#1407 Talking Afrezza with Paul Hanson, RN, BSN, CDE, T1D

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Paul shares his extensive Afrezza knowledge. 

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

Scott Benner 0:00
Have you ever wondered about inhalable insulin? Well, Paul's here today. He's a nurse, diabetes educator, a type one and an a fressa user. We're going to talk all about it.

Here we are back together again, friends for another episode of The Juicebox Podcast. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. Don't forget, if you use my link drink ag one.com/juice box, you'll get a free year supply of vitamin D and five free travel packs with your first order. And if you go to cozy earth.com and use the offer code juice box to check out, you're going to save 30% off of your entire order. Are you starting to see patterns, but you can't quite make sense of them? You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, if you're starting to think this isn't going the way the doctor said it would. I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group, just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 this episode of The Juicebox Podcast is sponsored by us Med, usmed.com/juice box, or call 888-721-1514, get your supplies the same way we do from us. Med, the show you're about to listen to is sponsored by the ever since 365 the ever since 365 has exceptional accuracy over one year and is the most accurate CGM in the low range that you can get ever since cgm.com/juicebox

Paul Hanson, RN, BSN, CDE 2:05
Hey, Scott. This is Paul Hanson. I'm a nurse diabetes educator. Was diagnosed with type one diabetes in January 2 of 1977 so you know, do the math. I'm coming up on 53 years. What is the math? 48 years? Good lord, I should check my blood sugar, huh? Pun intended. Honestly, I've been a supporter and follower of you and your daughter for quite some time, so really looking forward to the opportunity to connect with you today. And oh,

Scott Benner 2:32
that's crazy. I didn't realize that. I thought somebody put me in touch with you, and I didn't realize you knew who I was, honestly,

Paul Hanson, RN, BSN, CDE 2:39
absolutely I knew who you were, in fact. Little short story about us. You and I met at an insulate talk, I want to say, a national sales meeting when I worked with insulate, when I went to work for the corporate dark side and left, you know, clinical side of things. Yeah, you were there to give a talk, and I was in the audience, and I totally stalked you as you were coming out of the bathroom because I wanted to introduce myself, because was really a big supporter of you and your podcast. So I'm glad I didn't scar you, and that wasn't something that makes you stay up at night and not sleep, but that's how we first met. Yeah, I do

Scott Benner 3:15
have a scar from that day, if you want to know what it is. So I have a two fold scar from that day. I guess the first thing is, I had never given a talk to that many people before. Yeah, and I got it into my head, initially, to write out what I was going to say. And then, like, the day before, I was up in my hotel room, because this was, it was a national sales meeting. There were hundreds and hundreds and hundreds of people in that room, you know, because insult brings in. I mean, a lot of companies do this, but they'll bring their sales people all together once a year. And so I stood in my hotel room and I looked at what I wrote, and I thought, This is stupid. I can't, like, I can't do this like this, like, I just have to talk the way I normally do. I pivoted very late, and which made me nervous, because I was like, I had never really done nowadays. I just honestly, I just go up there. I'm like, huh, diabetes and go. But back then I was super nervous, and I got up there, and I was probably putting my whole heart into it, I would imagine. And at some point I recognized that was my first scar. Was being scared. My second one was when I recognized that a group of women and men, a mix of people in the front at the stage were crying while I was talking, and I didn't like it was the first time Paul I used to I get notes where people are like, Oh, I listen to the podcast, and it kind of makes me cry, or I feel emotional, and it's all like, nice, but I never had seen it in person before, and I almost felt like, sorry. Do you know what I mean? Like? I was like, Oh, I'm I'm like, I didn't mean to make you feel like this. And they were like, No, it's okay. And it just turned out that, you know, as in a lot of places, there are people working for companies that help people with diabetes that don't have diabetes, and some. Of them, don't. They're just selling a widget in their mind. You know what? I mean, like, it's the thing we make. And they're, they're moving along. But you have type one and, and I think this maybe is going to be why you're, you might be the right person to talk to today about Fresno. So how long? I guess? Let's give people just a high level overview. You've had type one since 77

Paul Hanson, RN, BSN, CDE 5:18
Yeah, January 2 of 1977 so, you know, that was, that was a long time ago. You know, that was when the cavemen were still around, and I had to, you know, dodge dinosaurs and hunt Willie mammoth to get my insulin. So how old were you then, Paul, I was four and a half. Yeah, okay. And truly, my first memory Scott is waking up in a hospital cold peanut butter sandwiches, because that was the snack that I was allowed to have, a mix of carbs and and terribly cold peanut butter. And watching my mom give injections with a at the time, monster sized needles into oranges, and that was my introduction into diabetes. Wow, to this day, I still love cold peanut butter sandwiches. That was a different reason why I was having it back in the day. Yeah. How Where are you on big needles? I'm not a big fan of big needles. I was right at that edge where they were getting into you know, I didn't have to boil my needles, luckily. But the needles back then were, I wish I could remember how big they were, but when I look, I swear I was like, it looked like an 18 gage needle. Holy cow. But I love the micro fine needles now and I, and actually, I do this every day with an ultra fine needle, with my long acting insulin trace needle, so needles don't bother me. I've given a gazillion injections, but it's not something I signed up for, yeah. So all

Scott Benner 6:33
right, so you managed back then. I mean, four years old, your mom, your your parents managed back then with what I mean, are you, oh gosh,

Paul Hanson, RN, BSN, CDE 6:43
ultra lente. Then, yeah, ultra lente and I was using porcine insulin back in the day. So insulin made from, you know, pigs, eventually, there might have been a mix of bovine in there. I, I'm not super clear on that, as you can as you can imagine. Then eventually NPH came out, and regular insulin was pretty amazing. So I was doing that, and I was injecting just once a day. Believe it or not, for years, I had a really And this speaks to the uniqueness of diabetes. But my MPH lasted for an abnormally long time, to the point where I would actually get nocturnal hypoglycemia quite a bit at night, and so they mph in regular in the morning, and then a little dose of regular in the evening. And that's what I managed for Honestly, all the way through college, really. Yeah, it's crazy. And then Lantis came out for me, and that was such a game changer, because you have diabetes, she's like, oh my goodness, I wish there was something more physiologic, more physiologic. And so when that came out, I got to go through the amazing fight with my insurance company, which I won't mention which one it was, about how I needed to have it. Long story short, I just said, Hey, no, no worries, man, just look forward to an ambulance call in the near future, you know, with the mph, you know, giving me issues in the middle of the night, and it'll be a good time. And you can pay for that, or you can pay for my Lantus. Yeah. They were happy to move along. Then, yeah, and then they paid for the Atlantis.

Scott Benner 8:08
Sometimes you have to say things on phone calls to get your get your meds, that's for sure. I've done it a number of times in my life, yeah, but you did regular and mph through college,

Paul Hanson, RN, BSN, CDE 8:17
yeah, yeah. I mean, remember I was, I was born in 1972 so we'll date me. Yeah. Awesome, yeah.

Scott Benner 8:24
So do you remember what your your outcomes were like then, like going back to college, for example, I

Paul Hanson, RN, BSN, CDE 8:32
do. I do. You had to be very regimented when you were on mph. And even with that regimentation, there was still going to be variation, just because, you know, the human body does what it wants to do based upon all the things that you're doing. So I would have to make sure that I had a snack with me in between, as I was walking through what's called the quad, I went to case, Western Reserve University in Cleveland, Ohio. And if I didn't have a snack, I would actually start to tank and get low in the middle of my walks. And of course, there are times where you're running late in one class and you're trying to get to the other because attendance in college for some reason in certain classes. In this case, I think it was statistics at the time, nursing statistics, you had to be in your butts and seat before the class started. So there were times where I would walk into a class and I'd be breaking out into a sweat. And it wasn't because I had had to run to class. It was because I was now having to fight off a low Yeah. Next thing you know, I'm I'm guzzling down a can of soda because that's what it was back in the day for me.

Scott Benner 9:33
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Paul Hanson, RN, BSN, CDE 12:12
to get started. Yeah. So I changed Atlantis that was, I want to say that was 1991 to be honest, maybe 92 okay, I might be dating myself. Apologies, yeah, so I was on regular still for a little bit, and I would give it to myself, because they would cover the land just, but not the rapid acting insulin yet, but then, like, honestly, within a month, I just let them know that that wasn't going to work, because I wasn't having coverage in the middle of the day, and the last thing you wanted to do was take an insulin that might work, you know, eight hours or more with the regular insulin, and give it in the middle of the day. And so I was having issues. And then at that time, right? I was studying to, you know, be a nurse, and I really paid attention to the insulin action times. And I was like, Look, here's a map, or not a map, here's a here's a graph of how my insulin is working. I need to have this rapid acting insulin. And so eventually I was able to get that covered, too. And so then I began multiple daily inject, I would say, probably 92

Scott Benner 13:09
there. Okay, 92 you're doing. MDI, now. Do you ever go to a pump

Paul Hanson, RN, BSN, CDE 13:14
I did? I worked at Seattle Children's, you know, an incredible institution there, and I was blessed to work with all the different reps there and be introduced to all the different devices, including an old one, which I was really, I was a big fan of the Smith Del Tech Cosmo back in the day. It was that introduction into the different pumps, seeing the results that other children were having, and hearing what the reps were saying at the time, actually, and just my own personal need to make adjustments for basal based upon at the time I was a collegiate athlete, to plan soccer having to adjust my basal rates. I wanted to have more precision over the dosing of my insulin. So I did. I started on pump therapy. Gosh, when was that?

Scott Benner 14:02
The Cosmo? Was that your first pump? No,

Paul Hanson, RN, BSN, CDE 14:07
actually, the the Smith first pump was gonna be a decent Tronic, but that wasn't gonna be covered. And then decent Tronic was purchased by Roche diagnostics. So I then waited a couple years, actually, because when I first wanted to go onto a pump, I wanted to do something unique. I was seeing, I was being seen by my Endo, Swedish Endocrinology at the time, and I said, Hey, look, this is what I have to do. I'm an athlete, and I was pursuing professional soccer at the time. I was like, Look, I need to make sure that I can simulate as close to possible a decrease in the phase the basal insulin. So I want to start on my pump with 50% of my basal daily being given by Lantis, and then the rest of the basal rate being figured out based upon that daily Lantis. And so I had to sell them on the clinical benefits of that. And I said, Well, look, you know, one of the things that you teach is. If you have a site failure, there's a chance that you can go into DKA faster I go. Wouldn't you think that it would be better if I have this 50% basal to minimize that risk? And that was actually what allowed me to go onto a pump with 50% of my basal being given with Lantis insulin. At the time, that was probably 1990 or no, not 1990 that was probably 2000 and which is crazy, 2006

Scott Benner 15:27
well, 2006 Yeah, I'm wondering, like, you know, you're making charts to tell people, like, hey, I need this. Like that. Do you think it was the fact that you were in nursing school, or is it more about how your brain worked? Like, why were you tracking it? I mean, I've talked to so many people are like, look, they told me how to use the instant I put it in. It didn't work. Well, I didn't do anything about it. Like, why were you so on top of it, why were you the one suggesting bigger ideas?

Paul Hanson, RN, BSN, CDE 15:52
Yes, this is actually part of my story, Scott. I think a large part of it is, yes, I was a nursing student. But I think I was a nursing student because at a very early age, on my eighth birthday, or my mom asked my endocrinologist, not the most healthy individual, I'll save the specifics, but asked if she would have risk of having grandchildren with diabetes. And in an effort to try to minimize her angst, he actually said something that was pretty crass, and you said, if you have other children, you won't have to worry as much about it, but you won't have to worry about it with Paul either. A, there's a small chance in B, he'll probably have passed by the time he's around 30 years old. So now this is, this is on my eighth birthday, and you know you're, you're a kid, yeah, and you're sitting on the doctor's table and your legs are swinging, Scott, and you're just like, don't, don't, I'm gonna get a sticker. It's my birthday, and everything just stopped. And to be transparent, I was a meek little kid at the time then, because I went from being the tallest, most rambunctious kid prior to diagnosis, according to photos and and stories from family to being told that I couldn't participate in gym class, I was on a calorie restricted diet, and I went from being about head size, taller than everybody, to up until I was, gosh, 12, whatever, having calorie restrictions, and clearly, like being the shortest kid and not being able to participate in anything. And so I became very meek because I was told, I can't, I can't, I can't, I can't, you're sick. You're sick, you're sick. And so that was pretty tough. So on this eighth birthday, I got that note from the doc, as my mom is now crying, yeah, and she just wanted to know about the risks of grandchildren, and he, he said, the bus, get the bus stuff.

Scott Benner 17:44
Make some more babies. This one's gonna die soon. Yeah, yeah, yeah. It's really,

Paul Hanson, RN, BSN, CDE 17:48
it was really happy birthday. So I got up, I hopped off the table, and I walked out. My mom kind of lost her at me, because he didn't understand why I was leaving. And I was in in the lobby, and she came back. She's like, you need to come back and apologize to Dr blank. I'll leave his name out of this. And, Doctor, how's that sound? Yeah? Doctor, I said, Mom, I'm not, I'm not going to apologize to Dr butthead. I'm going to say butt heads, whatever you're good with. Yeah. Yeah. And I was like, I don't want to see him anymore. She's like, you will get back in there and you will apologize now where you're grounded. So I feel like that's kind of when I just woke up, not the conversation with my mom, but that day. So I walked back in to see Dr Butthead, and I let him know. I said, Look, Dr Butthead, you're fired. I don't want to see you anymore. You're not my endocrinologist. You're gonna die a whole hell of a lot sooner. I didn't say, Hell if I was an eight year old, but you're gonna, you know you're gonna die a lot sooner than I will have a good life. And I looked at my mom, and I said, Happy Birthday to me. You can ground me. And I walked back out, and that night, I gave myself my first injection. Oh, wow. It took about a half an hour because I had to overcome the fear of jabbing myself with this needle. And it lasted that fear for for quite some time. And I've got a funny story afterwards about, you know what the solution was? Yeah, I think that's getting back to your original question. I think that's why I became so focused on not being limited because of my diabetes like so I truly believe no limits. You know, I no limits. I

Scott Benner 19:25
mean, that's first of all astonishing, that at eight years old, you're like, I'm drawing a line in the sand right here. How did your mom respond? Did she relent on the grounding thing? Did she see your side of it ever? Because it's 1985 she also could have taken you out of the car, beat you amongst your head and shoulders. So I'm not sure what happened exactly. Oh well. So

Paul Hanson, RN, BSN, CDE 19:41
actually, it was, it was 1980 at the time, when on my eighth birthday, she did not relent. You don't know my mom, I was definitely grounded. I still gave myself my shot that night, and what I decided that day, it was something I felt. Got like this guy couldn't even take care. Of himself, and he's gonna put this diagnosis in on me. And I had been limited already so much that I said, No, no, no more. And I started to learn about the insulin even more the next weekend, I forged my my my parents signature. I'm really kind of speaking a lot to my character right now, so I apologize.

Scott Benner 20:17
What were you doing? No to play

Paul Hanson, RN, BSN, CDE 20:21
soccer. Oh, okay, yeah, because I wanted to play, I wanted to go be a kid, and I knew, if I could have, you know, my mom was and dad were excellent about making sure I always had snacks around because hypoglycemia was, it was nasty back in the day, and I've got some really scary stories about just paramedics being called in. You know that the course of adrenaline that's running through your body and them having to call in two sets of medics because you're just whooping everyone's ass as an eight year old, you know, kid, you know, weighing nothing. And so it's, it's just, it's not a great thing. It wasn't a great feeling. I decided that with this, you know, with sodas and juices and other things. I was going to go play soccer. And when I was found out that I did that, of course, I was grounded for that as well, but I just said, Look, I'm going to be dead by the time I'm 30, so I'm going to have died playing soccer.

Scott Benner 21:12
Yeah. Why not soccer? I don't even think I might get the women. So I got over, yeah, yeah. I got limited, limited horizons. Here it feels like, how long did you go along thinking you were gonna die in your 30s?

Paul Hanson, RN, BSN, CDE 21:23
Not long it was after soccer. Basically, I put that out of my mind as like, Okay, you proved

Scott Benner 21:27
it to yourself. You're like, oh, I if I did the Yeah. Here's another thing they told me I couldn't do. I did that. So they might have been wrong about all this stuff. It wasn't even

Paul Hanson, RN, BSN, CDE 21:34
that I just I was gonna do everything to spite Dr Butthead, and I was going to learn everything I could and try to do the best that I could. And I knew at a very young age, I you can see and feel, if you think about it, we didn't have sensors. We had, you know, test strips, that you're checking your blood sugar, but you were limited on how many times you can check your blood sugar. But as a person with diabetes, you can feel when your blood sugar is high. You can feel when it's lower, it's coming on. You know, others without diabetes might not understand this. There would be times where I would sneak something. I would sneak a donut, because I was done being told I couldn't have a donut, or this, that, or whatever. And all of a sudden, my muscles would ache, and I would go and pee on the ketone strip and make sure it wasn't getting too high. But it would show that, you know, you're spilling glucose and all that stuff. And so I saw the cause and effect, and I was like, Well, if that's the case, if I want to have a donut, and my insulin is working this much, but my blood sugar is going to this high after I have a donut, means I can't have a donut, or I have to give some insulin for that donut, which honestly, at the time, was probably a little silly, because for quite some time, I was doing that with regular insulin, but I was not allowed to go to birthday parties or anything like that until I was around 1314, years old, because of those challenges and not being able to have cake. And my mom was worried that I was going to eat cake because I would pack my insulin. And she's like, you can't go to the party. I don't want you giving insulin there. You might get low, and I would and I would tell her, I go, No, I'm not this. Insulin is not going to kick in for the next two, three hours. I'm going to take one, one unit so I can have a piece of cake. Let's not prescribe like that. You can't I go, Yes, I can. This is how it acts.

Scott Benner 23:13
Yeah, I've been doing this. I'm paying attention. This is how you know, it's funny, Paul, your story. So mimics a situation that I had where I think a well meaning medical professional told me that I shouldn't worry about Arden's blood sugars going up and down, because it takes like, 30 years for diabetes complications to happen, except when she was telling me Arden was two, right? And so I stopped her, and I said, So you're telling me that when my daughter's 30, she's gonna have complications, and then there's that dead look, you know, that's there. And I go, that's not comforting, you know, in case, in case, she thought it was, and I think that might have been about the time that I thought I'm gonna have to figure this out, because I don't think anyone else is gonna help me. Yeah,

Paul Hanson, RN, BSN, CDE 24:00
yeah. Gosh, this could be an entirely other call, and it speaks to the challenges within, you know, endocrinology itself, and the support and all that stuff. But I do think we're still blessed within the pediatric space to have the support that we have. I've met

Scott Benner 24:13
a ton of good people along the way, and that person, by the way, was valuable to us throughout the it was just that one moment where they, I think, people don't think or Well, I mean, Dr butthead seemed a little more unnecessarily direct. Like, maybe, hey, why don't we let Paul go outside for a second while? I let you know that you should keep procreating if you want grandchildren without diabetes. Like, exactly, by the way, do you have brothers or sisters?

Paul Hanson, RN, BSN, CDE 24:35
I do. I'm the oldest of six, and none of them have diabetes. Wait. Your mom listened, though, huh? Yeah, man, she cranked him out, and I didn't even get a sticker that day. Scott, well, you

Scott Benner 24:50
know the downside of this is your dad probably loves the doctor,

Paul Hanson, RN, BSN, CDE 24:55
or does he? She also has six i.

