B (3:07)

I felt like this had ruined his whole life.

A (3:10)

Okay.

B (3:11)

I was sad for the things I felt like he wasn't going to get to do.

A (3:17)

Do you feel that way now?

B (3:18)

I don't. No, not anymore. Which is really great.

A (3:22)

What stopped you from feeling that way?

B (3:24)

I think it was meeting other kids that had it. Meeting other kids and parents and getting, you know, establishing a community of other people that could help you. Yeah, I felt like that's really what turned it around for me. And so this is actually how I found the podcast. We have an outreach group up there in Spokane. It's called STIX Diabetes Programs. They run a camp. They're very involved with the endo's office. And so their outreach coordinator puts together, like, a little packet for you, and they give that to you at diagnosis. They invite you to join their Facebook group. Right. And so I was in the Facebook group. Hadn't really introduced myself or anything. I'm just kind of watching things happen. Were obviously getting closer to school. And so I had asked a question about going back to school. Does anybody have any experience with the school? The school nurse? Do you have a school that you like or a nurse that you recommend? Right. Because I can ask to transfer the kids somewhere. Right. And so someone had left a comment and said, my son doesn't go to that elementary school, but is at this middle school, which is where my oldest son was. So. And the nurse there is great for the time that he gets there. Right. If you have any questions or you need help, let me know. Also, listen to the Juice Box podcast. It will really help you.

A (4:48)

Oh, wow.

B (4:49)

So that's where I had found out about the podcast.

A (4:51)

That's awesome.

B (4:52)

And so I immediately joined the group. And it was like that was. And that was at the same time. Right. Like, I decided, am I going to better myself or am I. Or am I going to stay sad? So bettering myself is reaching out in this group and immediately provided with a resource. And then it was like the whole world opened as far as information was concerned. And I felt like I'd learned so much from the Facebook group alone.

A (5:17)

Can you contextualize why what you were taught in the Hospital led you to feel sad. Like, where was the gap? Now that you have more information, what's the gap that left you feeling lost?

B (5:28)

I don't know. That's hard. I think it was just. I didn't have a good grasp of what it was, I think. And it just felt so monotonous. I mean, we were sent home with so much stuff. Pen needles and syringes and insulin and a meter, and, I mean, all this stuff. And so it just felt so monotonous to have to figure out exactly what he's eating. And at that time, they really want you to focus on counting carbs. And I already knew how to do that. It wasn't hard for me. But I'm the kind of person that will just measure everything. I'll measure all the food. And so now I'm like, putting the peanut butter on the scale, right? Because I need to know how many carbs of peanut butter he's having so I can get it exactly right. And then I'm calculating the exact carbs, and then trying to figure out the dosing on that. And then, well, do we round up or do we round down? Which one are we gonna do this time? Because we're, you know, on shots at the time. It just felt so overwhelming. And how do I send him back to school on pen shots? And then a nurse is gonna do this. How do I trust a nurse to do this when I don't even necessarily trust myself every time it felt hard allowing somebody else to do that for your kid.

A (6:39)

Hindsight. Is there anything the hospital could have done differently that would have helped you? Or maybe is it beyond their touch?

B (6:47)

I don't know. Maybe we rushed home. Like, maybe if we'd stayed a little bit longer, we would have received a few more of those touches. Right? Because they would send in, like, we did see the dietitian. Like, she came in and did a thing with us. We saw our educator several times, which was great. But, like, they had a psychologist that would come in and talk with us. We didn't see them because we didn't stay long enough for that. And then, of course, like, me hearing about their outreach group and then the Facebook stuff, that was just from me going through the packet that they gave me. Perhaps that would have have been mentioned, right. If we had stayed a little bit longer. And so maybe because we shortened the stay, we didn't get the full experience. And then knowing that there were other people out there to talk to, there were different things he could try. I don't know. It's hard to say, but we really did want to go home, and we had a good grasp of it. We put his Dexcom on in the hospital. We were able to show that we could give his insulin shots with no problem. Right. And so they just felt like we had a good understanding, we were equipped, and we could go home if we wanted to. So.

A (7:50)

Plus, there's a lot of honeymooning, so you're kind of getting a soft launch too, right? Yeah.

B (7:55)

Yeah.

A (7:55)

But you don't know that at the time.

B (7:57)

No. Nope. And we didn't really understand what that was like. They had mentioned the word, but we didn't really understand what that was like until we started hitting a lot of lows. And so then I got a hold of them. I was actually calling every day for a while. They wanted me to call every day and give them his numbers. Then they were, like, adjusting his carb ratio and stuff. And so it wasn't until we hit a bunch of lows and they're like, okay, well, the honeymoon's probably kicked in now that he has insulin on board. And so you're going to see this. That the pancreas is still helping a little bit. And I'm like, but you told me it was dead. Why is it working now? But he did tell us at. It must have been our October appointment, that he felt like the prolonged honeymoon that he's experiencing right now is because we were able to get the numbers in check so quickly.

A (8:47)

He thinks you found the diabetes pretty quickly, actually. Hindsight. How long do you think it had been going on where he wasn't feeling well?

B (8:54)

Oh, at least four weeks.

A (8:55)

Four weeks, okay.

B (8:56)

Yeah. So he was diagnosed July 1st, and I would say he was probably having symptoms the first week of June, like, noticeable. If I can look back, he. It was all of June. It was really ramping up when you saw it more. Yeah.

