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- [00:00]
A
Hello friends, and welcome back to another episode of the Juicebox Podcast.
- [00:13]
B
I work for an organization called daphne. So DAPHNE stands for Dose Adjustment for Normal Eating and it's a not for profit part of the NHS and we provide education for people with type 1 and type 2 diabetes.
- [00:28]
A
Nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Have you tried the Small Sips series? They're curated takeaways from the Juice Box Podcast, voted on by listeners as the most helpful insights for managing their diabetes. These bite sized pieces of wisdom cover essential topics like insulin timing, carb management and balancing highs and lows, making it easier for you to incorporate real life strategies into your daily routine. Dive deep, take a sip and discover what our community finds most valuable on the journey to better diabetes management. For more information on Small sips, go to juiceboxpodcast.com, click on the Word series in the menu. Foreign. The episode you're about to listen to was sponsored by touched by type 1. Go check them out right now on Facebook, Instagram and of course@touchedbytype1.org check out that Programs tab when you get to the website to see all the great things that they're doing for people living with type 1 diabetes. Touchedbytypeone.org the podcast is also sponsored today by TandemMobi, the impressively small insulin pump. Tandem Moby 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 today@tandomdiabetes.com Juicebox today's episode of the Juice Box Podcast is sponsored by the Eversense365, the one year wear CGM. That's one insertion a year. That's it. And here's a little bonus for you. How about there's no limit on how many friends and family you can share your data with with the Ever since now app. No limits Ever Since.
- [02:33]
B
So yeah, my name's Liesl. I'm a diabetes specialist nurse by. Oh, there's my phone. I thought I'd put that on silent. Sorry.
- [02:41]
A
It's okay. It's a great intro. Don't worry.
- [02:44]
B
I know I did put it on silent. It was to remind me to log on to this if I hadn't already done it. So that's what that's all about.
- [02:51]
A
Hold on a second. First of all, I definitely think we have to call this episode Liesel Lies All Culture. But that's a different problem for a different time. What do you mean? You put on a timer, in case you forgot.
- [03:02]
B
Oh, well, no, because I was. I had to do some training before this that I wasn't expecting to do, so I was going to have lots of time to prep and it was if I got carried away with the training, but I left them early because I was so conscious I didn't want to be late for you, that I left the training early and left a colleague to take over from me. So.
- [03:19]
A
Oh, is there a sick. Is there a sickly person in England now because you had to be on the podcast? What's going on?
- [03:26]
B
No, no, no, no, it's fine. Good, good, good.
- [03:29]
A
Tell me, Liesel, a little bit about your job. What is it you do?
- [03:35]
B
I work for an organization called daphne. So DAPHNE stands for Dose Adjustment for Normal Eating. And it's a not for profit part of the NHS. And we provide education for people with type 1 and type 2 diabetes, which is free of charge. And we also provide education for healthcare professionals who work in diabetes and we teach them about type 1 diabetes, type 2 diabetes, and also how to teach that education to the people they work with and support who have got diabetes.
- [04:07]
A
Would it fry your mind if I told you that today there's an episode up called Sneaky Chocolate Bar and Sorry, that part isn't what I thought would fry your mind, although I guess maybe it would. And Danny, who is from England, is telling his story in two parts. And in the first part, it becomes completely clear to me that he does not know how to take care of himself until he finds the DAPHNE program does that surprising to you?
- [04:36]
B
Not at all. I have been involved in Daphne now for 20 years, I think. So I was a diabetes specialist nurse and I was actively looking for a job outside of diabetes because I felt I had nothing else to offer. And a new consultant joined the team and said, we've got to do this Daphne course. We have got to do it. And so I got sent to do my DAPHNE educator training and I was really not that keen. I thought, everyone's going to eat pizza and chocolate cake and put weight on and it's going to be dreadful. But I went to a DAPHNE center to watch a DAPHNE course in person for a week. And as I sat there, I thought, this is so obvious. I should know how to do this. Like, I just know how to breathe. I couldn't believe what I was learning and how much I hadn't known before, even though I'd been a very diabetes specialist nurse for I think six years at that time.
- [05:34]
A
So I want to go back to.
- [05:35]
B
It does surprise me now.
- [05:37]
A
Yeah, give me a second here. So you. You were a diabetes specialist nurse already for six years, you felt disenfranchised or. Or just maybe. I don't know how you felt exactly. We'll find out. Exactly. But you're thinking about getting away from it. A friend says, let's try Daphne. And your first concern back then was that if we teach these people how to use the insulin, they're just going to eat a lot of food.
