#1814 Par for the Course

Summary

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Juicebox Podcast: Episode #1814 "Par for the Course"

Host: Scott Benner
Guest: Dr. Hannah Parr (physician, diabetes educator, T1D for 20+ years)
Date: April 2, 2026

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Episode Overview

In this thoughtful episode, Scott Benner welcomes Dr. Hannah Parr, an osteopathic physician, diabetes educator, and person living with Type 1 Diabetes (T1D) for over 20 years. Together, they cover the challenges and evolution of diabetes care—both personal and professional—including mindset, the intricacies of the healthcare system, and practical new care models. Dr. Parr shares her diagnostic journey and her passion for helping others live well with diabetes, emphasizing the crucial often-overlooked emotional and psychological aspects. Both host and guest reflect on gaps within medical guidance, the power of peer support, and the importance of community-driven resources for people with diabetes.

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Key Discussion Points & Insights

Dr. Parr’s Diagnosis and Early Experience with T1D

• Personal Background
  • Diagnosed at 13, no prior family history of T1D, but family history of autoimmune diseases (Crohn’s, sarcoidosis, hypothyroidism) [01:08]
  • Initial symptoms: frequent urination, diagnosed via urinalysis in a primary care setting.
  • Emigrated from Scotland to the U.S. just before diagnosis, compounding the disorientation. [03:24]
• Emotional Response
  • Felt "deer in the headlights" and tremendous shame/fear as a teenager—hid her diabetes from peers initially.
  • Lacked understanding of what her future could look like with diabetes.
  • “I was so ashamed of my diabetes in the beginning. I didn’t understand what it meant for me.” [08:00]

Turning Point: Diabetes Camp

• Attended Texas Lions diabetes camp at age 14, which catalyzed a dramatic 180° in self-acceptance.
• Found empowerment in community: “...the first time you’ve ever been okay showing something about your diabetes in public.” [11:20]
• Key insight: Seeing other kids living confidently with diabetes made it possible for her.

Transition to Medicine and Focus Areas

• Frustration with lack of actionable, holistic advice from her medical team prompted her to pursue nutritional sciences and then osteopathic medical school.
• Passion for lifestyle medicine: “I was so curious...I couldn’t get answers. That’s when I got this kick: I want to help other people find answers.” [13:58]
• Chose family medicine initially to treat both kids and adults with diabetes from a systems perspective, ultimately shifted to integrative/functional medicine to address patients' broader health and lifestyle needs. [16:17]
• Explanation of limitations in traditional practice: quick appointments, little room for education, systemic constraints.

Healthcare System Critique and Alternative Models

• Discussed barriers for physicians wanting to deliver education-driven care:
  • Institutional time and reimbursement pressures, lack of lifestyle training in medical education.
  • Most clinics not owned by physicians, system incentivizes volume over deep care.
  • Why patients often seek answers from places like the Juicebox Podcast rather than providers.
  • “There's so much more to learn that can impact the way that we feel about ourselves, the way that we take care of our body, how we can reduce our risk of chronic disease… I needed to be the change in medicine to fill the gap.” [19:35]
• Direct Primary Care Model [29:56]
  • Dr. Parr now practices in a membership-based clinic: $90/month, no copays, unlimited access, longer appointments (up to an hour).
  • More time results in more individualized care and better outcomes, valued especially by motivated, high-deductible patients.
  • “I am incentivized to keep my patients healthier because the healthier they are…the more people I can help.” [31:57]
  • Clarifies the membership model’s pros and cons—including billing, labs, and accessibility.

Mindset, Community, and the “Non-Compliance” Myth

• The host and Dr. Parr agree: Most patients are not "non-compliant"; rather, life circumstances often prevent optimal self-care. [57:48]
• Importance of the provider’s approach: different communication styles for different personalities (“engineers want the data; others just want to feel better”).
• The sense of isolation and the need for reminders/support: Even 20 years in, Dr. Parr still needs the “prebolus” reminder.
• Acknowledges that seeing others living fully with diabetes is profound for those newly diagnosed, especially teens and young adults.

Memorable Quotes

• “I just didn’t know if anybody would want to marry me. I didn’t know if I could have kids or if that was possible… If I could just see somebody, you know, five years ahead of me living their life with type 1 diabetes… that would really help.” (Dr. Parr, [47:25])
• “Everyone seems to know what the problem is and they either acquiesce to it or go off into private practice and charge people cash…No one stays and says, you know what, I could help these people while they're being covered by their insurance and do a better job of it.” (Scott, [22:18])

Peer Support, Online Presence, and Helping at Scale

• Dr. Parr has a YouTube channel (Dr. Hannah Parr) and runs a support group focused on the mindset of diabetes—a major gap she noticed from her own journey.
  • “My thing is really the mindset piece…That was the hardest part for me with diabetes, is that how do you not let it define you?” [45:11]
  • YouTube is more a passion project (“$100/month”), but its real value is impact, not income. [43:29]
• The therapeutic and communal value of regular podcasts and support groups: they make people feel less alone, inspired, and capable.
• Both Scott and Dr. Parr reflect on the foundational advice about diabetes management—timing, dosing, pre-bolusing, adjusting for variability—and the tragedy that it’s not delivered more explicitly in medical appointments.

Quote

• “No one out there listening is going to hear themselves in a diabetes influencer. You know what I mean? ...It just needs to be people who have never been asked to talk into a microphone and share their story.” (Scott, [64:35])

Burnout, Boundaries, and Personal Sustainability

• Dr. Parr speaks candidly about managing her own boundaries after medical training, especially as a physician with T1D.
  • Prioritizes maintaining her own health: works part-time, schedules self-care, and recognizes the need to fill her own cup before helping others.
• The challenge of “never-ending” patient needs in both clinical and online spaces.
• Scott describes his own approach to balancing helpfulness and personal boundaries, noting the unending nature of community requests. [38:32]

The “Can People With T1D Have Kids?” Knowledge Gap

• Dr. Parr shares her surprise in early adulthood, realizing only after meeting other women with T1D that pregnancy/childbirth was possible. [48:56]
• Underlines the damage a lack of relatable role models can do to the mindset and confidence of young people living with diabetes.

Supplementation, Evidence, and Keeping People “Bought In”

• Discussion of vitamins, GLP meds, and sustaining behaviors that don’t provide instant gratification.
• “I think people are motivated to do something when they truly understand the impact… If you're bought into the science behind it, you understand it enough to know that it could be something good in the future.” (Dr. Parr, [62:12])
• Acknowledgement: For lasting change, education and connection are paramount.

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Timestamps for Important Segments

| Timestamp | Topic/Quote | |------------|------------------------------------------------------------------------------------------------------------------------| | 01:08 | Dr. Parr’s family history, diagnosis, and initial emotional responses | | 08:00 | Feelings of shame and isolation as a teen with diabetes | | 11:20 | How diabetes camp was a turning point for self-acceptance | | 13:58 | Deciding to become a physician to fill education gaps | | 16:17 | Medical training—why not endocrinology, focus on family/integrative medicine | | 19:35 | Healthcare system limitations: “needed to be the change” | | 29:56 | How direct primary care membership model works | | 31:57 | Incentives in the new model: doctor and patient both benefit | | 38:32 | Burnout and boundaries in helping professions | | 45:11 | Mindset focus: “how do you not let it [diabetes] define you?” | | 47:25 | Power of seeing others living fully with T1D | | 57:48 | Debunking “non-compliance”—life barriers, not patient refusal | | 62:12 | Making the case for supplementation—need for education, delayed gratification | | 64:35 | Importance of diversity in diabetes voices on podcasts | | 69:27 | The organic, word-of-mouth growth of community-based resources |

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Notable Quotes

• Scott (on the system):
  “Everyone seems to know what the problem is and they either acquiesce to it or they go off into private practice and charge people cash...No one stays and says, you know what, I could probably help these people while they're being covered by their insurance and do a better job of it.” [22:18]

• Dr. Parr (on camp’s impact):
  “…this is the first time you’ve ever been okay showing something about your diabetes in public… after that camp, I was okay talking to my friends about it…” [11:20]

• Scott (on the “secret” to better A1C):
  “There you go. Like, there's the big secret. Like, you know, you guys don't have to listen anymore. You want an A1C in the sixes, just do those things.” [27:33]

• Dr. Parr (on mindset):
  “That was the hardest part for me with diabetes, is that how do you not let it define you? How do you imagine your life with it and not hold yourself back?” [45:11]

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Resources & Where to Find Dr. Parr

• YouTube & Instagram: Dr. Hannah Parr (search name; both platforms)
• Support Group: Monthly Zoom support group for mindset and T1D (details on socials)
• Practice: Direct primary care clinic, Austin area ($90/month, more info via Dr. Parr’s platforms)

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Closing Thoughts

In "Par for the Course," Dr. Parr and Scott Benner illuminate both the difficulty and possibility of living well with T1D—highlighting interdisciplinary, community, and mindset-focused solutions beyond conventional medical models. This episode is packed with real-life wisdom, stark honesty, and encouragement for those navigating gaps in medical answering, offering clear hope and actionable perspective.

