#1860 ER Match

Summary

Juicebox Podcast: Type 1 Diabetes

Episode 1860: ER Match
Host: Scott Benner
Guests: Matt (Type 1 Diabetic, ER Nurse) & Chassie (ER Physician, Matt’s Wife)
Date: May 26, 2026

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Episode Overview

This episode of the Juicebox Podcast offers an honest, heartfelt, and insightful conversation about navigating life, marriage, and the healthcare system while managing type 1 diabetes. Scott speaks with Matt and Chassie, an ER nurse and ER physician respectively, who share their personal journey through health challenges—most notably Matt’s late adulthood type 1 diabetes diagnosis and earlier battle with cancer. The couple’s unique dual perspective—medical professionals living as both provider and patient/partner—provides listeners with wisdom, empathy, and practical takeaways for better diabetes care and a deeper understanding of the medical maze.

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Key Discussion Points & Insights

1. The Couple’s Background and Relationship (02:36–04:24)

• Matt and Chassie introduce themselves, their careers, and explain how they first met and reconnected after years of near-silence as coworkers.
• Chassie notes Matt’s extreme shyness in their early working years.
  • “For him to not speak to me tells you just how shy he was and how much he's come out of his shell.” – Chassie (03:47)
• Their relationship began in earnest just before Matt faced a series of health struggles.

2. Matt’s Cancer Diagnosis Story (05:02–10:48)

• Matt describes being diagnosed with bladder cancer in 2020 at age 42, after years of mild, ignored symptoms (intermittent blood in urine).
• Chassie performed an ultrasound at work and detected a “softball-sized” bladder mass, initiating swift further testing and removal.
• The diagnosis: transitional cell carcinoma, resected early with good prognosis but needing regular surveillance.
  • “We know that this type of cancer has a 30% chance of recurrence… So Matt has to be under ongoing surveillance.” – Chassie (08:46)
• Discussion of occupational exposures as a firefighter/paramedic possibly being the cause.

3. Onset of Type 1 Diabetes & Diagnostic Challenges (11:21–24:54)

• Matt recounts the months of denial and rationalization as classic T1D symptoms developed—polyuria, polydipsia, rapid and significant weight loss—following travel, stress, and a round of steroids.
• Despite being healthcare workers, both were thrown by the diagnosis process:
  • “Unless you have a connection to type one, I think it does. You just don't even think of it.” – Matt (17:48)
• Matt's bias (thinking only of type 2 in adults, disbelief as a fit person) delayed action until symptoms became too severe.
• Matt credits Chassie’s persistence for finally pushing him to the doctor.

4. The Gaps and Frustrations in Diabetes Care Access (24:54–33:18)

• The difficulty of quickly getting an endocrinology appointment—“there are not enough endos”—and why ER visits often can't fully diagnose or manage T1D.
• Why don’t ERs do complete diabetes diagnoses?
  • Diagnostic antibody tests (GAD) aren’t hospital-based and take days/weeks.
  • The ER is designed for acute, life-threatening care (e.g. DKA), not complex chronic diagnosis.
• If someone presents out of DKA, they’re often pushed to outpatient care, which is slow and “broken.”
  • “You need to see endocrinology and you just can't get in… even here, we live in Orlando and there's just not enough to keep up.” – Chassie (24:55)
• Key Quote:
  • “The ER is a safety net… If we need to admit to keep care going, that’s absolutely fine.” – Chassie (35:04)

5. Understanding Medical System Bias & Cognitive Challenges (45:53–48:14)

• Stories about missed diagnostic clues and cognitive biases—e.g., assuming an elderly woman had just a UTI.
• The interplay between “pattern recognition” and the danger of premature conclusions is deeply discussed.
  • “It is… humbling to be in medicine, to unwire your brain and to think outside of the box.” – Chassie (46:08)

6. The Role of Technology and AI in Medicine’s Future (42:03–53:30)

• The group speculates on the future of AI diagnostic tools as a supplement to human expertise and as a solution to information overload.
  • “There's too much information for one person to process... That's why we talk about specialty all the time. But… somebody could just take a large language model for endocrinology and train it on everything that human beings have ever known.” – Scott (48:14)
• Matt wonders: Will patients accept doctors who use AI, or see them as “Googling” answers?
• Scott recounts a story of a nurse-in-training realizing after one class that formal training covers only a fraction of actual diabetes care.

7. The Emotional Weight of Living With Diabetes (56:22–65:31)

• Matt reflects on the total mental, emotional, and lifestyle impact of managing type 1—both as a patient and as a nurse.
  • “It takes every bit of my mind, every minute of every day.” – Matt (54:24)
• The crucial importance of day-one, high-quality education, and the reality that many providers don’t have the full picture.
• Emotional moment between Matt and Chassie, discussing fear of health crises and the desire to be a good partner:
  • “My entire fear with diabetes was that one day Chassie will find me on the floor, you know, unresponsive… it consumes me, but I don't want to do that to her.” – Matt (65:11)

8. The Power of Community Education and Advocacy (Mainly 58:00–end)

• Scott and the couple reflect on the gap left by formal education and why accessible, accurate patient-led resources (like podcasts, online communities) are so vital.
  • “It's so important that on day one, they get put in the right direction… once you put somebody on the right path, it's not a coin flip anymore.” – Scott (59:20–60:49)

9. Closing Reflections and Gratitude (62:45–73:06)

• Chassie shares how Scott’s podcast helped her step from “I can save a life in the ER” to “now I know how to be a real partner living with diabetes day-to-day.”
  • “That's the beauty of what you do, Scott, is that this is the day to day living life... your impact is so huge.” – Chassie (62:58)
• Matt and Chassie express thanks for Scott’s work and reflect on the unique value of lived experience and accessible education.
• The episode ends with humor and warmth, and the couple’s deep appreciation for each other.

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Memorable Quotes

On the shock of diagnosis:

“Unless you have a connection to type one, you just don't even think of it.”
— Matt (17:48)

On ER limitations:

“The ER is designed for emergency things. Now these aren't things that necessarily aren't important and don't need further care, but these are emergent diagnoses like in your population, DKA. But even something as simple as sending labs to actually test for, say, antibodies in your type one? Not possible.”
— Chassie (28:32)

On what patients need:

“It's so important that on day one, they get put in the right direction... once you put somebody on the right path, it's not a coin flip anymore.”
— Scott (59:20-60:49)

On living with type 1:

“It takes every bit of my mind, every minute of every day... I don't wish it on anybody, but I wish everybody would be as tuned into it as I am.”
— Matt (54:24, 56:22)

On the power of patient education:

“When you're not there with your doctor, you're not there with your nurse, you're not there with your nutritionist, you're not with a pharmacist. It's all of these moments in between where your impact is so huge.”
— Chassie (62:58)

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Key Timestamps

• 02:36 – Matt & Chassie introduce themselves
• 05:02 – Matt’s cancer diagnosis, discovery, and treatment
• 11:21 – Lead-up to diabetes symptoms and initial denial
• 17:48 – Bias & psychology of adult-onset T1D
• 24:54 – Challenges accessing endocrinology
• 27:11–29:38 – ER process, limits, and patient experience
• 34:14 – Why quick in-ER diabetes diagnosis isn’t possible
• 41:58–53:30 – Medical education gaps, the role of AI, and stories of missed diagnosis
• 54:24, 56:22 – Matt on the day-to-day mental load of T1D
• 59:20–60:49 – Importance of good education and avoiding “coin flip” outcomes
• 62:45–65:31 – Chassie and Matt reflect on podcast’s impact on their partnership
• 65:11–till end – Emotional conclusion, humor, optimism, and gratitude

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Tone & Style

The conversation is candid, warm, and layered both with professional insight and deeply relatable vulnerability. Scott’s approach is direct yet compassionate. Matt and Chassie are open about emotional tolls, marital dynamics, and the humbling gaps even seasoned clinicians encounter navigating chronic illness from the other side.

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Takeaways for Listeners

• For people newly diagnosed or caring for someone with diabetes:
  You’re not alone in feeling overwhelmed, and even clinicians face uncertainty. Seek community knowledge, be proactive, and don’t accept “wait and see” as your only option.
• For healthcare providers:
  Gaps in formal education exist—patient expertise and open dialogue can enhance care. Don’t dismiss the depth of lived experience.
• For everyone:
  Advocacy and shared resources can transform both individual lives and the broader culture of chronic disease care—education should not rely on luck or “coin flips”.