Scott Benner 25:00
So I think what we're highlighting here, and I'm glad you know that you were able to share this, because I'm trying to figure out how you get to inhaling insulin, because it's a leap, but now it's not a leap for a person like you, and so now that makes more sense to me. So you did pumps. You did i I'm gonna jump ahead now to for us, if you don't mind, I'm sure you tried pumps along the way. Everything else. Where do you first hear about inhaled insulin? What makes you start trying it? What did you experience early on that kept you going? Yep,

Paul Hanson, RN, BSN, CDE 25:30
I met Al Mann at an ADA event. I want to say it was, might have been the one in Washington, DC. It was some famous anniversary for the ADA. I can't remember what year it was. Al Mann himself was there in front of a video screen talking about this insulin. And for anybody who doesn't know Al man he's behind the creation of this inhaled insulin of Fresa. He created the company mankind. And I was so enamored by what he was discussing and the implications that it could mean in the diabetes space. Let's step back a little bit selfishly, just for me as a person that wanted to have something that was more physiologic, I would still, at the time, have challenges with my pump, and it was always centered around meals as a result, you know, I would know certain holidays or whatever, my blood sugars were going to be a little caddy Wampus for a while, and that's just what you did. Or at least that's what I did. What this meant for me was there was an opportunity and see if it could help with those challenges. Like, honestly, Scott, I I suddenly would have cereal until I started on a Fresa, because it was going to be a show, I could guarantee I was going to shoot up into the three hundreds. And then I was definitely going to stack my insulin. Because, you know, you try to get on top of that. It doesn't matter if you give it 30 minutes beforehand, at least in my case, because everybody with diabetes is different, I would still go up, and that was just based on, you know, the cereals. And so I was like, Man, this is a physiologic mimicking insulin that's getting into the lungs, which means it's getting right into the bloodstream. They differentiated it from the inhaled insulin exuber Which, you know, came out when I was working at Seattle Children's. And I was like, this, this could be a game changer in the diabetes space. So I watched it for a while. I kept watching it. Unfortunately, Al man passed mankind and Sanofi Aventis kind of partnered early on, and my perspective was that they took more of a type two route versus a type one route, where I was surprised by that choice. And this is just Paul Hanson as an n of one making that decision, because I saw in the type one space, the fact that we are so impacted by the need of insulin at all times, versus, you know, the

Scott Benner 27:54
type two space, and the speed of it being so important too, yeah, and

Paul Hanson, RN, BSN, CDE 27:58
the speed of it being so important and the fact that it cleared so fast, so honestly, I started on it about five years ago, okay, and the first thing I did was I was with a friend. I didn't get their permission, but he's in the diabetes space, and I can ask for forgiveness, but I was with two friends, and I'm going to share their names, and I'm going to let them know, Scott, unless you don't want me to, but it was Brian Lee and Gary Yamada, two very close personal friends of mine. Brian was actually working for mankind at the time, and he had been telling me about it. And so I ended up getting some of, you know, my own a Fresa, and we met, and I was like, Yo, I'm so excited about this. I want to get an obnoxious meal, and I want to test this. So we, we all met down in Southern California. I had chicken and waffles with regular gravy, knowing that it would it would have devastated me on my pump, yeah, and so what I did was I had my pump for basal and increased it, and then dosed for that meal. And honestly, I didn't get above, like, 180 200 and I was like, wow. What I noticed, though, is I needed to dose a little a little bit more later, you know, probably about two hours later. Okay, I recognize that this was going to be some learning for me, but I did not go into the three hundreds. Yeah, and I don't feel like for me, my muscles ache. I get cloudy a thought. I just don't feel great, dry mouth, all the fun things. So the next thing I did was I hadn't had a bowl of cereal. I sat down. This is when I came home and I asked my wife to pick up some cinnamon toast crunch. So of course, my kids, who were younger at the time, were like, sweet. I'm like, Look, Dad's getting the first bowl. And I had a college size bowl of Cinnamon Toast Crunch. And again, I dosed with more confidence, with a little bit more of the and I didn't shoot above 180 and, you know, I came back down like, probably. Just finished up at around 150 that That, to me, was such a game changer. To be clear, it's it was a process for me because of the fear of hypoglycemia, I

Scott Benner 30:09
would imagine, yeah, because you'd had diabetes for such a long time, and it's so ingrained in your head about, you know, mph and how long it lasts, and you got to eat at the right times and all that stuff. But that probably makes you a better, you know, navigator of learning this new thing too, yeah.

Paul Hanson, RN, BSN, CDE 30:27
And honestly, if you think about it, hypoglycemia dictates the actions of anybody with diabetes, of parents with children with diabetes, it's, you know, we want to prevent that, I mean, for obvious reasons. And so I was slow in my uptake of utilizing it all the time. I would probably use it for one or two meals a day, probably about three years ago, I went to it full time. I went to traceba, because for me, that insulin worked really well as far as basal control, as well as being able to exercise and not having the basal insulin itself drive me low as a result. And again, I'm an n of one. That was my result. And then with the ephraza and I've been for the last three years on a Fresa and placebo, the best I can get, my ANCs were around six three to six one, and they dropped to a five nine to a five seven. And I've actually had a five three, and that's with hypoglycemia ranging one to 3% only, wow, and, and that's a big

Scott Benner 31:28
change. No, that's huge. How would you describe your eating style? I'm still lower

Paul Hanson, RN, BSN, CDE 31:33
carb to be honest. I just, that's just my choice. But come holidays and stuff like that, I'm not limited anymore to having these desserts and worrying about my blood sugars. Early on, I put on a little weight because I was a little too excited. I was

Scott Benner 31:48
gonna say you were just like chicken waffles. Great, by the way, chicken waffles and gravy. Way to go. You're like cereal. What else I bet you were? I actually you know what I thought to say earlier. I bet you, Dr butthead and you had more in common by the time you figured out a phrase.

Paul Hanson, RN, BSN, CDE 32:05
It didn't get that bad, Scott, but honestly, you think about all those years of not being able to do things, and I probably put on eight pounds, okay, that was also after a knee surgery. So there's a combination of things, but that all being said now, exercising, you know, ex pro soccer player, I eat what I want, and I don't have to worry about it. My wife is Cambodian sticky rice, all the yummy things. I eat what I want, and I don't have to worry about the crazy spikes.

Scott Benner 32:35
Yeah, no, it certainly is. You're not a high carb all day person. But no, if you run into something now you would have ignored it in the past, and now you say, Oh, I'm going to give this a shot, because I feel like I can kind of crush this spike and stop it from happening, and I'm going to get a rise still, but not something that makes me feel terrible, or that lasts for four hours, or that ends with me crushing it and then having To catch it on the back end

Paul Hanson, RN, BSN, CDE 33:00
Exactly. This is the thing for me. And I shared this early on, because of the fears of lows. There'll be time when i times when I had dosed incorrectly, I had to give myself more, you know, an hour later, because there were times where I did estimate wrong, right? You know, you're carb counting, and you're doing all these things based upon in the past, I had an insulin to carb ratio and insulin sensitivity and and all that stuff. You know, you're putting together your best guesstimates. There are times because there is no perfect science with diabetes. I feel or it's very hard to get there. I did have to. I definitely missed dosed. But again, that was my my fear of lows, right? And so part of my journey with dosing of a fraza was the embracing of the fact that you had to always take about one and a half times the amount of the insulin that you would normally give with an injectable insulin. And in all honesty, you know, it's, it's kind of out there with mankind's peds trials, they're testing it at two times the dosing. And that's actually what I ended up finding myself is that I had to, I had to take around two times as much insulin, and so that that can scare a lot of people because of the fear of hypoglycemia. I want

Scott Benner 34:09
to dig into how the dosing works and everything. How long do you think it took you to figure out the dosing? I

Paul Hanson, RN, BSN, CDE 34:16
want to get this out for everybody so they know this. Again, diabetes educator, nurse. For a while. I did work for mankind, so I need to get that out there. Yeah, please. And even with that, though, because of my own personal experience with hypoglycemia, it probably took me nine months, okay, to a year, truly just me, because of my own you know, I, I don't, because you took to it because of the path, because I don't want to be a burden on my family. I don't want my wife. She has never had to call the paramedics, never had to deal with glucagon. She's never had to do that. My kids haven't had to see that. That's a driver for me, yeah, and so in those instances, I would probably run the risk of being a little bit higher because I knew that you could. Correct sooner, because it clears so fast, and that was the route that I took. That was my route.

Scott Benner 35:06
All right, so the reason I was am so excited to have you here is because I feel like I've talked to a handful of people using it at this point, and they've all done a great job of telling their story. And I'm certainly not, you know, saying otherwise. But I always end the conversations feeling like no one's been clear about how this works. Like, you know, you know what I mean, like, I know with like, you're using liquid insulin. It's insulin to carb ratio, it's insulin sensitivity, factor, it's, you know, it's your basal. Like, it's these, these things, right? And now there's algorithms that are that are moving, you know, dosing around for you within parameters, etc. And if you ask somebody to explain that, they can explain it, yeah, like, here's the formula I use to get to my insulin to carb ratio. And so when I count up 50 carbs, I take, I'm one for 10, so I take five units and, like, that kind of thing. I ask somebody on a pre to this, and they're like, oh, you know, a four and an EIGHT and a 12, and do you do two? And you wait one, and I'm like, I don't know what you just said. Like, like, so. And what's worse is I don't feel like they know what they just said. Sometimes, yeah, so please tell me I'm gonna

Paul Hanson, RN, BSN, CDE 36:17
try to expand upon it, okay, the way it would, and I had trained patients on it and stuff. Starting orders for this are, if you're taking up to four units of injectable insulin, four units of a fresn, but anticipate that your end dose is going to be an eight, okay, for that meal type, okay. Now there is a precision that we perceive that we have with injectable insulin based upon some crazy things, such as, we exactly know where we are, physiologically, we have absolutely crushed our insulin to carb count, in spite of the fact that, you know there is, I think, allowed up to 20 plus percent variability on the food labels, as far as carb count and all these things. And you know, you could, you've heard the story over and over that you could put a meal down in front of a bunch of registered dietitian dietitians and nurses who they do this for a living, and you're going to get such a wide variety of of carbohydrate estimates right. And so with that, we try to get as precise as possible. And I think we have tricked ourselves. If you take away the A I D component, automated insulin delivery, and you just go back to generic MDI and pump therapy, we have convinced ourselves that we've got a very precise algorithm, and it's exact. Yeah, I agree with you. That is just not true. Diabetes is complicated.

Scott Benner 37:40
When people say, I can do one thing one day, the same thing the next day, and two things that you know, like, You're not exactly are you dehydrated today? Were you less active yesterday than you were the day before? Like, you do your best you can right? Like, and so I assume the same is with a fresn. But like, just to start off by saying, like, Hey, if you're, you know, injecting insulin right now, and you're moving to a fresn, and normally this meal is four units. Well, it's probably going to be eight, but you also just said that the studies might indicate that it could be 16. So like, how do you figure it out?

Paul Hanson, RN, BSN, CDE 38:13
This is exactly what it is, right? You take what you would be given at that meal and one and a half times it, and you then round down, and that's for safety, for fear of hypoglycemia. You then check your trends one to two hours later, and if you're having to correct one to two hours later as a result, that then means that that dose was off probably by four units in that case. And just like anything, just like when you go onto a pump and you're having to call into the diabetes educator, and you're having to have basal rates adjusted, and you're having to have insulin to car races adjusted based upon two or three days data, and then you're having to do the same thing two weeks later, because now that data is incorrect and it's not working any longer. The same thing is happening with your friends. It's an if then statement from a safety standpoint, one and a half times round down if you then need to correct at that carb count with that meal type. Then next time, give yourself an example like this, an additional four units. It's really that simple and what, and I view it as simple, because I've done it, even though it took me a year. But my path, for me, it was year of lows. That was that reason, right? Not, not the precision. And what I have found is that I can look at a meal and it's more carb recognition versus carb precision, yeah,

Scott Benner 39:32
like this meal takes about this much. Yes, yeah. I mean, that's how I taught my daughter to do it as well, right?

Paul Hanson, RN, BSN, CDE 39:39
Yeah. And for anybody that is, how could I say this, at risk of underdosing and then later on stacking, or, let's talk in general, how hard is it to dose 15 minutes to a half an hour, depending on your blood sugar in advance, so that that insulin? Is ready to rock and roll as you're digesting your mixed meal with, you know, fat, protein, carbohydrates, etc, etc. It's not easy. And so the challenge that we see with a lot of patients, and I've faced this when I was in the clinical setting as well as, you know, on on, I say, the commercial dark side of things is that patients know so many times that if they sit down and they're giving their insulin at the start of a meal, the perception is, is that they're failing because of how hard it is? Oh sure, yeah, so that that kind of stinks. And so with for me, the reason I chose to go on a Fresno was I got to that point where I recognized carb recognition, and if I needed to, an hour later, I can give myself a correction, and I hear a lot of Doc saying, Oh, I can't even get them to give their insulin. How are you going to get them to, you know, to take it more insulin. An hour later, I would always just push back and be like, hey, just with all due respect, diabetes is hard, and this is an incredible option for those patients that and I'm going to push back even more doc that are taking their insulin, they're just taking it at the time that they eat, and that means they're not actually they're reducing their risk of success.

Scott Benner 41:08
It ignores how insulin timing works. You know, liquid insulin timing works, right? So I take all your points too. Like, you know, if you know you have to Pre Bolus and you don't, then the meal already started, when you're just like, Oh, I already screwed this up. Like, that feeling right? And then your blood sugar shoots up 1015, minutes later, and you're like, oh, here it comes. I do, like, not disagree, but like, I do think that it's okay to Bolus again. I'm not a person who says that. Like, oh, well, you know, the insulin action time is three hours, so you're gonna sit here and stare at this for three hours. My opinion is, if you missed on the dose, and your blood sugar shoots up, obviously you needed more insulin in there. Yeah, the sooner you put it in, the better, honestly, because at least then it's still working against the impact of the food, right? If you need it, I don't think you can stack if you need it,

Paul Hanson, RN, BSN, CDE 41:56
and I agree with you in that case, right? Because what happens is, A, you know, you messed up on the carb count. B, now your blood sugar is climbing. C, there's something called glucose toxicity, which then makes you insulin resistant to the quantity of insulin that you're taking in. Yeah. And so there's all these different factors that go into those, those times right, where it's really hard to say you're not going to stack, you know you're not going to give yourself more insulin. I don't

Scott Benner 42:22
have to Pre Bolus. Fresno, oh, you sit down

Paul Hanson, RN, BSN, CDE 42:26
and you eat and you take your insulin. And for for those with like, say, gastroparesis or others, they can actually wait until their CGMS are starting to trace up, and then they dose. They hit it there. This is the way it works. You inhale. It's in your lungs in less than a second. It's in your bloodstream in less than a minute. It's already an insulin monomer, which is the usable form of insulin, which the hexamer, or a monomer, bound upon itself six times, is actually breaking down into in the body to be in usable form. And now you're just you're inhaling it. It's a monomer. It's in your bloodstream in a minute. And you know, it's peaking and not peaking, it's starting to have a measurable effect in around 10 to 12 minutes. And this is all in the prescribing information the PI. It's mimicking a peak of physiologic insulin when you have a closed clamp study of around 45 minutes, right? And then the insulin response for somebody without diabetes. So it's pretty amazing, to be honest, there is the nuance of having to learn how to heck do I dose with this? And how do I overcome my fear of lows with this? I do want to say real quick, and we can put a pin in this. I also think the lows are different with an Ephrata than other insulin. My I'm not in front of the fridge inhaling because I know I might have three more hours worth of insulin in me if I, if I do get a low, instead of taking 15 grams, now I might take four to six grams. And I have these gels that I take that are, you know, around eight grams of carb, because it really just depends on, when are you having that low? If you're 45 minutes to an hour into your inhaled insulin, gosh, almost out of your system. So you don't need 1520, or a fridge full of food, because you've got hours of insulin, you know, sitting in your system. So there's that benefit as well. What

Scott Benner 44:10
number do you call low for me? 70? Okay, you would treat a 70. If it was falling, if I was

Paul Hanson, RN, BSN, CDE 44:17
falling at a 70, I would definitely treat that, I will tell you also something unique about amafreza. My understanding with the CGM is that their algorithms are based on 20 minute predictive values, right? And CGM technology is changing a ton, so I apologize if I'm Miss speaking slightly about any of the newer ones that have come out, but it's predicting where you're going to be. Well, the rate of change with the fresn, because it's so fast, is is different than injectable insulin. And so there are times where I've actually had a blood sugar that's been 100 and it's had a double arrow down, and I was like, Hey, when did I take my fressa? And I look in it, and it's like, oh, it's was 45 minutes ago. Up. I don't stress about it. I watch and I wait and I see how I feel, and 15 minutes later, my CGM will level out, and I might be 9295 but it thinks, because of that rate of change, that it's going to continue for that a long duration, because that's what happens with injectable

Scott Benner 45:20
insulin. Let me ask you a question. Uninjectable. You know, if I said the phrase, you can feel the fall, you know what I'm talking about, right? Oh, absolutely. It's Oh, yeah. Does that happen with a Fresa? I

Paul Hanson, RN, BSN, CDE 45:32
have not experienced that, okay, however. Well, now I want to back that up. I have experienced it, but it's not this anxiety ridden again. Have to get in front of the fridge. It's, it's the only, only thing I can describe is that it's different,

Scott Benner 45:49
yeah, because it feels physiologically different, or because you have a different feeling about what the outcome is going to be, combination

Paul Hanson, RN, BSN, CDE 45:55
of the of the of the two. Okay, right there. There are times where, if I've eaten a fattier meal, and it's slower to absorb, absorb, I have actually started to go low. It's made me nervous, especially if you know you're out and about with people. And so I will take an eight, you know, a quick eight, a hit of an eight gram gel, and I'll just continue to watch. And there are times where I've actually felt it and I started to sweat. That's another one of my physiologic things is I start to sweat. And it doesn't happen frequently, but when it does, those gels come out pretty quick. You know, they help me very quickly. And then what happens is, I know that that fatty meal is gonna drive me up later, so I just watch it. I was gonna say, dose again later. Do

Scott Benner 46:45
you use a Fresno, like, like, you know, like, thinking back to, like, an old square wave bowl, a certain extended bowl, the dual waves and all those, yeah. Do you put in some, like, you know, let's use, like, a real cheesy meat lovers pizza idea. Oh, 100% do you put a little bit in up front and then come in, what, 45 minutes an hour later, and hit it harder.

Paul Hanson, RN, BSN, CDE 47:04
I am so glad you asked me that question, because, man, pizza is such a pain in the butt. But, yeah, let's, let's, let's get even crazier. Let's go, you know, Dick crust, let's go, you know, Chicago style pizza.

Scott Benner 47:16
It's not really pizza, but go ahead. I'll, I'll allow this. Go ahead. Okay,

Paul Hanson, RN, BSN, CDE 47:20
I appreciate that.

Scott Benner 47:21
I know you're from Ohio and everything, but I don't think that counts. But go ahead,

Paul Hanson, RN, BSN, CDE 47:26
it doesn't. That's actually, yeah, that's a gut bomb. I hear you, but yeah, I'll dose more up front than I'll dose 45 minutes later, and I do dose every 45 minutes. Just to be clear with pizza is the concoction of the fat and the meat and everything, and the carbs I want to get on top of the carbs that are going to break down quickly. And so, you know, usually I'll take an eight there, and a pizza is going to be the dish that I take the most insulin with, for me, with my insulin needs. Yeah. So I'll usually take an eight, and then 45 minutes to an hour later, I'll take another eight, and then one hour later, I'll probably take another eight, and that's for, you know, two to three pieces of pizza. And I'm having to dose three, minimally three times for pizza. There are times when it's four, okay? There are some people say, just dose up front heavily for that. I have not had a good experience when you do that. The reality of it is, is this drug you down too far? Well, yeah, and this is a deal, and this is something I don't think is very commonly known. So at the smaller doses of friends of clear is super quick, right? Okay, but when you have larger doses, it does take a little bit longer to clear, okay? And so that might be some of the you know, the clinical rationale to just take more upfront if you're going to need that. I with hypoglycemia and the fear of hypoglycemia being with a driver, take a different approach as a person with diabetes, which is, I'm going to dose a good amount up front, and I am willing to dose, you know, three or four times so I can, a, enjoy that pizza, but B, avoid that risk of a low I

Scott Benner 48:53
think. Okay, we haven't gotten into this part yet, but you're inhaling it, right? So, and they're in little disposable like cartridges. Like cartridges, okay, how many of those do you think you use in a day? It depends, right?

Paul Hanson, RN, BSN, CDE 49:05
If, if it's a pizza day, then it's going to be significantly more standard day. I probably use between three to five.

Scott Benner 49:12
Okay. How do you carry them with you? They're in your pocket. Do you leave them in your car door? Like, how do you imagine

Paul Hanson, RN, BSN, CDE 49:18
an Altoid tin? Right? I went to training patients and when and for myself, I just went on to Amazon, and I found these black TINs that look like Altoid tins because I didn't, you know, want them to be minty fresh smelling as I inhaled them. And I get that the inhaler goes in there, and then I take out the cartridges that I need for the day. And I put them in there. I take them out of their foil wrapped and I put them in there, and they carry them with me. And so once you've taken them out from that little foil wrap, and they're and they're loose, they're good for three days.