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Transcript

[A]

Hi, I'm Dr. Hannah Parr, and more importantly, I am a patient with type 1 diabetes. I was diagnosed at 13 and now 20 years later, just had my diversary. I am working as a clinician and a diabetes educator, and I like to focus on lifestyle medicine. So not just what our blood sugars are and how we're counting carbs, but how we can feel great in our body, what other things we can do to improve our health over. And most importantly, I think the mindset piece is the part I'm most passionate about. So how we let diabetes define who we are and how we feel about ourselves, and that's my favorite part to talk to people about with diabetes is really the mindset of how we let it define us and what we can do about shifting it. Yeah.

[B]

And dig into all of that, but first, I want to find out about you being 13 and getting diabetes. So do you have other family members with type 1? Do you have family members or extended family members with other autoimmune issues? Do you have any other autoimmune issues?

[A]

Yeah. So I am the first one in my family with type 1 diabetes. I do have quite a few autoimmune diseases on my mother's side, and so Crohn's disease, sarcoidosis, hypothyroidism. So we're not. Not new to autoimmune.

[B]

Wow. You actually get. You know, I know I probably say this every time, but sarcoidosis was the throwaway diagnosis on House md, the television show.

[A]

I love that show.

[B]

When they didn't know what to say, someone would go, it's probably sarcodoist. And then I. And then. And then it never was. But then I had somebody on the podcast, I said that to them. They were like, I actually have it. I was like, wow, we finally found one. So there's a history of autoimmune in your family?

[A]

Yes.

[B]

Do you have Anything beyond type 1?

[A]

No. No. There was a point in my life where I had subclinical hypothyroidism, and I needed thyroid medication for about a year, but that resolved, and I no longer need that. So it wasn't autoimmune in nature. Yeah.

[B]

Resolved, meaning your levels went back to where you wanted to be or your symptoms went away?

[A]

My levels went back up, and I no longer needed it.

[B]

Oh, and you don't have symptoms?

[A]

No.

[B]

Awesome.

[A]

No. And I kind of get my thyroid screened yearly with my annual diabetes labs, and things are doing good.

[B]

How often do you think that happens for people?

[A]

Subclinical hypothyroidism we see in people now, this isn't kind of full blown Hashimoto's where we've got high antibodies against our thyroid and we're at very, very low levels of thyroid. I was borderline low with symptoms and so they decided to put me on medication. This was right before I started medical school and I was just kind of. They were worried about me going into med school and kind of being border with the fatigue I was having. And I took the medication for about a year and then noticed I started having symptoms of too much thyroid. So we tested and, and I didn't need it anymore. And it's kind of been been the same since.

[B]

So it fought off your fatigue pretty well. But then you started getting hyper.

[A]

Right? Because I was supplementing it, so I just didn't need it anymore.

[B]

Wow.

[A]

So I just kind of went back to baseline and that's not unusual for, for subclinical hypothyroidism.

[B]

Okay.

[A]

We see that not commonly in kind of full blown Hashimoto's where we've got the antibodies.

[B]

Got you. What do you recall about being diagnosed with type one?

[A]

You know, I, I think that I was pretty dear in the headlights. I was not diagnosed in a hospital setting. I was 13 and we had just moved. I grew up overseas in Europe and we had just moved to the US about six months before my diagnosis. And everything was new and everything felt scary. We were kind of in a smaller town in Scotland for most of my life. And then I started a very large junior high in Houston, Texas. And so I'd never even seen that many kids my age. I was so worried about being the new kid. There was a lot going on. And then my mom noticed I was urinating frequently and she took me to primary care to, to see if I had a uti. And they did a urinalysis, found the glucose and ketones and kind of said, we need to get you to endocrinology emergently. So they made a kind of a last minute appointment before the endocrinology clinic in. In town closed. And we drove over there in Houston traffic. And I remember my mom crying on the way. I just had no idea what was going on. You know, I had no concept of understanding what diabetes was. And that day they made me do my injection, my very first injection on my own in the office before they let me leave. And they sent us home with a little pamphlet and a CD back 20 years ago, they accidentally had given us the Spanish one. So I have this Memory of my mom sitting in front of the TV trying to read the, you know, diabetes education with a. Like a Spanish English dictionary.

[B]

Really?

[A]

And. Yeah, and it was just an accident, but that's all we had. And then I went to school the next day, and we just kind of figured it out as we went, you know, it was really no downtime with my diagnosis.

[B]

Your Scottish mom in Texas trying to figure out Spanish.

[A]

Well, my mom was American. Yeah. But we were there for 10 years before, so, you know, us stuff felt new, but it was. It was just. It just kind of felt wild, you know, and surreal when I think back to it.

[B]

No kidding. Wow. And then do. Do you have brothers and sisters?

[A]

I have one little sister.

[B]

Okay. Your parents married at that point?

[A]

Mm.

[B]

Okay.

[A]

Yeah.

[B]

Do they jump in and help? Is it them taking care of it completely? Do they try to give it to you? Do you split the duties? How does that all work? And 20 years ago, so my daughter was diagnosed, I think, in. I think 20. I do know this. 2006. So what were you, 2005, maybe?

[A]

I was 2006.

[B]

You were 2006.

[A]

February 2006.

[B]

Okay, so she was August. So back then, we got. They gave us syringes and insulin and a meter. Did you get anything different than that?

[A]

We. We. I got insulin pens.

[B]

Look at you.

[A]

So I was started on pens and a meter and then some carb counting flashcards, which I remember.

[B]

Carb counting five.

[A]

Yeah. Trying to go through all the cards to figure out, you know, where the apple was.

[B]

Yeah. I realize now more contextually that Arden was 2, and she weighed, like, 18. Well, she weighed 17 pounds, but she's diagnosed. And so we got syringes so that we could use little bits of insulin without the pens. And then no one. Do you know, no one ever switched her to pens, really. It never came up until she went right from just syringes to insulin pump.

[A]

Interesting.

[B]

I didn't even know to ask for pens, but anyway, so you get pens and a meter, you're on your way. But your car and your carb counting, because it's right there. Like, obviously in the time frame of diabetes, they're going to teach you to carb count. Were you having success or what did your life look like in the first couple years?

[A]

First couple years, I think I believe I had success maybe compared to the average child in my endocrinology practice. My A1C was low sevens, high sixes, kind of for most of my teenage years in high school after that. But I. I had a lot of Lows. I was frequent kind of having lows. I was active on the dance team and my parents really did, over time give most of my care over to me. I mean, when I was at school, right, there was no Dexcom follow, so it was all on me and the school nurse. And I felt like that gave me confidence. So we didn't have trouble, you know, with sleepovers or going to, you know, different camps or friends or things like that. You know, I think that that piece worked out well. But where I really struggled, Scott, was the, the, the mindset. I was so ashamed of my diabetes in the beginning. I didn't understand what it meant for me. I think I had a big knowledge gap on what life with diabetes could actually look like. And as this kind of scared 13 year old that already felt like the new kid after diagnosis, I was just terrified to tell people in my life. I didn't want my friends to know because I was afraid that they would think less of me and think I was even more different, you know, and friends are so important at that age. And so I really, I really struggled with the mindset pie. You know, I hid my diabetes for a long time until my parents pushed me to go to a camp for kids with diabetes. And then everything changed after that.

[B]

How old were you when you went to camp?

[A]

I was right at 14. So it was about six months to a year after diagnosis. And the camp Texas Lions camp, it really changed my life. It was kind of a week long, not a day camp, but an overnight camp. And I remember everybody cried at drop off and then I didn't want to leave. I was so happy, you know, crying at pickup. It was kind of that, that full 180.

[B]

When you said you were, I think the word you used were you were ashamed of it.

[A]

Yeah, yeah.

[B]

That you were different, that you had a medical issue. Like, do you remember where the shame like showed itself?

[A]

I think the shame was in not understanding. I didn't understand if diabetes was my fault. I didn't understand if there was anything I did wrong to get it. I didn't understand if it would mean that I had to live a different life or I wouldn't live as long. I couldn't do the things that my friends could do. I just felt so ashamed for being different.

[B]

Okay. And do you remember anybody treating you differently?

[A]

No. I mean, I have the most supportive family. They were incredible. Jumping in and learning and, you know, helping me with nights and figuring it out and. And I had great friends. You know, I still don't feel That I get treated differently. I don't know if I can think of many instances in my whole 20 years that I have. I think it was just that, you know, fear of. Kind of self induced fear of. Of being different.

[B]

Okay, all right, I appreciate that. It's interesting to look into the idea that at your age, you had all these worries. They were kind of unsubstantiated. And then meeting new people, branching out a little bit, helped you get rid of them. So once you get back from diabetes camp, is it like a whole new you where you're like, hey, everybody, look at this. Watch me. Watch me jam this pan into my leg. Or, I mean, how far do you swing the other way?

