A (3:13)

Okay. And any other autoimmune issues in the family?

B (3:18)

And not really on my side of the family. My. My husband has an aunt who has autoimmune issues, a half brother who had type 1 diabetes. So I think it comes from his side of the family. Yeah, Yeah.

A (3:33)

I mean, listen, Julie, it's fair. Go ahead and blame him for a second. Let's get.

B (3:36)

Right.

A (3:37)

Let's get that guilt off you if we can. Okay.

B (3:39)

Well, he. He would agree.

A (3:41)

So listen, still, it's worth saying if it makes you feel better. So the. The aunt with issues, do you know what they are?

B (3:49)

Not in total. I mean, I think she had. I want to say she had type 2 diabetes. She's. Other than that, I'm not exactly sure.

A (3:57)

Oh, so autoimmune wise, like, she doesn't like celiac or thyroid or anything like that?

B (4:03)

I'm honestly not sure. No, We. She lives. She lived in Michigan. She. She's actually passed away, but she lived in Michigan, and we. We barely saw her. So I didn't know the extent of it, but it was his half brother that he had several autoimmune.

A (4:19)

Oh, okay.

B (4:20)

Type. Type 1 being the main one, but he also had some, I think, psoriasis and things like that.

A (4:27)

Gotcha. A half brother on his father or mother's side? Mother's mother's side. Okay. And let's see, you two kids. Type 1 diabetes with the youngest, but nothing else.

B (4:38)

Yeah, I mean, my. My husband has some autoimmune things, but not anything.

A (4:43)

Well, what's he.

B (4:44)

Yeah, he does have. He does have autoimmune issues as well. Not diabetes, but. Yeah.

A (4:49)

Would you share with me what they are?

B (4:50)

We just discovered, actually, that he has thyroid hypothyroidism, and then he also has sort of colitis.

A (4:57)

Is that something. It's been throughout his life, since he's

B (5:02)

been about 22, I believe. Okay, 22, 23.

A (5:06)

So a lot of bathroom visits throughout his life, but we just, like.

B (5:08)

Unfortunately, lots of colonoscopies, which he's not thrilled about. Enjoyed very much.

A (5:15)

Yeah, it's all about your frame of mind, Julie. The thyroid, how did you figure it out? Did his mood change? Was he having trouble getting arrested?

B (5:28)

He did feel like he, more than anything, just was low on energy, but, you know, it wasn't something that he sought out lab work for. He just, you know, we went for annual wellness checkup, and he tested low, and so it was like, oh, well, that may be part of the explanation, so.

A (5:47)

Okay. Awesome. Did it help? The Synthroid?

B (5:50)

Yeah, I believe so, yeah.

A (5:51)

Yeah. Did you notice anything, you know, like, personally about him, change, or is it more about his. His energy?

B (5:57)

I think it was mostly about his energy, yeah.

A (6:00)

Okay, well, I appreciate you sharing that with me. So let's see. Your son was diagnosed about three years ago.

B (6:05)

Yes.

A (6:06)

How did you notice that? What were the signs?

B (6:10)

Yeah, so that was. It was kind of crazy because he was 15. I didn't know that he was going to the bathroom probably a lot more than he was before and drinking a lot more water. I noticed that he was tired a lot. And my. My husband, we took, you know, first day of school picture, and he was like, he looks so skinny. And I was like, well, you know, he's. He's had a growth spurt, so, you know, he'll fill out. It'll be fine. And in the midst of this, I was literally becoming accredited to be a diabetes educator, so.

A (6:47)

Seriously?

B (6:48)

Seriously? Yes. So then I don't. I can't tell you what. What prompted it, but one night I came home from work and I said, of course I'm. I had a. I had a glucometer at home because I'm a pharmacist nerd. And, you know, I just test everybody's blood sugar every once in a while just for the heck of it. And so I. I said, let's just check your blood sugar. And we checked it, and it was 578. So I said, okay, um, let's check it again, because I think maybe that's a mistake. And so we checked it again, and it just said, hi, because it only goes to 600, I suppose. I said, well, let me check mine. And it was 119. We just eaten. So we checked his again. Hi, Julie.

A (7:36)

Julie's like. Then I checked his blood sugar 63 more times.

B (7:40)

I was truly in denial. I mean, I knew the first time I was like, this explains a lot. And. But I didn't want to really admit it to myself. And so after. After checking it three or four times and we headed to the local children's hospital er.

A (7:59)

After you yelled through the house, hey, poop boy, see what your aunt did?

B (8:04)

Right? No, but, but, but, yeah, No, I was like. He was. We were. We were both. We were all in shock. But, yeah, we went to the er and he wasn't in dka. Thankfully, he did catch it pretty quick. Yeah, he was. I mean, he was close. And I mean, looking back, you know, in retrospect, I think that he had had Covid in June and of that year, and this was October, and I think that was sort of the trigger. If it hadn't have been that, it probably would have been something else. I don't know that, but that's just my best guess. Yeah.

A (8:36)

Let me ask you, the things that you said, you said that explains it. Explains what? What had you been seeing?

B (8:43)

So, mainly the tiredness and the. Just. He looked very skinny.

A (8:48)

Yeah.

B (8:49)

Nothing else, which I had tried to,

A (8:52)

you know, justify because you said nature's been stretching him. This is. This makes a ton of sense.

B (8:58)

Yes. And then I started remembering I would take him to tennis, and he said, well, I've got to stop and fill up my water bottle and go to the bathroom first before I even get on the tennis court. And I was like, we just got here from home. And it didn't ring any bells at that time. But then later, you know, in looking

A (9:18)

back, you start putting pieces together.

B (9:20)

I started putting the pieces together, yes. Like, he had never come home with an empty water bottle from high school before.

A (9:26)

I know you're praying they'll drink water and they never drift. Right.

B (9:29)

And every day it was completely empty.

A (9:32)

Tell me something. You been a pharmacist? Can you tell me how old you are now?

B (9:37)

I am 50.

A (9:38)

Okay, so you've been a pharmacist since you. I'm guessing you got out of college.

B (9:42)

Yeah. So pharmacy school. So I graduated pharmacy school in 2001. So, yeah. This will be my coming up on 25 years as a pharmacist.

A (9:51)

But that makes it your silver anniversary, is that right?

B (9:53)

Yeah, I know.

A (9:54)

I think you get a T set.

B (9:56)

Yeah.

A (9:58)

So you're doing that for 25 years.

B (10:00)

Right.

A (10:00)

What prompted you to want to be a diabetes educator?

B (10:04)

You know, it's interesting because it wasn't obviously, when I decided to do that, I had no idea that my son had diabetes. But my pharmacy actually. We sort of stumbled into actually getting involved in the Omnipod world, because we are a pharmacy that does medical billing. And Omnipod was running into some roadblocks with getting it covered through pharmacy benefit for some patients. And so they asked us, can you medical bill it? And we said, hey, we'll give it a shot. And. And we did. And then we just started working with the Omnipod rep. And so we were. We were very. Started getting very involved in the diabetes Community. And then it just was sort of a good fit, we felt like, for our pharmacy to kind of make that a focus.

A (10:48)

Right.

B (10:49)

So, yeah.

A (10:50)

Was it a business decision or did you feel some sort of kindred spirit towards it as well?

B (10:55)

I think it was a little of both. Diabetes has always been a very interesting disease state to me. One that I felt. I thought. One that I thought I knew a lot about. And I felt really comfortable in that space. Of course, until he was diagnosed and then I. I didn't know what. I didn't know. It was. That was. That was really interesting.

A (11:18)

People used to come up to you and be like, julie, tell me about diabetes. You say, well, let me just sit back and explain it to you. And then your son was diagnosed. You're like, I don't know, don't ask me.

B (11:26)

Right. Yeah, it was very humbling. And you know, when they roll in the whiteboard with all the car counting and correction factor calculations, I was like, I gotta. I gotta go for a walk.

A (11:40)

He's old enough. He'll be okay. I gotta. I'm.

B (11:43)

Yeah, no, yeah. And honestly, like, he, he was like, he took one look at and he's like, I got this. So he was, he really took it in stride way more than his dad and I did. Like, we, we were. Our. Our worlds were turned upside down. I feel like I felt like I was bringing home a newborn. Newborn baby from the hospital. Truly.

A (12:01)

Even though you're a bit of a veteran parent at that point, right? I mean, because if he, if he's 16, that means your other son was. Is three years older already, right?

B (12:11)

Yeah. Yeah. He's. Huh.

A (12:12)

Yeah. You're like, two kids are like, you're like, these kids are going to college and like, we're going to go live our lives. This. A whole thing is happening. Right. And then you're like, I don't know what I'm doing anymore and we're starting over.

B (12:21)

Yes.

A (12:22)

Oh, geez.

B (12:23)

Yeah.

