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Podcast Episodes

The Juicebox Podcast is from the writer of the popular diabetes parenting blog Arden's Day and the award winning parenting memoir, 'Life Is Short, Laundry Is Eternal: Confessions of a Stay-At-Home Dad'. Hosted by Scott Benner, the show features intimate conversations of living and parenting with type I diabetes.

Filtering by Category: Teplizumab

#481 Diabetes Veterinarian

Scott Benner

Kari is a D-Mom and a veterinarian who treats animals living with type 1 diabetes.

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

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

Scott Benner 0:00
Friends, did you ever sit down to do something having an idea that it would be a certain way? And then when it was over, it was way different than you expected? If that has happened to you, then you know what I felt like when I got done recording this episode.

Hello, everyone, and welcome to Episode 481 of the Juicebox Podcast. If I seem like I'm not as enthusiastic as I usually am, I'm doing something a little differently this week. I'm getting ready to go away with my son for a few days. So I'm editing a ton of episodes and getting them ready to like they're going to go up automatically because I won't be here. And I'm having trouble like, you know, bring in the Zoom Zoom for every one of these intros and outros, so I'm not a I'm okay. Anyway, this episode is really cool. It's Carrie, she's the mom of a type one. She's a veterinarian. She's the person who handles all the type one animals in her practice. And somewhere in this episode, she told me something that I didn't expect to hear. And it made it really a full conversation much more than I expected. I really appreciate it. Please remember, while you're listening 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. We're becoming bold with insulin.

This show is sponsored today by the glucagon that my daughter carries g vo hypo pen, Find out more at G Vogue glucagon.com forward slash juicebox. The episode is also sponsored by the Contour Next One blood glucose meter. It is in fact, the most accurate, easy to use, easy to carry easy to read blood glucose meter that I have ever personally held used. We're talking about. I am not kidding. Contour Next one.com forward slash juice box. And I'll tell you this, too. It's a really great website. It's not, you know, when you get on a website and like who made this, like did the person who made this website? Have they ever been on the internet you ever had that feeling you will not have that feeling at Contour Next One forward slash juice box. I'm holding up my hand like they do in court. Because I am telling the truth of the whole truth and nothing but the truth.

Kari 2:47
I am Kari I'm a veterinarian, and just general practitioner and I see a lot of cases and I tend to get a lot of our diabetics, because obviously we all know it's a pretty complex disease on the human side and equally complex but a bit different on the animal side. So a lot of the other doctors I work with are sometimes intimidated or or frustrated with the cases. So I I see a lot of them.

Scott Benner 3:19
What's your connection personally to type two diabetes?

Kari 3:23
My daughter is 14 and she was diagnosed at age seven with type one.

Scott Benner 3:28
Okay. So we're not gonna say your daughter's name. Is that right? Yep. Correct. Your daughter. That's how I'll handle it. Okay, how old was your daughter when she was not how old Excuse me, but what was the care like when she was diagnosed seven years ago. Seems like you might have been pump CGM time.

Kari 3:47
Yeah. So when she was diagnosed, it was 2014. And we got the Dexcom. couple months in and it was not in the cloud. And then somewhere along the way, in our first four, six months, we got the super expensive little base station so that when she was sleeping, it would the data would get sent to me my phone, whatnot. That was super exciting. And then seemed like shortly after that. It all just ramped up into total lead app and the receiver and the cloud and all that. And so then she went on a pump probably like six months after diagnosis. Gotcha. We started with animus and move to Medtronic and now t slim and chill like we've experienced a lot of the technology

Scott Benner 4:38
on the pumps. One thing I think either your hair or jewelry might be brushing the phone.

Unknown Speaker 4:44
Okay, I know that

Scott Benner 4:45
sounds crazy, but and I have a Dexcom cradle right in front of me. Do you all the old stuff that I've tossed that you know becomes, you know, unnecessary as the years go by? I can't seem to get rid of this one thing. Yeah. Because it, it worked out so oddly, that I mean Dexcom clearly produced these cradles because they thought it was going to take longer than it did. Yeah. To get that next device approved.

Kari 5:12
Yeah, I feel like it. I remember being pricey. Like, I don't know, 100 200 300 I don't know. And then within months, it was useless because things were better. But I mean, it was it was worth it while I had it. I guess.

Scott Benner 5:27
I imagined them all over desks at Dexcom with business cards in them. So that's how I say it in my head. But yeah, I mean, for people who don't go back that far. It was absolutely insane. Right, this little thing came out, and you would take your Dexcom receiver, slide it into it, and somehow then attach it to the cloud and somebody could follow you. Yeah, yeah. Yeah. Such a big deal. Just Yeah, big deal. And he could only use it really at night, right. Like it was kind of by them. Yes, I'd feeling.

Kari 5:57
Yeah. It was too complicated to like, get it to school. And we had our teachers trains to monitor and yeah, so it's just by our bed, but it was such a great thing to be able to just sleep and wait for the alarms. Yeah.

Scott Benner 6:13
Do you wonder now most people probably don't even know there's a receiver. They just use their phone? I would imagine. Yeah, that's fascinating. It really is. And then the the part that of course, was both kind of frustrating if you paid for it. And otherwise, is that that the new receiver that kind of had the chip built into it that could go to the cloud? it Oh, my god, it couldn't have been three months maybe. And it was available.

Kari 6:36
Yeah, that's what I remember. It was super quick. Well, that was a big investment for a couple months.

Scott Benner 6:43
But I can't believe I totally remember that. In that time. I guess I want to know a little bit about your, you know, your ideas around management. Like I mean, sevens pretty young. I imagine you were pretty involved with your daughter.

Kari 6:55
Yeah, for sure. Um, and because I am medical. I mean, I just jumped right in, I totally understood it. And she was so young. And it was first day of summer break. So I ended up spending a lot of days that summer going on her little field trips, the summer camp field trips, and I just hardly let her out of my sight. The the manager or whatnot. At the daycare she was with learned diabetes, no one there had ever had it in their recollection in recent years. So she took it on and helped me out quite a bit but any field trip dosing for carbs, you know, this and that. I was always there. So, and then we were fortunate enough when she entered second grade, we had the most amazing teacher ever, of all my kids years at school and she like took it on like a second mother and she was amazing. So so it went pretty well. All things considered. As much as pretty well could be.

Unknown Speaker 8:02
Yeah,

Scott Benner 8:03
back then something like this. What did you take to it pretty well? Where did you find Yeah, wishing she had kennel cough because that you understand?

Kari 8:11
Um, yeah, I mean it. It was different. I mean, it's managed very differently and animals and humans so but I understood all the science behind it so easily and but yeah, it's it's it's way different. I feel like we manage animals, like we did. 20 years ago. I remember. I remember a type one diabetic. Kind of a friend of a friend back when I was in college, and like they were doing, you know, twice a day shots and carrying a cooler. I remember going to Cedar Point they had the big lunch cooler. And you know, the glucometer and no, no remote Ma, you know, no CGM. And he had multiple seizures. And I just felt like, was so poorly managed 20 years ago compared to humans today. And unfortunately, that's kind of where we are with the animals not because we're behind the curve, but because it's just not super realistic to do all the intense carb counting and CGM and all that and all the animals. You just

Scott Benner 9:15
made me You just really made me focus on the idea that back then with like, regular and mph and those those kinds of things, that that that probably, I wonder, like, if you spoke to a doctor behind the scenes back then if they were just thinking, how will this person's pancreas stop working? So we're just going to do our best to keep them alive for as long as we can until stuff starts going wrong? Because that's Yeah, that's the vibe of the dogs. Right. And the animals Yeah.

Kari 9:42
Yeah, pretty much. I mean, we. Yeah, I mean, we do the best we can twice a day dosing and we have started playing it Some of us have started playing around with the freestyle lever or whatnot. And I've only had one Clients religiously try it, like, begging clients to try. But yeah, I mean, we just for lack of better terms, if somewhat winging it, I don't have owners do blood sugar's at home very often because they get too worked up on, you know, a blood sugar of 300 they all of a sudden want to increase insulin. But, you know, we don't we have a much wider curve. Yeah, on our dogs and cats, then some well controlled humans, not necessarily my dad or these things with hormones, but you know, they can fluctuate 100 to 300, and be pretty acceptable, we hardly blink an eye if the average is okay, so we don't micromanage it as much. So yeah, we just kind of do the best we can and educate the owners, but obviously, it's very overwhelming for many of them. And we try to dumb it down almost to to, you know, reduce their stress, and yet still do the best we can for the animal.

Scott Benner 11:04
So carry that sum. It sounds it sounds sad, I guess is the word I want. Like, like, the understanding that there's this thing that I guess that really is medicine, in general, though, right? isn't like we're getting better and better at it as time moves forward. But a lot of it is maintenance. Like just Yes. And when you mean maintenance, you mean maintenance, trying to stave off something, whether it be right a problem or the end, or whatever it is, you're just trying to slow the progression to this thing. Yes. And you can you tell owners of pets that or is that not something you've kind of freely share?

Kari 11:40
Um, I mean, I'm always very optimistic that, you know, we can give them a relatively normal life that the hard part, the hardest part probably is some of these dogs are just picky eaters. And to to have an owner at home kind of treating blindly without regular blood sugar, checks, blood glucose checks, you know, and all sudden, the dog doesn't eat breakfast, what do they do, and, you know, to try to give partial doses and to educate them on all that. So I try to just encourage them that, you know, we're going to do our best to give them a pretty happy healthy life. And one of the biggest fears is the needles and even the most scared clients realize the needles, no big deal. And, you know, I try not to overload them with all the heavy, potential negative stuff. But um, you know, main, a large portion of the dogs develop cataracts. So I do tell them that right off the bat dogs more than cats, and you know, I tell them, they're going to be frequent visits back to see me and it's, it's not cheap, paying, you know, full price for insulin and blood tests, you know, without, most of them don't have insurance. And so I kind of prep on that. A little bit of expensive disease, but you can do it and they're gonna feel great. And, you know, there may be complications down the road, there may be certain lifespan, but we'll deal with each one as it comes. And I try to keep things as light as I can. But still, you know, this is something to be taken seriously. And we can do this together. We're Team call me any time

Scott Benner 13:27
trying to make them feel a part of like the process of doing a good job. Yeah. How do you get a cat or dog to drink a juice box? While you're talking?

Kari 13:41
Yeah, so our go to is like Kira syrup or maple syrup on the gums. You know that, that sort of thing and, and call us if they're not coming around in 510 minutes.

Scott Benner 13:54
It's fun. It's funny how the problems are mimicking both sides, like I have two dogs. And one of them one of them's older. And there are some mornings, you know, like the process, you know, the morning goes exactly the way it goes every time and he comes back in from out back. And he's like, oh, man put the food down. And he comes over and eats the food. And some days he looks at it. It's not now and then he goes over and lays back down, which he never did when he was younger. And I'm trying to imagine I'm trying to imagine talking a dog into eating I guess. Yeah, I'm trying to wrap my head around. And it's making me think back to when my daughter was young as well. So

Kari 14:32
it's hard when there are picky eaters and you know, a lot of these dogs, like schnauzers are notoriously type ones and are you know, diabetics, dogs are more often type one and cats marfin type two, interestingly enough, but you know, these little dogs are not always big eaters, labs are prone to it. Also, and that usually goes well because they eat anything you give them. But yeah, some of these little ones. One of my most intensive cases is a little Chihuahua, and Elvis. He's an old man. And he's had cataract surgery and all kinds of stuff. She's the one actually who tried the the CGM, the lever. And he Yeah, so she's mastered it because she is all in as most of us are parents to type one. So we're all in and we're micromanaging. She, she lives her life to manage this dog diabetes, I swear. So what's my point? Oh, he's not, he's not the best eater. So she's, you know, always trying to finagle what he eats. And she's well aware of all the complexities of carb counts that I don't overwhelm my most of my clients with. So she knows like, what's high carbs, low carbs, and how that affects his insulin needs. And but yeah, when they're not good eaters, it's hard. So it's, it's a battle for them for sure.

Scott Benner 15:55
So I'm sorry, you, you've got me off, you've got me off kilter a little bit, because I literally am just picturing someone on their knees with a handful of kibble going, just have five of them, just please eat fine. I gave you your insulin already. How long does it take the dogs and cats to get used to getting a needle?

Kari 16:13
Honestly, they don't know what to set. Okay, they do great. So I have the owners, if possible, I have them feed twice a day dose twice a day. And I tell them, it, every vet does it differently. And I've tried to cope. My clinic that's to kind of do it similar to me, because there's such differences I've seen, I've seen some that say I'll do some An hour later. And you know, I use the food as a distraction. Once it looks like they're eating most of their food just give the full dose and most donors are shocked that the dogs never, and cats to never even act like they feel it. So they do really well. And it's done a little differently. We don't use the pen needles, we actually tent the skin and kind of angle it 45 degrees with a more traditional insulin syringe. Although I had one Schnauzer that was vicious to the owner, and they literally had to kind of just Dart the dog as it walked by his name was lucky enough, you should never name your animals lucky because it never works. It's always opposite. But um, so

Scott Benner 17:30
I know won't get back to this in a second. But it puts you in the position of attending to a dog who's passing away and having to turn to somebody who loves it and goes and sell them. Yeah, Lucky's gonna die.

Kari 17:41
Yeah. lackeys are there now never lucky. They're they hit by cars. They're the bad diseases. But yeah, this dog is the only patient and 20 years of practice that I've ever had us live little pen needles, and like literally just start them as he walks by. And it works. She kept them alive for quite a while. But yeah, they don't notice the needles. Honestly, they do so well. You know, the owners are more freaked out, but we demo it.

Scott Benner 18:13
They can kind of see it's not a big deal.

Kari 18:15
Yeah, we have them give them some sealing as a practice once, twice, three times whatever they're comfortable with. And they go off on their own. And almost every single owner is shocked how easy it ends up to actually inject to them and the pet

Scott Benner 18:30
that you said that you when you brought up type two, it made me think so in the I mean, how many years Do I have to go back into veterinary medicine before no one would ever consider giving a pet insulin?

Kari 18:44
Yeah, good question. I mean, my whole 20 years we've all been on board, okay. I don't know. I still have clients that occasionally request euthanasia when they're diagnosed. And it just breaks my heart because it's close to home and I just I've done I've probably given in and done to maybe in recent years but I do everything I can to talk them out of it and yeah, I don't know at what point you know it progressed through to little more effective treatment and the animals I would assume it's been quite a while I mean if this insulin spin out

Scott Benner 19:26
do you imagine that and I'm This is me guessing so if I'm wrong you stopped me but do you imagine that people who are able to seek frequent and regular care through a veterinarian for a dog Are you know better financial place than other people and does that not make us believe that people who can afford it still have pets?

Kari 19:45
Um, so yes and no funny enough. We My practice is like the edge of a big city and so we we pull in clients from the wealthy suburbs. Inner City I have learned through the years you cannot judge where they live, what car they drive for anything. We have, you know, clients with the fancy cars. I mean, no offense to anyone listening. But they're just absolutely appalled that I asked them to buy $110 lantis pen, we use the pens in cats as a vial, basically. So they don't have to buy a $380 vial of Lantus to use two units twice a day, we we buy packages of the pens and break them up and sell them for 110. And, I mean, people are just absolutely upset either with us or with, you know, insulin, crazy pharmaceuticals in general. And then we have, you know, people driving beaters and just not looking as well to do and that they don't blink an eye and they'll do it. So I've learned long ago like not to prejudge anyone, you lay it out there and let them know. Yeah,

Unknown Speaker 21:04
yeah.

Scott Benner 21:04
So do you people ever, like how harsh does it get? Like you said, they'll they like, has anyone ever said to you, you want me to spend $110 on something that cost me 20 bucks. Like is Does that ever get that harsh? Or do they not say that to you?

Kari 21:17
Um, so what do you mean? So what do you mean? 110? That cost me 20 bucks. So like, yeah, like,

Scott Benner 21:24
some people don't know that. I think there's some people that don't see a cat. I think they see it as a belonging sometimes and not a Does that make sense? And now Yeah, suddenly, like here, let's spend a lot of money to Medicaid, something that you paid $20 for at some point like that.

Kari 21:38
Oh, I see what you Yeah. Yeah, absolutely. Um, and again, that goes across the whole range, like, wonderful parents, you know, the shoe, the kids are there, and they're like, we're not doing this. Well go get them another cat next month, or, you know, whatever. And vice versa. You know, it's, uh, yeah, I mean, people just range I've had so many people say, Oh, I grew up on the farm, or, you know, we never treated our cats and dogs, they live to be teen. And, you know, you don't need to do this. And, you know, again, just recommend what's medically best, but then your medicine has evolved to be more intensive and more high quality. It's, we're actually built building a new building right now. And we have someone trying to sell us on a CT scanner, because that's the norm for dentistry, it's better. We thought we were doing great because we had dental x rays, but now the norm is to CT that the jaw, and it's just things are evolving so much, you know, just better care better technology. And, as a result, often higher bills and people do it, they love these pets, and you know, most of them will do whatever it takes, they may complain. But we, we My practice is always pretty good at kind of giving them options. You know, diabetes probably isn't a good example. Because there's not a lot of options you treated or you don't but you know, if you dogs vomiting, and it's prone to foreign bodies, but you're pretty sure didn't get into the sax. today. You know, if you want to just treat for virus and wait for an X ray, that's your choice. Or you can spend, you know, 180 bucks for x rays and see if there's a sock and its stomach. So we kind of give plan a plan B and so many people go with the full workup and I mean, they they want to take care of their pets. It's lovely.

Scott Benner 23:41
Really, I'm trying to decide what the number is for me not to take care of my kid. Like I'm like, What number would someone at this Happy Friday when I don't like them? Yeah. I'm sure there isn't one but it's a very, it's what I'm thinking too is that you don't get into veterinary medicine. Like by mistake, right? Like you weren't like trying to decide whether or not to be an accountant or a veterinarian. This was a calling for you. I would imagine.

This isn't much of a cliffhanger. I mean, Kerry's going to say that veterinary medicine was a calling. I mean imagine if she didn't imagine if she was just like, now I hate animals. That is not what happens. But anyway, that's neither here nor there. You'll find out all about that in a second. For now, I need you to know this. g vo hypo pen has no visible needle, and it's the first pre mixed autoinjector of glucagon for very low blood sugar and adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G Vogue glucagon.com Ford slash juicebox g Vogue shouldn't be used in patients with insulin, Noma or pheochromocytoma, visit je Vogue glucagon.com slash risk. I wish you all could have been here the day I learned to say pheochromocytoma, it was hilarious. Anyway, I need you to go to Contour Next one.com forward slash juicebox. Why are you going to do that? Well, it's easy. When you get there, you're gonna find a blood glucose meter that is accurate. Understand, it's easy to use, easy to hold easy to read has a nice bright light for nighttime viewing. And it has Second Chance test strips. Second Chance is exactly what it sounds like. You take a chance dip in the blood. Right? What other add in the world do you hear dip in the blood as part of the words you have put the test strip in the blood and say you don't get enough. Oh, that was your first chance. Now you get a second chance to go back and try it again. without interfering with the quality of the test. And you don't ruin a strip. Not bad, huh? Plus the things easy to use. I love it. I mean, as much as you can love a blood glucose meter. I love this one. That's an accurate, that's an accurate and honest statement for me. I mean, you know, like if you said to me, Scott, what do you love more sunny days are blood glucose meters I've been I kind of like glucose meters good I can do with or without the sun. But I mean, if it got down to my family, and you're like Scott, here's your wife and a blood glucose meter. I'm gonna go with Kelly. That's not the point. The point is, I love this meter. And you may too. You may also love a lot of the things going on at Contour Next One comm forward slash juice boxes. So head over and find out they have a test trip savings program. A lot is going on. It's a really I mentioned at the beginning of the episode. I don't mean to jump around in the middle of the ad, I'm sure right now that people are contour like, could you stay on topic, buddy, we're paying you here. But I am. It's a great website gets really well laid out. It's easy to find. And there's a ton of information on it. It's not overwhelming or confusing. It's worth your time. Contour. Next One comm forward slash juice box. You know, I got a bit of time left here in the music. So let me just say this. Find me on Instagram, find me on Facebook on bold with insulin on Facebook. I'm Juicebox Podcast on Instagram, and the private Facebook group where there are now 811 1000 users, a lot of them active every day. It's a jump in Facebook group full of cool people talking about type one diabetes, it's called Juicebox Podcast type one diabetes. That's it, you go there and you chat with other people just like you other listeners. 100% free nothing to do just, you know, ask answer a couple of questions. Make sure you're not a robot, or somebody trying to sell t shirts or other scams, that seems to be a big thing in the diabetes community. People come in and they go, Oh, ah, I have diabetes. And look at my brand new t shirt. Isn't it amazing? And they just take a picture. I'm gonna keep talking here for a second because this really pisses me off. So I'm just gonna take a second to share it with you. And I mean, pisses me off is harsh. It pisses me off. It's just it's a well done spam. Do you mean? So somebody takes a picture of themselves. And they're like, I have diabetes. And I know how hard it is. And it is hard. And my shirt says that I'm tough or whatever I want to call it, the shirt says, and then they don't. They don't like pimp it. They don't put a link up, right? They're not like me. They're not like Juicebox Podcast like they, they don't do anything. They wait for someone to say, Oh, I love your shirt. Where did you get it? And then they're like, oh, let me just give you this link, which goes to their store. These people don't have diabetes, they're preying on you, they're trying to sell you diabetes t shirts. Now, if people want to sell you a diabetes t shirt, they should just tell you, I'm selling your diabetes t shirt or I'm selling you another t shirt. That's fine with me. I'm all about capitalism. I'm good with that. But don't try to trick people. I'll try to make it look like it's one thing when it's not. I don't like that. So anyway, I try to keep those people out. And I do a pretty good job of it. So don't be afraid to check out the Facebook page. Well, this was long winded wasn't it? Let's get back to carry. This was a calling for you. I would imagine.