[A]

I remember so right before camp, having to give. The way that they kind of introduced the diabetes to school was we met with the school nurse, and then I had to hand deliver a letter my mom wrote to each of my teachers in each of my kind of periods through school. And I just. I did not want to give these teachers this letter. I was terrified. I remember shaking, handing it over, just being so scared, you know, that they would know this about me and it would make them think less of me. I wouldn't talk about it with anyone. And then after camp, my parents picked me up and I have this vivid memory of, you know, saying goodbye to my friends, learning through camp how other kids were confident with their diabetes, how they didn't mind talking about it, how they could live. They seemed like they were having fun and living normal. Kid lives with it. My parents picked me up, and we were wearing the camp shirt that said diabetes on it. I mean, it was very obvious. And we went to a Cracker Barrel on the way home, and I walked into that Cracker Barrel wearing these diabetes shirt, and my mom just started crying. And I. I was confused, right? So in the moment when you're a kid. But she said, you know, this is the first time you've ever been okay showing something about your diabetes in public, you know, and it was that. And it was after that camp, I was okay talking to my friends about it because I saw how the other kids at camp could explain it to their friends and talk about you, their insulin pump in a way that didn't seem so diminishing, and it really just helped. And I really think after that, it was a 180. And I still had so much to learn years later about confidence and what I was capable of. But it was. It took the shame out of it.

[B]

Right. When did you decide to try to go into medicine when you think of a CGM and all the good that it brings in your life is the first thing you think about. I love that I have to change it all the time. I love the warm up period every time I have to change it. I love that when I bump into a door frame sometimes it gets ripped off. I love that the adhesive kind of gets mushy sometimes when I sweat and falls off. No, these are not the things that you love about a cgm. Today's episode of the Juice Box Podcast is sponsored by the Eversense365, the only CGM that you only have to put on once a year and the only CGM that won't give you any of those problems. The Eversense 365 is the only one year CGM designed to minimize device frustration. It has exceptional accuracy for one year with almost no false alarms from compression lows while you're sleeping. You can manage your diabetes instead of your CGM with the Eversense365. Learn more and get started today at eversensecgm.com JuiceBox 1 Year 1 CGM this episode is sponsored by Tandem Diabetes Care and today I'm going to tell you about Tandem's newest pump and algorithm. The Tandem mobi system with control IQ+ technology features Autobolus, which can cover missed meal boluses and help prevent hyperglycemia. It has a dedicated sleep activity setting and is controlled from your personal iPhone. Tandem will help you to check your benefits today through my link tandemdiabetes.com juicebox this is going to help you to get started with Tandem's smallest pump yet that's powered by its best algorithm ever. Control IQ technology helps to keep blood sugars in range by predicting glucose levels 30 minutes ahead and it adjusts insulin accordingly. You can wear the tandemoby in a number of ways. Wear it on body with a patch like adhesive sleeve that is sold separately. Clip it discreetly to your clothing or slip it into your pocket head now to my link tandemdiabetes.com juicebox to check out your benefits and get started today.

[A]

Oh this is a great question. So I really didn't know what I wanted to do at the end of high school. Kind of My family was set on going to college and so I was trying to pick you know, what I wanted to study and that year I had been going to my endocrinology just office and asking how can I feel better with my diabetes? Like my blood sugars are pretty good, you know for where I AM with shots and finger prick. But. But how can I feel better? What types of foods are going to help me be healthier? What type of exercise can I do where I'm not so low? You know, just kind of more health questions and I just couldn't get answers. It was kind of like the, oh, you know, just exercise less if you're low and you can eat whatever you want. You know, don't worry about other chronic diseases in the future. And that was good. I mean, I get that they were trying to protect, you know, my childhood, but I wanted to know. I was so curious. And so I decided to study nutritional sciences and I went to Texas A and M for undergrad. Finally, I took a class where we learned about how to understand scientific literature that was published, like on PubMed and through different journals. And it was like it opened this world for me of answers to the questions that I had that I couldn't find other places. And it was so empowering. I learned a lot about health and started implementing what I was learning and I felt so much better. And then that's when I kind of got this. This kick of like, oh, I want to help other people find answers to these questions. And I thought about becoming a registered dietitian. That's what most of the people in my major did. But I realized that there was some limitations there on kind of the. What the MyPlay guidelines were at the time, what you could say, what you couldn't. And I really wanted to be able to help people kind of with a bigger picture of their health. And that's when I decided to go to do school. I'm an osteopathic physician, and I like the DO philosophy at the time, kind of reading about the difference between DO and md Dos are a little bit more holistic and looking at the kind of the whole person. And so that was the. That was the path I went on. So I decided my junior year of college and took six months off and then got into a school in Mississippi, which is close to where my grandparents were in New Orleans. And that's. That's kind of how it started.

[B]

Awesome. So you end up with. I mean, you get your undergrad, right, and then you move on to med school. Is that how it works after that?

[A]

Yeah.

[B]

And then when you're done there, do you do anything else or like, do you specialize or how does it work when you get out of medical school?

[A]

Yeah. So typically the traditional path is you would do four years of medical school and then you will go to residency in A different. There are many different residencies for different types of medicine. So there is residency for pediatrics, where you just learn about children, or residencies for family medicine where you do more primary care, residencies for surgery, internal medicine, where you're doing more hospital work. And I really was torn choosing my residency because there are. You can choose pediatrics and then go into endocrinology, or you can choose adult medicine and then go into endocrinology. But there was no choice to do, or for at least what I could see at that time, there was no choice to do kids and adults with diabetes, you know, and then move forward onto endocrinology. So I was really torn. And I felt that if I kind of pigeonholed myself into endocrinology, I would miss that whole person approach that I'm so passionate about. So I chose to go to family medicine because that is the type of residency program where you get to learn how to treat kids, women in pregnancy and adults. And I did one year of my internship in family medicine and decided that primary care was not going to be the right choice for me. There's so much beauty in family medicine and primary care and how people are helped in that setting, but it is typically very quick appointments, you know, where you're kind of back to back all day with appointments, and there's not a lot of room for the lifestyle education piece. And so I left after my intern year of family medicine and then I got my Texas medical license, finished my boards out, and I went on to do training in integrative functional medicine and which is more lifestyle oriented, prevention oriented. And then I did my diabetes educator and board certified in advanced diabetes management, which is not a traditional American board certification for physicians, but it's the kind of diabetes educator curriculum for prescribers. And so that's where I am now.

[B]

What is it about you that you think let you see? Well, this is how the process usually works. I don't want to be involved in this. Is there something in your personal ethos or was it something that you functionally saw with how the machine worked? What turned you off and made you choose this other path? I have always disliked ordering diabetes supplies. I'm guessing you have as well. It hasn't been a problem for us for the last few years though, because we began using USMED. You can too. Usmed.com juicebox or call 888-721-1514 to get your free benefits. Check. US MED has served over 1 million people living with diabetes since 1996. They carry everything you need from CGMs to insulin pumps and diabetes testing supplies and more. I'm talking about all the good ones, all your favorites, Libre 3, Dexcom, G7 and pumps like Omnipod 5, Omnipod Dash Tandem, and most recently the eyelet pump from Beta Bionics. The stuff you're looking for, they have it at usmed888-721-1514 or go to usmed.com juicebox to get started. Now. Use my link to support the podcast that's usmed.com juicebox or call 888-721-1514.

[A]

Oh, I love this question. I would say both to answer directly, but it was that going my journey in medicine started from wanting to be a change, wanting to fill the gap of the questions that I had that I couldn't get answered as a kid and growing up and still, you know, had struggled to get answered when I'm in these appointments. And it was wanting to really focus on the health education piece for people. And I realized that. And you know, this, Scott, I mean, we go to our endocrinology appointment and we see our diabetes educator after diagnosis and then we go on to live the rest of our life with short follow up appointments, right, to check in on things. And there's so much more to learn, right? There's so much more to learn that can impact the way that we feel about ourselves, the way that we take care of our body, how we can reduce our risk of chronic disease and complications in the future. There's so much, and that's what I absolutely love about your platform. And I was so, I so needed to be the change in medicine to fill the gap. That was where my heart was going through this journey. And as I saw myself going into full primary care and seeing, you know, 30 patients a day for 12 minute appointments and doing all this billing, I could see that there wasn't going to be room for the education that I wanted. And it really was. I was in my intern year family residency and I had had a patient that had type 2 diabetes and she came to me and she had been seeing a different resident prior and she we had had an appointment and kind of filled her diabetes medications and scheduled a follow up. She came back at the follow up. Her A1C had gone up and I asked her, you know, kind of what was going on, if she'd made any changes. And she was so motivated to try and help her type 2 diabetes that she read, she watched YouTube and found somebody talking about a grapefruit diet where you just eat grapefruits and grapefruit juice for two weeks. And that's what she had done, trying to help herself. She was so motivated to try and do something to make her life better that that sounds incredibly hard to do. And it was just heartbreaking. I mean, she kind of hurt herself in the process. And it was just the lack of, you know, being able to find information that was evidence based that could work for her. And I didn't provide that, you know, and I felt I really want to put myself in a space where I can share information that is more likely to work for people that is safe, you know, that. That we can have more education out there that's evidence based that people are looking for. And so that's long answer to your question, but that's kind of how it happened. And that's how I'm a little bit different than other physicians.

[B]

As a person who tried the baked potato diet once for two weeks, I appreciate that.

[A]

Yeah. Well, thanks.

[B]

By the way, it did work. Although I only ate baked potatoes without salt, pepper or butter for two weeks, I think I lost like 15 pounds.

