#1174 Cold Wind: Consultation Liaison Psychiatrist

Today's anonymous 43 year old female guest has type 1 diabetes, thyroid issues, gastroparesis and more.

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

Scott Benner 0:00
Hello friends, welcome to episode 1174 of the Juicebox Podcast.

Today's guest is going to be completely anonymous, their voice has been changed. My guest is a consultation liaison psychiatrist and a person who's had type one diabetes since they were eight years old. She also has a thyroid issue OCD, and an eating disorder. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. 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/juicebox if you have type one diabetes, or are the caregiver of someone with type one and a US resident please go to T one D exchange.org/juicebox. You will be helping with type one diabetes research by completing their survey AT T one D exchange.org/juice. Box takes like 10 minutes don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cozy earth.com This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox us med is sponsoring this episode of The Juicebox Podcast and we've been getting our diabetes supplies from us med for yours, you can as well us med.com/juice box or call 888-721-1514 Use the link or the number get your free benefits check it get started today with us med Today's episode is sponsored by Medtronic diabetes, a company that's bringing together people who are redefining what it means to live with diabetes. Later in this episode, I'll be speaking with Mark, he was diagnosed with type one diabetes at 28. He's 47. Now he's going to tell you a little bit about his story. And then at the very end of the episode, you can hear my entire mini interview with Mark to hear more stories from the Medtronic champion community or to share your own story. Visit Medtronic diabetes.com/juice box and check out the Medtronic champion hashtag on social media.

Anonymous Female Speaker 2:41
I'm a consultation liaison psychiatrist, and I've had diabetes since I was eight. So I am approaching my 35th year.

Scott Benner 2:50
Wow. Eight years old. You're 43 Now I will be in gym. Yeah. I just wanted to impress you with my fast math. Yeah, that was

Anonymous Female Speaker 2:59
that was good. But I was I was recently told that if you say I'm going to be 43 in June, that like makes you young seems younger. Right? And I'm like, Well, I if I say I'm 42 or whatever. But so yes, I will be 43 in June and August 1 will be my 35 year diabetic Versary. Wow.

Scott Benner 3:20
And tell me what it is you do for a living? What's your profession?

Anonymous Female Speaker 3:25
So I'm a psychiatrist. I do. It's called consultation liaison psychiatry. So I do consults for patients who are hospitalized, like medically and surgically. And so they're either like delirious depressed, anxious, like Kotick. They're inpatient, but they're not admitted to the psychiatric unit.

Scott Benner 3:48
Could they be if they weren't there for something medical, they,

Anonymous Female Speaker 3:52
they will often get transferred to the medical psychiatric unit once they're medically cleared. But the patients that I see are two medically ill for a psychiatric unit. Okay,

Scott Benner 4:05
I definitely have questions. Okay, I

Anonymous Female Speaker 4:08
have answer is gonna be good. Good. Let's

Scott Benner 4:09
start. Well, first, I want to start with you just to get a baseline on you. So what was your management style throughout your life? And what are you doing now to manager type one.

Anonymous Female Speaker 4:19
In preparation for this, I've been trying to go back but 35 years is a long time long time. I'll start currently, I'm on the Dexcom and Omni pod. And then prior to this, so I was on Medtronic. So I've been on two different pumps. I've been on the Medtronic and I've been on the Omni pod and I've been on Omni pod for for quite some time. Yeah. And I briefly like when I was in college know when I was in residency I tried the Medtronic sensor And that that old sensor you didn't enjoy that? No. Oh, my God drove me nuts. Yeah, I briefly did that looping thing. Okay. And that those were the worst three months of diabetes ever. I like I'm so happy for the people it works for but it did not work for me or your

Scott Benner 5:19
settings, like, good. You know, all these algorithms, if you don't start them with great settings and an understanding of how the algorithm works, you're doomed to failure pretty much.

Anonymous Female Speaker 5:29
I mean, that could be possibly it. Somebody had mentioned that, like, because I rise very quickly, and I drop very quickly. And that perhaps it wasn't like adjusting quite quickly enough for me.

Scott Benner 5:46
Do you Pre-Bolus your meals? No, that's why you rise very quickly. But I also have gastric precess Oh, there's another reason. Okay.

Anonymous Female Speaker 5:55
And so sometimes I drop really quickly. And like, I work out a lot and exercise drops me very fast. And now with the closed loop, though, and having like the activity mode, so much better. But in the past, I would have to, like it was I can't believe I did this, but I do this for years, I would start like a ride or working out. I had to be at least 400 to ride your bike. Yeah, and then like, and then I'd come back and I'd ride until my blood sugar was low. So,

Scott Benner 6:32
gastroparesis diagnosed. Yes, yeah. When did that happen?

Anonymous Female Speaker 6:38
Six years ago, okay. Yeah. And so like, sometimes it affects my absorption of food, and sometimes it doesn't. So some days I'll see myself, like, after I eat and other days, it's like, flat. And so it's really not predictable. But so I don't I am not bold with insulin, I have to be okay. And, and I don't eat, like 20 grand if I have like 20 grams of carbs. Like, I don't know how important it is to Pre-Bolus for that.

Scott Benner 7:14
Gotcha. Are you not aggressive with your insulin because of the gastro precice or have you never been?

Anonymous Female Speaker 7:22
I've never been like my A onesies have never been fantastic. When I was a child, I was diagnosed, like they were stellar. But my mom was always talking about how it was when you average very high blood sugars with very low blood sugars, you get you average off pretty well. In adulthood. I have managed basically like seven to eight. And when I get below seven, it tends like I tend to have a lot of lows.

Scott Benner 7:54
Do you think your settings are accurate? I mean, prior to this, you're using Omnipod five now is that right? Yeah. Okay. And that's and that sounds like it's working really well for you but prior to that, do you think you had good settings do you think you were just chasing blood sugars all the time and nothing was exactly where it needed to be. If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily jeuveau Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you storage evoke hypo pen and how to use it. They need to know how to use G vo Capo pen before an emergency situation happens. Learn more about why G vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys caught a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma visit G voc glucagon.com/risk For safety information.

Anonymous Female Speaker 9:25
I would say a little bit of chasing it because the thing is I go to my endocrinologist with like an eumc of 7.8. And then they would make one small adjustment and it's like well, I don't I don't think that's it. And then they'd always comment to the I don't really have patterns and as soon as you think I do have a pattern it changes. So I am not very like reactive. I've never been very reactive if for some reason like I'm consistently high at a certain point during the day, I really never adjusted my insulin without talking to the doctor because give it a couple of days and I'll be low at that time.

Scott Benner 10:12
When you were diagnosed the date did you wear your pants? So that was 89 I think.

Anonymous Female Speaker 10:19
Great math.

Scott Benner 10:20
Oh, please. I'm really showing off my simple addition and subtraction. So, so at that point 89 You were using did they put you on Lantis and humor log was

Anonymous Female Speaker 10:34
on like mph and regular okay. I was lengthy and ultra lengthy. And remember, like NPH was cool, because at that time, Doogie Howser was on. And Neil Patrick Harris, I had like a huge crush on him. And he was NPH. So I felt connected to him somehow through my insulin, the

Scott Benner 10:54
crush ends up being ironic because he's gay. That's interesting. And totally Yeah. Not that you can because I had a crush on you think you turned Neil Patrick Harris gay with your crush when you were eight years old? Exactly. Look into it. See if that's possible. So my point being like, was this a kind of like a set it and forget it disease at that point, like shoot insulin twice a day eat at certain times? That's about it?

Anonymous Female Speaker 11:18
No, when I was really young, we would call my pediatrician for every dose of insulin, okay. Like we'd call him with my blood sugar morning, like all throughout the day. And my dad was was graphing these things on like, programs in 1989. We would be taught like, Okay, this is what you give at breakfast, like I was eating very regimented. So it wasn't like, there wasn't any variety. And it was like you're having this much in terms of carbs in the morning. And so it was all about covering for like blood sugar. But I remember we would call Dr. Peter at seven o'clock every morning. And I don't know, I don't know what he would use to tell us what to give. But at that time, I was giving I guess I was getting three shots a day.

Scott Benner 12:10
Okay. Were you testing? Did you have meters? Oh,

Anonymous Female Speaker 12:15
I was testing six to eight times a day. Okay. I had actually been told just to test less.

Scott Benner 12:23
And so and your agencies were coming in? Were at that point. Do you know,

Anonymous Female Speaker 12:27
I think they were probably in the in like the sixes.

Scott Benner 12:31
But you think that these are accomplished with, like, offsetting the average, right, like a bunch of lows and a bunch of highs. So not healthy. But yeah, the the agency would average out like that,

Anonymous Female Speaker 12:41
like my highest weren't as high as they've been in adulthood. But I still had lows. Okay. Like, I guess, some reason and adulthood, I've managed to get to over 400. Not terribly infrequently. But that like if I got into three hundreds as a kid that was like, Oh, my goodness, what's happening?

Scott Benner 13:06
Your father was helping you or you were on your own?

Anonymous Female Speaker 13:08
Mostly? Oh, my parents were very involved. Okay.

Scott Benner 13:11
So what would you in hindsight, did they understand what they were doing? Or were they just involved? My

Anonymous Female Speaker 13:17
dad, very much didn't, they were quite involved. And I don't want to say helicopter parents. But, you know, I couldn't go to sleepovers. Because, you know, my parent, I had to be with my parents, because I didn't give myself shots for the first couple of years. Yeah. We always had to know like, what food was going to be served at parties. And I found, I found a letter that my dad had actually mailed to my doctor. And he said, you know, just the other day, a parent's worst nightmare came true. And I was like, like, Did I die? Like what happened? And he's like, there was an unplanned pizza party. And I was like, wow, that was your worst nightmare. That was his worst nightmare, an unplanned pizza party. My mom always hated being she would say, like, if I asked if I could eat this or eat that she said she hated being the food police. They were very involved. And it really wasn't until college that I became independent. Did you know

Scott Benner 14:21
what you were doing? Like? Could you meaningfully have outcomes that you were looking for without the spikes and the crashes?

Anonymous Female Speaker 14:28
is probably still don't know that what do you see your

Scott Benner 14:32
language is very interesting to me. And might I say indicative of people who have had diabetes for decades and decades and decades. Like it's super interesting to hear people say like, my parents were really involved, but then the conversation indicates they didn't really know what they were doing very much. Well, I

Anonymous Female Speaker 14:46
think at the time, like they're like without the technology and when the fast acting insulin and, you know, the glucose sensors. It's like, they didn't have nearly the information that we do now. Of

Scott Benner 15:00
course, no, all I'm saying is that the measure of involved or the measure of I was doing well or the measure of, I'm good at this is is skewed based on the time of management, you know, in the decade almost, and what the what the insulin was and what the technology was. It's really interesting to hear, like, you know, like, you feel like they were really good parents around diabetes. But yet, you know, your agency was kind of in the sevens and you bounced around a lot, and you have gastroparesis now, but you don't I mean, like 35 years from now, if I found an eight year if I found an eight year old diagnosed in 2024, and we went ahead 35 years, they wouldn't apply those measurements, those words of measurement to that outcome, it would sound completely different, do not I mean? diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email, it's a big button that says click here to reorder. And you're done. Finally, somebody's taking away a responsibility instead of adding one. US med has done that for us. An email arrives, we click on a link and the next thing you know, your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three, and the ducks comm G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 888-721-1514. Or go to my link us med.com/juice box using that number or my link helps to support the production of the Juicebox Podcast. Right now we're going to hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is Mark. I

David 17:20
use injections for about six months. And then my endocrinologist and nav recommended a pump.

Scott Benner 17:25
How long had you been in the Navy? Eight years up to that point? I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

David 17:35
I was medically discharged. Yeah, six months after my diagnosis. Was it

Scott Benner 17:39
your goal to stay in the Navy for your whole life? Your career? It was Yeah, yeah.

David 17:43
In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we made the decision despite all the hardships and time away from home, that was what we

Scott Benner 17:56
loved the most. Was the Navy, like a lifetime goal of yours? lifetime

David 18:00
goal. I mean, as my earliest childhood memories, were flying, being a fighter pilot,

Scott Benner 18:05
how did your diagnosis impact your lifelong dream?

David 18:08
It was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant, I was not prepared for that at all. What does your support system look like? friends, your family caregivers, you know, for me, the Medtronic champions community, you know, all those resources that are out there to help guide away but then to help keep abreast on you know, the new things that are coming down the pike, and to give you hope for eventually, that we can find a cure.

Scott Benner 18:34
Stick around at the end of this episode to hear my entire conversation with Mark. And you can hear more stories from Medtronic champions and share your own story at Medtronic. diabetes.com/juicebox

Anonymous Female Speaker 18:46
Yeah, um, so when I was thinking about this, like podcast, I'm like, I, when I came to be a diabetic, the world was very different than you, like, couldn't eat certain foods, and you could only eat at certain times. And it was so different. So it's hard for me to know, although my brother was diagnosed about 15 years ago, so he and I have very different diabetes, which is interesting. But yeah, my parents were involved in that, like, they Oh, they knew what my blood sugar were all day because I I still have some of the logbooks that I wrote, My blood sugar's down then for the first like 10 years, and they, you know, I never missed insulin

Scott Benner 19:33
on top of it, you were really on top of it and doing the things that you were supposed to be doing. Right? Yeah.

Anonymous Female Speaker 19:40
I didn't know the outcomes weren't always great, right.

Scott Benner 19:42
Do you think your brother has a different kind of diabetes? Or do you think he was just diagnosed in a time where expectations and and tools were different?

Anonymous Female Speaker 19:49
I actually think he has a different kind because he has only recently started like, almost against his will on the pomp and sensor until about like three or four months ago, he was just doing injections and testing his blood sugar. And his a one C was five to the point where the doctor was like, We need to get your your agency apple.

Scott Benner 20:15
You don't have to get a five a one C up if it's if you're getting to it, honestly, do you think he's getting to an honestly? Or do you think he's having a lot of lows too? Well, he

Anonymous Female Speaker 20:23
wasn't having a lot of lows, but he was having enough lows that he's feeling like he's not thinking near as clearly as he was. So they wanted him to come up a little bit, because he had a few pretty bad lows. But like, whenever we were together, it was like, if I saw his blood sugar above, like 100, I was shocked. I gotcha. And then he was also you know, he would eat whatever he wanted. And I was like, that's not the diabetes I have.

