Juicebox Podcast: Type 1 Diabetes

Episode #1630 - "Tilt-A-Whirl"

Host: Scott Benner
Guest: Gabby
Date: September 17, 2025

Episode Overview

This episode features Gabby, a 28-year-old Pilates instructor and dancer living with type 1 diabetes since the age of two, along with ADHD—a central theme of the conversation. Scott leaves the episode largely unedited, intentionally preserving Gabby’s natural pauses and thought processes to shed light on how ADHD impacts diabetes management, daily life, and overall mental health. Together they explore Gabby's history of seizures, struggles in college, the compounding effect of ADHD, challenges with insulin technology, and the emotional toll of managing a complex chronic illness.

Key Discussion Points and Insights

1. Gabby’s Background: Life with Type 1 Diabetes and ADHD

• Gabby (28) diagnosed with T1D at age 2.
• Works as a freelance fitness instructor and kids' dance teacher.
• Recently diagnosed with ADHD, takes Concerta but is unsure of its efficacy.
  • “To some extent, yes,” (Gabby on feeling ADHD symptoms all her life, 30:38)
• From a family with a complex structure and history of anxiety and ADHD—mom and sister similarly affected.

2. Fear of Lows and Seizures

• Lifelong pervasive fear of hypoglycemia (“fear of lows”—08:23).
• Gabby has had more than a dozen hypo seizures, mostly as a child during sleep before access to a CGM.
  • “Too many to count.” (Gabby, 08:45)
• Did not get a CGM until about 2018 despite long history of severe lows.
  • “It’s so crazy to me that you’re having all those seizures and nobody’s [suggested CGM].” (Scott, 21:45)
• Seizures continue to occur, though less frequently, largely attributed to rapid drops and complexity of self-management, especially during periods of stress or unstructured schedules.

3. Challenges with Technology and Site Management

• Gabby uses a Tandem Mobi (pump) and Dexcom G6 CGM, previously used Medtronic and manual pumps.
• Difficulty with site absorption and timing—especially on thigh sites, possibly due to muscle mass and activity.
  • “After the second day, it’s just like, nope, we are done.” (Gabby on thigh infusions, 09:19)
• History of disconnecting pump during dance in childhood, per earlier provider’s advice; later, adult providers discouraged this practice.

4. ADHD’s Impact on Diabetes and Daily Life

• Recent ADHD diagnosis has led to new insights on how attention and executive dysfunction affect her diabetes management.
• Medication (Concerta) helps somewhat, but she’s considering a higher dose or alternative (e.g., Vyvanse or Adderall).
  • “Sometimes it feels like [Concerta] pulls at least 10 of [20 things] together… so the one thing… can actually be done.” (Gabby, 28:49)
• Structure (like school schedules) helped in youth, but less so with adult freelancing.

5. Emotional Toll: College Years and Mental Health

• College years marked by poor blood sugar control, high anxiety, panic attacks, and feelings of defeat.
  • “My whole life feels like all the time [I’m] just trying to stay alive. You don’t even have time to think about, like, how could I stop this from happening?” (Gabby, 23:49)
• Lack of medical support/tools resulted in self-blame and feeling unsupported, despite strong personal effort.
  • “I was trying constantly and not set up for success and not… fully supported.” (Gabby, 23:04)

6. Gabby's Service Dog and Family

• Got a diabetes alert dog a year ago due to ongoing fear of lows and seizures.
• Support system includes a much older father (age 82), a mother and siblings with ADHD/anxiety, and a partner of 5 years (age 35) who also has diabetes (possibly LADA).

7. Evolving Relationship with the Podcast & Community

• Initially found listening to the podcast emotionally difficult due to resonant stories about childhood or severe lows.
  • “[Some episodes] would make me just sit down and sometimes just cry.” (Gabby, 39:04)
• Now listens daily while doing chores—has worked through the initial emotional triggers.

8. Navigating Healthcare and Self-Advocacy

• Gabby is preparing to see a new primary physician and has been advised to document symptoms and needs due to organizational challenges with ADHD.
  • “You would benefit from writing down your thoughts, loading them into ChatGPT, and saying, ‘Hey, can you turn this into a document…’” (Scott, 70:35)
• Considering testing for hypothyroidism due to recent fatigue and physical symptoms.

