#1742 Penny Drop - Part 1
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DAFNI, a UK-based program teaching dose adjustment for normal eating, while discussing the evolution of diabetes management and the vital importance of peer support.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner (0:00) Hello, friends, and welcome back to another episode of the Juice Box podcast.
Liesl (0:13) I work for an organization called DAPHNE. (0:15) So DAPHNE stands for dose adjustment for normal eating, and it's a not for profit part of the NHS. (0:22) And we provide education for people with type one and type two diabetes.
Scott Benner (0:28) Nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise. (0:33) Always consult a physician before making any changes to your health care plan or becoming bold with insulin. (0:46) Have you tried the small sip series? (0:49) They're curated takeaways from the Juice Box podcast, voted on by listeners as the most helpful insights for managing their diabetes. (0:56) These bite sized pieces of wisdom cover essential topics like insulin timing, carb management, and balancing highs and lows, making it easier for you to incorporate real life strategies into your daily routine.
Scott Benner (1:07) Dive deep, take a sip, and discover what our community finds most valuable on the journey to better diabetes management. (1:14) For more information on small sips, go to juiceboxpodcast.com. (1:17) Click on the word series in the menu. (1:30) The episode you're about to listen to was sponsored by Touched by Type one. (1:35) Go check them out right now on Facebook, Instagram, and, of course, at touchedbytype1.org.
Scott Benner (1:41) Check out that programs tab when you get to the website to see all the great things that they're doing for people living with type one diabetes. (1:48) Touchedbytype1.org. (1:51) The podcast is also sponsored today by Tandem Mobi, the impressively small insulin pump. (1:57) Tandem Mobi features Tandem's newest algorithm, Control IQ Plus technology. (2:02) It's designed for greater discretion, more freedom, and improved time and range.
Scott Benner (2:06) Learn more and get started today at tandemdiabetes.com/juicebox. (2:12) Today's episode of the Juice Box podcast is sponsored by the Eversense three sixty five, the one year wear CGM. (2:19) That's one insertion a year. (2:21) That's it. (2:22) And here's a little bonus for you.
Scott Benner (2:24) How about there's no limit on how many friends and family you can share your data with with the Eversense Now app? (2:30) No limits. (2:31) Eversense.
Liesl (2:33) So, yeah, my name's Liesl. (2:34) I'm a diabetes specialist nurse by oh, there's my phone. (2:38) I thought I'd put that on silent. (2:40) Sorry about that.
Scott Benner (2:41) No. (2:41) It's okay. (2:41) It's a great intro. (2:43) Don't worry.
Liesl (2:43) I no. (2:44) I did put it on silent. (2:45) It was to remind me to log on to this if I hadn't already done it. (2:49) So that's what that's all about.
Scott Benner (2:50) Lisa. (2:50) Lisa. (2:51) Hold hold on a second. (2:52) First of all, I definitely think we have to call this episode Lisa Lisa cult jam, but that's a different problem for a different time. (2:58) What do you mean you put on a timer in case you forgot?
Liesl (3:02) Oh, well no. (3:03) Because I was I had to do some training before this that I wasn't expecting to do, so I was gonna have lots of time to prep. (3:09) Gotcha. (3:09) And it was if I got carried away with the training, but I left them early because I was so conscious I didn't wanna be late for you that I left the training early and left a colleague to take over from me. (3:18) So Oh.
Scott Benner (3:20) There a sick is there a sickly person in England now because you had to be on the podcast? (3:24) What's going on?
Liesl (3:26) No. (3:26) No. (3:26) No. (3:27) No. (3:27) It's fine.
Scott Benner (3:27) It's all good. (3:28) It's all good. (3:29) Tell me, Lisa, a little bit about, your job. (3:32) What is it you do?
Liesl (3:34) I work for an organization called DAFNI. (3:37) So DAFNI stands for dose adjustment for normal eating, and it's a not for profit part of the NHS. (3:44) And we provide education for people with type one and type two diabetes, which is free of charge. (3:50) And we also provide education for health care professionals who work in diabetes. (3:55) And we teach them about type one diabetes, type two diabetes, and also how to teach that education to the people they work with and support who have got diabetes.
Scott Benner (4:06) Would it fry your mind if I told you that today there's an episode up called sneaky chocolate bar? (4:14) And, sorry. (4:15) That part isn't what I thought would fry your mind, although I guess maybe it would. (4:18) And Danny, who is from England, is, telling his story in two parts. (4:23) And in the first part, it becomes completely clear to me that he does not know how to take care of himself until he finds the Daphne program.
Scott Benner (4:32) Mhmm. (4:33) Did that does that surprising to you?
Liesl (4:35) Not at all. (4:36) I have been involved in DAPHNE now for twenty years, I think.
Scott Benner (4:41) Wow.
Liesl (4:41) So I was a diabetes specialist nurse, and I was actively looking for a job outside of diabetes because I felt I had nothing else to offer. (4:51) And a new consultant joined the team and said, we've got to do this Daphne course. (4:56) We have got to do it. (4:58) And so I got sent to do my Daphne educator training, and I was really not that keen. (5:04) I thought everyone's going to eat pizza and chocolate cake and put weight on, and it's going to be dreadful.
Liesl (5:11) But I went to a Daphne center to watch a Daphne course in person for a week. (5:16) And as I sat there, I thought, this is so obvious. (5:20) I should know how to do this like I just know how to breathe. (5:24) I couldn't believe what I was learning and how much I hadn't known before even though I'd been a diabetes specialist nurse for, I think, six years at that time.
Scott Benner (5:34) So I wanna go back
Liesl (5:35) that surprise me now.
Scott Benner (5:36) You know? (5:37) Yeah. (5:37) Give me a second here. (5:38) So you you were a diabetes specialist nurse already for six years. (5:43) You felt disenfranchised or or just just maybe I don't how you felt exactly.
Scott Benner (5:48) We'll find out exactly. (5:49) But you're thinking about getting away from it. (5:51) A friend says, let's try Daphne. (5:53) And your first concern back then was that if we teach these people how to use the insulin, they're just gonna eat a lot of food?
Liesl (6:02) No. (6:03) Not that's not quite the way it is. (6:05) I think when we looked at the press and the media around Daphne at that time, the press focused very much on people can eat whatever they like. (6:13) And in The UK at that time, education was about healthy diet and not about carb counting. (6:20) Mhmm.
Liesl (6:21) So there was this disconnect even for health care professionals around the relationship between insulin and carbohydrate. (6:28) So that wasn't something I'd ever been aware of ever, really. (6:32) And I just thought, well, if people can eat whatever they like, if they've always been told you've got to eat a healthy diet, you can't eat sugary food, you can't eat fatty food. (6:41) They're just going to eat whatever they like, and this could be a disaster.
Scott Benner (6:46) Okay.
Liesl (6:47) But then I went on the Daphne course and properly understood that triangle between carbohydrates, insulin, and blood glucose, which I'm ashamed to say I hadn't fully appreciated for the six years that I'd been a diabetes specialist nurse.
Scott Benner (7:03) Characterize for me the kind of care you were offering in the first six years in hindsight.
Liesl (7:11) Changing insulin doses for people in very small amounts without really taking into consideration what they were eating. (7:21) So not really being aware of why they might wake up above their target glucose in the morning, and perhaps it's because they had to have a bowl of cereal before they went to bed so they didn't go hypo. (7:34) But that wouldn't really come into it necessarily. (7:37) So it was really very limited, and I suspect I was not very effective in that role at that stage.
Scott Benner (7:45) Mhmm. (7:45) Did you think during those years that everyone who you saw was just eating watercress and and drinking tea and not really taking him any carbs and they were super healthy? (7:57) Like, was that your expectation of what was happening, or is that is that what you were told is that what they were being told to do when you were just making the assumption they were doing it?
Liesl (8:07) That's what we were recommending people were doing, but I'm a realist. (8:11) And I knew that people were not doing it because I don't have diabetes, and I wasn't doing it. (8:15) Mhmm. (8:16) So, you know, I think I think it's very easy to give advice, but what I wasn't doing in those days was listening. (8:25) I felt I was a vehicle of information, and my job was to give information and tell people what they should be doing because that's what was going to benefit them in the long run.
Liesl (8:37) But doing the Daphne course and becoming a Daphne educator taught me to listen
Scott Benner (8:42) Mhmm.
Liesl (8:42) And to understand what it's like as well as I can with a condition that you can't have a day off from. (8:51) Yeah. (8:51) And I will never truly understand type one diabetes unless I get it, but I owe it to anybody with type one diabetes to listen and do my best to understand what it's like for them as an individual rather than try and put a population wide approach to it.
Scott Benner (9:09) So do you think that the, I don't know, the the establishment idea was eat like this, very low carb, and you should do that because you have diabetes. (9:20) And if you don't, then you're noncompliant, and we can't help you. (9:24) And if you do, then maybe you'll get lucky and have good outcomes. (9:27) Is that is that how they thought about it?
Liesl (9:29) I don't think even low carb came into it. (9:31) Carbohydrate wasn't anything for me as a qualify I qualified as a nurse in 1990, and then I went into diabetes in 1999. (9:40) And I don't think carbohydrate ever really entered our psyche or our training at that stage.
Scott Benner (9:46) In 1999? (9:47) I'm sorry. (9:48) I talked over you. (9:49) In 1999?
Liesl (9:51) Yeah.
Scott Benner (9:51) Wow. (9:52) Okay. (9:53) Alright. (9:53) Okay. (9:54) When did Daphne begin?
Scott Benner (9:56) Do you know? (9:58) It I can look if you don't know.
Liesl (10:01) Origins. (10:01) Yeah. (10:02) No. (10:02) No. (10:02) No.
Liesl (10:02) Its true origins are with a man called Michael Berger in Dusseldorf back in the eighties. (10:08) And Germany were having or achieving much better outcomes for people with type one diabetes at the time than we were. (10:16) And there were some very influential people in The UK, professor Stephanie Amiel, professor Simon Heller, and doctor Sue Roberts, who went out to Germany to visit Michael Burger and to see the education he was providing for people with type one diabetes. (10:31) And through a collaboration with him and his support, they brought his education back to The UK in the late nineties and called it DAFNI, dose adjustment for normal eating. (10:42) So we had a randomized control trial in the late nineties, which showed reductions in h b a one c, and then that was rolled out in 2000.
Liesl (10:53) So DAFNI's been going it's our 20 birthday this year. (10:56) We've just had in October our birthday month celebrations.
Scott Benner (11:01) I have here begun 1999, teaches adults with type one diabetes how to adjust insulin to match their lifestyle and food choices rather than restrict diet, adapted from a successful German model of structured diabetes education, usually a five day in person group course run by diabetes specialists, nurses, and dietitians. (11:19) It proves it has been proven to improve h b a one c, reduce severe hypoglycemia, increase quality of life, and confidence in diabetes management.
Liesl (11:28) Yeah. (11:29) And the other thing it does is reduce diabetic ketoacidosis because if some or DKA. (11:34) So when people have had DKA in the past, that usually, excludes them from any kind of research. (11:40) Mhmm. (11:40) But because we collect real world data, we can show real world reductions in episodes of DKA and also in the number of people who experience DKA once they've done a Daphne course.
