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- [00:00]
A
As the holidays approach, I want to say welcome and thank all of my good friends for coming back to the Juice Box Podcast over and over again. I guess I have to be careful about what I say on the Internet because a couple of weeks ago I said I'd like to see Dr. Beach Jim on the podcast and here she is. You all went and told her on TikTok, Instagram, Facebook, YouTube, everywhere you could find her. You tagged her, you tagged me and you said we'd love to hear you on the Juice Box Podcast. And you guys did it. You're the producer of the podcast today. You got us Dr. Beach Jim and she is every bit as amazing as you think she is. She's known all over the Internet as Dr. Beach Gem or Dr. Beach Gem 10 and is a board certified pediatric emergency medicine physician. She's a wife and a mom and I had such a fantastic time making this recording with her that after we got done recording I asked if she would be interested in coming back and putting together a series with me about how type ones could have better success in the emergency room. And guess what? She is so lovely she said yes. So you'll see Dr. Beach Jim back on the podcast in 2026, maybe for a number of episodes. If you're here today because you're a big fan of Dr. Beach Jim and you have no idea who I am, my my name is Scott. I make this podcast, a Juice box podcast. It's 11 years old. We have 1700 episodes. An episode goes up every day. Most of them are conversations with people who live with type 1 diabetes or love somebody who does. Some people with type 2 and a lot of other autoimmune issues. Hashimoto's celiac stuff like that. If you like to hear people sit down and really openly and honestly talk about their life with their condition, I think you'll really like this podcast. It's not super serious, it's not super jokey, it is entertaining and I think you'll love it. Subscribe and follow. Give us a shot and at the very least you'll get more Dr. Beach Jem in the future. And please don't forget that nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Foreign. The episode you're about to listen to is sponsored by Tandem Moby, the impressively small insulin pump. Tandem Mobi features Tandem's newest algorithm, Control IQ plus technology. It's designed for greater discretion, more freedom and Improved time and range. Learn more and get started today@tandomdiabetes.com Juicebox Today's episode is also sponsored by USMED usmed.com Juicebox or call 888-721-1514. You can get your diabetes testing supplies the same way we do from US Med. The podcast is also sponsored today by the Eversense365 the one year wear CGM. That's one insertion a year. That's it. And here's a little bonus for you. How about there's no limit on how many friends and family you can share your data with with the Ever since now app. No limits. Ever since. So you're being recorded already. Just so you know.
- [03:21]
B
Awesome.
- [03:22]
A
But so okay. It's not. And there's no video. If you want to pick your nose, it's cool with me. No one's ever going to know. Although I get priorities. People are like, you should do a screenshot so you can do the social media. I'm like, I'm not good at social media. I'm going to just hope that she enjoyed herself and posts about it. It's like I, I'm not going to be good at cajoling people. We'll just jump right in. How do you want me to refer to you? What do I call you?
- [03:44]
B
Dr. Beach or Dr. Beach Jim?
- [03:45]
A
Dr. Beach or Dr. Beach jam. Okay. You can call me Scott.
- [03:49]
B
Jem is Meg backwards and my maiden name was Meg beach. So Beach Gem is Meg Beach. It's a play on my name, which again, I'm not allowed to use. But that's.
- [03:57]
A
Yeah, people have got it figured out.
- [03:59]
B
Pretty well a little bit. There's a couple people that are like, I'm on to you.
- [04:02]
A
I just figured that you loved the.
- [04:04]
B
Beach when I saw it and I live in Florida. Like it makes sense.
- [04:07]
A
People are confused and want me to ask you why you live in Florida but you wear Bill's gear?
- [04:13]
B
So I did training in Buffalo. So I spent three years. We, my husband and I packed up everything we owned, we sold our house, we bought two new cars that had four wheel drive and we moved to Buffalo. We didn't know a soul. With our two tiny babies. We lived there for three years. It's. I don't know the people who don't know. Buffalo is an incredible community. Very, very like welcoming and supportive and yeah, there's snow. But like the people, the festivals, everything is just amazing.
- [04:38]
A
That's good to hear. My daughter's friend just graduated from college and she got her first Job in Buffalo and she's leaving in a couple.
- [04:44]
B
She's going to have a blast.
- [04:45]
A
Awesome. I'm going to tell her that because I think she's worried. I think she just thought snow.
- [04:48]
B
Yeah, there's, there is snow. If you live north of downtown, it's actually, you don't get as much lake effect. It's like just south of downtown.
- [04:55]
A
I'll tell her that. Yeah, that's good advice. Okay, so you went to school there? Did you go to undergrad med school? What did you do there?
- [05:03]
B
I did my fellowship training, so my pediatric emergency medicine fellowship after my general pediatric residency, I spent a lot of time in school.
- [05:12]
A
Did you start out thinking like you'd be a pediatrician in an office and then kind of expand or did you always have this as a path?
- [05:20]
B
You know, I wasn't sure there were three things that I was interested in. I liked pediatric emergency medicine, pediatric ICU and pediatric endocrinology. Because when I was in med school, I did this summer camp just outside of Tallahassee for kids that have diabetes. And it's a one week summer camp and they bring like med students and people who are a little bit more savvy with medicine so that we're, you know, we're doing blood sugar checks and that kind of stuff in the middle of the night in these kids and can alert camp staff if there is something awry. So I fell in love with as much as you can fall in love with diabetes and the management while I was still in medical school.
- [05:56]
A
So a lot of doctors tell me that they, they make their students go to diabetes camp to really get a feeling for it. What happened to you? Can you tell me, like, what you didn't know that you left Understanding?
- [06:08]
B
I think like the glucose is still fuel. You still need the sugar. Even though sugar is like kind of the enemy, like, we want to keep it manageable, it is still fuel. And so when kids come into camp, one of the first things that they do is they adjust everyone's regimens. Like they go rogue because the kids are going to be much more physically active than normal. And so we need to make sure that they have a little bit more of that fuel accessible for what they're doing. And we actually had a kid have a really kind of scary low at one point. And so just to see that, like this is what parents are worried about when they tend to want their kid's blood sugar a little on the higher side and doctors want it a little on the lower side, but this is the scary Part that doctors don't always get to see that parents get worried about.
- [06:50]
A
Okay, so the reason I'm super interested to have you here is because I want your perspective, but I do first want to understand, like, you know, a little bit about you and how you got to where you are. Can we start with why you're famous? Like, how did that begin?
- [07:04]
B
Yeah, it's a great question.
- [07:06]
A
Because you are. Because I told you before we started recording. My wife has been cajoling me for two years to try to ask you on the podcast. I now watch you online. And then I was telling Dr. Beach Jem this story before we started recording, but she did a diabetes awareness video that a lot of people who listened to me must have seen. And then I kind of sicked them on her. I was like, hey, I'd love to get her on the podcast. Can you go tell her? And then they tagged you a lot. And me, I appreciate you not thinking we were crazy and coming on like, no one doesn't know who you are, who has social media, but did you set out for that to happen? Because it doesn't feel that way?
- [07:40]
B
No, I. This was an accident, kind of a happy accident, but this was never my intention at all. I started making content during the pandemic. I think everyone had a million activities. Life is busy. I had four kids. And then all of a sudden all that's gone. I go to work, I come home and I look at everyone. So I downloaded TikTok and then I started creating videos that kind of broke down science a little bit, you know, talked did some myth busting, discussed some of the misinformation, and talked about real science based stuff. And I guess I did it in a way that was authentic and accessible. And so people really were drawn to that, I guess.
