#1872 Agency and Anxiety Part 1

Summary

---

Juicebox Podcast: Type 1 Diabetes

Episode #1872 – Agency and Anxiety, Part 1
Host: Scott Benner
Guest: Erica (Mental Health Professional)
Date: June 9, 2026

---

Episode Overview

In this thought-provoking episode, Scott Benner and Erica discuss the interplay between agency (the sense of control) and anxiety, specifically within the context of living with diabetes. They unravel how understanding and fostering agency can act as a powerful buffer against the all-too-common experience of anxiety for both people with diabetes and their caregivers. The conversation leans into practical explanations, relatable analogies, and personal experiences, offering listeners a blend of practical psychology and honest dialogue.

---

Key Discussion Points & Insights

Defining Agency and Anxiety ([03:16]-[08:57])

• Agency:
  • Erica explains: “Agency is often used as the sense or belief that we can act and influence and affect outcomes... I can choose, I have choice, I have independence. I’m kind of in the driver's seat.” ([03:20])
  • Scott pushes for a plain-language definition, settling on: “It feels like it’s something I’m allowed to do. I’m comfortable making a decision, and I feel like it’s going to go, okay, I have agency, but I’m not going to wield it in some crazy way…” ([07:45])
  • They discuss how agency isn’t about being a control freak or an authoritarian: it’s about healthy ownership and the capacity to make choices.
• Anxiety:
  • Erica describes it as both a feeling and a physical response: “Anxiety... is the physical and mental experience of feeling uncertain, feeling like you cannot influence outcomes. So almost the opposite of agency.” ([08:57])
  • Scott frames it: “Anxiety is a false alarm in your brain, a feeling that something bad is going to happen and I’m completely powerless to stop it.” ([10:23])
  • They explore the wide variety in how people experience anxiety and agency and touch on learned versus innate qualities.

Agency and Anxiety in Diabetes ([10:41]-[13:35])

• Scott notes the prevalence of anxiety in the diabetes community and wonders if it’s linked to the chronic nature of the condition, inflammation, or even related autoimmune factors:
  “I can’t decide if that's because they're anxious because they have diabetes or... anxiety is an inflammation related issue and that autoimmune maybe makes it more common among this group of people, or if maybe it's maybe a mixture.” ([10:51])
• They acknowledge how poor education or lack of understanding about diabetes management can strip people of agency, which in turn fuels anxiety:
  “If you don't get educated well, or didn’t understand your education, you have no agency with type one.” ([13:35])

The Brain Science: The Hand Model ([17:37]-[22:01])

• Erica simplifies neurobiology, referencing Dr. Dan Siegel’s “hand model of the brain”:
  • The spinal cord is the wrist, the brain stem is the palm, thumb is the limbic system (emotion/fight-or-flight), fingers are the cortex (logic, empathy).
  • Lid-flipping (“When your amygdala overrides the cortex, your lid is flipped and your fingers go up”) illustrates how acute stress/anxiety causes logical abilities to go offline ([18:45]-[20:31]).
• Scott’s humorous aside:
  “You could have just said, if you punch wrong, make your hand like that, thumb inside your fingers... you’re going to break your thumb when you hit me.” ([20:45])
• Importance:
  Understanding these models helps people recognize what’s happening in their brain—awareness is the first step toward regaining agency.

How Agency Calms the Nervous System ([22:01]-[29:28])

• Regulation: Agency brings the prefrontal cortex online, allowing for rational decision-making and emotional balance.
• Biological effects:
  “When a person... feels helpless or unsure what to do, the amygdala ramps up and you’re feeling threatened... But when you feel like you can act and you’re experiencing... agency, the amygdala’s alarm response decreases.” ([22:01]-[23:13])
• Nervous System Shift:
  • Sympathetic dominance (fight/flight): Low agency, high anxiety—shallow breathing, rapid heart rate, on-edge.
  • Parasympathetic dominance (rest/grounded): Active agency—deeper breaths, considered decisions, decreased panic.
• Tip: Deep breathing can engage the parasympathetic system—a practical grounding strategy.

Disrupting Helplessness and Building Agency ([29:33]-[33:24])

• Learned Helplessness: With repeated failures/unpredictability, people may stop trying (the “helplessness circuit”).
• Agency’s Role:
  “It creates those micro successes that then retrain... your neural pathways. When I act, something changes.” ([31:05])
• Scott draws a parallel to “fake it till you make it”, breaking problems down into small, achievable chunks (“How do you eat a buffalo? One bite at a time.”) ([32:44])
• Building Agency: Micro-wins stack up to reshape the brain, forging confidence and agency over time—even if you have to start with pretending.

The Power of Expectation and Resilience ([36:55]-[41:50])

• Scott shares his perspective:
  “With the exception of... my own death... the worst stuff that's ever going to happen to me has probably already happened.” ([39:52])
• He reflects on how expecting there WILL be bumps (vs. expecting perfection) makes handling adversity more manageable:
  “I don’t expect perfection. I expect there to be bumps and bruises... I have a good confidence that I can bring things back into toe and keep going.” ([39:13])
• Erica emphasizes:
  “You have high agency... because you have all these micro successes, but you also hold the flexibility that it isn’t going to go perfectly.” ([40:49])

The Cycle: Agency Reduces Anxiety, Builds Resilience ([29:28]-[43:38])

• When agency is strong, anxiety is much less likely to spiral into overwhelm.
• Building agency takes time and deliberate practice—be patient and allow small victories to accumulate.
• Scott observes how his podcast structure mirrors this “micro-wins” approach to building resilience—a practical solution rather than an abstract theory ([34:14]).

