#1743 Penny Drop - Part 2

Summary

Juicebox Podcast: Type 1 Diabetes

Episode #1743 Penny Drop – Part 2 (January 21, 2026)

Host: Scott Benner
Guest: Jenny Smith, diabetes educator with 35+ years of personal experience

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OVERVIEW

In Part 2 of “Penny Drop,” Scott Benner and Jenny Smith take a deep dive into the psychological and practical challenges of living with type 1 diabetes. They dissect the role of technology, the power (and the limits) of diabetes education, the “DAFNE” course approach in the UK, and the profound impact of support—both emotional and practical. Throughout, their candid, compassionate conversation surfaces actionable strategies, memorable analogies, and some “penny drop” (lightbulb) moments that help listeners live “bold with insulin.”

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KEY DISCUSSION POINTS & INSIGHTS

1. The Hidden Burden & Magic of Technology

• Automated Insulin Delivery as a Game-Changer
  Scott reflects on how his daughter’s automated insulin delivery system (“algorithm”) has transformed her life, removing much of the daily stress of diabetes.

  • Quote: “She boluses for her food and then goes off and does something … because an algorithm is making changes … she doesn’t really pay that close attention … it lifts from you that you can’t really quantify and you won’t know until it happens.” (Scott, 01:23)

• But Tech Alone Isn’t Enough
  Jenny reminds listeners that tech reduces the load but doesn’t make diabetes effortless: “You’ve still got that wet towel draped around your shoulders.” (Jenny, 04:54)
  They emphasize the necessity of foundational knowledge—knowing how to manage variables like glycemic load and making smart settings adjustments.

• 'Wet Towel' Burden

  • Quote: “The tech is great ... but you’ve still got that wet towel draped around your shoulders.” (Jenny, 04:54)

2. Education Multiplies the Value of Technology

• Combining Tech & Education: DAFNE Case Study
  Jenny shares data from the DAFNE (Dose Adjustment For Normal Eating) courses:
  • Even with modern technology (CGMs and pumps), participants experience greater improvements in A1C, DKA, and hypo rates after education—matching or exceeding results seen before technology was ubiquitous.
  • Quote: "You give them the tech and the education and it’s boundless what they could achieve... it can double what they can achieve if they're given the opportunity." (Jenny, 05:33)
• Education Isn’t Just for Patients
  • DAFNE now trains doctors as well (Jenny, 27:29), transforming patient-provider relationships and encouraging more empathetic, person-centered care.

3. Mastering the Fundamentals

• Hallmarks of Successful Management
  • Understanding food impacts (carbs, fat, protein)
  • Insulin timing and dosing
  • Setting adjustments, autonomy, and not fearing “insulin stacking”
  • Quote: “If you threw me off a cliff and told me, help people with diabetes before you hit the bottom, I would yell back up: it’s all timing and amount.” (Scott, 16:08)
• Analogy:
  • Not everyone needs to understand the full science—just the “where to put your hands and feet,” like driving a car (Jenny, 08:46).

4. The Individuality of Diabetes Solutions

• No One-Size-Fits-All

  • Experiences differ: some people are unaffected by dietary fat, others are highly sensitive, etc.
  • DAFNE and the podcast focus on giving people all relevant information so they can adapt what fits (Scott, 14:22, 15:05).

• Reducing Psychological Burden

  • DAFNE asks participants to rate feelings of overwhelm, loneliness, and failure. These scores plummet after the course—and, importantly, stay low a year later (Jenny, 40:54).

5. Emotional Truths and Family Dynamics

• The Unspoken Emotional Load
  • Scott and Jenny discuss the subtle, persistent anxieties felt by people with diabetes and their families, such as dining out and waiting to know if someone has bolused.
    • Quote: “It’s the wet towel … cold and wet and just lay on top of you, a little shitty, you know, like. And you can’t make it go away.” (Scott, 39:47)
• Candid Reflections on Guilt, Grief, and Care
  • Jenny shares her own irrational guilt when a young family member was diagnosed: “Thank God I’m not a cancer specialist nurse, because then she might have got cancer.” (Jenny, 37:42)

6. The Importance of Empathy and Support

• Empathetic Healthcare Jenny on changing the doctor-patient dynamic: “They become more familiar with me as Liesl, not someone in a uniform … Suddenly they meet human beings who are healthcare professionals.” (Jenny, 22:55)
• The Power of Peer Support Both stress how group education and mutual understanding reduce feelings of failure and isolation.

7. The Evolution of Patient Resources and Community

• Podcasting as Medical Support
  • Scott describes how podcasting offers “peer support,” noting that survey data found listeners valued the podcast’s information above that of most clinical encounters (Scott, 43:38).
• AI and the Future
  • They discuss emerging use of AI for personal diabetes problem-solving, expressing a hopeful (but cautious) interest in how tech could further ease the burden (Scott, 35:21; Jenny, 36:00).

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NOTABLE QUOTES & MEMORABLE MOMENTS

• On Technology’s Hidden Value:
  “I think if you go on an algorithm, you’ll be able to sleep better. And I think you won’t know how much that’s gonna change your life until you’ve had it for a month.” (Scott, 00:54)

• The “Wet Towel” Analogy:
  “The tech is great. And as we've said, it takes Some of the burden away, but you've still got that wet towel draped around your shoulders.” (Jenny, 04:54)

• Hallmark Advice:
  “There’s some basic fundamental foundational stuff. And once you give it to them in a way that they understand … they have a lot of success after that.” (Scott, 07:52)

• On Individualization:
  “Everybody’s diabetes is different, because insulin would never have been discovered, we never would have finger pricking, we never would have CGMs, we never would have the tech that we have ... it’s the loss of that carefree living that I was mourning.” (Jenny, 12:12)

• Perfecting the Basics:
  “It’s about insulin timing and the amount of insulin. It’s about how much insulin you use and when you use it … that’s your entire fight. It’s timing and amount.” (Scott, 16:23)

• On Empathy in Healthcare:
  “We just want them to live the best life they possibly can. And that's why we work in diabetes.” (Jenny, 24:34)

