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- [00:00]
A
Here we are back together again, friends, for another episode of the Juice Box Podcast.
- [00:16]
B
My name is Danette and I'm from the Midwest.
- [00:20]
A
Hey, do you need support? I have some stuff for you. It's all free. Juicebox podcast.com click on support in the menu. Let's see what you get there. A1C and blood glucose calculator. People love that. That's actually, I think, the most popular page on the website some months. A list of great endocrinologists from listeners that's from all over the country. There's a link to the private Facebook group, to the Circle community. And we have a fantastic thing there, American Sign Language. There's a great sign language interpreter who did the entire Bold Beginning series in asl. So if you know anybody who would benefit from that, please send them that way. Just go to juiceboxpodcast.com and click on Support. While you're there, check out the guides, like the Pre Bulletin Guide, Fat and Protein Insulin Calculator. Oh, gosh. Thyroid glp Caregiver Burnout. You should go to the website. Click around a little bit on those menus. It really. There's a lot more there than you think. Nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan or becoming Bold with insulin. The show you're about to listen to is sponsored by the Eversense365. The Eversense365 has exceptional accuracy over one year and is the most accurate CGM in the low range that you can get. Eversensecgm.com Juicebox Today's episode is also sponsored by the Tandem MOBI system, which is powered by Tandem's newest algorithm, Control IQ technology. Tandemoby has a predictive algorithm that helps prevent highs and lows and is now available for ages 2 and up. Learn more and get started today at tandemdiabetes.com juicebox. The podcast is also sponsored today by usmed.usmed.com juicebox you can get your diabetes supplies from the same place that we do, and I'm talking about Dexcom Libre, Omnipod, Tandem and so much more. Usmed.com juicebox or call 888-721-1514.
- [02:30]
B
My name is Danette and I'm from the Midwest.
- [02:33]
A
Danette, that was awesome. Thank you. Some people struggle to introduce themselves. Danette, you have diabetes. You have a child with type one.
- [02:41]
B
I have a child, my daughter, she's seven and a half. She was diagnosed five years ago on February 1, 2021. And I am also the mother to a son who's 10 and a half. They're almost three years apart to the day.
- [02:52]
A
Wow, wow, wow, wow. Do you have any type 1 or other autoimmune in your family or any reason to think that maybe you'd have a child with diabetes one day?
- [03:01]
B
No. The doctor said, quote, it has to start somewhere.
- [03:05]
A
What an upbeat thought.
- [03:07]
B
I've got type two on my side of the family. My husband has some type 2 on his, but no type 1 that we know of. No other autoimmune that we can think of.
- [03:15]
A
Really? No celiac or thyroid or anything like that fluid floating around?
- [03:18]
B
No, not at all.
- [03:19]
A
I find a lot of people have thyroid and don't tell anybody about it. It's an interesting thing too. Does your family talk about health? Is it a thing you feel like you would know about if it existed?
- [03:30]
B
Yes and no. I think we hear about health problems after the fact. Like 17 years ago, my mom had a very massive heart attack and it was kind of like brought all the family together, but up until that point didn't really talk about health. It was like, yeah, my type 2 was bad, my health was bad, I didn't take my medication, oops, I had a heart attack, that kind of thing. But nothing really at the forefront like preventative, keeping on top of things. I think now that, you know, our parents or grandparents, they want to be around and so now it's more of a focus. But back then it wasn't really oops,
- [04:05]
A
I had a heart attack would be a great episode name if you would have just said a little later in the episode. So. Okay, I'm just going to ask a little further. Just like vitilago, psoriasis, anything even like inflammation related, like just terrible seasonal allergies or anything like that. How about that? Okay. Did she have a virus previous to the diagnosis? I mean, she was two and a half, right?
- [04:28]
B
You know, not that I could think of. You know, kind of look back at the pictures and you see like, wow, you could really tell that she was getting sick compared to my son. She was always kind of a chunker, so it was like she was starting to lean out. We thought, oh, she's going through a growth spurt, you know, that's just normal. Oh, she's wetting through her diapers because we have a bad batch of diapers. And so we were getting the overnights and that kind of thing. Then it just got progressively worse. I don't think she was sick before. Nothing that we could pinpoint. I mean, it was during COVID We avoided that. They were still in daycare. Didn't really get sick.
- [05:02]
A
No hand, foot, mouth?
- [05:04]
B
No, she actually got hand, foot, and mouth. After she had diabetes. We had a little stint in the hospital for an overnight because of ketones and things like that. And when I was changing her diaper, I noticed the rash on her bottom. And then she was saying that her applesauce tasted spicy. And so when I looked at her tongue, like, she had the dots on it. But that was after her diagnosis.
- [05:25]
A
Spicy applesauce? Yeah, I don't think that would be good. Maybe it would be. I don't know. I don't want to think about it right now because I'm hungry. I haven't eaten yet today. I was like, ooh, applesauce. I'm like a child. I love applesauce. My goodness. Okay, so she's diagnosed. You notice her leaning out. You go to a. Like a family clinician, do you end up at a hospital? What's the process of figuring it out and getting moving?
- [05:49]
B
So how we figured it out was both of my children were cursed early on with. They just stopped napping around, like, 18 months, 2 years old. And so she had been really lethargic. She was drinking a lot of water, but we didn't really put two and two together. And I had gone away on a day trip with some friends. And my husband had reported that my daughter was very cranky and lethar, like, just not feeling herself. And he chalked that up to, I was gone all day. Mom wasn't home. So this was on a Saturday. On Sunday, she took like two or three naps, which was unusual. And she was very clingy. She was eating fine. But then on Monday, I was working from home at the time, she just didn't seem right. She looked flushed. She had gone down for multiple naps. And I told my husband, I said, if she's not feeling better by tomorrow, I'm going to take her to our family gp. And so I went up to change her diaper, and when I laid her on the changing table, her. Her eyes kind of rolled back in the back of her head like she was going to just, like, pass out. And so I told him, I said, I think I should probably take her to an er. So there's one pretty close by our house. And we took her there, and she was very disengaged. She wasn't looking around. She wasn't excited to be in the car. And so when we checked in, you Know, the nurses are giving her the bracelet and getting my questionnaire completed, and she just looked very distant. And so I still had no idea what was wrong with her. But then when we got back to the room, the doctor comes in and says, well, we're going to do some blood work and we're going to do urinalysis, but I'm pretty sure she has diabetes now.
- [07:16]
A
He knew by looking at her, or did he smell her breath, maybe?
- [07:19]
B
I don't recall the ketone smell. I don't recall any, like, Kuzma respirations. She was just so lethargic, and I don't know. He just knew.
- [07:27]
A
Okay.
- [07:28]
B
And that was just kind of like a blow. I had no idea, like, how he could have guessed it, but he's like, we see this all the time. We're just going to get you admitted, and you'll probably be in the hospital a couple of days, and we'll go from there.
- [07:39]
A
Wow.
- [07:39]
B
So he seemed to know right away.
- [07:41]
A
Yeah. Prior to him saying that, you just thought, what, she's sick. She had a cold or the flu or.
- [07:46]
B
No idea. She had never really been sick before. Not like that.
- [07:49]
A
But she was your second, Right. So you had one already.
- [07:52]
B
Yeah.