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End of Summary.

Transcript

[Scott]

Welcome back, friends. You are listening to the Juice Box Podcast.

[Matt]

My name is Matt. Been diagnosed as a type 1 diabetic for just over one year and I'm here with my beautiful wife Chassie.

[Scott]

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 juicebox podcast.com and click on Support. While you're there, check out the guides like the Pre Bolus and 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 than you think. Nothing you hear on the Juice Box Podcast shop should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan. I'm having an On Body vibe alert. This episode of the Juice Box Podcast is sponsored by Eversense365. The only one year wear CGM. That's one insertion and one CGM a year. One CGM one year, not every 10 or 14 days. Eversensecgm.com Juicebox Today's episode is also sponsored 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. The podcast is also sponsored today by the Tandem Moby system, which is powered by Tandem's newest algorithm, ControlIQ plus technology. Tandem Mobi 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 tandomdiabetes.com Juicebox My name is Matt.

[Matt]

I've been diagnosed as a type 1 diabetic for just over one year and I'm here with my beautiful wife Chassie.

[Scott]

Hey, Cassie, how are you?

[Chassie]

Hi. Scott, I'm doing great. Thank you. I'm Chassis. I'm the wife of a type one diabetic. I'm an ER doctor and he's an ER nurse.

[Scott]

No kidding. How long have you been married?

[Matt]

I'll give you this one.

[Scott]

Do neither of you know, or are you just trying not to talk over each other?

[Matt]

September of 2022.

[Scott]

That's not that many years ago. Matt, you should not be saying that like you're not 100% sure.

[Matt]

We travel a lot, we work nights, and our schedule's crazy. So it takes a lot to just remember the day of the week.

[Scott]

Yeah, well, listen, watch this. 30 year pro, August 3rd, 1996. Boom. See that?

[Matt]

I've been there and done that, and this life is much better now.

[Scott]

Okay, so you guys meet at work?

[Matt]

We actually did.

[Scott]

Nice.

[Matt]

We worked in a different city years ago. And it's a funny story, actually. I'll let Chassis tell it. She's a better storyteller.

[Scott]

Go ahead, Chassis. I'll hear it.

[Chassie]

We did, actually. We worked together for several years and Matt was extremely shy. But we worked together for years in the same hospital and honestly never really spoke. I'm pretty friendly and outgoing, so for him to not speak to me tells you just how shy he was and how much he's come out of his shell. But yeah, we worked together for years and. And never really spoke for a very long time. And then now, once he finally approached me and we started talking, now he doesn't really stop. So we. We've been together for a while now.

[Scott]

Be careful what you wish for, I guess. Matt, were you married at the time and weren't talking about. Because you didn't want to do something inappropriate, or is that not the case? Were you not married when you guys started talking?

[Matt]

I was married previously for. We just talked about time that was 20 years. Wasn't happy, was in my head, was in a tough space. So I kept to myself, kept my head down, just did my job and just kept trucking on.

[Scott]

Yeah, I think he didn't want to talk to you because he's afraid, you know, he's going to hit on you while he was married. That's what I'm thinking, but we'll go with. He was quiet and. So when you get married, do you have any health issues at that point?

[Matt]

When we got married, yeah, us, I actually had just been diagnosed with bladder cancer and it was at work and Chassis was actually the one that found it.

[Scott]

No kidding. Okay, well, tell me about that first.

[Matt]

I had a. A Few years with a little hematuria, a little blood in the urine. Didn't really think anything of it. Talked to a couple other people. Because us in the medical field, we don't like to go get seen by other people.

[Scott]

You know how bad they are at their jobs. You've met them in person, so.

[Matt]

Oh, absolutely.

[Scott]

But Matt, I gotta stop you before you even get into this story. Did you say you had blood in your urine for a couple of years?

[Matt]

No, it wasn't consistent. Maybe three times.

[Scott]

You still married this guy even though that happened? What's going on?

[Chassie]

I know this. Imagine this kind of stubbornness and now throw on some type one. Spoiler alert, you already know he's type one. Yeah. That kind of personality. And now with type one, it's a. It's a fun roller coaster. It's marriage building skills, I bet you.

[Scott]

Okay? I'm sorry. So you notice this? You finally go see somebody, what happens then?

[Matt]

Yeah, well, I changed my diaper on my own, so she didn't have to help me with that.

[Scott]

Jesus, look at you doing your part, the help.

[Matt]

So, yeah, it was. It was sporadic. Just a couple times over a few years. Didn't think anything of it. Thought it may have been something else minor. We were at work one day and she was like, you know what, let me just go ahead and ultrasound you. Not looking for anything specific, just going over, you know, the body system with the ultrasound. And she got down to my bladder and her eyes just got wide. And of course I was like, what? What? And she was quiet and she's not a quiet person, which you'll learn. And she just showed me the video and it was like this softball sized mass in my bladder. The only one thing really comes in your mind when you see something like that. Yeah, I think we had just started dating at that time. We weren't living together. It was just. It was still new, so that's kind of an awkward start. So.

[Scott]

Yeah, I've heard. I've heard Tinder dates have gone wrong for much less than this. People will bail on anything.

[Matt]

I wouldn't know. I never went that route. But yeah, I couldn't see that being easy one to say, see you. But she had to work with me, so, you know, she made some calls. We got into urology. I went and did blood work, urine had a CT scan and all that stuff actually came back negative.

[Scott]

Okay.

[Matt]

But we have a video of this mass and an ultrasound and her being the doctor and. And knowing these other specialists, they were like, you know, come on in. We'll do a biopsy, not trusting the other results, and went in for a biopsy that ended up being a complete removal at the time. So I come out from anesthesia and the doc's like, yeah, it was. It was cancer.

[Scott]

And what do they take out? I'm sorry, what's a complete removal mean?

[Matt]

Terminology wise, Jassy, do you have a term? The neoplasm.

[Chassie]

Yeah. So he ended up all of Matt's blood work and lab work. Even the CT scan was normal. So I sent my images to a colleague that's a urology surgeon. And so he kind of knew what he was looking for when he went in and came out while Matt was still in anesthesia and said, oh, yeah, it's definitely cancer. I've got to remove all of this. So, yeah, came out, said it was definitely cancerous, but it was able to be resected at that time. And then we ended up getting pathology back that it was a transitional cell.

[Scott]

So what's that mean, transitional?

[Chassie]

It's a type of bladder cancer. Basically, for us, it was not malignant, meaning it had not spread to other organs. But we know that this type of cancer has a 30% chance of recurrence in life. So Matt has to be under obviously ongoing surveillance.

[Scott]

Yeah, I know.

[Chassie]

Scrutiny with 30% recurrence, that's pretty high. And especially for a guy with no medical problems, no medications. Yeah, that was a fun way to start dating.

[Scott]

Yeah, I imagine you thought, I've either got to marry this guy or leave and change jobs, right? You can't. You couldn't just go, oh, okay. Well, good luck and I'll see you around work. We're not dating anymore.

[Matt]

I'm glad she stuck around.

[Scott]

Yeah, no kidding. That's lovely. So is there damage to the bladder or what's the recovery like?

[Matt]

Every year I've gone for one or two cystos where they go in and take a look. I actually just went last week and got my five year clearance.

[Scott]

Oh, good for you.

[Matt]

Urine was clear from any cancer cells and the scope inside was completely negative. I've gotten some chemotherapy initially and luckily it took. Right now it's just maintaining urine and a scan I think once a year now. But yeah, everything is gone. No issues. I'm not dribbling everywhere, you know, it's pretty good as far as that goes.

[Scott]

That's a good sign. You keep going. You are going to find her a line one day. Dear diary, he's dribbling. I'm out. So I did my best. Wow. And Then tell me when that happened again.

[Matt]

What year that was founded in September of 2020. Normally it was under 50 and smokers or who was prevalent with. And at the time I was 42. And just to preface that, I was a firefighter paramedic for a long time and I worked on the hazardous materials team and we think it was a. From the foam that we use.

[Scott]

Oh, really?

[Matt]

Fight fires as an environmental exposure.

[Scott]

Matt, I gotta tell you, I worked in a paint shop in a sheet metal place for years and every day that I don't die, I'm pretty amazed, honestly. Yeah, yeah, yeah. As a kid I was just around, I was just around a lot of in the air and you know, we didn't wear mat. Nobody did anything. You just walked in at work.

[Matt]

Oh no.