• The Ripple Effect of Education:
  “Doctors who do DAFNE ask differently, listen differently, speak differently. For the people they see, that changes everything over decades.” (Paraphrased from Jenny, 27:29)

• On Reducing Psychological Burden:
  “At the end of five days, they're scoring a one or a two … they've maintained that psychological benefit. … Behind the data is a real person with a family who's living a different life because that emotional burden has got less.” (Jenny, 41:16)

• Hope for the Future:
  “Maybe the technical side of their life will become so unencumbered that they can spend more time on the community side.” (Scott, 36:39)

• Vivid Family Moment:
  “All you want to say is, hey, you bolused, right? But you don’t want to put that on her … yet everyone at the table knows that everyone else is thinking about it.” (Scott, 38:55)

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TIMESTAMPS FOR IMPORTANT SEGMENTS

• [01:23] – The real-life lift that automation brings for families
• [04:32] – The tech reduces, but doesn’t eliminate, the burden
• [05:33] – DAFNE data: Tech + education vs. tech alone
• [07:52–10:35] – Scott on the fundamental hallmarks of diabetes management
• [12:12] – Jenny reflecting on the loss of carefree childhood for kids with type 1
• [15:05] – The value of sharing all information; individualizing care
• [16:08–16:23] – “It’s all timing and amount.”
• [22:55] – How DAFNE education changes the patient-provider relationship
• [27:29] – DAFNE courses for physicians; changing clinical care from within
• [30:20] – Jenny: “I’m a fixer…” (On the urge to always help, even when what’s needed is support)
• [37:42] – Guilt and irrational reactions when loved ones are diagnosed
• [40:54–41:16] – Measuring the psychological impact of group education
• [43:37] – Survey: The podcast helps listeners more than most traditional resources

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HOW TO ACCESS DAFNE (UK LISTENERS)

• Website: daphne.nhs.uk
  Check for local DAFNE centers or ask your diabetes team or GP about referral.

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FINAL THOUGHTS

Scott and Jenny conclude that while technology is a powerful ally in managing type 1 diabetes, education, empathy, and honest peer support are what empower people to truly live well—and to “be bold with insulin.” The “penny drop” moments come from understanding fundamentals, from reassurance, and from the persistent, evolving community of support.

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For more practical tips and peer support, visit JuiceboxPodcast.com or scout Pro Tip episodes (#1000–1025) in your player.

Transcript

[Scott]

Hello friends and welcome back to another episode of the Juicebox Podcast. This is part two of a two part episode. Go look at the title. If you don't recognize it, you haven't heard part one yet. It's probably the episode right before this in your podcast player. 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. My Diabetes Pro Tip series is about cutting through the clutter of diabetes management to give you the straightforward, practical insights that truly make a difference. This series is all about mastering the fundamentals, whether it's the basics of insulin dosing adjustments or everyday management strategies that will empower you to take control. I'm joined by Jenny Smith, who is a diabetes educator with over 35 years of personal experience and we break down complex concepts into simple, actionable tips. The Diabetes Pro Tip series runs between episode 1000 and 1025 in your podcast player, or you can listen to [e-mail] by going up into the menu. Foreign. This episode of the Juice Box Podcast is sponsored by Omnipod5. Omnipod5 is a tube free automated insulin delivery system that's been shown to significantly improve A1C and time and range for people with type 1 diabetes when they've switched from daily injections. Learn more and get started today@ omnipod.com juicebox at my link. You can get a free starter kit right now. Terms and conditions apply and eligibility may vary. Full terms and conditions can be found@ omnipod.com juicebox 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 usmed. I said, here's what I really think. I think if you go on an algorithm, you'll be able to sleep better. And I think you won't know how much that's gonna change your life until you've had it for a month. And I stopped myself and I said and here's another thing, let's be more honest. I said there are days, chunks of my daughter's day where she boluses for her food and then she goes off and does something. She goes to class or she sits with her boyfriend or she goes out with her friends and and because an algorithm is making changes to her insulin during that time based on her data, she doesn't really pay that close attention to her diabetes. And and it's not that she's not aware of it. It's not that she won't do something if, you know, if something really comes up or whatnot, but she doesn't have to, like, go, oh, no, it went to 1:20. I got a bolus. Or it's gonna go to 1:50. Like. Like, yeah, like, you know, she goes to 120 and the damn thing gives her insulin. And then. And then it stops. Right. And. And, you know, and then if she tries to get low, it stops again. I was like, so in my mind, when you're asking me, should I get a pump? I think, yes, because of what it lifts from you that you can't really quantify and you won't know until it happens anyway. I wonder what.

[Jenny Smith]

It shoulders some of the burden for her, doesn't it?

[Scott]

I mean, when you sit in a conversation like this and go back to 50 calories today, 100 tomorrow, so that you'll die more slowly. Well, it's doing more than shouldering the burden. Right? Like. Right.

[Jenny Smith]

If you.

[Scott]

If you have. If you have that kind of context when you're thinking about it, it's magic. If you were diagnosed a year and a half ago, it's shouldering the burden. So your perspective has a lot to do with what you see it as part of these conversations. What I like about these conversations is that I hope to alleviate some of the mental anxiety that people have and the burden that they have because they live in a modern society where they're accustomed to everything kind of working the way it's supposed to, and diabetes then feels like it's not. But I'm telling you just. And say to yourself, holy shit, I'm getting away with something here, you know?

[Jenny Smith]

Yeah. I still think it's important for me as a health care professional and just as a person to recognize that I need to be careful that it doesn't come across as well. I know you've got type one, but you should be grateful you've got the tech, because there was a time when it wasn't available.

[Scott]

Yeah, I know. I don't. I wouldn't say that to somebody, but I do think it's important that they understand it.

[Jenny Smith]

Yeah.

[Scott]

Yeah.

[Jenny Smith]

And I. And I know that you wouldn't do that, but I just. Just say that people understand that. Just because the text there doesn't mean that I would expect somebody with type 1 diabetes to be a whiz at it just because the tech is there. Yeah, the tech is great. And as we've said, it takes Some of the burden away, but you've still got that wet towel draped around your shoulders.