- [07:52]
A
Yeah. So you'd even been through a little bit of that, and were you not even nervous at the hospital? Were you just more confused?
- [07:59]
B
It was, like, really confused. Like, how could this be happening? You know, she's so little. It was just kind of out of the blue, like, not even on the radar.
- [08:07]
A
I hear you. Okay. Is it more of a shock to you or your husband? Who do you think took it harder? Do you think somebody handled it better than anybody else?
- [08:16]
B
I think we were both kind of taken aback by it. I think early on, my husband was just like, we got to get through this. And he kind of compartmentalized it and never really kind of dealt with the fact that she had diabetes. It was, like, in the middle of COVID and all this crazy stuff, right. Until he'll even admit, like, he had never really processed the fact that she had diabetes. So I could think it hits him harder sometimes thinking about it. But, yeah, it was just completely off
- [08:42]
A
the radar during COVID meaning, like, during lockdown portion of it.
- [08:47]
B
So we were about a year in because we locked down in, what, February or March of 2020. And then she got diagnosed in 2021.
- [08:53]
A
Okay.
- [08:54]
B
So we were still working from home. So I guess in that regard, like, our companies hadn't really.
- [08:59]
A
We were in the part of COVID where we were all like, I Guess we'll just live in our houses for the rest of our lives.
- [09:03]
B
Yeah, yeah, pretty much.
- [09:04]
A
Right, right, I gotcha. All right, so that part, what did they start you off with? Technology? Was it harder to get educated? You know, what did that extra layer of separation create? Do you think it ended up being good or bad in the long run?
- [09:18]
B
Hard to say. I. It was just a complete shock. You know, they told us if you count your carbs and you just give insulin, it's gonna be fine. Right. And so I'm like, oh, this is like the best disease to have because I can count. Right. Which has been a nightmare since then. But yeah, we left with Lantus and Humalog with syringes. I think we were on a. The quick pen left with a ton of lancets and finger sticks and things like that. I was like such in a daze. I didn't even really understand the benefit of having a cgm. So I was against her having something on her body, which at this point I think that we should have done that from day one, you know, but there was no one telling me, well, this is why you need it, this is why it's important. So from the very get go, it was kind of like sink or swim. Figure it out yourself. Which is a very difficult position to be in.
- [10:04]
A
Yeah. I have to tell you, I'm still laughing at your assertion that while I can count, this is going to be a breeze. That really still has me amused.
- [10:12]
B
Oh, yeah.
- [10:13]
A
Oh, diabetes. About counting. I got 10 fingers, I got 10 toes. I know my gesynthus. This is going to be no problem at all. And then immediately didn't pan out that way.
- [10:22]
B
Oh, no.
- [10:22]
A
Yeah, yeah. Still hasn't, I imagine. What an interesting, like, first reaction. I love that. I don't know why that just. That tickled me. I'm sure it didn't tickle you when you realized that none of that worked out, but. So why didn't you want the cgm?
- [10:37]
B
Initially, I think it was just hard to see. What? I don't know. Like, they just came in, they handed me a pamphlet, they said, take a look at this, we can give you a sample. And then they basically walked out. No one said, this is the value. You won't have to do these finger sticks. You'll have data at your fingertips. So that along with a packet of like, you know, we could apply for some kind of financial aid to begin with because she was diagnosed, to get some of the hospital covered. And it was just so much information at once.
- [11:08]
A
Yeah.
- [11:08]
B
That there was no one there to say, this is why you need this, this is why it's important.
- [11:13]
A
Do you think that if it would have gotten presented to you differently, you would have had the bandwidth to even think about it or there's no way to know?
- [11:21]
B
Oh, I probably would have. I think so.
- [11:23]
A
Okay, well then how did you find out about it eventually? How did you eventually bump into the idea that. Oh, that thing they mentioned, I should look at that again.
- [11:31]
B
So my sister in law, not by blood, she has a lot of people in her family of type one and she was like, dee, you gotta get this cgm. Like this is gonna be very helpful. So having someone in my family say, this is why it's important. And then we didn't have a cgm, I'm gonna say for about two months and then still doing finger sticks randomly before meals and things like that. And one day we were about to have dinner and my daughter just looked very tired, like uncharacteristic. And it did a finger stick and she was like 40 something. And I was like, okay, we need data, we need to know when this is going to happen. Because we're just getting those snapshots. It's not really giving us the big picture. Yeah, I think that was the point where I kind of realized the utility of why we needed it.
- [12:14]
A
No kidding. Well, I'm a big fan. So I. Yeah, yeah. I think if you're using insulin, you should be wearing one. If it is all possible. Did you do diabetes long enough without one to feel the benefit? Or was it really just that one time situation that made you think, oh, this is scary, I don't want to do this again, I'm going to grab the thing, do you know what I mean? Like, if somebody asked you to explain to them what's it like to manage without it versus what's it like to manage with it? Do you think you have experience without it to talk about it?
- [12:45]
B
No, I think at that point we were still kind of in a daze. Right. We didn't know what was going on between meals. Finger sticks in the middle of the night, High all the time, low sometimes. I went back through some of our information. I was looking at, you know those little handwritten sheets they give you in the hospital, like log your dose, log your carbs, log your blood sugar before and after meals. It was just all over the place and we just didn't know what to do with that information.
- [13:10]
A
So you're just writing these random numbers down, but not having any actionable idea of what to do next. Now that you saw the numbers. Yeah, I mean, I had an incredibly difficult time trying to make sense of all those random numbers, too. You know, the CGM is just a. I mean, to say it's a game changer is just not enough. You know, it's not an effusive enough of a description of what it does for you. If you're using insulin and it's. It just opens the whole thing up, how quickly did you, I mean, obviously see the benefit of the cgm? Pretty quickly. But how quickly after that does it actually translate into better outcomes or does it not? Does something else need to happen? Diabetes comes with a lot of things to remember, so it's nice when someone takes something off of your plate. US Med has done that for us. When it's time for ardent supplies to be refreshed and we get an email rolls up and in your inbox says, hi, Arden, this is your friendly reorder email from usmed. You open up the email, it's a big button that says, click here to reorder and you're done. Finally, somebody taking away a responsibility instead of adding one. Usmed has done that for us. An email arrives, we click on a link, and the next thing you know, your products are at the front door. That simple. Usmed.com juicebox or call 888-721-1514. I never have to wonder if Arden has enough supplies. I click on one link, I open up a box, I put the stuff in the drawer, and we're done. US Med carries everything from insulin pumps and diabetes testing supplies to the latest CGMs like the Libre 3 and the Dexcom G7. They accept Medicare nationwide, over 800 private insurers, and all you have to do to get started is call 888-721-1514 or go to my link usmed.com juicebox using that number or my link helps to support the production of the juice box podcast. Why would you settle for changing your CGM every few weeks when you can have 365 days of reliable glucose data? Today's episode is sponsored by the Eversense 365. It is the only CGM with a tiny sensor that lasts a full year. Sitting comfortably under your skin with no more frequent sensor changes and essentially no compression lows for one year, you'll get your CGM data in real time on your phone, smartwatch, Android or iOS, even an Apple watch. Predictive high and low alerts let you know where your glucose is headed before it gets there. So there's no surprises, just confidence. And you can instantly share that data with your healthcare provider or your family. You're going to get one year of reliable data without all those sensor changes. That's the Eversense 365. Gentle on your skin, strong for your life. One sensor a year. That gives you one less thing to worry about. Head now to eversensecgm.com juicebox to get started.