Scott Benner 20:53
I see. I see what you're saying. Okay, so moving into your profession. I want to know about how people would type one are treated in psychiatric situations. So first of all, what are some of the situations I could find myself in, I end up in a hospital for, like you said, like a medical reason, but I'm a psychiatric patient, on top of that, there can be being admitted against your will there could be being admitted, like, right, voluntarily. But every time I hear about this, it's always, you know, if it's a voluntary admission into like a private place, they'll they don't take type ones usually. And I'm just wondering, I'm wondering about all your different experiences, actually. So I mean, just walk me through what you know about.

Anonymous Female Speaker 21:39
So, I mean, I guess I have experience as a, as a patient and as, as a dog, okay. And so I had been hospitalized for an eating disorder, multiple times. I never, I know, you've talked about, like, by bulimia or withholding insulin. And I never did that. But I met a number of people who did. And so when you're admitted for that, the kind of watch you like a hawk with with and like, often don't let you use your pomp and, and, you know, are like on top of you with when you're giving insulin, I never had that they, they would tell me like I'm testing too many times, I would get a little bit obsessive about that. Because I couldn't control my intake or my weight, I became very focused on having perfect blood sugars, which isn't ordinarily a focus of mine. I mean, not that I go out of my way to have bad blood sugars. But that was what I could focus on. And they would do we try to, like, get me to focus on other things. Hearing people talk about non compliant diabetics. Really, like I have colleagues that do that. Just

Scott Benner 22:57
Oh, yeah. Were you obsessive about other things are just this one specific situation? Yeah.

Anonymous Female Speaker 23:03
So I also have like, OCD diagnose, not like, who I like my desk, neat, but how does it manifest, it's manifest in in various ways over the years. Like, when I was a kid, like I had to, like, make my bed a certain way. And if I, if it got, if I got distracted, or I didn't make it certain that way, I'd have to unmake it and remake it. But it was never to the point where I was late for school or anything like that. It started to involve, like the eating disorder. And so I have to say things in my head a certain way, or I get fat, okay. And it was like, Oh, if I use that, if I say something negative about my mom, that's gonna kill her. You know, it's like, all sorts of things. And that,

Scott Benner 23:47
yeah, that was from a younger age. Yeah.

Anonymous Female Speaker 23:50
I mean, that was I in elementary school, and, like, even now, and I never got really got treatment for that. Until I until my maybe mid to late 20s.

Scott Benner 24:04
Was this before the diabetes or after or both? Well, the way we found

Anonymous Female Speaker 24:08
out that I had diabetes was because at eight I was weighing myself every day, because I was fat. Or I thought, Oh, okay. And because I was a gymnast and a swimmer. And so I was very self conscious about my weight. And I remember when I had lost eight pounds, my mom had said, if you lose one more pound, we're going to the doctor. And I was like, I don't want to go to the doctor, but I do want to lose one more pound. I was like, Well, how's that gonna work? Do

Scott Benner 24:40
you have a thyroid issue by any chance? I do have that as well. How long ago was that diagnosed?

Anonymous Female Speaker 24:46
I believe in college. That was quite some time. How

Scott Benner 24:51
well managed is that like, Where does your TSH sit up? Until

Anonymous Female Speaker 24:55
recently, it was really well managed, but for some reason now No, my like, TSH is a bit low, like, but I was requiring a lot of levothyroxine them. I was taking them like 200 micrograms a day. Right. And my uncle who, like had his thyroid removed, was taking less than taking that much. Right? Yeah, I was like, What? What? And he's like bigger and get up and so now I'm down to 175. And my TSH is still a bit low.

Scott Benner 25:25
Is it under one? Yes. Is it? Is it like negative? Or is it just under one?

Anonymous Female Speaker 25:32
I'm trying to think cuz I just got it back the other day, because it was point o six a few months ago.

Scott Benner 25:38
Do you think you're hyper or no? hyperthyroid? Or do you think you're hypo? And you're just really like managing heavy with the medication?

Anonymous Female Speaker 25:45
Um, doubt Yeah, I'm because my TSH has been as high as 123 G's. Okay. That was during intern here. And my doctor was like, aren't you tired? And I was like, Well, I'm an intern. I thought I was supposed to be tired.

Scott Benner 25:59
It's like not like that. Because I Yeah, because I'm just Austin. I was just wondering, because when you started talking about, you know, the OCD stuff and like, makes me think about anxiety. And then I was like, I wonder if the thyroids managed well, so that's what, that's all.

Anonymous Female Speaker 26:12
No, that's not the point, though. But so currently, it's point one, six. Okay. But yeah, I mean, it's really, really down there. Which, but it's getting better. Yeah. I don't really know why. Because I had been on the consistent, I was actually alternating doses, one to 175 and 200. For years, it was stable, and then now, it's not,

Scott Benner 26:36
and you're just taking T for you know, taking T three as well.

Anonymous Female Speaker 26:40
Yep, just levothyroxine. Okay, cool. My T four is what is normal?

Scott Benner 26:44
Okay. All right. So, so Okay, so But getting back to it like so, like you come in? Was that a voluntary thing when you were being treated for an eating disorder? Yes. Okay.

Anonymous Female Speaker 26:57
And how did you I had had the eating disorder for many years before I admitted to it to that, then I started to get help. How long

Scott Benner 27:07
were you? Were you in treatment? For? Was it a like it was an inpatient? You were at a facility?

Anonymous Female Speaker 27:12
Yeah, so I've been in, like an inpatient or residential treatment nine times. And the longest of those was, was three months. But it's been six years since my last admission, and that's like, wow, so long as they've gone and

Scott Benner 27:33
done, how do they manage diabetes in those situations, like, well, or not really?

Anonymous Female Speaker 27:38
Well see, I think, in those settings, and just in general, and hospitals, like, diabetes is a one size fits all type thing. And it's like, everybody has the same sliding scale. And it's like, from what I could see, it just seemed like, it just didn't seem personalized. But for me, like, I think my treatment was somewhat different, because I never manipulated my insulin, and like, they knew I was a physician. And so I had a lot more like freedom or leeway. With that,

Scott Benner 28:17
even though you found yourself in the same situation, as everybody. Right? Right.

Anonymous Female Speaker 28:21
Because that wasn't like I did presentations, like, around the country about it. I did some research on it, but that they knew I was, like, very vested in my be a good diabetic personality.

Scott Benner 28:39
Hey, this might sound like a left turn for a second. But I mean, it's a thing I've heard a lot. But do people who are searching for answers for themselves often become professionals in mental health?

Anonymous Female Speaker 28:51
I think everybody should be searching for answers. Well, I was actually going to be a pediatrician. And then I was going to be do a pediatric endocrinology. I didn't enjoy them as much. And I found psychiatry fascinating. So I decided I wanted to be a doctor when I was six. And so until my third year in med school, I was going to do pediatrics or pediatric endocrinology. psychiatry was never on the radar. And at that point, I had only recently started getting like mental health help, but I think some people do whether or not that's ideal, but I think everybody should

Scott Benner 29:36
have on some level. So for you, is it is it just the OCD or is it other stuff?

Anonymous Female Speaker 29:43
So I mean, I guess the OCD, the eating disorder. I'm an anxious person in general, regardless of what my TSH I gotcha, because I tend to think of like when my TSH is low, I tend to think He does more like physical. Like, you know, my heart rate is faster, I'm tremulous, I feel jittery, whereas anxiety, OCD things, those are more mental like, like thoughts and per separations, things like that. Gotcha. Is there anything else? Like? Do you have any other like mental health diagnoses?

Scott Benner 30:22
Yeah, beyond that?

Anonymous Female Speaker 30:24
No, I think that's, I think that's enough. That's enough. So

Scott Benner 30:28
well, let me ask this question. First, am I right to say when you try to go into a private facility, oftentimes, they'll say, No, thank you. If you have type one, have you? Have you ever seen that?

Anonymous Female Speaker 30:37
I haven't, I guess, because I haven't really worked in private. But I know for like, eating disorder facilities, some people will say no, but I think in general, for mental health care, I've never seen somebody turned away but again, they're not they're not. Right. They're not private.

Scott Benner 30:57
Well, what do you think people could do? Or should do to prepare themselves for an intake? If they have type one? Yeah.

Anonymous Female Speaker 31:04
So there's a fine line between advocating for yourself and being seen as difficult. And so as diabetics, we we have to know our bodies. And we have to know like, Look, I am very sensitive to exercise, I need to do this, you know, if we're going to do this activity, but when patients start dictating their care, I think that that sometimes causes a negative reaction from staff,

Scott Benner 31:40
can it come off as unstable, even if you're being realistic? Because a lot of people don't know what it takes to manage diabetes? So if you started listing things off, could you seem unstable while you were doing that?

Anonymous Female Speaker 31:52
I mean, that I mean, the setting, it depends on the setting, right? If you're in if you're in, like a psychiatric unit, and, and you start saying, like, I have to worry about this, I have to do X, Y, and Z. And I have to make sure this is like that. And, you know, gonna seem paranoid. Like, that sounds like anxiety or like a little bit obsessive, don't you think? Right. And so it really depends on the context about that. Whereas in other settings, it's like, wow, they're really on top of it.

Scott Benner 32:20
Right? Yeah. So what about if I'm just like, I don't know, I'm a very well managed type one who really understands that I'm going to go in for something because I need it right. And I'm, but I'm going to be there for a month. Is there a way to talk to the hospital as you're going in? Or do you think you're just going to be treated in that one size fits all situation that you explained earlier?

Anonymous Female Speaker 32:42
I mean, I think like, again, six of my night admissions were at the same facility. And so they, they knew me, and they were comfortable with me, I was comfortable with them. But I think, especially when it comes to people who are struggling with like suicidal ideation, or insulin omission, they want me to be cautious, because of the potential of what could happen. I lost my train of thought, I don't know where I was going with that. But um, you have to figure that out with the place you're at.

Scott Benner 33:17
Okay, so you can't just walk in and say, I've got a plan, I need you to follow my plan, you're gonna have to do it hand in hand with them and get it straight.

Anonymous Female Speaker 33:26
Right? Because they might have rules that you there are some units that won't allow insulin pumps, because you could hurt yourself with it. Right? Exactly.

Scott Benner 33:35
They're gonna want to have control over your insulin and be the only one who's administering it.

Anonymous Female Speaker 33:39
Exactly. So the fact that I could was based on my history of symptoms, and also my relationship with them, but I knew a lot of people who went from a pump to like shots when they were in the hospital.

Scott Benner 33:57
Was your blood sugar higher during that time? Like

Anonymous Female Speaker 34:00
while I was in the hospital? Yeah. Oh, no, that was actually when I had my best a one C. And I like framed it. It was 6.9 Because you were focusing on it. Like, to be honest, I don't know. Why. Some I mean, sometimes, yeah. Like, I'm not really quite sure. Because I mean, I was testing four to six times a day before that. I was always giving my insulin I was eating I was well, I mean, I was not eating, I was exercising. But I think sometimes like the stress of like starvation, just in and of itself leads to overall higher blood sugars. So even when you're not eating, you're you're I guess, I don't know if you're, like throwing out some glue gun or what but yeah, I my, I had an agency of 6.9 when I was impatient, and it's not I haven't been able to get that sense.

Scott Benner 34:59
What What would you want colleagues to know about type one? So other psychiatrists, if you if they asked you, you know, fill me in about diabetes? What do I need to know? If I'm helping someone with type one? What do you think they need to know?

Anonymous Female Speaker 35:14
It's not a matter of just following a few simple rules, you could do everything you're told and still have crazy blood sugars. And I've also had patients who don't do anything that they're told to do, and their agencies are better than mine. So, you know, it's like, not necessarily a reflection of one's effort. Yeah. And it consumes you. I mean, it has to like every, you can't just forget about it. So

Scott Benner 35:45
you, you would like doctors to know more about the personal and psychological side of diabetes? Not, you wouldn't your first thought is, they should understand how to use insulin or how it works or what some of the struggles you might be having with high and low blood sugars. Because of your I think

Anonymous Female Speaker 36:00
it depends on on the specialty, like for as a psychiatrist, I'm not going to be prescribing insulin, but I can, when and then when I do get patients with type one diet with diabetes. I do I say it sucks. Like, it's like the, you know, they get frustrated with their hives or, you know, their limitations. And I think being able to recognize how it impacts somebody's day and their relationships. And so it depends on what your specialty is, in terms of what you would focus on. But yeah, I don't need to know about like their insulin. As long as like, are you taking it? Are you skipping your insulin, but I wouldn't be adjusting someone's insulin.

Scott Benner 36:48
Are there any psychiatric meds that could impact people's blood sugar's? Oh,

Anonymous Female Speaker 36:52
yeah. So all of our anti psychotic medications, which aren't just used for psychosis, but I mean, most commonly, they're, they're used for like schizophrenia and bipolar disorder, but even some patients with anxiety and depression are on these medications. And so they can affect blood sugars, but in a large percentage of our like, chronically ill patients, they do lead to type two diabetes. Okay.

Scott Benner 37:20
The medications can,

Anonymous Female Speaker 37:22
yeah, because weight gain and insulin resistance. Yeah.

Scott Benner 37:31
But, but it's a it's a catch 22 Because you feel like they really need this medication.

Anonymous Female Speaker 37:35
Right. And it's not like, you take the pill and your blood sugar goes up. It's a matter of, like lifestyle. And, you know, sadly, a lot of our chronically ill patients don't have access to like good food and, and the ability to exercise and so it's, it's just a vicious cycle.

Scott Benner 37:55
Do you see people trying to medicate their psychiatric situations with with weed? And does that work? Or does it make it worse?

Anonymous Female Speaker 38:03
I see patients trying to treat everything with wishes. Like,

Scott Benner 38:09
I stubbed my toe, I think we would fix it. I gotcha. Like,

Anonymous Female Speaker 38:13
I'm like, constipated I have diarrhea, like, you know, it's like everything with weed. And they won't take like prescription meds because they want things that are all natural. I haven't seen cannabis or whatever be the miracle that it's supposed to be. But I see people trying all the time.

Scott Benner 38:29
Yeah. And do you see it make things worse ever? Patients will never tell you it makes it worse. There are studies that say that you could soak some people's brain chemistry, right. You could get blasted enough that it could alter you in a way that you don't get to come back from I know, it's not a very common thing that happens, but it is it is possible, right?

Anonymous Female Speaker 38:49
Especially the the synthetics like those can make you very sick. But I mean, I'll have patients who are requesting stimulants because they're so tired. And it's like, Whoa, how much weed Are you smoking? That's not what's making me tired. You know, and

Scott Benner 39:07
I think it's their ADHD. I need my ADHD medication, right?

