#1919 Hurricane Levi

Summary

Juicebox Podcast: Type 1 Diabetes

Episode #1919: Hurricane Levi

Host: Scott Benner
Guest: Tendai, mother of Levi (age 6, living with type 1 diabetes in Zimbabwe)
Date: August 3, 2026

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Episode Overview

This heartfelt and illuminating episode features Tendai, a mother from Zimbabwe, sharing her journey caring for her six-year-old son, Levi, who was diagnosed with type 1 diabetes just before Christmas 2024. The conversation dives deep into the challenges and triumphs of managing diabetes in a developing country, cultural perceptions, healthcare access, and the vital role of community and international resources (like this very podcast) in navigating diabetes care.

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Key Discussion Points & Insights

1. Levi’s Diagnosis and Initial Challenges

• Symptoms & Diagnosis

  • Levi was diagnosed at age four, shortly before Christmas 2024.
  • Classic signs: increased thirst, frequent urination, bed-wetting, weight loss, lethargy.
  • Tendai admits to delaying medical consultation due to self-doubt over the symptoms.
    • “I couldn’t get myself to do it… I thought that would come across as, you know, ridiculous.” (05:00)
  • By the time they sought care, Levi was nearly in diabetic ketoacidosis (DKA).
  • Hospital stay lasted nearly two weeks.

• Healthcare System Insights

  • Zimbabwe handles some health crises (like COVID, HIV) well, but type 1 diabetes remains poorly understood in the general medical system.
  • Misconceptions even among medical staff:
    • “A senior nurse… she says to him, look, you can’t have sweets. This is why you are here in the first place.” (15:55) – revealing confusion between type 1 and type 2 diabetes.

• Practical Advice from Doctors

  • Tendai’s pediatrician admitted, “I know the textbook stuff about this condition. I need you to get in touch with other parents… they’re going to tell you things I can’t.” (16:50)

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2. Navigating Diabetes Care in Zimbabwe

• Access to Supplies and Costs

  • Insurance: Tendai and her husband use different medical aids (insurance) to cover supplies—hers for insulin, his for continuous glucose monitors (CGM).
  • Cost of CGMs: $75-90 USD per sensor (lasts ~14 days), paying up to $200/month initially out-of-pocket.
  • Types of CGMs: Uses lesser-known brands (Links, Sinokay) as Dexcom and Libre have limited support.
  • Barriers: Tech restrictions (apps/software region-locked), lack of pump access, limited teaching around carb counting and insulin management.

• Insulin Regimens

  • Levi uses NovoRapid (short-acting) and Protophane (intermediate-acting, NPH) for basal.
  • Split basal (morning and evening), as directed by their doctor—but with rudimentary instructions and no individualized ratios.
  • Scott recommends she inquire about Tresiba or Lantus for more stable, modern basal insulin.

• Food & Carbohydrate Counting

  • Zimbabwean diets are mostly organic/local—food rarely labeled for nutritional value, complicating carb counting. Main staple: sadza, a thick cornmeal porridge.
  • Trial-and-error approach:
    • “Our food here... it’s mostly organic… you basically have to say that you know or you don’t know or you are guessing at best…” (26:00)
  • Suggestion: Use ChatGPT/AI or other internet resources for nutritional estimates (e.g., sadza = ~40-45g carbs/cup).

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3. Community, Education, and Support

• Role of Community

  • Family and local community are supportive.
  • Schools are generally receptive—though some show hesitancy or outright refusal to accept kids with type 1 due to lack of resources or fear.
  • WhatsApp groups and networks among parents in Zimbabwe and South Africa, where the Juicebox Podcast is routinely recommended to newcomers.
    • “There’s quite a number of us… One of the first things that parents say there are, ‘You need to go and check this podcast out.’” (30:36)

• Discovery & Learning Curve

  • Tangible improvement over time (“doing better now than we were last year”).
  • The podcast (and other parents) helped bridge the local system’s knowledge gaps, explaining basal/bolus distinctions and fine-tuning dosing.

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4. Cultural & Social Aspects

• Myths and Misconceptions

  • Community myths around “cures” (e.g., special plants, diets).
  • Confusion between type 1 and type 2 diabetes prevalent, even among medical staff.
  • No formal (or fear-inducing) talks from hospitals regarding prognosis/lifespan, but plenty of unsolicited advice from extended family/community.

• School Experience

  • First school rejected Levi due to concerns about staff burden: “We already have a child with Type one and we’re not jumping up and down to get another one.” (37:49)
  • Ended up in a larger, more receptive school—teachers help with injections, recognize lows/hypos, communicate with Tendai throughout the day.

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5. Emotional Journey

• Parenting & Coping

  • Tendai manages most of Levi’s day-to-day care, anxiety over delegating, but gradually involving her husband and older daughter.
  • Feeling “anxious, especially with these long-term effects that come with poor management…” (59:32)
  • No guilt (“When I realized what it was, I didn’t have any guilt at all…”) but a need to control and perfect management.

• Biggest Hurdles

  • Balancing work, care, financial burden, and education—especially with the layered complexity of healthcare in Zimbabwe.
  • “If you didn’t go out into the world to learn about this, what would following doctor’s advice get you?” – “We would be struggling.” (43:10)

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6. Strategies, Tools, and Suggestions

• AI & Technology as a Resource

  • Use AI (ChatGPT, Claude) for food carb/protein estimates and as a “sounding board” for bolusing.
  • Scott reinforces: “I’m not telling you to let an AI model manage your insulin, but… why wouldn’t you at least try to get a background from it and… see if it can’t give you some direction?” (76:31)
  • Tendai uses the podcast’s online bolus estimator and discusses issues translating U.S.-centric advice to the Zimbabwean context.

• Tips on Insulin Settings

  • Scott recommends pushing for newer basal insulins (Tresiba, Lantus) if available, clarifies carb ratios and insulin sensitivity calculation using the podcast calculator and AI.
  • Key calculation: a unit of insulin moves Levi about 8 mmol (or 146 mg/dL), aiming for a more modern approach once access improves.

• Building Knowledge and Advocacy

  • Continual learning, leveraging international communities, and advocating within Zimbabwe’s health & insurance systems has led to notable improvements.

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Notable Quotes & Memorable Moments

• On Delayed Diagnosis:

  • “When you’re living with somebody, it’s hard to see weight loss… you get used to that until you don’t notice it anymore.” – Tendai (03:40)

• On Hospital Care:

  • “She’s a senior in that hospital who thinks that you’re a 4-year-old who’s being diagnosed with type 1 diabetes is there because of his poor life choices.” – Scott (16:04)

• On Community Support:

  • “There’s quite a number of us… especially when we welcome a new parent into the group… [they say] you need to go and check this podcast out.” – Tendai (30:33)

• On Information Gaps:

  • “[The doctor said:] I know the textbook stuff about this condition… there are certain things you’re going to learn more out there than I can ever tell you.” – Tendai quoting her pediatrician (16:55)
  • “If you didn’t go out into the world to learn about this, what would following doctor’s advice get you? …We would be struggling.” (43:10–43:13)

• On Cost:

  • “It’s $90 in some places. Between 75 and $90, depending on the pharmacy… That is one [sensor for 14 days].” – Tendai (32:46)

• On the Podcast’s Global Reach:

  • “I don’t think you have in the slightest idea of your reach in terms of helping people to understand this condition and manage it better.” – Tendai (31:20)
  • “There’s part of me that when I see [listeners in Zimbabwe], just assumes that’s a bot… but it’s you. And, you know, maybe others too.” – Scott (30:17)

• On Using AI for Carb Counting:

  • “Do you have an AI model… you can use to break down the food? Because that’s got to be like… why don’t we do this?” – Scott (66:05)

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Important Timestamps

• 03:00 – Signs and symptoms before Levi’s diagnosis
• 05:00 – “I couldn’t get myself to do it…” (Tendai’s hesitation to visit doctor)
• 13:37 – Hospital care in Zimbabwe: gaps and cultural differences
• 15:55 – “You can’t have sweets. This is why you are here in the first place.” (nurse misconception)
• 30:17 – Podcast’s impact in Zimbabwe; parent WhatsApp groups
• 32:46 – Out-of-pocket costs for CGMs and supply acquisition challenges
• 47:22 – Balancing risk of lows vs. tight management (school challenges)
• 54:21 – Discussion of accessible basal insulins and suggested switch to Tresiba
• 66:05–69:00 – Using AI (ChatGPT) for nutritional analysis with Zimbabwean staples
• 73:11 – Calculating insulin sensitivity, ratios, and adapting to resources available

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Episode Tone & Style

• Warm, empathetic, and collaborative. Scott is supportive and conversational, making space for Tendai to share her story, laugh about difficult moments, and process the emotional toll.
• Practical and solutions-focused. Technical explanations, troubleshooting, and encouragement to leverage all available resources are interwoven with personal storytelling.
• Global awareness and humility. Both speaker and guest acknowledge cultural, economic, and healthcare disparities, while highlighting the universality of the diabetes parenting journey.