- [16:20]
B
Outcomes. I think that's why we're talking today. So when I look back at the numbers, right, it was just all over the place. I mean, high blood sugars and of course, we're new, a newly diagnosed family. We don't know what to expect. Our endocrinologist is saying, oh, you're doing fine. This is great. You know, better high than low, that kind of thing. The outcomes weren't where we. I wouldn't say where we expected because we had no expectation. Right? So it's, oh, just dose her after her meals. And when I had expressed concern that the blood sugars were very high, then the endocrinologist says, well, dose before. But, you know, part of the risk of that is if she doesn't eat, then, you know, what are you going to feed her? So putting fear in our mind right away. So it became like the what ifs, like, started almost immediately. So I would say that we struggle with the outcomes. We struggled with the feedback that we're getting, the advice that we were getting, like, oh, you're doing fine. A1C can be this high. You know, there's really no risk right now to having these terrible blood sugars. And when I'm not happy with them. You're touching the pump too much. You want to control this disease too much, and it's not controllable. You know, she's a child, that kind of thing.
- [17:31]
A
Okay. Yeah. So tell people how you and I come together today.
- [17:36]
B
Do you want me to cry an hour later?
- [17:37]
A
No, I mean, whenever you want. It's fine. But I didn't know you were going to cry.
- [17:40]
B
But.
- [17:41]
A
No, but explain how we got here and why we're recording. Danette, are you there?
- [17:47]
B
I am.
- [17:48]
A
Oh, honey, are you okay? I'm sorry.
- [17:50]
B
No, it's fine.
- [17:52]
A
Take your time.
- [17:54]
B
It's funny. My husband's like, you know, you can't record this at work. You have to come home for this.
- [18:00]
A
Are you at work crying right now?
- [18:02]
B
I am, but I'm in, like, the maternity room, so no one's gonna come in here.
- [18:05]
A
They hear a lady crying in the maternity room. No, One's going in. You're completely safe. What's going on?
- [18:12]
B
I'm just really frustrated about the level of care that I'm providing to my daughter.
- [18:22]
A
Okay. All right.
- [18:23]
B
You know, I feel like I am a right brain person. We were kind of hesitant about a pump to begin with because it's like she was so little, and just the idea of something on her was hard. But I mentioned before how she had hand, foot, mouth. And we went to the doctor, and we were, you know, triage in the er and one of the nurses came in and, like, she told me that we really needed to get on a pump and that she was a type 1 diabetic. And she says, I'm a nurse. I have three children, I have a great life. I have a strenuous job, and my diabetes doesn't prevent me from doing anything. And so that kind of set me up on our pump journey. And I feel like everything we've tried, we've never gotten good outcomes.
- [19:11]
A
Okay.
- [19:12]
B
We struggle with. And when I say terrible time and range, I'm talking, like, 50%, you know, blood sugars averaging in the high 180s. Oh, and children's Hospital, they just say, oh, you're doing great. You know, you need to focus on your sleep. You need to be present for your child, and it's hard to do that. And I feel like we've had a lot of, like, insane obstacles that, you know, I listen to the podcast, like, religiously is, like, in the background constantly just trying to glean any kind of help.
- [19:54]
A
Yeah.
- [19:55]
B
And I feel like I know all the steps that we need to do, but they just, for some reason, don't translate.
- [20:01]
A
Okay, so let's. First of all, I want people to know that you sent an email. And I have a lot of experience receiving emails from people, and you can kind of see when a return email isn't kind of enough. Does that make sense? Like, there was nothing you sent me in that email? Could I have properly responded to, if that makes any sense? What is it? I said, hey, do you want to jump on the podcast and we can just talk it through? Right. Is that how I did that? Okay. I have to be honest, I think to do that more often than I actually do it. But I don't know exactly what it was about your note that made me
- [20:36]
B
think we should, but I think it just oozed desperation.
- [20:39]
A
It oozed desperation. So let's go over a couple of things that your healthcare providers are telling you that is valuable, even though it's not. It doesn't feel supportive at the moment. Right. But they're not wrong that you gotta get some sleep because it's gonna make you crazy and you're not gonna be able to think and. But to say, don't worry about this. A1C don't worry about this. Blood sugar, when you're worried about it is not valuable at all. You're not gonna just stop worrying about it. It's impactful to you. I think you're right, by the way, to be concerned about it. I also think that there's a tiny bit of right with them where the world's not gonna blow up if it takes you another month to figure this that. But you're probably imagining it never gets straight and it's five years from now and you're still doing this because it's already been five years. Right?
- [21:28]
B
Yeah.
- [21:28]
A
Yeah. So I think I understand about where you're at. So let me start slowly. You have a cgm, is that right?
- [21:35]
B
Yes.
- [21:36]
A
Yes. And what kind of pump or insulin delivery system are you using? 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 auto bolus, 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 tandomdiabetes.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 Tandem Moby 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 tandomdiabetes.com juicebox to check out your benefits and get started today.
- [22:45]
B
So we started out on the Omnipod, I think probably about six or eight months in. Never really had a lot of success with it, but I'm like trying to force the fit because everyone on the podcast is using Omnipod, everyone in the and I know that's a generalization, a lot of people on the Facebook group are using Omnipod and then you can tailor the basil. You can do all these things. And for a while for us it was more of a way to stop doing so many shots, right?
- [23:11]
A
Yeah.
- [23:12]
B
So we did the Omnipod, and it was just a real struggle. And so then when the Omnipod 5 came out, I was very adamant about wanting to get on that to kind of relieve some of my overnight stressors. And our provider is hit or miss. I mean, he was kind of, like, on the verge of retirement. So he had flat out told me that he didn't think pump therapy was a feasible option for a child because, you know, they're too active, they get bumped off. You get the same outcomes as mdi, so no support there.
- [23:44]
A
I'm going to stop you a second. Where do you live? Not exactly. But, like, how come everybody's all shucks in you all the time?
- [23:51]
B
Exactly. I don't know.
- [23:53]
A
Okay. Okay.
- [23:55]
B
So I have since changed my attitude. Now I'm a more, you know, you work for me and this is what I want. But now we kind of have, I wouldn't say friction when I go. Probably. I mean, they probably can't stand to see me, actually.
- [24:10]
A
I wouldn't say friction, but I think
- [24:12]
B
they hate me pretty much. They basically handed me off to a new nurse practitioner because I disagreed so much with the other one that we saw. Like, I flat out told her wholeheartedly, I do not agree with your recommendations. And, yeah, I think they're just used to people maybe having better outcomes and who don't struggle as much, who just, like, go to the appointments and get their A1C and go on and that's it.
- [24:35]
A
Why do you assume the other people are having better outcomes? Why don't you assume that the other people are having middling outcomes and they're just agreeing with the doctor and not paying attention to it after that could be. Yeah, yeah, don't be hard on yourself.
- [24:47]
B
Yeah.
