#1884 Grand Rounds: Dr. Maggie Grillo

Summary

Juicebox Podcast: Type 1 Diabetes

Episode #1884 Grand Rounds: Dr. Maggie Grillo

Date: June 23, 2026
Host: Scott Benner
Guest: Dr. Maggie Grillo, Pediatric Endocrinologist, Associate Diabetes Director, Cohen Children’s Medical Center, Northwell Health (Long Island/Queens, NY)

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Episode Overview

This Grand Rounds episode features an in-depth conversation between Scott Benner and Dr. Maggie Grillo, focusing on actionable, realistic strategies for thriving with type 1 diabetes. The discussion unpacks the evolving landscape of clinical diabetes care, the critical role of technology and education, real-life psychodynamics between professionals and patients, and the value of persistent, personalized support. Dr. Grillo shares her professional journey, her approach to newly diagnosed patients, the challenges of diabetes education, and her perspective on empowering patients and fellow clinicians.

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Key Discussion Points and Insights

Dr. Maggie Grillo’s Background and Connection to Diabetes

• [02:58] Introduction: Dr. Maggie Grillo is a pediatric endocrinologist and Associate Diabetes Director at Cohen Children’s Medical Center, Northwell Health.
• [03:29] No personal/family diabetes connection; inspiration to work with diabetes came during pediatric residency training.
• [03:56] Became a doctor due to love of science and people, originally considered being a vet—decided pediatrics better fit her compassionate nature.
  • Quote:

    “I do like the science, but I really like the people...specifically for diabetes, I like all of endocrinology, but I really like talking and learning about families with diabetes because I feel like I become part of their unit.” — Maggie [05:10]

How Maggie Discovered Juicebox Podcast

• [05:33] Found Juicebox Podcast during Omnipod 5 rollout as a fellow; used its detailed pump/algorithm settings info to educate herself when faced with practical patient questions.
  • Quote:

    “I just didn’t know enough about [Omnipod 5]...when they were coming to me to talk to me about it, or if they were on the pump and needed to make changes to their settings, I did not know enough about it. And that’s when I sought you out.” — Maggie [07:22]

The Changing Role of the Diabetes Professional

• [07:35] Discussion of barriers to doctors understanding technology (time, rapid pace of change), juxtaposed with Maggie’s perspective that younger and newer endos do make effort to self-educate outside clinic hours.
  • Quote:

    “There is time. We just have to find it.” — Maggie [10:53]

• [11:25] Scott: Compares docs' lack of tech experience to mechanics not knowing how a new air gun works.
• [12:29] Maggie reflects that younger clinicians increasingly make tech education a priority—“the tide is shifting.”

Technology, Learning Curves & Patient Empowerment

• [13:27] Both highlight rapid progress in diabetes tech (CGM, pumps, AI integration).
  • Quote:

    “These iterations are coming...I think you want them moving forward and pushing.” — Scott [13:53]

• [16:33] “Evolving with the technology.” —Maggie

Educating Newly Diagnosed Families

• [16:35] Maggie’s approach: Meet each family where they are, gauge emotional/educational readiness, and provide just enough foundational info for hospital discharge; reinforce with regular follow-ups.
  • Quote:

    “I always tell my families...what I want you to learn from this is…how to give insulin, how to check a blood sugar, and what to do if you need to talk to us…The rest of it will come later.” — Maggie [23:27]

• [23:27-24:37] At Northwell: post-discharge, families get a next-day virtual nurse check-in, then see Dr. Grillo within a month, then quarterly.

The Limits of Provider Visits & Need for Ongoing Education

• [25:01] Scott proposes (semi-jokingly) a “newly diagnosed retreat” where people live under observation a week—a recognition that most learning comes between appointments, not during them.
• Providers only see snapshots of the patient’s experience (“12 weeks later...”), making continuous/flexible resources like Juicebox Podcast crucial.

Gaps in Nutrition and Practical Diabetes Education

• [29:05] Maggie: Their center does teach about fat/protein, but agrees much comes from trial and error; nutritionists are integral. Scott notes patients often feel “sent to nutrition” = “principal’s office,” and that many institutions still don’t explicitly explain that “fat slows digestion, throws off insulin timing.”
  • Quote:

    “There’s a lot more to diabetes than just, ‘here’s a carb, here’s insulin for that carb.’” — Maggie [30:44]

Core Competencies & Foundational Wisdom

• [31:10] Scott: Pro Tip series distills practical skills—timing, CGM interpretation, hydration, etc.—into simple, actionable phrases.
• Both agree experiential learning plus foundational pointers is the most realistic approach to surviving the early stages.

Psychology & Motivation in Diabetes Care

• [36:21] Maggie shares a story (“Emily”) about a patient who—unmotivated for years—transformed after being offered a pump.
  • Quote:

    “She went on the Omnipod 5, and...right away, you could see that she was almost always in range...[she] has a beautiful baby, and she’s taking care of herself for this baby.” — Maggie [37:58]

  • Scott’s takeaway: "People will help themselves for the love of someone else, but not often for themselves."
• [40:53] Reality: Many people with high A1c and erratic adherence can make major, incremental gains if their care is adjusted to their needs and psychology, not just to guidelines.

Communication, Teamwork & Patient Agency

• [46:11] Scott demonstrates new self-paced Juicebox web tools for micro-eLearning—"Pro Tip Practice," calculators, and searchable resources.
• Both advocate for patients being empowered to adjust settings and for clinicians to “go to work with some enthusiasm and treat them like human beings.”
  • Quote:

    “Have people’s best interest at heart, go to work with some enthusiasm, and treat them like human beings.” — Scott [47:10]

  • “If you’re not good at that part, find someone in the office that is…” — Scott [47:34]

Health Systems, Provider Fit & Sharing Resources

• [50:43] Maggie: At Northwell, patients can easily see different doctors if they don’t “click”—no hard feelings. Encourages patients to advocate for better fits.
• [54:07] Maggie is the rare endo who successfully brings Scott in for a patient/community lecture. Lays groundwork with staff and admin to get institutional buy-in.
• [56:11] Feedback from Scott’s talk: patients immediately called to ask about basil/bolus adjustments; reinforces the need for accessible info between (not just at) appointments.

Modernizing Diabetes Knowledge Sharing

• [62:03] Scott describes new, easily shareable, clinician-focused handouts for the Juicebox Podcast, searchable FAQ, and digital tools for patient/clinician empowerment.

Why Dr. Grillo Shares the Podcast with Patients

• [65:56]

  “I really think there is such genuine information...I can’t live life with you...so I need people to understand they can reach out to other sources and learn more about diabetes and figure out how to make diabetes work in their lives…” — Maggie

Changing Attitudes in Medicine Toward Digital Education

• [68:45] Big shift: “You didn’t say anything about, like, well, yeah, I’m a doctor suggesting a podcast. That’s ridiculous. You don’t think of it as ridiculous.” — Scott

Real-World Impact & Clinician Learning

• [69:49]

  “I have learned from your podcast. I think I can take care of people with diabetes better from listening to your podcast.” — Maggie [69:49]

Cautionary Mic Drops and Clinical Nuance

• [70:17]–[74:18] Scott admits to “mic drop” guidance at live events, such as advocating for proactive thyroid management, recognizing that context matters in pediatrics and nuance is needed, yet patients deserve to be educated/empowered on these less-discussed issues.

Final Words: Encouragement & Collaboration

• [86:10]

  “Please try and, you know, learn for yourself and come to us with your questions. We want to be a team.” — Maggie

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Notable Quotes & Memorable Moments

• On Technology & Education "Tiding":

  “Maybe that's—the tide is shifting. Maybe people are really trying to...as technology becomes more and more advanced...doctors are trying to learn more.” — Maggie [12:29]

• On Hospital Teaching Limitations:

  “I always tell my families...I learn something new about diabetes every single day. So I don't expect them to learn all of diabetes in the 48 hours that they're in the hospital.” — Maggie [24:37]

• On Patient Agency:

  “The most successful people have the knowledge and bravery necessary to make changes to their settings.” — Scott [49:31]

• On Professional Humility:

  “If you're not good at that part, find someone in the office that is.” — Scott [47:34]

• On Information Sharing:

  “Why not listen to a podcast?” — Maggie [68:45]

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Important Timestamps

• [02:58] Dr. Grillo’s professional introduction
• [05:33] Discovery of Juicebox Podcast
• [07:35] Why doctors struggle and how Maggie learned pump technology
• [16:35] How Maggie approaches newly diagnosed patients
• [23:27] The hospital education process, “overwhelming” amount of information, scheduling follow-ups
• [36:57] Real-life transformation story (“Emily”)—pump and pregnancy
• [46:11] Pro Tip Practice resource explained
• [50:43] How Northwell enables patient/provider fit
• [54:07] The “behind the scenes” of Scott speaking at Northwell
• [56:11] Real-world impact after Scott’s talk—patients requesting changes
• [65:56] Why Maggie gives patients the podcast
• [69:49] Maggie: “I have learned from your podcast.”
• [70:14] Debrief on thyroid management, TSH, and Scott’s “mic drop”
• [86:10] Maggie’s closing message to listeners

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Conclusion & Takeaways

This warm, candid episode shines a light on the best of modern diabetes care: open-minded, tech-savvy clinicians willing to learn from real-world experience; a host who values patient perspective above all; and a recognition that information and support must flow both ways. Dr. Grillo embodies the “bold with insulin” ethos by combining humility, enthusiasm, and evidence-based practice, while Scott’s relentless focus on empowerment and translation of expertise into actionable steps continues to bridge critical gaps in understanding for patients, caregivers, and clinicians alike.

If you’re looking for practical learning, professional warmth, and genuine insight into team-based diabetes care, this Grand Rounds episode is essential listening and a testament to what’s possible when ego is left at the door and the patient truly comes first.

Transcript

[Podcast Host]

Welcome back friends. You are listening to the Juice Box Podcast. 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 Beginnings 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 or becoming bold with insulin. Foreign. This episode of the Juice Box Podcast is sponsored by the only implantable sensor rated for long term wear up to six months, the Eversense CGM. Eversensecgm.com Juicebox this episode is sponsored by the Tandem MOBI system, which is powered by Tandem's newest algorithm, Control IQ Technology. Tandemoby has a predictive algorithm that helps prevent highs and lows and is now available for ages 2 and up. Learn more and get started today at tandomdiabetes.com Juicebox this episode of the Juice Box Podcast is brought to you by my favorite diabetes organization, touched by type 1. Please take a moment to learn more about [e-mail] on Facebook and Instagram touchedbytypeone.org check out their many programs, their annual conference awareness campaign, their D Box program, Dancing for Diabetes, they have a dance program for local kids, a golf night, and so much more. Touchedbytype1.org you're looking to help or you want to see people helping people with type 1?

[Scott]

You want touchedbytype1.org make sure that you're being recorded that I am. I'm saying testing and I'm being recorded. Try you.

[Maggie Grillo]

I'm not sure. How do I know if I'm being recorded?

[Scott]

Well, you just said something and I can see that you are being so we're good.

[Maggie Grillo]

There we go.

[Scott]

Perfect. Introduce yourself the way you want to be known.

