Juicebox Podcast #1637: “Over Producer”

Date: September 25, 2025
Host: Scott Benner
Guest: Alex (T1D, nurse, mother of four)

Episode Overview

This episode features Alex, a 33-year-old woman living with type 1 diabetes (T1D) for 22 years, who shares her in-depth journey from childhood diagnosis through turbulent adolescence, challenges with self-management and diabulemia, and her adult experiences balancing motherhood, career, and health. Most notably, Alex discusses a rare medical event—lactation-induced euglycemic ketoacidosis—which occurred due to her low-carb diet while breastfeeding with T1D. Her story is honest, emotionally rich, and loaded with practical insight for people navigating diabetes, especially through pregnancy and postpartum.

Key Discussion Points and Insights

Diagnosis and Early Management

• Initial diagnosis (age 11): Alex recalls her mother’s intuition around her symptoms (weight loss, frequent urination, excessive thirst)—all recognized because her mom was in nursing school at the time.
• First hospital stay: Managed as an adult due to the small size of her local hospital. Diabetes education focused on strict regimens suited more for type 2 (diet and exercise-centric), not the flexibility needed by a child and single-parent family (04:45–08:00).
• Early insulin regimens: Started on NPH and Regular; technology such as insulin pumps came later. “A structured life was, like, kind of out of the question…” (07:21 – Alex).

Adolescence, Management Struggles, and Lying About Care

• Hiding poor management: Alex discusses the emotional toll of not meeting targets and resorting to falsifying blood sugar logs (09:03–10:04).
  • Notable quote:
    “I do not like to feel like a failure at all... So I just stopped taking my blood sugar. I’d take my insulin, and I’d tell her like I was doing what I was doing … I just lied and wrote the numbers in the book.” (09:26 – Alex)
• Teen dynamics: As her mom became busier, Alex was given more responsibility than she could truly manage, leading to shame, hiding, and declining care.

Mental Health, Diabulemia, and Body Image

• Development of diabulemia: At 16–17, Alex intentionally limited insulin to lose weight, associating proper dosing/glycemic control with weight gain—an especially risky and under-discussed aspect of diabetes management (17:47–19:18).
  • Notable quote:
    “I associated insulin with being overweight.” (18:31 – Alex)
• Alex discusses the shame and isolation she felt, which kept her out of endocrinology care for years.

Turning Points: Love, Loss, and Motivation for Change

• Impactful career moments: As a labor and delivery nurse, witnessing the negative outcomes for another woman with uncontrolled T1D motivated Alex to change (21:18–22:45).
  • Notable quote:
    “[She] delivered a baby … 32 weeks. Her baby was nine pounds. … I just thought, that’s me.” (21:24 – Alex)
• Personal loss: Alex was left at the altar by her fiancé, who said, “I don’t want to have to take care of you,” further compounding her internal shame (23:44).
• Faith and therapy: Recovery included counseling (with a pastor-therapist), rediscovering faith, and family support (26:26–27:15).

Marriage, Motherhood, and Modern Diabetes Care

• Remarriage: Met her husband on Christian Mingle (10 years ago) and now is a mother of four.

• Transition in care: Engaged with endocrinology, moved to newer insulins (Lantus, Humalog), adopted CGM technology, and found benefit in a low-carb diet for her physical and emotional well-being (29:31–31:10).

  • Notable quote:
    “My A1C was like 11. And I just started crying … [my endo said] ‘this doesn’t have to be where you have to be forever. We can change from here.’” (30:05 – Alex)

Pregnancy with Type 1 Diabetes

• Pregnancy complications: Retinopathy worsened with rapid glycemic improvement; lost vision in one eye temporarily during her first pregnancy but recovered.
• Birth & NICU: Early deliveries due to preeclampsia and concerns based on her experience as an L&D nurse (36:10–44:23).

Rare Complication: Euglycemic Ketoacidosis from Breastfeeding (Lactation Acidosis)

• Unique postpartum crisis: After her third child, Alex experienced unexplained episodes of near fainting, tachycardia, and malaise, misattributed repeatedly to low blood sugar.

• Ultimate cause: After her fourth child, she developed lactation-induced euglycemic diabetic ketoacidosis—dangerously high ketones with normal blood sugar, triggered by aggressive low-carb dieting plus heavy milk production/postpartum metabolic stress (50:00–59:26).