- [24:47]
A
There. You're making a hell of a leap there that everybody's doing well but you. You know, I would imagine, if I had to guess, I'd imagine that everybody's been given, like, oh, you're doing great. Get some sleep. You know, that kind of like, homespun wisdom thing. And they're all just going, okay, well, she said, I'm doing good, so I'm good. And then I'm not going to think about it anymore. I think you're. You're maybe in that situation where you're the only one making sense, and you're being left to feel like you're the crazy one.
- [25:15]
B
Yeah.
- [25:16]
A
Yeah. Right. Yeah. And it's probably making you crazy, so we're going to try to avoid that. Okay. So I'm sorry. So you have Omnipod 5 right now.
- [25:25]
B
So we were on the Omnipod 5. We did that for about a year. I can't remember. It was a while. And it was just not working out. Like, we couldn't get the settings right. My daughter was having a lot of lows because it would kick out too much insulin in auto mode. So then we were having to do manual during the day, auto at night, making all these adjustments, and she started to get really bad reactions to the adhesive. I was constantly calling in pods because they would just stop working after 24 to 36 hours. My daughter was having a lot of swelling at the sites, pus in the cannula. It was interrupting the insulin delivery and then, you know, leading to the higher blood sugars. So I was very adamant against a tubed pump. But last June, we kind of finally hit our limit. And I was like, you know what? Let's just try the tandem mobi. It's small, and we'll just deal with it. We were on that for a while, and the outcomes were a little bit better. We were starting to see improvement. But then we started having this weird thing where my daughter was getting a lot of air in her tubing, and no one could figure out why. We got the pump replaced. And she kept having these air bubbles, like, near the pump site. So it wasn't just after a couple days. Yes, you get air in the cartridge and that travels its way down. It was like we were constantly flushing the tubing, constantly having air, and no one could figure out why. So we also kind of had a little bit of a budding heads with the nurses at school because they would just dose her, and then she would be 300, and they would just continue to dose. And I was like, I picked her up early today, and I checked her tubing, and she had air. And they're like, well, there was no air when we checked. I'm like, okay, I'm not saying anything about when you checked it, but when I did, there was air. And so we just got to the point where it's like, okay, at school, we can't control our numbers. We just need to go back to mdi, I guess, start from scratch and try to get the basics down.
- [27:17]
A
Okay.
- [27:17]
B
So we've gone through, like, all of the different. Not all of them, a lot of different options. Right now we're trying to explore the Twist pump, but it's not covered by my insurance. I found this out yesterday. So we're trying to do an appeal just because we're losing a lot of freedom with mdi. My daughter, she would send me pictures from the bus, like, hey, I want to eat this piece of candy. This is how many carbs it is. And we would walk through the app together about how to dose herself when she was on the Moby. So we've tried lots of different things, but we've never had steady, stable, predictable numbers.
- [27:50]
A
My guess is, is that either you are doing something, like, egregiously, not right, that you're unaware of, or. Or her body is somehow not conducive to the cannulas. Is it possible she's allergic to the cannula material? Is it. You know what I mean? Like, because you're a person who's paying a lot of attention, right? And I hear your frustration, and you're not getting outcomes even close to the amount of effort you're putting in. Is that about how it feels?
- [28:20]
B
Yes.
- [28:21]
A
Okay. And what's her A1C?
- [28:22]
B
Right now, it's 6.9.
- [28:25]
A
Okay. And her time and range is about 50, you're saying ish.
- [28:30]
B
Well, yeah. The last week has been hard because, so, you know, I am a religious listener, and I hear all the time about how you say, you know, people just look for ghosts. I'm like, I see ghosts, like, legitimately all the time. So.
- [28:42]
A
Yeah.
- [28:43]
B
Or when you say people like, oh, well, the insulin went bad. It had. It couldn't be the insulin, you know, so last week, when we decided to go MDI to kind of get things under control, we were going to use spring break as, like, a baseline. Well, she could an ear infection, and she gets on antibiotics, and we switch to an insulin pen, and her sugars are completely unmanageable. I mean, like, ridiculous. I'm giving her so much insulin now. I'm not a fan of big Boluses because I feel like I can't trust my own data that I have from any of her systems. But one day I was like, you know what? We've got glucagon, and if I have to use it, I'm going to use it. And for one morning on breakfast, I gave her seven units of insulin to cover breakfast and her antibiotic, her normal dose is about two and a half to three units. That was a big step for me.
- [29:27]
A
Yeah.
- [29:28]
B
And I'm thinking, okay, we're just gonna do it. And she still went to 300. And so I'm crying all day. I send you my crazy schizophrenic email, and I said, you know what? I'm just Gonna open a vial of insulin and give her a shot with a syringe. And that was the first time in a week that with any predictable forum, we got movement in her blood sugar. I'm like, are you kidding me? Did I legitimately have bad insulin in this pen that I've been using for a week with no relief whatsoever? But, yeah, it just seems weird. Like. And then another thing I think about you saying is, like, oh, people aren't brittle diabetics. You just don't know how to use insulin. Like, is she the brittle diabetic? Like, is she the. The unicorn? Well, if you will.
- [30:09]
A
Yeah. So let's reset your expectations a tiny bit for a second, though. A 6 9A 1C is good.
- [30:16]
B
Okay.
- [30:16]
A
Yeah. Is she getting low a lot?
- [30:21]
B
Okay, so the way I think about it, I'm not really thinking in terms of a 1C. Right. Because if you see these graphs, the CGM data, that is like 300 or 250 for hours and hours and hours.
- [30:32]
A
Yeah, we don't want that.
- [30:33]
B
Like, to me, it's like, okay, what are her lows? Because, like, my GMI or whatever on the Dexcom is always higher than what her A1C is. So then I try to really not spiral into, well, can I even trust this data? Is she running low all the time? Whatever. You know, so it's just so much information. But to be in range 50% of the time, it's not good. I'm not looking for that. 5A 1C. You know what I mean?
- [30:59]
A
Yeah. I'm not arguing with you. I'm trying to say, like, unless she's incredibly low for long amounts of time, you're not missing by a lot. You're missing somewhere. Obviously, if you're seeing 250s or 300s that are lasting for a long time. Let's start slow here. How much does she weigh?
- [31:14]
B
60 pounds.
- [31:15]
A
60.
- [31:17]
B
06060.
- [31:18]
A
Okay. And how much insulin does she use a day?
- [31:20]
B
About 20 to 25 units.
- [31:23]
A
Okay. And that doesn't seem like it's enough. Sometimes I wonder, like, what are reasons why she could be insulin resistant? You know what I mean? Like, I mean, she's a kid, right? So she's active, she's moving around.
- [31:37]
B
Right. And that's another thing, like with the pumps especially, we were having to have all these different basal rates around her physical activity because when she's active, she is so sensitive to insulin. And so it's just overall, just extremely difficult to manage because I cannot expect her to sit still after a meal because of insulin. But then once she's high, it seems like it takes a lot to bring it down.
- [32:01]
A
What's her basal at?
- [32:04]
B
So right now on mdi, we're at six and a half units of tracebone.
- [32:08]
A
Okay.
- [32:09]
B
And that seems to be a little on the high side because she's kind of drifting down between meals, and overnight, I think it might be a little bit too much.
