#1722 DKA Has Been a Problem

Summary

Juicebox Podcast: Type 1 Diabetes

Episode #1722: DKA Has Been a Problem

Date: December 29, 2025
Host: Scott Benner
Guest: Roxanna, Pediatric CDCES, Type 1 for 10 Years

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Episode Overview

In this engaging and insightful episode, Scott welcomes Roxanna, a pediatric Certified Diabetes Care and Education Specialist (CDCES) and ICU nurse living with Type 1 diabetes for a decade. The discussion centers on diabetic ketoacidosis (DKA)—how it can be missed, its long-term consequences, and the urgent need for improved screening and patient education. Roxanna shares her personal diagnosis story, the challenges of family genetics, her professional journey, and how bold education and new technologies are reshaping diabetes care for children and families. The episode is replete with practical strategies, candid confessions, and a focus on empowering both patients and providers to live better with diabetes.

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Key Discussion Points & Insights

Roxanna’s Diagnosis & DKA Trauma

• Personal Story (03:14 – 05:28):

  • Diagnosed with Type 1 at age 36 while working as a pediatric ICU nurse.
  • She mistook her symptoms for the flu. Friends, concerned by her absence, initiated a welfare check. She was discovered in a diabetic coma with a blood sugar of 1200, septic, and hypothermic—“Almost died for sure.”
  • Her friends “definitely saved my life that day” (05:34).
  • For her, DKA was missed—despite being a nurse with experience treating DKA in children.

• Family Tradition of DKA Misses (31:00 – 34:55):

  • Later recognized symptoms of Type 1 in her niece. Despite warning the family, her niece was not tested until she was severely ill and needed to be life-flighted in DKA. The same happened to her nephew two years later.
  • Scott: "I'm underlining that for everybody...your brother didn't have to figure it out, someone told him and he still couldn't bring himself to make that leap." (35:12)

• Long-Term Impact of DKA (69:43 – 71:16):

  • DKA is not a one-off—its impacts can be lifelong, from cognitive issues to organ damage.
  • “DKA is a huge problem...it has lifelong impacts on a child or on an adult.” (69:43, Roxanna)

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Diabetes Education is Broken—And Can Be Fixed

• Professional Perspective (17:49 – 19:15; 21:51 – 26:10):

  • Even as a nurse, Roxanna felt lost after diagnosis: “They...handed me two pens and said, ‘we’ll see you in a month.’ And I was like, wait, what? What do I do with this?” (18:27)
  • Formal medical/nursing education on diabetes management is minimal. “Nursing school does not prepare you for diabetes management at all. I don’t think med school does either...” (21:51)

• Endocrinology’s Gaps (23:48 – 25:15):

  • Many endocrinologists do not feel well-equipped and may have “imposter syndrome.”
  • Diabetes complexity means providers often rely on formulas that don’t reflect real life. Patients easily lose trust when protocols fail.

• Empowering Patients (43:39 – 44:29):

  • Roxanna encourages families: “Do not ask permission to change your carb ratio or your basal rate...I want you to understand why you’re doing it and how insulin works and all those things.” (44:06)

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The Power of Community & Peer Resources

• Finding Support (16:33 – 17:24):

  • Roxanna credits the podcast with giving her both knowledge and hope: “I use the podcast as a resource or recommend it as a resource for a lot of our families...[they do] incredibly well for the most part.”

• Roxanna’s Practice (41:16 – 44:52):

  • Now a pediatrics CDCES, Roxanna integrates lessons from Juicebox and her experience into every new diagnosis class. She gives out binders with podcast resources and QR codes.

• Impact on Outcomes:

  • “Let’s go with 60%. 60%...have an outcome that makes me say, hey, they get this and they’re putting it to practice.” (44:47)

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Screening for Type 1—A Message of Prevention

• Importance of Early Screening (36:27 – 38:24; 67:44 – 71:44):

  • Roxanna’s family had multiple autoimmune diagnoses; she’s now a strong advocate for antibody screening (TrialNet), pushing family and patients to get tested.
  • Screening is “the only way to prevent a traumatic diagnosis...[and] to identify candidates for new therapies and prevention trials.”
  • “DKA doesn’t have to happen. But you have to be screened and then monitored after and have this gradual introduction to education...” (71:16, Roxanna)

• Systemic Barriers (68:04 – 69:54):

  • Many families resist screening due to anxiety or thinking they’d ‘just know’ if another family member was getting Type 1. “Most of the time you don’t know. And I will tell that from experience.” (68:37)

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Changing the System—Education and Technology

• Changing Education from Within (38:44 – 41:51):

  • Roxanna applied for her current educator position during COVID, seeing a need for real-life, practical training: “If I can do this, surely anyone can do it.”

• Group Education & Challenges (48:11 – 53:28):

  • Every newly diagnosed family must attend her three-hour class before seeing a provider—this allows for a baseline of understanding.
  • Scott suggests bigger symposium-style interventions; Roxanna sees both promise and challenges in terms of engagement and customization.

• Tech for the Unengaged (53:33 – 55:13):

  • The iLet pump is offered especially to families struggling with management. “If you will just put this pump on and keep it charged...That’s all I expect from you. I don’t even care if you bolus...Those kids do really well.”
  • Technology isn’t a panacea, but can bridge the biggest gaps for unengaged or overwhelmed patients/families.

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AI, Tech, and the Future of Diabetes Care

• Artificial Intelligence (74:07 – 77:59):
  • Roxanna sees promise in using AI (like ChatGPT) to interpret CGM graphs or help patients problem-solve management: “AI is going to play a large role...it will help a lot of people much better than endocrinologists can.”

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Notable Quotes & Memorable Moments

• “I had taken care of hundreds of kids in DKA and did not recognize it in myself. I just knew I felt badly.” (04:41, Roxanna)
• “Almost died for sure.” (05:26, Roxanna)
• “You handed me two pens and said, ‘we’ll see you in a month.’...I have no idea.” (18:27, Roxanna)
• “Nursing school does not prepare you for Diabetes management at all. I don’t think med school does either...” (21:51, Roxanna)
• “DKA is a huge problem...it has lifelong impacts on a child or on an adult.” (69:43, Roxanna)
• “Do not ask permission to change your carb ratio or your basal rate... I want you to understand why you’re doing it and how insulin works and all those things and the possible variables that could be in there.” (44:06, Roxanna)
• On families missing diagnosis despite warnings:
  Scott: “Your brother didn’t have to figure it out, someone told him and he still couldn’t bring himself to make that leap.” (35:12)

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Timestamps for Key Segments

• Roxanna’s DKA diagnosis story: 03:14 – 05:51
• Family history, denial, missed diagnoses: 07:20 – 08:35; 31:00 – 34:55
• Knowledge gap in healthcare education: 21:51 – 26:10
• Role of the Juicebox Podcast and peer support: 16:33 – 17:24; 27:29 – 28:32
• Changing diabetes education as CDCES: 38:44 – 44:31
• Screening advocacy and barriers: 36:27 – 38:24, 67:44 – 71:44
• Technology for disengaged patients: 53:33 – 55:23
• AI in diabetes management: 74:07 – 77:59

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Tone & Style

The episode is characterized by a blend of candor, humor, empathy, and hope. Both Scott and Roxanna approach personal and systemic shortcomings with honesty but focus steadfastly on practical solutions and empowerment. The conversation often moves from deeply personal (and sometimes painful) anecdotes to actionable strategies and policy insights.

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Takeaways for Listeners

• DKA is often missed, even by experienced healthcare professionals and family members—but it’s preventable with screening and awareness.
• Education for both patients and providers is deeply lacking; real progress starts with practical, lived-experience guidance.
• Families should be empowered to make safe management decisions without waiting for provider approval.
• Bold use of technology—including AI—can bridge gaps for the disengaged, the underserved, and the overwhelmed.
• Screening for type 1 and other autoimmune risks in families is critical and should become routine.
• Diabetes care requires hope, patience, real-world strategies, and the courage to be "bold with insulin."

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For more resources and support, Roxanna recommends checking out JuiceboxPodcast.com and the podcast’s private Facebook community. She also encourages all families with any family history of autoimmune issues to pursue antibody screening.

Transcript

[A]

Here we are back together again, friends, for another episode of the Juice Box Podcast.

[B]

My name is Roxanna and I'm a pediatric CDCS, and I've been living with type 1 for 10 years now.

[A]

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 Juice Box 1795 to find episode 1795 juicebox podcast.com/lists. If you're looking for community around type 1 diabetes, check out the Juicebox Podcast. Private Facebook group juicebox 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. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan. The episode you're about to listen to is sponsored by TandemMobi. The impressively small insulin pump. Tandem Mobi features Tandem's newest algorithm, Control IQ Technology. It's designed for greater discretion, more freedom, and improved time and range. Learn more and get started [e-mail] Juicebox Today's episode is also sponsored by the Eversense365. You can experience the Eversense365 CGM system for as low as $199 for a full year. Visit Eversensecgm.com Juicebox for more details and eligibility. The podcast is also sponsored today 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.

[B]

My name is Roxanna and I'm a pediatric CDCEs, and I've been living with type 1 for 10 years now.

[A]

10 years? How old are you?

[B]

I am 45 now.

[A]

Oh, you have that young voice.

[B]

Yeah, that's what. That's what I hear. I don't know if I look that way, but. Or feel that way, but maybe I sound that way.

[A]

You should start a podcast, because on a podcast, people don't get to see that often. So it sounds like you. Yeah, no kidding. If you told me you were like, 16, I'd be like, I buy It. Why is that. Why is that why you feel like, are you not married?