Kari 29:11
Yeah, I wanted to be a vet my whole life and you know of course growing up all your friends do too We all did at one point right? Probably. But they drifted away to other things and I was a senior in high school or junior whenever applying to undergrad and like I've never thought about anything else maybe I should. So I looked into of all things architecture, and special ed and I thought well those are cool careers but now I won't be event so and then went on from there and some people because that school is kind of hard to get in. Depending on the school the average is one out of 10 applicants. So some people after not getting in move on to like the human side because I don't know if it's good or bad that it's easier to get into med school but I Couldn't do humans humans are kind of gross medically and and luckily I got in so I didn't have to think about what else to do or how many times would I apply, I get on first try by some miracle. And here we go. If

Scott Benner 30:16
I have to say that the first time I saw a veterinarian, express my dog's anal glands, I thought she really likes this is her calling? There's no way she's just doing this for money.

Unknown Speaker 30:30
You know, like, yeah,

Kari 30:32
there's some gross parts, definitely, we're pretty well staffed. So we've delegated out to your skill level and what you're trained at, so my unfortunate technicians get to do most of the ina glands. Unless they're busy, and I don't want to wait, then I'll do it. But no, yeah, no,

Scott Benner 30:50
I was asking. Because, I mean, I would think that a person who I'm guessing loves animals as much as you who went into a profession to keep them healthy, that when someone says to you, Hey, I don't want to give this thing insulin, let's just let it die, or can you put it to sleep? I don't imagine that you see much of a difference between that. And and if I were to come up to you and tell you, you know, we're not going to bother with your daughter. She's a lot of work. Like, I don't think you Yes, I would I am I right about that?

Kari 31:20
Yes, yeah, I agree. Um, and, you know, my, my partner's my associates, they, I think they accept that request easier than me, and the only one with a type one family member. But because it is pricey, and it's high stress, and it's high maintenance, and, you know, so when an owner is just not willing, you know, I find my we are all in it to help animals, but we also have a lot of really emotional hard things every day. So, of people who don't want to treat something, or people who, you know, think it's a charity, and their dog was hit by car, and they need free surgery. You know, it's a very emotionally draining career. It's not all petting cute dogs and cats and saving their lives every day. There's a lot of human emotion and ranges of quality of care and willingness to be compliant. And you know, a lot of difficult stuff like guilt trips, or blame or this or that. So anyway, I find the other doctors you know, if they diagnose a diabetic and the owner is just not willing, they sadly agree versus I put my foot down and like, absolutely not, am I euthanizing your dog? I can't, I cannot, I cannot, we are going to treat it. We're going to find a way.

Scott Benner 32:50
I did not want this turn into a therapy session for you. But the whole time, this is where I've been heading. So just say, okay, because I really felt like how is it possible that she could? Like, I didn't think you could disconnect that feeling from your personal life? And like, you don't I mean, like I couldn't I just don't know how, if I'm, I mean, I, I've been a pet owner most of my life. And I can't, and I can't fathom how somebody would just be like, Oh, it's sick. I forget it. Like, I don't understand that. But I'm also not, um, I don't know how to put this like, I'm not a crazy pet owner. Do you know what I mean? Like, again? Yeah. Like, I think there's a line, like you're saying, like, I kind of believe if my dog got hit by a car, and I brought him in, and he looked really bad. And you said, this is gonna cost $10,000 he's probably gonna die. I might be like, Oh, you know, me, like, that probably would hit me. But that would be because I feel like that would be because of the money. If I couldn't afford it, I think it's just a weird thing to look inside yourself to try to decide, you know,

Kari 33:53
yeah, yeah. It's hard. I mean, it's a daily battle. And it's hard. The owners, it's hard on owners to like you said you would love your dog. Can you do 10 grand, and there's a guarded prognosis. And, I mean, it's hard on them. And most of them are very understanding of the situation we're put in, and we come to a decision together, but there's, there's a lot of tough points where, you know, they they don't agree with, you know, our estimate, or they feel that this is an animal and we're, like, we're in it to help animals, we're obligated to do whatever it takes, and why are we trying to make a fortune and, you know, it also there's, there's hard stuff and there's owners, you know, that just don't understand why it's such a big deal that their dog has a, you know, a tumor that's probably malignant, the sooner we get it off, the more chance that we can prevent fatal outcomes. And now they're just going to watch it and you know, so we have to go with that. That's their choice, and we have to go home at night and let it go. And it's It's a hard, it's hard things sometimes. But I, I've learned through the years and this may sound cold, but I love these animals. I love the science, but I have emotionally distanced myself a little bit from the bond that these animals have with their owners and the owners lives. And I, I try, I try to be very thorough, very friendly, very helpful. But I try not to get too connected or too bonded to some of these pets. And there's always those ones that sneak through and I when they die, or when they're sick, I cry like, it's my own child that, but I think that's what's hard. In our profession. We actually have a very high suicide rate, we're ranked the highest in all professions, apparently. And it's like three times what an average american is. And yeah, it's it's a very emotionally difficult career because of all that stuff. So again, it may sound cold, but I kind of, I still absolutely love my job. And I find it's because I enjoy the animals, I enjoy the science, but I I try not to get too attached to each individual patient because I just, you can't handle it, you can't keep your chin up and deal with all these tough decisions and financial limitations. And, you know, it's just it's tough. So I, I do the best I can, but again, certain patients get through and certain causes like diabetes gets through, and I am absolutely attached to every diabetic patient I have and

Scott Benner 36:38
are you the diabetes doctor? Like is it is it that simple? Like you just hear from other rooms I carry? This one's yours?

Kari 36:43
Yeah, yeah, pretty much. Yeah. Yeah, because it's an ergonomic endocrinology is super tough. I mean, it was my hardest class and med school. And it's it's complex, all the hormones interact with each other and everything else in between. and, you know, as general practitioners, we treat everything and we treat minimum of two species, cats and dogs in, you know, small animal practice. I do some exotics, too, but so, you know, you have to know, everything possible about the heart and the kidneys and all the endocrinology and musculoskeletal and we do surgery and neurology and so yeah, these doctors who aren't living type one like I do with my daughter. Yeah, are like, okay, I just died. I died. The dose is this and oops, I don't understand why his blood sugar's not well controlled. Carry. Oh,

Unknown Speaker 37:43
I'm starting to wonder if everybody's endo doesn't feel that way. If

Unknown Speaker 37:48
that's true. I wish I

Scott Benner 37:49
could call someone else to come in here and help you. Yeah. Are there any odd animals that get diabetes? Like, I assume, not frequently, but what's the

Kari 37:59
I've diagnosed a couple of guinea pigs. And other than that, I don't know. I mean, I'm assuming every animal can, but we mainly just do cats and dogs. And, you know, back in vet school, we had to learn six species. The exotics, were kind of separate from that. But you know, cows and goats and horses and sheep and cows, goats or sheep. Yeah, cats, dogs. So those are the six. And I remember some endocrinology from the rest of them, but not a lot. To be honest with

Scott Benner 38:35
you, and I'm embarrassed I can't believe I'm going to admit this. People shouldn't don't get a podcast because if you don't tell people the truth, they won't listen. You said guinea pig and I thought, well, there's there's my line. I found it. Okay.

Unknown Speaker 38:51
Goodbye hundreds of dollars worth of insulin for a guinea pig. It's I think you may have found my line. I'm really not just embarrassed and ashamed. And yet I'm saying it so

Kari 39:00
No, it's fine. Yeah, and that's that's the thing because I do see exotics. I have a lot. A lot more clients probably that I'm, what am I saying? I mean, the ones that will bring a guinea pig in with a urinary issue and we're actually pay surgery to remove a Bladder Stone. It's shocking. But think about how many households have hamsters and gerbils and guinea pigs and rabbits and you don't see 99% of those. I mean, they all stay home and when they're sick, they the poor little kid holds them and cries and they die. But you know, the ones that come in those owners will do anything.

Scott Benner 39:43
You think, Mike because I'm so sorry. I cut you off.

Kari 39:47
Yeah, no, you're fine because they do make the effort to come and vet to begin with versus most owners do not and that's understandable. I mean, that's part of our job. I'm not going to make someone feel bad because they don't Yeah. supposed to do something? And also diabetes, then

Scott Benner 40:03
you will? Absolutely. So if any of you out there have a diabetic hamster or gerbil and you're not getting it treated, this person is not gonna let you off the hook, just saying. Where did you feel this way prior to your daughter's diagnosis? How was it different prior to that?

Kari 40:19
Um, as far as like binary medicine and the overall No,

Scott Benner 40:22
I look, you did that? Yeah, with the diabetes specifically in animals like, like, 10 years ago, if somebody's dog had type one in there, like, I don't want to do this, where you just like, Yeah, right. Or, like, you

Kari 40:32
know, cuz I've always been, so I have this theory that, that's get into many medicine for one of three reasons. And I think we all start off with a high compassion for animals. But almost equally common is the interest in science and, and the third is money. But believe it or not, we are a very low paid profession compared to other doctorate degrees. And that goes all the way through our entire staff, technicians, everyone, I mean, when I graduated, I got off track, but when I graduated med school, the average starting salary was 45, grand. And Ohio State there was for doctorate programs. And the next highest, I think, was dentistry, or whatever it was, it was 90. So that gives you example, it's a very low paid profession. So a lot of people feel we get into it for the money, but we don't make awesome money compared to human MDS and whatnot. So anyway, back to my, my philosophy on this, a lot of us are in it for the science too. So I definitely feel like you know, I'm equally compassion for these animals in science. So I always loved like, the internal medicine stuff, I actually had myself all set up to kind of become a specialist, I was hoping for internal medicine, there's two tracks to be a specialist of enter medicine, you can do the residencies, you know, and work at the vet schools or the you know, the referral hospitals or you can kind of do an in clinic, you almost self study for boards, and you have to have a couple mentors that are specialists, you have to present case studies and stuff like that. So I always loved all the science and I was definitely not an expert on diabetes, but I enjoyed all that stuff a lot. So I had my timeline, I had my mentors and one of my two case studies to apply all that stuff set up. And I love school I miss school I miss learning I was super excited. Had my books ordered.

Scott Benner 42:33
You are exactly like my wife by the way. Like this. Yeah, my wife has a is a biology major. And she she very much was was on the way to go into medical school when some things in our life kind of throw her sideways. But she talks about science and and the medicine that she also thinks people are achy, I don't think she ever would have been a doctor who would have practiced.

Kari 42:56
Yeah, just can't do it. Yeah, but I was all set. And then my daughter was diagnosed and it just took the wind out of my sails. So I still claim to be kind of the narrative the group I kind of have a very informal title of medical director I love I love implementing new things and learning new things. I'm the one who reads every magazine that comes through I'm the one who actually enjoys going to see continuing education. So I love all that stuff. But I don't think I I don't predict I'll ever have the energy to go through the program.

Scott Benner 43:32
If I said to you, money wasn't a necessity. And you could do whatever you want right now. You'd go back to school.

Unknown Speaker 43:38
Oh, absolutely. Yeah, I

Unknown Speaker 43:39
know your type. Okay.

Kari 43:42
But I don't want another profession. So I would just have to be a specialist. Yeah, I don't I don't have any other desire to do anything different. Maybe like business school because it is there's so much better medicine that's business oriented, that we just don't learn. They're implementing more business classes probably a very small amount but in that programs these days but there was zero when I was there so that would be maybe interesting but more so would just be to specialize and learn more stuff. Yeah,

Scott Benner 44:17
I know. Trust me, I know your world. I know at least this part of you if that's for certain I'm can we shift gears for a second to something you said back in the first couple of minutes? talked about I think you were alluding to things have been tougher management wise for your daughter since hormones is that seem like where you're headed? Um, what are you seeing is it just generally blood sugars that are just generally higher than normal? Worse spikes?

Unknown Speaker 44:48
Yeah,

Unknown Speaker 44:49
yeah, we

Unknown Speaker 44:50
already have it.

Kari 44:51
Yeah, all the above, higher blood sugars, irregularities, and honestly, I would say the biggest problem is Just she's 14, and she doesn't want to be bothered. And she's not total, like Debbie Downer about diabetes, she actually more days than not and that's that she kind of enjoys it. She has like, tons of awesome friends. She loves camp. You know, she's proud of her hard work on it. She loves the tight relationship she and I have we're a team, you know, so. But could I bother her to like Pre-Bolus for a meal at the end of the world? Or you know, if I'm not there to Nagar, you know, she's at a friend's house or at her dad's house or whatever. All of a sudden, she's 350. I text her Did you eat Did you Bolus? No, I forgot. So I think it's mine. It's hormones and just what that does to all the, again, endocrinology is complex, everything works together. So how it's affecting everything, but also just the teenage boy has a attitude of whenever I'll be fine, mom. Yeah, my a Wednesday is 8.2. But it doesn't matter. It's fine. And you're

Scott Benner 46:11
like, no, it's not

Unknown Speaker 46:15
killing yourself.

Scott Benner 46:16
I got a Schnauzer named Butch living better than you over here. This is not okay.

Unknown Speaker 46:20
Yeah.

Scott Benner 46:21
Do you take a onesies from pets? How do you know you're doing okay? Just because it's alive?

Kari 46:30
So, uh, yeah, we I mean, we just we question and monitor. So the best test we do is for Tosa mean, for dogs and cats checks. Like I tell owners, it's a lot like a one C, because so many owners are familiar with that. You know, it just gives us the two to three week average, basically. You know, and I question them? Do they drink a lot? Or they pee a lot? Are they maintaining their way? You know, just stuff like that. And if they're happy and perky and fructose means acceptable. We check it off as a win.

Unknown Speaker 47:03
How do you?

Scott Benner 47:06
Do their lives get shortened? Like, is there any way to know if they're if they're losing a little off the end? or?

Kari 47:13
Yeah, I mean, statistically they kind of do. Yeah, I'm just because I don't think we can regulate them as well as hopefully most of us are on the human side. Unless you have a 14 year old stubborn girl. Um, yeah, I think their lifespans are shortened I would say so. Just it, it takes its toll on the body for sure.

Scott Benner 47:38
Can you kennel a dog that has like, like, I'm trying to imagine like, how do I go on vacation, if my dog has diabetes, it will look like handled give injections, some of them maybe

Kari 47:49
typical kennels walls. So in our area we have we have a couple like pet sitting services that have registered Tech's on staff and they can do you know, home visits. We do medical morning, we don't do regular morning, but any of our clients that have intense cases like seizure dogs, or or diabetics, will, will do medical boarding and manage them there. But then that implements a whole other problem of the eating. You know, a lot of the dogs and cats don't want to eat well, when they're there. Their stress is changing their numbers and, you know, so it's it's hard for

Scott Benner 48:24
exactly the same for a dog or a cat as it is for a person.

Kari 48:28
Yeah, so it's hard on the owners. There's some others that have like, an amazing neighbor who can give shots or you know, whatever. You know, there's there's creative ways to go about it. But it's hard. It ties them down for sure. And then you want them to be pretty close to 12 hours apart. Which how many of us are home exactly? 12 hours apart every day of our lives? Yeah.

Scott Benner 48:48
Yeah, right. Hey, can dogs do inhalers?

Kari 48:54
No, I'm, well, we have I have not heard of any inhaled insulin going for dogs yet. We do inhalers or asthma on cats. So I've never actually thought of that. I wonder if it'll evolve to be a cat treatment or even a dog treatment. But yeah, as of right now I have. This is the first I've ever thought of that or heard of it. No, I just

Scott Benner 49:21
sit here thinking if somebody can make it happen, it might be you. And I physically understand if like a animal could do an inhaler. Like because, like, yeah, the idea of an inhaler is you know, to push the button and then breathe.

Kari 49:33
Yeah. So we have those. Those chambers for us are called Aero cats. And I can't I don't know what they're called on the human side. But I know like my son had one for his. He had like temporary asthma when he was younger. And that those little tubular chambers with that little rubber mask at the end. So yeah, so when we use like Flo vent or something for asthma for cats. Dogs don't tend to get asthma. So I have Never use some hidden dog but cats. Yeah, we we just kind of hold that little mask up to shake it up and we'll push the plunger or let them take four or five breaths and they're done. So yeah, I don't know, let me know. You hear me?

Scott Benner 50:15
Yeah, let me put this right here just in case if anybody out there ever finds themselves giving their cat or dog a frezza, I did it. Okay, I made it happen. Because this might be years from now, it might take a while for my idea to get through the through the mainstream. But I'm taking I'm taking credit for this right now, March 31 2021.

Kari 50:35
Some interesting idea, now we're gonna have to look into it. I swear,

Scott Benner 50:39
if this ends up happening, I would like a procedure named after me, you. You and I get together and decide on the name later. So what do you I know this is going all over the place, but I'm having a good time. By the way. Thank you for being chatty. I think I could have started this off and gone. Hey, everyone, this is Carrie. She's a vet, her kids got diabetes. And then I could have maybe left the room and come back because she we're good at this. Thank you, please. So now I'm gleaning from our conversation that you have like, you know, your your daughter, your kids go back and forth between two households. Are they with you more than they are in the other place? Or vice versa?

Kari 51:15
Yeah, they're with me maybe like three fourths? Two thirds, three fourths? Yeah.

Scott Benner 51:20
So that presents its own management issues? I would imagine, right? Because you don't think about diabetes? I mean, nobody thinks about it exactly the same way. So I'm imagining your acts, and you don't have the same ideas about it. Yeah, okay.

Kari 51:32
That's a good point.

Scott Benner 51:34
Sorry, I don't want to get you in a fight on a podcast. But okay. And so, I've done I've done episodes about divorce, and diabetes. And there, you got to find the exact right person, they want to talk about it. And and I did want to actually guy came on, he was terrific. And his ex wife said he could talk about and everything he was so like, good about it. But the point is, is that he had one management style. And then his his ex did not have the same understanding of it. And so I'm wondering, when you're when, when a child's already kind of like, I don't really, I'm not all that interested in this? Because one household make that easier than the other. And then does that put you in a weird position where you want to say something, but you feel like it's not your place? But you know, it is?

Kari 52:18
Yeah, absolutely. And luckily, my kids didn't have to split households till like a year ago. So you know, if it if she was seven, or eight, and I think it'd be super hard, but but I mean, she has her phone, she she knows it better than him. I don't hope he never listens to this, but she knows the whole disease and everything she needs to do better than him. She knows how to change your pump site or CGM better than him. So I kind of just worked directly through her while she's over there. And once in a while, I've had some, you know, some issues where I can't reach her or this or that I have to reach out to him. And you know, he says he's on it. But, you know, humans have different opinions. But yeah, luckily, again, she's a trooper, even though she doesn't want to be bothered a lot of the time she she accepts, at this point, her diagnosis and heard her need to take care of herself. And so I and we, she and I are very tight and very good together. So we, you know, I just worked directly through her for the most part. But yeah, her numbers are not usually as good over there. But I just gotta pick my battles.

Scott Benner 53:44
Aside of the pick the battles vibe, does it? Are you heartbroken while it's happening? Like, how do you deal with because if you told me right now that I couldn't text my daughter and tell her that her blood sugar was 139, and I wanted it to be at five. I would I would have, I believe what they call Arjuna the entire time. Does it bother

Kari 54:04
you? I Yeah, it does. But I also have to just kind of choose to let some stuff go. I mean, there was one time a couple weeks ago, I was just infuriated. And she was over 400 for six hours. And I couldn't reach her and or she was with the girlfriend and she hates being around her and she doesn't want to talk to her. And she didn't want to answer the phone because she didn't want to talk to me in front of her. You know, blah, blah, blah. It's just this whole ordeal. So her dad and I don't talk a lot. But I did end up reaching out. We use a court order to App our family wizard. I reached out to that and I kind of was pretty straightforward. I'm like, This is unacceptable. She's do this. You Do that, you know? And he's like, Oh, well, I just I just now after I reached out to him, just check ketone. She's fine. She feels fine. She forgot to dose her cereal this morning. We've been chasing the numbers ever since. So six and a half hours later. Yeah. Like, you know, Chase and Miss Bolus cereal for six numbers.

Scott Benner 55:21
I don't want to misrepresent why you're here. And then. But you just said something. Now I have to tell you. I'd stop this recording right now and then say the words to you court ordered app and then let you talk for an hour. Because I would love to understand what that is. More importantly, I'd love to hear the story about how you got to it. But that's neither here nor there. So yeah, but I am imagining something that when you look back on you both cringe and laugh, that's all I'm saying. Well,

Kari 55:49
I cringe and laugh, he probably cringes and doesn't laugh. has an anchor. Yeah, hold

Scott Benner 55:58
other story. Yeah. That's not why you're here. But you fascinated me when you use the words court ordered app. I was like, Oh, my god, there's such a story behind that.

Unknown Speaker 56:06
Yeah.

Kari 56:08
It's been a rough road. Better better.

Scott Benner 56:12
Yeah, I am really, I am super Sorry to hear it. I grew up like, you know, in a divorced house. And I understand all the serious parts of it. And I don't understand I do want to ask you this one question. You don't have to elaborate. But if you're comfortable answering, do you think the diabetes make it harder to be married?

Kari 56:34
Yes. So that is a great question. I love to analyze, you know, think about stuff. So I would never want my daughter to feel this way. But I feel, you know, big battles in our lives, either bring us closer, or break us up. And I felt with her and me and even my son, he's an amazing support for her. And he adores her. I mean, it's strengthen the family significantly. And my ex for the first year was all on board. And I mean, we were a team of four, we battled this, we're doing great. He has a history of mental illness and stuff like that. After about a year, he just kind of tanked. And I feel it led to a lot of troubles within himself and within us. And it just went downhill downhill downhill from there. So yeah, unfortunately, I think that first year, it was just this almost weird blessing. I don't want to call it that. But it was, I mean, we were tapes, and nothing would stop us. And we were upbeat. We weren't when those families that you know, just kind of break down in tears every day about this, we were like, We got this, you can do it. We're gonna do it good. I immediately got involved with jdrf. And that's progressed to the point of like a board seat on the board. And you know, my daughter, and I do tons of advocacy. And I mean, it's become like a new way of life. And for her and me, we've stuck to it, but it it spiraled for him. And I think that affected his mental well being and our marriage and everything.

Scott Benner 58:21
So yeah, I'm sorry, is is there? Um, is there autoimmune on either your side of the family or his?