- [06:03]
B
No, not. That's not quite the way it is. I think when we looked at the press and the media around Daphne at that time, the press focused very much on people can eat whatever they like. And in the UK at that time, education was about healthy diet and not about carb counting. So there was this disconnect, even for healthcare professionals, professionals around the relationship between insulin and carbohydrate. So that wasn't something I'd ever been aware of, ever, really. And I just thought, well, if people can eat whatever they like, if they've always been told, you've got to eat a healthy diet, you can't eat sugary food, you can't eat fatty food, they're just going to eat whatever they like and this could be a disaster. But then I went on the Daphne course and properly understood that triangle between carbohydrates, insulin and blood glucose, which I'm ashamed to say I hadn't fully appreciated for the six years that I'd been a diabetes specialist nurse.
- [07:03]
A
Characterize for me the kind of care you were offering in the first six years, in hindsight.
- [07:11]
B
Changing insulin doses for people in very small amounts without really taking into consideration what they were eating, so not really being aware of why they might wake up above their target glucose in the morning. And perhaps it's because they had to have a bowl of cereal before they went to bed, so they didn't go hypo, but that wouldn't really come into it necessarily. So it was really very limited and I suspect I was not very effective in that role at that stage.
- [07:45]
A
Did you think during those years that everyone who you saw was just eating watercress and drinking tea and not really taking in many carbs and they were super healthy. Was that your expectation of what was happening or is that what you were told? Is that what they were being told to do and you were just making the assumption they were doing it?
- [08:07]
B
That's what we were recommending people were doing. But I'm a Realist. And I knew that people were not doing it because I don't have diabetes and I wasn't doing it. So, you know, I think, I think it's very easy to give advice, but what I wasn't doing in those days was listening. I felt I was a vehicle of information and my job was to give information and tell people what they should be doing because that's what was going to benefit them in the long run. But doing the DAPHNE course and becoming a DAPHNE educator taught me to listen and to understand what it's like as well as I can with a condition that you can't have a day off from.
- [08:51]
A
Yeah.
- [08:51]
B
And I will never truly understand type 1 diabetes unless I get it. But I owe it to anybody with type 1 diabetes to listen and do my best to understand what it's like for them as an individual rather than try and put a population wide approach to it.
- [09:09]
A
So do you think that the, I don't know, the establishment idea was eat like this, very low carb and you should do that because you have diabetes and if you don't, then you're non compliant and we can't help you and if you do, then maybe you'll get lucky and have good outcomes. Is that how they thought about it?
- [09:30]
B
I don't think even low carb came into it. Carbohydrate wasn't anything for me as a qualify. I qualified as a nurse in 1990 and then I went into diabetes in 1999. And I don't think carbohydrate ever really entered our psyche or our training at that stage in 1990.
- [09:48]
A
I'm sorry, I talked over you in 1999.
- [09:51]
B
Yeah.
- [09:52]
A
Wow. Okay. All right. Okay. When did Daphne begin? Do you know it? I can look if you don't know.
- [10:01]
B
Origins. Yeah, no, no, no, it's true. Origins are with a man called Michael Berger in Dusseldorf back in the 80s and Germany were having or achieving much better outcomes for people with type 1 diabetes at the time than we were. And there were some very influential people in the UK, Professor Stephanie Amiel, Professor Simon Heller and Dr. Sue Roberts, who went out to Germany to visit Michael Berger and to see the education he was providing for people with type 1 diabetes. And through a collaboration with him and his support, they brought his education back to the UK in the late 90s and called it Daphne dose adjustment for Normal Eating. So we had a randomised control trial in the late 90s which showed reductions in HBA1C and then that was rolled out in 2000. So Daphne's been going. It's our 25th birthday this year. We've just had in October our birthday month celebrations.
- [11:01]
A
It I have here begun 1999 teaches adults with type 1 diabetes how to adjust insulin to match their lifestyle and food choices rather than restrict diet. Adapted from a successful German model of structured diabetes education. Usually a five day in person group course run by diabetes specialists, nurses and dietitians. It proves it has been proven to improve HbA1c, reduce severe hypoglycemia, increase quality of life and confidence in diabetes management.
- [11:29]
B
Yeah, and the other thing it does is reduce diabetic ketoacidosis because if some or dka. So when people have had DKA in the past, that usually excludes them from any kind of research. But because we collect real world data, we can show real world reductions in episodes of DKA and also in the number of people who experience DKA once they've done a DAPHNE course.
- [11:54]
A
Is the Daphne course akin to this podcast? Does it have a lot of overlap or no overlap with, like, with ideas of how to do things? Like, I mean, I guess I should have started here. Do you listen to the podcast at all?
- [12:10]
B
I haven't listened for a few weeks, but that's because we've had a lot of. We've had a bereavement in the family and I just haven't been running. But when I was running on my treadmill a lot, I was listening to the podcast while I was running.
- [12:19]
A
Okay, and you. And you've heard, I don't know, have you heard the pro tip series or one of those, like management series?
- [12:25]
B
I haven't heard those. I've heard a lot of people who have got either type 1 diabetes themselves or they have it in their family.
