#384 After Dark: Bipolar Disorder

ADULT TOPIC WARNING

Jonathan offers a raw look into his life with mental illness and Type 1 diabetes during this interview with Scott, which gives a 90-minute glimpse into the complications of living with poor mental and physical health. Jonathan shares his family history, stories of multiple suicide attempts and surviving DKA. He is a thoughtful young adult who calmly discusses his past and the turning point for choosing to live a healthier life with T1D.

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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 0:13
Hello friends and welcome to Episode 384 of the Juicebox Podcast. This episode is also the eighth in the after dark series. I call them after dark because they're topics that don't normally see the light of day. we've tackled drinking, weed, smoking, trauma, addiction, sex from both the female and male perspective, depression and self harm, divorce and co parenting. And today's episode is with Jonathan. Jonathan, among other things, has bipolar disorder, ADHD and depression. He also has type one diabetes. He's been in decay a number of times, and has had a couple of failed suicide attempts. Jonathan's life is going in a different direction now, and he was looking for some conversation about it. And that led to this episode. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. If you're concerned that the topics I've mentioned may bother you, this probably isn't the episode for you. And it very, very likely is not for your child to listen to, at least not alone. I want to thank the sponsors of this episode. dex comm makers of the G six continuous glucose monitor and Omni pod makers of the tubeless insulin pump that my daughter has been using forever and ever and ever. You can get a free no obligation demo of the Omni pod tubeless insulin pump at my Omni pod.com Ford slash juice box Podcast learn more about the Dexcom g six and even to get started. You can go to dexcom.com Ford slash juicebox. There are links in the show notes right there in your podcast player. And at Juicebox podcast.com. When you click the links, you're supporting the show. There are a few little electronic noises in the first number of minutes of the show but we get them worked out.

Jonathan 2:10
I am Jonathan. A lot of people call me john the diabetic kind of grew on that name. I have type one diabetes.

Scott Benner 2:20
JOHN, where do you get john the diabetic from? Is this a girl standing around one day and it comes up? Or how does that happen?

Jonathan 2:28
Um, it was one day with me and my friends were at the bowling alley. And I town a little town I use a little bit and I don't remember exactly what went on. But I did something funny. I remember what it was something to do with a pool table. But they sorry life and stuff I said yes. It's me, john the diabetic and ever since then. It's just been john the diabetic

Scott Benner 3:05
is listen, there's a little bit of an electrical noise behind you. Are you talking to me with your cell phone or with a computer?

Jonathan 3:14
with myself, your cell phone?

Scott Benner 3:15
Okay. It's no big deal. I was just I was wondering if we could move your cell phone away for theater. But if that's Are you near anything else or no? Like electronic?

Jonathan 3:25
No, cool. Okay.

Scott Benner 3:26
All right. So am I to infer that whatever thing you did was silly. And you were you blaming you're like you're like my blood sugar's low or you know how I get it? Was that kind of the vibe? I'm backing up in the in the bowling alley.

Jonathan 3:46
We're sort of talking about the name or Yeah, yeah, I was

Scott Benner 3:50
just wondering like when you responded, you know, um, you know, it's me. I'm john, the diabetic was that because do you do a lot of were you doing a lot of things that were attributed to your diabetes or you just pulled it out of your ass?

Jonathan 4:03
I just pulled it out of my head.

Okay, gotcha. Gotcha. Okay.

Well, listen, you don't worry. I thought I thought it was funny. I thought it was funny. Like I ever since I became a diabetic, I've always made it a fun thing. So I weigh when it bring me down. Personally, I see. Because I've met other diabetics that are way worse than me. Like, they would let the diabetes bring them down and stuff. So I decided not to do that.

Scott Benner 4:40
Yeah, just not to be sad about it and those sorts of things. I hear you. Okay, so So how old were you when you were diagnosed?

Jonathan 4:51
I was 12 years old. November the 11th of 2012. I got diagnosed 2012 Okay. November, which is kind of a big deal for me on that day because November the 11th of 2011. My grandma had passed away from type one diabetes. So and how old is your toll on me is

Scott Benner 5:21
doing now I was just gonna ask you How old was your? Did your grandmother have type one her entire life?

Jonathan 5:28
Yes, she did. Okay. And I believe she was 62 when she passed. Okay.

Scott Benner 5:34
All right. So she passed from like, I mean, you were young back then. Do you even know? Is it complicated? Do they call it complications of type one? Or did she have something specific, like a heart attack? Or what do you remember happened?

Jonathan 5:47
My My mom told me that it was complications of heart of her heart. She said her heart gave out. I don't exactly know what happened. But my mom's mom says is because her heart gave out now. I don't know. If I believe you know, yeah, sure. I don't know if it was because of that. We're the type one diabetes, but it's very possible that my mom told me it was just because her heart.

Scott Benner 6:24
Yeah. To keep me like, not upset about it, I guess. Oh, I see. Not the thing that maybe the diabetes is what what would help her under life early? And I say maybe your mom was protecting you. But no, I mean, now you know, you're older, the type one. If it's, you know, it could affect your, you know, her heart. And you could end up having a heart attack. But the heart attack might be facilitated by, you know, her blood sugar's being maybe out of whack or high throughout her life. But I'm so sorry. I'm sorry to hear I know, it's a long time ago, but I'm sorry to know that I am even more kind of amazed, as I'm sure you probably were on that day. That one one exact years later, you're diagnosed. You know,

Jonathan 7:08
it took a big toll on me. I was depressed from that day. On to, I want to say, three months ago, two months ago, I think I finally made out of depression. And no, it was a big toll on me really was Tell me

Scott Benner 7:29
tell me how old you are now.

Jonathan 7:32
I am 20. You're 2020 and a half.

Scott Benner 7:35
So through your entire sort of adolescence. You just you you were were you clinically depressed? Were they giving you retaking medication for it?

Jonathan 7:43
No, I was not taking medication for it. I I never did like to go to a therapist or anything or doctors or anything. I was just kind of I don't know what you call people like this. But I guess you'd say I'm one of those people that just deals with stuff by themselves. I guess. Yeah, you

Scott Benner 8:10
kind of just internalized it all and tried to work through it. And how did you? I mean, what were some of the things you did to try to work? It's interesting, right? Like it from 12 years old till till 20 What were some of the things you tried to do to help yourself?

Jonathan 8:24
One was smoking marijuana. I was one that, uh, that kind of helped. Actually. I smoked since this last May though. I kind of gave up on it. But smoking? Well, when I was a kid from like 12 to 16 I was taking this medication called Depakote because I was originally put on it for my anger issues when I was a little kid. Okay, that kind of like, helped a little bit because it's a mood stabilizer and

Scott Benner 9:01
around that around the Depakote was that prior to the diabetes diagnosis.

Jonathan 9:08
That was actually that was actually before I got put on that in 2009. Okay. And I was taking it from 2009 to, I want to say 2016 because 2015 I started having seizures really bad. And the doctor that put me on it told me that TEPCO helps with seizures too. But I found out that Depakote actually causes seizures as well. It depends on I guess he said, or I looked up on a documentary and stuff about it is depending on how much milligrams of it you take, depends on the outcome pretty much. Then we take in 1500 milligrams of Depakote a day What? Because I used to have seizures, right? And when 2016 hit, I was having seizures like every once a month, every two months, something like that, you know? And I finally just quit taking it. And I switched over to marijuana.

Scott Benner 10:18
Well, so I'm looking here because you're talking about things i don't i don't know about and it is it's very interesting. Depakote is an you know, an anticonvulsant. So it's prescribed for seizures. It's also prescribed for bipolar disorder, but doesn't an end can also help prevent migraines, it says, seems like it has a couple of different uses. And you were given it specifically for the seizures

Jonathan 10:44
specific. I was actually given it for the bipolar and ADHD. And then like a year later, we found out I helpless seizures. And so I stayed on it because I had seizures growing up. Gotcha. Like, are you are having lost five oh my god, I had one when I was 10 had one when I was 15. And then as soon as I turned 16 I just had them like every month, every two months. And all that became more frequent. Okay.

Scott Benner 11:15
Have you been diagnosed with bipolar disorder?

Jonathan 11:18
Yes, I have. Okay. I've been diagnosed with bipolar, ADHD, a DD and ADHD I, which I don't know if you know what that is not too many people do. I don't

Scott Benner 11:31
jump out when to do for me, can you tell me about it?

Jonathan 11:34
What it is, is you do stuff on impulse. You do stuff without thinking. And that does not make I could tell you right now that does not mix well with bipolar ADHD at all. I don't think it's a thing. But the doctor told me that it was. I don't know.

Scott Benner 11:57
Okay. All right. So I'm gonna ask you a question in a second. But before I do, I want to real quick disconnect the zoom and reconnect it just to see if I can get the noise out of it. Okay, and so I'm literally gonna hang up on and and reopen it right away. So you can click back into the link in like, 20 seconds. All right. Cool. So hopefully, this will do something. If it doesn't, I'm gonna live with it. I just wanted to it was worth a shot. You know what I mean? Right, right. Okay. So all right. I, I'd like if you can you explain to me how bipolar affects your life? Like, what is it? How does it kind of ebbs and flows? Am I right, you have different kind of segments of experiences.

Jonathan 12:37
So for example, when I was five years old, is I was in kindergarten, it was pajama day. My mom doesn't believe in wear pajamas to school, I wore my pajamas, and she told me Get ready for school. I told her I was ready. She said I wasn't gonna go to school in pajamas. So I went to the bus stop anyway, as she picked me up, took me home and said, You're not going to school and unless you get real closer. So I went to my room, and I had a metal bed frame. And I just bang my head on it, like bang my head on it. And because the bipolar that at that time, the bipolar took over, um, and my head was bleeding, and pretty bad. Because of it. She ran in there, it was like, What the heck, john, what the heck. And she took me to the ER, so cuz it was bleeding back. But that's the worst incident I've had because of that. I've had my moments where I would just flip out for no reason, or something. But, uh, over the years, I started to learn how to control it. I had a anger breakthrough, I guess you would say, in the last year and a half, two years, maybe. Okay. Which I'm really surprised. I mean, I still have my moments where I want to just hit on a wall or something or destroy something, you know, but I keep I keep calm about it. And I learned how to control it.

Scott Benner 14:34
Do you experience sort of the classic signs of like, you know, kind of high energy make like the mania where you don't really need to sleep and you kind of lose touch with reality. And then is there a depressive side of it? Where you're kind of more low energy. Does that sound familiar to you? Or does it not?

Jonathan 14:51
Yes. I have that a lot. Actually. I didn't even know that was a thing actually. But um, Yes, um, so like, some days I'll wake up, and I just, I just have those mornings where like, I don't want to do anything. I don't have the energy for anything. All I do asleep.

Scott Benner 15:23
Can those times go on for like long periods like weeks and months?

Jonathan 15:27
Yes, yes. Okay. I think last month, last month was pretty bad about that. I mean, I went to work and stuff, but I would go to work from three to 10, because I closed but I would go to work for like, five days a week. And then after, as soon as I will get off, I would go straight to bed and asleep to one or two. Get up, stay in my bed. And then 30 minutes before I had work, I would go to work. And then repeat. You just you just

Scott Benner 16:06
having to do it out of necessity. You need the money, you need the job. So you're forcing yourself to

Jonathan 16:11
do it. Yeah. Okay.

Scott Benner 16:12
And so, do you see a doctor for the bipolar?

Jonathan 16:17
No, um, I, the last time I seen a doctor for any of that was, I think I was eight. Or no, I was nine. Yeah, I was nine. I'm always seeing him for a year and a half. After that. I told my mom, I never wanted to go see another one. Um, I don't know why I'm like that. I just don't like talking to the therapists or doctors about that stuff. Like to figure it out on my own, which I probably should go see a doctor for it. I probably should. Well,

Scott Benner 16:56
yeah, I mean, I know someone who, who has bipolar. And it took them a fair amount of time, like, I'm not gonna lie to you, they didn't walk into a doctor's office didn't just come out with the answer, but they found a good doctor and have had like real, like real breakthroughs with with medication. It's funny, as you're saying, if they have ADHD, as well, this person I'm talking about, I don't see them getting angry, or, or they don't hurt themselves, like banging their head on things or anything like that. But they do get really kind of internal sometimes, you know, and you don't see them for long periods. When they come back, they kind of look like they haven't kept themselves up for a while, like just, you know, like, visually hair, nails, like things like that, you know, like, learn little things. Yeah, I mean, do you have healthcare?

Jonathan 17:50
loans? Yes. I had a Medicaid for when I was a kid. I had that too. I was a teen or just turned 19. And they finally dropped it. And then I got put on in home health care, home health care. And I was only on that for about six months, and then they dropped that. Why they never told me. Um, I was 19 and a half. And I had no insurance, no way to get my insulin and no way to get my diabetic supplies. I was bouncing from job to job at the time. Okay. And because I was I was so depressed. I didn't want to work. But same time, I just, I just worked for like a week just to get a check so that I can go get the stuff I need. Yeah. And that was a hard time in my life.

One of the hard times anyway, but

I started going to Walmart because they have this insulin called 7030. And I don't know if you know what that is.

Scott Benner 19:10
I know Walmart has a cheaper insulin, that it's very it's for

Jonathan 19:13
a rehash it costs $23 and stuff. Yeah. But I was buying that and using that what it is, is the long lysine short lysine insulin mixed. And that insulin I didn't know how to use properly because I could I didn't see no doctors because I had no insurance and I didn't want to see a doctor and not have insurance

Scott Benner 19:42
because then build up adds up. Yeah, no kidding.

Jonathan 19:48
So I didn't see a doctor for almost two years.

I was just doing the stuff on my own everything. I kept up pretty with it. Pretty good. I did do that. And then I moved to another town, which is where my mom lives now. It was just like two hours from where I was living. But I went, I came up here and I set up a doctor and stuff because I figured it's time to start taking action because I started feeling really crappy every day. I'm just not enough energy film week, all the time. All that you know, so I set up a doctor, and they got me a Medicaid and all that. Now I'm getting insolate and stuff. I'll have to pay for it now, um, which is a relief. I have a doctor now. I'm taking care of myself better now. Good for you. I just started seeing the doctor. I want to say June this recent June. Oh, that's it. It's recently Yeah,

Scott Benner 21:09
I for people listening it. That's just two months ago, when we're talking now.

Jonathan 21:14
Back in January, I think at the end of January, I went into DK diabetic ketoacidosis. Um, it was the worst feeling I've ever felt in my life. It felt like the devils inside of me just tears ripping me apart. My chest was burning. It felt like my chest was getting torn apart. I couldn't breathe. My shoulders and arms. I couldn't lift them because they hurt so bad. And my buddy Mikey, we're going to the store and I felt like that and one of the workers at Walmart. He was a diabetic. And he said, he seen a job down to the ground. He asked me if I was okay. I see my diabetic tattoo on my arm. And he said, What are you feeling? I told him, and he said, You need to go to the hospital now. And I was like, What do you mean, what's going on? And he's like, I'm a diabetic, too. And you need to go now. And so he picks me up over shoulders. And him on my body got in my buddy's car and put me in there. And this worker just walked off his shift to save me as I thought that was the most

crazy thing ever.

Scott Benner 22:49
Jonathan, I gotta tell you, it's made me cry a little bit. So yeah, yeah, that's really something.

Jonathan 22:55
So as we went to the ER, and when we got there, they're like, what's going on? I told him, I need to see a doctor now. I feel like I'm dying. And they they got me back there. There was 10 people in the waiting room. I felt so bad for two. There's 10 people before me, but they put me before them. 10 people, I felt so bad for it. But they said you're you're about to die. You were number one at that moment in time. And I thank them for it. But I still feel bad points.

Scott Benner 23:32
That's just how that works. Man. That's, that's there's nothing wrong with that.

Jonathan 23:35
I was in the hospital for two days for that. And they had me stuck up to IVs or all that, you know, procedures.

And then they finally let me out.

Scott Benner 23:50
Is that sort of the moment that brought you to like, I'm gonna, like pay closer attention to my type one or like you're even talking about kind of feeling like you snapped out of some depression at that point, too. What do you think happened?

Jonathan 24:03
I was I mean, I've been close to death more than once. But that right there. That that got to me. It made me open my eyes and made me more alive than what I was. I guess you would say, Okay, I'm

I'm tearing up right now. I am just Geez.