  • Notable quote:
    “It turns out I had what’s called lactation acidosis … because I ate such a low carb diet, I required such little insulin … I went into acidosis because I didn’t have enough insulin for my body requirements, but my blood sugars were totally normal.” (55:41 – Alex)

• Resolution: Hospital admission, correction with glucose, fluids, and dietary modifications—now ensures at least 50 grams of carbs daily.

Notable Quotes & Memorable Moments

• On the emotional side of diabetes:
  • “I didn’t want to have diabetes at all. So it was kind of like I didn’t want to have it. I didn’t feel like I knew what I was doing, but I was supposed to know what I was doing.” (11:03 – Alex)
• Impact of support system bandwidth:
  • “People have only so much bandwidth and hers [Alex’s mom] was used up already.” (14:03 – Host)
• Medical system gaps:
  • “Nobody had like… They were all probably ChatGPTing what was wrong with me, you know, over at the doctor’s nurses’ station.” (63:36 – Alex)
  • “I think the problem, like… is when people act as if they know everything and they’re scary. You know, that like, false confidence… that is what scares me.” (68:53 – Alex)

Timestamps for Important Segments

| Segment | Timestamp | |-------------------------------------------|---------------| | Childhood diagnosis, initial experiences | 00:14–08:00 | | Adolescent management, lying, shame | 08:04–11:26 | | Diabulemia, hiding, mental health | 17:47–20:10 | | Turning point: career, motherhood | 21:00–22:45 | | Faith, therapy, and family healing | 26:26–27:15 | | Marriage/relationships and management | 29:31–31:10 | | Retinopathy and pregnancy complications | 36:10–39:10 | | Breastfeeding and hypoglycemia struggles | 37:32–39:10 | | Postpartum collapse, rare diagnosis | 45:08–58:00 | | Medical system reactions & false confidence | 63:36–68:53 |

Practical Lessons & Takeaways

• Diabetes and dietary restriction: Even vigilant low-carb eating can pose risks for T1Ds, especially postpartum/breastfeeding. Too little insulin combined with metabolic stress (intense lactation) may result in euglycemic DKA—not just classic hyperglycemic DKA.
• Importance of carb intake postpartum: Alex’s key advice for nursing mothers with T1D: ensure adequate carbohydrates, even if you normally eat very low carb (59:01).
• Psychosocial support: The emotional/psychological toll of T1D—shame, isolation, the desire to be “normal”—can sabotage care and deserves real attention.
• Finding personal strategies: Low-carb eating, technology (CGM, pumps), and openness to ask for help were pivotal in getting Alex to a place of safe, sustainable self-management.

Original Language and Tone

The conversation is warm, vulnerable, and at times light despite heavy themes. There is humor, empathy, sarcasm, and plainspoken honesty throughout, as seen in quips about “just being a cow” when overproducing milk (37:53), or her tongue-in-cheek monologue about healthcare professionals using ChatGPT for rare diagnoses.

Final Thoughts

Alex’s story is invaluable for anyone living with T1D, professionals working in postpartum and maternal care, and families supporting someone through diabetes and motherhood. Her experiences highlight the dangers of under-recognized complications, the importance of checking one’s assumptions, and the ongoing need for compassion—in both the professional and personal spheres.

For listeners who are postpartum, breastfeeding, and eating low carb with T1D:
Be mindful that even when your blood sugars are “in range,” you may need more carbs/insulin than you think. Symptoms like unexplained weakness, rapid heart rate, or fainting deserves careful follow-up to rule out metabolic disturbances like euglycemic DKA.

Key Quotes Index

• “I didn’t want to have diabetes at all.” (11:03 – Alex)
• “I associated insulin with being overweight.” (18:31 – Alex)
• “I just thought, that’s me.” (21:24 – Alex)
• “This doesn’t have to be where you have to be forever.” (30:14 – Alex’s endo)
• “Nobody had like… They were all probably ChatGPTing what was wrong with me…” (63:36 – Alex)
• “That is what scares me.” (68:53 – Alex, on false medical confidence)

For more resource links and stories, visit juiceboxpodcast.com.