[A]

Wow. Interesting. Okay.

[B]

But to your point, the GLP worked a lot better. Yeah, I understand what you're saying, and I want to just take one more second to ask kind of a backward looking question for you. Whatever the hell this system is, you can call it whatever you want. Right. But why can't it do that? I think I ask every physician this question. Like, everyone seems to know what the problem is and they either acquiesce to it or they go off into private practice and charge people cash and hope that their insurance covers it. Afterwards, no one stays and says, you know what, I could probably help these people while they're being covered by their insurance and do a better job of it. What's stopping you? Is it just that the rules are written down somewhere? If the test says this, then you do that. Do you see what I'm saying? It doesn't seem like it should be that big of a deal.

[A]

This is such an important question. Yeah. So there are many, I think, variables that play into why this is so challenging. And it's from my impression and the physicians that I know, it's not because doctors don't want to help in this way. It's definitely because there's a lack of education for physicians. I mean, we get very little health training. We kind of learn about how the body works, what the diseases are, and then what the medicines and surgery are to treat them. And we don't learn about what's optimal for exercise or what's an optimal nutrition plan or, you know, those types of things as much as we could. So there's a lack of education on the physician side. But if a physician goes on to learn that and wants to implement it, there can be big barriers in the hospital based clinic setting. So if we think most clinics are not owned by physicians anymore, most clinics are owned by hospital systems, and hospital systems are more numbers based. And even though it's very intuitive, I think to you and I that if we have someone with diabetes type 1 or type 2, and we give them more diabetes education, that they will have less ER visits, which will ultimately cost the system less. Right? I think that's kind of pretty clear, but it has a lot to do. I think with insurance reimbursement, we don't get the same reimbursement for the time that we spend doing education as we do seeing more patients faster. And as the CEO or CFO of a hospital system, the numbers game is important for covering the overhead and profiting the hospital system. And so I think what I saw is that as a physician working for a hospital system, it would have been very challenging for me to carve out time to do things like a support group or extra education. And we have the referrals to the diabetes educators. But outside of that, you're working so much and the hours are so intense and the documentation is wild and I think growing with all the requirements and, and I think it's just hard to fill your own cup up as a physician and do extra on top of a full time clinic job. And so if a physician does go private practice, then they can. They're the owner of the practice, they manage the overhead versus what they're allowed to spend their time doing. And it makes it a lot more tangible to be able to do that. But if you take insurance, then it's harder to cover your overhead with the insurance kickbacks that you get.

[B]

Okay, so where does that leave a person who finds themselves in an office with an uncommon problem being delivered a common answer, not getting any real clarity, not getting better, whatever. Are they just left to think, well, I guess this is how it all works. I'll have to go figure this out on my own if I expect to figure it out at all.

[A]

I think that's how a lot of people feel. Yeah, I think that's how a lot of people feel. I know I felt that way. And I think that's why we see so many people turning to Things like the Juice Box podcast. Right. And YouTube and. And different things because they want to learn, you know, it's just that they're having trouble finding answers.

[B]

I think the podcast achieves a number of different things. Right. I don't want to sit around and philosophize about it, but if we just sat down and talked about just managing of diabetes, I honestly think the only thing I do is tell people to pre bolus, understand their food, understand how insulin works, and that's probably. I don't think I say much, to be perfectly honest with you. Like, I don't know how it's possible to have built something this large. It's so well regarded, generally speaking, off of such a small amount of information that's. That's available anywhere that like. And no one wants. This isn't what they want. Like, Hannah, no one says, you know what I really want? I want to get diabetes and I want to go to a doctor. Then I want to be left completely unhelped and then have to go, you know, fart around in the world so I can figure out who's even talking about this, then decide which one of them I can maybe trust, hopefully, then listen to them, then try to understand it, then put it into practice. Like, no one wants that. Like the thing I'm giving people, it's not a thing they want, it's a thing they find themselves in need of. And then when you get there and actually crack open the walnut and see what's inside of it, all that's inside of it is timing and amount. Pre bullish your meals, understand the impacts of your foods, and you know what, your settings are going to change due to variables. You should keep up with changing them. There. There you go. Like, there's the big secret. Like, you know, you guys don't have to listen anymore. You want an A1C in the sixes, just do those things.

[A]

Right, right. I agree.

[B]

Yeah, but that's insane. That's fundamentally insane. Like, it's not like they got to me and they're like, all right, this guy heard all about this. You know what I mean? And they sit down and they listen. They got a pen and then they go, oh, yeah, yeah. It's a very difficult thing. No wonder my doctor can't tell me about it. I mean, how would they tell me about this? I had to jump over three golden diamonds, go to the Amazon farce, get a snake milk it drink the venom. When you get to the end of it and you go, wait, it's timing and amount And I just pre bullish your meals and don't watch a high blood sugar. Like, that's nuts, Hannah. So, like, if there are days when I get up and I look at this thing and I think this shouldn't be like, like, if anyone was doing their job, I wouldn't have a podcast that I believe for sure.

[A]

I see it.

[B]

Okay, that's about the management stuff. Go say something nice about the community.

[A]

I get what you're saying. You feel like you're repeating the same things and that message is strong and it's important for everybody to hear. I mean, what you just said, I think is so crucial. But I see your work as something that helps people in a. In a bigger way. I mean, the voices that you bring onto this podcast and the amount of episodes that you publish to me are a constant reminder that we're not alone in this, that there are other people figuring it out too. Sometimes I need to remind myself to pre bolus 20 years in. I mean, you know, it's not like we don't need reminders or you get off track on something and, you know, you come back and your constant presence of different voices who I think remind people that they're not alone in this. And I think that there's a lot more to it than just the advice that you give. I think it's this sense of feeling not alone and feeling like it's possible, you know, to live this life because of the thousands of examples that you've brought on.

[B]

You're very kind and I, and I completely agree with you. I was really trying to cleave it down to this one idea. Right? Like, I mean, at the very least, if my endocrinologist can't tell me that the timing of how the insulin works is really important to the outcomes I have with my blood sugar. That's nuts. Wow, what a low bar. So how do you handle? Like, I'm assuming I don't know anything about you. I don't check into people, so. By the way, everybody, Hannah could be out of her mind. You'll have to figure it out on your. But so you went into private practice too? Are you one of those nice ladies who takes my insurance? No. And you can turn in your bill later and hopefully your insurance will cover it for you. Or how do you manage?

[A]

So I am in a practice that is. It is not an insurance based practice. It's called direct primary care. And it's a newer model of practice, it's membership based, and the majority of our patients are families of Business owners that have very high deductible plans. And so they pay a certain amount a month to have access to the practice. They can see any of the clinicians unlimited amount of times that month. And then they're not, you know, paying co pays. And our monthly fee is less than a copay would be without a deductible that's been met. So I think it's a good, a good fit for somebody.

[B]

You're like a large language model. I buy tokens and I use them. That felt right. I have like, I have credits, basically.

[A]

No, it's just like a gym membership.

[B]

It's like a gym membership.

[A]

Yeah, that's, that's how I describe it. It's like a gym membership.

[B]

So do some people overuse? Like, are some people sweating on the, on the machines constantly? And some people don't show up and that's how you're able to keep the thing going? I imagine. Like, what if you get a hypochondriac? You're losing money on them, right?

[A]

Yeah. But you're also helping them. Yeah, I would say. Yeah. It evens out. I, I get this question a lot when I tell people about the model and they say, how could that work? I mean, would people abuse the system? And we really don't have that. I mean, I think I get to spend a lot more. My patients, our appointments could be up to an hour if we need it. And that's wonderful. And I think because of that, I get to answer all their questions during the appointments. You know, it's, they don't leave with a list half answered. And so we get less questions, you know, between appointments, which I like. But, but I also think that it does, it just evens out. There are certainly people who, who come in for more follow ups because they're worried about things and others who, you know, don't check in as often, but they like the peace of mind that if they get the flu tomorrow, they can meet with us, you know, and have to wait four days to be seen at a different practice and pay more. Yeah, yeah. It just kind of evens out. The model works really well. And it's, it's, they're popping up all over the country. It's kind of a new wave of medicine.

[B]

No, for certain. So the business works for the business and the business works for the people?

[A]

Yes.

[B]

And you can pay your bills?

[A]

Yes.

[B]

Awesome.

[A]

And I am incentivized to keep my patients healthier because the healthier they are. Right. The less they come back to the practice. The more people I can help now that's better for me and it's better for them and that's the best.

[B]

Is this only going to benefit people who have that kind of money or do do some people see you have pay out of pocket and then turn that into their insurance and get some sort of coverage on the back end?

[A]

So we do, yes. So we can do a super bill where people can pay out of pocket. We also can, they can use FSA and hsa. We have some people choose to do that. Most people don't. But our monthly fee is $90 a month. So it's prohibitive definitely for some, but. But it's not I think at a place where it's out of reach.

[B]

Wait, so like a thousand dollars a year? That's my membership. But then is there billing on top of that?