[B]

I'm not married and have no children.

[A]

That's why. It wasn't hard to figure out why life hasn't drug you down yet. I was like, oh, okay, I see what's going on.

[B]

But I have four brothers, so I feel like that counts for something.

[A]

Oh, you've had your ass beat a couple of times then. I see.

[B]

Several times. Yeah. Absolutely.

[A]

But you're diagnosed in your 30s.

[B]

Yeah, I was diagnosed when? In 2016. I was 36 at the time.

[A]

Were you already doing this professionally?

[B]

I was. So I was a pediatric ICU nurse at the time, and I had no idea what hit me. I thought I had the flu. It's very similar to all other your. All the other diagnosis stories I hear.

[A]

Yeah.

[B]

But I started not feeling well, and I had some other health stuff going on at the time as well, that I felt, like, complicated the picture maybe a little bit, but I'd taken care of hundreds of kids in DKA and did not recognize it in myself. I just knew I felt badly. And it was traumatic for me, I'm sure, but similar to what you hear from everyone else. But at the time, I was doing travel nursing and started not feeling well. I just blew it off because I was a nurse and it was the weekend, and I was like, well, I am new to the city, and I didn't even have a PCP at the time, and I had to start my new contract on Monday.

[A]

Okay.

[B]

So, thankfully, my best friends knew I hadn't been feeling well. I stopped answering my texts, and they didn't know my address because I had just moved in recently, but they knew the apartment complex that I had been placed in for my travel agency. So they called to do a welfare check with the. With the depart. With the city department.

[A]

Really?

[B]

And, yeah, and they didn't. Couldn't find me at first. And then my best friend called back and said, please, I will, like, please just go check on her. Something has got to be wrong. So she walked them through where the apartment was because, again, she didn't have the address, but she knew what apartment it was. And thankfully, my door was open because it was, like, late at night. It was like 10 or 10:30 at night. And they found me down in my apartment. I was already in a coma at that point. My blood Sugar was like 1200. I was septic. My body temperature was like 89. And they pretty quickly. He's like, I don't know what's wrong, but something's wrong with her. And Roxanne went, got in an ambulance, was intubated and maxed out on pressers and in coma for a couple days. Almost died for sure. Wow.

[A]

Hey, what kind of gift do you have to get your friend the following year for their birthday after they save your life?

[B]

I know, I know. I. They are amazing people. They definitely saved my life that day. There was. There's three of them, and they were all living in different states at the time, and they just. They knew that I hadn't been feeling well and something wasn't right. And how about that? They were gonna fix it.

[A]

I would text you once a year and go, hey, do you remember the time I saved your. Like, I would definitely, definitely do that.

[B]

So every September 11, because that's when it was. September 11, really text back and forth and say, happy death Day. I say, thank you for saving my life.

[A]

September 11th. I seem to feel like that's a date. I should know. What year was it? 2015. Okay, so 20 many years later, but still, you almost had your own 9, 11.

[B]

Yeah.

[A]

Yeah. How about that? Oh, my goodness. Well, isn't that a fun way to start off the podcast?

[B]

I know.

[A]

So your friends, you said you had other health issues going on at the same time. Would you share what they are or what they were?

[B]

Yeah, so I really started to fall apart. I found when I once after I hit, like, early 30s, it was mostly like, GYN related. And they. My GYN told me I had a hostile uterus, and that was a quote. And I had a lot of, like, anemia and bleeding stuff going on. Just weird kind of stuff that. Still unexplained. I was on a million different. Tried a million different things to get the bleeding under control, and it just never worked. Just stuff. I just wasn't feeling well. And I knew. Now I know that a lot of that was probably tied to, like, the type 1 diagnosis. And when I look back, it was. Could have been caught probably a year prior. I had fasting blood Sugars in the 200s, and it just wasn't caught. You know, they told me to stop eating yogurt.

[A]

Wait, when you had a fasting blood Sugar in the 200s, they said, no more yogurt.

[B]

Yeah, they asked me what I. What, you know, I had, like, the night before I came in, and I said, well, I think I had some yogurt. And they were like, well, don't eat that.

[A]

That's the problem. Hey, did you try tranexamite acid for bleeding? That's not one of the things they gave you?

[B]

No, they both. It was basically a bunch of birth control pills that they tried, which then led to me. I had some pulmonary embolisms from that. Oh, from. Yeah. So it was just a traumatic time. Those early 30s were rough. I was like, is this one getting old as life? Because it is not fun.

[A]

Also, 30 shouldn't be where things start going downhill like that, I don't think.

[B]

Well, yeah, that's what I thought, but I was like, I guess this is it. I don't know. I guess you just. You're just tired, like, all the time and feel terrible and.

[A]

Best part of the ride's over already.

[B]

That's it.

[A]

Any other autoimmune in your extended family?

[B]

Yes. So now that I know you know, I've asked. My mom has Hashimoto's. My grandmother had graves. Grandfather on my maternal side had Ms. And then two years after I was diagnosed, my niece was diagnosed. And then two years after that, my nephew was diagnosed with type one.

[A]

Type one was coming.

[B]

Yeah.

[A]

You grew up not knowing your mom had Hashimoto's.

[B]

Nope. I knew she. So she actually is. Was raised Catholic. She did not raise us Catholic. That's fine, but she herself was Catholic.

[A]

All right, I get it. I know the vibe. I got everything going on here. I'm like, chad, GPT almost. I have enough data to make some pretty big leaps, talk to enough people. Your mom had a thing. She took a pill for every day. How many brothers and sisters do you have?

[B]

I have four brothers.

[A]

Yeah, that's right. You said that. I'm sorry. Okay. Did they know? No.

[B]

I still don't think they know, to be honest.

[A]

Ah, awesome. Not practicing.

[B]

I would say my. My two youngest brothers are my half brothers. So after my mom and dad got divorced, my dad got remarried, and I have two younger.

[A]

You have two younger brothers that are not your mom? Wouldn't it be weird if they knew and no one else did?

[B]

Well, yeah, but that's highly unlikely. Scott.

[A]

Your mom wasn't keeping up with your dad's new family?

[B]

No, no. She barely remembers her names now.

[A]

Might be apropos or nothing, and then I'll find out later if I wasted your time or not and asked you more than I should have. But no marriage, no kids. Is that on purpose or is that because.

[B]

No. I get asked this question a lot, especially being from where I'm from and the expectation all my best friends were married and had kids and they're twenties, if not earlier. Yeah, it's never been something that I have dreamed of doing. Like, I just. It's never been on my to do list. I guess if it happens, it happens. But that's part of it. I never was actively seeking it out. And then I think part of it was I spent a lot of, like, my. Those early 30s, like, not feeling well. And I traveled a lot. Like, I was moving every three to six months. And that's not conducive, really, to meeting anyone either. So I think it was like a combination of things.

[A]

You date and mess around a little bit, or were you pretty, like, single?

[B]

Yeah, like dating. For sure. That definitely happened. But now I just. I don't know whether I'm just too old or just too tired. Like, I just. I don't know. I just don't know if it's in the cards for me.

[A]

Yeah.

[B]

And that's okay. Like, I don't. That's not something that I have a strong desire to. To do.

[A]

I don't feel like you should. I was just asking, you know the movie Scent of a Woman with Al Pacino, by any chance?

[B]

I know of it. I don't think I've ever watched it.

[A]

No. There's a scene at the end where he's yelling at some people, and at some point he yells, I'm too old. I'm too tired. I'm too f. Cking blind. Every time somebody says I'm too old, that line runs right through my head.

[B]

Yeah.

[A]

Because it just. To me, the. The. The overall sentiment is. I'd love to argue here, but I just don't have it in me. The rest of that sense, by the way, is I'm too blind. Too blind to. If I was the man I was. If I was half the man I was 10 years ago, I'd take a flamethrower to this place, and he's like, in full Al Pacino mode. It's awesome. Nevertheless, I'm just interested for reasons that may end up being useless and I don't know, like, it might help the story come together and it might have nothing to do with anything, but I needed to understand sort of moving forward. So I appreciate you telling me.

[B]

And I think there's some disappointment, like, in my family, like, I didn't have kids and like, you know, I didn't get married. I didn't go that route. I think part of Windsor is, what did we do wrong?

[A]

Well, are you disappointed?

[B]

No, I'm not. But I think sometimes I feel like. Or maybe not disappointed. Just like, huh, like, you didn't do.

[A]

The thing that they expected.

[B]

Yeah, like, what happened to that one? Like, was it. You know. Because we modeled it wrong. My parents have been divorced for a very long time, but I also don't see very many happy marriages. Honestly, Scott, like, I just. I don't.

[A]

You kidding me? I just took the trash out this afternoon. Everybody looked happy when I did it. How old were you when your parents got divorced?

[B]

Oh, gosh, I think I was 6 or 7. And then my mom got remarried once, and my dad. This is his third marriage, I think. But they've been together for a very long time now.

[A]

Your mom's remarriage took. Is he still around?

[B]

No, they only lasted probably about a year.

[A]

Oh, so as a young kid, you saw your original father. Your OG dad goes. That new dad was there and gone. Were there other guys coming in and out, or did she give up after a bit?

[B]

So, no, she was pretty much done.

[A]

She's like, that's it. I. I ain't doing this again. Well, that. Maybe that's where. I mean, maybe that got modeled on top of you somehow. Yeah, you know?

[B]

Yeah, maybe so.

[A]

Well, at least it opened you up to do that travel nursing, which, from what I understand, pays pretty well. So congratulations on that.