A (9:10)

So now this has been a great conversation, but we have not touched on one of the things that you put in your list.

B (9:15)

Oh, yes.

A (9:16)

Is that my fault?

B (9:17)

No. I actually didn't even review it before we did this.

A (9:20)

Okay.

B (9:20)

At the time that I wrote that email, things have changed so much since then already.

A (9:26)

Oh, let me read it to you then. Maybe you don't even relate to this. It says, lack of education and general knowledge about type one in children, getting by and support from family members, school nurse relationships, Type one with sports, relationship evolution with our Type one neighbor.

B (9:46)

Yes.

A (9:47)

What do you want to talk about in that?

B (9:49)

So my neighbor is awesome. I love her so much. She was diagnosed as an adult. She was 19 and she just turned 40.

A (9:58)

Cassie, real quick. If you say you love everybody, then when you say you love me, it doesn't really hit the same way.

B (10:02)

I'm so sorry.

A (10:03)

It's okay. But I mean.

B (10:04)

But I love everyone in their own unique way. Right? It's just like telling your child that they're your favorite, but they're all. They're. They're all a favorite for a very.

A (10:12)

Has that ever seemed satisfying to one of your kids before it.

B (10:17)

Actually, my type one likes that a lot. I'm like, you're my favorite. And he's like, but you tell that to my brother. And I'm like, I know, but he's my favorite because he's so cuddly. And you're my favorite because you're so intelligent. And he's my favorite because he's so witty. And he's like, oh, I love that

A (10:33)

this kid's easily placated. I don't like that. My kids are like, one of us has to be better than the other one. And we're like, no. And they're like, come on.

B (10:40)

Well, I like to think of it that way. For me, like, with my siblings, I am the favorite. I mean, my mom would probably disagree with that, but I think I am.

A (10:48)

So you think your mom disagrees that she has a favorite?

B (10:52)

That I'm the favorite?

A (10:53)

Oh, wait, you think your mom has a favorite?

B (10:56)

I think I'm my mom's favorite, but I think she would say no.

A (10:59)

How many kids does your mom have?

B (11:01)

Three.

A (11:01)

What's wrong with you that you're not the favorite?

B (11:03)

I don't know.

A (11:04)

You know, what is it?

B (11:05)

I'm too sassy?

A (11:06)

Scott, are you the most like her?

B (11:11)

Probably, yes.

A (11:12)

Yeah.

B (11:12)

Okay.

A (11:13)

The one she likes the best is the one who acts the way she wishes people would be.

B (11:18)

No, probably not.

A (11:19)

No.

B (11:20)

No. Honestly, my mom probably does not have a favorite.

A (11:22)

But I feel like you're backpedaling now because you think they're going to hear this.

B (11:27)

No, she will probably hear this at some point. I actually didn't tell her about it, but I will tell her eventually.

A (11:32)

Also, be honest. The one she's chosen is a favorite. She picked the wrong one, right?

B (11:36)

No, I truly. I don't think she had.

A (11:39)

Okay.

B (11:39)

All right. I don't think so.

A (11:41)

I'll agree with you that you believe

B (11:42)

that if any of the kids were favorites, it's the grandkids.

A (11:45)

Well, that's easy.

B (11:46)

That's easy, right?

A (11:48)

Yeah.

B (11:48)

Yeah.

A (11:49)

I'm just telling you, like, my kids are like, come on. Which one of us do you like better?

B (11:52)

Which one of us do you like better? Sometimes I tell them it depends on the day. Like today, it's the oldest.

A (11:59)

They make a case for themselves, too. And I'll tell you what, they're good arguments.

B (12:04)

Yeah, they can be. They can be.

A (12:06)

We've gotten it down to which one's easier. That's the new discussion. Which one of us is easier? And I was like, neither of you are easy. And then each of them's like, oh, my God. Well, what about this about her? What about this about him? And I'm like, yeah, I mean, you're both the problem is what I'm telling you.

B (12:20)

Right? Yeah.

A (12:21)

All right. Okay. All right, I believe you. I'm sorry.

B (12:23)

No, you're fine. No. So my neighbor, we have a little community pool, and we get a membership there every summer. And so her and I will hang out and talk while the kids swim. And this is where the lack of knowledge about diabetes ties in.

A (12:38)

Okay.

B (12:38)

She never told me she was type one. So then one summer, because she's lived here, I don't know, five years now, one summer, I noticed tubing coming out from underneath her shirt, and I thought, oh, I wonder if that's an insulin pump. Oh, she must have this severe kind of diabetes.

A (12:55)

Oh, you thought that when you saw the tubing.

B (12:57)

Yeah. And so. And then that's what it was. She did. She had a pump. She was on the T slim at the time, and so she would just, like, tuck it into the back of her swimsuit. And so we had kind of struck up a conversation. I'm like, hey, I didn't know you had diabetes. And she's like, oh, yeah, I have type one. And, you know, I was diagnosed at 19, and at that time, I. I still thought it was probably type 2. Right. And what I understood of diabetes at the time.

A (13:20)

Right.

B (13:21)

Yeah. So in this time, where he's ill, she's made comments about him at the pool. Gosh, man, he's looking a little bit thin, and his lips are turning blue. Like, he's getting really cold in the water. Like, he'd lost £12 by the time he was diagnosed. And she's like, man, he's looking. You know, he's going through a growth spurt or something. So when I texted her from the hospital and was like, wes was diagnosed with type 1 diabetes. And she was like, I feel like such an asshole. How did I miss this? Like, I am type one, and I couldn't even tell you that he was Having symptoms.