[A]

So billing for labs. We have cash based labs for our patients with high deductible plans and those are discounted at the practice and they're honestly incredibly cheap. It's amazing how sometimes the cash based labs are actually cheaper than what you'd pay with your insurance. Yeah, but we do have patients that want to use labs, use their insurance for, for our lab. So we'll code and they can use their labs through their insurance so they get those covered and then prescriptions are obviously insurance as well.

[B]

For a number of years now I've been taking my family to just a cash doctor, you know, so it's very simple. You visit her and you it's $250. You see her a couple of times a year to check in, make sure everything's going well. But other than that, access through text messages, emails, portal system. She's very responsive. When you go into like check in with her, it's an east there for an hour. You know, you're in a soft chair with a lamp and a desk next to you. There's a pad of paper if you want to take not. It's a completely different experience. My health has never been better. I've never felt better supported when there is an actual emergent issue. It is not crazy for me to tell you that there was a time when we had a problem, we couldn't get a medication and I sent her a text and she said, oh, I have samples, you can come to my house and grab them. And like I know that that's not what you not. I'm sure that's not the norm but you know, I said okay. And she gave me an address and I went to her house, she handed it to me. She said, we'll get it all worked out. Use the sample for now. And I was like, okay, thank you. And I left. And maybe two years later, something similar came up where I texted her, and I was like, you know, there's a problem. And she goes, oh, you can come to my house. And I texted back and I said, I don't know where you live. And she said, you've been here before. And I said, oh, yes. But out of an abundance of respect, I deleted that because I didn't think. I didn't think I should have your address. And she was like, oh, that's so nice. We've been doing this now for three, four years, and it might sound expensive to people, but honestly, we maybe see her twice a year. And so for three, four people, it's $2,000 a year to see the doctor. And then we take those bills and give them to our insurance company, who I think they cover us at, like, 80%.

[A]

That's great.

[B]

Yeah. So I think we're paying, like, nothing really, like, you know, and getting way better care. She retired, so we're all really sad right now. Her husband got some great job in France and she's moving. I tried. I tried my hardest. Hannah. When she contacted us to say she was retiring, I said, you know, you've been married for such a long time, you must be sick of him. Why don't you just let him go, stay here and be our doctor? She said, I think I'm just gonna go to France and bop around. And I was like, okay, fine. Whatever.

[A]

Little life.

[B]

That's an older woman. She's, you know, getting towards her time, you know, to retire anyway. But the experience, I don't think I'm ever going to be able to. To remake somewhere else. She was a unique person in that. I don't believe that most of the money in her family came from her. I think it came from her husband. I don't think she needed to be, you know, grabbing at every dollar, and therefore, she was incredibly valuable. But I also don't know that it didn't burn her out. And I tell you that whole story to ask you, like, is there a system set up in here to keep you separated from having to give so much of yourself that you run out of stuff to give? Because I actually experienced that with what I do, and I had to set up boundaries for myself. And I was wondering if you have similar.

[A]

Yes. Well, I love that story about. About your doctor, and I think that's just amazing that, that, that's the kind of thing that I think that does change lives. And, and there's so many physicians that want to be able to practice that way. But yes to the boundaries question, I, and I've worked really hard on this and there was a time when I was in each step of my medical training, I, I would wonder like, can I do this with diabetes and not sacri, you know, like going into the night shifts. I remember my kind of the end of my training, it was 14 days in a row of 16 hour night shifts and I was alone, there was no team. So it's just me and all the pagers. And it was just like, oh, can I do this with my diabetes? Like this is, it seems so hard just not knowing how my ratios would change with all that. And so I had to learn that, you know, I really had to say, how can I set up my life so that I can fill up my cup first, first and then pour to my patients in my career? And that's hard to do in medicine because a lot of people think of these crazy hours that doctors work and I don't, I'm not full time right now. And it's for that reason because I, I like to take care of my health. And so I, I like to have a more balanced life. And I, I, it's giving me more time to do the online education that I'm working on, which has been wonderful, but it is, I really had to learn, you know, how, how many days can I see patients and how many hours in a row can I see patients where at the end I'm losing a little bit of empathy or my focus on details isn't as good. And for me it really is figuring out what are those things I need to do to keep my cup full and making sure I schedule those and then working on, scheduling my clinic days and my other work around it. And it took me a really long time to get there and it's certainly not always possible, but that's where I feel like, like I'm finally able to have a routine where I'm no longer worried that I'll burn out because I feel like my job fills my cup, doesn't empty it.

[B]

You know, what I found is that it's a never ending line of questions and people and they don't understand. What I would notice for myself is when they would see that I was online, it would start and if I kept going, it would never stop. It almost felt like a science fiction movie where you were, you had kidnapped somebody and you were Like a demon. And you were gonna suck out some of their essence to keep you alive, but you got crazy and sucked it all out, and they dried up and blew away. Like, I felt like if I, if I keep, if I keep facing the Internet, they'll absorb everything I have to give until I. I can't anymore. Like, because they don't see, they don't see my side of it. They see that they just. Oh, they're just having a quick 10 minute interaction with you. And I'm like, yeah, that's that 10 minutes, then the next 10 minutes, then the next one's 20 minutes, the next one's 10. And it never, it kind of ends. I almost couldn't equate it to. In the Facebook group, which I, I really adore my Facebook group. And, and I think it's incredibly valuable. I'll never stop supporting it. But I had to figure out better ways to support it. Because if you get involved in a conversation, like, you as the reader might jump in and be like, I have a thought about this. And then, you know, and directed at me. And then I'm like, well, then I'm responding to that. Well, you go away, you go live the rest of your life and come back six, eight hours later, maybe a day later to see if there's a response. People don't stop asking me, and I get stuck there forever. And I'm just wondering, like, I guess what I was getting to you already kind of alluded to, which is you build this, this model that really helps people, but then it. It's also opening you up to being pingable, and I don't know how long that can go. So then you, what do you do? You move to a different model where you, you're doing like, on. What was that next part you were talking about? Like, are you basically coaching people on specific ideas?

[A]

Well, I have been doing. I have a YouTube channel where I do type 1 diabetes educational mindset. That's kind of what I've just been focusing on. You know, with. With the reduced clinic hours.

[B]

I don't want to speak for you. Maybe there's somebody, like, paying your way somewhere. But, like, you're trying to make a living too. Does that make a living?

[A]

No, not at all.

[B]

No.

[A]

No, it's a passion project.

[B]

I was gonna say, what's, what's the.

[A]

Yeah.

[B]

And it's like, no, no, I don't have money. I guess I have to ask, are you married?

[A]

Yes, I just got married in October last year.

[B]

Oh, look at you. Congratulations. Very nice.

[A]

Thank you.

[B]

Yeah, Very nice. This is a good boy. Where everyone's happy. Mom and dad are okay with us.

[A]

Yeah. Yeah. We got lucky. Both sides were on board, so.

[B]

Both sides were on board. Yeah.

[A]

Trust me, you don't always get that.

[B]

I feel like I've seen it go the other way. Yeah. Yeah. So I've lived through it, by the way, in case you're wondering. So you're just. You're cutting back a little bit. Are you thinking of having kids? Oh, okay. Very nice. Does he have any autoimmune on his side and let's hope. No.

[A]

No.

[B]

Okay.

[A]

Yeah.

[B]

Is that part of your thought process during dating, by any chance?

[A]

If the person I'm dating has autoimmune, yeah.

[B]

Did you ever think, like, if I get somebody else to throw into this stew, we might end up with a kid with a carrot that has diabetes? Like, you know what I mean? Like, is it.

[A]

Yeah.

[B]

Do you think about that?

[A]

I've never, you know, I think in my decision to want to have children, I. This kind of the science brain had to look at this idea of, okay, what is the risk if I have a baby and they have an autoimmune disease or they have type 1 diabetes, will that crush me? I'm so grateful for my life with diabetes. I mean, I'm so glad I'm alive and diabetes isn't stopping that, you know, I feel like if I were to pass it on, that would be okay. It would still be a life worth living, you know, and so I, I guess I didn't think about that.

[B]

Super interesting. But that's a, that's an interesting question to ask yourself. Like, if this were to happen, would this derail who I am or my life? And you thought, no. So it's okay. We'll try.

[A]

Yeah, yeah, yeah.

[B]

Listen, I've heard all kinds of different answers. My favorite one is always been, well, I have diabetes and I'm okay.

[A]

Right.

[B]

That was maybe the most simplistic and my. My kind of favorite answer from somebody who had type one.

[A]

Okay, I love that.

[B]

Yeah. So let's pivot a little bit here. Like, I think YouTube seems impossible to get involved in and have success with. Is it working or what is your level of desire for it?

[A]

Yeah, I don't know. I don't even know how you define working. I feel like I'm helping people. And that's the point. Right. Is to put evidence based information out there, information that comes from my personal experience combined with, you know, working in practice. And, and I get comments from people who say that it's done something that's helped them or they've learned something or had a different perspective on something. And that's what makes me want to keep doing it. I mean, slow, slow growth. I'm posting about one video a week, and. And about maybe 2,000 subscribers right now. And it's monetized, so I get paid for the ads that come up in the middle of the. The videos now, but it's not making much.

[B]

I was gonna say, tell the people you're making untold tens of dollars. Is that right?

[A]

Yeah, 100amonth. I think that's where I am.