Scott Benner 49:51
Okay, out of the like, refrigeration or not refrigeration, no,

Paul Hanson, RN, BSN, CDE 49:55
out of the foil wrap itself. So got a larger foil wrap. Package, and then in it, right? That's got rows of additionally foil wrapped containers, right? And each each row has three, so you'll have 30, and then an entire foil wrapped package. What I do is I usually take a row of five out, so five times three, so 15 cartridges, and I leave that in my my diabetes draw. And each day I'll go and I'll take section of fours. So I'll take three fours and and three eights, and I open up that portion, I put them into my little tin, and that's what I carry with me. And that's, you know, to me, this to me, that's not a big deal. Okay? I either have it my jacket pocket or my work bag. You know, in the past, I would carry it in my pocket. I've seen tons of people that actually will just take their inhaler, put it in their pocket, take their their crutches with them. That's just not a choice I made. Did

Scott Benner 50:53
it ever occur to you when you were making the switch, like, maybe I'll just stay, like, on an A I D pump and then use a phrase that a crush, like, big highs and stuff like that.

Paul Hanson, RN, BSN, CDE 51:01
Absolutely, it totally did. I was at this point where I had to make a choice. I started to have some abdominal irritation with with the pump sites and with Dexcom sites or sensor sites. And so I really had to prioritize, where is what skin space is going to be used, and what's going to be the priority? And so I decided to go off of a IDs, because the importance of the sensors is so important to me. Earl Hirsch has done a bunch of, you know, work on this, and does mention that, you know, with tan, yeah, you can have increased sensitivity and challenges with with using adhesive over long periods of time. And so I just went on a break. And what I found for me was that perceived and afreza is what I liked. However, I have considered going back onto an A I D, using a Fresa with it to overcome those because again, the A I D, S man Scott, were blessed in this time where we have all these incredible devices. Like, seriously, like, if I was eight, and Dr butthead was going to tell me that, and I had foresight, and I could say, Yeah, guess what? Dr Butthead, you know, we're going to have all this technology in the future. And, you know,

Scott Benner 52:13
yeah, what do you say? What's making you is it just how great the A IDs are, like, or what's making you think about going back that way.

Paul Hanson, RN, BSN, CDE 52:21
How great the A I D s continue to get. They continue to get better and better and better. And I don't want to really name systems, but like, they just, gosh, I, I'm so impressed with them, yeah, like, like, truly, you think about when they first came out, you know, we, you know, we had Medtronic and we had some, you know, we're doing their thing, and tandem and and Omnipod, and now you got PETA bionics, and you've got SQL med tech, and you've got all these options for all these different patients who have all these different needs. Yeah, man, it's, it's incredible, like, purely, no,

Scott Benner 52:55
really is. How about insulin sensitivity for, like, use a menstruating woman as an example, right? Like, my daughter's uh, needs change pretty consistently through the through the month. Does that change along with it? Or is a fressa insulin? And this is going to sound stupid, because I'm pretty sure I know the answer, but I'm still going to ask the question, because I think it helps people understand. Like, is there anything about a fresn that makes it insulin sensitivity proof. Or, do you know, I mean, like, my sensitivity rises, my Ephesian need rises as well.

Paul Hanson, RN, BSN, CDE 53:26
Yeah, if your sensitivity changes, your need rises. That's just, that's a physiologic thing, and so you just need to take more insulin. It's as simple as that. So if, if she's gonna be more resistant because of, you know, her menses, then she's gonna, she's probably, no, not. Probably she's gonna need to take more meal time no matter what. Just like, yeah, yeah, it is what it is, right? Physiologically, your body is saying, hey, the insulin you normally doesn't make isn't gonna do the job, so it would naturally just create more insulin. We now have to supplement that. So

Scott Benner 53:58
Paul, what would you do right now? Currently, the way you're managing if your blood sugar was 115 and it had been 115 for six hours and it was not going to change from 115 and you thought, I really want my blood sugar to be 95 Can you do that with a frozen or is a four gonna move you too far in a situation like that? I know it's just for you personally we're talking about. But like, I'm trying to figure out if you can be more precise with it, or if you need to work in bigger like, you know what? I mean, it's

Paul Hanson, RN, BSN, CDE 54:25
a good question. Is a good question. So, very, very good question. This is not FDA approved. Uh oh.

Scott Benner 54:30
Are you about to tell me? You go and then, like, spit the rest of it out. Let's go, no,

Paul Hanson, RN, BSN, CDE 54:35
no. But you know, I don't know if you've, like, seen the movie Serpico or anything like that where they have glass mirrors out. I've heard, let's just say I've heard rumors of multiple individuals, and I'll even say I've done it myself, or I've taken a four and I've opened up the contents and, again, not FDA approved. Do not do this at home. We're not giving medical advice. I know that that four is going to drop. Me, let's say 60 points. I will take a half of that, put it back in the container, put it back in the cartridge, and inhale half of it.

Scott Benner 55:08
Wait. How the hell do you do that? Like, by the way, I thought you were telling me you were snorting it, so I wasn't sure what was going because you were like, you're like, mirror Serpico. I'm like, is this like a an odd code reference? What's going on here? No, no, sorry. I mean, no, no, don't be sorry. Like, can you explain it? Like, listen 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. Now, Paul, what do you do? I

Paul Hanson, RN, BSN, CDE 55:33
will, in this case, let's say I'm 120 or whatever, and I want to be 90. I will take out a blue which is a four unit cartridge. I'll open up the cartridge, and I will put it on a I'll put it on a mirror, and I will take half of it, put it back into the cartridge, and I'll inhale it, and I'll end up at 90.

Scott Benner 55:50
I know I don't know what you're talking about, but I'm assuming somewhere online, someone is like you. You spray it onto the mirror.

Paul Hanson, RN, BSN, CDE 55:55
No. So the cartridge itself is broken up, so there's, there's blue tops, like a white bottom chamber that has the the powder in it, okay? And so what I will do is I will separate the two so you can access the powder. Okay, okay. And then I will take that powder, I will put it on the mirror. I will then take a half of it, and I will put it back into that cartridge, reconnected to the blue top, and then I will inhale it. And this is absolutely not something that don't

Scott Benner 56:29
do this, but like

Paul Hanson, RN, BSN, CDE 56:30
at all, but that is the only way, in that case, if I want to go to bed and be 90 and I'm at, say, 120 and I want to go through the night, because I'm one of those type A personalities. And so I have heard, let's just say that others do that. And I have tried it, and it has worked. Listen,

Scott Benner 56:51
I say, steal a 1c overnight all the time. Like, if you can be lower and stable, like, I don't mean low, but like, you know, if you're 130 and you could be 90, then let's go for it. You know what I mean, right? And

Paul Hanson, RN, BSN, CDE 57:01
if you can be 90 for eight hours, yeah, the impact on your A, 1c, and just, just everything, it's awesome.

Scott Benner 57:07
Actually. It feels to me like you like it, but it doesn't have as fine of control as you need. And that's understandable. What about breathing issues? Like, have you? Do you get a cough? He's like, I have to tell you when, when a Fresno first came out, and someone said to me, because people come to me and ask me, like, Hey, are you gonna do this? And they said, you know, are you gonna do this for Arden? I was like, Look, that seems like another step of complexity that I don't need, having my kid inhale something, and I don't, I could have been 1,000,000% wrong. I have no idea. It just was a knee jerk reaction. Some people do have issues. Right

Paul Hanson, RN, BSN, CDE 57:42
again, if you take a look at the prescribers information, or the PI again, it's not recommended for anybody with asthma or COPD, because there is a risk of bronchospasm. But if you think about inhaling, gosh, some type of NDI inhaler, or even, you know, some other inhalers that are preventative for asthma, and you're inhaling a powder, you run the risk of a cough. It's just, it is what it is. You're inhaling a powder. So at the larger doses, if you just start and you're somebody that has a larger insulin need. Yes, there is a risk of having a cough. A cough is non progressive, and it tends to dissipate with time. There are also strategies that you can use that, such as taking a sip of water before and after, to minimize that risk. When I started, did I get a cough? I did not with the four unit cartridges. Sometimes with the eight unit cartridges, you have to be aware of it. It's something that tends to go away pretty quickly, usually about about two, three weeks, if you get that, did I have throat irritation? I did. I had some throat irritation when I started to inhale. It did that go away as well? It totally did. Okay. You

Scott Benner 58:51
didn't panic. You didn't go, oh, great, I have throat cancer. You didn't like, you know what I mean, I didn't

Paul Hanson, RN, BSN, CDE 58:55
panic about, you know, do I have throat cancer or anything like that? Medically, if you go back to my earlier part of the conversation, I thought, I thought this through. I mean, this is not sitting in the body or in the lungs for a very long time. It's literally in the lungs in less than a second, in the bloodstream in less than a minute. So I don't have to worry about anything going on there in my lungs, broke cancer, or anything like that is dissipating. It's being broken down. I mean, it's, it's it's getting out of the body and the FB KP, which is the carrier particle. It's called femural day keto pipe pairs. It's in art. So I, being trained by mankind, when I worked for them, knew this. I didn't stress about it, but it was something that, as you know an athlete, I did worry about. They have you do an FEV one or force expiratory volume, which is part of a larger thing called a pulmonary function test. They have you do that at the start, and providers are able to follow that and see if you have any you know, change in FEV one, or you know your force exporatory volume. I do not some people you know can have a change. Of they say, if you have a 20% change from your baseline, then the you know, your doctor should consider whether or not you come off of therapy. Okay, you tend not to, you tend not to see that.

Scott Benner 1:00:12
Well, do you have any idea how many people actually use it?

Paul Hanson, RN, BSN, CDE 1:00:16
I wish I had the exact numbers. I really do. I want it to be, and this is just me. I personally, as a person with diabetes, think this should be something that should be in everybody's tool kit, to be honest. You know, Scott, I get glucagon every single year, and I haven't used it, thank goodness, for 20 years, but I get that prescription. And so what I wonder is, is, are there are opportunities for individuals to get one or two of these prescriptions in a year. Practical, yeah, to deal with those circumstances, you know, where they've had a site failure, or they are going to go crazy, and they're not only going to have a Cinnabon, but they're going to get Carmel put on it, and they're going to have ice cream, and it's going to be one of those crazy days. I'm interested to see if that's an approach that is taken in the future, you know, by providers patients in their asks, for example, and will insurance companies allow it? I mean, that's just, that's another conversation altogether.

Scott Benner 1:01:11
That was my last question is, you know, is it covered by everyone's insurance? Even,

Paul Hanson, RN, BSN, CDE 1:01:16
yeah, great question with anything that is really beneficial to a person. Of course, it's not going to be covered by everybody.

Scott Benner 1:01:23
For you. No, probably not, yeah.

Paul Hanson, RN, BSN, CDE 1:01:26
So it's really, it's incredible for people with type one and type two diabetes. So of course, it's not going to be covered right away. As a first line, you have to do a prior authorization in most cases. Now, with the prior authorization, what I do know about, you know, mankind, they've done a ton of work. They've got a process where you can get it covered with that prior authorization. So that's not an issue, honestly, it's just, you know, you have to continue to fight. And it was the same thing with CGM and pumps, you know, honestly, for upwards of, like, 10 plus years, until the clinical, long term efficacy of these of this was shown. The thing

Scott Benner 1:02:04
that scares me about Fresa is I, first of all, I, generally speaking, I agree with you. I wish more people had access to us. They could try it. We could get a better understanding what people think, because you always end up talking to somebody who's just like, you know, all in because they know, but it's not growing. You know what I mean? Like, you know when you hear people talk about, like, I loop, and it makes it sound like everybody's looping, but really, there's not that many people doing it, compared to how many people have diabetes, right? Yeah. Like, that's the other idea. Like, I wonder if, like, is it going to get its day in the sun because it's been around for a while, it's past hands already. You know what I mean, from companies like, How long before somebody's just like, sing, catching on, yeah. And then we don't ever get a chance to really, as a community, absorb, you know, the knowledge that that comes with trying it to see if it's a thing that could, you know, spread. Does

Paul Hanson, RN, BSN, CDE 1:02:56
that make sense? Yeah, I know it totally does. And I'm gonna answer your question with a question. Oh, good, yeah. Do you think that overcoming clinical inertia is an easy thing to do?

Scott Benner 1:03:10
No, I think I actually have a job because nobody knows how to do it,

Paul Hanson, RN, BSN, CDE 1:03:16
right and so, you know, I think there's a lot of variables that go into this, into your question. One of them, I do think, is clinical inertia and comfort. Unfortunately, you've got providers now that are being forced to see more patients with less time and improve their outcomes, etc, etc, and they have got incredible staff that has done all this incredible learning to be certified on all these different devices. And now there's even more and more devices that then, when you bring in something that is as unique and is different than insulin to carb, ratio, correction factor, basal adjustments, X, Y and Z, it causes a reset. And sometimes that reset can be hard, yeah. So my hope is that it will be more commonplace and in more people's, you know, bags, so to speak. I wonder if newer prescribers are going to be more apt to take it up because they've been given access to that in college as far as their training, etc, etc. I don't have the answer to that. What I do know is that the mankind team is is continues to do an incredible job, as far as you know, really promoting it and working with younger prescribers, between you and I, I think this is something that was game changing for me, and so I hope that there are providers that want to seek The education and the understanding about what it is, so that they can offer it proactively versus reactively, because that's what I am seeing now. It's more reactive versus proactive. I think that is a place that would be really nice for, you know, the product itself. What

Scott Benner 1:04:58
did you do for the COVID? Company. When you work there,

Paul Hanson, RN, BSN, CDE 1:05:01
I was a Territory Business Manager, and I also trained patients sales training for a while as as well. Okay, so

Scott Benner 1:05:07
then, what have you seen work when you talk to a clinician and when it doesn't work, what do you think stops them?

Paul Hanson, RN, BSN, CDE 1:05:13
There is no magic bullet. I think it's persistence. I think it's getting that prescriber that has a few cases that are very successful, and then that's something that you can build upon. The challenges is getting those few cases. Other instances are you have a patient that comes in and and from a grassroots standpoint, they're very motivated and they want to have the product. And you have a prescriber that has either been resistant or you just haven't been able to get into right? Because that's that is a thing with a lot of healthcare systems, a lot of times these reps that are working their butts off, they can't even get in to have this conversation, because the faculty is is is protected, because they're seeing patients, seeing more patients, less time happy to get better outcomes, and so they can't be educated about it. So a lot of times it's the grassroots effort too. And so being able to support a patient, or support that provider, when they finally call and say, Hey, I need to know what the heck this is, I don't have the silver bullet golden, you know, whatever answer for that, I think it's going to take time, and I do think that it's continuing to grow. I've seen that in the space that I worked in and with the teams that I worked with, that it is continuing to grow, so I'm very optimistic about it. What have you heard

Scott Benner 1:06:28
as far as pushback? What's the doctor said to you? Like, the thing I said, right? Like, I don't know. I don't want them inhaling something. I'm sure somebody said that to you, even though a ton of medications are inhaled, you know, it's not, not an uncommon way for us to deliver medication. Yeah, what else have you heard people say that that have been pushed back?

Paul Hanson, RN, BSN, CDE 1:06:45
It's, it's basically lung safety. And then how are you going to get them the dose multiple times? If you know they need to take a follow up dose, I can't even get them to dose once. Yeah. And the reality right is, is what happens if we just, if you presented it as an option, and it was an insulin that this patient could take, and it can meet them where they're at, which is, you know, three out of or two out of three meals a day. They're not able to dose right away, or not right away 20 minutes in advance. So

Scott Benner 1:07:14
is that argument like, look, there's not enough people who are very motivated to take good care of themselves. And the ones who are already have an insulin pump, it's an A ID or something. They don't need another thing. And the people you're trying to get me to help, I can't get them to do anything. I can't possibly get them to do this. Like, is that? That kind of apathy from the doctor

Paul Hanson, RN, BSN, CDE 1:07:34
gotta I've got to be careful with this. I think that the reality is, is the A I D s are doing such an incredible job, like truly, the A I D s are incredible that I wonder if the systems themselves have a program set up within where the driving force is to get them to what appears to be the gold standard, which is an A I D

Scott Benner 1:07:58
Yeah, their sales is, is got a better story than yours does kind of idea, yeah, yeah, yeah,

Paul Hanson, RN, BSN, CDE 1:08:03
yeah, yeah. And so if you, if you spent all these years getting a system set up where your job, your job, but your goal is to get people on something that is improving safety and outcomes and and all that, and then you have resistance to that, you know, it kind of puts a little kink in your armor? Yeah,

Scott Benner 1:08:21
the doctor could be like, Look, we just got to this. I'm not going to start on something else.

Paul Hanson, RN, BSN, CDE 1:08:25
Yeah, so it's a really good question, Scott, I wish I had the answer that's, I wonder if that's the cause,

Scott Benner 1:08:31
yeah, it's just different enough that it feels too different. Yeah, is what I think can be like a stumbling block. I think the breathing part is a stumbling block too, that you inhale it in. But overall, it's just, it's the different thing. Yeah, it is different. And you they just spent the last decade trying to explain to people insulin pumps using insulin like, I know, insults been around for a long time, but adoption of insulin pumps is not as great as you would imagine among people who have type one diabetes. You're correct, right? And so you're working, working, working. And how do you even get that work? It's because you've got a company trying to sell a pump. Like somebody went out on a limb and was like, Here, we'll make the damn pump. Now we got to sell it. We're out of business. So now it's their job to go out there and and, you know, extol the virtues. And then you you know, you get moving in that direction. Then another insult company comes along. Does it again, and before you know it, it becomes Kleenex to the doctor, and they're all pumps. And, you know, like now you're hearing it from five different perspectives. And then someone comes along, goes, Hi, you know, this man named, you know, Al came up with this, and he's gone now, and sanafi had it, and they seem to not care. And and then they go, that's a big company. Though, if they didn't care, maybe there's a reason. And then it goes, reverts back to the company, and they're out there, small company, trying to push it, it just, it seems like a tough slog to me, like, I mean, it just, but it doesn't make it not a viable option. And that's why I'm I continue to have people on to talk about it, because I, I do think I have the ability to, like, get the i. A story out there, and I'd like people to hear about it, you know? I mean, there was a time, Paul that people came to me and said, and I'm certainly not taking credit for this, but, you know, I am probably one of the places where that is heard more than other places that came out. And today, look, I'll put my kid on this loop thing, you know what I mean? And, and it's like I said, again, still. I mean, if loops on 20,000 people, that'd be amazing, like, Forget 20,000 people, and there's no way that it is. But let's say loops on 100,000 people, that's still a very small percentage of people living with diabetes. Now it's nowhere near that number. I I asked the internet. The internet says that as of 2023, 30,000 patients with type one or type two diabetes have been treated with a fresn. It doesn't say they're using it currently, but they've tried it. This number is based on patient exposure analysis conducted between 2015 and 2021. A fresn developed by mankind Corporation, is the only Ultra rapid acting blah, blah, so you don't even that's a long time. Yeah, 30,000 people, not a lot of people. And no, there's no way to say that they're all on it. But I've also had people come on here and act like a Fresa is, you know, if you come like you can't pry it out of my cold, dead hands, kind of a vibe. So like the people who love it, love it, they should be able to talk about it, you know,

Paul Hanson, RN, BSN, CDE 1:11:19
well. And this is, I think this is where you're working for the company. And again, I'm no longer working for the company. But I think if you are right, the goal is, is to have your providers presenting that as a viable option because of the uniqueness, versus not talking about it because of its differences in uniqueness, right? And so I'm going back to what we said earlier, Scott, we are blessed being a very different time than when I was eight years old, sitting on the doctor's table with Dr butthead. We've got all these incredible algorithms. We've got these CGMS that are continuing to push the envelope. And now for you know, gosh, it's technically a phrase that came out in FDA approved on June 27 of 2014 so it's been out, yeah, for for 10 years. We've got an insulin now that's it mimics physiological activity. If you think about that, Banting and Best have to be doing cart, food, cart, you know, cartwheels and backflips.