A (12:24)

Did it hit your husband and you differently?

B (12:26)

I think so. He's. My husband is a physician and not in the diabetes world that he's a physician. And so he, you know, everything was from a medical perspective. He starts thinking about, okay, you know, complications. We gotta, we gotta make sure you're on a routine. We gotta, you know, he was worried about just all of the. The medical side of things, I think, and I was too. Of course, I'm in the medical field, but I think it was possibly a little more emotional for me as a mom. Just, you know, the worry dial gets cranked up quite a bit. It's already there, but it definitely got cranked up quite a bit.

A (13:05)

Would you talk a little more about that for me? Tell me how you were feeling and what you did to get through it.

B (13:11)

Well, yeah, so I, I mean, it was almost kind of a sense of grief, I would say, you know, grief for him because this is like, you know, he's not going to. And my husband felt a sense of that too. Like he can't just be a regular kid anymore, a regular teenager that he has to, you know, now be thinking about this all the time. And, and, and so that was part of it. And then just for me, just as soon as he was discharged, being a pharmacist, I went straight to my pharmacy and I was like, I'm putting him on a Dexcom. I'll worry about the prior authorization stuff later, but I want a continuous glucose monitor. I. They wanted us to do finger sticks for two weeks. I'm like, I'll do that, but I've got to have a Dexcom, the Follow app and all of the things. And. Yeah, no, I just mostly worry and, and sadness for him and just not being able to be a regular kid and, and, and also just, it just felt overwhelming.

A (14:04)

Yeah, okay. So you said there he was, he's not gonna have a normal life anymore, but it's three years later. Did any of that prove out to be true? Or where are you at today? Like, does it feel like he doesn't have a normal life or does it feel like you figured something out? The Dexcom G7 is sponsoring this episode of the Juicebox podcast and it features a lightning fast 30 minute warmup time. That's right from the time you put on the Dexcom G7 till the time you're getting readings. 30 minutes. That's pretty great. It also has a 12 hour grace period so you can swap your sensor when it's convenient for you. All that on top of it being small, accurate, incredibly wearable and light. These things, in my opinion, make the Dexcom G7 a no brainer. The Dexcom G7 comes with way more than just this. Up to 10 people can follow you. You can use it with type 1, type 2, or gestational diabetes. It's covered by all sorts of insurances. And this might be the best part. It might be the best part. Alerts and alarms that are customizable so that you can be alerted at the levels that makes sense to you. Dexcom.com Juicebox links in the show notes links@juicebox podcast.com to Dexcom and all the sponsors. When you use my links, you're supporting the production of the podcast and helping to keep it free and plentiful. Today's episode is also sponsored by Omnipod. We talk a lot about ways to lower your A1C on this podcast. Did you know that the Omnipod 5 was shown to lower A1C? That's right. Omnipod 5 is a tube free automated insulin delivery system and it was shown to significantly improve A1C and time and range for people with type 1 diabetes when they switched from daily injections. My daughter is about to turn 21 years old and she has been wearing an Omnipod every day since she was four. It has been a friend to our family and I think it could be a friend to yours. If you're ready to try Omnipod 5 for yourself or your family, use my link now to get started. Omnipod.com juicebox get that free Omnipod 5 starter kit today. Terms and conditions apply. Eligibility may vary. Full terms and conditions can be found@

B (16:20)

omnipod.com juicebox no, I mean, I would say that just like when you have a baby and you feel like you're never going to sleep again. Same thing here. I felt like we're going to be spending 30 minutes calculating insulin doses before every meal and he's taken it in stride for the most part. You know, it's not easy and I would like to say as a diabetes educator and pharmacist that I, I've got it all figured out and that he doesn't have highs and lows and he just coasts along with 100% time and range every day. But no, not so much. And for the most part, yeah, he lives a normal life. He's a freshman in college now. He enjoys, you know, the things that normal teenagers enjoy, video games and all that. He enjoys playing tennis. Still, he all of those things. So I would say yeah, he has a normal life, but it's still always at the back of my mind and I'm sure at the back of his to some degree. Although sometimes not as much as it should be. I get frustrated with them sometimes.

A (17:27)

Yeah, listen, you would have gotten frustrated with him even if he didn't have diabetes, I betcha.

B (17:32)

Oh yeah, definitely. For sure.

A (17:35)

How does this experience of seeing him live with it, watching the things that your husband went through, experiencing what you went through, is that helping you in your job? Like you say you're a diabetes educator, but like day to day, what is it you do. And has your experience been valuable in that?

B (17:51)

Absolutely. Yeah. So I think that it goes both ways. I think it makes me more empathetic as a pharmacist in general, but also working with diabetes patients. I get it. I did not get it before. I could talk about all the medications and the technical things, but in the eating and exercise and everything. But in terms of just the coping and emotional side of it, I didn't get that part. So it definitely puts a different spin on that. But on the flip side of that, I learn a lot from the patients that I have worked with, the groups that I've gotten involved with. Breakthrough T1D is great. And other mom, other parents, just all of that. I think I've, I've learned ways to help him. In fact, I was listening to a few of. I went back and listened to, to your omnipod episodes because I was like, he has a lot of lows in the middle of the night still. And. But it's because he's 19 and he stays up till 4am and it's hungry and eats and then takes an insulin dose and goes to bed.

A (19:10)

I'll fix this high blood sugar. Do what he said, I'll fix this high blood sugar, gives himself a bunch of insulin and goes to bed. Right?

B (19:17)

Yeah. Or, or he'll eat something. And you know, I've from listen, you know, it's like that time of night, you know, he's going to be more sensitive to the insulin and so he's, he doesn't, probably doesn't need as much and so you wouldn't think you would need an insulin to carb ratio difference at, you know, between 10:00pm and 4:00am but you know what, I set one for one to 14.

A (19:41)

Yeah.

B (19:42)

And during the day his is like one to eight or one to nine.

A (19:45)

When you say you wouldn't think you'd need a different one, why would you think you wouldn't need a different one?

B (19:50)

Well, because most people aren't sleeping or aren't eating in the middle of the night.

A (19:54)

So maybe they all need it. They just don't know because they don't eat in the middle of the night.

B (19:58)

Maybe. Oh, but yeah, I, I just did that like three days ago. I didn't do it. I told him, please, let's just try this and see what happens. So far so good. So I don't know, I think maybe that might be at least something that helps all of us get some more sleep. I haven't been able to turn the follow up off just Yet. So I don't know.

A (20:23)

Why would you want to?

B (20:25)

I don't know. I mean, I guess, I don't know. Part of me says he's an adult and I want him to be able to manage it, but part of me says, you know, nobody else is looking out for him other than him. And, and he might sleep through.

A (20:40)

And so, so let me say this. I talk to adults who, you know, vary in every decade of age. And you know, they all mostly tell me, I wish somebody could watch my blood sugar for me. It's funny, the people who have somebody watching their blood sugar for them will say, I don't need anyone's help. And you know, and, and you know, it's a, I don't want people watching me and blah, blah. And the people who don't have somebody helping them are like, oh, I wish somebody would help me.

B (21:10)

Right.

A (21:10)

People are fickle.

B (21:12)

They are. You always want what you can't have.

A (21:15)

Well, you know what, I think that's the saying for a reason, probably.

B (21:18)

I think you're right. I think you're right because we, you know, we bug them. We'll, we'll text them at three o' clock or hey, are you up getting something to eat or drink? And he'll, you know, I'm surprised he didn't send us just a bunch of eye roll emojis.

A (21:33)

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B (22:48)

Yes, and I think that he understands the why behind what we're doing. Obviously, you want your kids to listen to you whether they have diabetes or not. Right. But when they're teenagers, they. They think they know everything. I took him to a diabetes educator. That's not me. Because I wanted someone else to echo what I was saying so he would not think that I'm an idiot, basically.

A (23:15)

What were you telling him?

B (23:17)

Well, just that he needed to eat more real food, that he needed to have a routine, that he needed to have more balance in his. In his meals in terms of carbs and vegetables and proteins and all of that. He's. He's always been super picky. You know, it's hard to get him to. To eat a lot of different things. But yeah, just.

A (23:42)

Is his biggest issue the quality of the food that he eats?

B (23:45)

I think that's a lot of it. Yeah.

A (23:47)

How long has that been the issue

B (23:50)

with his diabetes or just in his life?

A (23:52)

However, like, whatever amount of time that occurs to you to say that, like so. Because forever. So then can I ask a difficult question?

B (24:00)

Sure.

A (24:00)

Who buys the food?