- [12:31]
A
Yeah, you've been listening to the stories from people. Okay, so there are a ton of series within the podcast. I was just wondering if you knew if there was overlap, but instead I'm going to talk to you about it and I'll see if there's overlap. So tell me, you know, in this five day course, like, what do you, what do you tell people? Like, how do you introduce the idea to them and how do you help them understand it?
- [12:57]
B
Okay, so before they join the course, we ask them if they want to do it. And the way we do that is by saying, what do you want to be different about your life with diabetes? So there will be people who say, well, I haven't been running since I got diagnosed because I'm frightened I'm going to have a HYPO or I really want to look after my grandchildren, but my, my daughter won't let me because I had a really severe hypo. And so there are things in people's lives that they don't do because they've got diabetes or things that they do. So they, they may eat the same food every day because they feel safe and they're anxious about eating something different. So they want variety, they want a social life back, they don't want people to judge them. So we ask them, what do you want to be different about life with diabetes? And then it may be that there's something within a Daphne course that would be absolutely ideal to help them achieve what they want. So we then say, actually, if you want to run safely, come on the Daphne course, you can learn all about that and then you can start running again when you feel safe. And then when they come on the course, the first day is spent talking about carbohydrates. So what is carbohydrate? What does it do? What is type 1 diabetes? And why is carbohydrate important in managing your body glucose? And then they go on to learn about carbohydrate. The com. The concepts build from very basic concepts to very complex situations over the five days. So they start out by identifying what is carbohydrate. So they have some food models on the table and they split them into groups. Those that contain carbohydrate, those that don't. And the ones they're not sure about, like burgers and sausages, baked beans, people aren't always sure about. And then we talk about those foods so they can understand why some do and don't have carbohydrate in. And then by the end of the week, they're working out carbohydrate in recipes that they make at home, in their cake recipes or their scone recipes or their curry recipes, whatever it might be, they're able to work out what they're actually going to eat carb wise and how to match that with their insulin. So they learn gradually over five days. And this building of concepts, and I have to say it was the best bit about being a diabetes specialist nurse, is watching people's confidence grow and seeing their understanding just expand beyond what they'd expected. And watching the penny drop, it's. It's like it's a professional drug.
- [15:27]
A
Delivering a Daphne course, do you find yourself, in the beginning, did you find yourself astonished or did you expect people's level of understanding about what's in their food?
- [15:45]
B
I Think the Internet is a wonderful thing, but it's also a dreadful thing because when somebody is newly diagnosed with type 1 diabetes, they can often be in this state of shock. There's a relief that all that sudden weight loss wasn't a life threatening diagnosis like cancer. But then there's the realization that they've got this condition they can't have a day off from. I can wake up in the morning and decide not to wash my hair, but you can't wake up in the morning and decide not to take your insulin. And so sometimes they're like a rabbit caught in the headlights. And so even though we might give lots of information about carbs at diagnosis, how much actually goes in, with the enormity of taking five injections a day and everything else they have to think about, I think it just doesn't stick. So then they can look on the Internet and there's so much conflicting information that I think people don't always know what to go with. So when they come on a DAPHNE course, it's almost a relief that somebody is saying this is what you need to know. You're going to learn it in a safe environment. You can practice things, you can make mistakes, we'll support you, we won't judge you, and you are going to become very much more confident and comfortable with, with self managing your diabetes in just five days.
- [16:59]
A
Yeah. What's the turnaround like? I'm going to ask you just to quantify it somehow. Do people come in at a confidence? Let's set confidence level between 1 and 10, 10 being the greatest. Where do people come in at mostly and where do they leave at? Like what's the, what's the build they get usually?
- [17:17]
B
Yeah. So we do something called PROM data. I don't know what you call that in the States. It's called person reported outcome measures. And so those are questions that we ask people before they do the immediately when they finish the course and then a year later and we ask them very specifically how confident they are with insulin dose adjustment, how confident they are with carb counting. And most people before the course for both of those will come in if one is not confident at all and 10 is supremely confident. Most course participants will come in with a score of 1 to 5 before the course. When the course is finished, they'll mostly be scoring between 7 and 10 immediately after the course. And for insulin dose adjustment, it's still a majority 7 to 10 score in a year's time. And for carbs there's a slight dip. Maybe between six and ten at one year.
- [18:13]
A
Is there.
- [18:14]
B
So it's huge.
- [18:15]
A
It's huge, yeah. Is there a wide difference between people's backgrounds in education or do you find that are certain people who don't need or come for the course and there are groups that more so do, or is it across the spectrum?
- [18:31]
B
I think on Daphne we talk about health literacy so you can be very well educated. You can have gone through university and got a degree, a master's, a PhD. But you may struggle with health literacy which is applying the numbers to yourself. You might have Left school at 14 with no qualifications but really strong maths ability and you'll fly with it. So there's no I wouldn't have any preconceptions around whether somebody would manage to self manage their diabetes based on their education level because in my experience that's not a good predictor.