[Scott]

Yeah. So yeah, I can't believe I don't have a problem from something like that. How long after this process does the diabetes appear and how do you figure that out?

[Matt]

Well, I was good. It was September of 24. I had kind of stressfully left a job here where we live now and we travel a lot. So we were preparing for a trip. But prior to the trip I had been to a concert with a friend of mine and there was like a beer tasting event like three hours prior to the concert. So we go around the room, we're drinking all this beer and I know everything was fine right then because I wasn't paying all the time. So drank all that beer, you know, peed like maybe once or twice. Watch a concert, everything was good. And then we went to Turkey in November and I'll just say that I may have had some touch up work that some people may do in Turkey.

[Scott]

Every now and then you get your eyes pulled back a little bit.

[Matt]

You do just a little, just a little bit, just a touch nice. And after that they give you some steroids after. And didn't realize at the time, but I, my vision was getting blurry, my close vision, but my distance was fine. And I just had LASIK surgery done the year before and my vision was perfect. So I contacted them, said, hey, my vision's a little blurry, give you some medicine and they're like, oh, it should, should go away. So I said that was November. And then sometime after that I just started like peeing all the time and I drink a lot of water, I work out all the time, so it's normal for me to, you know, pee. Yeah, this was just ridiculous. I couldn't sleep and working night shift and trying to come home to sleep and you're up every 30 minutes to an hour going to the bathroom. Like what?

[Scott]

So you're peeing like on the hour? Almost.

[Matt]

It was almost hourly. Like I'll drink in a gallon of water, work every shift and I'll drink a gallon when I'm home. So it's normal. But this was to the point where I'm like, what the. You know, right? This is unreal.

[Scott]

And did you think I'll just ignore this for a few years and then if it gets bad enough, I'll have my wife look into it?

[Matt]

Absolutely. Absolutely.

[Scott]

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[Matt]

Well, my. My vision got really bad, and it was. It was pissing me off. Yeah, I'm like, you know, these are kind of diabetic symptoms. I'm like, there's no way in hell that I'm diabetic. And so it goes on and on, and it's been, like, three months, and, like, I couldn't leave the house without, like, stopping in a parking lot or, you know, I had to plan everything. It just. It was so ridiculous that Jesse finally talked to me, and she's like, let's go to urology. That's the only doctor I'd seen here.

[Scott]

It's true.

[Chassie]

It's true. But that is the only physician Matt had, and that was only because he had bladder cancer and we were maintenance, so that's the only place I could get him to go. Because I agree, these are all screaming, yeah, he's not the stereotypical or what you think of. And that was such a hard barrier in his head to get through. He's like, I know I have the polyuria. I'm peeing all the time. I know I have polydipsia. I'm drinking water all the time. And he just made, you know, excuse after excuse, thinking, no, it can't be. No, it can't be. No, it can't be. And so. And he was suffering for three, four weeks, probably just miserable. And then when I finally said, matt, you look ill, I mean, you. You don't look well. Matt is a. I know this is a podcast, but Matt's a big guy. I mean, he works out. He looks big and buff.

[Scott]

Yeah. Matt, you're a robust person. Like.

[Chassie]

Yeah, he's thick.

[Scott]

Yeah, yeah, yeah.

[Chassie]

I mean, he is. He is extremely muscular, extremely fit. And Scott, he looked sick. I mean, he had lost 25, 26 pounds in two months, unintentionally.

[Scott]

Yeah.

[Chassie]

And with his history of bladder cancer, that's always a cancer diagnosis.

[Scott]

Right? But, Matt, tell me something. When you think diabetes, can you kind of go through the psychological thing that stops you from wanting to. I know nobody wants to think they're sick in general, but why is diabetes, like, even a bridge too far beyond that? Because people talk about it all the time. I'm wondering if you can put it into words.

[Matt]

Well, first off, type 1 had. Had never even entered my. My mind. Unless you have a. A connection to type one. I think it does. You just don't even think of it. Okay. You think type two, you think, you know metformin. You think Oh, I gotta lose weight. I've got to work out, get healthier. And I was already healthy. So to me, I'm like, there. There's just no way. And not to put a negative, you know, light on it, but I'm like, if it is type 2, what is there that I could change in my lifestyle? Because I'm the pickiest eater. I don't have a sweet tooth. I mean, my BMIs are, are both because the height and weight, you know, I don't go by that. And because if it was just taking Metformin or something like that and working out, there would be no problem. But I'm just stubborn. And I was like, there's. There's no way this is going to go away. And when it was brought to my attention how much weight I had lost, and I just. I'm not one that would weigh myself all the time, but it ended up being like 30 to 40 pounds. Yeah. After the three months and I didn't see it in my face, I started going back and looking at pictures and I was like, it really got to me, right? And I was like, okay, let's. Let's go ahead and get checked out.

[Scott]

At that point, are you thinking, I'd prefer this to be diabetes because I don't want it to be cancer? Do you have to have that thought?

[Chassie]

Absolutely.

[Scott]

Yeah, I would imagine. Also, let me just say here, for everybody who follows me on Instagram and knows this, but I'm having my office. I'm having an office built in my basement. And so I'm doing my best, but there are going to be times and you're just going to hear banging in the background, and I don't think there's anything. We'll just have to use this as a timestamp in the podcast for when Scott got his own office finally and moved out of this tiny room making the podcast. But I'm doing my best not to speak while it's happening, so editors can take it out later. But every once in a while, you're not going to hear it, but I'm going to hear it. That's going to be stuck in my

[Chassie]

head on this episode. You can blame me. I was beaten mad in the background for being such a stubborn patient. So for this episode, it was me.

[Scott]

In fairness, every physician I've spoken to, nurse, you guys are all the same. Like, you should all have to walk around the hospital with a shirt on. It says, do as I say, not as I do. You know? So I take how it happens. Does your Urologist do it or do you have to go find a doctor to actually give you a diagnosis? I used to hate ordering my daughter's diabetes supplies. I never had a good experience and it was frustrating. But it hasn't been that way for a while. Actually for about three years now because that's how long we've been using US medicine. Usmed.com juicebox or call 888-721-1514. USMED is the number one distributor for Freestyle Libre Systems nationwide. They are the 1 specialty distributor for Omnipod Dash, the 1 fastest growing tandem distributor nationwide. The number one rated distributor in Dexcom customer satisfaction surveys. They have served over 1 million people with diabetes since 1996. And they always provide 90 days worth of supplies and fast and free shipping. USMED carries everything from insulin pumps and diabetes testing supplies to the latest CGMs like the Libre 3 and Dexcom G7. They accept Medicare nationwide and over 800 private insurers. Find out why US Med has an A rating with a better business [e-mail] juicebox or just call them at 888-721-1514. Get started right now and you'll be getting your supplies the same way we do.

[Matt]

Well, first thing they do, like every visit, you go give a urine sample. Oh, by the way, I think the banging you hear is every time I say is chassis hitting me.

[Scott]

Trust me. I have weird connector words. It took me years to stop them. I used to have stickies on my monitor with words and like lines put through them because I would use connector words when I was thinking. I've learned just stop talking until the next word comes to you. It's an easier way to handle it. But don't worry about it. You guys are doing great. Don't think anything of it.

[Matt]

Okay, good. All right. So I give the urine sample, we go in the office and the urologist comes in. A great guy. He goes, you, you've got sugar in your urine. And just like stomach stunk. He's like, it's diabetes. Just like, you know, playing his day. It's diabetes. And still you don't think type one, right. It just doesn't occur. So he was like, let's go ahead and, and refer you to, you know, local endo. So we leave the office, go ahead immediately call on the way home. And it was just a garbage call. It's like, well, let give us your insurance information. We'll call you back next week. If you know, your insurance works with our office. That just wasn't good enough for chassis, who, luckily, she did stick with me. It's so loving and caring. She's like, let's find some other way.

[Scott]

Yeah, Chassis. There was not a half a second. You're like, I could have bailed back at the cancer thing. Well, Matt, what is it about you so delightful that none of these health issues run her off?

[Matt]

I just smell really good, I guess. I don't know.

[Scott]

That's the pheromones.

[Chassie]

Isn't that terrible? I'm a forever doctor at work, at home. Like, I'm attracted to my patient, my husband. Like, I get to doctor at work. I doctor at home. I'm really committed to the field is what I'd like to think.

[Scott]

I thought some guy must have just been really terrible at chassis in a former life. And she's like, this is a nice person. I'm sticking this out.

