#1877 Agency and Anxiety Part 2

Summary

Juicebox Podcast: Type 1 Diabetes — Episode #1877

Title: Agency & Anxiety Part 2
Hosts: Scott Benner & Erica
Date: June 15, 2026

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Episode Overview

This episode continues a two-part discussion on “agency" and “anxiety” in the context of living with Type 1 diabetes. Scott and Erica break down what it means to move from feeling powerless and out of control after a diagnosis, to reclaiming agency over management—and how that shift affects anxiety, shame, and day-to-day emotional wellbeing. The conversation pulls in personal stories, listener experiences, practical analogies, and actionable mindset shifts, offering nuanced insight for both patients and caregivers.

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Key Discussion Points & Insights

1. Defining Agency vs. Autonomy

[02:44–07:07]

• Agency: The capacity to affect and influence outcomes within existing constraints. It’s about skillfulness and decision-making within boundaries you can’t change.
• Autonomy: The ability to change the rules or act without external limitations.
  • Example: In a board game, autonomy is changing the game’s rules; agency is how well you play within the rules.
• Quote [03:15] — Erica:
  “Agency is about how you operate within constraints and autonomy is about where you operate in the absence of constraints.”

2. Diagnosis: Loss of Autonomy and Agency

[05:15–07:07]

• The diagnosis of Type 1 diabetes often comes with a sudden loss of both autonomy (freedom to live 'normally') and agency (sense that your actions predict outcomes).
• Early on, actions don’t always bring expected results, leading to unpredictability and high anxiety.

3. The Interplay: Low Agency, High Anxiety

[07:07–12:58]

• When you feel powerless to change outcomes, anxiety peaks, leading to two main coping extremes:

  • Hypervigilance: Over-monitoring, obsessively checking numbers, attempting to regain control.
  • Avoidance: Giving up, feeling helpless, “throwing hands in the air.”

• Quote [09:38] — Erica:
  “You might lean into the hypervigilance and kind of over-control, or the avoidance... I kind of helpless.”

• Both hypervigilance and avoidance lead back to the same problem: feeling stuck and emotionally overwhelmed.

• Scott describes how neither extreme—constant oversight or ignoring care—leads to sustainable diabetes management.

4. Regaining Agency Through Experience & Knowledge

[12:58–18:29]

• Skills, knowledge, and real-world practice help restore agency over time.
  • Recognizing patterns and learning your own unique variables boosts confidence and reduces anxiety.
• Memorable Moment [15:39]:
  Erica’s story from a meetup of experienced Type 1s:

  “One person who yelled out the word ‘knowledge’—everyone just… took a big breath and then laughed. It is so true that it does come. Time and experience does yield knowledge, but you don’t have to wait for years and years and years.”

• Not everyone learns at the same pace—some need years, others progress in months when the timing, resources, or mindset is right.

5. The Mysterious 'Click' of Understanding

[17:00–17:23]

• Questioning why the “click” of understanding comes at different times for different people. Often, people can’t pinpoint the moment—they just “lived in it long enough.”
• Quote [17:23] — Scott:
  “I don’t know, we’re baking a cake, and some people have to mix the cake for a minute, some people have to mix the cake for an hour. …The cake was just done one day, and I figured it out.”

6. Advocacy and Agency in Real Life

[19:00–22:19]

• A light intermission with Scott’s daughter Arden, who displayed agency and advocacy by speaking up to her professor about unrealistic exam requirements.
  • Scott: “Well, there’s agency and advocacy.” [20:38]
• Draws parallel to advocating in healthcare—sometimes, questioning “the rules” can make a difference.

7. Agency Reduces Anxiety (But Doesn’t Eliminate It)

[22:19–27:33]

• As agency increases, anxiety morphs from overwhelm to something more informational.
  • Anxiety “becomes more informational rather than this overwhelming experience.”
• Scott describes a listener finding confidence by stacking small, consistent efforts—likens it to the paper-folding metaphor (see below).
• Paper-Folding Metaphor [25:30–26:36]:
  Each fold doubles thickness; after 42 folds, it theoretically reaches the moon. Same with tiny, consistent changes in diabetes management: “You’re not going to notice it…but if you just keep doing it…before you know it, you got way more than you thought you were going to.”

8. Mindset, Shame, and the Numbers Game

[27:33–34:10]

• Reducing shame is crucial for sustainable management. Early on, data (like A1C) feels like a judgment of worth—but higher agency shifts numbers to sources of information, not self-worth.

• Quote [31:48] — Erica:
  “With higher agency, the imperfect data brings less shame. …It’s just a number. It’s giving…information. It doesn’t need to be overwhelming.”

• Scott encourages listeners not to catastrophize mistakes:
  “If you mess it up on Tuesday, throw it—who cares? And then just keep going…Don’t feel bad about it. You’re still doing way better than you were the week before.”

9. Overcorrection—When Agency Drives Anxiety

[35:17–38:32]

• Too much focus on control (overinflated agency) can backfire, bringing anxiety, self-criticism, and “crazy-making” frustration when effort doesn’t match outcomes.
• Scott notes this is common among “Type A” personalities and stresses the importance of patience and letting time teach you.

10. Meta Reflection: Building a Mental Health Pro Tip Series

[39:10–47:49]

• Scott proposes creating a more structured “mental health pro tip” framework for diabetes, offering psychological touchstones at various waypoints along the journey.
• Erica and Scott agree that while no “one size fits all” change process exists, articulating and normalizing the emotional journey is powerful and gives people touchstones and tools—even if everyone’s journey is unique.