[Maggie Grillo]

Okay, so my name is Maggie Grillo. I am a pediatric endocrinologist and the Associate Diabetes Director at Cowan Children's Medical center, part of Northwell Health, which is located on Long island in Queens in New York.

[Scott]

Very nice. And, Maggie, you are.

[Podcast Host]

Can I call.

[Scott]

Do you want me to call you Dr. Grillo, or do you. What are you looking for?

[Maggie Grillo]

Please call me Maggie.

[Scott]

Okay.

[Maggie Grillo]

You've had this conversation before. Please call me Maggie.

[Scott]

Want to make sure that's all. Maybe you've changed your mind. What's your connection to diabetes outside of your professional life, if any?

[Maggie Grillo]

Honestly, I never really had a connection to diabetes before I started my pediatric training. I had a friend when I was growing up who was diagnosed with type one, but this was when I was so little that I barely even knew what it was. And it really wasn't until my training as a pediatric resident that I was shown what diabetes is, and I learned a lot about diabetes and got very involved in it.

[Scott]

Okay, what led you towards wanting to be a doctor in general?

[Maggie Grillo]

You know, that's such a good question. I don't know if I have such a great answer. It wasn't like, one day I just had this vision and I was a doctor. It was either a doctor or a vet. And then I'm an animal lover. So the thought of having to put down animals just kind of turned me off of the whole vet thing, and I leaned into medicine.

[Scott]

Not. Not so troubling thinking of putting down a person.

[Maggie Grillo]

Yeah, right. That's why I do pediatrics.

[Scott]

Like, I get them at the beginning. Well, that's pretty cool. So what did you. I mean, at what age did you have that first feeling? Did it. Did it impact at all, any decisions you made through high school? Obviously college, but where. Tell me about that path.

[Maggie Grillo]

So I always knew I wanted to do something medical, whether it's being a vet or a doctor, even in elementary school. So all the way through high school, I knew that I was going to go to college. At that point, I knew I was going to go for medicine. So my high school was pretty geared towards the medical tract. And then in college, I was pre med, and then I studied neuroscience there, so I. I knew I was going to do medicine.

[Scott]

Okay, and you, like, you like the science, would you say? Like, I. I hear people talk about this all the time. Either they're people people or they like the science or what?

[Maggie Grillo]

What do you think? I do like the science, but I really like the people. And that specifically for diabetes, I like all of endocrinology. Right. I'm an endocrinologist at. At baseline. But I really like talking and learning about families with diabetes because I feel like I become part of their unit, you know, And I like, I love that.

[Scott]

Yeah. How did you find me?

[Maggie Grillo]

I found you. I was a fellow when the Omnipod 5 came out. So I was doing my training. For those of you who don't know what a fellow is, I was learning how to be an endocrinologist. And you had a three part episode or series on the Omnipod 5, the Algorithm and all the settings. And that's when I first listened to you and started learning about the Omnipod 5. And then the rest, I just kept listening.

[Scott]

Well, so I want to pick through all this, but you are a unicorn for me, so I'm excited to talk to you. I don't want people to think this, this is going to be an hour of me, you know, bathing myself. But I don't meet a ton of endos who are willing to come on the podcast and say, hey, Scott, I like this podcast. There's plenty of them that suggest it to other people in whispers, in hallways and things like that. But to have you come on and talk about it is a big deal for me. So I wanted to thank you.

[Maggie Grillo]

Oh, thank you.

[Scott]

And we'll also get to the part where I thank you for having me out to your institution to speak because again, another situation I run into pretty frequently, emails from hospitals. Would you come out and give a talk to the patient population? Would you come out and give a talk to the staff? And then eventually it gets far enough up the ladder and somebody says, you want to have a guy from a podcast come talk here? And then it, it usually gets the kibosh put on it as it would be. But I actually made it all the way to the hospital and spoke. You did, yeah. So I'm interested to see, you know, what got you thinking about that, because you are obviously the founder of the feast on that one. And then how, if at all there was any difficulty getting me actually there. So let's go back first, though, to the Omnipod 5 stuff. So you're a fellow, you're learning.

[Maggie Grillo]

Mm.

[Scott]

You're doing a thing that I'm always yelling at doctors to do, trying to learn about how the pumps work. So why did you feel like you had to go get that information? Why do doctors not have it intrinsically, Honestly?

[Maggie Grillo]

I think because the technology is ever changing and when we're, when we're learning how to be an endocrinologist and even as we're doctors, maybe we don't have, I don't wanna say we don't have enough time, but sometimes we just don't have that time to sit down and really dig into with, you know, a demo pod or something, how the actual mechanism behind the pump works. But then when I was a fellow, so many people were learning about the Omnipod 5 and were trying to switch over from whatever device they had to the Omnipod 5, or from multiple daily injections to the pump, and I just didn't know enough about it. So when they were, you know, coming to me to talk to me about it, or if they were on the pump and needed to make changes to their settings, I did not know enough about it. And that's when I sought you out.

[Scott]

So that in my. In my experience and for people who are new to the podcast, my experience is 1800 plus recordings and probably 20 years in the diabetes space, 12 years making this podcast, it's uncommon for doctors to take the second step like that, the I'll go learn about this on my own time thing. So that already puts you into a different category for me. No kidding. I just recorded with a person 3 hours ago who found the podcast, started doing better, and their doctor tried to fire them for touching their settings and. But it was done in such a way, and it made me angry when she explained it to me. It was almost like. It was like the doctor went to her and said, do you want another doctor? Which I found passive aggressive in a way. Do you know what I mean? Like. Like, let me pressure you now and tell you. You're obviously not listening to me, so. But it wasn't like something was going wrong. They gave her settings. The settings didn't work. The mom said, I think obviously I need more insulin.

[Maggie Grillo]

Right.

[Scott]

Put in some more insulin. The doctor slapped her hand, said, don't do that, because now I don't know how to help you. The mom's quiet thought in her head was, you didn't know how to help me before. And so I'm not sure why me adding more insulin isn't saying to you, well, obviously they need more insulin and adjust from there. It was all very, very strange. And to the woman's credit, she said to the doctor, no, no, no, you and I are gonna work this out together. And she. Yeah. And she stuck with her. But when I asked her quietly after the recording about that, she said, truth be told, it's a small town. I didn't have a lot of options. So. So she. She said, basically, the way I put it to her was she found that her husband was cheating, and she's like, no, no, no, you're staying and cutting the lawn.

[Maggie Grillo]

Yep.

[Scott]

And I actually Told her, I said, in a couple of years, I really want to know, does this doctor come around or does this end up being your. Your lifetime? Is this how this doctor ends up being your. Your prescription pusher and. And not a valuable part of the team? Um, but again, do you not see that as. I mean, it's a thing you thought to do, so you don't see it as special, but you do know other physicians at this point. Like, why is that not something I should just be able to expect as a patient? And I know it's a. I know your time is an answer, but it just.

[Maggie Grillo]

You.

[Podcast Host]

You hear that.

[Scott]

That doesn't ring true to me when you say that. Right?

[Maggie Grillo]

Like, right.

[Scott]

Yeah.

[Maggie Grillo]

And. And it's not so true. Like, I do a lot of my listening. I still listen to your podcast, even now that the Omnipod 5 is. Has been around for some years, where I don't have to listen to that podcast anymore, but I listen to you. I drive an hour to work and an hour back home once a week to go to a satellite location, and in that hour's time, I listen to you or, you know, throw in some music. But recently, I've been listening a lot to you, so there is time. We just have to find it.

[Scott]

Yeah, I mean, it's. To me, I know I say this a lot, but it would be like if I took my car to get new tires, and the guy was like, I'd to help you, but I don't know how this air gun works. Well, I mean, you're the guy. Like, you put up a sign, you said, I put on tires. Like, I. Let's come on.

[Podcast Host]

You know.

[Scott]

And then they say, well, they shipped a new air gun, and I don't know how that one works, so I don't know what to tell you. Like, go find a Facebook group. Like, wait, what?

[Maggie Grillo]

So, I mean, I can speak from my own experience. I mean, I'm. You've met me, so you know that I'm, you know, I guess, relatively young in my career, but the. The endocrinologists that I have worked with, both in my current position and as a fellow, they really do seek out and try and learn about all of these things. So I. I really think maybe that the whole. Maybe that's. The tide is shifting. Maybe people are really trying to. Maybe, yeah, maybe just as technology becomes more and more advanced and it's not going away and it's just helping people more and more, but I really do think people are trying and. And doctors are trying to Learn more.

[Scott]

Well, that's encouraging, because I've been doing this long enough that, you know, I'm willing to believe that. And also, you know, looking at how technology is moving so much more quickly, I feel like I've had this conversation already today. But like I said to that. That person I was interviewing, I said, you know, back when Arden was first diagnosed, we got a meter, syringes. I had to. I. I even had to learn that syringes came in half units, by the way. That wasn't even something someone told me. Um, we got it. We got a meter of syringes and a violin.

[Maggie Grillo]

Yeah.

[Scott]

And the red lily, the glucagon. That was it. That. That was literally what they gave us. Right. Um, and I think Arden might have had diabetes for two or three years. And then one day, the excitement, the diabetes community, that the people who made the meter made a new meter, but the meter, the new one wasn't any more accurate. It just looked different. And we were all happy about that. We're like, oh, my God, look, we got something new. And that's 20 years ago. Okay. And now things are moving so quickly.

[Maggie Grillo]

Yep.

[Scott]

Right. Like, each one of these companies is, like it or not, they're fighting with each other to make their algorithms work better. I love it. I think it's great.

[Maggie Grillo]

I think it's great, too.

[Scott]

Yeah. Yeah. Dexcom is iterating. Like, you know, they're out here telling you about Dexcom 7. People like, but I love the 6. And they're like, yeah, well, we're going to do a 15 day seven. So come on. And then. And then about the time they tell you about the 15 day 7 in the background, they're saying, here's what we're thinking about for Dexcom 8 already.

[Maggie Grillo]

Here's the 8. Yeah.

[Scott]

These iterations are coming. I take everybody's point. Like, it'd be great if it worked, but I. I think you want them moving forward and pushing, um, because I don't think you want to live in a world where you wait three years and go, oh, I. I got a meter. It's a different color. This is great. You know?

[Maggie Grillo]

Absolutely.

[Scott]

But when that's happening, I can see how an older doctor could get swept away in it, but younger people who grew up in this generation, they should be able to hang with this.

[Maggie Grillo]

I think I can speak to the people that I know, and I really do think that we are.

[Podcast Host]

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[Maggie Grillo]

evolving with the technology.

[Scott]

That's awesome. So when you talk to somebody about type 1 when they're newly diagnosed, do you come from the perspective of I need to tell them everything they need to know right now. I need to give it to them slowly over time? I'm fascinated by that because your job's incredibly difficult. Like mine's easy. I get to like, I put everything in one place and you can listen to it at your own time. But you see a person, a couple months later, they come back.

