager, even a college student, is going to be the more attentive at work you're going to be as an adult. So I

Scott Benner 08:06 just think that as you're trying to figure that out, if you're shooting for a lower a 1c by having lows half the time and highs half the time, and like you said, then the standard deviation says, Okay, well, you have a lower a 1c I'd prefer you had a 140 blood sugar that was super stable all day. Had a six and a half a 1c and learned how to make that 140 or 130 then learned how to make that 130 or 120 until you figured out the right the amount of insulin and the timing required to keep you as much as possible there. I

Jennifer Smith, CDE 08:39 think that's really valuable to say, because I think a lot of people come in with really variable blood sugars or just consistently running high, but have stability. And it's it's hard to get them to see that. Okay, your blood sugar is higher than we want it to be, but at least you have stability. You're not having this roller up and down. Great. We have an easier time actually adding a little bit extra insulin and keeping the stability there. As your body adjusts to the lowering of blood sugar values, you're also going to feel a lot better, rather than just going from an average of 180 down to an average of 100 that doesn't necessarily feel good within two days

Scott Benner 09:15 either. Yeah, you're so close. If you have stability at like 140 for example, you're just a couple of turns of a couple of knobs of getting where you want to be. Very likely. Okay, cool. I appreciate this one. Thank you. Of course. Are you starting to see patterns, but you can't quite make sense of them? You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, you're starting to think this isn't going the way the doctor said it would. I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 i. You can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group. Just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 if you or a loved one, was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bowl beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginning series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu. If you're not already subscribed or following in your favorite audio app, please take the time now to do that, it really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. You.

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Scott Benner 3/15/25 Scott Benner 3/15/25

#1462 Small Sips: More Insulin

A longer-acting insulin strategy helps manage high-fat and high-protein meals more effectively.

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Scott Benner 00:00 Hello friends, welcome to the sips series. These foundational strategies were nominated by listeners. They told me, these are the ideas in the podcast that truly made a difference for them. So I distilled them down into short, actionable insights. There's not going to be any fluff or complex jargon, just practical, real world diabetes management that you can start applying today. And I know your time is valuable, so we're keeping these short. Another small sip will come out once a week for the foreseeable future. If you like what you hear, check out the Pro Tip series or the bold beginning series for more. Those series are available in the menu at Juicebox podcast.com and you can find complete lists of all of the series in the featured tab on the private Facebook group. Please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. The questions you have, I guarantee you there's answers to them in the Juicebox Podcast, and it's all free. You let's go over more insulin. Yay. So these are topics picked by listeners that they found to be extremely helpful, and we're going to do a tiny little dive on each one of them so that we have some short form content around it. So cool. Apparently, in episode 121, is the first time I talked about just the concept of more insulin. Since then, it's come up in a diabetes variables episode and in a pro tip episode. But this is a takeaway from that episode. It says, apparently, this is me talking. It's gonna be odd to, like, say my own words out loud on a second insulin, because it's restricted by little pieces of tubing, though, that's you hold on a second. So you need to make it work. And then the end of them, then the reason is the moment as

Jennifer Smith, CDE 02:16 I'm reading it, I think what the person is making sense of or what whoever one of us said, this is the fact of in the moment, if you're trying to decide whether or not you need more insulin, you don't necessarily need a historical look at is there a trend to it in the moment? It's more like right now, I know I need more. This is happening, so give more. And then if you feel like in your brain, this could be a trend that you've kind of seen happening time of day, time of the month, whatever it is, then go back and historically, look at the information, because it may suggest that there's a setting change that actually needs to be made, but right now, don't putter around trying to figure out the reason. Just give more insulin if you really think that that's the right thing to do. Now,

Scott Benner 03:13 100% so this comment came from a listener named Monica, and what she said was, what helped me most was the idea of meeting the need and figuring out why later. So what ends up happening to people, more often than not, right, is they get a little, I guess, what you call paralysis by analysis. And you know, blood sugars have done a thing. Usually gotten high. They don't understand why. And instead of addressing it, they very often stare at it, worried about a couple of different ideas. They don't want to stack their insulin. They've been told not to stack they've been told that they can't Bolus often, you know, until three hours after the previous Bolus is finished, right? And from my perspective, if you've given yourself some insulin for food, and your blood sugar is shot way up and it's sitting there. My expectation is that something went wrong with either the carb counting, the insulin to carb ratio. Maybe you didn't understand the fat content. If you're hearing that now and thinking, I don't know what fat's got to do with it, don't worry. We have an episode for that too. But something happened, and the need for insulin is greater than what you calculated. That happens probably every day to people, all day long. I think it's important what you do next. I think if you sit and stare at it and wait for it to come down, often, it doesn't, and then you end up making a large Bolus, everything crashes low later. That happens because the foods finally digested out of your system. It's not impacting your blood sugar anymore. Now you've put in, put in all this, this insulin for the number, you come crashing down. People might say, Well, then why would I not come crashing down if I put the insulin in sooner? Well, while the food's still in. Are impacting you, you're gonna have more of a balance between the insulin and the need for the insulin. So when you talk about this with people, when when they see high blood sugars, what is it that that you find yourself saying to them most

