Juicebox Podcast: Type 1 Diabetes

Episode #1809 – Gremlins

Host: Scott Benner
Guest: Valerie
Date: March 27, 2026

Overview

This episode features Valerie, a woman diagnosed with LADA (Latent Autoimmune Diabetes in Adults, a form of Type 1 diabetes with slower onset) at age 39. Valerie shares her diagnostic journey, her experiences as both a medical professional and patient, and how her unique background—including childhood trauma, foster care, and working on cruise ships—has shaped her approach to living with diabetes. The discussion explores Valerie's transition through various diabetes management tools, her pragmatic approach to care, and broader reflections on resilience and self-advocacy.

Key Discussion Points & Insights

Valerie’s Diagnosis and Early Experiences

• Diagnosis at Age 39 (LADA):

  • Valerie was initially misdiagnosed with Type 2 diabetes due to her age [03:16]. She describes only mild symptoms: “I was only tired and thin because when you work on the cruise ship, it’s like 10-hour days.” [05:57]
  • Discovery was incidental, following a urinary tract infection and sugar detected in her urine [10:25]

• Misdiagnosis and Getting the Right Referral:

  • Lived with a Type 2 diagnosis for about 1.5 years [11:16]
  • A dermatologist, seeing unusual skin issues and abnormal labs, referred her to an endocrinologist, leading to her true diagnosis (LADA/Type 1) [11:20 – 12:04]

Navigating the Healthcare System

• Self-Advocacy: Valerie, due to her background in medical administration, knew how to push for specialist referrals when local endocrinologists were unavailable [12:47].
• Practical Challenges:
  • “I’m the one that does everything. Yeah, I just basically go in, like, I need these scripts...I pretty much from the beginning, I've been doing it myself.” [30:22]

Impact of Work and Life Circumstances

• Cruise Ship Life:

  • Long, taxing work hours, transient living arrangements—2 months on, 4 months off [09:07]
  • Saw direct consequences of others’ mismanaged diabetes on cruises [06:35]
  • "It's hard work every day sharing space...you don't really have any alone time." [09:37]

• Current Work as Medical Admin:

  • Now back in a hospital setting in Hawaii, working at an open nursing station (“an island on an island”) [18:09 – 18:16]
  • Describes rapid response demands and constant interruptions in her role [17:06 – 17:43]

Management of Diabetes Over Time

Medications & Devices

• CGM (Continuous Glucose Monitoring):
  • Valerie sought out a Dexcom CGM before insulin was required—"I paid for my own Dexcom before I started insulin... I didn’t mind finger sticking myself, but...it just seemed torturous." [19:59 – 20:54]
• Insulin Use & Caution:
  • Started insulin about a year after LADA diagnosis—less than the initially predicted 5-year grace period [19:53]
  • Focuses on avoiding severe lows and DKA over achieving “perfect” numbers
  • "I'm not bold with insulin... I've always given myself the least amount or enough to keep myself in range, but...I was just always afraid that I'll give myself too much." [21:21]

Pumps (Omnipod, Omnipod 5, iLet)

• Pump Evolution:

  • Started on mealtime insulin, then Omnipod, then switched to iLet [24:24 – 25:47]

• iLet Experience:

  • Loves lower input required with iLet: "I want less involvement. I want less involvement." [26:40 – 26:42]
  • Admits to “fake carbing”—announcing additional meals to trick the algorithm into delivering more insulin [27:29 – 27:42]
  • Prefers iLet over Omnipod, primarily due to infusion set longevity and reduced lows [58:12 – 59:19]
  • Still prefers pre-bolusing to avoid glucose spikes, even when the pump doesn't require it: "The pre-bolusing helped [to avoid peaks]." [60:02]
  • Aesthetically, misses Omnipod for dress-wearing ease [60:10]

• Approach to Metrics & Aggressiveness:

  • Keeps A1c in the 5s–low 6s, but doesn't “chase” numbers [22:33 – 22:53]
  • Focuses on steady management and personal safety
  • “I'm just trying not to end up in the hospital and not have lows.” [62:14]

Attitude Toward Healthcare Professionals

• Relies little on her endo/team for active management—"They don’t really help me. I’m the one that does everything." [30:22]
• Views most HCPs as regular people, given her professional background [31:07]
• Finds therapy helpful as a sounding board—mainly for documentation and the occasional insurance battle, not depression [47:19 – 48:33]