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Notable Quotes & Moments

• Defining Agency vs Autonomy:
  “Agency is about how you operate within constraints and autonomy is about where you operate in the absence of constraints.” — Erica [03:15]

• Mature Realization:
  “I just lived in it long enough that I understood it finally.” — Scott (on the diabetes learning ‘click’) [17:23]

• On Small Steps:
  “You’re not going to notice it when you do it, but if you just keep doing it and eventually…42 folds of a piece of paper, the moon is…about 384,000 kilometers away from the Earth. So it would take exactly 42 folds…to bridge the gap. And I think you can do that in your own life, too.” — Scott [26:36]

• On Shame:
  “With higher agency, the imperfect data brings less shame.” — Erica [31:48]

• Radical Acceptance:
  "You don’t have to pay attention to it. You just can’t let it make you nuts while you’re doing it. And I know all that’s easier said than done, but nevertheless…” — Scott [37:46]

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Timestamps for Key Segments

| Timestamp | Segment | | ----------- | ------------------------------------------------| | 02:44–07:07 | Defining and contrasting agency/autonomy | | 07:07–12:58 | Loss of control at diagnosis, coping extremes | | 12:58–18:29 | Gaining agency, learning through experience | | 19:00–22:19 | Real-life advocacy (Arden’s classroom story) | | 22:19–27:33 | Anxiety as information, stacking small efforts | | 27:33–34:10 | Shame, mindset shifts, not catastrophizing | | 35:17–38:32 | When agency becomes overcorrection | | 39:10–47:49 | Pro Tip Series idea—normalizing emotional journey| | 48:02–49:47 | Finding balance: agency, acceptance, compassion |

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Takeaways & Actionable Insights

• You can’t change the rules of diabetes, but you can develop agency—skills and confidence—within the rules.
• Anxiety after diagnosis is normal and peaks when agency is low. With time, knowledge, and experience, agency increases and anxiety becomes more manageable.
• Both hypervigilance and avoidance are common, but often lead to burnout and do not resolve anxiety. Gentle, persistent effort and seeking understanding are more sustainable.
• Shame is common when you don’t feel in control; as you build agency, these feelings lessen, and numbers can become useful feedback, not identity.
• Don’t beat yourself up over off days—restart as soon as you notice, don’t wait for the next “perfect” time.
• Everyone’s "aha" moment is unique; sometimes it's a slow accumulation, other times sparked by a new resource or mindset.
• It’s valuable to name emotional states (like agency, shame, grief) and normalize them—this alone can lessen their hold.

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Tone and Style

The episode maintains an empathic, conversational, and validating tone. Scott’s anecdotes and Erica’s gentle, therapeutic approach combine humor, warmth, and realism to demystify the roller-coaster of diabetes self-management—never minimizing but always centering the possibility of growth, self-compassion, and improvement.

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For New Listeners

If you’re newly diagnosed, feeling stuck, or supporting a loved one, this episode will make you feel understood, offer conceptual and practical clarity, and point you toward hope. Check out the Juicebox Podcast’s Bold Beginning Series and Pro Tip Collection for more in-depth tactical and emotional support.

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“Nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan.”

Transcript

[A]

Hello friends, and welcome back to another episode of the Juice Box Podcast. Diabetes can make it feel like your body is just happening to you, and that's where a lot of the anxiety lives. But as your skills grow, something changes. You start to see that what you do actually moves the needle. This episode is about that shift from feeling out of control to knowing you can respond. If you or a loved one is newly diagnosed with type 1 diabetes and you're seeking a clear, practical perspective, check out the Bold Beginning Series on the Juice Box Podcast. It's hosted by myself and Jenny Smith, an experienced diabetes educator with over 35 years of personal insight into type 1. Our series cuts through the medical jargon and delivers straightforward answers to your most pressing questions. You'll gain insight from real patients and caregivers and find practical advice to help you confidently navigate Life with Type 1. You can start your journey informed and empowered with the Juice Box Podcast. The Bold Beginning Series and all of the collections in the Juice Box Podcast are available in your audio app [e-mail] in the menu. Nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan. The episode you're about to listen to was sponsored by touched by type 1. Go check them out right now on Facebook, Instagram and of [e-mail] check out that Programs tab when you get to the website to see all the great things that they're doing for people living with type 1 diabetes. Touched by type1.org the podcast is also sponsored today by the Tandem MOBI system which is powered by Tandem's newest algorithm, Control IQ 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 Today's episode is also sponsored by the Eversense 365. The Eversense 365 has exceptional accuracy over one year and is the most accurate CGM in the low range that you can get. Eversensecgm.com Juicebox Erica we are back doing agency and anxiety part two. Just a two part little quick series, right?

[B]

I think so. I think it might be just a two parter.

[A]

Okay.

[B]

But we'll see.

[A]

Where do you want to start? I want to get you right back into your conversation. So okay. What do you want to do?

[B]

So thank you. I would like for us to first kind of just review agency and the Definition. And as I was thinking about our conversation from the first episode, I wasn't sure if we actually defined and differentiated agency versus autonomy. So I thought we could do that first and then talk about the kind of interplay between agency and anxiety and how agency maybe amplify or buffer anxiety when living with diabetes.

[A]

Let's do it.

[B]

So, okay, so first, you know, I know we were, as we were trying to define agency in the prior episode, it was, we realized it was. It's difficult. You know, you kind of have a felt knowledge of what it means basically that you can affect and influence outcomes and you have the power and the capacity to do so. You can affect change in your life, but it's within kind of constraints and limitations. And that is different from autonomy where you have the freedom to act according to your own rules, your own desires, and you aren't feeling or experiencing those external control or outer constraints. So I like the kind of. To think about agency is about how you operate within constraints and autonomy is about where you operate in the absence of constraints. One example, and I don't know if it's as perfect, is autonomy. If you're, if you're playing a game, autonomy, like a board game, let's say you might have the power to change the rules of the game using your autonomy, but agency is the ability to skillfully win within the existing rules. So you have these kind of constraints and boundaries and you're making choices that will affect an outcome that you are hoping for. But autonomy is like, well, I don't like these rules and I have the independence and freedom to change them. So then I can affect, change, or feel independent in my life.

[A]

Yeah, I'm following.

[B]

It's not a perfect example.

[A]

No, but I'm following what you're saying. There's some situations you're in that you can change, effectuate, get out of. And there's some that you're in that are concrete. They're not going to change, but you can still exist within them. When you use agency for. When you use autonomy for.

[B]

Yes.

[A]

Is that right?