Kari 58:28
Yes. So no type ones? Well, there were no type ones. I have two or three autoimmune conditions, celiac and then a rare one called poly myositis. And then little stuff like Rhino ads and x month stuff like that. My mom had scleroderma, my aunt had lupus and krones tons of autoimmune and my daughter was diagnosed with hypothyroid at the same time as diabetes. And she doesn't know it better bloodwork last week showed a high celiac antibody. So I have to deal with that. But um, and then my, her dad side had none. But interestingly enough, a young child was diagnosed on his side. And it is his half sister's granddaughter. So I don't know if there's some genetic stuff there. But that's she was diagnosed within the year, last this year. You know, so I don't know if there's any sort of link there. But

Scott Benner 59:34
the reason I asked initially is because I've I'm starting to get a larger number of people who come on to talk about that they have type one and they're bipolar. And it started making me wonder if bipolar was autoimmune, and there are some writings that seem to feel like it may be and and I was so interested by that when you said that

Kari 59:54
but interesting. Yeah, yeah. Well, that that could relate to her father.

Scott Benner 1:00:07
Have you come from like an Irish background ish? Do you have any of that?

Kari 1:00:12
No, I'm I'm Swedish and German. He's a mix of everything.

Scott Benner 1:00:21
Yeah, type ones. Is it is sweden, sweden, one of those places where it barely exists? Or where it's prevalent?

Kari 1:00:27
I am lucky. Good. Good question. But I feel like it's low,

Scott Benner 1:00:32
most common chronic diseases affect you on? Yeah, Type One Diabetes is one of the most common chronic diseases that affect children in Sweden.

Kari 1:00:39
Oh, really? Oh, good to see,

Scott Benner 1:00:41
I just I, after you talk to enough people about this over and over again, you just start seeing connections, you know, like certain certain backgrounds, certain places on the globe, like it just, you know, like with that you've got a number of autoimmune and that your daughter might have celiac? Does she show any symptoms?

Kari 1:01:01
No. So interestingly enough, you know, they screener once or twice a year for all that stuff. She had one of the antibody levels was high, oh, three or four years ago, and it was kind of a rough patch of time as a family. And I was also switching her pump. I think that's when we went from animus to Medtronic. And, you know, she was relatively young, and she wasn't symptomatic. And I talked to her doctor and like, Can we like, you know, for this hurdle, the pomp and you know, just take a few months to kind of settle back down, and then we'll address it. She said, Sure. So by the time we got around to considering scoping her, she's like, you know what, let's run bloodwork again, and her values are normal. Okay, so we never scope, but I feel like she's been on that trajectory. And I'm an optimistic person. But I'm a realist. And I kind of in the back of my mind, she's just been on that trajectory. And it's coming. And so yeah, I haven't heard from the doctor yet. About the blood results, but they post online thought, Oh, no, here we are again. And I haven't told her.

Scott Benner 1:02:15
Yeah, I would think that's not gonna be fun. I yeah, I've had to tell my kids a number of medical things. And it's heartbreaking leading up to it. And then yeah, and you got to be that cheerleader and help them get through it the whole way. And it takes months for it to like sit in and

Unknown Speaker 1:02:31
yeah.

Kari 1:02:33
Feel, and maybe, you know, grass is greener, I don't know. I have celiac. Like I said, You know, I would rather have type one than celiac. I can handle a needle, I can handle carb counts. And granted, I I'm not living it like she is. So that's probably a very flippant thing to say. But you know, the celiac it's, I'm so ultra sensitive. And she is such a picky eater, such a picky eater. It's going to be super rough if she has to go gluten free. And

Unknown Speaker 1:03:09
I don't know. Well, I have

Scott Benner 1:03:09
I have a number of number of episodes with people who really leaned into it and did a great job with it and would now tell you, it doesn't impact their life in any of the ways that you're scared of. So

Kari 1:03:23
this celiac, yeah, yeah, it's Yeah. I mean, I just, I don't know. I mean, I'm not one of those celiacs that, like, are afraid to eat out or anything, but I am really leery because I'll have them flagged my meal and, and I'll still get sick. And you know, it makes it kind of difficult to work or difficult to leave the house or do you know, it's just, uh, I just hate the unknown. And the, the,

Unknown Speaker 1:03:52
you know,

Scott Benner 1:03:53
no, I can't imagine but I do think I understand what you're saying. Like the idea like, at some point, you might just take a bite of something that throws your days off, like not just a couple of hours, right, but a stretch of time.

Kari 1:04:06
Yeah, I mean, I get I get crazy sick. And I can't even pinpoint where but I know it's gluten because I feel a certain way for gluten exposure. And it doesn't have to be like, a one time early on. I kind of forgot I was cooking hamburgers on the grill for the kids and all their friends. And you know, next thing I know, I had eaten a hamburger on a bun and I'm like, Oh my gosh, what the heck am I doing and I didn't get out. My friends are like, Oh, I was so sick. But I mean, that was a big exposure, but just small stuff. Like, you know, I can tell when it's gluten exposure versus just, you know, flu or a little, you know, too much coffee or you know, whatever. And it's it's unexpected and it's frequent. And it's I just dread with her picky eating and her social life. From her,

Scott Benner 1:05:02
does she see? I mean, she obviously sees you live this way to sit. Does it look burdensome to her? through your eyes?

Kari 1:05:09
Um, it does. But she's super supportive. Like, like, if I make something gluten free, I don't have a gluten free household, I feed them and me separately sometimes. But if I make something gluten free, she wants to try it. She never likes it. But so she's very supportive. She thinks it's unfortunate, but I think she feeds off of my, you know, I'm not one to like, Woe is me, I'm gonna have a pity party. My life sucks. And so I think she realizes it's just another burden in life. And, you know, what doesn't make us makes us stronger, makes us stronger. And, you know, I remind her that I'm healthier for being gluten free, because that's what I need. And, you know, she's okay with it. But yeah, it'd be a whole nother story if

Scott Benner 1:06:06
all of a sudden she's like, Listen, I know, we have a rah rah on you. But for me, boohoo, like, I feel that way. You know, I think I think anybody feels that way when something is kind of, quote unquote, taken from them. But, you know, it sucks to, I mean, that you've got the experience that you're not, you know, you're not having a great time of celiac. So it's not like, you know what I mean, it's not like you've like, oh, I've got it all straight, and it works great. And I never get sick. And I'm sure it happens to everybody. And then she's seen. Yeah, you're right. She's not gonna have a great reaction. I do not. I'm sorry for you that you're gonna have to give her that.

Kari 1:06:46
Yeah. I mean, we'll see. I it was, it was mildly elevated, and just one value, but nice port girl.

Scott Benner 1:06:55
I really do. It sucks. I have to tell you, I really appreciate this. I did not know how this was going to go. But I just want to ask you just a couple of drill down questions at the end. So the people whose dogs like So one more time, like what would people notice in their pets that would make them feel like they have diabetes?

Kari 1:07:15
Um, so pretty similar. I mean, lots of thirst. accidents in the house. Sometimes vomiting, definite weight loss. So all the kind of the same things really. Okay. lethargic. Yeah, same stuff.

Scott Benner 1:07:33
All right. And then they go to you and say, I'm seeing what looks like diabetes, you do a quick test, I guess and then they're on their way.

Kari 1:07:42
Yeah, so for most of these people diabetes isn't on the radar. There's like a it doesn't feel that he's been laying around and then a lot of times they don't mention that they're drinking like crazy. But I have my list of questions for every sick patient, like how, you know water consumption up or down any bombing any, you know, and I check a weight and I almost always No, I mean, there's a distinct difference between, say a cat and kidney failure and a diabetic cat like there's there's just a drastic difference. But similarity they both drink more, right? You know, so I tell them well, I you know, I usually do a full blood panel, we run it in house, we have results in half an hour. Like I'd like to check the kidneys and the blood sugar and there's some other stuff. Let's

Unknown Speaker 1:08:23
see what's going on. And,

Unknown Speaker 1:08:24
you know,

Unknown Speaker 1:08:25
there it is. Cool. Well, I

Scott Benner 1:08:27
really appreciate this. I'm going to say thank you and stop. I have something I'm going to tell you personally that I think your daughter might like this comes to the podcast so I'm not gonna bother the people listening because they already know but I want you to know and you can do whatever you want with it. So thank you very very much for doing this. It was delightful now you're very flexible with time and everything and I appreciate that very much.

Unknown Speaker 1:08:51
Sure. No problem all right.

Scott Benner 1:08:58
Huge thanks to carry carry What am I doing I carry carry carry carry Jesus This is what happens we let me do this late at night. A huge thanks to Carrie for coming on the carry a huge thanks to carry carry carry a huge thanks to carry carry. What a huge thanks. How do you sell? Oh my god, I just talked myself out of saying her name. A huge thanks to khari I don't even know I'm forgetting. I give up. I could go back and listen to her say it again. It might be something to do with a Midwest accent. I can't tell you. But one way or the other. I really appreciate her coming on and it's late at night. So coming in. A huge thank you to one of today's sponsors. Je Vogue glucagon, find out more about chivo hypo pen at G Vogue glucagon.com forward slash juicebox you spell that g v o KEGL Uc ag o n.com. forward slash juicebox. I'd also like to thank the Contour Next One blood glucose meter. I know it's not really a person, I can't thank the meter. But you know, it's the Contour Next One blood glucose meter. That's what you're supposed to know about. But it's made by assenza. So if I was really thanking somebody be like, I'd like to thank assenza then you'd be like, who in the hell is ascencio? Scott, which is why just say, I'd like to thank the Contour Next One blood glucose meter, check out there Second Chance test strips, by the way that the meter itself, it might actually be cheaper to buy in cash than than other meters are through your insurance. That's like another thing you can find out on that website. The website rocks, Contour Next One comm forward slash juice box head over and take a look around. While making the ads for this episode, I learned about myself that if you come on the podcast and say to me, hey, Scott, tell me what you think about people who scam people on Facebook and try to get them to buy t shirts. I could probably rant and rave about it for about 40 minutes. Which I didn't know until just now. I'm assuming you know, you're like Oh, yeah. That's not surprising to me, Scott. But to me, it was surprising. I was like, Oh, I have a lot of feelings about this. Yeah, right. That's pretty much it.


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#478 DKA on a Plane

Scott Benner

Jen's daughter has the most harrowing type 1 diagnosis story that I've ever heard.

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

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

Scott Benner 0:00
Hello friends and welcome to Episode 478 of the Juicebox Podcast.

On today's episode, I'll be speaking with Jennifer, she's the mom of a child with Type One Diabetes, living overseas, I guess, overseas, if you live here, if you live there, then I'm over. That's not the point. They don't live in America. And the diagnosis story that she's going to share with us about her child is in fact, the most harrowing that I've ever heard. And that's saying something. I think you're going to enjoy this episode. The conversation is terrific. She's terrific, great conversation, but my goodness, wait, wait, wait, are you here? While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. We're becoming bold with insulin.

Real quick, if you're looking for the diabetes pro tip series, they're available at diabetes pro tip comm where they begin at Episode 210 right there in your podcast player. If you're listening in the podcast player, please follow and subscribe.

This episode of The Juicebox Podcast is sponsored by the Dexcom g six continuous glucose monitor. And by the Omni pod tubeless insulin pump, you can find out if you're eligible for a free 30 day trial of the Omni pod dash at Omni pod.com forward slash juicebox. And to get started with the Dexcom, je six or to learn more, you're going to want to go to dexcom.com Ford slash juicebox. When you're finished with all that, head on over to touched by type one.org and see what they're up to. They're also on Facebook, and Instagram. links to these and all of the sponsors are available right there in the show notes of your podcast player. And at Juicebox. Podcast calm.

Jen 2:16
Hi, my name is Jen. I am the mom of two girls. One is three and one is six. And Nora is the one who has type one diabetes.

Scott Benner 2:26
And how old is Nora? She said she's the sex. Okay, yeah.

Unknown Speaker 2:30
Well, she'll

Jen 2:31
be seven here in a few months. So Gosh, I don't know where time goes.

Scott Benner 2:34
Tell me when she was diagnosed.

Jen 2:36
She was diagnosed when she was three and a half. So we've been doing this for for almost three years now.

Scott Benner 2:45
Isn't it funny? You've been doing it for like two and a half years, you know, like three years. 510 feels like a while now.

Jen 2:51
I know. Right? Like at one point, it felt like we couldn't get through the day. Like it was just it took forever to understand. And then it and then it didn't then it's just now it's part of life.

Scott Benner 3:01
When did that happen? The changeover between this is untenable to it's part of my life.

Jen 3:08
Probably when we got good at it, and by good. I mean, we understood what was happening. So we didn't always like the results. But like we understood what, why why we were why what was happening, what was good.

Scott Benner 3:21
Isn't that an interesting distinction?

Jen 3:24
Yeah, it is. It's a big distinction because I like I don't freak out when she's high. And I know why. Or she's low. And I know why. Whereas before it was, I don't know, there's I feel like there's a lot of common phrases like, Well, you know, it's diabetes and and what can you do? And, and, and I felt that way, I was totally there in the beginning and through through much of their beginning of it and, and no, yeah, there might be moments. I'm like, wow, I wonder what this could be. And eventually I'll be able to figure out I might not know in the moment, but I'll know. Eventually, it was a growth. Oh, she's getting sick. Oh, she did have a few extra skills at school today that I didn't know about or whatever. You know,

Scott Benner 4:11
I think it gets exciting when you look at the you have a Dexcom g six and you're using tandem pump. Is that right?

Unknown Speaker 4:17
That's right.

Scott Benner 4:19
I'm excited when I look down at the CGM and I look at the line and in a split second. My brain goes Oh, that pumps lights going bad. And yeah, I actually know what that looks like.

Jen 4:33
I'm getting there. Yeah, this is um, I don't know. I feel like it was there a while ago and this whole lockdown. We are actually in Amman, Jordan. And so we've had some pretty strict lockdowns over here. And the inactivity has been shockingly difficult for us to see her. See her change her activity level changes and her blood sugar. Just kind of revolts are getting sitting and not going outside as much.

Scott Benner 5:04
So she needs more insulin, I'm guessing for the sedentary lifestyle.

Jen 5:09
Yeah, she does. But she also then has a lot more weird lows like so that the minute she does something that's exciting. And at this point, even online learning is exciting. Well, I mean, it's great. Like she's in first grade, they're doing some fantastic stuff. But the minute she stops doing whatever is exciting, whether it's seeing a friend for a few minutes or being online, and she just drops, like she just drops, her body just stops. And so she's having some weird lows lately, too. So in addition to some highs, because of the extra insulin she's needed. She's having lots of drops that we hadn't seen in quite some time,

Scott Benner 5:46
I would expect and guess that you're using so much extra probably basil, and maybe even boluses for that, that inactivity, because our bodies not exercising and not moving and not using the insulin more efficiently. That it's I wonder how to like put it into a picture I guess. But it to me, it's the difference between football in the in the 40s and football today. Meaning if you if you look at offensive lineman, this is going to be a strange thing. But do you watch football? Or have I lost you already? Yeah, he got me out here. Okay, so, so offensive lineman. Back in the day, we're just these big, dopey guys who stood up and we're a wall of life, and they just kind of stood there and you couldn't get around them. And now everyone's such an athlete, right? Like they're, they're carved down to like bone and muscle. And they're, you know, they're they do things now that are absolutely crazy. And I think of that sort of similarly, meaning that when you're very sedentary and kind of doughy and slow, you just need this ton of insulin to hold down your blood sugar, this just big lazy, like flop like a weighted blanket on top of you of insulin. But when you start moving, everything starts being more efficient. And now suddenly, your body doesn't need all of that insulin that's in there, and then you slam down low. And it's

Jen 7:16
totally Yeah, I get that. Except for I'm talking about, like, cuz we were able to go outside, we're not totally locked down, except for one day a week here, we're physically able to go outside for most of the time. So we can go ride our bikes, we can go for walks, she has these dance videos on TV she likes to do to keep active inside. But I'm talking about when she's at school from nine to 230 online with very little like, their breaks and things. And it's first grade. So there's a little bit of activity, but not much when the school day ends, or her activity. And so like she's done with her work, and she has maybe an hour break, she'll drop for that break.

Scott Benner 7:53
Well, stress anxiety.

Jen 7:55
Yeah. And that's what I think it is. That's what I like, I'm coming to the realization that this is because we've only been doing two weeks, three weeks of online learning. And I'm watching it and it's it's we were lucky we were doing well here for the longest time. So she was in school. Last year, it closed down a little bit. And then she was she started school end of August, and she had been in school until a few weeks ago.

Scott Benner 8:17
And I want to amend my my answer slightly, meaning maybe it's not as much about the activity is is about the the world of life and like the stress and anxiety of listening and paying attention to focusing or just maybe doing something she's not completely comfortable with. So she's got more of a maybe an adrenaline or an anxiety high that you're fighting with insulin and then all of a sudden when that goes away, that would make sense why it drops even more quickly. Because that just like a split second. It's interesting.

Jen 8:47
It is but it's hard to predict when it's gonna happen, because it's not something that I'm watching. I can't like, I can't know she's gonna write her assignment in 20 minutes or an hour. And so when she says she's done, I know it because I see her blood sugar at this point.

Scott Benner 9:02
I know you're done cuz I'm running around the house looking for juice.

Jen 9:05
Yeah, exactly. No, no, we've actually have a diabetes drawer in her at home desk, which has Skittles right there. I'm like, go for it. You know what you need.

Scott Benner 9:14
I wonder if you don't choose a number of Skittles. And try one day as soon as school and she pops the Skittles in her mouth and see what happens.

Jen 9:23
That's what I think we're gonna go to we've talked about maybe doing a snack a few minutes before school and like maybe 1520 minutes before school and she just has has a little snack. And we'll we'll see maybe maybe that will be a good solution because it's it's now regular enough that I know it's coming. I just don't I don't quite know how to place it yet, but we're going to try a few things to see if we can sort that out.

Scott Benner 9:47
I have an interview coming up this weekend. That will be out with a concert cellist Her name's Alyssa Wyler Stein, and she told me a story while we were talking about her husband getting surgery and how her blood sugar Just shot up the entire time he was in surgery and would not come down No matter how much insulin she gave herself until she knew he was okay. To that, yeah,

Unknown Speaker 10:09
it's

Jen 10:10
just as hard. Yeah. And and it's, it's fascinating because I can see it I was shocked when she went back to school. Because they were they were back but with with masks and with like plexiglass in between the kids and very much sitting down and I finally I was there and I sat in class with him for maybe the third day or fourth day, cuz I'm like, something's different this year, like she's needing more insulin, and it's not working. So we've changed her pump, we've done a whole bunch of things, and I looked in, they don't have the socialists, they don't have the moving, they don't have the interactions that cause you to move during the day. And I hadn't thought about that.

Scott Benner 10:49
Ya know, it's that it happens to I think everyone almost and it's whether or not you see it or not, whether you can step back and, and see the causality and it's cool that you did, it's just and you'll figure it out. It really is. Yeah, yeah. You know, it's more insulin and then finding a better way of stopping below. before it happens. Yeah, you know,

Jen 11:12
yeah. And that's where we are that we started. We started a few different choices. And they're not they're not quite there yet. We've got a little bit more tweaking to do, but I have no doubt we will get there. Cool. Always. We always have. So we'll keep plugging away.

Scott Benner 11:26
So we have to figure a couple of things out here. One is, you seem to live. But you have a pretty he's a pretty white lady name, but you live somewhere else. No, it's

Jen 11:40
true. I was born in Pittsburgh, Pennsylvania, and we I haven't lived in America, really? Since I was 18.

Scott Benner 11:49
I have to tell you had you told me you were born in Pittsburgh. I wouldn't have asked if you knew what football was. That's for sure.

Unknown Speaker 11:54
Yeah. Right. Well, yeah, no, I

Jen 11:56
was born in the 80s. in Pittsburgh. So yes, I know what football is. No kidding. My parents have made sure of that.

Scott Benner 12:03
How do you leave the country? Anything? Are you running? Quickly, Jennifer? That's all I need to

Jen 12:10
know. Thankfully, no, no. The um, you know, those those career days at school, and somebody comes in and talk to you about it. And this guy said he just up and left at 18. And he went to study in Grenoble in France, and he loved his life of traveling, and I came home and I told my dad, I had my acceptance letter ready to go into u dub in Washington State. And he's like, Well, you could do that. And it really caused me to pause. I'm like, yeah, maybe maybe I could. Yeah, so I found it. I found a university and I went to university in in France, and tried to come back for a little bit of time to America after that, and it it. It didn't work. Were lots of years later, and I'm still abroad.

Scott Benner 13:00
So do you speak French fluently from that experience?

Jen 13:03
At one point, it was it was good. But that was a long time ago. I graduated in 2004. And yes, I speak enough to get by on a vacation whenever we could travel again. Um, I wouldn't call it fluent. anymore. It there just has been so little practice. And we're working on another language. Now since we're in the Middle East. No, Arabic is tricky. A lot.

Scott Benner 13:27
So a couple of things. First of all, your dad seems like a special guy to say that so freely, you know, because I've had those moments where Arden's like, She's like, do you think I could go and go to France and study fashion? And we're like, Yeah, of course. But what you mean is no, please stay here. But you don't say it.

Unknown Speaker 13:47
Right. I mean, I

Jen 13:47
don't think I fully realized that what he said how how hard that must have been until I had kids and I'm like, wow, like you want the best for them. But and that was a that was a big thing he said and and I don't know if he intended it to hit me so profoundly but it did

Scott Benner 14:05
you imagine he's he just walks into the other room. This is your mom. She's a solid dad and I just did out there I told her where she could go to France shall never go it's no big deal. You don't realize growing up in Pittsburgh make you want to go to Pittsburgh sometimes too. So we're just wherever you grow up, you know, like you're nice. And it seems small. It's true.

Jen 14:24
Yeah, I was only in Pittsburgh for a few months. And then I grew up in Washington State

Unknown Speaker 14:29
No kidding. But

Jen 14:32
yeah, I mean it's it's not that I loved where I grew up. I loved you know, I The hardest part obviously is being so far away from my family. Um, but I absolutely love it. I love being abroad. I love I love my family. I love the that we've the life we've created and all these random but not random places, and I don't know. It's cool.

Unknown Speaker 14:53
Working out.