[Chassie]

You're so good at this game, Scott.

[Scott]

Oh, okay. All right.

[Matt]

I'm a long term study. That's all it is.

[Scott]

Just like, I can't wait to see how this turns out. What a funny way to think of yourself. She's just really, like, you know, interested in what's happening. I. Listen, I've said over and over again, I'm only still married because my wife wanted our next kid to look like her first kid. She was probably like, how am I gonna move all this stuff out of the house by myself? You know what I mean? It's a lot of effort.

[Matt]

Exactly.

[Scott]

So, wow, man. So you get in with somebody quicker than a week. Did she, like, shake down some person she knows and make them see you? What happened?

[Chassie]

So it's one of the things that is so frustrating in healthcare. This is just a specific. Our niche, obviously with you is it's type 1 diabetes. And for our diabetic patients out there, and I think we all can agree, no matter where we're listening to this from, there are not enough endos. I wish that the world and the diabetic populations everywhere had more endocrinologists available. And even here, we live in Orlando, and there's just not enough to keep up with the patient needs. And so this was yet another example, and we were living it, of how, you know, you need to see endocrinology and you just can't get in.

[Scott]

Yeah.

[Chassie]

And Matt was again, he looked so unwell that I. I truly thought it was cancer, not diabetes. And so he was becoming more symptomatic and more symptomatic, and we obviously needed further testing, and he had no medications that he was Taking for anything. And he looked so unwell, and he had to be unwell for me to even get him to the urology appointment. And I thought, let me reach out to my colleagues. And so there's a women's physician group that several of us are involved in in Orlando. And honest to goodness, I just called in a favor. It was nothing more than just the graciousness of a colleague saying, oh, gosh, absolutely. I'll see him tomorrow.

[Scott]

So chassis if that wasn't possible, I mean, and with your background and what you do for a living, like, he's a prime candidate to go to the ER, right?

[Chassie]

100%. And that's exactly where I would have taken him, where we would have ended up, and the only place that he would have been able to at least be thoroughly evaluated and keep him from being very, very ill. Can I ask you a question?

[Scott]

Like, while we're on this subject here, of course. You're an ER doctor, and you have a patient in front of you who you love, who looks like he should go to the er, but you were still like, let me see if I can get him to another doctor. What's the disconnect there? Like, how come everybody who comes on here talks about the ER and, like, I mean, do you know I took my mom to the ER three times before someone found her cancer. They one time imaged her and said, this is a uti, but she's so full of urine, it's hard to tell. So we're going to drain her out and like, blah, blah, blah. But they imaged her first. The urine blocked the scan. You couldn't see the uterine cancer she had. Right? And then they were like, oh, she should. I mean, three times till somebody found a mass that was huge. Like, how's that possible? I know you're a good doctor. Okay? I've met you. You seem like a reasonable person. What happens? Like, where's the disconnect in something like this? Like, how come you didn't just put him in a car and drive him to the er? There's got to be a reason. Unless I'm thinking into it too far.

[Chassie]

No. I'm so glad you asked that. And it's something that I think in the ER that we take for granted because, oh, my gosh, every single patient, all you want to do is everything for every patient. You know, we in the er, remember, there is no specialty. You have to know everything from head to toe. I have this rash on my scalp. I'm vomiting. My baby has a rash. I've lost 30 pounds this week. And again, I think most of us in the er, we just want to fix and cure everything. And the problem is that there's a saying in emergency medicine that we're a jack of all trades and a specialty to none. And unfortunately, I wish that the ER could be a one stop shop for everything. That's just not how emergency medicine works. And the key to an emergency department is truly emergency things. Now these aren't things that necessarily aren't important and don't need further care, but these are emergent diagnoses like in your population, dka, those are all emergency things. But even something as simple as sending labs to actually test for, say antibodies in your type one. Not possible.

[Scott]

Yeah.

[Chassie]

In the er. A biopsy for your mom's mass. Not possible in the er. And so the ER is this huge catch net for every single ailment, pain, symptom, rash, bump, lump, symptom of I don't feel good, anything. And you do as much as you possibly can. And then we really have to rely on our specialty colleagues for all of these higher level specific tests to kind of get you in the right direction. Now if I could be an ob GYN and an endocrinologist and a urologist and everything, I promise you I would. I just am specifically trained in emergent situations and narrowing things down and being as thorough as I possibly can. And again, referring for follow up or consulting on my colleagues for those further evaluations and diagnoses and testing. Like for example, no ER doctor can order antibodies for testing the difference between type one and type two.

[Scott]

But why not? Because what it feels like is that you're involved in a special kind of medicine that's sort of like if this then that if my arm's falling off, you're the right place to go.

[Matt]

Right?

[Scott]

Like that kind of thing. But if I have, you know, diabetes, I'm gonna send you to endo. But then we all know that when you say, well, you're gonna have to go to endo, like they sent Matt out and he called immediately and got told, you know, we'll talk to you next week. And like, you know, if he was in DKA and you guys didn't have the background you have, like, you don't know where that would have ended up. He would have probably ended up back in the er. But then DKA would have made them say, oh, he has type 1 diabetes.

[Chassie]

Right, exactly. Okay, exactly.

[Scott]

From your perspective, like, what's the. Because everyone says it's broken, it can't be fixed, but it doesn't seem that difficult to fix. I don't know. It feels like the map we use to get to the end is just a little skewed. You know what I mean? Like, let me give you an example and see if this goes anywhere. I had to take Arden into the hospital. I don't know. Like, last year, she had an infection, and I was going through her symptoms with an AI model, and I had all the possibilities in front of me of what I thought was going to happen, what could possibly happen. And the ER doc would talk to her, disappear in the back, come back again, and then talk to me. And it felt like she was reading the ChatGPT answer that I had to me, which really made me think that she went in the back and did the same thing I did. And maybe not. Maybe just her training and her if this, then that, like, just comes out that way. And it's possible she was just a great doctor. Like, I have no idea. But my point is that if she and I came to the same conclusion and I have no training, why can't that thing say, hey, this could be type 1 or type 2 diabetes. We get to order this lab. Or we can contact Endo, who could give us a script right now digitally. Like, why does that stuff not happen? Like, why is it always go wait and maybe you'll get sicker? Or if you don't, good for you. Like, why does it work that way?

[Chassie]

So, for example, let's use specifically, since this is the Juice Box podcast, for example, type 1 testing. So there's only a couple of laboratories in the entire country that can test for GAD antibodies, which is one of the main antibodies that we look for to distinguish type one and type two. Right. So even if I'm standing in front of you and I have your blood and I send it off, that test takes over one week to complete.

[Scott]

Okay.

[Chassie]

It is not a test that exists in, well, any hospital I've ever worked at, and I've worked in many.

[Matt]

Right.

[Chassie]

And so a lot of these diagnoses that we experience are really are. They're very niche. These are things that take days to weeks to diagnose. And so that's one of the great things about the ER is that I hope nobody ever gets sick, but there's always a doctor 247 to help get you through those things. And if. If there's ever a gap in between, you know, managing you outpatient in the comforts of your own home, then that's when we utilize the Emergency department and inpatient, if we need to admit you. Now, here's the thing. I knew Matt was not in dka. I see DKA for years. I can look across the room and go, oh, boy, that's. Oh, they're in dka. And I knew that wasn't Matt. So did I know Matt didn't feel well? Yes. Did I know he needed other testing? Yes. Did he need to sit in a hospital room for days to a week until we get these answers?

[Matt]

No.

[Chassie]

Could we manage this outpatient? Absolutely. And if he needed to go to the E.R. in the meantime, even temporarily, to be discharged, you know, back home and still wait, then that was an option. But I am. I was very fortunate to know that, yes, Matt, we don't have all the answers. No, Matt doesn't feel good. Yes, we need to keep going. We're on a journey here to get diagnosed, treatments, things like that. But I also knew that we could always go 24 7, anytime, anywhere if we needed to. He just didn't need to at that point. He just felt bad. And we were impatiently waiting for follow up and testing.

[Scott]

Yeah. Okay. I have a question. Like, if you had somebody with a 400 blood sugar and you gave them some insulin in the er, brought their blood sugar down, took the insulin away, and it went right back up again, isn't that a pretty good sign it's type 1 and not type 2?

[Chassie]

No.

[Scott]

No, that wouldn't work.