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Episode Title

“Hurricane Levi” – Capturing Levi’s energetic spirit and the whirlwind nature of his diagnosis and family’s adaptation, as chosen by Tendai herself.

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Closing Note

This episode stands out as a powerful testament to the resilience of families facing type 1 diabetes worldwide, especially in under-resourced settings—and shines a light on the reach and positive impact of advocacy, education, and online communities.

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"Once you get one [autoimmune disorder], it's not crazy to get another one.... So keep an eye." – Scott (61:01)

"If you have that much effort, I think you should be seeing... I think you could easily see an A1C in the sevens. And if that's the case... what's holding you back? I think it might be the NPH or not having a more modern basal insulin." – Scott (53:08)

"No, let me tell you, I heard about you from another parent of a child with type one... in the WhatsApp group... one of the first things that parents say are, 'You need to go and check this podcast out.'" – Tendai (30:33)

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For resources, visit JuiceboxPodcast.com and Tendai recommends using community groups and AI tools to complement local care and knowledge.

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End of Summary

Transcript

[A]

Foreign. S We're all back together for another episode of 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 Beginnings series on the Juice Box Podcast. It's hosted by myself and Jenny Smith, an experienced diabetes educator with over 35 years personal insight into type 1. Our series cuts through the medical jargon and delivers straightforward answers to your most pressing questions. Hey. 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.

[B]

Foreign.

[A]

This episode of the podcast is sponsored by Mini Med and the Contour Next Gen blood glucose Meter. Mini Med, of course, 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 There is one blood glucose meter in this house. The Contour Next Gen blood glucose meter. That meter is on my daughter's person right now and at all times. It is incredibly accurate and waiting for [e-mail] juicebox hello, Scott.

[B]

My name is Tenday and I have a six year old son, Levi, who has type 1 diabetes and we live in Zimbabwe.

[A]

Tendai. It's nice to meet you. Am I saying your name right?

[B]

Yes.

[A]

Awesome. Is Levi your only child or do you have others?

[B]

Levi is my second child. My first daughter is 17 and Levi is 6.

[A]

Oh, wow, look at you. Are there other people with type 1 in your family or Levi's father's family, anything like that?

[B]

No, there's no history of type 1 in, in mine and my husband's family.

[A]

Okay, and. And how long ago was he diagnosed?

[B]

So he was diagnosed in December of 2024, just before Christmas.

[A]

Oh my. So, so it'll be two years this Christmas, correct?

[B]

Yes.

[A]

I almost said how old was he when he was introduced to type 1 diabetes? Which is ridiculous because I've asked, I've said to her, diagnosed thousands of times making this podcast. And I was like, I stopped myself. You'll hear me fumbling through it. I was like, why was I gonna say that? Well, so he's, what, was he, about four when he was diagnosed?

[B]

Yes, he was. He just turned 4 in August of that year.

[A]

Okay, and leading up to the diagnosis, things you noticed or did it, did it come up very quickly? Was it a slow onset?

[B]

Oh, yes, we, we noticed the, the usual signs that everybody talks about. So Levi was. Had been fully potent by that age. But I did notice he, he went back to bed wetting, he was drinking tons of water and. And then he started to lose weight as well as towards the, towards the end I did notice some, some weight loss, although it wasn't until my mother in law mentioned it to me because when you're living with somebody, it's hard to see weight loss. You get used to that until you don't notice it anymore.

[A]

Sure.

[B]

But I did notice that he had lost quite a lot of weight. And then also by the time I decided to take him to the hospital, he was now, you know, just lethargic and he would. Because he's an energetic child. Levi is quite, quite a handful, balls of energy. But at that time he started to, you know, become weaker. He would just lie down and fall asleep even in this middle of the living room on the floor. So I did notice that something was wrong. But I, I needed to mention this because I feel like maybe some people may identify with such a thing that when I was seeing all these symptoms, the, it did occur to me to take him to see the doctor. But then I, I couldn't get myself to do it because it was very strange to me to go to the doctor and say, well, my son is not eating much, he's drinking lots and he's going to the bathroom frequently. Because in my mind I thought that would come across as, you know, ridiculous. So the doctor will say, well, if he's drinking water, then obviously he's going to pee more, you know. So yeah, that's what stopped me from going to the doctor earlier than I should have. By the time we went, I think he was, it was close to DKA because we had to rush to the hospital, to the nearest hospital. And then they booked him in and we were in there for I think just a little over a week. Close to two weeks.

[A]

Two weeks? Really?

[B]

Yes. Yeah.

[A]

How long between when you, when you talked yourself out of going to the doctor and when you actually went to the hospital, how much time was in between there?

[B]

I think that took probably a few days, three to four days.

[A]

Okay.

[B]

Because I made the decision the night before when he looked just weak and then I said, no, I've got to go to the doctor. And I went the very next morning. Yeah.

[A]

How far was the hospital?

[B]

It was a think 10 minute drive.

[A]

Okay. Close, close to your house to where you live. Okay.

[B]

Yes.

[A]

Well, well, that's crazy. So out of nowhere for you? It just. He was fine one day, the next day he seemed tired, peed a lot drank a lot. And then sometime later you thought, he looks like weak, ill, close to death. Like, what was the thing that pushed you over the edge?

[B]

So he had been, you know, he'd been sleeping a lot more than usual. Like I said, he's very energetic because if he's not jumping all over the place, then something is wrong. So at that point he was just, you know, sleeping most of the day and not active at all. Then when I was feeding him supper, usually he would feed himself, but that particular day he wouldn't eat. He wouldn't even sit up at all.

[A]

Just lifeless.

[B]

Yes, basically lifeless. I tried to, I force fed him and he threw up a couple of times. And then I thought, nah, let me just let him sleep it off. I'll rush him to the doctor the following morning.

[A]

And your daughter at that point's maybe 13?

[B]

Yes.

[A]

Yeah. So do you, do you go as a family to the hospital or how do you. The Contour NextG Blood Glucose Meter is sponsoring this episode of the Juice Box podcast and it is entirely possible that it is less expensive in cash than you are paying right now for your meter through your insurance company. That's right. If you go to my link contour next.com juicebox you're going to find links to Walmart, Amazon, Walgreens, CVS, Rite Aid, Kroger Meyer. You could be paying more right now through your insurance for your test strips and meter. Then you would pay through my link for the Contour Next Gen and Contour Next test strips in cash. What am I saying? My link may be cheaper out of your pocket than you are paying right now even with your insurance. And I don't know which meter you have on you right now. I can't say that. But what I can say for sure is that the Contour Next Gen meter is accurate, it is reliable, and it is the meter that we've been using for years. Contornext.com juice box and if you already have a contour meter and you're buying test strips, doing so through my link will help support the podcast. Let's be honest, most of us would love to spend less time thinking about diabetes. That's exactly what Minimed had in mind with the new Minimed Flex system. It's small and sleek, you can control it from an app, and it uses the Trusted Smart Guard technology that automatically adjusts insulin every five minutes. Less juggling, less micromanaging, more freedom. That's the Mini Med Flex system available [e-mail] Juicebox There are links in the show notes and links@juicebox podcast.com to contour, minimed and all the sponsors. When you click on my links, you're supporting the podcast and helping to keep it free and plentiful.

[B]

No, at that time, I just. Because I woke up earlier than usual. So I say to everybody, it was. It was actually, we call them national holidays here in Zimbabwe. So it was Unity Day and everybody was home, schools were closed. So I said, I'm gonna rush Levi to the, to the, to see the doctor and I'll be back real quick. I didn't think it was going to be anything. I thought maybe he was just gonna prescribe him something and would come back home straight after because he was still fairly mobile. It wasn't completely out, but he was, you know, just really weak, but he was conscious. So I thought, maybe we're gonna get small prescription and, you know, rush back home. Yeah. Then when I got to the doctor, he started asking me all these questions, which I was just thinking, okay, you know, what, what do these questions have to do with anything? Then midway through the interview, then he says to me, look, I'm not certain, but I think he may have. He called it adolescents diabetes at that time. And I thought, what. What is that? I've never heard of such a thing. And he says, yeah, anyway, I need you to. To get to the nearest hospital because this was the doctor's surgery, sort of

[A]

like, what would we call that, like a. Like an urgent care or something like that. Right. Then they. And that doctor's telling you, I need you to get to the hospital. They transport you to the hospital or you have to get yourself there.

[B]

He said to me, do you. Are you good to drive to the hospital? And I said, yeah, of course. I think I can drive. Because I still wasn't grasping exactly what was going on. And he didn't give me that much of a sense of urgency. But he did say, can you get to the horse? Can you drive to the hospital and get there quickly? And I said, yes. There wasn't a lot of traffic. So I did. And he says, okay, can you get there now? And I'm going to follow. I'm going to close the. The surgery and I'm going to follow you in my own car.

[A]

Did that scare you then?

[B]

It did, yeah. That was the sign to me that says, okay, so this is. This is bigger than I thought it was.

[A]

Yeah.

[B]

And so on the way, I called my husband and said, look, this is what the doctor is saying. So I'm rushing off to. To the Hospital, the biggest hospital in the area that we live in. And I also called my parents, and I called his parents as well. And everybody met us there within, I think, 20 minutes.

