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- [00:00]
A
Hello friends, and welcome back to another episode of the Juicebox Podcast. My Diabetes Pro Tip series is about cutting through the clutter of diabetes management to give you the straightforward, practical insights that truly make a difference. This series is all about mastering the fundamentals, whether it's the basics of insulin dosing adjustments or everyday management strategies that will empower you to take control. I'm joined by Jenny Smith, who is a diabetes educator with over 35 years of personal experience, and we break down complex concepts into simple, actionable tips. The Diabetes Pro Tip series runs between episode 1000 and 1025 in your podcast player, or you can listen to it@juiceboxpodcast.com by going up into the menu.
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Foreign
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A
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 health care plan. Today's episode of the Juice Box Podcast is sponsored by the Contour Next Gen Blood Glucose Meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you@contour next.com Juicebox Today's podcast episode is sponsored by MiniMed, the innovators behind the Mini Med Flex system, a small, sleek and discreet insulin automated delivery system controlled from an app. Nothing comes close to freedom you can feel. To learn more, visit minimed.com juicebox juice
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B
my name is Amy. I currently live in a suburb of Cleveland, Ohio. I have two kids. One's my T1D and my husband and we have a German shepherd named London.
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A
I see London, I see France. I see Amy. Yes, on the podcast also, every time someone says Ohio, I just think of that Drew Carey Show.
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B
Well, my husband is originally from here. I am not. So there seems to be awful a lot of jokes about Ohio for some reason and I I don't know whether to join in on the jokes or not to defend my husband, but it's so funny. So I don't know.
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A
Well, there was a For people who don't remember television, there was a sitcom with Drew Carey in it. I believe it was called. I don't know how they came up with this title. I believe it was called the Drew Carey show. And there was a song, and I don't know any of the song. Like I couldn't sing it for you now if you paid me money. All I know is that the last line of the song, someone just goes Ohio. And I think it like and I think it echoes and that's what I think of every time. So nevertheless, I'm sorry that someone drugged you there if you didn't want to go?
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B
No. Well, it's one of those things where it's such a nice. It's a great place to raise kids, but there's like. It's, you know, it's.
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A
Now what?
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B
Well, it's like, you know. So I'm from Massachusetts. I was raised on the very southern west coastal Maine coastline.
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A
Okay?
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B
And we had the beach, we had mountains, we had Boston. And, you know, you go to Boston, it's like Harvard and all the, you know, tough and all these things. And it's just you're surrounded by, like, education and some of the. In my opinion, best sports teams in the country.
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A
Well, I mean, you're wrong about the sports thing, but the other stuff. I do understand what you're saying, you know, but.
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B
And then, you know, it's just so funny. And then you come here and it's great. There's nothing, like, wrong with it, but it's just, like.
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A
So from your perspective, this is interesting. May I? Before we get started, I recently went to Tennessee to look at a house. And everyone from here says, you're gonna move to Tennessee. And I'm like. I said, maybe. And they're like, well, then you'd be in Tennessee. And I was like, yeah, I think it's really pretty. And there's, like, mountains. And it's like. I found that it was, like, in the middle of nowhere, but, like, very close to something else. And, you know, and I thought. But then this thing came to me. I work a lot, and so does my wife, right? And we're probably gonna work for 10 more years. And so I said to them, I honestly think that if you pick the right day of the week, you could pick my house up. If you could magically lift my house up and put it somewhere else, I might not know that I'm not in New Jersey for days. And I was like, so what's the difference?
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B
Right? Very fair. Very fair.
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A
At the end of the day, when I do make it outside for a half an hour, what if I looked up and there was a mountain there and my neighbor wasn't right next to me? Like, what if that happened?
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B
Yes.
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A
I don't know. We.
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B
We lived in South Carolina, actually, in Greenville for a year. My son was born there. And so we were very close to Tennessee, and we would go. And you could go to, like, Gatlinburg and Pigeon Forge and Nashville. It's great. Like, I highly recommend Tennessee because I just think it's so beautiful. But, you know, we lived in Manhattan too. So I was very close to New Jersey at one point. So I. No offense, but that's a bit busy for me.
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A
It's getting busy for me, too. Okay. And I think that's a function of my age. If we get a chance later, I will tell you how that right before I did this, I was in the driveway of my house on my phone, ranting at the person who's supposed to pick up my recycling in a way that made me think, I got to get out of here. So, anyway, yeah, let's find out a little bit about you guys now. So good. Husband. Dog. Kids. Ohio. How many kids again?
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B
We have two.
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A
Two and the ages.
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B
So my T1D daughter is 12, and she turned 12 in March, and my son is 8 and he turned 8, so he's like 8 and a half.
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A
How old are you?
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B
I am old. I am 40. I just turned 44 in April. And I just hate saying that number.
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A
I am old. You said, I'm 50. I'm 54.
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B
Well, it's funny because a lot of women my age are like, oh, 40 is going to be awful. When you hit 40, all of this stuff goes wrong. And, you know, in my 30s, I was hearing that constantly. And 40 was fine. 41 was fine, 42 was fine. And I'm like, they're lying. I don't know what. You know, I'm running half marathons every year. Like, I'm like, I don't see what the problem is. And then 43 hit, and it was like, T1D diagnosis, 43. Everything. Like, my world is just falling apart.
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A
So wait till you go into what they call perimenopause.
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B
Well, yes. I'm like, shoot, now that's next. There's nothing. Like, there's no good coming. It's all downhill from here.
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A
Listen, I like being positive, but you're probably right. So all I know is my wife's downstairs, and if I brought her up here and she started talking right now, I think she'd go on for a while about what's. What's wrong, but.
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B
But, well, and it's funny because I'm an rn, too. I don't currently work, but, like, for a long time, I was always the person scheduling what I call, like, the older people tests, like colonoscopies and all these things. And now I'm like, shoot, that's gonna have to be me some soon. And these little young nurses are gonna be scheduling that for me. Like, when did that turn? I don't. I don't like it. I don't understand it. And it's just all terrible.
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A
It's gonna be. Some 23 year old girl with an ass like a drum is gonna flip you over one day and be like, oh, I hope this doesn'.
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B
That's exactly right. Yep, that's my fear. It's happening and it's gonna.
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Listen, here's the thing I said to somebody the other day. Getting old is terrible, but it's way better than the alternative, so I hope so. Well, the alternative is dying, Amy. You're like, wait, what if dying's better than the alternative? Old? Is that what you're saying?