[B]

Yeah, I had a good time doing that. I don't do it any longer, but I kind of stopped during COVID but. Oh, I definitely had some good experiences and saw a lot of things and learned a lot of things. For sure.

[A]

I bet. Are you still a nurse Today?

[B]

I am, yeah.

[A]

Yeah. Just doing.

[B]

I'm a pediatric cdc. Yes. So, yeah, I do a lot of. I work in a clinic now. Mostly outpatient stuff.

[A]

You told me that. I don't know why I didn't remember. I'm up. It's probably because it's Friday afternoon. I apologize. And my wife is texting me about this thing at the same time. Plus, I'm thinking about son of a woman now. There's a lot going on in my mind.

[B]

Okay, I get it.

[A]

I'm sorry about that. Okay. So how do you and I end up together? Because I feel like somebody hooked us up so that you could be on.

[B]

Kenny Fox is a mutual friend of ours. So he kind of said, you know what you should do? You should get on the podcast with Scott Benner. I was like, sure, why not? Sounds like a good time.

[A]

Why do you think Kenny thought? By the way, Kenny is in the episodes called Fox in a Loop House. I think there's six of them, if you want to know about DIY looping. Kenny talks all about it. In those episodes. But why do thought you were a good guest for the show. I have always disliked ordering diabetes supplies. I'm guessing you have as well. It hasn't been a problem for us for the last few years though because we began using US Med. You can too usmed.com juicebox or call 888-721-1514 to get your free benefits. Check USMED has served over 1 million people living with diabetes since 1996. They carry everything you need from CGMs to insulin pumps and diabetes testing supplies and more. I'm talking about all the good ones, all your favorites, Libre 3, Dexcom, G7 and pumps like Omnipod 5, Omnipod Dash, Tandem and most recently the ilet pump from Beta Bionics. The stuff you're looking for, they have it at usmed888-721-1514 or go to usmed.com juicebox to get started now use my link to support the podcast that's usmed.com juicebox or call 888-721-1514. This episode is sponsored by Tandem Diabetes Care and today I'm going to tell you about Tandem's newest pumping 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 link tandomdiabetes.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 Tandem Moby 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 tandomdiabetes.com juicebox to check out your benefits and get started today.

[B]

I think because the position I'm in right as an educator for kids with diabetes like I touch a lot of like their, you know, diabetes management and I use the podcast as a resource or recommend it as a resource for a lot of our families whether newly diagnosed or not because I have a touching point with every single, you know, kid that comes into our practice. So I always recommend it and he knew that and I have a little binder even that I have like you know I've made that has Juice Box podcast on it with, you know, some QR codes and then all, like, the series that I recommend to the families. You know, please, like, if you want to understand it, like, you know, I will talk to you all you need to talk about whatever, but I think this is going to be more helpful to you.

[A]

Okay, thank you.

[B]

Yeah. And so a lot of families pick me up on it, and those families do incredibly well for the most part.

[A]

Okay, so, I mean, you're diagnosed a decade ago. Fair enough. I mean, did you find the podcast before you, like, you and Kenny? Like, I'm trying to figure out, like, what the timeline is. Like, you find the podcast for you personally or you use it for. Professionally, or, like, how does all that work?

[B]

It was definitely personally at first. You know, the first couple years after I was diagnosed were really rough for me. I didn't know what I was doing. I was one of those people that had no idea what really diabetes was. I mean, I knew what it was like. Like I said, I'd taken care of lots of kids in dka, but that was the extent I knew that These kids came in and they were a lot of work and they were really sick most of the time. And my job was just to. Because I did. I didn't do any of the education aspect. I just wanted to get them out of the PICU as soon as possible to the floor where they could do whatever they needed to do. And that was kind of a mystery to me. What happened after that.

[A]

Yeah.

[B]

And when I was diagnosed, adults, and this is part of the reason why I started doing what I'm doing now, I realized how bad the education was out there. It was assumed because I was a nurse, that I kind of knew what I was doing. But they essentially handed me, you know, after a week and a half in the hospital, however long I was there, handed me two pens and said, you know, we'll see you in a month, like. And I was like, wait, what? What do I do with this?

[A]

No, I mean, they should have just.

[B]

Asked me to, like, yeah, no, thank you.

[A]

I'm good.

[B]

I was like. I was like, I have no idea. So I really did miserably. I was in. I think part of it was denial, I think, but part of it was I just didn't know what I was doing, and I didn't get much help from my endocrinologist.

[A]

Okay.

[B]

Not that they were bad people, but I think they are just. They don't really know how to help. I think a lot of the time. So I did not do well. You know, Covid hit and I stopped traveling. And I think I just realized like, my niece was diagnosed and that was kind of like a. That triggering point for me to say, okay, I've got to figure this out. Like, if not for me, like for her.

[A]

Oh.

[B]

Because she was only like 10 or 11 at the time.

[A]

If it wasn't for her diagnosis, do you think you would have gone on suffering? Personally?

[B]

I think yeah, maybe not indefinitely. I think I would have like gotten to feel so badly that hopefully I would have turned things around. But she was kind of like the starting point for me when I was like, okay, like, I've got to figure this out. And I did. I started finding everything that I could about diabetes, podcasts, books, like just anything I could figure out on my own. And I certainly asked my endocrinologist some to help, but they are busy people.

[A]

Yeah. Can you help contextualize something for me as best you can? Right. I mean, you do what you do for a living. I guess what I would say there is that you'd think that most people listening would think that this would predispose you to doing well at diabetes. So my first question is, can you explain to those people why you your ICU nursing background doesn't help you with your own type 1? Why would you settle for changing your CGM every few weeks when you can have 365 days of reliable glucose data? Today's episode is sponsored by the Eversense365. It is the only CGM with a tiny sensor that lasts a full year. Sitting comfortably under your skin. With no more frequent sensor changes and essentially no compression lows. For one year, you'll get your CGM data in real time on your phone, smartwatch, Android or iOS, even an Apple watch. Predictive high and low alerts let you know where your glucose is headed before it gets there. So there's no surprises, just confidence. And you can instantly share that data with your healthcare provider or your family. You're going to get one year of reliable data without all those sensor changes. That's the Eversense 365. Gentle on your skin, strong for your life. One sensor a year. That gives you one less thing to worry about. Head now to eversensecgm.com juicebox to get started.

[B]

Diabetes is so under educated on, I think because it's really complex and it's not black and white and there's a lot of gray in it. So I think nursing school does not prepare you for Diabetes management at all. I don't think med school does either, or PA school or nurse practitioner. Like, I don't think that's not gone over, like, in detail at all.

[A]

Specific to diabetes. What does it prepare you for?

[B]

That it exists. That there's a disease out there that causes high blood sugars and a lot of problems. Like, even the difference between type one and type two. Like, I wasn't entirely clear on.

[A]

How long had you been an ICU nurse?

[B]

Oh, close to 10 years.

[A]

If I asked you 10 years ago, day before you were diagnosed, how good of a nurse are you, what would you have said?

[B]

I would have said, I think I do an okay job. But as a baby nurse, I mean, I don't. I didn't know anything starting out in nursing school either. In general, I knew nothing about anything, much less diabetes, but I think I had the potential to be a good nurse.

[A]

But you had only started with babies. There's only a certain amount of information you needed. You were doing a good job at that.

[B]

Yes. Yeah. I mean, like, it was definitely, you know, when I started out as an ICU nurse, it's very steep learning curve. Like, there's a lot being thrown at you and there are some sick kids that you're dealing with. Diabetes is usually not like an acute, you know, unless they're a dka. It's not like an acute, you know, where you're going to see someone in the ICU and it's more of a chronic.

[A]

Let me be more specific with my question. If I asked you back then what kind of a nurse you are, you weren't disinterested. You weren't just there for the check. You weren't also doing, like, crack cocaine on the side. You were. No. You were an earnest employee doing their best with a good education behind you.

[B]

Absolutely.

[A]

Yeah.

[B]

I'm one of those people that's going to put in the effort to whatever I do.

[A]

Gotcha.

[B]

And do it well.

[A]

And yet you were in no way prepared to take care of somebody with diabetes, being yourself. So you also weren't prepared for somebody else to be doing it. The next obvious answer or question I believe comes up is that how come this exists in specialty, too? Like, how come I can get to an endocrinologist who's also not well equipped?

[B]

Well, I mean, I think there are certainly endocrinologists out there that aren't well equipped, and I don't have an answer for that because they, of all people, should be equipped and should have some kind of grasp on what diabetes Is, But I have certainly met my share of endocrinologists that don't.

[A]

Okay. Also, let me say this up front. I imagine there are a lot of endocrinologists that are awesome.

[B]

And yes, I work with some amazing.

[A]

Providers even suggesting that that's not the case. But when it goes wrong, do you see any common connectors between the ones it goes wrong with? Are they ladder climbing just there for the money? Anything you could say. Oh, they all seem to have this in common.

[B]

I mean, maybe like just disinterest. I mean, because endocrinologists is not. They don't just do diabetes. Right. Like, that's part of what they do. So I think that endocrinologists can have their quote favorites that they like to take care of. Like our, you know, not even just endocrinologists, but like our nurse practitioners and PAs too that are in endocrinology.

[A]

Right.

[B]

You know, some are more interested in growth hormones, some are more interested in thyroid. Like, so they all have like their, their niche, kind of like groups too, unless you're a specific diabetologist, but those are even more hard to find. So maybe that's part of it.

[A]

Would you say that when somebody finds themselves in that situation, like, oh, I prefer like, you know, do you think it's conscious, I guess is my question. Or do you think that they're maybe unconsciously don't give the same effort to the things that they aren't maybe as learned about or not as interested in?