But it It made me open my eyes to reality. And I was like I need I need to start doing this. I need to start taking care of myself because I had a cousin. His name was he had type one diabetes and he has seizures too. And he died at age 26. I believe because he didn't Take care of himself properly, like I wasn't.

And

I started to check my blood sugars and stuff because I never really checked my blood sugar since I want to say since I was 16

I think a lot of that had to do with marijuana.

Scott Benner 25:20
But how so you just kind of you just felt so chilled. You didn't care?

Jonathan 25:26
Or Yep, yep. And that's why I kind of gave up on it back in this last night because I, I I finally realized that when I'm high on marijuana, I don't care about anything, not even myself. I just chill and, and do whatever. And I realize I can't do that. I cannot do that. Yeah. It takes a level of you have to be interested in your diabetes, that's for sure. Yes, yes. And I've learned a lot this year. This year was the most I've learned about my self and my diabetes and anytime in my life.

Scott Benner 26:11
We had a lockout you have a lot going on, man. I'm Are you you're back closer to your mom now. Is that right? Yes.

Jonathan 26:18
actually moved up to so I was living in a town name. And last year, when my son's mother broke it off, which was August 26. Was x today's officially used it's me and her husband split. Which That's ironic, too. I moved up here, the 27th of august of 2019.

Which is close to

and march 12. Yeah, March 12. I went back down to for my son's birth. And I got stuck down there for a couple months. And in this last May, I came back up to to my mom's and

I've been living up here since

Scott Benner 27:16
then. Your boy is five months old. Now. This coming? 12th he will be six months six. He'll be six months really soon. Well, congratulations. Thank you. Yeah, he's healthy. Everything's good.

Jonathan 27:27
Yes, he's very healthy. Um, he he looks a lot like me. I can't I cannot believe how much he looked like me.

Strange, isn't it? Right?

Scott Benner 27:38
Yeah. Wait, it'll 20 years from now. And he's saying to you that you're just like, Ah, that's something I would have said to my mom. Right. But we want to get we want to get you to 20 years from now, Jonathan. Right. Right. Sounds like you want to be there too. So, you know, listen, I, it's hard for me not to think while we're talking that you are discussing health and life issues with me. And, and when you're talking about them, I feel like you have the problems of you know, somebody in their mid 30s. And at the same time, you're the same age as my son who, you know, we almost don't let be in charge of anything. So, yeah, he's got very limited, um, you know, he goes to school, and he, and he takes care of his, you know, his physical self on his own, he has friends and but we're not putting he's not in charge of understanding bipolar disorder. All the ABS and ages and all that you have, and, you know, hasn't tried to manage a serious health condition with marijuana. And, and, you know, have type one diabetes, you have a lot going on man, like you need. I think you found some grounded points, which is, is great, but I think you really need some support from people who can kind of help guide you a little bit. So let's start with is your mom that person? Or is she not the kind of person we put in charge of something like this?

Jonathan 29:02
Um, she could be somebody that we could put in charge for that. Good, but Me, me and my mom have a lot of issues that we don't talk about. So I, I involve her? Not as much as I probably should. But I pretty much just do it on my own. Yeah.

Scott Benner 29:28
Well, I think that I listen involving your mom creates different problems. You know, we can't just trade one issue for the other. That's not gonna. It's not really gonna help you at all. How did you find me? Like, why are we talking right now? How

Jonathan 29:42
did that happen? I'm actually, uh, I got on Pandora. And I was sorry. I was looking at podcasts. And I came across juice box. I didn't know what it was at all. So I listened to one of them. I don't remember what episode it was. I think is in the three hundreds. But it was the self hormone. But where that chick was talking about self harm and stuff, yeah. I listened to that. And that made me cry that that that made me cry. Um, and at the end of the podcast, well, I listened to a couple of them. I don't remember which one it was, but at the end of one of them said, If you said, if you have type one diabetes or know of somebody with Type One Diabetes, I would like to have an interview or talk to them or something you just reached out. I went on to, I found and I actually typed in your name on Facebook, because I found out your name was Scott Benner. And I went to see if you're on Facebook, and he was, and that's when I swung you that first time.

Scott Benner 30:56
That's right. You messaged me on Facebook. That's right. Well, so did listening to her talk about her issues. Did you feel like some commonality with it? Did you have similar feelings? Or no?

Jonathan 31:09
I felt what she was going through. I mean, I never I never.

I'm not trying to put her business out there.

Scott Benner 31:17
They she, she already did it. It's okay. It's enough as such, she knows. But

Jonathan 31:22
I mean, I have a, I've never cut myself. I never, I couldn't say self harm myself. But I never did those things. Okay. Because I have tried to sell for myself, just not in those type of way. But I understood what she was going through. Me and her go through different things, as I can tell, but I can relate to what she's going to they're going through. And that that hit me really hard. And

Scott Benner 32:03
I think it hit everybody pretty hard. Jonathan, to be honest with you. I think that everybody that heard it felt that way too. But you have more of a maybe you have a little more of a connection to the, to the feeling then than some others do.

Jonathan 32:15
Yes. And

I, I felt the way she was talking to you, and how comfortable she felt talking to you. And so, and I, and you seemed like a pretty understanding guy and stuff, you know. So I was like, maybe, maybe this can help a little bit. Cool.

Scott Benner 32:40
Well, I hope again, I i think i think we're on our way to under I think I understand, you know the the basic overview of your situation. I did want to ask though, just a second ago, you said you you've tried to hurt yourself, but not in that way. What have you done? Alright, let's take a little break. I'll tell you a little bit about the Omni pod tubeless insulin pump. It is just that an insulin pump with no tubing. Be clear about what that means. There's no infusion site on your body that leads to a thing that you have to carry a controller or you know the thing holding the insolent. Sometimes you'll see people's tubing run all through their clothing. And you know, they've got to hang this thing on their belt. None of that happens with the Omni pod. The Omni pod is one device, it is self contained. It goes right on the body, and the insulin is right there with it. So there's no tubing or controller to lead back to. How could that be. Because the controller you'll use for the Omni pod is wireless. It just goes in your pocket or in your bag. But it's not connected to you, you're not gonna have to stuff it in your bra. Wear down your shorts are in your pocket or in your sock. You can just you know, carry it the way you carry things. be normal. I love the Omni pod tubeless insulin pump for my daughter because she can bathe with it, swim with it and be active with it constantly getting the basal insulin that she needs. There's no disconnecting for soccer, softball, working out at the gym, you're always getting the insulin the way you're meant to. It's a huge thing. Too many times we talk ourselves into believing it's okay to disconnect for an hour or two I have to because you know I'm doing something active but that's really not the way to go. And with the Omni pod, you don't have to, you don't even have to take my word for how this works. Because on the pod, we'll send you a free, no obligation demo right in the mail. All you have to do is go to my Omni pod.com forward slash juice box fill in a tiny bit of information about yourself and the pod experience kit will show up right at your door. You can try it on and wear it. Go take that swim. See what you think. And if you don't like it doesn't matter because there's no obligation It didn't cost you a cent. I'm going to tell you about something that just happened here in the house. Arden had to change her pump. So she changed her pump. She's zoom learning right now, you know, she's doing the school online. And she's in a room by herself kind of quietly and I was trying not to bother. And her blood sugar started to go up at the site change. So we weren't able to make an adjustment to it until right around 190 blood sugar. So the new pods on right we're bolusing trying to get it down, but she kind of ends up leveling out at 200. Now she's done school and she's hungry. She wants soup with crackers. She's gonna have a couple of potato chips. She tells me this is like 70 carbs, but her blood sugar's 200. What do I do? She's hungry right now she doesn't eat normally. I'm able to make a bolus for the correction plus the food a full bolus on top of that 200 blood sugar. And then watch as Arden's blood sugar comes down right there on her Dexcom g sex at the exact right time I give her the food. I'm gonna catch the drop of the insulin with the food and level are out. And I can do that because I can see her blood sugar. That's just one way I use the Dexcom g six continuous glucose monitor. There's plenty of other ways. That is just one way I use it. I'm looking right now at her blood sugar's 115. And still diagnol down and it's indicating that it's falling still slightly. But I love that because I gave Arden her food at 150. This is going to level out. It's going to be amazing. Head to dexcom.com Ford slash juice box to find out more about the Dexcom g six you can learn about no finger sticks about direction arrows alarms to tell you when you're leaving ranges that you set. And the share feature which allows people with an Android or iPhone to follow a loved one with Type One Diabetes. And look at this Arden's blood sugar still indicating diagonal down but it's now at 119 which means we are leveling off. Her foods been going in for about the last 20 minutes. But the insulin has been active for over 45 minutes. That is not something I could have done blindly. I needed the Dexcom g six for that. And you know I made that Bolus with an omni pod, right. Alright, let's get back to Jonathan. links in the show notes at Juicebox podcast.com. For these and all of the sponsors. Just a second ago you said you you've tried to hurt yourself, but not in that way. What have you done?

Jonathan 37:29
Um, uh, I, I this is gonna be hard.

I was living in

the town I was living in, I got so depressed that my mom don't even know this. And I don't know if I have the heart to tell her this way. It happened back in 20s, the beginning of 2017 I do believe. But I tried to hang myself. Um, and it obviously didn't work. The knot somehow got untied when I kicked the little milk crate out from underneath me. And while there's a couple milk crates, but that I was hanging there for a minute, and I thought it was gonna hold. And then finally I just dropped down to the ground. I was like, it ain't my time. It's not my time. And it it was another year from that 2018 sometime in 2018. My brother he had a 12 gauge shotgun. And

I loaded a

bullet in it. And

I pulled the trigger. And that was when I was on all all the narcotics and jugs and stuff. But I I pulled the trigger, but it clicked. And it was it was a good show. There was nothing wrong with the gun the gun wasn't dirty, nothing. But all it did was just click and that that that time I officially knew it wasn't my time

because that gun should have went off

and it did it and I think the higher power for not going off. But when as soon as I pulled that trigger. A second later, my brother walked in He, he, he flipped out. He, he did he vow he about dropped to the ground and didn't know what to do or say. But that those are the times I I tried to self harm myself on that the other time was when I got on Tinder kardex and a jobs really bad. The worst drug I did was a meth.

I never did heroin.

But I was on meth really bad. And the only reason was, is because I was so depressed. I was trying to give up on life. And I thought figured that would be a not a good way, but a way to go out, I guess. Um, since the gun thing didn't work. Um

Scott Benner 41:11
Hey, man, take your time. Listen, you're doing great. First. Don't be sorry. You kidding me? You just said more difficult things in three minutes than I've ever admitted to in my entire life. So I'm, you're doing a terrific job. What I wanted to say was, is that so at the time of the of your first your first attempt, I guess is is with the rope. Were you using then?

Jonathan 41:37
No, no, not that was probably.

That was probably six months before I start using.

Scott Benner 41:44
So that was just a depressed moment in.

Jonathan 41:47
Yeah, that was just a depressing moment.

Luckily, it did it. That not came on time. Luckily, yeah, not came on time. Well, no,

Scott Benner 42:00
but let me let me let me say this man, if you if you're bipolar, and you're experiencing waves of depression, and then waves of, you know, they call it mania sometimes, but there's also normal times too. there's times where you're just you're not, you know, you're not like, full of energy and running around. And you're also not depressed, where you just kind of feel like it's what normal would feel like, do you feel like you feel normal right now? Yes, yes. So I'm thinking man, I'm not with you. And I'm never gonna be able to be with you. We obviously don't live anywhere near each other. But in this moment of normalcy for you, like I think you have to get to someone that can help you manage the bipolar piece, because everything else tumbles around that from your description, right? Like when you're when you're feeling depressed, you can feel suicidal, you can stop taking care of your blood sugar's you can, you know, there's all these are the things that are happening, but if you could get on a good, a good plan, and God knows I'm not the right one to tell you about it. But But my my limited experience with this would be that there are medications that can help take the craziness out of the highs, like you know, cut a little bit of the highs and take the Depression of the lows, and allow you to find the the middle more often. And I don't know that you won't struggle still as you're figuring it out. But at the very least you won't, you won't try to hurt yourself, you know, what would be the goal, I think Does your mom have this to

Jonathan 43:39
do what

Scott Benner 43:39
does anyone else in your family have bipolar?

Jonathan 43:42
Um, my mom does, it runs really bad in my family. And my sister, she has bipolar. She just got diagnosed with schizophrenia, too. And personality, or a

split personality, okay, or

Scott Benner 44:03
what? Listen, you're gonna you you need to worry about yourself and you need to be the unit, you need to be the first person in your family to, to address this head on and try to put an end to it. Because Do you could find an answer that could end up helping someone else in your family one day. I mean, I hope your son never suffers like this. But imagine, imagine if he does, and you you already know how to help him. Right? Because that's where you're stuck right now is you have so many people stacked up in front of you, who are supposed to be your support system who are already suffering the way you are, and through no fault of their own. They can't help you either. They've got their own struggle, but but maybe you can find an answer. And maybe you could help yourself first and then and then maybe be maybe you could be the person that helps other people. You know, I think that's a really that's a really decent goal to have, you know, for yourself personally, but then, you know, answers. I know it sounds silly, but, you know, I, I have like, you know, health problems that are, of course, nowhere near the ones you're describing. But I sometimes think that I work at them as hard as I do. As much for my kids in case they get those problems as I do for myself, like, I want to find the answer. So they don't waste their life looking for one if that makes sense. Right? You know, I and in your Listen, you found a good spot here, you had some things happen to you that that kind of shook you and are making you think of things differently. I think while you're thinking of things differently, and you're, you're you're working on things, this is the time to, to try to like take a big swing and figure something out. You know what I mean? Yes, yeah. How are you doing with your blood sugar's and everything like, how's that going?

Jonathan 45:52
Um, so like I said, I haven't really checked my blood sugar's since I was 16. Until

this reset.

is, right. Yeah.

Scott Benner 46:07
But But how's it? I'm just talking about those couple months. Like, how are you doing?

Jonathan 46:13
Um, I'm doing a lot better. I mean, the first month was kind of touchy. My blood sugar's were always high, a lot. run from 250 to 500. And then finally, like, I'm, like, second month, the second month, I, they started running about, I want to say 172.

To two ad 300. And that's

Scott Benner 46:51
way better than Yeah,

Jonathan 46:53
yeah. And then this last month, this last month, it's been, it's been staying in the hundreds every now and then it will be up above 200. But a bit up above 300. Looking at you for this last month.

Scott Benner 47:10
First of all, congratulations. That's really well done. And thank you, you know, you're very welcome. And is it? Is it helping you feel better? I mean, it has to be helping you feel better, right?

Jonathan 47:22
Yes, yes. I'm not feeling drowsy all the time. Not feeling weak anymore. I've I've actually been going out at night, and after work or something, and walk this trail we got down in the cold, bro. It goes to six, seven different towns and cities here, but oh, I'll just walk through one. That's the town I'm in. I walked out for about three, four hours every night with a friend of mine. And I think that's been helping me a lot of I've been in a lot more healthy to for you. I've been eating a lot of salads, a lot of eggs, protein. And I've been eating a lot of meat. And now I feel really feel healthier. That's excellent. I really do. This all came just from your dk scarin. Walmart.

I'm somewhat

somewhat, I had two more decades after the one in January. I had one in I want to say April. Yeah, it was April. It was two weeks before my birthday. I had one I was down in the town I used to live in at that time. Um, I I was throwing up and my little brother when I say I my brothers, they're not actually my blood brothers. It's just

really good friend boys. Yeah,

yeah. But anyway, one of my little brothers he asked me if I was okay and I said yeah I just don't feel good and stone off that's it. You know, I think I something bad boy. And because I literally thought I ate something bad. And I was just throwing it up. But an hour after I've sewn up, I my chest start hurting my arms and like what happened the first time started happening again.

Scott Benner 49:46
Yeah. So you knew when it was done.