[Scott]

Yep. And you still have earlier. So you also still have the rest of what Daphne's doing for people, because that technology is basically useless if you don't understand glycemic load, glycemic impact, how to change your settings, you know, how to bolus for fat in your food. Like, if you don't have those ideas, it's still going to seem chaotic. Yeah, yeah, yeah.

[Jenny Smith]

And I think that's a really good point, Scott, because when we look at our data, every year we've looked at our. We look at our. That we call it our key performance indicator data. So it's what happens to people's HBA1C when they've done a DAPHNE course a year later, their severe hypo rates, their DKA rates. And I guess I thought that once people had the CGM and the tech, that they would have a lower HbA1c before they did the course anyway, or they wouldn't have as much dka, there wouldn't be so many severe hypos. But what we're seeing is that people are coming in with the advantage of the tech already, but they're still achieving the same degree of reduction in their HBA1C than they were when everyone was doing finger pricking. They're still seeing the same reduction in severe hypos, the same reduction in dka. So that just goes hand in hand with what you said, which is if you give somebody the tech, they can achieve a lot, but you give them the tech and the education and it's. It's boundless. What they could achieve. You know, it just at least can double what they can achieve if they're given the opportunity. And part of my job is to try and make sure that they get given that opportunity.

[Scott]

No, it's wonderful. Also, I mean, to be completely candid, that the human condition still exists no matter what level of technology you have or what level of education you have, and the feeling that our bodies aren't supposed to work this way. You're not supposed to have to think, breathe in, breathe out. Or imagine if I said to you, look, hey, here's the problem. Your heart's not gonna beat if you don't consciously think, beat, beat, beat, beat, beat for the rest of your life. You'd be dead in three minutes. You know what I mean? You are asking people with diabetes to do that. You're asking them to be a pancreas, to be aware of how a number of different systems work and how food and exercise and stress and all and everything else impacts those systems. And the truth is none of us really understand it well enough. And, you know, so you give them. What I have found is that there's. There's, like, kind of hallmarks. And if they have the hallmarks, they can do well. Like. And I mean that very simply, you know, understanding the impacts of their food, understanding how to time insulin against those impacts, understanding seriously how fat and protein impact their blood sugars, that you give them the autonomy to make changes to their settings, that they don't feel like they have to wait for someone to tell them that their basil is not strong enough or not weak enough, that they, you know, that they should bolus again. That you don't saddle them with the idea that every. If they bolus without food, it's stacking, when that's not always true. Like. Right. Like if you can give them those kinds of hallmarks, then most people, most people can make the rest of the leaps. They can, they can, they can draw the rest of the lines themselves. And that's been my finding over and over again, is that there's. There's some basic fundamental foundational stuff. And once you give it to them in a way that they understand it and hopefully they're motivated to do something with it, they have a lot of success after that.

[Jenny Smith]

Yeah.

[Scott]

Yeah.

[Jenny Smith]

And I had somebody on one of my Daphne courses years ago, and she said, look, she said, I don't really understand how all of this works, but I don't understand how my car works. She said, I just know where to put my feet and where to put my hands, and I trust it to get me from A to B perfect. So if I know what to do with Daphne, I might. I don't have to understand the ins and outs of it as long as I know what to do when I know I'll get to where I want to go. And I thought that was quite, quite a good analogy of there's lots of things we do in life. We don't understand how an airplane takes off the ground, but we trust that the pilot knows how to do it. So we just jump on board. And she jumped on board with a Daphne course saying, I don't really quite understand, but I trust you and I trust the process and I'm just going to get on board with it. And I think that takes tremendous courage and a degree, a huge degree of trust in somebody like me to be providing her with the right information.

[Scott]

It's also thoughtful. It's incredibly thoughtful. And here's a secret that's not much of a secret if people are listening. There's a lot about this I don't understand either. And yet there might be. I am know how to put this? I don't want to sound like an asshole, but like, like, if there's a hierarchy to who's reaching people and helping people with diabetes, I've got to be up in the top of it. And there is plenty about it that I fundamentally like on a technical or scientific level. I don't. I struggle all the time. I say stuff all the time where I'm like, I don't really understand that. But what I've learned is I don't. It doesn't matter. Like, like what matters is understanding the fundamental stuff and being able to communicate it.

[Jenny Smith]

Yeah.

[Scott]

Yeah. And I don't need to be perfect or have, you know, a PhD level of understanding about, you know, a lot, a lot of functions in the body, which, by the way, I can't even pronounce, let alone explain to you.

[Jenny Smith]

Yes.

[Scott]

And it, it doesn't, it doesn't matter. Like, it would matter if I was going to be your surgeon. Okay. It would matter if I was going to be teaching a course at medical school. It doesn't matter if I'm just the guy saying, like, look, when you eat a cheeseburger with French fries, there's fat in the fries. And about an hour after you eat, you're gonna see a rise coming in your blood sugar. And that rise needs more insulin. And there's a quick formula you can use to try to figure out about how much fat was in there and how that translates to insulin. And then you can put that bolus in and then the rise never happens. Your blood sugar doesn't stay high for four hours afterwards, and you don't put in a bunch of insulin and get super low later and then take in a bunch of fast acting and then it goes back up again and then you lose your goddamn mind and you stop taking care of yourself. Right. Like that. That's the part I know for sure.

[Jenny Smith]

And I think the frustrating thing when. The thing that does frustrate people when they come on a Daphne course is there's so much that, that we can't just say, do this plus that, and you'll get success with what you want because it's so individual to the person, isn't it? And you must know that in your experience that it's great to have a starting point and say, you know, try this for Your fat, high fat, high protein meals. But if that doesn't work, and you see it doesn't work, you need to try a different proportion, different ratio or something. And the same with exercise. Exercise is so individual that it's great to have a starting point, but there isn't a black and white set of rules that says, do this and you'll be able to run a marathon or do that and you'll get through a game of football or something. It's so personal. And I think that is. It just shows that the more we understand, the more questions we have and the less we understand. And if it wasn't that way, insulin would never have been discovered, we never would have finger pricking, we never would have CGMs, we never would have the tech that we have. And I really hope that at some point. I have a family member with type 1 diabetes, and when she was diagnosed, I cried for 24 hours. And my husband said, I don't know why you're so upset, why you know about all of this. You can support her with it. And I just said, She's 11 years old. She will never go to a party again without thinking, how much do I have to inject for that muffin? How much do I have to inject for that pizza? I said, it's the loss of that carefree living that I was mourning. And I really hope that in her lifetime she's able to say, isn't it quaint? My auntie used to teach people how to manage type 1 diabetes and now we're just cured.