---

Notable Quotes & Memorable Moments

• Erica, defining agency:
  "It’s the ability to act as an effective agent for yourself." ([08:18])
• Scott, on anxiety:
  "Anxiety is a false alarm in your brain, a feeling that something bad is going to happen and I’m completely powerless to stop it." ([10:23])
• On brain science:
  “When your amygdala overrides the cortex… your lid is flipped.” ([18:45])
• Scott on progress:
  “How do you eat a buffalo? One bite at a time.” ([32:44])
• Erica summarizing:
  "When agency is strong, anxiety is less likely to spiral into that feeling of overwhelm." ([42:21])
• Scott reflecting:
  “I never would have used the word agency before today. I would have said confidence that I can get through it. But now as you’re talking, I realize… that’s agency.” ([41:54])
• Closing banter:
  “Seriously though, this was wonderful. Thank you.” ([43:24])

---

Important Timestamps

• Defining ‘Agency’: [03:16]-[06:18]
• Defining ‘Anxiety’: [08:57]-[10:41]
• Anxiety in Diabetes Community: [10:41]-[13:35]
• Hand Model of the Brain Explainer: [17:37]-[22:01]
• How Agency Calms Anxiety: [22:01]-[29:28]
• Building Agency Through Micro-Wins: [29:33]-[33:24]
• Expectation & Resilience: [36:55]-[41:50]
• Wrap-Up and Preview of Part 2: [42:21]-[43:38]

---

Takeaways for Listeners

• Agency and anxiety exist on a spectrum, often in tension, but agency—knowing you can act—offers a way through uncertainty and fear.
• Building agency is a process of small steps and accumulated "micro-wins." This takes patience, self-compassion, and time.
• Understanding the brain, even in basic terms, can empower people (including kids!) to recognize their stress responses and start to self-regulate.
• Within diabetes, a lack of understanding and confidence leads to heightened anxiety; education and small, manageable problem-solving steps can reverse this cycle.
• Stay tuned for Part 2, where Scott and Erica will apply these ideas more specifically to practical diabetes management scenarios.

---

For more straight-talking diabetes strategies, visit juiceboxpodcast.com

---

Transcript

[A]

Hello friends, and welcome back to another episode of the Juice Box Podcast. Anxiety is your nervous system noticing uncertainty and feeling like it can't do anything about it. Agency is the opposite, the sense that you can act and affect what happens next. This episode is about how that one shift calms the alarm in your brain. Agency doesn't erase the fear, it gives your nervous system a way through it. My Diabetes Pro Tip series is about cutting through the clutter of diabetes management to give you the straightforward, practical insights that truly make a difference. This series is all about mastering the fundamentals, whether it's the basics of insulin dosing adjustments or everyday management strategies that will empower you to take control. I'm joined by Jenny Smith, who is a diabetes educator with over 35 years of personal experience, and we break down complex concepts into simple, actionable tips. The Diabetes Pro Tip series runs between episode 1000 and 1025 in your podcast player, or you can listen to [e-mail] by going up into the menu. Nothing you hear on the Juicebox podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan or becoming bold with insulin. Today's episode of the Juice Box podcast is sponsored by the Contour Next Gen Blood Glucose Meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you@contour next.com Juicebox Today's episode is also sponsored by Medtronic Diabetes, who is making life with diabetes easier with the MiniMed 780G system and their new sensor options, which include the Instinct sensor made by Abbott. Would you like to unleash the full potential of the MiniMed 780G system? You can do that at my link medtronicdiabetes.com juicebox Erica. Erica. Erica, you have returned.

[B]

Hi. It's been a while.

[A]

Yeah. Yeah, we. I don't know what happened. What did happen? Is it scheduling?

[B]

The busyness of life scheduling?

[A]

Yeah, because you looked at me and you said, I haven't seen you in a while. I thought, I have not seen her in a hot.

[B]

April was a busy month. That was part of it and on my side and you were traveling a little bit.

[A]

Let's get this in now before I've got to go do the stuff I'm doing this summer and I won't be back for a while. So what are we going to talk about today?

[B]

So I believe and know that we have talked about anxiety in different ways in how we experience living with diabetes And I thought we could talk about it in the context of how agency and anxiety work kind of with and against each other. It all really ages and stages of diagnosis and also from the caregiver's perspective and also the person living with diabetes. So I thought we could just start by defining.

[A]

Yeah.

[B]

What agency and anxiety are.

[A]

Go for it.

[B]

Okay. So agency. But you might be more familiar with the term, you know, self efficacy. But agency is often used in the way that we can have the sense or belief or thought that we can act and influence and affect outcomes. Right. So I, it's often learned that might be a whole other interesting conversation of how does one develop agency? But I think that's what we're going to talk about throughout our conversation today. So just. Yeah. The belief in oneself that when I do, when I do X, I can anticipate that Y will happen in simpler terms.

[A]

Because I have to admit, I'm a little light on this definition myself. But is it just the idea that, like, I'm in charge and when I do, like, I'm in, I don't know, like, I'm in the driver's seat, like, I'm not a passenger in this. Or, like, what's the, what's the, like, real plain definition of agency? Because I think it's a word people throw around.