Jonathan 49:49
I couldn't move. I could not move. It was much worse this time than it was the first time and I couldn't say anything. I couldn't even catch my breath. And my brother came in there an hour later stuff. When all that stuff happened, we're starting to happen. And he said, john, you're not okay. And he put me and his mom's car and carried me to his mom's car drugged me. But, uh, and he, he's only 16. He didn't have a driver's license often, but he drove me to the hospital. And the hospital took care of me. I was in there for a couple days, you know, procedures. And then this last time, the third time was, it was actually three weeks, I want to say two or three weeks before I texted you, that first message. I woke up, or I had to work the day before, but I woke up at 12 at night. I remember I threw up and I veggie burger. I never had a veggie burger. But I ate one. So I thought I'd angry my stomach. Gotcha. So I threw up, I felt Okay, after that went back to bed. Six o'clock rolled around. I was supposed to be at work by a a, or no nine. I was supposed to be at work by nine by six o'clock rolled around. And I got up and I went to the bathroom. As soon as I got done using the bathroom, I went to go to my bed to lay down for another hour. And as soon as I laid on my bed, I just threw up everywhere. After that,

excuse me. After that.

I started feeling the chest pain and stuff. And I said this ain't right. This is not right. So I banged on my mom's bedroom door said mom get up now I need to go to the hospital now. And she was like, she didn't know what was going on. And she was half asleep, you know? And I told her call 911 now tell him I need everyone. It's because I already knew what was going on. Yeah, and I was gonna play around this time, I was gonna try play with it. Um, firetruck neighborhood showed up. And I couldn't, I was trying to keep calling about it. I was learning I learned from the first two, to not overreact about it to keep calm and slow breathing. And so that's what I was doing. I was still trying to catch my breath and stuff, you know, but I was keeping calm about it. And that one wasn't as bad as the first or second one. But the second one was the worst one I've went through. Well, let's let's have only I've only had three decades. And they were all this year. Yeah,

Scott Benner 53:12
I was gonna say let's focus on the price. Never having a fourth one. That's that's a neat, that's an end goal like you're after right? So what are you doing now to stop that? I mean, you've got these incredibly you know, improved blood sugars like what is it? You're doing now? You're eating better? You you're checking your blood sugar more frequently taking your insulin?

Jonathan 53:32
Yes, I checked my blood sugar every time I or at least 15 minutes before I eat. Um, I check it an hour and a half to two hours after I eat. And then I check it every pretty much I check it probably every two to three hours because I found out my blood sugar's like to skyrocket in a matter of minutes. Yeah. So I keep on top of it now. I take 50 units of a level

every morning.

And then I take I'm on a sliding scale so whatever my blood sugar is depends on however much insulin I take. Okay,

Scott Benner 54:28
yeah, I and and are you still using the Walmart than overland? No, no, you're using 11 year now and like

Jonathan 54:37
I'm using what the doctor prescribed Great, great. My short term, which is the one I take for the science scale is no vlog. And then my long term is loving here.

Scott Benner 54:48
Gotcha. Yeah, I'm sorry Nova or Nova Lin is a mix of the two I don't know. I you know what? It's funny. The word sliding scale made me think of like an older management styles like regular and mph Your management style. Right? But that's, that's really interesting. I wonder, now are you seeing? Obviously you're seeing a doctor? Are they checking your a one sees for you when you go in? Yes, yes, I see him every three months.

Jonathan 55:14
Actually October I had October 1, I got going for my next appointment. I see him every month or every three months. Do you

Scott Benner 55:23
remember what your lack? anyone see my,

Jonathan 55:25
my last one was 8.9. Okay. The highest spines ever been? was a thing is 14.1 which is really really hot. Yeah.

Scott Benner 55:38
What do you think it might be this time? Are you hoping for something in the sevens?

Jonathan 55:44
Yes, I'm hoping at least 7.302 that's a fascinating number for that.

Scott Benner 55:51
I like that. You're focused on that. That's, that's really cool. I think you're definitely going to get a decrease. Yes. And and are you experiencing a lot of

Jonathan 55:59
like lows? I'm not really go.

My butcher doesn't like to go well. I'm a always likes to go high for some reason. I'm the lowest I have ever been. No. I was in sixth grade. I was walking and talking just just like I always do you know, huh? And, uh, it was down to 15. Wow, that's low. You didn't have a season the nurse. The nurse told me she was like, you shouldn't even be walking right now, let alone talking. I was like, when you mean stone water was also shocked. Yeah.

Scott Benner 56:42
So look, I'm a little kid, stop talking to me and help me. Right? Well, listen, if you're, you know, if you come in next time, with a seven point, you know, whatever, that's amazing. If you're not getting low, you just haven't used too much insulin. But there's more space in there for you, you know, to be slightly more aggressive and to get to where you're trying to be because listen, getting your blood sugar's lower and stable, it really is going to make you feel a ton better. And when you already have other issues that kind of mess with the way your your heads working, you don't need another thing making you feel cloudy, or, you know, confused or anything like that, like, you know, you got enough going on, you don't need another thing. So so I think managing your blood sugars is a great way of feeling better. And then, you know, I can't I mean, listen, I'm not your dad, right? But I would, if you've got insurance right now, man, I would find a psychiatrist to help you with the bipolar. You don't want to just go to a general doctor. And I'm not saying psychiatrists, like, you know, you're crazy. Like I'm not saying it like that. These are just people who really understand these drugs and specific brain issues, right? Because if you could find a course of treatment, that would keep your like I said, keep your bipolar, the highs from being too high and the lows from being too low and keep you more in the middle. That plus your blood sugar's being better, man. That's a it's a 300,000% improvement your life. You know, it sounds like you want like, I'm not wrong, right? You. You don't want to die. You're not looking at how you're trying to keep yourself going. Right? Yes, yeah. That's the way man like, like getting those those two things. More. I don't want to say under control, but but having a good understanding of them so that you can manage them better. I think those are the pathways to you doing better, being alive for a long time and finding answers for yourself and being around for your son and everything else, you know?

Jonathan 58:56
Yes. Yeah. After my son was born, I held him and stuff of these point. It that kind of helped me open my eyes more. Um, I didn't want to die anymore, that I didn't want to do crazy stuff anymore. Like jugs or whatever. Yeah. Um, I wanted because him looking me in the eye when I held him. It was a feeling that no one can ever feel until that moment, you know? Yeah, really is something isn't it? I'm sure you know what I'm talking

Unknown Speaker 59:39
about. Right? Oh.

Jonathan 59:43
I cried. I really did. And, but seeing him in my arms and stuff and smiling at me. It changed my perspective on life. Yeah, I guess I did one die anymore. I wanted to To be something I wanted to be there for him. I wanted him to remember me as he went through a lot of stuff. But Parma language, will believe it or he wouldn't have. He went through a lot of stuff. And he's still here. And he's bettered his self. Yeah.

Scott Benner 1:00:22
Imagine you have a real opportunity. He's a druggie or something, you know, no, but you have a real opportunity to set up a life for him. That's just so much better than yours. You know what I mean? And yes, and that is the that's the goal. That it really is, I genuinely think that, you know, I don't think there's much I wouldn't do for my family. And, you know, and I think that right now, the best thing you could do for yours is, is to take care of your health, so that you can start making bigger decisions so you can get, you know, jobs that aren't just like week long jobs with their jobs that you you know, can grow in and make some more money and have more stability, make sure you get health insurance for yourself. You know, stuff like that. I love that you're eating better. I like that you're getting out and exercising that you got a group of guys that that sound like they got your back. You know, you haven't you haven't been How long has it been since you used?

Jonathan 1:01:18
A used? Like heavier narcotics?

Yeah. Um, let's see, um,

it was tomorrow will be a full year since I've used the date the data, or no, actually, tonight, actually, when my son's mother broke it off with me and stuff. I felt like my heart was ripped out. And so

Scott Benner 1:01:48
is that why

Jonathan 1:01:48
wait and

Scott Benner 1:01:50
do what is that why she broke up with you?

Jonathan 1:01:54
Know, uh, because I was actually clean at that time. I was actually almost a year clean. Um, but she, she

just fell out of love with me. So

that's what she said, anyway, but,

Scott Benner 1:02:13
girls? Tough. Yeah.

Jonathan 1:02:18
But that night, I just felt like, my whole life got taken away from me. So I were in USD, that night, which was August 27 26th. of 2019. Before that, it was I think, October 2018. Somewhere in there, I was the last day I used. Now's the time I put it, put the pipe down. I never shut up. I wouldn't ever do that. But I put I put the pipe down. And side. I can't I can't do it. I regretted doing it when she broke it off. And I've never used since that day, and I never will use again. There's a simple fact. I can't I can't let my son know that. I mean, he's gonna find out visually, you know?

Scott Benner 1:03:20
I'm sure you don't want to be the one to show. I

Jonathan 1:03:22
don't want him to Yeah, I don't want him to see me.

Scott Benner 1:03:26
Go through that. You know, did you've been through a lot? Yeah, seriously, let me talk to you for a second from the time you're 12 to now is only eight years, it's half your life almost. You've been through more than most people are going to be through in their entire lives, maybe two lifetimes. And the fact that you're standing here.

Jonathan 1:03:43
Everybody says that. And it blows my mind. Because I I feel like they're there. There should be they're probably there most likely is more people out there. In my situation, you know, not the exact situation, but you know what I mean? And it just blows my mind when people tell me that, um, I, I've been told I have a metallic mindset of a 40 year old. And from many, many people, and a lot of times I don't see it, you know, but it just blows my mind when people say that it really does.

Scott Benner 1:04:25
Well, my my point is that you've got a lot of experience, you've made a lot of decisions about what's right and wrong, like you're building your own structure of, of how to live like so when no one gives it to you when you're young right? When no one tells you this is right. This is wrong. You know, gives you an example of how to work your days how to take care of your your health. You're left to figure that out on your own. And to be perfectly honest with you, a 1213 1415 year old kid is not equipped to figure that out and if that kid happens to be bipolar. They're definitely not equipped to figure that out. So here's the way I would look at you, man, somehow, against the odds, you're still here, you tried to kill yourself a couple of times, you didn't take care of your blood sugar, you decay a bunch, you use hard enough drugs, you know, you've put yourself in situations. And here you are, like you said, You're still standing here. That's, that's enough of a reason to want to keep going. And now you've got some actual experience. And you down can see, you know, these are things I want to do. And these are things I don't want to do. And what I'm saying to you is, get yourself in the care of a physician that can help you with the bipolar thing before the bipolar swings a different way, and knocks you off course, because that could last months. And then you could end up back in DK again, you could get depressed again, you could there's a lot of things that could happen. I'm saying that to me seems like, like, that's the thing to do today. Like, like, forget tomorrow, like, get done with me. Find out what insurance you have. Find a doctor near you that can help you with this and get there. And so that you can tell him the story or her the story that you just told me and and tell him Look, I don't I don't want this. Like I don't want my left to go backwards again. I'm focused. I know what I want. Please help me stay here. That that's that's I think your your next step. I mean, unless you think unless you have a plan that I'm I'm just not aware of.

Jonathan 1:06:24
Oh, no, that sounds really good.

Right? I'm like, cheered up, right? Oh,

Scott Benner 1:06:29
yeah. Like, why why? Like, like, Don't give this away, man. Like, this is a, this is a moment for you. And, you know, and and i think dive in. You know what I mean? Like, I think I think be the person who comes back on this podcast a year from now and it's like, hey, Scott, what's up? You know, I'm, I figured out the bipolar thing that's gone way better. Buy a one season the sixes. I see my son. You know, like, there's there's a lot there for you, man. There's a lot of ceiling. You know what I mean? Like there's a, there's a lot more good in front of you, then, than not like, I don't see why you wouldn't reach for it.

Jonathan 1:07:04
Right? Yeah.

Scott Benner 1:07:06
That's all. I mean, seriously, how many of these things could have taken you down? And none of them did? So. You're only 20? Man. You have no idea? Like, you're like a baby. Yeah, I you wouldn't feel that way. Because you're, you're the oldest you've ever been right now to you. You're the you know, you know, this is this is the end. But this is the beginning. And you just, there's a lot there's a lot of ahead of you that, that it sounds attainable. How? What are you interested in doing for work? Like if you if you had your head about you and you weren't getting, you know, if you weren't feeling depressed and stuff like that? Is there something you'd like to be doing?

Jonathan 1:07:44
Um, I want to, I dropped out of high school, so I never got my high school diploma. Okay, um, I wanted to go get my high school diploma or my GED, and go to college for business, carpentry and welding. And I, I really want like my my main goal is to

not my main one, but my all time goal, I guess,

is to open my own business up for a carpentry work, or welding, or both.

Scott Benner 1:08:21
Yeah. I don't see why you. Have you done those things before you go to them?

Jonathan 1:08:27
Yes, I am very good at them. I used to I, when I was 13. I built a whole house trailer, just from the frame. Well, me and this guy my mom was with. He taught me a lot on carpentry. And me, we just had the frame of old house trailer. Nothing. No walls, nothing. Just a frame. And we built a whole house trailer. on that.

Scott Benner 1:09:02
That's cool. Kind of welding GG. Can you stick and megger? What do you What have you done?

Jonathan 1:09:08
I don't know what kind of welding it is, I think is wire welding or whatever. We got a little gun and it has a wire in it. Yeah, you just pull the trigger. And

Scott Benner 1:09:19
yeah, that's MIG welding. Yeah, that's the end that's incredibly valuable to that that. Yeah. Good for you see, dude. Those are our good, solid, attainable goals. That there's nothing that you haven't said anything that you can't do. You don't I mean, like you I know. It sounds stupid. It really does. Because it doesn't feel apples to apples, though. Hold on a second, but, but I think about it, you're talking to me right now you're gonna be on a podcast that reaches you know, at this point, it's reached millions of people. And, and I just one day said to myself, I'm gonna make this thing. And I know I didn't have to learn to weld to do it. Or, you know, or or get my GED first. But I didn't know what I was doing. I just decided to do it and figured out some steps and started taking them, I started, I did something, I completed it, I moved to the next thing, I completed it, I moved to the next thing, I completed it, and eventually there was a podcast there, and no one was listening to it. And then I just decided this is the right thing to do. I'll keep doing it, it'll grow. And it grew. And it grew. And it grew. Until one day it reached a girl who was hurting herself and depressed, and her life was out of control. And now she's not like that anymore. And her story brought you here, there's no reason why you can't move forward to she just got a job she told me about recently, she's doing really well. And so all she did was go to a doctor, you know, have the balls to go to the doctor walk in there and say What's up, and you've already said it here, you know, you've got the balls to do it, and followed some good advice. And, and things got better for I don't see why you couldn't be you know, have a have an easily have a handyman service that that, you know specializes in welding and, and, and carpentry? I don't I don't see why you couldn't do that.

Jonathan 1:11:15
Um, do you know what? Home advisors? Home advisor?

Scott Benner 1:11:19
Yeah, yeah, yeah, it's like one of those websites you go to, and you're like, I'm looking to have this fixed, and it tells you people in your area, right? Yo, I'm

Jonathan 1:11:29
within the next month, my plan is within the next month, um, to get on with them. So that way I have side work.

Scott Benner 1:11:40
Yes, in Leeds.

Jonathan 1:11:42
I used to work with them.

Back in 2018. where I used to live, I didn't get any jobs because it was a small area. But, uh, and I stopped working with them because I couldn't keep pay on them and stuff. Well, listen, you also, Jonathan,

Scott Benner 1:12:04
you want to be somebody to who when they show up to work, the person who's hiring you looks and goes, I feel good about this. Like, I've had people come into my home a number of times to do things. And sometimes sometimes people show up and you're like, Alright, I feel good about this. And the guy starts working does a good job. You know, like, all right, I've also had people show up, where I'm like, Oh, this guy strung out. You know what I mean? Like, I can tell right away, and then I don't feel good about working with him again. And and so you, you make yourself, you're the face of the company, you know what I mean? Like you be somebody that when you show up people speak to you're a genuine person, you seem very good hearted. And so you show up and you're good hearted and genuine, you work hard, you do a good job. And then somebody else tells someone Hey, and I had Jonathan out, he, you know, he, I don't know, he put he put a new patio on the front of my place. For me. It's great. And he did a good job. He didn't screw around. He didn't overcharge me. And I think you should use them too. That's word of mouth, man that's putting out a good podcast, and having someone listened to it, and someone else goes and checks it out. Because somebody says, Hey, you know, I listen to this thing. And it was good. That's all you're trying to you're trying to build yourself, build your brand. And and and be somebody that people want to be around? And, and, you know, make yourself desirable to them? I don't see how I don't see that that's not possible for you. You do you know, for somebody who's been through as much as you have, you're not an asset. And you're not lost. And your thoughts are clear. And you know, you haven't, you haven't gone too far the other way, man, like, Don't Don't think of yourself as lost. Just I would if I was you, I think of myself as having just popped out of that trail and, you know, into an open field, and you have a lot of possibilities in front of you. Right? Yeah. I appreciate that. No, man, it's my pleasure. Listen, if that's not how you came off today, I wouldn't have said that to you. You know, like, you could have said some other different stuff. And I wouldn't have felt like that. But that's, that's how you appear to me. You think you are that person? Yes. Go be that person. You know, you just you just got a couple of medical things you're going to need help with everybody listening to this podcast has medical things they need help with. And, you know, there's no shame in that. And so to deal with it head on, and, you know, maybe say a lot of weird things, take the bull by the horns, you know, whatever. But, you know, just don't let it happen to you anymore. Just, you know, you do something first, you try to affect it instead of instead of waiting for something crappy to happen, and then you haven't, you know, react to it. You decide what happens next. That makes sense. Yes, john, I think we did good here today. You comfortable with all this?