[Scott]

Yeah. Hey, listen, I'll take anything from cured to this box and this box talk to each other and I don't have to think and it just works because I don't. It's not. If we know for sure about fat, for example, then that could be a setting. And why is it not? Because it is. In some of the DIY systems, by the way, in some of the DIY systems, you can say there's this much fat in my, in my meal and it helps it to layer more boluses out over the future. So again, back to what I was saying earlier is you need the pump companies to admit that that's functionality that should be looked into and tried to figure out and put in. I mean, so put a little effort into that. And by the way, at some point they will ceiling out on what they're doing and they're going to have to move to those ideas to keep getting better, to keep making their money, to try to beat the other Guy. Which, by the way, is the only thing that keeps innovation going. I don't know if you're a capitalist or not, but that's pretty much what keeps people moving.

[Jenny Smith]

Yeah.

[Scott]

Yeah.

[Jenny Smith]

So having that as an optional thing on a pump would be great because some people, they really do have an impact with fat or high protein.

[Scott]

Yeah.

[Jenny Smith]

Other people, it doesn't affect them in the slightest.

[Scott]

It's crazy. Some people are like, I've never done that before. It's never been a problem for me. And I'm like, right on. Like. But at least, you know, like that to me is the idea behind the podcast is that I'm gonna put all these ideas out there. They might not all impact you or be important for you, but at least you know about them now. And if it did end up being important for you, that's awesome because you can do something about it. If it didn't, then right on. Then that's the thing you don't need to worry about. But I don't love that. I don't love. I just think people deserve all the information and then they can do with it what they want or what they're capable of doing with it, but it would be wrong to hide it from somebody.

[Jenny Smith]

Yeah. And you've just reminded me, you asked me a question almost at the beginning of this about what are the light bulb moments? What are the moments when the penny drops? And I think talking about information, basic information, can be a real penny drop moment as a, you know. Yes. High fat, high protein, that can be a real game changer for a lot of people. For me, one of the main learning outcomes for people with on a DAPHNE course is just understanding how long it takes their quick acting insulin to start working and how long it keeps working. The number of people who have said, now I understand why I had a hypo, because an hour after my meal, I was. I'd got a glucose of 17 and it should have been less than 7. And so I gave an injection of quick acting. But now I realize that my quick acting still hadn't even peaked from my meal. And so that understanding how their insulin works in real terms in that relationship with their glucose, their carbs and their insulin, that is a big game changer for people.

[Scott]

Definitely. Yeah. So I say to all the time that if you. If you threw me off a cliff and told me, help people with diabetes before you hit the bottom, I would yell back up. It's all timing and amount.

[Jenny Smith]

Yes, that's it. Yeah.

[Scott]

Yeah. That's the whole thing. By the way the podcast should be six seconds long, here it is for everybody again. It's about insulin timing and the amount of insulin. It's about how much insulin you use and when you use it. That's the entire thing. Is it as easy as the way I just said it? It's not. But that is at the core, that's your entire fight. It's timing and amount. So you get that right, you'll be, that's, that's the A1C you're looking for. That's the variability you're looking for. Now. You have to get it right at breakfast, at lunch, at dinner, at your snacks, you know, for your, your settings, for your, you know, you know that your Basil uses all day long. Your fear, you know, for your adjustments, you know, it's. But it's all. But again, at the end, it's just, it's the right amount of insulin at the right time. It's matching the impact of, of carbohydrates or body function against the insulin's ability to fight it off. It's kind of, it, you know, it's.

[Jenny Smith]

Like having another job on top of your normal full time job, isn't it? It's like having to run two jobs at the same time.

[Scott]

It reminds me all the time of. This is going to be out of context for you. But there's a movie now that's getting pretty old with Brad Pitt in it. It's called Moneyball. And it's a real story about an American baseball team that eventually like, kind of bucks the system and goes towards analytics and they start deciding to find the value in players that look valueless in, in a normal, in a normal setting, right? And so they go to this player whose arm is shot, who used to be a catcher and he needs to throw the ball a lot. And they want to move him to a position where he doesn't have to throw very much, but he's never played it before in his entire life. And they say to him, you know, the one guy goes, we're going to move you to first base. And he get. And the guy says, I've never played first base. Well, the guy turns to the other coach and goes, it's very easy. We'll teach you how to do it. Tell him. And he tells the other, he tells the other coach, he goes, tell him the guy's name's Wash. He goes, tell him, Wash. And he goes, it's incredibly difficult. And so, and, and I. And so the. While the one guy's going like, it's easy. It's just, we'll teach you how to do it. And then the other guy's like, I mean, I don't know, man. Maybe we could figure it out. But probably, probably not. And I feel like that's how I'm talking about diabetes. Sometimes I feel like I'm the guy who's like, we'll just move you to first. And then somebody else comes along and goes, it's incredibly difficult, but I think it's doable. Like, I've seen it enough times. And by the way, that was the leap for me. I'd love to meet the person who figured out the Daphne thing one day. Because I was like, look, I'm not in this space. I'm not a doctor. I'm not a. I'm in no way connected to the. The technical or professional aspects of diabetes. Right?

[Jenny Smith]

Yeah.

[Scott]

My daughter gets type one in 2006 when she's two years old. I am following what I am being told, and it is not working. And I'm becoming overwhelmed, and she's becoming sicker, and I'm 100% sure I'm killing her most days, and I'm probably right. And I. I look to the people who are supposed to be telling me what to do, and I come to the conclusion I don't think they're going to help me. I don't think it's because they don't care. I don't think it's because. I just think that whatever it is that they're programmed to say is not helping me.