[Maggie Grillo]

Right? Right. Yeah. I mean it really depends on the situation. Right. So a lot of it depends on. I'm pediatric, so I'm dealing with a lot of Parents. And the children too, of course. But are the parents distraught? Are they just so devastated that anything you say to them is going to just go over their head? In that situation, it'll be kind of like a slow and steady influx of information. Maybe it's a family who has, you know, a cousin with type 1 diabetes. Okay, they could. They're ready for more. But usually I like to go into a new onset diabetes patient room, I explain, you know, who I am, what I do. And then I always like to ask, what are you? What do you know that's happening so far? What is your understanding of why Jimmy is here in the hospital? Right, because I usually see them in the hospital and then we go from there. I like to talk about what is type 1 diabetes, what is type 2 diabetes? And just kind of talk about, you know, what insulin is, how insulin works. Why are we giving Jimmy insulin in the hospital? Why are we checking blood sugars? What's insulin gonna do to those blood sugars? What is food gonna do to those blood sugars?

[Scott]

Yeah. Do you find yourself being a little bit of a. Like an armchair therapist trying to figure out who these people are in the scenario? Are they quick learners? Are they not? Are they overmatched? Are they climbing for more?

[Maggie Grillo]

I like to. I also like to know what their background is. Are they, you know, what do you, the parents do for work? Like, we have a nurse here. Okay, maybe I can speak in a little bit more technical terms. I try and stay away from that, even with, you know, medical people, because it's. It's their kid, right? Or do they just need a lot more explanation and more simple terms to help them understand what's going on? So I do like to sit there and kind of learn about them as a family unit. Yeah.

[Scott]

Here's a little piece of advice on that heading. Architects, attorneys, people who work with numbers that kind of their brains. Like, give them the math. Like, like tell them about the rest.

[Maggie Grillo]

I believe it.

[Podcast Host]

Yeah.

[Scott]

Give those people the math. They. They want that. You know, they're like, oh, there's math here. I'll figure it out. That's super interesting to me. I would also tell you that of all the people I've interviewed over the years, some who struggle the most are often nurses. And I think that's because they get a little bit of. A little bit of everything, not a lot of anything. And what they were specifically told about diabetes is so much about just like, emergent care and like, you know, that. That when they hear diabetes, they go, oh, this isn't really a problem. You, like, you do some counting, and then you give some insulin, and then you do it again, like, hours later, and there's testing in between. I. I have found that they can get overwhelmed by it. It's almost like they can't. Some of them can't break free of the training they've had, which is obviously not. Not nearly enough for living with type one.

[Maggie Grillo]

Right. And it's their. Their child, too. I can give you a personal story. So I have three children. When my oldest daughter was maybe seven or eight months, she had her first Dorito chip. So at this point, I had graduated from residency. I was a fellow. So I was trained in cpr, pediatric cpr, and what to do if someone's choking. So she's choking on this Dorito chip at a party, and I lost my mind. I could not think. Okay, Maggie, all you have to do is give some blows on the back. Right? That's what we learned. I had to run across the backyard at the party we were at to find my husband, who's also a pediatrician, to tell him that our daughter is choking, for him to take her from me and just pat on the back and.

[Scott]

Is there a doctor in the house? Is there a doctor in the house?

[Maggie Grillo]

It was.

[Scott]

Ladies and gentlemen, we're cruising at 50,000ft. If there's any physicians on board, could they please come to the Dorito Bowl?

[Maggie Grillo]

Yeah. Oh, my gosh.

[Scott]

It was.

[Maggie Grillo]

Yeah. But my mind. It was my daughter.

[Scott]

You went blank.

[Maggie Grillo]

My mind. I was like, what do I even do? I just went blank.

[Scott]

Yeah. You should have seen me holding that. That lily red kit when Arden had a seizure when she had diabetes for, like, six months. And. And I was just staring at it. Um, I couldn't remember how to constitute the. I knew I had to constitute it, but I couldn't remember about the. The needle and the. Yeah, it just. By the time it was over, my wife handled the whole thing with, like, glucose gel on her cheek. Um, but, you know, I was not helpful. And. And later, when I looked back on it, it's funny. I. I like to tell you on the podcast, I wasn't prepared, but I wasn't prepared because our physician said, this is glucagon. It's for emergencies. Don't worry. You'll never need it.

[Maggie Grillo]

Right.

[Scott]

And I was like, well, I already have a lot going on. If I. This is the thing I don't have to worry about. I'm not gonna worry about it right now then.

[Maggie Grillo]

Right? You're gonna tune out yeah.

[Scott]

So I just never really. I never really put it. Now, having said that, the rest of it was the panic. Like I would have if your husband was across the yard. I definitely would have ran. Or what I'm saying, help me. But not my wife. My wife was like. She was rock solid. The next time, we were better.

[Podcast Host]

Yeah.

[Maggie Grillo]

If she ever choked on a Dorito again, I think I would handle that a lot better.

[Scott]

You think you would?

[Podcast Host]

Yeah.

[Maggie Grillo]

But luckily, we. We haven't had any more incidents with chips.

[Scott]

Hey, if I could just take an aside for a second. I know you love the yell. It's because of COVID Frito Lay. But a bag of Doritos is 350. It's not $9. I don't know what you're doing. Please stop. We can't. We can't afford your stupid potato chips anymore.

[Podcast Host]

Please.

[Scott]

There's a public service announcement to the rest of you, like, you stop pushing the price up just to see if we'll pay it. Okay? Because, you know, they're. They're just chips, and we don't want them that badly.

[Maggie Grillo]

Right.

[Scott]

My goodness. Okay. So, yeah, you can. You can panic a little bit. So when people are coming in, they're obviously panicked or they're quiet or sullen or sad. You're never gonna know. I mean, I've spoken to so many people that most of them will tell you the time in the hospital. They don't remember.

[Maggie Grillo]

Right.

[Scott]

And any one of them who's reasonable, when I ask them later, did you get what you needed at the hospital? They'll say no. But in fairness, I might not have been listening.

[Maggie Grillo]

Right.

[Scott]

So now you are in that position of trying to, like, send them home so they don't kill anybody. And they're not even listening. And this is all very difficult, especially in the beginning. So what do you do? Do you get them back a couple days later? Do you, like, what's the pathway to getting them stable?

[Maggie Grillo]

Right. So at Northwell, what we do, we have education in the hospital, and really, it's going to be so much information that it's almost overwhelming. And it is overwhelming. Right? So I always tell my families of my newly diagnosed patients, what I want you to learn from this is that how to give insulin, how to check a blood sugar, and what to do if you need to talk to us, if you need to call us. The rest of it will come later. Right? We go over it, but knowing that they're not going to retain everything. And I always tell them that I learn something new about Diabetes every single day. So I don't expect them to learn all of diabetes in the 48 hours that they're in the hospital. So then once they're discharged, we at NORTH will have them come back that sometime in the next week, we'll either do a virtual visit the day after discharge from one of our diabetes nurses. They'll check in and make sure. Did you get your supplies? Are you settled at home? What can I help you with? They'll reiterate some education, then they come see us. They see me one month after discharge, and then after that, they'll see me every three months.

[Scott]

Okay. So is it fair to say, from your perspective, that it's a fairly impossible task you're given and that it's not incredibly out of line for people to feel like they weren't told anything, but it would be nice if they were a little more understanding about the situation?

[Maggie Grillo]

Absolutely. I think it would be great if I could just go home with all of them.

[Podcast Host]

Right.

[Maggie Grillo]

Or if they could come to my house and we could learn all about diabetes together.

[Scott]

Yeah.

[Podcast Host]

You know, I.

[Scott]

One time I. I daydreamed about starting a. Like a. Not like a. A place where you could stay for a week after you're newly diagnosed to, like, to live under, like, supervision of people who could, like, help you get through the first bits.

[Maggie Grillo]

I thought, oh, that'd be amazing.

[Scott]

That might be really helpful. I don't know how you would do that or who would pay for it. Obviously, none of that would ever happen, but it felt like. It felt like the best idea at the time. Like, if somebody was just here for me to look across the room at and go, am I doing this right? Like, almost a nod, like, yeah, keep going. You got it. It would be really helpful. But I would also tell you that with hindsight, and it's the thing I say on the podcast a lot, but every experience you have, if you allow it to be, is a great. Is a great building block. And you almost have to go through all this crap so that you can get to a Zen place and move along through it. So you don't want the experiences to be taken from you, and you don't want to not have to fight your way through them.

[Maggie Grillo]

But.

[Scott]

But what I see after talking to so many people is that that only works for certain personalities, for certain situations. Some people are waylaid, knocked on their ass, and never get back up again. And then they're stuck wherever they fall over forever. And then that's the level of care that they get. And Right. While I think it's nice to say we'll get the next one at the next appointment and three months from now, we'll add a little more to it. Also, it doesn't work like that because you go into the office and it's, it never just picks back up. Like, you don't. I mean, be honest, like six months later, you don't know me. When I come back, you're. I, I'm words on a chart from six months ago. And, and it's not like you. Like, I remember our last encounter. If I, if you're my doctor, you don't remember it the way I remember it. And so now there's the, hey, how are you? How's the weather? How's your kids? Like that part. Now, boom, five minutes is going. Some people get chatty. I'll tell you, I've done a lot of in person diabetes stuff. Nothing like a person with type one. I want to sit down and tell you their story so, like, you don't have to laugh. But I know, I know you know. And then, like, you know, then, you know, then we're chit chatting and blah, blah, blah. And you're not going, hey, when you know, it's not like the end of a Netflix series where they let you REWATCH the last 30 seconds, you remember where you were. So then stuff gets missed.

[Maggie Grillo]

Right.

[Scott]

Right. And it. I don't know if there's a fix to that either.

[Maggie Grillo]

I don't think there is. And it's. It's a shame. I don't know if it's a shame, but we only see you guys, these patients with diabetes every three months that. I don't know how that changes. I don't know if it should change, but we're not with you every single day, so there's a lot that happens in between each of these visits. Even if I remember every detail of our conversation from our last visit.

[Scott]

Yeah.

[Maggie Grillo]

It's been 12 weeks now.

[Scott]

Yeah. You might not even need those things anymore. You might, you might. And then we might spend 10 minutes you figuring out that I already figured out the thing that you were here to tell me today.

[Maggie Grillo]

Right.

[Scott]

There's no perfect way through this. That's. Yeah, that's why, that's why I think the podcast works really well, because it's a la carte at this point. I'll go out in a limb and tell you pretty much anything you need to know is in there somewhere. And, and you, you know where you're at right now and you know what you need, right? So it's almost like having a bookshelf and being able to walk over to it and go, I need episode 1153. Because that's the thing I don't understand right now. And that's the next building block. And in fairness to doctors and, and the way things are set up to begin with, you're not going to do that. All I, all I want from doctors is like, I mean, seriously, I'd like you to know how the, the damn pump works. Like, you should be able to speak thoughtfully about how the pump works. And if you can't, like, call somebody like, I, you know, like, it, it's, it is frustrating. Now, I'm not saying that you, you know, you're going to be able to set it up for them. It's going to work just right. But also, here's the next reason these things don't work right, is why I'm not speaking for you. But why won't more people talk about fat and protein and around how insulin works? Why do so many people not get told about pre bolusing, not get told about the impacts of fat on their blood sugar? Things that have really significant impacts moment to moment?