- [08:17]
A
Do you find yourself thinking about that? Because this is not a thing a lot of people didn't try. I don't want to get like down a wormhole that's only for you and I, but I don't understand why my thing's popular and other people tried it and it didn't work. It's hard to pull out far enough, macro enough to see yourself like that. Do you have any feelings?
- [08:34]
B
I 100% agree. I don't really know why the social media kind of chose me because there's so many people that come out and I have a bunch of colleagues who do very similar stuff that I do, but don't have the same degree of following. And arguably they're smarter than me, most of them. You know, But I think that one of the things that I do is I do share a little bit more of, like, my personal life and my flaws and my messy house. And I think getting to know someone, you trust them more. They know that I've got the ADHD and that my house is messy. And I get anxious when I do public speaking, and they say, now she's gonna talk to me about this. But I can trust her because I know that she's a real human, and I think that letting people in a little bit keeps them here.
- [09:19]
A
I said something on a recording that isn't out yet that I still can't believe I even admitted about myself. I always think, like, maybe I'll just message the editor and be like, take that out. I don't think I should have said that even the. Just two days ago, I was recording with a lady, and she was talking about her antibodies for type one. And she goes, there's three. And I went, I think there's five. And there is five, by the way. I was right, but I wasn't sure. And I've been doing this a really, really long time. And it does give you a moment where you're like, am I not the right person to have this? Whatever this is? You know what I mean? Like, what do they talk about? Imposter syndrome? I don't feel imposter syndrome. I don't feel that way. I just. I'm worried that I'm not doing as well as I could be. Sometimes people. I don't know if that makes sense or not. But anyway, it seems to be going okay. So, okay, you did not do this on purpose. You started making videos. People like you. And then when does it occur to you that you're a slave to the machine now? Because at some point, you have to make content, right?
- [10:10]
B
Yeah, I do feel like I kind of have to make content. There is a certain degree of pressure there. But at the same time, I don't really feel like a slave to the machine because it's still something that I really enjoy. I really enjoy making the content. Deciding on what to talk about that day. Like, this is still something that I. It's my coping mechanism for what I deal with, what I consider the real world at my real job. This is still something that I really enjoy. So it doesn't really feel like work. You mentioned before we got on that you work seven days a week, and I was like, oh, I guess I also work seven days a week on this. But I. I just don't look at it. Like that, because it's still something that's really fun.
- [10:44]
A
Yeah, it doesn't feel that way to me, but it's true. And actually, of all the strange things, Covid helped me with that because I stopped caring what day of the week it was when I was working. So I've said oftentimes, like, there'd be like 9 o' clock at night on a Wednesday. And I'd say to my wife, we'd eaten dinner and we kind of, you know. And I was like, I'm gonna go work more. And she's like, why? I'm like, why not? I was like, we're just gonna get up and exist in this house again tomorrow. I might as well do something, you know, that's really interesting. Okay. So I would also tell you that when I first started doing this, there was a person who told me, well, you won't be able to do it long cause you'll run out of topics. And I have found that to be the most untrue thing that anyone has ever said to me. Yeah, I think that there is a way to continue to help people and be thoughtful about it infinity just to keep going. There's so many things to talk about that people don't understand or have context for. My question is, what do you see that you talk about that really helps people that you didn't believe? You just thought, oh, I'll just talk about this today. And then you realized how impactful it was.
- [11:44]
B
Probably. Honestly, some of the diabetes stuff that I've talked about. I diagnosed a friend's child with DKA and Carline, and I tell that story every year. And, and throughout the year, I get tons and tons of comments still on those videos. And then people sending me messages like, hey, I knew what to look for. I was able to get my child or a friend's child early diagnosed. They didn't go into DKA because, you know, we knew the symptoms ahead of time. So some of that content, I feel like has been among the more impactful stuff that I've done.
- [12:15]
A
You might not know this, but type 1 diabetes is one of the best represented disease states as a community online. It has been like that since I started blogging in 2007. And, you know, it's interesting because back in the day, like, I'd have people come to me and say, we'd really like to start a community for type 2. There's so many more people with type 2, but they don't seem as interested as being in a community. And then. And do you Realize, like, there's something about Type one that makes people, they can't hide it. Right? You can't ignore it and you need support. I didn't realize even when I started doing this. This will maybe make you laugh. When I started making the podcast, I actually just thought I would take my most popular blog posts and read them into the podcast because I knew they helped people. I didn't realize it was going to go like this. And people are like, like, please don't do that. I pivoted a little bit, but as I started growing, I kept thinking all I was doing was sharing tools. And then when I started seeing that tools. I think tools and foundation are really important. I think the confidence to make decisions about setting changes is a huge thing for type ones. But community and support from people who understand. I don't want to sound silly because maybe I, maybe I feel old, but I didn't realize that was a big deal. And now I see it as like half of it, you know? So maybe that's one of the reasons why you're seeing back from people with type 1 because they are engaged, because they need to be. And I think when you talk about it, they're like, oh, there's somebody who's outside of diabetes a little bit who's willing to, like, talk about this. It must just be exciting to hear somebody speak about it thoughtfully. Yeah. Yeah. Okay, so now we understand how you got here. Now I'm gonna ask you my difficult question.
- [13:51]
B
Oh, boy.
- [13:52]
A
I hate the word advocate for myself. I hate to think that you, like, here's how I think about it. When I go to the to get tires on my car, I don't go, hey, get me four new tires. Let me watch and make sure you pick the right ones. Let me watch and make sure you put them on the right way. Did you balance them? Did you fill them up with air? Did you tighten the lug nuts? I got to advocate for myself to make sure you do your job right. Like, why do we have to advocate in health care? I used to hate ordering my daughter's diabetes supplies. I never had a good experience and it was frustrating, but it hasn't been that way for a while. Actually, for about three years now because that's how long we've been using USMED, usmed.com juicebox or call 888-721-1514. USMED is the number one distributor for Freestyle Libre systems nationwide. They are the number one specialty distributor for Omnipod Dash, the number one fastest growing tandem distributor nationwide. The the number one rated distributor in Dexcom customer satisfaction surveys. They have served over 1 million people with diabetes since 1996 and they always provide 90 days worth of supplies and fast and free shipping. USMED carries everything from insulin pumps and diabetes testing supplies to the latest CGMs like the Libre 3 and Dexcom G7. They accept Medicare nationwide and over 800 private insurers. Find out why USMED has an A rating with a Better business bureau@usmed.com juicebox or just call them at 888-721-1514. Get started right now and you'll be getting your supplies the same way we do. When you think of a CGM and all the good that it brings in your life is the first thing you think about. I love that I have to change it all the time. I love the warm up period every time I have to change it. I love that when I bump into a door frame sometimes it gets ripped off. I love that the adhesive kind of gets mushy sometimes when I sweat and falls off. No, these are not the things that you love about a cgm. Today's episode of the Juice Box podcast is sponsored by the Eversense365, the only CGM that you only have to put on once a year and the only CGM that won't give you any of those problems. The Eversense 365 is the only one year CGM designed to minimize device frustration. It has exceptional accuracy for one year with almost no false alarms from compression lows while you're sleeping. You can manage your diabetes instead of your CGM with the Eversense365. Learn more and get started today at eversensecgm.com juicebox1year1cgm.
- [16:41]
B
Oh, you know, healthcare is tough and healthcare is not your car. It's not as easy as putting tires on something. You know, disease states are complicated and people make them individual. And you know, I work in emergency medicine so my job is looking for emergencies and so I can say, you know, I may say to someone, this is not, I don't know what this is, but this isn't something that's gonna kill you tonight. And this is the plan for follow up. And it can be complicated because, you know, what's your insurance status? What can you guys get approved as an outpatient? There is so much more that goes into decision making in healthcare. Just let's throw some tires on. So I have to think, is this person that doesn't have an emergency going to be able to get this test done? Can they get into their pediatrician? Can they get into this test done as an outpatient? And so I think when we talk about the decisions that we have to make, it's just so. It's not even three dimensional, it's four dimensional. And I think there are a million different ways to approach conditions and decisions. And I think when we're advocating, we're trying to bring everyone to the table, to the same table.