[B]

Yes, I think that's good general reflection. Okay, so when we are thinking about getting diagnosed with diabetes, one of the first things you experience is the person who is diagnosed and the caregiver and the family system as a whole is that loss of autonomy. Right. Because you feel like the life you once knew, the freedom to intuitively eat whenever you want, all of the examples we can think of, that is immediately lost and you feel out of control. So that, that is autonomy. That's a loss of autonomy in that. In the original diagnosis and probably also agency. But loss of agency is experienced at a diagnosis or stages of change or probably any time you feel like you're. You've thought you can affect an outcome and it is not what you expected. So when you, you know, you leave your doctor's office or the hospital, you have your insulin to carb ratios, you have your, your target number. But when you, in the beginning, and again at stages of change or stages of burnout, when you anticipate doing A or X, you don't always get Y. Right? So you might get A, B or C, and that might be as honeymoon or growth hormones, et cetera. So the system and the procedures and the outcomes that you are expecting feel really unpredictable. And anxiety will increase because the consequences feel immediate. So we're going to get into kind of now this interplay between when agency is low, anxiety is high, and vice versa. But I'll pause there.

[A]

Okay. When agency is low, anxiety is high. And when you think about it, on the scale of diabetes, you don't have any autonomy to change diabetes. Right. But you have some to change what your own actions. Or maybe I should just let you move on before I ask my question.

[B]

Yes. So we'll get there. How autonomy is kind of reintroduced.

[A]

That's okay. I'm going to wait and get myself more fully formed before I talk.

[B]

Okay, go ahead. So in again, I know I often say in the beginning, but you might feel this way at any point in your life's time with diabetes or from the caregiver's perspective, that the outcomes feel externally driven. And you might experience this feeling of my body's unpredictable. Whatever I do, it doesn't happen the way I expect. And this kind of coincides or correlates to the messaging of the perceived body betrayal that we talked about in the body grief series. Right. That feeling of like, my body failed me no matter what, it has totally abandoned me. And every fluctuation can be interpreted as failure or danger. Right. So that's when your lid is flipped. Like we talked about you. You are experiencing every single blood sugar decision. And as you're eating or navigating any of the variables, you might experience that, that feeling of failure or danger. And it actually might. Right. It might be dangerous. You might be high or low. Okay. So your nervous system is interpreting this as, you know, you, you are, you're offline and you're. But you're leaning towards this vigilance and threat monitoring. So this is why, when the agenc low. Right. You're feeling like you cannot affect outcomes or influence outcomes. Anxiety is high. So as a result, this is when you might feel the anxious symptoms. And to try and regain a sense of control, what often occurs is kind of that hyper vigilance. I'm going to try and, you know, just stare at the numbers. I'm going to finger prick 20 times and I'm going to figure this out.

[A]

Does that actually work though?

[B]

No, no. But it feels like you're doing something right. So it's your body's response to saying, I am feeling so dysregulated no matter what I do isn't working. You kind of often will do two things right. You might lean into the hypervigilance and kind of over control or the avoidance, like kind of hands in the air. No matter what I do, it is not working and I kind of helpless. Right.

[A]

Both of those decisions, oddly enough, kind of lead to the same place. Because the hyper vigilance usually, I mean, some people figure it out, but a lot of people end up in a situation where they're staring at it so long and so hard and they're so exhausted they can't make any sense of it anyway. They're still having the outcomes they don't want. And the people who let it go maybe experience a slightly higher a 1C or a little more variability, but they don't end up on, you know, you can't wish yourself into success either. But she's like, I'll throw it up to God and let's see what happens next. Because what's going to happen next is your blood sugar is going to get high. Okay, all right, I got that. I'm okay. When you think of a CGM and all the good that it brings in your life is the first thing you think about. I love that I have to change it all the time. I love the warm up period every time I have to change it. I love that when I bump into a door frame, sometimes it gets ripped off. I love that the adhesive kind of gets mushy sometimes when I sweat and falls off. No, these are not the things that you love about a cgm. Today's episode of the Juice Box podcast is sponsored by the Eversense365, the only CGM that you only have to put on once a year and the only CGM that won't give you any of those problems. The Eversense 365 is the only one year CGM designed to minimize device frustration. It has exceptional accuracy for One year with almost no false alarms from compression lows. While you're sleeping, you can manage your diabetes instead of your CGM with the Eversense365. Learn more and get started today at eversensecgm.com juicebox1year1cgm let's talk about the Tandem Moby insulin pump from today's sponsor, Tandem Diabetes Care. Their newest algorithm, Control IQ technology, and the new Tandem Moby pump offer you unique opportunities to have better control. It's the only system with autobolus that helps with missed meals and preventing hyperglycemia, the only system with a dedicated sleep setting, and the only system with off or on body wear options. Tandem Mobi gives you more discretion, freedom and options for how to manage your diabetes. This is their best algorithm ever and they'd like you to check it [e-mail] juicebox when you get to my link, you're going to see integrations with Dexcom sensors and a ton of other information that's going to help you find learn about Tandem's tiny pump that's big on control. Tandem diabetes.com juicebox the Tandem Moby system is available for people ages 2 and up who want an automated delivery system to help them sleep better, wake up in range and address high blood sugars with auto bolus.

[B]

So that is how sometimes it kind of the low agency might amplify the failing experience of anxiety and then the result is that either avoidance or hypervigilance. These are obviously stereotypes, but these are, these are the trends, right, that we might experience. So how, how does agency increase with diabetes? So over time you, you know, as skills and knowledge and understanding develop, we expect that that belief in oneself and that feeling that I can affect change. The agency will grow within you. Right? As you start to recognize patterns, you learn maybe your insulin to carb ratios better. You're more aware of how the variables might impact your blood glucose levels. And that's where agency can become a protective factor. Even within uncertainty, you have an increased understanding in kind of how you can predict outcomes. You can see how you're changing your actions, change outcomes. Even though it might not be perfect all the time because your anxiety or the anxious thoughts or feelings are starting to be reduced even though it's not, you know, you might, you're not going to nail it every time, right? Okay. So your behavior becomes more intentional with that. So you are more mindful with the increased time and knowledge. Right? I know we always talk about like diabetes is a time, it's A chronic illness that you do learn and grow and benefit from time and knowledge. Right. And experience. So this is. Actually, I just wanted to share a quick story. I was recently at a meetup for grownups living with D1D, and we were playing a game, and one of the questions was, what's a sign or symptom that you have been living with diabetes for a long time? And there were some funny ones, you know, like you have, you know, your storage closet is packed full of all of your stuff. There might be some hard one hard answers, like you might be living with some complications, but the one person who yelled out the word knowledge, everyone just kind of took this. We all kind of took a big breath and then laughed like, it is so true that it does come. Time and experience does yield knowledge, but you don't have to wait for years and years and years.