[Maggie Grillo]

Definitely. Definitely. I don't know from wherever I've been, both as, you know, resident fellow in my current position, we do teach that. Yeah, we teach, you know, we have a specific, two specific nutritionists in our clinic that see our diabetes patients. We have a nutritionist in the hospital that talks to every single newly diagnosed patient. So it's there, but I think a lot of it's going to come with trial and error, which I'm sure is frightening for a newly diagnosed parent.

[Scott]

Can I tell you something from perspective of a patient, of course, being sent to talk to the nutritionist feels like, oh, someone's about to tell me I don't eat well. Feels like I'm going to the, to the principal's office, going to detention. Yeah, yeah, yeah. So like, because they caught me, I, we were getting away with it, but now the diabetes is here. Someone's going to notice there's crimp. It's in the freezer. You know what I mean? That's a, probably a local reference, but still, you, it, it's not a thing you go into comfortably for me, at least you. I went in there thinking like, oh, someone's going to tell me what I'm doing wrong now. No, listen, hand to God, okay? My kid went to a really good institution while she was a minor and nobody ever said to me, hey, Fat slows down digestion, which throws off the timing of insulin. That's where you're getting these late rises from.

[Maggie Grillo]

Interesting.

[Scott]

And, and I've said that to physicians who don't know what they're talking about when you say it, so that's not uncommon either. I've, I've said, like, how come you don't talk about fat and protein? They're like, what do you mean? How would I talk about that? It's carbs. Count the carbs, put the stuff in the, the machine takes care of it, that stuff, you know?

[Maggie Grillo]

Right, right. Anyway, I think it's hard for people that don't have diabetes to understand that fully. Maybe without, maybe if we ourselves were CGMs, we can see how it, how it happens in our own bodies, but maybe it's just, I don't know, maybe we need to increase our own education on nutrition specifically. But there's a lot more to diabetes than just, here's a carb. Yeah, here's insulin for that carb.

[Scott]

So for me, it, it all of that. There's a lot about life that would be nice if it worked a certain way, but it just isn't how it goes. So the reason I think that Pro Tip series works so well is because it really is boiled down to T shirt slogans and. But it's everything you need to know to get you going in the right direction and at least give you enough of experience and an idea that when you see the next thing happen, you can make better sense of it. Um, I, like we send you to a nutritionist. Could you just tell me Fat slows down digestion and that throws off the. Where the insulin hits. Please, Cuz I don't want to learn about nutrition right now. Or, or, you know, can you please just tell me, you know, that I need to be hydrated or the CGM might not work or like, you know, like these little things that are, I think they're foundational. My point is, is that my experience has taught me that there is no functional way to upload all the information to people that they actually need. So you. But if you give them. Yeah, if you give them these foundational things, it is enough to keep them alive and educated and ready to accept an experience when it comes at them as a learning experience. To me, that's the answer. But I mean, I'd love to know if you think otherwise or if there's something else you think that I'm missing.

[Maggie Grillo]

No, that, I mean, that's very fair. Right. And what people need in certain situations. And we have two excellent nutritionists. Right. Maybe for a newly diagnosed patient, that's a great place to start. But maybe in six months, they need to talk to nutrition about. I don't know, maybe they're trying to increase muscle mass or something and they need to talk to nutrition. But there's no. There's no appointments or when they come to nutrition, when they're able to see them or see the doctors, their needs are ever changing. And I think that's why it's so great to have something like this podcast where just like you're saying, you go to the bookshelf and you pull off exactly what you need for that specific moment in time. Yeah.

[Scott]

It just isn't.

[Podcast Host]

It.

[Scott]

The model isn't there. Like, it's. I don't get me wrong, like, I want there to be doctors, and I want you all to go to medical school, and I want you to be there when I fall over and I get hurt and everything else. But there's a limit to it that. That people outside of the medical field, it can't be aware of because, again, I go back to, like, doctors, right? Teachers, cops. You grow up. Somebody tells you, listen to these people. They know what they're talking about, don't do with them. And you're just like. And look, by your own example, your kid starts choking, you're like, I don't know what the. Somebody better help. So you're a person is my point. And I try to make this point all the time. Like, you've got to drive through traffic to get to work. You might have been fighting with your kids before you left. Maybe your kid's sick. Maybe your husband's a jerk. Maybe, like, maybe you got cut off in traffic and you're pissed. Like, there's a lot of things impacting your day as well. You work for somebody, they have, you know, requirements of your time. And now I'm coming in here and asking you to learn how to, like, use a pump. And you're like, look, I ain't got a time for this. Like, I'm trying to stay alive, too, you know? So I'll tell you, it really makes me hopeful about technology in other ways, too, because again, going back to this interview I just did right before yours, she told me was she realized she wasn't getting enough from her doctor. She found me, she got some more. She realized she needed a little more. She didn't know what to do. A friend of hers whose kid had type 1 diabetes was having trouble talking to their Physician. So she asked ChatGPT, how can I have this conversation better with my kids endocrinologist. It helped. It helped her to do that. She told the story to the person that I interviewed. That person said, oh, I'll try ChatGPT. She went to ChatGPT and said, hey, look, my kids on Pandemoby. I am not having the outcomes that I'm supposed to. What do I do? And basically ChatGPT walked her through resetting her settings.

[Maggie Grillo]

Wow.

[Scott]

And then she heard. I don't know if you've heard. Did you hear Laurel Messler on the podcast talking about Tandem control iq?

[Maggie Grillo]

I don't think I did.

[Scott]

It's real recent. But you, you like her. She's really good. She works at Tandem, but she talks more real world nuts and bolts about using the pump when she talks about it. And so she heard her say something about, you know, this setting had to be a certain way. And this lady cobbled all that together and gave her kid a five nine, a one C. Wow.

[Maggie Grillo]

I think it's going to be so cool to see what AI does for diabetes in the future.

[Scott]

Yeah, me too. Yeah, I really do. Like, and I mean far future. I'd like to see your algorithm assessing reassessing more than just like, here's the math and where we think it's going to be the way they kind of work out, the way they work now. It'd be cool if they could, if they could think on their feet a little more than they do, and maybe they will one day. I don't know. You know, you see what Beta Bionics really is behind that, like, we don't. Don't count carbs idea. Like, Right. And I've heard Medtronic, like, whisper about. Not a whisper, but she was on the podcast and she said, like, I, I don't think you're gonna have to enter carbs forever.

[Maggie Grillo]

That would be so cool. Yeah, that'd be life changing for so many people.

[Scott]

Well, yeah, and I, I would say, I would ask you to talk about that a little bit too, because while it's nice to say, here's what you do, and if you just do all these things, it's gonna work out. That's really not how people's brains work. And it is really unfair too, by the way. Like, and I don't think we talk about that enough, that's not how you're supposed to be living your life. So what do you see, even for people? So there's people who struggle and there's people who look like they're succeeding. There's people who are succeeding who are probably struggling quietly. What are your like. Like, deeper kind of psychological takeaways? After helping people with type one, what do you. What do you think?

[Maggie Grillo]

Can I tell you a story?

[Podcast Host]

Yeah.

[Scott]

What's going on behind their eyes?

[Maggie Grillo]

Okay, so I have a patient. I will call her Emily. Okay. So Emily came to me with A very high A1C for many, many, many years. I took over her diabetes care. And I. Just. Once a month, I made it. I would see Emily every single month. And she just didn't want a bolus. She didn't want a pre bolus. She didn't count carbs. She was. Was on multiple daily injections. I don't give my lantus every single day. Just didn't really care. After a couple months, we talked about insulin pumps, and I just saw this light in her eyes, like a switch flipped. And she said, I have been wanting a pump for so long. So, you know, okay. We took a gamble, got her on the pump. Can I tell you something? The entire month before her pump training, she gave insulin for every single meal. She did not miss one dose of Lantus. She went on the pump.

[Scott]

Her.

[Maggie Grillo]

She went on the Omnipod 5. And I. Right away, you could see that she was almost always in range. She's since had a baby. So I. I mean, I. Of course I'm not gonna take care of her, but she is doing exceptionally well.

[Scott]

What do you think happened? Her. Her interest got reignited because of the pump being introduced?

[Maggie Grillo]

I think so, yeah. I mean, I. I'm not. I can't take credit for that. That was all her. Emily did. She just did it herself. And it was just. I don't know what that turning point was for her. Maybe it was just that she wanted this pump forever and no one listened. And not that no one listened, but she gave up. But then it just reinvigorated her to take care of herself. And now she has a beautiful baby, and she's taking care of herself for this baby. It's just. It's beautiful.

[Scott]

My other takeaway is people will help themselves for the love of someone else, but not often for themselves, which is so sad. Yeah. But I think it's very, very human. And I mean, at least that's my takeaway. After making the podcast all these years, father has type 1 diabetes forever. Doesn't take great care of it. Wipes up his butt to take care of it. He doesn't. He doesn't. One of their kids, that's Diagnosed. Boom. He pulls it right together. Like, I don't want to be a. I don't want to be a bad influence. So let me. Let me do this. A lot of young girls, you know, who talked to me, you know, I went to college. I didn't pay attention, that kind of stuff. But when I realized I wanted to have a baby, I knew. And it wasn't about, like, you'd be surprised. It's not about. I know that my A1C has to be a certain place for me to be pregnant. It's part of it for some of them, but for some of them, it's just the idea of, like, oh, I. It's important that I be alive. It is.

[Podcast Host]

Is really.

[Maggie Grillo]

And I'm healthy for this thing that I just made.

[Scott]

Yeah. I'm responsible for something now. Now I have to act responsibly. It is super. It is sad. Like, it's sad that we all don't just feel that way out of the box. And some people obviously do, but I overwhelmingly. I think that's another thing that holds people back, is they're like, well, I mean, what's the point? Like, I'm just here going to my dumb job, doing this, blah, blah, blah. Like, you know, I mean, can you imagine, like, skipping your Atlantis on injections? And by the way, you said you took a leap. What's the. What's the common medical idea behind not giving someone a pump? It's that at least they're shooting their basal insulin. What if they don't put the pump on?

[Maggie Grillo]

The thought is, like, what happens if. Let's say, the pump runs out of insulin and now you have no insulin going, and it. You can go into dka, of course, very quickly. But she wasn't giving her lantus anyway, so she was at a high risk of going into DKA anyway.

[Scott]

Yeah. I find that to be backwards thinking a little bit. Like, I mean, what happens if the pump runs out of insulin? What happens if they don't put insulin in through the needle? I mean, isn't that the same thing? And. And what happens when the pump drops their average blood sugar? Like, I don't know what Emily's A1C was, but, you know, 14.

[Podcast Host]

Well, that.

[Scott]

See, that's what I was gonna say is that I have the. It's the benefit. But it also gets dubious at some point because most people who come on here are aggressively trying to help themselves. Right. So I don't get to talk to enough people. There are not a lot of people who are excited. I Guess Maggie, to run out and tell you the story about how their A1C is 14 and they don't shoot their insulin all the time. Right. So you don't hear from those people as frequently, but those people make up a larger percentage of people with type 1 diabetes than not, I think.