Jonathan 1:14:53
Yes. Yeah.

Scott Benner 1:14:54
You You want to you want to let people hear this or would you just rather this have been a nice conversation you and I had together Well, we'll put it away.

Jonathan 1:15:02
I don't mind people listening. Cool. That's great. I think you'd hope?

Scott Benner 1:15:07
Well, I definitely think I definitely think it could. I will, I'll tell you what, when I go back, if you want, I'll be back like the names of your town. Would you want me to do that? Do one, like you said, the names of towns you've lived in before? Would you want me to take those out? Or are you okay with them being there?

Jonathan 1:15:24
Uh, you take them out? Yeah,

Scott Benner 1:15:26
I didn't want to stop you while you were doing it. Because I didn't want you to feel really self conscious while you were talking. But I'll do that. I'll be about your towns. And, but other than that, do you? How do you feel right now? Do you feel better? Does this did this make you feel bad?

Jonathan 1:15:42
It helped. It helped a lot. I'm glad I really am getting somebody else's point of view. It helped.

Scott Benner 1:15:52
That's cool. Well, listen, and now you got to find that other person in your life like can't be me, right? But you got to find someone who you look at and go, this person's got their head screwed on superstrate they know what's up. They could be, you know, a guiding figure for me for a little while, because you can't nobody can do it by themselves. You know, like, I listen, my sons had a lot of advantages in his life. And he's 20. If I if I left right now, if my wife and I were just like, he's fine, and we just abandoned him. His life would not go as well as it could. He needs guidance. Still, he's 20. They say By the way, people's brains aren't even fully formed while they're in their mid 20s. So, you know, you just need to help sometimes, and there's nothing wrong with that. You just need a little guidance from somebody who knows. And if you don't, if you're not related to somebody who can do that for you. You know, you might have to end up finding other people like that's and that's not as easy as it sounds probably. But But look for those people look for people who make sense, you know, and, and, and see if they can help you make sense to lean on people a little bit. There's, there's no shame in that whatsoever. there anything we didn't talk about man that you'd like to talk about? Um,

Jonathan 1:17:09
there was one thing Yeah. Um, I want to talk to you about uh, I used to be on a insulin pump. Is the T slim on a few? I know that one.

Scott Benner 1:17:22
I don't have it. My daughter doesn't have it. But I know a fair amount about it.

Jonathan 1:17:27
Um, I got when I first thought I was diabetic. I got put on regular shots with syringes and all that. Yeah. Or the needles.

When I was

the teen

No, yeah, I was 15 or just turning 15 something like that. Somewhere around that time.

I got my doctor.

He suggested insulin pump. Because I didn't like taking the shots every two, three hours. Okay. So he suggested this on pump. And I got put on insulin pump. And it was working pretty good. It was working really good. And then I think it was

2017

the end of 2017

it about killed me.

I was I had just filled us out. I was living out in the middle of nowhere. At my brother's and his mom. Yeah. Um, and everybody had went to work. I was there by myself. I had no phone at the time. So no way to get ahold of anybody is I've just had fill my insulin up the night before. And it took 300 units. I think it was okay. Yeah, and I filled it up and all that. Well, apparently it stopped working in the middle sometime in the middle of the night. It just stopped giving me is my guess is the screen would still turn on and stuff. Right? It just wasn't pumping insulin anymore. Well, I woke up around six or seven sometime in the morning and I felt like crap. So I didn't think any of it

my insulin pump not working.

So I ate something you know, put in my

thing, my insulin pump you know put the carbs in and all that because I used to count cards. I did all that in a calculated for me, you know, like anyway, a three, four hours went by myself and I started throwing out those. There's about

10 3011 I started throwing up.

My brother came home around 3pm and that's when he got off. When he got home the kitchen four was filled with throw up. And I started picking up blood. Yeah, because there is nothing else in my stomach.

Scott Benner 1:20:36
Urine DK because you

Jonathan 1:20:38
weren't acid just.

Yeah, I think that's what that was. No, you are

Scott Benner 1:20:43
that that's exactly what Oscar's

Jonathan 1:20:46
the doctors that told me is DK, but I'm pretty sure it was. I started throwing up blood and stuff and he could add like, I was laying on the couch. I don't remember this part my brother does. He told me what happened. But he he couldn't find me. He didn't know what's going on. So he heard me a gurgling and stuff. Because I was I was choking, choking on my own vomit and stuff. Yeah. Because I couldn't move. And he picks me up. Or turn me on to my side. What the liquid come out, you know, and I could barely breathe still. So here, we only lose like 10 minutes from the hospital. But he drove me to the hospital. He was speeding, he had two cops with red lights on following him because he was speeding. And they didn't know what was going on. Guys, er stuff. Cough charts stopping stuff, but they realized that I wasn't okay. Right. And so that they they were chill about it, you know?

But, uh,

I went in there. And they told me if I showed up an hour to an hour and a half later, I would have most likely been done.

Scott Benner 1:22:12
Yeah. The Jonathan was that simple? You need an answer, right? Yeah. And, and they were you just you need insulin. And without insulin, you've seen it in your life when you're injecting or with a pump. So if something went wrong with the pump, or if you did something wrong with the pump, or whatever, and you're not getting that insulin, this is your body's reaction to not having this insulin. I mean, it's just it's simple. Are you thinking you'd like to try a pump again? But you're worried? Is that what you're asking me?

Jonathan 1:22:40
Um, I mean, somewhat, but I'm really worried because that the pop mound function, the doctors look at it and that it did not function. Okay. It was just one of those mount function ones, you know? I mean, I would love to try another one again. Yeah. But at the same time, I'm kind of fine with the pins. Yeah, the insulin pins I got. Because it was hard for me being on the pump. Because when when I was on the pump, man, I couldn't do things that other people could do, such as playing football, or just messing around and wrestling. You know?

I could, I couldn't do those things. Well, I think

Scott Benner 1:23:36
you should do whatever makes you comfortable. Seriously, right. If I'm good with injections,

Jonathan 1:23:46
or with the pins my bed? No, I'm, I do believe in the future. Like maybe when I'm in my

3540

Scott Benner 1:23:56
I might switch over back to the pump. Right. But I mean, right now, I'd rather just stick with the pins. Cuz What? I'm young, and I still got a lot more stuff I can do. You know, listen, I think you should do whatever makes you comfortable. First of all, but don't think that like you today is not you then you understand that when your pumps stop working, your blood sugar started going up, but you weren't testing your blood sugar. So you'd have no idea you were just like this thing will take care of that is a true, right. But nowadays, you'd be like three hours later, you'd test your blood sugar and go, Hey, my blood sugar is going up and you'd look at the pump and figure out what was going on. It was just you were a different person than than you are now of around your diabetes. So I'm not saying switch to a pump. But I'm also saying don't get it into your head that you'll be more I don't know mature or less done doing active things in your 30s and it'll be easier for you because there are plenty of people who wear pumps and are really active and but I'm also not telling you to switch I'm just saying don't feel limited by that one situation. I think if you were testing back then the way you are now, that would not have happened to you. That's all I'm saying. Right, you know, so.

Jonathan 1:25:08
And I fully agree with that.

Scott Benner 1:25:10
Yeah. Also, I think you have bigger fish to fry, as they say, at the moment. Like, I really think, man, your first step is the is the depression bipolar piece, like that's where you, you want to put your effort right now. And then once you have that in a handleable situation, maybe you'll maybe then you'll start thinking about a pump or a glucose monitor, maybe you don't maybe you'd rather have if you're going to wear something, and your insurance will cover it get index calm, so you can see your blood sugar in real time, like we do you see how that helps you use your insulin? Like, that's really cool.

Jonathan 1:25:44
I've been thinking about asking my doctor about that, too.

Scott Benner 1:25:47
If your insurance covers it, man, go for it. Seriously. But but just you know, first things first, get somebody to help you or you call your insurance company and get numbers and find yourself somebody who can help you with the bipolar piece. Like I can't stress enough that I think that's that should be your next step.

Jonathan 1:26:09
I agree. Yeah.

Scott Benner 1:26:11
That's it, man. I think I think that's, that's, that's a good place to leave off for you and I. But, you know, I, you please send me a message and let me know how it's going. And I will, I would, I'd love to know that you found a doctor and that you're working on just remember to once you find that doctor, I don't know how smooth it's gonna go in the beginning. So try to have patience with it. Okay. Right. Yeah, this medications can be difficult to get dialed in correctly. But if you think you're going to, you know, if you're if you think you're going to have an episode without help, then I don't know. I like who you are right now. I'd like you to be able to stay this person. You know, I'm saying thank you. You're welcome. Hey, I really appreciate you doing this. This is could not have been easy.

Jonathan 1:26:57
I appreciate it. Was it really was it? Yeah, I appreciate you letting me have this opportunity. It's my pleasure. It was

Scott Benner 1:27:05
my pleasure. I'm glad you reached out. Well, I can't thank Jonathan enough for coming on the show and being so incredibly honest with everybody. Thanks also to Dexcom and Omni pod for sponsoring this episode of the Juicebox Podcast You can find those links at Juicebox podcast.com in the show notes of your podcast player, or you can go to my on the pod.com Ford slash juice box to get a free no obligation demo of the Omni pod tubeless insulin pump sent directly to your home. And of course learn all about the dexcom g six, including those alarms. And that follow feature. up to 10 people can follow the Dexcom g six on an Android or Apple phone. It's pretty amazing. dexcom.com forward slash juicebox. The National Suicide Prevention Lifeline is that 1-800-273-8255 the National Suicide Prevention Lifeline is the United States based suicide prevention network of over 160 crisis centers that provide 24 seven service toll free it's available to anyone in suicidal crisis or emotional distress. If that is you call the number right now. 1-800-273-8255. The US Department of Health and Human Services has a helpline for people who are struggling with mental or substance use disorders. It's the essay MH essays national helpline 1-800-662-4357 it's one 806 six to help 4357 the national hotline is confidential, free and available 24 hours a day, 365 days a year. It's in English or Spanish for individuals and family members facing mental and or substance abuse disorders. This service provides referrals to local treatment facilities, support groups, and community based organizations. callers can also order free publications and other information, check them out@samhsa.gov or call 1-800-662-4357. If you're in distress, go find help. Are you enjoying the afterdark series. But think there's more that we could cover something I'm not thinking of send me an email Scott at Juicebox podcast.com always looking for new topics and new people to talk to. Don't forget, you can check the blog out at Juicebox podcast.com. And if you're looking for a wonderful community where you can speak to other people who are not only people living with Type One Diabetes, or somebody who cares for them, but someone who listens to this podcast, if you're really looking for somebody who gets you there is a Facebook page that is private. It has nearly 600 thousand users. 4000 of them are on there every day. It's the Juicebox Podcast, private Facebook group. You can get to it through Juicebox podcast.com. There's a link at the top, you can go to Facebook and search for it. Just answer a couple of entry questions. And just like that you're in and you're having conversations with people who are living the life you are. It's an amazing group. Thanks so much for listening to this episode of the Juicebox Podcast and once again to Jonathan for sharing his story. We'll be back soon with another episode. I appreciate you listening and sharing. I really appreciate when you subscribe in your podcast app.

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#383 What's in your Go Bag?

Listener Feedback Included

Scott offers helpful tips on packing your overnight diabetes supply bag. He asks the Facebook group for suggestions about what a Type 1 diabetic should pack when leaving home. This short episode gives helpful links and ideas for anyone looking to pack for a weekend trip or when preparing to leave in an emergency.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

Diabetes Disaster Response Coalition

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:01
Hey, everybody, its Scott, how are you? It's a short episode that just has me in it. giving you time here to let your disappointment fade away.

A few days ago, I was watching some news reports about the fires burning out in the western part of the United States. And it seemed like the next story was about hurricanes. That made me wonder what people do about their diabetes supplies, if they have to run from their home, I thought about myself, you know, being a boy, I pretty much don't pay attention to stuff like that. And what would I do? Probably just run over with a bag and take Arden's entire drawer and just dump it in when I run out and forget something or would I remember to go to the refrigerator and get the insulin? I don't really know. So I thought, I'd like dev a list of things to take with me or a bag prepared or something? And how do I come up with the right thing to do? Because I'm just not that well prepared? Not that person. So I thought I'd find some people who are headed over to the Juicebox Podcast, private Facebook group. And I asked the question, what would be in your go bag? The post received ad replies, and this is what people said.

This episode of The Juicebox Podcast is sponsored by the T one D exchange. You may have some questions. So what is the T one D exchange? It's a fair question. See if I can give you a fair answer. The T one D exchange gathers information from people living in the United States who have type one diabetes or care for someone who does. They use the information which I've already submitted, I've put hardens information. It took me less than 10 minutes, I actually think it took like seven minutes to accomplish. And the questions weren't, you know, deeply probing or overtly personal. They were just questions about living life with type one. T one, the exchange then takes that information. And that information helps to make change in the lives of people living with Type One Diabetes. Here's a couple of ways how the registry has impacted Medicare coverage of CGM devices. It has impacted the FDA is expansion of dexcom CGM labeling that includes now finger stick replacement. It helped to change the American Diabetes associations guidelines for pediatric a one see goals. So like when you walk in the doctor's office and Doctor feels like they arbitrarily are like, you know, we're aiming for a seven Well, you know, they used to say you were aiming for an eight. better information helps the doctors make better asks of patients, and that leadership comes from the ADA. And the ADA, use of lower guidelines came from this information. It's kind of convoluted, and it's kind of simple. The research has also led to increased insurance coverage for blood glucose meter strips, and there's more coming, but they need your answers. It's completely anonymous, 1,000,000%, HIPAA compliant. And if at any time you want to remove your information from the registry, you absolutely can't. You don't have to leave your house, you can do it from your phone or from a computer. You don't have to see a doctor, you don't have to get a blood draw, and you're still helping research about life with Type One Diabetes.