A (13:56)

She saw changes in him, but she didn't relate them back to diabetes.

B (13:59)

No.

A (13:59)

Okay.

B (14:00)

And she goes, and these are all the same symptoms I was having?

A (14:02)

Yeah.

B (14:03)

Yeah. So it was crazy. So the difference between where I think we're at, where she was at, she would say she didn't have a lot of support at the age of 19 when it came to this. So what's been cool about it has been able to be able to relate to her, and obviously not the same. Right. I'm a parent taking care of a child, and she is the type one. But being able to talk about it so she can. She'll text me pictures of her graph and tell me, like, man, I missed the mark on this bolus. That sucks. Right? Or, you know, I had this really bad load today. I must have given too much insulin. I feel like crap. Right. It's been cool to kind of talk about it back and forth. I had listened to all of the episodes available on the GLP stuff because I was so interested. My mind went to, would they give it to Wes so that we can prolong his honeymoon as long as possible? Probably not, but that's where my mind went. Right. Can I get him something like that that we could microdose, and then we can just, like, try to keep this pancreas alive as long as possible. But in listening to that, then I was able to relay information to her and say, hey, this is something I think would really help you. Like, I think based on where you're at, you should push your endo for this. I really want to see this for you. Because she was experiencing a season of burnout, and she did. She ended up getting on a GLP1, and she has seen immense improvements. She ended up moving from the T slim to the Omnipod, and she loves it. It's been working so well for her. She feels like she has so much more freedom. So it's been really cool. And I would say just from the conversations that her and I have had, his diagnosis was a benefit in that relationship because it was almost like she had found a support system. You know what I mean?

A (15:43)

Right. Wow. Does she listen to the podcast?

B (15:47)

No, but I've told her about it. I don't know if she's ever listened to a single episode, but I have sent her ones where I'm like, hey, you need to listen to this. It's so good.

A (15:55)

That's really nice for me to know. I appreciate you sharing that with me.

B (15:58)

Yeah.

A (15:59)

That means that it's possible that the thing I made helped a person who has never heard it before.

B (16:04)

Yeah.

A (16:04)

Oh yeah, I like that.

B (16:05)

Yeah, Absolutely.

A (16:06)

Awesome. And she has diminished need for insulin. Her insulin needs have gone down. You can manage diabetes confidently with the powerfully simple Dexcom G7. Dexcom.com juicebox the Dexcom G7 is the CGM that my daughter is wearing. The G7 is a simple CGM system that delivers real time glucose numbers to your smartphone or smartwatch. The G7 is made for all types of diabetes, type 1 and type 2, but also people experiencing gestational diabetes. The Dexcom G7 can help you spend more time in range, which is proven to lower a 1C. The more time you spend in range, the better and healthier you feel. And with the Dexcom Clarity app, you can track your glucose trends. And the app will also provide you with a projected A1C in as little as two weeks. If you're looking for clarity around your diabetes, you're looking for Dexcom. Dexcom.com Juicebox when you use my link, you're supporting the podcast. Dexcom.com Juicebox Head over there now. Today's episode is brought to you by Omnipod. 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@

B (18:06)

omnipod.com juicebox yes, she's increased her A1C dramatically. Like, it's been so good and she's just thrilled.

A (18:15)

Decreased.

B (18:17)

Yes, decrease. I'm sorry. Yeah, she's decreased it. Yeah.

A (18:19)

Oh, that's wonderful.

B (18:21)

Yeah. Yeah. So that's really cool.

A (18:23)

Very nice. Look at you. You're out there, like, doing good works,

B (18:26)

doing the Lord's work, you know.

A (18:28)

All I heard was that there are people who sit at the pool and I thought, what am I doing wrong? That's all I heard. And that's all I thought I said, what am I doing wrong? She's sitting at a pool.

B (18:37)

Yeah, we sit at a pool. It was probably built in the 80s. I'm sure the lawn furniture is from the 80s as well. I mean, it's a thing, but it's usually the same families every year. And we do. We just go down and we hang out. We just hang out at the pool while the kids swim.

A (18:50)

I want that. I want a day where I hang out at the pool. I'm going to do that.

B (18:54)

Yeah.

A (18:54)

I don't have a pool, but I

B (18:56)

know we don't either. I mean, we could. The area that we live in, it gets pretty hot. So, yeah, we could, but. Yeah. No, at the time, like, when I had sent the email, we had made a turn in the relationship with our school nurse. And so, because he was so newly diagnosed, it had been like seven weeks. When he went back to school, she was so excited because she thought he was going to be mdi, and then he wasn't. We got him on the Moby three days before school started. And so she was like, ugh, I don't know how to use this pump. I'm like, that's fine. He does.

A (19:27)

It's got buttons on it. You'll figure it out. Let's go.

B (19:29)

Yeah. And I don't think she ever managed it. Like, she never used it. She would just stand there and he would bolus. So I would write a little note in his lunchbox. He would put in his carbs, show her, administer his insulin, and then he'd eat his lunch.

A (19:44)

I'm always surprised by how easily people are put off by technology sometimes. Yeah, it's just an insulin pump. It's not difficult to use.