[B]

I think it's, maybe it's that they get feel frustrated or like it's that they don't, they can't understand it. Right. So they don't feel like they can ever have a grasp on it, especially if you don't have it or caring for someone with it.

[A]

Yeah.

[B]

Diabetes is a really tough disease to understand if you're not in either one of those positions.

[A]

Right. Maybe they, they have like imposter syndrome inside of that to some degree.

[B]

Maybe like all they know is like, okay, well I know that this is what you're supposed to. And you know, are you doing it? And they say yes, and it's still not working. And you don't understand why.

[A]

Okay.

[B]

And that's the same, I think, frustration families get too. And that's why I think they lose a lot of faith in their, the healthcare system and their providers because they're doing what they're, whoever told them to do, you know, their endocrinologist or nurse practitioner or whoever it is said, okay, that this is X amount of carbs if you just use this simple formula and dose, you know, when you eat carbs, then it should work and your blood sugar should be fine. Well, when that doesn't work, and most of the time that doesn't work because there are so many variables going on, then they're like, why this doesn't work, like, what am I supposed to do? And then the provider's like, I don't know.

[A]

I don't know.

[B]

Try this.

[A]

How the hell should I know, Connie?

[B]

Exactly.

[A]

Okay, so I'm going to take you back to your. To your niece being diagnosed and you start running around looking for information. You kind of, you know, catch yourself out of that fog. Maybe you're in. What do you learn first? What's more, what's most valuable to you? What allows you to start laying a foundation under yourself and getting going?

[B]

I think the first thing that, you know, just even started me on the right path was just knowing that there are people out there that could do this, that were achieving. It wasn't just something that's completely out of my control and unmanageable, which is kind of what I thought it was. I think that gave me a lot of hope and I just wanted to figure out what those people were doing and those people being, you know, like people I heard from on the podcast or, you know, I read things like a pancreas and a couple other books. Just anything that I could find to help me understand and understanding how insulin works. I think that was like the first piece that, like taught me. Okay, now I know how insulin works, then I can match it to what other variable I have. Understanding what it does to, like, my blood sugar. And that, I think was my first real understanding of diabetes. And a lot more has come and I still learn something new every day. Right. But I think that was the first piece that really helped me understand.

[A]

I have a question that'll feel self serving if you don't like me. If you do like me, it'll just sound like a question where we get to an answer. The idea of understanding how insulin works being the basis for moving forward. I mean, that's how I talk about it. So do you think it because I told you to think it, or do you think it because you heard a bunch of stuff and that was your natural decision?

[B]

I think you certainly help lead me there. If not, you know, if we're at the, the starting point for it.

[A]

Okay.

[B]

I don't know. It just, I think it just came to me like, I was like, okay, well, this is how insulin works. Then I can figure it out from here. And I don't all the time, but at least I understand why it's not working most of the time, right?

[A]

I ask. I want to be clear about why I asked, because I'm trying to decide, is this the right answer or is it just one of many right answers? And you went with it because you heard me say it, and then it worked out for you. Because when I started saying that out loud, I didn't. I want to be clear with everybody. I didn't really 100% know that that was right or not. I just, for me, I was like, this feels like to me, it all starts with understanding how insulin works and that if you don't have that, then not only are you incapable of covering food and needs and et cetera, you don't understand why you're getting high, you don't understand why you're getting low. You end up with a fear of insulin. You don't use enough of it, like it snowballs, but you understand that. I hope everyone listening understands. I didn't go to college. I don't have any background in this professionally. No one told me these things. It all just started coming to me as I was living through it. So I was interested to know if there was a delineation between the information and your understanding or if it all blended together. But I appreciate your answer, but thank you. Just wanted to make sure you understood why I was asking.

[B]

Yeah, I do remember the first podcast I listened to of yours was the newly diagnosed or starting over? Because just by my searching, well, that's what popped up, right? And I don't remember even exactly like what it said, but that kind of was what started me on. I can figure this out. And from there it just. It's just anything I could get a hold of, I wanted to know.

[A]

Awesome. Well, I'm glad. I'm glad it got you there. So how long after you fix. Fix yourself up do you offer this information back to your niece or do you like. I mean, do you guys become like a partner in crime here on this or how does that benefit her or did it not?

[B]

My niece is pretty sure that I gave her diabetes.

[A]

Oh, but at Thanksgiving, would you hug her at Thanksgiving or something like that?

[B]

I'd come home for Christmas. I was there visiting and we had gone to the movies and with my mom and my brother who took her dad, and she was sitting next to me and she had gotten box of Sour Patch Kids and she had had a big thing of water too. So we Went and saw this movie. I don't remember what the movie was. It wasn't a very long movie. But that girl, she ate her box of Sour Patch Kids and went through her water. My water, her dad's water, everyone's water. Had gone to the bathroom countless times. And we left that movie theater, and I said, I think we need to check her blood sugar. Oh, you said that she lost her mind.

[A]

Yeah. We'll say, honey, you just drank $24 worth of bottled water, so we're gonna have to check on this. Okay.

[B]

She was so mad. And I was leaving the next day for my next contract. So she just was. My mom was like, you know, let's not make a scene. Let's just go home. Think about this. And I was like, okay. Like, but I think we should check her blood sugar. Like, she looks thinner. I felt like they didn't have that perspective because they see her all the time. I was coming home. I hadn't seen her in six months, or you saw longer at that point. And she was so mad at me, she refused to say goodbye to me. The next day, she wouldn't come near me because she was afraid I was going to poke her finger. And then that was right before Christmas. And I went to do my next contract, which was about three hours away. And about two weeks later, I was working in the picu, and the charging nurse came up to me and said, I just want to let you know that your niece is being life flighted here in severe dk.

[A]

And so I have a couple of questions. First of all, when you said it, do you think they were like, oh, this one's got diabetes now. She thinks everybody has diabetes. Was that there a vibe there like that?

[B]

Yes.

[A]

Okay.

[B]

My brother told me to quit being dramatic is what he told me.

[A]

Ah, hold on a second. He must owe you a good birthday present, too.

[B]

Yes.

[A]

And then my next question is more on a, like, a psychological difficulty level. How hard was it knowing what happened to you leaving there, being sure she had type one and nobody was listening to you?

[B]

Yeah. You know, looking back, like, I am mad at myself because that could have been prevented. She was very sick.

[A]

Right.

[B]

And it was. It was just sad. She, you know, rolled in, and her. And I was working at the time. Right. So she rolled in from the helicopter with my brother, like, right behind her. And my brother's just looking at me like. And it took all I had in me not to say, I told you so.

[A]

No kidding. Because she is half dead. Or it would. Because it would have Been inappropriate. But you were thinking you her. I told you this was going to happen, and no one listens to me. And, oh, I would have had all those thoughts.

[B]

I was furious he let her get that sick and feel that badly. I was. I was mad. That was definitely, I feel like the starting point, you know, of it all. And then, you know, a couple of years after that, when my nephew was diagnosed who I was actually working here at the time at the same hospital that he came to, my brother called me and said, we're on the way to the ed. And I said, why are you on the way to the ed? And he said, well, I think, you know, has Covid or the flu or is sick and he might have type 2 diabetes. And I said, type 2 diabetes? How old he goes? 14, I think, at the time.

[A]

Okay, wait. Same brother, different brother.

[B]

Same brother, same brother.

[A]

Oh, yeah.

[B]

And so I was like. He's like, well, you know, we checked his blood sugar at home, and it was reading high or 400 or something. I said, Jonathan, he has type 1 diabetes. He was like, no, I don't think so. He really thought it was type two, but gets there. He's also in, you know, severe dka, and he gets lifelighted also, too.

[A]

Your brother's a little thick. Huge hospital. A little. A little.

[B]

That's the thing. He's an incredibly smart guy. Like, he. And I think he knew, like, in his mind as well. I think he was just kind of hoping that it was. That's not what it was.

[A]

Can I say sometimes. Sometimes I let the stories tell the lesson, and sometimes I like to go back and point so that I make sure you guys don't miss the lesson in the stories, I think. And I don't love that as a podcasting thing. Like, I was actually just listening to a podcast today where the guy explained to me what he was going to tell me before he told me. And I said, you could have just told me. I would have figured it out is how I thought about it. But I think this is important to maybe highlight for a second your brother, who you're describing as a bright person, right, who clearly loves his children, is told by his sister, who's an ICU nurse who has type 1 diabetes. Hey, I think your daughter has type 1 diabetes. And not only did he not listen, but it took him two weeks and an illness that was so unavoidable to actually come to grips with it. And then it happened to him again, and he had the same experience. So I'm underlining that for everybody who finds themselves blaming themselves for not figuring it out sooner. Like because your brother didn't have to figure it out, someone told him and he still couldn't bring himself to make that leap.

[B]

Yeah.

[A]

So I wish people wouldn't hold themselves to such a high standard on this one. I think it's an incredibly difficult thing to come to grips with or to figure out.

[B]

It really is. And after my niece was diagnosed, you know, I am a firm believer in screening and that we should be doing it and hopefully one day at a general population level. But at least you know now with if you have family history that it doesn't have to be that way. It doesn't have to be like a traumatic diagnosis. And I made everyone that was eligible to get testing at the time through Trialnet, get their antibodies tested. My siblings.

[A]

Well, yeah, you had a lot of power by then, huh?

[B]

Yeah. And the only one that did not get their Ottawa and bodies tested was John.

[A]

Oh, sorry. I was this. I thought John, I thought your brother John for sure was the one that was going to be like, no, I'll remain hard headed on this. But wait, your nephew didn't.