[B]

Almost 10 tens. Scott, let me just tell you.

[A]

So worth the time? Probably not, but it makes me feel good. And I think if I can grow, if I can grow, could be a good.

[B]

Maybe it could help more people. I have to tell you, when I talk to Jenny from, like you've probably

[A]

heard on the podcast, Integrated Diabetes. Jenny. Yeah. Yeah, of course.

[B]

When I talk to Jenny privately, because I always wonder, like, I don't. Like, she's not an employee. I don't pay her to be on the podcast. Like, I mean, you guys listen. Like, there's no ads for her on it, like, back to where she works or anything like that. She's just Jenny there. And I one day was like, why do you keep saying yes when I ask you to do this? You know? And she just told me one day, she's like, I just don't feel like I help enough people. That was it. Like, she's like, I work with people all day long. I mean, there's an argument to be made that Jenny's helping more people with diabetes than most people are. And yet she said very similarly to, I guess, how I feel about it. Like, it's such simple information, really. What you just need is time to give it to people. And I just like that she's like, I like that your podcast reaches a lot of people at once. And I feel like I'm helping a lot of people. And I'm like, awesome. So we've been doing it together for such a long time now, but I guess that's kind of what you're looking for, too, because, I mean, if you're working part time, then you are making a living. You're keeping your hand in, you know, you're keeping your license going and all that stuff. You can decide what you're going to do about building your family, but you're trying to reach more people, too. So you're telling me you are not like, you don't have, like, visions of grandeur. You don't imagine that one day there'll be, you know, 100,000 people following your YouTube channel, and it'll be cranking down 50 grand a month. And that's not your goal. Your goal is find people, help them?

[A]

Yeah, I think my goal is just to create a space where people can find the answers that they're looking for. And I think my thing is really the mindset piece. You know, that was the hardest part for me with diabetes, is that how do you not let it define you? How do you imagine your life with it and not hold yourself back? How do you know that you can do the things that you want to do and bring diabetes with you? And. And I think I spent a lot of time feeling broken. You know, even after I kind of dropped the shame, I still felt broken for a long time. And that was something my doctor's office could never help me with. And so I'm starting a support group next month that's on Zoom. That'll. It'll just be a place to have those types of conversations with people. So, yeah, I would love to help more people. And I think I feel Jenny in that is waking up every day thinking, am I helping as many people as I could help with the knowledge and the education I've taken the time to get? Is there more that I could be doing that would be helping more people? I don't know how to answer what enough is, and I think that's probably something I need to work on, is feeling content with that. But I think it is. It's touching lives for people who are looking for the answers that they can't find other places?

[B]

And.

[A]

And the more I can grow that, the better. But. But, yeah.

[B]

Do you think of it more as, like, therapy, like group therapy, or, you know, getting a bunch of people together to have a similar. I mean, the way I. I kind of big picture think about it is that if you understand in general terms and maybe a little more specifically how to manage insulin, that alleviates a lot of the other stuff. It doesn't get rid of all of it, but it. At least it lifts. It lifts a lot of the weight. And that in my mind, if I could lift that weight for people, then they'd maybe have more, you know, brain power, time, space to think about the other stuff and, you know, maybe more about the, you know, the mental impact of having type one. But it sounds to me like, I mean, you had such an impact of this in your own personal life. That this is your. Am I right about this? Like, this is where you trip the most. So you're trying to. You feel like you're trying to help people with it. Is it because you feel like you have an answer, or because you feel like the answer is getting a bunch of people together and just, you know, saying, this is a problem. We should all be paying attention to it?

[A]

This is a great question. Yeah, I think a little bit of both, I think. I remember when I was starting college, and I didn't know. I still had no idea what my life would look like with diabetes. I didn't know if anybody would want to marry me. I didn't know if I could have kids or if that was possible. I just had so. So many knowledge gaps. And I remember just wishing that if I could see somebody, you know, five years ahead of me living their life with type 1 diabetes in a way that it worked, that would really help, you know, if I. If I could just see how this could work in people's lives, you know, what's available. And the camps that I went to and then now volunteer at really helped me with those examples of people, you know, a couple steps ahead of me that had figured out that next chapter. But I went to a conference that was called Students with Diabetes. It's not around anymore. But it was Nicole Johnson, who was Miss America in 1999. She has type 1 diabetes, and she ran the conference, but she would talk a lot about her life, and she brought her daughter. And that was the first time that I realized that people with type 1 diabetes could have kids. In my 20s, you know, I just didn't know. And I just felt like, wow, if I. If I could. Just learning about how she lived her life really helped me figure out that I could live mine in more options than I thought before. And so it's that, you know, it's a little bit of wanting to pass on what I've learned, my trials and errors, and also knowing that when we bring people together and we feel like we're not the only one having the stress about diabetes, that it brings a sense of community that helps us grow. So I think it's both.

[B]

Can I dig into the I didn't know like that phrasing?

[A]

Yeah. Yeah.

[B]

You didn't know people could have babies, but you knew, but you just never thought about it. Right. Like, it just seemed like an impossibility or a thing you hadn't dreamt of yet, and then you saw someone because you didn't. Maybe I'm wrong, but you didn't fundamentally not understand that a person with type 1 couldn't have a baby. You just thought, like, how would that possibly work? Am I following that correctly?

[A]

No, I really didn't know if it was, like, if it would be something that would be healthy to do.

[B]

Oh, I see. Okay.

[A]

Yeah. I didn't know. I didn't know if it wasn't advised or if it wasn't possible. I really didn't know. Yeah, no one ever told me.

[B]

I think we're both saying the same thing, just slightly differently. So. Okay. You didn't think that if I met a boy and we had sex, a baby wouldn't come out? That's not what you were saying.

[A]

Right.

[B]

Okay.

[A]

Yeah. I didn't think I could. Couldn't get pregnant. I just didn't think it could work. Right. So there's.

[B]

Yeah, I understand. I just want to make sure I understood. I was like, she's a doctor. I was like, I don't. I don't.

[A]

Well, this was early 20s, right? This is like, right after high school when you're trying to figure out what you want to do for your life. And I just. I just didn't have a lot of women in my life with type 1 diabetes, and I didn't know it was possible to have a family.

[B]

I know exactly what you're saying. I. I don't mean to joke my way through it. I just. Right. Awesome. And what are you seeing, like, with your effort, like, twofold, with your effort with, you know, working in, you know, private practice the way you are, are you seeing better outcomes for people that start there at work? Like, do you. Are you seeing better outcomes for people? Are they happier? Are there real measurables that, you know, you can point to and say, look, this is really working for them, or are they still struggling? And you're like, oh, this isn't helping either.

[A]

Yeah, that's a great question. So there are always, I think, patients that you feel like you're doing your best to help, and they're not getting the improvement that you would want. But I think in the model, I'm in the direct primary care model, I have a lot of patients with pre diabetes that we reverse, a lot of people with type 2 diabetes that we can help lose weight and get off medications. I have a lot of patients who I teach about nutrition, and they find a food plan that works for them, and we have a monoclonal glucose monitor. We do a nutrition log, and we can make tweaks. We find a lot more nutrient deficiencies. Because I look for them. You know, I feel like the amount of care that we can provide is a little bit more holistic because we have more time to talk to them about their lives. And with the type of training that I got, I really do. I ask all my patients about their nutrition, their sleep, their movement, their stress level, their relationships, their family history, what their current symptoms are. Yeah, we have a lot more time to talk about those things. And so I think we find more answers. And patients who at least seek this type of care are often the ones that are motivated to change. And so I think it works for that way. It's not that I'm necessarily better, but I do think that it is not uncommon for me to help patients move the health trajectory in a right direction, not just put them on more medications.

[B]

If there's a person who's interested in asking, then you find that if you're able to deliver the answer to them, these are the same people who are more willing to follow through and try to make it work.

[A]

Work. Yeah, yeah, yeah, absolutely.

[B]

If in a regular practice, somebody came in, you were just like, hey, you don't have enough vitamin D. And they might be like, I don't care what you think, Dr. Person, and then not take their vitamin D. But if somebody came to you and said, hey, I am having a problem, I want to understand in any way that you can maybe make sense to me. I'm motivated to be here. I want to do something. You say, well, your vitamin D is low. Take some more vitamin D. That person might be like, God, awesome. Give it to me. I'm glad I found out about this. How does that feel when it goes the other way? Like, how does it feel to have somebody come into your office only because they have to, because they know if they don't come to see you, they don't get their insulin prescription, for example, and then you get there and highlight a bunch of things for them to do, and then three months later come back and recognize that none of those things happen. Is it difficult for you not to just feel like, oh, they don't care? Are you able to see all the other life things that might be possibly in the way?

[A]

This is such a struggle, I think, in medicine for people on this side, you know, is that there are two ways. I think it's hard when you. You want to help someone and you give them the tools that you think are going to help them, and they come back and they didn't apply them. That's hard. And it's easy. I Think, especially if a physician or clinician is going through burnout to just say, well, it's, you know, they weren't going to do it anyway. It wasn't on me.

[B]

Non compliant, not my fault, let's keep moving. Right, right.

[A]

But, but I can't do that because I feel like, I don't know, maybe that's my personality.