[Maggie Grillo]

I think so, too.

[Podcast Host]

Right.

[Scott]

And so if you put a pump on that person and their 14 turns into a 10, isn't that amazing? And victory. Yeah. And what if some of their brain fog lifts and then they're like, huh, I have more like, mental space now. Like, let me put a little more into this. I think there's all those different pieces of it that nobody's considering that get their blood sugar lower and stable and see if it doesn't help them reignite themselves somehow. Right. Like, I talk about this all the time, but the drift to poor health, generally speaking, happens so slowly that you don't see it happen. It's the same way when you see somebody get divorced. They're like, what happened? I don't know. We grew apart. That's not what happened. You didn't grow apart. A million little things went wrong over the last 15 years that you didn't notice. And now at the end, you don't have an answer for what happened. And health is the same way. Gaining weight is the same way. You don't gain £75 on a Tuesday. You gain a quarter of a pound today and a half a pound tomorrow and three pounds next week and a year and a half from now, you're like, hey, what happened? And. And so if bad health works that way, you know, you don't know. You don't know what's going on in a person's brain. And. And if their blood sugar's 40 and then it's 65, and then it's 400, and then you're. And you. And you get them aside. You go, I need you to pre bully. They're. They're probably not thinking straight, and. But they're still going to come in your office, put a big smile on their face and try their hardest.

[Maggie Grillo]

Right. You know, and she showed up, which was. It's a big deal coming, which was awesome. And I tell you, Scott, I could see the change in her face and just the way when I would open the door when I first met her in the first couple months, she was just always down and just not really happy with herself because she knew it was going to be not, you know, in her eyes, the best visit.

[Scott]

Yeah, here comes the warden.

[Maggie Grillo]

Exactly. But then as she's on the insulin pump and as she's doing better, I would walk in the room and she would have this giant smile on her face and she couldn't wait for me to see the download. And I was just proud of herself

[Scott]

and she wants to show something, somebody.

[Maggie Grillo]

Yep.

[Scott]

Yeah.

[Maggie Grillo]

I was so proud of her.

[Scott]

Well, this is the, See, this is the message. If you're a doctor and you're listening, it's all right there. You just. I can give it to you from my perspective. People ask about, you know, more business minded people. I mean, Maggie, it's, it's a bit of a feat to keep a podcast going for 12 years. It's not a thing that normally happens. How do you do this? They, they think there's some like, magic business idea that they're gonna. I said, I just wake up in the morning, I think about other people. I just get up and I think, what'll help these people? What, what am I hearing out in the world that they're talking about? That maybe I could reframe for them or find in my bookshelf and deliver hand delivered to them or something like that? Like, how can I be helpful to these people? Oh, well, what about making money? I said you help people, you make money. It just happens. Like, like, right, like I, I sell the ads. It's fine. Like, I'm good. Why don't you want to make more money and I don't want to. Well, you could paywall this. You could sell them that. Like right now I have 50 adults. Here's the thing, nobody even knows. Let me take a drink. I have 50 adults demoing a 22 day. Hmm. How do I explain this to you? It's.

[Maggie Grillo]

I'm excited.

[Scott]

I'm glad you are. So hold on a second, because if you weren't, then you wouldn't be the right person to be here. So I can't give it away yet, but it's basically called Pro tip practice. A 21 day guide of reflections on living well with type 1 diabetes. Built on the juice box Podcast. Pro Tip series. Five minutes a day free. Reflective, not prescriptive. And so it doesn't cost anything to do. You can skip a day, come back, etc. It's up to you. The browser remembers where you are without keeping any of your personal private data. And I am not charging you for it. And trust me, I know I could charge people for this.

[Maggie Grillo]

Absolutely.

[Scott]

I am not doing that. Just so you all know, click on the ads. Okay, so I'm. My personal. I'M personally going through it and I'm on just to see how it works day to day. And I just finished day three. There are people online that are ahead of me. So now day four says the number is the smallest part. Most people read their CGM the way they were taught to read. A finger stick meter. Glance at the number, react to the number, forget the number, repeat. And that's not what a CGM is for. A finger stick gives you a snapshot. A CGM gives you a story. The number is one frame of the story and not even the most important one. Today's idea. A CGM shows you three pieces of information. The current number, the direction it's heading, the speed in which it's heading there. Most people use the first one. The second and the third are where the actual decisions live. A 130 with a flat arrow is fine. A 130 with a steep up arrow is on its way to 180 in 30 minutes. A 130 falling fast is on its way to 70 in 20 minutes. The number 33 different, same number, three different situations, blah, blah, blah. And then it says here's it gives you a quote from the Pro Tip series. The number on the CGM is the smallest piece of what it's telling you. The direction, the speed, carry the rest of the story. It's from episode 103. For the next four days, you're going to relearn how to read what you've been looking at the whole time. And today's affirmation is the number is a piece of the story, not the whole story. And it gives you something to notice for today. Every time you look at your CGM today, name the direction out loud or in your head before the name, before you name the number. Even if you don't change anything, just practice that. It gives you a link to a small sip episode that will reinforce it and it gives you a reflection for the evening. What did I notice when I started reading?

[Maggie Grillo]

The first?

[Scott]

The arrow first. And once you mark that day complete, it'll move you to the next day. And at the very end, very cool. Thank you. And at the very end of all of this, it helps you write a letter to your doctor to tell you about what you've learned doing it and what you're hoping to do.

[Maggie Grillo]

Nice, right?

[Scott]

And so anyway, the the key to helping people if you're a doctor and listening is just have people's best interest at heart, go to work with some enthusiasm and treat them like human beings and realize that they have A lot more going on than you think. This is not a cold, calculated. We're not. You're not buying a bagel and a Yoo Hoo from these people. Like.

[Podcast Host]

Right.

[Scott]

It's not. It's not that kind of interaction.

[Maggie Grillo]

Right.

[Scott]

And if you're not good at that part, find someone in the office. That is, because I can tell you that one of Arden's endocrinologists had the personality of wet paper. I mean, she. I'm sure she was good, but, my goodness, she couldn't talk to you. And when she touched you, it felt like a robot was touching you. Oh, you know, I'm not kidding. She. I used to talk all the time about, like, I used to believe that for insurance purposes, she had to physically touch Arden once a year. They weren't allowed to bill us. And I don't know if that's actually true or not.

[Maggie Grillo]

Oh, my gosh.

[Scott]

But. So Arden was only ever managed by the practitioners. Right. But once a year, this endo would come in and do this very awkward, like, hand on knee thing to Arden. And you could see Arden was like, why is the robot touching me like this?

[Podcast Host]

And, like.

[Scott]

And it was all very awkward. Now, I don't think. That doesn't mean she's not a fantastic physician or her brain.

[Maggie Grillo]

She wants to help.

[Scott]

I'm sure all of that I believe is true. She just was not good at this part, you know? And so then she'd leave the room, and then the other ones would start their song. You know, they. The music would start back up again, and the personality would come back in the room kind of a thing. But, I mean, if you can't do the thing that Maggie's explained to you or the thing that I'm telling you has helped Maggie, I'd like to be humble here, but I think I've helped tens of thousands of people with type 1 diabetes.

[Podcast Host]

Like. Right.

[Maggie Grillo]

Sure you have.

[Scott]

Yeah. And. And the truth is, is that I've never met any of them. So ask yourself, how am I able to help people when I don't even know who they are? And the answer is that all their needs on a basic level are the same. You know, like, people just need to know how to use their insulin. And if you don't teach them how to use insulin, if you don't teach them that, you know, having the ability to change their settings is a paramount skill that they need to you, and they together need to develop, like, you know, the most successful people have the knowledge and bravery necessary to make changes to their settings.

[Maggie Grillo]

And I think they need to be empowered to make changes to their settings too.

[Scott]

Yeah. And yeah, that's up to you. Because they're scared, they think, yeah, they think, you know, then it goes poorly and that the assumption is, well, I listen to the person who knows it's not going well. I guess this is my life. Right.

[Podcast Host]

Yeah.

[Scott]

So.

[Maggie Grillo]

And you have to remember you being, you know, a patient that's coming to see me or a parent of your child that has type one. I only see the data for the past two weeks. Right. So I can make decisions on the past two weeks and generally they're, they're good decisions on what's happening now. But just because it's happening now doesn't mean that next week is going to change. Yeah, it very well might.

[Scott]

Do you think there could be a list of rules like you're doing a good job, I'm talking to you because you're forward thinking, obviously, or I wouldn't have ended up at your place talking. Or there are probably some people listening that think it was malpractice that you had me there. But that listen, that's it's between them and Jesus. And so like, is there a way to automate this or is it just, is it as lucky as I get a good one, I get a bad one, I get a new one, I get an old one, hopefully all together it all shakes out. Like, is that, is that really the.

[Maggie Grillo]

I think if you are unhappy with the person, usually what happens. Right. Is when you are, when your child or you are diagnosed with diabetes, the on call physician becomes your primary endocrinologist.

[Scott]

Okay.

[Maggie Grillo]

I will urge you, if you don't, not everyone clicks with each other and that's totally fine. If I'm not right for you, there are zero hard feelings. I want you to find someone that you click with and jive better with and I seek that out.

[Scott]

But that's a top down thing in your organization though. Like that has to be something that somebody told you it's okay for us to, to be like this. Like so how.

[Maggie Grillo]

Yeah, we. So the way. I didn't mean to cut you off, sorry. The way that we do it in our practice, if we all see each other's diabetes patients. So we have, of course, you know, I, I'm Jimmy's endocrinologist. I still want to see him every three months, but maybe he can't make that three month appointment with me because he has soccer practice and I don't have any time. So he sees my colleague and that we Share patients in that way that if I'm unavailable, there's another provider that's available, and maybe Jimmy likes this other provider better. That's fine. I'm female. Maybe you want to see a male provider, but you're confident.

[Scott]

You're confident in that there's also going to be doctors who aren't confident, who don't need 10 jimmies bailing on them because it isn't going to look good for them. You know what I mean?

[Maggie Grillo]

I guess that's true.

[Scott]

See you. You work in a good place. You don't. You don't really see a lot of

[Maggie Grillo]

these problems or if they. If they happen. Maybe I'm not privy to them.

[Scott]

Yeah, you guys have washed that person out already. Okay, so when you have the bright idea to have me come out and speak at this, you call me. I remember us talking on the phone.

[Maggie Grillo]

I went into your Instagram DNS. I DM'd you. Yeah, and you called me.

[Scott]

Yeah, I get the least sexy DMS of people on the planet, by the way, so. So I called because. Tell me if I'm remembering this incorrectly. I was calling to tell you this isn't going to work out. And I appreciate you asking, but why don't we not always start time?

[Maggie Grillo]

Pretty much. Yeah, pretty much.

[Scott]

And not because I didn't believe in you, but because this was countless times number, whatever, that this has happened to me. So you are not nearly the first person to reach out from a place and say this to me. You are the first person that worked it out. So how does that happen when you go back to people? Like, I mean.

[Maggie Grillo]

Cause.