Anonymous Female Speaker 39:10
I can't focus. How much weight are you smoking? That's telling me this?

Scott Benner 39:16
How much is that being? How much is ADHD medication being abused? professionally? Are they just giving it to everybody?

Anonymous Female Speaker 39:25
So I guess I'm the generation of Doc's before me, were very into, like pleasing the patients at the expense of like, their health. And so when I was in med school, we were taught like, pain is a vital sign and pain is unacceptable. We have to treat pain and so I've seen a lot of patients whose doctors were all about, you shouldn't have pain, you shouldn't have anxiety, and you should have like super Human focus, but basically pathologizing just being human. Yeah. So I think my generation, we're trying to kind of come back from pullback. And, you know, we're facing patients with a lot of struggles with addiction. And, sadly, these patients are getting angry.

Scott Benner 40:21
Well, they're are they addicted to that medication at this point? Yeah, yeah. Right.

Anonymous Female Speaker 40:25
I mean, you hear of people going and, you know, shooting their doctors for not giving them their prescription. So they're, they're addicted, they're dependent. And they've not been told no before. But it's like, at this point, you know, it's like, do we actually need this medication? Is this actually clinically indicated? Is it helpful? And just giving you what you want isn't exactly my job. Yeah,

Scott Benner 40:51
I want to go back over that, actually. Because so what we're saying here is that, at some point, the teaching was you shouldn't be having human problems, pain, anxiety, stuff, like, I don't mean then crippling anxiety. I mean, just being anxious and like, then it gets around, right. So you start prescribing it to the people who really need it. And then people are out in the world. They're like, Oh, I used to be anxious. But you know, I told my doctor, and this happened, or I used to have trouble focusing. But now I'm on ADHD medication, which is like, it's it's speed, right, like ADHD medication is,

Anonymous Female Speaker 41:27
it's an it's like, some people

Scott Benner 41:29
need a Yeah, right. But what I'm saying is, then they get out into the world, and then somebody who has a tiny bit of trouble focusing, it's like, Ooh, I love that. And now we're basically putting them on speed. And they're hyper focused. Right,

Anonymous Female Speaker 41:41
right. And, and I think we've, like when patients come like, oh, you know, my parents died. And I'm very sad. It's like, yes,

Scott Benner 41:53
that is how we, that's a sad thing. We're supposed to be sad. When that happens. You're I am. So like, sometimes

Anonymous Female Speaker 41:59
I'll be asked, like, I need medication to get rid of my normal response to things. And so I often hesitate, because when patients eyes are really crappy, I don't want them to think, well, if you take this pill, you'll you'll just be you know, happy and dancing on tables, despite everything that's going wrong. So I'll discuss that with my patients. Like, I'm not giving you this medication, because I think that you shouldn't be dancing on tables. But to take the situation out from like, right in front of their face and give them some room to breathe to actually process the situation.

Scott Benner 42:36
Did this happen with depression medication to it start off with people who are crippled and depressed and then go down to like, I feel a little sad sometimes, like, Here, take a pill, you'll feel better.

Anonymous Female Speaker 42:46
Exactly. Yeah. And so that's part of being human are moods go up and down. And, you know, we respond to things and when if we don't, I'm more concerned, like when when patients are saying like, Oh, I'm anxious about, you know, I'm moving across the country and starting a new job. I'm really anxious about that. That's appropriate. I'm not going to medicate that away, you know, if the anxiety is to the point where it's like, I can't leave my house. And I have to like flip the switch 14 times. Um, you know, that's different. But

Scott Benner 43:21
so this is not just happening in physical doctoring. It's happening in mental health doctoring as well, like that idea of like, eventually, it just becomes so commonplace that the mere mention of it's almost like, if somebody came to you and said, Hey, listen, I eat an entire pizza, and then I had acid reflux, you would might want to say to them, don't eat so much pizza, but instead, some doctors gonna be like, oh, we'll take this proton pump inhibitor, that'll get rid of the acid reflux. Right? Right. And you're telling me, you'd be more worried about a person who came into your office and sat down with you and said, My parents just died? And I'm not upset at all? That would be Yeah, that would be more concerning, then. I'm sad. Yeah.

Anonymous Female Speaker 44:00
I tried to normalize emotion. Because we've we've gone from like, one end of like, don't tell anybody about your feelings to like pathologizing every emotion. Yeah, I think we're kind of trying to find a healthy middle ground. Since

Scott Benner 44:18
we're gonna keep you anonymous. Yeah, I'm gonna ask you another question. I don't know. I don't want to be judged by my question. Okay, so the thing I'm noticing it feels like a lot of people want to be labeled Hmm They want a diagnosis of something Yeah. To explain their personality almost. Is that is something you see as well or am I making that up? Yeah,

Anonymous Female Speaker 44:42
I've been my patient population is is different because I'm seeing like the medically ill patients a lot of my patients are like, much older but I am noticing especially with with younger folks and it's like it before you never would talk about like, you know, depression or anything but now I was like, there's almost some pride in having a label. You know, like I am bipolar and, and we often and they're often used in correctly. I have PTSD. Well, yeah. Oh, if people say they have OCD, and then they're like, because I like my desk to be clean. I like that drives me bonkers.

Scott Benner 45:21
That's not OCD. OCD is stepping in and out of a room 75 times so you can leave.

Anonymous Female Speaker 45:25
Right? Yeah. Like, I need to call my mom because I might have killed her. And I need to check that I didn't kill her.

Scott Benner 45:33
Oh, and there's no way you killed her because you weren't even with her? Well,

Anonymous Female Speaker 45:37
I because I said something badly about her. Oh,

Scott Benner 45:39
I stepped on the crack. Break your mother's back like that line of thinking, Oh, yeah.

Anonymous Female Speaker 45:44
I've been convinced that I've killed my cat because I used the wrong machine at the gym. And so like, I wouldn't ever use that machine again. That's OCD.

Scott Benner 45:54
Tell me that you've literally used the wrong gym equipment. And your brain told you this action we've involved ourselves in may have killed our cat.

Anonymous Female Speaker 46:04
Yeah, because my cat died the day I changed machine.

Scott Benner 46:07
Oh, that's OCD when we're talking about OCD. Okay. All right. I

Anonymous Female Speaker 46:11
got and it's like, I know, that's not possible. Like, I don't want to test it out. Because we'll die in the next time.

Scott Benner 46:20
That's where the illness comes in. Right? OCD. Yeah, like there's a difference. So if you're walking along in a sidewalk, and I put it in your head that if you stepped on a crack, your mom's back would break. And then we had a conscious conversation about it, where we all discussed it and believe that there was no way that you stepping on this crack would break her back, I couldn't get you to put your foot on that crack still. No,

Anonymous Female Speaker 46:40
OCD is different for everybody. So it's like you couldn't induce like, an obsession or compulsion in me. But if you had it, the connections are drawn in my interested in my irrational head. So nobody said, like, what did you do this morning? Because our cat bought it? Clearly, it's tied to something you did. Yeah. But the OCD brain is like, Well, I must have done something. And if I did, that means that if I don't do that, again, I can control the outcome. I say, um, so there's, there's some of that to

Scott Benner 47:15
something and the idea of like, wanting to be labeled, so you don't think I'm off on that, like, people find comfort and being like, there's a couple of them from the last couple of years that really throw me off. You're not all being gaslighted? That's one thing. And every guy you met isn't toxic. And what's the other one that Oh, you're not autistic? If you're not autistic, like like the amount of adults who want to tell me, I have a little autism, like, you don't have a touch of the autism? Is that what you're saying? To me? I'm a little prick. Yeah, you know, I think sometimes I think I might be autistic. That's very insulting to people who are actually autistic, first of all, and, or have autism. I'm sorry, if I'm using the phrasing wrong. And but what a weird, odd thing to say. Like, like, like, it would be like walking around and saying to somebody, like, Oh, I think I have diabetes, right. Sometimes I think I might have a little diabetes, or, um, you know what I mean? Like, I don't understand, there's this thing. I'm assuming that most people would give away if they could wish it away. And you're telling me because of a personality trait, you think maybe you have a little bit of it. I don't know what that means. I think, like more

Anonymous Female Speaker 48:22
of like, this explains my behavior. And I don't maybe have to work on myself because I have a diagnosis that like, I

Scott Benner 48:31
can blame you because by the way, if you have autism, that's I'm not arguing about that. I'm literally talking about people walk around who like say something silly and go like, or they get confused about something. You've seen it right. Like, it's the weirdest damn thing. Like, oh, that's my autism or, oh, yeah, that's my Autism Act. And up. I'm like, What are you talking about? And it's not an isolated thing. People love saying stuff like that. Yeah,

Anonymous Female Speaker 48:57
I had a colleague that would mean she wasn't great. interpersonally but everything was because of her autism.

Scott Benner 49:05
What's the one where you talk and then you're tired from being around people? I'm introverted. Yeah, I have so I'm socially awkward. Like like I guess there are some people are socially awkward. Just some people just don't like talking to other people. You're not socially awkward. You don't enjoy talking to people. Like Like, it's it's okay, if you don't, and

Anonymous Female Speaker 49:22
then people will say antisocial, and that's not they don't mean antisocial. They mean a slow

Scott Benner 49:27
Alright, anti socials. Like that's a real mental distinction right where you could kill somebody.

Anonymous Female Speaker 49:34
antisocial people, you know, are tend to be very charming, but often, you know, they're out for themselves and not really worried about others. Yeah. And so antisocial. People often become politicians and CEOs, but they're often also on the other end of the spectrum, just they, you know, harm other people and they have they have no remorse like a handsome serial killer kind of a situation. Right? All right. So anyway, Liz, so many people are so interested in labeling themselves all the time, do they actually cause themselves more problems than they would if they just bumped up and said, This is who I am, and like, I just like it or don't like it, I don't care and let me move on, or I'm doing this thing. And I'd like to change. So I have to put the effort into changing. I think the, the labels often lead to being medicated when it's not necessary. And I think that that, you know, being labeled being medicated being then, like, pigeonholed and like groups of other people who have that diagnosis. I think that definitely changes like your your behavior, but also your your chemistry and right. Yeah, I mean, when you start saying that, like I have this illness, I am this illness, I think your trajectory changes. Yeah,

Scott Benner 50:58
I want to be very clear, I'm not talking about the anyone who's actually afflicted or has something or I'm talking about the people who live in the, in the nebulous part in between, and they just want to, they just want to say things for me, you talking about advocating for yourself, I think you have to be very aware that everything looks like a nail to someone who only has a hammer, right? So if you're eight, so if you go to a surgeon, and your toe hurts, the surgeon is going to want to do surgery, if you go to a physical therapist, a physical therapist is going to do physical therapy, if you go to a psychiatrist, they might write you a med, if you go to a therapist, they might want to talk at the desk, everyone's gonna use the tool they have at their disposal. A good anything will say, Hey, you called an electrician, but you need a plumber. Right? But a bad electrician will say you call me I'm going to find a way to bill you for this. Exactly.

Anonymous Female Speaker 51:47
Because I mean, I do that all the time where I'm like, I don't think medication is necessary. I'm not going to push this pill on you. When I think you know, I think therapy would be better or but yeah, I mean, then you create a customer base, you know, and they keep coming back. Yeah. As physicians, we need to be really cognizant of, like, if I had other tools, would I would I use those? Or am I just using this? Because there's all I've got?

Scott Benner 52:16
Yeah, I mean, like if I see somebody in talk therapy for 30 years, I think, man, you're paying for someone's boat, this brain? Yeah, yeah. Like, you ain't got this worked out yet. But you're maybe you're in the wrong spot, then if that's the case, and not to say that you couldn't value. Listen, I think if you wouldn't spoke to somebody for the rest of your life, it would be valuable. But if you're in there saying I have a problem a and we're this close to getting it fixed, but we never quite get there. I think you got to wonder about that a little bit. Maybe this isn't the therapy for you, or not the right therapist, or you're barking up the wrong tree or whatever. It's just it's, I don't know, this all seems very obvious to me, I have to tell you.

Anonymous Female Speaker 52:57
I mean, but I think some people are just like, so desperate for help or answers or Yeah. And then like, if I'm doing therapy, that I'm doing something, but not really taking stock of like, is this effective, like, and kind of going back to the diabetes, like, in retrospect, you know, I'm, I, you know, I check my blood sugar, and I give insulin and all this, but I never made adjustments because my blood sugars were high. That just wasn't part of it. And so, but I always felt like, while I'm doing what I'm supposed to do, so, like, I literally had the thought, Well, I'm doing what I'm supposed to do. So I won't have consequences.

Scott Benner 53:39
And if I do, it's not my fault. It's someone else's.

Anonymous Female Speaker 53:41
Some people do that. But mine was like, I'll be protected from from the consequences because I'm at least doing what I'm supposed to be

Scott Benner 53:50
interesting. Oh, God, I have to tell you, because we mixed your personal story with your background. Like there's there's a blend in this hour, but the last half an hour of it is I haven't such a good time. So like not that I wasn't in the beginning. But in the beginning, I was like I was told interview, let me know, let me find out about our life and everything like that. But then when we really dove into it, I was like, Oh, this is the lane for this conversation right here. This is perfect. You are having a unique situation you are a you're a psychiatrist, not nothing wrong with therapy, but you're not a therapist, you're not a you're a psychiatrist, you're you're a medical doctor. At the same time you are and have been in need of a doctor of your type. And you have type one diabetes, and you grew up at a time where there wasn't a lot to expect out of management.

Anonymous Female Speaker 54:40
Yeah, and then I mean, we could go even deeper as like as a physician being terribly unhappy with the system like the medical system as it is and then becoming victim of it as a patient to

Scott Benner 54:55
let's finish with that. What's wrong with the system in psychiatry I

Anonymous Female Speaker 54:59
I can't say psychiatry specifically. But the the medical system is failing us, like completely. I don't know how to fix it every day, I feel like we're, we're doing more harm than good. I think it's a matter of, well, that it's become a business. And that like hospitals are run by people with business degrees and not with medical degrees. Doctors are encouraged to do more, faster, not better. And it results in in bad care. Yeah, I it seems like I feel like at this point, the system is basically it has to crumble, and we have to rebuild it. But I don't know how long that's going to take. And it feels like it's, it's very close,

Scott Benner 55:51
it almost feeds itself. It's interesting, this conversation shows you too, it almost feeds itself very great it makes like this, the way things are set up, make people who think they need all this help, then then they go for the help to a bunch of people who were told 15 minutes, make sure there's something on that paper you can check off that we can bill insurance for and then get them out of here.