Jennifer Smith, CDE 05:12 often, if you're seeing high blood sugars, my first consideration is, is it a normal right? Is this a normal thing that suggests a change to a setting? If it's abnormal then? And I can see where the question here really is, in the moment, address the issue and then move forward and figure out kind of why. But in the moment, sometimes there are considerations as to, Why could it be that the site is bad? Is it leaking? Does it smell like insulin? So there are still things outside of willy nilly, just saying, I'm going to take more insulin. There are some things to assess right here and now. Is it a problem? Is it a disconnected site? Did your cat chew through the tube? Blah, blah, blah, right? But outside of that, it's really addressed the high blood sugar, and I guess in a time frame of the previous dose having been taken, you know, if you like, you just said, if there is mis timed insulin, it might be that you had enough insulin there. You just didn't give enough time for the insulin to start working. So now adding more insulin could lead to a drop later, because you really don't technically need more insulin you just needed to time it better and more insulin right now is still going to have its action profile to get going and to impact things, whereas if it's in the aftermath of a meal miscounted because you were less than precise, you didn't have the information you needed, very likely you need more insulin. So give some more insulin in a safe manner. You know, if your insulin needs around a meal are usually a unit for a fairly good sized meal and your blood sugar is high and you're like, Well, I'm gonna knock it down with another two units. That's really not the greatest idea. Be conservative, but more aggressive in your range of what you know about insulin and how it works for you,

Scott Benner 07:01 right? Yeah. I mean, I don't want people to ignore the idea that there could be something wrong, but the amount of times that you see somebody say, Well, I don't know. Like, is the can you live in? Is my is, did my insulin go bad? Like, that stuff doesn't really happen that frequently. You want to rule them out. It shouldn't, yeah, right. It shouldn't happen that free. But you know, if that stuff's happening very frequently, you have a larger issue. But my problem with that, it's not a problem, but, but what I've seen from people is that they'll get so frozen on the things that are probably not happening that they don't do the obvious thing, which is just say, well, maybe I count these carbs wrong or the right. You know, like, I mean, we talk in all kinds of episodes about glycemic load and glycemic index, the idea that 10 carbs worth of one thing will require more or less insulin than 10 carbs of something else. So if you've eaten something and thought, Oh, well, this said 40 carbs. And you know, my insulin to carb ratio is good. It works all the time for me, but this thing has more fat in it, more protein, and it's something that's going to push your blood sugar up. I just think that once people start using the insulin, not more aggressively, but where it's necessary and how it's needed, they start having experiences that show them I did this, then this happened, and then it empowers them moving forward, it's almost like kind of the same thing as not sitting on the same settings for a year and waiting for a doctor to tell you, you know, do something about it. I think that once people with type one diabetes have a firm idea of how insulin works and how to manipulate it, I think that leads to a leveling up of your understanding and lower a one CS, and less variability in all the good things that you're looking for,

Jennifer Smith, CDE 08:44 and more comfort level with using again, more insulin when you need it. You have a comfort level from understanding insulin usually works this way. For me right now it doesn't seem to be that way. So I'll give more insulin again in a safe manner. But also, as we go back to considering, is it a site issue at this point? If you've given more insulin, and it doesn't move your blood sugar, and it was a good enough of more insulin, absolutely. I mean, my go to is one correction on a high that looks weird, and if it doesn't work, I am changing my site. Take care of it, bring the blood sugar under control.

Scott Benner 09:22 I'm in favor of injecting if you're wearing a pump to check to see if the site's bad. But also, I think important to bring up here, if you're on an automated system and you just willy nilly put in more insulin, like you, you know, say, you said, Oh, this is 40 carbs. And then 45 minutes later, you're 250 and you think, Oh, I'm gonna put in another unit and a half, if you put that in the automatic system that you're using now believes that you have way too much insulin. It doesn't look at the number and have the same conscious thought you're having. It says you told me 4040, was this much insulin. I don't care about what your blood sugar is, right now, I believe I've got enough insulin in here you put. More, it's going to take away your basal, and then you're just going to end up trading your like little mini rage Bolus is for the basal that it takes away. You will stay high forever, like that,

Jennifer Smith, CDE 10:10 for a much longer time. That's right. I mean, the aid systems are wonderful, all of them, FDA or non FDA approved. They're all really fantastic in many ways. But you're right, and that's why an injection, it's a way to quietly, sort of unknown to the system, give insulin and evaluate is the insulin working from the injection? Well, clearly, then the site is the problem, because that didn't bring it down.

Scott Benner 10:37 Yeah. So I'll leave a couple ideas here for people to check out. If you think, Oh, I don't want to stack insulin, we have episodes about stacking. I'll tell you that in a one sentence. Takeaway, I don't think it's stacking if you need it. I think that's bolusing, but I do think you can stack insulin. I do think it could be dangerous, so. But those are two different thoughts if you want to learn more about glycemic load and index and why some carbs might hit you differently than others. Again, in the Pro Tip series, there's a great, longer conversation about that, but for now, I would like your takeaway from this to be, if my blood sugar is high, I shouldn't just stare at it. I should do something about it. That, to me, is the takeaway from this idea. Yes, awesome. Thank you. Of course, you music, 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 beginnings 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 you.

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Scott Benner 3/14/25 Scott Benner 3/14/25

#1461 Cold Wind: C.D.E.C.S

"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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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,

the podcast episode that you just enjoyed, was sponsored by ever since CGM. They make the ever sense. 365, that thing lasts a whole year. One insertion every year. Come on. You probably feel like I'm messing with you, but I'm not. Ever since cgm.com/juice box, 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, Hey kids, listen up. You've made it to the end of the podcast. You must have enjoyed it. You know what else you might enjoy? The private Facebook group for the Juicebox Podcast. I know you're thinking, uh, Facebook, Scott, please. But no. Beautiful group, wonderful people, a fantastic community Juicebox Podcast. Type one diabetes on Facebook. Of course, if you have type two, are you touched by diabetes in any way? You're absolutely welcome. It's a private group, so you'll have to answer a couple of questions before you come in. But make sure you're not a bot or an evildoer. Then you're on your way. You'll be part of the family. I can't thank you enough for listening. Please make sure you're subscribed, you're following in your audio app. I'll be back tomorrow with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording, wrongway recording.com, you.

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