[B]

Well, maybe it's because you have diabetes and you know that there's more to it.

[A]

There's so much more. Yeah. And so I think, okay, well, I think, what did I miss? You know, what am I not, am I explaining it in a way where they're not understanding the importance of it? Am I missing that there's a big social, emotional barrier in the way of doing this? You know, is it that I'm not, You know, I really, I think I'm hard on myself in that setting because I want to help people who come to me regardless of their motivation to change. You know, I mean, they're coming to the doctor's office in order to get what they need. And as much as I can say things in the right way, describe the importance, highlight, you know, how it's going to be aligned with the things that are connected to their goals, you know, whatever it is. I think I'm constantly changing the way I present things or the way I ask questions to people because that's the goal. It's really hard to see people. You can't, you feel like you didn't help, right? It doesn't feel good, Scott. It's hard. And it's constantly helping me grow and become better at listening and better at explaining and learning what types of things are better to explain than others. And it's been interesting. I've got some patients that are engineers and I know they're data driven. These are the people that want the before and after lab. They want the study with a percentage risk. Like they're data driven. And there'll be other people who they, they don't care about the numbers. They don't want to know the prevalence of the thing or the risk. They just want to know how they can feel better. Right. And they want to talk about their emotions about it. And it's, it's so interesting trying to learn personality types as you, you are in medicine because the way you describe something matters so much.

[B]

For sure. I'm going to share something with you. Try very hard not to imagine it in your mind. But I was in the shower this morning, okay. And I was using my water pick because my dentist told Me so. And it occurred to me that if I had my old job working in a sheet metal shop that I had when I was 20, if I was still raising two little kids, if I was doing any other number of things in any other portions of my life, I would not have the time to stand in my shower water picking my gums. The only reason I'm able to do it is because I actually have the time to do it because of how my life is set up. Because I make a. I almost cursed. I make a podcast kit. And like, so if I take five more minutes in the shower, the whole world's not going to burn down or I'm not going to miss a bus or be late to something and somebody's going to fire me over, you know, like that kind of stuff. And then I started to think, how many people has this dentist told use a water pick who went, wait, I can't afford a water pick. Or they bought the damn thing and now it sits on the counter because they don't have any time to do the thing, you know, and then they get back to him and he goes, ah, these people, they just don't care about their teeth. Teeth. And I'm like, that's not the case at all, right? And I'm coupling that with this feeling, this idea. Something I've been doing with my daughter recently is I've been waiting for when we have quiet moments and I hug her but don't look her in the face and tell her quietly that I know she has to do more than most people. That's all. I don't follow it up with, if you need something from me, let me know. Or I don't, I just say, hey, I just want you to know I know you have to do more than most people. That's it. I just, I see you and that's all I give her when I do that. Because anymore and she gets uncomfortable if you give her too much time. I think if she looks at me, I think she, I think she feels like she's letting herself or me down. Do you know what I mean? Like, so it's just kind of a quiet voice that says, I see your life and there's a lot of decisions you're making and a lot of things that are happening to you that don't happen to other people. And you're still, you're still doing it. Like it's really quite something. And I just don't think that in a regular day to day she has time to think that like to give herself that positive feedback and that if I give it in the wrong way, even though it feels right to me because I've tried it so many different ways, but this is the way I found, like just a hug from behind. I see you. I know what's happening. I'm on your side. If you need something, that's it. Done. I'm seeing a real shift in our attitude over it too.

[A]

So that's beautiful.

[B]

I don't know how many people you have to talk to before you realize, like I'll, I'll tell you right now, I'll say this over and over again. I don't think people are non compliant. I think people are in just different situations where they don't have the time, the money, the expertise, the idea, whatever, all these different things that could help them, them to do this thing. Maybe they don't even realize how important it is. I've never met a person who doesn't want to feel well.

[A]

Right.

[B]

That's my point, I guess.

[A]

Yeah.

[B]

Yeah. And then I used to be very angry at doctors for not just pushing through it till I interviewed 50 or 100 of them. And I realized they're just people too. And they have sometimes very limited education. The education, you know, look at all the stuff you're trying to jam into someone's head before you put them out into the world. It's still not enough. They might not have a health issue, so they don't even understand. They're just giving you a, B and C. You come there, I can see how easy it would be to be a physician, sit in a room and go, my God, you made all this effort to come here and then you didn't do the thing. You're an idiot. And then why am I going to put my time into you? Because I barely have any time and I have kids at home and a wife at home too. And I've got to go home and live my own life. I don't have enough bandwidth for you not to, not to pull your own weight in this situation. And I can see how I would feel that way as a doctor and maybe lose sight of the fact that they also have those issues at home as well. The whole thing's just very delicate. So, yeah, I don't think there's a fix. I just think that if we put enough options out there that maybe enough options will cover enough needs, like in the way people need. You said something earlier about how everyone's different. You have to talk to them differently. Like maybe if there are enough options and they're lucky enough to find the one that fits them better, they'll have a better outcome.

[A]

Yeah, yeah, I love that. And I think you're right. It's priorities. I mean, that person that didn't take their vitamin D, you know, I don't know, maybe they have a family member in the ICU and that just wasn't the most urgent thing that month. Right? Yeah, you just don't know. And I think that's part of medicine is when we have more time with people and we can learn where they are and meet them where they are. That, that's, you know, that, that helps. You know, it's, it's like your dentist maybe if back when you had your kids and they were young, you said, you know, just try water picking twice a week, you know, for 30 seconds, not even two minutes.

[B]

Right.

[A]

Like maybe that's what you needed.

[B]

I'm exhaust. My kid has diabetes. I can't water pick my teeth. But thank you.

[A]

Right.

[B]

No, you know, you just said something. You use the vitamin D as an example. So let's like kind of focus on this at the end because I, I am very focused on this in my, in my own life and on the podcast too. Too.

[A]

Okay. Yeah.

[B]

Supplementation in many different ways. Like, I think if you say that out loud, people think you're talking about vitamins, you know, zinc D, stuff like that. Yes, that. But other stuff too. Like I now see my GLP medication as supplementation. My body doesn't have enough of something to do something optimally, and so I put it in artificially and it makes up the gap. Right. So the GLP to me feels like a supplement. I look at, you know, simple things. Vitamin D not getting sick as often, like that kind of stuff. I supplement myself with vitamin D every day. I think the problem with supplementation is that it doesn't flip a switch. So when you say to a 25 year old, hey, your vitamin D is low, just take this and a few months from now you're gonna feel better. By the time they feel better, they don't even remember it was from the vitamin D. And then they probably stop taking it. That's a huge problem in medicine. It's a huge problem with humans is that, you know, this has been proven over and over again. I think that it was, it really got a light shown on it 20 years ago around like depression medications. Like, people would come in depressed, they'd give them a medication, they'd stop feeling depressed. And the very first thing they would do when they stopped Feeling depressed was stop taking the depression medication because they were like, well, I'm not depressed anymore. I don't need depression medication. That's a very human thing. I just don't know how supplementing, how you're going to get it through to most people. When the masses here, oh, you took a GLP to lose weight, you're cheating. Like, when that's somebody's like, you know what I mean? Like, yeah, I don't know. Like, I. I feel like maybe there's always just going to be a segment of the population who's just not going to buy in. But how do you get people to, I don't know, take their vitamins on a basic level, especially with autoimmune?

[A]

Yeah. I think you. I think people are motivated to do something when they truly understand the impact that it can make on their lives. And like you said that instant feedback is more helpful. Right. Like, if you take insulin, we see it work immediately. Like, okay, I know that works. You know, I don't have to wait three months for the vitamin D to make a change. But. But I think that it. I think there's a knowledge gap, and when people understand the why, they're often more likely to. I have a lot of people who don't understand why things, you know, and it's. It's. That's harder. I think it's human nature to not do something if you don't really believe that it's going to do something positive.

[B]

Yeah, but.

[A]

But if you're bought into the science behind it, you understand it enough to know that it could be something good in the future. We do things that don't have instant gratification. Even though it is, you know, not as likely in society, it's still possible. And as humans, we do that, right? We, like, go to school forever so we can finally get the job we want, or we push gratification off, and it's often just a knowledge gap. So I think education is the answer for that. If people are concerned or struggling there,

[B]

I'll share this with you. I think that a portion of my job. I shouldn't say it that way, but part of what I do is I think I'm a cheerleader.

[A]

Yeah. Yeah.

[B]

I think I'm the person that stands behind you and goes, you could definitely do this. Like, you should go out there and start swinging your hands. I think you're gonna win. And did you get beat up a little bit? That's okay. We'll do it again. Learn from your mistakes. Try at, you know, and we'll go back at it a little better prepared the next time. I think that somewhere between information, community, not feeling alone, understanding that failure might be part of success, those things really are like, they're all paramount, oddly enough, mixed together, then delivered to you in the way that hopefully you can pick it up. But also, you said there's so many voices on the podcast that part of the reasoning behind having so many regular people on the podcast all the time is that no one out there listening is going to hear themselves in a diabetes influencer. You know what I mean? No one's going to hear themselves in the shiny mom the. That donates all of her time to the jdrf. I know they changed their name, but they shouldn't have because I'm not online.