- [17:50]
A
Okay?
- [17:51]
B
Because a lot of times, and granted there are great providers out there and not so great providers out there, but I'm sitting at my emergency medicine table and they're sitting at their parent table and we need to be sitting at the same table. And I don't understand their insurance and their transportation and all of this other stuff. And so I think advocating is really trying to get us all on the same table so that we're understanding all of the same things.
- [18:12]
A
Okay.
- [18:12]
B
I don't want to defend the not great decisions that happen out there, but I think some of the decisions that are made in medicine are decent decisions just not made for the right person.
- [18:21]
A
And is it different for people with type 1 because they often have such a deeper understanding of their illness than other people do? Right. So when you say something that smells a little wrong in the ER for me, I'm like, ooh, that ain't right. And then like, suddenly there's a, a chasm there, like, oh, we're gonna take your pump off. You're like, dude, don't do that.
- [18:40]
B
Yeah.
- [18:40]
A
Or you know when somebody finger you every hour when you're wearing a CGM and you think like, are you just doing this so you can charge me for the finger stick? Like, what is happening right now? And like, so I ask you the question. It's a bit of a trick question because people feel all the time like medicine doesn't understand diabetes. But I've been doing this for so long and I've spoken to so many different doctors that I think it's kind of a like a multi pronged problem like you are. You said and you said something. I feel like, like you as the patient, you're the variable because you don't know, am I on the ball? Do I not understand this at all? Like, where's my diabetes? Understanding, like, so you have to treat us all like we don't know what we're doing. Because that is probably what you see most frequently, right? People with higher A1Cs who aren't quite sure about how to do what they're doing. And then there's your level of education, your level of experience, like how tired are you? Are you fighting with your husband? All this is happening at the same time. And then there's the insurance piece. So can I even run this test? Am I right to say that, like, there's basically a checklist and if you don't meet everything, then there's a test you can't run even if you wanted to?
- [19:42]
B
Not necessarily a checklist in all situations, especially again, I'm in the emergency department. I have relative free reign as long as I can justify it.
- [19:51]
A
Got it. Okay.
- [19:52]
B
So I can't order, you know, a random outpatient send out test that has nothing to do with your visit today, but I can order an A1C if we're concerned about X, Y and Z. And it makes sense with your visit, I do have more leeway than a lot of outpatient providers, which is cool.
- [20:08]
A
Which is really cool because you're in a more of an emergent diagnostic situation. This episode is sponsored by Tandem Diabetes Care. And today I'm going to tell you about Tandem's newest pump and algorithm. The Tandem MOBI system with Control IQ technology features auto bolus, which can cover missed meal boluses and help prevent hyperglycemia. It has a dedicated sleep activity setting and is controlled from your personal iPhone. Tandem will help you to check your benefits today through my tandemdiabetes.com juicebox. This is going to help you to get started with Tandem's smallest pump yet that's powered by its best algorithm ever. Control IQ technology helps to keep blood sugars in range by predicting glucose levels 30 minutes ahead and it adjusts insulin accordingly. You can wear the tandemoby in a number of ways. Wear it on body with a patch like adhesive sleeve that is sold separately. Clip it discreetly to your clothing or slip it into your pocket. Head now to my link tandemdiabetes.com juicebox to check out your benefits and get started today.
- [21:17]
B
Yep. Like if I can justify it with the visit today, like we could probably make it happen. But I think one of the things that gets complicated is that like you said, there are a lot of situations where people have higher A1Cs, maybe not managing quite as well and then for whatever reason, and so we have all of these protocols and checklists that we have for new onset diabetes or maybe hyperglycemia. And so we click these checkboxes for orders and now it's saying everybody that comes in with hyperglycemia is going to get a blood sugar Every hour. And what if your CGM is not working? So I think that we are in this super cautious over here phase where you're like, I got my CGM, we're good. My blood sugar is 10 points different than it was an hour ago. But we have to function in this more conservative space, and we use these protocols to do that. And it's nice because we can override these protocols in certain situations, but a lot of times the default setting is going to be going by these protocols.
- [22:16]
A
Okay. People also want me to ask you how can it be possible that when kid comes into a pediatrician's office with flu, like symptoms, that a finger stick is part of the diagnostic? Because that's usually where people are misdiag, like, could be diagnosed and aren't. Right. Is that what, like, is that a money thing? Like, it's such a strange idea that it's not just part of it.
- [22:38]
B
I don't know if it's as much as a money thing, as a resource thing, because you have to make sure that that blood sugar meter every day has to be like, you have to check it to make sure that it's working. I forget what the thing's called. You have to calibrate it every day, so you have to have the person to do it. And then if it's not done, you have to calibrate it. That takes time. That takes your nurse that's busy, that you guys have 40 appointments today, and instead of doing this now, she's calibrating and then checking a blood sugar, which takes time. So I think it's more of a resource thing. I will say that's one of the more commonly missed things is gastro or flu, like illness. And it's actually, you know, new onset or dka. And we do our best to check blood sugars frequently in the er, but it is something that could easily be missed. I would say in the er, that's all we see all day long. And so it goes back to the resources we calibrate every day anyway, because we check enough of them. But that's probably the biggest barrier, I would say, is doing it.
- [23:33]
A
So I often, I sit around and I think sometimes doctors jobs are really unfair, right? Like you expect them to. Like, first of all, you go to. If you really were gonna go to medical school and come out with a complete understanding, you'd have to go to medical school for a hundred years, right? Like, so you get a little bit of everything, and then you're left to just remember, oh, did I hear a thing one time about that or have I ever had this experience? There's times when I think when you come into an er, you should just be talking and an AI should be listening to you. And then it should say, here are the possibilities in case you miss something. And then layer the human side on top of it, because that is what we're asking you to do. And there's. There's no way you're going to be able to do that. Like, even the sharpest, brightest, most focused person isn't going to have access to everything they've ever encountered in the world, every thought and every teaching, and they might have missed one. And so, I mean, your job must feel like rooting around in the closet without a flashlight in the dark, right? Like, is that. Am I getting close?
- [24:29]
B
Yeah. The saying that we have is you're walking through a minefield in clown shoes because it's four years. And in that four years, you're supposed to learn everything that you need to have to go start practicing. And then you've got three to six years of residency where you're supposed to learn everything else. And I can tell I learned a lot during that time, but I certainly didn't learn everything that there is to know, especially when there's getting into these really rare genetic conditions and stuff like that. It is hard, and we have to be perfect 100% of the time or else somebody's life could be in danger. As a human being. Right. 100% of the time is just impossible. I will 100% agree that. I think that bringing things in, like AI to help us not miss things and to help give us ideas. I think that we're gonna see all types of new things coming onto the horizon and hopefully not missing things to say, like, check a blood sugar, do this. I feel like my other response was a little more defensive. I am all about checking a blood sugar in literally anyone I can order it on.
- [25:28]
A
Right.
- [25:29]
B
In a kid that's vomiting, I'm asking the questions, how are they drinking? How are they peeing? You know, some screening things in addition as well. But it's not an easy job, and it's a. It's a heavy lift sometimes.
- [25:39]
A
Yeah. It's interesting that you said you felt like you might be being defensive. I pay attention to your content, and I know that you're having some sort of a medical issue, I'm sorry to say this. With discharge from your breast, right?