B (24:02)

Well, that's a fair point. Now, that being said, in college, I have no control over it. And at home, at least for dinners, I always made the point of. And even lunches, I packed his lunch. And it was. I feel like I packed him a fairly healthy, balanced lunch. And I always, you know, for the most part was the. At dinner was like, okay, this is what we're having, and if you don't like it, then you need to learn to cook something else for yourself. Because I'm not going to cook, you know, multiple meals at dinner. But I have, I mean, I have modified things to make it to more plain, I guess. Yeah, but. But yeah, no, I do at least try to get him to eat healthy and put the food in front of him, and I've always done that.

A (24:50)

Do you eat that way?

B (24:52)

Yeah, for the most part. I mean, I can't say I'm. I eat perfectly, but yeah, I feel like I eat pretty healthily. And I've always. It's been important to model that for.

A (25:01)

That's what I was wondering. Like, are you. You're modeling that behavior? It's just. He's just not picking it up. Does your husband eat similarly or does your husband Know.

B (25:08)

Oh, yeah, he probably. He honestly probably eats healthier than me.

A (25:11)

Gotcha. But the damn kid won't listen.

B (25:14)

You tell him, right? Yeah. But no, yeah, we've. I'm the primary cook, and so it's always been, you know, it was like, okay, you know, I'll make you some Mac and cheese. I was that mom who would. I would puree squash and spinach, and you're trying hard stick it in there. Yeah. To get some vegetables in them, so.

A (25:36)

Well, so let me ask a different question then.

B (25:39)

Sure.

A (25:40)

If that's just how he eats, then what is the outcome that you're, you know, you're telling him, please don't eat that way, and you're telling him, I'm assuming, A, for nutrition and just quality of food. But B, it's.

B (25:50)

Right.

A (25:51)

It's difficult with his diabetes. Right. What makes it difficult? Because, you know, my kid doesn't always eat very well, but, like, we kind of bolus around it and everything. Is he not doing something else that would lead to success even with that food?

B (26:04)

I think he's pretty good at, you know, if he's gonna sit down and eat, you know, half a bag of marshmallows or something, just get.

A (26:13)

Has that happened?

B (26:13)

Which. I mean, probably. Yeah. I mean, where, you know, he. He does. He doesn't. He goes all in when he eats something, you know, or, you know, half a bag of chips, whatever it is, like, he does a pretty good job of. Of, you know, pre bolusing and with time, you know, earlier, if he's just gonna have carbs and counting the carbs pretty well. So. So he. He. He does a pretty good job of managing for what he eats. It's more just the quality of it, and, like, it would be easier, and we feel like if. If he would, you know, and just better for him if he would just eat better food.

A (26:56)

Well, I mean, listen, I agree with you. I'm not saying that. Yeah, yeah. What. What I'm interested in is, you know, I mean, listen, it's. It's a. It's an interesting juxtaposition. Right. You're a diabetes educator.

B (27:08)

Right.

A (27:08)

I'm jumping to the. The conclusion that, you know how to handle, like, carby or, you know, processed foods as. As a, you know, as a person bolusing for them and that you guys. So is it a situation where if he's bolusing for it, it doesn't go well, but if you were to bolus for it, it would go well, or is it just physiological where, like, no matter what you do, you kind of can't make it work. By work, I mean no big spike in a meal, no low later. That's all I'm talking about.

B (27:35)

I think he probably honestly does better than I would in terms of pre bolusing and stuff. I think it's more about, you know, the physiologically and, you know, as, you know and yeah, as I've learned that there's so many things, you know, he's a teenager with hormones and all that

A (27:57)

and it's a lot.

B (27:59)

There's just lots going on. Stress, school stress. And so it's hard to. I'm trying to learn. I'm actually listening to that thing like a pancreas right now on Audio Audible, but just trying to factor all those different things in. I don't. I think we're both sort of trying to figure that out.

A (28:19)

So. Have you heard the Pro Tip series in the podcast?

B (28:23)

Some of it. Oh, but I need to work my way through it more.

A (28:27)

Yeah, yeah. Has he or did you show him?

B (28:30)

Well, I have, I have, I have shared it, believe me. I've, I've. I share episodes with him all the time. I tell him, go listen to this podcast. Listen to this book on Audible. I don't know if he listens to any. Follow this person on Instagram because they really have a lot of good advice. I don't know if he listens to anything I say.

A (28:49)

Have you tried saying, hey, listen to this series and this podcast and if you do, I'll pay your tuition or you could come home?

B (28:58)

Unfortunately, that ship is sailed, baby. We're already paying his tuition, so I could probably make it. I could come up with another deal, though.

A (29:07)

He swipes his card for food and there's no money there. And you go, oh, oh, oh, did you want money?

B (29:13)

Right, Right. Did you want me to pay for your gas? Maybe for the next six months.

A (29:18)

Oh, yeah, yeah, yeah. How would you like to drive again?

B (29:20)

Yeah.

A (29:21)

But seriously, like, what a tough time? Like, diagnosed at 16.

B (29:25)

Yes.

A (29:25)

Right. In the middle. High school. Towards ending high school, off to college. Did he go away to school or is he at least local?

B (29:30)

He is local. So that, that gives me a little more peace of mind for sure.

A (29:36)

Local sleeping away or local comes back to the house every day?

B (29:39)

Well, no, he's in the dorm. He comes home a lot of weekends, but he does. Mostly he's in the dorm.

A (29:45)

He come home with his laundry.

B (29:48)

You know, he doesn't come home with,

A (29:50)

like, he might like you then. That's nice.

B (29:53)

He has yet to bring A sheet tone with. I'm like, please tell me that because you haven't washed them. And he assures me. Because he's texted me on how to. How to manage it, but he assures me he's washed them at least a couple of times, so.

A (30:06)

At least a couple of times. He's a senior, right? No, I'm just kidding.

B (30:10)

Freshman. Yeah. Right.

A (30:12)

Well, it's. I mean, it's all. It's very, very interesting. So when you do your job, are you doing it in a health care facility? Are you doing it for a company? Like, how. How do you. Like, what does your job entail?

B (30:25)

My pharmacy has a. Actually has a classroom, and so we have a space to. To. To offer the education. And so we just. We depend on referrals from physicians, and we've sort of made the rounds to let them know we do this. And it kind of ebbs and flows in terms of having patients to. To provide the education. But yeah, we have. We actually have the facility there. There in the pharmacy.

A (30:50)

How'd you get your 10,000. I don't know how many hours is how many hours, how many hours you need to become a. A diabetes educator? But how did you get those hours? Did you work? Like, where'd you do the work?

B (31:00)

So there's a certified diabetes educator, which you have to get, like, I believe a thousand hours and take a test to be a certified diabetes educator. Recently, I don't know, in the last couple of years, they've decided pharmacists, like, have the knowledge base to educate on diabetes, but we still need to be accredited, so I didn't have to get all those a thousand hours to be a certified diabetes educator. So I'm like, I think it's just like a diabetes care and education specialist, but I'm not a certified diabetes educator.

A (31:33)

Okay, I see. So your. Your previous schooling made up for some of it. Then you do. What did you do classroom work or how did you get the rest of it?

B (31:44)

Well, no, so it was all just. There's an accreditation process where you just kind of work through, like, what are the different modules you need to teach when you're teaching someone about diabetes. And then. And I. And I have. And I get. I have to get 15 hours of continuing education every year that are diabetes focus for this to. And just to keep up with. With, you know, all the. All the changes and everything.

A (32:09)

So I would like someone to send me that accreditation in the mail right now.

B (32:14)

I can email my certificate.

A (32:16)

No, no, I want my own. I. I want people to Listen to the podcast and go, okay. And then just give it to me.

B (32:21)

You probably earned it. I think you have enough hours that you definitely earned it. And, and like you really, truly give some great advice and have some great guests.

A (32:30)

So you're very nice. I, I would not do the 15 hours of a continuing education. I would lose it the first year.

B (32:37)

Well, what stinks is like I have to get 15 hours for pharmacy too. And anyway it doesn't in some of it doesn't have. It has to be another thing. So I end up getting like twice as much as I have to, which is really.

A (32:50)

Is it valuable though? Do you find it to be valuable or is it part of the.

B (32:53)

I do find it to be valuable. I do definitely. And so, and I'm also, I also am doing the insurance. I have an insurance licensed insurance agent as well. And that's. I know that sounds crazy, but it actually help our patients understand insurance more. Mostly Medicare. But we do a lot of helping people jump through the hoops of getting things covered, which is a huge problem in diabetes, as I'm sure you're aware. That's one of the reasons why like we're, we try to be kind of a go to place because we chains tells you they can't fill something, we'll just come to us and we'll, we'll problem solve it to death to make it work.

A (33:35)

What else is going on in the back of that farm is you guys got cockfighting and card games back there too or what? What?

B (33:42)

Yeah, we've got all kinds of stuff. Yeah, we do a little bit of everything.

A (33:46)

Yeah, there's a dice, there's a dice game back there for sure. Yeah, but is that a byproduct of like small town, like living like trying to put a lot of services in one place for people?