[B]

Yes. And often in the, in kind of the mental health world, therapy world, we use it a lot. So the simplest way is, yes, I can act, influence, and affect outcomes. However, it also is used in a way like, I can choose, I have choice, I have independence. I, yeah, I'm kind of in the driver's seat. But it comes with this, like, overall sense that you kind of have ownership in your life, and maybe not in all areas and aspects of your life. But, for example, people might use agency as, okay, let's. There are some things that you are, you are wanting your kids to do, right. You have guidelines, you have expectations. But maybe you want them to experience agency tonight by saying, hey, we're going to have dinner tonight, but do you want to have pizza or pasta? That's letting them experience a little bit of agency where they have choice.

[A]

Choice and control to some degree.

[B]

Yes. Yes.

[A]

Okay. All right.

[B]

Does that feel.

[A]

Yeah, no, no. I, I, it really is one of the, you know, my son makes fun of me all the time. He's like, you don't know what that word means? And I was like, I do. And I use it in a sentence. And I go, that's correct. And he goes, what's it mean? And sometimes I'm like, I think it's just a word I say. I think when you say agency, everyone gets a vibe about what that means. And I think you're getting your point across. But digging into it is like, I think interesting. So like, how do you, like how do some people just have it? How do you give it to somebody? How do you go find it if you don't have it? Right? Like that's, I mean there's a lot of questions in there, to be perfectly honest.

[B]

Yes.

[A]

Okay, but how does it go. Say that. I'm sorry.

[B]

No, I said we're going to get into that. I think. Is it something that you just have or is it something that evolves? Is it something. And I think it, the general sense would be it's something that you kind of learn. Right. And you also can be given if you're the child, agency, but you also can exercise it right in your, in your own life.

[A]

Is it a thing that like could be misread? Like I think people would say that I feel like I'm in control of like what I'm doing. I make decisions kind of like promptly, boldly. I have confidence in myself. But other people would look at that and call that a problem. So like, you know, like, you know, he thinks everything he does is right. He's a narcissist, like that kind of thing. Like I feel like I trust myself, but I think I trust myself because I grew up without people helping me with things. And I've made decisions and I haven't died. So I believe that my decisions are generally speaking going to move me in a good direction. Like very simply, like, I think that's how it feels.

[B]

You have the capacity to make the decision. You have the ability, whether it's kind of learned over time, but it's not.

[A]

Is the capacity something.

[B]

Someone could take it's capacity, but it's not like I hear you, it's not like, like a right, like I have a right to, to dictate. It's like a dick.

[A]

It just feels like so, so somebody could maybe deconstructing it helps. So someone could take the capacity from you. You could have an overbearing parent that doesn't let you make any decisions and therefore you don't have agency.

[B]

Correct.

[A]

Okay. And you could also have a parent that's, you know, giving you too much freedom and maybe turning into a, a little bastard and, and like, you know, like just like.

[B]

Or entitled.

[A]

Right. But you have agency. But it maybe has gone too far. So like agency Seems to me more like a middle ground of. Of I feel. I feel like it's something I'm allowed to do. I'm comfortable making a decision, and I feel like it's going to go, okay, I have agency, but I'm not going to wield it in some crazy way where I'm a terrorist to people, you know, and they're in the moment and. And I don't have my head down and don't feel like I can raise my eyes up and make a decision for myself. The middle there is agency.

[B]

Yes.

[A]

Am I getting it okay?

[B]

Yes. Having a choice. And I just. Actually, I like this definition. It's the ability to act as an effective agent for yourself. I mean, we're using the word and the definition, which is a. No, no. But I think.

[A]

What's blue mean? You know, blue.

[B]

But it's.

[A]

Yeah.

[B]

Actually, it's interesting. Even as we try and define it, it is one of those words that you can just like, it's a feeling.

[A]

Yeah.

[B]

Yeah.

[A]

More than. More than a word. Right. So. Okay. And now let's move to anxiety, because I'm. I'm confused about how they're going to intersect with each other. So.

[B]

Okay. So, I mean, anxiety also will probably be very. It's a feeling. Right. It's. It is two different things. I think if we're thinking about worry, which might feel more like the mental exercise of anxiety. Anxiety is usually more defined as the physical and mental experience of feeling uncertain, feeling like you cannot influence outcomes. So almost the opposite of agency, but it's the perception that you do not have the ability to influence outcomes. So kind of feeling out of control. And as a result of that feeling of being out of control, you might experience worry. You might experience symptoms of anxiety that feed each other.

[A]

Is anxiety the worry about a thing you don't have agency over? Because if you are thinking about something you can control, that's thinking about it.

[B]

If.

[A]

Right. Because you get nervous when you. You know what I mean? Like, if you put me at the end of a rope bridge and it was broken and I thought I could probably fix this and get across, I'd feel a little anxious, but I wouldn't collapse. I'd feel like, oh, I can do the thing and get across. But then there are sometimes that people look at something. And I always imagine that what anxiety is, is when you're worrying about the unknown.

[B]

Yes.

[A]

Because you don't have the rest of the story. So you can't complete the circle and decide if it's a conquerable thing or not.

[B]

That's right.

[A]

That's how I think about it. But. But I could be wrong too. Interesting. Okay, I have here, anxiety is a false alarm in your brain, a feeling that something bad is going to happen and I'm completely powerless to stop it. Why do some people feel anxiety more than others? I guess that's the million dollar question, right?

[B]

Yes. I don't think we can answer that.

[A]

Yeah. Is this a good place for me to put in my fishing idea about anxiety or do you want me to wait till later?