[Scott]

Right, you're. You're going to go pitch to somebody who doesn't know me, and you're going to say, hey, there's a guy that barely got through high school. He lives in New Jersey. He has a podcast, and I want him to come here and talk to a couple hundred of our patients and the staff. And his medical background consists of. He doesn't have one. So where does. How do you please explain that conversation to me? I would love to know how to.

[Maggie Grillo]

Well, first of all, I didn't pitch you like that.

[Scott]

Well, you should have. That would have been honest. Okay, what'd you say?

[Maggie Grillo]

Um, I explained that you are a parent of someone with type 1 diabetes, that you've learned how to manage your daughter's diabetes, and you like to share that information with others. You actually gave me a blurb about yourself that I included, and then I just encouraged, you know, the higher ups to listen to Listen to you and

[Scott]

you think that happened? Or do you think they got tired of you and just said that, it's fine, you can bring it. Leave us alone. Maggie, what the hell?

[Maggie Grillo]

No, I'm sure they did. I'm sure they did listen to you. It helped us know some of our diabetes nurses listen to you as well.

[Scott]

That's a great group, by the way.

[Maggie Grillo]

Diabetes and. Oh, they're the best. The best. Um, some of them have Type one and have listened to you, and their families have listened to you, so they were in your corner, too. So I just.

[Scott]

So you just created a buzz.

[Maggie Grillo]

Yeah.

[Scott]

Yeah. Look at you. You're marketing. You're.

[Maggie Grillo]

So.

[Scott]

Was there anybody who pushed back?

[Maggie Grillo]

Not that I'm aware of.

[Scott]

Okay. And even on the late.

[Maggie Grillo]

I wasn't in any of those meetings where it had to be, you know,

[Scott]

because I had to go into a. I had to do a zoom with a group of people. And it's funny because my. I, of course, show up imagining these are the people who really don't want me to come, and they're trying to, like, vet me, but I did. That's not the vibe I got from them, like. But they still were quiet and reserved, and I. I realized I am not a professional person. So sometimes people just acting professionally seems odd. Like, why are they sitting up so straight and smiling? But. But I had a. I. I had a really nice conversation, and, you know, I. I went over some things that I wanted to say, and if I'm going to be completely honest with you, they asked me not to talk about fat and protein, and then I just did it while I was there. So did that get you any trouble?

[Maggie Grillo]

Bold move, Scott. No, it did not.

[Scott]

Oh, okay. Because I was asked directly not to talk about that.

[Maggie Grillo]

Oh, gosh.

[Scott]

Sorry, faggy. You went out on a limb for me.

[Maggie Grillo]

That's okay.

[Scott]

And so I. I was asked directly in that meeting, like, please don't talk about that. And not. Because I think they thought I was wrong. I just think maybe they thought it was too nuanced or something. But I do know. I mean, you were there.

[Maggie Grillo]

I wasn't part of. I don't think I was part of that meeting.

[Scott]

No, no, not that meeting. You were there when I spoke. And so, I mean, tell the people. I'm really good at this, aren't I?

[Maggie Grillo]

You're. You're a good speaker.

[Scott]

Thank you. And.

[Maggie Grillo]

And.

[Scott]

But I paint a nice picture that kind of coalesces together. It feels. It feels actionable when you leave.

[Maggie Grillo]

Yeah.

[Scott]

Yeah.

[Maggie Grillo]

And we did have A couple people call the next day asking to change Basil's, which I will say maybe we can put a little disclaimer on your talk.

[Scott]

Go ahead.

[Maggie Grillo]

That for those on the Omnipod 5 that are in automated mode, maybe changing the Basil is not going to do much.

[Scott]

Yeah. So it, it is become a tough world to talk about all this in because when I put that Pro Tip series together originally there were no automated systems.

[Maggie Grillo]

Right.

[Scott]

And so you're, you're hearing me talk about how I was acting as an automated system. Like. And so my, my point to people would be, is like those are foundational ideas. Now when you start applying them to these other systems, most of it still tracks like you still if you, you need to understand how insulin works, you need to understand how your food's impacting you, you need to understand timing. That's the, that stuff that's all never going to change like for, for the foreseeable future. But in a system like Omnipod 5, for example, like you put your settings in, then you flip into auto and then what you typed in yesterday is meaningless.

[Maggie Grillo]

Doesn't matter. Yep.

[Scott]

And I don't know how that's going to be with their next version. They're very close to getting that next version through the FDA and in people's hands.

[Maggie Grillo]

Nice.

[Scott]

I, I'm not allowed to tell you why I think that.

[Maggie Grillo]

Are you going to be doing a three part series on how the technology works and the algorithm works?

[Scott]

I don't know if we'll be doing that, but I'm, I can't say. Oh wait, that was very. I'll tell you, Rob, bleep all this out. All right, Rob, I'm going to say I just went to. And then after that everything goes. Leave it as blank for people. I think it'll be amusing. I just went out to California to shoot a commercial celebrating the new target of 100 for Omnipod 5.

[Maggie Grillo]

Oh, that's awesome.

[Scott]

Okay, Rob, now that people can hear when she said oh, that's awesome. And going forward. So my point is I don't think they would have done that if it wasn't close.

[Maggie Grillo]

Fair.

[Scott]

That's how I figured through that. And then, and I think they have said publicly, what are they shooting for? Lower target. And then there's some other adjustments being made to the algorithm that aren't specifically been named yet. And then I think they're working on the next version of it now too. Which would be Omnipod 6. Maybe.

[Maggie Grillo]

Maybe.

[Scott]

Yeah. I don't know. I mean, remember when it was Horizon, then It was Omnipod 5.

[Maggie Grillo]

Oh, I forgot that it was Horizon.

[Scott]

Yeah. That whole time that they were trying to build this thing and get it out the door, for years they called it Omnipod Horizon.

[Maggie Grillo]

I forgot about that.

[Scott]

Yeah. And then there was a changeover in leadership and then they switched to Omnipod 5. Wow.

[Maggie Grillo]

Yeah.

[Scott]

So anyway, you can't just. There are settings in Omnipod 5 specifically that when you're in automation, if you change the settings in the pump, it's not actually changing anything in automation, it's changing your manual settings, which might surprise the hell out of if you ever flip back into manual again because you've been yakking the knobs all over the place. They're not actually doing anything. I would tell you that that three part series I made describes very well what's impactable and what's not in automation. On Onipod 5, you should check it out. Yeah. Having said that. So you had people call in and say, hey, I'd like to look at our Basil. Yep. Was it valuable for them, do you think?

[Maggie Grillo]

I think so. I think a lot of people really got benefit from it. So there were. There was a freshly diagnosed family there maybe a week out from diagnosis, all the way up to people who've had diabetes for decades. Right. So I think a lot of it was good for everyone. Maybe the nuance that, you know, it took you years to become comfortable with it. Maybe that wasn't there so much, but you really only had what, 45 minutes to speak.

[Scott]

It was a quick talk. I would tell you this, is that I've learned that my goal at those is to leave you with the idea that there's more that could be done. It's not that confusing. And I should ask.

[Maggie Grillo]

Yep.

[Scott]

That's that. That's my goal when I give that

[Maggie Grillo]

talk, usually I think you achieve those goals. I really do. And the very next day we have people calling to make changes and that's awesome.

[Scott]

Good.

[Maggie Grillo]

Yeah.

[Scott]

Because how would you know otherwise that they felt like they were in need of those changes?

[Maggie Grillo]

I don't think we would. I think they would. I think they think they have to wait until their three month appointment to come to see us and then at that point we can make a little tweak to the insulin to carb ratio. Hope that works. And then see you in three months from now and you can tell me how it works.

[Scott]

Yeah. Which is not. Which is not. It's not a recipe for success, really.

[Maggie Grillo]

No. And I always tell my patients Please, if this doesn't work, call us, email us, reach out to us. We're. We don't have to wait for three months.

[Scott]

Yeah, but, you know, they don't want to bother you too.

[Maggie Grillo]

I know, but that's my job.

[Scott]

I understand, but they don't want to bother you. They don't have the time to be calling you all the time there. Also, I think there's a learned helplessness that comes eventually, too, where you just feel like nothing I do is going to work, this doesn't matter, you know, and that's not true, obviously, but I do think it. It's a wet blanket that can lay over top of people.

[Maggie Grillo]

I can. I can see that.

[Scott]

Yeah.

[Maggie Grillo]

So tell, like, come to us for help. We want to help you. Please.

[Scott]

Yeah, I hope so. Did you. Did I send you the link that I made for doctors to share the show with?

[Maggie Grillo]

You did.

[Scott]

Good.

[Maggie Grillo]

You did.

[Scott]

Is it. Did I do a good job with it?

[Maggie Grillo]

I think so.

[Scott]

Good.

[Maggie Grillo]

I really. I liked it.

[Podcast Host]

Good.

[Scott]

I'm glad. Thank. A nurse practitioner in Toronto, Saskatchewan, somewhere in Canada.

[Maggie Grillo]

Okay.

[Scott]

She reached out to me and she was like, I need a better way to share your show.

[Maggie Grillo]

That's great.

[Scott]

Yeah. She bullied me into it, basically. And they say Canadians are nice, but she was very aggressive. No, she was. She. This poor lady was like, I need help. And I was like, will you get on the phone with me and tell me what you. And she was like, I guess so. So we. We jumped to the phone. I was like, just what do you. What do you want to do with this thing and what do you need from me? And she told me. And now I guess, listen, I'll. I'll put it out there for people. It's juicebox podcast.com clinician-share and what it will give you is just simple buttons. You can. Like Bold Beginnings pro tip series, small sips and defined diabetes are at the top. You can print a handout, generate an email or a text with all the episodes and links that it needs, or you can hit copy so you can paste it into something yourself. Or like I said, you can click print and just print out the list. I've also added there. Like, it's a short seven minutes from some ladies, some conversation from the show where this lady named Bethany describes how her diabetes educator, her daughter's school, and the community she lived in had already been shaped by Juice Box podcast around type 1 diabetes before their. Her child was ever diagnosed. And how all the little things that those people had learned along the way created a community around her she didn't even know existed till her child was diagnosed. And then I put my search bar in there, which, if you guys haven't looked at it yet, the search bar on the pod on the website. My website does not get enough play, Maggie. It's a. It's like a language, like a real language search. So I'm just going to type in, how do I fix Basil? As soon as you type that in, it gives you links to episodes that apply to what you've typed in. If it doesn't give you something that you want, you can open up the full Frequently Asked Questions page, which is awesome. And it produced, like, hundreds of results that might attach to your question. And then once you're there, you can look and change your question around if you want to. But, you know, how do you calculate how much to change your basal rates? Using overnight iob math and loop popped up. You know, what should I do if I miss or forget my mdi? Basil injection? How and when should you use a temp? Basil Raising my max. Basil should help my algorithm in Omnipod 5. Like, you know, Basil set too low. Like, all this stuff you click on, it gives you, like, quick, quick access to listening to that episode. So that's there as well on the clinician page. And then I kind of boldly, I think at the bottom there's a little button down there, just says for clinicians. And you can go listen to the Grand Round series, which is conversations like this one with Maggie, where doctors just talk about what they think their patients need. And then there's takeaways from the Ground Round series, the Grand Round series, and a place where you can put your name in for juice box docs. If you think you're the kind of doctor that people listening to the podcast would enjoy, you can put yourself on my community source directory for providers. It's all free, obviously, so lots of great information there. Yeah, I'm working hard over here, Maggie.