Anonymous Female Speaker 56:12
Right. And then, and then, you know, mediocrity is kind of what we're aiming for in medical care, unfortunately. And so that's rewarded. And so you know, in 15 minutes, I can give you like, three different prescriptions, and then you'll be happy and you'll come back, and I'm probably hurting you more than I'm helping you. Yeah. But if I were to have an hour or two with you, I would probably be able to help you better, but I would help fewer, or help in quotes, I'd see fewer people, so I'd make less money. Right.

Scott Benner 56:46
You know, I spoke at an event this recently, and like hundreds of people with diabetes parents of children, adults, and the feedback that's coming back from it already is wow, you know, he was just here a couple of days ago, like, look at my graph. My graph is so much better. I'm doing this better. I'm doing that better. Bob, I just, I was just with a group of people. And I floated in and out of conversations and gave talks every once in a while. Yeah. Like

Anonymous Female Speaker 57:11
I'm, I'm very intrigued by, like, when I'm, you know, seeing other people and like, their, their graphs are phenomenal. So that I have to admit, but I also worry about them. Because I see people posting like, like, Oh, my goodness, my, my, my daughter's blood sugar went to like 150. And, and it's like, well, that's great. So it's like, I do worry that like the that we might be breathing like this. Perfectionism

Scott Benner 57:40
if I may I think it's possible you're worrying about them through your lens. Totally

Anonymous Female Speaker 57:45
100% Like, like when people are like I worry about the kids on like the low carb diets. But you're right, it's 100%. Milans. Yeah,

Scott Benner 57:55
but it's a valuable perspective, like it can, because there are going to be there are going to be people out there who are going to have your reaction to it. Like when it's put on them, or when it's their their walk that they're walking. And there's just as many people who like can say, Oh, 150 I messed up a meal. Let me fix that and never think about it again. Yeah,

Anonymous Female Speaker 58:16
and I don't even I don't even think I messed up, like my blood sugar's 150. And then I go on.

Scott Benner 58:24
Yeah. But my point always is like, like, look, I don't know the right answer for the world, right? My point is, let's put all the information out in the world, and those of us who want it and can use it. Good. And for those of us who need to modify it, so it fits us better. Good, but at least we all know, you don't I mean, and whether or not it's going to see the I can give you the opposite argument, which is if we hold back information so that people who are burdened don't feel more burdened than people who would not be burdened by it are going to be unhealthier. Needless, yeah, no, I

Anonymous Female Speaker 59:03
mean, I'm I think it's wonderful and people's lives are being changed. And I think also like, I was this perfectionist, and I was, I always thrived on like, people telling me how good I was with like, nobody really, really cared what my blood sugar's were but they knew I ate right I exercised and I checked my blood sugar. I was told like, Oh, you don't cheat on your diet. I was I was always a good diabetic. And then I but I'm like, the standard is getting really high. Now.

Scott Benner 59:37
Well, you're a professional perfectionist by by manifest of your of your OCD. Right,

Anonymous Female Speaker 59:44
right. Yeah. And so that's what I think they end when I've gone into the hospital and no longer been really in control of what I eat. I see myself like trying to perfect the blood sugars. That's me, not everybody else. Yeah, it's also interesting to be so awesome to be able to see like, stable blood sugars. Like,

Scott Benner 1:00:07
I wish you could watch your blood sugar through my eyes for a week. Because you wouldn't hold on to like anything. You just see this? You don't I mean, I've

Anonymous Female Speaker 1:00:17
never I don't adjust my insulin. I only I wait till my endocrinologist. You've been doing this

Scott Benner 1:00:24
for 30, like 35 years, why not? Why won't you adjust your insulin? Well,

Anonymous Female Speaker 1:00:28
I think in part more recently, it's like, as a physician myself, when patients adjust their meds, it's especially like controlled substances. It's, it's just, it's not good. But it's also like, frustrating, but I mean, that can't be the only reason. You know,

Scott Benner 1:00:47
yeah, we're not talking about like, let me just take two more of these Zoloft. Like that's not like, right, right. Yeah, it's, this is a very specific, this is a very a because, you know, if you made adjustments, you'd be better off, right. Like for outcomes and numbers? Yeah,

Anonymous Female Speaker 1:01:02
I just where do you think we don't know how to do it? Person honest, like, I don't know. I don't know if it's what those adjustments are like, this is like, it's like, fairly embarrassing.

Scott Benner 1:01:13
I'm enjoying listening to be so, so honest. It's great. When you when you're anonymous, isn't it you can just say, gay, you can just let it go.

Anonymous Female Speaker 1:01:23
I mean, you know, is like a carb ratio issue is a sensitivity issue. And, and, or did they just count the carbs wrong? Or like, yeah, you know, blame the diabetes fairy. So I blame her a lot.

Scott Benner 1:01:39
So, so for you and algorithm really is valuable. The Omnipod five, like just kind of I don't really want to know what it's doing. I just needed to do it.

Anonymous Female Speaker 1:01:47
Well, I would like you would, I would like to know, and it doesn't always do it well, like being like, in the closed loop. I'm still you know, in the mid seven,

Scott Benner 1:01:59
perfect. You're not Pre-Bolus thing because of gastroparesis, but you could be doing, you can Pre-Bolus a little bit with gastroparesis, then putting the rest once you know, you're seeing the impact, and that alone might stop your spikes.

Anonymous Female Speaker 1:02:11
Yeah. And then also, like, I use the Ask, which is like, supposed to be really fast acting right. And so I guess I was told that, you know, I'm a pump and with this insulin, you don't

Scott Benner 1:02:25
need to get the feeling like it's fast acting. It works right away. Right. Yeah,

Anonymous Female Speaker 1:02:29
it doesn't work that right away. Yeah, gastroparesis is really not the main reason. Okay,

Scott Benner 1:02:35
well, then, may I make a suggestion? Please? Episode 1000 to the podcast through episode 1025 Is the diabetes Pro Tip series. Okay, if you listen through that, and you don't have an A one C and the low sixes afterwards, I'll be surprised. Really? Yeah, I promise.

Anonymous Female Speaker 1:02:54
Just like exercise is big for me. Okay. You can exercise. And like that. That has been very helpful. But I do worry about being getting too much insulin and exercising.

Scott Benner 1:03:10
Would you be willing to try it? Yeah, email me when when you're done with it. Listen through there. Like I think it's 25 or 26. Episodes what they begin at 1000. And you listen to those, and then send me an email three months later and tell me if things aren't better. Okay,

Anonymous Female Speaker 1:03:27
and like this, or like, I will understand what you're talking about.

Scott Benner 1:03:31
Oh, my God, of course. Did you understand me while we were talking now? No, I didn't really win you over at the diabetes stuff. You didn't some of that.

Anonymous Female Speaker 1:03:39
No, no, I'm just kidding. I was like, Wait, now you're gonna be sarcastic. I have no idea what you said this whole time. Don't

Scott Benner 1:03:46
add sarcasm now. Like, we either gotta lead with it and go the whole way. Or like, you can't just drop it into the end. I was like, Oh, my God.

Anonymous Female Speaker 1:03:55
You have no idea what I said. No. I was a psychiatrist. I pretended that they did.

Scott Benner 1:04:00
Oh, that's very interesting. Tell me more. Is that what you say? When you not offer a second when somebody's talking? Oh, that's interesting. Can you put that in a different way for me? Yeah.

Anonymous Female Speaker 1:04:12
What you're saying, Tell me again,

Scott Benner 1:04:14
let me read you know what, instead of me recapping, you just tell me which, which means I was thinking about my checkbook and that I was thinking of having Chinese tonight, right?

Anonymous Female Speaker 1:04:23
Or I wonder what my blood sugars do.

Scott Benner 1:04:25
I would genuinely be interested to hear from you after you listen through that a couple of months after you did.

Anonymous Female Speaker 1:04:30
Okay. I'm excited to try something because what I'm doing is is not working.

Scott Benner 1:04:36
Oh, all right. Okay, well, then let's call it a promise from you. And then we will. We'll get that out. You'll I'll hear back from you at some point. Okay.

Anonymous Female Speaker 1:04:45
My doctor is not going to get like upset with me. Well, she doesn't carry my phone calls or messages.

Scott Benner 1:04:51
She's not responding to your phone calls and messages. I say maybe we don't care what she thinks.

Anonymous Female Speaker 1:04:57
I sent her I sent her a message. I think so. Six weeks ago, I'm still waiting.

Scott Benner 1:05:03
Well, I think by the way, I think I'm gonna I'm gonna get this anonymized. I'm gonna put it in the cold wind series and I'm gonna call it cold wind professional perfectionist. Oh, I like Yeah. All right. I gotta jump. So let me say goodbye. Okay.

Anonymous Female Speaker 1:05:16
All right, wonderful. It was nice to talk to you to.

Scott Benner 1:05:23
Mark is an incredible example of what so many experience living with diabetes, you show up for yourself and others every day, never letting diabetes to find you. And that is what the Medtronic champion community is all about. Each of us is strong, and together, we're even stronger. To hear more stories from the Medtronic champion community or to share your own story. Visit Medtronic diabetes.com/juice box. Don't forget, we still have marks conversation at the very end. It's a terrific kind of mini episode about 10 minutes long, that goes deeper into some of the things that you heard Mark talking about earlier in the show. A huge thank you to one of today's sponsors, G Vogue glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. A huge thanks to us med for sponsoring this episode of The Juicebox Podcast. Don't forget us med.com/juice box this is where we get our diabetes supplies from you can as well use the link or call 888-721-1514 Use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. You have questions? Scott and Jenny have answers. There are now 19 ask Scott and Jenny episodes. That's where Jenny Smith and I answer questions from the audience. If you'd like to see a list of them, go to juicebox podcast.com up into the menu and click on Ask Scott and Jenny. And now my full conversation with Medtronic champion, Mark. Mark. How old were you when you were diagnosed with type one diabetes? I was 2828. How old are you now? 4747. So just about 20 years? Yeah,

David 1:07:42
19 years?

Scott Benner 1:07:43
What was your management style when you were diagnosed?

David 1:07:45
I use injections for about six months. And then my endocrinologist at a navy recommended a pump. How

Scott Benner 1:07:51
long had you been in the Navy? See eight years up to that point? Eight years? Yeah, I've interviewed a number of people who have been diagnosed during service. And most of the time they're discharged. What happened to you?

David 1:08:03
I was medically discharged. Yeah, six months after my diagnosis.

Scott Benner 1:08:07
I don't understand the whole system. Is that like honorable? Yeah. I mean,

David 1:08:11
essentially, if you get a medical discharge, you get a commensurate honorable discharge. I guess there could be cases where something other than that, but that's that's really how it happened. So it's an honorably discharged with but because of medical

Scott Benner 1:08:22
reasons, and that still gives you access to the VA for the rest of your life. Right?

David 1:08:25
Correct. Yeah, exactly.

Scott Benner 1:08:26
Do you use the VA for your management? No,

David 1:08:28
I used to up until a few years ago, when we moved to North Carolina, it just became untenable, just the rigmarole and process to kind of get all the things I needed. You know, for diabetes management, it was far easier just to go through a private practice.

Scott Benner 1:08:42
Was it your goal to stay in the Navy for your whole life? Your career was? Yeah,

David 1:08:45
yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we've made the decision despite all the hardships and time away from home, that was what we love the most. So that's what made it that much more difficult

Scott Benner 1:09:02
was the Navy, like a lifetime goal of yours or something you came to as an adult lifetime goal.

David 1:09:07
I mean, as my earliest childhood memories were flying being a fighter pilot and specifically being you know, flying on and off aircraft carriers. So you know, watching Top Gun in the ad certainly a weight was a

Scott Benner 1:09:19
catalyst for that you've taken off and landed a jet on an aircraft carrier 100 times is there anything in life as exhilarating as that? No,

David 1:09:28
but there there's a roller coaster I wrote at I think it was it's Cedar Rapids up in Cleveland Sandusky, and they've got this roller coaster rotation from zero to like, it's like 80 or something. You go up the big hill and you come right back down. So the acceleration is pretty similar. I would say to catapult shot I'm

Scott Benner 1:09:46
gonna guess you own a Tesla.

David 1:09:49
I don't I I'm a boring guy. I got a hybrid rav4 I get made fun of I get called. You know, my my wife says I drive like a grandpa. I'm a five miles per hour open. Speed Limit person, no more than that. So yeah, in the car, I'm boring Scott. So

Scott Benner 1:10:03
you've never felt a need to try to replace that with something else.

David 1:10:07
You can't replace it. It's irreplaceable. That's what I thought. So up until the point where someone you know, buys me an F 18, or allows me to get inside a two seater and fly it, you can't replace it. How did

Scott Benner 1:10:17
it make you feel when you saw or maybe you haven't seen? gentleman named Pietro has his large aircraft license. He's flying for a major carrier. Now he has type one diabetes, does that feel hopeful to you?

David 1:10:27
Yeah, it does. You know, when I when I was diagnosed, that wasn't a possibility. The FAA prohibited commercial pilots who had type one diabetes, but I think it was 2017 when they changed their rules to allow type one diabetics to be commercial pilots. And part of the reason they did that was because of the technology advancements, specifically in pump therapy, and pump management. So I don't have any aspirations of going to the commercial airlines. But one of my sons who has type one diabetes very much wants to be a commercial pilot. So, you know, in that respect, I'm very hopeful and thankful. Yeah.

Scott Benner 1:11:00
Do you fly privately now for pleasure?

David 1:11:03
I do. Yeah. One of my favorite things to do is fly my kids to the different soccer tournaments they have all over the southeast us. So last week, my wife and I and two of our boys flipped to Richmond for their soccer tournaments up there. And Charlie, who's my middle child has type one diabetes. So you know if I can combine flying family and football and one weekend to me that's I think I've just achieved Valhalla.

Scott Benner 1:11:27
So then it sounds to me like this diagnosis was a significant course correction for you. Can you tell me how it affected your dream?

David 1:11:34
Well, I you know, if I guess three words come to mind first, it was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant. And I was not prepared for that at all. The second emotion was, it was scary. I hadn't thought much about life outside the Navy, certainly not life as anything else, but a fighter pilot. And Heather and I were getting ready to move to France, I was going to do an exchange tour with with the French naval air force. So we were taking French classes. So pretty quickly, I had to reinvent myself. And then probably the most important thing at the same time that all that was going on, I had to learn how to deal with type one diabetes, and how to manage it effectively. The third thing that pops into my mind, I guess, is challenging, you know, new daily routines, I had to establish first with injections, and then eventually, you know, through pump management, and then learning how to count carbs and recognize highs and lows, how my body reacts to blood sugar trends based on exercise and stress and those types of things. And my goal at that time, and it still is today is to leverage technology and make sure my habit patterns are effective so that I take diabetes management from the forefront to the background.