B (33:59)

I would say so. And just part of it is independent pharmacy or local pharmacy is a, is becoming a dying breed for a lot of reasons that would take me hours to explain and you'd probably fall asleep listening to it. But we have to be creative and innovative in what we do to, to stay alive and get the privilege of doing that in something that I enjoy. So yeah, it's not just about dispensing medications. It's more to us about taking care of our patients. And so that means educating them on diabetes. That means helping them pick an insurance plan. That means helping them problem solve insurance issues, getting their Omnipods or CGMs covered and teaching them how to use it, whatever, you know, whatever they need.

A (34:47)

So yeah, it's almost like a community center, but for. For health issues, right?

B (34:53)

Yeah.

A (34:53)

Yeah. Because I guess once they're done, what is the real finding here? Like, let's be honest for a second, Julie. They go to the hospital, they get a basic overview that's probably not very valuable. Then they go to a doctor who's. What? Not as. Not very valuable, too, who then passes them off to you and says, hey, try to help these people. Is that the. Is that the process?

B (35:12)

Yeah. I mean, generally, of course, in the setting that I'm in, I'm mainly saying type 2 people with type 2 diabetes.

A (35:19)

Okay.

B (35:19)

You're automatically going to be seeing an endocrinologist. Not everybody gets fabulous care when you're. They're type one, but you get more attention, for sure. And type two, it's like, stop eating the white stuff. Get some exercise, and, you know, here's a prescription for Metformin. Have a nice day.

A (35:36)

Wow. It's no cookies, crackers, or cake. Here's your Metformin. Good luck.

B (35:40)

Yeah. No cookies, cake, pasta, or bread. Stop eating that stuff and. And have. Yeah. I mean, it's very, very limited. I mean, partly because they just don't have time. Yeah. I mean, there's just only so much they can fit in. And so that's where I try to come in and. And be more thorough and really give them some more tools.

A (36:01)

Are you seeing doctors talking to Type twos about GLPs, or is that not even commonplace at this point?

B (36:07)

Oh, yeah. Type twos or type.

A (36:10)

Type twos.

B (36:10)

Oh, yeah, yeah, we. Yes, we. Very commonplace. We. Yeah, I see. I see. GLP is a lot.

A (36:19)

Are people using them? Are they staying on them? Are they having success with them?

B (36:24)

For the most part, yeah. I mean, unless you have the. We have some people who can't tolerate them because of the nausea and whatnot. But I would say, especially people that want to lose weight, they love them, and they never want to get off of them. The biggest. The biggest hurdle is the expense. And then with pharmacies, believe it or not, we actually struggle because we. Insurance companies often pay us literally $100 less than what it costs us to buy it.

A (36:55)

So how does that work?

B (36:57)

Don't get me started. But that's a good question. But that's a good question. That's the way that our health system works. It's not good. So. Yeah. So we end up a lot of times having to, we can't do this or we'll go out of business. If we lose money on every prescription, we Fill. Right. So they have to get it somewhere else, I guess, basically. But yeah, they are very widely prescribed and we're seeing a lot of people that literally have type one and type two because you have type one for so long and then develop that insulin resistance. And so we have type 1 people with type 1 diabetes that are on insulin and they have been for 30 years, and then they're starting to put them on GLPs and, and on.

A (37:41)

Yeah.

B (37:42)

Other medications. Yeah.

A (37:43)

Well, I'll say that I don't think you, you don't have to have had type 1 diabetes for a very long time to have insulin resistance as well. Yeah. I think you're going to see more and more people diagnosed with like, you know, they'll call it type 1 and type 2 or something like that, you know, insulin resistance with type 1 diabetes. However, they're going to end up talking about it. But I think that could happen for you. I don't think that has, I mean, not that it couldn't become worse over time for some people, but I think that's a common way that people thought of it in the past. But now you're seeing, you know, my, I mean, my daughter has insulin resistance without a GLP. She uses 30% more insulin.

B (38:21)

Wow.

A (38:22)

You know, I've seen it with other young kids. I've seen it with adults. You know, it. I, I think it's, I don't know, brought to light more and more as the days go by. But it's just interesting to hear you talking about it from like an on the ground perspective.

B (38:35)

Yeah.

A (38:36)

Is the whole thing just sounds a little bit, Can I be candid? It sounds like a mess.

B (38:42)

It is. That's a. Honestly, it's the best description.

A (38:47)

Yeah. Yeah. And then, and then there's people like you who are like, look, I have got some background in this, you know, I'm, I'm going to try to help people. Like, hopefully we can get them in here and get them going in the right direction and give them the stuff that they need and help them understand what's going on. But still, in all, it just really feels like a twister going on and you're just reaching up into the dirty air, trying to grab someone up and go, hey, you know what you could do? Try this. And then like let them go back into the funnel again, you know?

B (39:12)

Right. Yeah.

A (39:13)

Is there a clear path to how that doesn't need to happen? Like, forget the excuses. Like they don't have time or they don't. Like, like, where would, where should we be intersecting these people so that they don't get to the point where they're like, well, maybe the nice lady at the pharmacy can help.

B (39:28)

I don't know. And I've been asking myself that question and trying to figure that out because that is an issue. Like, you know, even, even If I got 20 referrals tomorrow, you know, how many of those people they'll show up for the first visit and then slowly they stop coming to classes. And like you said, they don't. The excuses come in. And so, you know, I wish I had the answer. I don't know if it's some kind of incentive. I don't like using scare tactics. I don't think that's the way to go.

A (39:58)

So can I ask a question?

B (40:00)

Yeah.

A (40:00)

It might be hard to answer. Is that okay?

B (40:03)

Yeah.

A (40:03)

Do they not come back because they don't find the classes valuable?

B (40:07)

Well, I hope that's not the reason because I will say what I have found is that the classes that have stayed together because I meet with everybody one on one for an hour, hour and a half, hear their story, and then I get a group of at least four people, sometimes more together, and we have group classes. And so the groups that stay together and make it to the end are groups that mesh together from the first class. So I think that that may have something to do with it. And so part of what we're trying to do is maybe offer like some support groups or something like that. There's, there's a lot out there for type 1 diabetes, but not a whole lot for type 2 diabetes. And with, with support groups and stuff. And so I don't know, you know, I, we, we've tried a lot of different things. I think that they find the information valuable, but sometimes it's, it may be somebody that's been diagnosed for 20 years and they, they want the Cliff Notes. I think, you know, they want the, the. Which I hear a lot of people, if young people don't even know what that is, I guess, but they know they want the fast version.

A (41:16)

It's got something to do with cheating. They understand what it is.

B (41:18)

Right. They want the chat GPT version. How's that? Yeah, no, but they want the quick and easy. Just to sum it up for me in a couple hours and let me go on my way.

A (41:30)

Why don't you do that?

B (41:31)

Well, I, for, it's considered a follow up, I guess, but I've started to consider that being kind of one of the, the methods I go by because Medicare's model is 10 hours of first time education. That's a lot of time. Yeah, there's a lot to cover and you really get into the weeds and a lot of it. And it is valuable information, but even that can be overwhelming.

A (41:56)

Is it necessary or valuable? Because. Let me ask you a question.

B (42:00)

Yeah.

A (42:00)

Do you care if they understand it as long as they're having good health outcomes? You know what I mean?

B (42:05)

Like, no. I mean, yeah, that's fair. Like, I don't, I don't. I guess the answer is no. But in a sense I feel like if they're, if they are given the tools to truly be able to manage it themselves, then I mean, I've had classes where they've had good outcomes from the start to the finish, great outcomes from the start to the finish. Now what happens after that? You know, I don't necessarily know, but I feel like, you know, arming them with that information is very valuable. Now whether is 10 hours necessary? I don't know the answer to that. But, but yeah, I think that there's, there's something to be said for like maybe trying, you know, a shorter, brief focus. Yeah, yeah.

A (42:50)

Trigger points.

B (42:51)

Yeah, exactly.

A (42:52)

Do you think it's over people's heads sometimes? Do you think that it's overwhelming sometimes? Or like. Because it seems to me that the funnel is that the, you know, whatever the governing body is is telling you that this is the education you have to give to people. And then you're saying, well, if they come back, they get it and if they stick together, they do better. But you know, I guess I'm asking you, like, if you were the governing body, would you tell them they need these 10 hours or do you think that's not the path?

B (43:20)

To me, it's not about the time. To me, it's more about the value they're getting from the information. And so do I think that it requires 10 hours to get the important points across? Not necessarily for some people maybe, but not for everybody. But I think that people learn the important points better when they are in a setting with other people that they can ask questions. Yeah, they feel comfortable, they share each other's stories with each other and they get ideas from each other and share recipes and all of those things. And so that helps is really valuable.