[A]

Yeah. The doctor wanting to escort you over made you think, oh, gosh, this is really. I mean, he's closing the place up and following my, my car and then starting to think about, like. And he asked me, am I okay to drive? Wait, what? Like, and then. Yeah. Wow. So there's this, there's this heavy thing over you that you can't quite conceptualize yet, but the, the clues are starting to put it together for you. And your whole family showed up. Your parents came, Everybody was there.

[B]

My parents were actually making their way from another town, which is far away. But my, my, my husband's parents actually leave. I think it's a two minute walk from, from the hospital. So they were there before the hospital had even finished checking him in.

[A]

That's nice. Yeah.

[B]

So, yeah, the support system was the right quick.

[A]

But then how is the, how is the medical system? Like, I mean, were you there two weeks because that's how it is there, or because it's not great, or because he was so poor, poorly, like, was he not doing well? What's the reason for the long stay?

[B]

Okay, so now with, with hindsight, I think I can put it this way to say being in a third world country, Zimbabwe. Right. I think our medical system is not. It's not that bad, but it could be better. And now there's certain things that they do really well, you know, in our country, like with things like, I don't know, maybe they really did well with COVID They do well with, you know, immunizations and others, you know, pandemics and HIV and whatnot. But with in particular, type 1 diabetes, I think it's still something that is being discovered for the most part. Because I'll tell you one incident that happened while we were at the hospital. I think this was maybe day three or four. So we were in the children's ward. Right. And being in the children's world, obviously there are other children with different conditions. And being Christmas time, most of these kids were getting treats and all these snacks and know nice things. Meanwhile, our, our doctor has put Levi on a strict diet at that point. So he was not having most of his favorite foods. He wasn't having snacks. He wasn't, you know, having everything else that other kids in the same room were having. Okay, so then there's a, there's a senior nurse was just doing her rounds. I Think she was just going around looking at the patients and then she sees me struggling with Levi. Like I said, Levi is, you know, he's a handful. So he was really giving me a hard time. He wants, he wants sweets or whatever because he's seeing everybody around having those. And I'm saying, you can't, you can't have those right now. And then, so she comes in. I think she meant well, she wanted to help. Then she says, she's trying to talk to him and she says to him, look, you can't have sweets. This is why you are here in the first place.

[A]

Oh, so awesome.

[B]

And she says she's a senior in that hospital who thinks that you're a

[A]

4 year old who's being diagnosed with type 1 diabetes. Is there because of his poor life choices.

[B]

Exactly.

[A]

Gotcha.

[B]

So that's, that's the dynamic already. You, I, I'm sure you get the picture.

[A]

Sure.

[B]

And also our pediatrician, when, when he was, now when we were about to go home, and he's great, we're really happy with everything that he taught us, but I have to give him credit for something that he said to me when we were now leaving to go home. He said to me, look, I know the textbook stuff about this condition. And he said to me, I need you to, to get in touch with other parents that have kids with this condition because they're going to tell you things that I can't tell you. I don't have a child with type one and I don't live with the condition, you know, on a day to day basis. So there's certain things you're going to learn more out there than I can ever tell you.

[A]

Well, that's, that's good, honest information. That's good, honest information at least. But not, not incredibly encouraging, I would imagine. Imagine when you're in the hospital and the people in the hospital like, listen, we don't know the first thing about this, so can you go make a friend who knows about it? You're like, probably not.

[B]

Yeah, that's, yeah, it gave me mixed feelings, but I've noticed that, yeah, she definitely. This whole, this world is, it's, it's a crazy world to be thrown into. Sure. And no matter where you are, couldn't possibly know. You don't know what you don't know. Right. As far as this condition.

[A]

Hey, you, you listen to the podcast, right?

[B]

I do, yeah, I do listen to it as often as I can. Yeah.

[A]

So then, you know, when I talk to people from Canada, I tease them And I ask them if they ride a polar bear. So it would be unfair if I didn't ask you if there's, like, lions walking around where you live.

[B]

You know, I. No, unfortunately. Unfortunately, I wish they were. We. We do have. In my country, we do have, you know, what they call the big five in terms of wildlife.

[A]

Okay.

[B]

Biggest game. So we do have a lot of that, apparently.

[A]

Can I guess?

[B]

You have to. Yes, sure.

[A]

Hippos, elephants, rhinos. I'm not going to get the other two giraffe lions. And lions. Did I get them?

[B]

Yes, yes.

[A]

Look at me. I've been to the zoo. I know what's going on. Yeah, yeah. Oh, well, that's. And. And like roaming naturally. Are they in preserves or how is that handled?

[B]

Yes, they are in game reserves, just in selected areas around the country. So you're not going to see them roaming. But they are certain. You know, we call them rural areas. There are certain rural areas where you're going to find that elephants do roam freely and they. You could probably see an elephant just a few feet from your. Your yard in. In other places in the country. Like, I think it's. I don't know. Binga. Is it? I'm not sure.

[A]

Do people keep them.

[B]

Is not good.

[A]

Your geography. Don't worry. You're asking the wrong person. I'm trying to imagine what time zone you're in right now.

[B]

What.

[A]

Do people keep them ever on, like, farms or on their property or. Is that not a thing that happens?

[B]

No, no, they. They wouldn't. They are protected, obviously, by the government, so they would be. They just roam freely.

[A]

You want to hear the weirdest thing?

[B]

Specific areas. Yeah.

[A]

You want to hear the weirdest thing about America ever? Do you. Do you know that Texas has the. Has more big cats in it than that are privately owned than anywhere else in the world?

[B]

Oh, yeah. Really?

[A]

Isn't that weird?

[B]

People in Texas keep them as pits.

[A]

Yeah. Tigers and lions in Texas, I mean. Okay, let's go. I thought so, too. Nevertheless, it's absolutely true. Well, okay, so you're. You're at the hospital for, you know, a bit of time. Are you actually able to cobble together a plan while you're there, or are you just in a panic trying to go out and meet a friend who has diabetes?

[B]

So during our stay, our doctor gave us, like. Like I said, he gave. He put my son on a. On a diet. He recommended the diet that we should follow. And then he also gave us, you know, some. Just some reading material. Just get to know what's going on and how this condition came. You know, just information about the condition.

[A]

Right.

[B]

So we did have that support because obviously the meals were provided by the, by the hospital, and he would come in and see us three times a day, morning, afternoon, and evening, just to check, check on everything. Also to. To keep. Keep tabs on the readings because we were not on. We didn't have a continuous glucose monitor during our time in the hospital. We were, we were just using the, the glucometers to test his sugar levels. Yeah.

[A]

Are the, are the tools provided by. By the government, by the hospital, or do you have to acquire them privately? How does it work there?

[B]

Okay, so here we have. We have medical aid. I think you call it medical insurance. Same thing. So my medical aid from where I work, I work for a bank. It doesn't cover. They don't provide CGMs, but my husband's workplace does. So we've been fortunate enough to get those from using his medical aid.

[A]

Okay. Yeah. Here you could only use one. So if usually a family is covered under one person's employment, that's great that you have two options. I guess that's not completely true. I've seen people do it both ways. So you were able to put your son on your husband's aid, which got him the cgm. Yes, I see.

[B]

And then on my aid, that's where we get the insulin and.

[A]

Oh, that's interesting. You can get some from yours. And so that. That's actually very reasonable.

[B]

Yeah.

[A]

What, is it expensive for you? I. Can I pick in a little bit? Like what. What's a good income where you live? What's an average income?

[B]

I want to say, if you're going to be comfortable, have everything taken care of, you could probably do well with maybe 1,200, 1500 US dollars a month.

[A]

Okay.

[B]

Take home. But then I say that with a bit of reservation because obviously it depends on your lifestyle. Some people can get by with 500.

[A]

Okay. But you have. I mean, you're a family.

[B]

Just depends.

[A]

Yeah.

[B]

On your choices. Yeah.

[A]

And you're a family of four, but l. With his mom or your mom?

[B]

No, it's just the two of us and our two kids.

[A]

Oh. Oh. So, okay, I. I misunderstood at some point where the. A parent was. So you're a family of four, you're both making an income.

[B]

Yes, yes, we're both making an income.

[A]

And does. And is diabetes manageable for you? Is it impossible? Is it somewhere in the middle?

[B]

I think it's somewhere in the middle. I think We, I think we're doing better now than we were last year and then, than we were in the first year.

[A]

Okay.

[B]

It's helped to listen to the podcast every day because there's definitely things that I, I have discovered that I, I didn't know about. I like, for instance, I didn't understand the difference between the two injections that we have to give him. We, he's, he's on multiple daily injections.

[A]

Right.

[B]

So he's not on a pump. But when we first came out of the hospital, it was really confusing to me. Which, which the differences between the injections because we give him two, he's got a short acting, that's Novorapid and then he's got the long acting, which is protofen. The two injections meant, you know, they were the same to me at first.

[A]

Right.