Scott Benner 1:12:41
Have you had success with that? Do you feel like you've made the transition? Well,

David 1:12:45
I have I mean, I believe in continuous improvement. So there's always more to do. I will say the technology since I was diagnosed specifically with pump management, it's just, it's just incredible. It takes less of me intervening, and it's really done by the pump itself and by the algorithms through the CGM comes in to me again, that that should be the goal for everybody is to not have to focus so much on the daily aspects of type one, diabetes management, you know, we should let technology do that for us.

Scott Benner 1:13:14
What else have you found valuable? I've spoken to 1000s of people with type one diabetes, the one thing that took me by surprise, because I don't have type one, myself, and my daughter was very young when she was diagnosed. I didn't really understand until I launched this podcast, and then it grew into this kind of big Facebook presence. I heard people say, I don't know anybody else who has type one diabetes. I wish I knew more people. But until I saw them come together, I didn't recognize how important it was. Yeah,

David 1:13:43
I think similarly, I didn't know anyone with type one diabetes growing up as an adult up until when I was diagnosed. And then all the sudden people just came out of the woodwork. And when CGM is first hit the market, certainly within the last five years. It's amazing to me and my family, how many people we've noticed with type one diabetes simply because you can see the CGM on their arm. I mean, I would say, a month does not go by where we don't run into someone at a restaurant or an amusement park or a sporting event or somewhere where we see somebody else with type one diabetes. And the other surprising aspect of that is just how quickly you make friends. And I'll give you an example. We're at a soccer tournament up in Raleigh, this past Saturday and Sunday. And the referee came over to my son Charlie at the end of the game and said, Hey, I noticed you're wearing pomp. And he lifted up his shirt and showed his pump as well and said, I've had type one diabetes since I was nine years old. I played soccer in college, I'm sure that's your aspiration. And I just want to tell you don't let type one diabetes ever stop you from achieving your dreams of what you want to do. And it's the other man was probably in his late 50s or 60s. So just having that connection and seeing you know, the outreach and people's willingness to share their experiences. It just means The world to us, it just makes us feel like we're part of a strong community. Yeah.

Scott Benner 1:15:03
So would you say that the most important things are strong technology tools, understanding how to manage yourself and a connection to others. Yeah,

David 1:15:12
technology for sure. And knowing how to leverage it, and then the community and that community is your friends, your family, caregivers, you know, for me, the Medtronic, champions community, you know, all those resources that are out there to, you know, help guide the way but then help help you keep abreast on you know, the new things that are coming down the pike, and to give you hope for eventually, you know, that we can find a cure, you

Scott Benner 1:15:34
mentioned that your son wanted to be a pilot, he also has type one diabetes, how old was he when he was diagnosed,

David 1:15:40
so Henry was diagnosed when he was 12 years old. That was just at the start at COVID, we were actually visiting my in laws in Tennessee, we woke up in the morning, and he had his bed. And several years before that, we had all four of our boys tested for trial net. So you know, predictor of whether or not they're going to develop type one diabetes, and Heather or Henry and one of his brothers tested positive for a lot of the indicators. So we always kind of had an inclination that there was a high degree of possibility he would develop it. But we always had at the back of our mind as well. And so when that event happened, at the beginning of COVID, we had him take his blood sugar on my glucometer. And it was over 400. And so right away, we knew that without even being diagnosed properly, by endocrinologist that he was a type one diabetic, so we hurried home, to get him properly diagnosed in Charlottesville. And then we just started the process, first grieving, but then acceptance, and, you know, his eventual, becoming part of the team that nobody wants to join,

Scott Benner 1:16:43
how old is he now?

David 1:16:44
He's 15 years old. Now,

Scott Benner 1:16:46
when's the first time he came to you? And said, Is this going to stop me from flying almost immediately.

David 1:16:53
So like me, he always had aspirations of flying. In fact, he out of all four boys wanted to be in the military, that was a difficult part of the conversation, and maybe something that we don't talk about as a community. But there are some things you cannot do as a type one diabetic, and that's a hard fact of life. And unfortunately, joining the military is one of those hard and fast things you cannot be, you cannot join the military as a type one diabetic. So it was very difficult for him and for me and my wife to get over. Then we also started talking about being a commercial pilot. And so I saw that same excitement in his eyes because like me, you know, he can be an NFA teen or a 737 or a Cirrus SR 20 That I fly and be just as happy. So he still has that passion today and still very much plans to eventually become a commercial pilot.

Scott Benner 1:17:37
I appreciate you sharing that with me. Thank you. You have four children do any others have type one? They

David 1:17:43
do? My oldest twin Henry has type one diabetes and my middle son Charlie has type one diabetes as well. The boys are twins. The oldest two are twins. One has type one diabetes. My middle son, who is not a twin has type one diabetes.

Scott Benner 1:17:56
I see. Is there any other auto immune in your family? There isn't

David 1:17:59
I'm really the only person in my family or my wife's family that we know of with any sort of autoimmune disease, certainly type one diabetes. So unfortunately, I was the first to strike it rich and unfortunately pass it along to to my sons with celiac thyroid or anything like that. Not about nothing. We're really a pretty healthy family. So this came out of nowhere for myself and for my two sons.

Scott Benner 1:18:23
That's really something. I appreciate your time very much. I appreciate your sharing this with me. Thank you very much.

Unknown Speaker 1:18:28
Anytime Scott.

Scott Benner 1:18:29
Learn more about the Medtronic champion community at Medtronic diabetes.com/juice box where by searching the hashtag Medtronic champion on your favorite social media platform. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

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#1173 Grand Rounds: Dr. Maggie Mueller

Dr. Mueller is the mother of a son with type 1 diabetes and a Urogynecology and Reconstructive Pelvic Surgeon.

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

+ Click for EPISODE TRANSCRIPT

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COMING SOON

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#1172 Perfection vs. Health

Erika Forsyth and Scott discuss the balance between perfection and healthy.

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

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

Scott Benner 0:00
Hello friends, welcome to episode 1172 of the Juicebox Podcast.

In this episode of the podcast, Erica Forsythe is back, and we're gonna discuss the balance between perfection and health. Learn more about Erica at Erica forsythe.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. 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 don't forget to save 40% off of your entire order at cosy earth.com All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cosy earth.com If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes and you're looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook this show is sponsored today by the glucagon that my daughter carries G voc hypo pen. Find out more at G voc glucagon.com forward slash juicebox. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next one.com/juice box. This episode of The Juicebox Podcast is sponsored by the ever sent CGM and implantable six month sensor is what you get with ever since. But you get so much more exceptional and consistent accuracy over six months. And distinct on body vibe alerts when you're higher low on body vibe alerts. You don't even know what that means to you. Ever since cgm.com/juicebox. Go find out. Eric, I feel like I haven't heard from you in a while. What happened?

Erika Forsyth, MFT, LMFT 2:32
It does feel like it's been a while January and February happened. I think it was a disease two months the holidays. Yes. Well, this

Scott Benner 2:39
is better than the last time there was a gap in me hearing from you when you have like some surgery or something like that. Yes,

Erika Forsyth, MFT, LMFT 2:44
I had my knee replacement. That was a couple months. It was couple two years ago. But we were we didn't talk for a couple of

Scott Benner 2:51
months. Cuz you were busy rehabbing. You have a life or something like that, that I'm not completely aware of. So what I did this time, because we're getting back together, and we finished up the parenting series, which by the way, the last episode of it goes up in a couple of days. Okay, what I did was I sent you for ideas that were sent to me by the moderator of my Facebook group based on things that people had said in the Facebook group. And they're, by the way, literally saying, Hey, would you talk to Erica about this? It wasn't just like a abstract question. It was like you should talk to Eric about this. And it's like, all right. Oh, that's fun. Yeah. So you picked one of the four tell people what you picked. So

Erika Forsyth, MFT, LMFT 3:33
I thought that we could focus on finding the right balance of, you know, living with a chronic disease. But I think we can hear that with perfectionism and trying to go back and forth between what is it like to try to manage your blood sugar from a perfectionist perspective? And then how can we move to a more balanced way of managing and living it whether you're living with it or the caregiver,

Scott Benner 4:04
right? Do you know while you were talking, I did my best Google foo and I typed in finding balance between perfectionism and chronic illness. And a lot of scholarly articles came back. That interesting that

Erika Forsyth, MFT, LMFT 4:17
is, and I did some Googling and I just perpetually impressed by how many articles there are on mental health and diabetes that was not present. Even 10 years ago, you know, as a the prevalence of it. Yeah. Yeah.

Scott Benner 4:33
Nobody was thinking about that. I don't think so. Okay, so what do we have here? We have an every day situation that some days is more in the forefront and some days more in the background, always very important. You know, when you're ignoring it, it's to your detriment. And at the same time, if you run around trying to be perfect about it, it's going to burn you out or make you crazy. Yes. And so what's the middle of that?

Erika Forsyth, MFT, LMFT 4:59
Yeah. is one of our first few episodes I think we ever recorded was on burnout. And I think we'll definitely touch on that. But I think and we've talked about, you know, the mental load of, of being a parent in general. And I also thought I just realized I'm holding up to Scott, my February 2024 issue of Psychology Today. Oh, look at and what is the title burnout

Scott Benner 5:23
about that burnout? Yeah, that's not specifically about diabetes. No, no, but

Erika Forsyth, MFT, LMFT 5:29
in and I'll probably reference it maybe a few times because I just was reading through it this morning. Talking about you know, the data with parenting with children with chronic illness. And that right currently, as many as 20% of parents identify as feeling burnout but the rates are higher from parents of children with a chronic illness and that's According to research from or re bro Sweden forgive me for the pronunciation but 20% so that that's a that's a significant amount without chronic illness

Scott Benner 6:00
no chronic illness in the life and parents are still one in five parents is like I am I visit them too much.

Erika Forsyth, MFT, LMFT 6:08
Yes, gotcha. Yes. And we can talk about those factors. Yeah. So

Scott Benner 6:12
I my brain goes immediately to that there's a utopia in your mind when you get married. That's something you expect and then when you have children, you build a family and then the further it gets away from your image. The more I Gosh, I don't want to say disappointing but maybe the more disappointed you are and then maybe the more difficult that is then to rev up to do the things that you didn't expect you don't I mean, like it's a very simple idea but on the 7000 day in a row that you've made lunch there's a voice in your head that goes through it is gonna be dead soon. Like you're wondering why do I keep making lunch? It just it the repetition is is numbing sometimes if you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, G vo Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you storage evoke hypo pen and how to use it. They need to know how to use G vo Capo pen before an emergency situation happens. Learn more about why G voc hypo pan is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma. Visit G voc glucagon.com/risk. For safety information. Far too often we accept the blood glucose meter that someone hands to us, the doctor reaches into a drawer and goes here and take this one. That is that is that the one you want. Is that accurate, you have no way of knowing. But if you want accuracy, and you want to be confident in the blood glucose readings that you're getting from your meter, you want that contour next gen, it's incredibly easy to get the same meter that Arden uses, just go to contour next one.com/juice box, that's all you have to do. The cons are next gen is easy to use, and highly accurate. It features a smart light that provides a simple understanding of your blood glucose levels. And of course, Second Chance sampling technology that can help you to save money with fewer wasted strips, contour next one.com/juicebox. And sometimes

Erika Forsyth, MFT, LMFT 8:59
you might not even be aware of the level of either anxiety or burnout that you're feeling. But perhaps you've noticed that you're really irritable, or you're not performing well at work or your relationships are deteriorating. Those are indicators that like you might be feeling the frustration of not wanting to make the lunch for the 7000 a day. Yeah, but you can't quite connect the pieces but then you're screaming at you know your colleagues. Yeah,

Scott Benner 9:25
no, i By the way, I'm not kidding. I picked the big number on purpose because I'm talking 25 years into it. You're like another egg. Okay, I'll make an egg. What and then you go to put the fork to your mouth. This is my life. As soon as my food gets warm, the dog has to go outside. I personally feel like he's waiting for my food to hit the table. Then he goes, Oh, look how happy that guy looks pretty good bark by the door now. So but with your kids, with your spouse. I mean even especially to when you start settling into the norms. And this is just who I am this is just who you are right? And I'm not a bad guy, you're not a bad lady. But I wish you would do this a little differently. And you wish this about me and we've talked about it and it doesn't change, but it's not a deal breaker. But then there it is, every day, you know what I mean? And, and then you have 1000 things going right in your life. And you see the four things that aren't that I think is what puts you into that space. And then you made such a good point a moment ago, you don't necessarily know you're in that space. Right? Yeah, and I think too, when you're, I was gonna say UNGA. Bissen. But I don't know how much interest we're gonna get out to people here. But like, when you're feeling like, you know, unsteady, it is not your first thought. To look at yourself. It's always you always look at what is happening around you these things, these people, they're making me feel this way. You know what I mean? So

Erika Forsyth, MFT, LMFT 10:55
yes, are you right? Yeah, the circumstances, any kind of environmental stressor?

Scott Benner 10:59
Yeah, I'd be fine. If it if it wasn't for my dog barking when I when I went to eat every day, or if my husband just wouldn't do this all the time like that. But the truth is, is if you fix that thing, you would just move on to the next thing in your head. Right? Yes.

Erika Forsyth, MFT, LMFT 11:14
Yes, our brains, our brains are really, they like to hold on to the the negatives and the misses. Yeah, instead of like, we don't fixate on cashed, I really nailed my dinner Bolus.