9. Future Strategies Suggested

• Scott strongly advises Gabby to seek better ADHD management as a prerequisite to more effective diabetes care.
  • “You need somebody without ADHD to help you… Seems like most of your issue.” (Scott, 47:02)
• Discussion about GLP-1 medications as a possible avenue (though likely only worth exploring if insulin resistance/weight a major issue).

Notable Quotes & Memorable Moments

• On ADHD and Diabetes:

  • “It feels like if you put me in [a Tilt-A-Whirl] and started asking me how to bolus for pizza… I feel like you're always in a state of being shook up.” (Scott, 48:51)
  • “It’s just because… it’s like nail on the head.” (Gabby, 49:29, moved to tears by Scott’s summary)

• On Self-Blame & Support:

  • “I was trying constantly and not set up for success and not… fully supported.” (Gabby, 23:04)
  • “My whole life feels like… just trying to stay alive…” (Gabby, 23:49)
  • “Lots of my human work is undoing that… My brain would go, ‘Oh, I’m so stupid.’” (Gabby, 32:06)

• On Family Patterns:

  • “My mom, like, 100% is exactly the same as me and my sister… She just does what I do now.” (Gabby, 33:07)
  • “Sticky notes are my best friend.” (Gabby, 55:04)

• On Navigating the Medical System:

  • “You, of most people… would benefit from writing down your thoughts, loading them into ChatGPT, and saying… ‘turn this into a document’…” (Scott, 70:35)

Important Timestamps

• 03:17 — Gabby introduces herself, shares age and diagnosis history
• 08:23 — Gabby’s first reaction to life with T1D: “Fear of lows.”
• 08:43–09:01 — Discussion of hypo seizures and early diabetes management, lack of CGM
• 13:09–16:19 — Detailed talk on pump sites, body image, and managing infusion sites as a dancer
• 23:04–24:27 — Gabby describes overwhelming, unsupported attempts at managing diabetes in college
• 30:34–31:33 — Late diagnosis of ADHD and how structure masked symptoms
• 34:55–35:40 — Family history of anxiety and ADHD
• 41:03–43:26 — Recent seizure explained; accidental over-bolus at night due to pump error
• 47:02–48:51 — Scott underscores ADHD’s central role in Gabby’s management barriers, introduces the Tilt-A-Whirl metaphor
• 49:29 — Emotional reaction: Gabby tearfully acknowledges how well Scott understands her struggles
• 53:01–54:54 — Conversation about ADHD medications and switching/side effect management
• 66:16–69:16 — Gabby wonders if she is hypothyroid; discussion of symptoms and testing plan
• 70:35–71:13 — Scott advises strong documentation/self-advocacy for upcoming medical visits

Additional Notes & Tone

• Tone: Warm, open, occasionally self-deprecating and humorous—Scott and Gabby balance vulnerability with wit, frequent laughter even while unpacking heavy issues.
• Episode Theme: Deep dive into the lived experience of managing type 1 diabetes with comorbid ADHD, emphasizing how executive function and focus are essential (and often overlooked) tools for chronic illness self-management.
• Memorable Episode Title:
  • “Tilt-A-Whirl” as the metaphor for Gabby’s ever-spinning, hard-to-navigate mental landscape.

Actionable Advice/Takeaways

• For Listeners with Similar Struggles:

  • It’s critical to address comorbid ADHD with your healthcare team if it’s affecting diabetes management.
  • Advocate for yourself: write things down, prepare notes, consider using digital tools to summarize symptoms for doctors.
  • Don’t accept feeling unsupported; better tools and strategies exist, but sometimes require persistent self-advocacy.

• For Medical Providers:

  • Listen deeply to the patient’s context (pauses, hesitations), not just the bullet points.
  • Structural interventions—like help with organizational strategies—might be as important as medication.

Listen to the original episode for the full, unfiltered conversation: JuiceboxPodcast.com