B (19:53)

Yeah. And she had experience with an Omnipod controller. Yeah. She had never seen the Mobi before, and so she was like, no, I don't. As long as he knows how, that's fine.

A (20:03)

I watched my wife forward me a PDF today, and it looked like she had never seen a computer before the way she did it.

B (20:08)

Oh, dear.

A (20:09)

I think you'd be surprised by how many people record an episode of the podcast. And the beginning, before you guys hear what's happening, is spent with them going like, I'm so sorry I'm so bad at technology. It's not technology, it's zoom. I mean. I mean, there's not a lot to it, you know, or when you say to something, I say, hey, listen, you know, your microphone just needs to be turned up. There's not enough volume in your microphone, or. I don't say microphone. I go, I can't hear you. You know, you need to turn that up. If you go into audio, there's settings in there. Well, in the audio, there's settings for speaker, and there's settings for microphone, and they can't hear me, and they turn the speaker up, and they're like, oh, you're louder in my ears now. I'm like, well, did you turn up speaker? And I said, yeah. I said, well, turn up the microphone. That's the thing you're talking to me with. They go, oh, I'm sorry. I'm not good at this.

B (20:52)

Oh, my gosh.

A (20:53)

Good at what? I don't even.

B (20:57)

Simple direction.

A (20:58)

Yeah. There's the sound going one way and coming back another way.

B (21:01)

Yeah.

A (21:02)

You talk into a thing, it reaches my speakers. I talk into a thing that reaches your speakers. Are we confused by this?

B (21:07)

Confused, Very.

A (21:08)

So when somebody says, you know, I've never seen this insulin pump before. I'd rather you be mdi. I mean, what do you care?

B (21:15)

I know. Yeah.

A (21:16)

It's not that hard. It's that thing that puts people off. Any kind of change is difficult for. For some people, for some reason.

B (21:23)

Yeah. But, like, the Facebook group is where I learned about texting diabetes. And then, of course, the podcast. Right. You've talked about it.

A (21:29)

Yeah.

B (21:30)

And then as soon as he was getting back to school, like, I'm on Spotify, and I'm, like, searching keywords because I wanted to listen to every last episode you ever had that talked about a 504 plan. I mean, I was digging into it. Right. And so it started off a little. I felt like she was overbearing. And then it got to the point where she was like, well, I don't want you texting him and telling him to correct in class, because I have to do that. Like, that's not in his medical orders. And I was like, I can tell him whatever I want, actually.

A (21:58)

So, fine. Thanks. Don't worry. We got it. Yeah, I'll never do it again. Don't worry.

B (22:04)

Yeah. And then we also had, like, a. A nurse. She shared schools at the time, and so we had a nurse that would come in one day a week. She was an lpn. She was the worst. The worst. And I'm so glad she's not there this year, even though I don't. My kid's not there anymore. I'm so glad she's not there. She would not follow our rules for treating lows, and so she would make him do 10 to 15 carbs. And I was like, his medical orders don't even say that. The kid is so carb sensitive. Even at camp over the summer, they were like, we realized he only needed two or three. I'm like, I wrote that on his paper. I told you he only needs two or three. You can't give him a 15 carb juice box. He'll reach 400 in like 10 minutes. It just isn't going to happen like that.

A (22:49)

Yeah, I want to pivot back here because we're kind of at the end, but I want to come full circle now that I understand your story. Right. You're going to the doctor. You've got the A1C from the sixes to the fives.

B (23:00)

Right.

A (23:00)

I've now talked to you for a while. You're not crazy. Congratulations, Cassie.

B (23:04)

Oh, thank you.

A (23:04)

You're welcome. You've been diagnosed by a non medical professional. Is not crazy. And you had some ideas. You were trying to chase after more stable, lower number. You get there, the doctor tells you you're trying too hard, you're going to burn yourself out. You weren't burned down?

B (23:19)

No.

A (23:19)

You weren't concerned about burnout. And how long ago was that?

B (23:23)

That was December of last year. So it's been a full 12 months

A (23:26)

now since he told you that?

B (23:28)

Yes.

A (23:28)

And has that been brought up again?

B (23:31)

No, it actually has become more positive.

A (23:33)

Okay.

B (23:34)

Yeah.

A (23:35)

So he realized that you weren't burning out at some point? It sounds like.

B (23:38)

Yes.

A (23:38)

Okay.

B (23:39)

Yeah. Yep. I think he realized that we weren't burning out. And so when we saw, gosh, it must have been the October appointment. So we had a zoom one in July. It was like right after camp. So there was no A1C then. And then, of course, we got to October. Now it's been 10 months. And his A1C was 5.4 again. So we've maintained this almost a whole year now.

A (24:06)

Yeah.

B (24:07)

And at that point he was like, man, great numbers. Good job. And I was like, thank you so much. I said, really, honestly, I think a lot of this is just insulin timing. We've really figured out the insulin timing.

A (24:19)

Sure.

B (24:19)

I review his reports every two weeks, and then I make basal adjustments as they're necessary so that we're keeping him stable in between. And so he's like, yeah, no, that's great. That's exactly it. And he goes, so my encouragement to you, if you're ready to take the next step, there's a new metric that they're talking about. It's called Tight range. And if you would like to see what that takes for him, 70 to 140. You guys can start playing in that. But, hey, let's play with the Dexcom reports real quick. And let's see, how often are you in tight range, which they're saying 50% of the time. Okay, well, he's in tight range 73% of the time.