Scott Benner 11:31
We don't fixate on that, I'm happy to say here and never tell her it's here. But if she finds that, that's fine with me telling you that my wife has a point system in her head that she doesn't know that she has. And it only works in one direction. So every time I do something unfavorable. I lose a point. But if I were to cure cancer, I would not gain 10 points. It would be well, it's about time he cured cancer. I like like, right. Because it's always felt like it's me. It's not just her by the way. I think it's personal relationships. Like it feels like you start with 100 stars, and you lose one and lose one and lose one. But you don't gain them back ever. Like you never, you know, you never give people their flowers, you just go take them from them. And then to kind of bring this to diabetes, I think that same thing can happen. Like that's why I try pointing out like, hey, there's a lot of good that comes from having type one. I know it's not something you would willfully take type one for. But people are often much better at their own health more in tune with their bodies. You know what I mean? Like, yes, that's a big deal. You don't see that in the aggregate maybe. But as it shakes out over your lifetime, you'll notice it. So I don't know. So what do you think like how do we talk to people about understanding that it's going to be difficult, and that these things that we just talked about are kind of drag you backwards and backwards and backwards. But at the same time, there's a lot of pluses happening. And while your health goals are very important and can't be ignored, they also can't be the reason that you give in? No, no, that's a lot, actually. Yes,

Erika Forsyth, MFT, LMFT 13:13
it is. So we have we have the understanding, we all know the chronic illness of this chronic illness that maybe feels different than other chronic illnesses because of the consistent decision making and mindfulness that we have to have around it and I like that word mindfulness instead of like we're having to worry about it oftentimes I hear others talk about like I'm always worried about my numbers. I'm worried about my my daughter's going high my dad I'm just worried worried worried. And what's driving that is there's fear right? There's the anxiety is being driven by fear of the higher the low.

Scott Benner 13:54
This episode of The Juicebox Podcast is sponsored by ever since. And ever since is the implantable CGM that last six months ever since cgm.com/juice. Box. Have you ever been running out the door and knocked your CGM off or had somewhere to be and realize that your adhesive was about to fall off? That won't happen with ever since ever since won't get sweaty and slide off, it won't bang into a door jamb and it lasts six months, not just a couple days or a week. The ever since CGM has a silicone based adhesive forged transmitter, which you change every day. So it's not one of those super sticky things. It's designed to stay on your forever and ever, even though we know they don't work sometimes. But that's not the point. Because it's not that kind of adhesive. You shouldn't see any skin irritations so if you've had skin irritations with other products, maybe you should try ever since unique, implantable and accurate so if you're tired of dealing with things falling off, or being too sticky or not sticky enough or not staying on for the life of the sensor, you probably want to check out ever since ever since cgm.com/juicebox, links in the show notes, links at juicebox podcast.com.

Erika Forsyth, MFT, LMFT 15:17
And even just changing the language from anxiety, like I'm worried, too, I want to be mindful is reminding yourself reminding your mind and your body of like, okay, we do need to be mindful and intentional. But what I don't want is the motivation to be driven by fear. And I will kind of get through I want to do I think it's important to talk about the perfectionism and how that is develops with sorry, go ahead.

Scott Benner 15:42
Does that stem like, I feel like what I hear you saying is that because there are so many decisions to make, so consistently, that I'm being put into an anxiety inducing situation, every five minutes or every hour or a couple of times a day, even depending on how, you know, well, I have things balance for myself. And so you never really get a chance to what, like go into that. Because I don't have that thing. But my wife talks about it. She said, I talked to my sleep the other night, and I said something very loud. And she described how her adrenaline popped up. And then she couldn't go back to sleep. And I was like, oh my god, like I swear to you, you could bang a garbage can in my bedroom. And I'd be like, what is happening? But that garbage can away? And then I go right back asleep. But that's not that way for everybody. Cuz you hear this all the time, by the way? Yeah. It's a it's a thing in the community that you hear frequently. The idea about like, oh, it's been said that people with type one diabetes make X amount more decisions a day than everybody else. And I've always just thought like, oh, I don't why does that matter? But I think that's because of my personality. I don't think of it that way. But a lot of people can be dragged down by that.

Erika Forsyth, MFT, LMFT 16:51
Well, and I think in the beginning, everyone, I sure, regardless of personality, or coping mechanisms are going to experience that level of you know, the nervous system is on kind of flares up and you're in fight or flight like trying to make these decisions. I don't know, is one unit gonna help us too? Is it too much? You know, those types of things. So you're in like the cortisol level is pumping pretty consistently in the beginning. And so what we want to address is over time, how can the cortisol levels be reduced by not only just experience, but also mindset of? Does it have to be an 80 to 120 95% of the time? Because I think people do feel like an end, you know, obviously, I'm not a medical doctor. And the ADA recommends 70 to 180 70% of the time, but there really isn't data yet. or long term CGM used to back that up. But yeah, like that's maybe a good window. It's a

Scott Benner 17:57
tough world where you need to make a health decision for a mental health decision, because you are trading one for the other at some point, because I mean, listen, you've had diabetes. A long time i Arden's had it now, for my God. She's how long, almost 18 years? Wow, is that true? Yeah, well, I don't want her blood sugar to be 180 didn't mean like, if it is we get it back, and that's fine. And we don't like we don't like cling to it. But honestly, if you take the mental health out of it, and look at the physical health, that is not a thing you want. And so there it is, again, right. Like and you you mentioned the cortisol, the goal is not to like learn to live in it. The goal is to not have it happen, right? Because learning to live in, it just probably just killed me when I'm 50. But I'll be like, people be like, Oh, my God, he was so cool under pressure, but you're not cool under pressure. If you're still feeling it, you're just making good decisions in a bad situation. It makes sense. Yes,

Erika Forsyth, MFT, LMFT 18:54
yes. And I often will ask clients who are struggling with this very issue of, you know, feeling like they need to live in his perfect line, or zone or range. But then I said, you know, at what expense, right? Like, is it? Are you living in a heightened state of cortisol pumping, you cannot sleep you cannot function. You're hysterical crying. And I'm not talking about like, the initial grief stages. And that is that is normal. Yeah, in the beginning, it just is and that will subside. But years and years and years of living with this kind of I need to be perfect needs to be perfect, but that is not sustainable. And that's where you get into the burnout phase. Obviously,

Scott Benner 19:40
I didn't mean earlier to say that I wasn't ever like that. I'm just not like that now, but I the beginning. I was crying like every day for three years. By the way, like a couple of years. I would just in the afternoon. I tell people all the time, my wife would come home and be like, Oh, I didn't have a chance to get a shower. Then I'd get in the shower. So I could cry because nobody can hear me that I'd come out and I'd be like, everything's great. But it was And even on the third day of Arden's diagnosis in the hospital, I recognized what a shift this was going to be like to my, my own personal health. And even I remember saying to my wife, do you think we'll get divorced because of this? Like, just a couple of days, because I was extrapolating it out. Yes. And I was like, oh my god, like, she's not what we thought she was now. Right. So you have to re, like, configure that in your mind, we could kill her with the medication. If we don't get rid of the medication, we could kill her. There's going to be the possibility of long term complications, we won't see them while we're happening. So they'll always be in the back of our head, we're gonna disagree, we're going to argue we're going to be short on sleep, we're going to be all jacked up on cortisol, which isn't a thing I talked about 20 years ago, but you knew you were going to be on edge, you know. And I kept thinking, like, Oh, this is how we're going to get divorced. Because it is a coin flip steal to get divorced, by the way. And then it wasn't six weeks later that the endocrinologist said, the incidence of divorce in America is one and two. But if you have a chronically ill child, it goes to two and three. And I was like, Oh, my goodness. Yeah. So yes.

Erika Forsyth, MFT, LMFT 21:14
And when you're in that stressful state, worst case, scenario, thinking can feel real. Like that's like, it's really going to happen.

Scott Benner 21:21
Yeah. Oh, no, it definitely felt like it was gonna happen. I was like, Well, this is I felt like a self fulfilling prophecy. To me, I was like, Well, this is it, all the cards are out on the table, they all point to this, you know, we're going to flip one over one day, and one of us is going to get pissed about something and say something we can't take back. And that's gonna be the end of it. Like it really is what it felt like. But day to day, that same pressure exists if you're managing type one for a child, or if you're an adult living with it, like, When am I going to experience something that just pushes me over an edge? I don't come back from and I just say to myself off, it may once he's eight, I don't care. You know? Yes.

Erika Forsyth, MFT, LMFT 22:01
Well, I think in that sentence, and question, it is the day to day, which is so different from, we used to have this evaluation every three months with the agency, we did not have this data. And I think there is the shift, just like I know, you know, social media and all this instant, you know, news and numbers like feed like you, if you're using that data to determine your sense of like self worth, there's two pieces, right? There's the data determine, am I going low? Or am I having long term complications? And then you can connect it to I'm a terrible person, or I'm a terrible diabetic, or I'm failing my child. And that's the piece. I mean, there are there are the real truth of having lows and long and highs. And that is real. So I'm not dismissing that. But where we're talking is the is the gray area of what is that data? How is that defining you as a human being? I'm

Scott Benner 23:05
following you completely. Yeah, I know it feels convoluted, but I don't find it to be when you're saying it. You know what I'm is that weird example, ever seen those jumped videos, the scare videos where people like turn a corner and scare a lady and she's like, goes crazy. And then they just do it to her over and over and over again. If you did that, to me, I would punch you, I wouldn't go back and go, I would come forward at you. And so it's personality driven. Like I just had a conversation with someone the other day about their young son 12 years old, a little bit in his hands a little bit in his parents hands, parents, one of the parents has type one diabetes. But the kids they once he was in the AIDS, and then G seven came out, they put the clarity app in with the G seven app, the kids now seeing it sort of like a goal. And he got his a one seen on a six one, the little 12 year old boy, like by himself amazing, right? Because his personality and how he's wired. When you jump scare him, he comes forward. And now you put that same technology in someone's hands, who goes backwards and they go, Oh, look at me. Now I'm being judged every day by my app, this is terrific. And he thought, Oh, this is great. I can battle with this and have a good time like a game. And so you don't know who you are. And again, like we were talking about earlier, as it's happening to you, you can't step out of yourself and go, Oh, I'm just reacting to this wrong. You know, this, this could be really good information for me if I just changed the way I'm perceiving it. And is that right? Yes,

Erika Forsyth, MFT, LMFT 24:33
it will. And I would as a practical tip, I would if you are looking at a clarity app or any of the apps that are connected to your your meters, I mean, your your meters, your CGM or your pumps. If you're looking at that constantly and looking at the trends or the percentages, and that is too much data for you. And that is leading you to shame based thinking. I would definitely encourage like Those are great information, maybe could look at your clarity report once a week, like when you get your weekly email or pull back a little bit

Scott Benner 25:07
weekly, not daily. Don't make yourself like if you if you're feeling shaken up by it, don't keep doing the thing that makes you feel shaken up about it. Correct? Correct. Isn't that great advice for so many things in life that nobody takes that advice? Like, shouldn't I also not pick up my fan? dewlap? Like, you know, right, like, how do you Yeah, sometimes we feed ourselves the exact thing we, we know, we don't need, and I didn't use feed to like invoke food, but maybe there too. And so like, it's very, I don't know, like, I once said to somebody, it feels like you're happier when things are shaken up. And then as I thought about that person, I think, well, that's how they grew up. Like they grew up in a household that was like, always, like, it felt frenetic right and off kilter, and nothing was ever stable. And so when things get good and stable, that person gets uncomfortable, because that's not what that's not where they, they're comfortable, because they didn't grow up like that. There's so many different ways to get you. So I come into your office, because nobody's going to come in and say, Hey, I need therapy. I'm great under pressure, like so like, so someone comes in and says, Hey, look, I've got all this great data. I know, it's valuable for me, but I can't stop looking at it, as you know, condemnation. Is that a self confidence? Like, where do you start with that when you try to help them? So

Erika Forsyth, MFT, LMFT 26:35
I would want to understand how are they perceiving themselves in other areas of their lives in their work? Is there are they you, I think, we talked about the different types of perfectionism, there's the self oriented perfectionism, where you have the expectation that you will perform and perfectly in all areas, and then there's the socially prescribed perfectionism where you think others around you are expecting you to be perfect. So I would look at those two factors in other areas of your life. Do you have that in your relationships, in your work? In your own self image body image? Or is it just with diabetes, oftentimes, you might see in other areas, so you'd start there. And then I would want to understand your what is the self talk going on? So if you are feeling like, gosh, I cannot maintain, I cannot stay in range all the time. And therefore I'm telling myself, I'm not good enough. Again, met medical data aside, we wouldn't be necessarily looking at that. But we'd be looking at that to see how was that prescribing who you are? And how much are you listening to that? And where can we find moments for truth, and grace and compassion? In kind of the broader sense,

Scott Benner 28:01
when I talk to people who are what's the phrase I would use here? realists, right, this is somebody who's not willing to ignore the idea that a 250 blood sugar is bad for me. But they also live in the world where their cortisol has jumped up, and they're having these self doubts, and you know, and all this stuff is happening, they're feeling, you know, they're feeling like everything is a judgment, they're failing that whole thing. So when you feel that way, but you can't let go of the reality of what those numbers mean to your health. That's where I see people get stuck the most. They seem like ping pong balls, like flying back and forth. You know what I mean? Like, I know, I should be kinder to myself, but I'm dying here. But I'm gonna go crazy before I die. Like, like, you don't even like in that. That's, that's the part I feel. When I see people in that space. That's the one I feel the worst for. I think you don't I mean, because yes, because it's not like you're tricking yourself into being upset, you're really upset for a good reason. And the thing that you're trying to avoid, it's real, like so. I mean, it would be no different than if you and I were in this house together. And there was a guy outside with a gun. And I was like, oh, Erica, don't worry about it. You don't I mean, like, and we all feel great for 10 minutes till he came flying through the door with his gun pointed and we're like, oh, you know, we probably should have thought about that. So like, that's how it feels to me, ya know? Yeah.

