Juicebox Podcast: Type 1 Diabetes
Episode #1752: Diabetes Spectrum – Part 1
Host: Scott Benner
Guest: Trisha (51-year-old mom, former healthcare administrator, current master’s student in counseling)
Date: January 28, 2026
Episode Overview
In this first part of a two-part conversation, Scott Benner welcomes Trisha, who shares her complex, decades-long journey to a correct diabetes diagnosis. Trisha’s story is an illuminating case study on how autoimmune diseases, family history, and healthcare systems intertwine—at times to the patient’s detriment. Together, they explore the challenges of “the diabetes spectrum,” the pitfalls of standard medical practices, and how lack of critical thinking or communication between providers can delay care. The episode aims to empower listeners to question, advocate, and understand that diabetes and its related disorders can be much more nuanced than simple “type 1 or type 2” labels.
Key Discussion Points & Insights
1. Background and Professional Experience
[02:33–07:47]
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Trisha details her background working in New York City’s hospital administration.
- Supported operations, budgets, employee health (notably during COVID-19).
- Observed the tension between “patient-centric” care and the business realities of health systems.
- Insight: Focusing on patient and employee wellness is “contagious,” transforming work culture for the better.
- Quote: “When your leader cares about the patient, it's generally also going to be someone who cares about you. So it really changed the whole environment. It's contagious.” – Trisha [07:06]
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Increasing regulatory demands (e.g., Joint Commission surveys) can bog down actual patient care.
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Insurance’s controlling influence over what care patients receive.
2. Trisha’s Medical Odyssey: Missed Diagnoses and Family History
[09:19–21:49]
- At six, Trisha was diagnosed with Hashimoto’s and started on Synthroid, but was taken off in adolescence when numbers improved.
- Chronic, worsening symptoms (constipation, weight issues, irregular menstruation), were repeatedly dismissed or attributed to benign causes.
- Family culture (her mother’s lack of diabetes education and communication) led to medical red herrings and lack of follow-up.
- Quote: “We can't look at the care through the lens of now. And what happened to me was a perfect storm… It shows the impact of type one on a family if it isn’t education.” – Trisha [14:56]
- Multiple instances where doctors defaulted to “treating the symptoms” (acne, menstrual irregularities) without investigating root causes.
3. Gaps in Care: Silos and Assumptions
[21:51–34:58]
- Trisha’s symptoms worsened in adulthood, including severe constipation, abdominal pain, and gynecological problems.
- Despite a family history rife with autoimmune disease (mother with type 1 diabetes, paternal relatives with Graves’ and hypothyroidism), doctors rarely did comprehensive screening (e.g., no regular A1c testing).
- Quote: “My primary never gives me A1C in my 20s, despite family history. My new doctors don't give me A1C because I'm under 45, even though I have family history.” – Trisha [23:30]
- Paper charts and scattered records compounded the confusion and broke continuity of care.
- Misattribution to lifestyle or family norms (“that’s just how we are”) further delayed diagnosis.
4. Autoimmunity: Family Ties and the “Purebred Problem”
[27:08–31:55]
- The family’s Irish/Austrian heritage and lack of genetic diversity seemed to contribute to a high incidence of autoimmune issues.
- Quote: “You’re having purebred problems.” – Scott [29:23]
- Discussion on the clustering of autoimmune diseases and the environmental, generational, and possibly genetic factors involved.
5. The Trouble with “Normal” Labs and Slow-Progressing Diabetes
[32:07–43:46]
- Trisha’s slow-onset type 1 (LADA) flew under the radar because of “normal” lab values—normal A1C, normal glucose, despite symptoms.
- Multiple doctors ignored autoimmune markers unless they perfectly fit established clinical parameters.
- Quote: “People do not know. You can have diabetes and have a normal fasting blood sugar. You can get type 1 diabetes and have a normal A1C.” – Trisha [34:02]
- She highlights the danger of relying solely on labs without critical thinking, as well as the need for root-cause investigation rather than symptomatic patchwork.