[Chassie]

No. I wish. Oh, my goodness. You know how finicky diabetes is. I wish it was that simple. But no. And that's. Honestly, I think that the biggest takeaway as a physician with your patient, and I speak for me, but I hope I speak for all of my physician colleagues out there, is that's why it's so important just to have healthy conversations with your patients, to say, hey, you know, it looks better now, but this can go on and this can go up, it can go down. And if you're not feeling well and Matt can attest to this, I tell my patients, if you're not feeling well or if something happens, it's okay, just come back. I don't want you out there suffering and being miserable. Even if I can't do everything you need here from the yard, I don't want you out there in the world alone or being sick. And if you need something, that's okay.

[Scott]

Yeah.

[Chassie]

Our plan B is always, you come back here. This is always a safe space. This is a safety net for you. And if we need to admit to keep care going on, that is absolutely fine. I hope you never need to be admitted to the hospital, but if that's what it takes, then that's what we do.

[Scott]

Can I ask you why? Why do you think that there aren't more just diabetologists, like, just people who are not full blown endos, but like, just handle diabetes? If diabetes is so prevalent in the population, why aren't students wanting to be doctors who take care of it? Is it because the prevalence is mostly type 2 and that people don't seek treatment until they're. Is it a money thing? Can you not make money doing it? Like, I'm wondering why it feels like that's the thing everybody would be rushing to do. Because there's a need. You know, the needs there, and the need would translate to business.

[Chassie]

Oh, the need is definitely there. And again, this is the Juice box podcast. So our niche here is endocrinology and type 1 and type 2 diabetes. But there's also so many different disease processes out there that, you know, sometimes just grab your heart as a doctor or a nurse even, or when you're young and your grandma goes through X, Y or Z. And I do, I think all of us just have these different life moments that kind of draw you into where you end up in life, in your job. Like, even with you, with Arden. I mean, look what Arden has brought you that's led you down this path. And if she had had a, you know, a different process or struggled with a, A different disease, I think that you'd probably be really passionate and be the next expert in X, Y or Z.

[Scott]

Something different.

[Matt]

Yeah.

[Chassie]

Yeah. And that's the beauty of life, is that experience is a great teacher. And I would like to say that, my gosh, I have an extra, extra deep place in my heart now for all of my diabetics, type one and type two, you know, because when you live through something, it does. It makes you passionate about it and it makes you want to be more and learn more. And so I'm thinking that with the prevalence, like you're saying, surely there's so many young nurses and young doctors out there who are being affected by type 1 and type 2 diabetes, and they are, they're going to be passionate about this and go into these fields.

[Scott]

A great insight. I appreciate that. Seriously, that is a really great insight because I just, I always think of it as, I mean, I know everybody's. You're hoping your doctor is one of those people just grew up thinking, like, I want to help people. Some of them grew up, like, I'd like to try to make some money. And so, like, why would those people not flood to where the need is? Because the need is billable. But it's just. I don't know, it's a real. It's very interesting. And that endo shortage is across the country. It is, as far as I can tell from talking to people, it is.

[Chassie]

And it's a career that's too long for you to just do it for the paycheck, I think. I'm sure there are people in every specialty or every field in the whole world. World that can do it for the paycheck. But medicine is a tough job if you don't actually really like what you do and like your patients.

[Scott]

I hear you.

[Chassie]

And yes, you. I think as a patient, you probably want the doc that enjoys that specialty and enjoys that niche because again, it's just a win. Win all around.

[Scott]

Matt, you feel that with what you do, like, if people are amenable, the job's easier.

[Matt]

Without a doubt.

[Scott]

Okay. All right.

[Matt]

You want to treat everybody the same and you normally can, but of course you get attitude and you have, you know, demands and, you know, it kind of. You keep a happy face and you keep doing your job the best you can and don't wish any ill will. You just want to help people and in our field move on to the next one because they're definitely lining up, waiting to come.

[Scott]

But that attitude stretches. That makes the day a little longer, huh? Yeah. Yeah, Gotcha. Okay.

[Matt]

I do want to say with. As far as education goes, I actually recently looked into becoming a diabetic. I'm going blank on the name of the title.

[Scott]

The certificate is like a diabetes educator.

[Matt]

Educator, yes. And when I looked into it and the time it takes, and obviously type one is at the forefront of my mind. And I looked into the certificate and it was gestational. It was type two. It was type one. And to me, I thought it's too much to try to be a specialist at all of them. I'd rather be a specialist at one of them. And I think type 2 has a pretty good handle right now. But I just. I need to be an advocate the most I can for type one. And I've joined all these research groups and I do want to give a shout out to my endo, Dr. Goodrell. And I preferred like four or five people to her just because she is so amazing and we even have to drive to get to her and I tell people she's forth the drive. Yeah. Just because she came from an educational Background and teaching background. And I was blown away by the care I received by her and I'd never met her before in my life. And she had this plan written down and explained things to me in ways that I've never known. Because coming from a paramedic background, you learn really just diabetes, like one form diabetes. You're like high or low. From an emergency standpoint, if it's low, you bring it up, if it's high, you bring it down.

[Scott]

Sure.

[Matt]

And it's like, are they conscious? Are they unconscious? They have a gag reflex. Can you just give them something to eat? You have to start an IV and give them D50. That was my background. And then getting into nursing, I took a bridge program that was paramedic to rn. And I. I can't speak for all courses and all schools, but I don't remember anything diabetic related. And you hear DKA and just your acidosis and this and that and, and DKA is not really a sugar issue. It's a fluid issue, an electrolyte issue, which leads to arrhythmias and that's where your death comes from. And one of the reasons I didn't go to the er, it's not that chassis didn't say, hey, do you want to go? It was all on me. But I wasn't vomiting. You know, I wasn't worried about ketones. I stay in a ketonic state right now because of the way I eat.

[Scott]

Yeah.

[Matt]

I try to stay as low, as low carb as possible. And you want to make sure your potassium is right, your fluids right. And I take multivitamins and I drink water. So I wasn't worried about dka. I mean, no matter how high the sugar got, I, I think I kept myself out of it. But it's just the specialties are I'd rather be a master at one, even though I am an ER nurse. And you do learn a little bit about everything. But I wish there was more training on, on diabetes. When you go through the, you know, the RN course, I think it's because their specialties like endo and these diabetic educators that they don't really lean on it.

[Scott]

Do you guys wonder if diagnostic stuff is going to go more towards a computer?

[Matt]

I think it is. It may be beneficial and it may not. Like you're saying imaging was missed on your mother. I've seen it time and time again. When you have imaging done in the er, it gets sent off to the radiology and normally it's not read in house and we Wait for the radiology, that's their specialty, to come back and say, hey, you know, this is what I see. And I've seen just in chassis. I've seen time and time again where she looks at an X ray, she looks at a CT that has a negative read by the radiologist, and she's like, there's something there. There's just something there. So call back and say, you know, of course, as polite as possible. Can you take a look at this? And, you know, this is what I think I see this. This is your spectrum, but this is what I'm seeing. And they've said, oh, yes. And actually, in my case, that actually happened with my CT with my bladder cancer. They came back as negative. And I'm so thankful that I had her just with this video of the ultrasound to say, no, there's. There's something here.

[Scott]

Yeah.

[Matt]

And call was made back to that radiologist who was very apologetic and, you know, made an addendum to the CT read. And of course, now there's something there after it was removed, so I could be pissed off. And that makes me think how many people have missed, you know, diagnoses. And it's a. It's a sad state of medicine there.

[Scott]

The thing that happened with my mom was that what would happen is basically the mass would block her bladder. Her bladder would fill up, she'd be in pain. She'd go to the er, they'd image her, say, oh, her bladder's full, and then say, this must be a uti, and then, you know, drain her, and then everything's fine. Then she's okay again. She goes back. And this happened again and again. But every time it would happen, someone would say, her bladder's full, so we can't really see what's going on. But nobody ever said, so, maybe we should scan her after we do it again. That didn't happen. I had to be the one to say that. On the fourth visit, I finally said, why don't you get the urine out of her and then scan her? That's it. And somebody went, okay. And then they did that. So, I mean, I don't know what I'm talking about. I had to see it three separate times before it occurred to me to say something about it. But they knew each time that the full bladder was a problem, but then nobody did anything about it. They just said it, oh, that was a problem. And then moved on again. And I assume it's too many people, not enough resources. People are tired, probably have, you know, less trained People, because it's moving so quickly, I realize there's a lot of big issues. I mean, these things must happen over and over again. Like, wouldn't a trainable AI model who you're teaching if this. Then that could then figure out, oh, by the way, drain the bladder first instead of asking humans to hold so much information in their head. Like, if you couldn't just have it that way and be a little more directive for them. Not that you want to take the human part out of it, but just as a reminder, because how are you supposed to remember, like, you know, chassis. You said about it a little while ago, like, you can't be great at everything. Like, you know what I mean? Like, you know, emergency medicine. So wouldn't it be cool if a voice came from over your shoulder and said, hey, don't forget this? Or look at this real quickly? I don't know, maybe I'm wrong, but it feels like that's gonna happen.