A (44:03)

Do people, generally speaking, do you find not understand food meaning, like the difference between good and bad and the impacts of fat, protein, carbs? Like, are they really lost about the science behind food?

B (44:18)

I would say so, yes. I mean, I think that just like the whole, the quick don't eat, don't eat sweets and don't eat pasta and bread and potatoes is kind of what is in their mind really about. About that. And so, yeah, understanding that is a huge part of it, I think.

A (44:39)

You think you feel like the fun police to them when you start talking.

B (44:43)

No, because I don't. I always. I make it a big point if I don't talk about diet. I don't use the word diet. I don't use the word exercise because I think that they get in their head that they have to go on this boring food that doesn't taste good diet. And I'm like, no, you eat balanced, eat, find food that's good for you, that you love. Experiment with different things. Maybe cook things a little bit differently. And if you want to have a little bit of mashed potatoes or a piece of cake, have a piece of cake. But, you know, maybe leave off the mashed potatoes that night.

A (45:25)

Don't. Don't have the mashed potatoes, the cake, and then another piece of cake later.

B (45:28)

Yeah. And a bowl of ice cream later. Right. But you know, to me, like, my message, you don't have to stop eating foods that you enjoy. Like, you maybe find foods that are healthy that you enjoy, but also, you know, let yourself have. Have what you want sometimes. Like, that's fine.

A (45:48)

So everything in moderation. Yeah, yeah, sure. So, yeah. So why don't the T shirt slogans work? Like, seriously, like, you're really in the trenches. You're talking to people. Like, yeah, like, if I put you in charge of the whole thing and I was like, listen, just tell me now, Julie, like, what do we forget? Everything else and everything everyone's got to tell you. I'm. I'm giving you two visits with these people because we're not sure if they're going to come back. Like, what would you tell them in that time?

B (46:13)

Wow. I would tell them, wow, gosh, that's. You're putting me on the spot. Let's see.

A (46:19)

That's the whole point of this. Yeah.

B (46:22)

Well, the first thing I would say is move your body every day in some way. It doesn't have to be a marathon. It doesn't have to be a run or even a walk. Just move, move your body. Even if you're at a desk job all day, every hour, like, just stand up.

A (46:39)

And is that happening? Are people living a life of, like, Wally? Are they sitting in a chair?

B (46:44)

I think so, yes.

A (46:46)

Do they tell you that?

B (46:47)

Yes. Like, I have. I've had several people that like, yeah, I have an Office job, and I sit at my desk all day long and except for when I get up to go to lunch or when I leave for the day, and it just, you know, and I'm like, set an alarm on your phone and just like, for a minute, just. Just a minute every hour, just move around.

A (47:05)

Okay.

B (47:06)

Something simple like that. If you have somebody that's older that. That has mobility issues, there's chair yoga or there's even. You can sit there. And I mean, I don't care if you sit there and flail your arms and legs around, you're still moving, you know, just move in some way you're meant to move. So that would be one of my biggest messages, I think, because I think that's just as important as what you. Or almost as important anyways, what you eat. And then just not only. Not just everything in moderation, but I was like, like, find food that's good for you that you enjoy. Like, do you enjoy out of people, a lot of times things that they didn't realize that they really liked or maybe if they just roasted it in the oven instead of, you know, covered it in butter and fried it or whatever, that. That it actually kind of tastes pretty good that way?

A (48:00)

Yeah.

B (48:01)

A few different. Just a few small modifications to the foods that you enjoy and in the way that you cook them can make a big difference.

A (48:10)

Wow. Super interesting. Are they not taught from a young age about the quality of the food that they're eating? Is it all they have access to? Is it a financial issue? Is it a mix? Is it like, is it ignorance? Is it inability? Like what. What is it exactly?

B (48:26)

Yeah, that. That's. That's the hard part.

A (48:28)

It's.

B (48:28)

It's. It's a little bit of all of that. And so I'll have people tell me I can't afford to buy fruits and vegetables because that's what's expensive at the grocery store. I mean, everything's expensive at the grocery store.

A (48:40)

Can we talk like, like, like friends for a second, Julie?

B (48:42)

Yeah, you bet.

A (48:43)

Do you think they're full of. And they just want to eat like a ho ho? Or do you think they really can't afford a clementine? Which do you think it is? Because I can get a bag of clementines for $4, eat them for a month. Right. Like, so what's. I mean, that sounds pretty cheap to me. No.

B (48:56)

Yeah. Or a bag of apples. Apples are cheap. Bananas are cheap. Bananas. Bananas have a lot of sugar in them. That's. That's probably the. The worst fruit. But that's still better than, like, a half a bag of marshmallows.

A (49:07)

I just wish you would have said a $5 apple bag, but nevertheless.

B (49:13)

Oh, gosh.

A (49:14)

But.

B (49:14)

But.

A (49:14)

Because then I definitely would have called your episode $5 apple bag.

B (49:18)

Oh, shit.

A (49:19)

No, no, no. I hear. I hear what you're saying, though. Like, you know, melons, and not even, like, high sugar stuff either. Like, just, you know, get an avocado. Avocados are expensive, actually.

B (49:30)

Yeah.

A (49:30)

And so I take that. I mean, I take the point that the money is an issue. But it's funny, though, isn't it? Like, you know, like, look at all the money that's going out for the health. It, like.

B (49:39)

Right.

A (49:39)

Just maybe put that money into the food. But you're saying that it's about. I feel like I've heard you say more than once that they want something that tastes good. So do you think that they're.

B (49:47)

Yes.

A (49:48)

Their. Their palate's been judged up to a hundred, to the point where nothing tastes good anymore unless it's, like, got sugar and, you know, high fructose corn syrup on it and nine other, like, sugary things, and then they can taste it.

B (50:01)

I think that's a big part of it. I mean, I think that, you know, it depends on the age and. And how and. And all. And all of that. And so I think there's been a shift. I mean, I don't. I know when I was a kid, like. Or I would go to high school not having had breakfast and eat a bag of M and Ms. And Mr. Pib, and that was my breakfast. I'm embarrassed to say that, but it's true.

A (50:21)

Please.

B (50:22)

So. And it's not that my parents didn't provide us with healthy food. I mean, they did, but the big thing then was. Was low fat and who cares about all the sugar? So.

A (50:34)

Yeah. Yeah, you're that right age where you got caught up in that. You got caught up in that messaging that as long as you eat low fat, you'll be okay. Because it was. They thought it was about your heart. Right. Like now it seems to be shifting. I mean, it's been shifting for a long time.

B (50:46)

And I think that that's a lot of the problem is that people don't know what to do, because it's like, is it the food pyramid? Is it keto diet? Is it the Mediterranean diet? Or, you know, like, what. What is the right way to eat? I don't know, because I've been told one thing for 10 years, and then all of a Sudden it changes, and I don't know. I don't know anymore.

A (51:05)

And Doritos taste awesome, so.

B (51:08)

Well, that too.

A (51:08)

Well, yeah. Yeah.

B (51:09)

Right.

A (51:09)

Because I don't know what to do, but I do know what tastes good. And I also don't have a to time. It's not like we're not all sitting around like a Kardashian wondering what to do with our morning.

B (51:18)

Right. Yeah.

A (51:18)

Like, people are getting up, they're hustling to work or school, they're hustling home, they're doing other things. They don't. You. They don't have time to sit around and philosophize about. About what they're eating. They.

B (51:28)

Right. Yeah.

A (51:29)

You know, it. It's a quick. Again, a cyclone. You get. You get scooped up into it very quickly. You don't have any time to think about it. You get bad direction, probably can't afford it to begin with. And now you're just, you know, like, I gotta go, I gotta go. Until all of a sudden somebody says, you. You're sick, and that's what stops you.

B (51:46)

Right?

A (51:46)

And they say, hey, you're sick. You know what will fix us? Stop eating all the food you can afford that you've been eating for 20 years that you like. And I really hope people hear that, because I am sometimes stunned by the frequency in which someone will say to me, we went out to dinner. And then they finish that thought by talking about going to a place that I don't think I would not eat at.

B (52:09)

Yeah.

A (52:09)

They think of it as a local restaurant or, you know, like, good food or something. I'm like, oh, my God. That's. You're. It's. McDonald's. That's not. You shouldn't go there. Yeah, I went over it recently in an episode we did. We actually did. We have a series called Bolus for. It just kind of breaks down a food item. Like, here's how you bolus for a potato. Here's how you. Yes, but we did. Here's how you bolus for McDonald's. We did it because a lot of people go to McDonald's and they still have to know how to bolus their insulin for it. Right.

B (52:36)

And.

A (52:36)

And I'm going through that website, picking through fat, protein, carbs, everything, and some of this stuff, and it's astonishing.

B (52:45)

Right?