Scott Benner 14:54
Where did you meet your husband in Paris. Okay, but he wasn't from France, either.

Jen 15:00
No, no, that was the one thing my grandma said she's like, don't go to France and meet a French guy moved to France. But now he's he's actually from Yemen. So, um, when we got married, I moved to Yemen.

Scott Benner 15:13
Your grandmother should have more specifically said don't go to France meet a guy from Yemen and move the Jordan.

Unknown Speaker 15:19
Well, right.

Jen 15:19
I know. It's true. Like, nobody could have predicted any of the craziness that has happened once I got my acceptance into France to university there, but yeah,

Scott Benner 15:30
that's really something. Okay, how long have you guys been together?

Unknown Speaker 15:34
Uh, um,

Jen 15:35
I was in Paris when you read in Paris? 2002. To 2005.

Scott Benner 15:41
Okay, so you've been out you were married a good bit before you had children then too?

Jen 15:47
Well, yeah, I, um, we. He worked for a while. And I actually decided that I wanted to live in America and work. And, and that was the direction we were going. So I went back to America, and I got a job and I loved it. And it was fantastic. And then decided to get my master's degree. And what better opportunity to go abroad than that. So I went to the University of Edinburgh, in Scotland, for my masters, and I haven't been back to America since except for vacations. We decided to get married as soon as I graduated, and that's when I moved to Yemen. Wow. So, john, you

Scott Benner 16:24
have wanderlust?

Unknown Speaker 16:26
I do? No, no, no,

Jen 16:28
this this this lockdown without traveling as Jeremy bunker?

Scott Benner 16:31
Well, that's what I was gonna get to is. So are you in a spacious palace over there. So it's not so bad. I started having this thought, yesterday, I live in what I think would be a fairly modest home in America. And I have had a mattress that my we bought, we got my mom a mattress, she didn't like it. And I didn't have the heart to just toss it. I couldn't find anybody who wanted it. I drove the mattress from my mom to my house, I'm storing it here. And two weekends ago. I say to myself, we don't have the space for this mattress, I'm gonna have to toss this mattress in the garbage, no one will take it. And as I do that, my brother says, Hey, I could use that mattress for my daughter. I was like, Oh, that's great. So my brother moved recently, and I had been to his place yet, I took him to the mattress yesterday. And I got there and thought, Oh, my gosh, his place is so much smaller than mine. And then I noticed that he and you know, is what he's not married, but his partner. They're both working in a room together. There's two kilometers set up. And I'm like, oh, boy, like, I wonder how long? That's like, forget my brother. Like, how long is that going to work?

Jen 17:50
Right. It's true. We we set Nora, we got our desk and put it in my office. And, and there are times I'm like, why? Like we all need space. And we did. Thankfully, we have enough space to kind of have everybody do their own their own thing most of the time. We're missing the outdoors? For sure. Yeah, we have.

Scott Benner 18:08
So I found myself complaining that we were all in separate rooms doing something. And now I feel lucky that we have separate rooms. Yeah. And but tell me about the protocols that you're living under? How do they because you said one day a week you can? Like how does it all work there?

You know, you need peace of mind, you need comfort, you need a little respite? What can offer that to you? Well, in my opinion, the data that comes back from the Dexcom g six continuous glucose monitor. Now, why is that? Well, if you're using insulin, if you have type one, or type two diabetes, or you love someone who does, being able to see the speed, and direction, and number of that person's blood sugar is invaluable. Let me tell you a little more. My daughter had breakfast this morning. And we missed a little bit on it. You know what I mean? Like it's been a couple of hours now. And her blood sugar is still 135. And I've been able to see over the last 45 minutes, that there's just no more impact from the insulin that we used. So we very comfortably gave her more to move this 135 number, somewhere where we're more comfortable. It wasn't just 135 By the way, it was 135 and steady, stable, not following or dropping. The Dexcom showed me that it showed me how long it had been stable. And then you get confidence from that information. You think Alright, this really is some stability. This looks like where we're where we're at now. Well, I'm 35 I'm going to do something about it. Now without the Dexcom I might be thinking I don't know this still could go down or maybe it's gonna I don't know. Like I'm gonna wait and see. But I don't do a lot of waiting and seeing since we found Dexcom I'm seeing my daughter's blood sugar on my eye. Phone, you could also see it on yours or your Android phone. And you can share that data with up to 10 followers of your choosing. Check it out dexcom.com forward slash juicebox. Sometimes you want to do something, but you just can't bring yourself to make a change. I understand that. And so does Omni pod. That's why they're offering some of you a free, no obligation trial of the Omni pod dash that lasts for 30 days a 30 day free trial, you may be eligible head over right now to find out Omni pod comm forward slash juice box. Can you imagine? Of course you can't you mean 30 days, you know how long that is? Anyway, you get this, this little whatever we're gonna call it trial, right? And you give it a whirl 30 days is enough time to decide I like this, I don't like this, let me find out, you know how I feel no pressure, maybe just like, I don't want it. And that's okay. Or maybe you do want it. And that's great. Now, you know, choice is what you should have choices but on the pod wants you to have, they want you to be able to make a decision without a lot of pressure or that feeling like oh, I don't want to make this big decision and then not like it. What if I do and if I don't like you shouldn't have to feel like that. Just head over to Omni pod.com forward slash juice box and see if you're eligible for the free 30 day trial of the Omni pod dash. That's the way to get started. If you're not looking for a big 30 day trial on the pod also offers a free no obligation demo, it's just one nonfunctioning pod that you can actually wear just to see how you feel about it. There's a lot of options over there and on the pod.com, forward slash juicebox. And I would like it very much if you went and took advantage of them. Don't forget while you're out on the internet, getting around the pod, get your Dexcom that you should be checking out touched by type one.org. And finding them on Instagram, and Facebook. They're a great organization doing wonderful things for people with type one diabetes. And all they've asked me to tell you is that they'd like it for you to know that. And for you to check them out. At touched by type one.

Jen 22:14
They've put in some restrictions. And they were they started a while ago. And then they were lifted because we were doing great, like people were concerned here when there were 22 cases a day. And it was nothing like compared to the world and to what I saw with my family in America or or even anywhere else. And so the restrictions got lifted. And then and then as a not that long ago, the cases just started going up. So they've started to put some new restrictions and so they closed down

Unknown Speaker 22:42
schools for a while

Jen 22:43
it was a fourth grade and above. And then kindergarten through third grade, I think in 12th grade were allowed to be on campus and then and that went on for I think a few weeks. And then I want to say two weeks ago now or three weeks ago now. They shut down all of the schools, nurseries are allowed to stay open, but schools are closed down. And then I think at that point is when they decided that Friday, we can tear Friday, Saturday. So Friday. There's a 24 hour curfew essentially. So there's a curfew in the night every night. I can't remember exactly what I'm not a night person. So it doesn't matter.

Unknown Speaker 23:24
Like it doesn't matter to me.

Jen 23:25
Yeah, it's it's either 11 or 12 o'clock at night, not like this in a cafe right now anyways, with everything else going on, um, but 11 or 12 at night to 6am is there's a curfew and then every Friday for 24 hours, there's a curfew. So that means you're not allowed to leave your property.

Unknown Speaker 23:42
Gotcha.

Jen 23:43
Wow. And we have an apartment so

Unknown Speaker 23:45
you're not leaving an apartment?

Jen 23:47
Well, we're not like words, like we can go run around in the garage and do some bubbles on the roof. But we're not going to go for a walk. We're not going to do anything else like that.

Unknown Speaker 23:55
Is it working? Or numbers going the other way?

Jen 23:58
For a while it wise and no, it's things are going a little more about 2025 between 2020 500 cases a day, I think and 30 ish deaths which I get is still good compared to a lot of different countries. But for the majority of the time, it was a bad day if there were 50 cases and no deaths right yeah, so there's there's been a significant change and I know that they're doing what they can to try to sort it all out while not completely destroying the economy and I applaud them for that for all the government's honestly because there's just so much balance that has to be happening right now. with everybody wanting different things

Scott Benner 24:39
was your daughter. We're both your daughter's born in Jordan.

Jen 24:44
No Sonora was born when we were living in Yemen, but we didn't have her in Yemen. We went back to America for that. Um, and then Dahlia the three year old was born here.

Scott Benner 24:56
What are their first languages English Okay, so you guys, you guys out

Jen 25:01
there, but they're learning Arabic? Yeah, yeah. No, my husband, if you were to have him, like just talk right now to you, he you would not guess that he had an accent from a country. Okay. And he can put it on obviously and he will sound like he has an accent if he tries but I wouldn't have assumed that he grew up outside of America if I hadn't asked him.

Scott Benner 25:21
So you guys are learning the language? Because you're because you feel like you're gonna stay in that they're gonna grow up there.

Jen 25:27
Yep, well, and it's their family too. Like he's maybe it's, it's half of them who they are is an Arabic speaking people. So they they need that's how they would communicate me. Obviously his family's fantastic. And they all know English. So they, they talk far too much English just to learn our Arabic very well. But that's it's lovely. Because then we, the girls don't aren't isolated because of the language. So they are learning. We're all learning.

Scott Benner 25:58
How is it? How does the healthcare system work there? What's the process?

Unknown Speaker 26:05
It's pretty great. Well,

Unknown Speaker 26:07
um,

Jen 26:07
if you're comparing it to America, it's fantastic. We're lucky to be here.

Unknown Speaker 26:13
I'm

Jen 26:15
coming from Yemen, we have access to things which is so important, especially for Nora now, we don't have to worry about getting the technology or whatever else. Um, so insulin here is equates to about $25 a vial. You don't need insurance, you don't need a prescription. You just go in and say what you need. I need Nova rapid and they give you How many do you need? Do you want some ice with that? It's literally like that simple. It takes me about like, it's a huge culture shock go into America, and we're there for the summer for a holiday or whatever. And they're like, put your prescription hasn't been renewed yet new, or you have to call this and I'm like, yeah, I forgot. Like, you have to prove that you still have diabetes. Like, it's not going away. Like why? Why do you have to keep proving it. But I get that there's a whole bunch of other things. Why you have to do that. But um, things are available here. Obviously, you can have test strips, you can have, like good meters, there's Dexcom Medtronic are both here, obviously, we, you know that we're on a tandem sum. And we have chosen to do that because we love the fact that you can upgrade with an online

Unknown Speaker 27:29
update. Yeah.

Jen 27:30
So that you don't have to be anywhere particularly in the world, you just have to have the prescription from the doctor. So nor does have to endocrinologist she has the one here that we see when we're here. was fantastic. Pretty hands off but but there when we need her in a pinch there when we have any questions, and then a doctor in America that we see once a year and we get a prescription so that we can maintain the technology that we like, because while there is Dexcom here it there on chief orangey five, actually, although i know i think they just said that they're phasing out the g4 finally. And Medtronic is also one one generation behind I think they've got the 640. It's even different from what it's 640 or 630. I know there's a little bit different because it's the year peon version.

Scott Benner 28:17
Wow, that's interesting. They can kind of balance those two worlds and end up getting what you need out of it.

Jen 28:24
Yeah, like I gotta tell you, like I have a phone with an American SIM card that's on all the time, in addition to my Jordanian SIM card, and I get random calls at the middle of the night. Excuse me, it's time for you to reorder this. And I'm like, Oh, yeah, I forgot this was the night I need to, I need to be up and do my American insurance or ordering or whatever it is. And so yeah, I mean, we're doing this because it's the best care for Nora and we're lucky to be able to do that and to have the ability to maneuver between the two worlds by

Scott Benner 28:55
just helping healthcare workers healthcare funnel through employment there or does it does everyone have it and you just there's a certain amount you pay? How does that part work?

Jen 29:04
If there would be healthcare for everybody here if you were Jordanian. But because we are not we have private insurance. Now, because we are American living in a Middle Eastern country, or for that matter, Europe, like they kind of all bundled together a lot of the times if you're trying to get everything together our insurances It's strange. It's It's very, it's very complicated. And it turns out to be more like travel insurance for me and the girls. Because we want to include America. And because because we need that bit we're there we go to visit my family in the summer. Because we need that bit in America if the girls were to break their leg or like like in Nora's case, God forbid we have to ground a plane because somebody is diagnosed with this new disease. We need it to cover us kind of everywhere. So we renew it every year and Hope it keeps on going at this point, it's my April stress every year just to make sure that it, it continues because I know that we can't necessarily be covered as what we want worldwide if we get it strictly from America, and they will not cover us from over here. And if we try to get it through a company, then it's like, ridiculously expensive. So

Scott Benner 30:24
Wow, that's a lot. So it must be great living there if you guys are willing to do

Unknown Speaker 30:29
it is no, no,

Jen 30:30
there's huge trade offs. Like we love living here where we're thankful to be in a place because my husband still does go back and forth where his job and Yemen. So we tried being in America and the 12 hour timezone change or the 10, or whatever it is, when you have Daylight Savings Time to the east, to the west coast. Is, is really hard it like it's too far away. So we're we're happy to be here in a place that has welcomed us. And I can't speak highly enough about Jordan.

Scott Benner 31:00
So you basically can't live in America for one of the reasons because your husband can't work then because the time shift is too different.

Jen 31:08
Well, no, he he, he goes to Yemen. So he still travels for six weeks, two months at a time and he'll go working him in. And then so if we want to talk to him at all, or if we want to see him or the kids, I mean, I can say we can figure things out. But the kids, obviously with a 12 hour timezone change. It is really hard in America to get those toxic, meaningful. And if there's too much traveling involved to try to get like it's a three hour flight from here to there. So it's it's possible to do. I wouldn't say simply, especially right now, but it's possible to do much less complicated.

Scott Benner 31:50
I'm just trying to imagine that your kids at like three in the morning like you're holding the phone in front of face like say hi to daddy.

Unknown Speaker 31:54
Yeah.

Jen 31:57
I'm assuming it'd be a lot like if if you give more juice in the middle of night where she's got like half an eye open and she looks at me like, what do you think you're doing? And then she rolls over and she's like, I'll see you later, mom.

Scott Benner 32:09
I stopped asking many years ago. Do you remember having a juice last night? That doesn't? Nobody remember? Yeah. No,

Jen 32:16
the only like, the only time I know she remembers is if it was particularly a bad night and she has to go the bathroom potential wakeup so that balance will come and be like she did we have a lot of juice tonight. Yes, sir. is bad night, honey. That's hilarious. It's funny.

Scott Benner 32:29
Arden only has to pee overnight if her blood sugar is high, not if it's been low, I guess she she's must have a tank somewhere she puts that juice in so

Unknown Speaker 32:37
well, um, and

Jen 32:38
it, like I said doesn't happen much. But if we completely do something wrong, it was in new food or whatever. And she's just low for an extended period of time, it actually sometimes will take her quite a bit of juice to come up. So, and I think she, she just goes about them a lot. So

Scott Benner 32:56
listen, I'm one of those people. If I'm up, I might as well go. I just figure you know, what the heck? I've maybe she's in the same part. Feeling

Jen 33:05
make sense to me?

Scott Benner 33:06
Yeah, no kidding, right? You're already in that direction? Well, how did you find? Like, how did you locate the podcast? And has it helped you at all?

Jen 33:17
So yes, it has helped me a lot. So Nora was diagnosed in a very strange way. But the way back to here where we live permanently in Jordan, it took us some time to get here. And then the rules for food and the rules for diagnosing or not diagnosing. But for managing. Because we were in three countries before we finally got back here we were in Canada, we were an American, we were here and they all had different versions of how they should be handled. And nobody was willing to kind of walk us through the huge details, although they were all very kind and very, you know, generous with what they wanted. But they're like, but you need to find what works for you wherever you're going to be with whatever technology or things you can have. So we didn't have a fantastically solid start to diabetes. Um,

Unknown Speaker 34:10
and then.

Jen 34:12
Okay, so then, and we and we were doing fine ish, we kind of got through for about a year. And then we had to redo the insurance and they didn't ignore it. They said her agency was too high and it was unreasonable for them to try to it wasn't an American company and it was something else we were trying to do. And I was like, What are doctors say she's doing? Well, like she had a seven ish seven and a half ish, a one c it was an

Unknown Speaker 34:39
awful. Um,

Scott Benner 34:40
so the insurance company used her a one C to try to deny insurance.

Jen 34:45
Yeah. And, and, and to be honest, like, it took me a long time to be okay, like, I feel like the her diagnosis was really hard on me. Um, it was a really, it was it took me a long time. Trying to be okay with thinking about it with with with with everything. So I just kind of we got by for a long time and our doctors were saying that we were doing okay that there were things we can do better and then she was denied insurance and I was like, No, like, yeah, okay, we can manage here we can we can spend 25 GED because at that point, I think she was using like half a vial or she was on a pen at that point. So we were using like, half a pen a month, like there was no enzyme being used in such a tiny little body. But I'm like, but the doctor saying we're okay, so why is this person not saying we're okay. And somehow it clicked at that point that there might be more I could do. For some reason I hadn't thought like the doctors were just saying you keep going, you're doing fine. And as they do, and they're very, you know, supportive and everything. So then we then I started looking, and I found I found sugar surfing actually. And I was like, well, this is interesting, we had never thought about some of the concepts of managing a little bit more fluidly. or concepts like giving insulin before the kid eats. And then making it up if if something goes wrong with a young kid who suddenly doesn't want to finish, you know, spaghetti or whatever. And so it got me thinking. And that's at that point, that's when we kind of dropped into the fives for her agency. And we've been that way now for a year and a half for two years. And, but I still feel like I still felt like and this was maybe five, four months ago, five months ago, in the beginning of the when she first came home from so last March. Um, she was going flow a lot. And at that point, I realized that we were masking perhaps a lot of what was happening at school with whatever was happening like it just like it was like we just kept kind of pushing through. And there was a lot of room for improvement. So while she had a pretty good center deviation, she was low a lot more than I was comfortable with. And I think the juice was causing some other issues with her maybe with her eating or with some other stuff. Like she was just full because she was being pumped a lot. And so I then I started looking, I'm like, okay, so there's got to be maybe some more information out there that I'm missing. And that's when I found the podcast and started trying to figure out what we can do to to bring to bring down her lows, like not bring down but you know, like reduce the amount of lows that she's having. The amount of essentially what he cared about was making sure that she wasn't having too much chips or Skittles.

Scott Benner 37:37
Yeah, looking for more stability. Jen, you have been on a What's the time, like, frame for that? How long did all that take?

Unknown Speaker 37:47
Which like

Scott Benner 37:48
everything you just said, a year of your life to get from A to B? Was it two years? How long did that like? Ignore I was

Jen 37:56
diagnosed five weeks after Dahlia was born. Okay,

Scott Benner 38:02
hold on, hold on, hold on, slow down. There we go. So five weeks after your second daughter's born, your first daughter is diagnosed because you said it was hard on you. And you were It sounds like you were struggling? Can we talk about that for a minute? Like the struggle you had?

Jen 38:16
Yeah, cool. So we, um, we come every summer we ever since we moved abroad, that was kind of our deal that we would still spend the summers with my family because, you know, we miss them. And then that gives us a good chunk of time to be an American, I can go visit my grandma or my sister, whoever.

Unknown Speaker 38:33
Um,

Jen 38:34
so we were on our way to America. I'm with a five week old baby. And here let me like rewind a minute, because we did go to a doctor here we did notice that Nora was acting strange, like she was drinking a little bit more. She had an accident here there despite being potty trained. And the doctor here said she was fine. Like that she was jealous of the new baby. Um, and so we're like, oh,

Unknown Speaker 39:01
my God,

Jen 39:02
I'm tired. Like, she's a doctor. She's certified in America. Like, she must know what she's talking about. And well, we'll get through this and we'll go do our annual checkup in America with the doctor there and show him or put us on a plane. And I was by myself with the two girls. And Nora went into DK somewhere between London and Phoenix over a huge body of water.

Unknown Speaker 39:26
And

Jen 39:29
she was we knew she wasn't feeling fantastic, but I just figured it was maybe nerves or I don't know if we're sure there's a lot going on. And so we just kind of we kind of like ignore this just push through on the other end is grandma grandpa will just take a nap on the airplane and watch some cool movies. And she's like, yeah, sure, mom. And then, I don't know two or three hours after this is a 10 hour flight after takeoff. She just stopped responding kind of um She, yeah, she just kind of it didn't look okay. And she threw up a couple times on the airplane. And we were lucky, actually, the head of Phoenix Children's Hospital was on the airplane with us. Then he came over and he checked her. And nobody was telling me actually what's going on. But they're like, I think it might be time for us to land the plane, really. And the first place we can land, the plane is in Canada. And I think it's about two hours away. We're too far to go back. And we're not there yet. So hold tight, and we're going to get as fast as we can to, to Canada, to the first place we can learn. And so we did, we landed in Canada. And I like I don't even remember the name of the city anymore. Like I said, there were several things that I blocked out, because literally, it was like, me and my two girls on this airplane, ready to go to Phoenix and like we are in our T shirts, and it's 100 degrees in Phoenix. And they're like, hey, so we have a couple things we need to tell you. First of all, it's literally freezing outside, and you guys are in T shirts. So here's some blankets here. Like we're gonna wrap you guys in these until you can get into the hospital, although I don't remember being cold, but I know brand new baby. Like that wasn't brilliant. Um, and then second of all, you have to have a car seat for your second kid. For the baby. Like we're in Canada, you can't just hold her in the ambulance when we land, and we can't find your car seat. So I need you to tell me whether you want to go in the air ambulance with Nora or you want to wait here with Dahlia to we find her car seat? And I was like, wow. Like,

Scott Benner 41:42
that's what that movie is about? You know?

Jen 41:44
Yeah. makes that choice. And, and and then thankfully, they did find it. And, and then we moved to the hospital in this small town. And I mean, we got there and they looked at me and they're like, so do you have diabetes in the family? And I'm like, oh, what's going on? Like, what's going on? And she told me like, she told me that Nora has type one. And I'm like, is she gonna be okay? And she's like, I hope so.

Scott Benner 42:15
Was she unconscious at that point.