A (24:58)

Yeah. So you're already there.

B (25:01)

Yeah. So he goes, well, you're already there. So he goes. The only other challenge to you is just to increase that. It's just to do better at that.

A (25:08)

I would ask him at some point, and I wonder if he would even remember, but I would ask him at some point. Do you remember a year ago telling me, hey, slow down. You're too in the weeds. Blah, blah, blah. Like, why'd you say that to me?

B (25:18)

Yeah.

A (25:18)

And how come there's never been, you know, a mention of it again? How come you haven't said to me, hey, you know, I told you to slow down, but obviously you were doing great, and I see what you were concerned about, but that was not great messaging at the time for me.

B (25:31)

Right. Yeah, no, it felt very defeating.

A (25:33)

Yeah. No, people, Cassie, all the time. I mean, I'm telling you, it happens all the time. That somebody comes to me or puts up a post and says, I went to the doctor today. I was so excited to go because we figured everything out and put it all into play. And this was it. I was getting back my report card. It said what I wanted it to say, and then I got yelled at for 15 minutes. And I wonder if they really got yelled at or if somebody was just talking to them. Like, you got spoken to. And it feels like you're being yelled at because you tried so hard and then you did the thing that you were told was the pinnacle of it. And then somebody said, oh, no, you shouldn't do that. Like, people are fickle.

B (26:08)

Yeah.

A (26:09)

Like, everybody always wants to be tinkering and touching things. And I don't know why that couldn't have just been like, hey, you're doing great. I do think it would be. It's incumbent upon me to say to you that if this is taking up too much of your time and intention, you do need to be worried about getting burned out on this. But if that's not happening to you, then God bless you. Doing a great job. How is it you're accomplishing this? You know what I mean? Like, why is that not the answer? Hey, how'd you do that? You know, like, maybe you Know something? I don't know. Would you share it with me? It's never like that. It's always the. Everything's bad. Everything's going to be bad. Let me just warn you, I'll be negative even if I don't think it's being negative. People hear that negatively, and I think they should, by the way, but. Oh, all right. Well, I mean, it's fine now, so whatever, I guess don't rock the boat.

B (26:54)

And the reason that I say he's great, like, my son loves him. He is part of the camp that my son has gone to. I mean, he's really passionate about diabetes. The only reason that I say that, I think it was coming from a good place. Right. Even though it felt crappy.

A (27:11)

No. But I believe it was, too. I want to say.

B (27:13)

Yeah. He has two type one kids.

A (27:16)

Oh, the doctor does.

B (27:18)

Our endo is a dad of two type ones himself. Yeah.

A (27:20)

Like, you don't want to end up in the same booze hole my wife is in. Be careful.

B (27:25)

Yeah. So one of our educators had told me at one point in time that he had actually gone back to school after his kids were diagnosed.

A (27:33)

Wow.

B (27:34)

Specifically to specialize in endocrinology.

A (27:38)

What a good dude.

B (27:39)

Yeah. In endocrinology. Yeah. And he's very passionate. He's a lovely man. And I think that he does really care about people. And so I think, honestly, it was coming from a good place, but it did, like, it felt not good at the time.

A (27:51)

Yeah, no, I understand the balance there. I wrote a blog. He went to medical school. Juice. I didn't try as hard as I thought I did. He's like, wait, he was a doctor?

B (28:03)

I believe he was a nurse.

A (28:04)

Really?

B (28:05)

And became an MD he became a physician's assistant.

A (28:08)

Physician's assistant. Hey, listen, that's. Yeah. Again, all I did was write a blog. That seems, like, harder. Very cool. Well, do you have any concerns about your other boys? Do you get them tested?

B (28:19)

So I haven't gotten them tested right off the bat. I had gotten the trial net kits. My oldest, who's 14, does not want to know anything at all whatsoever. And so we decided we would respect that. If he does not want to have blood work done and he doesn't want to know because he has actually expressed to me like, I found him in his room very upset, and he said, I'm scared. I'm going to get it. I can't do it. Wes is great at it. I can't do this. And I'm like, no, I understand. And so he would rather not know. Like, if it happens, it happens. I don't have concerns for him. I have this weird mom gut feeling that maybe the youngest might. He did want. But he's also the one that asks me like, well, when do I get to have diabetes? And I'm like, well, you don't. I mean, you don't want it. But he's curious. He loves to check his blood sugar. He's worn a Stello for a little bit. He wore it for a couple of days. We saw some excursions on it. I was told not to worry about them, but he hit like 190 on cereal. And I was like, that's wild. He just randomly took his blood sugar a couple nights ago after we had. Oh, McDonald's. They get that like once a month at this point. He had McDonald's and he just randomly decided to check his blood sugar. And three hours after eating, he was still 150. And I'm like, I don't know. I don't know.

A (29:38)

Fat. That's a lot of fat in that, too. Was there a milkshake with it as well or something like that?

B (29:43)

No. Nope. It was two cheeseburgers and a medium fry.

A (29:46)

Have you tested it in the morning fasting?

B (29:49)

We have. And he's usually like 100, 110.

A (29:53)

That's all right.

B (29:54)

I know. Yeah.

A (29:56)

Any other autoimmune in the family?

B (29:59)

Yeah, so we do have. My side of the family has rheumatoid arthritis, and his side of the family has a ton of thyroid.