[B]

So it was only when I listened to your podcast and when I talked to my sister in law who's a nurse, and she explained as well to me. Okay, so this is what this one does and then this is what this one does. But then there's also things like the things that you explain on your podcast about, you know, bolasing and basil and timing and everything and how to balance those two. That was a bit of a mystery in the beginning. It was just a mess how I think we were handling it. But I think it's gotten better now. There's still a lot of room for improvement because I'm yet to, to master the calculating the carbs, I think.

[A]

Is that because our food's not labeled properly or how, why does that cause you an issue?

[B]

Because our, our food here in Zimbabwe, it's, it's mostly organic. It's easier to find organic food than the processed foods.

[A]

So

[B]

being organic means there's no labels. You basically have to say that you know or you don't know or you are guessing at best how many car or how much protein or fat is in a particular meal that you've prepared. So I think that's where I'm yet to really try and zero in on that and master that.

[A]

And are you able to use the Internet to help you or how do you, is it trial and error?

[B]

I've tried the Internet. Yeah, the Internet has helped. There's. It has definitely helped, but also it's most, most of it has been trial and error. Just by observing. I can observe that our staple food here, we call it Sadza, I've observed what Sadza does and what the quantities are and how much insulin work well with what quantity of sada.

[A]

And that's a. Like a. It's that. That's like a porridge, right? Like a cornmeal porridge.

[B]

It's exactly, but it's thicker.

[A]

Thicker. Okay. And something. I believe it or not, I actually, I'm doing a little bit of like, research because I want to be able to talk to you about it. And I just asked. It might surprise you. I asked Chat GPT for five common meals in Zimbabwe. Sadza was the first. And then it list. And then it lists it with beef or chicken or goat. Ready? Hold on. Mirawu andovi. Leafy greens cooked with peanut butter. Is that right?

[B]

Yes, exactly. Yeah.

[A]

Yeah. And so these are things that you just contextually, you just have to guess. So do you know even like, did they give you settings for him? Carb ratio, basil? Or do you have to figure the whole thing out or did they at least get him set up by his weight to begin with?

[B]

No, that. That part. I really had to go onto your. Your website to try and figure things out on the. And then to also Google the rest of the stuff.

[A]

Are you using, like, my settings estimator and things like that?

[B]

I used that one time.

[A]

Yeah.

[B]

When I was trying to. Because we had. We had a disaster with pizza one time. And I just went and I said, no, no, no, by the way, they have something on there, so let me go and try and, you know, work it out. And I went there and I think it worked. Well, I may not have given it the amount of time that I should.

[A]

You needed to give it more time?

[B]

I think I need to give it more time because it doesn't look like it. It's too difficult. I'm just. Yeah. Just got a full plate on my. On right now. Things to do with stuff, school and everything. But I think I'm gonna crack it. If I give it more time. I'm sure we'll be on top of things pretty quickly.

[A]

I'm sure you will too. I have to just to take a turn here for a second. This conversation. You're filling my heart up so much today. Thank you so much. No, I really. To hear that this has been valuable to you in a place on the globe that I never even imagined anybody would hear this at is. It's very fulfilling to hear this conversation. Like, it's. I really do appreciate you taking the time to do this. You know, when I try to quantify what I do, it's difficult. Like, I don't always understand it. And sometimes people might hear me on here saying, like, you know, the podcast is, and it is, it's the, it's the best downloaded diabetes podcast in the world. In the United States by leaps and bounds. But, and, but in like 45 other countries, it ranks. And we've, we've, we are. It ranks in Zimbabwe. And there's part of me that when I see that, just assume that's a bot or like, you know, something, but it's, it's you. And, you know, maybe others too. I mean, in fairness, it could just

[B]

be you, but no, let me tell you, I heard about you from another parent of a child with type one. You know, these people that I started to connect with you following.

[A]

No attendee. You're gonna make me cry. Hold on a second.

[B]

So I'm, I'm in a city called Bulawayo in Zimbabwe, and this lady is in Harare, that's the capital city. So she said to me, can you go and listen to the juice Juice box podcast? And then in the WhatsApp group that we have with several parents, I'm not sure how many we are, but there's quite a number of us. Yeah, it includes parents from South Africa as well. And everybody does mention, you know, recommend, especially when we welcome a new parent into the group. One of the first things that parents say there are, you need to go and check this podcast out and it's got a lot of information. So, yeah, I don't think you have in the slightest idea of your reach in terms of helping people to understand this condition and manage it better.

[A]

Well, thanks to you, I have a much better idea. And you did make me cry a little, but I just not a lot. So I would tell my family my eyes are just watering and they're like, you know, you're crying. And I'm like, I don't know. It doesn't feel like crying yet. Well, gosh, that, that's, that's really amazing. I really do appreciate you sharing that with me. So, around cost, I just want to make sure again, like, you feel comfortable with it. But is it a lot of out of pocket for you or does the medical aid cover it all?

[B]

Yeah, it's, it's. There is a lot of out of pocket because in the beginning we, we had, we did have to pay cash for the, for the CGMs before I knew that I could get medical aid to pay for it. So in the first couple of months, we were paying cash for it.

[A]

Tell me, when you bought CGMs, how many zig is that to buy them?

[B]

Okay, so, so interestingly we actually don't use a lot of sig in. In this country, especially in the. In the part of the country that I'm in, we mostly use the United States States dollars.

[A]

Oh, you're using US Dollars there. Oh, okay. Well then I don't have to figure it out. Go. What were you paying for CGMs?

[B]

It's. It's $90 in some places. 7. Between 75 and $90, depending on the pharmacy that you. You. You. You've gone to.

[A]

For how many?

[B]

That is one.

[A]

Oh, my gosh.

[B]

No. 14. 14 days. Most of them last 14 days.

[A]

They last 14 days. Okay, so, but. So you're paying like $200. I mean, somewhere between 150 and 200amonth for two CGMs.

[B]

Exactly.

[A]

My gosh. Okay, so you're using what, the leap. You're using Libre there?

[B]

No, no, we use Links.

[A]

Links. I don't know it.

[B]

And it's a really good one.

[A]

Okay.

[B]

And then there's another one called Sinokay. That's the one we started off with. Then we moved on to Links. I did get a Libre from. From a relative from England. I tried it.

[A]

Shootandi. I thought I heard a little bit of British in your accent. Like 10 minutes ago. I should have said something. I would have seemed like a genius. Damn it.

[B]

I don't know. I don't think. I don't know what it was. But my country was colonized by people written. So maybe that's it then. Yeah, but I've never been there. I've never been to.

[A]

No kidding. Okay, no. So you had somebody send you a Libre, but you. So you have 2.2cgms there that you like that I've never even heard of before. So Dexcom doesn't make it into. Into that part of Africa.

[B]

I wanted to try out the Dexcom. I even have one, which we also got from. From the same relative. But then I think I need to. Somebody said I need to change my Google account.

[A]

Yeah, yeah.

[B]

Because there's no support services in Zim. Same thing for Libre. So those. Those people in Zim who use Libre have configured their settings to make. To make it look like they're in South Africa.

[A]

Yeah, I was just.

[B]

They can download the app.

[A]

Yeah, I was just thinking. I. I just heard. I don't think it's out yet, but I did this interview with this lady. Her son was diagnosed in South America on a ski trip and she had type. She has type one, the mom. So when she flew to meet him at the hospital because he Was there not speaking the language, being diagnosed as like a teenager. Right. And she flew there to help him. She put a bunch of her supplies together, brought them down and then tried to slap a DexCom on him, but it wouldn't work because her app was, was. Was coded as she lived in America, so it wouldn't let her start it. And that's got to be the same problem. I see. I wonder why they do that.

[B]

Yeah, it doesn't. It sucks. It really does.

[A]

We already paid for it. What do you care?

[B]

You know, I just. I don't want to see them go to waste because we've got three of them right now that we can't use because of this problem.

[A]

Right.

[B]

Not something I'm just going to hold on to them and then figure it out.

[A]

Yeah. So now he comes home, he's diagnosed. Is he in school at that point? How do you manage all of this?

[B]

So he was in preschool at the time and I, I had to quickly message his teacher just before schools opened in January, that, that was the second week of January. So I taught her and I said, so this is the, this is what's going on with Levi and I'm going to need help with abcd. And they were very, very helpful, I have to say. They were open to. To learning about everything that was going on and they reacted very quickly.

[A]

That's lovely.

[B]

So, luckily my employer was able to give me the time to work from home whilst we tried to. To kind of figure it out, get to understand and figure the whole thing out. So I had, I think about a month of working from home and being able to go to school and react as quickly. However, I wanted to mention that when, when he was now coming into. Into primary school, Right. So he started primary school this year and I was looking for. I decided to change him and put him in a smaller school than the one we originally wanted to take him to. So I had an interview with the. The headmaster of the school, I think it was the deputy head or something, and I said, look, could we please have our son come here? It's a. It's a very. One of the most popular private schools in. I explained to him what the condition was and in everything. And to my absolute horror, he said to me, look, we already have a child with Type one and we're not, we're not jumping up and down to get another one.

[A]

We're not. We're not too keen on this. Why don't you keep that kid? Yeah, that's got to break your heart.