Scott Benner (11:53) Is the Daphne course, akin to this podcast? (11:56) Does it have a lot of overlap
Liesl (12:00) or no? (12:01) Overlap with
Scott Benner (12:02) what like, with ideas of how to do things. (12:05) Like, the I mean, I I guess I should have started here. (12:07) Do you listen to the podcast at all?
Liesl (12:09) I haven't listened for a few weeks, but that's because we've had a lot of, we've had a bereavement in the family, and I just haven't been running. (12:15) But when I was running on my treadmill a lot, I was listening to a podcast while I was running.
Scott Benner (12:19) Okay. (12:19) And you and you've heard, I don't know. (12:21) Have you heard the pro tip series or one of those, like, management series?
Liesl (12:25) I haven't heard those. (12:26) I've heard a lot of people who have got either type one diabetes themselves or they have it in their family.
Scott Benner (12:30) Yeah. (12:31) You've been listening to the stories from people. (12:32) Okay. (12:33) So there are, a a ton of of, series within the podcast. (12:38) I was I was just wondering if you knew if there was overlap.
Scott Benner (12:42) But instead, I'm gonna talk to you about it, and I'll see if there's overlap. (12:45) So Okay. (12:45) Tell me, you know, in this five day course, like, what do you what do you tell people? (12:51) Like, how do you introduce the idea to them, and how do you help them understand it?
Liesl (12:57) Okay. (12:57) So before they join the course, we ask them if they want to do it. (13:00) And the way we do that is by saying, what do you want to be different about your life with diabetes? (13:05) Mhmm. (13:06) So there will be people who say, well, I haven't been running since I got diagnosed because I'm frightened I'm gonna have a hypo, or I really want to look after my grandchildren, but my my daughter won't let me because I had a really severe hypo.
Liesl (13:19) And so there are things in people's lives that they don't do because they've got diabetes or things that they do. (13:25) So they they may eat the same food every day because they feel safe, and they're anxious about eating something different. (13:34) So they want variety. (13:35) They want a social life back. (13:37) They don't want people to judge them.
Liesl (13:39) So we ask them, what do you want to be different about life with diabetes? (13:42) And then it may be that there's something within a DAFNI course that would be absolutely ideal to help them achieve what they want. (13:48) So we then say, actually, if you want to run safely, come on the Daphne course. (13:53) You can learn all about that, and then you can start running again when you feel safe. (13:58) Mhmm.
Liesl (13:59) And then when they come on the course, the first day is spent talking about carbohydrates. (14:04) So what is carbohydrates? (14:06) What does it do? (14:07) What is type one diabetes? (14:09) And why is carbohydrate important in managing your glucose?
Liesl (14:13) And then they go on to learn about carbohydrate the com the concepts build from very basic concepts to very complex situations over the five days. (14:23) So they start out by identifying what is carbohydrate. (14:27) So they have some food models on the table, and they split them into groups. (14:32) Those that contain carbohydrates, those that don't, and the ones they're not sure about, like burgers and sausages, baked beans, people aren't always sure about. (14:42) And then we talk about those foods so they can understand why some do and don't have carbohydrate in.
Liesl (14:48) And then by the end of the week, they're working out carbohydrate in recipes that they make at home, in their cake recipes or their scone recipes or their curry recipes or whatever it might be, they're able to work out what they're actually going to eat carb wise and how to match that with their insulin. (15:04) So they learn gradually over five days in this building of concepts. (15:08) And I have to say it was the best bit about being a diabetes specialist nurse is watching people's confidence grow and seeing their understanding just expand beyond what they'd expected and watching the penny drop. (15:24) It's it's like, it's a professional drug delivering a Daphne course. (15:28) Mhmm.
Scott Benner (15:29) Do you, find yourself in the beginning did you find yourself, astonished, or did you expect people's level of understanding about what's in their food?
Liesl (15:44) I think the Internet is a wonderful thing, but it's also a dreadful thing because when somebody is newly diagnosed with type one diabetes, they can often be in this state of shock. (15:56) There's a relief that all that sudden weight loss wasn't a life threatening diagnosis like cancer. (16:02) But then there's the realization that they've got this condition they can't have a day off from. (16:07) I can wake up in the morning and decide not to wash my hair, but you can't wake up in the morning and decide not to take your insulin. (16:14) And so sometimes they're like a rabbit caught in the headlights.
Liesl (16:18) And so even though we might give lots of information about carbs at diagnosis, how much actually goes in with the enormity of taking five injections a day and everything else they have to think about, I think it just doesn't stick. (16:30) So then they can look on the Internet, and there's so much conflicting information that I think people don't always know what to go with. (16:38) So when they come on a Daphne course, it's almost a relief that somebody is saying, this is what you need to know. (16:44) You're gonna learn it in a safe environment. (16:47) You can practice things.
Liesl (16:48) You can make mistakes. (16:50) We'll support you. (16:51) We won't judge you, and you are gonna become very much more confident and comfortable with self managing your diabetes in just five days.
Scott Benner (16:59) Yeah. (17:00) What what's the turnaround? (17:01) Like, I'm I'm gonna ask you just to quantify it somehow. (17:06) Do people come in at a confidence like, let's set confidence level between one and ten, 10 being the greatest. (17:11) Where do people come in at mostly, and where do they leave at?
Scott Benner (17:14) Like, what's the what's the build they get usually?
Liesl (17:16) Yeah. (17:17) So we do something called prom data. (17:20) I don't know what you call that in The States. (17:22) It's called person reported outcome measures. (17:24) And so those are questions that we ask people before they do the course, immediately when they finish the course, and then a year later.
Liesl (17:31) And we ask them very specifically how confident they are with insulin dose adjustment, how confident they are with carb counting. (17:39) And most people before the course for both of those will come in if one is not confident at all and 10 is supremely confident, most course participants will come in with a score of one to five Mhmm. (17:53) Before the course. (17:54) When the course is finished, they'll mostly be scoring between seven and ten immediately after the course. (18:01) And for insulin dose adjustment, it's still a majority seven to 10 score in a year's time.
Liesl (18:07) And for carbs, there's a slight dip maybe between six and ten at one year.
Scott Benner (18:13) Is there So
Liesl (18:14) it's huge.
Scott Benner (18:15) It's huge. (18:15) Yeah. (18:16) Is there a a wide difference between people's backgrounds in education, or do you find that there are certain people who don't need or or come for the course and there's groups that more so do, or is it across the spectrum?
Liesl (18:31) I think, on Daphne, we talk about health literacy. (18:34) So you can be very well educated. (18:37) You can have gone through university and got a degree, a master's, a PhD, but you may struggle with health literacy, which is applying the numbers to yourself. (18:46) Mhmm. (18:46) You might have left school at 14 with no qualifications but really strong maths ability, and you'll fly with it.
Liesl (18:54) So there's no I wouldn't have any preconceptions around whether somebody would manage to self manage their diabetes based on their education level because in my experience, that's not a good predictor.
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Liesl (21:08) No. (21:08) Not at all.
Scott Benner (21:09) Gotcha. (21:11) Do you find that there's one part is there an moment in the five days? (21:19) Like, I know you said it's it starts basic and it builds the more complex, but is there something that gets said that you you just see people's faces light up? (21:26) Like, is there a takeaway, a tagline you use, something you say over and over again that makes you can see it light people's eyes up?
Liesl (21:36) I think one of the main things which they learn on the first day is that they couldn't have done anything to avoid it. (21:42) And that's a big moment. (21:44) Because in the media, certainly in The UK, there's a lot of judgment around type about around diabetes, and there's a lot of judgment based on people's weight or lifestyle. (21:54) And whether you've got type one or type two, that stigma seems to apply. (21:58) And so often people have been told, well, surely if you just act differently, you wouldn't have diabetes.
Liesl (22:05) So the realization on the first morning of the first day that they were going to get it and there was nothing they could do to avoid it Mhmm. (22:12) It's not their fault. (22:13) That relinquishing of guilt for a lot of people is really powerful, and that happens within the first couple of hours of the course Yeah. (22:20) Starting.
Scott Benner (22:21) It is I mean, listen. (22:24) I've never been to England, so I'm guessing and basically going off of things I've seen on television. (22:30) But but are you are you guys, overall, societally not a warm fuzzy group who talks about their illnesses together a lot? (22:40) Or like, I'm wondering if this is also valuable because you get into a room with other people who know your story and and are living it as well.
Liesl (22:47) Oh, I think you've just hit the nail on the head. (22:50) I can walk through a waiting room in a hospital, whether it's a diabetes diabetes waiting room or people with broken legs, and you won't find people sitting there easily sharing their stories necessarily. (23:02) So when people come on a Daphne course, it's often the first time they've had a proper conversation with somebody else who lives with type one diabetes. (23:08) Mhmm. (23:09) And often they're quite reserved on the first day because everyone thinks they're going to be the worst in the room at managing diabetes, and then they realize that they're all as good as each other or they're all as bad as each other.
Liesl (23:23) And they all share the same problems, the same anxieties, the same fears.
Scott Benner (23:27) Yeah.
Liesl (23:28) And so I think that leveling of the playing field when you have a bunch of people together is the is the most powerful thing. (23:34) And I don't think we'll ever really know with Daphne. (23:37) Is it the Daphne principles around carb counting and dose adjustment, or is it the peer support? (23:42) And if you took the peer support away, would people achieve so much? (23:46) I don't know.
Liesl (23:46) I wouldn't like to have that guess.
Scott Benner (23:48) I'll tell you that, so the podcast, you know, in its entirety, it's it's been around for almost eleven full years now. (23:58) And at the end of this year, it'll be the end of the eleventh year. (24:03) And I'm gonna start right back up again, year 12 on, you know, January 1. (24:07) But the of the 20,000,000 total downloads that have happened over the last eleven years, a a number of million of them happened this year in 2025.
Liesl (24:16) Mhmm.
Scott Benner (24:17) And I I just looked and by, you know, by country, and I don't think this is surprising. (24:23) Obviously, it is most popular in The United States. (24:25) Canada's second. (24:26) The UK's third. (24:28) And there there are a significant number of downloads in The United Kingdom.
Scott Benner (24:32) From there, for people interested, it goes Australia, India, Germany, Ireland, Sweden, New Zealand, and China. (24:38) Those are the top I think those are the top 10. (24:42) I and I and now I'm sitting here wondering if I did a deep dive on people's national ability, I'll say, to be open and and and to talk to other people about stuff like this. (24:54) I do think I I don't think I'm incorrect to say that Americans are probably uniquely seen as really willing to talk about things that other people don't talk about. (25:03) Is that true, do think?
Scott Benner (25:04) Mhmm. (25:05) Do you do you think of us that way? (25:07) Well,
Liesl (25:09) my, my niece is half American, and and she's very happy to talk about almost anything. (25:15) So I think just going on that personal experience, I would say yes, and I adore her for it.