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We don't know what we don't know.
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A
Right?
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Like, you know. Oh, man, it's funny.
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I guess that's why at the end you do see older people who've lived a long time, they just go, it's ok, I can die.
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And that's exactly right.
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It's fast. That is maybe one of the hardest things to understand when you're younger. When you look at a person who's just like, I'm. I'm good with going. You're like, no, you can fight. And they're like, it's all right, I'm good. I've done enough.
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B
Yeah, exactly. Really interesting.
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A
Okay, so how old is your child? When. When they're diagnosed.
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B
So she was ten and a half, pretty much. It was like the end of summer and her birthday's in March, So. Okay. Yeah. 10.
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A
What? What? So you said you were an RN. So did you? Please. I'm waiting for somebody to go. I immediately know what it was and I jumped into action.
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B
But.
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A
But tell me what happened.
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B
So we lived in England, the uk, for like six years.
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A
Your husband's a spy, right? Or something? What's going on?
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B
Yes. Okay, I can't tell you more, but he definitely spies on people.
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A
You guys, what have you said to me? Massachusetts, South Carolina, Ohio, England, New York City.
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B
And I lived in Hawaii for four years as well. Yes, but that was pre.
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A
Kids, I gotta tell you. You are gonna explain this to me at the end of this episode.
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B
So.
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A
Okay, so. Okay, so anyway, go ahead. You're doing what now?
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B
Yeah. So my husband's job, he worked in a British pharmaceutical company and a different company too, so two different companies took us to the uk. Total of six years. While we were there, my daughter got very sick and she. It was like. It was like post Covid, but not really. So it was the rules about who was in the hospital with who was tight still, but you could kind of go to a restaurant. So it was like. And UK was different than America in terms of their regulations and stuff. But she was really sick. Both my kids were. Her cough lingered and then it like turned bad. And so I went to see our private doctor and he was like, well, here's a prescription antibiotic. Take it if she spikes a fever. And it was like 24 hours later, I'm like, this isn't going anywhere. I'm going to just start giving her this antibiotic. And then like probably 12 hours later, she was like on the couch, not able to eat, not able to drink, not even able to like, speak because she was just so lethargic. And I was trying to like spoon chicken noodle soup into her and, you know, whatever. And then we brought her to the hospital, they admitted her, she had pneumonia. And so, okay, fine. So three days IV antibiotics, we went home, all's fine. But they delayed the treatment, in my opinion. And she's always had my dad. Long backstory. My dad died when I was 10 from polycystic kidney disease. And my daughter has had blood protein on and off in her kidneys since she's been two, which was picked up by a very kind teacher at the Primrose School in Greenville, South Carolina, who just thought we had. We thought she had a uti, but it was. It was just like a little bit of an infection kind of. But anyway, nothing. Nothing bad enough to fix anything. There's nothing to do. It's like a benign hematuria is what they call it. So they're functioning fine, they're just not perfect. Right. So like a filter that's just not perfectly filtering. It's no big deal. We got the pneumonia fixed, we're fine. A couple years go by, we move home. Just because we're like. That was a scary experience. Like the healthcare in the United Kingdom is really difficult and not great. Move back to America. So we did. We picked Ohio because my husband was convinced that the housing market was cheaper here. So we moved to Ohio. And the summer of 24, we went to back to London for two weeks to visit and we landed and we were doing our thing and it was summer. Not a lot of places have aircon in them. She was drinking some water, but it literally didn't. I did not stand out in any way. We came home, back to Ohio, four days unpacked, repacked. We drove to Maine and on our. Because that's. We do our summer holiday there for about two weeks every year. And on the drive to Maine, we stopped at a rest Area filled up with gas. There was a Starbucks. She downed a frappuccino in like 10 seconds. And my son was barely sipping it and he had never had one before. In the UK we didn't really have Starbucks very frequent. So I was like, but she loves sugar and like sweet stuff. And I'm like, oh, that Emily, like now you're going to get sick, right? So she had peed twice while we were there. And I just thought, well, maybe like, come on, you just, you're just drinking too much. Like, this is silly. You're just downing this stuff. It's gross. We get back in the car, we're on 90 heading east and they shut the highway down because of a massive car accident. They're trying to land a helicopter. So they funnel everybody off on these back roads in Pennsylvania for to pass like two exits. And during that time it was bumper to bumper for probably an hour. And she started having to pee. And she has had to go so bad that she was crying about it. And I was getting mad because I was like, you're making this drive difficult on purpose. You're back there just doing whatever, drinking because you're bored and whatever.
- [13:15]
A
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- [14:51]
B
So we finally get to a rest area. It got so bad, though. I thought about asking like, a random house, knocking on a door and being like, can my daughter pee? But that's weird. So we didn't do it. Found a bathroom somewhere, got her settled, got back in the car, got to Maine. The end of the two weeks comes, and she came up in the middle of the night and was like, I'm thirsty and I have to pee. And the whole two weeks they had been complaining about the location of their bedroom in this rental property that we had. And so they're a little bit bougie. They're used to Ohio, where we have air conditioning in the house. A lot of main houses don't have air conditioning. It was a hot night. Just like, whatever. You're just being difficult. Go to bed. It happened this second night, and that was the last night of the trip. And it was 2 in the morning, same thing. I'm thirsty and I have to pee. And all of a sudden, in my head, I was like, fuck, you have type 1 diabetes. But it was 2 in the morning. We're on the coast of Maine. There's no children's hospital. It's like 45 minutes north to Portland to the Barbara bush Hospital or 45 minutes south to Boston. And I was like, but I didn't. I knew it, but I didn't know it. And I was like, nope, nope, nope. Like, this is not it. We're fine.
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A
She's just a pain.