[B]

Yeah, And I get it that he, he also has down syndrome, so he is a little bit challenging for sure. So getting him to. He didn't want that would have been challenging. But ironically, I just interviewed a lady.

[A]

The other day who has, whose child has down syndrome and type one.

[B]

Yeah, he's hard. He, you know, my brother has his. He works hard with them. It's. That's hard.

[A]

It's a lot.

[B]

Yeah, yeah, it's a lot. They can't get him to wear CGM or anything. He's just living his best life.

[A]

Okay. Wow. All right. You're like an oracle in that family that no one listens to.

[B]

Yeah, I know. That's what I say all the time.

[A]

So when I said to you, do your friends ping you once a year to say, do you remember when I saved your life? I assume they don't because they're not related to you. But I bet you're up your brother's ass all the time about this.

[B]

You know, I try to keep it in check, but sometimes I just.

[A]

Yeah, yeah, sometimes you gotta like whip it out, I would imagine, right?

[B]

Yes. But he has certainly helped me out with a lot of things myself, so. I mean he's, he is an incredibly bright guy. He really is. He just. I think it's just hard.

[A]

I million percent think it's incredibly difficult to just make the leap. So.

[B]

Yeah, screen Everyone should screen.

[A]

Yeah, no kidding. But I can say, oh, okay, so now you have all this information. You got family members, you're doing better. I imagine at some point, when do you make the shift in your profession? Like, when do you say, hey, I think I could teach this?

[B]

I think after I realized that, I mean, if I can do this, like, surely anyone can do it.

[A]

Yeah. You're like, well, I did it, so. By the way, that's what I say when I make the podcast. I'm like, I figured out you guys should easily be able to do it.

[B]

Yeah. And I just kind of. It just kind of fell on my lap. Honestly, I was Covid. I decided to stop doing travel nursing. And I was at home visiting and I was laying on the couch at like 2:00 clock at night, like, just scrolling through possible job opportunities because I knew I didn't want to travel anymore. And there was a position for a. An educator at our local children's hospital. And I was like, I think I could probably do that. Like, I think that sounds like something I could do and like, I would have a passion for. And I applied and I think at like 2:00am and they called me at like 8:00am, like the next morning saying, can you come in for an interview? Because I don't think anyone else wanted the job, quite frankly.

[A]

They came in in the morning like, hey, we got a sucker on the line. Hold on a second.

[B]

That is exactly how it. How I imagine this happened. And I was hired very shortly after. I went through a few interviews, and again, I don't think there was any other option.

[A]

So I was just talking to a nurse yesterday who was asking me about if I could put resources together for her to give to people. Because she shares the podcast with all people a lot. She's like, could you make a printout or something that I could print out over and over again? And we kind of talked back and forth about what it was. And I chatted. I was on the phone with her and I chatted with her for a couple of minutes. What's going on? She's like, oh, we're pretty rural. And we did get an endocrinologist finally. But he filled up so quickly that it now takes a year to get an appointment with him.

[B]

Oh my.

[A]

Like that fast. As fast as he got there, the place was basically closed to new. To new clients.

[B]

I believe it.

[A]

Yeah.

[B]

We have actually had some luck recruiting some good providers to us. So we are. We. There was a time when it was really hard to get in, but now I Feel like we are in a much better spot in terms of a little better offering provider spots.

[A]

Let me ask about the timeline one more time. So you're diagnosed 10 years ago. Ish. Okay. Around Covid time, you maybe kind of pull it together a little bit, figure things out, Right?

[B]

Yeah.

[A]

And now at that point, you have the podcast as a. As a tool for yourself. Okay.

[B]

Yeah.

[A]

You start doing this job how much later?

[B]

I mean, it was around Covid, like when I got this job during COVID So that was what, 20, 21.

[A]

Okay. Okay. Yeah. So I'm going to ask a question again. It's going to sound self serving. I don't really mean for it to be, but I've been saying for years, maybe more privately than on the podcast, that, like, one of my goals is to kind of help be part of putting a new, I don't know, generation of educators out into the world who are thinking more boldly about how to use insulin and stuff like that. Like, is it fair to say that, like, not that you need me, but you're a protege of the podcast out there in the world kind of thing?

[B]

I would say yes. I mean, I get a lot of my management approach to how the podcast approached diabetes.

[A]

Okay.

[B]

Because that is kind of how I learned so naturally, that's kind of how I evolved into my own teaching and education.

[A]

Okay. So you learn that way, you manage yourself that way, you talk to people that way. Are they having outcomes similar to yours? I guess so. My question is, is that we put all this. I could be setting myself up for a big no here that I guess will make me cry. But is that helping people?

[B]

Yes, sure, absolutely. I think if they actually take the time to figure it out, and I'm not saying it's easy, but it does take effort on the parts of the families. I can't teach them everything. I mean, I wish I could, but everyone's diabetes is also a little bit different. And I hope that what I give them is the, like, impetus to like them, to go further because they spend, you know, what, 05% of their. They come see, even come seeing us every three months. They spend like.05% of their lives with me and with the, with our clinic. My hope and what I want the families to know is that to like them, to feel like, empowered, I guess is the right, right word to understand that diabetes doesn't. It's always there. Like, you can't come to us once every three to four months and expect to make us to make one change on your basal rate and to be okay.

[A]

That's going to be the whole thing. And that is some people's expectation.

[B]

Yeah. And that. And that's what I really hope that families understand, that they. It. As long as they understand what they're doing and why they're doing it and doing it safely. Like, they don't. Don't ask permission to change your carb ratio or your basal rate. Like, that's what I. We are here to help you get through those questions, but really, it's. I want them to know that this is how diabetes is going to work.

[A]

Okay.

[B]

That I want you to understand why you're doing it and how insulin works and all those things and the possible variables that could be in there. It's going to be a lot on the family, and that's not fair. But that's how diabetes is. It's one of those rare diseases that, you know, you're kind of making decisions on your own. We're not telling you how much to take or when to take it.

[A]

It's.

[B]

For the most part, it's on you.

[A]

So this obvious doesn't need to be perfect, but 1 out of 10, 2 out of 10, 3, 4, 5, 6, 7, 8, 9. How many out of 10 families do you think have an outcome that makes you say, hey, they get this and they're putting it to practice?

[B]

Oh, I would say let's go with 60%.

[A]

60%, okay. That's pretty great. Do you think the other 40% get it at some point, or do you think there's another barrier that your interaction with them can't help with?

[B]

Oh, yeah. I mean, I think they're certainly barriers. I mean, and I think some people, like, even myself, like, it just takes them a while to figure it out.

[A]

Right.

[B]

Or to want to figure it out, because you can talk until you're blue in the face to someone and until they're ready, they're not ready.

[A]

Right.

[B]

And there's not really much you can do about it. All you can do is offer them, you know, continue to encourage and support and, you know, be there to answer their questions, generally, like threats or, you know, scaring kids.

[A]

No, that's going to work.

[B]

There are families. Doesn't really work well. I mean, there are some teenagers that works well with. But typically it's not going to work. And there's nothing you can do to enforce that. At least nothing that I found that that works. It just doesn't.

[A]

Of those, like, 40% of people, do you still think some of them are going to get it? At some point, I do. Yeah.

[B]

I mean, I'm. Case in point, I didn't get it at first.

[A]

Right.

[B]

And I eventually got there. But it did take. It did take a while of acceptance and learning and. And all those things to get me where I am. And not that I am perfect by any means, but I certainly, you know, I'm not pretty far along where I was. Yeah. Where I would literally just go to work and be like, oh, forgot to put my pump on after that shower.

[A]

Oh, well, are there people that, for whatever reason, financial, educational, intellectual, whatever. Are there people who, if I gave you a million dollars and I made you bet, you'd bet against them ever figuring it out? And do those people have anything in common that you can identify? If so.

[B]

I think that there's always a way. It may not be a way that you expect or the traditional way. I think a lot of it has to do with the health literacy.

[A]

Okay.

[B]

And the way that it's approached, because we, you know, we approach everything, like, the same way, and every family is a little different. Like, you know, some families do really well what they want, all the information up front, and they're, you know, why didn't you tell us this from the very beginning? And some families need a slower introduction to things, to not feel so overwhelmed and, like, burdened by it. Just throw their hands up immediately and say, this is impossible. And they make them give up right then and there. So I think it's also about, like, feeling out families a little bit. Right. Like, everyone's kind of individualized in how they learn. I think there's always hope for families. You just have to find what works for them. You know, whether that's.

[A]

I agree with you, by the way. I think there are very rare instances where there's people who just couldn't get it.

[B]

Yeah.

[A]

I mean, I agree there's a way to reach. I would say most of them, yes. Is my anticipation, but that's also. It's not like you have a podcast. You can't talk into the rear five times a week and make them listen. Right. You have them for, what, a short amount of time. Quarterly.

[B]

Yeah. I do one big class with all of our new kids that come in. That's about three hours, and then, you know, I'm there as needed, kind of after that.

[A]

How do you get that covered? Because my. My idea that I've now heard other people say, not only have they wanted to do the same thing, but apparently there are studies that, again, this is one of these things that I thought I thought of. And then I realized I didn't. But why can't once a year, why can't you take the whole practice? I don't know how many people you see in the practice. But like, let's say it's, you know, let's say it's 500 families. How come you can't split them up into, you know, five days of 100 and do like one like day long session with all of them to kind of like up. I know it's a hard thing to bill. Right. But how do you. But how are you doing the one session with the newly diagnosed kids? Because you're billing for that too.