[A]

If you just make your way through almost blindly, you will amass that knowledge over time. Like, you just end up having so many experiences, it's almost impossible to ignore, you know, what you're learning at some point. But it's nice if somebody steps in and gives you more and gets you sped up, because that loss of time eventually weighs on people. And especially if there's complications, then you start thinking about, like, well, now I know it, but if I would have known it before then, this might not have happened. And that can come with its own set of consequences for you psychologically afterwards, after that all kind of comes together. But that's interesting that in that setting that everybody kind of like, wholly agreed. Like, I have learned a lot about this over time. Yeah.

[B]

Mm.

[A]

It's a shame it can't be sped up without the time going past. I don't know, maybe it can be.

[B]

And, and, and what is time? Is it six months? Is it.

[A]

Yeah.

[B]

Six years? Is it.

[A]

You know, it's different for everybody. That's what I've learned after talking to people, is that some people jump in. Some people are handed tools and ignore them for years or don't understand them for years. Then they hear something or have an experience. It makes the whole thing crystallize for them. They go, oh, I got it now. And it just starts to work in a different way. And some people. I've seen, I've seen some people jump in, go through Bold beginnings pro tips. Six months later, send me a five and a half, a 1C and go, I understand it. And I'm like, awesome. Like, that's great. And everywhere in between.

[B]

So, right. And then. And what was that? That moment for that person that they then were able to digest the education. Were they not in a stage of shock, you know, and dismissal? Were they ready to hear it? Like, we don't. I think that that is the human element. Right. Like, at what point does the knowledge help?

[A]

I ask everybody who gets to that point, can you point to what got you there? What did you hear that made sense? And no one ever knows. They. They're just always like, I don't know. Just one day, it all made sense to me. Everybody says the same. Every once in a while, somebody will say, well, I listened to something or I saw something, or someone said something to me, and it made, like, something click for me. But overall, it's more about, like, I feel like their answer is, I just lived in it long enough that I understood it finally. Like, that's what I feel like their answer really means is that. I don't know, we're baking a cake, and some people have to mix the cake for a minute, some people have to mix the cake for an hour. And I don't know, the cake was just done one day, and I figured it out. It's really interesting that the human part of it is. It's pretty fascinating, especially when you look at all this and you see how you can be held back by something that's sort of outside. It feels like it's outside of your control. You can be helped by something that might also be outside of your control. You know, you hear people are like, well, some people handle situations better than others. And for my 10 years of asking people, I can't figure out the difference between one and the other.

[B]

You know, it's interesting, and I'm. As you're sharing this, I'm trying to think about, you know, that moment for me. Yeah. Of when did I want to understand, when did I feel, you know, experience that agency? And it is almost an undef. Like this nebulous experience that occurs.

[A]

Erica, hold your thought for a minute. Arden, I'm recording with Erica. What's up?

[C]

No, I was gonna call you and tell you. Guess what me and my class just spent the last 45 minutes of our class doing.

[A]

What did you spend the 45 minutes doing?

[C]

Convincing our professor that it's actually impossible to write 5. 5. Okay, 5. 5 paragraph essays in our final exam period.

[A]

She wants you to write five. Five paragraph essays during the exam period?

[C]

Yes. We're like, that's impossible. We can't do that. And she was like, why not? And this kid was like, well, half of writing an essay Is like finding all of the materials and figuring out how you're going to write it. He's like three times in my exam period, he's like. He's like, I could maybe do like two. And she was like, this isn't making sense to me. And then I was like, what if you made it like two and then did like multiple choice questions or something? And she was like. And we're like, oh, my God. She's like, I'll reach out to you guys and tell you what we're gonna do. What am I supposed to write five essays?

[A]

I don't know. How long is the exam? How long is the exam period? How long is the exam period?

[C]

Like, two and a half hours maybe.

[A]

I don't know. I mean, that seems like a lot of writing.

[C]

I can't write five essays in a day. I was like, is she serious? Anyways, I spoke up. I was like, yeah, I can't do that. So.

[A]

Well, I'm interested to see what. What comes from the conversation. All right, I'm going to go. Thank you for sharing this with me. I'll see you in a bit.

[C]

Bye.

[A]

Well, there's agency

[B]

and advocacy.

[A]

Yeah. A little bit of autonomy. She's like. She's like, maybe I can change my situation. I can't do that. I.

[B]

Yes, actually all three.

[A]

She was like. She's like, I don't think I can do that. I'm going to speak up. And also, no, I wonder. They'll probably.

[B]

That does sound challenging.

[A]

Yeah. I mean, five different five paragraph essays in two and a half hours. I don't know. I'd have to think about it. I haven't written that much in a while. I don't think it would be good. I might be able to hammer out the first pass of it.

[B]

And how many words are we talking? And pages per essay.

[A]

I have to tell you, though, I know this is off the track and make sure you have your finger on where we're at. But.

[B]

Okay.

[A]

It's just like with talking to doctors when they ask you something and then you go no. And they go, okay. Like, if the teacher really knew something, then she would have said no. It's five essays, five paragraphs each and two and a half hours. This is the requirement. Do it. But she doesn't even know if that's right. Like somebody brought it up to her and she went, oh, maybe it's not easy to do. Like, maybe it's not doable. And I don't know. I just. I always feel like that when doctors Say something to you. And then you go, well, I can't. They go, okay. I'm like, well, wait, was it important or was it not important? You know? Anyway, I'm sorry. Anyway, that was Arden, everybody. She's almost done with her psychology degree, which apparently she's using on that teacher right now.

[B]

Well, yeah, I also be curious. Yeah. What's. What's the standard? Has she always done that?

[A]

It's. It's all over the place.

[B]

A lot.

[A]

Yeah, yeah, no, it feels like a lot. Anyway, I'm sorry. Where were we?