[Jenny Smith]

Yeah.

[Scott]

So I dig into my daughter's health and become as much of an expert on all the aspects of it as I can. And when I get to the edge of my understanding of it, I start, like, interviewing other people and trying to find out their understanding of it to kind of, you know, bring together ideas. And one day, it just hits me. I've got my daughter's a 1C in the low sixes now. I've had it in the fives, and I know what to do. I never quantified it. I never wrote it down. I'm not as smart as your grandmother who had the list. Nothing was written down. I just had come to the conclusion that there was a certain number of things that I did. And when I did them every day, her blood sugars were stable and we had outcomes that we were looking for. And so by then, I had the podcast, and I just sat down one day against my nature and wrote down the things that I thought helped people, that helped Us. And then I said, I think this is universal. It's not exact. Don't get me wrong, you can't just do exactly what I do the way I do it. And it's going to work for you, but it's foundational enough that you can adapt it to yourself. And when I started sharing it like that, I get a lot of pushback from people, by the way, who said it was dangerous and it was going to hurt people and blah, blah, blah. And just a lot of like, you know, people, you know, toe in the company line and we don't talk about it like that. I think back then they were still aiming for an A1C. That was eight. They were telling you if you had an eight A1C, you were doing well. And. And I was like, I don't think that's right. You know, and so I shared my thing. And then people actually, you don't know this, but one of the. When I very first started writing a blog, like, one of the first pieces of correspondence I got back from a reader that said that the blog was valuable from them was from a person from England who said that.

[Jenny Smith]

Really?

[Scott]

Yeah. She said her and her daughter have been finding a lot of value in the things I've been sharing on my blog. And then from there it just kind of grew and grew and grew. But it's not growing from my understanding, it's growing. I think maybe my, my understanding is the seed of how it started, but then I had to keep bringing in other voices to try to add on top of it, you know?

[Jenny Smith]

Yeah.

[Scott]

And then making it and. But then back to what we were talking about earlier, that's all nice for me and my kid, but if you can't find a way to get it to other people, then. If a tree falls in the woods, did anybody hear it right? So, like, then, then your job becomes getting it out to people without letting it die. Like, so you have to, like. Right. Because at some point that pump company was like, we got a pump. This is it. Now go out there and sell it. Make sure people can get it, put it in their hands. And then they stopped innovating. So if you innovate and sell and innovate and sell and keep doing that, that to me is the way you reach more people. And I think. I'm sorry, I think the more people that we reach, the better chance we have that doctors and clinicians will, will understand that there's a. An elevated expectation from people and that they need to meet it. Sorry, that was my whole thought, no.

[Jenny Smith]

No, I, and I think one of the things that you notice if you being a Daphne educator and being on Daphne courses is the relationship that, that I have as a Daphne educator with the people that do the course is different. It's changed then forever because they become more familiar with me as Liesl and not somebody in a uniform sitting on a desk telling them what to do. And I understand more about their lives, how they live with diabetes, what the, the challenges are for each person as an individual. And then they get to meet a doctor on a Daphne course and where they will always say, I only come to clinic to get told off. Suddenly they meet human beings who are healthcare professionals. And so there's that mutual understanding and a realization that we're doing what we do not because we like to be bossy, but because we genuinely care and we genuinely have and are working hard to understand, to have empathy, to liberate people from that sense of guilt and to give them information so they can live their best life. Isn't that just what we want for everybody? Whether they've got diabetes or not, whether they've got arthritis or not, whether they've got any other kind of life limiting condition or potentially life limiting condition. We just want them to live the best life they possibly can. And that's why we work in diabetes. Because you either come and work in diabetes and you get spat out really quickly because it's not your thing, or, or you get sucked into work in diabetes and you realize you can't get out because this thing that I hated when I was a staff nurse on a ward suddenly became my be all and end all and that, yeah, I'm in it for life pretty much.

[Scott]

Diabetes comes with a lot of things to remember, so it's nice when someone takes something off of your plate. Usmed has done that for us. When it's time for ardent supplies to be refreshed, we get an email rolls up and in your inbox says, hi, Arden, this is your friendly reorder email from usmed. You open up the email, it's a big button that says click here to reorder and you're done. Finally, somebody taking away a responsibility instead of adding one. Usmed has done that for us. An email arrives, we click on a link and the next thing you know, your products are at the front door. That simple usmed.com juicebox or call 888-721-1514. I never have to wonder if Arden has enough supplies. I click on one link, I open up a box I put this stuff in the drawer and we're done. US Med carries everything from insulin pumps and diabetes testing supplies to the latest CGMs like the Libre 3 and the Dexcom G7. They accept Medicare nationwide, over 800 private insurers and all you have to do to get started is call 888-721-1514 or go to my link usmed.com juicebox using that number or my link helps to support the production of the Juice Box Podcast. Today's episode is brought to you by Omnipod and we talk a lot about ways to lower your A1C on this podcast. Did you know that the Omnipod 5 was shown to lower A1C? That's right. Omnipod 5 is a tube free automated insulin delivery system and it was shown to significantly improve A1C and time and range for people with type 1 diabetes when they switched from daily injections. My daughter is about to turn 21 years old and she has been wearing an Omnipod every day since she was four. It has been a friend to our family and I think it could be a friend to yours. If you're ready to try Omnipod 5 for yourself or your family, use my link now to get started. Omnipod.com juicebox get that free Omnipod 5 starter kit today. Terms and conditions apply. Eligibility may vary. Full terms and conditions can be found@ omnipod.com juicebox can there not be or should there not be? Or maybe there is a DAFNI course for doctors? Because it occurs to me that any reasonably intelligent physician with a tiny bit of a heart who heard the last hour of our conversation wouldn't pull somebody into a room and scold them. And so like, is is maybe that not a place where Daphne could could be valuable?