Unknown Speaker 3:56
And

Scott Benner 3:57
bonus, I get a little money. I mean, so if you want to support the podcast, while supporting great research that is really genuinely helping people with type one diabetes, check out T one d exchange.org. forward slash juicebox. Join the registry. All you have to do is for us residents who have type one diabetes, or are the guardians or parents of children who have type one, support the podcast support research. Okay, now let me head into this Facebook group. I don't know if you're part of the group or not you should be fantastic Juicebox Podcast Type One Diabetes is a private Facebook group where people talk about management type one and all kinds of stuff. It's incredibly supportive and lovely. So I asked the question real quick before I start, nothing new here on the Juicebox Podcast should be considered advice, medical or otherwise please always consult a physician before making changes to your health care plan or becoming bold with insulin. Anyway, I went into the group and I asked What should be in your diabetes go bag? I thought I mean, how many things could people say right? But well, I said a lot of different things. So I think you have to really start to wonder, what's my go bag for like, Greg, am I just going, you know, is this something I have next to the door in case I have to go to the hospital? Or, you know, going out the door, you know, I'm gonna spend the night at my girlfriend's and I didn't think I was going to, you know, or is there, you know, is the west coast of the country on fire? are we about to be thrown into civil war? You know, what level of bag Am I looking for here? You know, so the first number of answers were what you would expect in are using an omni pod. You got to grab pods, you have a dex comm grab sensors in the transmitter. If you're using like skin tack, or, you know, alcohol wipes, or some like, you know, barrier spray, bring that with you. If you're using a tube pump you you're gonna need you know, sets or batteries, in some cases, a charger. Well, if I need a charger, then I need electricity. What if I don't have electricity? Well, you know, some people said, we have these kind of big battery backups that we have. And they're always charged to take with us. Some people said they had solar chargers to use and I'm like, oh, what are these people like they're running from zombies. You know, they mean, they're gonna perch up on the top of the hill and charge up their phone so their phone can run their kids loop. And they got they got everything. So what is it, you're preparing for it? That's your decision, right? If it's a quick bag for an overnight, it should have what it should have in it. Pump supplies, glucose tablets, you know, low snacks, test strips, your meter, Lance, your Dexcom stuff, I wouldn't take garden somewhere overnight without having a change of a CGM. If she needed it or a couple, I bring a couple of extra pods. You know, just in case one of them. You know, I don't know, something happens, you know, that's what you're doing here. We carry Arden's insulin in a small, like Yeti, it's not a cooler, it's, what would you call that it's like a there's a word for it. thermos, there's the word, but it's much smaller. It's almost like a single use thermos and I put a little bit of ice, I take a vial of insulin, wrap it a little bit in a paper towel. I don't know if this is like a good reason for this, just how I've always done it. And then I put it inside of a baggie, so it can't get wet. I put it in, you know. So ice, then that bag with the insulin and a little more ice on top. little screw top thing. I've had to keep insulin cold for days. It's really cool. But that's the next thought, right? am I bringing a vial of insulin with me? am I bringing all of my insulin with me? am I leaving my house and coming back tomorrow in six hours? Or do I think I'm never coming back? And then that starts getting into, you know, like a prepper mentality. And what do I do if I'm running out the door? Am I going to forget things in a pressure situation? Now, I can't speak for you. But I'll tell you right now, I'm gonna forget stuff. Because I'm just gonna run around like a crazy person yelling and screaming, grab a drawer, dump it into a bag and take off and probably run right past the refrigerator never grabbed the insulin. If you're using a pump, should you still bring syringes or your pen? Probably, you have a cooler, you have foods that you can use. What about water? And so on doesn't work. If you're not hydrated, you have water? How about your prescriptions? Give your medical instructions written down. Someone said I have our passports and birth certificates near the exit of our home. People talked about emergency radios, medical IDs, ways to communicate if you get separated. And I started thinking, huh, all that in a bag. And just as I was thinking all that in the bag, right? I have to find it for you. The people who live in places where there are hurricanes started jumping into the thread.

Amanda called herself a hurricane prepper which I thought was great. And she just said as a hurricane prepper I have 14 to 30 days of all diabetes supplies, including a battery pack and all insulin on hand. All supplies go in a 30 gallon plastic tote except for the insulin that goes in a mini cube cooler. She said if I was prepping to leave in case of a fire, I'd take everything I could fit in my car. Where's the other one about this? Hold on a second. And he said that she lives in Oklahoma, where there are of course tornadoes. She said, be sure to pack a whistle. Now I wondered what the whistle was for. And so did Megan who asked Danny and Annie replied, not often but if the tornado rips through a house, you can be trapped in the shelter. You need a whistle to alert people who are looking for you. Yelling works but you can get tired and anxious and it depletes your energy. So a whistle and a number of people who have to deal with hurricanes. echoed this sentiment, I don't have a bag, I have a plastic tub or a container with all the diabetes supplies in it that I can just grab. Now, if this seems like overkill to you, it might not be alone. I live in a place where there are no hurricanes and we haven't seen wildfires in a very long time. And I have to admit, I don't have a go bag. I don't have a go box. I don't have a go. don't have anything. That's what I'm saying. But as I'm reading through this, it's hard to ignore bill Who said I just lost everything in the Southern Oregon wildfire. And it hits so fast. I had five minutes to pack forgot most of my stuff. So please pack before it's too late.

Unknown Speaker 10:42
Anyway,

Scott Benner 10:43
there's gonna have to be a fine line between lunacy and preparedness, and I think you could find it. So insulin, pods, if you're on on the pod, other pumps, supplies if you're on a pump, that isn't the only pod you're gonna need batteries, you're gonna need a way to charge things, your Dexcom supplies transmitters and sensors, tape and barrier wipes. Make sure you've got your glucagon and not your glucagon packed away somewhere where you can't get to it. But there too, you need to meet her and test strips and Lance's syringes, glucose tablets, other treatments for lows, not just one or two, either you could be gone for a while. juice and water to stay hydrated. Do you have an emergency radio a cooler? One person says they always have ice packs frozen in their freezer in case something like this helps. person said if you're looping, don't forget your Reilly link. And that's and many people echoed the sentiment, you may not have access to electricity, and a lot of our technology counts on that. What about Internet access? What if you lose internet access? You're gonna lose your dexcom share, you're gonna lose nightscout? Do you have a way to handle those situations, maybe you should practice a little at home, you know, managing one day without the internet. Portable chargers, if you have them, that's great. If you don't keep them charged, they won't help you much. You could have the charger, not a cable not going to help you so much again. You have your prescriptions, medical ID, alcohol wipes Ziploc bags just to keep things clean. How about your medical instructions? What if your child or you gets separated from the group or are incapable of helping yourself? How are people going to know what to do? Money, pocket change cash, your passport, your birth certificate identification, make a list for yourself. Let this be your starting point. Then sit down and make your own list, decide what goes in your bag, and then pack the bag and put it somewhere a hall closet near a door and have a plan so that when you grab that bag, your very next thought is Do I have the insulin? Maybe there should be a note pinned to the bag that says insulin? I don't know. Keep in mind, not all these bags are going to be for the same thing and how many bags you're going to have. Right? So there's an overnight kind of an idea. And then there's a Oh my god, there's a fire coming idea. So you're either bugging out or you're leaving for a couple of days. I started feeling very responsible when I started making this, this episode and I thought I can't just you know, leave it up to the people making the list. There should be something else and thanks to Amy. She reminded me about the diabetes disaster response coalition. The ddrc has a great preparedness plan that you can go print out or follow. There's a checklist on there. If you have questions you can call them it's actually a really cool organization. It was started by make sure I remember this right. It's the ADA and the jdrf. And hold on a second. Diabetes disaster. Response coalition.org. The American Diabetes Association insulin for life and the Juvenile Diabetes Research Foundation are the founding partners of the DD RC it's actually a great little website. There's diabetes preparedness plans, diabetes resources, emergency prescription refill links, patient assistance programs, good little resource they actually have some stuff on here about COVID. If this, let's just look at this for a second. Emergency prescription refills during a disaster states may activate an emergency prescription refill rule. Learn what you need to know to prepare for your medications. Oh, cool. It's very informative. Simple website. Diabetes, disaster response.org. All of this has made me wonder what if I don't have time to even grab the go bag? Right? What if something like that is happening? And we just run? Well, you have to know how to manage yourself at a minimum, right? Like what do you do if you don't have your phone or your fancy pump? Or your fancy CGM? You know what's that? the bare minimum you can get by on and get by Well, I think that's something that maybe gets lost in a comfortable world full of technology. And I believe that it's worth your time to try one day, maybe the next time you have a pump change instead of putting it right back on again,

oh, try MDI for a day, see if you can do it. At the very least sit down and give it some thought, you know, look at your pump settings once in a while, so you know how much bazel you're getting in the course of a day and you could easily swap back to a an injected slow acting insulin, you know, know that you get a unit an hour and that that's 24 units a day. Have some concepts around that. All right, I don't want anybody to be scared. I just want you to be prepared. So don't let this add any anxiety to you. This should be a calming thing. I'm ready. should be the feeling. And what's that old saying? It's better to have it and not need it. And to need it and not have it right. Hope for the best. prepare for the worst. I want to thank all the good people the Juicebox Podcast private Facebook group for putting their thoughts into the thread. Nicole, Laura, Sarah, Rebecca, Rachel, Jenny Liske. Caroline, Amber, Mariah Sara Kelly, Sarah, Ariana, Jamie. Jamie who by the way, put in her document that she has her own thing that she fills out that that goes in her bag. It's got all this great information on it. She put it in there in case you want it. Lisa, Nikki Amanda, Deidre, Rachel, Julie, Jessica. Teresa, Karen Chelsea. Elena, Shannon. Megan again different Megan, Wendy, Melissa, Leanne, Jason, Laura Britt, Ryan, Marta, Amy bill, Jill, Nash, Annie, Brittany, Santina, Kenny, and Laura. Greatest Type One Diabetes Facebook page in existence, in my opinion. Thank you all so very much. Well, it goes without saying that I hope your go bag sits in a closet and you never touch it. But if that happens, don't forget to rotate the supplies out of the bag. The worst thing that could happen is you make your go bag today. Two years from now you're running from a grizzly bear. You grab your go bag. I don't know how the bear gets in your house. But let's just say it does. You grab your go bag you're taken off and what you've got in there is an expired glucagon and you know some candy that nobody can eat. So rotate the bag back into your stock. I know I've just given you an extra job. But if you want to do this, it's going to be worth doing right. Thank you so much for listening to the Juicebox Podcast. And thanks to the T one D exchange for giving me the opportunity to help with their registry. T one d exchange.org. forward slash juice box. Hit the link in your show notes. Fill out the information support the podcast support type one research. The T one D exchange is looking for up to 6000 per snippet precipitants. Well, I'll try that again. The T one D exchange is looking for up to 6000 participants. So please add your name and on that note, we Cue the music

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Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate

#382 Stem Cells and Type 1 Diabetes

Jeffrey R. Millman, PhD

After reading an article about stem cell research, Scott invites Dr. Jeffrey Millman onto the show to talk about stem cells and Type 1 diabetes. Dr. Millman discusses how he and his colleagues developed a protocol for generating functional pancreatic beta cells in vitro from human pluripotent stem cells. In this episode, Dr. Millman describes the fascinating research currently being developed at the Millman Laboratory at Washington University School of Medicine in St. Louis.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

Dr. Millman on Twitter

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:06
Hello friends and welcome to Episode 382 of the Juicebox Podcast today, my guest is Jeffrey Millman. Jeffrey is a PhD. He's a researcher, and he is working on some very interesting stuff regarding Type One Diabetes that I think you're going to enjoy hearing about. I reached out to Jeffrey, after reading an article online that started off by saying new technique efficiently converts human stem cells into insulin producing cells, I thought, well, that's interesting, and seems like a leap. I reached out to Jeff, and he was kind enough to come on the show. Best thing about him is that as he's explaining all of these, what I'm going to tell you are pretty technical ideas. He does it in a way that you can understand. I mean, I understood it, so I'm assuming that means we all can. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making changes to your health care plan. We're becoming bold with insulin.

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I have a handful of questions, but mainly, I just like to hear your thoughts.

Jeffrey R. Millman, PhD 5:35
Yeah, I appreciate the invite. And one of the things that we try to do over here is to reach as wide of an audience as possible. And so I view this as a good opportunity to reach further into the Type One Diabetes audience. Hi, my name is Dr. Jeffrey Millman. I'm an associate professor of medicine and Biomedical Engineering at the Washington University School of Medicine. My lab uses sim cells for the study of treatment of diabetes, and I'm very happy to be here today.

Scott Benner 6:05
Thank you so much for doing this. Okay. How do we do this? am I calling you Jeff Jeffrey. Dr. Millman, what do you like?

Unknown Speaker 6:12
Um,

Jeffrey R. Millman, PhD 6:13
I would say,

Scott Benner 6:15
Jeff, would probably be best. Hi, Jeff. Well, I'm Scott. And I saw an article that was floating around in the news. Let me see if I could be more honest than that, Jeff. There's the thing that I think of is cure season, where everyone floats their research out as far as they can, I always assume they're looking for more funding. And it has this sort of unintended consequence of reaching newly diagnosed people who think that they've been diagnosed just five seconds before the cure was going to come. And so I always kind of pick through them to see what's interesting, and what seems more like, you know, what I just described, and your seemed really interesting. And I just thought this, this seems rooted in real science. It seems like science that's available to us now that we understand. And that's why I reached out, I guess, first, let me understand, you know, how did you Why did you go to college for what what were you thinking of doing when you were becoming a student?

Jeffrey R. Millman, PhD 7:18
Right, so I definitely didn't have diabetes research on my mind, when I went into college, even doing biomedical research was not a thought that had crossed my mind. My I went to the college and got a degree in chemical engineering, actually, I had, I came from a very poor and rural area in North Carolina that didn't have a very robust school system. And so I wasn't actually exposed to what, what that what biomedical research was little known what kind of biology was, and so I went into college thinking, I would just go and be an engineer, get a good paying job, you know, raise a family and all that sort of good stuff. And actually, during my time, as a undergraduate doing chemical engineering, I became more and more exposed to the overall biomedical sciences. And I thought, well, that's pretty interesting, you know, maybe going and doing work that is actually helping people's health is more interesting than going and working at a chemical plant to go and make the latest and greatest and shampoos, for example, or at a petroleum plant, which is pretty typical for a chemical engineer, as I went on, after my undergraduate work, to complete a PhD still in chemical engineering, but I sought out a laboratory that did some work with stem cells. And about halfway through my time during my PhD, mostly trying to catch up on the biology, kind of classroom training, but that I hadn't yet received during my undergraduate degree, I received a unique opportunity that my lab received funding from the jdrf, which is one of the largest supporters of diabetes research in the world. And that set me on the course that I've been on ever since. So they they awarded a grant to my lab that covered the last portion of my training during my PhD. And during that I got exposure to diabetes, the the needs that patients diabetes have in house themselves could be helpful for them. And so that prompted me after I got my PhD, that I was looking at all the options that I had after after that, and I was like, well, I really enjoy doing the research. But scientifically that the questions of how do you make a cell from a stem cell that can respond to sugar and secrete insulin? I thought that scientifically was very interesting. And I obviously didn't realize how major of a need that that was for a lot of people. Yeah. And so after that, I switched my trajectory completely to stem cell biology for for the context of coming up with a functional cure for diabetes. And that's led me to where I am today.

Scott Benner 10:34
That's cool. I want to ask you a question. I don't want to get too far off the path, though. But you went to MIT. So I was wondering how frustrating it was in high school, to not be in a terrific school system, is that something you felt as a kid, I

Jeffrey R. Millman, PhD 10:49
didn't really understand my situation until I was much older. If you're kind of born and raised in a certain area, you don't really know what you're missing out on. And I was fortunate in that for the last two years of my high school, I was able to get into this state wide magnet school program. So I was actually able to bless you with your high school, leave my school district and go as far as a high school that's actually part of the UNC system. And so I got to live on campus there for free and get advanced course work that I did not, I was not able to get during my, you know, pre High School and first two years of high school in my school district that I grew up in. And so that's really, you know, began to open my eyes to what the other possibilities were, though I didn't really get my head wrapped around by middle sciences. Until I got into college, I would say going to that Magnet School for high school was very important to be because I don't know if I would have been a fairly

Scott Benner 12:09
receptive to the new knowledge out there about you know, what biomedical research actually was, if I hadn't received a stronger foundation that the the second high school that I went to was able to afford me. So in hindsight is frustrating. But at the time I did it, it really realized what my situation does. It is really interesting, isn't it that you just don't know what you don't know. I'm, by the way, imagining your entire family that they must have Monday through Sunday t shirts that say my son went to MIT, my brother went to MIT, I would be wearing them constantly, I'd said to me, it's a very impressive thing. So you know, it's an it's amazing path to get from where you were to there and now doing this. So I wonder if you could tell me why stem cells are more interesting than other avenues for helping people with who can't make insulin.