Scott Benner (25:20) Yeah. (25:21) I I had there's I won't tell you now because it has nothing to do with anything we're talking about, but I found myself a few weeks ago in the middle of a conversation that I did not think would go a certain way and somebody brought something up. (25:32) And the next thing you know, was a half an hour later, and I I got done and I thought, why do I share any of that? (25:38) Like like like, how did how did that even and I and it just would have made more sense for me not to. (25:43) But, you know so and I've seen, like, on this side of it, Lisa, I don't know how much of, like, I of the little ecosystem I've built here you're aware of, but I have a a Facebook group that has it's coming up on 80,000 members, and, it's incredibly active.
Scott Benner (26:00) Right? (26:00) Like and I mean, average one twenty to 160 posts every day. (26:08) Like, eight eight thousand comments, likes. (26:10) Like, there's at any point in time in any day, there's at least 40,000 of those people are active. (26:16) And I was not I haven't I haven't talked about this in a little bit, but, like, I didn't start that Facebook group on purpose.
Scott Benner (26:24) Like, the the listeners sort of made me. (26:27) And it was not it wasn't a thing that I really was interested in doing. (26:30) Meaning, I I I I don't not like the community aspect of it. (26:34) Like, I was scared of the idea of, like, well, I I don't wanna be in charge of a Facebook group. (26:37) That seemed like a problem to me.
Scott Benner (26:39) And it hasn't been. (26:40) It's been lovely overall. (26:42) But it it really has given me the opportunity to just sit back and watch what happens when people get to meet somebody else or get to ask a question that there's nowhere else to ask it of or to say something that they would have felt judged by in one place but but don't get to feel judged by there. (27:00) It's a a revolution for them. (27:03) Really, really truly is.
Liesl (27:05) I think and I think as Brits, we have a reputation for being quite reserved. (27:10) But I think with diabetes, there's so much stigma around it that people are afraid to talk about it because they're afraid that if they say anything, they're going to be judged. (27:18) Mhmm. (27:19) And so when you get a group of people in a room together and say, you're free to talk, and they've got type one diabetes, then they're fairly shy to start with, but not for very long.
Scott Benner (27:29) Yeah. (27:30) Happens pretty quickly.
Liesl (27:31) And in fact, I think that's I my second ever Daphne course was way back in 2006, 2007. (27:38) And the people that were on that Daphne course still get together every couple of months on a Saturday for lunch.
Scott Benner (27:46) No kidding.
Liesl (27:46) So we're now talking nineteen years later. (27:49) When I stepped away from being a diabetes specialist nurse and I joined the Daphne organization full time, they reached out to me and said, now you're not our nurse. (27:58) Would you like to come to lunch with us? (28:00) So I get to have lunch with them whenever I can several times a year on a Saturday. (28:04) And they might talk diabetes for a few minutes, but they talk about life like any other bunch of friends.
Liesl (28:09) Yeah. (28:09) But they have that irreplaceable, innate understanding of each other without saying a word of what it is like to navigate those life situations with type one diabetes. (28:22) And sometimes I am usually, I am in awe of them because they manage all the normal things of life that the rest of us manage, but they manage it while also living with type one diabetes. (28:35) And I don't think you can ever underestimate the effort that that actually takes. (28:40) And I take my hat off to them, and and I adore them.
Scott Benner (28:43) There's something about the way you just described that that made me feel like if if I don't have, you know, if I don't have a thing excuse me one second. (28:55) If I don't have a thing that's that's invisible, but yet I can kinda feel it, like, right, like and it's always with me, then it's then it's always with me. (29:06) And no matter where I am or what I'm doing, I have that feeling and no one else has it. (29:11) And and the way it hit me, like, visually was almost like if you could imagine, like, a thin towel a thin wet towel laid over top of you. (29:17) How uncomfortable that would be, right, if you were just living like that.
Scott Benner (29:21) But nobody else could see it but you, and nobody else could feel it but you. (29:25) But you still had to go to school, go to work, drive a car, go grocery shopping, and you always had that little wet towel over top of you. (29:32) And and somehow when everybody has the towel, it then it disappears. (29:36) It's gone. (29:37) Yeah.
Scott Benner (29:38) Yeah. (29:38) Yeah. (29:39) Yeah. (29:39) Oh, that's awesome. (29:41) I and listen.
Scott Benner (29:41) I it's just a different way to think. (29:43) It's not lost to me. (29:44) I I I do a lot of in person stuff, and I've done more of it in the last couple of years than I have in the past. (29:49) But I've you know, just this year was at a an event with two thousand people who had type one diabetes. (29:55) I you know, it was and I I don't know how to quantify what you've just said, but I know it's true that when they're all together, that that there's a lightness about them that I don't know exists when I see them in other places.
Liesl (30:11) And it's a sense of safety, isn't it? (30:13) They're not gonna be judged. (30:14) I think a few minutes ago, you used a word which is my absolute bugbear of a word and I wish it didn't exist, but there's a word noncompliant. (30:23) Right. (30:24) And that is used in medical terms to describe people with diabetes, particularly people with type one diabetes.
Liesl (30:32) So if somebody comes to a clinic and they see a health care professional and they've not been carb counting very much, they might be labeled as being noncompliant. (30:41) But actually, if that health care professional was to listen to them and find that they've just had to move house or they've just had a bereavement or they've got a sick child or they're working as a carer, they do shift work, and how difficult it is to be a carb counter and manage type one diabetes in those normal but frenetic situations. (31:02) If you understood that, you'd never label somebody as noncompliant. (31:06) And one of the things that we ask our Daphne educator trainees and our Daphne doctor trainees to do is to count carbohydrate in their day to day life for five days in a row. (31:18) Not because we want them to be perfect, but because we want them to have some shared experience with the people that they're supporting who live with diabetes all the time.
Liesl (31:28) Yeah. (31:28) And the number of doctor trainees or educator trainees who manage to do that completely 100% for five days is really small. (31:38) And that's not a criticism. (31:40) It's just a reflection of Well life.
Scott Benner (31:43) Yeah. (31:43) Lisa.
Liesl (31:43) Impact it has on people's managing ability.
Scott Benner (31:46) Isn't it true that those people were noncompliant with the task? (31:50) Right? (31:50) You asked them to count cards for five days in a row. (31:52) They became noncompliant. (31:53) Yeah.
Scott Benner (31:54) And and Yeah. (31:55) I listen. (31:55) I use that I use that word in the same way you you use it. (31:59) I I hope you could hear the underpinnings when I was speaking about it. (32:01) But Yeah.
Scott Benner (32:02) I don't think anyone I I've been doing this a very long time. (32:06) Okay? (32:07) And, by the time this year ends, I'll probably have had 2,000 separate conversations with 2,000 different people. (32:15) And I will have probably 300 more next year and and, you know, if everything keeps going the way it's been going, I probably have two or 300 more for the next coming years. (32:25) I I I hope really by the time I'm done this to have had 3,000 or more, maybe 4,000 conversations with people with diabetes.
Scott Benner (32:32) And I don't think any of them, no matter their situation or their outcomes, I don't think I'd be comfortable pinning noncompliant on any of them.
Liesl (32:44) Gosh. (32:45) No.
Scott Benner (32:45) Right? (32:46) No. (32:46) I think it's just life is hard, and and being, you know, a body system is hard, and it's unrelenting. (32:55) It doesn't stop. (32:56) It's not you know, it's so easy to say, like, you know, Christmas, Easter, 02:00 in the morning, doesn't matter.
Scott Benner (33:03) You still have type one diabetes. (33:05) And and Exactly. (33:06) You know, and it's just the peep those people have to make those people have to make a decision between their mental health and their physical health, which is unfair. (33:16) Like, right there's it that shouldn't there should be no situation where I say to you, you have to make a decision right now. (33:23) We're gonna make it again 20 times today.
Scott Benner (33:26) And you have to air on the side of making yourself crazy or making yourself physically sick every time. (33:33) And there's no win. (33:34) You can't win. (33:35) There's some people I I'll take that back. (33:37) There are some people who have such a specific personality that the taking care of the diabetes scratches an itch for their, like, type a personality.
Scott Benner (33:47) Does that make sense?
Liesl (33:48) Yeah.
Scott Benner (33:48) Yeah.
Liesl (33:49) Yes. (33:49) It does.
Scott Benner (33:49) Those are the perfect people to have diabetes. (33:51) And, like like, because they they can treat the management as, a reward system for themselves. (33:58) And I see it work for them incredibly well. (34:01) But everyone else is going to be on this very slow swinging pendulum that's going from center to left and center to right, and they are just, what's that thing? (34:12) We you ever see those people on the pole?
Scott Benner (34:14) They go up on a top of a real tall pole, and they just, like, they go back and forth and keep it from falling. (34:18) Do you know what I'm talking? (34:19) It's like a circus trick. (34:20) Right?
Liesl (34:20) I do.
Scott Benner (34:21) That's what those decisions are like. (34:23) Like, I can't fall one way, and I can't fall the other way, and I can't get the damn thing to stay steady. (34:28) So I just have to decide, like, what side do I give this to so that I don't either lose my shit or lose my sight. (34:36) And, that's not a and and when that's your situation, anyone who would understand that situation fully and then call being perfect is an asshole. (34:48) And anybody and anybody who would do it without understanding, it is just misinformed.
Liesl (34:52) Yeah. (34:53) And I think I I think the other thing we've to be careful of is even people who you I think you said type a personality, they, you know, they're the people to get it because they have a specific personality to manage it. (35:03) But I still think we have to be fully aware of diabetes burnout. (35:07) And now with the advance of technology, so most people with type one diabetes in The UK or in England now have got CGMs. (35:17) And that's brilliant.
Liesl (35:18) However, there's a risk of tech burnout, and sometimes they give you too much information, and that can be overwhelming. (35:25) And as a health care professional and as a human being, I need to understand and be mindful of that. (35:33) But, also, I think the one thing that tech has done is it's made type one diabetes visible, which it never was before. (35:40) So especially in the summer, you see somebody at the pool or someone at the beach or somebody out walking in a sleeveless top, and you see their CGM, or you might see their pump on their arm. (35:51) And so it's it's a bit like spotting a when you see people with type one diabetes and they meet each other and you can see they're looking and thinking, do I say anything or do I not?
Liesl (36:02) And I think, oh, do I go up to them and say, well done. (36:05) You're doing a blinder because I know they've got type one diabetes, or do I not because they might not want me to draw attention to it? (36:11) Yeah. (36:11) So it's making type one diabetes visible, which it never was before.
Scott Benner (36:15) We need a Jeep wave. (36:16) That's probably not something you know about. (36:18) But everyone who drives Jeeps in
Liesl (36:22) That's what we need. (36:23) Yeah. (36:23) Need a type we need a type one wave.
Scott Benner (36:25) We need a type one wave. (36:26) Yeah. (36:27) That way, you don't have to be right up some on somebody, but you can still give them a nod, you you know, and they'll and they'll know where it's coming from. (36:33) You you said two things I wanna go back to. (36:36) Type a thing.
Scott Benner (36:38) I again, I I not that I think I was taken that way, but, like, I'm not saying it's awesome for those people. (36:43) I'm just saying they're more perfectly suited for it. (36:45) But they should still be said, they are still giving an amount of effort and time and focus to something that nobody wants to be focusing on. (36:54) It's still unfair to them. (36:56) They just have Yeah.