[Jenny Smith]

We do that already. So we've been training doctors to become Daphne doctors since Daphne started in 992000 when it was rolled out. And that's what I was doing this afternoon before the podcast. I was doing a Daphne doctor workshop. And so we get them to carb count so they understand what that's like. We will often talk about the language that's used and one of the doctors on the course today has been in diabetes for about a year and her comment was I'm already speaking to people differently. I'm not telling people what to do. I'm asking them how they are. I'm asking them what they would like to be different about their life with diabetes. I'm asking them what their challenges Are. And she's only been in diabetes a short time. And so everybody that she ever sees in the length of her career, which could be another 30 or 40 years, is going to benefit from her having that different approach because she's done her Daphne training and she's out there now understanding a lot more. And I'm very proud of that.

[Scott]

Yeah, I would be as well. I just had a 16 year old boy tell me the other day he wants to be an endocrinologist. And I thought, oh, he understands the diabetes. The way I talk about it, he might be an endocrinologist one day and talk about it like that to people. Yeah, and, and I think that's just it. Really, it's fabulous. You know, there, there's, yeah, could be nothing better. It's sad that, you know, it takes so long to change things in society, but there's nothing you can do about that. So this is, this is what you do. You plant a lot of seeds, you talk to a lot of people and you wait for that stuff to grow and, and hopefully things move in a better direction. And just generally speaking, they do. When people like you are out there doing what you're doing.

[Jenny Smith]

Yeah, I'm not perfect. I have had a situation with somebody where I, and again, it's a family, another family member with type one. And I said to her, what's the one thing you could do differently that might make things different or might improve things? And she just looked at me and said, why can people not just say well done, well done, you're doing the best you can today and well done, you did the best you could yesterday and well done, because tomorrow you'll do the best you can do tomorrow. And I just thought of all the people that she knows, I should be the one not to ask those questions of what's the one thing you could do differently that might make it better? You know, really, I should have just said well done, you're doing your best every day. And I know that.

[Scott]

Yeah, you, you're trying to get, still get it wrong. But, but let me, let me stick up for you for a second. Right. So you probably don't see this person that often and you probably saw that they, they made an advancement. You thought if I can get them thinking in this direction, they'll make another one. Is that about right?

[Jenny Smith]

It's, it's because my personality is a fixer. I like to be a fixer. That's the thing.

[Scott]

You know, my, I, I hate to say that part one of my favorite things about this conversation is that when your voice gets a little higher, you sound like Sharon Osborne when she was younger, which is delighting me.

[Jenny Smith]

Do you know the funny thing? So that she's from Birmingham, isn't she?

[Scott]

I don't know. I just know that you sound like her sometimes.

[Jenny Smith]

Well, I was born in Birmingham and I haven't lived there since I was three, but maybe I'm a bit like my mum and when I get excited or passionate about something, a little bit of a brummy twang comes out in what I'm saying.

[Scott]

Yeah. I so much want you to yell.

[Jenny Smith]

Aussie.

[Scott]

Exactly. That's awesome. Is there anything we haven't spoken about that you want to. Anything that we missed or skipped over?

[Jenny Smith]

Goodness, we've covered so much, haven't we, Scott? We've talked about so much. Just the value of education for people with diabetes. It's what they deserve and it should be an entitlement. That's what I believe very firmly. If they want it, if they want education, they should be able to have it.

[Scott]

Yeah. No, I agree. I think in any way we can get it to them is important. I will tell you that. I was just having this conversation with, actually with my nephew. He's in college and he needed to interview people about media, but he had to interview somebody over 50, so it ended up being me. I wasn't thrilled that I was the right one for that. But he's asking me about how things have changed, about how I consume television or movies and stuff like that. And I found us getting off of a little bit of a. He asked about the podcast a little bit, and I said, you know, it's interesting is that before the cell phone, the podcast wasn't really possible. Yeah, right. So the cell phones came and then suddenly there was a place to send the audio to. But it really didn't take off until data became cheaper because people couldn't afford to download an episode of anything. Cause you used to pay for your data by. I forget how you did it, but. But it was expensive, right, to download something. And when data became kind of ubiquitous, then all of a sudden people could share their. Their thoughts. And I said, and then it. And. And then you think, well, that's great. Until then, everyone realizes that's possible. Then they flood the area again with. With, you know, I mean, listen, I'm sure everybody's podcast has value, but like a lot of information that maybe isn't as valuable, then it becomes confusing to the consumer, then they don't know how to parse through it. And then I could hear him, like, getting a little, like, numb in his head. And I said, how many times have you sat down in front of Netflix and scrolled through it for an hour but never watched a movie? And he goes, a lot. And I was like, right? I was like, so is that much choice good or bad? Because you didn't watch anything? And he just froze. And I was like. So I said yes, because he asked me how. Like, he asked me about the distribution of the podcast, and I said, so, yes, the distribution is the only thing that made it blow up, but it also let everybody else who could figure out how to sit in front of a microphone do it, too. And then it puts me in a position of having to, like, persevere through that to get to the other side, to continue to reach people. I was like. I was like, there. And anyway, my point to him was, there's no perfect answer to your question. Because his question was, you know, should we all be going to the theater still or streaming better or, like, you know, what. What do you find more valuable? And I said to him, I was like, you're. That's not the question. I was like, the question is, what's going to win? What ends up being here when it's over? You know, like, what is it that we end up settling on, that we end up building on for the next thing? And I just. I keep thinking about that since I've been talking to him about the, like, the diabetes aspect of it. Like, what do we. What have we settled on that helps people? And how do we build on it to try to get to the next thing, to get to the next fight to see if we can fight through it, to see what perseveres comes out the other side. How do we build again on that over and over? I'm super excited for it to be. I mean, I really. I don't know. Like, I'm the wrong person for this idea, but I'm seeing people right now using AI for their diabetes in ways that is really fascinating. Me. I don't know if you've seen people do this or not, but I'm starting to. I've done it on the podcast once or twice. I probably will do it a little more with people, but I watched somebody do it online recently where they were having trouble with their insulin, and they just. They were at wit's end. They didn't know what to do, and they just started feeding their. Their. Their graphs into one of the AI models and then having a live conversation with The AI model and. And the person flat out said in their post online, I didn't even know if it was right, but I was so screwed. I had to try something. And then they tried it and it worked for them. And I was like, that's fascinating because I find that's how people get to the podcast. When I was talking to my daughter's friend the other day, trying to help her through her thing, I said to her, try to imagine where a person has to be to say, I'm going to turn a podcast on and listen to it about my health. I was like, imagine how lost you have to be to make that decision. Right. Because that is not a. That's not a. On its face. That's not a reasonable decision to make for somebody who doesn't know me or doesn't know what's here or anything else. Right. I was like, that's how lost people are when they're walking around. They're like, maybe a guy will tell me, maybe my AI will know what to do with this graph. And anyway, like, you're now seeing the AI does seem to know what to do with the graph. I. I don't know if you've done this, but I've had people, go, go, please. What are you going to say?