[Maggie Grillo]

I believe it.

[Scott]

Me and my assistant, John. Claude Van Chat. Actually, it's Claude, so. Because I don't know how to code crap. And when you get to that website, you're going to be like, wait, somebody who doesn't know how to code a website did this? Pretty impressive, but. But nevertheless, like, there it is. Hopefully people will use it. I know that the podcast grows through word of mouth and It's. It's probably 50, 50 patients and doctors. So would you explain to me from your perspective why you're comfortable sharing the podcast with a patient?

[Maggie Grillo]

Because I really Think there is such genuine information, right? I, I can't go home and, you know, figure out your routine and figure out your insulin needs with you every second of the day. I can't live life with you. Maybe I'd like to, but I can't. Right. So I need people to understand that they can reach out to other sources and learn more about diabetes and figure out how to make diabetes work in their lives. It doesn't need to be this awful burden on them. And, of course, I'm sure you're always going to feel that there's a burden. I hope not, but I can imagine it might feel that way. But I really want patients to feel empowered to search for their information themselves and learn more than what I can give you in 30 minutes.

[Scott]

I have to thank you because I, I, I just realized something. I've been doing this for so long that the, the tone and tenor in which people see the Internet is completely different now than the way they saw it when I started doing this. And it's possible, like, I'm somehow rooted in old ideas when I think about this at times. Because you didn't say anything about, like, well, yeah, I'm a doctor suggesting a podcast. That's ridiculous. You don't think of it as ridiculous. You don't see me as a person who you shouldn't be introducing other people to. But I've been doing this long enough that it used to be crazy, right? Like, it used to be. A lot of, you know, a lot of practitioners would tell me, I'd stand in the room, let the endo talk, grab them, take them out so they can make their next appointment, and then slip em a sticky Note that said juiceboxpodcast.com on it. And she's like, I've had people directly tell me. I don't even speak. I just hold it up and I go. And then I hand it to them because I know they just got bad information on that room. They know it because they're walking out, looking at me like, hey, what the hell just happened in there? And, like, and, and they don't know what to do. And I can't suggest this, but the world's changed. And I. Yeah, and I'm. I just realized that while you were talking, like, I gotta stop acting like I'm some, like, I don't know, guy skulking out of, you know, from behind a dumpster as you're walking down the road. I know a thing about Basil. And so I guess maybe I've. You made me feel like I might have elevated myself and was unaware of it. Just.

[Maggie Grillo]

I think you have to give yourself more credit.

[Scott]

Thank you. I really do appreciate that in this

[Maggie Grillo]

world where we use Claw and ChatGPT, everyone is expanding their knowledge and trying to learn more about everything. Right? I mean, we all are on our phones all day long, maybe reading more and learning more. Why not listen to a podcast?

[Scott]

Yeah, no, I mean, I agree, but, like, I was. You understand that when I first started talking about this, I sounded crazy to people, like, because the world hadn't. Because I was ahead of the role on podcasting. Right. I've been listening to podcasts forever, way before most people have been, and so like it. But. So when I started doing it, it seemed normal to me, but it wasn't normal to everybody. But now it is. But I'm still a little stuck in the idea of, like, I'm doing this crazy Lenny Bruce thing over here, which is not true. And also a referen. No one under 50 is going to get it all. And so. But that was really. Thank you so much. Like, I. I really do appreciate it. I don't have imposter syndrome. Like, if you asked me to be direct, I'd tell you this podcast is awesome. It'll definitely help you. And. And I think I do a fairly good job of. Of making it. But the idea that you would, like, you're an actual under. You're a doctor. You went to medical school. Like, I met you. You're not crazy. Like, you have all the prerequisites for me being very impressed by the idea that you like me. And so, like a. That you would say that out loud is really. It's valuable to me because it's not a thing I thought somebody would say.

[Maggie Grillo]

You know, I have learned from your podcast. I've learned I think I can take care of people with diabetes better from listening to your podcast.

[Scott]

Basically, I'm a doctor you're saying I should get.

[Maggie Grillo]

So go back to medical school. All right, I will say one thing, One thing we should talk about is the tsh. So I want everyone to imagine Scott at the end of his talk. Now, he's already talked, apparently, about fat and protein, which he was not allowed to talk about.

[Scott]

I wasn't.

[Maggie Grillo]

And then at the end, oh, I

[Scott]

just randomly threw in about your test, your tsh, as I left the state.

[Maggie Grillo]

Literally almost a mic drop. He says something to the effect if you have positive antibodies for Hashimoto's, which can cause hypothyroidism for those who don't know And a TSH above 2.1 with symptoms.

[Scott]

I said if you're, if you're 2.1 with symptoms and your doctor won't give you medication, ask them why. Yes, did I cause a problem?

[Maggie Grillo]

Exited the stage, you didn't cause a problem. But I would just like to dissect that a little bit if that's okay with you.

[Scott]

Please, please.

[Maggie Grillo]

So you have to remember that we're in a pediatric population, right? So a lot of pediatric people don't like getting their blood taken. And if you have anxiety when the blood work is being taken from your arm, that can elevate the tsh.

[Podcast Host]

Okay.

[Maggie Grillo]

Now you're also talking to a room full of people with type 1 diabetes. So they have an autoimmune condition. So it's not so far fetched to think that maybe they have the antibodies that are positive for Hashimoto. So in not every situation where the TSH is above 2.1 and there are antibodies, not every patient needs medication.

[Scott]

No, no, I wouldn't imagine what I'm saying. And maybe I could have stayed 30 more seconds, have been more clear. But it's a thing that I find that if I don't say it, people don't hear it. And again, colloquially, from talking to people over and over again, there are a lot of people walking around with untreated thyroid issues. I believe that they create them a lot of problems for them and when, and doctors will very frequently tell them, no, you're in range. Even though they're standing there with seven symptoms, it's completely obvious they need thyroid medication. And somebody goes, yeah, but your TSH is 3. We don't treat that. So like that's, you know, again, if they, if they bugged you a little bit for a week after that, I'm okay with that. You might not have been, but I'm okay with it. And at least it's in their head now. Yep, that's how I think about it. They at least it's in their head.

[Maggie Grillo]

More knowledge and that's, I think that's wonderful.

[Scott]

Well, it's a good way for them not to turn into a 16 year old kid who's 60 pounds overweight, tired all the time, can't pick their ass up off the ground. And, and their doctor's like, oh, I mean, listen, we checked your, it's not that. And, and then I look at their labs and I'm like, I mean, pretty obviously is. And, and, and where does that come from? From me, it comes from personal experience watching people not treat My wife, well, it comes from my daughter being diagnosed, getting medication right away and going from the smallest girl in her school to one of the tallest people her age. And it comes from episode 413, which is with an endocrinologist named Addie Bonito who just retired very sadly because her husband got a great job and she's going to go live in Paris. And I guess I'm wishing her well, but it would be she'd stay behind and take care of us or take us all with you, you know, and she deserves it. She's helped a lot of people over her life, but she's the person that tells you once I'm helping you with your, your, your thyroid, I want you managed under a 2.1. And you know, and if you have met, if you have symptoms, we were going to try to get rid of them with your thyroid medication. And she's not just throwing pills at you, she's doing math. She's like, take one on this day, take two on the first Sunday of the month. Like, like, she's really like, thoughtful about it, but most people aren't going to be. And listen, my wife will eventually come on this podcast one day and tell you all how she didn't get her thyroid medicated for seven years and it ruined a lot of her adult experience. So, you know, you don't get the, you don't get the hit, reset and live again. So, you know, I'd rather, I'd rather you push, especially in a world where a doctor is not going to, is most doctors are not going to look at a 2.6 TSH with symptoms and do anything about it. Is that fair?

[Maggie Grillo]

That's fair. Yeah, that's fair.

[Scott]

So I'm like, a lot of it

[Maggie Grillo]

depends on what the thyroid hormone level itself is too. Let's say it's very, very normal. Then maybe we watch for a little bit.

[Scott]

Exactly. And nothing wrong with that. But like, let's not forget about it. Also, let's not pretend I'm a doctor. I don't know what the hell I'm talking about. I'm just telling you that, like I, I've had enough conversations with enough people to know that you should pay attention to this because it has the opportunity to ruin your life. Yeah, yeah. And you won't know it because again, slow drift into nothingness. It'll all just seem like, because you, I swear, every time I bring it up, especially to middle aged women, they're like, well, I'm older. I'm supposed to feel like this I'm like, I don't think you are. I don't. You're not supposed to be tired all the time. You know, same thing with, you know, if I. If I could have picked that mic up and dropped it again, I would have told them to, you know, get their. Their iron panels done.

[Maggie Grillo]

It really was a mic drop moment.

[Scott]

Because, seriously, like, also, how many of these type ones are running around anemic?

[Maggie Grillo]

Right?

[Scott]

Nobody does anything about that either.

[Maggie Grillo]

And that's why it's so important to know, as someone with type one, that every year, at least once a year, we're going to run blood work and we're going to check these things, but if you have symptoms in between, please reach out to us.

[Scott]

Yeah. Oh, 100%. Also for you don't see somebody's ferritin at 20 and go, we'll take a supplement. Oh, cool.

[Maggie Grillo]

Thanks.

[Scott]

I'll be. I'll feel better in 1979.

[Maggie Grillo]

Like.

[Scott]

Like when it comes back around on the calendar again, it's going to take so long. Like, you know, have a steak. Awesome. Can you get me an infusion, please? Like, what are we messing around for? Like, you know, 20, 26 and all, but. Yeah, listen, low B12, low vitamin D, iron, thyroid. You have type 1 diabetes. I want you looking at all of this, you know, and then I want the doctor to actually not tell me. Well, it was green on the test, so we didn't look at it, which I hear people say.

[Maggie Grillo]

Really?

[Scott]

Yeah, it was green. It was green. Come on. You get. You get to talk to people who are happy because they come to a good practice. I get to talk to people who are out of their minds because somebody's been ignoring them their whole life anyway. Why did you want to come on here and do this? I mean, I invited you and all, but, like, what made you say, yeah, this is a good idea, I should do this?

[Maggie Grillo]

I just thought it would be a really good conversation.

[Scott]

Has it been?

[Maggie Grillo]

I think so.

[Scott]

Okay, good, because I. I'll get pressured pretty quickly. I think I messed it up. Yeah, I. I appreciate that. I. I love having. Listen, you are. You fall right into my sweet spot of how I hope people's endocrinologists are.

[Maggie Grillo]

Thank you.

[Scott]

No, seriously, I. I'm so happy you're out there and. And helping people, and truth is, I'd like to have more conversations with people like you and. And you in general. I hope that doctors who find themselves in a position of not feeling that they're doing the same kind of work that you are can Listen and hear that there's nothing special things special about what you're doing. Like you're, you're staying up to date on things. You're listening to people trying to see a bigger picture, you know, and putting them in touch with community and ideas that are, he can't be so ego driven that it all has to come from you. Like, that's, you know what I mean? Like any good teacher is going to show you other teachers not, not just say, well, if they don't hear it from me, then I don't want them to hear it.