Scott Benner 1:12:24
Yeah? No, no, they. I mean, there's part of you that wonders if it's not just, like, you know, the whole VHS beta max idea. Like, you know, those beta people were probably just like, wait, what's, I don't understand. Ours works. It's better. The quality is better. The tape is smaller. You're going with VHS, why? Like, how doing the wrong thing. But I mean that can, that can happen also. It begs saying that when, when I went to a large Children's Hospital, you know, a well respected large Children's Hospital, with my little kid and I was looking for an insulin pump, for the first time I saw this a long time ago. I saw an Omnipod, and no one wanted to support it, and so, like, I I've told this story in the podcast, but I'll tell it to you because you don't know it likely. It was basically like, you know, you go in this room, it's a conference room, and they had tables everywhere, and there were pumps. Like they were like, just laid all over the place, like they were just selling these pumps. Like, you know, like, like, oh my god, people are excited. And I walked the whole room is a big room. There are a lot of people in there, over in this corner, like, this cut out corner of the room was this small folding table, and there was something on it. So I walked over to see what it was. But as I got closer to it, it realized it just looked like somebody tossed the thing on it, like it almost looked like somebody was walking to the table, got about eight feet from it, and were like, I don't feel like going the whole way and like, just pitched it off the wall, and it landed on the table. Okay? And you know what that was on that table? It was an Omnipod. And I went, I picked it up, I went over to one of the people working there. I said, Hey, I don't know anything about this, but my kids little, and there's no tubing on this that's really attractive to me. It's also it's self contained. So it occurs to me that if the company should upgrade it, it's not like they're going to make 1000 different versions of it, like, you'll probably keep getting the upgraded version like, at least more quickly than I would with something else. I had all these reasons why I thought it might be a good idea. And the woman looked at me. She looked at the pump. She goes, you don't want that. Now, this very, very long time ago, okay, like before, right before omnipotent had its foot in the door. You don't want that. I said, why not? And she gestured to my daughter, and she said, she's too thin for that. Now, time after that, I heard people who were approached the same way and told, Oh no, your kid's too chunky for that. You're too chunky, you're too thin, you're too old, you're too young, you're too this, you're too that. What the hell like? How can there be so many reasons why this thing's not gonna work for me? And I, of course, said, you and I probably have a lot in common. I said, Well, I'm gonna get it anyway, and then. As soon as, as soon as I, I said, I'm going to get it anyway. Then the scare tactics came about the insurance Well, if you buy, if you get this and you don't like it, you're stuck with it for four years and, like, this whole thing, right? Which, it's not even the case anymore, one way or the other, because it's, you know, it's not adorable pharmacy benefit now, but, but anyway, that I was then it was your daughter's the wrong size. You don't want that. You're then the scare tactic about the insurance. Then two years later, Paul, after one of my daughter's appointments, the doctor asked me to stay behind. Said, can Arden go out in the hallway with the nurse? And I talked to you for a second, I was like, I know I did something wrong. This is coming. And, I mean, she don't want to say it in front like, Dr butthead would have just said it in front of me. Yeah, at least, yeah, you had a good doc. So it's scary what's going to be said, but it turned out to be a nice thing. And she said, We want you to know that based on how well Arden is doing on Omnipod, we are going to start prescribing OmniPods to children out of this practice. And I said, okay, like, I was like, whatever. And but I said, let me ask you a question. Why did you try to stop me all this, you know, a couple years ago? And she just gets very still and quiet, and she says, well, in honesty, it was new, and we didn't know anything about it, so we didn't want to try to support something that we didn't understand. And I said, maybe that would have been the best thing to tell me back when I asked about it. Yeah, yeah.

Paul Hanson, RN, BSN, CDE 1:16:24
And Scott, I think you hit the nail on the head is there is, there is pride and expertise that we go to when we walk into the institutions and they have it period. However, when there is something new, they might not have that same level of expertise, and that can cause a little bit of discomfort. Yep. And how do they then, whomever respond when there is excitement about something that they don't have a lot of information about, it can cause discomfort. And I'm wondering if that's what you you saw

Scott Benner 1:17:00
there. That's exactly what I saw there, and it's what I'm guessing is going to happen to people who go into a doctor's office and say, Hey, I'd like to try that. Inhaled insulin. Yeah, there's this, there's that. It's that. Don't do that. It's gonna It's scary. Boo, yeah, I

Paul Hanson, RN, BSN, CDE 1:17:13
heard you. I heard you cough five years ago. You might not want to try it. You know, you're not gonna be

Scott Benner 1:17:17
able to breathe if you take that, right? You want to breathe. Breathing is important to you, doesn't it? Like the world keeps changing and and I get it's funny. I get scared. Sometimes I think that what seemed like common sense 10 years ago now seems like bashing to people. Sometimes I'm certainly not bashing anybody, but I think what you just said is right, is that people are still people. I this is my job to teach you this. If I don't understand it, how am I going? I don't have time to understand it. I can't learn about it. Blah, blah, blah, like, you know, maybe it's a control thing. May I want the control here. I don't want you know more than me. I don't know what it is people are. You know, humans are fallible and delicate, and they make all kinds of decisions for all kinds of reasons. But if you're making a decision about what you're managing your diabetes with based on something that's being said to you by, you know, a person who you think you're supposed to listen to. I still think it's on you to do your diligence and find out if that's correct or not. I agree. I agree because Paul did it, and it worked out well for him. I did it for my kid. And you know, you're all welcome. Who lived in the Philadelphia and surrounding areas back then and got an Omnipod like, but you know what I mean? Like, sometimes you just gotta push on.

Paul Hanson, RN, BSN, CDE 1:18:27
I agree. I agree with you. And reality is, everybody is going into those, you know, pump nights or visits with a different type of energy and different things on their plate that day. And it might not be a great day for them to go in with that chutzpah that say you had, and I had, for example, that's hard, and as a result, they might not push for that thing when it's new, and they might take the advice from somebody who doesn't have the understanding about the new thing. Yeah,

Scott Benner 1:18:55
you always have to wonder if you're being offered something, because the salesperson is pretty and knows where the better bagels are.

Paul Hanson, RN, BSN, CDE 1:19:03
I'm not a good looking man, so I can't really speak to that. Oh, Paul,

Scott Benner 1:19:06
you're, you see, you're at fault on this for as the thing I see what's going on. But, but no, seriously, like, if I, if I'm a, if I'm the lady at the front desk at the doctor's office, and it's my job to blah blah, blah, and sales people come in and I like that sales person better, then I might be more likely to say the thing that they're selling. When you ask a question, oh, what's the best insulin pump? Oh, you know, the best insulin pump is, it's the tandem. Why so? Well, the answer being because, you know, the bagels from the tandem person are really awesome. And the, you know, the Omnipod lady brings in donuts, and they always seem a little not fresh, and whatever it ends up being, I don't even know where the law lies anyway. By the way, 20 years ago, you could take a doctor on vacation to Hawaii and call it a work meeting. I don't think that's legal anymore. That's not, yeah, no, that's not. But I still think you can bring a bagel or a pen or something, or stand there and be delightful for 20 minutes. You know, I'm not a salesperson, but I think if. I was, I could rule the world. Paul, somebody's rolling into your doctor's office turning on the charm. You know, forget the bagels and everything else. The person at the front desk likes them. And then they go back to the doctor and they say, I think we ought to take a harder look at this. They made some compelling arguments. Who knows what those compelling arguments were? You don't

Paul Hanson, RN, BSN, CDE 1:20:16
know. You kind of just really provided a really good summary, which first and foremost is the world is changing in so many different ways, but within the diabetes space, for example, B, humans are fallible, right? And so, you know, based on whatever influences, they might not always be at their best when they're trying to help. So what that then means is, C, as people with diabetes, or families with diabetes that are really wanting to learn the most about the options out there. The hope is, is that with all the information out there, that information is easily found, and then when you're in front of that team, you can have an audience to have a really good conversation and make the best you know choice for yourself. Yeah,

Scott Benner 1:21:00
I just don't care. I'm not just talking about a fresn, honestly. Like, if you want a GLP, go fight for a GLP. If, you know, if you're in there and you think I want an Omnipod five, and they're trying to give me a T slim x2 argue with them. If you're trying to get a T slim and they're trying to give you an Omnipod five, argue with them. Like, you know what I mean? Like, geez, if you're in Minnesota, they're gonna offer you a Medtronic, I guarantee you, like, you know what I mean? So, like, Paul's laughing. He knows the business a little bit. Yeah, stick up for yourself a little bit. And when somebody tells you no, don't just say, Okay, say, why? And if that reason doesn't make sense to you, then you got a little more work to do.

Paul Hanson, RN, BSN, CDE 1:21:35
I agree. And, and you can decide if you're going to keep this in here or not. But you mentioned, you know, the GOP ones. You're not going to be surprised about this at all. But as a type one, I fought like the dickens to get onto a GOP one IP combo, because I started to, as I got older, started to have a little bit of resistance, and I was not used to that. And this is after, you know, fifth knee surgery. It wasn't active, put on weight, all the all the things, right? And they just like, Well, no, you can't, because it's not for type one. I was like, might speak to somebody who's medical versus somebody who's just reading a check the box type thing, because type one diabetes is much more than just your beta cells being affected and like this is nonsense. Long story short, I have an incredible endocrinologist who helped go to battle with me, is able to help me get that I don't use it with the regularity of a weekly dosing or anything like that, but what it's done for me is it's helped with that sensitivity, and it's pretty incredible. And I am interested to see what's going to happen over the next, honestly, five years or so with, yeah, with the type one space and GLP ones,

Scott Benner 1:22:47
I've done a ton of content already. Listen, I got it for my daughter. I got it covered, by the way, you argue enough, you can do anything that's for all you're out there. It's tough because the lowest dose is, is too much for her. It's so robs her of her, like, hunger, that it's just, it's too much. So we were, you know, working with, like, trying different doses, different time frames, but, you know, like, and then we actually have, we don't talk about this very much. Arden has a pretty significant needle phobia that comes and goes once in a while, and so that's been a problem. I actually just got her a sample of rebellious to try that, to see if maybe we can make make some impact with that. But when she's on the GOP, her blood sugars are legit stable, and it is difficult to get her blood sugar over 140 when she eats. Isn't that crazy? Yeah, that's awesome. And so I am nativity is amazing. Yeah, I am going to figure it out for but I also don't want her walking around not hungry. I don't want her like, you know what I mean, like, I'm not looking for that, so we're working it out. But, yeah, no, I'll leave it in here. I have a ton of content about GLP. I'm a I'm a proponent. So, yeah, no, all right, Paul, I'm going to let you go, because if weeks goes any longer, my editor is going to charge me extra.

Paul Hanson, RN, BSN, CDE 1:24:00
It sounds good. Hey, it's been so great to connect again. I'm glad I didn't have to stalk you at the bathroom. It would have gotten a little awkward, actually. So I

Scott Benner 1:24:09
mean, here at the end, if you wanted me to go pee to make you feel better about it, I probably could go. I think we'll

Paul Hanson, RN, BSN, CDE 1:24:13
just pass on that.

Scott Benner 1:24:16
Thank you. No, no, it's my pleasure. You're really great. I'm glad. Hey, who helped me get you, Steven, it was Dave Akers. Dave Akers, oh, okay, well, oh, and Stephen went to Dave. Dave, go into you. That's right. Well, thank you everybody who behind the scenes puts in this kind of effort to make sure we talk to good people on the podcast. So, yeah, thank you so much. Hold on one second for me, Paul, I did a good job, right? We covered it all. Yeah,

Paul Hanson, RN, BSN, CDE 1:24:40
I think it was a great it was a conversation. It's organic, which is, again, one of the reasons why I listen to you. It's organic. I appreciate

Scott Benner 1:24:46
it. All right. Hold one second for me. Man,

can you name the only CGM that has only one sensor placement and one. Warm up period every year. Think about it. It doesn't matter if you can I can ever sense 365 is sponsoring this episode of The Juicebox Podcast, ever since cgm.com/juice box, a year is a long time. A huge thanks to us med for sponsoring this episode of the juice box podcast. Don't forget us, med.com/juice, box. This is where we get our diabetes supplies from. You can as well use the link or call 888-721-1514, use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us. Med, I can't thank you enough for listening. Please make sure you're subscribed or following in your audio app. I'll be back tomorrow with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording, wrongway recording.com, you.

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#1406 British Doughnuts

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Martin was sent by his wife. 

• Martin’s wife has lived with type 1 diabetes for decades. Now retired, he’s rethinking how to support her.

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

Scott Benner 0:00
Martin is 62, years old. His wife (type 1 30 years) asked him to come on in hopes that he might learn something about diabetes.

Friends, we're all back together for the next episode of The Juicebox Podcast. Welcome. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com if you or a loved one was just diagnosed with type one diabetes and you're looking for some fresh perspective, the bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginning series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu.

Touched by type one is excited to host their first ever walk steps to a cure. This is going to happen on March 8 at Lake Eola Park in Orlando, Florida. You can join touch by type one as they walk united with their community to elevate awareness of type one diabetes, to raise funds to find a cure and to inspire those with type one diabetes to thrive. Learn more at touched by type one.org Go to the Programs tab. This episode of The Juicebox Podcast is sponsored by touched by type one.

Martin 2:09
Hi, Scott, so my name is Martin. I'm from the UK, as maybe you can tell from my accent, and I'm married to a type one diabetic. You're married to, I'm married to, yes, excellent, excellent. So I don't have diabetes or anything like that. I My experience is purely second hand. Oh, this is

Scott Benner 2:32
gonna we don't get a lot of this. This is excellent. And I love your topic, by the way, that you that you included when you signed up. I can't wait to get to that. No, okay. Well, do you

Martin 2:41
have kids? We do have kids so they don't live with us anymore, because we are that old, we are both retired, and the kids have moved away and live in different parts of the country. One is married and has their own family, and one is just dating at the moment, but happily in relationships, happily working, going really well. Daughter did. She's pregnant again at the moment. Daughter did have gestational diabetes during her first pregnancy, but so far, that hasn't reared up during the second pregnancy.

Scott Benner 3:23
Has there been conversation that that might mean diabetes in the future?

Martin 3:28
There has indeed been conversation around that, yeah, and the NHS here is keeping a close eye on it. She was, in fact, tested yesterday. She's at 24 weeks.

Scott Benner 3:40
Well, congratulations on being a grandfather again. Is that difficult that like you and your wife sitting down with your adult daughter and saying, hey, you know gestational could mean diabetes in the future, not so

Martin 3:53
far, no, she knows the sort of risks. Frankly, we don't come with just diabetes as a health background. I'm asthmatic, so that's something that the kids occasionally suffer from. I had eczema when I was younger. The kids both suffer from that now. So we come along with lots of health problems. They're used to that kind of inherited health danger, I suppose you could call it or or risk.

Scott Benner 4:23
So what about your wife? Besides the type one, does she have anything else? No, nothing, no thyroid or celiac or anything like,

Martin 4:30
oh, apologies. Yep. Good. Good. Prompt, nicely done. She does have if it or she's regularly taking stuff to keep the thyroid under control.

Scott Benner 4:39
Hypothyroidism, she takes, uh, Synthroid. Maybe

Martin 4:43
you're going into way more detail than I know. I'll be Martin. I'll be honest. Tell me. How long have you known her? So we are not now. You're really asking tricky questions that I hadn't expected and hadn't prepared for. We've been married over 30 years. Let's put it

Scott Benner 5:00
that way, 30 so you've been married over 30 years, and if I said to you, does she take a little white pill every morning? You're not 100%

Martin 5:06
certain he does take a little white pill that comes in a really nice cardboard box. But what the name is on the outside? I have no idea. I love that you said

Scott Benner 5:15
it's a very nice cardboard box

Martin 5:18
that's just keep them fresh, isn't it?

Scott Benner 5:21
That's listen. I only asked not to embarrass you, but to point out that, you know, you could live with somebody for 30 years and be like, I don't they do take a pill every morning. I mean, if I'm being honest, I'm asking you, because if people are listening who are just starting their journey with hypothyroidism, for example, I'd like them to know that 30 years from now, their kid, or they might be with a person who loves them very much, is like, yeah, it's not that big of an impact for them. You know,

Martin 5:46
agreed, now that it's under the control of the drugs, it doesn't actually impact her. She occasionally has to get assessed to get the dosage adjusted, sure. But actually, that is working out

Scott Benner 5:58
fine, excellent. No, that's great. Yeah, yeah, it's a big problem if you're not taking the medication. I agree. And I actually have a personal friend right now who's fighting with the doctor, you know, who wants to just point at everything except the obvious. They have a TSH that was five and a half. They tested it again. It was 2.6 it's bouncing all over the place. And the doctor is like, what could be your liver? It could be this, it could be that. And the person goes back and says, Well, elevated liver enzymes are common when TSH is elevated. And the doctor goes, yeah, it's not, it's not your thyroid, but it's just, like, but my hair is falling out and I'm tired and I have, like, like, just lists all these thyroid system the doctor goes, you know, maybe you have fatty liver. Maybe it's this, like, Can I try this generally harmless medication to see if, like, you know, it helps me doctors like, ah, we might want to test you for fatty liver. Like, oh my god. Like, just trying to make money, you know, like, I don't know. But anyway,

Martin 6:50
that sounds such a tricky situation when you're suggesting to the doctor based upon my symptoms. It could be this, but I suppose it does fit in with how the world works at the moment, we do a lot of diagnosis by Google. It's

Scott Benner 7:04
an interesting problem, you know, nevertheless, so your wife had diabetes when you met her, or was diagnosed during your relationship?

Martin 7:13
No, she'd had diabetes for quite a while. When I met her, she was at that point, because it was quite, quite such a while ago. She was obviously just injection controlled, but it's now become, as with all the technology, she now has a CGM on her arm, and she's still injection based, but it she's changed insulin several times during that

Scott Benner 7:40
so when you start dating, how prevalent is the idea that she has diabetes? You're really testing a memory now, a long time ago. But do you remember being like, I like this girl, but or do you remember not thinking about it? I remember not thinking about it frankly. Okay, it was an interesting aspect of her, but it wasn't a risk or a don't go there type flag, nothing like that. I have my daughter's dating a boy, and I resist every time I see him from asking questions that are meant to lead to are you judging my kid because of this? Are you worried about it. Like, are you scared? Would you flee if she had a problem? Like, like, I don't do any of I don't do any of that, and it doesn't overwhelm me when I'm seeing him, but I would be lying if I said I wasn't interested in where his mind was. And then there's part of me that thinks he probably doesn't even notice. Like, she barely you'd be hard pressed to know that Arden has diabetes if you were looking at her, you know what I mean? And interesting? Yeah, and she's, I mean, she wears her stuff out. But people get used to that very simply, like, I don't think it takes long for someone who's around you not to see your pump. For example, she's not overly involved in it. It goes very well. So there's not a lot to do, is what, I guess, is what I should be saying, not that she's she's involved in it. She's giving herself insulin every time she needs it, etc. But it's going so well that, you know, there's not, like, a lot of pit stops, I guess is my point. No, that's great. Good. Good for her, yeah. But I do wonder, what's that? I'm sorry I'm good for him as well. Actually, yeah, yeah, no, I hope so i It seems like that. I guess if I was worried, I'd probably open my mouth, but I must not be anyway. So you start dating, there's no notice of this or anything. But then through your life, like, what are the stories that stick out in your head that were diabetes related, maybe things that you were like, Oh, I didn't realize this was going to happen. Or, you know, that stuff like that. So

Martin 9:40
significant steps are definitely as you are changing your insulin regime as because as you move from one injection to another injection, that has always seemed to disrupt her and it takes several weeks to get through and. A new regime and to settle and to be under control again, pregnancy was, at times a little bit tricky. We always had to keep a set of chocolate biscuits on hand, as things would change quite rapidly when she was actually pregnant, those are probably the major things that that actually stick out now, she's obviously, most of the time, well controlled, looks after herself. At the moment, we're having a bit of a discussion, and I'm interested as to what your experience around this is, because I think you know a lot more about the the situation than me, obviously being my experience being second hand around a diabetic. I've not read through a lot of the background to diabetes, and I I'd be honest, I don't understand the dosage. And you quoted TSH at me earlier. I think your medical background is much deeper than mine, because I didn't actually understand that phrase. So I don't actually understand, I think, the mechanics of diabetes and the dependence upon the injections for the provision of insulin. And we're just having a discussion around that at the moment as to whether I should become more versed in that in order to understand what's going on with, you know, the amount that she's eating, the amount that she therefore needs to be dosing, the amount of exercise, and all those other factors that that come together to keep someone balanced with type one diabetes. What are your thoughts around that? Earlier,

Scott Benner 11:40
I told you about touched by type one and their steps to a cure walk, which is happening on March 8, 2025 you can go to the website touched by type one.org, and register now. But guess what? This weekend, there's a special steps to a cure kickoff event. You can join touch by type one for a light breakfast at their walk kickoff, come meet fellow participants, learn more about the walk and get excited for the big day. Then you can enjoy a complimentary day at the Orlando Science Center. Get out of here for free. What the heck? Touch by type one.org Go to the Programs tab, get registered. Now. This thing's happening on Saturday, January 18, at 8am you gotta go register right now on the website. Get going. I have to ask first, do you not know about it, because you were busy working, and she was raising a family, and you had two separate kind of lives around that, and now you're, are you guys retired now? We are indeed retired now, and now you're retired. Is she starting to think about, what happens when I get older? What if I can't do this for myself? Is that the concern? Or is she or did she look up and go, How did this jackass make it this far without understanding my diet? What's the um, the onus together? Think about, I'm gonna

Martin 12:47
go with the second one, frankly, that she really thinks I ought to be understanding some more of the situation in order to be under probably more of a sounding board as to whether she is actually going the correct way with the regime. Yeah.