A (52:45)

And then you, like, start talking about, like, you know, like, the reality of it. And the example I used was my wife left recently in the middle of a stressful moment during the day, and she came back with a bag of McDonald's. And I was like, what's going on here? You know? And she's like, ah, things are out of control. And I was like, okay. She couldn't eat very much of it, right? And she says to me, do you want a chicken nugget? And I was like, when's the last time I had. I'll take a chicken nugget, right? I said, let me. Let me pair that chicken nugget up with three french fries and a short dip in this sweet and sour sauce.

B (53:18)

Yeah.

A (53:18)

I take a little bite of that. She and I chat for a while. Middle of the day, we're just talking. And then I go to leave. I'm gonna come back upstairs and keep working. She says, do you want another nugget? And I went, no. And I reached into the box and took one because, yeah, both were truly. I did not want one. And I was like, let me see about this.

B (53:36)

Yeah.

A (53:37)

I bit into that nugget and it had gotten chilly, and you couldn't distinguish what it was anymore.

B (53:43)

Oh, gosh.

A (53:44)

And I was like, when it was hot and the grease was still a little popping and you get the salt. I was like, this is chicken. Because someone told me it was chicken. And five minutes later, I was like, I could not attest to this being chicken right now.

B (53:57)

Right. It's like that. You're thinking back to the pink slime.

A (54:01)

I don't know what. I just. I went like. I went like, I don't know if you know this noise, and had that right into a napkin. And I got rid of it, right?

B (54:07)

Yes.

A (54:08)

But five minutes before, I was like, chicken nugget. And. And. And I think, like, wow. And at the very least, the argument used to be like, look, it's not good for you, but it's affordable. It isn't even affordable now, Right? So when the whole world's full of this food, you know, I just think telling people, just stop eating stuff that tastes good and go for a walk. And, boy, I'll tell you What, I think 20 years from now, this is all going to straighten right up for you. You just keep on this path. That's why you're seeing people have so much success with the glp because they can eat it, or they lose their flavor for it, or they can't stomach it, like, literally. And then I think the one people. The people you see go, I can't tolerate this. I am super interested to know what they mean by I can't tolerate this is I kept eating a bunch of crappy food and my belly hurts, so I'm gonna stop because my belly don't hurt when I'm not taking the glp. Like, if it didn't stop them from eating it. So they're having that slow digestion problem of putting that, all that fat in there to begin with. Anyway. That, that's sort of my. I don't know how you're supposed to fix that from the back of, of a dice game, but good luck.

B (55:15)

And I will say that, like, a couple of things I do talk about, like you were talking about reaching for the chicken nugget when you didn't want it. I say, I, I tell people, pay attention to mindless eating. Like, we do so much mindless eating. And it's like, enjoy your food. Like, people will sit down. Like, it's like going to the movies with a bucket of popcorn.

A (55:37)

Yeah, sure. You're gonna find the bottom.

B (55:38)

Are you really? Even you. You can get to the bottom of that bucket of popcorn and, and not even really, really tasted it or enjoyed it or realized that you ate it and you've just consumed, I don't know how many, you know, 3,000 calories and 100 grams a car.

A (55:55)

Whatever and whatever buttery flavored topping is.

B (55:57)

My God. Yeah. Or just sitting down to, to watch a movie at home and you've got a bag of chips and, and you before you know it, or a sleeve of Oreos and before you know it, you've eaten the whole sleeve of Oreos and half a bag of chips. Like, making people aware of. Of that, of what they're eating and not mindlessly eating. Like, just really taking the time to enjoy their food is one thing. And then two. Like I and myself shared about my high school breakfast. The more that I have cut out artificial sweetener, which I used to be, like, drink three diet doctor Peppers a day. I don't have crave sugar as much. That's a real thing. And so I think that make it a slow process. Don't do anything. Don't do anything extreme. I think that's the other message is don't try to go from zero to 60 in a week. Start slowly introducing better foods or slowly if you don't exercise. If you have a desk job that you sit at eight hours a day, then start by walking down the driveway to your mailbox and back like every day for a week.

A (57:10)

You're freaking me out with the idea that people don't move at least that much.

B (57:14)

I am dead serious. Like, like I you working in the, in where I work, like we see everything. And yeah, there are plenty of people that. That don't move. But I say that. I should also say that a lot of it is people that are older, that have lost some mobility. So there is that side of it. But even they can get some movement. And some of that may be a product of just having bad habits for a long time. But you can always start good habits, even if you start them really slowly. Just make it a slow process. And before you know it, you may be walking a mile or two every day. Who knows, you know? Or you may be. You may be eating salads and grilled chicken, and it tastes good. So, yeah, no, you can. I think you can make good food that's good for you, tastes good. And. And I think everybody can move in some way every day.

A (58:17)

So can I agree and disagree with you at the same time? Watch this.

B (58:20)

Absolutely.

A (58:21)

Okay. I think you're right. And I think that if. If that's a thing that we could get people to do, then that would be awesome. And I also think that for some people, and I don't know the percentage of those people, it could be half of them, some of them, most of them, few of them. I don't care. It's not going to work for them.

B (58:39)

Right.

A (58:40)

I mean, you and I have discussed a myriad of issues that impact people. Right?

B (58:45)

Right.

A (58:45)

My thought here is, is that people's lives are only so long if you think about life genuinely. Right. What is it? It's 20 to get going, 20 to live, and the 20 where you die, right?

B (58:57)

Yeah.

A (58:58)

Honestly, yeah. The first 20, you're learning stuff. You're growing, you're having fun playing baseball, you're learning how to go to college, whatever. If you're lucky, you get a job in the first few years after high school or college, maybe not even. Even that's being stretched now. People in their mid-20s are still looking for work. Maybe you're going to, like, bump into a girl who can tolerate you. You'll bump into her a couple more times and a baby will come out. You'll raise that. Now you're 45 or 50 by the time that kid goes off to college or, you know, gets the hell out of your house, that's about the time your arm starts hurting for reasons you don't understand.

B (59:33)

Right.

A (59:33)

And then, like it or not, you get older for the. The next, like, 10 or 15 years, you're like, I'm gonna. I'm gonna live forever. The 50s, the new 30. And then you get in your mid-60s, you go, holy Hell, and then it's over. And then you slowly die. Okay, like so, like when that's. I mean, listen. And that's if you get lucky and don't get cancer.

B (59:54)

Yeah.

A (59:54)

So when that's the thing. And you start off with a mom who's like, hey, off to school. Here's your Mr. Pibb in your and your M and M's. And you broke free of it. You're eating pretty well. A lot of people won't. And you know, they don't have the education behind the food. The food system set up the way it is. You a don't know what you're supposed to be eating. And most of the stuff that's being shoved towards you is no good for you anyway. You're putting somebody in a completely unwinnable situation and then you're telling them, why don't you try walk into the mailbox? You know what? You walk to that goddamn mailbox, you better put that mailbox on the moon. Because like if. Because if that's not what's going on, you're not going to overcome the landslide of social, psychological, financial that's holding you back. And that's why I say, and I'll say it right here and now, save up your money, jam that GLP thing into your. And shut off your hunger long enough for you to hopefully be able to reset yourself, as I think that might be your only chance.

B (60:53)

Yeah.

A (60:54)

All that other stuff needs to get fixed. I don't know how that's all supposed to happen in my short lifetime, is my point.

B (61:00)

Yeah.

A (61:00)

That's all.

B (61:01)

Yeah. Well, yeah. And gosh, that's depressing.

A (61:05)

But hey, the truth often is.

B (61:09)

That is true. That is true. But no, I. And that's one thing that, you know, I worry about with the GLPs is, is there a world in which you are able to get off of it because you've gotten yourself into a good weight level and a good Julie May. I better.

A (61:28)

Who cares?

B (61:30)

Well, I guess that's a. That's a fair. That's a fair point.

A (61:33)

Right.

B (61:33)

But like, in my pharmacist brain, how long have they been out? I don't know. Not that long. We don't know.

A (61:40)

Well, no, no, they've been out. They've been out over a decade.

B (61:42)

Yeah. Which in the, in the pharmacy world is. Is not. I mean, decades.

A (61:48)

Pretty.

B (61:48)

Everything moves pretty fast now.

A (61:49)

Yeah, right, right, right.

B (61:50)

I forget that. You know, it's not. We're not living in the days of penicillin discovery, so. But no, I mean, they're finding some, some negative things. And so I guess, you know, that's what negative things. You know, women who are losing a lot of weight are also losing muscle mass and they're. And then losing bone density. And so that's a big problem because that increases risk of fractures. That brings with it a whole host of.

A (62:14)

I hear you. I don't know how to choose between a fracture and a heart attack. Do you?

B (62:19)

Yeah, I mean, yeah, I guess. Yeah, that's. What can I say?

A (62:24)

I know you can't say anything. I'm not asking you to say anything. 2005, by the way, by Etta came out, it's approved as the first glp.