[Jenny Smith]

I've not, because I don't work face to face with people with diabetes anymore. I'm kind of more in the background. So watching somebody use AI for their diabetes is not something I've seen. But I do know that there's more and more reliance on apps. And one thing I like about your podcast is that it's people talking. And if we're not careful, people are going to lose that peer support from talking to other people who either have Type one or have family with Type one, because it's all going to be about an app on their phone and the technology. And I don't think you can divorce that personal connection.

[Scott]

Allow me to be hopeful. Allow me to be hopeful. Maybe the technical side of their life will become so unencumbered or that they can spend more time on the communities sudden. Yeah, that would be lovely.

[Jenny Smith]

I hope so.

[Scott]

Yeah, I saw. Oh, gosh, what was I going to tell you? Geez. The thing with the thing and the thing and the thing. Oh, Scott, this is terrible. It was with an AI. Oh, Lisa, look what happened. My age got caught up with me there.

[Jenny Smith]

Oh, don't worry. It happens to me all the time.

[Scott]

Yeah, yeah. I'm so disappointed. I had one last thought, but that's also a Misnomer. Because I could just keep talking forever. So I don't really have one last thought.

[Jenny Smith]

I could talk to you all night.

[Scott]

Well, you're very good at this. I was going to say you're chatty as hell. It's awesome. You've mentioned a couple of people in your life that have type one that are in your family. Is there other autoimmune in your family? Do you have any autoimmune issues?

[Jenny Smith]

No. None at all.

[Scott]

Celiac thyroid. You don't see it through the family.

[Jenny Smith]

Nothing. And you know what? I think the biggest lesson I learned when I got really upset when this family member was diagnosed. And it just goes to show how you cannot, however much you know, you can't divorce emotion from the situation. Because I was in tears talking to my husband and he was a bit flummoxed as to why I was so upset. And through my tears, I just said, thank God I'm not a cancer specialist nurse, because then she might have got cancer. Oh, now, how irrational is that? It doesn't make any sense at all. But it was just this whole, oh, my God, this somehow. Is this my fault? Of course it's not my fault. It's just bloody bad luck. But it just taught me the family members of anybody I've ever met who's got type 1 diabetes will perhaps have gone through emotions, irrational emotions, which I would have laughed at if I hadn't experienced it myself. Thank God I'm not a cancer special specialist nurse. I'm a diabetes specialist nurse. Because she's got diabetes and not cancer. Well, I mean, that just doesn't make any sense, but that's genuinely how I felt on that day.

[Scott]

The unseen stuff, like, the unseen psychological stuff is fascinating. Like, imagine you. I go out to dinner with my family and I sit down and it is in the. My daughter's 21 now, but it's still in the back of my head, like, is she gonna pre bolus for this? Has she Bolst? And I haven't noticed because now it's on her phone and I can't really tell, you know, and now you're all sitting there and. And all you want to say is, hey, you bolist. Right? But you don't want to put that on her because, a, if she forgot, that's on. She doesn't need to feel like I'm watching her. And if she didn't forget, she doesn't need to feel like nobody trusts her. But yet in the silence, when nobody says, hey, did you bolus? Yet everyone at the table knows that everyone else is thinking about it. And it's. And it's in the background. It's not right on the front of your head. It's in the background. But there's an when. I've noticed that every time I sit at a restaurant, until I know my daughter has Bolst for food, I'm on some level a tiny bit uptight or on guard or something. I don't even know really how to put it. And the minute I realize that she's done it, it's lighter and I wonder if it doesn't feel that way to her as well, you know what I mean? And that's the kind of little stuff that if we sat here long enough and talked and talked and talked, we could sit and make a list of a million things like that. And, and those things are happening to you all day long, whether you're the person with type 1 or the, or somebody that loves them. It just, it's unfair. There's that. It's the wet towel. Like, I swear I've never thought of that wet towel analogy before in my life, but now I realize it's like, it's, it's like, you know, you know those like thin, clingy, like sarongs that women like wrap around the beach. It's like that thin material but cold and wet and just la on top of you, a little shitty, you know, like. And you can't make it go away. But again, I have seen people with diabetes get together in a room and I watch that feeling looks like it lifts off them. So.

[Jenny Smith]

Yeah, and, and actually, until you said that out loud, I think I recognize that and I'm conscious of it, but I'd never been properly conscious of that feeling of, of sitting and waiting. And once you know that they've bolused, the meal can start and you can all enjoy it. And the other thing you mentioned something we're talking about emotions. One of the things that we ask our Daphne course participants is about. We ask them three very specific questions and we ask them to quantify how overwhelmed they feel by the responsibility of diabetes, how alone they feel with their diabetes, and how much they feel as if they're failing with their diabetes. And what we see at the end of that five day course is they've gone from scoring a five or a six, which is what you don't want them to feel. A five or a six is that it's a serious problem or a very serious problem. And at the end of five days, they're scoring a one or a two, which is it's not a problem or it's a slight problem. So to see that impact on somebody's psychological health in just five days is phenomenal. But when they fill in the forms a year later, they've maintained that psychological benefit. And I don't know any other intervention in healthcare, be it a tablet or physio or anything else, that can achieve that improvement in five days and maintain it a year later. And even though, as an educator, I always knew that was the case and never had the evidence to back it up, now we ask the participants to answer these questions. They answer them on their own, away from anybody, so there's no coercion. And now we can quantify exactly what that improvement is. And that makes me emotional every time I look at that data, because behind the data is a real person with a family who's living a different life because that emotional burden has got less. And that, to me, is. Is truly what it's all about.