Scott Benner 13:04
Can I ask you, like, a slightly personal question, did you when this came up? Did you have any hindsight? Did you think, wow, why didn't I think about this sooner? No,

Martin 13:14
that wasn't the thought that occurred to me. The thoughts that have occurred to me around this are, frankly, we have a relationship, which does work really well, but can be just a little bit prickly at times when we don't agree on something. And I just feel that if I knew more about the diabetes, then I would be saying, Why are you giving yourself three units at the moment, you've just run around the park. Shouldn't it be two? And I could see that creating more tension than actually providing the value that she feels. It might do

Scott Benner 13:54
is everyone hearing a wise man who's been married for 30 years, speaking very carefully. This is wonderful, Martin. Thank you. What Martin is saying is there were times over the years I thought to speak up, but I imagined it would end with the resolution of my marriage and me living above a donut shop, so I kept my mouth shut.

Martin 14:17
Maybe the donut shop is questionable, because we don't know many of those in the UK. But the general gist is there,

Scott Benner 14:23
yeah, of course. And by the way, I want everyone to know, my brain struggled for a more British centric food. It didn't find anything, and I just decided to move on the thing. Ah, have you not been to the UK? We said crumpets, fish and chips would be the one that would come out in the UK. Yeah, I don't know. I was looking for a baked good for some reason. Now the reason is, is that that joke here in America is that every guy I've ever known who ended up divorced lived above a pizza place for a while, while they were getting back on their feet, and I wasn't certain if pizza was a was a delicacy in England or not. Oh yeah, went off to come sometime and try it. But anyway. I hear what you listen, I get what you're saying. Like people don't want to be alone. They want someone to help, and they want support. But when that support comes from someone who's too close to you, a lot of times, your reaction is, leave me alone. I don't need your help, and nobody's looking to fight. So you guys probably settled into a space where you kept your distance on this, and she quietly resented that you weren't helping her. And had you helped her, she probably would have quietly resented that you were involved. But now you're now, you guys are together all day long. You're seeing the reasons why it would be helpful if everybody, if there was a sounding board, somebody to just run through it, I'll tell you, simply stated. I think the Pro Tip series in the podcast would be really helpful for you. Okay, yeah, no kidding. Episode 1000 to like, 1025 and there's even stuff in there about pregnancy, and just, I have a whole series about gestational stuff, and if your daughter should run into the problem, again, the diabetes part, you could figure out easily, right? Especially because she is she using a pump with an algorithm.

Martin 16:12
No, no. She was using the T slim, and that just completely didn't fit her lifestyle. It was making way too many assumptions about if this happens, I should do that, and it was either allowing her to go too high or pushing her too low. So that didn't last very long. At the moment, she is long term injecting once a day, and then since where I start become hazy and probably need to learn more, I think it's three times she injects on the rapid acting stuff. She's

Scott Benner 16:52
doing what they call MDI, multiple daily injections. And once a day she's using her her long lasting insulin, her basal insulin and Yeah. Then at meals, she's shooting for for carbs. Is that why it ends up being three times a day? Yeah? Does she ever shoot in between a meal to adjust down a high blood sugar? Occasionally? Occasionally, she does. Do you know what her a 1c is no, no. When she goes to the doctor, they give her that report about what her average blood, Yeah, agreed. Interesting. Have you ever gone to the doctor with her? Not about diabetes, because she doesn't want you there, or because you've just never thought to go. I've

Martin 17:34
just never thought to get. Been honest with you, how old are you?

Scott Benner 17:38
6262 Okay, so I have no medical background at all. Martin, I want to be clear. I barely got through high school, everything I know I know from I'm not kidding you, I didn't go I imagine I've said this on the podcast, but I missed 53 days of my senior year of high school, and I did that because I was poor, and I went to work instead. And, gosh, I look back on it now, and I realized I would work an eight hour day to make $40 before taxes. I'd skip school all the time to go to work. I got done with high school. There was no expectation of college. I grew up like in a very blue collar family, they just wanted me to go work, and I went off and did that. What I know I know because of having these conversations on the podcast, I know because of paying attention to my daughter's health and wanting better for her. And then my wife, who has hypothyroidism, you know, and she's 50 years old, she's had, you know, problems along the way, paying attention i My son has hypothyroidism. I couldn't process iron for a lot of my adult life. So my ferritin levels, my iron levels, were always very low. If you grab me right now and pointed at me, at one of my family members, and said, Tell me about their health background, I would know all about it. I have, like, a very deep caregivers mentality. I hate saying this out loud, because I think some people might hear it as sounding sad, but I don't think of it that way, I genuinely care more about the people around me than I do about myself, and if I'm not doing that, I'm not happy, generally speaking. So I'm very aware of everyone else's life and their situations, where they are the medications they take when they need to be doing it. And I'm going to tell you that for the most part, some people appreciate it, and some people are like, I don't want you involved that much. And there's like, a whole spectrum of the responses you get back from people. I understand that I'm unlike most people like in that regard, that if I interviewed 100 spouses, forget men or women, and asked them about their spouses medical stuff, I generally think they wouldn't know that much about it. I don't think that's uncommon the situation you're in, but I think it's really uncommon that you stand up and try to, like, figure it out. And I think this is, that's why this is a great conversation, because you're, I mean, you lived a long time not doing a thing, and now you're trying to figure out how to do it. The

Martin 19:59
fact. Myself just a little on that in the not doing anything. Obviously, I'm around whenever there is signs of a hypo or trying to help with a Hypo. But you're right. I've not got involved with the mechanics of how that hypo came on. About, yeah, so I didn't really know the background. I don't know the background. Yeah, my

Scott Benner 20:22
wording was poor there, like not being, yeah, yeah. But what I'm saying is that I don't think that's uncommon. I think the person with diabetes probably, like, if I got your wife on here and said, How come you didn't pin Martin down earlier on this, she might say, I didn't want to, I didn't want to burden somebody. I didn't want people to see me as sick. I didn't like she probably have her own reasons why she was more private about it, and allowing you to feel like, I don't need you to be involved in this, and then that's a pass for you. Then you're like, Okay, she's got it, and that's the end of it, you know what I mean? And then you go live your life and do all the other 8 million things you had to do with the last 30 years. This is so interesting, Martin, because I've never gotten to talk to somebody about it from this perspective. But I will tell you that I think the management of type one diabetes is at its core about the timing and amount of insulin, right? So whether that's the basal insulin or the meal time insulin, if you're making a correction to a high blood sugar, that's the timing and amount. You have to time it well. You have to measure it well. You can't measure it Well, if your settings aren't good, there are pretty reasonable ways to figure out what your basal should be, what your insulin to carb ratio should be, what your correction factor is, your insulin sensitivity, meaning, like, you know, a unit moves me exactly how far you know how many carbs are covered by a unit of insulin. These numbers are super important. If your wife got onto a pump, especially an algorithm based pump that was making decisions without her settings being pretty solid, that's why the pump probably felt like it wasn't working, because control IQ is a great algorithm, and if it was crashing or low or letting her get high all the time, you have to remember that that pump only knows what she told it or what her physician told it on the day they set it up. This is how much basal you need. This is your sensitivity factor. This is your carb ratio. And then beyond that, if no one's ever taught your wife that, for example, going off and having a salad, you know will, and let's say she has a salad and there's 20 carbs in it, that's different than having 20 carbs of French fries chips, because, yeah, the absorption, right? Is completely different. And you know why that happens? No, I wouldn't like to say, oh no. It's the fat in the fries slowing down your digestion and keeping the carbs impactful for a longer amount of time. It's not, yeah, that it's so it's so much about your digestion, because if you think about the timing of it, the timing is, whatever the carbs are, they go in. They're absorbed a couple of different ways, right beginning right away with the lining of your cheeks, which is why you would, if your wife was having a low blood sugar, put gel in her cheeks, or ask her to, you know, take one of those hard glucose tablets or something like that, because your body absorbs right through your that simple sugar, right through your cheeks lining, if you have, You know, I don't know a burger. That burger doesn't really get absorbed so much through your mouth. It goes down into your stomach and your body, for the lack of a better way of talking about it, your body kind of prioritizes things, and it breaks down. So if that burger went down there with cheese and bread, the bread is going to hold your blood sugar up. The fat in the in the ground meat will slow down digestion. The fat and the cheese will slow down digestion. And the entire time that digestion process is happening, that bread is kind of leeching off those carbs and it's and her body's picking that up in her bloodstream and raising her blood sugar if she eats that same burger and cheese without the bread. Well, there's not many carbs in there, so it doesn't really matter how long, although at some point, 45 minutes later, with this burger, this pretend burger with cheese, with no with no roll, your body starts to store the protein as glucose. So as it's breaking down the protein, it stores it as glucose. So you'll get even if you ate very low carb, you'd see some sort of a bump, 45 minutes an hour later, where your blood sugar would start to go up. And that's another thing. So my point is, is that if people don't understand how food is impacting their blood sugar, then they can't figure out where to put the insulin. That all makes sense. Yep,

Martin 24:38
understood. And yeah, I have come across aspects of that before. Because definitely, for example, when she eats a pizza, it hits several hours later, right?

Scott Benner 24:47
It's exactly why. And if the pizza has protein on it, like a sausage, for example, even longer. And so even a plain pizza versus a sausage pizza would be different. Yeah. And that all is just bonkers, because most people, no one tells them that. They tell them, count your carbs, push the button, you know, inject and go live your life, right? Yeah, that is not helpful when you're trying to make big decisions, and that puts your wife or and other people like her in that situation where they're making decisions which are driven by doctors. And, you know, Doctor says, Look, do this. And you get home and it doesn't work, and you're like, Well, I did the, you know, it was almost cursed. But it's like, yeah, yeah, I'm thinking I was told to do and it's not working. And then you're over their shoulder from the other room going, Honey, what's wrong? She's and she's probably thinking, I don't know. I you know, like, instead it turns into like, leave me alone. I'm trying to get this like, and I think that's how this gets sideways. Seriously. Yeah, that that fits the situation. So, what do you want to do? Like, what is your what is your goal? Like, what kind of a sounding board Do you want to be?

Martin 25:55
Oh, that's an interesting one. There are several ways I could play it. I could try and be a know it all, but I don't think that would actually work very well within our marriage, we don't tend to work like that and get on it would be much more a listener and then, in effect, an advice giver, as in, yep, That's the right way to do it, or no, have you thought of X, Y, yeah, whatever it is. So much more the gentle background sort of person, rather than the Oh, hey, it's time for you to three units,

Scott Benner 26:35
dear. Yeah, she's, she's not looking for you to, I mean, she's been doing a long time. I wouldn't, no,

Martin 26:39
she'd been doing it a long time. She's still alive. She's doing really well. Oh, by the way, I don't know how you think of it, but I don't think of diabetes as a sickness. You mentioned that earlier, and I was just wondering if that was your phrasing, or whether that was very interesting. Yeah,

Scott Benner 26:55
I don't think of it that way, either. But what I'm saying is that I've talked to enough people who say, I don't want to feel like I'm XYZ, like whatever the phrasing is that they use, yeah, I don't want people to see me as broken. I don't want people to see me as sick. I don't want it's not necessarily what they think of themselves. It's what they're worried other people will think that's kind of how it seems to me. Okay, understood is that, you know, and listen, fair enough, I've also spoken to people who see themselves as those things, and, you know, like so a lot of it is perspective. And you know, how people see the world. What I've heard from people is either don't see me as broken, or don't see me as a problem, or they're just frustrated that this thing is interfering with their day. Forget. They don't give a shit. You think about it. They don't want to be involved in it either. You know, like it's it's difficult to remember sometimes that this person who's doing this thing and making it seem so effortless is constantly thinking about it, burdened by it, doing their own work, mental gymnastics, to not be thinking about it. And they they very much wish none of this was happening, too. And that's an experience I've had to have with my daughter, where, like, not that you forget, but she just does such a good job that you're just like, Oh my God. You know, like, it feels effortless, and it's definitely not, you know, it's just definitely not. Yeah, agreed. Did you live at all any time worrying that your kids would get type one? Did your wife ever talk about it? Yeah, that's

Martin 28:34
been a conversation, and that's obviously a risk we're still aware of luckily, that hasn't happened so far. Yeah, could still happen, but hasn't happened so far. So

Scott Benner 28:47
it's interesting, because you're a generation B, I'm 50. I turned 53 a couple days ago. Okay, it does feel like a crazy thing, you know what I mean? Like, like, you're just like, I can't believe I'm this old, but I'm happy I made it. But my point is, is that you're, you're, you're a generation beyond me. So even this thing about like, being more involved, like, it's not common, it wouldn't be common for you, right? Like, this interlapping, like, you guys are kind of learning to be new people as you're retired, I guess is my my thought,

Martin 29:20
exactly, yeah, yeah. It's one of those new phases in life.

Scott Benner 29:24
Is that frightening? Is it something you're looking forward to, like getting away from the diabetes idea?

Martin 29:29
Yes, it is definitely something to look forward to and enjoy. We have plans for travel playing with the one existing grandson. That's great fun. So yeah, we have lots of good things to do. I mean, I'll I'll be honest, I also one of the reasons I retired was I wasn't actually very well. I had to have open heart surgery back in end of November. So things are a little bit different than they were. But yeah, we're enjoying. It so far. How did you come through the surgery that took a while to get back to feeling how it was before? I wouldn't like to say my stamina is back yet. And I wouldn't like to say that my stamina was back at those pre levels, because the even last year, I was skiing quite a bit, and that that was only sort of six or eight months before the actual surgery, but looking forward to getting back to it next winter. What

Scott Benner 30:30
did they tell you, like, what led to the need? Were you? Was it diet, weight, just genetic? I'll admit,

Martin 30:37
again, it shows my sort of disinterest in medical things, but I don't really know what the cause was. It was much more. I thought I was feeling ill. Started to go to talk to some doctors about it, and they said, Oh, it's not your breathing, it's your heart. That's what's slowing you down. And it just sort of snowballed from there through to you need to have some heart surgery. You need those three of those replaced. Okay,

Scott Benner 31:05
wow. Martin, that is so of your generation. It's fantastic. It really is,

Martin 31:13
in which way is that my,

Scott Benner 31:14
I don't know, man, like, I'm so involved in my own health. Like, if I like, if I get up and I'm like, Oh, what was that? I might do something about that? And you're just like, I don't know I was going along. And then Doctor told me my heart was falling apart.

Martin 31:28
But these things happen. You deal with them. When they happen. You get over it. No Inkling prior to that my breathing wasn't doing so well. But I've asked them anyway. So I was, I was used to that

Scott Benner 31:42
your breathing wasn't, well, yeah, and you had asthma. Oh, see, so there you go. So you had asthma. So you're like, Oh, this is something I'm accustomed to

Martin 31:50
exactly. So it was the symptoms didn't really push me down that heart route at all. And it was only when I started talking to some doctors, they said, Oh, by the way, this breathing thing may not be breathing at all. It, it may be your heart, and it's got a problem. Let's do some investigation along that route. And that was

Scott Benner 32:10
the right one. Interesting. That is very interesting.

Martin 32:14
See, whereas you would have been there with the I need to find out on this. I need to work out what could be causing this is that, oh

Scott Benner 32:21
my god, I would have Martin. I'd sit down in front of chat G P T and tell it a whole story about my health, and let it tell me what it thinks and and the whole thing. Oh yeah. I'd be like, I'd be like, first of all, I gotta tell you something. I've had some of the most thoughtful conversations with chat G P T in the last couple of months. So I know that sounds ridiculous, but you sit down in front of an AI thing, I do it over my phone, and so it actually talks back to me. I will literally say to it here, watch. I'll do it for you right now. Let me see if I can load it up for you. I'm having some medical issues, and I'd like to chat with you about it. If I sat down here now and talked you through some of the things I've experienced in the past, would you help me work it out? Listen to this, Martin. It's thinking, Okay, give it a second. Oh, now it's gonna let me down. Chat. GPT, what are you doing? You're always Martin, how embarrassing is this for chat. GPT, 4.0 hold on. A second. Let me start over again and not

Martin 33:22
they. These large language language models are not my fault. Hold on a second.

Scott Benner 33:30
I'd like to talk about some medical issues I've been having. If I went over some symptoms, would you help me figure out what might be going on? Absolutely, Scott, please tell me about the symptoms you've been experiencing. I'll do my best to help. Lately, when I eat greasy food, my bowel movements aren't firm and my stomach hurts. It sounds like your body might be having trouble digesting fats. Do you think that has anything to do with my previous problems not being able to absorb iron, because previously, I've been having trouble absorbing iron. Sorry about that. I got a text in the middle that messed it up. You're right, but so I now I've put on this big show about it, and I'm like, and now I'm it seemed like, but I'm swear to you, I had a 20 minute conversation with it, a 20 minute conversation where it actually helped me think about things that I hadn't considered before. Yeah, is so it is not it isn't crazy. I know just now it didn't go as well as I was hoping. It's not like that normally. So I literally just like talked it through, and it gave me this idea, and I thought, Oh, I hadn't considered that. And it led me down a road. I went and talked to my doctor about it, and my doctor was like, Yeah, that makes sense. And so then we worked on it, really crazy, but not just that. Like, seriously, I would think about all of that, but tell me why you wouldn't. Like, what is that idea like? Just that life is what it is. And it ends when it ends, and I'm not in that much control of it. I'm

Martin 35:04
intrigued that you think you do actually have that that much control life can be planned, but only to a certain degree. There are a lot of things that that happen that are completely out of your control, that you have to react to and do the best you can your health, I thought, and would still think, actually, is one of those factors. You don't know the DNA that you're born with, and therefore you can't, at any point say, Oh, well, 2025 I know I'm going to get that in growing toenail. Now, if I start to wear the right socks, I can deal with that. That sort of thing doesn't occur to me. Doesn't make me want to do the research. When I get the ingrown toenail, I'll get the right socks.

Scott Benner 35:53
It's so simple. So all right, so I'll tell you a story. Okay, okay. There have been a number of people on the podcast just recently. And those people are lot of they have lot of diabetes, so type one, but, you know, just getting going and okay, you know, they maybe had it for four or five years. They've been using insulin. They've got auto antibodies that indicate they are definitely type one. On their way to type one, but their body's probably still making some insulin. They have a very slow onset of type one, and they're taking one of those GLP medications that are for type two diabetes or for weight loss, like ozempic or Manjaro, that stuff you hear about all the time in the news, right? Some of them are almost either completely off or completely off insulin right now, now, like that's not a thing that anyone would consider in the past. That is a new idea. So because they were paying attention to the world and what was possible. Now, I interviewed a man who's literally, at this moment, not using insulin. Now, isn't that fantastic?