[Maggie Grillo]

Right.

[Scott]

You know, that's all. Also, you could stand for days and talk about this and see how the world has meaningfully changed. Like, you know, you know, in the last handful of years, if not the last 20 years. And if you, if you're a 70 year old doctor right now. I get that you don't understand what I just said. When, you know, when somebody said, oh, somebody with the chat GPT and talked it through with them. There's no way anybody, you know, no,

[Maggie Grillo]

it's intimidating at that point. 100%.

[Scott]

Listen. That the, the frequently asked questions page on my podcast I took, I have, who have no, no knowledge of how computers work other than I, I'm an operator of them, but I don't know how they work behind the scenes. I took, I think I took the top 250 most googled type 1 diabetes questions. I took a list of struggles that listeners made for me. So it was like 90 pages of returns from people about things they struggled with. We distilled it down into like, you know, into categories and subcategories and stuff like that. So I took the 250 most googled questions about type 1 diabetes. I took the struggles list and then I mapped it against all of the management series of the episodes of the podcast. So, so then you can say like I just clicked in the search bar again because I was talking about it. It gives you a populate with like 15 things that you can. It says like, try asking this, can my child eat cake at a party? And you click on that and it gives you a bold beginnings episode, a mental wellness episode. And ask Scott and Jenny a bolus for like right away just around the that question. Wow. But I don't know how to do that. I literally sat down at Claude and I said, I have this and I have this and I spoke to it in plain English. I want it so that when people do a search, they get mapped to the episodes that might have an answer in it. For them. And it took me a couple of weeks, but it works really well now.

[Maggie Grillo]

That's really cool.

[Scott]

Yeah. And so having said that, let me ask you this question. This is where we'll probably end. You'll hang up and say, I'm sorry, I can't answer that question. But on my website I have an estimator. It's a bol. It's a bolus estimate. You put in your insulin to carb ratio, your sensitivity factor, the target blood sugar you want and then carbs, fat and protein in a meal. You can put in your current blood sugar, any insulin you know of on board, and the, the trend line of your cgm and it will give you. I mean, let's do it together real quick. Let's just. What, what's an average insulin to carb ratio for a. A 10 year old?

[Maggie Grillo]

You could do 20, 20.

[Scott]

And then what do you think their sensitivity is?

[Maggie Grillo]

Maybe 80, 80.

[Scott]

And let's say that they listen to the podcast and their blood sugar is 1 10. Or let's say their target is 90. Okay. And they're going to eat how many carbs? What do you see in a kid's meal usually?

[Maggie Grillo]

Oh my gosh, it really depends. My own kids, they'll just crush chicken nuggets. But I don't know, just maybe we can make it easy. Maybe say they're gonna have 50 grams of carbs. Cause everyone's different.

[Scott]

We never know how much fats in those 50 grams of carbs.

[Maggie Grillo]

What are they happen?

[Scott]

I don't know. Let's say they're gonna have fries with it. You wanna put 15 grams of fat in there?

[Maggie Grillo]

Sure.

[Scott]

Okay.

[Maggie Grillo]

Sure.

[Scott]

And protein. Chicken you said. So let's put in 5 grams of protein. Okay.

[Maggie Grillo]

Okay.

[Scott]

I'm gonna make their current blood sugar 110. And no insulin on board. And let's give them a stable arrow. Right. You hit simulate strategy and it gives you a 2.75 unit bolus. It wants you to do a 0.39 based on the Warsaw method over three hours. So that gives you. The theoretical requirement is 3.14. And it says you should probably pre bolus around 11 minutes.

[Maggie Grillo]

Wow.

[Scott]

And let's say that you just believe that that works. Okay. Is that a thing you would share with people or is that a bridge too far?

[Maggie Grillo]

I might share this with people. You can make this into an app too, because there's that bolus calc app that we. It. It helps people with. With the math behind insulin doses.

[Scott]

Mm. So on this one I actually have A show calculation step. So it, it, it shows you everything that it did if you want to see the math behind it. And it actually gives you a very significant breakdown of what the tool is, what it is, and what it's doing. I mean, it's a, it's kind of like a, A short master's class on bolusing and fat and protein. Right. Um, I can tell you it is one of the most popular pages on my website. Now, I can't make it into an app because then I think the FDA might talk about it being, you know, a medical device. But I feel like I've done a good job of setting it up so that it's a teaching tool. Because. Because the way you really like what I love about it most for teaching is you can go right back and say, okay, well, what if this was actually 75 carbs? And what if there was 25 grams of fat in there? And then resimulate it and to see like, wow, that moves at the four units up front and 0.6 over. Now it's four hours instead of three hours that I'm gonna see an impact. Oh, and the. But the pre balls didn't change. Isn't that interesting? Like, I think that, like, it's. I think it's valuable to sit and just change the numbers around and watch how it changes the bolus to give you kind of an idea. Anyway, I have that on my site. I also have one that just does fat and protein. There's a fat and protein estimator. There is a basal estimator that uses weight. You can just kind of drag your weight around. Like say you weigh 113 pounds. Your pre puberty child, uh, you have activity level, you're active. Um, these are all sliders that you can change to see how it changes things. And then you can just say, estimate my basal. And it, of course it changes your weight into kilograms, does some math and everything, and then shows you that your estimated basal range is between like 10.3 and 19.3 a day. And then it shows you how it calculated all that. Like, I just. That's the kind of stuff I don't think, I don't think people know that. When you come into the office and ask your doctor, hey, where should we start? With settings. They take your weight and just do that. You know what I mean? Right.

[Maggie Grillo]

And that's where we have to start. Right. It's just a math equation. It doesn't mean that it's perfect for everyone and certainly needs change. Right. Girls get their Period. They go through their, you know, menstrual cycle. Your basal changes.

[Scott]

Yeah, yeah.

[Maggie Grillo]

During that cycle. So please understand that what we. It's a very good estimate, but it's. It's just math.

[Scott]

And it's also not perfect, too. Like, I think I. I would tell anybody, because I have another page that you. It starts with weight, too, and I'll. I'll put it to, like, I'll. I'll put it to 1:13 again, because that's what we used. You can also tell it like, am I on this one? Am I highly sensitive? Am I standard sensitivity? Am I resistant? Am I highly resistant? You can kind of like, make a choice there, and then it shows you, like, when you make that choice, it's just using different math to figure out what your theoretical total daily insulin is. So 113 at resistant, it has you at about 33 a day. At standard 28. Highly sensitive 23. Then it uses that same information. You scroll down, it tells you your basal's probably about 11 and a half units a day, maybe about 0.5 an hour. If you're on a pump using the 500 rule, your insulin to carb ratio theoretically should be about 21 and a half. Your instance sensitivity using the 1800 rule should be about 78. It's all just on one page. It's. It's super simple, like, because it's all just simple math, all based off of right? Now, having said that, those numbers could be completely wrong. Like, I'm not saying, like, go type in your weight and be like, aha. Like, you know, But. But what I do think is that if. If you did that and you're. It says, hey, my total daily insulin is around 23 units, and your total daily insulin is around 15 units, and your A1C is high. Maybe that'll make a person go, huh, I wonder if I'm not using enough for too much insulin, vice versa, you know, so, anyway, they're pretty cool things. They're all built from, you know, stuff I've learned on the podcast. And, you know, Claude, basically so and so. And if you don't want to use my thing, don't, like, I don't care. I don't get anything out of it. Go do it yourself. It's. Yeah, yeah, it's. It's. You can. You can learn this on your own if you try. You can learn anything on your own at this point, so.

[Maggie Grillo]

That's very true.

[Scott]

Yeah. Head out there. All right, Maggie, what. Have you not said that you wanted to Anything that was on the tip of your tongue that didn't get out?

[Maggie Grillo]

I don't think so. I think I just. I mean, I want to reiterate to everyone listening, please try and, you know, learn for yourself and. And come to us with your questions. We. We want to help you. We, as your providers and your diabetes educators, nutritionists, we want to help you. So please come to us with questions. Do some research on your own. Ask us questions. Ask us how we can help. And we want to be a team.

[Scott]

Yeah. And, Maggie, if somebody lives, like, tell them where you work again, in case they. They're interested.

[Maggie Grillo]

Of course. So I work for Northwell Health. It's kind of on the border of Queens and Long island in New York. So come see me.

[Scott]

Yeah, good luck getting there. But.

[Maggie Grillo]

Oh, my gosh. I know.

[Scott]

I came out to speak in the afternoon. I don't know. I. I think I was total time in the car both. Both ways, I think. Seven hours.

[Maggie Grillo]

Unbelievable.

[Scott]

I believe I drove, I don't know, 80 miles. I know the.

[Maggie Grillo]

So bad.

[Scott]

You know. The next day I left to go to Atlanta to do a talk for touched by type 1.

[Maggie Grillo]

It probably took you less time to get there.

[Scott]

It's so funny. I had this. I had this thought in my head after having driven for the first seven hours, headed to Atlanta. I'm like, I drove from my house to Long island and back again in the same amount of time it took me to drive to, like, I think it was, like, the bottom half of Virginia.

[Maggie Grillo]

It's brutal. The traffic here, it's pretty rough.

[Scott]

Yeah, yeah. But it's worth it. I mean, to get a doctor like Maggie or one of the people she works with. I'll tell you, like, everybody I met there was. Was really thoughtful, patient, forward, and I'm telling you, like, they had me out then, and you like this podcast and you're near there. These people would be a great fit for you.

[Maggie Grillo]

So thank you.

[Scott]

Yeah, of course. Well, I really do appreciate you taking the time, and I know I kept you longer than an hour, but. But thank you very, very much.

[Maggie Grillo]

Thank you so much. Thank you.

[Scott]

Of course. Hold on one second. Okay.

[Maggie Grillo]

Yeah.

[Podcast Host]

Head now to tandomdiabetes.com juicebox and check out today's sponsor, Tandem Diabetes Care. I think you're going to find exactly what you're looking for at that link, including a way to sign up and get started with the tandem mobi system. This episode was sponsored by Touched by Type 1. I want you to go find them on Facebook, Instagram, and give them a follow and then head to touchedbytype1.org where

[Scott]

you're going to learn all about their

[Podcast Host]

programs and resources for people with type 1 diabetes. A huge thank you to Eversense CGM for sponsoring this episode of the podcast. Are you tired of having to change your sensor every 7 to 14 days with the Eversense CGM? You just replace it once every 6 months via a simple in office visit. Learn more and get started [e-mail] Juicebox. Hey kids, listen up. You've made it to the end of the podcast. You must have enjoyed it. You know what else you might enjoy? The private Facebook group for the Juice Box Podcast. I know you're thinking, oh, Facebook, Scott, please. But no. Beautiful group, wonderful people, a fantastic community. Juice box podcast type 1 diabetes on Facebook of course, if you have type 2, are you touched by diabetes in any way? You're absolutely welcome. It's a private group, so you'll have to answer a couple of questions before you come in. We make sure you're not a bot or an evildoer, then you're on your way. You'll be part of the family.