- [25:50]
B
Yes.
- [25:50]
A
And I watched a couple of videos where it was interesting because, like, what you do professionally as a doctor what you do professionally, on social media. Like on social media, you know that like, people go to the hospital and have outcomes that aren't great and that they could be better. But yet when it was you personally, you were like, I have a good doctor and I'm going to listen to what they say even if I don't agree with what's happening. And I was like, well, that was such an interesting separation for me because you're a doctor and you know what it feels like to be your doctor. Can you untwine all that for me? Because you know what I'm talking about, right?
- [26:23]
B
I do.
- [26:23]
A
Okay.
- [26:24]
B
So I had an experience where I was supposed to have a test performed and I didn't have a great experience having that test perform. They actually weren't able to do it. It felt to me that they were being kind of condescending. And, you know, I'm not dumb. I have an OB GYN who I trust because of other things that I can't really talk about. But I trust her, right? She knows the system and she's. She knows the stuff. And so if she tells me, hey, you need to do this test, like, I trust her, it's not the answer that I want to hear, but I will go and do it. And she recommended that I see a specialist. And in the end we're going to end up skipping the test and move right towards surgery, which is kind of what the evidence based stuff shows. And I'm a big fan of evidence. You've probably seen that in my videos, like, show me the evidence and we'll follow it. So I know as a patient there are things that I don't want to do because it's uncomfortable or unpleasant or I don't want to go back into that situation again. But I do trust my doctor and what she says, especially when she can provide me with the evidence to back it up.
- [27:19]
A
So how do you make that leap when you know I'm just guessing, but you've made mistakes as a doctor, right? So when you're sitting there sick, having this problem that people are like, I don't see, like, I heard you say this one thing, that you went in for a test, they couldn't produce the result to prove what you were seeing. Then I think you went out into the waiting room and like, were having it and you kind of ran back in and you were like, it's happening now. And they're like, don't worry, we'll look another day. Like, when you know you've been wrong before, how do you still say, I'm going to trust the process when you've seen the process be wrong and now you're the one who's in jeopardy?
- [27:52]
B
Yeah. So I was trusting my doctor who ordered the test. Not necessarily. I. And I had some frustration with that situation. And I know based on lots of things, that that facility actually does really good work. And I. I go back to, we're all human and we all have bad days sometimes, using your word. I had to advocate for myself in the next step, and I usually don't advocate for myself. I'm actually really bad at that for lots of reasons. But I did that day. I stepped back out and I said, look, here's my symptom. And they said, no, thank you. I go back to the doctor that I trust. And she called me the next day and said, what are we thinking about next steps? And we had a really great talk about it. We kind of went over the next plan. But I think it's hard because I want to trust my medical colleagues. This is a system that I work in. These are my people. And it is maybe more disappointing for me than for others. I'm not sure about that. But it feels more disappointing to me because, like, these are the people, this is me. And, like, when I'm disappointing myself, that's hard. So I feel like, like, if they're going to do anything, like, like, let's fight for the same team. And it's just, you know, sometimes it all falls apart.
- [29:02]
A
I just found it kind of fascinating because, like, you don't have white coat. Right. That doesn't happen to you. You don't know. Right. So you have other reasons. You're a people pleaser or something like that.
- [29:11]
B
Yeah.
- [29:12]
A
Gotcha. Okay. Okay.
- [29:13]
B
I don't want to go against the grain, right. Because this is my team. So, like, we should all be in it together and doing the same thing. So I don't want to go against the grain.
- [29:20]
A
See, that's what I was wondering, like, if you're not like a wide receiver on television, like, not wanting to say something bad about the offensive line, like. Right. Yeah, yeah. Because why? Because you have a respect for them or because you believe that you could be in their position quite easily in another situation.
- [29:37]
B
Probably, yeah.
- [29:38]
A
Probably that there's a lack of confidence underneath all of it. So it's interesting because I think people see doctors, I think doctors, teachers, and cops, right. Get like a pass because you're brought up like, be kind to the police officer, listen to your teacher, listen to your doctor, and Most of your life, that works. And then usually, even if you get sick, it works. Right? I say all the time, break your arm, go somewhere right away. I've had my shoulder repaired. I've had my ankle repaired. There are things medicine is awesome at. And then when you get into type 1 diabetes, it very quickly becomes, how strange is it that endocrinologists all over this country will get you in a corner and go, hey, listen, you should go listen to the Juice Box podcast. Do you know what I mean? Like, how strange that is? The endo is like, you know what your best bet would be here? Go do this. Like, because I can't help you as much as you want to be helped. I can't figure that part out for my life. Like, I can't figure that. Like, how am I a better resource than your nurse practitioner?
- [30:38]
B
Oh, I think part of it is going back to the resource. You know, time is one of the biggest resources that we have in medicine. And the way that insurance reimbursement goes, we have to see a certain number of patients to keep the lights on. And when you look at medicine and the way that doctor salaries are going up, there's a lot of other people that are going up way faster than doctor salaries. Like, we're not really keeping up with that. I mean, we're doing okay. No complaints. Complaints. But the resources, the time, because we've got to get in and get out and see the patients. And so we tend to refer to resources that are going to be supportive, resources that are going to be educational, resources that are going to be given great life tips. I think that we're finding community is also important, where you can share. And community that's going to be giving good information is vital.
- [31:23]
A
Yeah. I have such a great idea that nobody takes seriously because I think they don't know how to bill it. But I think that instead of coming in and having an appointment once every four, every three or four months, right after 15 minutes, I think a huge group of people should come to an auditorium three or four times a year and have a group experience. Because I've gone and spoken at events where people come in, don't know what they're doing in an hour later, they're better off. And then six months later, they send me a note, oh, my God, my 1C went down two points. Because that thing you said. Right. Which is a wonderful feeling, but, like, we should find a way to do that for people. I know that that's not the system, but, like, if 15 minutes isn't enough, then give them more time. And who cares? Like, in the end, like, my opinion is, like, who cares? Like, just bill it the same way, but give them different tools. Like, right. Like, you could do that a few times. I could give that talk every day. Like, right. Like, and. And so could other people. And I. I also think it would help the physicians at some point, too, because so much about type one is timing and amount. Dr. Beach. Jim, I tell people all the time, I'm like, if. If you push me off a cliff and said, teach people about diabetes as you were falling, I'd say it's all timing and amount. Like, just use the right amount of insulin at the right time, it'll all be okay. And there's obviously more to it than that, but that really is. That's the seed of the idea. And then you have to understand how food impacts your blood sugar, how your blood sugar impacts your food, about activity. Like, there's other stuff obviously to layer on. But every time you look at one of those layers, the truth of it is at its distilled end, it's timing an amount. Very few people are told to pre bolus their meals. Very few people are told that fat and protein impacts their blood sugar later, like, really simple things that have such a huge impact. What I ended up saying at some point on the podcast is that you will leave your doctor with what I consider to be don't die advice. Like, it's enough to keep you alive, not really enough to keep you healthy. And to your point, you need more time to absorb all that. So you're telling me that what doctors need is they need to get paid by the download the way I do. And I wonder how to fix that. And I don't know, because I can step back and look at it like, big picture in the world and go, look, this is how insurance works. We're not going to fix any of this. This is bigger than all of us, right? And then I can also look at people's lives one at a time when I interview them and see the incredible impact it has on them. Just to not be told that. Like, as you have a million stories, I will tell you one. All right, so I'm put in touch with a person who has type 1 diabetes and a lot of kids. She's got like six or seven kids, and she's in her mid-40s, and she's online looking for help. Nobody can help her. Somebody points her to me, she sends me a message, and I'm just like, just call me. She gets on the phone. I give her the talk, basically. And the next day, I get a text back from her. She wants to know if she can call me back. I get on the phone, and she's angry. Not at me, I realize. And she's like, my blood sugar was so stable overnight. She's like. It was like 90. All night long. I slept. I feel so much better. Why didn't anyone tell me this? That was what she was angry about. She was angry about lost time. And then she started talking about she has complications. And someone could have just told me this 30 years ago. And, like, the desperation in her voice about, like, not knowing where her health was going to go, the recognition that she had lost time to a struggle that she did not need to be involved in was heartbreaking. It sticks with me to this day. You know, I don't know. Like, I want there to be a better way. I don't think there is. And. But if that's the case, then how do we make it so that where people with type 1 or type 2 touch doctors, there's more understanding? Because if you ask a type one, what they're most scared of, it's going to the ER or being admitted to the hospital. So I kind of would like to shift into that now, and I'd like you to help me help them have a better experience when they. If they end up in the hospital.