[B]

Yeah, go ahead, share. Share away.

[A]

I just, I shared with Erica before we started that I feel like if I had started a podcast on a different topic, I would not have met so many anxious people. And I can't decide if that's because they're anxious because they have diabetes or if. Because their child does, or if anxiety is an inflammation related issue and that autoimmune maybe makes it more common among this group of people, or if maybe it's maybe a mixture of it or not one and maybe all the other. I'm not sure. But I. I record five days a week, three people call themselves anxious. I talked to a woman the other day. She was anxious. Would it be word, you know, like she was really tortured by it. And then I spoke to another woman who felt anxious. But then after I asked her more questions, I realized she was anemic. Like, I think I diagnosed her as being anemic while I was speaking to her, but she was having like this crazy anxiety. Yeah. And I was like, I'm like, were you. Have you always been anxious? She's like, not this much. I think she was blaming the kid's diagnosis and I started asking a bunch of questions. Then she mentioned she had a hysterectomy. And I was like, hey, are you anemic? And she goes, no. Well, they did give me iron after the hysterectomy. And I went, oh, okay. She emailed me after we got done recording. They did give her iron. She had a Ferritin of 14. It only moved it up to 20. She's anemic and like, so maybe she's an anxious person to begin with, but anemia actually makes that. There's technical reasons why that I can't just pull out of my right now, but I know are there and there's reasons why you might seem more anxious while you're anemic. And also I meet a lot of anemic people and I think that's also got something to do with the autoimmune too. Like, I feel like it's all like, you know, right church, wrong pew kind of thing. Like, I think it's in the building. It's just not always. Not like you have diabetes, so you're anemic or you have autoimmune, so you have this. But man, I meet a lot of people who are anemic, a lot of people who have anxiety, a lot of like I've, I've mentioned before, I meet a lot of people with a bipolar relative. Just the general population doesn't know that many bipolar people, do they? You know, like. Right. But like I talk to people with type one and they all seem to know somebody and with, with that situation. So anyway, I think anxiety is partially, I think it's partially like inflammation or something that like is nebulous to me. But it seems obvious, you know, colloquially.

[B]

So nevertheless, I mean, yeah, there, there could be. And it could be a result of this kind of interplay between living with a chronic illness that can increase anxiety when you don't experience a lot of agency all the time.

[A]

Yeah. Oh my God. Well, by definition, if you don't get educated well, or didn't understand your education, you have no agency with type one. And then on top of that, if you're experiencing physical implications, imagine you're a little anxious and a little anemic and don't understand the tools to take care of your diabetes with. And all the problems you have are just worry because you don't understand how to get to the end of them. I mean, that's a perfect storm. Unlike other systems that will wait until your blood sugar is 180 before delivering corrections, the MiniMed 780G system is the only system with meal detection technology that automatically detects rising sugar levels and delivers more insulin as needed to help keep your sugar levels in range, even if you're not a perfect carb counter. Today's episode of the Juice Box podcast is sponsored by Medtronic diabetes and their MiniMed 780G system, which gives you real choices because the MiniMed 780G system works with the Instinct sensor made by Abbott as well as the Simplera Sync and Guardian 4 sensors giving you options. The Instinct sensor is the longest wear Sensor yet, lasting 15 days and designed exclusively for the MiniMed 780G. And don't forget, Medtronic Diabetes makes technology accessible for you with comprehensive insurance support programs to help you with your out of pocket costs. We're switching from other pump and and CGM systems. Learn more and get Started today with my link. Medtronicdiabetes.com Juicebox the contour next Gen blood glucose meter is sponsoring this episode of the Juice Box podcast and it's entirely possible that it is less expensive in cash than you're paying right now for your meter through your insurance company. That's right. If you go to my link contornext.com/juicebox, you're going to find links to Walmart, Amazon, Walgreens, CVS, Rite Aid, Kroger and Meijer. You could be paying more right now through your insurance for your test strips and meter than you would pay through my link for the Contour Next Gen and Contour Next test strips in cash. What am I saying? My link may be cheaper out of your pocket than you're paying right now, even with your insurance. And I don't know what meter you have right now. I can't say that. But what I can say for sure is that the Contour Next Gen meter is accurate, it is reliable, and it is the meter that we've been using for years. Contour next.com juicebox and if you already have a contour meter and you're buying test strips, doing so through the Juicebox podcast link will help to support the show.

[B]

That's. Yeah, it is. Yes, it is a perfect storm. So what do we do with this? So what I think is really fascinating is to talk about how agency can play a protective role.

[A]

Okay.

[B]

Agency doesn't eliminate anxiety, as you were just sharing with the end of the ropes analogy. It can play a protective role and it can help shift how you interface and interact with thoughts and feelings of anxiety. So the bullet points here that we're going to get into is that agency can play a protective role in anxiety because it can increase your perceived control. It can support active coping rather than avoidance or shutdown. It can reduce the escalation of your nervous system by interrupting your cycles of helplessness. And it will help shift the nervous system from the reactive threat state to more the regulated. I can make decisions, I can affect change to a more goal directed action. Okay, so we're going to get into those things.

[A]

Okay. Yeah. So you're going to step through them?

[B]

Yes.

[A]

Awesome.

[B]

Before we do that, I thought it would be cool to talk about the brain. And as, as I said before, I am not a neuro scientist. I'm not a neuropsychologist.

[A]

I am. No.

[B]

Okay, good, good.