[Matt]

That would be great. I always tell people we're practicing medicine, we're practicing, and hopefully one day we get it right. Yeah. Just to keep it a little light. But I do know for diagnostics, like, if they're doing ultrasound in the bladder, they want the bladder full because they get a better view. And it sounds like her bladder being full was causing pressure, causing more pain. But they absolutely should have scanned, you know, before and after. It's just kind of follow the steps, and they should have gotten there without you saying that.

[Scott]

But, you know, it's situational, and people jump to conclusions. Old UTI, right?

[Matt]

Yes.

[Scott]

Overweight type 2. Like, instead of just doing the steps in between, they make a leap. And that leap, you know, maybe sometimes works out and sometimes doesn't. But I know it's when it doesn't work out is when it's scary.

[Chassie]

No, I. I'm so glad you brought that up. And that is a constant challenge, probably in any field, but especially in medicine, that you'll have a cognitive bias because your brain is trying to pull in all this information and make connections. You know, we're the human body. We are so much more intimately connected than we even realize. And. And you try to make associations. Like, you said, old lady uti. I bet that's it. And it's a beautiful thing of the brain. It's amazing that we can take all of these random data points and put them all together and come up with this. Not even in medicine, just in life. You take all of these data points and make sense of them, you know, and it's so important, and it's so humbling to be in medicine, to unwire your brain and to think outside of the box and to think, oh, no, no, no, disassociate that. Let's don't think about that. What if it isn't that? What if it's this? Or could it be this? And it's. It's definitely a humbling part of medicine that I think you work so hard to learn and make associations and train and have keywords and think, oh, gosh, I bet it's this. And yet you have to be so diligent to make sure that you don't associate all of those things, that you keep taking a step back and taking a step back and taking a step back as you're trying to div your patient and better understand them. And that's one of the beauties and one of the most frustrating parts of medicine is making it make sense and then taking nothing and making that make sense as well. So it is. It's a humbling part. And I think, to your point, that AI definitely has a place in medicine and the rest of the world. Just anything that could help you be a better physician, a better nurse, a better podcaster, you know, a better investor, anything like that to make the human world better is fantastic. And there's definitely a role in taking some of the cognitive load out of medicine with AI. And there is. Yeah.

[Scott]

When I first started making this podcast, I'd just be angry about it. Like, why didn't they know? How come they didn't like that kind of thing? But the more I've done this for years and years and spoken to more and more doctors and people who are actually in that situation, my takeaway is just that, I mean, there's too much information for one person to process. And that's why we talk about specialty all the time. Because if you put somebody in a unique enough position, you can maybe make them enough of an expert where they're going to see it most of the time. I would have been all right with that right up until a couple of years ago, when I realized somebody could just take a large language model for endocrinology and train it on everything that human beings have ever known about it. And then you're at a point now you can talk to it. You could say, here are my symptoms, and it can point you in a direction and then blend that with the human artistry of, I've seen this before. Or I've. You know, somebody said that to me one time like, that Kind of stuff. I just think that we're asking too much of people. And in a situation where if you make a mistake, somebody has a really significant, you know, from death to, you know, injury and pain or whatever, I just think that we've reached our limit for what we can do. And the information's out there. Why not let something who's got the ability to hold more ideas in their head and draw more connectors, like, why not let it do it? It makes sense to me.

[Chassie]

So I love that. And I'll even interject and say that's a beautiful metaphor for emergency medicine, that sometimes we've done all we can do, like, let's go to the specialist, let's keep going, let's figure this out. Because, yeah, you do. You tap out in what you can do and what you want to do. And I don't know, that really hit home with what you just said about feeling like in the emergency department that you want to do everything in the world and you want to fix everything. And how do we take all that information and still keep going and take the next step?

[Scott]

Well, sometimes you just get to the end of your knowledge, you know, like everything that's going to occur to me has occurred to me. You know, maybe I can sleep on it or think about it, but that's going to be too late for a person in the er, right? Like, and that job you guys have already talked about, it's tiring. Weird hours, weird shifts, people yelling at you like it's not even. It's nowhere near a utopic situation where you could sit and think, maybe I'm out of my mind, but this seems obvious to me. So we'll find out what's going to happen. But it makes a ton of sense to me.

[Chassie]

No, I love it. I don't think that any forward thinking physician that just wants the best for their patients or any forward thinking nurse that just wants the best for their patients, I don't see how we. None of us would not be asking for more help. You know, if it's a better outcome for the patient. That's kind of what we're all here for anyway.

[Scott]

Yeah, right. Who cares how you get to it? If somebody's better off, they're better off.

[Matt]

I do wonder how that would be looked at. Like you said, you use an AI model and you felt like the doctor went back and read the same model. And if it was common knowledge that, hey, we're using computers or AI to come up with a game plan, are they going to say oh, this idiot just went back and Googled, you know, my symptoms. At what point does it become, hey, this is the way things are done, or, hey, they just don't know what they're doing and they're, you know, I could have googled it.

[Scott]

Yeah. I think the answer is my kids. Kids will be okay with it. It's a generational thing. You're gonna have to live through it. You know what I mean? So. But it doesn't mean that they'll be right, by the way. I didn't. I was kind of comforted by it, to be perfectly honest. Like, you know, I mean, this wasn't some great detailed thing like, was figuring out about Arden, but, like, I was able to take her symptoms and say to myself, like, I think it might be this, but I don't want to jump to a conclusion. Let me ask the model. The model came back and said, well, it could be this, this, or this. It most likely is this. And that made the most sense to me. I did not mention it to the doctor. And then, like I said, she came back. It felt like she was reading me back the same list I had in my pocket.

[Chassie]

And see, you know, that's a great doctor right there. That tells me that, yes, I wasn't there, but I'm going to have faith in my colleagues out there. And, yes, that means that we are all on the same page, that we are all getting good information in, and you're getting good information.

[Scott]

I felt the same way. Like, I felt like she was older but not old. Old. And I thought, she's probably been doing this forever. And the same. If this, then that ran through her brain. She started with that and she came up with the idea. I thought it was awesome. But it also proves out that if a human knows the entire map to the diagnosis, then we can write it down one time, and then the model can go find it, too. I see all the other reasons where people's egos would get hurt by this, or, you know, people are going to say, well, why would I be a doctor if I'm just going to be a button pusher? And, like, I mean, I can see all the. There's a lot of possibilities for where it could go wrong, but I don't know, I just see it as potentially valuable and something somebody should be looking into, you know, because you guys are terrific. You love your jobs, and, you know, it'd be great if you could have more, I don't know, bullets in the gun when you're doing it. Matt said something earlier, it made me think of this. Arden's friend is in nursing school right now, and she just called me in the middle of the day and she said, hey, we just had our diabetes lecture and everything. And I was like, right? And she goes, and we're done. And I said, okay. She goes, so I'm not going to learn more about diabetes. And I said, okay. And she goes, I couldn't keep Arden alive with what they taught me today.

[Chassie]

Wow.

[Scott]

But she only knew that because she grew up with Arden, so she was stunned. She's like, wow. I've said this on the podcast a few times because I really want people to hear it. Like, she's like, well, what else didn't they tell me about? And now I know all the stuff they didn't tell me about. And it freaked her out. And I said, listen, if you really want to be freaked out, wonder about all the other things you thought you learned front to back that you completely think you understand now, not just this was the one thing you had enough context for to call it out and go, wait a minute, that's not nearly enough information to understand type 1 diabetes. Yeah. And I told her. I was like, listen, you are being trained, just like you guys were talking about. I told her the same thing. I said, you are being trained to, like, save somebody in a moment, like, to see the big picture stuff that's going to end their life and slow that thing down. You're not learning everything about anything. And she's 21. It was interesting to see how it hit her, you know, like, it was shocking to her a little bit.