A (30:09)

Interesting.

B (30:09)

I only have it on one side, on my side, and then he has it on both sides. His. Both his mom and his dad have thyroid.

A (30:16)

How about your middle son? Because you said he was small. How's his thyroid?

B (30:20)

They tested all of that in the summer at his one year mark, and everything came back beautifully.

A (30:26)

We don't care about the numbers, though. What do we care about? We care about the outcome. So do you know what his TSH was?

B (30:31)

You know, I knew you were going to ask me this.

A (30:33)

And what happened, Cassie?

B (30:35)

I didn't look it up.

A (30:36)

Is that information in the same place where the dustpan and the vacuum are at? Is that what's going on? Hold on a second. I like that you said I'm not good at cleaning that house.

B (30:46)

No, I actually don't think I know that. It's online, like in his portal.

A (30:50)

Does he have any other thyroid symptoms?

B (30:53)

Not that I'm aware of.

A (30:55)

You know what they are?

B (30:55)

I don't know. And I was. Honestly, I was like, I need to ask him about this. So my mom's side of the family is very small. My mom's only four nine.

A (31:02)

Okay, that is small. Sorry, I didn't mean to laugh. That was weird.

B (31:06)

My grandfather was like five foot. My grandmother was five one.

A (31:10)

Oh my gosh.

B (31:11)

Right? Very tiny people. I'm five four. But our oldest son is already five nine. At 14, like he's huge.

A (31:18)

Okay.

B (31:19)

But then Wes is small and I mean he would. It's so funny. He had to do this like age verification thing on Roblox to use the voice chat with his friend and they like scan the face. It's super creepy. I didn't really want to do it. I put it off as long as I could. Anyway, it estimated him to be nine.

A (31:38)

They were like, stop it. This is a baby you put in front of us here. Don't.

B (31:41)

And He's. And he's 12, but he is like. So he was in jiu jitsu for a little bit and I mean, we figured that out. Like, keep the blood sugar up while he's doing that. That was awesome. But he would often be paired with kids that were like second and third grade because they were the same size.

A (31:57)

Okay, here's the last thing we're going to do together. I'm going to read, you're going to say yes or no.

B (32:02)

Okay.

A (32:02)

Extreme fatigue. Feeling tired, sluggish or exhausted even after sleeping.

B (32:06)

I wouldn't say often. No.

A (32:08)

Feeling cold when others are comfortable. Inability to warm up. Sometimes constipated. Frequent or persistent difficulty making a poo poo. Sometimes dry hair. Dry skin.

B (32:22)

Yes, Very dry skin.

A (32:24)

Puffy face. Swelling, particularly around the eyes. Sometimes hair loss.

B (32:29)

No.

A (32:29)

Have a raspy or deep throat, deep voice.

B (32:32)

Yes.

A (32:32)

Deep throat. I didn't mean that. Sorry.

B (32:34)

Deep throat muscle, raspy voice. Yes.

A (32:36)

Talking about your 12 year old. Muscle weakness. Feeling weak, particularly in the upper arms and thighs.

B (32:42)

Thighs. Yep.

A (32:42)

Brain fog. Difficulty concentrating, Forgetfulness or fuzzy thinking?

B (32:46)

Probably sometimes.

A (32:47)

Does he have what they call low mood apathy, lack of interest in activities, depression. In other words, no slow movements, moving or speaking more slowly than normal? No, I slowed down to say that. That was interesting.

B (33:03)

That was interesting.

A (33:04)

Does he have any menstrual changes? Hold on a second. Let me skip that one. Look at me being funny. Joint muscle pain, aches, tenderness or stiffness and muscle and joints.

B (33:12)

Sometimes in the legs. Yeah.

A (33:13)

Okay. Seriously, what was this? Tsh.

B (33:16)

I'm looking.

A (33:18)

You're going to tell me it was like 2.3 or something like that and they told you it was great.

B (33:24)

Okay. Let me look.

A (33:25)

Oh, here's one. Poor growth resulting in short stature, delayed development of permanent teeth, or delayed puberty.

B (33:33)

Yeah, I mean, maybe. I mean, he's got all his teeth.

A (33:36)

He's got all of his teeth. Look at him go.

B (33:38)

He's got all of them. No, they said that they actually fell out very quickly for him. He's got all of his adult teeth now. Uh, let's see. Okay, review. Now, there are things in here for Wes. Great. I'm going to open this up and I'm going to see. I'm going to tell you we're fine.

A (33:55)

We're at time, but that's fine. We can. We can. We can talk another minute. Don't worry, we're working on something. I've revamped juicebox docs.com.

B (34:05)

oh, okay.

A (34:06)

Yeah. So it's a list of doctors that listeners have sent in. It's really kind of cool. Like, you log on, the first one that pops up is in Alabama because it's in what you might call alphabetical order. And giving the example, Chelsea Zimmerman is at East Alabama Medical Center Endocrinology. And there's a little badge that says she's a pediatric endo. There's also a little badge that says provider has type one. So there's like little badges, like, so you can kind of make through. There's an address you click on, it launches up a Google map. You can click on the telephone number to make a phone call to them, or you have a website. The link to click on. It's really pretty excellent. And you can search it like, for instance, you're in Washington, right? So I type in Washington. And just like that, there's somebody at the Mary Bridge Children's Outpatient center in Washington, the doctor's Clinic, Cavalion Place, Washington. Let's see, Advanced Diabetes and Endocrinology Care in See Washington again. So there's adults, pediatric. It's nice. It kind of pops up. Now we have Washington D.C. washington state. And if they provide, like, good support for algorithms, if somebody says, hey, look, they're really great with an algorithm. We have a little badge for that. So you kind of know what you're looking at.