- [19:07]
A
Today's episode is sponsored by a long term CGM that's going to help you to stay on top of your glucose readings. The Eversense 365. I'm talking of course about the world's first and only CGM that lasts for one year. One year, one CGM. Are you tired of those other CGMs, the ones that give you all those problems that you didn't expect, knocking them off, false alerts, not lasting as long as they're supposed to. If you're tired of those constant frustrations, use my link eversensecgm.com juicebox to learn more about the Eversense 365. Some of you may be able to experience the Eversense 365 for as low as $199 for a full year. At my link you'll find those details and can learn about eligibility. Eversensecgm.com juicebox check it out. Let's talk about the Tandem Moby insulin pump from today's sponsor, Tandem Diabetes Care. Their newest algorithm, Control IQ technology and the new Tandem Moby pump all offer you unique opportunities to have better control. It's the only system with autobolus that helps with missed meals and preventing hyperglycemia, the only system with a dedicated sleep setting, and the only system with off or on body wear options. Tandemoby gives you more discretion, freedom and options for how to manage your diabetes. This is their best algorithm ever and they'd like you to check it out@tandomdiabetes.com Check out Juicebox when you get to my link, you're going to see integrations with Dexcom sensors and A ton of other information that's going to help you learn about Tandem's tiny pump that's big on control. Tandemdiabetes.com juicebox the Tandem mobi system is available for people ages 2 and up who want an automated delivery system to help them sleep better, wake up in range and address high blood sugars with auto bolus. It's not a good predictor of health literacy.
- [21:09]
B
No, not at all.
- [21:09]
A
Gotcha. Do you find that there's one part. Is there an aha moment in the five days? Like I know you said, it's. It starts basic and it builds to more complex, but is there something that gets said that you just see people's faces light up? Because there are a takeaway, a tagline you use, something you say over and over again that makes you can see it light people's eyes up.
- [21:36]
B
I think one of the main things which they learn on the first day is that they couldn't have done anything to avoid it. And that's a big aha moment. Because in the media, certainly in the uk, there's a lot of judgment around type, about, around diabetes. And there's a lot of judgment based on people's weight or lifestyle. And whether you've got type one or type two, that stigma seems to apply. And so often people have been told, well, surely if you just ate differently, you wouldn't have diabetes. So the realization on the first morning of the first day that they were going to get it and there was nothing they could do to avoid it, it's not their fault. That relinquishing of guilt for a lot of people is really powerful and that happens within the first couple of hours.
- [22:19]
A
Of the course starting is. I mean, listen, I've never been to England, so I'm guessing and basically going off of things I've seen on television. But. But are you guys overall, societally not a warm, fuzzy group who talks about their illnesses together a lot or like, I'm wondering if this is also valuable because you get into a room with other people who know your story and are living it as well?
- [22:48]
B
Oh, I think you've just hit the nail on the head. I can walk through a waiting room in a hospital, whether it's a diabetes waiting room or people with broken legs, and you won't find people sitting there easily sharing their stories necessarily. So when people come on a Daphne course, it's often the first time they've had a proper conversation with somebody else who lives with type 1 diabetes. And often they're quite reserved on the first day because everyone thinks they're going to be the worst in the room at managing diabetes, and then they realize that they're all as good as each other or they're all as bad as each other, and they all share the same problems, the same anxieties, the same fears.
- [23:27]
A
Yeah.
- [23:28]
B
And so I think that leveling of the playing field when you have a bunch of people together is the, is the most powerful thing. And I don't think we'll ever really know with Daphne. Is it the Daphne principles around carb counting and dose adjustment, or is it the peer support? And if you took the peer support away, would people achieve so much? I don't know. I wouldn't like to have, I guess.
- [23:48]
A
I'll tell you that. So the podcast, you know, in its entirety, it's, it's been around for almost 11 full years now. And at the end of this year, it'll be the end of the 11th year, and I'm going to start right back up again. Year 12 on, you know, January 1st. But of the 20 million total downloads that have happened over the last 11 years, a number of million of them happened this year in 2025. And I, I just looked and by, you know, by country, and I don't think this is surprising. Obviously, it is most popular in the United States, Canada's second, the UK's third, and there, there are a significant number of downloads in the United Kingdom. From there, for people interested, it goes Australia, India, Germany, Ireland, Sweden, New Zealand, and China. Those are the top. I think those are the top 10. And now I'm sitting here wondering if I did a deep dive on people's national ability. I'll say, to be open and to talk to other people about stuff like this. I don't think I'm incorrect to say that Americans are probably uniquely seen as really willing to talk about things that other people don't talk about. Is that true, do you think, do you think of us that way?
- [25:09]
B
Well, my, my niece is half American and, and she's very happy to talk about almost anything. So I think just going on that personal experience, I would say yes, and I adore her for it.