- [35:25]
B
Yeah, that's tough. I think, especially for pediatrics, go to a pediatric facility. The way that DKA and type 1 diabetes is managed in adult facilities or community hospitals is quite different than a pediatric facility, I'll be honest. We manage a little bit of type 2, a little bit of insulin resistance, but we manage so much Type one. I feel very comfortable with type one management, and I, as much as I can, defer to the family's kind of expertise about their kid in that situation. And you can tell pretty quickly talking to a parent. I could Almost guess their A1C. After that first discussion with the family and kind of the way that they're managing things at home, I think it's really important to stay on top of things as much as possible. We do a lot of protocols, will ask you to remove the pump. If we are in dka, just because we're trying to, you know, we're going to end up putting on an insulin drip and stuff like that. So it's. It helps manage a little bit more cleanly so we know how much insulin is going in. But these times can be very tough, and I do think it is really important to be at bedside and ask, you know, when they're checking the blood sugar and what was it and how much insulin are you giving? Because obviously those are. It's pretty big deal making sure that they're getting what they need to get.
- [36:43]
A
Yeah. It's interesting to hear you talk about it because I trust you and I know you're smart and I know you understand this, and your answer still seems a little like, I don't know. And I appreciate that, by the way, that you're not bull me. Like, I really do appreciate that. My daughter has a friend who ended up in. She had ketones. She got sick. She got ketones, and she couldn't get them to go away. She got panicked. She went to the hospital. And then she called me three or four days later, and she was exhausted, and I was like, what's going on? She goes, I just, I shouldn't have gone to the hospital. She said it did not take long for me to realize that I knew more about this than they did, and I don't know a ton about it. Like, she's a young girl. Like, she's still understanding her diabetes. You know, I asked, like, different questions. She said they kept my blood sugar really high. They wouldn't, like, give me insulin for food. Like, she's like, they kept bringing me things that were, like, really heavy in carbs to eat and then not giving me insulin for it. And as my blood sugar got higher, I felt sicker. I was trying to, like, she's trying to convalesce from some sort of an infection with a high blood sugar, which I'm not wrong. Right. That makes that more difficult. So what happens in that situation? She's there. Is it what you said earlier? Like, you come into the emergency room, if it's not killing you, then I'm not focused on it. So in the hospital, if it's not the thing you're there for, is it background, then not I, I. Because it shouldn't be. You're.
- [38:00]
B
Oh, it shouldn't. It shouldn't be. And I think that my ER DKA and my ER type 1 diabetes with a viral illness pathways in my head are very different.
- [38:10]
A
Okay.
- [38:11]
B
In which case, like, I know I'm going to give you a fluid bolus, and I know that's going to bring down your blood sugar automatically. I might not want to treat, you know, the couple sips of Gatorade that you just took. I might want to let you roll a little higher because I know your blood sugar is going to come down with fluids. And I'll be honest, I may not verbalize that as well to a family. I may just, like, give the bolus and like, hey, we'll check blood sugar again and 60 minutes and see where we're at, and then we can make some plans. I may not verbalize always my thought process behind that, and maybe I need to get better at that. And especially with families that are, like, really on top of their stuff, they know it and they're starting to get anxious as they see that CGM creeping up a little bit.
- [38:50]
A
Yeah.
- [38:51]
B
And again, DKA management, for me, different. Different pathway.
- [38:55]
A
Is there another side to this? Would ignorance be bliss for me? Would you get me through my hospital experience better if I shut up and didn't have opinions and then I could go home and get my blood sugar back down again? Or is that not the right answer either?
- [39:08]
B
I don't know. I don't think that's the right answer either, because I, you know, sitting on the floor with a high blood sugar like you, getting DKA in the hospital is not good for anyone. Right. So I think we need to be managing it. And I think sometimes there could be some oversight potentially. I know my people in my hospital are like, again, we're following protocols. We're checking blood sugars at these certain intervals because we want to avoid all of that happening. And I think, again, finding a facility that knows what they're doing, so a pediatric facility, and ask what their protocol is like. I can print it out and hand it to you, and I can say, this is our protocol. This is what we're going to be following while you're an inpatient. We're going to be doing insulin like this. We're going to be doing blood sugars like this. So I think it's reasonable to ask, could you show me your protocol for patients that are admitted with diabetes and a gastroenteritis? Show me what you're going to be doing. Show me that protocol, and then if they're not following it, you can hold them accountable there.
- [40:00]
A
So expectations should be that you're going to be a part. Hopefully, they'll allow you to be. But you should be a part of the process if you wanted to get more.
- [40:06]
B
Absolutely.
- [40:06]
A
Okay.
- [40:07]
B
Really, medicine should really be a partnership between the patient and family and the providers, the nurses, the doctors, the RTs, whoever's taking care of them, no matter what.
- [40:15]
A
So would it surprise you to know that mothers who are nurses who end up with kids with Type 1 often seem the most confused to me when I'M talking to them. Why would that be? Because it used to freak me out, but, you know, it stopped freaking me out when a. A Hopkins brain surgeon contacted me privately and asked me to explain to him how to take care of his kid. That's when I was like, oh, okay. And here's my last little piece. One of my daughter's best friends is in nursing school right now. She's probably three or almost four years in. I think she's almost done with her first four years, her undergrad. Right. And she came to me a few months ago, and she's obviously grown up with Arden, and so, you know, has a pretty tight understanding of what's going on. And she said, scott, we just went over diabetes and in class. And I said, yeah. And she goes. And I sat there, and all I thought was, wait, is that all you're going to teach us? Because that would. That's not enough to keep Arden alive. And then she said she had a stark moment where she thought, what else? Did I now believe that I have full understanding of that I don't have an understanding of. It was a real interesting moment for her. So, anyway, I. I'm not asking you to say anything bad about the nursing profession. I'm wondering, like, what happens between. Because when you're in the hospital, like, I. I don't want to say who, but I know somebody who was just in the hospital who tried to advocate for their diabetes. And the nurse was like, I know better than you. Like, shut up, basically. And that was not the case. So, like. But she really believed it. Does that all make sense?