Scott Benner (36:57) You know, they just their outcomes seem to work out a little better sometimes. (37:00) And maybe they don't go as bonkers about it because it it leans into whatever their, you know, whatever their wiring loves for them. (37:09) About the tech stuff, you know, it I take your point. (37:15) I really do about the beeping and the buzzing and etcetera. (37:19) But I'm really hoping that gosh.
Scott Benner (37:22) I'm really hoping that in a reasonable amount of time that the the trade offs are still I mean, I I believe now the trade offs are still valuable. (37:31) But I think in a reasonable amount of time, the it might get easier and easier again. (37:36) Like, hopefully, this technology will continue to grow. (37:38) I'm I'm I talk a lot about on here that, you know, I like that there are a number of different companies. (37:46) I like that they are aggressively trying to make their algorithms, more accurate and, you know, give them lower targets because it keeps it keeps those companies trying.
Scott Benner (37:58) You you know? (37:59) Like, I think
Liesl (37:59) Yeah.
Scott Benner (37:59) I I think when you saw, you know, the back in the day when there was one big pump company, you know, I'll tell you that I think they innovated and then they kinda sat back and were like, oh, we did it. (38:12) Here's the thing. (38:13) We gave it to you.
Liesl (38:14) Yeah.
Scott Benner (38:14) Right? (38:15) And I just, by the way, interviewed the CEO of that of that, company and and and put it to her. (38:22) I I was like, the what happened to you guys? (38:24) Like, it feels like you made the thing and then spent so much time selling it, you stopped worrying about whether it could get better again. (38:30) And she was very candid and said, yeah.
Scott Benner (38:33) I think that happens to a lot of businesses, and I think that happened to us too. (38:36) And and so that's not gonna happen again now because now you have No. (38:41) Medtronic and Tandem and Omnipod and Yeah. (38:44) You know, and now Twist and iLET. (38:46) There are more and more companies coming.
Scott Benner (38:48) If they wanna stay alive and make their money
Liesl (38:51) Yeah.
Scott Benner (38:51) They gotta make the thing better. (38:52) I think there's that's nothing but good news for people with diabetes.
Liesl (38:55) Yeah. (38:56) And that well, and it's similar with us in Daphne. (38:58) We're not we're not tech manufacturers, but we are developers of education for people with diabetes. (39:04) So Mhmm. (39:04) We haven't just got the Daphne course for people that use multiple daily injections.
Liesl (39:08) We've got the pump Daphne course for people who use a pump. (39:11) We've got the closed loop essentials course for people who are gonna be going onto a hybrid closed loop so that they've got an understanding of what it can do and what its limitations are. (39:21) So they don't so they go into it with realistic expectations and a confidence that they'll be able to manage it. (39:27) And we've just this year, we launched a course for people with type two diabetes who use multiple daily injections, And that's a very different focus. (39:35) That's about increasing their insulin sensitivity, decreasing their insulin resistance, and simple activities they can choose on a daily basis that is gonna help them with that.
Liesl (39:47) So rather than being stigmatized, judged, focusing on the fact that, oh, type two diabetes is always somebody who's overweight, which is not the case, understanding there's so many other reasons why somebody has type two diabetes. (40:03) And so we're trying to evolve to suit diabetes in the twenty first century rather than just sticking with most people in this country are still on multiple daily injections if they have type one diabetes.
Scott Benner (40:15) Sure.
Liesl (40:15) There's a big move to get people on closed loops in England, and there's a big move to get people on pumps. (40:20) We've got most of our people with type one have now got CGMs, but there's still a majority of people with type one in this country on multiple daily injections, and so that education is absolutely crucial.
Scott Benner (40:31) Mhmm. (40:32) You know, it's funny as you're talking, it occurs to me that you Daphne knows it works. (40:37) Right? (40:38) But it still has to innovate and continue if it wants to keep going because things can get stale and stagnant and die even when they're valuable. (40:45) Yeah.
Scott Benner (40:45) And I I it's funny how this is all gonna tie together because that happened to the pump company. (40:49) Right? (40:50) And it it you're they didn't defend against it, and now they're making they're making their comeback. (40:56) And you guys have the same thing. (40:58) Like, you know this thing you're doing works, but you still have to get it out there.
Scott Benner (41:01) You have to find people. (41:02) You gotta put it in their hands. (41:03) You gotta make sure they understand it so they go tell somebody else about it. (41:07) And not dissimilar, I'm telling you, that's what I have to do. (41:12) Like, there's Yeah.
Scott Benner (41:13) There's a value and this is gonna sound crazy, but, like, to some people. (41:18) But I know the I know how valuable the podcast is. (41:20) I get a lot of feedback. (41:21) Right?
Liesl (41:21) Yeah.
Scott Benner (41:22) And Yeah. (41:23) But just like I I I always say, like, I don't know what the what the old timey, like, British version of this is, but, like, if if things didn't need to be new all the time, then we'd all just be still watching MASH because that was a really good TV show, and why did they have to make another one? (41:36) Right? (41:37) And Right. (41:38) Yeah.
Scott Benner (41:38) So, you know, so why do you have to keep innovating and being modern and being in people's faces so that they're aware that something's there and happening that they should be looking at? (41:47) It's because that's how people's minds work. (41:49) So, like, I am constantly being forced to try to find new ways to have conversations or to say something to continue to help people. (41:58) And the only way I can accomplish that like, the only reason I can put that much time and effort into it is because this podcast also takes ads and it pays my bills. (42:07) And if it if it didn't, I wouldn't I I would go, well, I made the thing.
Scott Benner (42:12) Here it is. (42:13) And I can't keep going because I gotta go I gotta go find a way to turn my power back on. (42:18) Right? (42:19) And you guys ahead and take it, and then it would just die. (42:21) Would wither on the vine.
Scott Benner (42:22) It would it would be gone already. (42:24) Right. (42:24) Right. (42:24) So there's
Liesl (42:25) But I
Scott Benner (42:25) Go ahead.
Liesl (42:26) No. (42:27) I was gonna say, so a hundred and two years ago, I had a great aunt who was nursing in Liverpool, and I have her old notebooks. (42:34) And she has one side of paper on diabetes, and it's a diet to keep people alive with newly diagnosed diabetes. (42:44) And it starts off they can have 50 calories to eat on the first day, 75 on the second. (42:50) And I think over the course of two weeks, it goes up to 250 calories in the day, and then it goes back to 50.
Liesl (42:57) So she would have been looking after people and nursing them to their death when insulin suddenly appeared. (43:03) And a doctor said to her, give this injection to the child because this will save the child's life. (43:09) And so insulin, what was nineteen twenty two, twenty three when insulin became widely available. (43:14) So we went from having a fatal condition to something that people could live with. (43:19) And then in the nineties, I looked after somebody who'd had diabetes for seventy years.
Liesl (43:24) So he'd been diagnosed just at that time when insulin was made available. (43:29) Mhmm. (43:30) And I think he had lived all of those years measuring and weighing his bread and having so many grams of carbohydrate for breakfast, midmorning, lunch, midafternoon, evening, and going to bed. (43:44) And then suddenly, urine testing came in for him in the sixties and seventies, and that was an eye opener to him. (43:51) He could see that he had glucose in his urine.
Liesl (43:54) And then I was a student nurse in the late eighties when finger pricking came in on the wards. (44:00) That was just mind blowing. (44:02) We could still took three minutes to get a glucose reading, but, you know, it was still innovative and it was amazing. (44:07) Mhmm. (44:08) And then when I became a diabetes specialist nurse, that was when blood glucose meters were available to people with type one diabetes and particularly the pregnant women who had type one.
Liesl (44:19) And that was a big innovation, and that was twenty five, twenty six years ago. (44:24) So to think in the last twenty five years, we've gone to pumps and CGMs, rapid acting analogue insulins, ultra long acting basal insulins. (44:33) We've we've seen so much develop in twenty five years that if DAFNI as an organization doesn't keep up with that, then we're not providing what people with type one diabetes need.
Scott Benner (44:44) Yeah.
Liesl (44:45) And we're not here for shareholders. (44:47) We're not here to make money. (44:48) We're here so that a person that we've never met who has type one diabetes has a better quality of life, better psychological health, better long term health, and better confidence day to day with their type one diabetes. (45:01) And those are the people I'm thinking about when I'm doing my job is how is this going to impact them? (45:07) Because if it's not gonna have a positive impact, I need to do it differently.
Scott Benner (45:11) Yeah. (45:11) And it shouldn't be lost that that effort happening over and over again day after day is what what drags you into the next part. (45:19) Right? (45:19) Because there will be a time. (45:21) I am confident saying based on just the story that you just told, I'm confident saying that there will be a time that people will look back on 2025 and say, oh my gosh.
Scott Benner (45:29) Those algorithms were nice. (45:31) I mean, I see how it changed people's lives, but look what we have now. (45:34) You you you know? (45:35) And that's look how many times that's happened just since the the twenties. (45:40) In in a hundred and you know, what is that?
Scott Benner (45:42) A hundred and five years, maybe not even quite. (45:44) Like, look how many times you said, and then this came along, and then this came along, and then this came along. (45:50) Like and I realized at some point, it feels like, well, it'll stop, but I don't know that. (45:57) I you don't you have no idea how someone's gonna apply AI learning to diabetes over the next five or ten years. (46:05) And, you know I yeah.
Scott Benner (46:07) Yeah. (46:07) And my daughter already can may I? (46:10) Can you hold your thought one second? (46:11) Would you mind?
Liesl (46:11) Yeah.
Scott Benner (46:12) I I just got done speaking with a friend of my daughter's yesterday. (46:16) So they're the same age. (46:17) Her friend has had type one for ten years. (46:20) And she asked me, I just got a CGM last month. (46:23) This is the first time she's had a CGM.
Liesl (46:25) Wow.
Scott Benner (46:26) Do you think I should get a pump? (46:28) And and what would a pump do for me? (46:30) And I found myself telling her the stuff I say all the time. (46:33) I said, well, you know, with a you know, first of all, you don't wanna disregard somebody's care. (46:38) She's doing a very good job.
Scott Benner (46:39) I'm like, there's not much that you can't do with, MDI that you can do with a pump that's different. (46:44) Here are the differences. (46:45) You can do temporary basal increases and decreases. (46:48) Yeah. (46:49) You know, you could shut your insulin off.
Scott Benner (46:51) You could, you know, change your ratios very quickly without having to, like, do math again. (46:57) You know, blah blah blah. (46:58) But I said, here's what I really think. (47:00) This episode was too good to cut anything out of, but too long to make just one episode. (47:05) So this is part one.
Scott Benner (47:06) Make sure you go find part two right now. (47:08) It's gonna be the next episode in your feed. (47:18) Touched by Type one sponsored this episode of the Juice Box podcast. (47:22) Check them out at touchedbytype1.org on Instagram and Facebook. (47:27) Give them a follow.
Scott Benner (47:28) Go check out what they're doing. (47:29) They are helping people with type one diabetes in ways you just can't imagine. (47:34) The podcast you just enjoyed was sponsored by Tandem Diabetes Care. (47:38) Learn more about Tandem's newest automated insulin delivery system, Tandem Mobi with Control IQ plus technology at tandemdiabetes.com/juicebox. (47:48) There are links in the show notes and links at juiceboxpodcast.com.