- [32:18]
A
Okay. So overnight she's drifting down, but getting low or drifting down.
- [32:23]
B
Just difficulty all around. Like, I can never get her to bed at a normal number. Like, she's got sports and things like that, and she's rebound highs and we're fighting with those. And so then by the time she finally is in range, she needs an applesauce because I was too heavy on the bolus. It's just different because we've been doing MDI for two weeks.
- [32:41]
A
Yeah.
- [32:42]
B
So it feels like it's all over the place.
- [32:44]
A
I found myself wondering, and this is probably a great place to repeat this. I am not a doctor and this is definitely not advice. And what I'm wondering is, are you seeing lows mainly after meals or after correction boluses?
- [33:03]
B
I don't even know because I wonder
- [33:05]
A
if maybe your basil is not just could be more aggressive and then your carb ratio could be less aggressive. Like, what's her carb ratio at?
- [33:16]
B
For breakfast, it's 1 to 9. Lunch is 1 to 14. Yeah, it's like 1 to 14 the rest of the day.
- [33:22]
A
Okay. So again, I might say a ton of stuff that's wrong, but you sound like you're a little out of your mind over this. So, like, let's just try to, like, kind of spitball here and see what we can kind of figure out. Okay. What I'm wondering is, is there a way to use more basil and less meal insulin to overall affect what's happening? Like, is that possible? Because if she's using 25 a day, if you were going to accept a 50, 50 split as, like a place to start, basil to bolus, then she'd be like a half unit an hour or 12 units a day in basil. But you're doing half of that at six.
- [34:03]
B
Yeah.
- [34:04]
A
Right.
- [34:04]
B
I mean, when we were on the Moby, like, if we had a good day. So when I proposed to our care team that I wanted to take a pump break, I looked at all the days that she was in range 75% or more, and then I looked at the split between basal and bolus insulin, and the average bolus, or the average basal insulin was like, 5.75 units.
- [34:24]
A
5.75. Okay.
- [34:27]
B
I didn't want to take into consideration those days where she had an air bubble or something in, like, control IQs, cranking out all this extra insulin, and she's getting, like, quote unquote, 12 units a day when she obviously didn't. If she was like 300 all day on those good days, her basal was as low as four and a half.
- [34:42]
A
Does she have hypothyroidism?
- [34:44]
B
No.
- [34:45]
A
Has she ever had her TSH checked? Do you know what it was?
- [34:50]
B
I don't recall. She had all that run last year. She's due for it again.
- [34:55]
A
Do you remember it being in range or how they talked about it?
- [35:00]
B
Everything was in range.
- [35:01]
A
Did she have any symptoms of hypothyroidism?
- [35:04]
B
I don't believe so, no.
- [35:06]
A
She's not tired all the time or.
- [35:08]
B
No.
- [35:09]
A
Moody? Cranky? No. Okay.
- [35:12]
B
Great disposition. I mean, she rolls with everything. Yeah.
- [35:15]
A
I'm trying to think of reasons why the insulin might not be working as well or as effectively. Not sure. There's part of me, by the way, that thinks that when we're completely done this conversation, we should immediately make a transcript of it, roll it through a large language model, and then see what it spits back out to. I'm sort of interested in that because you've been through too much. Like, it seems to me that you've climbed up every tree there is to climb up, and you are probably confusing yourself at this point. You know, God bless her. Or she's brittle. You know what I mean? Like, or something that's happening that we're unaware of or something like that. I don't know. Like, it just seems to me one to nine is. I mean, when Arden's on a GLP, her carb ratio is one to nine, and she weighs 125 pounds and, you know, is eating probably more aggressively than your little kid is over there. I'm just wondering if you don't have enough basil going. Is everything just not working because of that? And that could be overly simplified. I have no idea. Does that make any sense to you, or does that sound crazy to you? I don't know. You. Like, I'm just trying to work through what you said to me. So, like, if I said to you, you're using six units of basil right now, try eight tomorrow. Do you think that would, like, ruin things? Like, do you think it would crash her or something like that?
- [36:42]
B
I don't know. So, like I said last week, we just had a hell of a time with the insulin and things like that, plus the antibiotic. So it was going to be our opportunity to kind of reset. What I wanted to do is relief, dial in her settings, send her back to school with the shots and be on our way. But because of the illness and the antibiotics and all that stuff, it was just not an ideal week to do that. So now we are trying to do that with her at school, with the activity. The only good thing about that is that she's got, you know, scheduled meals throughout the day, so she's not constantly eating like she was during spring break. But I don't know. So for example, on Tuesday she got her snack and they dosed her for it, plus a correction, she went low. So is that because the correction was too much? Is it because the basil was too much? Once I get her stable overnight, she's drifting down. Her line is not flat. So that makes me think that the basil is either too aggressive because she should just be flat. Right?
- [37:40]
A
Yeah. Say it again for me. I'm sorry. Literally just start over and say it one more time. I was thinking about something. I got lost for a second.
- [37:47]
B
Once I get her number in range, her number doesn't plateau out, she keeps drifting down, down.
- [37:56]
A
How many hours after her last bolus?
- [38:00]
B
Like more than four or five.
- [38:02]
A
And she drifts to a low spot or a place where you have to stop it.
- [38:08]
B
Yeah. We're treating so high 60s.
- [38:11]
A
Okay. So try to imagine a world where, because right now you're covering one unit, is covering nine carbs. Okay. And she's getting what, 0.25 an hour, basically, or six units a day of basil. And she's getting 25 units the entire day, basal and bolus combined. So if you look at a 60 pound person just with a standard basal rate, you're looking at like 15 units a day total daily insulin. But we're saying that's not what she's doing. She's doing 25. I'm using an estimator that's on my website right now. I don't know if you've seen that before or not. So basically what I did was I put her weight in at 60, and on a physiological factor profile of standard, it says her total daily insulin should be about 15 units a day, seven and a half total basil and an insulin to carb ratio of 1 to 33. But that's not her situation. She's using 25 a day now. Is she using 25 a day because you're creating lows and feeding her more often than you have to.
- [39:22]
B
I don't think so.
- [39:22]
A
I don't know. But if you don't think so. Okay, so I just make her highly resistant on the chart, which then puts her theoretical total daily insulin at like 24 and a half, which is matching what you're telling me. When that happens, it's indicating that her basal needs should be about 12 a day or 0.5 an hour, but that her carb ratio should be 1 to 20. So my thought here is, is if you meaningfully up the basil and meaningfully decreased the carb ratio, maybe that's where the balance is. Like, maybe you are as simply as if the basil is not right, nothing else is going to work. Is it possible that that's the situation and that she's been gaining weight and changing and you've been switching from shots to this pump to that pump so much that you just aren't seeing enough to make a reasonable decision?
- [40:16]
B
Probably.
- [40:16]
A
Is that possible? So if that's the case, and if that's a thing you want to look into, we just have to figure out a way for you to test it for a couple of days. So my thought would be, spring break's over, right? Yeah, yeah. My thought would be to choose a lot of meals that you know how to bolus for. Do you see what I'm saying? And something that you're really good at, because right now, like, forget all the math for a second, like, think of a lunch that you give her. And you know that if she gets a certain amount of insulin, it's going to go well, right? Like, what is that? Lunch? How much insulin is that?