- [41:39]
B
Yeah. And again, diabetes, type 1 diabetes, I think, again. And, you know, this traditionally looked at as a pediatric disease, and those kids do grow up and become adults, which is awesome. So I think that there are people that can manage type 1 diabetes well, but I think as kids are growing up and you're seeing this more in the adult population, a lot of the people that are taking care of the adults are thinking about type 2 diabetes management and not necessarily having that stronger experience with the Type one where you need the insulin, you need to be monitoring the ketones, you need to be getting insulin, you need to be carb counting, you need to be monitoring what you're eating, your nutrition. It's complicated. And I think the thing about coming in as a parent without medical knowledge or a medical background, you're coming in like, I just need to learn it all. I need to learn it all. I'm going to start at the beginning, and I'm just Going to learn as much as I can possibly learn. Or I think sometimes us as medical professionals, we can go. I know a little bit about that. Let's just go with this. Let's see what we can do. Or maybe we nitpick what we can learn about this or that. So we have this baseline knowledge that sometimes we rely too heavily on. But I think if you had a nurse that had more specific. Like our. One of my floor nurses manages type 1 diabetes all the time. And I think that if one of their kids ended up with it, I think they would probably feel more comfortable managing it.
- [43:05]
A
Yeah. I also want to point out that I've also heard countless conversations and stories from people who had fantastic doctors and fantastic nurses. Right. Like, it's not. I'm not trying to say that everybody's lost. I always say it's interesting because when you get a doctor, you don't know which one you're getting.
- [43:20]
B
Yeah.
- [43:21]
A
And you're going to believe them no matter what. What if I got the one that doesn't know? And what if I got the. That's what made me think about with your situation earlier, too. Like, you don't always know who you're getting. And then there's. There can be ego involved, too. And I don't mean like in a, like a God complex way. I mean, like, I went to undergrad, I went to school, I did this, I did all that. I got a guy now telling me what to do. Like, you know what I mean? Like, he's sitting in a room being like, no, you don't understand. Like, I don't understand. I mean, imagine me, I'm a podcaster. Like, right. So imagine if I was in a room going, no, I think this is what you should do. I can see where that could be difficult, too. Plus there's a ton of pressure and stress. I mean, I can't imagine being a doctor, to be perfectly honest with you. Like, it must feel like your hair's on fire all the time. No.
- [44:05]
B
You know, we have days. I can't imagine doing anything other than this. This is what I was. I was made to do. And so, you know, to me, doing air conditioning seems really stressful. But doing this feels very natural. But there are days that I second guess my decisions or I go to bed thinking about that one patient. Did we do the right thing? Did I do this right? Or wonder how they're doing now kind of thing. We second guess ourselves a lot.
- [44:31]
A
What do you think it is about your personality that lends itself to the Job?
- [44:35]
B
I have no idea.
- [44:36]
A
No, it just works for you.
- [44:37]
B
It just does. It's the ADHD and it's the seeking adrenaline and wanting to help people. But I. I don't know. It's just. It's. We're all made to do something, and I think I just found what I was made to do.
- [44:51]
A
When you put yourself out there online, because I've gone through this, I imagine you have too, right? Like at some point somebody says, oh, you're busy telling me what to do. But look at you. I'm sitting in front of you today, two and a half years removed from starting GLPs. I'm 70 pounds lighter than I was, and there were times where I didn't put myself on video because I thought, I know my stuff is rock solid about type one, but I don't want somebody to look at me and go, there's an overweight guy trying to tell me about my health. Right. Like, I actually had that feeling. I was like, I shouldn't probably do that. Right. Have you had any experience with the people being shitty to you? How do you deal with that? And does it slow you down at all with the things you talk about?
- [45:34]
B
Yeah, you know, emergency medicine and the lifestyle for emergency medicine does not lend itself well to physical health. The late nights, early mornings, the, you know, eating on the go, not necessarily the healthiest food. So I'm, you know, I'm sitting a couple pounds heavier than I would like, especially with the hurricanes and all the moves and stuff like that. So I do get comments occasionally like, oh, look at this fat person telling me, you know, to be healthy. And for the most part, I'm not really talking about, you know, weight loss and nutrition. I'm talking about ways to keep your kid from getting at a E bike crash.
- [46:06]
A
Right.
- [46:06]
B
And realistically, people don't get to choose their provider in the emergency department. Like you said, you got to get stuck with whoever walks into the room. There might not be an alternative. I might be the only one there. People tend not to, in real practice say, like, hey, I'd like another doctor. Is there somebody skinnier that could come in and see me?
- [46:23]
A
I mean, it's obviously on. Are people that directly horrible?
- [46:27]
B
Yeah, online they are. You know, and it's social media. Like, everyone has an opinion. And I, I have, like I said earlier, I have really good social media boundaries and I do a lot of, like, just delete and block. Like, I don't need someone.
- [46:39]
A
Yeah.
- [46:40]
B
Like that in my comment section for my own mental health insanity.
- [46:43]
A
Good for You. I brought it up because my wife is very impressed with how you manage that. That she said to me, she's like, I really like the way she takes care of that. And I was like, okay, well, I'll bring that.
- [46:52]
B
Like, I try to eat pretty healthy and I do work out and exercise, so I'm strong. Like, I could bench press some. I can bench press some stuff, but I'm like, like 140. I could bench press. I'm doing all right. So, you know, I.
- [47:06]
A
Well, listen, I hear you. I sit still a lot. And also, in truth, I do not eat much differently today than I did two and a half years ago. I am pretty much a fan of the idea that there might be some metabolic help that's coming from GLP1s for some people, because it hasn't really changed a lot about. I mean, it's true you're not hungry ever. Like, you know, like, I ate breakfast this morning because I know I needed to. So I'm not saying that it isn't benefiting me in that way, but I had an instant, Like, a very instant impact from. I lost 14 pounds, like, the first five days. Wow. Yeah, it was crazy. I used to be anemic. Like, I had to get iron infusions three times a year. I don't have to do that anymore. So I don't know if maybe I'm just digesting my food better now or I'm holding onto it long enough to extract it. I don't even care. I've never been in a situation before. I was like, I actually don't care. I just. I'm happy it's working. So I've seen it with other type ones, too. I've seen it with type twos. I know plenty of type twos who've lost weight. A1C. Like, their variability is better everything. But more and more type ones are getting a hold of it now, and it really is interesting to see their insulin needs sometimes go down 30% and their spikes get lesser. And I'm like, wow, I wonder where this is all going. Like, it seems like so new, but I would imagine the only, probably the only intersection you have with is probably who. People who don't do well with it. Right. Because in the er, you're just coming in because, what, you have gastroparesis from it or low motility or something, Right.
- [48:31]
B
Pancreatitis, vomiting, dehydration, chronic abdominal pain, gastritis. But, you know, in pediatrics, I think Wegovy has been approved for 12 and older. But for like just obesity and not diabetes. So there's. We've only seen a handful in the pediatric population so far. And I don't really treat adults when I can manage it. But I think we are going to see more and more of the kids that have the type 1 and type 2 diabetes on these medications and the kids that are struggling with obesity on these medications to avoid the longer term complications. The research that's coming out about the GLP1s is really cool. I mean, some of these conditions that you wouldn't even think are related. I saw something the other day on pseudotumor cerebri, which is extra CSF fluid that's produced creating pressure and it can create injury to the eyes and really bad headaches. They're seeing improvements on GLP1s. Just some really cool stuff coming down the line with these medications.
- [49:27]
A
Yeah, I would have kissed The Gila Monster 20 years ago if I knew about this. I'll tell you, ladies with pcos getting pregnant out of nowhere, that's crazy, right? My wife swears that it helps with inflammation. So much so that she thinks that her perimenopause was easier because of it. You know, I've seen people say that it's less than impacts of long Covid. Oh, that's something I wanted to ask you about. That's real, right? Long Covid?
- [49:51]
B
Yeah.