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B
She's just a pain in the ass. Like, whatever. I can't even handle you. You're just ruining my sleep on my vacation. Right? Like, so I'm just annoyed. And so we packed. The next day, we're driving home and I emailing her nephrologist, who we just have annual well checks with. So I'm like, listen, I don't know, but I need you to run all tests. And she's like, okay, fine. Because we had an appointment with her probably three days later when we got back in Ohio, okay? She's like, fine, no big deal. So blood work, there's a whole other story with needle therapy exposure for Emily, because my daughter, because she is just terrified of needles. So this was a. We had like eight people holding her down. We got the blood work. I expected to be wrong. Like, I was just Praying I was wrong. We went to Dillard's, which is a local department store, to do some back to school shopping. And we were driving out at a red light. It turns green. My phone rings. It's a local Ohio number. I didn't really even dawn on me who this could be, so I pressed okay on my car, so it's over the speakers, so there's no way of hiding it. And my doctor's on the phone and she's like, your daughter has type 1 diabetes. I need you to get to the emergency room right now. And I just was like. And she's in the backseat, and the light screen, there's people behind me. The cars in front of me have gone. I can't pull over. She's like thinking she's going to die immediately because she doesn't know what this means. I'm like, my God, like, I don't even know. So I pull over as fast as I can. The doctor's trying to calm her down through the speakers of the car. You know, I'm just like, oh, my goodness. So we race home, pack a bag, tell my husband, and the four of us drive to the local hospital where the sweetest, kindest, loveliest peds endo is on call waiting for us to arrive. So we get there and we were admitted for two nights, three days. Yeah. And then here we are. Diabetics. Yep.
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A
Wow. Geez. That's something else. Yeah. No, I imagine. And did you get to go to Dillard's? Did you do the shopping or no?
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B
Yeah, we did the shopping. We was a great mother daughter day. Like, everything was good, you know, she didn't. She wasn't like, drinking every day like crazy and peeing every day like crazy. So I thought, you know, maybe it was just a fluke. Yeah, maybe it was a flu. Maybe it was a little sickness. Maybe it was exot. Heat exhaustion. Because we go to the beach every day, all day in Maine, and it can get warm and you know, you're tired, you're not getting sleep, you're not in your house. We don't have air, like, whatever. It could be a million things.
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A
Why in my brain, Dillard's not because I cared about the shopping, but I was trying to figure out if she. If she was like, you know, how she was feeling. This sounds like she was doing okay that day. I got great.
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B
Oh, she was walking the little Runway within the dressing room, like, trying things on. And we had a great. We had a great morning.
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A
So I like when you say I have to Tell you, I don't, I'm not going. I'm not vacationing anywhere warm without air conditioning. And I don't think of that as bougie at all. I think of that as bare necessity.
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B
It's so funny. Well, we grew up as kids in Maine and we never had it. You would open the windows and you'd have a little ocean, ocean breeze and you were fine.
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A
Yeah. But as we went over earlier, Amy, you're old. So that's a different.
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B
That's exactly right, yes. The world, the climate has changed.
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A
Listen, we, we grew up. I don't know if I've ever really talked about this before or not, but I grew up in a rented house that was rented to my family by a church. So the church had a parsonage. A parsonage is a place where usually your, your pastor lives. And they were renting it because the pastor had his own house. So I, I grew up in a three story home that I didn't belong in. Like we couldn't, we couldn't actually afford. Okay. But I think I, as I look back now, in hindsight, I think the church was trying to be nice to my family and everything. I, I see now that I was on some sort of welfare that I didn't understand. But, but that, that, but neither here nor there. We did not. That house did not have air conditioning and we didn't have what you might call money. So my parents eventually like scraped up enough to buy one air conditioner that went to a window. And what we did was, is we basically figured out what the largest room in the house was, that we could afford an air conditioner that would fit in. And then we put it there, which ended up being the living room slash dining room.
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B
Okay.
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A
Now the problem is, is that there was a doorway into the kitchen and it didn't have a door on it. But we, the air conditioner wasn't strong enough to actually air condition the kitchen too, so we had to hang sheets over doors to keep the cold air in the space. And then all summer long we all slept in the, in that room. Right. And I'm going to tell you right now, I can physically feel right now pulling the curtain aside and walking into the kitchen like, like how waved. Exactly. Just like hit in the face of this horrible heat. You know, you tell me to sleep in that now and I'll say, no, thank you. I've ascended, I've ascended beyond this. I'm not doing this anymore.
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B
So funny. Well, the houses in England don't have air Conditioning, really?
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A
And so that's why we all left.
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B
Yes, yes. That's the only reason. And we, like, the upstairs are built so well, and, like, the upstairs just is stifling in the summer. And they don't have screens on the window either. So you can't open the screens at night because bugs come in. And you can't not open the window because there's no aircon. So I don't know how people survive. Heathens, like, because.
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A
Yeah, no, I understand.
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B
It's awful. It's awful.
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A
I listen. I vacationed in Vermont once, and I listen to that noise. She knows already. And so, like, so I. Living in society here, where. Where, you know, people live in civilization. I never imagined there wouldn't be an air conditioner at the house that I rented. And my wife arrived earlier. Arden and Kelly went ahead because Cole and I were at a baseball tournament. And so we're now driving to Vermont. She's there. And I remember Arden, this little girl, she called. She goes, hey, mom called and said, this house doesn't have. Mom says this house doesn't have air conditioning. And I went, it's a house. Of course it has air conditioning. She goes, no, this house does not have air conditioning. Everyone was mad at me for a full week. I just want you to know.
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B
Oh, no, they need a redo on their vacation.
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A
I've never slept so close to a fan before my entire life.
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B
That's so funny. Welcome to New England.
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A
Yeah. Pulled together Vermont. Terrible.
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B
They're all eating Ben and Jerry's. They don't know.
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A
Well, hey, we did the Ben and Jerry's tour. It was nice.
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B
Yeah. Yeah, absolutely.
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A
So. So impact on you, rest of your family, then I want to hear about your daughter. But, like, is it. I mean, obviously, it's shocking, but how do you. How do you process it?
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B
Oh, my gosh, it was awful. Like, I was just in the hospital, and I'm so. As I'm watching things from a medical side because I'm an rn and I'm also trying to be her mom, and she is terrified. And, like, the anxiousness, the apprehension, like, I don't. There's no word that could even describe how anxious my poor daughter is. And before this, ironically, the probably eight months leading up to it, she had the flu shot the fall before. And our pediatrician was like, her reaction to getting a shot is not okay. Like, she needs to see a therapist. So we went and we saw a therapist who she hated to see, but he was sweet as can be, and he did needle Exposure therapy. So he brought in insulin syringes, like the old school kind, to just let her touch and feel and like, you know, and he actually let her poke him with one and to just try to get over like this irrational fear. No, it didn't. And it was just miserable. And then we go on these trips and we get diagnosed and I have to call him and be like, listen, like, randomly, the one kid in the world who should not have a disease that's based around needles just got diagnosed with type one. And he was like, what? Like, this is so random.
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A
That's. That's like it. Well, listen, we, you know, Arden is. Has a fairly heavy needle phobia too, so. And I. I know what. She's tried a couple of different things, and so far none of it really helps. So.