- [41:02]
B
You know, I really couldn't even tell you.
- [41:04]
A
Okay, all right.
- [41:05]
B
There's just so many variables. I feel like. And this is why I look at her numbers constantly, because I don't know if I'm going to get what I expect.
- [41:14]
A
Okay?
- [41:15]
B
We get different outcomes with the exact same situation. And you know, when we talk to a nurse or a provider, it's, well, that's just diabetes. And for me that doesn't work because I want stability. I don't want to have to call the nurse and say, hey, she just had this 30 point drop. You need to give her an applesauce. You need to give her juice. I don't want to have to pay attention.
- [41:35]
A
What's her insulin sensitivity? One unit moves her how far?
- [41:39]
B
So we have that at 1:50 during the day, because when she's on the pump, based on the types of auto corrections that she was getting, like even a quarter unit or 0.2 was making her go low with her activity schedule.
- [41:55]
A
If this was me, I would be simultaneously moving the basil more aggressively while I make the carb ratio less aggressive. Just hoping that that puts me in a good enough place that I don't really have to worry about corrections for a minute. Because just the math on 25 units a day at her weight is saying 0.5 an hour, Basil. One unit covers 20 carbs, one unit moves her 75. And I don't know if any of that would be right or not, but what I do know is it's nowhere near what you're doing. Let's just imagine for a second that 12 Basil is right for her. I mean, that's, it's aggressive for a 60 pound person. What I'm going to say is, is that it's possible that once you get these things kind of adjusted in better, you might find that her total daily insulin is not 25.
- [42:54]
B
Right.
- [42:54]
A
It's going to probably be lower than that by the time you do it, but you're not going to be able to get to it if you're under baseling or over bolusing things, making her low, feeding her again, then drifting lower all night long and having to add food, which eventually needs insulin. So I don't know how much extra insulin you're using because of the, the way things are happening, but I think if this was me, I'd move her basal up. I would be less aggressive on carb ratio using some foods that are not super fatty or difficult to bolus for or really sugary for a while just to get stable. Because I don't want to sound like an old timey CDE here, but like, it feels like what you need is like some good old fashioned basal testing, right, to get that set in. And then once you're comfortable knowing, hey, look, this basil is working now, you could dial in the carb ratio a little bit and say, okay, you know, I'm good at this meal. Seems like one unit is covering X amount of carbs, then get that closer. Then once you've got those two things figured out, then you can start fiddling with the sensitivity a little bit and trying to figure out what that is. Because your numbers are like, like everything doesn't sort of make sense. Which to me says the basil's not right.
- [44:18]
B
Right?
- [44:19]
A
That's really, I mean, that's it. To me, it doesn't. She's getting six a day, Basil. I think it would be fair to try eight and then see what happens. It's Tracebo. Right. So what's it running like that weird clock. But do they say it's in her for 36 hours till it's gone or something like that? Right. It kind of overlaps with the next injection. So if you wanted to move up more slowly, I would think that would make sense. Like, if you're six, go to six and a half, wait till your next injection. She's not getting low. Great, let's go to seven, you know, and then with an eye on maybe seven and a half as maybe the baseline. And then hopefully you're using less insulin at meals because you've got more basil going. You will use less insulin at meals because you've got more basil going. Right, Right. And then just keep kind of dialing that in. It probably shouldn't take you more than like a week to get that straight if that ends up being the issue. But I don't know what else it could be like. I mean, I am a little. You know, she's had pus in her cannula, that kind of stuff. I don't think it's worth ignoring that. Maybe she's having allergic reactions and her sights aren't working well. Like, maybe that's why she's needing more insulin. But still, if that was the case, I mean, she's MDI right now. Right. So, I mean, even if that was the case, that's not going to be a thing you're going to notice right now. So if you got the settings great on MDI and then went back to a manual pump and they didn't work, but she was having inflammation around the cannula, and so then maybe you'll say, okay, she seems to be having a reaction to the cannula material, which is why her insulin needs are going up. Does any of this making sense at all to you?
- [46:02]
B
Yeah, it's just hard to think about when to implement that.
- [46:06]
A
When to implement what?
- [46:08]
B
Like to start titrating up and evaluating meals and things like that.
- [46:14]
A
We're not going to give her any more insulin than she's getting now. We're just going to move it in a different place.
- [46:17]
B
Yeah.
- [46:19]
A
So weekends here. Right. She goes to school on Friday. When do you shoot the basil? In the morning or in the evening?
- [46:27]
B
Evening.
- [46:28]
A
Awesome. So Friday night, move up a half a unit and then live through Saturday using less insulin for meals by how much? That's the thing is, I don't really know, but, I mean, we could do some, like, rough math. Let's do this. So if she goes up Just a half a unit a day. Then what's the percentage of that?
- [46:54]
B
But won't it take time to see that? Because we're working. That's another thing also, is that we're working with an educator from integrated diabetes, and she said that Tresiba can take a couple days to change. Yeah, yeah. So, like, you have to evaluate it, like, two days at a time, basically.
- [47:10]
A
Yeah. Because it's not an in and out in 24 hours kind of thing. It overlaps on itself. So some of. Some of the injection from Friday night is still going on Saturday night. But my point is, is that you. Just a half a unit up on the basil. Okay. And then, I don't know, change the insulin to carb ratio, make it a little weaker, just a little bit, just to kind of make up for it, in case you're worried. But I don't imagine that another half a unit of Tresiba is going to suddenly make her low all day long. And by the way, if it does, then you're going to feed the insulin, and then, you know, you won't do it the next day. Like, it's going to be like a life and death situation if you move a half a unit at a time. Almost a rounding error. To me, that's the only thing that makes sense, is to get a better balance of the insulin going. But if it doesn't make sense to you, I mean, I would go talk about it with other people. If you're using somebody integrated, I have that conversation with them. I wouldn't ask your doctors. They don't sound like. Yeah, they're just going to say, oh, shucks, ma', am, you're looking too close at all this.
- [48:11]
B
Yes, pretty much.
- [48:13]
A
We got the sugar. It's. What are you going to do?
- [48:16]
B
Yeah, yeah.
- [48:17]
A
And are you sleeping?
- [48:20]
B
No.
- [48:20]
A
No. Because you sound a little frazzled. Is that fair? Oh, yeah, yeah, yeah. Because you're in a really interesting situation. You're not the first person I've met like this. You're like, I'm at my wit's end. I need something to do. What would you do? And I say, what about this? You go, I can't do that. I didn't laugh at you because you're in a dire situation tonight. No, but like. But earlier when you said it, I was like, this is incredibly common because you're at the point now where you can't even fathom doing anything differently. Right? Like, it's just like, how do you even, like, contextualize making another change when all you've been doing is making changes for five years and nothing's working right. I would say go back to basics on this one. If the basal is not right, then the boluses aren't going to work. You're going to be higher, you're going to be low, you're going to be feeding insulin, or you're going to be shooting more to get a down. Get the basal right, work on the carb ratio after that, then look at the insulin sensitivity at the end, which should be pretty easy by the time you have the two together. Mm. I think that's what you should be doing. I mean, the truth is, is, like, if you just brought her here and left her here, I think I could get it straight for you, but it's because I've been sleeping and I haven't been staring at this mess for five years, so I wouldn't be burdened by any of the what ifs. You said it earlier like you're seeing ghosts at this point. Like, well, what if it's the cannula? What if it's the insulin? What if it's this? What if it's that? I say stop thinking it's any of that and just go back to the three things that we know. Definitely impact, blood sugar. And if we can't get that right, then we could look at the what ifs again. Does that make sense?