6. Breaking Through: Finally, a Doctor Listened
[58:21–59:02]
- Eventually, during menopause, an A1C of 5.7 and worsening symptoms led her new endocrinologist to recognize, “Diabetes is a spectrum. I’ve seen it.”
- Quote: “Diabetes is a spectrum. Can be a spectrum. I've seen it.” – Trisha’s new endocrinologist [59:01]
- The validation—after years of confusion—was vital for Trisha’s health and perspective.
7. Larger Systemic and Human Issues
Throughout
- Critical thinking is sorely lacking among many healthcare providers, who may be overloaded, data-focused, or lacking comfort with diagnostic complexity.
- Quote: “There was no critical thinking.” – Trisha [42:10]
- Scott and Trisha critique a medical system that isn't built for the gray areas of autoimmunity, or the “spectrum” nature of diabetes.
- Patients often become their own best advocates, piecing information together through lived experience and community knowledge.
- Quote (Scott): “What makes people good doctors doesn't necessarily make them good at communicating, and it doesn’t necessarily make them good at … the investigatory part of it.” [57:15]
- The value of sharing these stories: real-world experiences fill the knowledge gaps left by medicine.
Notable Quotes & Moments (with Timestamps)
- “Focusing on patient and employee wellness is contagious… it really changed the whole environment.” – Trisha [07:06]
- “When your leader cares about the patient, it's generally also going to be someone who cares about you.” – Trisha [07:06]
- “You’re having purebred problems.” – Scott [29:23]
- “People do not know. You can have diabetes and have a normal fasting blood sugar. You can get type 1 diabetes and have a normal A1C.” – Trisha [34:02]
- “There was no critical thinking.” – Trisha [42:10]
- “Diabetes is a spectrum. Can be a spectrum. I've seen it.” – Trisha’s new endocrinologist [59:01]
- “What makes people good doctors doesn't necessarily make them good at communicating, and it doesn’t necessarily make them good at … the investigatory part of it.” – Scott [57:15]
Memorable Moments & Listener Takeaways
- Scott draws parallels between Trisha’s family’s medical history and the overlap of autoimmune symptoms across many families and communities.
- Both discuss the staggering number of people whose hypothyroidism or pre-diabetes go untreated due to rigid provider mindsets.
- Discussion of how breaking the “type 1 or type 2” dichotomy is vital: there is a spectrum, and failing to acknowledge that costs real time, money, and wellness.
- Stories from listeners and family members—highlighted by Scott—underscore the importance of broadening medical curiosity and skepticism.
Timestamps for Key Segments
| Segment | Timestamp | |--------------------------------------------------|----------------| | Trisha’s healthcare administration background | 02:33–07:47 | | Family history, medical culture | 09:19–14:56 | | Gynecological and digestive issues, missed cues | 21:51–34:58 | | The "purebred problem" and autoimmunity | 27:08–31:55 | | Living with "normal" labs, slow-progressing LADA | 32:07–43:46 | | Providers and critical thinking | 42:10 & 57:15 | | Spectrum of diabetes acknowledged | 58:21–59:02 | | Importance of speaking out & community learning | 64:43–65:33 |
Conclusion: Message to the Community
The episode ends with a call to arms—spread the word, advocate, and don’t accept “this is just how we are” or “your labs are in range” when symptoms persist. The spectrum of diabetes and autoimmune conditions is broader, subtler, and affects far more people than standard medical paradigms recognize.
Trisha: “You don't just get type one and then there's type two. CGMs are showing us that people are high… Some people are high glucose responders… We did not really see what diabetes was in the past.” [64:45]
Scott: “If you took my GLP from me today, I'd go find a Gila monster and I'd French kiss.” [65:33]
Stay tuned for part two, where Trisha continues her story and discusses approaches that finally helped her reclaim her wellness.