- [24:40]
B
Yeah, yeah. I mean, it's like for blood draws, we have to go downtown. They have to bring in the child life specialist. They have a dog. They have like, you know, a gift, toy shop. Like, whatever. You know, we have to bribe her with whatever it is she want. Like, it's. It's awful. It is awful.
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A
I should say that recently, Arden had to get a blood draw and she went by herself.
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B
Oh, okay.
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A
And there's definitely part of me that when she came back, I was like, there's a coin flips chance she's gonna walk in the door and go, well, I didn't do that. And so. But she did. I was really proud of her. So.
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B
Yeah, that's huge. That's huge.
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A
Yeah.
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B
So I had swollen eyes like I was in. I was walking around the hospital with sunglasses on my face because my eyes were so swollen from just crying the whole time. And my. So my mom has type one, but she didn't get diagnosed until she was 40 something. When my dad passed away, like the same year. They think it was stress. Her dad had it, but he didn't get diagnosed until he was in the 60s. And they both were like, no, it's type two. But it wasn't like the doctors were wrong.
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A
Amy, your grandfather was diagnosed with type one in his 60s, your mom in her 40s, and your dad had polycystic kidney disease.
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B
Yeah.
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A
What do you have? You have. You definitely have hypothyroidism, right?
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B
You're correct. I have Hashimoto's. Yeah, my mom has Hashimoto's. And actually I got Hashimoto's like my fourth month of being pregnant with Emily. With my daughter. Yes.
- [26:10]
A
And Emily's anxious, you said, too.
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B
Oh, like that doesn't Even come close. That's the closest word I can figure out to describe her, but it's awful.
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A
A cat in a room full of rocking chairs kind of thing.
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B
Yep, yep. Like, four hours to change a dexcom for the first six months of our diagnosis. Like, four hours to put one on and never mind taking the old one off.
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A
I know. Arden's like, I just wanted to pull it fast. I'm like, I mean, we have done this 800,000 times.
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B
Yes, yes.
- [26:41]
A
Wait, what else? What else is. So if you listen, you know, like, I don't imagine that anxiety is autoimmune, but I do think it's inflammation related to some degree. And I also think that. That I'll say this over and over again if I have to, but I've interviewed nearly 2,000 people now, and I think that if I left the typo in community and interviewed 2,000 more people, I would not hear this much anxiety from people. Like, so I think it's all kind of interconnected somehow. What else is going on? Anybody got celiac?
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B
Not that we know of.
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A
No.
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B
Not that we know of. No, I don't. Nobody.
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A
Nervous belly. Nobody's running to the bathroom all the time?
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B
Not that I know of. So I. I can get that sometimes, like, when I ran and stuff like that, But I don't know. Like, it's not bad enough where it's like a thing, but it's sometimes. So I think it's just two Hashimoto's and the.
- [27:37]
A
The two type ones. Well, now. Three. Three. Three ones now. Yeah, yeah, yeah, yeah. How about your husband's side? Anything going on over there besides thinking that the. The real estate in Ohio is the way to make a decision?
- [27:50]
B
Mental ill. No, I'm joking. So he had. He had anxious. He was very anxious in college. Like, almost like panic attacks, but not really. Okay. But that's it. I don't think they have.
- [28:06]
A
How the two of you find each other high in a therapist's office. What was going on? We.
- [28:12]
B
He worked actually for a pharmaceutical company, and he was living in Connecticut when I was living in the New England area. And we just met through mutual friends, but.
- [28:22]
A
Okay.
- [28:23]
B
Yeah, they were like, hey, I think
- [28:24]
A
if we put you guys together, you'll have a really anxious kid.
- [28:27]
B
Yeah, but I've never been an anxious person. Like, I mean, I lived in Hawaii. I was just chill. I was very relaxed, like, my whole life. I feel like I wasn't an anxious person. I was just about having fun and whatever. And.
- [28:44]
A
Do you have any siblings or.
- [28:46]
B
I have Three sisters. Yep. My oldest one is my dad's child only, so she's my half sister. She has a lot of like, urinary issues, like UTI, like chronic UTIs. They all have had, ironically, they have all had blood and proteins in their urine, I believe. I know blood, I'm pretty sure about proteins more than I have. And so when I was pregnant, the doctors were all over my kidneys and there was never anything wrong, so I felt like I was skipping that. But I take after my dad more than my mom. Like my looks, my height, my colors, like all the things. And those girls, the other my full two sisters take after my mom's side more. And honestly I just thought if anyone gets anything, it's going to be those kids, my sister's kids, because they kind of resemble her more. But I just feel like we got, you know, slammed with it.
- [29:41]
A
Any autoimmune with the girl, with your sisters or anything else with them?
- [29:44]
B
Not that we know of. My youngest nephew who is what, five? Maybe he recently, in the past six months. I don't know too, too much about it because they're not sure what's going on yet, but he will get super cranky, super like, like just hangry until he has a snack. And so they are keep checking his blood sugars. And then I went online and I don't know if it was within your Facebook group or just T1B parents or something, but somebody actually posted about my kid having a low blood sugar for a very long time and then they got type 1 diabetes. And I don't know if that's like
- [30:20]
A
a thing or it is like sometimes, sometimes people get low before they get diagnosed.
- [30:25]
B
Yes. And he like, needs a snack, like, or he's freaking out apparently.
- [30:31]
A
I don't know if that's the. Actually we should figure that out. While I'm figuring that out, let me read this real quickly. For people. Polycystic kidney disease, or pkd, is a genetic kidney disorder where many fluid filled cysts grow in the kidneys. Over time, those cysts can make the kidneys larger, damage normal kidney tissue, raise blood pressure and sometimes lead to kidney failure. So plainly, the kidneys slowly get crowded by cysts and the crowding can make them work worse. Common things connected to PKD could be high blood pressure, backside or belly pain, blood in the urine, kidney stones or infection, cysts in the liver, gradual loss of kidney function. Let's ask the question why. Wait, wait, hold on. Is there a medical reason that someone who will one day get type 1 diabetes would experience low blood sugars. Is that. I think I did that right.
- [31:34]
B
Yeah.