Jen 42:18
She was unconscious at that point. And it took her about 12 hours to regain consciousness. And so then, once once she was conscious, I knew that we'd be fine. But you're in this teeny tiny hospital? I don't know, on the edge of Canada is the best I can describe it. Because I mean, it was beautiful flat blue sky snow on the ground. But we were we were inside. Like for two or three. Because the first little bit we were there and just trying to make sure that Nora could pull through and she's a fighter. So we're, she's always been a fighter jet. So she did.

Scott Benner 42:56
What can I tell you? This is the I mean, this is I don't mean this poorly. But this is the most like viscerally disturbing diagnosis story anybody's ever told. Like I'm vibrating. And I now understand why I love submarine movie so much. And I just did an interview with somebody last week who was diagnosed during a heroin bender. And so I'm just like, oh my god. Yeah, make sure you listen to that one, by the way. Absolutely fantastic. But, but um, but seriously, it's the it's the I mean, not that this is any stretch for anyone listening, but it's the being on the plane thing over the ocean, and understanding what DK is. I'm like, Oh my god, that kid could have just died on that plane. That's Yeah, insane.

Jen 43:45
Yeah, well, and then yeah, there was that there. There was a lot of things that I learned afterward that I'm very happy I didn't know before. Because there like I said, there really isn't type one of my family although my great uncle's my grandma's brother did have type one. Um, but we didn't talk about it. And it never came to my mind at the time. Um, and there is thyroid so I get how it could happen. But I but it's not close enough that I would have ever put signs together. And having the doctor tell us that she's just jealous. Like, I didn't think much of it. I was just kind of bracing myself for this, this huge kind of 24 hour plane travel with these two small girls. And I don't know, it's like, it took me a long time to get over the parts that were hard. You can choose I mean, because then there was a snowstorm and we couldn't leave a small hospital because we had to be airlifted to the big hospital. But because we're coming from a foreign country, it'd be quarantined for MERS or SARS or something I don't remember at the time. And then once we got to the big hospital, that's when my dad could finally get there. So I was two or three days alone with these these these two girls one hooked up to every possible tube and the other one mostly peacefully asleep. Thank God with lots of lovely, lovely people who would just kind of do Whatever for her.

Scott Benner 45:02
Do you? Do you think that this situate by the way your episode is going to be called DK on a plane? keshawn.

Unknown Speaker 45:10
Good to know.

Scott Benner 45:12
And I'm just seeing Sam Jackson run around looking for insulin and there's snakes falling everywhere. This is how it's gonna go.

Jen 45:17
No, but the thing is on the plane, nobody told me I could not get out of them. I'm like, so what is happening? And he's like, I I'm not prepared to say anything quite yet. And I think it was probably to maintain my sanity before we got on the phone. But I did not know that. This is what they were thinking that anybody had a good idea was going on the Dr. Phil, I

Scott Benner 45:35
Children's Hospital didn't ask anybody for a meter. You didn't see them test your blood sugar and nothing like that.

Jen 45:39
No, he did. He did. Oh, and I didn't put it together.

Scott Benner 45:43
Okay.

Jen 45:44
And it was a meter from the UK. And so her blood sugar appeared low. But he didn't know it's from the UK. And she's he's American. So there was some juice given like it was it was really like no, I looked back at it. And there was some things that was just it was really hard all around.

Scott Benner 46:04
Wow. Wow. That's all crazy. Geez, I swear to you, I I've heard 500 people tell me how they are their children have gotten diabetes that those initial things and I am no lie. I've never felt so stressed out my entire life while somebody was telling me that I've never felt like what people would consider triggered nowadays by any story that's been told to me on this podcast. But I started like, I got nervous and, and warm while you were talking about it and my chest got tight. I was like, Oh, Jesus, and I knew the kid was okay. By the way.

Jen 46:40
I mean, you know what, we're here. We're here talking about diabetes. Yeah, she did pull through. Like but but but like, it's taken me a long time to get here to want to talk about well, that's

Scott Benner 46:49
that's what I was gonna ask you Next is that that that scenario, that situation? Those few days? Had to I'll just put this out that had pretty good, right?

Jen 47:00
Yeah. Okay. It did. It did really well. And then we got, you know, and then we got to like, I can't remember that the phone call that when we finally landed the plane and microphone turned on a heads reception, like, Oh, my God, I got to call Omar and say he just put us on a plane, but we're five hours early from my husband. And and tell him that we're actually in Canada, and our daughter's on an ambulance. And I've got no idea of why. And then I had to call my mom and say, you know, sorry, mom. We're actually still in Canada. Like, I don't know, what else to tell you. Um, so yeah, like, but then I think back in like, I like, I don't know how I must have given my phone number and at some point, but like, there was one lady on the plane that just told Dahlia for like, five hours. She's like, No, no, you have a lot going on. Like, I'll just hold your baby so that she doesn't cry. And she did. And the guy next to me, he's like, well, I can get your bags off in London or in, in Phoenix and like, I'll call your mom and will like, sort out whatever you need. Like if you need if you can't get whatever. And obviously for security reasons I had everything with me. But like, I don't know, a pilot called later just to make sure that she was fine that everything was ended up okay. And I don't know just the kindness of people that they like.

Scott Benner 48:20
It's I'm trying to hold on to. Well, now I realize I'm gonna cry Jesus. This is I thought we were having a nice conversation for the first time. Five minutes.

Jen 48:28
Cheese. Yeah. And we were we were we still are. I don't know if I could pass you tissue.

Scott Benner 48:37
I have them here. Don't worry. I'm used to.

Jen 48:40
Okay, excellent. So I'm not the first one to make you cry.

Scott Benner 48:42
No, no, I cry once in a while. While I'm doing the I just don't usually say it. But now you got me the pilot called the ladies home. Baby. Doctor misunderstood the meter.

Jen 48:52
Yeah, like, the one thing that I think, yeah, there's like, there's not many things. I'm the times I'm going to say that diabetes has helped our life. It has added lots of extra stuff to us. But the community of people that we have because of it. And it started on that day with all these people just being kind nobody having any day was going on. But they were just like, here, what can I do? And they just kind of did it with with love. And from that day forward. I mean, the people that that I find the kindness are the ones that don't know anything about diabetes and are just like, Can I give you a hug or bring you a sandwich? It looks like you might not have eaten or slept or? I don't know. Like, I love that about this. I love that. That's the part I love about diabetes is the community of people that have kind of band together to help each other figure it all out.

Scott Benner 49:48
I have to agree with that. That's for certain. Oh, geez. Okay, all right. I don't want to hear any

Jen 49:55
good. The good news is like she made it after. So for seven days in Canada, my dad was there for most of the time. So he just had a ball with Dahlia, they checked into a hotel, and God knows what they did. But they were having a good time. And then we moved to Phoenix. And we started to figure it out. But because of the situation that I, you know, showed up to Phoenix with my, they gave me an exchange chart for food in Canada. And so I was like, okay, so I pull whip out this chart, the hospital and I'm like, so we were told that we're allowed to have one bread that can be exchanged for one, whatever, at breakfast, and this and so there had been been a few times of relearning stuff. Yeah. So it's just been, it's been a challenge, because there are a lot of ways one can deal with diabetes, some, obviously, better than others, but everybody has their own style. And so it's just been a weird journey of going through trying to learn everybody's style, because you obviously you're in a new place, you want to see how they do it, what they can do, um, and then trying to make it work for you. And so that I mean, thankfully, there's a lot of information out there.

Scott Benner 51:08
I think that one of the things that your episode is going to really, I hope drill into people's heads, and it's thanks to your wanderlust, by the way, is that seriously, because you've been in so many different places. And that actually happened during your daughter's diagnosis? Is that wherever you are, right now, someone's telling you, this is how you do it. And that's not necessarily true. There are a lot of ways people do it. There are a lot of different considerations that people give, you know, not everybody gets a chart with a Tim Hortons on it that tells you to have a Tim Hortons takeaway to breads, you know, like that? Yeah.

Jen 51:45
No, it's true. Like it was it was exactly.

Scott Benner 51:49
And, and, and not everybody. I mean, I'm still, you have to understand that when I started this podcast, I didn't, I knew what Pre-Bolus thing was, I did it for years upon years. And so I still get notes to this day, from new people who are just their minds are boggled by the idea of using the insulin in a timed fashion.

Jen 52:13
It's me, it took us It took us a year or so to even come to that car. Like I never dawned on me in the beginning. Because I mean, to be honest, nor was a picky eater when she was younger, she's better now. But I couldn't count on anything. But that doesn't mean you couldn't have worked it out some way. I hear of lots of people dealing with that in ways where you kind of break it up or you extend or something like that, if you have a pump or whatever, yeah, but um, but to tell you the truth. I was like, I didn't look for information for a long time. There was a lot of adjustment of trying to get to America and then and then see my parents and be like, okay, so mom and dad. Turns out our summer of fun, still will be fun. But there's gonna be a little more more to do. And then and then doing that, again, when we came back to to Jordan at the end of the summer, and finally seeing Omar and be like, Okay, so here is, here we are, and we have a lot of new ways of doing things, but then also been organizing that with, with what's available here in Jordan. So so taking what we could from America, but then also realizing it had to be tweaked a little bit once we got here.

Scott Benner 53:23
And so he didn't see her for months after she was diagnosed.

Jen 53:29
No, he hasn't been able to get a visa for America for for a while.

Scott Benner 53:33
That's amazing. I'm sorry. So.

Jen 53:35
So the choice was we because we had big talks about this, whether we just kind of pick up we see my parents for maybe a week or so and then pick up and come back and all catch up and figure this out together. Or I spend the summer as planned, see my parents, figure it out in America and and then come back here and we've had to make that choice. It'd be less traumatic for the girls to not pull them away from what they were expecting. Well, nor at that point, I didn't remember much, obviously. So we decided we decided to stay and I can't imagine him making that choice. It was a completely selfless choice on his part. Well, no, that's

Scott Benner 54:09
really something I'm, I'm still trying to wrap my head around. If I was, if Arden was diagnosed in one place, they gave us one set of information. And then I was just Time Warp somewhere else to another place where they talked about it differently. And just as I was probably beginning to not even understand but at least get some semblance of like normalcy about it. I go to a different place where a third set of people talk about it a different way as well. And yeah, then you try to meld all that together. While you don't know what you're talking about. That seems impossible to me.

Jen 54:45
It was which is why I think we coasted for for a while like we were just like we were getting by with all of the like, I can't Well, you must know obviously like this, just diabetes is so much to process. And then when you're told different ways to process it like it's just There was a wall plus plus there was just so much else going on. We're just grateful to all be together to be healthy and, and together. And so we kind of did what we could to keep what was normal, because I think the one thing, the only thing that was common in those three locations was, but don't worry, you can do everything you want to do, you can have a normal life, you can eat what you want, you can grow up to be whatever you want. You can be happy or healthy, you can be sad or unhappy. But it will all be your choice. You just have to kind of go through and I love that message. Like I love it. That is one of the first messages that people tell you. But there's no real assistance and getting there like you just kind of have to keep trying. I and

Scott Benner 55:40
yeah, I hate that. That the idea is espoused without the supporting information, meaning, yeah, no one, no one will tell you that. They'll just say like, Oh, this is your Basal insulin, your Basal insulins job is to keep your blood sugar stable away from food. Okay, great. No one. And then they say, and this is how much Basal insulin you get. It's it's x amount of units a day. If you're if you're, if you're injecting, or they'll set you up on a pump and go, okay, it's point three, five an hour, this is it. No one ever mentions that that might be wrong, or that it might not be enough or too much, or that if the basil is not right, then the Bolus is won't work, or that we may have set your carb ratio to a classic diet, but you're going to go eat a carb heavier diet, or you're going to have more simple sugars. And that's, that's all insane. It just really is. It's it's the idea of, I don't know, just it's teaching someone to drive a car and tell me you push that one down to go and you push that one down to stop. And there's really a little more to it than there's some nuance in there. And the nuance gets lost as it does, by the way in everything in life. When it's being explained or or disseminated usually. But nobody even says, Hey, listen, this basil is going they don't they'll say it may change once in a while. But they won't say it's going to change. You know, like be aware of that the first time you see blood sugars that are too high for too long, could be the end of your honeymoon it could be and I get that it's a lot of information. It seems like important information to me.

Jen 57:18
Well, the thing I wish that people would talk about in this obviously is worldwide is so this is what's going on right now. But tomorrow may be very different. I know you'll have no idea what to do tomorrow, but call me and then keep learning. Here's some resources like it doesn't even matter. Like if you want to start with like an old question book or a fold out of like, you know, card exchanges, I don't, I don't care whatever information you want to give them. But if the idea that what I left with a hospital was going to pick a hospital, it doesn't matter. Because they all it all felt the same. That that was that was law that was right. And, and whatever was happening was something else, or you know, it's diabetes, and it's just, it's really hard. So there's gonna be some roller coasters. And that's, that's sad, I find I find, I find the the idea of the fixed the fixed pneus of diabetes, especially in this age where you can have the technology to sort things out a lot faster. You have test strips that you can use, you have Dexcom, you have all the CGM and the pumps that can can help you figure out, figure out what you need to do to extend insulin or to watch your blood sugar to catch things that you would never have been able to catch before. Like with that technology, there should be a disclosure thing. There's a lot of new things going to be coming your way. It's not just ideas about food, but it's technology. It's it's your kids body as they grow or change through this disease, but also through life. Like if you could, if you could tell anybody something important, you should say that, yes, we could can do anything, but everything they do is going to cause a change in their body and just watch out for it. And

Scott Benner 58:59
the I find the bigger issue around that is that they'll tell you, you know, oh, today, you know, nothing. Today might not be like tomorrow might not be like the next day. And that somehow gets distilled down and translated into diabetes, you never know what's going to happen. So just write it out. Instead of the idea that, you know, today there was more stress or less activity or you ate this food instead of that food 10 carbs, this isn't going to impact you the way 10 carbs that does. There's so much in there that's easy to understand if you hear it, but instead they give you this magical idea that, oh, there's nothing you can do about this. It's just going to happen and you're going to have to let it happen. And once someone tells you that, especially in a life where until then medication has likely meant to you to have these every six hours. One of these every morning. You name it like and then that's it you don't think about it again. When you see algorithm, Jen manipulate insulin You see it, take it away and give it back and add more and bring it away. When you see that happen, you realize that a static basil rate and a static idea of how to give insulin for foods is archaic at this point.

Jen 1:00:16
Well, it totally is like a man tell you like it was shocking. We came back here and we saw a doctor not not our current doctor in Jordan, but a different one. And this was after Canada, the first place that didn't give us a fixed, fixed anything they were, they were just telling us what to dose like, I would call them and say, Okay, we're gonna eat this for lunch, and they'd give me insulin because he knew I was traveling. So they were just helping me to get to the next place. And then America, there was nothing fixed either it was a what you want, and then do it on this kind of thing. It was this tiny scalar ratio, I can't remember how it was in the beginning, because things have changed a million times. We got here and he's like, so based on her weight, she'll have this much basil, which is her heaviest meal of the day. Okay, so she'll have one unit for breakfast, she can have only this. At lunch, you'll have two units and a dinner, she'll have one unit. Because lunch is the heavy meal here. And that's that. And I'm like, I looked at him. And I'm like, but we've been doing it differently. And that seems like a really rigid lifestyle. Why? Why do we have Why do we have to do that for such a young kid? And there was no answer. And there were lots of tears when we left that doctor's office. Because I just that seemed really, really wrong. To have to take away the freedom of all that. Um, but yeah, when you have all that, when you have all the technology, there should be there should be freedom of choice, there should be. But with that responsibility, like there's no way a pancreas does nothing. Like it doesn't just sit on his back. Because I know at the beginning, when we started doing these things in our I was actually doing really well with like her time and range and things where things were going, but you could see she was feeling better. Omar looked at me and he's like, well, this, this is a lot of work. Isn't this too much work for you for us, because the brunt of it falls on me because he travels so much that I've kind of taken on the scope of diabetes. And then when he's here, he kind of if things have changed, he kind of relearns where things have changed, anything jumps back in. But I'm like, Well, I mean, your pancreas doesn't stop and my pancreas doesn't stop. And yeah, it's a lot of work. But like, she's healthy.

Scott Benner 1:02:18
Right? I am, you know, as you're talking, I realize I must be a full. Because this all seems so obvious to me. And I'm, I've been in the past kind of thrown off by the fact that it wasn't obvious to other people. And now I realize maybe it's maybe it's just not obvious, I just, it was obvious to me at some point that this needed some sort of a fluid management style. But I might really be in the in the minority still around? Well, I

Jen 1:02:57
yeah, I just think that if there's there's a lot of training that goes into small Kids Worldwide, that if an authority figure tells you something that it's the right thing, like like, not in a bad way, like they're not purposely trying to mislead you, but if your doctor says this is what you need, very much like when I was diagnosed, or any of the first doctors that this is the right amount of insulin, and it maybe it wasn't one point, the right amount of insulin, and then she just she changed and she needed more or less or whatever. Um, I, I had a hard time questioning that now my head wasn't exactly in a place where I could take on a huge new challenge for a while. And that was understanding what was going on and actually diving into and figuring out, you know, glycemic index or, or any of the things about macros or whatever else. And it's taken me a long time to get there. But I wasn't I was, I was in a place where I think I was looking for the answer to be like, what they tell you in the beginning, insulin and carbs, you figure them out, you give the insulin, you do the math, right with whatever the doctors say. And that gives you the answer. You circle it and you turn it into the teacher like I was at a place where I wanted that to be the answer. And obviously it's not a get that I understand that. And so you combine the fact that maybe you have parents and caregivers that are having a hard time with it with doctors that have done this for ages. This is the way it was done. Before you had ways to watch graphs before you had ways to figure anything else out. I mean, it's a hard change to make. It's taken me a long time to make it and like a lot of work

Scott Benner 1:04:39
wouldn't have been easier in hindsight like in hindsight, if I'm not I'm not trying to pump up the podcast I just as an example like it in hindsight, if somebody would have left the hospital with you and said, Look, this is going to take you a couple of months, but every day I want you to listen to an episode of this and too much now you'll be done. Do you think you would have skipped over Is there a lot of that turmoil?

Jen 1:05:04
I don't know. I hope so. I would I would like to think I would, because then I probably would have had a project to focus on as opposed to memories. Yeah. Because Because I left, I left with this wonderful goodie bag of ladies who knit, like a quilt for Nora. And like, these these Christmas lights that this lady gave nor because no one liked Chris, like, I don't know, like, I left with these memories, and these, these, these kindness and this gesture, and I got stuck there for a really long time. And so I wasn't I wasn't ready to. I think personally, I wasn't ready to move on for for the challenge part of diabetes. I call it what you will, and it might have been some version of denial, I guess. But um, I don't know. Like, at the same time, I really didn't think to look somewhere else. I, in my mind, there was no way that if a doctor said do this, and they said that her results are within range of what is what is right. According to the pediatric, diabetic, whatever, whatever those guidelines, things are. Yeah, they're the guidelines. If it was in that range, like Yes, I'm the type of person that would like to strive to do better, but I wasn't in a place to do so. So I don't know, I don't know how I would have. I don't know, I would I would like to think that I would have I would like to think that if somebody gave me a book earlier that was a little bit more current rather than dated. Um,

Scott Benner 1:06:35
did not feel sick to you. Like What Did you think I have a sick kid, and she'll be sick forever.

Jen 1:06:42
No. Oh, you mean? Like on the airplane or

Scott Benner 1:06:45
No, I mean, in general, like once you're home, you don't have any real knowledge of what you're doing. Do you just have that like underlying feeling like oh, I have a child who's going to have maladies and, and struggle? No, no, it didn't feel like that. Okay,

Jen 1:07:00
no, Norris Norris something else. She is bold. And she's spirited. And she's creative. And like, I don't know, nothing holds her back. Like she just she goes and, and the whole summer like, I would look at her. And I feel like, wow, how did you just go through that? And I just went through that. And I look like a train ran over me. And you're like jumping in the pool with Barbie? Like, I don't understand. Like, I want that. So it

Scott Benner 1:07:25
all seemed it still seemed very possible. You weren't like, you weren't in a no, it

Jen 1:07:30
did it? It totally did. And that's and that's part of the reason why, like, why I think I got through because if this doesn't affect her, like, this is her body, this is going to be her life forever. It shouldn't. I shouldn't project the way I feel about my experience of that same event onto you so that you have taken on my experience. Because if you don't have that experience, I don't want you to have it. I wouldn't want anybody to have that. But especially

Scott Benner 1:07:58
her, you're a smart lady, Jen, you were able to figure through all that, while you were still like, somebody felt like you've scrambled your brain, I would imagine.

Jen 1:08:08
Well, like I said, the only thing I want out of all of this is her to do whatever she wants in life. Like I don't I don't care what it is, like if she decides that she wants to move to Paris and paint the Eiffel Tower every day. And that makes her happy and she's able to do it by all means if she wants to become a doctor and you know solve all the world's problems also fine with me like but I don't want to be the reason for for stopping her. And at that point in time, it felt like my, my emotions about all of this could easily have been turned into hers. Right?

Scott Benner 1:08:42
Well, yeah, I do think it's important not to project because you're having a completely different experience than that you're

Jen 1:08:48
like for the longest time she had one of those, you know, baby patches with the blueberries and apples or whatever. And the last thing I think she remembers on the airplane was throwing that up and there was blueberry pouch all over the towel, the blanket that they gave her, and it was nasty. And for the longest time if anybody asked her Yes, I have type one diabetes. Blueberry pouch gave it to me. Um, me she was three to three and a half like she she was trying her best to figure it out. But it took me a very long time to convince her that she did not get diabetes from eating this particular pouch on this place, right?

Unknown Speaker 1:09:27
Oh, so yeah, that's cute

Scott Benner 1:09:30
and understandable. By the way, I for a very long time thought KFC made my appendix explode. I didn't really but it was like I was driving home one day, trying to rush home for the kids. middle of the day. I was out doing something. You know how us moms are running around all day doing stuff. So I'm out doing something I'm driving home trying to be on time for the kids to get home from school. I'm viciously hungry I whipped through a drive thru and I grabbed just chicken like little chicken pieces and I'm throwing them in as I'm driving. And then four or five hours later, I'm calling an ambulance. And I couldn't. I mean, not that I am a KFC person to begin with. But if you get me anywhere near it, I'm like, Oh, no, no, no, no, no, that made one of my body parts explode. And I have like a very visceral reaction to it.