[B]

Yeah, it's a strain on our teachers and all this and all that. So. So we went back to the big school where we. We had already planned to take him since he was a baby. And to my surprise, they were, you know, more welcoming and more receptive. Of course, there's. They. They had a healthy amount of fear and, you know, just hesitation about, okay, can we do this? So did they really been helpful?

[A]

Yeah. The school he ends up at, did they have background in this or were they just willing to learn?

[B]

No, I think. I think there could be one or maybe one or two other kids, but they are older kids, so the teachers don't have to intervene as much as they have to with. With Levi, who's six. Yeah, six in August.

[A]

It would be interesting to hear from that. That deputy headmaster, like, what, what, what makes it such a struggle? Like, maybe that child comes there with. No, I mean, like, listen to what you left the hospital with. You weren't sure the difference between Basil and Bolus insulin, right? That maybe that kid's in that situation. And they're like, no, you don't understand. This is a show. And, and they don't. We can't do two. You know, and yeah, that's. It is very interesting.

[B]

It's a lot. It is a lot. Because I've asked the teacher, his teacher right now she has to help him with injections. I had to ask her because of course, now I'm trying to get him to, to inject himself. He can. He can inject himself.

[A]

Oh, awesome.

[B]

If you, of course, you have to measure out the units for him. But she still has to help with that. She has to communicate with me when she sees the signs of a, of a hypo.

[A]

Yeah.

[B]

And I have to call her when I get the, the alerts to say, okay, he needs an injection now, or things like that. But they've been really great with that.

[A]

That's awesome. Hey, is there a cultural belief about lifespan or health with type 1 diabetes is like, did you get the big speech in the hospital? Like, his life's going to be different or shorter or do they tell you anything?

[B]

No, no, no. Never told us any of that. But there is no shortage of advice that you get in myths from society about how it can be cured by, you know, by this plant or that diet and things like that.

[A]

Are you in the Facebook group by any chance? In mine, yes.

[B]

Yes, I am.

[A]

There's a post in there the other day, some lady said she was on a vacation and I, I forget if it was an Uber driver. Somebody told her if the kid just sat in a cold, dark room, it would go, oh my gosh. So do you get a lot of, you get a lot of that around there? A lot, a lot of, A lot of grandmoms telling you how to handle it.

[B]

Yes, we do get a lot of that.

[A]

Yeah.

[B]

So I always try to explain that. Look, there's a difference. There's two, two types. And so the other one is reversible, the other one isn't.

[A]

Yeah, I just, I asked because it's been a long time ago now, by a long time ago, maybe 10 years ago, I did a talk in the Dominican Republic. I did a diabetes talk in the Dominican Republic. And while I was there, the, the, you know, the community there was sharing a story with me about a 13 year old who had passed away from like advanced issues from type 1 diabetes. And, and the child had only had it for five or six years. But that's how, that's, it's sad, but that's how little the understanding of the management was in the air. It was almost like, well, you have it. But you know, I think I, if I'm, if I'm not mistaken, they were allotted one test trip a day.

[B]

Oh, no.

[A]

Yeah. So, so really difficult. So it's, I mean, you, you described where you live as, as third world and I don't know what that means. Like, I, I find myself think, sitting here thinking, like you described an amount of money that you could live on for a month, that some people here pay for their car payment. And, and so I was, I'm like, I know I don't have context for, for your situation, you know, but I, so I was wondering, do people hear type one and go, that's like, I was wondering if maybe you heard, you know, death sentence and thought, no, no, I'm going to go figure this out on my own or.

[B]

I don't think, I don't think my mind went there at first. I was, I was taking it one day at a time, literally. Because I also don't remember a lot of what was going on during those days. It was all a blur, sure. But I was just taking it one day at a time. I never thought beyond the next couple of days.

[A]

Yeah.

[B]

Do you think that could have helped?

[A]

Do you think that, I mean, do you have context for. If you didn't go out into the world to learn about this, what would following doctor's advice get you?

[B]

Yeah, we, we would, we would be struggling.

[A]

Okay. You mean?

[B]

I think we would be.

[A]

What, what do you think the struggle, like, what do you think the struggle

[B]

would look like just to understand what is even going on?

[A]

Okay.

[B]

Because it's a lot with, with diabetes. So we got basic information. Like I said, it was what he called textbook information. And that, that had nothing to do with you understanding that rice does that. That sugar levels react differently to rice than to sadza, than to pasta, than to pizza.

[A]

Right.

[B]

And there was nothing said about insulin on board. There was nothing said about, you know, even the ratios, the carb to insulin ratios or things like physical activity at school, all of that.

[A]

Nothing at all.

[B]

So.

[A]

So the basic information they gave you was his pancreas isn't making insulin anymore. And you're going to need to inject this.

[B]

You inject 5 units of this one in the morning.

[A]

Oh, gosh.

[B]

And in the evening. And you inject five units of this one 30 minutes before every meal. And you test and you Correct and.

[A]

Yeah. Are they testing his. His A1C?

[B]

We, we've gotten it. We've. We've. We've had that done twice since his diagnosis. Yeah, I figure we're getting the test once a year.

[A]

What, what, what was his last day? Once a. Do you know?

[B]

It was eight, nine.

[A]

Eight or nine. Okay. And then on and on. His. Does his CGM give you information about, about like time and range or an average agency?

[B]

Yeah, it does. It gives us time and range. It give. It gives us, you know, the average glucose level over the last 3 hours, 6 hours, 1224. Then of course you get the report once it's. It's done, the. The 14 days.

[A]

And what are your goals? What are you trying to accomplish? What are you trying to get to as far those, as far as those outcomes go?

[B]

We're trying to be in range Maybe, I think 100% of the time would be very ambitious. I'm just trying to get to maybe be in range maybe 80% of the time.

[A]

What's the range you're trying to stay in?

[B]

So we're trying to stay between 5 and 10.

[A]

Okay, fine.

[B]

I don't know if that's okay.

[A]

Hold on a second. I have to pull up my little A1C estimator. Available@juicebox podcast.com and 5 and 10. So somewhere between 99 and 180. You're shooting for right around there.

[B]

Yeah.

[A]

Okay. 90 and 180. Okay, well, I mean, that's a very reasonable range. Are you having luck with that or is he. I mean, if his A1C is 8 or 9, he's higher. More than you want him to be, right?

[B]

Yes, definitely. There's lots of work to be done. Yeah.

[A]

And what would you say that is? Is that your understanding of the insulin? Is it the food? Is it the time you're able to spend with him? Like, what do you think is.

[B]

I think it's the time that I'm able to spend with him because I'm only with him when I get back home from work. And then he's at school from, from 7 up to 12, and then he's with the nanny from the. Until I get back home.

[A]

Is he experiencing many hypers, any. A lot of lows, or is he mostly higher?

[B]

It's a, it's a combination of both, to be honest, because sometimes it, it has to do with maybe he went to school and then they went for swimming or he went and did some type of sport, and then the, the particular teacher or coach that was with him during that time didn't know to watch for the, for the alerts, and then they didn't give him the glucose tablets that he needed so he can

[A]

get, he can get low and stay low. And are you mostly. Are you not being as aggressive with insulin because you're worried about him getting very low when he's away from you or.

[B]

Yeah, sometimes I'm conservative because the. Another thing is that I've noticed it's winter here right now.

[A]

Okay.

[B]

Just started the winter season. And I've noticed that he's more insulin sensitive for some reason.

[A]

Some people talk about that to pull

[B]

it back a little bit, and I'm still trying to figure out what the right dosage should be.

[A]

Yeah.

[B]

And I think I changed it. Yes. Just yesterday.

[A]

And what insulin is he using right now?

[B]

We're using Novorapid and Protofen Novo rapid.

[A]

Okay. And how, how much does he weigh

[B]

is 20, 22 kgs.

[A]

Okay. And. And you're. So you're shooting. Does that basal insulin go in once a day?

[B]

No, we g. We give him basil in the morning. Yeah, we give him. For the morning, I, I give him between, between seven and nine units of the basil, and then in the evening I give him five.

[A]

So they have. You're splitting it because that's the directions for the medication or because it's what you found worked better.

[B]

That's what the doctor told us to do.

[A]

The doctor, you know, can you spell the name of that, that Basil insulin for me?

[B]

It's P R O T O P H E, N.

[A]

Got it. Yeah. So they say it. I wonder if that's Levomir. Hold on a second. I'm gonna try to find out.

[B]

Okay.

[A]

Is. Because if they're asking you to split

[B]

it,

[A]

It's not Levomir, it's mph. Okay, so he's using MPH and Novo Rapid. Do they not. Do you not have available. Something like. Hold on. List basal insulins available.

[B]

I know people who use Tresiba.

[A]

Yeah, that's what I'm wondering about.

[B]

You know, I kept meaning to ask him about it because I. I haven't heard of other people who use protofin for basil.

[A]

Yeah. I think the reason I didn't recognize the name is because it's so old, most people don't use it around here anymore. If you have access to Tresiba, I would switch to that.

[B]

Okay.

[A]

Yeah. That would be One injection every 24 hours and.

[B]

Really?