B (62:30)

I knew that the daily one by EDA was the very first one. I remember that one. It had been out the longest. And then by durian and then I think Victoza may have been.

A (62:40)

Look at you.

B (62:41)

Still a day.

A (62:41)

I'll give it to people. 2005 Byetta 20 Victoza 2012 by Durian. That's the injectable. The first time Trulicity comes out in 2014. Saxenda Sassenda comes out in 2014. 2017 Ozempic. For all the people who are like, ozempic, it just came out. Ozempic, 2017. That's nine years ago.

B (63:03)

That's crazy. It's only just recently exploded, though.

A (63:06)

Yeah, well, it's because they zhuzhed it up enough that you, like, people were saying it and a couple of famous people got thinning. You're like, hey, that chick from the office looks like a twig. What's going on?

B (63:14)

Yeah.

A (63:15)

2019 rebelsus 2021 wegovy. 2022 manjaro. Yeah, yeah. And so like, it's been around since 2005.

B (63:25)

Right? Right.

A (63:27)

But my bigger point is the bigger point, which is it's nice to say what we should be doing, but that's not happening. And in that time, people are getting, you know, type 2 diabetes, right. They're having heart attacks, strokes, you know, experiencing all kinds of, of different issues. Weight related issues that can touch a thousand different things, including like inflammation and like, you know, some people have autoimmune issues that are holding them back. My point is that while I think while the system is telling people, you just be perfect and then we'll see where that gets you. I'm saying everything's a tornado. Jump in the tornado and start swinging your hands and see what you can get for yourself because you're not going to live forever. Like, if you told me I was Going to live for a thousand years, then I'll walk to the mailbox for a hundred years and see what happens. Right. Like, but, like, I don't have that kind of time. If I've got to educate them and then I've got to give them enough money to pay for the food, then I've got to teach them which food is the right food to eat. And then I've got to show them how to exercise after a life of not exercising. Which, by the way, now they're overweight, their joints hurt, and they probably got brain fog. And now I want them to go for a walk to fix the whole thing. Like, I'm not saying that isn't the right way. And I'm also not saying that there aren't people who get to it that way. I'm saying when you're thinking about the big picture of everybody, I would drop it out of airplanes, okay. And then raise a generation of people who are not hooked on Oreos and then see if maybe their kids don't learn differently. See if maybe that doesn't impact the, the industrial complex that makes our food. And maybe if they can't sell Oreos by the metric ton, maybe they'll stop making them. And then maybe you'll get a avocado that costs 49 cents the way it probably should. But do you see what I'm saying? Like, it just.

B (65:19)

I do. Yeah, I do. I just think. I do think that the, the, the unfortunate side of that is also, in a perfect world, GLPs would be affordable. And that's the other thing. You know, people complain about food not being affordable. GLPs cost. They're a thousand dollars a month.

A (65:36)

Nah, they're 300 bucks now.

B (65:38)

Not yet. Hey, I work in a pharmacy and I see the cost to us and I see what insurance is paying. So there may be backdoor ways to get them that way, but right now we're not seeing it.

A (65:48)

So I'm just saying it might be that it's not. Maybe that's not the way to do it at this point too, because it's.

B (65:54)

Yeah.

A (65:55)

As of late 20, 25, GLP medications are $299 a month. You can get them through Lilly Direct that way. There's ways to accomplish that. And my point would be at $300 a month, I mean, that. I'm not calling that a little bit of money, but if a pack of Oreos is $8, I bet you could walk through your kitchen and find $300 worth of food. You shouldn't be eating. And so come up with the first 300, get ahead of, Create that sugar craving and then stop. You know, at some point, you're gonna have to put your foot down and make a decision about what you're gonna do.

B (66:27)

Right, Right. It's the same argument with getting like, I help people quit smoking, you know, like 100%, tons of money on that. But are they gonna. But then, like, you tell them a consultation or to quit is $75. Or. Or a, where am I getting that from?

A (66:43)

I gotta buy cigarettes.

B (66:44)

Yeah. Or a box of patches is $50 for a month.

A (66:48)

I have someone in my family, I hope they never hear this, because you'll be on the phone, you'll be on the phone with them, and they're talking about all the stuff they can't afford. And in the background you're like, I don't know what I'm do. I can't afford anything. I'm like, is that a $20 cigarette you're smoking back there?

B (67:04)

Right?

A (67:04)

Telling me you can't. You can't put gas in your car? Is that what just happened? Because it feels like that's what just happened. But also, I'm not saying they're not addicted to it. Like, it's not as it would be like saying to an alcoholic, like, hey, just stop drinking.

B (67:18)

Right.

A (67:18)

You know what I mean? Like, it's not that easy. And so all my point is around this is if there's a way to help you, whether it's pharmaceutical, I would. I don't even care what it is, if it's pharmaceutical or another way to help you try to get off this roller coaster of what the world is offering and what you have access and availability to, then why not, like, try to put a foot in the ground, stop, and start over again? But I also think that that's not how it's put to people. Like, I don't think they understand that they're on a death spiral twister ride.

B (67:51)

No. Because it's too slow.

A (67:53)

Yes. Oh, that's such a good point. Right? Like, yeah, yeah. Because it comes on you too slowly, and you don't realize it's happening until someone says to you, hey, we have to unclog that artery or you're gonna shut off. Right, right.

B (68:06)

That's the worst part of diabetes. Type 1, type 2, any of it. It's. Is that everything happens at such a slow pace that you tell somebody 20 years down the road that X is gonna happen. They'll be like, well, 20 years down the road. You know, I'm not worried about that.

A (68:21)

Cross that bridge when we come to it.

B (68:23)

Right.

A (68:24)

Except when you come to the bridge, there's a big hole in the middle of it, and you're too heavy for it, and you fall through. Yeah, yeah, yeah. No, no. It really is terrible. Like.

B (68:31)

Yeah.

A (68:32)

Yeah. Can we call this episode Mr. Pibb? I think we could, right?

B (68:35)

No.

A (68:36)

No. Why not? Please?

B (68:37)

Well, no, we can, but I do want to just make a point of that. It is 100. Not my mother's fault. Like, she. She fed me. Well, I. I would. I would go to school, wake up in time, barely, to. To get to school, and then I would buy it at the snack bar at school, so. Which they. They had in the mornings before school started. That's all it was. Candy and sodas.

A (68:59)

No, I know. No, but that is part of my point, is that it's been. It's been marketed to you a thousand different ways. After I graduated from high school, I had to come back a couple years later for something, and I was like, there's a soda machine in here. What an odd thing to put in a high school. I even thought it was, like, a young person. And then I walked down the hall to drop something. I was like, I think my brother was still there. I was dropping something off, and there was a candy machine. I was like, there's a candy machine and a soda machine here. That's nuts. It really is. That's an insane thing to do. But that's very common now.

B (69:30)

Yeah.

A (69:31)

So, yeah. I mean, listen, again, you're caught in a loop. I don't normally talk about political stuff, but you're caught in a loop here. You're being fed with one hand, and then the other hand's telling you to, you know, go for a walk. Like, all right, that's not going to help me. That walk is to keep you busy so you don't notice that they're draining your pocket with Oreos. Listen.

B (69:50)

Yeah.

A (69:51)

Get out there and fight for yourself. I don't know what to say.

B (69:53)

Yeah.

A (69:53)

Julie, this turned out really fun. Thank you.

B (69:56)

Yeah. Well, good. I've had fun.

A (69:58)

Me, too. Good, good, good.

B (69:59)

I feel like we ended up Talking about type 2 diabetes more than anything, but I think it's information that's good for. For both or just for people not even with diabetes.

A (70:07)

You know, every conversation is not going to be the same. That's what makes them special.

B (70:11)

Well, good.

A (70:12)

You know, it makes me special. I don't know. I don't know. My mom. My mom told me My mom never told me I was special. I was, I waited for it for a long time and she was like, you seem average at best, so.

B (70:24)

Well, maybe you need to give me some bullet points on if you were to teach my class, what would those bullet points.

A (70:32)

You want to finish there? I can do that with you?

B (70:34)

Yeah.

A (70:34)

If I was teaching a class for somebody with type 1 diabetes or type 2, either one.

B (70:39)

Okay.

A (70:40)

Well, they're.

B (70:40)

Yeah.

A (70:41)

I mean, if it was type two.

B (70:43)

Yeah.

A (70:43)

I think I would come from this perspective. When my little brother was 12, I caught him smoking cigarettes. And I said, somewhere right now there are 10 really rich people sitting at a conference table laughing at you for buying those cigarettes. And they're taking that money and they're buying an island with it and having sex with models. I just want you to know that that's what they're doing with your money. I was like, they're, they're off leaving a lavish life while you kill yourself and send them your money. And I said, and I bet you none of them smoke cigarettes. And then years later I heard this. The people who, you know, invented doom scrolling and, you know, and social media say, I don't let my kids have a cell phone.