[Matt]

It's almost like you have to have some tie to that disease process to learn more, know more. Like the Type one, when I went into my endo and I didn't know anything about Basil, I had no clue. Like I said, I knew high, I knew low, and I knew how to fix that.

[Scott]

Yeah.

[Matt]

But she's explaining Basil to me like a sink faucet just dripping a slow drip throughout the day. And I was like, damn. In one of your other podcasts, I don't remember which title, but talked about, when you go to the er, it's like, listen to your Type one patient. They know better than anyone, and it's absolutely true. And I've even talked to co workers who, if you saw me throughout the day, Type one consumes me. It takes every bit of my mind, every minute of every day. And they see me at work, I've got my phone open, looking at my cgm, my pump's Beeping, you know, my times to change. And it's a diabetic haven, the ers, because there's cookies and, you know, snacks. That's. That's how you make nursing staff happy, is you feed them crap. And. And I don't eat anything. And then I'll eat, like, I do protein bars, protein chips, and I'll even. Something I learned from one of your podcasts going, I'm not afraid of insulin by far. I love to see bold with insulin. I'm very aggressive with insulin. So I'll go low and I'll dose for what I'm eating. And they're like, you're crazy. You know, like, no, because it's going to go up and I can't do the fight with the high. Low. Roller coaster. Yeah. I said, you don't understand how this feels. You know, as a type one, it goes low and I get horrible stomach pain. Like, my legs start trembling and I go high. I get hot, sweaty, and it's horrible. I'm like, I'm not fighting that. And I've learned how to handle this, but you have to have that tie. And now when I see people with. I'll see an omnipod on somebody, and I get goosebumps. Just like, patients, family.

[Chassie]

Yeah.

[Matt]

And it's emotional to me. I went to discharge a little boy the other day who wasn't even my patient, but it was at shift change, and his mother's sitting there, and I see an omnipod on the back of her arm, and I, like, pointed at it and, like, immediately got goosebumps, and it's just become a whole. It's my life. I don't wish it on anybody, but I wish everybody would be as tuned into it as I am. And I wish everybody could. Could manage it like I do, but it's taking a huge, huge mental hit on me. I feel I'm getting emotional right now even talking about it.

[Scott]

No, I feel it. I'll tell you, I have very not similar, but similar feelings. When I look at all the people in the Facebook group and the people that come on and talk about how they feel. You know, I've said before, like, I've been doing this a really long time. So when somebody comes on and says, you know, this thing you taught me is really saving me, I feel incredibly emotional because I don't just think about them feeling better today. Like, I think about their future and, you know, the things that they're avoiding and, you know, the possibility of, like, having their own kids one day or you know, wherever life's going to take them. And then you, you know, juxtapose that over the knowledge of, like, you know, even your co workers, you just said, right. They think you're doing it wrong. They don't understand. I spoke with an endocrinologist recently in a private situation, and I was talking about, you know, how fat impacts blood sugar. And this person didn't know what I was talking about. I mean, they were an older person who'd been doing this probably the better part of 30 years. And they weren't telling me, like, oh, that's not a thing I teach. It's too advanced. They were saying, what's this now? You know, And I'm like, yeah, you know, you have a high enough fat meal, slows down your digestion, often unbalances the bolus, and then you're left with a carb hit later that there's no insulin for. And they were like, I don't know what you're saying. And that's a person who's like, front lines talking to somebody. And this was a. Not a small institution. It's not like I was talking to somebody in the middle of nowhere, you know, so what chance do people have really, to get enough of an understanding to do a good job for themselves? And there's no one to blame. I feel like this conversation proves that out. You can't blame the guy in the ER when you get diagnosed. You can't even blame the endocrinologist because there's no training there for them either. You are literally at the. It's a coin flip. Do I get somebody who looked into this further on their own and understands it better, or did I not? And then that's the path you get to go on. No matter which endo you get, you're going to believe them when they tell you something. So then maybe if you get given bad information and you have enough trouble in your life, you might dig in and look for yourself. But that's not how most people's minds work. Like, I've been talking about this a lot lately because somebody called me direct. They were like, scott, you're very direct. And I didn't know what they were talking about. I was like, what do you mean? I'm direct? You say what you mean. I'm like, everybody says what they mean. Like, no, they don't.

[Matt]

No.

[Scott]

Recently I had a young girl tell me, like, she only stuck up for herself in a doctor's appointment because she thought that's what I would do. And she said, Otherwise, she would have just taken what was said to her and just accepted it. And when that's the case, then it's coin flip after coin flip as to whether or not. Like, just imagine you're walking through the earth, and every time you come to a fork in the road, you got to flip a coin and then walk in that direction with all the confidence in the world that you're moving in the right direction right up until you find out you're not. How do you find out you're not? You have neuropathy. How do you find out you're not? Like, you could trigger finger, you know, your blood sugar is 40, and then it's 400 all day long. And then you're caught in a situation where you're now altered, like, your mind's altered, and you need to make a good decision without any direction or knowledge. I'm telling you that this is what happens to people. It's so important that on day one, they get put in the right direction. Like, we made that whole grand round series. It really is made for doctors so that they can get you going on the right foot. Because once you put somebody on the right path, it's not a coin flip anymore. When you get to the next fork, there's somebody standing there waiting for you to say, oh, this is the right way to go. Go this way now. And that's how you end up. Well, it's actually not that difficult. But, you know, explaining it to people, getting it spread out across the world, like, I mean, that's the part that's kind of impossible. Like, I think I'm having some impact on it, but not nearly enough, you know?

[Chassie]

Do you remember what I told you when I first met you? You've made a lot of people. You probably don't.

[Scott]

I remember where we were standing, but I don't remember what we talked about.

[Chassie]

So what I said to you when I met you is I thanked you for all the work that you've done. And I told you that I know how to treat sick versus not sick. And if Matt were dying right now, I can save his life. If Matt was struggling or crashing or in DKA or having a heart attack or had limb ischemia, losing his leg, I know how to save him. I can treat him and make sure he stays with us another day. But being his wife and living by his side minute to minute, hour to hour, with type 1 diabetes, I felt so clueless, so lost. And to be honest, I told you that it made me feel dumb. And I thanked you for showing me how to be a partner to Matt and live through this with him and keep him well so I never have to see him in those states where he actually needs me. And that's the beauty of what you do, Scott, is that this is the day to day living life. When you're not there with your doctor, you're not there with your nurse, you're not there with your nutritionist, you're not with a pharmacist. It's all of these moments in between where your impact is so huge. Because now day to day, when Matt's not with his medical team, he's doing great.

[Matt]

Yeah.

[Chassie]

And that's all I want for him.

[Scott]

That's very kind and thank you. It touches me to hear you say

[Matt]

that he jumped in right before me. I was going to say, I hope when I first met you standing there all alone like a lost puppy dog, I had to come to you and talk to you. I hope I didn't come off like an idiot because I remember being just so thankful to you and it was really the first to get to you was my endocrinologist who first visit with her, she said, listen to this podcast. So luckily I had. It seems to be the right people at the right time in my life that everything, my whole life has been timing. And luckily the timing's on the right side for me now. I thank you. I think I didn't even. Don't even know how to truly thank you, but. And even at the time when I met you, I hadn't listened to like the. I forgot how it word on the website. The like at the dark.

[Scott]

After Dark stuff.

[Chassie]

Yeah.

[Matt]

After. After Dark stuff. Yeah. I didn't even know about that because I just been listening on like YouTube. I have no social media chassis's on the Facebook page, so I just do YouTube. And I went up to the website and I was like, oh my God, there's so much more. So I'm just constantly going through it. I'd be in the gym, I'm listening to everything. And it just led me just from the basics. I'd listen to the Omnipod stuff and the Dexcom stuff and how to like Meal Bolt. And I realized that I used my version of Meal Bolt and didn't realize it. So you came out with that podcast. I was like, shit, that's what I'm doing. Yeah. And I realized that I've learned so much just picking everything up and then trial and error. It's just amazing. And I wish I could teach everything I Know to other people, but it's. Unfortunately, Arden was diagnosed, but you've helped so many people, including her.

[Scott]

I don't know. I think she's the last one. I hope to be perfectly listening to her argue with me last night about changing her pump. And I was like. I was like. I said, you ought to listen to my podcast.

[Matt]

Can still hear you saying, oh, she loves going the most and she loves their queso, but she gets the testitos. There's little things that just stuck with me, and I forgot what it was. Dude, not gummy bears. I forgot what her sugar thing was.