Erika Forsyth, MFT, LMFT 29:28
So if the person with the with the 250. We would want to look at okay, what is yes, we all want to be in range and have, you know, an agency under seven. So we that's like the goal. But what are the behaviors that are leading to the the ups and downs? Are they consistent highs? And is it burnout coming from perfectionism? Is it ambivalence which maybe, I guess we're kind of talking about that right now? But no, we'll get into that. it later and is it or is it not knowing how to to manage? Is it the depression a lot? You know, there's no real motivation. And is that due to the diabetes is it also is it in general depression. And so we would want to kind of suss that out, like what is. And it could be a combination of all of those things. So knowing how to do it, having the motivation, not really caring. And those can be a messy trio, right, and then cycle of all impacting to be feeling like crap physically and emotionally, not knowing how to manage,

Scott Benner 30:40
right. So from my perspective, as the person who's raised a two year old to a 20 year old, and I've gone from not knowing what I was doing, being incredibly upset all the time having all the feelings that we've described, to slowly figure it out. And now to getting to a point where, honestly, I don't really know what you could ask me about diabetes, where I wouldn't be like, oh, yeah, just do this. Right. Right, like so. And that took a long time. People get to fast forward a little bit, listen to the podcast, because I had to figure it out. So I could come here and talk about it. You guys just get to hear somebody talk about it and go, Oh, okay, I'll do that. You know, and which is, which is terrific. But what I keep thinking while you're talking is maybe you got to fake it till you make it. Like maybe you have to say to yourself, I know one ad is not great. I know, 250 is way higher than I want to be or 300 My God, like, you know, I mean, like, I know all that's true. But I believe that I'm not going to be there one day. And this is part of my learning process. Like while I'm learning, I can't get 100 on every test. So I'll accept the B plus, I'll accept the C minus as this is where I am. But here's where I'm going. And when I get there, I won't see 250 blood sugars anymore. And I really I want to tell you, between you, me and everybody listening, I do not know the last time Martin's budget has been over 250. Like they didn't You mean, like unless there's like a failure of something, or something like that. But day to day making decisions. We just don't see that. You know, I would call 180 A spike like a like a pretty, like, drastic spike for her. But that's because we know what to do we know when to do it. And we do those things. Yes. Now, back in the day. 250 was a Tuesday. Didn't you mean like, I would have been like 250 We're killing it. Like it's not 350. Let's go Yeah, like this is going our way. But but if I could look back and give my my backward looking advice would be that if you're working towards it, and you're getting good information, and you're taking meaningful steps, you will actually get to a point that I've just described. And honestly, the easier you are yourself, the more grace you give yourself in the moment, the more you're able to say, yeah, it didn't go this way today, but I know I'm getting to it. I think the quicker you'll get there, because now you're spending time learning and and moving forward instead of spending time beating yourself up and woe is me. And we're hand wringing and stuff like that. Does that all make sense? Yes.

Erika Forsyth, MFT, LMFT 33:14
Because yes, because shame, as we've talked about before, likes to keep you there. Yeah, it does not want it to, to shift. Yeah. So when and, you know, I certainly have fluctuations. And it'll be, you know, whatever number and I will say, oops, like that. That was Miss. Oops, I forgot to Pre-Bolus for dinner tonight because I had 18,000 things going on, right? But I'm gonna I'll catch it up. But that also comes from 34 years of living with it. And knowing how and like all the things, all the factors, right, like protective factors. But I could wear and I certainly have been here in my past, like, oh, my gosh, I'm at this number. I'm in the TOS. And I'm going to this is going to affect me long term. How did I do this I terrible person. And you get stuck there, you almost

Scott Benner 34:14
become a parasite in your own story. And I don't know if How do I mean that? Oh, there are some parasites that go into animals that rewild rewire the animal's brain to poop on its own food so that other animals will eat the food with the parasite in it so that the parasite can spread itself apart. That's an actual thing.

Erika Forsyth, MFT, LMFT 34:34
That's That's so crazy. I can't even I don't even know why you know that. Yeah.

Scott Benner 34:38
Okay. Well, we all know anybody who's listening now knows why I know this. But so there's a parasite that can go into an animal. It will tell the animal like literally, like crap on the food, because I know other animals will come by and eat the food and then I'll get the spread myself out and go on my journey. You kind of become that in your own life when you have the self doubt hits you. And almost the feeling bad feels normal, like I talked about a minute ago. And so you almost make yourself keep feeling bad. And also, when you're feeling badly about your health, you can do this thing where you like, again, like we talked about earlier, isn't it interesting how this all comes together? And I don't mean for it to, you can point to a doctor and go, it's her fault. She didn't tell me. That doctor I spoke to he could have told me about Pre-Bolus thing, but he didn't. So my blood sugar spice now my fault, therefore, likely my parents fault or Oh, my parents didn't tell me they left me alone too long with it. They didn't stay with me till I figured it out. They stayed with me too long and made me you know, what's the word? When you're now can't help yourself, help us. It's a psychological word that I just lost. It's not going to be important data, they can see me it'll pop, it'll pop up into my head, like 10 minutes after we're done, I'll be gone. But agency agency took away my agency. And so I it was always them doing it's their fault that I don't know how to do it because they were doing it for me. Like no matter what happens to you, that's the thing you're going to blame. That is just such a human thing. Like I mean, you go find a billionaire somewhere right now and be like, Tell me who's screwing you and they're gonna have a list. They're gonna be like, well, here's what's happening to me, like, but I'm like, nothing's happening to you. If a billion dollars, it's all going well, like, like, just try looking at the good things. But we can't do that. Like we never do that. Something's always wrong. It's always something else or someone else's fault. Because that's the only way you can sometimes stop from feeling like this. Like, look what I'm doing. to shame we can we blame? Yeah. Is that Is it a t shirt slogan that I just go to?

Erika Forsyth, MFT, LMFT 36:45
Yeah, that's it is it is a common phrase for sure. To avoid

Scott Benner 36:49
the shame. We can blame we can blame. Nice. I'm putting that on a t shirt. Shirt. Can you imagine you walk into the shoe people like what does that say? And then they start going, Oh, I do that on my butt. But that's the point to is. It's that feeling of like, oh, look what I do. When I feel ashamed. I blame other people. It's not what you do. It's what everyone standing on two feet does. That's the fake it till you make it give it away. Because you know, you're headed in the right direction. Part of it like this is just how people's brains work. Like don't get stuck in this part. And I know that's easier said than done. But that is a clue, though. I mean, you're, you're almost willfully keeping yourself here. And eventually, you know, the secret is, most people get out of it eventually. It's how long you're stuck in it. That is really the thing. I think you have more sway over than you think. Yes. Because you know what I mean, I interview a lot of people. And I enjoy talking to a 65 year old person whose story when they were 15, you would go oh, God, if I heard that story while they were 15. I think this person's done. Like they're never getting out of this. But they do. You know, like, I don't know. I don't know what the answer. Obviously, these are just conversations. I don't think there's a hard and fast answer in any of this. But right.

Erika Forsyth, MFT, LMFT 38:05
And I think that the sooner and this might be a lifelong process to realize that blaming is a dead end, and you will get stuck in that. Not that conversely, I want to say well, you should just shame yourself because, like, be read that way, right? Like, well, don't blame others. But shame yourself because shame is not a productive, proactive feeling. But we often get stuck in that and I know as parents to care as caregivers, that can be a very common experience. And particularly when you're managing blood sugar's feeling like you're responsible for your child's health. And so it's naturally, you know, feeling like oh my gosh, I mismanaged their blood sugar. Shame on me, now they're gonna have they're gonna lose their their vision.

Scott Benner 38:54
Does it have to be shamed as taking responsibility have to be shame? No, no, no. But that's where, where our minds go. Our minds

Erika Forsyth, MFT, LMFT 39:02
go. Because who? Because then like a parent would say, or I would say if I if I, you know, I don't my children don't have type one. But if I were to make a mistake, that caused them pain in the moment, it was on me because

Scott Benner 39:17
there has to be a reason because that's how black and white we are. That's why everyone comes on. And they they're so adamant to tell that diagnosis story because they want to show you where they got diabetes. This wasn't my fault is Coxsackie virus and by the way, that's true, but they need to say it out loud. And they want to tell other Pete Oh, it's about the reason. Like I need a reason. This is not just about diabetes to people need that's why everybody works in, in black and white. That's why the that's why the ambiguity. Ambiguity is not comfortable to people. Is that right? People like an answer. That's why they want to be on a team you If

Erika Forsyth, MFT, LMFT 40:00
we want to ascribe ascribe a meaning and a reason behind things and not I mean we, you can get stuck in black and white thinking or all or nothing thinking for sure. And where you want to move out of because oftentimes, it's all bad, or it's all on me when the alternative could also be true. But that's hard, it's hard to retrain your brain. And that's where, you know, trading, retraining your neuro pathways and your thought patterns is really significant and helpful. And you can do that and in therapy.

Scott Benner 40:31
So to use another example, oh, my God, I see it, okay. So there are some people who will tell you, it's just diabetes, there's nothing you can do about it, it's gonna go up and down, you're a once he's not really in your control, I've given it up to God or whatever like, like saying you want to do and that makes you comfortable that you're not hurting yourself. And then there's the other, there's an opposite side, say, like a very keto diet person who's taken in 10 carbs a day, and they're barely using any insulin, but they have a lot of stability. They know if they if they try to weight from that edge, that they've found their, their comfort in, and they start letting more carbs in, then they're going to have more variability, then they're not going to know what's going on. So they have to defend their their position, you have to defend that position is the right decision. Because look, it works out well, for me, just like the person on the other side can defend that this isn't on me, it's on, it's on something else. And both of them are trying to avoid feeling like it's their fault if something goes wrong. And on the one side, you get to take credit for the decision you've made, I'm going to eat very low carbon doing this thing. And on the other side, you get to take credit for believing in a different power this in charge of you and not yourself. And I'm in the middle here telling people you have to understand what foods impact you how they impact you how to use your insulin, and that uncertainty is uncomfortable for the edges. But there's also a great amount of people who are very comfortable in that I want the knowledge so I can decide. And these are the three different psychological, like, norms that you find around diabetes. Did I just figure all that out while we were talking? Or am I wrong? Am I making sense? Yes,

Erika Forsyth, MFT, LMFT 42:17
I think and I think I can almost see you thinking about all of all of the stories. Yeah, that's exactly what all of the comments from the Facebook group and kind of synthesizing

Scott Benner 42:29
Yeah, I just acted like my own AI from it. I just fed everything, did some research, like data collection, I was like, wait, I know what I'm saying. Because I don't by the way, I don't care. If you eat low carb, I think that's terrific. I don't care if you are like, hey, my a one C seven and a half. And I'm happy and this is the best thing to do. If that's you, then that's terrific. But I'm trying to see the psychological side of it. Because then there's also people who are like, look, sometimes I eat low carb because it's easier. And sometimes my blood sugar gets out of whack. And I say, whatever. And like, I don't think there's anything wrong with any of those three perspectives. But understanding where they're coming from. It's just very interesting. Because I've heard these stories, so many different ways, so many different times. And in the end, it's all about it's just all about humans and how they react to things. And we do fall into buckets, to some degree. And I think specifically about this, these are kind of the three buckets. You know, I have found myself recently, as I'm recording those cold wind episodes, and talking more about like how doctors should talk to patients and stuff like that. Every time I get done one of one of those conversations, I have this like enduring thought, almost like when I get done talking to you, I think, I don't know if this is a thing you can ever make black and white to just tell somebody, like follow these steps and you'll feel better. Like that's what I think I believe in the therapy so much because you need somebody to walk you through it. And while you don't even know you're being walked through it, but to this other thing with a cold wind and you see all these people who like became a nurse or became a doctor and are still delivering substandard care and their understanding is not that and when I get to the end of the conversations, I always think to myself, so it's just it's a human problem. And then everything's a human problem on one level or another right like it's our ability or inability or desire or you know, to work hard at something and make an impact or in some of us are just like look, it's just the job I'm going to show up I'm going to do the thing, and I'm gonna leave I don't I'm not trying to make an impact. And you mix that all together in a soup and you get you get society I should have gone to college I might have enjoyed it

Erika Forsyth, MFT, LMFT 44:44
oh gosh. Yes. I mean is it is it. It's human nature. But in going back to kind of these these buckets, it's you know, where do you feel comfortable? Is it is it control? Like we all want to feel like we're in control. And I know we've talked about this before too. look like, but if I don't know how to control and we can't perfectly control diabetes, do we? Can we stay in that gray zone of I'm going to do what kind of works for me, I'm going to make mistakes, and I'm gonna have to move on? Or do I have to live in the rigid? Yeah, like, you know, on the on the rigidity of, it has to be this way. And if it's not, then I'm gonna mess up. And I'm going to feel terrible about myself,

Scott Benner 45:24
all these different decisions are just different levels of you. Giving your brain and the way it works, the freedom to do what it does, like I don't know if that makes sense or not, like if you if I took a low carb person with a four or five, a one C, and I tried to drag them over to the other side and said, Hey, you're not going to worry if your blood sugar goes to 200. They couldn't make sense of that. Like that would not work for them. It's not how their brain works. If I took that person who said, hey, you know, once in a while it is what it is. And I made them eat low carb forever. They couldn't deal with that. And I think the people in the middle, if you took them to either side would say this is too rigid one way or the other. I need a blend, I need gray. Like, you know, that's so interesting. We should rename this episode, watch Scott, understand everything we all got in our first Psych class in our freshman year of college, as if it was a new idea that the world just found, it really is interesting for me, because I've learned about life. The same way I learned about diabetes, like I didn't ask anybody for help. I didn't go to a class, I just picked my way through it. And I didn't go to college like so as I live. I know there are times I see things. And I'm like, I bet you this was described to somebody and like, you know, their sophomore year Psych class, I'm seeing it like, like a newborn, sometimes. You know what I mean? And maybe that's valuable, because it can be explained to all the other people who didn't end up in college, listening to this. Because once you understand how people think, you stop being mad at them. In any mean, you're just like, oh, this is just who they are. Like, it's and I know, it's a simple thing. And people say all the time, but once you really see it when somebody is doing something, and you don't ascribe like bad actor, like vibes to them, like, Oh, they're doing this on purpose, or she's trying to make me feel this way or something like that, once you realize that's not what's going on, life just gets so much easier. And I wonder if diabetes couldn't be the same way?