- [25:21]
A
Yeah, I, I, there's, I won't tell you now because it has nothing to do with anything we're talking about, but I found myself a few weeks ago in the middle of a conversation that I did not think would go a certain way, and somebody brought something up, and the next thing you know, it was a half an hour later, and I, I got done and I thought, why Did I share anything, any of that? Like, like, like how did, how did that even. And I, and it just would have made more sense for me not to but you know, so. And I've seen like on this side of it. Liesel, I don't know how much of like I, of the little ecosystem I've built here you're aware of, but I have a Facebook group that has. It's coming up on 80,000 members and it's incredibly active. Right. Like, and I mean average 120 to 160 posts every day. Like 8000 comments likes. Like there's at any point in time, in any day, there's at least 40,000 of those people are active. And I was not. I haven't talked about this in a little bit. But like I didn't start that Facebook group on purpose. Like the listeners sort of made me and it was not, it wasn't the thing that I really was interested in doing. Meaning I don't, not like the community aspect of it. Like, I was scared of the idea of like, well, I don't want to be in charge of a Facebook group. That seemed like a problem to me and it hasn't been. It's been lovely overall, but it really has given me the opportunity to just sit back and watch what happens when people get to meet somebody else or get to ask a question that there's nowhere else to ask it of or to say something that they would have felt judged by in one place but don't get feel judged by their. It's a revolution for them. Really, really, truly is.
- [27:06]
B
I think and I think as Brits, we have a reputation for being quite reserved. But I think with diabetes there's so much stigma around it that people are afraid to talk about it because they're afraid that if they say anything, they're going to be judged. And so when you get a group of people in a room together and say you're free to talk and they've got type 1 diabetes, then they're fairly shy to start with, but not for very long.
- [27:30]
A
Yeah, happens pretty quickly.
- [27:31]
B
And in fact, I think that's I. My second ever Daphne course was way back in 2006, 2007, and the people that were on that Daphne course still get together every couple of months on a Saturday for lunch.
- [27:46]
A
Okay.
- [27:47]
B
We're now talking 19 years later when I stepped away from being a diabetes specialist nurse and I joined the Daphne organization full time, they reached out to me and said, now you're not our nurse. Would you like to Come to lunch with us. So I get to have lunch with them whenever I can several times a year on a Saturday. And they might talk diabetes for a few minutes, but they talk about life like any other bunch of friends. But they have that irreplaceable innate understanding of each other without saying a word of what it is like to navigate those life situations with type 1 diabetes. And sometimes I am. Usually I am in awe of them because they manage all the normal things of life that the rest of us manage, but they manage it while also living with type 1 diabetes. And I don't think you can ever underestimate the effort that that actually takes. And I take my hat off to them and. And I adore them.
- [28:44]
A
There's something about the way you just described that that made me feel like if. If I don't have, you know, if I don't have a thing. Excuse me one second. If I don't have a thing that's. That's invisible, but yet I can kind of feel it, like, right? Like. And it's always with me. Then it's. Then it's always with me. And no matter where I am or what I'm doing, I have that feeling and no one else has it. And the way it hit me, like, visually was almost like, if you could imagine, like a thin towel, a thin wet towel laid over top of you, how uncomfortable that would be, right? If you were living like that, but nobody else could see it but you, and nobody else could feel it but you. But you still had to go to school, go to work, drive a car, go grocery shopping, and you always had that little wet towel over top of you. And. And somehow when everybody has the towel, then it disappears. It's gone. Yeah, yeah, yeah. Oh, it's awesome. And listen, it's just a different way to think. It's not lost to me. I do a lot of in person stuff, and I've done more of it in the last couple of years than I have in the past. But I, you know, just this year was at an event with 2,000 people who had type 1 diabetes. I, you know, it was. And I don't know how to quantify what you've just said, but I know it's true that when they're all together, that there's a lightness about them that I don't know exists when I see them in other places.
- [30:11]
B
And it's a sense of safety, isn't it? They're not gonna be judged. I think a few minutes ago you used a word which is My absolute bugbear of a word, and I wish it didn't exist, but there's a word, non compliance.
- [30:24]
A
Right.
- [30:25]
B
And that is used in medical terms to describe people with diabetes, particularly people with type 1 diabetes. So if somebody comes to a clinic and they see a healthcare professional and they've not been carb counting very much, they might be labeled as being non compliant. But actually if that healthcare professional was, was to listen to them and find that they've just had to move house or they've just had a bereavement, or they've got a sick child, or they're working as a carer, they do shift work and how difficult it is to be a carb counter and manage type 1 diabetes in those normal but frenetic situations. If you understood that, you'd never label somebody as non compliant. And one of the things that we ask our DAPHNE educator trainees and our DAPHNE doctor trainees to do is to count carbohydrate in their day to day life for five days in a row. Not because we want them to be perfect, but because we want them to have some shared experience with the people that they're supporting who live with diabetes all the time. And the number of doctor trainees or educator trainees who manage to do that completely 100% for five days is really small. And that's not a criticism, it's just a reflection of life.