[A]

I'm nothing, by the way. But you are a thing, by the way. You went to, you went to college at Least.

[B]

Okay, so agency, as we were saying, doesn't eliminate it, but it can change the way your nervous system reacts to the feeling of being out of control. Right. It can restore the sense of influence. So if you are familiar with Dr. Dan Siegel, who has written a ton of books, he's a very well known psychiatrist and professor. He wrote the Whole Brain Child. Along with countless other books, he has created the hand model of the brain. So if you. Once you're done listening and you want to go look up Dr. Dan Siegel's hand model of the brain, you can do that, but quickly. I thought I could walk you through it. So if you're holding up your hand with your palm up.

[A]

I'm doing it.

[B]

Okay. Yes. Okay. So your wrist is the spinal cord, which goes up into the middle of your palm, which becomes the brain stem. So then if you fold your thumb over so you're still. Your hand is open, but you're folding your thumb over. Your thumb represents the limbic system which houses the hippocampus, the amygdala. That's your fight or flight response. Okay. Oops. Okay, then if you fold over your hand, that is your cortex. Okay. And the cortex represents the upstairs brain, and that's responsible for your logical thinking, your empathy, your emotional balance. So when your fingers are down over your thumb, which is the limbic system, he calls that, that's your integrated brain, and that's what your cortex is kind of online. Right. And it's managing your limbic system, it's leading to calm, rational behavior. When your amygdala overrides the cortex, which is your fingers, then you, he's. He kind of defines it as your. Your lid is flipped, you flipped your lid and your fingers go up. Okay. And that basically is the example of, you know, you've. Your stress system, you've kind of gone offline. Right. And to regain control, reactivating the prefrontal cortex, which are the prefrontal cortex, are basically in this hand model of the brain. Your fingertips, like the first index of your fingers. Okay.

[A]

Yeah.

[B]

First knuckle. Thank you. Through deep breathing, mindfulness, kind of restoring balance back into your brain. Did that. That's a very, very simplified way to understand our brain.

[A]

You could have just said, if you punch wrong, make your hand like that, that's thumb inside your fingers.

[B]

Okay. Yes. Yes.

[A]

Yeah.

[B]

Okay. That's right.

[A]

Do you ever see a kid go like this? I'm like, oh, you're going to break your thumb when you hit me.

[B]

Wait, so how are you supposed to

[A]

punch your Thumb should be on the outside underneath of your knuckles so that you lead with the tops of the long part of your hand like that.

[B]

Okay. Okay.

[A]

So you don't want your thumb inside your hand.

[B]

Good to know.

[A]

Yeah. Well, now you know.

[B]

Okay. Okay. So I think. And the reason why I think it's important and why Dr. Diane Siegel has really spent a lot of time trying to educate people on the basic understanding of the brain is because he believes, you know, you can change both the function and the structure of the brain by knowing about how the brain is structured, by having understanding, it really helps. And they teach this in schools, I bet. If you're listening and you have children, I wonder if they have not been taught already about the hand model of the brain. Okay, so why is that important? So as we talk about agency, as we're referencing parts of the brain, I thought that'd be interesting to know.

[A]

It is. Yeah.

[B]

Okay.

[A]

Please.

[B]

So. So agency reduces the threat activity, which is the amygdala. Right. Which is the limbic system represented by your thumb. So when a person, when you feel helpless or unsure what to do, the amygdala ramps up and you're feeling threatened, and you might. Your lid is flipped, so to speak. But when you feel like you can act and you're experiencing and have that sense of agency, the amygdala's alarm response decreases. You don't feel, you're not experiencing those threat cues, that something bad is about to happen. You're not entering into that fight, flight or freeze mode. And then your body produces fewer of the stress hormone of cortisol. So why does this happen? Because if you are experiencing that perceived ability to act and influence outcomes, that situation that you're faced with is less, is not as. It's not threat based. It's a challenge. Okay. I can problem solve. I can figure this out because I know, I've learned when I do X, Y happens, and I know that's very simple. And we're going to talk about how this works or does not work with diabetes, but we're talking kind of in general.

[A]

Yeah. Can I tell you something really interesting?

[B]

Yes.

[A]

I do this with a lot of frequency. I'm very transparent with people. Like, you know, Erica tells me what she wants to talk about. Sometimes I tell her, I let her lead the conversation. She comes with notes and everything. But sometimes, just to help myself, I'll. I'll open up on a chatbot somewhere and I'll be like, agency and anxiety. Like, just break it down for me and you end up doing everything and I don't really need help. But when you brought up the hand model, I didn't have context for it at all. So I said to it, it, I told, I told the robot, I told it, I said, and I just typed in the doctor's name and hand brain. So it broke it down for me. And the question I had leaving that description was what makes you flip your lid? So I just, I swear to you, I just said, what flips the lid. And everything it gave me back, it contextualized around diabetes, even though I did not mention diabetes at all in this, this LLM knows the podcast I make.

[B]

Yes.