Martin 36:59
I agree that's tremendous. But isn't that the I have the in growing toenail and now founding, there are sock options. I could have a blue set. I could have a red set. I could have a pink set. And he works really well. His feet work really well with the pink set. Is it not that kind of situation? Rather

Scott Benner 37:17
than, I'm not following you, I'm not finding exactly like, so, like, he's paying it, he's paying attention to cutting edge technology, and it's working for him, yep. And so if he wasn't paying attention, he'd never find out. Like, never. A doctor wouldn't tell you about this. You know what I mean? Okay, yep, you're coming from restoring. A doctor wouldn't tell you about this. Never, ever. I promise you, by the time a doctor thinks to talk about this, it's going to be, it's going to be too late. It'll be 10 years from now. You know what I'm saying? It'll be 10 years from now, and they'll be like, You know what we're finding out, we're finding out, and like, and I'm going to be the guy running around going, is that what you're finding out right now? Because Scottie knew about that 10 years ago. And like, and that's the thing that I'm interested in. Like, I'm interested in, why not just do it like, you know what I mean? Do it? Do it right now. Pay attention to it. Get out there and and just like, try something. Like, I'm not talking about, like, bio hacking exactly, which is even probably a term you're not completely at ease with, but it is that simple. Like, you know what I mean? Like, it's if you're very low in vitamin D? Well, there might be a real reason for you to take extra vitamin D, like, why not try it? Like my my friend who, right now can't get a doctor to give them medication for a high thyroid stimulating hormone value, even though they have all the symptoms of it, my argument to the doctor is like, look, this medication is fairly benign, right? If I take it for a week or two and I didn't really need it, then you know, it's not going to kill me, but if I start seeing my symptoms go away, then can't we say, Wow, this is working. And would that really hurt to try it? Would a person that I'm seeing now who has type one diabetes, who's taken this GLP medication completely off label, and they're micro dosing it, giving themselves little bits of it every day, instead of the whole thing once a week. It's impacting their insulin needs and not causing them not to be hungry like that's a thing that I guarantee you Martin that five years from now, someone will say, we've done a study, and what we've learned is, and that woman will have lived the past five years of her life happy because she figured it out now and and so that makes me wonder, like, what else could I be paying attention to to benefit myself? Like, that's why, like, I'm not just saying to you, like you should have known something was going to happen to your heart. For it happened, but by staying kind of ahead of the curve, the opportunity is there. At the very least, that makes sense. Yep, that does indeed make sense. I see where you going. I'm just still a little bit nervous about that as an approach, because we are talking healthier and

Martin 40:22
trying, as you say, something new with your health doesn't feel to me a safe way forwards. Frankly, there haven't been a study if you don't know what those longer term effects can

Scott Benner 40:35
be, I take your point, and that is definitely a way that I would think you would think about it. But here's the thing, right? How much longer do you think you got? What do you think so? So if you try something like, like, I'll let you into my life a little bit. Okay, so it's interesting, because you, you don't listen to the podcast that much, I imagine, not at all. I'm afraid. How did you end up on it? I was volunteered by your wife?

Martin 41:01
Yeah? Oh, she listens. Send us to talk to you. I

Scott Benner 41:06
sit in front of you today virtually, yep. 53 years old. I weigh this morning. I weighed 184 pounds. Oh, my God. What is that in like, what do you got pounds? Like, that's fine. You understand what I'm saying? Yeah, I'm just understanding, okay, okay, a year and a half ago, I weighed 236 pounds. That's a bit much, right? It certainly was. I am not nine feet tall, Martin, so it wasn't working on me. Yeah, now I have a fairly sedentary job. I'm not gonna lie about that, but I do not eat poorly. I as I you and I talked before I started, I don't even I don't drink caffeine, I don't smoke, I don't drink alcohol. I've never had a cup of coffee like I'm a pretty clean eater. I'd made all these changes to my life over the years. No oils. I don't eat oil. I don't do all these things. None of it would impact my weight, nothing. No matter what I did, if I really, like, really starved myself, I could maybe lose like, 10 or 12 pounds, but generally speaking, I couldn't lose weight, and I was unhealthy. At times, my body would not absorb iron. I was at the in a position where, twice a year, twice a year, I had to go to the hospital, and I had to have them infuse me with iron, because my body was like shutting off. No lie, like I my ferritin level was nine at one point should have been a minimum of 70, and I would bend over to pick something up off the floor and almost pass out like I was that from this low iron, I said to myself, there are people losing weight on this GLP medication. I'm going to try it. And I tried it, and lo and behold. Now I'm, I mean, gosh, 3646 I'm laying like almost 50 pounds lighter than I was. My life is fundamentally changed. My knees don't hurt. I'm not creaky and achy. As crazy as it sounds, even though a doctor would never have told you this was going to happen, my body now absorbs the iron by itself through my nutrition that I take in. I don't have to take supplements for it just to keep me from dying. I don't have to go to the hospital and have interventions. And no one would have told me that that medication was going to do that okay, but now the research on just this medication alone in the last couple of years is saying that it is alleviating PCOS symptoms for women that a ton of women who for their whole life haven't been able to get pregnant, are suddenly getting pregnant because of this medication. Now a doctor will tell you, Well, yeah, well, they lost weight, but it feels like it's more than that, like I've seen plenty of overweight people pregnant. Do you know what I mean? Yeah, and and then now there's a study out that says that it might impact dementia and it might and there's on and on and on, because this medication, among other things, is eliminating inflammation in people's bodies like Fascinating, right? And people with type two diabetes are taking it, and some of them are not needing insulin anymore, or they're my brother is a type two is a one c1 from the mid sevens to the fives. He didn't change anything else, except he's taking ozempic once a week. My point is, they're even talking about heart health and ozempic and weight and etc and like, you don't know. Man, we're so close to figuring things out, and you're still you're young, 62 right? Yeah. So if you look at chat, GPT, 4.0 versus 3.0 3.0 was garbage, compared to 4.0 and 5.0 is going to be insane. And five years from now, I think what you describe is kind of scary, like, how am I just going to know if this is okay without a doctor? I think that's how people are going to interact with their health. I think they're going to pull their phone out of their pocket and tell the phone. Own. Hey, this is who I am. This is my weight, this is my height. Here's my medical history. Don't forget that. Keep that in memory, and then it's going to know all about you, just like you imagine your doctor does now, but they really don't. No, you know, the doctor stops outside the door, opens up, the chart, reads it, you know what I mean, like, uh, like, and meanwhile, you're in there with this, this warm feeling like of the last time you met, and the guy really likes me. He's a good guy. He knows that. He don't know anything about you, but that algorithm will. And then you can wake up one day and say, Hey, algorithm who remembers everything about my medical history that I've ever told it I woke up this morning, and on my lower right quadrant, I have a pain that feels like this, blah blah blah, and it might say, oh, Scott, you are having blah blah blah. That's where this is going. Now, there'll be a person on the other end to make sure, but I think that's what's going to happen. I think it's going to happen with diabetes and with health in general. That's my thought. And I think you could pay attention to that stuff and help yourself in little ways that would build up and be bigger ways eventually, it's an interesting future. What do you think, though, at your at your age, what do you think of all that? What

Martin 46:09
of all the the large language model stuff? Yeah, yeah. Oh, that's a absolute longer conversation at this point. Well, I can, I can summarize into it's a superb way of using the currently collected information that is available on the internet. However, I don't trust all of the information, or quite a lot of the information that's on the internet, and therefore, I'm not particularly trusting of those large language models. I

Scott Benner 46:42
don't disagree with you. You know, the question becomes like, how? How does it know what it should be paying attention to and what it shouldn't be? But when we're exactly, but when we're just talking about Martin, and it only knows about Martin, what we told it about Martin. Now you have a large language model for your health, and you're not going to and even if, even if you end up telling it something that's specious, something that you like, you know, was a ghost for you. You thought it was one thing, but it was actually another thing. Over time, you'll be able to weed that out and go back in and tell it, hey, you remember, like six weeks ago when I told you, I thought this was what was going on with me. I don't think that's what was happening. And just like that, it

Martin 47:20
won't think about that anymore, personalized, focused items, it could be very effective.

Scott Benner 47:24
I would agree. Yeah, it's going to do all the things that human beings can't do, keep, like, competing ideas in their head, but don't judge them based on bias. It's going to be able to remember things you told it six months ago about, like, you know, I got up in the morning and my toe really hurt. Just really, really hurt. Then it stopped hurting. But it'll remember six months later that your toe hurt six months ago, there in is where, like, you know, it might be able to put block, like puzzle pieces together and say, Oh, had you considered this? You know, if you said I was out of breath today, and it was after I went for a walk. And then you forget about that six weeks later, but it happens to you again. It would say, Hey, weren't you out of breath six weeks ago? I wonder if we shouldn't go to a cardiologist or maybe visit your pulmonologist, who would have then said, Oh, it doesn't look like it's this. Let's take a look at your heart, like that kind of stuff. Man, I'm super excited about that kind of stuff. You know, it's a good it's a good future, yeah, and imagine your wife even, like, as you guys get older, like, because this is the thing we don't talk about. Like, type one diabetes is just going to keep happening, like, for her, and she does if she does a, you know, a good job, and keeps her her stuff where it belongs to live a long, happy life and etc, but one day, it'll be harder to push the buttons, or it'll be harder to inject the medication or to do the math or that kind of stuff. But just imagine if you could, you know, say, you know, Alexa, can you tell me I'm about to eat a ham sandwich. I think you know about how many carbs you think are in this ham sandwich, and then it comes back and tells you, I think it's 23 carbs. And you go, great. I don't remember, but what does that mean for me? How much insulin do I need right now? And have it come back and say, Oh, that's two units for you. That might be very comforting as people get older, you know, agreed, hey, it might get you out of having to understand all this diabetes stuff. Martin, don't think that was gonna happen. No, no, no. So your wife sent you on here to learn something, to get schooled. What do you think her her onus was?

Martin 49:36
Oh, to talk about my experiences with her type one diabetes, to hear your opinion on that, because there are some parallels to our situations. You learned about diabetes because of your daughter, yep, but you're definitely getting it all secondhand. And frankly, would that persuade me that I should. Be more involved or not. What do you think? Do you think you should be? I did, actually, when you said expert series from Episode 1000 on, I did write that down. Good. I do need to start listening to you. Scott. Good, well,

Scott Benner 50:15
I'm glad, honestly, it that series is myself and Jenny Smith. Jenny is a nutritionist. She's a CDE, a certified diabetes educator, and she's had diabetes for over 35 years now. And I'll tell you what, what had happened. So I'll tell you what you're gonna get. Some background on me is that my daughter was diagnosed when she was two, but today she is 20. Actually, she's gonna be 20 in a couple of days. Couple of days. She's had an A, 1c between five, two and six, four for probably the better part of the last 10 years. And a long time ago, gosh, a very long time ago, after she was diagnosed, she was diagnosed in 22,006 and in 2007 about almost the exact year later, I started writing a blog about being the parent of a child with type one, and I was as lost as everybody else and her a 1c was, you know, in the mid eights, and I didn't know what I was doing, and just, you know, I was following what the doctor was saying, and it wasn't going well. But over time, I realized, like, if this is on me, like, if I don't figure this out, she's not going to live as good a life as she could have. And so I start, you know, putting pieces together and figuring things out. And one day I said to my wife, like, one day after I got her a 1c down into the fives, I was like, I said to my wife, I was like, I have a system. And she's like, What are you talking about? I'm like, it's not obvious. I don't call the steps that I take a thing. It's not written down like bullet points, but I know there are things, and if I do these things, Arden's a 1c. Is lower and stable. Her blood sugars are lower and stable. There's a system in here somewhere, and I started writing about it on the on the blog. But then one day, I launched this podcast, 2015 in January. I was making it for a while, couple 100 episodes, and people would get back to me all the time and say, I listened to the podcast, and my a 1c, goes down. I don't even know why. They'd say, like, I don't know. I'm just listening. I guess I'm doing the things I'm hearing you saying, because I don't like, most of my conversations are, like, the one I had with you, right? Like, it's not a lot of like, do this, then this and this, it's more big ideas. You pick out of the ideas and figure out for yourself. I would tell people all the time, listen, if you want your a 1c to go down, if you want your blood sugars to be more stable, just listen to the podcast. It'll happen. And people would have that experience. But then one day, I was like, God, there's 200 episodes. Like, How long am I? Like, how much should I expect these people to listen to, you know? And so I went to this girl, Jenny, who I know is now a very good friend of mine, and I said, I love the way you talk about diabetes. You have a more medical background, plus you have type one. I think I have a system. Would you sit down with me and talk about it one episode for one idea? And she was like, I'd love to so we did that. And then we could say to people, go listen to the Pro Tip series, if you don't have time to listen to the whole podcast. And then people would come back and say, I listen to the Pro Tip series. And a month later, my a 1c was down to six. Or I get notes all the time. My ANC went from eight and a half to six. It went from 12 to seven, and then it went to six and five and and, you know, all I did was listen to this. That's all you really need for your desire. You can keep listening if you want to. Yeah, you can go back and hear stories of God. I have after dark series where people will tell you anything from about their eating disorders to being bipolar and having type one. One girl came on here and told me she was diagnosed with type one on a heroin Benner, like, literally out on the town, scouring the town for heroin. She diagnosed with type one during that. And when you hear people's stories, you will pick things out of them. You'll hear little bits, and you'll think that's important, I should remember that. Or, my gosh, I didn't realize. Or you start to have, like, a community feeling, where you recognize you're not completely alone, and then other people have other ideas that are maybe even more valuable than the ones you have about an idea, and you can adapt and borrow from me and borrow from them until you have a, you know, a plan and a family that that kind of keeps you more shielded and protected. And that's that's how the podcast ends up working for people. No, that's really good, you know. And I'm not 62 but I'm 53 and I gotta tell you, this wasn't in my wheelhouse when I started doing this, and I was surprised by a lot of what happened. I really thought I know how to use insulin. I'll jump up on this microphone and tell people how I do it, and then hopefully they can get some success right. But instead, I learned about community, which is not a thing I really understood back then. I knew it was nice to know you weren't alone, but I didn't realize how important it was, and then to see that everyone basically has the. Same set of problems. You know what I mean? Like, basically has the other set of problems, and nevertheless, like, your story impacts my story impacts someone else's, and it makes your burden lighter as you go. And so it's not just about the nuts and bolts of diabetes and how you could have felt better, etc. It's really about a lot more than that. I hope you find some value in it, and that it's helpful, and that, you know, you and your wife can, uh, you'll have something else to talk about, and it'll be about me and my conversations I had with somebody the other day, that'd be crazy. That'd be that'd be insane, even literally, where are you at right now? You're in what I don't want you to tell me, like, what street you're on, but where do you live?

Martin 55:44
I live in Guildford, which is about 30 odd miles outside London, 3045,

Scott Benner 55:49
and I'm in New Jersey. Isn't that crazy? That's great, and I don't have diabetes, and your wife is finding value in a thing I'm saying in a spare bedroom in my house into a microphone. Yep, like the world's crazy. Now, I tell people all the time they have a private Facebook group I think has like 52,000 people in it now, and by the time somebody hears your conversation with me, it'll have 1000s more in it. And this podcast, which has now reached I'm getting close to 18 million downloads in the time that it's been recording and available for people in over 40 countries, the podcast charts like, well, like people listen to it in mass in 40 different countries. It's all because of the cell phone, because without the cell phone, people couldn't get podcasts. And people used to talk into microphones, and they'd sit down at browsers and try to listen through the internet. But it's not, really not, not a great way to take in audio, right, like until you could have it portable and with you and in your ears. It really blossomed at that point. So somehow, a guy in New Jersey who doesn't have diabetes is helping a lady in London who's had diabetes for 30 years because of cell phone technology in part. And I think it's going to keep happening like I think that as AI doubles on itself, and as technology gets faster and better, you're going to be able to get information to people in different ways. For example, I um allowed a company called Vision AI to absorb, absorb my podcast. So they took the transcripts from my podcast and absorbed it into their large language model for people with type one diabetes, and when you not only does it attach itself to your CGM data like I have it set up with my daughter's data. So if I go into this large language model right now and just say, what's my blood sugar, even though this thing is not attached at all, you know, to anything my daughter is wearing, it comes back and says, Your latest recorded glucose levels, 129 the trend is stable, and if I just asked it, what should I Bolus to get to 99 when it answers, it'll explain the whole thing to you, but it'll also break it down. Tells me what my insulin sensitivity is. It shows me the formulas and everything else. But then it just clearly says, you know, here's how much you should Bolus to do. That gives you like, you know, that kind of stuff. It also says tip from the Juicebox Podcast. And one of the Juicebox Podcast episodes, Scott mentions the importance of monitoring trends and making adjustments based on real time data. And Jennifer suggests using cautious approaches, starting with smaller adjustments and observing glucose responses for future fine tuning, and then it gives you follow up questions that would be smart to ask and that kind of stuff like, and that's just going to get better and better. You know, I don't know, man, like, I'm so interested in how to help people. I think all of this has something. It all has a place in it somewhere, because I've put so much information into this podcast that that idea of like, just go listen to it, you'll understand one day might be just go ask the prompt. It'll know, yeah, you know, super exciting. Anyway, I spoke way too much today. I apologize.

Martin 59:20
You're okay. No, no, no, no problem. Really

Scott Benner 59:22
good. When you leave today, what do you think you'll go tell your wife? We had a

Martin 59:27
good conversation. I thoroughly enjoyed the conversation with you that you are definitely passionate about the large language models and that that is a future approach, and the one thing that I will be doing is listening to some of your expert expert podcasts, which were 1000 on, I believe the episode number was,

Scott Benner 59:50
it's called the diabetes Pro Tip series. And okay, and that would be, and that's going to be dug down, but I'll tell you what to Martin, there's an app. There's a series called Bold beginning. Things that's for newly diagnosed people. So if you think I'd like a little more elementary lead into it, go bold beginnings first, and then go to pro tips. Okay? And there's also a series called defining diabetes that takes everyday terms around diabetes, in case people are, you know, throwing terms around and you're like, I don't know what that means. Those will help you understand Bolus basal, all the way up to things like feet on the floor, things you've never heard of before. But believe it or not, when people get up in the morning, when the world hits them that adrenaline, sometimes their blood

Martin 1:00:34
sugar goes up. Yeah, agreed. Now that one, that one on you, yeah. And

Scott Benner 1:00:38
so there's all kinds of different terminologies that I think get thrown around that stop people from understanding their diabetes well and all the rest, man, like there's a world of information. There's 10 years worth of conversations in there. I hope some of them help you and and your wife. And I really impressed with you guys, because I know some people who've retired and they don't talk to each other anymore, and so I am super impressed that you guys are so excited to to know each other like this. Yeah, new face, yeah, good for you. You excited to it? You excited about it? Yeah, yeah, yeah. How often you get to see your grandkids?

Martin 1:01:19
At least once a week. We look after him for a whole day once a week. Oh, that's really cool.

Scott Benner 1:01:25
That's lovely. Good for you. I bet you wait. I bet you wait for it every for the other six days, you're just waiting for him to come back, right? Oh, yeah, chatting about him. Don't you worry. That's wonderful. All right, man, it's really nice to talk to you. I appreciate it. Cracking to talk to you. Scott, yep. Hold on one second for me,

I'd like to thank touched by type one for sponsoring this episode of The Juicebox Podcast. And I have to remind you again about this steps to a cure kickoff event that's happening this weekend, january 18. Man, if you're in the Orlando area, I'm talking about a big day for you. Join touch by type one for a light breakfast at their walk. Kick off. You come meet fellow participants, learn more about the walk. You get excited, but then you're enjoying a complimentary day at the Orlando Science Center. I'm telling you, you're not going to get a better deal anywhere anyhow. Touched by type one.org Go to the Programs tab, head over there now. Man, you're lucky to be in Orlando. Are

you starting to see patterns, but you can't quite make sense of them. You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, you're starting to think this isn't going the way the doctor said it would. I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group. Just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 if you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Hey, what's up? Everybody? If you've noticed that the podcast sounds better and you're thinking like, how does that happen? What you're hearing is Rob at wrong way, recording doing his magic to these files. So if you want him to do his magic to you, wrong way. Recording.com, you got a podcast. You want somebody to edit it. You want rob you?