Scott Benner (47:52) The podcast episode that you just enjoyed was sponsored by Eversense CGM. (47:57) They make the Eversense three sixty five. (48:00) That thing lasts a whole year. (48:02) One insertion. (48:03) Every year?
Scott Benner (48:04) Come on. (48:05) You probably feel like I'm messing with you, but I'm not. (48:07) Ever since cgm.com/juicebox. (48:12) Check out my algorithm pumping series to help you make sense of automated insulin delivery systems like Omnipod five, Loop, Medtronic seven eighty g, Twist, Tandem Control IQ, and much more. (48:25) Each episode will dive into the setup, features, and real world usage tips that can transform your daily type one diabetes management.
Scott Benner (48:32) We cut through the jargon, share personal experiences, and show you how these algorithms can simplify and streamline your care. (48:38) If you're curious about automated insulin pumping, go find the algorithm pumping series in the Juice Box podcast. (48:44) Easiest way, juiceboxpodcast.com, and go up into the menu. (48:48) Click on series, and it'll be right there. (48:59) Hey, kids.
Scott Benner (48:59) Listen up. (49:00) You've made it to the end of the podcast. (49:02) You must have enjoyed it. (49:03) You know what else you might enjoy? (49:04) The private Facebook group for the Juice Box podcast.
Scott Benner (49:08) I know you're thinking, ugh, Facebook, Scott, please. (49:11) But no. (49:11) Beautiful group, wonderful people, a fantastic community. (49:15) Juice Box podcast, type one diabetes on Facebook. (49:18) Of course, if you have type two, are you touched by diabetes in any way?
Scott Benner (49:22) You're absolutely welcome. (49:24) It's a private group, so you'll have to answer a couple of questions before you come in. (49:27) We'll make sure you're not a bot or an evil doer, then you're on your way. (49:31) You'll be part of the family. (49:33) Thank you so much for listening.
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#1741 Body Grief - Part 1
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This series explores body grief, the sense of loss and mourning associated with an ever-changing body, including diabetes and other physical changes.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner (0:00) Hello, friends, and welcome back to another episode of the Juice Box podcast. (0:12) Body grief is the sense of loss and mourning that comes with living in an ever changing body. (0:17) And in this new series with myself and Erica Forsyth, we're gonna talk all about it. (0:23) Nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise. (0:27) Always consult a physician before making any changes to your health care plan.
Scott Benner (0:33) My grand rounds series was designed by listeners to tell doctors what they need, and it also helps you to understand what to ask for. (0:41) There's a mental wellness series that addresses the emotional side of diabetes and practical ways to stay balanced. (0:47) And when we talk about GLP medications, well, we'll break down what they are, how they may help you, and if they fit into your diabetes management plan. (0:54) What do these three things have in common? (0:56) They're all available at juiceboxpodcast.com up in the menu.
Scott Benner (1:00) I know it can be hard to find these things in a podcast app, so we've collected them all for you at juiceboxpodcast.com. (1:07) If you've ever heard a diabetes term and thought, okay. (1:10) But what does that actually mean? (1:12) You need the defining diabetes series from the juice box podcast. (1:15) Defining diabetes takes all those phrases and terms that you don't understand and makes them clear.
Scott Benner (1:21) Check it out now in your audio player or go to juiceboxpodcast.com and go up into the menu. (1:30) This episode of the juice box podcast is sponsored by Medtronic diabetes and their MiniMed seven eighty g system designed to help ease the burden of diabetes management. (1:40) Imagine fewer worries about missed boluses or miscalculated carbs. (1:44) Thanks to meal detection technology and automatic correction doses. (1:48) Learn more and get started today at medtronicdiabetes.com/juicebox.
Scott Benner (1:54) This episode of the juice box podcast is sponsored by the Kontoor Next Gen blood glucose meter. (2:01) Learn more and get started today at kontoornext.com/juicebox. (2:07) Erica is back with us today. (2:09) We're gonna start a conversation about body grief. (2:12) This is something that Erica's been talking about in some of her public speaking, with me privately probably for the last I don't know.
Scott Benner (2:19) You think you're a couple years into thinking about this at this point, or how long has it been?
Erika Forsyth (2:24) We've we've certainly talked about grief in general and disenfranchised grief in various episodes. (2:31) But this specific term, body grief, I was introduced to through this book that we're gonna be referencing, about six months ago. (2:40) Oh, So we've been talking about it, yes, in this past few months.
Scott Benner (2:43) And you gave a talk recently about this. (2:45) Is that right?
Erika Forsyth (2:46) I did. (2:47) Yes. (2:47) At the Touched by Type one conference in Orlando.
Scott Benner (2:51) You felt like that went over well? (2:52) How did the audience, seem to feel around the conversation?
Erika Forsyth (2:58) I think and, hopefully, if you're listening, this is true. (3:01) I think they enjoyed it. (3:02) My I did ask a colleague who was in the audience for some feedback, and she agreed with my assessment that I was trying to cram in a lot of information in forty five minutes. (3:14) So that is partially and and and Scott had this idea for us to do this series and really kind of take the time to process and think through a lot of the the terms and the stages and the application.
Scott Benner (3:27) So Awesome. (3:28) So we'll jump into it. (3:29) Yes. (3:30) Yeah. (3:30) Tell me about the book.
Erika Forsyth (3:31) Okay. (3:32) So body grief is it's actually the book is called This Is Body Grief by the author is Jane Mattingly.
Scott Benner (3:40) Mhmm.
Erika Forsyth (3:40) And she has gone through her own journey of of chronic illness and and disability. (3:48) And so through her life story, she and she's also, I believe she was a social worker and maybe also a psychologist. (3:59) I actually can't remember her her credentials, but has worked with with clients and patients. (4:05) So through her own personal journey and working with clients, she created these stages of body grief. (4:11) And so we over the next we're gonna be introducing the the ideas and concepts today and then over the next few series going through the stages that she has coined and created.
Erika Forsyth (4:23) And then we will be applying those terms and stages and definitions and looking at them through the lens of living with diabetes.
Scott Benner (4:31) Awesome. (4:31) How did you how did you find her book?
Erika Forsyth (4:34) Well, actually, I was talking in my own therapy, and my therapist recommended this book.
Scott Benner (4:41) Interesting. (4:42) Because of your type one?
Erika Forsyth (4:44) Yes. (4:44) She said, have you heard of this new book? (4:46) It I think it came out last March or April. (4:49) So that's thanks to my therapist. (4:52) I was introduced to this book.
Scott Benner (4:54) You found it helpful?
Erika Forsyth (4:55) I did. (4:56) It it it is if you do decide to read it, it it takes a long time to get through. (5:03) It's kind of a you know, you pick it up and read it and there's some reflections in it Mhmm. (5:07) Journaling. (5:08) So it's it's a book that you can kind of take your time and and read through.
Scott Benner (5:12) Awesome. (5:13) Okay. (5:13) Well, jump right in. (5:15) I'm gonna probably, for people listening, be a little more of a more of a fly on the wall, like, oh, I have a question, person in this in this conversation. (5:24) So you're gonna hear a lot from Erica, and I I wanna let her get going.
Scott Benner (5:27) So
Erika Forsyth (5:28) Okay. (5:28) Okay. (5:29) Thanks, Scott. (5:30) I in our world and life, you we hear these thoughts, and you might have had these thoughts yourself. (5:38) Like, why me?
Erika Forsyth (5:39) Why did this happen? (5:41) Or if only I had eaten some something different, then this thing would have happened or done something different. (5:49) So that's the if only I had then mindset. (5:53) Or my body failed me again, or my pancreas failed me, or who am I without a working pancreas, or who am I without, you could fill in the blank, with anything within your body. (6:10) So those types of thoughts are what we are going to be kind of thinking about that kind of encapsulates body grief.
Erika Forsyth (6:19) Mhmm. (6:19) And so the actual definition of body grief from the book is the sense of loss and mourning that comes with living in an ever changing body. (6:32) So the sense of loss and mourning that comes with living in an ever changing body. (6:36) So to start off with, body grief is something that every human experiences because we all are living in bodies. (6:45) And it also can be very personal as we get into kind of, you know, the the nuts and bolts of it all.
Erika Forsyth (6:52) So body grief can occur when our body changes in ways that feel like it's out of our control. (6:59) It feels like we can't go back to the way things were. (7:04) It feels like it's no longer our own. (7:08) You might have that experience of feeling like, ugh. (7:10) Won't be able to go back to the way it functioned, the way it looked, the way it felt.
Erika Forsyth (7:17) And with that sense of loss comes this unraveling of your identity and your sense of self. (7:24) So this can happen when you get a cold. (7:28) Right? (7:28) It's it's not a big it can be a big sense of body grief and a small body grief. (7:34) Right?
Erika Forsyth (7:34) So when you get a cold or you get an illness or you have a physical injury or surgery, pregnancy, pregnancy loss, infertility, perimenopause, menopause. (7:48) I'm acknowledging those are a lot of maybe more kind of issues that that women face, but also men go through their own sense of of body grief loss too with changes in their systems.
Scott Benner (7:59) Can it So can I ask can it be as can it go from functional to just the way you see yourself? (8:07) Like, you know what I mean? (8:08) Like, could it for a guy, could it could it go from the range of, like, erectile dysfunction down to I just I'm not as strong as I used to be?
Erika Forsyth (8:15) Yes.
Scott Benner (8:16) Really? (8:16) Okay.
Erika Forsyth (8:17) Yes. (8:17) Yes. (8:20) While it can be something actual actually physical
Scott Benner (8:24) Mhmm.
Erika Forsyth (8:24) It can be the way the way I interpret it is that it can be also a kind of this mindset around your body and what you think it you felt like it could do but can no longer do.
Scott Benner (8:36) Okay. (8:37) Thank you.
Erika Forsyth (8:37) Yes. (8:38) That's a good question. (8:41) One of the important things, I think, to note is that body grief doesn't go away simply because we don't wanna feel it. (8:49) And we we might try and ignore it. (8:52) We might try and fix it.
Erika Forsyth (8:55) But the this I think the concept that our body grief can't be fixed, it must be felt, can be a challenging one. (9:05) I think if we think about the the normal or the the grief stages that you might be familiar with already around, for instance, a death, which is, they're either five or seven. (9:18) So, denial, shock, depression, anger, and acceptance. (9:28) Those are usually kind of the five grief stages, and and these will feel a little bit similar to those.
Scott Benner (9:34) Mhmm.
Erika Forsyth (9:35) We often I think when we think about grief, we think we're like, well, I just gotta go through the grief stages, and then I'll be okay.
Scott Benner (9:40) Yeah. (9:40) Think you pop out the other side of it if
Erika Forsyth (9:42) Right.
Scott Benner (9:42) That's what they tell you. (9:43) Right?
Erika Forsyth (9:43) Right. (9:44) That's we we a lot of believe that. (9:45) Right? (9:46) Yeah. (9:46) Just work the stages.
Erika Forsyth (9:47) But with body grief and and sometimes that might feel true, but we also know that with grief around the death of a loved one, the intensity might change, but it still it still felt that
Scott Benner (10:00) loss. (10:01) Right.