[A]

I know. I keep saying jdrf, too.

[B]

Those voices are good to hear sometimes, but not every day, like, daily. It just needs to be people who have never once been asked to talk into a microphone and share their story. Like, that's my idea behind the way I do the interview stuff in the podcast. I just want people who have no story to tell, they think when they start, start, and then let them begin to talk. You know, hopefully they'll get out a little something that somebody listening will go, oh, okay, you know what? I, you know, that makes sense to me. I've seen that before in my own life. What did they say? Fix it for them, you know, and maybe move people in the other direction. I mean, do you do stuff like this often? Do you get interviewed with any frequency?

[A]

Off and on? Yeah. Yeah, I have. Yeah.

[B]

So you have a way that they kind of goes for you sometimes. Did it go that way today with me

[A]

as far as the question and answers and kind of the flow of things? Yeah, Yeah, I would say it felt good, definitely.

[B]

Okay, good.

[A]

Yeah, no, I'd say it, definitely. I think it's that. That question answer. But I love that when we scheduled this, we didn't have any topics, and I walked in today just wanting to connect with you and maybe share something that could help somebody out there. And I love that we just let our conversation go where it took us. To me that that's, that's more authentic and it, I think it gets us further. You know, it's sharing things.

[B]

I listen, I'll tell people listening right now, I mean, we're, you know, we're. We're at the end here, we're done. But I'll tell people right now that when you said, like, how the practice you, you work in and what you do. And when you said, I have a YouTube channel, I want you to know, and I don't mean this disrespectfully. I had no idea about any of that. I was like, oh, that's interesting. Part of my preparation is not understanding what it is I'm about to talk about, because I just think it lends to me, I don't know, saying stuff that anybody would say in that situation. I try really hard for that not to happen. Like, a couple of times during this conversation, you said, oh, that's a good question. And I thought, she's either very well born and knows how to make me feel good, or I actually asked her a good question.

[A]

No, you definitely, I think you asked me questions I really care about, you know, and things that we talked about today are so important to me. And it wasn't, you know, just like, what are the rates of this? Or what's the prevalence of that? Or, what do you do in this situation? Medically, you know, is the real kind of truth behind my life. And so I appreciate your perspective there.

[B]

Oh, I'm glad. I appreciate that. The truth is, is that if somebody thinks, oh, I'm going to go on that podcast and it'll make my YouTube channel bigger, like, stuff doesn't work that way.

[A]

Right?

[B]

I can't do anything today that's going to help you. You're going to go make that thing, and I'll tell you right now, here's how it's going to work. You're going to go make that thing, and if it helps people, they'll tell somebody else about it.

[A]

Right.

[B]

You know, I got approached recently about going and, like, doing an interview somewhere, and person was very nice. And absolutely no, like, nothing against, like, the idea of doing it, but I was like, I don't really want to do that. I don't see the point in it. And, you know, like, what am I going to go talk people into liking me and then they're going to come try what? They'll grab the wrong episode once. They'll be like, that guy's asshole. And I'll be like, oh, great, there we go. All that work to get somebody to listen once in the. And the one episode they pop onto, they, you know, they didn't like a thing I said or, you know. You know, a person told me recently it took him a while to get started with the podcast. The parent of a child with type 1. Imagine this if you can, Hannah.

[A]

Okay?

[B]

First episode that comes on for her is a woman telling the story of The. Of the school nurse giving her daughter 200 units of insulin by mistake.

[A]

Oh, no.

[B]

Yeah. Can you imagine if that was your first episode of the podcast? Oh, my God. Right? Somebody's like, well, you come and you'll tell your story. And I'm like, ah, I. I don't. I don't want to. Please leave me alone.

[A]

Right. Like, you've got the people, Sky.

[B]

I'm like, leave me alone, please. I just don't know, like, what the point is. And that person was like, well, you'll expose yourself to a different audience. And I was like, I don't care. But I didn't mean I don't care like that. I meant, like, if this. What I really come to believe is that if this doesn't grow organically through. Helped people telling someone else, then. Then the growth is sort of meaningless.

[A]

Right. Yeah.

[B]

So anyway, like, you know, I hope your thing does great, but. Because.

[A]

Thanks.

[B]

Yeah. Because if it does, it'll mean you're helping people. People.

[A]

Right.

[B]

You know, and I want that. That's the thing I want.

[A]

Well, you're doing great there. I was. I was telling my husband last night, it's like, oh, the Juice Box podcast. I don't know anybody with type 1 diabetes that doesn't know about this podcast that heard it from somebody else with type 1 diabetes. I mean, that's. That's it. I mean, that's. It's really amazing how well you spread yourself, but it's amazing that it's all through word of mouth. But I think a lot of people can see themselves in you. You know, you're a parent that cares deeply about their child with type 1 diabetes, and you're trying to figure it out, you know, and. And then you're interviewing other people doing the same. And I. I think that it's. It's kind of a calming voice just to know that, hey, somebody did it. I can do it, too.

[B]

I appreciate that. Thank you. And I have a nice, deep voice. Really? That's really all that matters. So you have a nice speaking voice, Hannah. That must. People must like listening to you. Do you work? Do you use a lot of lighting and all that stuff? Or are you just, like, holding your phone up in front of your face or what are you doing on.

[A]

I live in an apartment pretty close to downtown Austin, and they actually have a. Like a. They call it a podcast room, but it's basically like a little kind of wework space.

[B]

Yeah.

[A]

And it's never. It's never used. So I just go in there with My phone and balance it in front of the window and it's like a little bookshelf background. That's all pretty and nice. That works out pretty good.

[B]

That's awesome. Good for you. I'm glad you're enjoying it. I really hope it does what you hope for today. Do you can tell people? How do they find out? Please.

[A]

I am on. I'm Dr. Hannah Parr on Instagram and on YouTube and that's probably the best place to get started.

[B]

P A, R R. Hannah. Classic spelling.

[A]

Yes. H A, N N A H. Yeah. And it sounds funny to say that because I just changed my name just this past month. So I feel like I'm introducing myself newly with the new last name.

[B]

Oh yeah, you got married and you had to change. Did you want to change your name or did you that. Was it a sticking point?

[A]

No, I really wanted to. I like that we had a unified family name growing up and so that was important to me. But I kept my maiden name as my middle name now, so it's still a part of me.

[B]

Question you don't have to answer, but I'll, I'll end on this because I find the people your age and like younger people have real opinions on this. Do you combine your money? Did you get one bank account or are you keeping your money separate?

[A]

Oh, you know, this is such a good question. When we started talking about this, we're like, what do people do? We don't even know. We asked chatgpt. We were lost. I mean, really, it was like, what's a. What are ways to strategize this? So we combined our finances, but we are keeping our own, like our personal savings that we have up until now in our 401k retirement stuff. We're going to keep that all in our own name and then have a combined checking account where our paychecks go. And we like live out of that.

[B]

Look at you. Very old fashioned. Very nice. Yeah, I like it.

[A]

Yeah, it's. It was interesting. It's kind of. It's something I hadn't thought about a lot before it got time to figure it out.

[B]

I'm pretty old. I'm from the world where my money is her money and her money is her money. And that's how that works. And then they just let me eat. So I think it's fantastic.

[A]

It's like the one pot strategy. That's what my dad's like right now. It's like we just have one pot and we figure it out from there.

[B]

And I like that we're either in this or we're not is kind of how I figured it. Well, good for you. I, I, I wish you a ton of success. Sounds like you're going to build a family soon. I hope you have a lot of good luck with that, too.

[A]

Thanks.

[B]

Thanks for coming on and doing this with me.

[A]

Yeah. Thank you so much for the opportunity. It was great to talk to you more, and I just, I'm so impressed with what you're doing and just so glad that you're a voice for people.

[B]

Oh, you're very nice.

[A]

You've helped me and countless people, and it really, I think you're very humble and how you talk about how people wouldn't like you, but it really does change lives. And I know you know that, but it doesn't hurt to hear it again, I'm sure.

[B]

Thank you. I, like, I find if I mix my humility with my sarcasm, it's hard to understand what I'm saying. And then it's pretty much, Much. That's the only level of comfort I can find in all this. The truth is, like, Hannah, seriously, I, I won't, I won't bore you any longer, but I am not completely comfortable being the person who's helped all these people. It's hard to be comfortable with that. And it's hard. And it's hard. It's difficult to say out loud what you've done, because then it just sounds. It's garish. You know what I mean? Like, I mean, I could sit here and lay out for you what I think I've done for people, and I think it's all, I'd be accurate about it, and it would sound like I was bragging, bragging, but I don't feel braggadocious about it at all. And so when somebody says something nice, you just kind of go like, oh, thank you. Because you, because either I'm gonna say, oh, no, you're being too kind, or I'm gonna go, no, you're actually. You're right. But you haven't said enough. Let me explain to you, right? I don't want to be that person, because I'm not. And the other person, that just kind of feels uncomfortable. I'm trying hard not to feel uncomfortable, so. So I just use sarcasm and bad humor to try to skirt my way through it, which I think I'm doing pretty well so far. Thank you. I really do appreciate it. Hold on one second for me. I'll let you get back to your life, okay?