[A]

And it like, so I don't know, be, be, be scared or be happy. I'm not sure exactly what, but it's under what flips the lid. It said sudden high stakes uncertainty, like a jump scare. What could that look like? A sudden double arrow down on a CGM when you're driving or an unexpected occlusion alarm in the middle of the night. Number two, cognitive exhaustion, decision fatigue. The lib flips not because a specific number is terrifying, but because the logical brain is just too tired to do the math one more time. This is when a slightly stubborn blood sugar at 8pm causes a complete emotional breakdown, whereas the exact same number at 10am May have been handled with more calm. Number three, the collapse of the action response map. Total loss of agency. The brain interrupts this unpredictability, not as a math error, but as a total loss of agency and a profound betrayal of the body or by the body. The helplessness circuit lights up and logic is abandoned because logic didn't work anyway. And the amygdala takes the wheel in a state of deep frustration or grief. Which, by the way, is fascinating because I always say to people, like, why do you always just say, well, that's just diabetes. And what they're saying is, I did something logical and it doesn't work. That's how diabetes goes. Like, that's so fascinating to put that together.

[B]

That there. Yes. And that's what we're going to get into.

[A]

Oh, my God. Am I foreshadowing?

[B]

You are foreshadowing.

[A]

Should I do the fourth one or do you want to leave? To leave you alone. She's like, why don't I just go if you're going to do this. Yeah, physiological.

[B]

I'll see you next week.

[A]

Yeah. Bye, everybody. Sleep deprivation, illness. This is physiological vulnerability and especially hypoglycemia. When blood sugar drops, the brain is literally starved of glucose and needs to power their prefrontal cortex. Well, there you go, everybody.

[B]

So now you know that when your. When your lid is flipped, your. Your cortex has gone offline, right?

[A]

Okay.

[B]

And yes. So what we want, we're in kind of going through the steps and those. Those were all great illustrations of what makes your lid flip. We are going to talk through what is it in. In more. Some more illustrations as well, is that. That paradox of the agency and the anxiety.

[A]

Okay.

[B]

And so agency increases, and that's what we want, is more of that prefrontal cortex engagement. Right? Cause that's, again, it's responsible for the planning, the decision making. You can regulate your emotion, and you're constantly integrating information through the prefrontal cortex, which is the part that's right behind your forehead.

[A]

Y.

[B]

Okay, so when agency is present and this is it, you know, the pf, the prefrontal cortex comes back online, allowing you to flexible thinking, problem solving. You also are remembering prior successes, which is an important piece. Like, okay, last time this, I did this, and this worked. Which again, is interesting with diabetes, right? Because sometimes that works, sometimes it doesn't. So you're shifting from reactive to intentional. And you're able to do that because you're engaging in that. Prefrontal cortex is engaged.

[A]

So you trust that what you know is going to happen is going to happen. And that creates, like, resonance, reinforces the agency again.

[B]

Yes, yes. It's a reinforcement cycle.

[A]

Okay.

[B]

So agency shifts. We have. We have the autonomic nervous system, which some people say is composed of two branches, some people say three. But the. The two kind of main nervous system branches that we think about are the sympathetic and the parasympathetic. So when we have the sympathetic dominance, we might be experiencing low agency. And this is where the physical experience of anxiety lies, right? We have the shallow breathing. You might be feeling on edge, your heart is racing. You might have thought racing. You might be on high alert, right? Like that experience that you just have the double arrow down that might trigger a sympathetic response, or you might already be there, and then you see the double arrow down, and then that reinforces that fear response. Okay. If you have active agency, you might have more of a parasympathetic dominance. And that is the nervous system that. That part of your nervous system slows down your breathing. You're able to ground yourself. You have more capacity to deliberate your decisions and consequences, and you have that decreased panic like sensation. So there's a reason why when we say you're experiencing that increased heart rate, the increase the Thought racing, the shakiness of anxiety. The most common first intervention you'll hear is to do your deep breathing, and that's to engage the parasympathetic nervous system.

[A]

Huh. This is fascinating. Thank you for bringing this up.

[B]

Okay.

[A]

Yeah. Really keep going. But thank you.

[B]

Okay. Okay. Good. Good. Okay, so. And that's what I just said, that, you know, that's why doing something when you. But. But that's the heart. It's hard, right, when you are in this panic state and maybe even experiencing a panic attack. And people say, well, just, you know, do your deep breathing, do your grounding exercises. It almost feels impossible to do in. In a really heightened state of panic. So as you're anticipating and feeling the symptoms leading up to perhaps even a panic attack, doing something does actually feel calming. Whether that's the grounding or the breathing or even making a plan or doing something. Engaging with your diabetes does reduce the intensity of the sympathetic nervous system. Okay. Shall I keep going?

[A]

I think. Yeah. I'm not gonna stop you. I'm having a good time. Yeah.

[B]

Okay. So agency also disrupts and kind of interrupts this helplessness circuit. So the formal term is neural. Neural circuitry. It's hard to define. I actually looked it up to see if I could define it well. But basically, it's the way we learn things. And you can have learned helplessness comes from that neural circuitry. Unless you find a good way to describe it or define it in simple terms with. Neuron

[A]

got beyond our. You got beyond our depth there.

[B]

Yes. Yeah, it did. It did. Beyond our. My pay grade here. So when you have repeated experiences of unpredictability or failure. Right. Which happens a lot and, you know, in various life's life experiences, that's how you develop this learned helplessness. And then you can often experience that. Well, I don't. I don't even want to try. I'm not motivated. You might experience shutdown, overwhelm because of that. What agency does. Again, going back to that belief that I can influence outcomes, I can act, I can make this choice, I can do this, make this decision. It creates those micro successes that then retrained that nervous system, your neural pathways. And you can say, when I act, something changes when I respond, or do this things improve. When I use my skills or the things that I've learned, I can influence the outcome. The challenge is we want to have all of that automatically. Right? Like we want to know. We want to have that faith and trust in ourselves. The challenge is building patience, because that occurs over time. These small corrective experiences accumulate and then that is what reshapes the brain's. The neural pathways in your brain.