[B]

Okay, so we are talking about as agency increases, anxiety can decrease. Right. So you're having this. Not only you're experiencing the physical kind of improvement in your management, you're also experiencing this psychological transition.

[A]

Okay.

[B]

Right. So you're going from, my body is happening to me. My body failed me. I can. What. No matter what I do, I cannot land in range, you know, whatever it may be. So you're having that. That low agency, high anxiety, and also high grief. Right. With that, which can transition to. I'm interacting with my body through skillful action. So you're having active agency and regulated anxiety. And I think it's important that even if you are living in a space of high agency and confidence in your management, it doesn't mean that you aren't going to experience any anxiety. You're going to have that lived experience. I know. We know that. I just think it's important to highlight that. Yes. So it changes the quality. Right. So anxiety becomes more informational. And maybe anxiety isn't even the right word there.

[A]

The fear you be you.

[B]

The. Like. Yeah. The fear that the lived. The feeling of being out of control, which is also anxiety. So maybe it is. So it becomes more informational rather than this overwhelming experience where you feel so dysregulated in all areas of your life.

[A]

Okay.

[B]

So. Yeah. Do you want me to keep going?

[A]

No, there's nothing to pause for because I'm. I listening. I just. You know, I told you before we recorded. I just recorded today with somebody who I realize. I mean, you actually helped me realize. I was talking to him. I was talking to him about anxiety, agency, autonomy, and I didn't realize I was. I wasn't using those words when I was speaking to him about it, about finding a way to just do better for himself because he's, you know, he's sure you guys will hear it on the podcast at some point. But as you're talking, everything you're saying came out in that conversation I had with him. Where he talked about, you know, he. I guess he doesn't feel like he has agency. So when diabetes needs something from him, he. He has that feeling of like, I don't want to comply with being told what to do by diabetes. And then it puts him into a situation where he's now being told what to do, but it's so dire, he actually has to do it now. And that when he looks back on it and realizes that his actions previously led to what's going on now, he feels bad about it. It's exactly what you're explaining here. So I can't wait to find out what the answer is, because I told him to put his head down and keep going. So, And I'm. And, and that, you know, life's not fair. You know, you've got to slowly build on experiences, make little changes that give you tiny bits of confidence. It'll grow after a while. I, at one point I said to him, I was like, you know that thing they tell you if you fold a piece of paper in half and keep folding it in half, eventually it reaches from the earth to the moon. Do you know that mathematical thing?

[B]

Maybe it's buried back there.

[A]

Explain folded paper to moon. I don't know it well enough to, like, explain it. I just know that there's this idea that if you take one sheet of paper, fold it in half, fold it in half again, and continue to do that, eventually the distance that it would create is pretty amazing. And I said, I think about that that way with, you know, effort and experiences like, try a thing and continue to try and continue to try. You'd be surprised at how just like, saving money, you put a thousand dollars away and you wake up in 30 years and it's $6,000. Or that's not a thing that you really expect the folding over. Here it is. Hold on a second. Imagine you have a standard piece of paper that's 1.1 millimeters thick. Every time you fold the paper in half perfectly, its thickness doubles. So you fold it once, it's 0.2. Twice, it's 0.4. Three times, it's 0.8. 10 folds makes 10 centimeters. 42 folds of that paper is 439,800 kilometers.

[B]

Yeah, I just think I can't even.

[A]

Right, you can't. But I think that's the point, is that it's the same with effort, and it's the same with sticking up for yourself or trying to change your situation. Like, you're not going to notice it when you do it but if you just keep doing it and eventually There you go, 42 folds of a piece of paper. The moon is on average about 384,000 kilometers away from the Earth. So it would take exactly 42 folds of a standard piece of paper to bridge the gap between the Earth and the Moon. And I think you could do that in your own life too, you know. So anyway, that's what I ended up telling him. Hopefully it'll be helpful for him. I also told him to get therapist because of, you know, because of the human parts of it here that like every time in the conversation you could see how he felt got into his way or how he thought got into his way, like his mindset was a little skewed or he was coming at it from a wrong perspective to help himself. But anyway, please go on. I really do like this conversation.

[B]

So I think that just even that example of the I don't want diabetes to tell me what to do or diabetes isn't going to get in my way. I think there is that the wrestling of the autonomy, right. Like you have now, these external constraints that nobody wanted. Right. So you're wrestling with that sense of grief and loss. And then if diabetes isn't going to get in my way, we care like, well, that can be, you know, that can be a positive mindset around. I'm going to keep doing the things I want to do in life. I'm going to achieve my goals, my dreams and I'm going to ensure that I know how now as best I can to manage as well as I can with in range values, etc to reach my dreams. Yeah, right. Then conversely, I don't want. Diabetes is not going to get in the way because no one's going to tell me what to do in that wrestling with that autonomy piece. It is still getting in the way. Right. As you.

[A]

Yeah.

[B]

Like, it's like if you, if you. I'm not going to, it's not going to tell me what to do. I'm not going to pre bolus. I'm going to just do what I want in terms of what I eat and how I eat and when I do it, it's still. Diabetes is going to get in the way.

[A]