- [31:43]
A
Yeah.
- [31:44]
B
The impact it has on people's managing ability.
- [31:46]
A
Isn't it true that those people were non compliant with the task? Right. Yes. And to count carbs for five days in a row, they became non compliant. And listen, I use that word in the same way you use it. I hope you could hear the underpinnings when I was speaking about it. But yeah, I don't think anyone. I've been doing this a very long time. Okay. And by the time this year ends, I'll probably have had 2,000 separate conversations with 2,000 different people and I will have probably 300 more next year. And you know, if everything keeps going the way it's been going, I probably have 2 or 300 more for the next coming years. I hope, really, by the time I'm done this, to have had 3,000 or more, maybe 4,000 conversations with people with diabetes. And I don't think any of them, no matter their situation or their outcomes, I don't think I'd be comfortable pinning non compliant on any of them.
- [32:45]
B
Gosh, no.
- [32:46]
A
Right? No. I think it's just life is hard and being a body system is Hard. And it's unrelenting. It doesn't stop. It's not. You know, it's so easy to say, like, you know, Christmas, Easter, two o' clock in the morning. Doesn't matter. You still have type 1 diabetes, you know, and it's just those people have to make. Those people have to make a decision between their mental health and their physical health, which is unfair. Like, right, there's. That shouldn't be. There should be no situation where. Where I say to you, you have to make a decision right now. We're gonna make it again 20 times today. And you have to err on the side of making yourself crazy or making yourself physically sick every time. And there's no win. You can't win. There's some people. I'll take that back. There are some people who have such a specific personality that the taking care of the diabetes scratches an itch for their, like, type A personality. Does that make sense?
- [33:48]
B
Yeah.
- [33:49]
A
Yeah.
- [33:49]
B
Yes, it does.
- [33:50]
A
Those are the perfect people to have dia. Like. Like, because they. They can treat the management as a reward system for themselves, and I see it work for them incredibly well. But everyone else is going to be on this very slow swinging pendulum that's going from center to left and center to right, and they are just. What's that thing where. You ever see those people on the pole, they go up on the top of a real tall pole and they just, like, they go back and forth and keep it from fall. Do you know what I'm talking. It's like a circus trip, right? That's what those decisions are like. Like, I can't fall one way and I can't fall the other way and I can't get the damn thing to stay steady. So I just have to decide, like, what side do I give this to that I don't either lose my shit or lose my sight. And that's not a And when that's your situation. Anyone who would understand that situation fully and then call being perfect is an asshole. And anybody who would do it without understanding it is just misinformed.
- [34:53]
B
Yeah. And I think the other thing we've got to be careful of is even people who you. I think you said type A personality, you know, they're the people to get it because they have a specific personality to manage it. But I still think we have to be fully aware of diabetes burnout. And now with the advance of technology, so most people with type 1 diabetes in the UK or in England now have got CGMs, and that's brilliant. However, there's a risk of tech burnout and sometimes they give you too much information and that can be overwhelming. And as a healthcare professional and as a human being, I need to understand and be mindful of that. But also I think the one thing that tech has done is it's made type 1 diabetes visible, which it never was before. So especially in the summer, you see somebody at the pool or someone at the beach or someone, somebody out walking in a sleeveless top and you see their CGM or you might see their pump on their arm. And so it's a bit like spotting a. When you see people with type 1 diabetes and they meet each other and you can see they're looking and thinking, do I say anything or do I not? And I think, do I go up to them and say, well done, you're doing a blinder? Because I know They've got type 1 diabetes or do I not? Because they might not want me to draw attention to it. So it's making type 1 diabetes visible, which it never was before.
- [36:15]
A
We need a Jeep wave. That's probably not something you know about, but everyone who drives Jeeps in America.
- [36:23]
B
That'S what we need. Yeah, we need to type one way.
- [36:25]
A
We need to type one wave. That way you don't have to be right up some on somebody, but you can still give them the nod, you know, and they'll know where it's coming from. You said two things. I want to go back to the, the type A thing again. I, not that I think I was taken that way, but like, I'm not saying it's awesome for those people, I'm just saying they're more perfectly suited for it, but they should still be, they are still giving an amount of effort and time and focus to something that nobody wants to be focusing on. It's, it's still unfair to them. They just have, yeah. You know, they just, their outcomes seem to work out a little better sometimes and maybe they don't go as bonkers about it because it, it leans into whatever they're, you know, whatever their wiring loves for them. About the tech stuff, you know, I take your point, I really do, about the beeping and the buzzing and, etc, but I'm really hoping that, gosh, I'm really hoping that in a reasonable amount of time that the, the trade offs are still, I mean, I, I believe now the trade offs are still valuable, but I think in a reasonable amount of time it might get easier and easier again. Like, hopefully this technology will continue to grow. I'm. Yeah, I'M I talk a lot about on here that, you know, I like that there are a number of different companies. I like that they are aggressively trying to make their algorithms more accurate and, you know, give them lower targets because it keeps, it keeps those companies trying. You know, Like, I think, I think when you saw, you know, back in the day when there was one big pump company, you know, I'll tell you that I think they innovated and then they kind of sat back and were like, oh, we did it, here's the thing, we gave it to you. Right? And I just, by the way, interviewed the CEO of that, of that company and put it to her. I was like, what happened to you guys? Like, it feels like you made the thing and then spent so much time selling it, you stopped worrying about whether it could get better again. And she was very candid and said, yeah, I think that happens to a lot of businesses and I think that happened to us too. And so that's not gonna happen again now because now you have Medtronic and Tandem and Omnipod and, you know, and now Twist and Eyelet. There are more and more companies coming. If they want to stay alive and make their money, they gotta make the thing better. I think there's. That's nothing but good news for people with diabetes.