Resilience, Childhood, and Mental Health

• Early Trauma and Foster Care:

  • Removed from abusive parents at age 7, spent years in multiple homes—“about 14 until I was 18” [35:40]
  • Bonded but guarded with her adoptive family, difficulty with attachments [35:53 – 36:07]
  • Found significant support and positive experiences in non-biological families, counterbalancing early adversity

• ACEs and PACEs Testing (Adverse and Positive Childhood Experiences):

  • Takes the test live with Scott, scoring high on positives, which is “why I’m better at thriving” [43:44 – 43:57]
  • Discusses how positive supports in foster/adoptive care may have buffered some damage from early trauma

• Resilience & Humor:

  • Maintains positivity, avoids dwelling on the past: “It’s a waste of energy and I. I don’t have depression, luckily. I do my best to move forward.” [45:42]
  • Makes light of her life story—“God. Very Buddhist of me. I'll say a prayer for you.” [49:24 – 49:27]

Reflections on Relationships and Identity

• Not actively dating but has strong friendships; attributes guardedness to parental dynamics and childhood trauma [32:54 – 33:41]
• Multicultural background (half Thai, half Greek), experienced different traditions in various foster homes, but not religious [49:31 – 49:57]
• Values open-mindedness from diverse living situations: "Just to have an open mind." [50:34]

Notable Quotes & Memorable Moments

• On Misdiagnosis:

  • “I don’t believe this diagnosis. Like they did a lab draw...I guess I believe I have diabetes, but I don't understand how I have diabetes.” —Valerie [10:25 – 11:16]

• On Living Alone and Insulin:

  • “I'm not bold with insulin...I do live alone...I'm just afraid of passing out.” —Valerie [21:21 – 22:04]

• On Managing Diabetes:

  • “As long as no one's calling 911 on me and like, they're not doing a wellness check, I think I'm okay.” —Valerie [32:12]

• On Pump Preferences:

  • "I want less involvement...The marketing of the eyelet, it spoke to me on that level." —Valerie [26:41 & 62:00]

• On Resilience:

  • “I'm amazed I'm not a psychopath for what I've been through.” —Valerie [37:08]
  • “I am better at thriving. Maybe that’s the word.” —Valerie [43:40 – 43:44]
  • “People saved you, huh? That’s something.” —Scott [46:12]

• On Therapy and Documentation:

  • “It’s mainly more for documentation purposes. Slash, a sounding board when, like, my insurance ain’t gonna cover something.” —Valerie [47:19]

• On Letting Go and Acceptance:

  • “I don’t dwell. It’s...I think it’s a waste of energy and I...just try not to dwell on [the past].” —Valerie [45:42]

Timestamps for Key Segments

• LADA Diagnosis Journey: [03:16 – 13:55]
• Working on Cruise Ships: [03:33 – 09:37]
• Dermatologist’s Role in Diagnosis: [11:20 – 12:04]
• Life in Hawaii, Medical Admin Work: [13:43 – 18:16]
• Transitioning to Pump Therapy: [24:24 – 27:04]
• Pump Preferences & Automation Discussion: [27:04 – 30:07, 58:12 – 62:31]
• Self-advocacy vs Provider Reliance: [30:22 – 32:07]
• Childhood, Foster Care, Resilience: [33:24 – 46:10]
• ACE/PACE Questions: [40:50 – 43:40]
• Personal Philosophy & Humor: [47:19 – 53:12]
• Skin Issues & Aging: [55:00 – 56:46]
• Closing Reflections on Diabetes Philosophy: [61:42 – 64:52]

Final Takeaways

• Valerie’s Core Approach:
  Valerie embodies pragmatic, self-reliant diabetes care driven by her medical background, guarded optimism, and past adversities. She seeks the least burdensome tools (CGM, iLet) to avoid hypoglycemia and maintain independence.

• Resilience Shaped by Childhood:
  Her ability to thrive stems from key positive supports after early adversity, openness to diverse experiences, and humor. Valerie’s adaptive philosophy suits the “Bold With Insulin” ethos—though her boldness is in sustaining herself, not chasing perfection.

• Advice for Listeners:
  Valerie’s story is a testament to the power of self-advocacy, adapting technology to fit your lifestyle, and the lasting impact of supportive relationships—no matter when they come into your life.

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