- [31:36]
A
Let's see. Let's see what? Today I'm using ChatGPT. I would have used another one if it was open, but I was using. I was using this one to make images for the website, so it's open on my browser. I look forward to your emails telling me not to use ChatGPT to make images. I can't wait to delete them. Yes, it can happen, but it's not a common pattern. Well, it seems common when I'm talking to people. Erratic insulin release from stressed beta cells, insulin antibodies, autoimmune hypoglycemia, reactive hypoglycemia that is unrelated to future type one. Okay, so the three things that it highlighted was in early autoimmune diabetes, the pancreas may still make insulin, but not smoothly. Some research has described post meal reactive lows before overt type 1 diabetes, possibly from delayed or excessive insulin release. There are published case reports and small studies showing hypoglycemia before insulin treatment in a minority of people later diagnosed with type 1. One study found that 6 of 87 people, or 6.9% insulin autoantibodies, autoimmune hypoglycemia. Rarely, the same autoimmune process around type 1 can involve insulin autoantibodies that mess with the insulin availability and cause lows. This is uncommon, but documented. And then reactive hypoglycemia that is unrelated to future type 1. This is probably the more common explanation. People without diabetes can get shaky, sweaty, weak, anxious, hungry or foggy a few hours after eating, especially after high carb meals. The Mayo Clinic notes that reactive hypoglycemia in people without diabetes often has unclear causes, but can relate to meals, alcohol, gastric surgery, inherited metabolic conditions, or rare tumors. Wow, life. So much fun.
- [33:22]
B
So much.
- [33:25]
A
Yeah. Good time. Like you said earlier, like I said, could be worse. You could be dead. And you went,
- [33:32]
B
in that case, I mean, you know, so.
- [33:35]
A
Okay, so I think we understand the background of, you know, your family. So I guess I would like to dig in for a second. She's diagnosed. She has a terrible needle phobia. And so how does she handle the diagnosis? And how do you get through this? Because now it's what, three and a half years later, did you say?
- [33:54]
B
It'll be two years this August. So we're not. Yeah, we're still. We're still kind of in the fog. So she's. I. When she was first in the Hospital. She had been in the hospital for the pneumonia in England, and she had the IV and that was awful, but that was it. Like, there wasn't multiple sticks and all that kind of thing. Obviously this one, you know, just involved waking us up all the time for the finger sticks and all the things. And I just think she thought, like, that would end. Like, there would be. That's just while we're here in the hospital and then we go home. And that's not like that. We have a restaurant called the Yard House that we go to every Friday. It's like five minutes from our house, and it's just our Friday family thing to do. And I remember telling the doc, like, on the rounds, I went out because I was so interested in what they were saying, the RN part of me. And I stood there in rounds and I was like, listen, we're out here by 3:00 today. Like, I'm done. I can't do this anymore. So whatever you need to do to discharge us by three, we are going to the Yard house tonight. It is Friday. We are out of here. Like, I'm done. And I just remember getting to the Yard House and being like, I have no idea what the f I'm doing. Like, how am I going to keep her alive? What is a French fry? I don't know. I have zero clue.
- [35:07]
A
You know, everyone, we're leaving the Yard House immediately.
- [35:10]
B
Everybody else, yes. The poor kid was starving. And I just was like, you know, in the hospital, they just try to teach you so many things at once, but also super basic stuff, like you can eat meat and cheese and there's no snacks. This is what you do for breakfast. This is what you do for lunch. This is what you do for dinner. So I was like, this kid can't have a snack ever. And I remember my nutritionist, two days after diagnosis being like, no, that's not true. And I was like, oh, thank God. Because I don't know what. I don't know.
- [35:40]
A
We bought 20 dozen eggs and 35 pounds of bacon.
- [35:45]
B
Oh, and she's gonna die now of clogged arteries at 12. Like, I don't.
- [35:50]
A
Good news. Her blood sugar's terrific. Her cholesterol is not looking good at. At all.
- [35:56]
B
And then sodium, you know, so then her kidneys start failing. You're just like, damn it, man.
- [36:01]
A
And that all really does go through your mind in those two days.
- [36:03]
B
Oh, 100%, you know, and, you know, and. And I haven't slept. I honestly, I. I feel like I. She's still mdi. And we're just like two days ago, received Tandem Moby in the mail, and we haven't received the, the supplies with it, and we're waiting for our training. But this is the first time in almost 24 months that she's even been like, well, maybe I could potentially, let's say, see, try this. Maybe because you want to run from the needles. Even though she hates them, anything new is so scary to her. Like, and not even necessarily diabetes. Diabetes. Like, if I was like, try softball, she'd be like, ooh, I don't know. You know, like, it's just mom softball.
- [36:45]
A
My God. You know what's gonna go wrong, right?
- [36:47]
B
Yeah. Yep. So anything new? So it's like, that was what we were doing. She couldn't deviate from that, you know?
- [36:56]
A
Poor kid. That's terrible.
- [36:57]
B
It's awful. And I haven't slept in, you know, 22 hours. Like, literally every two. It's worse than a newborn. I am up every two hours all night. And my sweet husband, he'll sleep through the night. He travels a lot for work, so I'm. I don't work currently. I'm the primary caregiver for the children. So he gets restful nights when he's away and he gets restful nights when he's home because he has to work, like on the weekends, we take turns and stuff, but I'm like, you know what, Monday through Thursday, like, this is all, it's fine. I can try to rest during the day, whatever. And he'll be like, just take 10 minute power naps. And I'm like, for someone who gets consecutive sleep, a 10 minute power nap might work, but when you're sleep deprived of that deep restorative, restful sleep, a 10 minute nap.
- [37:43]
A
You okay?
- [37:44]
B
Literally, this is what I want to say. I need a four hour nap and a bottle of tequila.
- [37:51]
A
About three months. And you all try to stay alive till I get back.
- [37:54]
B
Yes. Yes. And I don't know if it's because I'm mom or Ann and RN or both or one or whatever it is, but she, for the first, I would say 13, 14 months, wouldn't let anybody touch her but me.
- [38:08]
A
Yeah.
- [38:09]
B
So if it was like, I couldn't even see, couldn't even be like, amy, I got this, like, you rest tonight because she would have a massive panic attack because daddy was trying to fix it. And bless her heart, one night I did go 45 minutes away to a mom's night out. It's a diabetic conferencing for parents of T1D.
- [38:29]
A
Sounds fun.
- [38:30]
B
Yes. And it was 45 minutes away and I got a call during the dinner service at like 7:30. She's like, Mom, I'm going low. Daddy just gave me a sugar free juice. And I was like, oh my God. God, this is, this is why I can't leave home.
- [38:43]
A
13 year olds on the phone going, hey, this idiot you married is trying to kill me over here. Okay?