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Scott Benner 0:00
Whether it's shots, pens or an infusion, needles are part of life with diabetes, but what if just the thought of them makes your heart race today, Erica Forsyth and I are going to talk about the fear that's more common than you think, needle phobia. You

if you'd like to reach out to Erica, she's available at Erica. Forsyth.com nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. Don't forget, if you're a US resident who has type one or is the caregiver of someone with type one, visit T 1d exchange.org/juicebox right now and complete that survey. It will take you 10 minutes to complete the survey, and that effort alone will help to move type one diabetes research forward. It will cost you nothing to help when you place your first order for ag one, with my link, you'll get five free travel packs and a free year supply of vitamin D drink. Ag one.com/juice, box, the diabetes variable series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about travel and exercise dehydration and even trampolines. Juicebox podcast.com go up in the menu and click on diabetes variables.

This episode of The Juicebox Podcast is sponsored by cozy Earth. Use the offer code juice box at checkout at cozy earth.com and you will save 40% off of your entire order. Today's podcast is sponsored by us med. Usmed.com/juice box. You can get your diabetes supplies from the same place that we do, and I'm talking about Dexcom, libre, Omnipod, tandem and so much more us, med.com/juice box, or call 888-721-1514, Erica, welcome back. It's good to see you.

Erika Forsyth, MFT, LMFT 2:17
Thank you. It's good to see you too. We

Scott Benner 2:21
just finished up our our short series on caregiver burnout, and we're jumping right into another, another sizzling topic, needle anxiety and needle phobia. You were nice enough to pull together some some notes and thoughts. I've been doing the same. I've also put up a post in the private Facebook group. It's been up now for about a month. It got back about 50 comments, people sharing their needle phobias and stories and some things that helped them. So we're going to weave that into this conversation. But overall, I think that people with diabetes can get, I can't believe I'm going to say marginalized, but I think they can get marginalized around this because people just say, Oh, you have diabetes. You must be fine with needles. That's it, as if having a needle phobia goes away if you have type one or type two, which is just kind of silly, but definitely what I've seen in the world with Arden over and over again, dentists, blood draws anywhere where you intersect a needle. People just assume, like, Oh, you must be like, totally cool with this, because you have diabetes. But I don't think that's the case, absolutely.

Erika Forsyth, MFT, LMFT 3:25
And I think one of the interesting research facts that I learned is that it's really common to have a needle a fear of needles, needle anxiety, or actual needle phobia, which the technical term I also learned is trypanophobia, okay, which is the intense fear or aversion to needles injections or medical procedures involving needles. And if you have kind of the diagnosed trypanophobia That is a specific phobia, meaning it's you have this irrational and overwhelming fear that goes beyond the normal discomfort most people feel about needles, but from this research, this is 25% of adults, 50% of teens and 63% of kids are freaked out by needles, And that's from the make Foundation website, which I'll reference throughout our conversation, which is a great practical tool, but I just think, Wow, that's a lot of us out there in the world, whether you're living with with diabetes or not, that most of us, when we go and get our blood drawn, aren't like, feeling great about

Scott Benner 4:37
it. People aren't just like, oh, this is gonna be awesome, right, right? And why would you I don't have a phobia. Like I have a procedure, I realize, like, if I get a blood draw, I've learned to breathe in during the needle being inserted. That was my thing. Like, you inhale as that's happening, and something, it lightens the pain. But in the end, you're at the you're at the mercy how good you're full of. Omnis is a lot of times too. You know, that's

Erika Forsyth, MFT, LMFT 5:02
so interesting. I do the opposite, Scott i I've learned to breathe in, and then as soon as I feel the needle going in, I breathe it out. Oh, okay, right in that moment. Anyway, whatever works Right, exactly, right.

Scott Benner 5:16
And it just, it's tough, because I was getting blood draws a lot for a stretch, back around my low iron problem, which I thankfully don't have to do anymore, but I was found myself there a lot, and you really do learn it is a crapshoot. The person who's helping you is either sometimes magical at it, yes, or it just feels like they're just like, just hoping the blood comes out, you know. So I can see that being a problem. But anyway, this is a much larger issue than you would think, and I learned that reaching out through the Facebook group, but also to be candid, and I'm not going to share over share, but Arden has a pretty significant phobia, and I'm confident calling it a phobia, based on her reactions to to injections. So anyway, where do you want to start? Yes,

Erika Forsyth, MFT, LMFT 6:01
so I think just having an understanding that it is really common, and there's nothing wrong if you have a needle, a fear of needles. And I also think it's important to note that while we're going to be speaking about this for the person getting injected, whether we're talking about IVs for a procedure or blood draws or site changes or injections or insulin. I also want to just note that parents who are having to inject or chase their child around or hold them down, you can also have a real traumatic experience as you're trying to save your child, right, keep them alive, but in so doing, you are feeling like you're instilling this traumatic experience on them. And so we want to walk through some of these experiences and tools, but just that that is so painful and so hard emotionally for you as the parents. So I just want to address that, and what we will speak to that as we work through these topics? Yeah,

Scott Benner 7:01
that's awesome. I concur. I've have had the experience. So I know it's I know what it's like. Can I read this thing that you have here from the MEG foundation? Yes, pain is a biological, psychological and social experience. On the biological side, the body's way of telling us something is wrong to check it out. A nervous system sends messages to your brain. Our physical state impacts how painful something can be, like hunger, sick or tired. So, yes, okay, and then psychological here it says, pain may be worse depending on our mood. I didn't know that. And socially, how we react or view others around us impacts how we experience the pain. Wait, what does that mean?

Erika Forsyth, MFT, LMFT 7:42
Yes, so, okay, so, for example, I think as we talk about pain from this framework that it's a biological, psychological and social experience with the social part when your child is running down the street and they trip and fall and they skin their knee, and they look at you as the parent, and if you are, we've talked about this even in the parenting series, overreacting and oh my goodness, do we need to go run home and like, over, over, over, dramatize the situation that child is then learning, oh my gosh. This is really scary. I really hurt myself. This pain is really bad. And I certainly we're not encouraging you to like, to be like, you're fine. Get up, you're fine. You know, it's finding that sweet spot of enough validation without over dramatizing the moment. Okay,

Scott Benner 8:30
that makes sense, and I've tried that while Arden is upset about an actual injection, and truth be told, like they doesn't get us to the finish line, but it does, I don't know. I mean, the reason I brought this up to do is because, after having this experience with Arden for so long, and then I was like, let me reach out and see how other people are feeling about this, and then getting so much feedback back from people, I thought like, I mean, I know you have to do it to stay alive, but the minute that it doesn't become to stay alive, Arden will do anything to avoid it. She becomes the bad guy in a bad movie when he's caught. Like, you know what I mean? She would do or say anything to avoid the injection, like it and she doesn't. She knows it's not making sense while she's doing it, it doesn't matter. Like, it's irrational, oh, she's begging for her life in that moment. Is how it feels really. It's really sad, but interesting too. Yes,

Erika Forsyth, MFT, LMFT 9:22
it's so intense. And when we're gonna talk through that, that fear that feels so consuming, but yet you can, you can have an out of body moment and say, Gosh, I know this is I know I'm gonna be okay. I know it's gonna hurt for a second, and then I'm it's gonna be over. But in that space of anticipation and fear can become so overwhelming and paralyzing. Yeah,

Scott Benner 9:47
and it doesn't seem to make any sense, because the second it's over, like laughter will come sometimes just like, from abject fear to like, just, I can't believe I was that upset. She will tell me that part. Of the consternation in the process is that she understands how ridiculous it is that she's scared and she's almost scared and mad at or embarrassed with herself at the same time. Yeah, yes,

Erika Forsyth, MFT, LMFT 10:15
there's, there can be so much shame attached to this experience, and I think it's important to understand as we talk about the pain, it's not just about the needle or the pinch or the site change pain, right? So, and I think also the physical state impacts how painful something can be in the biological realm. So if you are hungry, tired, sick, you're going to experience your brain is going to send in the nervous system that message like this hurts way more now because I'm sick and tired or hungry, that if you are not those things, just something to remember. Do you want to

Scott Benner 10:54
go through the causes of needle phobia? Yes, yes. So

Erika Forsyth, MFT, LMFT 10:57
and what we ultimately want to get to is when you are stressed, it's going to feel more painful. When you don't have any support or validation, it's going to feel more painful. And again, I'm talking about psychologically and physically. And so we want to get to a place of having more coping skills, and you will feel more in control of the situation, so that the causes could be a variety of things post traumatic experiences. For example, you might have a painful or negative medical experience from a procedure and and someone referenced this actually in the Facebook group where they had a procedure and they couldn't find their vein with the IV and they were poked 32 times. Yeah,

Scott Benner 11:42
that'll stick with you. Yeah, that's a real

Erika Forsyth, MFT, LMFT 11:44
trauma. Yeah, you are then probably going to have to work through that experience every time you go in for, you know, any needle blood draw or IV learned behavior, observing someone else's fear of needles, or hearing stories about expat bad experiences. So even now as you're listening to this, just be mindful if this is becoming overwhelming for you, as we talk about needles or hear us reference various stories and you already are in that space, maybe pause. Take some deep breaths. Come back to this episode. You might just have a biological predisposition. You might just have a genetic tendency to develop intense fears, and it's being played out with the needles. Interesting, the basal vagal response, and some people also reference this experience in the Facebook group, that even the site or anticipation of the needle causes a drop in blood pressure and heart rate, which is then going to lead you to faint and possibly vomit. And then when you have those experiences connecting to needles, that's going to reinforce, oh my gosh, this is a really scary thing. I don't want to I'm going to avoid at all possible in engagement with the needle. Yeah, so those are some possible causes of needle fear or needle phobia.

Scott Benner 13:02
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Erika Forsyth, MFT, LMFT 17:33
It's makes so much sense, right? It's so connected to all the different systems

Scott Benner 17:37
go through the symptoms of what happens when it when it strikes you, okay,

Erika Forsyth, MFT, LMFT 17:41
and so these and these symptoms can be, as you said, you know, for days in advance, she's thinking about that injection. So this could be occurring for you or your child, seconds, minutes. You know, we site change every three days, 10 days, right? That you anticipate the physical symptoms could be increased, heart rate, sweating, nausea, dizziness or fainting. Someone in the Facebook group said it feels like a low, like you're having a low blood sugar episode. The emotional symptoms could be intense, fear, panic, feeling of dread at the site, or even the thought of the needles, and then behavioral, you know, avoid avoidance of the medical procedures, maybe skipping vaccinations, refusing blood tests, despite knowing that perhaps it's going to help you in the long run, or for your health. And it's important, you will avoid being, you know, interaction with the needle. And then what happens as a result? Right? If you do have needle phobia, you might delay the treatment or the or the blood test, or even, you know, a surgery, possibly some people shared very vulnerably about that experience of wanting to avoid the needles that were so it was so scary that you you risked other components of your of your health?

Scott Benner 19:02
Yeah, they're gonna let other aspects of their health fall apart to avoid this needle thing, yes, yeah, it's very real. Yeah. I didn't realize how big of a deal it was people when Dexcom, I don't know what people are gonna remember, they used to have that inserter that was kind of like the clear tube, almost, it sat on an angle, and you had to plunge it yourself, and you could kind of see it all happening. And when, when they went to a self inserter, like, is on this the g7 a lot of people like, well, that's way better, because you can't see the needle. It's such a big deal for me, they would say not to be able to see the needle first. Yes, I guess it's just another one of those things. If you don't go through it. It's not going to make a ton of sense to you know what I mean, like, just, unless it's the way it hits you, you just pick out just it hurts for a second, or it pinches. Or sometimes you hear people say, sometimes doesn't hurt at all, depends on where it goes in. Or sometimes it's things. I take an injection once a week, and I mean, I'm like, like, I the other day I realized I didn't do it. I. I was sitting on my desk, I was getting ready to go out, and I went, Oh, I should have done that. And I just yanked my shirt up and went, click, boom. And I and I just left. I didn't think twice about it. And then later I looked back on it, I thought, Oh, gosh. Like, you know, Arden's like, oh, let's do it. And then the needle comes out, and then it's like, this, slowly I turn thing, and then she's just going in a different direction. Anyway, I just, I want to say, like, if people are having these kinds of reactions, I know, like some of you are like, you know, some some people are using needles to dose insulin, like a lot of them are. But if you're having this reaction, it's, it's tough call, because you got to do it. You can't not do it right and but at the same time, I don't think, I don't think that ignoring it or just acting like, Oh, come on, it's not that big of a deal. I don't know it's tough because I also, I also take your point about like, not making a big deal out of it. Like, like, you know what I mean? Like, you don't want to start like, because somebody's like, I don't want to do that. Of course, they don't want to be like, no one wants to do that. But if you just go, Okay, well, you don't have to, like, are you setting a precedence where it's not that, you know, oh, we'll skip this correction. Your blood sugar is only 180 we'll just let it sit like this for a few more hours because you don't want to do this. I'm sorry. It's just, it's just another thing. We talk you and I talk about that. I'm just like, seeing both sides of it, and neither side feels exciting. But I'm sorry. Go ahead. Go Yes,

Erika Forsyth, MFT, LMFT 21:17
No, you're good. I think just the validation of like this is really complicated, and definitely in seasons of your life, living with with diabetes or with your child, it might feel like it's never going to get better. You're never going to get over it, right? And if you have a needle phobia, it's not necessarily. We're not saying hey, we're going to give you the steps to get over it. We are here hoping to to validate your experience, but then also to provide some tools to help you manage your emotions, your physical pain, through it. Shall we move into some some tools and coping? Yeah, yeah, please. That'd be awesome. Okay, okay, I know I've heard and seen a lot of people use the buzzy bee product, and on their website, they actually had a really great thing that I loved, of making kind of addressing pain and the needle moment in a three prong way. One is to make a plan to address the anticipation or fear, and we're going to talk about that. And then two, manage, have a plan to manage the actual pain during the injection. And then three, have something to focus on during the injection. So I'm saying injection for all the all needle examples that we've mentioned. Yeah, one of the things, the reason why we want to focus on that it's a psychological experience, because what we are telling ourselves beforehand is so important, and obviously one of one of the treatments that if you are in a really needle phobia would be cognitive behavioral therapy, in addition to all the things we're also going to mention, but that would be really important to address. Do you have post traumatic experiences from needles. And then how can we work through that trauma, by also understanding how your thoughts and feelings are affecting your behaviors? That would be kind of on the more, perhaps not necessarily extreme, but more intense or severe, needle phobia, as well as exposure therapy. I was just thinking about, you know, the picture that you posted with when you asked for,

Scott Benner 23:21
oh yeah, that's threw people off, even then someone

Erika Forsyth, MFT, LMFT 23:25
said, Oh my gosh. That makes me scared. And, I mean, it was an intense picture, but it did grab people's attention. And, you know, exposure therapy would be beneficial, like, if you had a visceral response experience or response to seeing that picture, that could be a cue to say, you know, maybe, maybe exposure therapy could be helpful for you to, not to. Basically, you learn the coping skills as you are exposed to that trigger. Yeah, so perhaps you're talking about needles, and then you're working through the coping skills, and then you're envisioning it, and then you see a picture of the needle. Then maybe you're holding the needle and then you're giving yourself the shot. Those are kind of the therapeutic approaches. So the rest of the things we're going to talk through are things that a lot of you already probably do, but we wanted to kind of leave them all here in one, one space, a lot of these things you guys referenced in the Facebook group, and things that I do myself, and then Scott does so just not looking when it's happening. I know that seems really simple, but what you want to do is give your child or yourself that option, all of these things. We want to give yourself and your child the control, and one of the things from the MEG foundation for pain.org, website, they have great you can have an app, have kind of a whole little plan, a printout. So as we go through all these things, you get to engage with your child or yourself. What is helpful for me? What? So we're making a plan. Mm, hmm. To reduce the fear. So do you want to look or not look when it's happening? And you have this discussion, but way before, and a lot of you probably already do this, right? Do you want to hold this stuffy or that stuffy? Do you want to do it in 10 minutes or 20 minutes? Do you the shop. These are more kind of the actual tangible things, the shot blockers, which I've seen some pictures of. I've never used them myself, but apparently they are really effective. And they have, like, the little raised, yeah,

Scott Benner 25:33
they kind of seen them. They kind of conf you. It's like a plastic thing you pinch with a little bit, I guess it's got little, like, pokey plastic things that kind of confuse your your nerve endings, right?

Erika Forsyth, MFT, LMFT 25:42
Yes, yeah, yeah, blunt skin contact points is what they call them, okay? And so you push it down. I don't know, I so I apparently though they're really effective. The buzzy bee is the vibration. It has vibration with a cold pack. I know a lot of people use that the numbing cream, specifically Alma cream is been referenced a lot. I port from Medtronic, yes, as helpful for people for injections. Dia Spider was a new product that I discovered upon researching for this chat. Apparently, I think it's for insulin pens, and it kind of looks like it combines elements of the shot blocker, yeah, basically I'm like, the shot blocker, and just a total distraction, have you? Are you looking at?

Scott Benner 26:33
Looking at a picture of it now, yeah, oh, I see. So it goes around an insulin pen to kind of like, give you the the shot blocker, feeling like something touching and giving you that that confusion, plus it makes it look a little more, little less like an insulin pen might be good for kids like visually as well, yes,

Erika Forsyth, MFT, LMFT 26:51
and also has you know, you choose your color again, this is really To instill control and coping and choice reduces that anticipation and fear, and then hopefully also simultaneously reduces that pain in the moment. Well, apparently, being hydrated or not is really important for pain of the actual injection. Plus, if

Scott Benner 27:17
you're doing a blood draw, so that your yes, the blood volumes up and your veins are easier to get to. That that can also be really helpful. Yes, I read about that too. Even just the having someone drink 16 ounces of water before the injection, it almost like takes their mind off of it, because you're, like, trying to get down 16 ounces of water. Like, yeah, right, it just sort of, it takes your attention away a little bit. That's what I never thought of. What else you got on this list? That's so

Erika Forsyth, MFT, LMFT 27:42
that's so good, because what you have, you have a goal, and you're focused on that drinking, and it has a kind of a two prong positive outcome, play, have a calm music playlist. These are a lot of things that people mentioned in the Facebook group, laying down, or laying down with your knees up, having peppermints in your mouth ice pack on the back of your neck. You know, we talked, we already talked about, you know, inhaling or exhaling, breathing is really important. Oftentimes, we hold our breath when we're scared. One story that the founder of Meg foundation, I wrote her name down here. I'm just looking

Scott Benner 28:18
here. By the way, cool flavor a room of peppermint can redirect attention from the needle to the sensation in the mouth. Gives the brain something else to focus on, helping reduce the intensity of anxious thoughts. No kidding, I love Yes. Could also be grounding. Sucking on the mint can be grounding. Peppermint has calming effects to some people. Anxiety causes dry mouth. The peppermint can stimulate saliva production, making the person feel more physically comfortable. How about that? And because when you said that, when I was like, what peppermint? I'm sorry, I got you off.

Erika Forsyth, MFT, LMFT 28:52
No, that's good. No, peppermint is well, also peppermint is good with, like, nausea too. You might have already just said that.