- [49:56]
B
Yeah.
- [49:57]
A
Yeah. You sure?
- [49:59]
B
Yeah, I think so.
- [50:00]
A
Okay. Do you feel any better now that we've talked?
- [50:04]
B
I mean, yes and no.
- [50:06]
A
Why not tell me the no parts?
- [50:08]
B
It just seems like there are just so many different things, like, oh, well, then. I don't know. It's always something.
- [50:14]
A
You know, I asked you to stay in the three things and you were beyond them again, so. Are you anxious?
- [50:21]
B
I'm not an anxious person until it comes to this.
- [50:24]
A
Okay. And because you feel like a failure.
- [50:28]
B
Yeah. Or I can't control it, or she's not with me, so let me just go ahead and up her basil and send her to school. And, you know, the nurses won't let me text her to have a couple gummies here and there. I have to wait for them to do it. Nope. There's not an emergency across the street that they're attending to. These are all just. I don't want to say stupid, but.
- [50:47]
A
No, they're what ifs. Yeah, I understand, but. So are you a control freak?
- [50:52]
B
I mean, apparently.
- [50:53]
A
Would you have seen yourself that way before? What would your husband say if I asked him that? Baby.
- [50:57]
B
Oh, my God. He would say, of course no.
- [50:59]
A
Okay, well, then can I give you the greatest advice that you'll never get from your husband and wouldn't take from him if he gave it to you?
- [51:06]
B
Stop being crazy.
- [51:07]
A
You should calm down.
- [51:07]
B
Yeah, yeah, yeah, you said that before.
- [51:10]
A
Just, just listen. If I could just get my wife to listen to me one time. My wife's been telling me the same thing. I want you to know that I got married in 1996. It is 2026 right now. I dated that girl before we were married, okay? So I think we've been together something like 33 years or something like that. My wife's a very hard working person, okay? She is what we used to call type A, but now we call anxious. I said to somebody the other day, I can't wait to find out what we call it next time because, you know, remember? And it used to be like, oh, they're wound pretty tight. Like, we've had all these little sayings for anxiety, like, throughout the world. My wife's an anxious person. She's also a go getter. She's a type A shoe. However you want to think about it, you give her a job, she can do a really good job, okay? And she's in an industry where something's always happening. Something's always happening. Probably 10 things are always happening. Probably a hundred things are always happening. She's always behind. My wife always says to me, when I get caught up, I can stop working so much. And I say to her, it's been 30 years, you haven't caught up yet. Maybe it's time to stop thinking that's gonna happen. But she's like, no, no, no, no, I'm gonna get it. That's the place you're at in the end. Those doctors are a little right. It is diabetes to some degree. Like, it's not a thing. You're just gonna know black and white all the time. And if you don't have that art part of it, if you can't just go, well, let's turn this up and see what happens. You know what I mean? Like, if you can't do that part, then you are busy trying to cage a tiger made out of water. It isn't a thing you're gonna be able to make perfect, but you can get it close enough that perfect doesn't matter. And I think that's where somebody like me with this sort of like, hey, let's just see what happens attitude, I think you're probably stuck in years of what you perceive as failure, which I would tell you is not failure. It's just not perfection. And you're stuck in a little bit of that feeling of, I'm letting her down. I can't stop looking. I can't look away. If I look away, what if this happens? Like, those are a lot of uncontrollable things. It's probably how you get yourself in the situation. And I don't mean, like, you did it to yourself, but how you find yourself in the situation where a person who doesn't know you that well, who's only seeing you every three months, says to you, maybe you should just be happy with what you got, Which I think is their way of saying, lady, calm down. Yeah, but they can't say that to you because, you know, laws and polite and everything. But I think your settings are wrong. That's it. I think your settings are probably a little wrong. And once you got them a little closer, you wouldn't be chasing stuff around all the time. You probably wouldn't be over or underreacting to something, causing the next problem, because that's all that's happening. You need to start over. You need a baseline to start over at. I mean, you got the right idea, and you tried to do it at spring break, and then she got that infection. That must have felt like a cruel joke when that happened. Yeah, yeah, yeah. By the way, like, oh, it's okay. Spring break will come next year again. I don't know. Like, you have to tell me, honestly, do you think you can just. I mean, I don't know. Do you have weed? Like, is there a way you can calm down for a little bit and relax and just kind of, like, turn your focus down by 40%?
- [54:24]
B
I don't know. I guess if I'm intentional about it.
- [54:27]
A
Yeah. That was very honest. You're, like, not sure. Hey, is your mom anxious?
- [54:31]
B
No.
- [54:32]
A
No.
- [54:32]
B
Like, when it comes to this kind of stuff, like, the diabetes is the only thing that makes me anxious. I mean, I will tell you, I was talking to someone at work, and we're just kind of talking about life. He was like, oh, that must be really hard to constantly worry about your daughter. I was like, you know, I'm good at everything I have ever done. Like, no effort whatsoever. Successful, you name it. I can try things that I've never done before and just be good at them. Except for this. That's what it feels like.
- [55:00]
A
Yeah. I think it may be the goalposts are getting not just moved on you, but maybe they've given you 10 goalposts and they're all moving at the same time and you're trying to put them all where they belong. And that's just not how this is going to work.
- [55:13]
B
Exactly.
- [55:13]
A
You know what I mean? I hate to do this to you. It's timing and amount. You just have to put the right amount of insulin at the right time and it'll work for you. And so if you can, at least I think step one would be just try to believe that for a second and stop wondering what else could be happening. And then step two would be, I know that Trasiba doesn't they want you to have two days worth of data before you know if you're making a change or not. But I mean, honestly, you only have the weekend. You have a Friday night injection, a Saturday night injection, and maybe a Sunday night injection to make a decision before you're going to send her back to school on Monday and feel like, oh, God, what did I do? They're not going to let me call her. I can't give her a gummy bear like before all that hits you. So you're just going to have to do it. And so maybe it's going to take a bunch of weekends instead of a week. Like, maybe you're going to have to go a little more on Friday, a little more on Saturday, pause, get to Friday, do it again, and it might take you maybe two or three weekends till you get the basil where it's supposed to be and you start getting a better feel for what the carb ratio actually might be. That's possible. I mean, it sounds like a plan to me at least.
- [56:25]
B
Yeah.
- [56:26]
A
Oh, God. Was this helpful at all? Aren't you glad I didn't try to text this back to you? Oh, my God.
- [56:31]
B
What'd you say?
- [56:32]
A
I said, aren't you glad I didn't try to just answer your email? Because I would have said something that would have just frustrated the hell out of you without the conversation, I think. Yeah, yeah.
- [56:40]
B
I mean, it just seems almost too simple. Like, for example, we took her all the way up to like seven and a half units of Tracebo. She was going low, so took it back down. Like all this back and forth is just so maddening.