Erika Forsyth, MFT, LMFT 47:24
It makes sense. Yes, you know, you're making me think of, you know, one of my faves Brene Brown, who did research on and data collection on people's stories. And that's how she came up with the, you know, the concept of vulnerability. I mean, she didn't come up with that concept. But how that is really challenging for people to be vulnerable, based on all of the interviews and research she did, and did data collection based on people's stories, which is what you're doing, you know, through the podcast, and the in the group, I

Scott Benner 47:57
just have always felt like, I know, there's more to life than I understand. And I like to wonder what it is, if you ask me my favorite thing to do. I know I've said this before, but like, like going out to the end of my understanding and wondering what's beyond it is one of my favorite things to do. And you can't just do it in your head. Because you only know what you know, you have to talk to other people and listen to other people or, and then instead of judging them think where did that come from? Like, you know, and not be upset about it. Like if it came from a bad place or a good place. It's like, whatever this is where it came from. So I love the after dark episodes sometimes to people who are willing to like, come on and say like, Hey, I'm a heroin addict. Here's my story. Be vulnerable. Yeah, yeah. And and let that out there. And if you're willing to, if you're willing to meet that vulnerability with your own kind of openness, then you can you grow from it. Like I actually found myself thinking it's funny, I was thinking about this in the shower this morning. But I didn't know I was thinking about this. I kept wondering how can I pass on my life's experiences to my kids so that they can fast forward a little bit. But I can't think of a way to do it. Because sharing my experience as a story only goes so far, they actually need to go through this too. This is why we progress so slowly. You know, and maybe that's by design or, or necessary. You know what I mean? Like maybe if we kept leaping forward, we wouldn't be able to readjust fast enough. Oh, maybe that's what we're seeing with social media too. Right? Like technology keeps leaping forward and people can't catch up and then we're all anxious because this isn't the soup we're supposed to be swimming in. That's

Erika Forsyth, MFT, LMFT 49:38
right. Yeah. You have to do the work yourself. And while yes, it would be so wonderful if we could say here's exactly how to live a balanced life, living with a chronic illness or caregiving for your child with diabetes. Take a walk go outside like you know, everyone knows all those tools. Take a break do deep breathing, be kind to yourself, but it really is slowing down to understand the process that you are undergoing. And doing the work yourself, which is not an easy answer,

Scott Benner 50:15
right? I almost wonder if it doesn't help you to like, take a large step back and say to yourself, can I really be mad at somebody in 1950, for how they treated women, when that's how it was done. And now that we've moved forward, we see, that's not the way to do that. Like, right, and you can see, like, we've made progress. And I guarantee you that in another 70 years, you'll look back on, you know, 2024, and think, Oh, I can't believe that's what we thought about those things. And then, you know, but then understand that along the way, there were these people's lives that were, you know, finite and shorter, given the grand scheme of things, and that they were stuck in one thinking pattern, and they probably were never gonna get out, or they'd grow a little bit by the time they got to the end. And their growth would rub off on their children a little bit, their children would start slightly ahead of them and grow a little more, and we keep going. And if you can take that idea, and flip it back on your, on your diabetes, then I think that's what I'm saying. I think you're faking it till you make it like you're like, I know, I'm not perfect, but I'm not bad. And I'm trying, and then level up, and then do it again. But don't judge yourself on what happened in 1950. Just go, Okay, three years ago, I didn't know to Pre-Bolus. But I know now. And let's level that up and keep going. And hopefully do that quickly enough that you avoid. You know, I mean, catastrophic, like health concerns, and so on. There's no answer, but that's the answer. It's all in there. Just listen to that over and over again until it makes sense to you. Or go see a therapist. And again, we're gonna call this episode watch Erica, watch Scott. Figure out common ideas. Sometimes when she looks at like, where's Eric and I see each other while we're doing this, it's sometimes I have there's this look on her face that I remember my mom like looking at me like, oh, look, he figured it out.

Erika Forsyth, MFT, LMFT 52:09
It's an encouraging expression. Yeah, she's

Scott Benner 52:12
like dummies getting it. I see it happen. No, I know. You don't think that way?

Erika Forsyth, MFT, LMFT 52:17
No, it is. It's it's fun to watch. Yeah, the process.

Scott Benner 52:20
I can never tell if you're like, I'm glad I have these conversations with him. Or if you think I should get on a podcast or somebody understands more.

Erika Forsyth, MFT, LMFT 52:30
No, it's good stuff.

Scott Benner 52:31
Good. It's excellent. I appreciate doing this with you so much. Like, if I just sat down by myself and tried to think my way through this. I wouldn't get as far as I do as I do when I'm with you. Like I'm actually I'm getting tired. My I'm warm from thinking do you know what I mean by that? Yes. Yeah. Yes. My fingers overheating. It's hard. It was how hard is it not to look at me and think look how thin Scott looks. It's amazing.

Erika Forsyth, MFT, LMFT 52:59
You really you really have Yeah, I mean, pretty soon. Not gonna see Yeah. Oh, no,

Scott Benner 53:04
that's not going to happen. But, but I'm still it's funny. Like talking about how your brain works. Like, I still like I'm focusing at looking at you because if I look at myself, I start going. I don't even look like myself. Again. You can feel like a you can feel yourself drifting away a little bit. And you can go oh, I should have done this sooner. Or how come I didn't figure this out earlier. But you know, to me like, shame, shame pop. Yeah, I feel ashamed immediately, actually. But I have felt that way. But then turned it. Then I just I just turned it on the pharmaceutical industry. I was like, well, they should have come up with that drug faster. But I did say to my wife the other day. Do you ever get sad that this drug didn't exist sooner? Because we're 50. Now like, what if they would have come out with these jell PS when we were 30? Like, would we have had a different life? Like, you know what I mean? Like, it's I'll never know,

Erika Forsyth, MFT, LMFT 53:55
do you? Because I'll I asked that about CGM 's and automated insulin.

Scott Benner 53:59
I bet you do. Right? Yeah. Oh, I had I had that conversation with someone the other day. Guys had diabetes for like 45 years or something like that. And I asked him, Do you ever wonder about what your life would have been like if you were born now instead of that? And he said he tries not to think about it. Yes.

Erika Forsyth, MFT, LMFT 54:16
And I think just the question you asked why, why didn't I do this sooner? Of course, as soon as you want it is you're starting to have a healthier mindset of how you view yourself think about others in the world. The old way of thinking shaming still wants to pop back in so it just still was trying to like ah, you should have coulda woulda

Scott Benner 54:34
as I felt it coming. I got in front of it. Because this isn't my fault. Like, I mean, honestly, Erica, I'm not a doctor, quite obviously. Obviously, I'm not educated it anyway, if you've been listening for the last 15 minutes, the GLP has made a big difference. I must have a GLP deficiency because I have not drastically changed how I eat. I had pizza this week. I just want to tell you I bought a pizza, ate at one night, got up the next day, had it for lunch and then had it for dinner a third day and I lost a pound this week. So like, you know, like, I'm not to say that I eat like that all the time. But this week, I wasn't eating very much. And I didn't have a flavor for anything. And I thought, Well, maybe it's better for that eat something than nothing. So I mean, I got this pizza, not the point. The point is, is that even on a GLP, I'll lose a pound this week, having eaten six slices of pizza spread out over three days, if I would have done that, without the GLP, I easily would have gained four or five pounds. And so it's not a thing I couldn't have. I couldn't have done it, the thing didn't exist. It's so funny how my brain was willing to leap over that truth. Like, this was not a thing you could have done. 20 years ago, Scott, this didn't exist 20 years ago, and I went right to why didn't I do this? Like I let go of all the reasons why to blame myself for a second. And I stopped myself. And I said, this isn't my fault. It's Eli, Lilly's fault for not making stuff down sooner, or whatever. I don't know. And I let it go. But there are people who will they get stuck in that pothole right there? Oh, it's my Yes. Yeah, and why?

Erika Forsyth, MFT, LMFT 56:03
Why didn't Why didn't I make this change sooner? Why didn't like even you said the Pre-Bolus thing. I mean, I didn't Pre-Bolus For the first 25 years of my diabetes life. And, but I didn't know. And that's okay. And now and so like, when you as soon as you hear yourself going whitened. I coulda shoulda just say, Okay, where are you right now, in this moment, going back and doing a mindful exercise or doing the grounding that we've talked about, and bringing yourself to the present. And you can say, wow, look where I am today? Yeah, like the journey is right now.

Scott Benner 56:38
I talked to a guy the other day, who had had diabetes for over four decades. And he told me that in the last handful of years, I taught him to Pre-Bolus his meals.

Erika Forsyth, MFT, LMFT 56:47
I honestly might have heard about people's for the first time through the podcast. Yeah, honestly, it's a crazy,

Scott Benner 56:52
it's such a, it's such a stupid idea. Like, like, like, I used to talk about it like this. I used to say, if I taught you to drive, and you never driven before, and I said, Okay, Eric, as we approach this curve, I only want you to push down on the brake halfway, and then go through the curve. And I said, if you were doing that, and you press down on the brake halfway and saw you were gonna go off the road into a stone, would you just hold the brake down halfway and go, it's what the guy said to do? Or would you push harder and say, I don't want to hit the rock off to the side of a road. But so many times with diabetes, we just go That's what they told us to do. I guess I'll crash. You know what I mean? And then I'll tomorrow I'm gonna get a new car and crash again. And they over and over again. And how much of that is mixed in with, like the godly way we see physicians. So the guy didn't tell me the lady didn't tell me. So it's obviously not a reason or a rule. So I'll just keep doing what they said over and over again. It's fascinating. It really is like, how do you not say to yourself, I give myself insulin at noon, I eat at noon, my blood sugar goes up. What if I gave it to myself? Five minutes before that, or 10 minutes before though? What would have happened? Again, that's me. If you jump scare me, I'm gonna punch you in the face. Like so when I saw the thing happening with the blood sugar's I was like, that's not right. Like, I always think that I always, by the way, I always think that's not right. And they don't know. But that's just, but that's an abundance of, I would call it self confidence. Yeah, I'm sure somebody else would call it narcissism. That's between me and my therapist. And, but, but I trust myself more than other people. But I also had to count on myself growing. And I had some wins along the way. So I had a reason to trust myself. I've made decisions in the past before that have gone well. So I think well, I'll try it again. I bought it worked out the last time. Let me see what Scott brain thinks this time. You don't I mean?

Erika Forsyth, MFT, LMFT 58:49
Yeah. I wonder I'm sure. I know. We're totally now in a different topic, but not really. But with the the Pre-Bolus concept. I'm sure you and Jenny have talked about this before. Did did the Pre-Bolus. I mean, I used to Pre-Bolus with regular insulin. And it was like third way to give her injection 30 minutes before we ate. But then when we transitioned to cue melodic fast acting,

Scott Benner 59:14
Jenny blames the naming.

Erika Forsyth, MFT, LMFT 59:15
Yeah. Is that what it is? Because I feel like then I got the concept just left. Yeah,

Scott Benner 59:20
they told us it was fast acting insulin. We stopped talking about the timing of the insulin. Yes, yeah. Okay. And you're old enough to remember that. Yeah. It's just a naming. Again, that's a that's a human mistake. It really is. Like when you listen to that Grand Rounds series that she and I are making. Everything that a doctor does that throws you on the wrong path is is usually a communication error. Just not knowing how to talk about things and see the implications of the words you're using. Super simple. I mean, nobody knows how to talk. So it's not super simple. Yeah, diagnosing it is simple. Like I see what's happening. I don't know how to get somebody to fix it. I also don't know how you It's funny because a scientist called it fast acting insulin, or faster acting insulin,

Erika Forsyth, MFT, LMFT 1:00:05
because it was faster than that regular. Yeah, yeah. But again,

Scott Benner 1:00:09
a person who you should not put in charge of artistic endeavors. Like you don't you mean, like you don't ask a structural engineer to write a poem, because their brain doesn't work that way. So you should get the structural engineer to build the bridge, and then have an artist come in and call it something. Yeah, right. And because they know how to talk to people, and I know how to talk to people I don't like and I have enough understanding of diabetes, that I can take that understanding and put it into words that you can hear and pick up and use somewhere else. I think that's my whole value to this is that I had to teach myself diabetes because I couldn't let my daughter be unwell. And I'm a good storyteller. Like, I know how to talk. And it's not on purpose. Like I swear to you, here, I'm going to tell everybody something that will let them go. I sent you four topics. And I said, ladies choice. That was the extent of our preparation for today. Okay. And then you texted me a half an hour before going, Oh, I forgot to tell you, this is the thing I chose. I didn't read what you sent me. So when we popped on and started talking about it, as you hear me warming up in the first couple of minutes, it's the first time I've considered this today. So and then I start accessing all the stories I've heard on the podcast, and then trying to work my way through it. That's all you're hearing is, that's what you just heard for the last hour and Erica artfully pointing me at the truth about how people's minds work to keep me on that path, which is I'm assuming what you? Yeah. Which was, I'm assuming what you would do if you were my therapist, this you would keep going, Hey, look up, dummy. Keep walking in this direction. You only go back to the theme and the goal right now it's beautiful. Anyway, if anybody heard this and doesn't believe in therapy, they you're not paying attention. Erica forsyth.com. What are your states that you can help people remotely? California?

Erika Forsyth, MFT, LMFT 1:02:04
Oregon, Utah, Florida and Vermont. Oh, Vermont. Sticking? Yes. Vermont sticking nicer now? Yes. Good. Good. Good. And

Scott Benner 1:02:14
if you live local to Erica, she will tell you where she's at. And you can sit with her and do this.

Erika Forsyth, MFT, LMFT 1:02:18
Yes, I'm leaving office in Pasadena in person, but also virtual as well. Again,

Scott Benner 1:02:25
Erica forsyth.com. If you don't see what she did this hour with me and think that could help me to again, I don't think you're paying attention because I couldn't have put these thoughts together without you today.

Erika Forsyth, MFT, LMFT 1:02:37
So Wow. Thank you, Scott. Seriously, nice compliment.

Scott Benner 1:02:42
Oh, hurricane. You know, I've had a couple of therapists on here before I landed on you. You're the right one. Don't you worry. I saw what was going on. I paid attention. I was like, yeah, good conversation, but not right for me. And then I pick through and I was like, Erica works for me. And you know, the big, I'll let you go. But the first reason that I thought that about you is that if I tried to generalize you wouldn't let me when we were first together. Like I would try to generalize think to be entertaining, and you'd be like, No, I was like, Oh, she pushed it back for we're trying to have fun here. And then I was like, Oh, I remember. I was like, she'll be good to talk to you about this stuff. So anyway, I love you. So thank you very much. Oh,

Erika Forsyth, MFT, LMFT 1:03:21
thanks, God. I appreciate that. Bye. Oh, gosh.

Scott Benner 1:03:26
There you go. That's perfectly a blessing. Don't please.

I want to thank the ever since CGM for sponsoring this episode of The Juicebox Podcast. Learn more about its implantable sensor, smart transmitter and terrific mobile application at ever since cgm.com/juicebox. Get the only implantable sensor for long term wear get ever since. A huge thanks to the contour next gen blood glucose meter for sponsoring this episode of The Juicebox Podcast. Learn more and get started today at contour next one.com/juice box. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chico Capo pen at G voc glucagon.com Ford slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. 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. The diabetes variable series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about true Travel and exercise the hydration and even trampolines. juicebox podcast.com Go up in the menu and click on diabetes variables. Lots of people with autoimmune seem to have trouble with their thyroid. And that's why I've made the defining thyroid series juicebox podcast.com Click on defining thyroid the menu to find out more. The episode you just heard was professionally edited by wrong way recording. Wrongwayrecording.com

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