Jen 1:10:20
I'm assuming that's exactly the same as if she felt no, I think we moved on from that because Dahlia had a pouch the other day and nor asked for one so and with no comment about blueberry steamy diabetes is gonna give you diabetes or something. Yeah, exactly. So I think we moved on but but like, yeah, it was a long time before she she understood that. It wasn't

Unknown Speaker 1:10:40
that.

Scott Benner 1:10:41
Jen, is there anything that we haven't talked about that you wanted to because this was very emotional, I need to get away from you.

Unknown Speaker 1:10:49
I get it. It's a

Jen 1:10:50
lot. Like I said, it took me a long time to get here. Um, no, no,

Scott Benner 1:10:55
you feel better now. Things are smooth. You understand what you're doing? And that

Jen 1:11:00
is, yeah, we have our moments. But yeah, we know what we're doing. And we know what's going to change. And we're okay, we're together. You're happy. That's that's what matters more than almost anything else?

Scott Benner 1:11:11
Well, you said something in the very beginning that I find to be pivotal, which is, you know, you trust that what you know is going to happen is going to happen. And then those things that you expect to happen, begin to be your outcomes. And then you feel like, ooh, I did that on purpose. This is this is good. I made a decision about insulin, and what I thought was going to happen happen. That's good. Now if it if it, if it later doesn't happen that way, you can at least say to yourself, I know this wasn't me. So what are the other influences here that it could have been? It opens up your abilities to diagnose on the go? I think it sounds like you're at that. Yeah,

Jen 1:11:52
we are. We are we're doing well. We're in the process of she's so she's so proud. She's trying to do it herself. So she's got to watch now and she's getting text messages from me or from Omar, and she'll give herself insulin and she'll give herself, um, juice or Skittles, or whatever she needs at the moment or check her finger. And, and so she's in the process of trying to figure out how many carbs are in things. So we had, I think there's a case it is or something other day, and she looked at me, she's like, looking at the plate. So Mom, this looks like 400 carbs, like Okay, so now we have our next project to work on. So now we're trying to transfer

Unknown Speaker 1:12:31
the information from me.

Unknown Speaker 1:12:34
Because Lord knows there's not 400 carbs, and I'm just

Scott Benner 1:12:39
as long as her pump has that little that safety thing where it can't give her too much insulin.

Unknown Speaker 1:12:44
But it does, it does. But but I

Jen 1:12:46
see her trying so so there have been a few, you know, Miss boluses, and a few missed things because she's trying to figure out how to do it. And she wants to the minute she doesn't want to, we'll pull back but she's at home. And I think this is kind of a fun challenge for her to get out. So she's got a calculator now and she's trying to give her the card counts in certain things. And she'll kind of add them together and put that in there and then check it with me. So it's been a fun, it's a fun new phase. It's gonna be challenging, I know. But I the

Scott Benner 1:13:12
way I did it with Arden is and I still do it is we put a plate out or whatever she's having. And I'll be like, how many carbs you think that is? And then I have my guess. And then she guesses and I tell her what I thought and then we usually go with what she said just to see what will happen. And you know, unless she's way off, and I'll be like, No, I think it's more or

Unknown Speaker 1:13:33
don't think we're going with 400 carbs. No, yeah, no,

Scott Benner 1:13:36
you know, what are not 400. But, but that's a good idea.

Unknown Speaker 1:13:39
I like that. It's a very

Scott Benner 1:13:40
simple way over time, like it's not going to pay. This is not a process that will pay you back in three days. But it'll pay you back over years. When eventually I pay back quickly. Yeah, right. Exactly. Eventually, you just see the plate and you're like, that's 70 done. And, and let's go Arden had a really she's having her period right now. And so she's had like a really carb heavy day yesterday. We used a lot of insulin yesterday. And she was good. She did a good job of, of understanding how much she was eating and, and at this point to, in my mind, it's a blend of how many carbs are actually there. And how many, how much insulin it's actually going to take. I don't really care about the carb count as much as I care about like that looks like she Arden had a Bolus it was 16 units. So yeah,

Jen 1:14:32
can't word out there. Yeah. 400 carbs for Nora,

Scott Benner 1:14:35
when that happens the first time.

Unknown Speaker 1:14:37
Right?

Jen 1:14:38
Yeah, see, that's the best the problem when we're trying to I'm trying to figure how to transfer this to her obviously not fully or even partially yet. But if she's having a good stable, predictable day, whatever, then or at that period of time when she's trying to eat the no problem. I don't mind her guessing her carbs and putting it in but if she's about to have PE or if she's just finishing her school or something They like that. And it's different.

Scott Benner 1:15:01
Yeah, when the variables pop up that they can't

Jen 1:15:04
Yeah, grasp. Yeah, that those are those are in my head. Those are things I feel are no, those are things that she knows yet. Um, so

Scott Benner 1:15:12
listen, I think you're using one of the most important diabetes parenting tools that exists that people don't think about all the time and it's texting.

Jen 1:15:22
As it has been revolutionary, this year, when we had school, um, first of all, her ability to read and write obviously has taken off, and so she's able to last year she wasn't there yet with this.

Unknown Speaker 1:15:35
But

Jen 1:15:37
COVID at home, she's had a lot more tech time, on her school iPad or whatever. So she understands how it's all working. And she, she enjoys that she enjoys having the independence, she gets to have playdates by herself. Without me, she gets to do things. And I think that has been a huge incentive for her to want to kind of take some of her time back or I don't have to go pop into her room and she's, you know, wanting to just rest or read a book or whatever, I can just send her a message and she'll do it by herself.

Scott Benner 1:16:03
I think it's, um, it just it can't be it can't be stressed enough how helpful texting is for all that stuff, the feeling a little you know, autonomous and being able to make adjustments more quickly, especially like the idea of going to the nurse's office is an antiquated idea for me.

Unknown Speaker 1:16:27
Yeah, you know, yeah, well, it's

Jen 1:16:29
hard right now to like the nurse obviously her hers her health center is for for sick people. Like they blocked everything off because they wanted to have a well clinic and that clinic and so to have to try to take Nora somewhere to check her blood sugar or to give insulin is just right now impossible. So the fact that she's willing to do this by herself. She has, you know, fantastic teachers that have supported her and double check to make sure that it's going well, while she's busy at school or whatever. But it's been it's been really great.

Scott Benner 1:17:00
Can you have a really good attitude, I appreciated this conversation very much, except for the part where you made me sad and upset at the same time. And I felt nervous and anxious. And by the way, gained a completely new appreciation for action stars, because you certainly were not Bruce Willis. In that moment on the plane, you were just like a and I would have been to just so you know, I'm just saying that I think those movies aren't real, john.

Jen 1:17:26
No, no, there's no way. Like, I don't see it. Like, maybe there's a few people that would spring into action. And I was like, Oh,

Unknown Speaker 1:17:33
no, no, okay.

Scott Benner 1:17:34
I've been alive almost 50 years, and I've not once seen anybody act like Bruce Willis didn't die hard. And you would think by now, you've seen one person. I think we all do about what you did. We're like somebody hold my baby. You're a stranger here. Take it. And the thing is, I

Jen 1:17:49
did I didn't. The baby was asleep in the little bed that they have, you know, on the airplane she offered when she woke up, she came to me and she's like I have I'm a mom, I have five kids or four kids or something. And you look like you need some time with your other kids. So can I just please take her for you? Like it was the kind of thing?

Scott Benner 1:18:04
Oh, nice sexually liberal woman helped you with your five kids? Yeah.

Jen 1:18:10
It was her and her husband. It was their vacation. They were going home.

Unknown Speaker 1:18:13
Like I don't know this.

Jen 1:18:14
I remember the weirdest things about this trip. Because I literally, I do not know the name of the city we landed in. But this lady like I know her life story. She told me once. She called me a few times afterwards, like kindness, absolute kindness. Lovely.

Scott Benner 1:18:29
Very nice. All right. See, there's goodness in the world everybody, all you have to do is go into decay over a body of water airplane to find it.

Jen 1:18:39
You know, if you can't find it there then you're really not going to find it anywhere.

Scott Benner 1:18:50
First, I want to thank Jen for coming on the show and sharing that story. And for making me nervous. I want to also thank the Dexcom g six continuous glucose monitor which you can learn more about@dexcom.com forward slash juicebox and of course, on the pod and that free 30 day trial of the Omni pod dash that you might be eligible for head over to Omni pod comm forward slash juice box last Of course, but never least touched by type one.org. There are links in the show notes of the podcast player that you're listening to right now. Or at Juicebox podcast.com.

If you're listening in a podcast app, please hit subscribe or follow if you're enjoying the show and think you know someone else who might enjoy it to let them know about it. If you really love the show when you have this beautiful five star review pent up inside of you that you just can't wait to let out do that wherever you listen, Apple podcast, etc etc. are you looking for the diabetes pro tip episodes Don't forget they're at Episode 210 or at diabetes pro tip comm You can also find them at Juicebox Podcast comm there are so many to choose from Get started today.


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#477 The Pot Roast Story

Scott Benner

Marina Nitze is the former Senior Advisor to the US CTO at the White House, the former CTO and Senior Advisor to the Secretary at the Department of Veterans Affairs and the founder of Task Tackler. She also has type 1 diabetes.

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

+ Click for EPISODE TRANSCRIPT


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

Scott Benner 0:00
Hello friends and welcome to Episode 477 of the Juicebox Podcast.

On today's show, I'll be talking with Marina Nitze. Among other things, Marina is the former senior adviser to the US Chief Technology Officer at the White House. She was the chief technology officer and senior adviser to the Secretary of the Department of Veterans Affairs. She is passionate about improving America's child welfare system, the developer of test tackler and she has type one diabetes, I quickly realized how much I love Marina as we were talking, and I think you'll enjoy the conversation as well. Please remember while you're listening, that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. At the end of this episode, I'm going to tell you the power of story. If after this conversation ends you're interested, you can learn more about Marina at tasktackler.com or MarinaNitze.comm links in the show notes

this show is sponsored today by the glucagon that my daughter carries g vo hypo Penn. Find out more at G Vogue glucagon.com forward slash juicebox to learn more about the blood glucose meter that my daughter carries. And let me tell you something, it is the most accurate blood glucose meter I've ever seen in person and that's no BS. Go to Contour Next one.com forward slash juicebox and learn about the Contour Next One blood glucose meter.

Marina Nitze 2:02
Hey Scott I'm Marina Nitze. Nice to meet you.

Scott Benner 2:06
It's nice to meet you too. I have to say first of all, when I reached out to you it was because people asked me to and that I guess they had heard you somewhere else. They were like you have to get this person on the podcast. I was like, Okay, so now this is me sheepishly sending an email like or a message somewhere. I'm like, Hey, would you come on the podcast? And you're like, I know the podcast is like, oh, that put me in a good feeling in my chest. I felt puffed up a little. But then you big time me when you sent me your calendar. I was like, ah, she knows how to do this. Usually, I'm the one who sends out calendar like so I was like, You figured out how to work around my schedule. And you were like, here, here's my schedule, figure out where it sounds like she does what she's doing.

Marina Nitze 2:48
But then we have the double zoom links, so that but we navigated that successfully

Unknown Speaker 2:52
go to look at us.

Scott Benner 2:55
We were able to create two zoom links and then choose one. Absolutely amazing

Marina Nitze 3:01
pandemics skill. These are key pandemic skills.

Scott Benner 3:03
Why I have to tell you that prior to COVID, I was using zoom and loving it. And I was in a panic when everybody found out about it. I thought oh, they're gonna ruin my thing. But luckily, that didn't happen.

Marina Nitze 3:16
Yeah, it seems like they just strengthen it. The one thing zoom is missing is a popcorn feature. I don't know how many large group meetings you're on. But when they're like, Oh, just pass it to the next person. Like then you spend the whole time being like there's 35 people here. How am I supposed to keep track of who's gone and who hasn't? Oh, no

Scott Benner 3:30
kidding. Oh, that's interesting. Now I only ever do it one on one or sometimes, you know two people at a time. But yeah, I only use it like this and for audio, but it's been terrific. For me. That's not the point of any of this. So I guess let me just start by asking how old you were when you were diagnosed with type one.

Marina Nitze 3:48
I was nine years old in 1994 94 2004 1424

Unknown Speaker 3:50
minus 321 years ago.

Unknown Speaker 3:57
26 years ago. Oh

Scott Benner 3:58
my god. I'm never gonna get this stuff. Right. Okay. Did I submit accurate? No, I let's not let's not take time to figure out what I did wrong. 26 years ago, you were nine years old. Now. I can do this that makes you 35. Yeah. See? Now you're impressed. Right now you're like, how do I get out of this? So so you're nine years old? A long time ago? Are you regular an MPH?

Marina Nitze 4:25
Oh, yes. And I think like lenti is that maybe we call them regular NPH. And then somewhat even longer acting on a need mix all three.

Scott Benner 4:36
That sounds like a lot of fun. who managed that for you?

Marina Nitze 4:39
Primarily me from the beginning. I had a care team that was really kind of empowered about getting the kiddos responsible for their own diabetes care which in retrospect, I appreciate a lot. No kidding.

Scott Benner 4:51
So but in fairness and for clarity for people who are more newly diagnosed now in here in 2021. You were just kind of like What were you doing drawing up some insulin and shooting it like couple times a day?

Marina Nitze 5:04
Yeah, we we have a lot of structure then. So you test at certain times, and you had to have a strict number of carbohydrates per meal at a certain time. And so my care team would then adjust that accordingly. So I was in charge of counting the number of carbs to get to my set number, which I want to say was something like 30 at lunch, and then having my three o'clock snack of 15 grams of carbs. And yes, you drop the insulin and take it, but it was a very structured day, the goal being that by the time you checked with your meter, which at that time, took like 45 seconds to give you a reading, with a giant drop of blood. The goal was for you to be like back in range by the next meal, but you really have no insight into kind of what you were doing in between meals.

Scott Benner 5:43
So you drew up a predetermined amount of insulin, injected it. And then we're sure to eat a certain amount of carbs at certain times, and then hacked into yourself at the end of the day to make sure you were still alive with one blood test. Yes, wow. That's something Do you look back on that and think that seems really primitive? Or was it? Or what is your perspective of it's that you lived through it?

Marina Nitze 6:07
I think, more primitive seemed later. So when I was like, 910, it made sense to me, given the tools that we had that checking blood sugar at certain meals, and having and following the structure made sense. What seemed more primitive was like teenage years when there's like a pump. And then you're kind of left to navigate the like, any number of carbs, and any amount of you know, fat with the carbs, which I don't even think was a thing that was conceived of when I was a teenager around like, you know, you need a longer Bolus for pizza than you would for something fast acting. Yeah, I think that was, that seemed a little bit crazy to me, relative to my like, overall time with diabetes.

Scott Benner 6:45
So that's interesting for people to hear. Because in the beginning, when the outcomes aren't really well tracked, right? Then, if you set up rules and follow the rules that feels like you're doing everything perfectly, is that right? Right. And then then you start getting more insight. But the tools aren't quite there yet. And then it seems kind of harried and, and senseless. Yeah, it

Marina Nitze 7:08
felt like if I were looking back with 2020 vision, having a pump, and that level of freedom without a CGM, I think is probably what felt like, more haphazard, looking back on it, because like I remember very clearly making, I guess it wasn't Excel was Excel, even around then, like a chart for my endocrine team. When I was like 11, or 12, I wanted to stop taking a shot at lunch at school. And so I made like a very detailed chart showing like my average numbers, three o'clock, and there were something like 125, or something. And I was arguing that was close enough to 120, that I should be able to skip my lunch shot. I don't think there was no, not that level of data and structure when I was a teenager, because I was eating whenever whatever. And then there was not that sort of consistent data to work back from so I can think I think about it that way.

Scott Benner 7:58
What's what was the measure of success then, like not passing out?

Marina Nitze 8:03
When I was first, like nine through like, up till the teenagers, I think the measure of success, it was definitely still a one see. And that was back, you know, they had to do it, like a blood draw and wait, like days for them to call you back with it. But my team then like really tracked your blood sugar log, which was this little like, many, I don't know that everybody uses them today. But it was like a packet of paper that you'd carry around with you with your meter. And you'd write in each time and the number that you were, and the goal then was like all of your numbers at your key testing points should be under 120. But obviously not low.

Scott Benner 8:34
Right. When if that happened, how did that translate a one CD? You remember?

Unknown Speaker 8:40
I don't,

Unknown Speaker 8:41
that's a really good question.

Scott Benner 8:43
I'm interested but how much of it was well meaning? And how much of it actually worked out? You know what I mean? It's

Marina Nitze 8:50
Yeah, yeah, you're totally right. I don't remember I don't really remember thinking of it once too much until I was a teenager. I do remember thinking a lot about my individual numbers in the glucose log. But then, like, if a number say was starting to creep up above 120, I understood that then there were kind of two things that you input, you either increased one of your three insulins, right earlier in the day, or you would adjust your like carb count on to I felt like maybe there were simpler math than

Scott Benner 9:20
the pumping nowadays, versus when you first got a pump? Is it a fairly similar experience? like nuts and bolts wise, has anything really changed very much.

Marina Nitze 9:33
You know, it's I got my first pump in 1996. And I've been pumping ever since.

Unknown Speaker 9:41
The size of it, I

Marina Nitze 9:41
don't know that's changed very much. I was on a Medtronic pump for forever. I've only switched Omnipod in the last year. And so the pump size seems the same to me. Although maybe if you held mine up from 20 years ago, I would feel differently, but the insertion definitely like got way better. I mean, it used to be a little bit like jamming or One and a half inch thumbtack into yourself. And I still have scar tissue honestly, for my teenagers that I do not have like now as an adult, I think they've improved that a lot.

Unknown Speaker 10:09
Is that physical or emotional that scar tissue?

Marina Nitze 10:14
But I meant physical. Yeah,

Scott Benner 10:16
no, I understand. Wow, that's really crazy. Okay, so. So you're listening unless you're just really good at representing yourself online, you seem like a fairly accomplished person for your age. So, or you're an amazing writer? We'll find out in a second. But I think it's the former. And so what was your mindset coming through high school? and graduating thinking? I'm assuming thinking about college, did you know what you wanted to do?

Marina Nitze 10:44
I did, but I didn't know that there was a word for it. So I loved even from the time I was very, very young loved business process engineering, I love seeing a problem and like solving it, delivered on those logic puzzles, you can buy them kind of in the airport, and it's like St. Susie sitting next to Bob, but like, isn't sitting next to Susie and then you have to put the X's and O's.

Scott Benner 11:03
That's when Scott puts the puzzle down.

Marina Nitze 11:06
Okay, I upset to this day like I obsessively loved those those logic puzzles. And so I wanted to be and when I was in high school, I referred to it as being an efficiency consultant. And I went on to call myself an efficiency consultant. For a little period of time, I was the only Google result for efficiency consultant. And I know that because if you've noted like the dummies books series, like knitting for dummies, whatever for dummies, I got reached out to by them to write business efficiency for Dummies. And the pitch literally said, like they were googling the term business efficiency, and I was number one search result. Now today, that is definitely not true.

Scott Benner 11:45
That is how I got on the Katie Couric show. Because they were looking for a stay at home dad near New York, and they googled stay at home dad, New York, New Jersey, Pennsylvania, and my blog popped up so I got to be on television.

Marina Nitze 11:59
That is amazing. People under still, to this day underestimate SEO, I think you gotta you gotta find your keyword.

Scott Benner 12:05
Not me. I love SEO. I it's it's a large portion of the reason for the popularity of the podcast, and you have to put effort into it. It's not easy. And it's weird to understand. And I and I, I am I'm proud of myself. I do not write to SEO. Like I don't sit down and say I'm going to say something in writing now that I know will drive people because of the words I use. I do it. Like I think if my content draws that it draws. And if it does, if it doesn't, it doesn't so but yeah, that's I'll never forget, like turning to the producer and be like, how did you find me? She's like, I just googled these words. You're the only one that came up. I was like, Oh, well, then let's get me the makeup. Yes. Very odd experience. But I but I hear you say you were calling yourself something based on your Now let me ask you and try to be honest, if you can love of the process, or strange baked in type A does need.

Marina Nitze 13:06
I tell you, you can't see me I'm literally drinking out of a mug that says type A on it. So I definitely I'm an INTJ to the core, which is like the Myers Briggs mostly says you being type A so part of it's definitely my personality. But I think maybe if it is your personality, then that's the work that you're drawn towards. And you get the most joy out of

Scott Benner 13:25
Yeah, no, I agree. I think it ends up being but you're my wife is incredibly good at what she does. And you and she probably have very similar personalities. And it's the kind of work that people who don't feel that way about precision, and getting things accomplished getting them accomplished correctly. Like that sort of stuff. If you watched one of those people watched my wife work for 15 minutes, you'd think to yourself, like, Oh, I would do anything to this, like, please get me away from this. But she loves it. And she's amazing at it. And I imagine this is similar for you. So

Marina Nitze 13:56
yeah, I describe myself as someone who loves lists and finds comfort in lists. Like if I'm feeling stressed out, I will resolve that by making a list. I know many other people, including my very beloved husband, who the list makes him more stressed. Right. And so it's just acknowledging that we all have different work styles.

Scott Benner 14:13
Can I ask you a question before we get too deep into this? Do you mind? Do you mind being like a therapist for me for a second? Absolutely. If I said, Let's pretend you and I were married for a second. And you saw that I have no desire to follow a list. I keep one because I'm an adult and I have things to do. But if the 10th thing on the list suddenly becomes the most important thing to me, I'll abandon the first thing on the list and then do the 10th thing on the list. Like I'm very flexible about how I handle my days that bleed into my weeks to bleed into my month. Is that maddening to you or do you just see that as a style?

Marina Nitze 14:49
I used to that is a style and it's a style that you can accommodate. Like for example, even though I'm very type A, I also procrastinate and recognize that about myself. I find Ways to be the most productive in my procrastination, for example, I've learned that if I see tasks that are due, in two days, I'm more likely to do those than I am to do the task that's due tomorrow, what you think about it is a tricky way to keep those tasks that are due in two days from ever becoming overdue, right? Because they're still getting done ahead of time. So finding like tricks about the way that you work that way I would, and then exploiting them, is what I would recommend

Scott Benner 15:25
to teach people how to do that, or is that just something you do for yourself?