[A]

Yeah. And I would wonder if you wouldn't see a fairly reasonable reduction in his A1C too.

[B]

Okay.

[A]

Yeah.

[B]

All right.

[A]

Yeah, I think that would be a great idea for you, actually. I mean, ask the doctor and see what they say.

[B]

Yeah, I kept meaning to ask him, but the last appointment, I think it slipped my mind. I'll give him a call. Thanks for that.

[A]

No, of course. You treat that like that's an important thing to do because. Because I think it really could end up being meaningful for him.

[B]

Yeah.

[A]

Yeah.

[B]

Okay.

[A]

And save him a shot, at the very least a day.

[B]

Yeah.

[A]

Yeah. Are there pumps there? Are you thinking about pumps?

[B]

We've thought about pumps, but right now we had to shelve it because for me it was just having. Aside from the cost, of course, because I don't think our medical aids would cover pumps.

[A]

Okay.

[B]

Because they're already bulking at the cgm, so.

[A]

Really?

[B]

Yes. Okay. It was quite. I had to do a lot of research to get them to cover that. I think they may have been hoping. I didn't know that I was entitled to it.

[A]

I see a lot of whistling and looking at the ceiling. Yeah, yeah, yeah.

[B]

So it happens a lot around here. If you don't know your entitlements, you might miss out on things that you should be getting. So you really need to do your research. And so we got them to cover that. And I think pumps. I don't even know if there would be support. I don't know anyone who is on a pump. I think one or two other parents in Harare, but they may have had to go to South Africa to. To. To get set up and. And all that. So I know very little about. About a pump and the cost.

[A]

Well, I would tell you that whether you can get a pump or not, if you can get your hands on Tresiba as the basal insulin, I think that would be a big deal for him.

[B]

Okay.

[A]

Yeah.

[B]

All right.

[A]

For real, because you are. I mean, listen, you're educating yourself, you're paying attention. You're doing the best you can with the communication tools you have for during the day when he's not with you. People are looking out for him for the most part. With that much effort, I think you should be seeing. I think you could easily see an A1C in the sevens. And. And if that's. And if that's the case, and I'm asking myself, what's holding you back? I think it might be the mph or. Or, you know, or not having a more modern basal insulin. And Treba is maybe like. I did a little bit of Googling here. It looks like you can get what you're using now. You can get Lantus, Baslogar. Some might. Might be Semigli glar given Levomir, Tresiba. But I think if you're asking me, I'd shoot for the Tresiba.

[B]

Okay.

[A]

I don't think you want. You know, Atlantis would be great if you could get it Levomir, you might have to split the way you are now doing one every 12 hours to get really good effect out of it. But honestly, any of them, Lantis, Levomir, Trasiba would be better than what you're doing, I think.

[B]

Okay.

[A]

All right.

[B]

Trying to write that down.

[A]

Yeah. I would go Trasiba first. If you can't get Tresiba, ask for Lantus L A N T U S. If you. If you can't get Lantus, see if they have Levomir. Although I'm hearing it's being discontinued in America, but I don't know if that means it's being discontinued other places.

[B]

I see.

[A]

Yeah. So honestly, I think that'd be a big deal for him.

[B]

Oh, great.

[A]

Yeah. Well, definitely add some more stability to his background insulin. Add more stability to his blood sugars. I would have bet it would balance out his time and range and give you a more of a fighting chance when you're making decisions.

[B]

Great.

[A]

All right, you're not done yet, but let me know if you're able. Would you send me a note and let me know if you're able to get a hold of that?

[B]

Yeah, sure.

[A]

Okay.

[B]

I'll give you an update because we actually scheduled to see him this Saturday. Oh, conversation we're going to have.

[A]

Awesome. Tell him the guy from the juice box podcast Said to give it to you. And if that carries any weight in Zimbabwe, I'm running for president. What do you think of that?

[B]

So it does. Trust me, it does.

[A]

That's crazy. I can't wait to go downstairs and tell my wife about this after we're done. I tell my own kids stuff, and they don't listen to me. And you're telling me that people in Zimbabwe going, like, you got to listen to this guy. God, on that podcast.

[B]

You should come and maybe have a few conferences, because I'm sure you would be surprised with the turnout.

[A]

No, kid, I, I was surprised in, in the Dominican. I spoke at a big. I spoke at a big event there. It was really. It shocked me, but it was so long ago. I, I, it's kind of out of my, out of my. I, it's been so long since I was there, it's hard to remember. I, actually, the one thing I'll tell you is that I got there and I had this whole talk set up to give, and I, I looked around at my surroundings, the, you know, where people lived, what the level of income seemed to be, what. And I thought, oh, my talk is completely wasted here. I had to. I actually was supposed to go to dinner that night. Instead, I went back to my hotel and I, I sat down and rewrote everything I was going to say because they, they would have had no context for what I was going to say. And it was really, you know, for similar reasons back then, availability to technology and, and the way they even think about it was all just, it was different than how. So much different than how I thought about it that I thought, oh, what I'm going to say isn't going to be helpful. So I changed my, I changed my talk up. But listen, if anybody wants to fly me to, to Africa to give a talk, I'm in.

[B]

Yeah.

[A]

Like, I would. Are you kidding me? How many shots am I gonna have to get to go do that? They're gonna make me do a bunch of inoculations.

[B]

I don't think so. Really? You may, I don't know, you may get a malaria shot. I doubt, though.

[A]

I, I can handle that. Would I get to go on a safari while I was there? I would like to do that.

[B]

Oh, yeah, there's. You would. I think you would love it. Yeah. If you love the outdoors and.

[A]

Yeah, I do.

[B]

And animals and, and nature. Yeah. There's really some, some beautiful places to, to, to visit.

[A]

I'm looking at my list of advertisers right here, trying to Think of which one would want to send me to Africa. And I'm pretty sure none of them is the answer. But I'm putting the call out right now. Oh my gosh. Well, okay, so he's in school. There's some struggles. You're getting through them. You're getting good support from the school, which is awesome. How involved if this is cultural, I'm not sure. But my question is, and I don't want to cause you a problem, but is your husband involved in, in his care too? Is it all on you? Are you guys splitting it? How do you do that?

[B]

Yes, he's, he's involved in the care a lot more so on the financial side only because I, I think I've had, I've really had a tough time relinquishing control over this thing because I, I obsessed over it in the beginning and getting all the information and, and all that. So I've felt I'm only now starting to, to release a little bit of, of responsibilities even to my daughter. She's, she's great. She also helps quite a lot. But yeah, everybody's involved. My husband is a bit, you know, hesitant with the injections, but he's good with everything else. Okay. The alerts and just keeping an eye on, on everything. And also our parents are great. Yeah, Mother in law's been awesome and my sister in law not scared to

[A]

help and give insulin and stuff like that.

[B]

Exactly.

[A]

That's great. That's great. Hey, do you have guilt? Do you feel guilty about it or anxiety from it? How would you describe why you're holding on so tight?

[B]

I think it's anxiety because when, when I, when I was researching about it, I. At first I did ask myself what I could have done wrong that led to, to this condition. But when I, when I realized what it was, I didn't have any guilt at all. But I am anxious, especially with, you know, the, these long term effects that come with, with poor management.

[A]

Right.

[B]

Really anxious about that. But yeah, I think I'm one person who likes to do everything myself. I have a tough time delegating.

[A]

Were you like that before the diabetes too?

[B]

Yeah, I've always been like that.

[A]

Yeah. Do you have, are there any other autoimmune issues in your family? Do people have hypothyroidism or celiac or anything like that?

[B]

My brother has hypothyroidism. Yeah.

[A]

Have you ever been tested for it?

[B]

No, I've never.

[A]

Make sure they test, make sure they test Levi once a year for it. Okay.

[B]

Okay.

[A]

Yeah. You Want to watch for that? Symptoms are, you know, unexplained weight loss or weight gain, hair loss for you could be brittle nails, weight gain. No matter how much you sleep, you can't feel rested. Always, always cold, heat, intolerant, stuff like that.

[B]

Okay.

[A]

Yeah.

[B]

All right.

[A]

So make sure you're. You're paying attention for that because it's. Once you get one, it's not crazy to get another one. Didn't surprise me that your brother has hypothyroidism, for example. So, you know, just keep. Keep an eye. Anybody anemic?

[B]

My mom.

[A]

Your mom is. Yeah. Again, not totally surprised. So. Yeah. Autoimmune issues. Yeah, autoimmune issues can kind of run in families. You don't always all get the same one, though. Yeah. And anxiety, while not an autoimmune issue, is a thing that I like. From my personal experience talking to so many people, I see a lot of anxiety in families who have Type one.

[B]

I had anxiety myself, but that was. I think that was linked to. That was in the few months before I got diagnosed with. With epilepsy myself. I used to have a lot of anxiety.

[A]

Did you?

[B]

But I think that was because of stress from work.

[A]

Yeah.

[B]

Well, I didn't think that was co. Connected.

[A]

What's more stressful, work or that diabetes? Hard to tell.