[B]

Well, as they come in order to see a provider, then they have to go to the class first, whether that's being transferred in or whether they're a new onset. So they have to have a touch point with me before they're even see the provider. And that a lot of families get upset with that or not upset. Maybe don't understand, I guess, why they've had diabetes for 10 years. Like, why are we making them go to this, you know, class before they see a provider?

[A]

Okay.

[B]

But it's a good way to like level set. Right. Like to I don't know where they came from. They could have had been, not seen anyone for a while and be managing really well. Would have or have no idea what, you know, long acting insulin is versus rapid acting insulin.

[A]

Yeah. You have to start somewhere. You have to get a base line for everybody, right? Yeah.

[B]

And just kind of introduction to how we think about diabetes and you know, how we manage diabetes and kind of assess where they are and you know, what they need. But that's.

[A]

Does my idea not carry water for you or did I not articulate it correctly? Like I go speak it touch by type one. Right. As an example, there's a day there where there's somebody speaking. Actually there's like usually four people speaking every hour. And you can pick a class to go to. Like, is there not a world where you could bring everybody in, keep them there for, you know, a whole day, give them a symposium, have them sit through a number of different things and, and level them up in one day. Instead of trying to level them up 15 minutes a time, four times a year.

[B]

I mean, I think in theory, yes, that's great. I don't think you would ever just based on what I see here, get that level of engagement. I mean, they don't even want to come to the class most of the time. Now most families afterwards find it very helpful and some that's not. I'm, you know, I'm generalizing here.

[A]

Yeah.

[B]

Some are want to come and they're very engaged and they're ready to ask questions. But most are like, why on earth do I need to come to a class for three hours on diabetes?

[A]

If you spend the three hours saying, you know, shoveling crap to them and common sense stuff that like, you have to really like, dig in and tell them something, you know, like you have to make them. I mean, that's been my expectation in my finding when I do these public speaking events. And I'm certainly not throwing shade at anybody, but somebody's going to feel that way. I've seen sessions that I thought, oh my God, I'd get up and walk out of that. Like, I, I don't know why anybody's sitting in there. Right. And I don't just mean to touch. But I, I gotta be honest with you. I've. Every place I've ever spoken or been to, I've stuck my head into a room or sat in a room and thought, oh God, what a. The time. And you know, and when people come out of my sessions, they're like, wow, that was great. Thank you. You know, like, so I mean, you have to help them at that level. You can't just repeat stuff they've heard already or put them in front of somebody who's speaking, who doesn't know what the hell they're talking about or is new to it or is going to recite the, you know, the company line or something like that.

[B]

Yeah, I, I agree.

[A]

I think I'm seeing the problems and.

[B]

I try to make my classes engaging like, you know, I, I do, I try to like what. Especially these new kids that, and they don't, they're easier, I feel like, because they don't know anything. Typically they don't know what, you know, pre bulletin is or, you know, how insulin works. They were sent home from the hospital with very black and white guidelines. Like you, you know, you let your kid eat three times a day and free snacks in between and you don't correct but you know, this amount of times. And so I feel like the class, I hope in parts, like, you know, kind of opens their eyes a little bit about. You don't have to be so restrictive like timing of insulin is important and we talk about variables and, you know, technology and how important that is and glycemic index and glycemic load, like, but some of it, you have to read the room a little Bit too, if you know what I mean. Sure.

[A]

No, no, I do. I understand.

[B]

Some families aren't. There are some families that have much better. We're coming in with much better health literacy than others. And then it gets really challenging. We put two of those families together or than that and they're all on different levels and you're trying to engage all of them.

[A]

Health literacy is a polite way of saying what?

[B]

Like they don't understand how to count carbs or like their math skills are just not there.

[A]

Gotcha.

[B]

Like that's, I feel like the polite way of saying it.

[A]

Are we not eyelet pumps on those people? Is that not a good idea?

[B]

Yeah, we are very pro islet here. We do a lot of islet pumps and not necessarily for just kids that were like, oh, they are never going to figure this out. Like just for kids that are like burnout too.

[A]

Yeah.

[B]

And aren't going to do anything. Like they're not doing anything now. And I'm like, if you will just put this pump on and keep it charged and keep it filled with insulin. That's all I expect from you. I don't even care if you bolus. Don't bolus, whatever. Yeah, just put it on. And those kids do really well.

[A]

You're seeing good returns from that.

[B]

What is better?

[A]

Yeah. What does that mean?

[B]

Like A1C wise, you know, their A1Cs are hanging out 10, 11 and they go down to a seven, seven and a half.

[A]

That's hard to argue with, isn't it?

[B]

Yeah. With like no effort on their parts as long as they are, you know, the care and feeding of it is what they call it, you know, keep it charged, keeping it charged and keeping it on. That's all I can ask of them. And that's. Those teenage years are. Are tough enough. And so I feel like that has helped kids get through.

[A]

I'm out a lot. Yeah. I'm a proponent. I am a specific use case is. I mean, I, I want to just say, like, unless some things change. Like I wouldn't ask my daughter to wear a pump where she couldn't adjust her insulin or anything like that. But for people in that situation, boy, it seems like a slam dunk to me, you know?

[B]

Yeah, I tried it. I tried it for a while. I mean, I've tried, I've tried all the pump systems for the most part since I've been diagnosed. Anyway, I try to try them all and it was not for me for sure, but I could see the utility in it and how helpful it could be. I mean, it wasn't horrible by any means. Like, I did. Okay. Just not. I'm way too much of a micromanager, I think, to have let that control go.

[A]

Right. Hey, listen, in fairness, I think they're the only pump company that doesn't buy an ad from me. And I'm telling you, I. In this use case, I think it makes sense. They'll wallpaper people with them.

[B]

Yeah, yeah, yeah. Especially if they're in. You know, most people with diabetes aren't even managed by endocrinologists. A lot of them are managing primary care, so that's like, different issue. Perfect kind of scenario for that situation.

[A]

Right. Because the doctors also double. Don't know what they're talking about in that, in that scenario.

[B]

So you have people who, they're terrified. Right. Like, they just wait. All I got to do is put a weight in this thing. Great.

[A]

Yeah. Yeah, I, I would imagine that's a, an interesting subset. Those are. And by the way, I would also imagine that that subset's a lot bigger than you, and you might believe while you're listening, but there's people who are not having good outcomes, who don't have, for whatever reason, the, the ability to do better. And they've got a doctor who's basically just like, here's insulin so you don't die. And they're like, I get the insulin from the guy so I don't die. And that's the extent of their care.

[B]

Right, Right. Yeah, exactly. And that is what most people in the United States, how they receive their diabetes care is in that, that exact manner. There's not enough endocrinologists or, you know, majority of people with diabetes are being managed by primary care.

[A]

Yeah. Well, you know, there's probably a world where you could make about a five episode podcast series that maybe wasn't more than about 20 minutes long a piece and just like email it to people in that scenario. And it could easily help them understand why an eyelet pump would be a good vibe for them. I wish, I wish Isla would reach out to me. I feel like we could help those people. I'm not that. I'm sure they're doing fine on their own, but I really feel like there's an opportunity there.

[B]

Yeah.

[A]

Yeah.

[B]

I think they. It's a great, it's a, A great option for, for a lot of people.

[A]

Yeah. No kidding.

[B]

For sure.

[A]

What's your A1C right now? Can I ask you, put you on the spot.

[B]

I. I mean, I maintain like low to mid fives.

[A]

Look at you. Any special, special eating style?

[B]

No, I kind of, you know, I. I mean, I try to eat healthy, quote healthy, but I certainly eat Oreos every now and then and, you know, everything in like, moderation is kind of my motto. But I'm definitely not low carb or, you know, I do kind of naturally follow like an intermittent fasting just because I'm not a breakfast person. But other than that, I kind of do what I want, eat what I want, but try to eat healthy.

[A]

Okay.

[B]

Lots of fruits, vegetables, you know, protein kind of situation.

[A]

Has your niece come to you for help yet? Or does she still think you gave her diabetes and.

[B]

Oh, heavens no. I mean, I make her like every once in a while I make her come down and I'm like, okay, let's look at your Dexcom like, report. Because she was one of those kids that did not want to pump. She cried for four hours trying to get a Dexcom on her, and now she wouldn't live without it. But every before when she was MDI doing injections, we'd sit down and look at her Dexcom report and I'd make her go through it. So she has a pretty good idea of, like, what she's doing now.

[A]

Yeah.

[B]

And right now she's doing. She did actually get on a pump just this past summer. She did Moby and is really doing amazing on it. I think her A1C is better than mine, honestly.

[A]

Awesome. Good for her.

[B]

Yeah, she does. She does great. She is very independent and takes care of herself and knows what she's doing. And I like to think that some of that came from me, but, you know, she's not going to say that.

[A]

Yeah, no. Okay. If everybody listening wants a pump and this is talking into it, in the show notes, your podcast player, there are links to every pump company except for. Except for Eyelet. Yeah, Twist is in there. Omnipod, Medtronic, Tandem. Yeah, I got them all go in there and even CGMs. By the way, Dexcom the implantable ever since I'm working really hard. Maybe in 2026 of from you hearing from the good people at Libre about their cgm. So that might work out.

[B]

Yeah, I'd love to try that Twist Twist pump in the Eversense. Honestly, we don't have it available in our area yet. It's not quite out.

[A]

But Twist pump is just loop.

[B]

Yeah.

[A]

In a new, new form factor.

[B]

It's not as good as loop.

[A]

No, it's loop. It's loop that adjusts with basal, right?

[B]

Yes. It doesn't have the. The autobolus branch on it. And I think that's coming, but it'll have to go through, like, the fda, which I hear shouldn't be too painful, but. And it doesn't have. You can't do all the custom presets from what I understand. Like, there are two, like, set presets that you will lose that kind of customizability that you have with loop.