[A]

Right. It's that saying, I don't know what it's. How do you eat? It's like a big animal. How do you eat?

[B]

Oh, yes.

[A]

What's the saying?

[B]

How do you eat? Like a buffalo. It's like one bite at a time.

[A]

Yeah, I. That and fake it till you make it jumped into my head. So I figured when, like when you're really. When everything's a real show, just fake it until you make it because you trick yourself into believing you're succeeding and then that's a little micro win, right?

[B]

Yes.

[A]

And then they build up and get bigger and bigger and bigger and then you just take the problem in chunks that are handleable and then you move on. And then those grow and grow and grow and that builds your confidence. Then your confidence gives you agency. And then eventually this is. What is this all that people mean when they're like, hey, do it for a while, it'll get better. Is that really. Is that it?

[B]

Yes. And that's very simplified because then what gets in the way that we've talked about, I think in other episodes or series is the cognitive distortions get in the way. Right? Like, well, if I can't. The all or nothing thinking or the catastrophic types of thinking, which leads to different types and experiences of anxiety. Well, if I can't figure this all out, then I'm a failure or whatever it may be. So that's what interferes with that mindset.

[A]

The fallibility of humans is what gets in the way at some point. Right. Like it's us at some point. We are the bottleneck for everything. You know, you get into a situation and you're making good progress, but you feel like it's not going quickly enough. So you try to take a bigger chunk out. That bigger chunk makes it overwhelming and you slide back to it's Chutes and Ladders. Then you slide back to where you started and you just have to be able to pace yourself, take in good information, get a little wind. But you know, I really don't. I'm going to say something out loud that I'm sure it'll be mocked by most people listening, but I don't want to make this about me. But when I stop and think about how I've structured the podcast, I'm fascinated by how much of it is coming out of this. Except I've never heard about this before today when you started telling me about it really is like, I'm not giving myself. I might be patting myself on the back, but I don't mean to be. I mean, I mean to, like, focus on the idea of, like. Like, my dumb. Just took the way I got through life. Oh. Because I grew up in a really bad situation, I've probably done all these things and I didn't realize it, like, segmented myself, did one little thing at a time, didn't get out over my skis, took my time to get to the thing, made it a little better, reset, did it again. And then I just took the common sense way that I got through that. And then I just said this to Jenny today when we were recording earlier in the day, and I said all I really do. If you really listen to the podcast, I just take common sense life advice and remove a couple of words and jam diabetes words into it. And I'm like, this is a common sense way to take care of this problem. That's all I'm doing. I don't know anything about diabetes. I know about, like, problem solving. I think that maybe is what I'm good at because my whole life's been a goddamn problem. Oh, yeah, that all makes sense. Okay. I am not giving you a copay because that would not be legal. You are not my therapist. Keep moving.

[B]

Oh, my gosh. Okay, so agency, we kind of have already said this, maybe in the beginning, but it thrives when our brain cannot predict the outcome, right? And, like, what it cannot predict, there's that sense of unknown. And what when agency thrives is when we have these patterns, these templates, and we have these internal models that we. Our brain just wants to know. Like, our brain, we thrive, Right? We thrive in knowing, like, if I do this, and I know this is going to happen.

[A]

Okay.

[B]

And that feels very safe and secure. And we are always looking for that type of reliance and security. Okay. So. Yes. So the nervous system is looking for that. And then we experience that sense of calm, and it relaxes when we know the map. Right. And even though the map isn't always going to be perfect and 100% reliable and predictable. And that's the hard part.

[A]

Oh. Even if the end isn't going to be great, knowing the path is relaxing.

[B]

Yes. Oh, yes.

[A]

That's interesting.

[B]

Yes.

[A]

Is that why some people are scared by horror movies and some people aren't?

[B]

Oh.

[A]

Cause, like, if you tell yourself going in, everybody's gonna get axed to death and be dead. And it's not that scary. Cause it's coming and you Know it and you're ready for it. And it's less jarring. A person who's like, I wonder what's gonna happen next is gonna be jump scared by it more. Maybe this is a ham fisted explanation, but, like, let me make it more real world. A lot of stuff went wrong in my life. I expect things to go wrong. When they do, I'm like, okay, well, we'll get the soldiers out and we'll point them in the right direction and we'll overcome this. But I'm not upset by it going wrong. I expect it to go wrong. And why am I not upset by it? Because I've gotten through it so many different times that I have a healthy expectation that I'll get through whatever comes next too. And I don't. I could take this out farther if you needed to. I also am not a very religious person. I don't believe in an afterlife. So I just think you're here as long as you can be. And even when death comes, I am very like, okay, well, this is part of it. Like, you know, like we, we got as far as we could. We did well, and you know, now mom's going, and this is sad, but like, I'm not, like, I really don't saying this out loud, I don't want to say it the wrong way, but like, like my mom's death wasn't devastating to me. It was upsetting and it's terrible and I wish she was here right now, but with a little bit of space of time, I'm okay. Whereas I have friends whose parents have been gone for 15 years and they are still as shattered as if it happened yesterday. And I wonder how much of that has to do with maybe a Pollyanna way of thinking about life to some degree. I don't know if Pollyanna is the right word. That might be insulting. I don't mean it that way, but I expect things to go wrong. So I don't know, maybe just having fought through it a couple of times gives you. You know what I mean? Like, when the bullets start flying, why do some people duck and some people run forward? That kind of feeling.