Marina Nitze 15:29
I am increasingly, I have a task app that I built for myself 10 years ago called task tackler. And I'm just now about to like make it available for other people to use. And so it may be a platform that I can, it's built the way that my brain works, acknowledging that most other brains don't work this way. But if there's like 1000 other brains that work the way that mine does, and those people can't program their own task apps, I hope to bring them some

Scott Benner 15:55
relief. I would imagine that some people listening think that I set that question up knowing what you're going to answer, but that would not be the truth. So I've just googled now to find out, and now you're thinking, Oh, my God, you didn't even read like the first page of my website. Probably. I apologize. I like not knowing too much about the people I'm about to talk to

Marina Nitze 16:14
you. I am not judging in the least

Scott Benner 16:16
Thank you. Well, if you want to judge just say it out loud, so everybody can hear it. That's fine. Wow. So you're gonna make this like a, like a public thing. Optimize your mood at relevant task details. Cool. I'm sure there. Will it have applications outside of business? Is it just everyday life? But well, it's

Marina Nitze 16:33
just everyday life. I mean, I literally like I have tasks related to diabetes. In it, I have tasks related to being a good godmother, like it really is pretty helpful. You can use it for whatever it's going on.

Scott Benner 16:43
Nice. Task isn't always going to be task. tackler calm.

Unknown Speaker 16:48
Yes. I mean, presumably,

Scott Benner 16:50
unless you get crazy and you're like, well, you just said SEO is important. You're not gonna start changing now you're

Marina Nitze 16:56
for 10 years. So I'm, it's it's a little weird to SEO could persuade me to call it something else. I only comms I

Scott Benner 17:04
have a, I have one episode of this podcast that was driven by SEO. And then it didn't end up going anything like I thought it was going to go.

Marina Nitze 17:17
Can you tell me what that

Scott Benner 17:18
was? I would be happy to I'm now telling everybody at the same time. So it's the one where I had the paramedic on to talk about how they handle emergencies, such as situations with people with type one. And I did that because Type One Diabetes tattoos is an incredibly powerful SEO search term. So everyone does it. So I get this, I get this person on. And like I just said, I don't plan ahead. So I tell her what she's gonna do. And she's excited to do it. She comes on. And I asked my question, which I will admit, I thought was a leading question about like, Hey, where's the best place to put your type one diabetes tattoo so that, you know, emergency medical people see it? And she goes, I don't recommend those. I was like, Wait, what? So we ended up having an amazing conversation, and she explained everything to me. But in her professional opinion, if you want people to know you have type one diabetes, getting a tattoo of it is the least effective way to do it. And I said, Well, what if you put it right on your wrist or on your arm she has now she was I don't know what you think I'm not looking at your tattoos while I'm trying to put an IV in you. And I was like, oh, and then she explained the whole job. And I was like, that makes a ton of sense. not what I expected for my SEO like my big SEO campaign, but it ended up being a really amazing interview.

Marina Nitze 18:36
Or you get that type one tattoo. It seems to me that that podcast is what you would actually want to land on if you're researching them. And if they're not effective, and you're tattooing yourself,

Scott Benner 18:44
I agree I also think it probably pissed everyone off that already had one like I even said like what about your chest? Like What about here? She's like, she started saying like, there's some places that might be a little better but she would not guarantee it. She was we're ripping your clothes off sometimes. And putting in lines and she goes we're not we're not reading your tattoos. And I was like, Oh, well she's like a necklace or a bracelet. I think bracelet was the best. And then maybe a necklace with a medallion on but we have bracelet was the best if I recall. Anyway, it did not go anywhere near see the one time I tried to do something like really pointed it just I was like I forget it.

Marina Nitze 19:20
I think I've heard of people that tried to get Do Not Resuscitate tattoos and they're ignored in any way. Go. Yeah,

Scott Benner 19:25
yeah. That's not a legally binding contract. I

Unknown Speaker 19:27
don't, apparently not.

Scott Benner 19:29
Can you imagine you're just an emetic, you're like, Oh, wait, no, this person has a tattoo says they don't want to be saved. I guess we'll leave now. Like, I mean, how would that work? You know? Okay, so what do you end up going to college for

Marina Nitze 19:42
political science, which you might think was connected to my later working in federal government, but they had absolutely nothing to do with one another.

Scott Benner 19:50
Okay, well, let's find out why that is. So you do an undergrad in political science? Is that all you did? Or did you do any continuing education

Marina Nitze 19:59
after that? I actually did not finish college, because I was too busy working in my company making efficiency application.

Scott Benner 20:07
Wow. Okay, so you start a company while you're in school.

Marina Nitze 20:11
I actually started when I was 12. Making, I made professional websites for different soap opera celebrities. And then I've gone on to build like websites for like family, friends, companies and things like that. And when I was in college, I was getting hired by actual company, it was the right timing, right? It was like just when they the World Wide Web was coming out. And lots people didn't have any website at all. They maybe had like an AOL keyword. And so I was it was really nice timing where they were willing to hire anyone to come and build their application. And then I got to take my logic skills, right, where I watch their current process and their current dot matrix printer and there as 400, and their chalk board or whatever they had going on, and then build an application that helped their business work better.

Scott Benner 20:54
Anybody from General Hospital?

Marina Nitze 20:56
Oh, yes. General Hospital, it was my favorite soap opera net. And Alexis, the couple was my first website.

Scott Benner 21:03
No kidding. Do you know there's there was a character named after my daughter on general hospital because of this podcast?

Marina Nitze 21:10
I did not know that.

Scott Benner 21:11
There you go. I don't know how to, like rightly so. Well, I get a message one day from a woman who says that, um, that, you know, the podcast is helping her I think she has questions or something, we end up on the phone, we're chatting, I'm like cleaning the house. And you basically if you're talking to me on the phone, I'm cleaning the house. And, and she's going online, and I bring up that I wrote a book. And I felt so silly later, because she's like, Oh, I'm a you know, I'm a writer too. But she never really says, like, in what? Like capacity. And then we kind of bumped into each other again, like online and I set her up to be on the podcast. And it turns out, I'm trying to pull it up so that I can find it. Exactly.

Unknown Speaker 21:51
She character's name is artist.

Scott Benner 21:54
So the character's name will be like, it's like she was like a district attorney. So it was like Ada Arden. And, and, and the woman's name was Kate Hall. I'm looking it up. Now this happened back in like 2019. So I have like a little clip on my website of, of the actors, like using my daughter's name and in a scene and everything. But it turns out that Kate Hall's like, you know, not just a writer, she's like the head writer, General Hospital. So

Marina Nitze 22:19
that is an awesome story. Wow, Arden was probably doesn't appreciate like how cool it is. I mean,

Scott Benner 22:24
she's, she smiled, and she was like, that's really nice. And then she should, like she showed a friend and then she was sort of done with it. But it was a it was really I thought it was an I thought it was just an amazing indication of the show, honestly, like did the podcast that helps somebody so much that you know, that they felt compelled or desirous of doing something nice like that? I just thought was really sweet. Yeah, that's awesome. Yeah. And I grew up when I was younger, coming home from school and watching General Hospital with my mom in the afternoon. So I know all about Luke and Laura, and a lot of other things that I'm not embarrassed to say.

Marina Nitze 23:03
Yeah, good for you. Watch it. I don't I'm not as religious these days. But I still I still keep playing.

Scott Benner 23:10
But you're 12 years old making websites for people. And what does that lead you to like after you kind of like, drain that? Well dry where do you go next?

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Pull out your blood glucose meter, look at it, and then question it. Is this the best blood glucose meter you can be using? You're paying for it right? You're paying for the test strips you're paying for the meter. There it is. Are you paying for the best? Are you paying for what works well? does it add something to your life? Or is it taking something away and you don't even know? Now I don't know what blood glucose meter you're using right now. But you should be looking into the Contour. Next One blood glucose meter. Something that gives you such important information shouldn't be an afterthought, make a purposeful, make a purposeful decision to carry a great blood glucose meter. The Contour Next One has Second Chance test strips so there's no wasting of strips should you touch the blood but not quite enough. You can just go back in with a Contour. Next One Try again, without impacting the quality or accuracy of your blood sugar test, that alone is a reason to do it. But if you need more, let me tell you this, the Contour Next One has a bright light for viewing at night, it's got a bright screen that is easy to read. It has a compatible iPhone or Android app, if you would like to use it. And if you don't want to use the app to collect your data, you don't have to, it's full of choice. Contour Next one.com forward slash juice box, head over and take a look. There's a test trip savings program, you might be eligible for that some of you may be eligible for a free meter. There's only one way to find out. You go to Contour Next One comm forward slash juicebox question what you're doing, make good decisions make purposeful decisions? Don't just No, no, I'm not going to almost ruin the pot for a story. But I'm not going to you have to wait till the end.

Marina Nitze 26:08
I would say rather than like one well going dry, like they sort of kind of worked in parallel. So for example, it's websites, but then like, I wanted to make soap opera games like hang man or trivia games and things. So I had to learn how to program to make those games online. And once I had that skill, then you know, when you run into the local business, or a friend's parent, or whoever it may be needs a website, then I can do that. And then I could do more than just the website. But they'll like applications that actually work for their company.

Scott Benner 26:35
And you still have this skill, like if I told you that their episode that went up the other day was about how to count fat and to Bolus for fat. And then there's an actual mathematical equation that goes with it. If I said to you, here's this equation, can you turn this into an online app? Like Could you do something like that?

Marina Nitze 26:53
Absolutely. Let me know if you need it. Are you

Scott Benner 26:55
serious? That's I wasn't asking. I was just amazed that you could do something like like that was a an idea I had while I was talking to the person. And I thought, well, that would be amazing, because then instead of this kind of difficult math that you have to do around this, this these fat calories. You could just put in a couple of numbers and be done. They could tell you like this many units over this many hours. And that would be it. And I was like that seems

Marina Nitze 27:20
I mean, you loop right around? Arden does Yeah. Yeah. There's an app fpu mod of loop that you can put in fat, and it will change your loop calculation.

Scott Benner 27:30
No kidding. Yeah, I don't think I pay very little. I shouldn't say this, but I don't pay much attention outside of my out of outside of my bubble. I guess I say this on the podcast once in a while. But I'm incredibly concerned about appearing to steal anyone's idea. So I don't like to know anybody's ideas. And I also think it drives me towards being more differently innovative about diabetes, that makes sense or not. So for sure, yeah. Okay. So you just keep growing basically, like you're, you're a person who learns how to do a thing, which leads them to another thing that leads them to another thing, and it just kept going and going. So but you still went to college? But how does how does something become so successful that you're like, I don't need to finish college? Well, I

Marina Nitze 28:14
think for me, it was a gradual thing. It was like I'm just I'm so busy. I can't like meaningfully do college and complete my paying work. And my paying work seems pretty important. So I'm going to just take, you know, one semester off, and then it's like, I'll just, I'll go back next semester. And then I moved to a different state. And then I was like, oh, I'll go back, you know, next year, and then it just kind of keeps piling on.

Unknown Speaker 28:33
So your parents

Marina Nitze 28:34
so far has not held me back in any way. So I'm not wildly persuaded to go back. Yeah, I

Scott Benner 28:39
mean, I don't listen, it doesn't matter to me. I took one college credit ever in my life, and I have the most popular diabetes podcast on the planet, so I'm okay. But, but at the same

Marina Nitze 28:49
time, okay, you're okay. That's

Scott Benner 28:52
the only thing I would say that through my 30s maybe my late 30s, early 40s. I did have that like feeling of like, I really should have gone to college. And I didn't know why I felt that way other than it felt like I let myself down or something like that. Meanwhile, didn't seem to matter for me. But did you have living parents that you had to tell you were not going to college? Amer

Marina Nitze 29:14
I, I it wasn't really a conversation. I don't know. Nobody. Nobody's upset with me. Nice.

Scott Benner 29:21
Is this do you think this is based on a lifetime of like, she's always doing the right thing? She'll be fine.

Marina Nitze 29:28
Yes, I think that that probably like I've always been a little bit outside the box, but effectively so I guess I've also with the exception of working the federal government never had like a real job. I've always worked for myself. And so I am pretty comfortable doing that. And I think other people are just used to me kind of going my own way.

Scott Benner 29:47
Yeah. I if I had to work for people again, I would be making me cry. I would cry. He really would. I very much like being able to set my own pace and and and I like to have I like being able to have ideas that I know if I went into a room and tried to discuss with four people, that they'd shoot it down, and that I just get to go, I'm gonna do that anyway. I like that a lot, actually. Okay, so you're on your way, you're doing a thing You just said you ended up working for the federal government at one point, what were you doing there?

Marina Nitze 30:19
Yeah, I was a senior adviser on technology to President Obama in the White House. And then I was the Chief Technology Officer for the Department of Veterans Affairs for five years after that.

Scott Benner 30:29
What is the Veterans Affairs job consist of? What are you trying to accomplish?

Marina Nitze 30:34
I was told on my first day of work that my job description was to redefine the art of the possible of how America honors and serves its veterans. So you know, no biggie. In practice, a lot of my time over those years was about bringing new technology talent into the VA, but really primarily shining the light on the experiences of real veterans, going out and sitting with veterans that are experiencing homelessness, who needed VA health care, but couldn't enroll and understanding like, what were the specific obstacles they are facing? And how could we as the VA, remove those obstacles?

Unknown Speaker 31:09
Did you come to any conclusions in your time, there

Marina Nitze 31:12
are quite a few. And actually, it's kind of cool. The VA right now is being lauded as really effectively delivering vaccines to veterans and their caregivers. When I was there, there actually wasn't a database of veterans. That might sound crazy, there were 64 different ones. And so we set out a course and a vision of like, what would it be like, imagine if a veteran could update their address in one place, and like the VA knew about it. And so it's pretty cool to see the groundwork that we laid in 2013 now mean that in the time of a national pandemic, the VA can really effectively deploy and serve,

Scott Benner 31:45
how much of the, how much of bureaucracy gets built, because people come and go and have new ideas. And instead of either working with what they have, or starting fresh with something, they end up just building a sunroom on the side of it and keep going like is that? Is that how it gets confusing like that?

Marina Nitze 32:04
Oh, I think it's a ton of it. I used to keep a chart on my wall in the office of like, people's beliefs when they first came in from the private sector and join my team relative to their beliefs in six months. And I think part of it is coming in and not understanding what was there before. But I think part of it is also coming in with a belief that like, your new thing can be exempt from the rules, or you can get like a waiver. Or if you just build a kind of over in the corner, nobody will notice it. And that's not how government works. Government is designed, designed to not change very quickly and to be very risk averse. And so my advice always when people are coming into a government situation is you have to understand the real rules like why is this the way that it is? And how can you change the fundamental rule or law or form behind it? Because that's how you make real lasting change. You're kind of innovation that you stick on the side? Would you say like a sunroom? Yeah, they'll just bold like there's there's a full bulldozer fleet that is designed to look for some rooms and bulldoze them.

Scott Benner 32:58
Okay. So is this in some way similar to how people get told to care for themselves with diabetes, like that you're standing in front of a doctor who's, I don't know, 60 years old, and somehow his sweet spot and diabetes was 1986. And because there's still some people who get diagnosed, they're like, they're there on a sliding scale. Like that actually happens, though, and

Marina Nitze 33:21
hear about that, or they're, they're told, like the right balance is 50% or less 50% basil, independent of what they eat, or what their basil doesn't matter,

Scott Benner 33:28
yet, no one ever discusses that their carb ratio might have something to do with the glycemic index or a load of their food, like, nothing like that. Like it like those ideas. So you get you end up getting that doctor, right. And then he starts you or she starts you in 1984 with your diabetes. And then there's no one there to, to do anything about it. So that's just the path you're on. And isn't that sort of, is that kind of bureaucracy to? Like, get like, at some point? Shouldn't every doctor in the world just get together bulldoze the whole thing and start over again?

Marina Nitze 34:03
Yeah, I think it is bureaucracy. And then you think about like, how do you fix that? Right? Because at some point, that doctor got licensed and isn't allowed to see a bunch of patients and put them on a sliding scale today, right? So like, what framework has allowed that to happen. And then you look at other things like our whole healthcare system, why is type two diabetes exploding, and people are getting worse and worse, you know, the VA spends more now on amputations due to diabetes, and to combat wounds, which should make someone raise an eyebrow like, but we keep using the same old advice of like, we'll just have another STL to inhibitor. And I think we need to fundamentally rethink how we're treating diabetes, type one and type two. As a country,

Scott Benner 34:42
we live in a world where I think we just experienced I think this is something that people don't say out loud over the last year and you know, but I don't think I mind because it seems to me to make perfect sense. But throughout COVID no one ever was like, hey, if you were healthier, you might not get as sick. He gets sick. Like we we never say that, that people like we never like that's it's always, it's always, like you said like something bad's definitely gonna happen to you. And we'll see if we can't stop it from killing you. Like that always seems to be the way we do things instead of getting in front of them. I know that's a very simple idea that is pretty obvious to people. But we never talked about it like that, like prevention, I guess.

Marina Nitze 35:23
I wish we talked about prevention a lot more and then look upstream. Like I think it's wildly unfair to blame individual people for their own health outcomes. And we have to consider like the environment that they're in. So if we have corn subsidies that make cheap processed foods that are worse for your blood sugar, cheaper and easier to access than other healthier food, if we limit what you can get on food stamps, if we don't allow food delivery for healthy food, but we allow it for, you know, super processed food, the contents of school lunch menus, the contents of hospital meals, frankly, I had my appendix out last May in the hospital, and the nurse just straight up told me there was nothing on the menu that I could eat as an diabetic. And I was like, Well, okay, um, you know, we need to change those sorts of environmental variables. For people,

Scott Benner 36:07
I'm thrilled you said that, because that is exactly how I feel. And that would have been the rest of what I said, which is, you can't you, you can't take a baby, and lock it in a room with a bag of heroin and a bunch of needles and cocaine in that corner. And, you know, 13 pot plants and some psychedelic mushrooms over here, and then later go, I can't believe you couldn't avoid drugs. Like it's, it's it really is what we do with food. And a lot of other things, too. It's just, you know, I spent most of my time discussing on the podcast, how to manage insulin, and how you can use insulin dough, you know, combat spikes, and prolonged highs and things like that. And I am totally not a person who tells people how to eat, I don't care how you eat, my daughter eats what I would consider a fairly American, you know, lifestyle. So it's not like, we're over here counting macros, and, you know, telling everybody else, it's going great, you know, and I haven't chicken to like it, you know, we're fried chicken too. So I don't, I don't care how people eat, I think it's up to you. And then I just want you to know how to use your insulin after that. But fundamentally, most people don't seem to understand that processed food or foods that aren't real, are really difficult for their bodies to process. And to get out the other end without leaving on you poor health outcomes. Wait, you don't want etc? And that's, I don't know if that's education, where a fits opportunity? Or if it's not a little bit of both? It sounds like you think it's a little bit of both, right?

Marina Nitze 37:38
Yeah, I definitely think like there's a lot of there's a lot of government incentives, their subsidies, they're thinking about, like, how dietitians are trained. What is my plate look like? And then you're right, like, what are the standards of care for diabetes? And how do we update those given today's faster insulins CGM, and knowing what we know about standard deviation, which is a number you couldn't even calculate when I was diagnosed? Yeah. And now that's a number I keep, you know, very close eye on.

Scott Benner 38:04
So So let me ask you a question. Because this is your, I didn't expect any of this to go like this. Well, I'm having a good time. So it is my I have, I have a macro goal and a micro goal for the podcast. So every day, I just tried to put out good content that I think people will enjoy, that will help them live with Type One Diabetes better in some way. And my pullback goal is that I want this idea of being flexible with your insulin, being aggressive, not you know, abiding by high blood sugars, not staring at three hundreds for six hours going, it'll come down, like you know, stuff like that to become so the norm, that it's how people are taught. But I, I can't really affect that from here. I mean, I can, but I can't reach enough people to make it happen. So my question is, if I took you and made a, you know, another job where you were in charge of that, how would you impact the health care system to talk to people specifically about diabetes in a more proactive prevention way?

Marina Nitze 39:05
I have a very specific, wonky answer for you, which is I would change the way that Medicare Advantage star ratings work. can I explain that Julie's? Okay. So right now, Medicare Advantage is a kind of Medicare, where the federal government pays an insurance company a certain amount of money every month for you, Scott, and they're gonna pay that amount of money, no matter what happens to you that month. So your insurance company, the idea is, is now incentivized to keep you healthier, because if they can get you fresh produce, drive you to the doctor, make sure you're refilling all your prescriptions on time, then you're less likely to be hospitalized that month, and then the insurance company gets to actually pocket that amount of money that month that they receive for you instead of going in debt, sending you to the hospital with ambulance rides and surgery and whatnot. And right now, Medicare Advantage has a lot of diabetes related measures and it gives doctors more money. per per patient per month, the more of these measures that they hit. And the measures include making sure everyone's diabetes is on cholesterol medication, no matter what else stressed, you have diabetes, you're on cholesterol medication, making sure everyone is on high blood pressure medication, making sure a once he is under eight, things like that. And I would really like, Look, this is the heart of like payment and healthcare in America, how can we change those measures so that they're more aligned with your actual health care outcomes and enjoying a successful life with diabetes? And not? I mean, I don't know 8%, I wouldn't feel good at 8%. And that shouldn't be the goal, to my mind. And if we want to change the incentives of the healthcare field, we have to change where the money is directed.

Scott Benner 40:41
And is there a way to do that within the system now? Like, where would the system have to be completely revamped to support that?

Marina Nitze 40:48
I think if you got enough of a coalition to support and you do it incrementally, maybe we could change the Medicare Advantage star rating from an A one C of e to 7.5. And then we could bump it down a little bit more and give those doctors and those patients more tools like you provide right to help get those numbers more in check. I don't know that a lot of diabetics know how to really address a 300 quickly or know that there's no muscular injections or know the impact of low glycemic index foods on how they may Bolus for one food over another. And I think there's a lot of these tools that can be taught and people deserve. We can all make our individual health choices, but people deserve to have a full menu of options.