Erika Forsyth (10:02) And so with with body grief and as we think about with diabetes, it's it is always there. (10:07) We are always gonna be experiencing these little micro moments of loss, which we'll get to. (10:13) So the we wanna think that we can fix it, but we can't. (10:19) And we we try and tell ourselves, and you might hear other people say things like, oh, just, you know, just go ahead and eat. (10:28) Like, bolus later.
Erika Forsyth (10:30) Love your body. (10:32) You are beautiful at any size.
Scott Benner (10:35) Mhmm.
Erika Forsyth (10:36) Time heals all. (10:39) At least it's not cancer, or you are a warrior. (10:43) You are a t one d or t two d warrior. (10:46) Right? (10:47) Like, so we hear these things.
Erika Forsyth (10:48) And now those are all beautiful statements. (10:51) Those are aphorisms. (10:52) It's a new vocabulary word I actually just learned. (10:56) That are they're they're there's well intentioned. (10:59) They are true.
Erika Forsyth (11:01) Those are all true statements. (11:02) Right? (11:03) Like, we can be grateful that at least it's not cancer. (11:06) But when we hear that or we tell ourselves that we're trying to kinda fix or avoid the feeling of that body grief in that moment.
Scott Benner (11:14) Okay. (11:15) Is it possible that the harsher those statements feel to you, maybe the more intertwined you still are in that grief and that you haven't been able to process it or found a way through it? (11:26) Because I I do see people really rub up against some of those. (11:31) You know what I mean? (11:32) Like, I some people who, you know, call somebody a warrior and and there's a group people think it's awesome, and then there's somebody in there who's like, I I didn't wanna be a warrior.
Scott Benner (11:41) I wasn't looking for this. (11:42) You know, you always hear, like, different sides of the argument. (11:45) I wonder if your reaction has a lot to do with where you are in maybe the process that we're talking about today. (11:52) And that's kind of an open ended question, but it it's what I was wondering while you were while you were going through that list.
Erika Forsyth (11:59) That's a that's a really great point.
Scott Benner (12:01) Yeah.
Erika Forsyth (12:02) I think the the intensity of your response might vary, but, yes, based on where you are, how close you are to the that grief.
Scott Benner (12:15) Yeah.
Erika Forsyth (12:16) But it it also can hit just like because we aren't gonna go through the stages and be done, it it can affect you in ways that you might be surprised. (12:27) You're like, wow. (12:27) I thought that didn't bother me anymore. (12:29) And then all of a sudden
Scott Benner (12:30) Right.
Erika Forsyth (12:31) This person is telling me you can't eat that, or can or can you eat that? (12:36) Or It just hits You have type one, but it's not cancer. (12:38) I'm like, well, actually, you know
Scott Benner (12:39) Yeah. (12:39) And you get a reoccurrence of that feeling again. (12:41) Right.
Erika Forsyth (12:42) Yes. (12:43) I think that I think it's important to bring up these types of statements because instead of giving allowing ourselves to feel what we're actually feeling, We're trying to hold on to some of these truths, but they also don't give you any room to feel the intensity of the whatever the emotion is. (13:05) And I think the the t one d wire slogan, I think, is is, yes, so beautiful, but also doesn't depending on the time. (13:15) Right? (13:16) Like, we I will share you know, as I've shared before, growing up, it was like, k.
Erika Forsyth (13:22) You can do all things. (13:24) Don't let diabetes stop you. (13:25) You're gonna achieve all your goals. (13:27) And we hear that narrative, and there's nothing wrong with that. (13:30) That's a beautiful narrative.
Erika Forsyth (13:33) But when your child or yourself, you actually don't want it or you're feeling angry or you're feeling really sad about having it, if that's the only thing that you're allowed to feel or think or say, it pushes down these other feelings.
Scott Benner (13:51) Mhmm.
Erika Forsyth (13:52) But they're still there.
Scott Benner (13:52) You have to be ready to accept the idea. (13:55) Right? (13:55) You can't just it's not a thing someone just says to you, oh, you know, if you just, blah blah blah, then it'll all be okay. (14:01) You have to there has to be a I would imagine amount of time and consideration. (14:06) You have to be in the right headspace.
Scott Benner (14:09) You're making me think a lot about, a gentleman I interviewed the other day who, is blind. (14:15) He's not just legally blind. (14:17) He's he he put it as I'm in the dark blind. (14:19) And I I I don't think I've spoken to anybody with a better attitude in a long time. (14:25) And I just I I couldn't I asked him.
Scott Benner (14:27) I was like, how do you get to this? (14:29) You know? (14:29) And his answer was his answer was his his faith, honestly. (14:34) But I I would imagine it doesn't matter how you get there as long as you can, I mean, transcend the moment and ascend to that idea? (14:43) I don't I I don't know.
Scott Benner (14:45) I I I want you to keep going. (14:47) It just it may it is making me thinking about him a lot because he just was it he had he had described so many of these different, like, grieving processes and things that he lost along the way, but then his attitude, what he was saying, how he actually felt didn't didn't carry any of the what you would think was obvious anger or sadness that you could have in that situation. (15:11) So, anyway, I don't that Mhmm. (15:13) Why I brought that up exactly.
Erika Forsyth (15:14) He was on he's on his own journey of processing and getting to a place of peace.
Scott Benner (15:21) Yeah. (15:21) And he got there. (15:22) Mhmm. (15:23) You know? (15:23) But by his by his, you know, by his description, in my opinion, he's there.
Scott Benner (15:27) So okay. (15:28) I'm sorry. (15:29) Please.
Erika Forsyth (15:29) No. (15:29) That's that's good. (15:30) Yeah. (15:31) So as we remember, you know, the the definition of body grief, the sense of loss and mourning that comes with living in an ever changing body. (15:41) Mhmm.
Erika Forsyth (15:41) As we layer that definition over the lens of diabetes, we experience loss, these micro moments of loss. (15:51) And, again, this might feel really insignificant or a lot bigger to you based on the moment or the day or as a caregiver, how you're bolusing, you know, and with the loss around that for yourself.
Scott Benner (16:03) Right.
Erika Forsyth (16:04) So the loss of being able to eat, exercise, sleep, and live without thinking about the blood sugar do you and do you loss of even time as we think about it too. (16:17) Around do I have my insulin, my my blood sugar kit, my carbs? (16:22) And then we also might experience loss as we think about all the unseen aspects of managing diabetes. (16:32) We we are probably familiar with these stats around the 180 plus decisions a day, the 40 plus variables that we're considering every time we bolus. (16:43) The device management, you know, every time you have a pump or CGM malfunction or site change day or maybe even receive a comment about your devices.
Erika Forsyth (16:57) You beep in class or in a meeting and the heads turn. (17:02) You have the constant you know, the the stigma. (17:07) Again, we'll get into a lot of these topics throughout the series, but there's the stigma and misconception. (17:13) So every time someone says something that feels like they're trying to be they're trying to be compassionate and encouraging, but it just kind of lands as as ignorant, you might be experiencing that micro moment of grief, of body grief.
Scott Benner (17:31) Right. (17:38) And anytime any of these things happen, it's as if there's a small megaphone in the back of your head reminding you, like, something doesn't work right, and it's Yeah. (17:46) And it's you. (17:47) Your body doesn't work right. (17:49) And even if you can separate yourself from you in your thoughts and you in your shell, it's still you.
Scott Benner (17:55) Right? (17:56) So my my pancreas isn't working correctly, and therefore, this happened. (18:01) That's not my fault. (18:02) I didn't do anything to this oh, that that does give I've I've long I've long wondered a number of things that people, fight against. (18:11) One of them is how how vociferously you'll hear type ones make make the argument, make sure you understand that type one diabetes wasn't like a dietary or a lifestyle choice.
Scott Benner (18:24) And I always think, like, what why do they care? (18:27) But this is why they care. (18:28) Right? (18:29) Because then these these other impacts come in from the outside and then those that that would probably feel like attacks whether they're meant that way or not are felt as a reminder that my body doesn't do a thing it's supposed to do. (18:43) Contournext.com/juicebox.
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Erika Forsyth (20:56) Yes. (20:57) And then you can get stuck in that stage of my body failed me. (21:05) And and you kind of bound and again, right, you're queuing up really well these great stages and themes around how do we what happens when we get stuck in that my body failed me
Scott Benner (21:16) Okay.
Erika Forsyth (21:17) Mindset. (21:19) So as we're kind of we you you guys know all of the the details of managing, whether it's for yourself or your child, all of these micro moments of per se of of loss. (21:34) It's not even perceived loss. (21:35) It can be felt as real loss. (21:38) They this whole mental load can contribute and become the terms that we've defined before diabetes distress and diabetes burnout.
Erika Forsyth (21:48) And I thought it would be interesting just to pause here and kind of review the definitions of distress and burnout. (21:55) Mhmm. (21:55) And when and I just kind of wanna think about is that our is diabetes distress and burnout our version of body grief? (22:04) Or because of that, do we experience body grief? (22:09) And that might sound confusing as I kind of introduce it.
Erika Forsyth (22:13) But the, you know, diabetes distress is the emotional response to living with diabetes. (22:22) Right? (22:23) The burden the relentless this is from the ADA definition. (22:26) The relentless daily self management, the prospect of or reality of its long term complications, the social impact, which is the stigma, discrimination, unhelpful, you know, reactions from people, the financial implications of from, you know, insurance, treatment, etcetera. (22:46) So that's distress.
Erika Forsyth (22:47) It's like this emotional response to living with diabetes that every single person living with diabetes has experienced once if not many times. (22:57) It is very normal. (22:58) And and and also the caregiver can have diabetes distress versus diabetes burnout, which is oftentimes just described as distress can lead to burnout, but doesn't have to go that way. (23:14) And this is more that the state, right, in which this is from beyond type one, in which someone with diabetes grows tired of managing their condition, and they just simply ignore it and for a period of time or or forever. (23:27) And this can look like having strong negative feelings.
Erika Forsyth (23:31) You're overwhelmed. (23:31) You're frustrated. (23:33) You have these thoughts that you're being controlled by diabetes. (23:36) You feel really alone. (23:37) You're either isolating because of the burnout or or vice versa.
Erika Forsyth (23:42) Mhmm. (23:42) And you're avoiding doctor's appointments, other, you know, planned things that are helpful for you. (23:48) So as we think about distress and burnout, again, I I just wonder how much of this of these two terms do we experience because we're trying to fix or ignore or push down the body grief stages and feelings. (24:08) Or is it all is it all does it maybe it's not even important to to understand which comes first or are they intertwined? (24:16) And I'm not posing these questions to incite shame.
Erika Forsyth (24:20) Like, if you don't if you don't go through the the body grief stages and feel your feelings, that's why you're in burnout. (24:26) That's not at all what I'm suggesting. (24:31) But I just wonder to kind of just hold that question for us to kind
Scott Benner (24:34) of
Erika Forsyth (24:34) mull
Scott Benner (24:35) over too.
Erika Forsyth (24:36) As we work through the stages. (24:37) Does that make sense?