[A]

Well, right now, once they get the auto bolus version out of it, I would say that makes it even more valuable and more. And I've heard the same thing, that it's. It's not fast tracked, but it's not. It's certainly not something they're ignoring. I wouldn't say.

[B]

Right.

[A]

Yeah.

[B]

Yeah. I think it has. Has great potential. As soon as it is in our area, I will certainly give it a try before we start doling it out to our children.

[A]

What happened here? Kenny relocated. He and his family relocated. They end up. They end up at your children's hospital. Tell me the story.

[B]

Well, I just, I. I mean, I knew. I knew of his name just from loop, because I am familiar with, like, looping. I started. Well, I knew what looping was, but I started looping myself this past summer, so I recognized the name for sure. And I was like, what? I don't think that there's no way, like, why would he be here of, like, all places? And sure enough, it was him. We connected and he sat down and helped me with, like, some loop settings because I had recently just started looping when he came through.

[A]

Okay.

[B]

But yeah, he saw the juice box binder in class and was like, huh, do you mind if I send a picture of that to Scott? And I was like, sure, why not? So he did. I think he said, I think this is great. And he, you know, he had to. He came to the class and, you know, if there's someone that knows a lot about diabetes and how insulin works, it's kidney fox. And so he thought, you know, the class was at least, you know, I think he. I don't know if he loved it, but I think he thought it was useful.

[A]

Hey, that's a win. Inside of. Inside of a health system, that's a win.

[B]

And he was. He was a lot of fun to do class with. I think he was. There were several other families in there. And so we had a good time learning. And he was, you know, he's a very natural educator himself. So we had a good time. And he said, you know, he's like, you should. If we should reach out to Scott and do a podcast. And I said, why not? And actually, our section chief did a podcast with you name a couple years ago, Dr. John Odin.

[A]

Oh, John's in the. He's in the grand rounds series.

[B]

Yes.

[A]

Yeah, he was very impressive.

[B]

Yeah, he's a very smart man.

[A]

Yeah.

[B]

And has type 1 himself and takes really good care of our kids.

[A]

No, I remember thinking when he was done, everybody should have this guy for a doctor.

[B]

Yeah, he's great. So we are lucky to have him here, for sure.

[A]

How does that help the practice when the top thinks about it a certain way? Does that actually reach everybody or.

[B]

Oh, yes. I think that is certainly very influential on how we manage diabetes because it, you know, every protocol or practice or how we manage diabetes in the hospital kind of, they look to our, you know, our department, and therefore our section chief to say how we should do that. Like, you know, what's the age cut off? Or like pre bolusing and like, how. How we manage, you know, sick day and ketones and that, you know, he's certainly a voice of leadership, I'd say. And how we do all those things.

[A]

That's awesome. I'm having a problem here. This is very embarrassing. There's a rogue cricket in the room.

[B]

I hear it.

[A]

You can hear it. What am I gonna do about that?

[B]

I think just leave him. He's fine.

[A]

No, but it gets in the recording, and now Rob is very upset somewhere. You understand? Like, in the. In the future, Rob is like, what? Who am I working for? Is what he's thinking right now. This guy can't keep a cricket out of his goddamn office. I'm so careful with them.

[B]

Maybe, yeah. Did he escape out of the.

[A]

I don't know. Well, listen, I appreciate that. You listen. I. That's very nice. Here. All right, give me one second to see if I can figure this out. I'll be back in two seconds. I think I've isolated where he is.

[B]

I got silent, so you must have done something.

[A]

The. The key is to tap on the enclosure, and once you tap on the right one, wherever it is, he stops. Yeah, yeah. He won't stop for long. And then there's another trick where you can kind of like crack the door to change the air pressure in there, which kind of throws them off for a while. So I've done. My God, look at. My life has come to. I'm not going to apologize, Damn it. I really like these things, and it's a very comforting part of my life. So you guys can All I. I need something to take care of. My kids got older, okay? So leave me alone.

[B]

I'm fine. I was just gonna ignore it. I'm very good at tuning things out.

[A]

Well, the problem is, when I start talking, you'll hear it behind me. Like, Rob will cut out the gaps where you're talking, and I'm not talking because that's the only place it is recorded, is on my mic. So he can just chop that out. But I started asking you a question. As soon as I open my mouth, you'll hear the chirping behind me at the same time. Anyway, did you know it's not their legs that make the noise? It's. They get wings as they get older.

[B]

And that's what they rub together.

[A]

Yeah. And that's what makes the noise. And I don't.

[B]

I thought. I definitely think. I thought it was their legs, but that makes sense.

[A]

That's probably from Disney. You thought that with Jiminy Cricket.

[B]

Probably so. Probably so.

[A]

They lied to you.

[B]

You're right.

[A]

Wonder what else they lied about. No, I'm just kidding. I have nothing against this.

[B]

So many things.

[A]

I don't even care.

[B]

Took a turn.

[A]

Let's talk about Walt Disney, shall we? I hear his head is mounted on a coffee can in a freezer somewhere. Have you ever heard that?

[B]

I've heard all sorts of conspiracy theories about poor Disney.

[A]

Poor Walt Disney's head and where it might be or where it might not be.

[B]

Yeah, Just somewhere. It's probably somewhere in the park.

[A]

That'd be awesome. Wouldn't would under something in a freezer. Nobody even remembers it's there.

[B]

Where's Waldo?

[A]

It's great.

[B]

Send people out to go find it.

[A]

Finally, I'd go back to Disney again. I'd be like, listen, I'm on the. I'm on. Oh, a headhunt. I'd be on a headhunt. Look at that.

[B]

A literal head hunt.

[A]

Yeah, exactly. When you came on, do you have any expectations, or is this going pretty much the way you expected?

[B]

No, I just came on to, I don't know, say, hey, be on it. Yeah. And, you know, Kenny kind of put me onto it. And just about. I think education and. And screening, those are kind of my big. The big things that I. That I talk about.

[A]

Yeah. Trying to push people towards screening, obviously, is a really big deal right now, because. And I feel like I can just say this. It's a big deal right now because my ex. Listen, this is from my perspective, okay. Sanofi bought Tzield from Prevention, Bio and the only way they can get you to use it if they know you need it. So there's a big push for screening right now, and I think that has something to do with the $3 billion they paid for teal. That's my thought.

[B]

Yes. And they're certainly. Sanofi is a big pusher of screening for that same reason. But, you know, I see it more as T field is just the tip of the iceberg. Like, we are moving in a direction where, you know, there are going to be, like, cell therapies and islet transplants that you have to, like, you need to be screened. You know, if you want the benefits of these. A lot of these therapies.

[A]

Yeah. They need to identify who you all are right now and figure out better ways to do it, et cetera, so on.

[B]

Right.

[A]

They're the reason that you can't stop seeing Chrissy Teigen on things, in case you're wondering.

[B]

Yeah, yeah. That was a huge boost, wasn't it?

[A]

Yeah. They were like, oh, whose kid got diabetes? Someone write her a check and let's get her into People magazine. That's pretty much my expectation of what happened there.

[B]

Exactly.

[A]

So you'd like to see people get screened.

[B]

Yes.

[A]

I mean, isn't that a difficult thing to pull off, like, talking? I mean, you couldn't get your. Well, you did. You got your family members to do it. Honestly, overall, like, you did a good job, but, like, for the average person, like, hey, my kid just got diagnosed with Type one. You call your sister and say, I think you and your kids should get screened for diabetes. I'm thinking it just be like, oh, my God, you're such a pain in the ass, then that's the end of it.

[B]

Yeah. I do think it is hard. Like, a lot of times it is. There are families that are ready to go and they want to do it, but there are a lot of families that are hesitant. And I get, you know, it does bring a sense of, like, anxiety. I think it'd be anxiety provoking, too, for a lot of these families, and I completely understand that. It is still, like, a very much a personal decision whether you want to get him screened. And a lot of families think, oh, well, I already have one kid with type 1. I will know. Most of the time you don't know. And I will tell that from experience.

[A]

What was the gap of time between your brother's kids?

[B]

Two years.

[A]

He forgot about two years.

[B]

Yeah, he forgot. You know, a lot of people think that, oh, well, just the PCP can do A finger stick. Well, a finger stick isn't really the answer. If they're already 300, you've missed the boat.

[A]

Right.

[B]

You want to catch them early. That's the whole point of early detection, right. Is you prevent decay. That's the primary goal of like screening is prevention of dka. And then comes immune modulating therapies with the new T cell that was, you know, that was FDA approved. Now if they qualify for it, you know, offering them clinical trial is another big deal that we could, that we can offer these families if we start screening them. And I think in the future it will be general population screening. This will just be something that when your kid goes in for their, well, child checkup or for their lead screening or whatever, that they're going to start checking for these auto antibodies so they can catch them and prevent dk. DK is a huge problem. It, it's not just like, oh, I had an episode of decay. It, you know, has lifelong impacts on a child or on an adult.

[A]

Yeah.

[B]

And if we can prevent that, let's do it.

[A]

Hear that episode recently? That girl that had the dead skin tissue in her digestive tract from her decay.

[B]

That, that's a lifelong, that like vomited up or something.

[A]

It's a lifelong problem now. But listen, what I'm gonna tell you is I'll be a little cynical now. There's some money behind it now. You're gonna get the testing because DK has always been a problem, but they haven't moved on it like this. Like so. Yeah. So now there's some onus on them to be able to identify these people so they can use these newer drugs. And now you're gonna see, yeah, somebody gotta get off their ass now and figure it out.