Jeffrey R. Millman, PhD 13:04
I guess they were sorry, I'll start off by saying that there is a functional care for diabetes that is already out there. And that is cell replacement therapy, taking introducing cells that can be taking from a deceased donor, and transplanting them into a patient with Type One Diabetes. And it's not a perfect procedure. But in a lot of cases a patient will have can have reduced or eliminated the need for insulin injection, a lot of nuances there, I'm skipping over but that does exist. And this procedure is done probably about 100 times per year, more or less worldwide. And so I think that this is kind of unique in the cell therapy space of their being a kind of putting diabetes aside and thinking about it more generally, when it comes to cell therapy, what you would use themselves for this is pretty unique that there's already you know, very strong proof of concept that this can work. So why aren't Why isn't everybody receiving a cell therapy? Then and the very first challenge which I've dedicated the last 10 years or so, to overcoming is the problem of cell sourcing. I mentioned that the cells currently come from deceased donors and there just aren't that many deceased donors that are rounds and available for providing replacement, introducing cells for patients. It's kind of like if you ever watched these medical dramas like Chicago hope or Grey's Anatomy or you know or whatever, and you're like oh, we need to have a you know, replacement heart or liver or kidney in the next 24 or 48 hours. Are the patients going going to die and there isn't immediate organs available is that sort of thing, they just aren't that many donor organs available overall. Okay. Fortunately, for for diabetes, we have a therapy that is very effective and can, you know, maintain people's health for many decades, and that's insulin. But we still have this problem of self sourcing. And so when I was looking at options out there for what we would use, besides, besides the sea stoners, I felt that humans themselves for the most obvious choice that to make that occur. And the main reason for that is that the stem cells are capable of growing and dividing and making more of themselves virtually indefinitely. In my academic lab here, which we are not a, like a manufacturing facility, we don't make cells for going to people. So we're relatively small scale versus a company that would actually do this. But even in my in a relatively humble laboratory, we easily make several billions of cells every single week for our own studies here. And that would be enough for, you know, multiple people as as well. So having the ability to make a virtually unlimited number of cells as your starting material is a clear advantage. And most cells can't do that you can't just like take interesting cells in the body and grow them up indefinitely, they just like they just don't grow. So you'd have a stem cell to do that. The other advantage of these stem cells is that they essentially represent a cell type that is very early during embryonic development. And what that means is that we can, if we give them the correct signals, basically putting in like proteins, or sugars or chemicals into the, into the flask that we're keeping the cells, then we can direct them to transform from the sim cell into any cell found in the body. So you have a one mixture of proteins and chemicals, you can go and make heart cells, a different mixture will give you liver cells. And of course, the mixture that we care about quite a bit is, is producing cells in that particular cell type that produces insulin in the body is called the beta cell. So this is a unique feature that isn't really replicated by any of the other options there. And we've been quite successful with it, I believe, with our preclinical modeling in diabetic mice. Let me just interject here and make sure that people understand they're listening when you were talking about doing a transplant, that then infers that the patient needs anti rejection meds, is that right? Right. And that's still a pretty major problem. Right?

Scott Benner 18:02
Right. And so now you're basically treat change or excuse me exchanging Type One Diabetes for possibly cancer? Is that the concept of why that's not more widely considered? Do you think

Jeffrey R. Millman, PhD 18:14
so you need that you need a suppressant drugs can have a whole host of side effects. I'm not quite certain of cancer is one of them. Okay? Is there it's possible but the most obvious issues with that is that you're weakening a patient's immune system in order to make them so they don't reject the introducing cells that are be transplanted into them. So they'll be more susceptible to infection or sepsis, for example. Yeah. And that's maybe where it's a decimal as part of the reason as well, why there are only a few procedures done each year, because the people who are receiving these is facing cells from deceased donors, basically, the sickest of the sickest. They have severe hypoglycemic unawareness usually been hospitalized multiple times, because of that other organ failures to

Scott Benner 19:08
sorry, other organ failures as well, that sometimes

Jeffrey R. Millman, PhD 19:12
Yeah, severe complications. In addition to that, though, for though, I think one of the more scary things since what I've spoken to patients in the past, and you probably know better about this than I do is the is the issues of, you know, loss of eyesight, but also hyperglycemic awareness is fear that you might just go to sleep and not wake up. Yeah. And so, you know, these are these are particular, these are the sickest of the sick when it comes to patients type one diabetes. And so in that case, the negative side effects of immunosuppressant drugs outweighs the complications that they have from from their diabetes, right, right. However, that's obviously a calculus that boasts patient with type one diabetes. BDS can't accept, in most cases, the side effects of immunosuppressive drugs is not worth it in order to have better management of their diabetes. So this probably gets to maybe the third advantage of working with stem cells as a cell source here is the fact that we can genetically engineer these cells in order to make them better for transplantation. And kind of one of the newer areas that my lab has gotten into in recent in the recent year is to genetically engineer the cells so that you do not need to give the patient's immunosuppressant drugs anymore. That's basically change what signals the interesting cells are giving to the immune system to trick the immune system into thinking the cells are, should be there and are not from an actual donor.

Scott Benner 20:59
That's that's magic. Jeff, that's, that's absolutely amazing to hear it really, it's, it's astonishing to hear someone say that I tell the cell to give off a signal that makes the immune I mean, that's crazy, man, like, You're brilliant. How did you? Thank God, you're not making shampoo? Although I bet my hair would be amazing.

Jeffrey R. Millman, PhD 21:20
Yeah, your hair probably be great. Maybe some stem cells can help you out with that. No, I and the analogy I get here is that, you know, the sentences I just said, you know, a few years ago were like, legitimate science fiction. Being able to do this, in a like a realistic way was simply not possible even a few years ago, it was an idea people had. But the theology wasn't there, both on the stem cell technology side, but also the genetic engineering side, in order to be able to do that at all meaningfully. And only really, in the last, I would say, year or so half both the genetic engineering capabilities and the stem cell technology doesn't the point that we realized that we can do this now it's no longer, you know, five years ago is definitely science fiction of like, oh, that'd be nice to do. But a year ago, we realized that, oh, we can do this now. And you know, overcome one of the major challenges of a cell therapy for patients with diabetes. So this may be one of the fun aspects of my job here, as a faculty member, is that, you know, we get we had the flexibility to, you know, start pushing the envelope and going beyond a transforming things that are science fiction into something that's reality, and hopefully, eventually a therapy that can help the millions of people that could benefit from it.

Scott Benner 22:56
And tell me how you go about testing this? It's, it's on lab mice, is that correct?

Jeffrey R. Millman, PhD 23:02
Right. So the test out how effective ourselves are in terms of as a potential therapy, we take lab mice, we give them a compound that is able to destroy the mouse's own introducing cells, we get the mice diabetes, by you know, basically killing off their their own cells, and then we do a transplantation into these mice at the sea, you know, are we able to first reverse diabetes in these mice? Can we do it rapidly? And the second question is, how long are we able to keep that diabetes care? And number three, are there any ill effects of the transplants? Do they one of the fears is the potential of the cells we're putting into the mice to perhaps become a tumor? And so we go and we look for any signs of tumor formation, or you know, any other sort of, like biochemical changes in the blood chemistry of the balance that would be indicative of major health problems. And it really only this year, with our recent scientific applications, have we been able to answer positively to all those questions, and with heinously, the cells that we have now are able to virtually instantaneously reverse diabetes in these mice. It takes about a week or so because we have blood the blood vessels grow into the cells we're putting into the mice, but after that, the diabetes has been reverse diabetes reversal last for the lifetime of the mice, which is about a year and then there has been no signs of any health problems associated with the transplant the blood chemistry looks Good. And the there's no signs of tumor formation. And we've done this a lot of times. Now I think the total number of mice that we have transplanted with our latest version of the technology is over 100. And so far, we have a 100% success rate when it comes to curing diabetes, and a 100% safety rating when it comes to mice we have transmitted,

Scott Benner 25:28
what's the next step after a mouse? Unless, by the way, Jeff, and I'm just thinking out loud here? What if you found a way to turn a person with diabetes into a mouse and then gave them stem cells, then turn them back into a person? I think really that maybe is what you should be looking into. But just in case, that's not possible, what do you do after you've proven it out over and over again, in a laptop mouse? Do you move on to a larger animal something that's more closely related to people? I don't know, what's the process?

Jeffrey R. Millman, PhD 25:57
Well, I think also, we have to keep in mind how important the diabetic mouse community is to us. And maybe they should be the priority first. I'm just kidding, of course. So, actually, you asked a very hard question. And it's actually been in a lot of discussions, and there have been a lot of people who are, you know, experts in the field that give very different answers to the the question that you just just proposed, there are, there's an argument to be made, that having great success with a mouse model of diabetes is sufficient, and that we shouldn't waste any more time trying to make larger animals work with the technology instead should just go straight into a phase one clinical trial, I think it's a lot of merits to that. There's also an argument to be made, that a large animal like a nonhuman primate or a pig has a physiology that is more similar to a person than what a mouse is. And that showing pre clinical success. And one of those models is a necessary stepping stone, when it comes from going to where we're at right now with great care rates in mice before we put it into a person. And so I I personally am kind of stuck between these two positions. And I think a lot of it depends on sort of your,

on your

what you're trying to get out of this, I think as maybe a if I put on my academic hat, I think it's a lot of value. For going into the larger animal models, we can do a lot more testing and a lot more invasive work. When it comes to large animals. And I apologize for the siren in the background. I'm actually at the medical school that you

Scott Benner 28:19
might get, you might get more work done if you moved out of that firehouse, I think

Jeffrey R. Millman, PhD 28:26
well, the Dalmatians are very nice to keep about lab morale, you can give them

Unknown Speaker 28:31
diabetes and see if you can.

Scott Benner 28:34
Well, you're in between you're not I'm in between what what stops? So is it biases is that people who are just like, Look, I want to move on this, I think it works or is there real, scientific reasoning for both of the ideas? Maybe we should try another animal larger? Maybe we should jump to a person like what are the arguments for each Do You Have you heard them? So the

Jeffrey R. Millman, PhD 28:57
arguments for going into a person is that there is that mice are as good as a large animal in terms of guaranteeing the safety of a person. In fact, there's already when he made that mice are better safety model. For them what a pig or a non human primate is, because of some of the special genetic mice that we have. They allow for health issues to be easier to detect than what you would see inside of a large animal. So the argument for going to people would be that mice are as good if not better than then barge animals to ensure safety of a person. And so if we already have all the data, proving the safety of the product before going into a person, we might as well go into a person to you know number one, help to accelerate transition to translation of this over to a, a care. And number two, the the effectiveness of the treatment in a person is going to be more meaningful than the effectiveness of a treatment in any animal model. Because obviously, we care about how it works in a person a lot more than we care about a monkey or a pig, or a mouse or a Dalmatian. So that's the argument for doing it. The argument for doing it in a large animal is that we can you know, do, we don't have to go through as much regulatory hurdles, basically, to go and get answers in terms of effectiveness inside once transplanted into a large animal model. There isn't a you know, FDA? Well, at the clinical trials when it comes to large animals or regulations for it, we can't go about it, willy nilly. And there's ethics to consider. But those you know, those are similar to what we already do with with the mice. And so we'd be able to, if we decided to do large animal work today, we would probably be able to in Sydney, we didn't have the program going right now, we would be able to realistically do this in probably two or three months, as opposed to if we decided we wanted to go into a person today, assuming the FDA didn't require the large animal intermediate. I don't know the answer to that. Right now. It would probably take two years to go into a person.

Scott Benner 31:38
Well, I have questions around this. Because I'm always fascinated that as people we see things as either or it's always one or the other. Why not? Both? Why not move forward on both of them at the same time? And then abandon the one that that doesn't end up being needed? Like, and and are there any? I don't know what the word I'm looking for is, but does the FDA ever make allowances for people in situations that are dire? And Couldn't you find a person in their 60s has had Type One Diabetes their whole life? Who is really at the end of their health rope and just say this is this is reasonable to try with them? Do you know what I mean? Like, when does common sense? jump into this?

Jeffrey R. Millman, PhD 32:21
Right, and I think the way you phrased the question at the beginning, it kind of matches what I the way that I do this is at the flexibility of being a academic working in the space, that I try to do what I can in order to, you know, in terms of developing new technologies, and giving advice to people to help companies go into clinical trials as fast as possible. But in the meantime, we do our own academic research here. And I'm not doing academic research on people. And so we have already done some large animal transplantations as part of our academic mission here. So essentially, kind of terms of like me personally, when it comes to being in the field. You know, I'm kind of able to play both sides, if you will, without having a academic program that uses large animal models of diabetes, while also trying to help companies that may be wanting to bypass that and go into a clinical trial. However, when it comes to, you know, an individual company's perspective, and I don't want to I'm not speaking for anybody in particular, but just kind of thinking about the types of questions a company would want to ask themselves, they would need to make a decision on you know, if, you know, they want to, you know, spend finite resources on a large animal models or on clinical trials are trying to split it across both and they may face the reality that they don't have the resources to, both and you know, may need to go and choose one over the other. So that that's maybe the argument for not doing everything is if you don't have the finances to do it, or the ability to do it, you got to go down the only option that you have available to you. So you made reference to kind of a an emergency clearance type of decree, I don't know what the exact terminology is for it's from from the FDA. And this is it's been happening a lot when it comes to like COVID-19 testing. I know a lot of these diagnostic kits I've been receiving like emergency clearance from the FDA, since we're in the middle of a global pandemic that is killing hundreds of thousands of people this year alone in diabetes, for the most part doesn't really fit in terms of

terms of that there being a good pill parallel there.

Overall, the FDA again, as I as I understand it, I'm not I don't represent the FDA or anything, but as I understand it, the, you know, FDA is wanting to balance risk here. And if you have a new therapy that you're wanting to do a trial for get a vergence, the approval for what is the alternative there? What's the relative risk and reward there. And since

diabetes is,

you know, that is controlled to at least a certain degree by insulin or insulin sensitizers. The oftentimes there isn't a, I could imagine the FDA looking at that and thinking that's there is not a justification for a kind of an emergency clearance or emergency clinical trials, when it comes to a cell therapy. With that said, there's gonna be maybe some sub populations of patients for which that could be an argument for I could imagine I'm just kind of spitballing here a little bit, but there are kind of going outside of type one diabetes, there are certainly certain rare genetic forms of diabetes, the so called like Modi's or neonatal diabetes, or Wolfram syndrome, or cystic fibrosis and do cbds, that maybe some of those cases could fall into that that'd be one possibility going forward with it. But it just that some,

Scott Benner 36:33
somewhere the imperative lies that it's worth the risk and taking the leap. And by the way, like, I'm obviously not a historian on this, but don't most of our major advancements fit into a mold like that, like just something that had to be done. And we did it and it works. So we kept going.

Jeffrey R. Millman, PhD 36:51
Yeah, I'm no medical historian. Well, I don't know if I can really

Scott Benner 36:55
yeah, think about, it just makes sense. Listen, maybe I'm writing science fiction, too. But it just makes sense that, you know, there's somebody out there who's in a dire enough situation that be like, Hey, give me the mouse thing. And let me see what happens. And if it doesn't go, Well, it doesn't go well. But I didn't have much to lose to begin with. And, you know, he just would think that was I don't know, Jeff, maybe we left prisoners with type one out for doing that, you know, there's got to be a way is what I'm saying. There's got to be somebody who would be willing to like make take the risk, because the risk would be reasonable for them.

Jeffrey R. Millman, PhD 37:27
Oh, you mentioned the prisoner thing. I don't know if you're aware of medical care. And but I do know a little bit when it comes to prisoners, when it comes to what we call human subjects research, there's actually been a bit of an issue in the past in this country, on kind of compelling prisoners to engage in human subjects. Research, I don't know that it's the proper clinical trials. But there's actually a lot of it becomes the issue of like, having the ability to properly consents to things. And if you're a prisoner, and do prayer, given you're kind of maybe can feel compelled to do things that are against your self interest, because of the imbalanced power dynamic. So actually, if you want to do any research with human subjects, and you want to do it with prisoners, there's actually a lot of additional regulations involved in doing that. Because of the inherent, disproportionate power dynamic that occurs when you're dealing with a prisoner, to the point that I don't think there actually is much work at any done with prisoners. Because of what's happened in the past.

Scott Benner 38:49
It's, it's funny, I was just reaching in my mind for someone who would be in a dire enough situation, like I wasn't saying to, like knock three months off of a larceny run, I was talking, you know, I was talking more about like, I'm gonna spend my life in prison, maybe I would take a risk with that life to to get it out. And meanwhile, I completely understand what you just said, and all the other parts of that, that seem untenable. I really, I could have just as easily reached for any other, you know, example out of my head, I wasn't like, you know, we have those prisoners, we should use them. That's not what I was.