- [38:48]
B
Yeah. So, yeah, yeah. And my son, who's 7 or I think 6 at the time, he's like, I can hear him in the background like, don't worry mom. I gave her a regular juice with Sesame street on it. Because that's the kind we buy is the little ones with the Sesame street on it going.
- [39:05]
A
My 7 year old's the only one holding this together right now.
- [39:09]
B
I'm not just so not. You're not wrong. Like there's times and I'm like, oh my God, this is like he knows more, I think an honest opinion. He would know more about pediatric type 1 diabetes than the average adult ER physician. I'm not even like, I honestly believe this wholeheartedly.
- [39:29]
A
Well, it's just sad on its own, by the way. So awful. So, okay, I think I understand the bigger picture here. And, and, and so now completely serious, you know, you can't keep doing this for much longer, right?
- [39:44]
B
I honestly feel like I told, I, I've had moments where I've just melted down and, and like you know, screamed at everybody because I don't feel like they quite understand that if mom dies of sleep deprivation, like, or cancer because I haven't slept or sick, whatever, like driving my car into a tree because I fell asleep driving, like I'm not going to be here to take care of you anyway.
- [40:07]
A
Listen, if I go, we all have to go together, okay? Because I'm, I'm, I'm looking up like maybe he could do okay without the kids, but I think with the kids it's not going to go well. Maybe, maybe just give the seven year old a couple of grand and let him go feral and see what happens.
- [40:20]
B
You know, I used to, I, I used to be in the philosophy of we all fly on a separate plane because you don't. But now I'm like, no, we're all together in this one, guys. Hop aboard. Because if it goes down, at least
- [40:30]
A
what we need, we need to all go if we're gonna go. You're, you're, you're in the, that crazy, like you're like crazy lady on the News, like, level right now. What happened? I just. They can't live without me. I'm like, they probably would be fine. So. So. But seriously, they probably would be fine. So, like, you're like, you know what I mean? Like, what do you. Honestly, they pull together, right?
- [40:53]
B
Well, you know, I do think in the. I think my husband has been, you know, she has, you know, made him feel awful enough for that one night that he's really learned to, like, look at what he's giving her for low snack. But. But I just think she is. It's 100% nothing to do with him. He's great. But it's just her personality, and it's just her changing it up from something. And Mom's always there. Mom's. You know, my body will literally wake up, and then the next change on the Dexcom, it'll hit a low, and I'll be like, my. It's just, like, something in my body.
- [41:30]
A
Why is she getting low so much?
- [41:33]
B
It's so weird because, you know, I've listened to you a lot, and I'm like, what am I doing wrong? But she, like, I'll do the same thing the same time, the same food, the same activity. And one night, she's 200 plus overnight, and I'm waking up every three hours to give a correction and whatever. And then the next night, you know, I give the same correction right before bed, and she's dropping. You know, I have my.
- [41:58]
A
The movie's gonna fix a lot of this for you.
- [42:00]
B
Oh, I praise God. Like, if they. If. If it does, I will find the creator of that pump and give them a big old kiss, because I'm like, I need someone to come save my life right now. Like, this is. But my. My anxiety in all of this is there have been plenty of times that the G7 is so off that I am terrified of it being like, oh, she's 180. And Moby's like, okay, here's some insulin, and she's 40. You know, and I.
- [42:32]
A
You're telling me there are times that her blood sugar says 180, but she's 40.
- [42:36]
B
There's been times the G7 has been 100 points off. Yes, but.
- [42:40]
A
But like that or.
- [42:42]
B
Yeah, like, yeah, yeah, yeah. So one time it was. I was checking her, and she's like, mom, I just don't feel right. And her actual finger prick wasn't 40. That's an exaggeration. But it was. I think it was like, 62 or something. And the Dexcom was like, 150 or, you know, something you wouldn't have even, like, almost to the point where you're like, you're fine. Like, I don't know what you're bitching about, you know?
- [43:04]
A
But I'm gonna ask you all the questions. She's well hydrated most days.
- [43:09]
B
You know, there could be a day at school or something like that where she's not. But I do try to make sure that, you know, she's drinking well enough. I do try to make sure it's in the right spot. I do. It's not a compression low, you know, like, with the Dexcom's low. And she's not. Like, all the things you just. But it's like she's standing. She put her left foot forward, and the wind's blowing north today. Like, I don't know. Like, what is the. There's nothing that I can think about that changes, you know?
- [43:39]
A
You are in desperate need of a step back.
- [43:42]
B
I am in desperate need of, like. And we used to have such a good life. Like, for six years, we lived.
- [43:47]
A
No, I heard you got a good white lady thing going on.
- [43:49]
B
I heard it traveled to Italy. We went up on the weekend. You know, we were like, let's go to Rome. Why not? Let's drive to France, Belgium. Let's do it. You know, like.
- [44:02]
A
And you're not doing that anymore?
- [44:04]
B
No. We live in America, which. It's like, where we're gonna go. Michigan. I'd rather not do that.
- [44:09]
A
A lot of people listen from Michigan. I love Michigan. I just want to say that out loud. Also Ohio.
- [44:16]
B
I just want to say there's nothing wrong with Michigan, but it's not Rome. Italy is my point. You know what I mean? Like, it's not.
- [44:23]
A
Yeah, I hear you. Okay. Well, I mean, I think even the people of Michigan would say that this is it.
- [44:27]
B
This is it. That's my point. Yes.
- [44:29]
A
So.
- [44:29]
B
But. But.
- [44:29]
A
But wait. Let's.
- [44:31]
B
Let's.
- [44:31]
A
Let's slow down for a minute. Amy, are you. So you said you're anxious, too.
- [44:36]
B
Well, I'm anxious about the fact that if I do something wrong, she's dead. And you're supposed to take care of your children, right? So you're supposed to protect them, and you're supposed to provide.
- [44:46]
A
You're not gonna kill her. It's fine.
- [44:48]
B
I'm just.
- [44:49]
A
You gotta let go of that.
- [44:50]
B
Oh, man. And it's like, you know, everything has just become so complicated in life. Like, we've flown. We were in Hawaii. You know, we go on a holiday every summer, spring, School break and the amount of crap. We went to Connecticut for two days because we're supposed to move for my husband's job now, and Connecticut was the first option, so we went. And being from New England, I was so excited. And we got there, and I'm not like, we lived in Westchester county for a little while, too, and it's right on that purchase, like, new Cannon line or whatever. And we were there for two days, and everything went wrong. The Dexcom went. Failed. The second. The one I brought for. We were there again for two nights, so I brought one extra because the one she had on was supposed to last. We were in, like, day two or something. It failed. The one I brought. The wire stuck through the hole. Then we spent, like, two hours at CVS trying to get another one, and then that one failed, and then I had to get a third. Like, you know, it was just like, Amy.