Scott Benner (24:38) It does. (24:38) I am also really enjoying how you've taken this this book that was introduced to you for personal reasons and found the through lines to diabetes. (24:47) This is really this is lovely what you've done here. (24:50) Thank you.
Erika Forsyth (24:52) Well, thank you. (24:53) No. (24:53) It it's been helpful, for for me personally because I think one of the other things as you asked in the beginning, when we hear those types of thoughts or comments, are they gonna hit us differently or land us you know, land for us differently based on where we are in our journey? (25:14) I think that's one of the the beautiful things to have. (25:16) The reason why I really appreciate these terms and stages, not only does it give us vocabulary to normalize what we're going through Mhmm.
Erika Forsyth (25:25) Because we can feel like you know, I've lived with type one for thirty five plus years now. (25:31) But when something happens, whether it's diabetes related or not or a new complication or a new, you know, physical injury, you absolutely can go through and experience body grief in a separate way. (25:47) So I guess I'm just bringing that up that it's it's yes. (25:50) We can we're gonna be talking about through diabetes, but it's also really helpful as we think about our universal experience.
Scott Benner (25:56) And do you think this is a, kind of an exploded view because the diabetes is so, I I guess, ever present. (26:06) But this is if you you've had no contact with diabetes or or chronic illness, you're still experiencing this stuff, probably just not at the same rate. (26:15) But but, you know, you you said something earlier that probably sounded so simple, but, I took it deeper. (26:21) But you said we all have a body. (26:23) You you know, like and and everyone's body is changing and slowly failing or, you know, falling apart or however you wanna put it, like, as you go.
Scott Benner (26:32) And it could be something as simple as, like, I can't believe my heel hurts every time I walk. (26:36) And, you know, like and then that's I guess that gives you a little bit of the, I'm not right where I was before. (26:44) I hear people talk about it all the time. (26:45) They joke about it, like, well, I'm getting older so my back hurts now. (26:48) And then they just your back doesn't stop hurting, but you just give a give up the the fight on it, I guess.
Scott Benner (26:54) Go, okay. (26:54) I accept that. (26:56) But I guess there's that maybe not seen by everybody impact of that of that process of of having the the, you know, the the thing that fails, you having to get over the idea that it's ever gonna go back to the way it was before. (27:12) And these are for small things, they're still difficult for people. (27:16) So when I stop and I think about them, you know, on something big like this, my, you know, my kid's pancreas stopped working.
Erika Forsyth (27:23) Mhmm.
Scott Benner (27:24) I now see why people are so intent, some of them, on figuring out why it happened. (27:32) I don't know if they think they're gonna fix it once they figure out why, but some people are very intent on, like, why did this happen? (27:37) I need to understand why this happened. (27:39) And the word normal, it gets brought up all the time. (27:43) Like, big people are always like, my life's never going to be normal again.
Scott Benner (27:47) That that that that really hurts them. (27:49) And I guess it's because of the finite nature of it. (27:53) I don't know. (27:53) I'm just I'm just listening. (27:55) I didn't get to hear your talk in, Orlando.
Scott Benner (27:57) So, I'm I'm having a lot of fun learning about it now. (28:01) And you see I know we're not done, but you see this going forward as a series where we break these ideas down into smaller episodes. (28:07) Is that right?
Erika Forsyth (28:08) Yes. (28:08) And and the questions and points that you're bringing up, what what is exciting for me is that even though this woman wrote this book kind of in general, the the concepts are so applicable to the, you know even the question of normal. (28:25) Like, what is normal? (28:26) Yeah. (28:26) Why do we even have that concept that there's normal and not normal?
Erika Forsyth (28:31) Mhmm. (28:32) The why me? (28:34) Who can I blame? (28:35) How can I fix this? (28:36) Who's at fault?
Erika Forsyth (28:37) And I think before we go into these last two points, I thought it might be maybe helpful to just review the stages of body grief.
Scott Benner (28:45) Please.
Erika Forsyth (28:46) So dismissal. (28:49) And, again, she these are not like any grief stages, they are not linear, but we're gonna talk about them as you might experience them, but you can always go back and forth. (28:58) So there's dismissal, shock, apology, fault, fight, and then hopelessness and hope. (29:15) So within those kind of seven stages, I think it's important for us to kind of review these two key concepts that that she talks about. (29:28) And the first one that are kind of applied and discussed through each stage, the first one is called perceived body betrayal.
Erika Forsyth (29:35) Mhmm. (29:36) And this is the narrative that somehow our body has betrayed us, that we and we have all felt this, whether it's with our pancreas or something else. (29:43) You just gave examples, my back, my heel, my eyesight. (29:47) You know, maybe it's even your voice. (29:49) You get it.
Erika Forsyth (29:49) You've lost your voice, and you have a sore throat. (29:52) Right? (29:52) So and we live in this narrative because it's our effort to control what's happening. (29:59) It's our effort to control our body. (30:02) And she says that this perceived body betrayal is the core driver of body grief Mhmm.
Erika Forsyth (30:09) Because it it then places us and and catapults us into this deep disconnect between our body and ourselves. (30:16) So we're pitting ourselves against our bodies when we have this kind of language that my body failed me. (30:21) My body gave out. (30:22) My pancreas failed me. (30:24) And it makes it seem like you were just kind of saying earlier that we're it's us against our bodies when when it's not.
Erika Forsyth (30:34) But that's what it actually really feels like.
Scott Benner (30:36) Right.
Erika Forsyth (30:37) And we'll go into all the reasons why.
Scott Benner (30:41) Well, I guess it could also feel like you against you. (30:45) Right? (30:45) Like Mhmm. (30:46) Like, almost like, another version of you attacking yourself. (30:50) Like, because I I am gonna get stuck on this idea a couple of times.
Scott Benner (30:54) I do hear what you're saying about it's it's my body is failing me. (30:59) But there's another I mean, you are your body. (31:02) Right? (31:02) Like, I know you're not, but you but you I mean, in the context of, like, reality and the way you think about it, I don't know how you're supposed to separate those two things. (31:10) I'm sure you can.
Scott Benner (31:11) And I'm I I would imagine that people who fight with things like cancer or people who have had type one diabetes for a long time and appear to be on the other side of it now, I imagine at some point they have to find a separation between me and it. (31:27) I don't know if that makes I might be wrong, but it's it's striking me that way.
Erika Forsyth (31:32) So the this concept of perceived body betrayal, yeah, is a natural response.
Scott Benner (31:39) Mhmm.
Erika Forsyth (31:39) But the way it's kind of understood and articulated is that if we it drives the grief, and then we but we don't wanna get stuck in that because we're always then gonna be trying to find, well, why did this happen? (31:55) Who can I blame? (31:57) This is unfair. (31:58) Those are all really normal and healthy responses
Scott Benner (32:01) Yeah.
Erika Forsyth (32:02) To a perceived loss, right, or mourning and the change in your body. (32:08) But you're kind of what I wanna understand your reflection is can see. (32:15) It's natural to stay kind of differentiated.
Scott Benner (32:18) Well, it seems to me that, like, if if you're feeling like your body failed you, I don't know how you're I don't know how I could separate, like, the feelings of the body being me. (32:32) Do know what I mean? (32:33) By that, like, like, how how am I not gonna get to the point where I feel like I failed myself, I guess, is the is is my statement. (32:40) Meanwhile, you're not in any control of the the physical attributes that you have, don't have, how well things work, or don't, how long they last, or don't. (32:49) But I don't know how it I it's almost like when you see, an athlete get hurt and they're so angry.
Scott Benner (32:55) Like, are they angry at their leg or are they angry at themselves? (32:59) Like, that's that's what I'm wondering if we'll we'll get through and find Mhmm. (33:02) At the, through the conversation. (33:04) Also, I'll tell you that this I feel so I feel, like, very hopeful about this conversation because I do know a number of people who've had significant illnesses or have lived with type one for a long time who when you meet them, they really I I I would bet my life that they're on the other side of this problem somehow. (33:24) And if they got there, I would imagine that understanding the process could help other people get there maybe even more quickly.
Scott Benner (33:32) Right? (33:32) Because if we're all really going through this thing, I often think that diabetes is just like a mirror held up to your face that feels like it's fast forwarded. (33:41) Because we all get sick and get older and and are you know, and have more and more health issues as we go. (33:48) Diabetes just speeds the whole thing up a little bit, and and it gives it I think it gives more or all of it to you in in a short amount of time instead of the way that, I guess, nature intends it is for you to, like, slowly experience these things. (34:04) And and I I just think that maybe once you see them all, know them all, if you could process them all, maybe you could leave them all behind at least, you know, as much as possible.
Scott Benner (34:15) Anyway, I I think this is gonna be great.
Erika Forsyth (34:18) Yes. (34:18) And there there there is hope because there has to be, and that's, you know, why why I do what I do and why I'm bringing this this into our kind of, hopefully, our our mindfulness, our awareness that and I know you said kind of get on the other side of it. (34:39) And I know what you mean, but you are always kind of in these stages.
Scott Benner (34:44) It's not gonna stop. (34:45) Right?
Erika Forsyth (34:45) But gonna stop, but you're gonna have maybe more awareness and more tool practices.
Scott Benner (34:49) So that it doesn't hit you. (34:51) Maybe doesn't hit you as hard in the moment or you're able to process it
Erika Forsyth (34:55) Yes.
Scott Benner (34:55) More more judiciously maybe.
Erika Forsyth (34:58) Yeah. (34:58) Or and and process it and not try and ignore it or fix it.
Scott Benner (35:02) Right.
Erika Forsyth (35:02) Yes.
Scott Benner (35:03) Yeah.
Erika Forsyth (35:04) So kind of conversely from this perceived body betrayal concept, the other important one is called body trust.
Scott Benner (35:14) Okay.
Erika Forsyth (35:15) And this is important because our body and this might this is kind of hard to understand without gonna going through all the stages, which we will get there, that our body actually does not fail us. (35:28) And so she talks about body trust as this kind of reciprocal concept. (35:34) Right? (35:35) So body trust is defined as a two way street. (35:40) In order to trust our bodies, our body needs to trust us to take care of it, to be kind to it, and to nourish it in all ways.
Erika Forsyth (35:51) Right? (35:52) So there's this kind of back and forth between in order to trust our bodies, our body needs to trust us. (35:59) And this this concept, takes some time to understand what that actually looks like, feels like, and and in practice. (36:09) But underneath it is this mindset that our body is not against us. (36:14) It's not like, oh, I'm gonna go.
Erika Forsyth (36:15) I'm gonna I'm gonna shut down this thing and see what she can do with it. (36:19) Right. (36:20) Right? (36:20) That our bodies are always on our side. (36:24) And when we work through these stages and engaging in the body grief, it means that we get to meet our body where it's at right now instead of trying to ignore it or push it down or say, I'm fine.
Erika Forsyth (36:41) I'll be fine. (36:44) But to that's part of the body trust process is saying, okay. (36:48) Where am I hurting right now? (36:50) Or where am I not hurting physically or emotionally? (36:56) And just being present with that in the in the moment.
Erika Forsyth (37:00) Yeah.