Scott Benner 28:58
Oh, listen, I went to school in the 80s. If you went to the nurse and you didn't feel well, they gave you a peppermint water to drink and then sent your ass right back to class you don't feel good, drink this now. Get out of here. That was childcare in the 80s. Yes,

Erika Forsyth, MFT, LMFT 29:13
peppermint cure it all. So, so Dr Jody Thomas is the one who created the make Foundation, and she shared this story as she was in training about breathing. And I just thought it was so great. I wanted to share it here, also with and some of these coping skills will work for you or your child for a couple months, and then, just like anything else, you might need to switch, but the breathing, she asked the child, and you can do this for yourself as you're about to get the blood draw, envisioning a color that feels calming or comforting, and then think of a color that is like painful and uncomfortable. And so the child said green, so they and black, green for comfort and black for pain. And then so she, you know, had her close her eyes and invited her to think about inhaling the green and images of green and then exhaling black, the color and feelings around it. And so I just thought that I liked that we've talked about different breathing techniques, but I liked that one to share here. It is

Scott Benner 30:17
important too, because I think when people tense up, they do stop breathing right away, which, you know, a bunch of physiological reasons not to do that. But this is, it's a nice idea. Like, take the good stuff in, let the bad stuff out. Be visual about that. Like, in the end, I'm going to tell you something. I've tried a lot of this stuff with Arden, and usually what she says is, and we'll probably have to bleep this out, Q, that's not going to help, right? But in fairness, I didn't have a lot of luck getting her to do the things. And so I did say, I'm like, I do think we should do some breathing stuff. I do think you should look away for she's like, I have to see it. I'm like, Why are you torturing yourself like she stares at it while it's happening. One time she said, I just want you to just do it, but I'm gonna defend it if it happens. So somebody's gonna have to hold my hands. My son came into the room and literally, like, held her wrists out in front of her while I did the injection. It was horrible, honestly, for all three off, all of us, all three of us, had a different, horrible experience. But as I and it's a self injector, Erica, it's like, click and over. Like, it's that fast, right? And while it's happening, I hear, like, in kind of an amused tone for my son, She's biting me. Then it ended, she cracks up laughing, and she's like, I'm so sorry. I didn't mean I thought I was biting my own hand. I couldn't even tell it wasn't me. Like, she was just looking for some like, I don't know, release, release, yeah, yeah, something. And I'm telling you that all of this took, I mean, it took like, 10 seconds, and it felt like, it felt like we were fighting a war. When it was over, everybody was just like, we did it. But five minutes later it was, it was just like it had never happened, like she and I went out to do the next thing we were going to do, and was just over. It was I looked at her for an hour after that, being fascinated at where we were an hour previously, you know, just really something anxiety and and that adrenaline and the fear mixed together. It's just, it's bad stuff, you know,

Erika Forsyth, MFT, LMFT 32:18
yes, well, but I love that she like part of, you know, if you wanted to use the plan maker resource, it's beforehand going through like because, you know, she likes to look at it. And now you know, like physical touch. You know your body, your brain, can only focus on so many points of physical touch. And so you know, as little as often times with parents, you might hold your child on their lap as they get their, you know, immunizations or their injections, holding asking like, do you want? Do you want me to hold your wrist? Do you want me to give you a tight hug? You know, research shows that, you know, laying your child down on their back and holding their arms down is actually pretty negative, yeah, in terms of their medical trauma? Yeah, they will probably have some medical trauma around that, because it's you're so vulnerable and pinned down. But I also know we have sometimes you have to hold your child to make it happen. So just if you can holding them on your lap, Wrapping Arms Around like you're giving them a big hug, but they're sitting up. I wish

Scott Benner 33:17
that this would have been talked about when Arden was younger, because she was like a chaser around the house kid, you know. And I do wonder how much of what's happening to her now is from back then, because all I knew to do was, like, grab her and do it. You know what I mean? Like, it's, I mean, Erica, it's, you know, you were injecting insulin. It was happening a number of times a day. And yes, you know, sometimes she was cool with it, sometimes she wasn't. But I do wonder how much of the process that we went through led to where we are now, and I'll never know. I I'll tell you that before she went off to college, Arden hasn't had a correction with a pen ever. Arden's never used an insulin pen once. So she went right from syringes to pump to Omnipod. Yeah, me too, yeah. And you've never used the endocrine and so she stopped injecting when she was four. That's when she got an insulin pump. And I've told this story before, but that a couple of years later, I wasn't sure if she had a bad site or something, but I wanted to inject insulin to check. And we got the syringe out, and she didn't remember it, which, at the time, I took really well. Like it was a couple of years she was maybe six, seven years old. At this point, she hadn't had a syringe in a few years. She's like, what is that? And I was like, Oh, we're gonna have to inject the insulin. And I just acted like, you know, this, I've done this to you 10,000 times, you know? And she had no memory of it, which I thought was great. And it was for a long while, but then all of a sudden, I don't remember exactly how old, but maybe a couple of years later, we were just at a blood draw one time, and she, like, climbed the wall, almost in the room, to get away from it. And then suddenly she had her it felt like she overcame it, but she tells me, in retrospect, she didn't overcome it. She was just like willing herself through it. She was having the same feeling every time it. Wasn't until we got to this send her off to college, situation where I said, Look, I can't send you off to college, not knowing if you can give yourself an injection. If something goes wrong, I'm like so your next bowl is today. Let's just draw it up in a syringe, and you do it. She took that syringe and stared at it for 20 minutes, and then eventually left the room. She locked herself in the bathroom with it, and she came out 45 minutes or an hour later, and she's like, I did it. But she looked like she just ran a marathon coming out of that room, like, I don't know what she went through. She wouldn't let us in, she wouldn't let us help. She's like, I'm gonna do it. I'm gonna do it. It was an hour and I swear to God, she came out. She looked like she just been through three rounds with a heavy weight. She was sweaty and disheveled and like she looked half crazy. She's like, alright, I did it, and that was the end of it. And I don't think she's done another one since then. It's been, like, three years. But anyway, and then people say, but there's a needle in the Omnipod, the one great, one of the great things about that Omnipod is, you put it on, you pinch, you push the button and it's, it's between you and Jesus at that point, like, it's just gonna happen. You know what I mean? So you like, you click, and you just kind of wait. And she doesn't have any problem with the with the Dexcom inserter for the g7 either she doesn't like it and she flinches every time, as if it's never happened to her before, which I've always found interesting. Like, like, it never stops being what it is. If that makes sense, yes, we're not through all your tools, though. I apologize, yeah, but you

Erika Forsyth, MFT, LMFT 36:26
know, but she does so well. That's, I think that's really common, though, for those of us who are on devices, CGM pumps, but to also, as you said in the beginning, to have an aversion to needles or blood draws or IVs insertions, because it's out of our control. Yeah. And so there's something, you know, and I think however you can set up, like, for example, going into a blood draw when she, you know, said she's just crawling up the walls. I think the more you are able to understand what you need, even if you feel like it might not even help, but to then advocate for yourself in that way. Some of these, I thought these were really great examples of if you're able to get an appointment, a lot of people are not able to get appointments for blood draws, but to prevent the time in the waiting room while you're watching everyone else feel nervous, maybe you're hearing kids scream like so if you can get get a blood appointment or ask to be outside and get a text when you're there, your numbers up, yeah, for some people, some people, you can schedule it with the same, you know, Nurse phlebotomist, and develop that relationship. I actually just learned recently I've I my veins are hard to to access for whatever reason. They just, they like to hide. And so I know on my left arm, I know the vein that works. So for years, I go in, I don't look, I point to the vein that works. And they say, Are you sure? I'm like, yep, just this vein. Just do that one, yeah. And I look away, and I do my inhale, I exhale when I breathe, but just this last blood draw, the nurse said, you know, I I'm noticing some scar tissue here. And I said, Oh, why? No one's ever told me that. I just know that's the vein that's easy to find. So anyway, something I said, is that problematic? She said, No, we just might need to use a smaller needle, whatever.

Scott Benner 38:16
I guess, like, I need the spot to last at least, like, 4050, more years.

Erika Forsyth, MFT, LMFT 38:21
So, you know. And also to say, when you get walk in to sit down, if you know your plan, you can tell the person, hey, I'm not going to talk to you. I'm going to look away. This is the arm that I like. I need to lay down. So you're not in your head worrying, yeah, you're not worrying about, oh, do they think I'm rude? Or do they? You know, it doesn't matter,

Scott Benner 38:42
right? Just give yourself less to worry about, yeah, by being prepared ahead of time.

Erika Forsyth, MFT, LMFT 38:46
Yes, yeah, um, one, 1% person said this in the Facebook group, which I think is great if you're an adult and you have children, but you're the one who's having to get the needle blood draw, have your child come with you, because oftentimes that their presence might either calm you, or you might have to stay more calm because you don't want them to see your fear. That I know that can be helpful. Sometimes this

Scott Benner 39:11
person in the group said that I used to pass out when I was going to get a flu shot, and I'd feel kind of woozy. My dad would pass out as a kid from getting it, and and so prior to having to get my first COVID shot, my mom took me to a therapist to do EMDR therapy, and I think that helped that interesting, like, that's the pre planning we're talking about. Also, the lady that did my COVID Shot said to me, this is my first one. I'm a volunteer, and then stabbed me like we were in the middle of World War Two, and she's trying to kill me on the battlefield. And I was like, Oh, wow. It's supposed to go on your arm, but down a little bit, I think she stuck it into my shoulder, my shoulder. I was like, what is happening? She got done. I went over to my wife, and I was like, oh, oh god. What happened? She goes, what happened? I said she hit me in my shoulder. Should have known, because five minutes before, she shouldn't figure out how to use the iPad. And I'm like, You're right. And she goes, this is my first one. We're all volunteers. And I was like, oh, okay, I thought that meant she'd be more careful, not that she'd just swing like Jason in the Friday the 13th movies at me. It was not pleasant, but again, I lived through it, yes, yeah. And I also don't have a needle phobia. So in the end, I just had an unpleasant experience. I was like, yeah, that hurt. Like, what'd you do that for? And then, like, I was done with it. But if, but if I was predisposed to this, that one experience could have put me down a bad path, for sure, because it was a, it was a really crappy experience, to be perfectly honest with you,

Erika Forsyth, MFT, LMFT 40:37
absolutely may perhaps had you been in a real, you know, anxious space or fearful space, you maybe have the plan to say, I'm going to ask for what I need, and I need someone who's with experience. Yeah, I think we get, we get nervous when we when we are nervous, we often feel fearful to say, You know what I'm going to pass I'm going to wait for this person over here who says they have five years experience, whatever. I wouldn't wait

Scott Benner 41:02
for the lady who knows, though, how to open the iPad that might have been like, like, at least she's been here a day. I would think, usually what I tell people in these situations, they're like, Oh, this is gonna hurt, or I'm sorry. I go, I'm married. It's okay. I'm trying to make light. But you know, humor, I've been through a few things. This isn't gonna be the worst thing that's happened to me today. You should be around with my wife yelling at me about something, this is nothing, or else, something like that, which not even true, but fun to say. I don't but I do wonder, in a real, in a real way, like, it's just like the other stuff that we talk about, where you have something, you don't have something. It's like, when you're talking about somebody with anxiety, I'm like, It's so strange for me to listen to somebody speak with anxiety, because I'm like, I just don't feel that way, and I feel lucky not to feel that way. But this is the same idea. Like, I know the needle is gonna suck, but like, I just don't care. Like, it's gonna hurt, and then it's over. I don't even have trouble the dentist. And I hear some people talk about going to the dentist, like, like, it's the worst thing that's ever happened to them, you know, anyway, I'm sorry. What? Keep going. No,

Erika Forsyth, MFT, LMFT 41:57
well, and speaking of the dentist, I think the I was going to share an example recently with my my daughter, who had two she had two cavities, and the first time we went, we didn't give the we didn't give her the laughing gas. And it was, she was highly anxious. She said it was really painful. So we didn't do the second one. We went back a couple weeks later, did the laughing gas. It still was, it still was painful for her, but her anxiety and her pain scale was a lot lower. Same procedure, same steps, except she had the laughing gas. And I think just our emotional state is so important to acknowledge in conjunction with the actual perceived level of pain. Yeah, right. And I joked with our pain, yeah. I

Scott Benner 42:43
was like, You want us to try to find you some weed or something before we have to do this again? It's like, well, I'm starting to think, like, what's going to help her relax before she has to do this? And I don't know if that would help or hurt her, not, but my brain went there. I thought, Is there something we should do to, like, get her a little loopy first? You know what I mean, like, so I don't know, we didn't end up trying that. But anyway,

Erika Forsyth, MFT, LMFT 43:06
medication, yeah, you know pain medication, or anti anxiety, you know Xanax in the moment. Some people need that, and that's totally okay. I mean, that's your situation. Get something done, right? Like you need to do the thing to keep yourself healthy and to help find a way that works best for you. Is, is great, whatever that, whatever that may be, I'm imagining

Scott Benner 43:29
people showing up the dentist a little, a little half in the bag, going like I was listening to a podcast. They said, sorry if I chilled out a little before this. But I do wonder, how many people do that, self medicate stuff like that. I bet you more than you think,

Erika Forsyth, MFT, LMFT 43:43
yes, and it's okay to ask, right? Like, ask your doctor. Hey, I have, I have needle anxiety, and I have this blood draw. Can you prescribe me one Xanax? I think that's totally probably more common. It's something that people don't talk about. Yeah, this at last one is the the kind of correct term is applied Tension Technique. But basically, if you are if you feel like you're going to faint, just squeeze your muscles, your leg muscles, your butt muscles, your abdominal muscles, repeatedly while the needle is going in, it's keeping your blood circulating through your body okay, and will prevent you from, hopefully from from fainting. So knowing like and you can pre you practice that with yourself or your child. Okay, I'm going to squeeze my butt or my legs or my stomach, and we're okay. We're doing 123, we're going to press the button, any tool or tip to do beforehand, to talk through, to practice, gives both yourself or your child that confidence, that you know what to do when the fear starts and when the pain starts, the physical pain.

Scott Benner 44:51
What is this here? If you're for adults, if you have kids, have them present to watch, and that may be Oh, because parents feel like they got to hold it together. In front of their children? Yes,

Erika Forsyth, MFT, LMFT 45:01
yeah. So I was, I think someone wrote that in the Facebook group and, yeah. So like, if you're this is for someone as the adult, if to try, if that helps, right? Because you want to be calm for your child. You're trying to model for your child, and having your child present as you're having the needle inserted, you're thinking about them. You're not thinking about what's happening. You're staying calm. That could be another tool. I mean, I don't know if you want to intentionally do that, but if it happens, that has worked for some people.

Scott Benner 45:31
I mean, that makes sense to me. I mean, all these things you got to pick and figure out what's going to help you, for sure, yes, but that makes sense to me,

Erika Forsyth, MFT, LMFT 45:38
you know, and having the actual distraction when it's happening. We've talked about the medication, the mindfulness breathing, I think we've covered most of the tools. And just honestly, if you if you're hearing this in your experience needle phobia, your child is I really encourage you to to not shame yourself or your child, particularly as maybe your child's getting older, you know, you don't want to say, Oh, you used to do this when you were a baby. You know, it's time to grow up. Or, yeah, get over this. Get over it. Telling this to yourself like that is that is not helpful for yourself or for your for your child. And so to validate the fear that you're experiencing or your child's experiencing, and then to make a plan, I think is really, really helpful to help you get through this, the experience. Yeah,

Scott Benner 46:32
I'm just going through everybody's feedback on the Facebook group, which I can't say enough thank yous for, because these are really, these people really being honest here, you know, I mean, I've locked myself in rooms. I've have I've had irrational fears about needles my whole life. A lot of people do say like they passed eventually for them, which is, as they got older, I've had minor panic attacks. One person says their kid passes out when they do it. That just happens every time the kid, boom, just goes under. That's crazy. I've had needle phobias as a child. Back in the 1960s like this, this brought in people of all ages, you know, shapes and sizes, to make the to say that this has happened to them. I just think it's very important what you said before, just to not act like, oh, this doesn't really exist. You know, just because you don't feel that way doesn't mean somebody else doesn't.

Erika Forsyth, MFT, LMFT 47:22
Yes, and to this is emphasized from the MEG foundation for pain website that medical providers, they may only get seven to 10 hours of pain management training in their schooling. And so while they want to help you, and, you know, treat you the best you can, for you to feel comfortable, knowledgeable and empowered to ask for what you need. Now again, that says we're talking about, you know, when you're going into into the hospital or labs and then at home, for you or your child to feel the same way, to be educated, to know what's actually going through, to make sure they know what's helpful for them, I think is just is so important and was helpful for me to kind of refresh, to go through my memory, yeah, go through this like, okay, yeah, what is helpful for me and what is helpful for my children? You know, as we, as we face these different experiences with needles, the

Scott Benner 48:20
one thing that even I found like staggering, is the person in the group that said, like, I have tattoos all over me, but I can't give myself an injection. It's fascinating, really. You know, just the way some people react to things and others don't. I'm super happy we did this because you found Meg foundation for pain.org, which is a great resource people should go check out if they're struggling with this. I think whether you're an adult or a person trying to help a child, this would be a good website for you to look at,

Erika Forsyth, MFT, LMFT 48:45
yes, and you're so you're just, you're not alone. It is. It is so common. And I hope that, yeah, that you find some help in this or the other resources. Listen,

Scott Benner 48:57
I can just tell you from personal experience, it ain't no joke, some of Arden's reactions, I can't believe they're happening while they're happening. Like, like, really I I'm standing there, like, what is and it's so you brought it up earlier, like, I don't want to make this about me, but it's hard to be in the room trying to facilitate this thing. Like, you know what I mean? Like, when somebody says to you, no, I guess it's why I can't understand hurting another person, like, because when she's begging, like, begging for this not to happen, and I'm like, Oh no, I'm gonna do it not harshly, like that. Like, in your mind, you're like, No, we are going to get to the end where you are going to get this, and when it ends, you're not even going to care, which is, like, it's even hard to wrap your head around, because, like I said, five seconds after it's over, it's just over, but you're standing there, I feel like I'm gonna hurt somebody. I'm causing somebody distress. I mean, you're not, but it feels like you are. You know, you're having to do it for another health reason, but I don't know, but it's just of all the you know, diabetes sucks. I guess that's really what we should just say. Anything that makes you do this sucks because, but I hope you find a way through it. Like, I don't know how. Valuable we were we weren't the last hour, but I wanted to do this because I just don't hear anybody else talking about it, and I knew a lot of people had to be struggling with it. So here it is. I hope it's helpful. You can go find some resources to to get through it, or use Erica's idea, where you just take a Zanny and then everything's okay. People are gonna be like, hey, this lady, Erica, told me, and I just I took some wine. Now I don't have any trouble with anything anymore, being serious, like, if this was happening to you, like, this badly. What do you think the steps are like after you've heard all this and been through all this stuff? Like, what do you think the steps are that you would take for yourself if this happened

Erika Forsyth, MFT, LMFT 50:39
to you? So if I knew that I had trauma like, you know, severe medical trauma, I would definitely be really intentional in therapy, whether it was EMDR or CPT, to work through and reduce my association with that trauma, and then I would be really clear with what I needed to get through each site change or IV insertion. So if it was that level, right, I was just thinking about, you know, like claustrophobia, for people who are claustrophobic, I am for one, and I know if I were in a small if I had to take an MRI or something like that, or you're in, I can do elevators, but their treatment whether it's medication or coping skills. So I think to think about needle phobia like another really, we probably hear claustrophobia more often than needle phobia, but it's okay. It's okay to take medication, it's okay to go to therapy for this. It's okay to know what you need, and it's okay to advocate, so I would probably start with therapy. Know what my coping like tools are, and feel confident that I could use those. And if that didn't work, then you know, maybe it is taking a Xanax for a blood draw, but maybe you're okay with your site changes, but I think it's really practicing and trying out different tools and knowing what works, going

Scott Benner 52:04
back in my experiences, and looking back over the last however, many years, I do wish that we would have taken Arden to somebody to talk about I didn't realize that it was going to stick to her like this or that, and I think it maybe would have helped her to have, like, talk therapy around it when she was younger, even if it was just specifically for the needle thing, I think it would have been time, well, spent, you know, looking in the rear view mirror. It seems that way to me, at least. Well,

Erika Forsyth, MFT, LMFT 52:29
no, no shame or blame on you as the parent. You know, this is part of, part of the journey as a lot of parents have to go through. And it's never too late, right? Like, it's not too late, if she were open to that, yeah,

Scott Benner 52:41
sure. You go tell her. I mean, that's always the problem with getting people help on something like this is that you have to explain. They have to agree to do it, and it's not always that easy. Like I tried to I'm like, Hey, let's try grounding stuff. She's like, that's not gonna work. I'm like, Let's do breathing. That's not gonna work. I'm like, Arden, the stuff. People say this works for them all the time. She's like, Ah, just do it. But then at one point she's just like, she was almost begging. She's like, I we need to find a different way. And I'm like, Well, I don't want you to feel then there's the other side of it, like you're having a ton of medical, like, benefit coming from this thing too. So like you're trying to find the balance. So anyway, we called it, basically called it off for a couple of weeks. Now we're trying the pills that actually starts today, and then we'll see how that goes. And if that goes well, then great. And if it doesn't, then hopefully, maybe, just like I said, Maybe her situation overall in her life, feeling better might lead her to go, oh, okay, I could try this again. So but one way or the other, we got to figure it out, because she's not going to stop having diabetes anytime soon. So to me, this is just, it's the thing we have to figure out. So hopefully we can get her into a more accepting place. And then I'll bring up again, maybe going and talking to somebody about this, see if I can get her to the joke. I'm not going to give up, but it's a long process, is all I'm going to say, a journey. Yeah, they're sorry, yes, okay, well, thank you again for doing this with me. I appreciate it. You're welcome.

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