Jeffrey R. Millman, PhD 39:23
But I think I'm glad you brought it up, though, because I I spent a lot of time speaking to audiences of patients with that diabetes in their families. And I know that there is a frustration that exists when it comes to the perceived slow pace of scientific discovery. And that actually being translated into a into an actual therapy that been themselves or a loved one, and oftentimes gets very direct questions about like, why is this true? Like you can already do amazing stuff with mice? Like, why aren't we just putting it into people right now as a very reasonable question. And the frustration behind the question, I think is very reasonable. But I think the like the prisoner thing is an example of the types of considerations so we have want to keep in mind that the path from a having very good preclinical animal model evidence of a new treatment, or functional care for for diabetes, is just the beginning. And to go from where we are at right now, academic research into a therapy that can benefit yourself or a loved one, loved one is a long path that has to be treated very, very carefully. You know, the prisoner thing kind of illustrates one of the ethical dilemmas that could occur, you know, issues of, you know, the large animal model that we talked about several minutes ago is another one as well, like, is that required or not, and people who are experts in the field, you know, disagree on that, on that one issue. So I think all the points we've been bringing up here, I think, very clearly illustrates that it's not a straight in easy and direct line going from where we are to where you want to be that there is, you know, a lot of care that needs to be taken in order to do this correctly. Otherwise, we're going to end up, you know, taking even longer to translate this care to help people in the long term, and, you know, could potentially hurt some people along the way, we're not very careful in how we're doing this. And we, we don't want to, we don't want for that to to occur. And to give you maybe an example of that, this is pretty, pretty another again, I'm not a medical historian, but I do know a little bit of things that are becoming more famous kind of a case studies that are out there. So in the 90s, there was a lot of hope and hype for gene therapy to care, a lot of diseases, we were getting better at genetic engineering technologies at the time. Of course, now we're a lot better. But the 90s is really where a lot of the stuff started to happen. Instead, there was a clinical trial started to do gene therapy for children with a severe genetic, immune deficiency that you may have heard, like bubble boy type of terminology, these people have mutations, a mutation that basically gives them little to no immune system. So there's clinical trials that happen in the late 90s, in order to in order to treat these patients, and one of the patients, a young boy actually died from the treatments. And so what happens is a bit that's very unfortunate, very tragic. And what happened to the field is that basically, all work with clinical trials with gene therapy stops, and nobody was willing to pursue gene therapy for people for about two decades, and only now have things kind of warmed up to begin doing this again. And fortunately, it seems to be a lot of people are treading a lot more carefully. And are and are, you know, doing a lot better. Again, the technology is approved a whole lot and gene therapy, the way we do it now is a light year ahead of where things were in the 90s. Right. So and so so i think is a cautionary tale that if we do this wrong, we can end up you know, hurting people and then delaying progress to a cure potentially for decades. Because Because the academia side will run away from it, because it's like, it's scary, and it went wrong. And you don't want to be attached to it at that correct. Yeah,

Scott Benner 44:24
I say so there's that human so it's just a myriad of things to consider. And some of them have the potential to significantly waylay progress. And and so you want to be careful moving forward and do it in a meaningful way. I you know, I don't listen, I'm not a person who thinks that you've got the answer over there on your desk and you're just not giving it to us. I don't have that feeling but a lot of people do get that idea of like, well, there's more money in the treatment that there isn't a you know, in this but this is not a cure either. This would be you know, this would be a treatment that would go on you don't honestly know it. You would need more cells, as a human life move forward at this point. So

Jeffrey R. Millman, PhD 45:05
yeah, the timing issue is one of the big scientific questions right now. And the city where the large animals actually have a benefit here, that we are limited by the lifespan of the mice that we're using currently, in our studies, and that's about a year. And so we know for for a year for the lifetime of the mice, the cells seem to function perfectly fine until the mouse is dies due to old age. And so we don't know if that means that at like, one year, one day in a person, all of a sudden, the, the transplant doesn't work anymore. And then the patient wouldn't need a dosing, or if those are going to last for years and years and years or decades, or for the lifetime of the actual patient. Right. It's but I do think that even kind of in the worst case scenario here, if the cells end up, only working for a year or so, which I just intuitively, I think that's not going to be the case. But as soon as That's true. I suspect that many people would choose a dosage of cells every year or so over what they have to do every single day. Again, I'm not I'm coming from this from an outsider's perspective, I am not diabetic, and I don't have any family members who are diabetic as well. But I spent a lot of time because like, it's very important to, you know, keep the eye on the prize here. So I spend a lot of time speaking with patients understand their stories and their motivations there. So that I had that in mind while I'm conducting my academic research here. And from from like, from, from my discussions with everybody, and to get out of you know, this a lot better than I do. That I think that most people would accept a once a year treatment over what they have to do right now.

Scott Benner 47:05
Well, yeah, I think for my daughter, I would definitely want that. And I believe she would do as I'm speaking for, but and what are we talking about? Do you do know how we're talking about the implantation? Is it just a large needle? Like thing? How do you How would you get the cells where they need to go?

Jeffrey R. Millman, PhD 47:22
I, I guess how?

Unknown Speaker 47:24
Much another question. Yeah,

Jeffrey R. Millman, PhD 47:27
yeah. So the way we currently do it in mice is not the way that we would do it in people. One of the problems with with my side, everything is anybody. And we don't necessarily have like cutting edge. microsurgery equipment in my lab literally is like me sitting there with a mice. So to do surgeries for my lab, like the only real thing that I'd be as the director of the lab, I feel to actually do in the lab. But you know, it's literally me over a mouse, putting themselves into the mouse. And so we actually currently in the mice, transplant them into the kidney. Because for practical reasons, not for translation reason, okay. But for for people, we would need to figure out the best location to do this. And the complication there is, is basically the amount of blood that is available. One of the great things about producing cells is that they don't actually need to be in the pancreas or native Oregon, in order to do their job. If they have enough blood flow, they're able to sense the sugar levels and the blood and deliver insulin into the bloodstream. So that's the only real requirement there. But not every area in your body has the same amount of blood available for the institute's themselves do their job. And so a lot of people are hoping just to be able to put the cells just underneath the skin, or maybe into a muscle so they could have a needle injection type of thing. And that's looking promising. Now, it's kind of hard to do that, just with like naked cells into the into the spaces because of the relatively low density of blood vessels there. But if a lot of work done with various types of biomaterials that can help to promote an increase in blood vessel formation there in order to enable so you basically kind of created like a little pockets underneath your skin or in your muscle that is supportive of the introducing cells to do their job by providing them with enough enough insulin. Alternatively, you could put them into a different organ. People don't want to do it in the kidney because of a lot of people with diabetes, having kidney issues. So what's actually done clinically right now is to inject them into the liver. So that is highly vaster alized as an Oregon, and also most of the work that insulin does, and your body actually occurs in the liver, and so having the instantly delivered directly into the liver is good. From a physiology perspective.

Scott Benner 50:24
That's really incredibly interesting. I'm having a lot of fun talking to you about stuff that I thought I wasn't gonna understand. But I am understanding I, I, I want you to know that over the years, I have many opportunities to talk to people who are in similar positions to yours, but I never felt like what they were doing had a real chance. And and you talked earlier about how things have sped up so much recently, I just wondered if we could detour for a half a second. What made that leap? Is it? Is it like the advent of supercomputers? Are there like how did you how did we speed up like this,

Jeffrey R. Millman, PhD 50:58
I wish we could figure this out with supercomputers, because that'd probably be a lot less work and less pipetting on my teams. And in order to do this. So really, the watershed moment here, occur occurred, actually, before I became a faculty member here at washu. So after I got my PhD from MIT, I, and I decided I wanted to do diabetes research, I actually did a what's called a postdoctoral fellowship, which is basically your time between getting your PhD and becoming a faculty member. So I did that down the streets, from MIT at Harvard University, in a famous diabetes lab over over there. And so the test that I had during that period of time was to figure out how to make these cells basically, when I started doing my fellowship, I, the field didn't actually know how to produce these cells at all, we knew how to make progenitor cells. So these are cells that were kind of halfway between a stem cell and a introducing cell. But we didn't know actually the correct proteins and chemicals to, to put into our flask in order to make them go all the way into a insulin producing cells if people had tried to do what you just suggested with supercomputers or that kind of kind of computational methods in order to do that. And the truth of the matter is, we don't understand biology enough, in order for these, what we call in silico methods to be able to be very productive predictive of approaches to making it so I was tasked with basically trying to figure out how to get over this problem that have existed for the 20 years that themselves had been since since those had been invented 20 years prior to this. And we hadn't been able to figure out how to make these cells during that time period. So essentially, the trick was to read a lot of papers that were describing how this occurs, naturally in embryos. So this is mostly like, how do you get cells and fruit flies or fish or mice. And so those are the, what we call model organisms that we use to try to understand how a embryo develops, develops naturally, to go and look at what lessons people had learned from studying these animals, and then trying to translate them over to our humans stemcell bioreactor context. And so I literally went through I did, I did a estimation after the fact there was about a 180 papers, and found that only about two or three of the

papers actually

provided chemicals and proteins that we could put onto ourselves cells in order to actually make them basically it was a matter of going through the literature, finding papers that were irrelevant to actually making the cells in our artificial lab ground context, and find the few that were actually relevant and to kind of make these what to call first generation cells. So we're able to take these few papers, figure out the compounds from it, and be the first to make introducing cells that were capable of controlling diabetes in mice. And once we were able to do that with them, first of all possible with existing technology, and do some of the Pacific compounds for how to do that. It became a question of being the first To do it to taking these cells that were very immature still, but were definitely the correct cell types that we wanted to make there and optimize. And so that's optimization is taking something and making it better, is infinitely easier than going from nothing to being the first to create something. Yeah. So it's really the watershed moment that we went from not being able to do this for 20 years, to then, over the course of then figuring out how to do the first iteration of this, and then go for the next five years after that into a improved sell product that is now able to reverse diabetes and be safe. And all these great things that we talked about earlier. I want to understand the

Scott Benner 55:47
timeline, you reading that literature and coming to that, that idea. How long ago was that?

Jeffrey R. Millman, PhD 55:54
So I started in 2011, doing this, and we pretty much had figured it out by 2013. And we published the scientific reports on that in 2014.

Scott Benner 56:11
And one day, well, this becomes a thing we're gonna call it the milman method, is that correct? We're gonna get your name, right.

Jeffrey R. Millman, PhD 56:16
Well, there's a reason I keep on using the word we and that seems to Team science, right? It's like, nowadays, science is so big and so hard that it is really difficult for a individual to be the one to to come up with something that's truly transformative, that moves the field forward and not impossible. But more often than not, you are better off working with, with grapes. And now of course, I lead a team of 10 scientists here at Wash U. And so everything that I'm involved in, but obviously involves other people on my team, and oftentimes other people at other institutions as well. And so I really think that team science is the way to go forward here, because it's not going to be one person. If this is a problem, that is too important to expect a individual person to solve, we all need to be working together. In order to do this. And everybody that I work with on this all shared the same vision that we're all in this together for the greater good of coming up with a therapy.

Scott Benner 57:30
And we're seeing this with COVID. Right now, too, right? Aren't labs sharing information at a, just an unprecedented rate now around COVID?

Jeffrey R. Millman, PhD 57:40
Yeah, it's something that I have never seen, to that extent before in my professional career, that, you know, we have these groups that, you know, we're never working together, all of a sudden started to work together to solve this very important problem of how to deal with COVID-19. And it's complications. And I think part of this as well is kind of where we're at now, in terms of the ease of communication and the ease of disseminating information. There's a lot of me, this has been a lot because of how much the Internet has advanced even in the last 10 years. But in particular, it's become kind of a trend in the last maybe three years or so it's on my radar. I know it existed before. This is what we call preprint servers. So normally, when you publish a scientific article, you write it up, you have to be submitted to a journal. And then there's an editor assigned to it editor goes through it to kind of make sure it's not completely wacko. And then it goes through a process called peer review, where sent out to usually three other scientists in your field, your peers, and they go and they critique it. And they recommend that it's either published as this has to be revised or is rejected. And this is a process that maybe on average, can take between six months and eight months. But it's not uncommon for it to take over a year before it's actually published and out there for the scientific field to go and benefit from. However, there have been what are called preprint servers that have been developed where before you submit it to peer review, like a discus, you'll do an additional step before that you submit the article to a preprint server, it still gets a quick look over from an editor to make sure that it's not something you know, crazy or inappropriate. But then within 24 hours of being submitted, it is online and available for everybody to look at again, it's not peer reviewed yet as this disclaimer forth, but these preprint servers have been amazing. In order to not have this six month, eight month, one year lag, and information being disseminated, and the information is out in 24 hours after being submitted, and obviously, that's very important when you're facing a immediate healthcare crisis of a, a pandemic.

Scott Benner 1:00:20
Do you think that generationally that that researchers have moved along with society thinking, bigger picture? Do you see that as well? Because I mean, listen, if I was going to cure something, I can see, I'm 50 years old, I can see me thinking, I want my name on this, I want people to know, I cured this, I can also see how when we get to COVID, everyone in the lab all over the country in the world are starting to think well, Hell, I could get this too. So I guess maybe we ought to get to work on this. And, you know, like, I could see that kind of breaking the levee have been maybe not caring so much about who gets the credit, but more caring that there's a way to treat. And, and I do but I do wonder like, I look at the like my son's 20, he doesn't have type one. But you know, I look at his generation. And I listen to hear him speak with friends. And it all just feels a little more inclusive when they're talking. And I do wonder, too, if that isn't a little bit of maybe credits, not the most important thing, although, you know, I mean, you know what I'm saying? Like, I'm wondering if things aren't just shifting in general, but what you said about the internet and communication improving is huge. I don't think people think of the internet as, as all that it really is, you know, I think they think of it as making the Xbox work or, you know, being able to send an email. But but it's really fascinating. Jeff, I'm thrilled you came on. Can Oh, let me ask you the question. First, do you think that there's a the community, the scientific communities moving along with maybe the social world,

Jeffrey R. Millman, PhD 1:01:49
I think there's definitely parallels there. And I definitely would say overall, younger and newer faculty tend to use the, like the preprint servers and the early rapid dissemination of information more than senior investigators, I'm not certain how much of that is kind of a different inherent kind of technological aptitudes of younger people and older people overall. Or, you know, if there's the the mentality when it comes to the credits, but but I guess that is an important thing to acknowledge that one of the things that scientists like myself have to balance is that, you know, we all come into it with kind of ultra altruistic views of wanting to benefit. No people, in this case, you know, people with with diabetes is something very, very important to me. So we come up with all sorts of views. But there is a kind of a reality that a scientist needs the face of, you know, being able to have a career and maintain a laboratory, we, you know, we all have to compete, because it all comes down to money, essentially, but not like not like money that we're taking home, to an editor in our bank accounts, but like money in order to actually do the work all scientists, diabetes researchers and all the researchers, we're all competing for a finite amount of research funding that is out there. And thankfully, we have foundation support from you know, jdrf, and American Diabetes Association to allow for them to be more money, focus on diabetes, then there would be otherwise we're just relying on federal money like the, from the National Institutes of Health, but then it is all still finite. And in the end, you still have to as a scientist, you know, compete for these grants and publish papers of sufficient renown. In order to motivate a foundation or government agency to give you the funding, there is a balance that we have to strike, because we want to do good. But we also need to ensure that we are competitive for the money in order in order for us to do the good that we are, you know, striving to accomplish. So when I talk to my trainees in my laboratory about this, I oftentimes will purposely point out that I am thinking about the discussion one way or another, I'm like, okay, we're thinking about we're talking about this right now, in terms of what is the best stuff we can be doing in order to lessen human suffering or improve patient health? And then or switch be like, Okay, well, this is the stuff we need to do in order to ensure that we have funding for the next five years, and the way we approach questions or the steps we might take can be different depending on what is kind of the immediate concern there. If only and we as scientists have to balance all of this, and it's a juggling act, that different scientists perhaps have different durations will come to different answers to? Well,

Scott Benner 1:05:16
I'll tell you what you just said, it's not lost on me at all. Because this podcast, I know, you don't know it, but this podcast helps people. A lot of people understand how to manage their insulin, which brings their time and range, tighter brings their agencies down and gives them better health outcomes. And it's a full time job making this podcast so I take ads on the podcast, and there are some people who think you shouldn't take ads, but to them, I would say, if I didn't have an ad, then I'd have a different job and you wouldn't have this podcast. So you know, at some point, you have to, you know, you have to you got to you got to eat right, you're not you're not rolling around St. Louis in a Lambo. I don't imagine Jeff, right. When you say, when you say you need that money, you need it for equipment, lab space, materials and quality people, right? Like I imagined someone who knows what they're doing cost more than someone who doesn't know what they're doing.