B (71:23)

Yeah.

A (71:24)

I think I'm gonna bet that if we find, you know, the company that owns the company that makes the cookies that you love, first of all, that company is probably owned by a different company. It's probably a cigarette company that owns a food company. I'm making quotes around a food company, right. And they have found a way to get you to send them money for a cookie. And I bet if you go to their house, you won't find one of those cookies there.

B (71:49)

Yeah.

A (71:50)

So I understand that this is the situation you've been put in, but I wouldn't want to be made a fool of. And, and that is really how it occurs to me. There are people out there picking your pocket by getting you addicted to salt, sugar and fat. And you're sending that money to them. You know what I mean? Like, like, don't, don't give them that. Don't give them your money. You go buy an island with your money, you know, or whatever it is you want. Don't get caught up in this game. And the payment for this game is your life. And you're telling me, I, you know, I can't, I can't afford 10 hours to come to this class. You come to this class, I'll teach you about food. I will teach you about nutrition. I'll teach you about what it's doing to you. We'll talk about ways to mitigate the problems you have right now. If you're type two, let's hope we can get you through it and maybe get you to a point where you don't need medication. But at this point, right now, you're in too deep. You're in a hole and telling me you want to climb out by walking to the mailbox. I'm telling you I think we need to throw a flashlight and a ladder down there and help you get out so I can help you use this medication. There are some things you're going to have to do when that medication comes to you. Right? We can't inject the GLP and then go eat a pizza. We can't do that. Okay. So your first couple of weeks gonna put you on, you know what's going to seem restrictive to you. But I'll tell you, six months from now, you're going to think of it as fantastic. Because that's been my experience. Julie and I would, I would share my experience with them that once you get like you talked about, once you kind of get that sugar out of your system and you're not eating all that stuff all the time and the medication's helping you not feel hungry and to feel full a little bit. If you just trust that medication and say I'm full and realize that when you go to reach for food, that is a, that's a habit, that's a psychological issue. It has nothing to do with hunger and it has nothing to do with nutrition. If you can ignore that for a few weeks or a few months, you're gonna pop up on the other side in a flower filled, sun drenched field of happiness. I promise you. And then I'd show them a picture of myself three years ago and a picture of myself now. And I'd say, just hang on. That could be you. If your stomach starts hurting, you're probably eating stuff that you're testing that medication a little too much. Let's not do high fat, let's not do real thick, heavy foods. You got to go to the bathroom every day. You ain't pooping every day, we got a problem. Here's a bottle of magnesium oxide. Start with one a day. If that don't make you go, go to two a day. But I want you pooping every day so your belly doesn't hurt. Because I want your belly not to hurt so that you can stay on this medication long enough to get into that field full of flowers and sunshine. That's where your work's going to be. Your work's going to be ignoring the thing your brain is telling you and the thing that your memory is telling you that like, oh, you know, it's not Easter without jelly beans. It's not. Yes, it is. It's still Easter. Okay? Like, don't eat a bag of jelly beans, please. I just, you know, I think of Christmas and I think of this. Think of something else. Back when my grandmother put out a little candy at Christmas in a dish. It was a butterscotch or like a mint. And you had three of them in December because when she bought them, the bag had 6 ounces of candy and it's the only bag she could afford. And that's all you got. Now when I go out and buy a bag of candy, it's five pounds, it costs $3, and if it runs out, I'll just go get another one. Now I'm eating 17 pieces of butterscotch a day. You're not in the same game anymore that your brain's telling you you're in. So I mean, for type twos and then, yeah, once you start losing weight and you can move a little bit, get going. Like, right, like, get moving. Stand up, don't sit down. Walk around your house. Like, you know, you got stairs up and down, up and down, up and down. Like, keep going. You've no idea how good you're going to feel in a couple of years. And if you don't want to do that, God bless you. That's the path to this whole thing.

B (75:46)

Yeah. Okay. And what last thing, what type one. Tell a 19 year old boy, oh,

A (75:51)

your son should be listening to this one. Yeah.

B (75:54)

Just won't listen to his mom.

A (75:55)

Just tell him to listen to this small Sip series that I made. That's all. Like, that's it. It's juicebox podcast dot com. Go up to the menu, click on Small sips. It's like 20 episodes or a few minutes long. That's foundationally pretty much everything he needs to understand to take care of his insulin and his diabetes.

B (76:13)

Okay.

A (76:13)

He wants to expand from there. He should go to the Pro Tip series to listen to longer conversations about it. But in the end, it's about timing and amount. It's about understanding the impact of your food and how that food impacts your insulin, how that insulin impacts your food. You get those three ideas down, he's gonna have an A1C in the low sixes. Yeah, that's it. It's, it's, it's about it's about. And, and if I, if I may, this is the thing. I can't get through to anybody yet. I'm still trying. A little bit of effort now takes away the need for a lot of effort later. And that's day to day and throughout your lifetime. So around type 1 diabetes, get up in the morning, your blood sugar is 150. You don't eat, you get your blood sugar down, then you pre bolus that meal, then you eat, you pre bullish your meals, you stay ahead of high blood sugars. If you stay ahead of high blood sugars, you're not going to fight with highs. You're not going to always be either giving yourself more insulin or worried sitting there going like, I don't feel like doing this and not giving yourself more insulin, which is, you know, eventually going to lead to a low later, which you're going to have to put more effort into. So a tiny bit of effort up front saves a ton of effort throughout the day. It lightens your load, makes this whole thing much easier. Timing, amount, understand the impact of food. You know, get ahead, stay ahead. That's pro. That's pretty much the whole thing for Type one.

B (77:34)

Yeah.

A (77:35)

Yeah.

B (77:35)

And he does mostly a pretty good job of that with. He just needs a little tweaking. But yeah, I appreciate that and I think that he just needs to, to listen.

A (77:45)

Yeah, no, but super seriously, it's just. Yeah, I understand being a kid and I understand not wanting to do things and all that stuff, but you know, in the end, Julie, you just, it's about, it's like everything else. Like at some point you're just going to have to do it and if you don't, no matter what it is, forget diabetes. There's things you got to do and if you don't do them, there's going to be, you know, there's going to be consequences on the other side.

B (78:07)

Sure.

A (78:07)

So I don't know. All this stuff is exactly the same. Get ahead, stay ahead. You know, do your part, go for a walk pretty much at hand. That's all. I'm good, thanks. Excellent. Joy, you were awesome.

B (78:18)

Sounds good.

A (78:19)

Hold on one second for me, okay.

B (78:20)

Okay. Yeah, you bet.

A (78:28)

A huge thank you to Cozy Earth. A long time sponsor cozyearth.com use the offer code juicebox at checkout. You will save 20% off of your entire order when you use that code. Don't let me down, kids. Head over there now. Get yourself some joggers, some towels, some sheets, save yourself some money, support the podcast, make your life beautiful and comfortable all at the same time. Cozyearth.com use the offer code Juicebox at checkout. Today's episode of the Juicebox Podcast is sponsored by the Dexcom G7 and the Dexcom G7 warms up in just 30 minutes. Check it out now at Dexcom.com Juicebox this episode of the Juicebox Podcast is sponsored by Omnipod5. Omnipod5 is a tube free automated insulin delivery system that's been shown to significantly improve A1C and time and range for people with type 1 diabetes when they've switched from daily injections. Learn more and get started today@ omnipod.com juicebox@ my link you can get a free starter kit right now. Terms and conditions apply. Eligibility may vary. Full terms and conditions can be found@ omnipod.com juicebox thank you so much for listening. I'll be back very soon with another episode of the Juice Box Podcast. If you're not already subscribed or following the podcast in your favorite audio app like Spotify or Apple Podcasts, please do that now. Seriously, just to hit, follow or subscribe will really help the show. If you go a little further in Apple Podcasts and set it up so that it downloads all new episodes, I'll be your best friend. And if you leave a five star review, ooh, I'll probably send you a Christmas card. Hey kids, listen up. You've made it to the end of the podcast. You must have enjoyed it. You know what else you might enjoy? The private Facebook group for the Juice Box Podcast. I know you're thinking, oh, Facebook Scott, please. But no. Beautiful group, wonderful people, a fantastic community. Juice box podcast type 1 diabetes on Facebook of course, if you have type 2, are you touched by diabetes in any way? You're absolutely welcome. It's a private group, so you'll have to answer a couple of questions before you come in. We make sure you're not a bot or an evildoer, then you're on your way. You'll be part of the family. The Juice Box Podcast is edited by Wrongway Recording, wrongwayrecording. Com. If you'd like your podcast to sound as good as mine, check out rob@wrestwayrecording.com.