[B]

There's this whole, and I can't remember the name of it, but there's like a whole like, I don't know, like checklist that you have to go through to make something quote, screenable in like the United States. Right. Like there has to be an easy way to identify it is one of the things. And there has to be a treatment for it is one of the things. And like there's like this checklist and I think all the things that were missing in type 1 was an actual treatment for it.

[A]

Oh, I see.

[B]

So now that there's like TZ old, I think it's called the younger and who I can't remember. I don't want to misspeak. But now that they had T zeal that's FDA approved, they've kind of hit that last checklist, Right? That last check on their list.

[A]

Yeah. I mean, again, that's now something we can sell because there's a treatment for dka, it's called insulin. So, you know.

[B]

Yeah, yeah. What if you prevent decay all to begin with.

[A]

Right, right.

[B]

That's the point.

[A]

Yeah.

[B]

You don't want to get to that point. You want to introduce insulin initiation before they get to that metabolic, like, you know, emergency that they're. They're in because that affects them for the rest of their lives.

[A]

Yeah, yeah, for sure.

[B]

So you want to hit that up before it happens and then they don't have to have this traumatic, like, introduction into diabetes with spending two days in the hospital. You could be life flighted somewhere in icu. Like, avoid that. Like, that doesn't have to happen. But you have to be screened and then monitored after and have this gradual introduction to education that doesn't hit you like a baseball bat to the head where you're trying to learn how to keep your kid alive in two days in the hospital.

[A]

Yeah.

[B]

No, it doesn't have to be that way.

[A]

I'm a little cynical about why they're doing it, but I'm happy it's being done, you know?

[B]

Yeah.

[A]

Yeah.

[B]

So, yeah, I mean, yeah, I guess I don't really care why it's being done. I just want it done.

[A]

I just want it done. Yeah. And then just the idea of getting out, educating people and giving them good information so they can hopefully make better decisions for themselves, grow their understanding, and maybe over time get to a point where they can say, this isn't too bad. I'm doing okay. Gotta go to a 1C. My variability is not bad. Yeah, that's a great purpose. Do you think you'll do this for the rest of your career?

[B]

I think so. I mean, pick you. Nursing was not somewhere I was going to stay forever. It just wasn't. You know, I learned a lot and, you know, I'm glad I did that, but I didn't really have, like a passion for it. And I don't. Until I was diagnosed, I don't think I would have had a passion for this either, honestly. But this is definitely where I'm supposed to be.

[A]

Yeah.

[B]

And helping. What I want, hope I'm helping families. And these kids just know that this is. They can do it. Like, this is something that is absolutely, like, possible. And their kids can have long, happy, healthy lives. They just have to figure it out.

[A]

Yeah. Do you see any need or value in you continuing your education? Is there anywhere that you see yourself going from here or do you like the level you're at and do you think it suits your goals?

[B]

Well, I think I'm happy where I am. I don't, you know, I know I could always go on and get my master's and maybe do nurse practitioner, but I sometimes think it's, it's more stress and I get to spend more time with these families in the position I am. Our providers don't get to spend time like I do.

[A]

Yeah.

[B]

With these families. So I think for what I want to do and what I like to do and where I think I'm most helpful is having that flexibility to actually spend time with families.

[A]

Okay.

[B]

Our providers don't do, you know, three hour classes or have the availability to sit down with the family when they just don't understand how to bolus for a meal or to sit down and look at their dexcom graph and say, okay, what is happening here? Like, what does this mean? You know how to make adjustments on your owner? Providers don't have that kind of time to do that.

[A]

Have you tried to, and this isn't me saying to try to do this. I've seen people do it. Have you tried to put graphs into AI, ChatGPT, the Google one, like, or whatever and say, hey, what do you think this is A person using type 1 diabetes? What do you think they need to do? Have you tried doing that yet?

[B]

I have, not personally, but families have because they'll send in messages saying, hey, this is what ChatGPT thinks I should do.

[A]

Right.

[B]

And I think it can be. I mean, I am, I am pro AI. Like, I can't wait till we can unleash Dexcom graphs on AI for actual knowledge on progression of like, early type 1. I think that's where I would really like to see it go. Yeah, I think it can be actually pretty helpful and insightful. I mean, not perfect, but I think it can give some pretty good insights assuming you let it know all the variables that are going on. I think that's the key because even when I blindly look at a dexcom graph, I don't know, I see a flat line overnight. I don't know that they're up feeding their kid smarties every 45 minutes just to keep their blood sugar at 80. I just see, wow, they're doing great. And so I message back and I'm like, you guys are doing great. No changes.

[A]

They're like, are you sure? Because we don't sleep anymore. Well then, yeah, they got to Give you the rest of the information. I just, I saw a lady kind of shared her entire chat and she's basically sat down and had like a conversation with it and it gave her a lot of valuable insights. So, yeah, that, you know, I was like, I wonder. Wonder how much longer it's going to be before if that's not a thing you start talking to people about. Like, start conversating with the answer machine and see what it says, you know, like, I don't know, like, I have no idea. I'm just. I'm wondering when you're going to see that happen or not happen or if it will or won't.

[B]

Yeah, I think AI is going to play a large role in. In helping people manage their diabetes. I mean, even with like the, like, Gluru, where you can take a picture of your food and it kind of estimates the carbs, we use that one a lot as a good recommendation for our families because carb counting is hard. It is an art and not a science. And, you know, no one really does it well. It all becomes about estimation for the most part, and more about like, the meal composition. And I think that is, you know, that is definitely AI at it at its best, helping families learn. And so I think with Dexcom graphs and even like research stuff like, you know, them putting, you know, these like digital twins in there and being able to get answers much quickly than they would in an actual research study because they have that ability to kind of simulate things right on a actual and versus like doing a clinical study that takes 20 years to complete. So I think AI is important and I think it will. It's going to tell us a lot about diabetes management and help a lot of people much better than endocrinologists can.

[A]

Honestly, I mean, I think that's maybe my bigger point. It's not. It's not like some people are. I mean, I guess, you know, some people have access to really great care, but even that really great care is limited to a certain number of times a year. Limited ability for them to understand what's actually happening. Like, you know what I mean? Like, it still falls on the user and the people who don't have that great care or the understanding or a number of the things that we've talked about here today. They're just left to languish and, you know, basically in failure and, you know, and health, health concerns that keep mounting. I mean, I think you'd be better off sending the door prompt and saying, ask your questions here, see if it makes sense or Maybe it'll even help you come back with ways to talk to me about what's happening or what. Whatever. Like, I. I think it's gotta be worth trying, honestly.

[B]

Yeah. I don't disagree. I think AI definitely plays a role in a helpful one for the most part.

[A]

Yeah. We'll see where it all goes. Okay. I really appreciate you doing this. It was lovely speaking with you, especially on a Friday afternoon. It felt relaxed.

[B]

Yeah, same.

[A]

You know, this isn't fair to say here. You're a professional person, but I know who you are. I know what you look like. You're adorable. Do we need. Should I. You want me to send the boys over? Or is that not what you're looking for?

[B]

Or, like, I don't know, maybe. I don't know. Maybe one day I'll be ready. It's gonna have to be. It's gonna have to be someone very nice, though, and who just does, I guess, whatever I want.

[A]

Okay, well, if you're very nice and obedient, and you're.

[B]

Terrible, you're looking for.

[A]

A lady in her 40s who's not up for bullshit. Maybe go find Roxanna.

[B]

Yeah, I'll be here.

[A]

That's awesome. Well, I appreciate all the good work you do and that you took time coming on here to do this. I really do. I do. Thank you a ton for adding your. Your voice to the podcast. And I'm thrilled, generally speaking, that the podcast was valuable for you and that even if it's just your vibe that's made it into your practice and your professional life, it means a lot to me that that happened. So thank you for telling me about that.

[B]

Yeah, of course. Thank you for all you do.

[A]

It's a pleasure. Hold on one second, okay?

[B]

Okay.

[A]

This episode of the Juice Box podcast was sponsored by US MED usmed.com juicebox or call 888-721-1514. Get started today with US MED. Links in the show. Notes [e-mail] 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. 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 hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of the Juice Box Podcast. Hey, I'm dropping in to tell you about a small change being made to the Juice Cruise 2026 schedule. This adjustment was made by Celebrity Cruise Lines, not by me. Anyway, we're still going out on the Celebrity beyond cruise ship, which is awesome. Check out the walkthrough video@juicebox podcast.com JuiceCruise the ship is awesome. Still a seven night cruise. It still leaves out of Miami on June 21st. Actually, most of this is the same. We leave Miami June 21, head to CocoCay in the Bahamas, but then we're going to San Juan, Puerto rico instead of St. Thomas after that. Basteria. I think I'm saying that wrong. St. Kitts and Nevis. This place is gorgeous. Google it. I mean, you're probably gonna have to go to my link to get the correct spelling because my pronunciation is so bad. But once you get the St. Kitts and you google it, you're gonna look and see a photo that says to you, oh, I want to go there. Come meet other people living with type 1 diabetes, from caregivers to children to adults. Last year we had a hundred people on our cruise and it was fabulous. You can see pictures to get at my link. Juiceboxpodcast.com juicecruise you can see those pictures from last year there. The link also gives you an opportunity to register for the cruise or to contact Suzanne from Cruise Planners. She takes care of all the logistics. I'm just excited that I might see you there. It's a beautiful event for families, for singles. A wonderful opportunity to meet people, swap stories, make friendships, learn. 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. Have a podcast. Want it to sound fantastic? Wrongwayrecording. Com.