- [38:56]
B
Yeah. And that. Well, and it's similar with us in Daphne. We're not, we're not tech manufacturers, but we are developers of education for people with diabetes. So we haven't just got the DAPHNE course for people that use multiple daily injections. We've got the Pump Daphne course for people who use a pump. We've got the closed loop essentials course for people who are going to be going onto a hybrid closed loop so that they've got an understanding of what it can do and what its limitations are. So they don't. So they go into it with realistic expectations and a confidence they'll be able to manage it. And we've just this year we launched a course for people with type 2 diabetes who use multiple daily injections. And that's a very different focus. That's about increasing their insulin sensitivity, decreasing their insulin resistance and simple activities they can choose on a daily basis that is going to help them with that. So rather than being stigmatized, judged, focusing on the fact that, oh, type 2 diabetes, it's always somebody who's overweight, which is not the case. Understanding. There's so many other reasons why somebody has type 2 diabetes. And so we're trying to evolve to suit diabetes in the 21st century, rather than just sticking with, you know, most people in this country are still on multiple daily injections if they have type 1 diabetes. Sure, there's a big move to get people on closed loops in England, and there's a big move to get people on pumps. We've got. Most of our people with Type 1 have now got CGM, but there's still the majority of people with Type 1 in this country on multiple daily injections. And so that education is absolutely crucial.
- [40:32]
A
You know, it's funny, as you're talking, it occurs to me that you, Daphne, knows it works, right? But it still has to innovate and continue if it wants to keep going, because things can get stale and stagnant and die even when they're valuable. And I. It's funny how this is all going to tie together because that happened to the pump company, right? And they didn't defend against it. And now they're making, they're making their comeback. And you guys have the same thing. Like, you know, this thing you're doing works, but you still have to get it out there. You have to find people, you got to put it in their hands. You got to make sure they understand it so they go tell somebody else about it. And not dissimilar. I'm telling you, that's what I have to do. Like, there's, there's a value. This is going to sound crazy, but, like, to some people, but I know that. I know how valuable the podcast is. I get a lot of feedback, right? Yeah, and, yeah, but just like I, I always say, like, I don't know what the, what the old timey, like, British version of this is, but, like, if, if things didn't need to be new all the time, then we'd all just be still watching mash because that was a really good TV show. And why did they have to make another one? Right? Right. So, you know, so why do you have to keep innovating and being modern and being in people's faces so they're aware that something's there and happening that they should be looking at? It's because that's how people's minds work. So, like, I am constantly being forced to try to find new ways to have conversations or to say something to continue to help people. And the only way I can accomplish that, like, the only reason I can put that much time and effort into it is because this podcast also takes ads and it pays my bills. And if it did, if it didn't, I wouldn't. I. I Would go, well, I made the thing, here it is. And I can't keep going because I gotta go, I gotta go find a way to turn my power back on, right? And you guys go ahead and take it. And then it would just die. It would wither on the vine. It would be gone already. Yeah, right, so there's good.