B (35:23)

Oh, that's cool.

A (35:24)

Yeah, it's great. And if you have a provider that you like, you can scroll to the bottom and submit your provider and they'll show up.

B (35:29)

Oh, perfect. Yeah, I remember looking at that in the beginning to see if there was anybody else we could find that might be close.

A (35:35)

And they're much better now. What they call searchable Searchable.

B (35:39)

Yeah, searchable now? Yeah, yeah.

A (35:40)

Before it was just my best attempt to like, make a list, but now I'll just say now with the advent of vibe coding through AI, you don't really need to know how to code to make stuff work anymore.

B (35:52)

Yeah, that's crazy.

A (35:53)

I'm sure all the coders are thrilled to hear that. And this is a very basic code. I also think that maybe, you know, data engineers are still probably pretty safe. And then also while I'm telling people about stuff. Juiceboxpodcast.com settings if you are looking to get like a basic starting point where your settings might be, this does it completely by weight. Oh, do you know that boy's weight over there?

B (36:19)

67.

A (36:20)

67. So I put in 67. And then it allows you to choose between highly sensitive, standard sensitivity resistant, or highly resistant to insulin. Where would you place them on that? Sensitive still? Because he's.

B (36:32)

Yeah, he's still pretty sensitive. Yeah.

A (36:34)

It tells me from that that a starting point for his total daily insulin should be about 13.7 units. Does it seem right? Does he use about 14 units a day?

B (36:43)

Yeah, he's about 15. Yeah.

A (36:45)

And it says that a good place to start with his basal insulin would be 6.85 units a day or 0.3 an hour.

B (36:51)

Do you have that is almost spot on for him right now.

A (36:53)

Hold on a second. One unit covers about 36 and a half carbs.

B (36:57)

It says his carb ratio is one to 15.

A (37:00)

Okay, well, yeah, again, it's just a starting spot and sensitivity factor. One unit moves him about 131. Is that right?

B (37:07)

Yeah, he's hit one to 125.

A (37:09)

Okay. And that's just a little calculator that gave us all that just by putting in his weight.

B (37:15)

That's crazy.

A (37:16)

It's not. It's math. Now. Juicebox podcast.com forward/, Bolas4. This is the next one. I'm super excited about this one. So now we take his insulin to carb ratio. What is it again? One unit covers 15. 15. Insulin sensitivity we said was 125.

B (37:37)

Yep.

A (37:37)

Target blood sugar. We're gonna make it 80. Let's pretend like he ate 50 carbs and that meal just was 50 carbs. He's got no insulin on board. His arrow is stable, and his blood Sugar is currently 110. Click calculate bolus. It tells you that he needs a bolus of about 3.57 and that you should pre bolus about 11 minutes. If suddenly that that meal had 10 units of fat in it or 10 grams of fat in it. And hit calculate bolus again. It's still the same thing. Nothing different has changed. And watch how it happens as I put the fat up. Now I'm at 15 grams of fat. Oh, at 15 grams of fat, it would like to see 3.57 as an initial bolus, then a extended bolus over three hours of 0.9, for a total of 4.47. The pre bolus is still at 11 minutes.

B (38:28)

Oh, I love that.

A (38:29)

Yeah. If I add protein in it, 5 grams of protein, and let's say I say his blood sugar is falling instead. And I hit calculate again. Well, now it says that's fine. We're still 3.57 as a bolus again of 1.03 over three hours to cover the fat and the protein. But it says please eat immediately because of hypo risk or low blood sugar.

B (38:52)

Oh, okay. This is almost like that calculator that Nico shared, but it's, like, on steroids.

A (38:58)

I made one of my own and kind of zhuzhed it up a little bit now.

B (39:01)

Yeah, I love that.

A (39:02)

A lot of disclaimers. It's just a. I'm not a doctor, and I'm not a coder.

B (39:05)

It's just a tool.

A (39:06)

It's just a tool for you to look at, but it's. Yeah, it's pretty awesome. Did you find his thyroid stuff yet?

B (39:12)

I did. It's 1.54.

A (39:14)

Damn it. It's not his thyroid. Has it ever been higher than that?

B (39:19)

Not that I know of. This is the first time we've ever had it tested.

A (39:22)

Keep testing it because it can bounce sometimes, but anything over 2.1, 2.2 with symptoms, you really got to start asking for the medication. Okay, so look for bouncing like there's a world where you check it again and it's much higher or it's super stable. Did they do his iron by any chance? Do you have low iron?

B (39:41)

That's a good question, too. Okay, I've got screenshots of everything. T4 was a 7.1.

A (39:46)

Okay.

B (39:47)

Microalbumin, creatinine ratio.

A (39:51)

That's 15 TSH was what, 1.5?

B (39:54)

1.5. Yeah. What is this tissue? Transglutaminase, IgA less than 2. Some of these, I don't even know what they are. They just said normal.

A (40:06)

Did they do T3?

B (40:08)

No, I don't think they did T3.

A (40:10)

Okay.

B (40:11)

Immunoglobulin, globulin.