Jeffrey R. Millman, PhD 1:06:08
Right. And it doesn't get good, good, maybe a good distinction to make fair like when like when by my lab gets a research grant from jdrf, or ADA or NIH or whatever, I personally don't get like a raise or anything like I don't take home, I have a salary, I have a set salary. And that set salary is there, no matter if I am doing a good job in terms of curing diabetes, or doing a bad job when it comes to curing diabetes. Or if I bring in big grants or I'm not begging and break the big grants, the amount of money I take home is the same. So I actually don't receive any of the money personally, but you're right, the money, the money all goes to supplies and equipment and the salaries in order to hire people or to train people in my lab in my laboratory. And that's very important as well, that part of my mission here is not just to be you know, coming up with a functional cure for diabetes, but also to be training the next generation of scientists and so I have undergraduate researchers come to my lab and some of them need have financial aid requirements in order to be attending watched in the first place and so I have to pay a portion of that in order to have them have the privilege of being able to do Diabetes Research. Same thing with a PhD students, I have to pay their siphon and their tuition, and also postdoctoral fellows as well. And these are all people that I'm training that are doing the work but I'm hoping are going to be trained to then you know, go on and either companies or in their own academic labs to continue the fight for a cure for diabetes and they but they but they need to if they don't get a salary to be able to do it then they're going to go and do other things like not a big purchase or go work on a different disease area and I'm rather than work on diabetes with me then go and you know, make shampoo at Johnson and Johnson but like I was thinking about doing for a while or you know, go and work on a different disease area, no offense to that disease areas, but my focus is diabetes and so I'm going to compete in order to do the best I can in terms of research and in terms of training in order to advance that as much as possible.

Scott Benner 1:08:36
That really speaks to me what you said honestly, you need quality people who who want to do it and I loved your answer because I want people to hear that I honestly want people to know that you're listening in my estimation, you're a brilliant guy who could be doing other things you could be rolling around a lab working on conditioner, wearing $200 shoes and driving a you know a fat car and and living a completely different life but you're putting your ability to think through these ideas into something as important as diabetes and and I appreciate that I hope other people do as well. I have a couple of quick questions. And I'll let you out here. I know we're over time a little bit different does this have any application what you're working on to type to

Jeffrey R. Millman, PhD 1:09:18
get at the type two situation is a little bit more complicated than type one. But the short answer is yes. The type two type population is more heterogeneous and there are definitely many people maybe even most people with type two diabetes that probably wouldn't benefit from from this because their diabetes is already managed sufficiently with diet and exercise and or with these other you know, drugs like the instances of Tyson drugs. However, I think that in my discussion with endocrinologist backs us up as Well, that's the more severe type two diabetic patients, the ones who are taking insulin like patients Type One Diabetes do as well, they would be able to benefit from it, since you could think about these cells as essentially a insulin production source. And the patients need insulin, then it could become from the cells and set up in the insulin injection, the complication there, which makes it a little bit maybe a little bit more challenging than in the Type One Diabetes case is that most patients with type two diabetes have what's called insulin resistance. And so they per kilogram of or pound the body weights, they require a larger dose of insulin in order to maintain normal blood sugar levels. And so what that would translate over to is that you would be the transplant even more cells into a typical patient with type two diabetes than the typical patient with Type One Diabetes. But that is a hurdle that could be overcome, again, because of the positive features of stem cells in terms of being a self renewing cell source that, you know, we can go and make a few billion cells for them, as opposed to baby 1 billion cells that a patient with Type One Diabetes would need.

Scott Benner 1:11:25
Okay, I see. All right. My last two questions are this one seems kind of outlandish, but are there like you taught a cell how to sense glucose and make insulin? What else could you teach it to do? can it make me taller? Or like what else? Like, you know, I'm saying like, Where's this headed?

Jeffrey R. Millman, PhD 1:11:44
So I guess the way to think about it is that we are only teaching the cells, what evolution already taught the cells, basically, we're not telling them to do anything that is artificial. All we're doing is trying to give them the signals, they would normally get in the developing embryo that would tell them to become a beta cell or is producing cell, all we're doing is trying to copy that inside of the laboratory. So evolution already figured all this stuff out for us. And all we're doing is trying to copy evolutions work in the laboratory. So that means that we have so we do some sort of exotic genetic engineering tricks just possible, I guess, but at least with how we're making the interesting cells, that means that we can't tell the cells instruct the cells to do anything that they wouldn't naturally be able to do in the body. But with that said, I mean, maybe he gives them a growth hormone artificially to go and make you grow taller, and produce insulin, but you're probably better off not doing that. Yeah, I was hoping you could

Scott Benner 1:13:05
fix my plantar fasciitis actually, or, or I could dunk one or the other. I wasn't sure what I was going for exactly there. But I just wanted to understand, you know it. And that's a really great explanation of it, that you can just do what what nature knows how to do, that's, that's really is probably comforting, to be perfectly honest.

Jeffrey R. Millman, PhD 1:13:26
My, my professional advice for you would be to just get the shoes with like platform shoes, or like, get a springboard in order to go and probably to be much more economical for you, then try to use a cell therapy for it. Well,

Scott Benner 1:13:40
Jeff, I was gonna tell you, you could come back on the show whenever you want it if I could jump higher, but now you're making me rethink my offer. Well, so two things. And so I don't forget to say it whenever you were terrific. And I really enjoyed this. So if you ever have anything else you want to say, carpenter, you just let me know. And I guess my last question is then timelines like, what are your What are your hopes for this?

Unknown Speaker 1:14:07
Yeah, I

Jeffrey R. Millman, PhD 1:14:10
you can imagine I dislike the timeline question because, of course, should I be held anything but also because it's very difficult to predict timelines when it comes to any clinical work little than kind of a major novel clinical treatments, like a cell replacement therapy for for diabetes. I am hopeful that in the next few years, we there would be clinical trials that are like could be initiated, and we have been in discussions with a lot of partners in order to make that happen. And that does seem to be very realistic. So I feel pretty good about in the next few years clinical trials could begin. However, I think the bigger question which is a lot harder to answer is, when is this going to be a widespread treatment that the average person with diabetes could have made available for them? And that's simply impossible to know the answer to I've been doing this a long time, I'm not naive enough to ask you that question.

Scott Benner 1:15:31
I was just wondering what you were hoping your next steps were? So what what gets you to those clinical trials? Is it money?

Jeffrey R. Millman, PhD 1:15:37
Money? Yeah, it comes down to money. And that's both in terms of, you know, advancing our technology, but also just doing the necessary steps to translate our kind of, we want to call it a research grade process into an actual clinical grade process, it all comes down to dollars and cents, is it

better? It's,

Scott Benner 1:15:58
I'm sorry, Is this better off in academia? Or would it be better off privatized? What if somebody came along and bought it with this fear be then that they might not follow through the same way, and they'd want to bastardize it for something else? Or, like what gets it done more quickly?

Jeffrey R. Millman, PhD 1:16:13
I think that there are viable paths with either direction. And kind of the fear that you mentioned, when it came to kind of a company involvement, that there are protections that can be put into place to make sure that a company doesn't like swoop up the patents, and then sits on them to prevent a care from actually helping people, Jeff,

Scott Benner 1:16:39
is that I don't mean to cut you off. But is that light bulb story true? You ever heard that, that 100 years ago, a guy designed a light bulb that would never burn out and a light bulb company called him in, bought his patent from him burned everything he brought and broke all the light bulbs right in front of him? Have you ever heard that?

Jeffrey R. Millman, PhD 1:16:56
I have heard that I have no idea if this actually true or not. But I think we I think the the people who manage, like technology portfolios are a lot more savvy than they are 100 years ago. And I guess one of the aspects that we haven't talked about when it comes to to my research here is that in addition to the the core technical team that we have here, Washington University, also has an extensive technology management office here. And their job is to worry about these sorts of things to make sure because obviously, I'm not a patent attorney or lawyer to give me the file past inventions or to figure out licensing deals with, with companies or other entities, I don't know how to do that stuff. It's so washu. And it's pretty true for other major research universities as well have a office that is dedicated to that, in order to protect the interest of the university, but also the interest of the technology. And so this kind of relates to the protections that are put into place to make sure that somebody doesn't go and buy the patent for your light bulb and then destroy everything and make it so it's not available for people you can write, you write in into these contracts, essentially, that the person who license or buys the path that has to proceed with commercialization. And there are very strict deliverables that a licensee has to do in order to continue having the rights the patent, if they do what you said, which is the sit on the patents, then they're in violation of the agreement, and the path that reverts back to Wash U. And in this case, to or the university, whoever holds that the patent rights are originally and then we're able to go and you know, find a partner who was not going to play these, these silly games. Yeah, I guess it's possible, but there are ways of protecting yourself and also protecting the interests of patients. And so this idea that that companies are out there and would never allow for never allow for a cure for diabetes to come. Because they make so much money off of insulin just isn't true there. There isn't any real basis in reality for it. And in fact, I would say that, overall, the companies that that I'm aware of in the space, all view this as being the future and all have at least a small internal program and not a large program to make sure they end up not following The the lesson of like a Kodak, for example, who were the ones who discovered digital photography, and they just decided not to pursue it because their film industry, business was making so much money. But then other people develop digital photography, and Kodak get left in the dust because there's a Kodak and Polaroid Sorry, I forget which one, right, but the film one. So I think that's actually probably the the more relevant analogy here than the than the lightbulb analogy that these companies make money from from insulin and that's true, and you're gonna get arguments that they make too much money from from insulin, as well. But they all believe that the future is cell therapy, and they don't want to be like, Polaroid or Kodak, which whichever company was to, you know, be out of the diabetes business because they didn't adjust your business model with the time

Scott Benner 1:21:00
Well, people are still going to be diagnosed, and they're still going to need this treatment. And they'll just find a way to build this treatment to cover the cost they lost on something else. So it's it. I believe that totally. And I think that, like you said that people are smart enough to see that there are other applications and you want to be involved. So what are we looking for here? Do we need, like Beyonce type money to start getting interested in diabetes? Or do we need Elon Musk? Or what level of wealth? Do we need to get interested in type one for this to move forward? You know, I'm saying like, it's not just like, you know, not like a B level actor, we need something else, right? Who do you think Who's your Who's your dream guy who like wakes up one day, it's like, I care about type one diabetes, all of a sudden,

Jeffrey R. Millman, PhD 1:21:45
I, I don't know that I have a good answer to that. I think that'd be a little bit beyond beyond my paygrade. But Elan Musk, you know, going and, you know, sending being the first private company to send astronauts into space. And yesterday, that rocket with his car to Mars, I'm sure that I'm going to guess the amount of money that went into that would be a good amount of money. That's one day that that would definitely help out quite a bit, though, of course, what he's doing with this company is very, very valuable as well. So I don't have a good number for you. But I can tell you that the number number one limiting factor towards progression, for here, it all comes down to money and the limited amount of money that's there. And especially in the world of COVID-19, for which where, you know, there's a lot less money to go around, both because a lot of money thing rejected COVID-19, again, which is a very important thing, but but also, like foundations overall are raising less money in the economy has slowed down a whole lot. There's less money available overall. And a lot of the traditional diabetes foundations that have been very supportive. In the past, I've had to really clamp down in terms of the amount of money they're giving out right now, because their fundraising has been so small this year, versus that years past. And so it's unfortunate that it does seem that COVID-19 is making it so that we were already in a bad situation where there wasn't enough money for diabetes research. And now there is even less money for diabetes research.

Scott Benner 1:23:28
Alright, so I think you know, what we need to do is whatever that powder is, you give the mice that makes their pancreas stop working, we got to slip some of that into like Joe Rogan's coffee or something like that. I think this is the way to get. I'm obviously

Jeffrey R. Millman, PhD 1:23:40
I don't think I would support that.

Scott Benner 1:23:41
No, I don't either. I'm just being Jeff, I genuinely cannot thank you enough for doing this. And I just want to let you go, because I've kept you much longer than I said I was going to, and thank you. And honestly, if there's any thing you ever want to add, and you found this valuable, please come back on. Yeah, this

Jeffrey R. Millman, PhD 1:24:01
is really my pleasure. I really enjoyed our conversation. And I'm hoping that your audience gets, you know, a little more information about what's going on when it comes to diabetes futures, because it really is exciting. And I think there's a lot of reasons for hope. And I hope that message came across in our discussion. So thank you very much for having me on.

Scott Benner 1:24:17
It's my pleasure. Is there any way they can track your progress online?

Jeffrey R. Millman, PhD 1:24:21
Yeah, so I'm very active on Twitter, at Jeffrey r Millman. So that's usually the first place that any announcements about progress come from from from my lab. And we also have a website that is fairly up to date as well. That is kind of a complicated address. But if you just look up milman lab Wash U it should be the very first result in Google.

Scott Benner 1:24:48
Thanks so much to Dexcom and Omni pod for sponsoring this episode of the Juicebox Podcast. Get your free no obligation demo of the Omni pod tubeless insulin pump at my Omni pod COMM forward slash juice box and learn all you need to know about the dexcom g six continuous glucose monitor@dexcom.com forward slash juice box, lend your support to the T one D exchange at T one d exchange.org forward slash juice box, make an addition to that research and help people with type one diabetes to live better. Don't forget to follow Jeff on Twitter, Jeffrey r Millman I don't normally. What I mean to say, I've seen a lot of people cure a lot of mice of Type One Diabetes over the years. This just felt new, a little different to me. And I thought it was well worth understanding the process that got Jeff and his group to where they are right now. I hope you found it interesting as well. I also really thought it was interesting to hear more about, you know, some of the financial support that research needs and, and how difficult it is to get and the you know, considerations behind Do you want to get a regular company involved in this? Or do you want to keep it academic. I like finding out more about you know, the corners of those stories. I really appreciate what Jeff did today, I thought he was a great Shepherd of information did a really good job of explaining it without over promising or you know, hyping it beyond what it was. I hope you enjoyed it as well. Thanks so much for listening to the Juicebox Podcast for sharing the show. There's a couple of great new reviews up on Apple podcasts in the US and Canada and a couple of other places. I appreciate all you guys taking the time. And thanks again, for sharing the show. Just the other day, the show had its most popular downloaded slash stream day in the history of the show. And it was 25% greater than the last most popular day. And as a matter of fact, over the last four months, the show has bested its downloads every month. It's really growing. That is definitely because of you guys. And I really appreciate it. Last thing, if you're interested in a private Facebook group, for the listeners of the show, one of those exists, just head over to Facebook and search for Juicebox Podcast, it'll pop up Juicebox Podcast colon type one diabetes, that's a private Facebook group, you'll have to answer a couple of easy questions to you know, prove your human being. And then once you're in, you're going to see what is now 5500 users 4000 of them are active every day. It's an amazing Facebook group, maybe one of the biggest anomalies in the world might be more of a crazy thing, this Facebook group then telling a cell to make insulin. And by that I mean people are actually nice on Facebook and helpful and thoughtful and not awfully ego and not always trying to prove people wrong. It's a it's an uncommon Facebook group that I think you might like and if you think you can make an addition to it, please jump in. If you're not looking for that much activity, but you want to keep up with the podcast on Facebook. There's also a bold with insulin public group. And if you're more of an Instagram person you're looking for at Juicebox Podcast. Also, if you're looking for the diabetes pro tip episodes to listen to again or share with a friend and you're finding it difficult to dig them out of you know the many many episodes that are there in your podcast app. I've put them all at diabetes pro tip.com. And of course if you have a great diabetes practitioner or you're looking for one, check out juicebox docs.com. Give a penny take a penny kind of an idea you can leave your great endo for someone else or take someone else's and give them a try.

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