- [49:51]
A
Okay. All right. So if I told you, please don't disconnect. If I told you that I don't know. Eight months ago I was listening to a podcast and I randomly heard some guy say like, nicotine helps with long Covid. And I didn't really register it right? And then two months ago I had a lady on the podcast and she said, just kind of offhandedly, I've had long Covid for a while, but it's really getting better. And I just said, oh, what did you do? Because my wife has it, suffers with it pretty badly. She said, I did a 21 day nicotine patch protocol. And I was like, googled that. And there was a website and I was like, well, this doesn't look like it was made by a serial killer. So I read it and I said to my wife, I'm like, I don't think a nicotine patch is going to hurt you one way or the other, right? Like. So she was in the middle of a bad flare to real foggy. She couldn't get rested and everything. And my. You don't know my wife, but this was not a thing she was up for, right? Like, and I just. I caught her on a day where she was so bad off, I'm like, look, I'm just going to stick this on, you know? Then I was like, and we'll stick another one on in 24 hours. And about seven days later, she goes, hey, you know, I feel better. And 14 days later, she's like, telling other people about it. Now, I don't know how. How long you've been married, but I've been married 30 years. My wife doesn't run around saying nice things about me out of hand, so she's now telling other people. I think Scott saved me with this nicotine patch thing. Now when I know that's happening, I know something's really going on. Okay. And now it's been a month later, and she's a different person. Oh. Something about, like, receptors that nicotine sticks to and I don't even. Again, I can't believe I'm saying this. Don't care. Like, she's so much better off and she's not using the patches anymore.
- [51:25]
B
It's pretty crazy. Nicotine is interesting. There's a couple different disease processes that nicotine influences in a positive way. And again, no, not to encourage people to go out, smoke, or use at any. But there are. It is something that works in your body and can do certain things. And I think it deserves continued research, especially with things like that when we're seeing positive effects.
- [51:50]
A
Okay. How willing are you to talk about what's happened over the past 10 years about people's concepts about vaccines? Are you comfortable talking about that?
- [52:00]
B
Yes. I can't get too controversial.
- [52:02]
A
I don't want you to get controversial. I want you to tell me your opinion.
- [52:05]
B
I think that we have tremendous evidence for at least the childhood vaccines and influenza vaccines, that they are low risk, extremely effective, and I think we're already starting to see the impact of decreased vaccine uptake.
- [52:22]
A
Yeah. You think the population is getting sicker in ways that it doesn't need to be.
- [52:26]
B
I mean, we're about to lose our measles elimination status because we've had, you know, a pretty significant measles outbreak since. I don't think we've had this many measles cases since 1992. I believe we've had three deaths this year from measles, one in an adult, two in previously healthy kids, all unvaccinated, unfortunately. We've seen polio in wastewater up in New York. I think that we should have a level of concern that some of these, like, really bad things are going to.
- [52:53]
A
Come back how frequently do you find yourself talking to a patient where you think, oh, gosh, they've been radicalized by some sort of online thing and they have a belief that is completely just bull. Do you find yourself standing in front of people who you're like, oh, my God, I can't believe I have to explain this to you, but here we go.
- [53:12]
B
Yeah. So obviously, online all the time. All the time. In my practice, about 2 to 3 in 10 kids under 2 years old are not vaccinated. The younger kids, it's between 75 and 80% are vaccinated. But when kids are not vaccinated and under three years of age, there are increased risks for bacteria in the bloodstream, something called epiglottitis, which is an airway blockage meningit. And so I have to talk about the risks and potentially an increased workup because they have these additional risk factors or at least don't have the protective factors of vaccines. And I try not to ask why they are not vaccinated. I really just want to present it in a nonjudgmental way because the most important thing is creating that partnership that they're willing to trust me. And if I start asking too many of those questions, I don't want to alienate them. I want to be able to really have that discussion about. These are the things I'm concerned about. This is what I like to do, and this is why.
- [54:08]
A
Yeah.
- [54:08]
B
I try to limit anything that could be interpreted as judgment.
- [54:12]
A
Right. I appreciate you being willing to talk about it. Can you please take me back to the day that you got really famous online and somebody had to have pulled you into an office at your job and went, hey, what the hell are you doing? Did that not happen? I mean, it did, right?
- [54:25]
B
Yeah. Yeah. So, you know, I started making content. It was kind of the middle of 2020, and I had a video, actually, about vitamin K deficiency bleeding. So a baby that hadn't received vitamin K at birth. And I presented like, a Google article. Like, I Googled an article. So it was a research paper, and I put it up. Someone told my job that I had used a patient picture and a patient case, which I, again, I'd used. You could clearly see the Google. And so that's kind of. That was my job's introduction to. I'm putting stuff online now. And obviously they were like, yeah, no, you're good. Obviously, be careful. But I've had many a discussion with HR and vice presidents of things. Again, open communication, partnership. They're fine with me doing what I do. As long as we have certain boundaries and obviously protecting patient privacy and stuff like that. So we have some rules and boundaries in place. I'm very appreciative that they're letting me do all of this and I think they appreciate me putting evidence based information out widely.
- [55:29]
A
I was gonna say it's gotta be good for them too, right? Maybe. You're really well liked.
- [55:34]
B
Yeah, you know, I don't know.
- [55:36]
A
You don't know?
- [55:37]
B
Like, you know, because I think anything you do on social media, there's gonna be someone that is upset. Like, even if you just say like, have a great day, there's gonna be someone that's like, I don't want to have a great day. You know, I think that, you know, a hospital that really is focused on, you know, taking care of kids in the best way possible and all of a sudden, you know, you've got someone on social media and it's like, you know, our focus is really trying to do this and, and you're over here, you know, making these little videos. I think that they are really supportive, but I think that, you know, they're really focused on their mission of trying to help kids.
- [56:10]
A
Do you have people that hate listen or hate watch you all the time?
- [56:13]
B
Yeah, of course.
- [56:14]
A
I have a small band of people who I think maybe are unwell, who enjoy listening to me, but don't seem to like me or anything that I say. Yeah, I always explain to them when they're listening, your downloads sell to the advertisers just like everybody else's. So thank you very much. What about being like this person online? Is there anything about it you don't like?
- [56:36]
B
No. The negativity that comes with it, sometimes I think that gets a little frustrating. But my main goal of like, I want to educate people, you know, I want to use this as a coping mechanism to avoid burnout at work. Like, I think it's functioning well in those aspects, so.
- [56:52]
A
Good. That's awesome. I, I'm glad to hear that. I don't have a lot of downside to what I do either. I just, I was wondering if there was like, how was the businessy side of it? Like you have like, obviously you guys listening reached out to Dr. Beach, Jim, and she, she gave up and, and, and messaged me like, so thank you. At the same time, like, then you passed me off to like a management company or something like that. Like the day you did that, were you like, oh my God, I have a management company. Like, that's got to be crazy, right? No.
- [57:17]
B
Yeah. I am really bad at answering emails, as it turns out. And so when I was doing brand deals and they were trying to do onboarding stuff and I had to answer emails to get paid, I wasn't doing well with that just because I want to focus on the good stuff. And so I hired a management team or I kind of was approached by someone that encouraged me to find a management team. I am absolutely in love with the group that I have. Linnea is amazing. They really just help get everything organized and on board and she kind of knows when I'm awake and when I'm sleeping and can just make things happen when it needs to happen.
- [57:52]
A
I don't have anything like that. Like so. But there's something that sounds incredibly attractive about it. I don't, I don't want to ask you this question because I feel like I'm going to ask you, do you make enough money that that makes sense financially? But I don't want to ask you that.
- [58:04]
B
Like, so I think the thing that most influencers or creators will tell you about a management company is that they will sift through the deals and find the ones that work for you. They will also go out and find deals if that's something you're interested in. And most of the time they will ask for more money from whatever brand deal you're going to be working with enough that it more than covers their portion of it.
- [58:27]
A
Oh, you're saying I'm not charging enough?