[Scott]

You know, what the data helps you with, too, is it helps you stop wondering if it's true. It allows you to believe it's true and press forward. Yeah, I did a thing a few years ago that helped me a lot. I did a. There was this really. This lovely girl that people reach out to help me all the time. They're like, I, you know, the podcast helped me. How can I help you? And at one point, there was this grad student, and she's like, how can I help? And I said, I want to do a survey to see if the podcast actually helps people. And I don't know how. I don't know how to do that. So you go ahead and do it. And she put a survey together, and we actually got 1200 people to take the survey, 1200 listeners to take it, which was. Is a pretty big data set.

[Jenny Smith]

That's a great number.

[Scott]

Yeah. And it turns out that the podcast helps them significantly more than their doctors do or anything that they found print online or etc. For their diabetes. And I don't. I mean, it's somewhere. The data, somewhere that from the thing. But the point is, it didn't matter because it let me. What doesn't matter is that. That I can't quote it to you anymore. What it did for me was what was most important. It took this thing that I thought I was seeing that I believed was true. It proved it to me enough that I could stop wondering about that part of it and just push forward. And it really. It really did allow Me to, to, you know, because I'm not a, I mean I joke around on here a lot and I think I try to keep this entertaining so that people will listen about their diabetes, which is not a thing I think most people are inclined to listen to. And when I joke around, I think there are times that I can come off like a dumbass because I'm, but I, I'm not, I'm not a, I'm not a, like a crazy narcissist who's just like every time I see something I believe it and I'm like, yeah, I'm great. And like, and I move forward. Like I really wondered like, is this actually doing what I think it's doing for people? Like, I believe it is, but I don't have the ability to just like, I don't know, like to just take it on face and go. And that data coming back was really helpful to me. To me. And I think, you know, same for you is like you can say, look, because when you said the thing about the first five days and their score goes up from day one to day five, my follow up question before you told me about the year after data, my follow up question was going to be, but yeah, but does that actually matter in the long run? Like, or are you just talking them into believing they can do it and they get home and they can't actually do it and you know, and that there's your answer and so beautiful. Then run around yelling Daphne at people. You know what I mean?

[Jenny Smith]

I do. My friends, that my friends will be, if, if they, if they listen to the podcast, they'll be like, well she was in heaven because she was talking Daphne basically for an hour and a half. So she was absolutely in heaven because.

[Scott]

Yeah, well, very good.

[Jenny Smith]

That's what they know me for.

[Scott]

Well, I can't, I can't thank you enough for reaching out and for sharing all this. I think this has been a really terrific conversation and I, I, is there anything if people in the uk, if they don't like, how do they reach like a Daphne course if they, if they want it?

[Jenny Smith]

So we, we deliver Daphne's delivered in 117 different centers and over 200 locations in the UK. So if anybody is interested in coming on a Daphne course, they just need to go to our website, www.daphne.nhs.uk and it will show you where there's a Daphne center in their area. And it may be that they already have their diabetes care in Daphne a service and if they don't, they can ask their GP or their service to refer them to somewhere that does deliver Daphne so that they can access a course.

[Scott]

Well, you asked before we started, like you said before we started recording. You said, like, if I use any like, like British colloquialisms that don't make sense, you stop me. And I have to admit, like, I'm just going to call this episode Penny Drop, but I don't know. I'd never heard that before in my life, so.

[Jenny Smith]

Have you not.

[Scott]

So anyway, that's. That's what your episode's going to be called.

[Jenny Smith]

Thank you.

[Scott]

Yeah.

[Jenny Smith]

I've really enjoyed talking to you today, Scott. Thank you so much. And as you know, I can. As you now know, I can talk about diabetes till the cows come home. And having a conversation with somebody else who's in the same position is. Is really lovely. I've really enjoyed my afternoon. Thank you so much.

[Scott]

No, me too. The feelings mutual. Hold on one second, please. A huge thanks to my longest sponsor, Omnipod. Check out the Omnipod 5 now with my link omnipod.com juicebox you may be eligible for a free starter kit. A free Omnipod 5 starter kit at my link. Go check it out. Omnipod.com Juicebox terms and conditions apply. Full terms and conditions can be found@ omnipod.com juicebox the conversation you just enjoyed was brought to you by usmed usmed.com juicebox or call 888-721-1514. Get started today and get your supplies from U.S. med. My Diabetes Pro Tip series is about cutting through the clutter of diabetes management to give you the straightforward, practical insights that truly make a difference. This series is all about mastering the fundamentals. Whether it's the basics of insulin dosing, adjustments or everyday management strategies that will empower you to take control. I'm joined by Jenny Smith, who is a diabetes educator with over 35 years of personal experience. And we break down control complex concepts into simple actionable tips. The Diabetes Pro Tip series runs between episode 1000 and 1025 in your podcast player or you can listen to [e-mail] by going up into the menu. Hey, do you need support? I have some stuff for you. It's all free. Juiceboxpodcast.com Click on support in the menu. Let's see what you get there. A1C and blood glucose calculator. People love that. That's actually, I think, the most popular page on the website. Some months a list of great endocrinologists from listeners that's from all over the country. There's a link to the private Facebook group, to the Circle community, and we have a fantastic thing there, American Sign Language. There's a great sign language interpreter who did the entire beginning series in asl, so if you know anybody who would benefit from that, please send them that way. Just go to juiceboxpodcast.com and click on Support. While you're there, check out the guides like the Pre Bolusin Guide, Fat and Protein Insulin Calculator. Oh gosh. Thyroid GLP Caregiver Burnout. You should go to the website, click around a little bit on those menus. It really. There's a lot more there than you think. I can't thank you enough for listening. Please make sure you're subscribed or following in your audio app. I'll be back tomorrow with another episode of the Juice Box Podcast.