[Scott]

Yeah, she's using gummy bears right now, but she's pretty sick of them, so now I'm just eating them.

[Matt]

Yeah. Yeah. I forgot what I had in my drawer. Now I had some buy one, get one something, little snacks, but I hardly ever need them. I'm so focused on it.

[Scott]

Yeah.

[Matt]

My entire fear with diabetes was that one day Chassis will find me on the floor, you know, unresponsive. And I think that's what kept me going and being so focused and a pain in her ass, or pain in everyone's ass, because I'm, you know, like I said, it consumes me, but I don't want to do that to her.

[Scott]

Oh, Matt, listen.

[Matt]

Or anybody else, but. But her. Her in particular.

[Scott]

Let me lighten this up for you. You've been very emotional and open. I feel like you are going to have a great night tonight. I just want to say that I feel like she is like, oh, I did pick the right guy. This is awesome. Special night for you coming up. Matt, make sure there's those snacks are in the bedside table, okay?

[Matt]

Oh, yeah. Oh, yeah.

[Chassie]

You have no idea how hard we try to not be a patient.

[Scott]

Well, no, but I. That fear you have, I mean, that's what motivated me when Arden was little. Like, I just did not want my daughter to be the kid that passed out at school. Like, that was a lot of my initial motivation. You know what I mean? It's like, just to try to avoid a problem for. You know, I interviewed a woman the other day who helps people with diabetes. And I don't want to give her details, but, like, because you guys will hear at some point. But my point is that I was listening to what she does, and I think she does a really good job at it, but her ability to reach people is one on one. Or sometimes she'll go to, like, a JDRF event. Probably ends up talking to 40 people, which I think is amazing. For those 40 people that are there. And I still don't think that I'm saying anything that a lot of other people out in the world aren't saying. I think that the thing I did was I just found a way to put a megaphone in front of it that other people have failed at doing. And maybe they haven't tried or maybe it just hasn't worked out for whatever reason. My thought always was, and this started out as a competitive thing, but now talking more about, like, this idea of, like, spreading good information around, it's become more about that for me, obviously, over time, but it started out as competitive. Like, if I'm gonna make a podcast, I don't want 50 people to hear it. Like, I'm not wasting my time on that. Like, I want 5,000 people to hear it. I want 50,000 people to hear it. I want a hundred thousand people here. I have that kind of motivation. And so once I was able to build it up that big, now I'm like, okay, now we're actually en masse. Like, look, your endocrinologist said, go listen to that podcast. You're in Orlando. I have an email that I answered two weeks ago from, like, northern Canada where someone said, hey, I need a website where I can share your podcast easier with my patients. That's an endo there. And I looked this morning to see that the show was incredibly popular in New Zealand for some reason yesterday. And, like, that's the kind of stuff, I don't know. That's my. Maybe I am more direct or aggressive or. I don't know, I don't honestly care. But what I'm saying is, is that, like, it's nice to help a person. It's really nicer to help 10, and it's really cool to help a hundred thousand of them. Like, that's how it's going to spread around. Because then if you bump into a bad start at your physician's office, maybe you've got a real chance to get off of that coin flip path and onto a meaningful path sooner. If the information is not just available, but, like, forget this podcast. This podcast, YouTube channels, any way people get information out. They're all stuck in an if a tree falls in the woods, does anybody hear it situation. There's probably somebody out there doing it better than me or understands it better than I do, but they're not as good as communicating it in this time in history. Like, that's the thing I'm really good at. And so, you know, I'm just hoping it reaches more People like you, because listen to you. Like, you don't know Matt, Matt. If Matt was standing in front of you and he would give you the feeling that he could grab you by the side of your head and throw you if he wanted to. To hear him be vulnerable, like, this is strange, because I've met him in person and, like, you know, face to face, I wouldn't think of you, and this is me jumping to conclusions, obviously, but you wouldn't strike me as a kind of person who's running around with this fear inside of them. But if you are, then everybody is. You know what I mean? So I don't know, man. Like, I'm glad the podcast helped you and that it's obviously making your relationship better, and I'm thrilled about that, but I just want to make some more people hear it. Like, that's really what I'm trying to do. I. I have a limited time on this planet, and I am trying to make it so that as many of you as possible don't suffer. It's really it. And hopefully it all comes back and supports my daughter somehow.

[Matt]

Yeah, yeah, yeah. I don't care how anybody else does it. You're the guy.

[Scott]

But there's a lot of ways to do it. But I appreciate that.

[Matt]

Thank you. But you don't have the ego. You're down earth. But maybe because we're so, you know, open and forthcoming and honest that it just. You struck us as, you know, that you're it.

[Scott]

Now, maybe what that tells you is that more people feel that way than you think, because people pretend to be dainty or demure or, you know, like that kind of thing, but when you really start talking to them, more people have my attitude than don't, you know, like it. Maybe they don't have the nerve to say it out loud or stick up for themselves, but they have that feeling inside.

[Matt]

Yeah.

[Scott]

You know, like a person who doesn't speak up still feels like they wish they could. I'll tell you that when I first started making the podcast, my wife was like, what's the tone you want to strike? And I said, well, I mean, there's a lot I don't understand, so why don't I just be the avatar for the listener and I'll come from the why don't understand this perspective? Somebody teach me. And that way, you guys can feel more vulnerable and let that information flow through. And, you know, it's just. I don't know. At this point now, it's a mix of everything. I can't Dissect what this is anymore. To be perfectly honest with you, it's perfect.

[Matt]

It's what everybody needed. That's what it is.

[Scott]

I appreciate that.

[Chassie]

It is. It's. It's. I'm telling you, it's great for the layperson, the medical person. I think that you are at a really interesting fork. We'll call it Fork, since you're talking about the coin flip. You're at that interesting fork where you can have the candid approach to diabetes, but you also have enough medical background and enough accurate knowledge to manage it, too. And what a beautiful spot you're sitting at to be the candid, supportive dad, but to be so well informed that you can keep up with physicians and nurses and other medical professionals and again, say the things that all of us want to say and maybe just don't communicate it from the patient side or just don't get. Communicate it from the medical professional side. So enjoy that fork because you've taken it and you've shown amazing, amazing things to both sides of this.

[Scott]

Yeah, you're very nice. Listen, we're out of time, but let me ask you a question. Can I call this one Turkish Eye Lift or no,

[Matt]

because it's your podcast.

[Scott]

Also, can they get rid of these crow's feet for me? What does that cost?

[Matt]

I can tell you it's cheaper there. If you want to do it, that's the place to go. I don't know about right now in this world, but it's the place to go.

[Scott]

Listen, I'm not leaving America right now. I don't. I'm not looking to be judged outside of the country at the moment. So, yeah, I'm holding on, but travel plans have changed. Well, you guys are terrific. I wish you a ton of success. It sounds like you're obviously off to a really great start with all this. And, Matt, you know, I can't imagine what it's like living with that background noise of, like, you know, having to go check on cancer every six months or every year. But I hope you're able to not think about it day to day, just

[Matt]

become the way of life. I'm on the better end of it now, so. And I've got the support system that I needed and never had before, and chassis has been everything to me and almost as important as you are to me. Almost.

[Scott]

Jassy, you heard that?

[Matt]

But she'll. She'll get there. Yeah, she'll get there one day. Yeah.

[Scott]

Later tonight, she'll jump ahead of me in that race. I'm pretty sure. So you guys are terrific. I'm so glad we were able to work this out so you could both be here. Thank you so much. I really appreciate it.

[Chassie]

Thanks so much.

[Scott]

Yeah. Hold on one second. Okay. A huge thanks to US Med for sponsoring this episode of the Juice Box podcast. Don't forget usmed.com juicebox this is where we get our diabetes supplies from. You can as well use the Link or call 888-721-1514. Use the link or call the number, get your free benefits check so that you can start getting your diabetes supplies the way we do from usmed. The podcast you just enjoyed was sponsored by Tandem Diabetes Care. Learn more about Tandem's newest automated insulin delivery system, Tandem Moby with Control IQ [e-mail] Juicebox There are links in the show notes and [e-mail] 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. Kavanaugh Fine. You probably feel like I'm messing with you, but I'm not. Eversensecgm.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 an Apple podcast 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. Would you like a Christmas card? Have a podcast. Want it to sound fantastic? Wrong way recording dot com.