- [42:27]
B
No, I was gonna say. So 102 years ago, I had a great aunt who was nursing in Liverpool and I have her old notebooks and she has one side of paper on diabetes. And it's a diet to keep people alive with newly diagnosed diabetes. And it starts off they can have 50 calories to eat on the first day, 75 on the second. And I think over the course of two weeks, it goes up to 250 calories in the day and then it goes back to 50. So she would have been looking after people and nursing them to their death when insulin suddenly appeared. And a doctor said to her, give this injection to the child because this will save the child's life. And so Insulin, what was 19, 22, 23 when insulin became widely available. So we went from having a fatal condition to something that people could live with. And then in the 90s, I looked after somebody who'd had diabetes for 70 years. So he'd been diagnosed just at that time when insulin was made available. And I think he had lived all of those years measuring and weighing his bread and having so many grams of carbohydrate for breakfast, mid morning lunch, mid afternoon evening and going to bed. And then suddenly urine testing came in for him in the 60s and 70s and that was an eye opener to him. He could see that he had glucose in his urine. And then I was a student nurse in the late 80s when finger pricking came in on the wards, that was just mind blowing. We could still took three minutes to get a glucose reading. But, you know, it was still innovative and it was amazing. And then when I became a diabetes specialist nurse, that was when blood glucose meters were available to people with type 1 diabetes, and particularly the pregnant women who had type 1. And that was a big innovation. And that was 25, 26 years ago. So to think in the last 25 years we've gone to pumps and CGMs, rapid acting analog insulins, ultra long acting basal insulins. We've seen so much develop in 25 years that if Daphne as an organization doesn't keep up with that, then we're not providing what people with type 1 diabetes need and we're not here for shareholders. We're not here to make money. We're here so that a person that we've never met who has type 1 diabetes has a better quality of life, better psychological health, better long term health, and better confidence day to day with their type 1 diabetes. And those are the people I'm thinking about when I'm doing my job is how is this going to impact them? Because if it's not going to have a positive impact, I need to do.
- [45:10]
A
It differently and it shouldn't be lost. That, that effort happening over and over again day after day is what, what drags you into the next part. Right. Because there will be a time, I am confident saying, based on just the story that you just told, I'm confident saying that there will be a time that people will look back on 20, 25 and say, oh my gosh, those algorithms were nice. I mean, I see how it changed people's lives, but look what we have now, you know, and that's, look how many times that's happened just since the 20s. In 100, what is that, 105 years, maybe not even quite like, look how many times you said, and then this came along, and then this came along, and then this came along, like. And I realized at some point it feels like, well, it'll stop. But I don't know that you don't. You have no idea how someone's going to apply AI learning to diabetes over the next five or 10 years. And, you know.
- [46:07]
B
Yeah, yeah.
- [46:08]
A
And my daughter already. May I? Can you hold your thought one second? Would you mind?
- [46:12]
B
Yeah.
- [46:13]
A
I just got done speaking with a friend of my daughter's yesterday, so they're the same age. Her friend has had type one for 10 years and she asked me, I just got a CGM last month. This is the first time she's had a cgm. Do you think I should get a pump? And what would a pump do for me? And I found myself telling her the stuff I say all the time. I said, well, first of all, you don't want to disregard somebody's care. She's doing a very good job. I'm like, there's not much that you can't do with MDI that you can do with a pump is different. Here are the differences. You can do temporary basal increases and decreases.
- [46:48]
B
Yeah.
- [46:49]
A
You know, you could shut your insulin off. You could, you know, change your ratios very quickly without having to like do math again, you know, blah, blah, blah. But I said, here's what I really think. This episode was too good to cut anything out of, but too long to make just one episode. So this is part one. Make sure you go find part two right now. It's going to be the next episode in your feedback Foreign. Touched by Type 1 Sponsored this episode of the Juice Box Podcast. Check them out@touchedbytype1.org on Instagram and Facebook. Give them a follow. Go check out what they're doing. They are helping people with type 1 diabetes in ways you just can't imagine. The podcast you just enjoyed was sponsored by Type Tandem Diabetes Care. Learn more about Tandem's newest automated insulin delivery system, Tandem Moby with Control IQ technology@tandomdiabetes.com JuiceBox There are links in the show notes and links@juiceboxpodcast.com 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 Check out my Algorithm Pumping series to help you make sense of automated insulin delivery systems like Omnipod, Five Loop, Medtronic 780G Twist, Tandem Control IQ and much more. Each episode will dive into the setup, features and real world usage to tips that can transform your daily type 1 diabetes management. We cut through the jargon, share personal experiences, and show you how these algorithms can simplify and streamline your care. If you're curious about automated insulin pumping, go find the Algorithm Pumping series in the Juice Box podcast easiest way juiceboxpodcast.com and go up into the menu. Click on Series and it'll be right there.
- [48:54]
B
Foreign.
- [49:00]
A
Listen up. You've made it to the end of the podcast. You must have enjoyed it. You know what else you might enjoy? The private Facebook group for the Juice Box Podcast. I know you're thinking, oh, Facebook Scott, please. But no. Beautiful group, wonderful people, a fantastic community. Juice box podcast type 1 diabetes on Facebook of course, if you have type 2, are you touched by diabetes in any way? You're absolutely welcome. It's a private group, so you'll have to answer a couple of questions before you come in. We make sure you're not a bot or an evildoer, then you're on your way. You'll be part of the family. Thank you so much for listening. I'll be back very soon with another episode of the Juice Box Podcast. If you're not already subscribed or following the podcast in your favorite audio app like Spotify or Apple Podcasts, please do that now. Seriously. Just to hit, follow or subscribe will really help the show. If you go a little further in Apple Podcasts and set it up so that it downloads all new episodes, I'll be your best friend. And if you leave a five star review, ooh, I'll probably send you a Christmas card. Would you like a Christmas card?