I hear people all the time when they tell me, I told them diabetes isn't going to stop us or I don't let diabetes stop us. That you have to tell me what that means because it either means that you've taken control of it and it's not stopping you because it's not having those impacts, or you've thrown it up in the air and said, like, ah, I'm not letting diabetes stop me. I'm also not paying attention to it. So I'm just going to keep, no matter what bad thing is happening to me. And I said, that's not a sustainable model because one day the health implications will come for you. I don't know when I was talking to this guy. He's lovely. He wouldn't mind if we said his name even, but you guys will hear it in his episode. I said to him, and if you're not going to do this, he knows what to do and he's not doing it. And I said, and if you're not going to do it, then don't do it. Gleefully, I said, don't live 50 miserable years. Live 50 awesome years and see a therapist and figure out why it is you don't want to live 80 awesome years. I was like, but like, I mean, if you're going to. I said, own your decision, really think about it. And if this is how you want to live, then live this way. But don't beat yourself up about it while you're doing, like, you're literally not moving. You're both not having success and you're not moving forward. You're sitting perfectly still bemoaning what's happening to you. I'm like, you're going to do that? It's already been four years. It's going to be soon, it'll be 10. I actually said to him, I was like, if you want to do heroin, do it. Like. Like, just do it. Go shoot it up and nod off and enjoy yourself. I'm like, I don't think you should, but if that's what you're going to do, why are you beating yourself up about it while you're doing it? Just go for it, whatever you're going to do. I said, I hope you don't do it. Like, I said, I hope you take good care of yourself. I was like, but right now I'm just talking to a person who's just circling the same drain over and over and again. They have the feeling that they're circling the drain, but they never go down the drain. I'm like, you're just sitting there. It's. It's sad. I mean, obviously that's not what I want for people. And I wouldn't, you know, if you're asking me my advice, it's not do heroin. And what the hell, if you're doing that already, like, I Mean, it just seemed doubly sad to like to beat yourself up about it at the same time, you know, like, just shame is a powerful. Yeah, yeah, be my dad. Just smoke the cigarettes and die. He wasn't going to stop, so just go for it, you know, like, life is too short to spend the whole time in a flux, you know, I don't know. Like, there's something about that, you know, when you look up at some people who live a, live fast, die young lifestyle and they just have made a decision that that's what it's going to be. Those are all the people in all the movies that were like, I wish I could do that. You don't wish you could have died younger. You wish you had that carefree attitude that they have. There's gotta be a way to have a carefree attitude and not do heroin is all I'm saying. This does not seem like a heavy lift. Okay,

[B]

is that, that's the answer?

[A]

The answer is don't do heroin and have a carefree attitude. God damn it. Get out there and start working. Well, listen, in this last little bit of your notes, the answer to this problem must exist.

[B]

Okay, well, I don't know if there's an answer. I think the, the one other point I wanted to make around as we're talking about mindset and shame, right? With, with higher agency, the imperfect data brings less shame. And that, that is a journey, right? But we hear often the messaging that your, your blood glucose value, your A1C, your time and range, those are just numbers. Don't let them define you. Don't let them reflect your worthiness or your value or your identity. And that is 100% true. But, and part of that, getting to that mindset that, okay, this, this blood glucose value does not tell me that I'm a bad diabetic. It does not tell me that I'm a bad parent managing my child's diabetes. But we so often equate that right to our how we're doing as, as a person with diabetes or a caregiver. So, but to shift to. It's just a number. It's giving it's information. It doesn't need to be overwhelming. But part of that is a mindset shift and being intentional with how you assign value to the number. But it also is stemming from the higher levels of agency that you experienced over time. So right in the, in the beginning, when you're learning the, and you don't have high levels of agency, it makes sense that you also are experiencing high levels of shame and unworthiness and feeling out of control. And so you're experiencing high anxiety and high shame. So with. With the evolution and increase in levels of agency, it's like those levers, right? Like you're. You're increasing with. With the knowledge and experience and experiencing more predictable outcomes. When you don't get that outcome that you have expected this, the shame around that number is decreased because you realize, okay, I know that I, oops, I forgot to do that, or I shouldn't have done this, or, you know, it was just one of those days. It's okay, you know, So I think just highlighting too, that it's not only about reducing the anxiety and increasing the agency, but also that shame narrative shifts as well.

[A]

It's another thing I said to him. I was like, look, you know, because at the end, I was like, well, let's make some sort of a plan for you. He's like, let me get out a piece of paper. I was like, write down all the things you think you should do. And after talking for an hour, he goes, do the thing. And I was like, yeah, that's pretty much all of it, but let's break it down a little more. And so we're breaking it down. And I said, and listen, do two things for me. Don't do that thing where it's like, if I missed a day, so I'm going to restart on Monday. I was like, that's a human failing that we do. Like, I'm going to start my diet on January 2nd, or I'm going to do, like, that stuff. I was like, that's bull. I was like, just, if you mess it up on Tuesday, throw it. Who cares? And then just keep going. And don't wait till Wednesday. If you figure out at noon on Tuesday didn't do something right, just go back to what you were doing. Like, it's a habit. Like, do the. Do the habit right. But don't feel bad about it. You're still doing way better than you were doing the week before. So be happy about that. Like, stop seeing things as an error all the time. This is an experience you had. You had an experience. Build on it. Like, I have such a good idea. I made a note off to myself, I don't want to forget. But before you and I go, I want to talk to you about it. But anyway, I'm sorry, let's keep going. I'm all over the place.

[B]

You had a good idea.

[A]

I had a good idea. Finally.

[B]

Okay, so lastly, when. When agency becomes dysregulated, you. There's this non linear dynamic that occurs. Right. So if you then are feeling. And this is kind of when agency and anxiety are both at a high level. Because if agency becomes overinflated or rigid, like I must control the blood sugars. I must know that when I do this at A, then B will happen. And that hyper fixation, the hyper vigilance around control, you know, paradoxically, anxiety will go up, back again. And this we see, you know, this again happens in, at all stages of diagnosis, particularly in the beginning.

[A]

Yeah. And it, listen and it shows why, like I live with a woman who is, you know, you would have colloquially called her type A a couple, you know, 20 years ago. But she's got anxiety and it makes her incredibly good at what she does. But I watch her do this. Like she thinks that the, the mastery of something will make the anxiety go away. I'm like, the anxiety is what's making you master it. I was like, you're, you got this backwards, you know, like she's always telling me, like, when I get this done, it'll feel better. And I was like, you, that is not gonna happen. And, and in this, like, you know, in this small example, the being hyper vigilant about the data, emotionally reactive, self criticism, shame, all that stuff, that's what I see from people when they double down on. Like, I'm gonna get this. You don't understand, Scott. I'm the one who fixes this stuff. I'm like, you're not. Just step back, chill out, have the experiences, let time pass and one day you'll just wake up and go, oh, I get it now. And then that'll be it. And you'll have saved all of that time in the middle flogging yourself. It's, I can't fix this for everybody. Just chill out.

[B]

Yes, as, as they, yes. As we all listen say, okay, that's just, we'll just do that.

[A]

Just chill out, I guess. Scott. No, but like, but, but the answer really is in there for everybody. You just have to, you really do just have to mellow out a little bit. Have experiences and, and you know, and let time pass until you have the tools and the, and the education things start making better sense and you can kind of give, I, I do it now. Like, I mean, you can go back and listen to this upset about a higher blood sugar about something. I'm not like that anymore either.