- [56:52]
A
When you put her to seven and a half, did you change the carb ratio?
- [56:55]
B
Well, because we were on that bad insulin, we didn't make any changes. I did make a change today because yesterday uncharacteristic, so we had switched to fiasp because we just weren't getting a lot of, you know, we want that faster acting Insulin. Because they are pre bolusing her at school, which is fine. It is what it is. But she has recessed, like, right after lunch, and it's starting to get warm outside, so she is running super hard, and we're having to back off her doses. And now we can't do an extended bolus, which was helping us on the pump. Right. To kind of do an 80, 20 split over an hour. And now we're losing that ability. So it's kind of relearning. How are we going to approach dosing? So it's just like you said, it's just so many things at once.
- [57:33]
A
You have made more changes to that kid's regimen in five years than I've made in 20 years. Yeah, yeah. Stop talking about diabetes for a second, because you just said something that I want to dig into in this last little bit here. I know you got to go. They're probably like, how long is that lady pumping? I didn't even think she had a baby. You said, I'm successful at a lot of things. I just set upon doing something and I do it. Which means that your gut usually gets you there, right?
- [57:59]
B
Yeah.
- [57:59]
A
Like, your gut decisions work out, generally speaking. And so this is maybe part of the issue. It feels like you're trying to find the answer so hard, you're just not doing what common sense says. So in a regular life situation, like, taking the diabetes out of it, I changed this. I moved that. I did this over here. I can't get. What would you tell yourself? You'd say, go back to one. Simplify. Right? Just simplify. Let's push out the external extraneous stuff. Focus on the keep ourselves alive ideas. Let's sit in the house and watch movies all weekend. Right? Like, life's overwhelming. What do you do? Life gets overwhelming. You get to the weekend. You put a ball game on Friday night, you watch a movie on Saturday, you stare at a goddamn wall on Sunday, and you go back to work because you didn't. You were gonna, like, end up in a clock tower somewhere. Like, Right. So do that to diabetes. Just go back to go, like, start over again. Forget all you think you know about what's happening. And just what does your gut tell you to do, right? Like, get her basal right, set her carb ratio, work on the rest later. You keep saying, well, she's going to run around. It's hot. There's this, there's that. You can't balance all that. Your brain isn't capable of that. I don't know we could feed all that into a machine and get out the right answer. So just control the parts, you know, do it at a basic level, go to basic life support. Control the parts you understand, See where that gets you. And build slowly. I think it's possible you maybe started too many projects all at once, so you don't know what's impacting what anymore. Does that ring true to you at all?
- [59:38]
B
Yeah. That's fair.
- [59:39]
A
Yeah. All right, I fix it.
- [59:41]
B
Good. Well, there you go. Do that, then I can unsubscribe and I can stop listening then.
- [59:45]
A
Well, hey, listen, if this works for you, you better download every episode. Just let it play overnight. I don't care if you listen or not. I feel like this has been a valuable conversation, but I don't know if it has or not. And you won't know for a while either.
- [59:59]
B
Yeah.
- [59:59]
A
Will you like reach out and let me know what's going on?
- [60:02]
B
Yes, I will.
- [60:03]
A
Okay. If this actually works, you're gonna come back and record for like another half hour. Will you do that for me?
- [60:09]
B
Okay, I will.
- [60:10]
A
And if it doesn't work, you can come back and yell at me. That'll be fun. Gosh, I hope you can. On top of what I just said, you're married, right? You didn't kick that boy out, right? So I would tell him, on Friday night I'm going to sleep and you're taking care of that kid. And on Saturday night I'll do it for you. But you and I are both sleeping 10 hours at least once this weekend because I think that will help you. We didn't talk about it a lot, but from my personal experience, when you start getting low on sleep like this, that's when you start sounding like you're sounding when you're talking about stuff. You seem frazzled. And I'm telling you, like sleep drips away slowly. You don't recognize it as it's escaping out through the seams. And it's not a thing you can power through even though you think you can. You get some good sleep, a lot of this might make more sense.
- [61:03]
B
Yeah, that's true.
- [61:04]
A
Yeah. I'm being dead serious with you. Like the light of day on good sleep, you make a lot of better decisions than you are right now. Listen, I've been married a long ass time. I don't have a serious conversation about anything after 8pm because when people are tired, the later it gets, the worse it goes. And you're in the middle of that conversation and you think you're right, you Think it's important. You think it's right. You think it's life or death. I have to make this point right now. And you wake up in the morning, you think, what in the hell were we arguing about last night? And I'm telling you, that's all being tired. So I would do trade offs the next couple of weekends. Everybody gets a full night's sleep at least once on a weekend. Get her stuff going a little better. Your life could look just completely different in a month, you know? But you got to stop chasing all the ghosts and thinking you're actually going to catch them all, name them, put them in order and make sense of them. None of that is probably even important. I heard you quote the podcast a bunch of different times in this hour. Don't forget, often the best thing to do is nothing. Yeah, often there's nothing to do. People just over engineer everything and touch too many buttons. And I mean life, not just diabetes. Yeah, chill out. Watch a movie, Go out for dinner. When's the last time you had sex? Do that. Try to chill out a little bit.
- [62:25]
B
All the things. I'll do all the things.
- [62:27]
A
Yeah, do them. All right. Act like you're 20. Was the weed idea good or you don't do that.
- [62:32]
B
No, I don't do that.
- [62:33]
A
All right, well, find something. Don't drink. Okay. I'm pretty sure drinking's bad. All right, we're good.
- [62:39]
B
We're good.
- [62:39]
A
All right, hold on one second for me. Okay, we're gonna stop.
- [62:41]
B
Okay.
- [62:48]
A
The podcast episode that you just enjoyed was sponsored by Eversense CGM. They make the Eversense 365. That thing lasts a whole year. One insertion every year. Come on. You probably feel like I'm messing with you, but I'm not. Eversensecgm.com Juicebox the conversation you just enjoyed was brought to you by usmed usmed.com juicebox or call 888-721-1514. Get started today and get your supplies from us Med. Today's episode of the Juice Box podcast was sponsored by the new Tandem MOBI system and control IQ technology. Learn more and get started today at tandomdiabetes.com Juicebox check it out. Okay, well, here we are at the end of the episode. You're still with me. Thank you. I really do appreciate that. What else could you do for me? Why don't you tell a friend about the show or leave a five star review? Maybe you could make sure you're following or subscribed in your podcast app. Go to YouTube and follow me. Or Instagram TikTok oh gosh, here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page. You don't want to miss please do you not know about the private group? You have to join the private group. As of this recording, it has 74,000 members. They're active, talking about diabetes. Whatever you need to know, there's a conversation happening in there right now and I'm there all the time. Tag me. I'll say hi. Have you tried the Small Sip series? They're curated takeaways from the Juice Box Podcast, voted on by listeners as the most helpful insights for managing their diabetes. These bite sized pieces of wisdom cover essential topics like insulin timing, carb management and balancing highs and lows, making it easier for you to incorporate real life strategies into your daily routine. Dive deep, take a sip and discover what our community finds most valuable on the journey to better diabetes management. For more information on Small sips, go to juiceboxpodcast.com, click on the Word series in the menu. Have a podcast? Want it to sound fantastic? Wrongwayrecording.com.