- [58:29]
B
Okay, it could be.
- [58:30]
A
And all right.
- [58:31]
B
A lot of times we undervalue ourselves. Like we talked about this. Like we're, we're in it to educate, we're in it to talk to people and help people be better, be their better selves. And so we undervalue ourselves kind of as it is. And I never would have thought, you know, this brand deal would have brought in, you know, near what it did. But I have someone who believes in me that said, you know, this is what you're worth.
- [58:54]
A
Is there ever been a moment where you wondered if you're going to keep practicing? No, it's not. Gotten that. And you love it too much to stop doing that anyway, is what I'm hearing. Yeah. Yeah.
- [59:04]
B
And if I stopped, I think I would have a hard time restarting just because you can lose skills. So this is not something that I would change.
- [59:11]
A
Oh, so you do see this as something that could possibly flare out. The social media thing.
- [59:16]
B
Everyone asked my five year plan and there is no plan. I'm just, you know, one day at a time and whatever happens, happens. And if I can work for another 15 years and keep doing it, we'll keep doing it.
- [59:27]
A
Yeah. You would probably connect much with the idea that every year, I think this is the last year I'm making the podcast. Anybody who works with me on a professional side, I'm like, well, I mean, obviously it'll be over after this year and then, you know, we'll all go on our way. And they're like, why do you think that? I'm like, well, I mean, because this is ridiculous. That's why. Like, like it's not a real thing. I keep thinking I'm just going to end up being like a really popular Walmart reader because unlike you, I can't fall back on being a doctor when my fingers bad. Like, I'm a. I was a stay at home dad who became a popular podcaster. Like, I don't have a. There's nowhere for me to go. Exactly. I don't. It's funny, you said the same thing that I always think is that I don't have even the life skills I had before this. I don't even think they're transferable to now. And I don't know that I really remember what I was doing before that. Actually, it's really interesting, your family at all. Do your kids. I heard you say you have kids, Kids, your husband. Do they mind any of this or. They're good with it.
- [60:19]
B
They don't seem to mind very much. I think I've been doing it so long they've just gotten kind of accustomed to it and it's been kind of slow growth. Like it hasn't just jumped very quickly. It's really just kind of been a slow growth over time. You know, I think we've created some, like, safety things for them. Like when we're out in public, I get approached quite often by people that just want to say hi or a selfie. But, you know, there have been times where they've been more interested in the kids. And so we've had to create good boundaries there. The kids, I don't think it registers as much for them.
- [60:50]
A
Yeah.
- [60:50]
B
You know what? This actually is, I have to tell.
- [60:52]
A
You, the coolest part about you, besides the fact that you're incredibly normal and yet lovely to speak to and knowledgeable, is that you don't have any of that influencer vibe. Like, I've never felt that once from you. I've never felt like you've turned the camera on and willed yourself to be excited. Do you know what I mean? Like, hey, everybody. Like, you know, like, that kind of thing, or, like. Or ask one of those leading, like, social media questions that, like, they know the algorithm. You don't think about any of that, do you?
- [61:17]
B
I do try to, you know, sometimes bring a hook.
- [61:20]
A
Okay.
- [61:21]
B
Like, a little something to bring it in. And maybe it's, like, the top of the screen or the bottom of the screen, because I want you to hear what I have to say. Like, I think what I have to say is important, but I try not to do the, like, the cringy hooks as much as I can.
- [61:33]
A
Yeah.
- [61:34]
B
Like, I made a Christmas one yesterday where I very quickly said something that would catch someone's attention. And I'll avoid saying it out loud at this point, but you can go see that Christmas video if you want to find that out.
- [61:45]
A
Follow and subscribe.
- [61:48]
B
I just. I don't know if there's kids listening, and so I just.
- [61:51]
A
Oh. Oh, no, I saw that one. That one's awesome. There might be kids listening.
- [61:56]
B
Yeah.
- [61:56]
A
It's so funny you said that, because the way you did it with the visual, I thought that's what everyone wants to know from an ER doctor. But what have you found in people's butts? And you have to go home and tell people. Right? I mean, you keep their details out of. But you don't not go home and say to your husband, I found a Christmas tree candle, and how would you not.
- [62:12]
B
Yeah. You know, people always ask, like, what's the most interesting case you've ever seen? And they actually don't want to hear about the most interesting case. They want to hear about the butt stuff. And, you know, I don't know, maybe, like, the first couple cases that I saw, you know, like, someone put something somewhere up. But at this point, like, working in pediatrics, like, we see it pretty commonly.
- [62:32]
A
And white kids put stuff in their butts.
- [62:34]
B
Yeah. And I see up to the age of about 21. And so some are teenagers or some are younger adults.
- [62:39]
A
Gotcha. Gotcha.
- [62:40]
B
I don't know how to say this in a way, you know, I think it's important to talk to kids about their bodies. And sometimes kids experiment with their bodies in ways that we wouldn't necessarily expect. And kids are way, way more honest than adults are about that situation. Like, yeah, they'll tell you, you know, what happened, and, you know, they're kind.
- [62:58]
A
Of like, yeah, okay, well, listen, I think it's. When people are honest and communicate well, I think everything seems to go better. Did you enjoy doing this with me? Was this Okay, I did.
- [63:08]
B
I did. This was good.
- [63:09]
A
Good. I will thank you very much for doing this and ask you just to hold on one second for me. But please, first, before you go, tell people how to find you. I mean, I don't think they need my help, but are you everywhere or.
- [63:20]
B
I'm on TikTok at Beach Gem 10 and YouTube, Facebook and Instagram at Dr. Period. Beach Gem 10. Or just Google Beach Jam and you could probably find me.
- [63:29]
A
Wow, that's awesome. All right, well, Dr. Beach, Jim, thank you so much for doing this. I really do appreciate your time.
- [63:34]
B
Appreciate your time as well. Thank you.
- [63:42]
A
Thank you so much for listening. I hope you enjoyed my conversation with Dr. Beach Jam. Don't forget, she'll be back soon. So subscribe and follow not to miss any of that. And in the meantime, if you have type 1 diabetes or you know somebody who does, please don't forget to suggest this podcast to them if they need management help. We have the Bold Beginning series, the Diabetes Pro Tip series, and much more. Having trouble with burnout, mental health issues, anything related to diabetes? We have that information for you. Check out Those lists@juiceboxpodcast.com lists the podcast is completely free. Always has been, always will be. Nothing's behind a paywall. Everything you need to know is available to you right now. The podcast episode that you just enjoyed was sponsored by Eversense CGM. They make the Eversense 365. That thing lasts a whole year. One insertion every year. Come on. You probably feel like I'm messing with you, but I'm not. Eversensecgm.com juicebox head now to tandomdiabetes.com juicebox and check out today's sponsor, Tandem Diabetes Care. I think you're going to find exactly what you're looking for at that link, including a way to sign up and get started with the Tandem MOBI system. A huge thanks to US Med for sponsoring this episode of the Juice box podcast. Don't forget usmed.com juicebox 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 looking for community around type 1 diabetes, check out the Juice Box Podcast. Private Facebook group juice box podcast type 1 diabetes but everybody is welcome. Type 1, type 2 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 juice box podcast type 1 diabetes on Facebook. All right, let's get down to it. You want the management stuff from the podcast. You don't care about all this chitting and chatting with other people. Juicebox podcast.com lists they are downloadable, easy to read. Every series, every episode, they're all numbered. Makes it super simple for you to go right into that search feature in your audio app. Type juicebox1795 to find episode 1, 795-juiceboxpodcast.com lists. Have a podcast? Want it to sound fantastic? Wrongwayrecording.com.