- [45:51]
A
Amy, Is it possible you're the problem? No. Are you sure?
- [45:55]
B
They never fail. Fail on me. They never fail.
- [45:58]
A
Oh, okay. You just had, like, a weird string of them right there.
- [46:00]
B
It was. It was a weird thing. And there is. There is a girl, and she's posted on her Instagram that she has a theory. Marley. You know Bane. Like that little boy.
- [46:12]
A
Yeah, she's lovely.
- [46:13]
B
She. She at one point said, if they're made in Malaysia, they tend to have more problems than the ones that don't say Malaysia on the box.
- [46:21]
A
Well, I think the company would tell. I think the company would tell you that's not true. But I don't know. Like, I have no idea. Listen, I.
- [46:28]
B
But I saw it, and I was like, oh, she's on to something. Like, all four of these are from
- [46:32]
A
the laser, by the way. Very welcome. I have no idea. What I'm saying is that, like, there used to be this. Gosh, I wish I could remember the number. There was a theory years ago that one of the codes was a problem.
- [46:46]
B
And.
- [46:46]
A
And. And then. But you really have to stop and think about this. Like, the number of those CGMs that are. Are made and put out into the world is a massive number. The number of people online is a much, much smaller number.
- [47:03]
B
It's very logical.
- [47:04]
A
20 of them say, oh, this code is bad. Then everyone online goes. Everyone's saying it's this code, but no one's pinging the other million CGMs that were made this year. And so.
- [47:16]
B
Very fair.
- [47:17]
A
Yeah. So, anyway, I don't. What I would say is. Is I don't think that's a good mathematical way to Figure it out. I. And I'm also not telling you you're wrong, because I have absolutely no idea. I would just. I would just, you know, say it feels like you got a bad string of them or maybe, listen, maybe a lot of them came out. A lot. You know, not a lot, but a lot.
- [47:37]
B
The lot. Yes. I kept.
- [47:40]
A
I could have kept saying a lot over and over again. I wasn't going to get anywhere. And maybe they came in that area. Like, I have absolutely no idea. I. I'll tell you right now, that goosenecking thing that you talked about.
- [47:51]
B
Yeah.
- [47:51]
A
When it first came out, I think Arden put three on in a row that did that.
- [47:55]
B
Yes.
- [47:56]
A
And it was clearly a problem, and now it seems to be much less of a problem.
- [48:01]
B
Well, and here's the thing. Like, if she was a very chill girl, and it just like, oh, shit, this wire popped through. Let's rip it off and do another one. It would be, like, no big deal, but it is, like, meltdown. Like, it, you know.
- [48:11]
A
Well, I don't want to. I don't want to undervalue her situation, but I also don't want to undervalue other people's situations. I think it's a big deal for anybody. I think that, like, you know, you don't want to stop and change a device, and then you. You do it, and then it doesn't work. You're like, you got it. I got to do this again. And then not only do I have to rip it off, poke myself again, but now I got to call the freaking company and tell them it didn't work so they can send me another one. And then now there's people online going on, but you can do it through your app. I'm like, I know you can do it through your app. And then. And like, you know, but you still got to go through all that problem. And it is frustrating.
- [48:43]
B
Yeah. And there's just absolutely. And there's nothing worse than seeing your daughter or your child so sad and so scared and so upset and so worried. And I think she's worried she's going to die. Like, she will not wake up in the morning, or she'll be. I don't think so, because I'm not. I've never, ever been like, oh, this is. This is bad. Like, she's.
- [49:04]
A
Well, you just told me. You just told me you're afraid that if you mess up, she's gonna die.
- [49:08]
B
Well, that's me. But I've never put that on her. Like, when I'm around her, she'll be like, mom, I don't feel good. I'm having a lot. I'm like, that's all right. Just sit down. We'll poke your finger. Let's get a juice. Let's figure it, you know, like, one on one.
- [49:18]
A
You're like, you're. You're. You're. You're Hawaii, Amy. One on one.
- [49:22]
B
Yes. Yes.
- [49:23]
A
You're like, oh, it's gonna be fine. We'll meet a handsome boy. We'll stay in Hawaii forever.
- [49:27]
B
Yeah, but I think, like, in the back of my head is, like, even as an rn, if I was working, I'd be like, okay, I gotta do the five rights here, because if I mess up this medication, like, that's bad. But so it's. It's a general. Like, this actually could happen. Am I losing sleep about potentially killing her? That's not the reason I'm losing sleep. You know, I'm just. I always.
- [49:48]
A
Up, down.
- [49:49]
B
In the beginning, I couldn't sleep, and I don't think my body has gotten past that. You need to be awake in case something happens. But during the day, I'm not. Like, can I check and follow every 10 seconds?
- [50:00]
A
Can I tell you what really happens is they get older and they become a bigger pain in the ass.
- [50:03]
B
You come.
- [50:04]
A
You come less worried. You come less worried about whether or not people die or not. You're like, you know what? I've had enough of all of you. So.
- [50:12]
B
Oh, man, that's so crazy. Like, oh, yeah.
- [50:15]
A
But seriously, like, you know, obviously, I don't want anybody to die, But.
- [50:19]
B
But, But.
- [50:21]
A
But, you know, like, I'll use. I can just use yesterday's example. Arden finished her last. Her last final. It's her. You know, she's got, like, three more classes left, and she graduates. Her boyfriend's graduating now. All of her friends are graduating now. So they went to a. They went to a house party yesterday, and she lost her signal. I'm gonna guess she put her phone down. Right. But she didn't have a signal for hours. And I have to tell you, I never worried about it once.
- [50:51]
B
Yeah.