A (40:14)

A look at you.

B (40:16)

113.

A (40:16)

Look at you saying words. Hold On a second.

B (40:20)

And a 1C 5.4.

A (40:23)

Wait a second. If someone with thyroid symptoms despite normal TSH and total common possibilities include free T3 could be low. Symptoms often track more closely with. Did they do free T3? No. Ask for it next time.

B (40:39)

Okay.

A (40:40)

Tell them to do a complete thyroid panel, not just TSH and T4.

B (40:44)

Okay.

A (40:44)

And then say. Because here are some symptoms he's having. All right. Also, low ferritin iron deficiency, low B12, low vitamin D. That stuff could possibly cause some of those symptoms as well.

B (40:59)

Okay.

A (40:59)

All right. Don't let it go, though. Don't just say like, it was okay, and then never pay attention to it again.

B (41:04)

Oh, for sure. We're not really in that boat, so we want to make sure that he's as healthy as possible.

A (41:09)

Good, good, good.

B (41:10)

I mean, he is growing, and so it's just slow. And then they want to equate him being small to just. Well, that's just family genetics.

A (41:19)

Very well. Could be. I'm not saying otherwise. I'm just saying, like.

B (41:22)

Yeah, no, but it is something that's very bothersome for him. I mean, to the point where he's like, well, mom, like, I've heard about, like, growth hormone. Like, is that something that the doctor would put me on to help me get bigger? I'm like, well, probably not, but.

A (41:35)

Did you say probably not?

B (41:37)

Yeah, I told them probably not.

A (41:39)

Why not? Maybe they would.

B (41:40)

I don't know. Yeah, I mean, that's a good question.

A (41:43)

I also have a prompt I've been working on. So you drop the prompt into right now. I'm using it in Google Gemini. You drop the prompt in hit return, it says, please give me your insulin to carb ratio, your fat protein adjustment factor for Warsaw. Or just type default if you don't know. And a link to a recipe.

B (42:02)

Oh.

A (42:02)

So I gave it a 1 to 12 carb ratio. I told it default, and I gave it a recipe for baked ziti. You hit enter again and it comes back and it says, hey, we've divided this recipe into one tenth, a tenth of this recipe. 47 carbs, 16 fat, 21 protein. You'd want to do a bolus of 47 carbs at your instant to carb ratio. That's 3.91 units. And then there's a extended bolus for the fat and protein. It gives it to you like that. 3.9 for the immediate 0.95 over four hours for the rest of it. It explains to you the strategy behind why you're doing it. And it Breaks down the meal for you and tells you what was in the meal. If you're interested in how it broke down the ingredients and all this stuff, and how the ingredients impacted your blood sugar, like in like two clicks. It's pretty.

B (42:51)

That's crazy.

A (42:53)

So I'm hoping people find that stuff useful.

B (42:55)

Now I just use my little recipe thing and then I plug everything in and divide it, figure out my carbs.

A (43:00)

See, the thing here is with the prompt, the prompt's already written, so you really need to just drop in the link and your insulin to carb ratio.

B (43:09)

Oh, that's so cool.

A (43:10)

And it, like, tells you the rest. So I'm trying to figure out a way to share that. I'm not sure if I'm going to or not, but the other two calculators I did share, so they're on the website.

B (43:18)

Well, they're. I mean, I've seen people ask about that. Like, if I'm creating a whole meal, how do I figure out what the carbs are?

A (43:23)

Yeah, it's tough. It really is to break the whole thing apart. So basically what. What I've learned is, simply put, is that you can take any recipe and just say to ChatGPT or to Gemini or whatever you're using. Like, please, you know, I need to understand the, like, the macro breakdown of this recipe and how many carbs are in a serving and how many. This is in a serving. That's in a serving. And it does a really reasonably good job of giving you a return back.

B (43:47)

Yeah, that's great. I love that.

A (43:49)

Yeah, it's very cool. Okay. Cassie, you were awesome. Thank you for doing this with me.

B (43:53)

Well, thank you so much. I really appreciate it.

A (43:55)

All right, hold on a second. 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. Eligibility may vary. Full terms and conditions can be found@ omnipod.com juicebox Today's episode of the Juicebox podcast is sponsored by the Dexcom G7. And the Dexcom G7 warms up in just 30 minutes. Check it out now@dexcom.com juicebox okay, well, here we are at the end of the episode. You're still with me. Thank you. I really do appreciate that. What else could you do for me? Why don't you tell a friend about the show or leave a five star review? Maybe you could make sure you're following or subscribed in your podcast app. Go to YouTube and follow me. Or Instagram TikTok. Oh, gosh, here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page. You don't want to miss, please. Do you not know about the private group? You have to join the private group. As of this recording, it has 74,000 members. They're active. Active, talking about diabetes, whatever you need to know. There's a conversation happening in there right now and I'm there all the time. Tag me. I'll say hi. Hey, do you need support? I have some stuff for you. It's all free. Juicebox podcast.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 Bold 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 Bolusing 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. If you have a podcast and you need a fantastic editor, you want Rob from Wrong way Recording. Listen, truth be told, I'm like 20% smarter. When Rob edits me, he takes out all the like, gaps of time. And when I go and stuff like that and it just, I don't know, man. Like, I listen back and I'm like, why do I sound smarter? And then I remember because I did one smart thing. I hired rob@worldwayrecording.com.