[B]

Some days it's hard to tell. Good question. I really couldn't make up my mind, but I think that the diabetes was stressful when I didn't know what I was doing. But I know that it's something that I can. I can perfect at some point.

[A]

Yeah.

[B]

Not perfect, but get as close to perfection as possible. And the fact that I. I have some sort of control over, you know, how things may go make. Makes it less stressful than work.

[A]

I think you've said a few things while we've been talking that I. I'm. I don't want to ask because I think it sounds distasteful to ask, but it feels like you're mimicking some of my words back at me. So are you learning those ideas from the podcast?

[B]

I don't know, because maybe it's possible because I do listen to. To your podcast every morning when we're getting ready, you know, in the morning to go out. We. We usually have your podcast playing and, you know, that could be. That could be it.

[A]

Well, that's just. It's all good things about, like, you know, just having expectations for, you know, getting better at this over time and stuff like that. Like, it's nice to think that you're, you're finding value in it at all, honestly. Does your husband ask, like, does he make fun of you for listening to a podcast from a guy in New Jersey? He does, right?

[B]

You know what? He, he has, he has several times something has been said on the podcast, and he's, he's looked at me and said, can you replay that? Can you rewind? I didn't hear that.

[A]

Oh, well, yeah, you know, you're making my day. I have to tell you.

[B]

Yeah. I think it could be a joke and something that you would have said that.

[A]

Oh, the guy, part of me, he likes that part. I got you. Okay.

[B]

Yeah.

[A]

Well, that's like, hey, however, however. You get him listening, who cares? Exactly. Right? Hey, how old are you? I didn't ask you in the beginning.

[B]

I'll be 40 in July.

[A]

You'll be 40 in July. Oh, happy birthday. I'm July two on the 12th.

[B]

Ah, nice. Yeah, nice.

[A]

Yeah. Do you find any of that zodiac stuff to be true about cancers?

[B]

No, I've never.

[A]

You're not emotional or like, like, have you ever read, like, the. I, I don't believe in astro. I want to say I don't believe in astrology at all, but Arden read me something the other day, and I was like, that all does really sound like me.

[B]

I've never paid attention to any of that stuff, actually. Me either, in front of me until,

[A]

you know, the other day, she just, like, she's like, hey, does this describe you? And she read a whole bunch of stuff. And I was like, oh, I think it does that. We read some other ones. I'm like, these all just, I think these are just written so they describe

[B]

everybody, but, but they're generalized like that.

[A]

Yeah. Are you getting sleep? Are you sleeping okay?

[B]

I think I sleep okay.

[A]

You're not worried about right now?

[B]

I'm not sleeping much because I'm also studying. I'm doing further studies, so I, I don't get to sleep because of that.

[A]

But the diabetes isn't keeping you from sleeping.

[B]

There have been days, they've been days, especially in the beginning, when we couldn't figure a lot of things out. But now I know. I know what to do. Especially with the cgm. The arrows tell me how to, how to react or how to respond to an alert here, which usually keeps us good for the next few hours, especially if I'm with him. I'm able to. To get ahead of it so I can get some sleep.

[A]

Good, good. You know, I have to tell you, like, I, I, I, I Try. I don't want to be like. I don't want to say something that sounds stupid. I guess I'm trying to be careful here. But you have. Do you have an AI model? Do you have, like, chat GPT there or something you can use to break down the food? Because that's got to be like. It just occurred to me, like, why don't we. Why don't we do this? Can you give a nutritional breakdown for sadza? I need fat, protein, and carbs. Let's see what happens.

[B]

Okay.

[A]

I'll give a plain serving estimate since I changes a lot depending on how much maize or meal is packed into the portion, it says. And now it's looking online for answers. So let's see what happens. And while it's doing that, I'm going to ask a different model, the same question to see if we get a reasonably similar answer. All right, So I did ChatGPT first. It says that 100 grams cooked sadza should be between 20 and 45 carbs, between 2 and 5 grams of protein, and it only has about a gram of fat in it. A medium serving, which they're calling 45 to 55 carbs. So 4 to 6 protein. Okay. So the wide ranges become a size that can be soft or thick. Water adds weight but not calories. So a wetter sadza has fewer carbs per 100 grams than a dense one. So that might be helpful to know, too. If it's denser, it might have more carbs in it if it's wet or less. And then I used. I also use something called Claude. I don't know how many of these you guys have there, but a rough nutritional breakdown for a typical 1 cup serving, which is about 240 to 250 grams of cooked sadza. Again, 40 to 45 carbs, 4 to 5. Protein. Yeah. Fat, 1 to 2 grams. So does that. Is that about what you imagine or is that helpful information?

[B]

I think this is helpful. I've never. I don't think I've ever broken it down like this.

[A]

I have to tell you. I just. It makes a ton of sense to me because. Do you guys eat boda? Am I saying it right?

[B]

What?

[A]

Or kapenta Wisadza

[B]

Capinta is not a favorite of mine.

[A]

No. Okay, well, I don't know what I'm doing. I'm just going by. I'm just giving you a list of what's been sent back to me. But what I think is, no kidding, if you have access to ChatGPT, it's as simple as give me a nutritional breakdown for the food and ask for fat, protein and carbs.

[B]

Do you know, it's, it's actually quite funny because I use chat GPT almost daily for my school.

[A]

Yeah.

[B]

I never thought to, to ask for a breakdown for, for food.

[A]

I would give it, I'd give it a shot. And, and if you go, if you want to go back to my website, there's a, a bolus estimator there. So you could, if you, you ha. If you know his settings, his insulin to carb ratio, his sensitivity, you can plug that all into that little estimator and then put in the carbs, the fat and the protein and it'll give you a suggestion about where to start with a bolus.

[B]

Yeah, yeah. It's crazy. I never thought to, to prompt chatgpt about that. But I did go to, to the calculator thing on your website. The only thing that threw me off was how to determine sensitivity.

[A]

His insulin sensitivity, the metrics.

[B]

Yeah. That number is only know that he's more sensitive or he's less sensitive. But the numbers.

[A]

Yeah, yeah. So what you, what you would do there is that's how much, how much, how many, how far? Like what number does one unit of insulin move him? So when you put in the, the, the fast acting insulin, like I guess the, the question here would be if his blood sugar is. Oh, I have to bring up the, I have to bring up so I can talk to you in, in your. I'm not good at talking in millimoles. Hold on a second. If, let's say his blood sugar was, let's say it was 10 and you wanted it to be so for people listening, it was 180. Your blood sugar was 10 and you wanted it to be 80. How much insulin moves him from 180 to 80? Do you know? Do you have a guess?

[B]

So that's from ten to.

[A]

Yeah. To ten to like four and a half. So think about it like five. How, how much insulin moves in five millimoles.

[B]

Wow. Because there's also the time factor to say how quickly does it get him there. Right?

[A]

Exactly. Maybe time a day for his activity and stuff like that. Yeah.

[B]

So if, okay, maybe if I, if I give you the, if I give you the correction scale.

[A]

Okay.

[B]

Does that, does that give you.

[A]

Maybe.

[B]

But first a better picture at first.

[A]

Tell me what does he weigh? How many kilograms does he weigh?

[B]

22.

[A]

So he's about 49 pounds, maybe 48 pounds. And I. So you're not using a Modern basil and sun yet. So there's a little bit here that I don't know. But my, the guess here from this is that a unit of insulin moves him about 146 milligrams per deciliter, which should be. Let me find out how many millimoles that is. I know the people who know this are like, they just know it because they do the math real quick. So 146 would be about 8 millimoles.

[B]

Okay.

[A]

Yeah. So would a unit move him about that far, do you think? Oh, wait, I have it here. I'm so sorry. Yeah, yeah, eight. My, my, my estimator does that. I did. I never clicked on it before. Oh, it works. Congratulations. So there's a, there's a settings calculator here that helps you guess by weight about what settings would be. So, so my point is that if, to check, you could check to see, does one unit of insulin move him about 8 millimoles? If that's right, then you understand his insulin sensitivity to be one to eight.

[B]

Okay.

[A]

Okay. And then you can, you know, when you use the calculator, that's about the sensitivity you would put in. And his carb ratio is. What do you think? Like, how many car, like how many carbs does a unit of insulin cover for him?

[B]

Let me see where I look. One second.

[A]

Take your time because this has a guess based on his weight. So I'm interested to see how close this is to your reality.

[B]

Okay, so I. Well, on average, maybe if, if we give him, if, if he's having a meal with maybe 30. 30 calves, that could go with roughly two, two to three units.

[A]

Two to three units.

[B]

And that's the short acting.

[A]

Okay.

[B]

The Nova Rapid. Yeah.