[B]

And maybe a diagnosis. When she was 2, there was probably a higher level of anxiety longer than that.

[A]

But thanks to the Good friendship of the people who've come on the podcast and shared their stories, and you and Jenny and all the people who come on here and help me. I've worked my way through it. Now I'm not the same person today as I was back then. Luckily, I don't have the kind of personality that beat myself up too much in the middle. I did still, but not as badly as I see some people suffer with. And I can tell you, if I could go back in time and change something, it would be not to beat myself up as much as is going to get there, but not to the level of throw it up to God, it's all going to be okay. No, you have to pay attention to it. You just can't let it make you nuts while you're doing it. And I know all that's easier said than done, but nevertheless, I'm sorry.

[B]

I was trying to come up with another example of one of the few experiences and this which makes our community so unique under. We understand each other. When you work so hard at something and the outcome doesn't match your effort or even your knowledge all the time, that is crazy making. Right. And so it's understandable that it's the intertwining.

[A]

Yeah, it's the intertwining of all of it. It's the. It's. It's every. So this is. What should I say my thing now or no. Yeah, I'll say my thing now and then you can. You can do. Then we'll. We'll finish up here.

[B]

Okay. Okay.

[A]

It has occurred to me that over the years of you and I talking, we've had these, like, thoughtful conversations about, like, you know, specific ideas, agency and anxiety and that kind of thing today. But also body grief and, you know, and all the other things that we've. Yeah. And resilience and all the other things that we've talked about over the years. Like, it occurs to me like we've got the pathway to, like a. It's almost like a mental health pro tip series for diabetes. And maybe it's a map you follow and you. Because everybody gets to the same thing. It happens to everybody. Like, everything that happens, happens to everybody. Wouldn't it be nice to know that when you get to this part, it feels like this, and then this is kind of the mental health idea. You have to understand to traverse this part and then go to the next part, by the way, now this thing's going to happen and you're going to feel this way and this will happen. Oh, by the way, if you're having trouble with all that. Have I told you about the 5, 4, 3, 2, 1 method? I think you and I are building like a real compendium of ideas. The problem is for usability, like for people who listen through them. That's good, but because you're explaining it to me and I'm trying to absorb it, it gets very conversational and not as pointed as it could be. And I'm wondering if we couldn't create a flowchart that goes through the standard things that happen to a person along a diabetes diagnosis in lifetime and then show them where that branches off into ideas that might help them as they get to those different stations. That was my idea. Do you think that works?

[B]

Well, I'll have to think about that one, Scott, because it feels very.

[A]

It's a big idea.

[B]

I think it's a very complex. It is complex, but variation on a theme of mental health. Yeah.

[A]

And you might tell me I'm wrong, but like what I've been hearing during this two part episode is that, forgive me if I'm, if I'm, if I sound pompous for half a second, but the ideas that are in here are already covered in the Pro Tip series. They're just covered very colloquially, do you know what I mean? And they're all in there. I'm not saying you can do them. I'm saying that they exist inside of that. Now. I didn't know about any of the things that you and I have talked about over the last handful of years. I don't think I was exposed to any of it except through life experiences. I didn't have words to put to it or a textbook to point to. As I was talking about how I took care of art and diabetes and how it ended up working out for me. I think I've had all of these experiences going through. Has it led me to a perfect mental health situation? Of course it hasn't, but we're in a good place. And it at least gives you the framework to see that, like, sure, something else might happen to you and maybe it's not going to happen exactly like this, but there's value in knowing that part because just like in the Pro Tip series, the Pro Tip series doesn't tell you exactly how to take care of diabetes in every situation that may come up, but it gives you enough foundational ideas that as you bang your way through this and have different experiences, you can rely on those foundational ideas to get through the new struggle. Is the framework of The Pro Tip series. An end all, be all. Of course, it's not. Some of it you might never need. Some of it you might need differently. Some of it might not help anything, but it gets you through. And I don't know that you and I haven't done the same thing. I know you don't think about it the same way I do, which is good because that's why you have your job and I have mine. But I think that there's a foundation through all of our conversations that would shepherd somebody pretty well through this life and at least give you a shot at it. And anyway, go ahead and think about that. Yeah, think about that.

[B]

The larger themes of, you know, grief and validation and normalizing one's experience. And then what we're doing today, you know, and have done in other EP series, is giving, you know, naming what's happening is so powerful. And is that going to reduce this experience? Is it going to reduce the pain? No, but I think having an understanding of what's actually occurring and why, even though it's going to be, people are going to hear it and receive it through their own filter and lens because of their own history.

[A]