- [50:52]
A
And then she got her signal back, and her blood sugar was too high, obviously, because she was probably snacking and whatever else she was doing and not getting insulin from her automated system. And then it came back online. I gave her insulin, she went down. And I'll tell you right now that five hours later, she got low, and then she drank a juice, and it was all fine. And I never worried about it once. I think there's Amy Give me a second. I think that the time that I've been doing this, I can now see how eight years ago, someone with Type one, an adult, would have listened to me and been like, this guy. It doesn't have the whole picture yet. And they would have been right. And I don't have the whole picture now, but I have a lot more of it than I did eight years ago as an example. And eight years ago, I would have sounded like you. I've been like, oh, my God. The signal went by. This thing doesn't work. You got to do this. Like, it's going to be a problem. She's going to die. How's the algorithm not going to know what to do? Is she going to get too much insulin? And I would. But you know what? Then I meet a ton of adults who have type 1 diabetes, and they all have something in common. They've been through it enough that they don't. They don't flinch anymore. They're like. They're like people who live in a war zone. If you shot a rocket over my head right now, I would probably die. Like, I would probably, like, short circuit, fall over, and explode myself. But there are places in the world where rockets fly over people's heads all the time. And I've seen videos. They don't even flinch.
- [52:24]
B
Oh, my goodness.
- [52:25]
A
They're just like, this is what happens here. And you get used to it. And I think that it's a. It's a bombastic example. But I'm telling you, I think maybe it's not when it comes to diabetes, like, because you feel like you're gonna die, you feel like she's gonna die, something terrible is gonna happen. But if you live through it long enough and have enough experiences, I don't think that feeling. I think that feeling goes away to some degree. Like, I don't know. You know what I mean? Now, for her or somebody who's that anxious, maybe it's not gonna be that way for her, but for you, it could be, because I genuinely wasn't worried yesterday.
- [53:00]
B
Yeah, that's good. No, I do feel like I've improved. Like, the first 12 months was awful. I would say the last six months, I've kind of felt like today is, you know, this is the worst thing that could ever happen to us. We had such a good life. Like, this is like, this. So much has changed. This sucks. It couldn't get any worse. And then I'll wake up the next day, and I'll be like, you know what? She's not in a wheelchair like she has. You know, she could be stuck in a hospital bed. She could have terminal cancer. Like every, you know, she's fine. She's going to get on a pump one day, her numbers will be more stabilized, her kidneys won't fail because she potentially already has a precursor to a problem that could be exacerbated by the diabetes. Like, all that stuff's going to be fine. We're not even two years in. We have to still find our rhythm. You know, she's a kid. She's 12. She's going through puberty. That's going to change a lot of things day to day. You know, I don't restrict her food because she's already had so much taken away that I'm like, eat a donut, I don't care. We'll just give you insulin for it. Like, she's not, I'm not strict in that way.
- [54:05]
A
Amy worries. A waste of imagination is a phrase that I find really helpful because, what, you might not be wrong, by the way. Like, something, something terrible might happen 25 years from now. Okay.
- [54:20]
B
Yeah.
- [54:21]
A
But there's literally nothing you can do about it today, right? I mean, there's some basic things pre bullish your meals, you know, make sure you understand the impact of your food. Try to keep blood sugars from being wildly up and down. Like, look for stability. Try to get an A1C as low as you can. That's, you know, comfortable in your life. That doesn't cost cause like problems. And then, I mean, there's that old, like, country song, right? I beg your pardon? I never promised you a rose garden. Like, what did you think life was going to be? Perfect? You know what I mean? Like, so, like, there's going to be problems along the way. And I guarantee that a well rested, not out of her mind Amy does a better job in that moment than the one you are right now. You know what I mean? Like, and so, like, I don't know that you're ever going to be like, hey, the rockets are flying. I don't care. Keep playing. Like, I'm, I'm outside playing badminton. I'm not going to slow down. Like, maybe you're never going to be that person and maybe you shouldn't be. I have no idea. But like, I don't. Like, for everyone listening and for you, I would just tell you that as your experiences pile up, you should take stock of them and, and try your hardest to not stay stuck where you are. Because right now you're. I've Heard you say we used to have, we used to have a good life. You must have said it four or five times already. Yeah, I would argue you still have a good life.
- [55:44]
B
Fair. And that's fair. And here's the thing, like in other parts of my life, I'm so easygoing. Like, I was a first time mom with a two month old baby who had to move to the UK for my husband's job. I had to learn how to drive on the other side of the road with a. I had to learn how to be a mom. My husband left to go to Brazil for work like a week or two after we moved there. So I was like, where's the grocery store? Like, you know, so there. But I was like, whatever, we'll.
- [56:08]
A
No problem. You were, you were like, I can do this.
- [56:10]
B
So I got this. So this is one, one month from now we're moving to Texas for my husband's job. I've never had Texas in my, you know, in my vision. And here we go. Just west of Plano. He's working in his offices in Plano. So instead of Connecticut, we picked Texas because there's sunshine and warmth and, you know, whatever, I guess, you know, cheaper homes and it's beautiful.
- [56:38]
A
Amy. No, no, no, no income tax, state income tax either.
- [56:43]
B
This is the other thing.
- [56:44]
A
I didn't, I didn't pick, I didn't pick Tennessee by mistake, in case you're wondering.
- [56:48]
B
And so Connecticut and New York, we're like, that's a double whammy where if we go to Texas we can, you know, save a few bills. So, you know, that's what we're going to do. And I've had friends who have been like, I would have a toddler fit if my hus had to move to Texas. And I'm like, really? Whatever. We've moved nine times and I just do it and it is fine. And everyone's like, how are you doing that?
- [57:10]
A
Like, so why can't you translate this to that?
- [57:13]
B
I don't know. Scott, if you could answer that question for me, we would both be so happy.
- [57:19]
A
Well, can I give you the, Can I give you the advice?
- [57:22]
B
Yeah, yeah.
- [57:23]
A
I mean, Foreign. This episode was too good to cut anything out of, but too long to make just one episode. So this is part one. Make sure you go find part two right now. It's going to be the next episode in your feed. I'd like to thank the blood glucose meter that my daughter carries the contour Next gen blood glucose meter. Learn more and get started today at Contour Next Juicebox and don't forget, you may be paying more through your insurance right now for the meter you have than you would pay for the Contour Next gen in cash. There are links in the show notes of the audio app you're listening in right now and links@juiceboxpodcast.com to contour and all of the sponsors. Something new just arrived from minimed. It's the Mini Med Flex system. Think about everything people love about Minimed technology designed for great outcomes, helping keep you in range and made to be easy to use. Now in a pump that's the size of two stacked vials of insulin, Mini Medflex is fully controlled from an app designed to stay tucked away and powered by the proven automation that helps over 600,000 people manage diabetes day and night. Order today minimed.com juicebox I can't thank you enough for listening. Please make sure you're subscribed or following in your audio app. I'll be back tomorrow with another episode of the Juice Box Podcast.