[A]

And that's probably because you're not getting a lot of backing from the, the background insulin. Oh, so it's possible. It's hard to talk about right now because you're using that, but it's possible that if you can get him moved to Tresiba, what you're going to find is that he's going to use about six units of Tresiba a day. And then, then you might find that a unit of insulin covers about 40 carbs for him with the basal insulin with the MPH. I honestly don't know how to talk about that. Like, I'm not sure. But if you're finding, if you're finding that it takes two units to move him for 30 carbs, then at least that calculator could probably give you an idea of like, well, about how much is Here, based on your settings. And then you could, you know, you can hold that up against what you've been finding. And my thought here is, what if you. What if you say, oh, well, I would put in, I don't know, three units for this meal, but this. This estimator is telling me it's more like four and a half, and maybe that's why his A1C is eight and not seven or not six. Do you see what I'm saying? But again, I might hold that thought until you shake that Tresiba out of that doctor on Saturday. I think that's. That's. That's the. That's the way to go. If you want to point your anxiety at somebody, point it at the doctor and ask for Traceeba so see what you can get.

[B]

Definitely going to ask for it. Yeah.

[A]

I mean, it would be a big deal. And listen, once you have that, hopefully you get it and it works well for you. Go tell your friend group, too, in case they're doing the same thing, because you're managing with insulin that we don't really even use here anymore.

[B]

Okay.

[A]

You know, and if you have the other stuff available, then. Then I say go for a more modern basal insulin.

[B]

Okay.

[A]

Yeah. Is there anything that we haven't talked about that you wanted to. I don't want to skip. Anything that you want to talk about.

[B]

No, I think. Yeah, I think I got everything out that I wanted to.

[A]

Good. I want to tell you and people listening. I'm not telling you to let an AI model manage your. Your insulin, but a person in your situation, I don't know why you wouldn't at least try to get a background from it and say, look, my son is this old. He weighs this much. He takes this. This insulin at this time of day this much. He takes this, he takes another shot of it 12 hours later. That much. This is what he's using for meals. Remember that? And now here's what we're eating. Can you help me bolus for this and see if it can't. And see if it can't give you some direction?

[B]

Yeah, I don't.

[A]

I don't. Listen, again, everyone should talk to their doctor first, but of course.

[B]

Yeah.

[A]

Thank you for saying that. 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. But I'm seeing some people online who are doing this, and it's helping them a lot. A lady put up some graphs the other day, and she's like, I didn't know what to do. I had trouble understanding the podcast. I've been talking it through with a large language model and look at my kids graphs. So basically just treating it like a sounding board for, and giving it as much information as they could about what was going on and it was helpful for.

[B]

It's interesting because I just, I don't know why I never thought of it.

[A]

Yeah, maybe, maybe because it's a little silly, but it works. So for a lot of people. So maybe it's worth a shot.

[B]

It makes a lot of sense.

[A]

Sure.

[B]

Yeah.

[A]

Listen, I was in a store the other day, I had to buy lumber just two by four, you know, to build something with. And I got there and realized I'm like, I don't want to buy extra. I just want to, I want to be able to make, you know, I don't want to have a bunch left over. And so I, I opened up my phone, opened up chat GPT. I was talking to it in the store and I was like, I'm building a frame in this area, like here, here, here. It's going to have four sides and four legs and then four other sides. I'm going to make a stand out of it. I don't want to buy extra two by fours. Tell me exactly how many I need to get these pieces out of it. And it did the math in like a split second and told me and I was like, right on. And then I bought four two by fours and I left. So, and, and I, and I even said to it, I was like, hey, are you accounting for all the cuts I have to make? Like not just giving me like the number of inches I need, you know, or the amount of distance. And it said no, I already, I already thought about all that. I was like, oh, awesome. So anyway, I don't want to get replaced in Zimbabwe by chat GPT. But I do want, I do want you guys to be healthy and happy. So I think any, any tools you can find that are valuable, you should use them, you know, it's awesome. Hey, what time is it there? You're about eight hours ahead of me right now.

[B]

It's 7:21 in the evening.

[A]

Okay. You're six hours ahead of me. Okay. I could, I wasn't sure if you, you said you weren't good at geography and I couldn't figure out if you were east, west or central Africa, so neither can I.

[B]

Trust me. I don't even know is,

[A]

do you not get to leave ever? Have you ever been to another country?

[B]

Yeah, I've been to. I've been to South Africa, I've been to Botswana, and I've been to Mozambique.

[A]

Have you ever left the. Have you ever left the continent?

[B]

No, no, not yet.

[A]

Is there a place you'd like to see?

[B]

Yeah, of course I want to see. You know, to see New York, Los Angeles, Las Vegas, France.

[A]

Those places will flip you out. I listen. I watched my. I watched somebody once come into New York City through the subway from the airport. So I got to walk up from underground into the middle of Manhattan with them for the first time. And they walked up out of that hole and their head just kept going back and going back and going back. And the. Bill. The. She was from. She was from Wisconsin, from the middle of. And she's like, oh, my God, this is insane. I've never seen anything like this before. Until you see all those skyscrapers stacked on top of each other, it is a. It's only a thing you can. Pictures don't do it justice. When you're standing on the ground, it's really. It's really crazy. So if you make it over here and you can get a look, it'll. It gives you a different perspective, that's for sure.

[B]

So you're telling me that this person from Wisconsin, the difference between where she's

[A]

from and Manhattan was starkly, shockingly different.

[B]

Shocking. Okay.

[A]

Yeah. There's 100 story buildings there, and they're just one after another. And you're this tiny little speck on the ground looking up at them, and cars are going in a thousand directions. All you can hear are cars, motors, tires, people talking, feet moving. On a breezy day. There's this really interesting thing that happens in Manhattan that the wind only goes in one direction. So you could be walking down one road, be in a wind tunnel, then get to another, like to an intersection, and it just stops and. But it's just a very different place to be. So. Yeah, I've never been to Vegas, but I am going next year for my. For the first time to see it. I'm gonna go see a concert in the sphere that big. Like, have you ever. Have you seen that? The. It's like this giant building that's literally in a sphere. And you. I'm going there next, next year to see Metallica.

[B]

I guess I've never heard of that. And I know this is. There's a Las Vegas strip. I don't know.

[A]

Yeah, I think that's just casinos and hookers. I'm not really sure if that's anything else. You might want to skip that. You might want to skip that. Unless you're. I don't know what you're looking for. So maybe you. Maybe it's up your alley. I have no idea.

[B]

But it's just to see the most common places that we hear that. That America is famous for.

[A]

Yeah. But New York, it's different than any other place, but it is very. It is very much, I guess, an American icon. New York City. Yeah. Philadelphia is pretty awesome, but it's nowhere near like New York. I hate to say that because I'm from Philly, but.

[B]

Okay.

[A]

Yeah. All right.

[B]

I have a friend who says she stays in Philadelphia somewhere. An old high school friend of mine.

[A]

No kidding. Yeah. No, I'm very. I'm close to there now, actually. I don't want to tell people exactly where I am, but I'm within an hour of Philadelphia because I have had people send things to my home before, which. I appreciate it. Thank you all, but it freaks me out, so don't do that. Okay,

[B]

but.

[A]

But nevertheless, I really do appreciate you doing this with me. This has been a lovely conversation. I hope you found it valuable.

[B]

I did. Thank you very much.

[A]

Yeah. I appreciate it. What should we. Oh, of course. What should we call this? There's no way to. I. At one point, you said. You said. You said we had a pizza disaster. I thought is Zimbabwe pizza disaster, too.

[B]

Could.

[A]

Is that too much of a title?

[B]

You could call it Hurricane Levi. Yeah, we spoke about, you know, how energetic he is, and sometimes that's what I call him.

[A]

What do you call him? Say it again.

[B]

Hurricane Levi.

[A]

Hurricane Levi. Okay. I know you've mentioned it, like four times. That kid, you were like, he's a handful.

[B]

He's a handful. I think I should have had him because my kids are far apart in age.

[A]

Get a little tired.

[B]

Him in my 20s, when I was younger.

[A]

Well. But let's be honest. I know. Is he more like you or your husband?

[B]

He's more like my husband.

[A]

Okay, I see. So you got two little boys. You're. You're wrangling over there.

[B]

Yeah.

[A]

Yeah. Well. Well, thank you so much. If you hang on the line for just one more second, I. I'll tell you a couple things about how this will come out, but. But you're all done. And I do. I really do appreciate it. Hold on one second. Of course. It's a pleasure. Something new just arrived from Minimed. It's the Minimed 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 Med Flex is fully controlled from an app designed to stay tucked away, empowered by the proven automation that helps over 600,000 people manage diabetes day and night. Order today minimed.com juicebox Having an easy to use and accurate blood glucose meter is just one click on away contour next.com juicebox that's right, today's episode was sponsored by the Contour Next Gen Blood Glucose Meter. It's the meter my daughter uses. She has it on her right now and you're one click away from having it too. And don't forget, using Juice Box Podcast links helps support the show. Friends 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 am joined by Jenny Smith, who is a diabetes educator with over 35 years of personal experience, and we break down the 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@juicebox podcast.com by going up in the menu. If this is your first time listening to the Juice Box Podcast and you'd like to hear more, download Apple Podcasts or Spotify? Really any audio app at all? Look for the Juice Box Podcast and follow or subscribe. We put out new content every day that you'll enjoy. Are you tired of scrolling past clips that last five seconds? Are you an adult? Would you like to have a long conversation? Juice Box Podcast is the place to be. Follow and subscribe. I'll be here tomorrow with another episode. I hope to see you again.