Yeah, but it gives you a better shot. It's even like parenting. You don't parent somebody and explain every ounce of everything that's ever going to happen to them. Right. You give them big ideas and touchstones and things to say like, these are rules we follow, these are rules we bend. This is important to us. This isn't as much so. So that when they run into a terrible situation or something that they don't know what to do, they at least have these little, I don't know, these foundational ideas that they have about how to live, and they apply it to that situation. And generally speaking, it gets you through that. Like, I know you think about it as, like, maybe I'm inferring something, but, like, I think you think of it more as, like, if we're going to say something to somebody, it should be perfect for them. And I get that. And that would be a good reason to go to therapy and talk to somebody who is speaking to you directly. But when you're just talking out into the air for people, I mean, there are a lot of things that happen over and over again to people who either have type one or love somebody with type one. And then they hit that spot, I feel shame. Right? Then they just feel shame forever because they don't have any tools or even words for the shame a lot of the times. So if you Let them know when this happened, you are feeling ashamed. And over here on the side are ideas about that that you can go into further and try to understand. Maybe they'll actually go over there and understand it and then come back and go, oh, and then find a way to give away some of that shame and move forward a little bit, because it just feels like that's what we're talking about, is that people are walking a path, they fall into a pothole, some of them they jump out of, and some of them they crawl out of, and some of them, they get stuck in. I'm saying, let's throw a rope ladder down there and a flashlight and see if they can figure out how to get out, you know, and maybe some of them will hold the flashlight from the last pothole and mix the next one. In a world where our parents don't teach us this stuff, and I'm not saying be mad at your parents. Their parents didn't teach them anything either. Like, in a world where we don't pass this kind of stuff on to each other, you're left to just figure it out as you're fighting your way through life. And I'm just telling you, most people just get stuck. But my experience with the podcast is that when you give people good tools, a lot of them traverse their thing better. And then they're not stuck as long and go get stuck in the next thing, Erica, and maybe get to the end where they grow some marigolds and drop dead. That's what I'm. That's my plan. I'm going to put some marigolds the ground, I'm going to watch them, and then I'm going to give up. But on the way, I don't want to be stuck so long everywhere. I think about that with the diabetes the same way. Like, it's heartbreaking to see somebody stuck for five, 10, 15 years. Well, because they didn't know their basal was too low. And they're not putting their insulin in enough time before they eat. That's not enough to not knowing. That shouldn't ruin 15 years of your life. And then it exasperates all this other stuff that we're talking about here. Everything feels worse. Because that's why when I think about diabetes, I just think if you know how to get your settings right, you know how to time the insulin, it's not a perfect system, but it alleviates so much that it might give you enough conscious time to think about other things. And I think the mental health stuff gets ignored by people greatly. In a regular lifetime. People who are going through this kind of stuff have even less time and mental energy to put on something like that. So anyway, I mean, you can just go listen to all of them. I think you'd be okay. But like, I don't know if there's not a way to like reframe it. Something to do in 2027 is what I'm saying.

[B]

I, I think it's an interesting idea. I think the, the concept of, you know, how does one person change is a larger.

[A]

There's no answer to that part.

[B]

Right?

[A]

Yeah.

[B]

Right. Like, is someone going to change based on them listening to the Pro Tip series or a mental health Pro Tip series, so to speak, holding that larger question of what is one's motivation for change and what do they need to get there? Could. Could a series be beneficial? Yes. Is. But how does true change actually occur?

[A]

Well, that's between them and Jesus. This is just a podcast. They can go figure the rest of that other. I just think it's nice to throw tools on the ground and see if people pick them up and use them, that's all. And it's not like they're tools that they're going to cut their hand off with. It's. This is what shame feels like. This is what agency is. There's nobody right now listening whose parents told them about agency. Okay. That just didn't happen. And if you did, then your parents were therapists and you have a whole different group of problems then.

[B]

Yeah. I wonder when actually the term agency became more common.

[A]

Yeah, I don't know. Into the, into the zeitgeist vernacular.

[B]

Yeah, no idea.

[A]

So go ahead, finish up. I'm sorry.

[B]

Yes. Yes. No, I think those are all good.

[A]

Thank you.

[B]

Wonderings. And I think to the end this, this two part series, the goal, you know, ultimately ending with, you know, having that balance. Right. To not feeling like you are trying to control a partially controllable system. Right. That leads to that heightened anxiety and working really hard to try and control something that isn't fully controlled. You know, we don't even. I don't like using that word either. You know, doing the best you can to manage as best you can. So the goal, having enough agency to act with confidence and know how and trust within yourself and your body, but also holding that place. That's what we were talking about earlier, like enough acceptance, enough grace to tolerate the unpredictable or when, when things don't go, you know, as, as you anticipated, how do you bounce back from that and how can you be kind to yourself in that space while still holding the agenc. This whole process that we've been describing, this, you know, the rebuilding of agency, which really coincides with. With your grief and experience that restores that felt economy. So going back to what we were saying at the beginning, you do have. Have a true lived experience of loss of autonomy when you have this diagnosis within your family system. But as you increase the agency and the compassion, you have a restored felt autonomy. So. And that comes with acceptance and compassion.

[A]

So this is what it is, right? And then I have to accept that I can't change. This is our reality. And then I go out there and I make, try to make good decisions, I try to get good tools, I try to learn from my experiences. Trying to beat myself up too much. And maybe after the passage of time, you might pop up and feel like, okay, I got through that part now. But it is very interesting to break it down into those pieces that are valuable to have when you don't understand why you feel the way you feel or why you thinking what you're thinking, because it all feels out of control. So it's nice to put words to it. It really is. Okay, well, all of you use your autonomy to create some agency. I know those are. It seems so confusing to me still, but, you know, go get it. You can do it, by the way. And if you can't, ask like one of these large language models because this thing is in front of me about the folded paper. And it just said to me, would you like a visualization to make it clearer? And I said, yes. And it just built this thing with a slider on it. Now I'm watching paper fold in half and get. It's amazing.

[B]

I might need to go do that.

[A]

I watched your face when I said it. You're like, I know that's not right. Yeah, well, it's right. You just keep making one good decision and you make another one and before you know it, you got. You got way more than you thought you were going to. So thank you. I appreciate this very much.

[B]

You're welcome. Thank you. Scott.

[A]

The conversation you just heard was sponsored by Touched by Type 1. Check them out [e-mail] on Instagram and Facebook. You're gonna love them. I love them. They are helping so many [e-mail] Are you tired of getting a rash from your CGM adhesive? Give the Eversense 365 a try. Eversensecgm.com Juicebox beautiful. Silicone that they use it changes every day. It keeps it fresh. Not only that, you only have to change the sensor once a year. So I mean, that's better. The podcast you just enjoyed was sponsored by Tandem Diabetes Care. Learn more about Tandem's newest automated insulin delivery system, Tandem Mobi with Control IQ [e-mail] juicebox there are links in the show notes and [e-mail] thank you so much for listening. I'll be back very soon with another episode of the Juice Box Podcast. If you're not already subscribed or following the podcast in your favorite audio app like Spotify or Apple Podcasts, please do that now. Seriously, just to hit follow or subscribe will really help the show. If you go a little further in Apple 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? If you're looking for community around type 1 diabetes, check out the Juice Box Podcast. Private Facebook Group juice box podcast type 1 diabetes but everybody is welcome. Type 1 type 2 gestational loved ones it doesn't matter to me. If you're impacted by diabetes and you're looking for support, comfort or community, check out juice box podcast type 1 diabetes on Facebook. 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. Have a podcast. Want it to sound fantastic? Wrongwayrecording. Com.