[B]

Oh my gosh, you're asking some big, deep questions.

[A]

Sorry.

[B]

When you say you expect things to go wrong, I almost want to challenge that and say it almost like, but you expect. You don't expect perfection.

[A]

I was just gonna. You brought that up and I was gonna correct myself. I just don't expect everything to go perfectly. And so when it doesn't.

[B]

Cause it feels differently.

[A]

Use my There. Use your less coarse wording. I don't expect everything to go perfectly. I expect there to be bumps and bruises along the way. And I have a good confidence that I can bring things back into toe and keep going a little bit because I've done it so many times and I've had bigger problems. I think I've already experienced, with the exception of what I would imagine would be my own death, my wife's death, or God, I hope my children don't go before me, that with the exception of those things, the worst stuff that's ever going to happen to me has probably already happened.

[B]

Yes. Yes.

[A]

Even if life just plays out reasonably well for me, it's a win. It's way better than what I've been through already. And having that experience lets me not feel like, oh, no, what's coming next. I never feel that way. I just think, like, oh, what's, like it's. This is only going to fit for the people who have seen it. But like, it's in the West Wing way of, like, you know, when the president would go, what's.

[B]

I have not. I need to. I need to watch the West Wing. Not in its entirety. I know, I know.

[A]

Oftentimes after a crazy day of like, everything going wrong and the whole world blowing up, they'd get through it and the president would look up and go, what's next? And that's kind of how I feel. Like, all right, we did that. And then maybe tomorrow will be chill. And I gotta be honest with you, if three or four days go by and it's chill, it's kind of boring. I had a night off last night and like by 9 o' clock I was like, I guess I should just go to sleep. This sucks.

[B]

You have high agency. I mean, that's what it is.

[A]

I feel like that's ridiculous, though. You know, enough about my life. I shouldn't have that.

[B]

But you do, because you have, have all of these micro successes, but you also hold the flexibility that it isn't going to go perfectly, but you have enough moments over time that you can affect change.

[A]

That's luck. Isn't it though? Like, could, couldn't a couple of.

[B]

I'm trying to think of in what.

[A]

Well, couldn't a couple of those things have just gone sideways? Well, I mean, I wouldn't feel that way. You know what I mean? So if that was a conscious decision I made or someone made for me that moved me in the right direction, couldn't somebody have made a decision that put me in A wrong direction. And I wouldn't have the confidence that things were going to work out. And I'd be one of those people running around saying, the sky's falling. And then every time something happens, see, see, we're all going to die. Instead, I'm just like, oh, wow, another problem, Something fun to fix. I like fixing problems.

[B]

There's like a balance of optimism and hope.

[A]

And I never would have used the word agency before today. I would have said confidence that I can get through it. But now as you're talking, I realize an agency. Okay, so how do we give each other. Are we up to that part yet? Sorry.

[B]

So I think we're. We're just about there. So. Yes, the. The nervous system. I think we can pause here, like,

[A]

jump back in for next. Another part. What do you think?

[B]

I think so. Let's. We can pause here.

[A]

Erica, put a pin in it.

[B]

Let's. Oh, my gosh. So, yes, in general, when agency is strong, anxiety is less likely to spiral into that feeling of overwhelm. I think what might be interesting for us to talk about in the next episode is, you know, applying this, this concept and conversation of agency and anxiety through the lens of living with diabetes.

[A]

That sounds good. Name five things Scott would never say for 500. Put a pin in it is definitely one of them.

[B]

Yes. After, after agency.

[A]

I never would have said agency. I would have just said, like, I would have said something stupid like, my life's been forged in fire. Like, you know, or resilience sharpens iron. Like that kind of crap. You know what I mean? Like something you would have heard on a bro podcast somewhere. You know, like, who's going to row the boat, Erica? Who? Huh? I love that one. Who's going to row the boat? You're nine feet tall. You row a thing. I'll just ride in it. How's that sound?

[B]

Oh, my gosh.

[A]

But seriously though, like, this is really. This was wonderful. Thank you.

[B]

Oh, good.

[A]

How did we get to this? Was this your idea? This was awesome. I should listen to you more.

[B]

Yes, thank you.

[A]

No, really great. I'll talk to you soon.

[B]

Okay, thanks. Bye.

[A]

Having an easy to use and accurate blood glucose meter is just one click away. Contour next.com juicebox that's right. Today's episode is sponsored by the Contour Next Gen blood glucose meter. I'd like to remind you again about the MiniMed 780G automated insulin delivery system, which of course anticipates, adjusts and corrects every five minutes 24 7. It works around the clock so you can focus on what matters. The Juicebox community knows the importance of using technology to simplify managing diabetes. To learn more about how you can spend less time and effort managing your diabetes, Visit my link MedtronicDiabetes.com Juicebox 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. My Grand Rounds series was designed by listeners to tell doctors what they need, and it also helps you to understand what to ask for. There's a mental wellness series that addresses the emotional side of diabetes and practical ways to stay balanced. And when we talk about GLP medications, well, we'll break down what they are, how they may help you, and if they fit into your diabetes management plan. What do these three things have in common? They're all available at juiceboxpodcast. Com up in the menu. I know it can be hard to find these things in a podcast app, so we've collected them all for [e-mail]. have a podcast? Want it to sound fantastic? Wrongwayrecording. Com.