Scott Benner 41:27
Yeah. So I think that the the least common denominator way that we do a lot of things. I think it's lazy. And I don't think it's even true. Like I think the I think the messaging is, and this is the you know, the example I frequently use, I think the messaging is if there's 20 kids in a class, and three of them are brilliant, and 14 of them are average, and three of them are struggling. Well, we don't want to, we don't want to leave the three behind who are struggling. So we'll, we'll bring the entire course level down so that they can keep up with it. And in my mind, what that does is it eliminates the idea that the other 17 kids might Excel. And so I think we do that with health care, but it's around they do it around safety. They say well, we can't you know, we can't tell people how to Bolus, you know, aggressively, they'll kill themselves. But that doesn't happen. It's just what people say. It's the and I think they say it because they don't know how to explain it. And if they say that they can't explain it for safety reasons, then they'll never get called out for not really understanding it to begin with.

Marina Nitze 42:30
I think the risk frameworks are all pretty perverse here. So you have an endocrinologist who is arguably afraid of being sued for your really bad hypo glycemia event, but will never get sued. If you have complications from being high or even tech, you failed a test because you were 300 for so long that you had brain fog. But then you meet other health professionals like an ophthalmologist who could look at an A what your endocrinologist might say, oh, you're 6.5 a one see his thumbs up and you know, ophthalmologists will look at it like, Oh, we got to tighten this up. Because I want to prevent you from complications are you talk to an obstetrician for a pregnant diabetic, and they're upset at any blood sugar over 100. And it's a totally different framework, but they're their risks, they're worried about you and your baby. And so I think a lot about how do we align these risk frameworks more that the risk can't just be about going low. And there's also steps toward that, like, I don't suppose you recommend people get super aggressive with insulin tomorrow, if they kind of barely understand how it works today, like there are steps in that direction,

Scott Benner 43:28
you don't start off at the ninja level, you you in my mind, it's you understand what basil is for, you get it set up, well, then you start understanding how to Pre-Bolus your meals. And then you begin to understand the different impacts of foods. And then you go from there you go, you stay flexible, you understand that fat might keep carbs alive in your system longer you like start building on it. But in the beginning, in my mind, the core of it is basil Pre-Bolus saying glycemic load index, if you can get those three ideas, right, that's an A one c somewhere in the sixes with very few lows. But you don't yet I don't, but you can't just have your your your basil can't need to be 1.5 an hour, but it's actually point six. And you usually try to correct the high with two units, then all of a sudden, you're like, I'm gonna use seven. Like that's not, it's not what we're talking about. Like there's a there's a balance. And I think it's why it works in podcasting, because you don't need to understand that all in one day. And you get to kind of like listen through it, hear people talk about it, and go and then find what's applicable to you and what isn't, and then set it in place. Now are there going to be those three kids in the class listening to the podcast who never quite get it? I assume Yes. But I pride myself on talking about it in a way that I think everyone can understand it. I think that's valuable across the board. But I also am just not the kind of person who is willing to let 17 people's health slip because three people might not understand what we're talking about. But I don't think that's valuable.

Marina Nitze 44:58
And it's like what we're talking about earlier. We're like you and I have different personalities with lists, but we find ways to make them work for ourselves. You know, I totally believe that there are some people that love regimen and they can MBI routine, like the same as I was on when I was nine or 10. Like might work just fine for them today, they like eating the same amount of meal at different times different day. And they like that regimen. And that's great. There are different people that are super confident, like sugar surfing with like, large amount of carbs, and there's lots of space in the middle. And also we have different bodies I have, I am super, super insulin resistant in the morning, to the point that I do not eat breakfast, I haven't eaten breakfast for 22 years. And that works for me, I have coffee, you know, totally happy that someone else may need breakfast. And they absolutely need to find a different way for that to work. And we all have to kind of work work within those frameworks, right?

Scott Benner 45:44
So my idea of infiltrating from the outside the healthcare system isn't really going to work because they're not incentivized to teach people these things.

Marina Nitze 45:55
Well, unless you get your listeners that grow up and go to medical school, and become doctors, like there's a long game here. So we

Scott Benner 46:01
do have a few people who are becoming nurse practitioners, I have made a couple of CDs, which they don't call them CDs anymore, but I am not willing to learn the new acronym, so. But I have a few people who are becoming CDs, there are a number of people who are who find this podcast through their doctors direction, which I think is very progressive and amazing. So you're saying I might have an impact that I don't, I'm not gonna get to see what you're getting on here. Right?

Marina Nitze 46:28
You're definitely having an impact. And it's like, there's a lot of levers in the system. And if you can start influencing other diabetics to even just understand what's possible, I think, you know, knowing what is possible, even if you maybe make offset choices for your own lifestyle or activities or whatever, we should all know that we are entitled to have like normal non diabetic a one sees and experience like not having the the roller coaster of Oh my God, I'm crashing low and then I overtreated enough. Now I have brain fog. Because I'm high and I feel like crap all day. You know, we should have, we should know that there are ways in a different direction to me. And we all have different ways to get there. And not everybody's going to choose to do that work.

Scott Benner 47:10
And that's, by the way, if that happens, that happens, I don't feel encumbered by everyone's health. But you should at least have the opportunity to know that thing exists and make a decision for yourself as to whether or not you want to implement it or not. But you shouldn't be told that you're a one sees, okay, because it hits some arbitrary number that was set by a board of people who don't have diabetes. And that's just how the doctor ends up getting paid by somebody if you're a once he comes in under a number like that's not health, like I very clearly on the podcast, I say that most doctors give, do not die advice. And they give it the exact reason you brought up earlier because if you die today, it's their fault. And if you die 12 years from now, it's your fault. And that's what they want. They want the fault to be with you not with them.

Marina Nitze 48:01
Yeah, and we have other numbers like an A one C is a measure, right? And you and I both know, but when you and I both have enough tools that we could game it if we needed to. And there's other measures that you want to take into account too, like a standard deviation if you have an ANC of 5.5. But it's because you're 40 halftime and 200 other half the time like and you're at standard deviation 60. You know, you're probably way worse off than someone with a one to six,

Scott Benner 48:24
you're screwed and the doctor gets paid. And that's Yeah, that's not the way to go. So I noticed you're not in government anymore. Was it exhausting? And was there was there something fulfilling about it that you would like Could someone get you to go back?

Marina Nitze 48:44
It was absolutely exhausting. It was also like the most impactful amazing scale of work ever. And I was a political appointee. So I got kicked out with the with President Obama the same day that he left, but I actually work in foster care reform now. So I do I would say I caught the public sector bug. I'm just in a different part of the organization at the moment.

Scott Benner 49:05
Okay, what do you do for that?

Marina Nitze 49:08
I similarly, I work with different states doing business process reengineering, to help them, find family for kids faster, and help get those families approved for kids to live with them faster.

Scott Benner 49:19
So the kids get out of homes and into out of like foster home institutions and get into real into single family homes.

Marina Nitze 49:27
Now, the goal for me is always if a kid has to be taken away from their parents for health and safety reasons, and they should be placed with an adult that they already know and trust, whether that adult is their grandmother, their baseball coach, their moms, or their friend's mom. And then we should resource that family in that placement so that it stays together so that a kid if they do have to enter foster care doesn't have to move around a bunch. What happens today is you know, you're taking your place in a home that is generally a very poor match with strangers and then you move 17 more times, and then we act confused why you're acting out and you're not doing well in school. Do kids

Scott Benner 50:00
become commodities in that system because the people who take them in are paid to have them,

Marina Nitze 50:05
I have seen a lot less of that. But you do have to keep in mind that like in a group homes, there is a huge financial incentive for group homes to be full. And they there's a lot of money to be made in a group home environment, I think there's a lot of wiggle room in the middle like we need to acknowledge, like, there's so much stigma from a Little Orphan Annie around paying a foster parent anything. But we need to acknowledge that if we don't have any in between space, then the choices are just you're in a foster in his traditional foster home where they only get reimbursed for your kind of food and clothing. Or you're in a group home, where we're paying a full time staff to take care of you. And there's definitely some middle ground where we could pay an experienced foster parent to help a child with a higher level of needs. But stay in a home environment

Scott Benner 50:48
is that is the concern that when you pay, then some people take advantage of the system. But isn't that usually far fewer than who are actually doing good with the way it works?

Marina Nitze 50:59
It is the concern and I would say it's far and away. It's people that are doing good, good work. And they're really, really sticking their necks out for these kids. I mean, nobody is getting no individual foster parent is getting rich. If you look at the foster parent rates,

Scott Benner 51:11
it's barely covering the cost of a kid's shoes and clothes. If you put them with people that they know previously, does that physically make them more likely to stay together as a unit long term?

Marina Nitze 51:23
astronomically? Yes. And how astronomically better outcomes in terms of high school graduation not being pregnant or not, you know, parenting before they're ready. finishing college, getting education, employment, making the same amount as their peers. I mean, the the outcomes for foster kids are just abysmal right now.

Scott Benner 51:44
What, um, where's my question? I had a question, oh, once a child's removed from their natural parents, what's the likelihood that they'll go back? And is it usually a good situation where it's

Marina Nitze 51:57
about 5050 likelihood that they'll be reunified. And there's a lot of hoops that parents have to jump through to get their kids back. A lot of hoops. So, while some kids do come back into care, I would say that there's a lot of focus on reunification. And to make those successful, a lot of our focus needs to be on wrapping around supports around those birth families, like a story I tell all the time is we very regularly take, you know a mom or dad, they can't afford daycare, they're working really hard. They leave their kid home alone, because they don't have the money for daycare, some neighbor calls in a neglect report because the kids have been left home alone. We remove the kid we create tremendous trauma to this family and we placed them with strangers. And then we give those strangers money for daycare. Yeah,

Scott Benner 52:39
it could have given the parents for the daycare.

Marina Nitze 52:42
Yeah, we could have I put daycare in originally and kept a family together.

Scott Benner 52:46
When I don't want to be cynical. But when people don't get through the reunification process, is it sometimes because they're I don't want to say happier. But I guess happier is the word. Are they happier that the kids not with them anymore? Does that happen?

Marina Nitze 53:02
I wouldn't say that I would say some people have deep struggles with drug addiction and with mental health challenges that as a society, we are not doing a great job of helping them remediate. And a lot of people try what I see are birth parents trying and trying and trying and jumping through tremendous hoops to get their kids back. How do you help?

Scott Benner 53:21
So it's just very interesting that you that you said mental health and drugs is like your example. So it are those two things, drivers behind problems and a lot of sectors of society.

Marina Nitze 53:35
I use, I work in veterans and I work in child welfare, I would say like in those three spaces, like they can be very problematic.

Scott Benner 53:42
Can you help people when they're in those scenarios, like, that's always the like, I know you the goal would be to win that you would want to and I would want to if you put me in charge as your magic wand me I was like, I definitely be like I'm gonna help these people. But I've also interviewed people who are bipolar, for example, and you're talking to them One moment, and everything's right. And then you talk to them three days later, and you're like, well, that's not the same person I spoke to three days ago. And I don't know, like, how do you? How do you help people in that in those scenarios? When they're gripped by something other than themselves, I guess if whether it's a mental illness or if it's drugs, something that's outside of their control, I guess, I don't know if I'm using the right word or not. But that's how it feels. It feels like an outside driver to me.

Marina Nitze 54:32
I think there are a lot of successful treatments for mental health and for drug addiction challenges, but we need to make them available to people and we need to make them available people where they are. And I actually mean that quite literally in the sense that if I if I say you know okay, I've taken Arden from you and to get her back you need to go to therapy. Four times a week. Therapy is two and a half hours away from you. And you can only get there by bus and I'm not getting a bus pass and then I also by the way need you to visit her at In order to account for court visitation, and then I also need you to get stable employment and stable housing, and I'm not going to help you with any of those things go while you're already struggling, potentially, you know, presumably deeply struggling if you've had your children removed, like there's even missing things about, like, how many providers are at bus stops? Like, we don't know that that isn't tracked. And that might seem like a very, very basic thing. Do we send reminders to birth parents about court dates, you know, like, they may not have a Google Calendar like yours in mind that is so full that, you know, we're getting alerts every five minutes. And we I think we really could do a much, much better job as a system of helping parents to succeed and not set them up for failure

Scott Benner 55:37
is a is a big part of helping people not judging them.

Marina Nitze 55:42
I think so absolutely. You have to give everybody like a really fair chance at succeeding, and you have to really recognize that not everyone is starting from the same point on the course,

Scott Benner 55:52
I have to imagine, too, you have to not apply your judgment of success to their lives as well. Like, like, if if I don't either, so I'm not sure what I mean here. But there seems like there's a whole section of, of our culture, who wants everything to be perfect for everybody. And which is a lovely idea, except that when something could be perfect for another person, and it might not be perfect to you. Is there? Is there a problem there? Where we're trying to get people to something that they're just unaware that even exists? Or couldn't get to even if they knew it was there? So it makes sense?

Marina Nitze 56:32
Yeah, I'm not sure where you're going, I would say it's less that they can't get there. And it's more that there are different standards for communities and for families in different places. And it's wildly unfair and judgmental, to hold everybody to one standard. Like as a quick example, many states require foster parents to include like grandma's or Auntie's that are taking you in, to have recycling, to have a working oven and stovetop, to have the right quote, unquote, number of windows in your bedroom, which fits for a standard colonial home. But Native America, I live in a colonial style home. But for a Native American long home, they have the quote, wrong number of windows in their bedrooms. And when you just have a lens that the whole world looks like my world, you miss those things. And then you start, you know, traumatizing and separating families, because you're not there understanding that they have different and perfectly acceptable homes, they just are shaped a little bit differently.

Scott Benner 57:27
Is the windows thing for egress during fires and other emergencies? Is that what that's for? Yeah, I couldn't imagine any other reason. Like, that's the only thing that popped into my head. So. So then this thing, that we're taught this big idea around foster care. And if you switch real quick and talk about, you know, health care, or diabetes care, it is all really arbitrary rules that have been slapped on top of other things, because at some point, because at some point, some kid died in a fire, right, and the fire was on one side. This is like when I rented my first apartment with my wife, we were signing the contract. And it said explicitly on the contract, that you could not swim in the pool with an open wound. And that made me and that made me look at the woman. And I said, how many people try to swim in the pool with open wounds? Because my brain said if it's in the contract, it's a problem. It's something they've come up with before she goes, Oh, it's happened a number of times. And I laughed, because I thought it was funny, except that there's some kid who doesn't get placed in what would be a good foster system. Because 20 years ago, there was a fire on the east wall. And that was the only window in that room. That's the truth. Right?

Marina Nitze 58:41
Correct. Yes. And we really need to rethink fundamentally, what these rules are and how we can make them more flexible. The goal is that you can escape from a bedroom in an emergency. I'm okay with that goal, but I'm not okay with counting the number of Windows.

Scott Benner 58:55
Yeah, you know, I don't know if I've said this before. on here. I'm sure I have at some point. But there's this little parable about a girl making a pot roast with her mom, and the mom.

Marina Nitze 59:05
I love the one from Reader's Digest. I

Unknown Speaker 59:07
tell people,

Scott Benner 59:08
I just I think it's it's so insightful. And it's it's what I use around diabetes to tell people like, there's no way to do something. I know, you think there's a rule? Because you heard somebody say, and then you went on Facebook and somebody said, Oh, that's what my doctor said to and they're like, Oh, I heard at one place. And her doctor said it, obviously a role. I wish people understood the freedom that I have in the way my brain works. I am not encumbered by what any person who came before me thought. And I think, you know, we could dig into that I grew up adopted and I was brought up in a lovely home with wonderful people, but I may have been a little I may have been a little more intellectually strong than they were. So I was always figuring out my own things. But more importantly, I was never relying on what they said to me to figure things out. I was always looking for my own answers. And I just I'm such a big fan of looking for your own answers. And, and this just seems like what we talked about all the time, but there are people look at you, you're out there like there's somebody out there right now going I have a seven, three a one. See, I'm winning, because somebody said a number for reasons you brought up earlier. And meanwhile, a 731 C is terrific. But there's more room under that, and a way to get to it and no one's ever going to tell it to you. Yeah,

Marina Nitze 1:00:30
my I'm not here saying anyone with a seven three a one C, you know, Dad, I'm saying that I want them to know that there are other tools out there that they could leverage that don't mean they have to give up, you know, their life or they have to like follow a clock. There's ways they can do it that work with their lifestyle, exactly how I feel. And

Scott Benner 1:00:46
this whole, the last five or six minutes of this conversation have made me angry, not at you. But can you imagine if I was like I'm mad at you. But just that whole idea. That arbitrary nature of things is is bothersome to me that we have rules we follow for reasons that don't even exist anymore? Or maybe we're never good reasons to begin with or just stop gaps for somebody. I really want people to think about that. Like how many things do you do in the course of a day that are senseless? And they seem utterly, like they're the most important thing that ever happened? Oh, my gosh, so how do you Okay, so now you you recognize that? And I don't know what you do? Like, I don't understand how to fix anything, doesn't it feel like we're just building on top of that? Like, like, how do you how do you start fresh with things?

Marina Nitze 1:01:40
It's definitely frustrating. And I think it does this sort of stuff. It's one person at a time and and helping one person learn that, oh, that is a tool that could work for me or that person sounds like me, I could learn from what they're doing. And just again, knowing that there's hope, I think I spent a long time having diabetes thinking that 6.5 was like the holy grail, and he couldn't do any better. And I'm really grateful to know differently now. And I want other people to know that too.

Scott Benner 1:02:07
Well, I how do I not have you on Twitter? What did how did this happen? You know, I only know you by your little picture. Like when someone likes when somebody said your name to me. I was like, I don't know who that is. And then as soon as I looked for you, I was like I know that face. Isn't it weird how social media works? I'm like, that person I'm aware of. Then you look into what you do. And I'm like, but I don't know about any of this. So how did what you were on another podcast? Right? But you weren't talking about diabetes? You just brought it up at the end? Is that what happened?

Marina Nitze 1:02:37
Yeah, it was a podcast called people I mostly admire from the Freakonomics team. And we were talking about sort of my career path around the federal government. And then Steve interviewed me a little bit about type one diabetes in my experience that with that,

Scott Benner 1:02:54
Isn't it weird how that and then someone who listens to this pocket a number of someone's listened to this podcast heard you on that? And I got immediate notes, please have this person on your podcast. And I was like, I'm on it. Like, like, geez, I felt very pressured. I'm not gonna lie to you. When the third email came, I was like, I'll do it. Okay.

Unknown Speaker 1:03:12
And you were very kind of those people. Well, you

Scott Benner 1:03:14
were very nice to answer back so quickly, because I have to admit, like, once I found you, I was like, she's not gonna answer me

Marina Nitze 1:03:22
have the most streaming diabetes podcast? Why would I not write back? I don't know, I

Scott Benner 1:03:26
feel I, you know, I don't know. I didn't grow up

Marina Nitze 1:03:30
like an imposter syndrome. I

Scott Benner 1:03:31
didn't grow up with a ton of self confidence is, my guess, is the real answer. But no, I was so thrilled like, and you don't ever want to like, it's a weird note to send. You don't say hey, by the way, I'm here am I you know, like, but you have to sometimes there are people I've gotten on this show, by sending them the downloads to the show. And it's the only way you can get them because they're more sought after. And they you know, you didn't do that. But, but they're sought after and they don't waste their time. They don't they don't do things that nobody hears, you know, which makes complete sense. This was really good. Did I not bring up anything that I should have?

Marina Nitze 1:04:10
I it's your show. I feel

Scott Benner 1:04:13
you're not holding anything inside right now. You're like, I can't believe you didn't lead me to this point. Yep. Thank you so much for doing this. I don't remember where I heard the pot roast story or whatever it's called, initially, but I did write about it in my 2013 book, titled Life is short laundry is a turtle Confessions of a stay at home dad. And I'd like to read that passage to you here. When I first became a stay at home Dad, I thought about certain tasks that I was performing in very gender specific ways. Eventually, my new life helped me to understand that there is no such thing as a woman's or man's task. When it comes to raising family, only parental responsibility. This topic reminds me very much of an old anecdote about pot roast that I've heard told over the years. I can't remember where I first heard it. But it makes the point that you should question what you know. The story goes that while preparing dinner one evening, a mother cuts the ends off of a pot roast she's about to put in the oven. Her daughter sees the cuts made and asks the mother why she removes the ends of the roasts. The mother thinks for a moment but doesn't know why she always makes those cuts. She tells her daughter that if she wants to find out she should call her grandmother and ask her since she is the one who taught her mother the method. The girl calls the grandmother, but she doesn't know either responding only that she did so because their mother did. still not satisfied the girl contacts her great grandmother by phone to get the answer for which she is so desperately searching. The woman answers the phone she is old and wary and has to think for a few minutes before she can recall the answer to the girl's question. Suddenly, the great grandmother remembers why she cut the ends from all of those pot roasts so many years ago, and says, Oh, that's right. I cut them off because my pain was so short that they didn't fit. So whether you're a bureaucrat making up rules as to who can serve as a foster parent, or a doctor telling people how to Bolus for their food, or anything in between. You really should stop once in a while and ask yourself, why do I say the things that I say? Is there really a reason? Or am I just repeating something that I heard someone else say?

A huge thank you to one of today's sponsors, g Vogue glucagon, find out more about chivo hypo pan at G Vogue glucagon.com forward slash juice box, you spell that GVOKEGL Uc ag o n.com forward slash juice box. Thanks also to the Contour Next One blood glucose meter. Learn more at Contour Next one.com forward slash juice box you may be eligible for a free meter, you are going to want to look into the test trip savings program. You want to find out about the most accurate blood glucose meter I've ever seen. It's not just accurate, it's super easy to hold. Super easy to use. It fits well into your life. If you're enjoying the podcast, please subscribe or follow in the podcast player that you're listening in right now. If you're listening online, please consider listening in a podcast player they are free and very handy. But last if you're enjoying the show, share it with someone who you think will enjoy it as well. Thank you so much. I'll talk to you soon. Find Marina at Marina and Itsu calm ma rinnitze.com and her app task tackler is available at task tackler.com


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