Scott Benner (37:02) Well, you're making me think of all the people that I've interviewed who have, like, what you would consider to be, like, significant extra things to to work through Kate, who's been on the show a couple of times, you know, who's in a chair and, you know, even the gentleman the other day who's you know, he's completely blind. (37:22) He was even able to, like, forgive. (37:24) Like, he was diagnosed at a time where he you know, the insulin regimen wasn't great. (37:29) He didn't really know what he was doing. (37:31) He was misdiagnosed for a long time, so he was living probably with LADA and being treated for type two.
Scott Benner (37:37) You know? (37:38) And then, you know, one day looks up and sees, like, spots in his eyes, and the next thing you know, it's, you know, it's thirty five years later, and he's been blind for decades. (37:48) And he even told me that he had, initially, after seeing the spots, had a surgery, and he's not even sure if the surgeon didn't maybe make things worse for him. (37:59) And he still wasn't mad. (38:01) I was I really like, the guy somebody should study him.
Scott Benner (38:05) But, you know and and thinking about Kate Brim and and, like, her talking about I'll never forget when she told me about the worst thing that could happen is getting in bed and realizing you left a light on when you're when you're a paraplegic.
Erika Forsyth (38:17) Yes.
Scott Benner (38:18) And and I thought, well, what a simple little thing. (38:20) Like, we've all jumped in bed and thought, ugh, I left the light on in the hallway. (38:24) And, you know, and the worst thing that happens to you is, oh, I gotta get out. (38:27) It's gonna be chilly. (38:28) And she's gotta go through an entire process if she wants to go put that light back off again.
Scott Benner (38:32) And yet, there she was with maybe one of the best attitudes I ever heard in my life. (38:37) And and I'm I I've been trying to tell those people stories in the hopes that somebody can, you know, I don't know, take something from it and try to apply it back to their own life. (38:49) And, again, I'm just I'm very happy today because I think this is really gonna maybe, help that for a lot of people. (38:56) I can't I can't help it to to that keeps going over in my head while you're talking that that that maybe this thing that I've been hoping, which is I I'll just keep telling stories till somebody goes, hey. (39:05) You know what?
Scott Benner (39:05) That makes a lot of sense. (39:06) I'm gonna try to adopt a little bit of that. (39:08) Maybe there's actually a process of adoption that, that that would, be helpful. (39:13) I'm sorry. (39:14) I'm talking over.
Scott Benner (39:14) I apologize.
Erika Forsyth (39:15) No. (39:15) No. (39:15) That's good. (39:15) I'm I think that's a great way to to pause our, to conclude our our intro Okay. (39:23) With those hopeful stories.
Scott Benner (39:25) Yeah. (39:25) Well, I really appreciate this. (39:26) I I can't wait to get back together and and go on to the next part. (39:29) Do you do you have the rest of it laid out? (39:31) Can you tease it here a little bit, or do you wanna just let them find out the next time they see an episode?
Erika Forsyth (39:37) Yes. (39:37) I mean, I think we can review. (39:38) We'll just from this kind of introduction around, you know, what is what is body grief? (39:43) How can we discuss it and think about it through the lens of diabetes? (39:47) These concepts of perceived body betrayal and body trust.
Erika Forsyth (39:51) We then will move into the stages, that I can say again are dismissal Mhmm. (39:58) Which is I mean, should I just Yeah.
Scott Benner (40:00) Roll roll through them real quick so people know what's coming.
Erika Forsyth (40:02) Yeah. (40:03) Okay. (40:03) Okay. (40:03) So, yeah, so these are the stages again. (40:05) So dismissal, which can feel like denial, right, in the normal or the kind of traditional grief series.
Erika Forsyth (40:14) Dismissal, shock, which is actually another stage in the grief stages, apology, fault, fight, hopelessness, and hope.
Scott Benner (40:29) Okay.
Erika Forsyth (40:30) And so we will move and kind of discuss move through those stages and discuss them and then apply them to the to our, you know, life with diabetes.
Scott Benner (40:40) Awesome. (40:40) So this one will be called probably body grief introduction or something. (40:45) And then, you'll look for those those other, topics, moving forward. (40:50) And I really appreciate this. (40:51) Thank you so much.
Erika Forsyth (40:51) Yes. (40:52) You're welcome. (40:53) Thank you.
Scott Benner (41:00) Thanks for tuning in today, and thanks to Medtronic diabetes for sponsoring this episode. (41:05) We've been talking about Medtronic's MiniMed seven eighty g system today, an automated insulin delivery system that helps make diabetes management easier day and night. (41:13) Whether it's their meal detection technology or the Medtronic extended infusion set, it all comes together to simplify life with diabetes. (41:21) Go find out more at my link, medtronic diabetes dot com slash juice box. (41:26) I'd like to thank the blood glucose meter that my daughter carries, the Kontoor Next Gen blood glucose meter.
Scott Benner (41:33) Learn more and get started today at kontoornext.com/juicebox. (41:39) 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 Kontoor Next Gen in cash. (41:49) There are links in the show notes of the audio app you're listening in right now and links at juiceboxpodcast.com to Kontoor and all of the sponsors. (41:58) Hey. (41:58) I'm dropping in to tell you about a small change being made to the Juice Cruise twenty twenty six schedule.
Scott Benner (42:03) This adjustment was made by Celebrity Cruise Lines, not by me. (42:06) Anyway, we're still going out on the Celebrity Beyond cruise ship, which is awesome. (42:11) Check out the walkthrough video at juiceboxpodcast.com/juicecruise. (42:15) The ship is awesome. (42:17) Still a seven night cruise.
Scott Benner (42:19) It still leaves out of Miami on June 21. (42:22) Actually, most of this is the same. (42:24) We leave Miami June 21, head to CocoCay in The Bahamas, but then we're going to San Juan, Puerto Rico instead of Saint Thomas. (42:31) After that, Bastille, I think I'm saying that wrong, Saint Kitts And Nevis. (42:36) This place is gorgeous.
Scott Benner (42:37) Google it. (42:38) I mean, you're probably gonna have to go to my link to get the correct spelling because my pronunciation is so bad. (42:42) But once you get the Saint Kitts and you Google it, you're gonna and see a photo that says to you, oh, I wanna go there. (42:49) Come meet other people living with type one diabetes, from caregivers to children to adults. (42:55) Last year, we had a 100 people on our cruise, and it was fabulous.
Scott Benner (43:00) You can see pictures to get at my link, juiceboxpodcast.com/juicecruise. (43:05) You can see those pictures from last year there. (43:08) The link also gives you an opportunity to register for the cruise or to contact Suzanne from Cruise Planners. (43:13) She takes care of all the logistics. (43:15) I'm just excited that I might see you there.
Scott Benner (43:18) It's a beautiful event for families, for singles, a wonderful opportunity to meet people, swap stories, make friendships, and learn. (43:27) If you're looking for community around type one diabetes, check out the Juice Box podcast private Facebook group. (43:34) Juice Box podcast, type one diabetes. (43:37) But everybody is welcome. (43:38) Type one, type two, gestational, loved ones, it doesn't matter to me.
Scott Benner (43:43) If you're impacted by diabetes and you're looking for support, comfort, or community, check out Juice Box podcast, type one diabetes on Facebook. (43:52) I can't thank you enough for listening. (43:53) Please make sure you're subscribed or following in your audio app. (43:57) I'll be back tomorrow with another episode of the Juice Box podcast.
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#1740 Bolus 4 - Potato Chips
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Jenny and Scott talk about bolusing for potato chips.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner (0:0) Hello, friends, and welcome back to another episode of the Juice Box podcast. (0:15) In every episode of bolus four, Jenny Smith and I are gonna take a few minutes to talk through how to bolus for a single item of food. (0:22) Jenny and I are gonna follow a little bit of a road map called meal bolt. (0:27) Measure the meal. (0:28) Evaluate yourself.
Scott Benner (0:30) Add the base units. (0:31) Layer a correction. (0:33) Build the bolus shape. (0:34) Offset the timing. (0:35) Look at the CGM.
Scott Benner (0:36) Tweak for next time. (0:38) Having said that, these episodes are gonna be very conversational and not incredibly technical. (0:44) We want you to hear how we think about it, but we also would like you to know that this is kind of the pathway we're considering while we're talking about it. (0:52) So while you might not hear us say every letter of Mielboldt in every episode, we will be thinking about it while we're talking. (0:59) If you wanna learn more, go to juiceboxpodcast.com/meal-bolt.
Scott Benner (1:05) But for now, we'll find out how to bowl us for today's subject. (1:14) Nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise. (1:18) Always consult a physician before making any changes to your health care plan. (1:23) Jenny, I, today, just today, in fact, went to the interwebs and said, what are the most popular junk foods in The United States Of America? (1:34) And it put it into categories for me.
Scott Benner (1:36) Potato chips, chocolate bars, frozen or fast food pizza, soda, candy, fast food burgers, ice cream and frozen treats, cheese snacks, which is interesting, I thought, packaged cookies, snacks, cakes, and pastries.
Jenny Smith (1:56) There's some fancy organization there.
Scott Benner (2:01) I like that this is the way they thought to put it, that AI saw this. (2:05) Like, because this what I use. (2:06) I use AI just to to pull it together real quick. (2:08) I also did a couple of Google searches, put it all together. (2:10) But
Jenny Smith (2:10) And are these, like, the number the first one that was listed is the number one, or are these just the top and they're not ordered by which one's the most popular of these?
Scott Benner (2:20) I asked for them to then be put into popularity by category. (2:25) So potato potato chips gave me, let's see, Lay's, Ruffles, Pringles, Cape Cod, and Kettle brand. (2:33) Oh. (2:33) So we're gonna today, we're gonna do Lay's potato chips.
Jenny Smith (2:37) Lay's potato chips. (2:39) Got it.
Scott Benner (2:40) Got it. (2:41) Alright. (2:42) And I have a thought about all this when we're done. (2:45) So Lay's classic potato chips, yellow bag, thin chip, no ridges. (2:49) You understand?
Jenny Smith (2:50) Mhmm.
Scott Benner (2:51) Total fat, 10 grams. (2:54) Saturated fat, 1.5. (2:55) Cholesterol, none. (2:57) Sodium, a 170. (2:59) Total carbohydrates, 15.
Scott Benner (3:02) There's a gram of dietary fiber. (3:04) They claim there's calcium in it and a couple of other things. (3:08) But this is for a serving size of about 15 chips.
Jenny Smith (3:14) Mhmm.
Scott Benner (3:15) Okay. (3:15) It says there are eight servings per container.
Jenny Smith (3:18) Do you want a little factoid right there with the carbs and the chips?
Scott Benner (3:21) I do.
Jenny Smith (3:22) You said 15 grams of carb. (3:24) Right?
Scott Benner (3:24) Mhmm.
Jenny Smith (3:25) And a serving is approximately 15 chips.
Scott Benner (3:28) Yep.
Jenny Smith (3:29) In general, a good rule of thumb, if you don't have a label, is a potato chip is about a gram a carb per chip.
Scott Benner (3:37) No matter what brand?
Jenny Smith (3:39) Again, this is a it's a generalization, a broad one. (3:41) But in in general, I mean, Lay's chips aren't teeny tiny chips. (3:45) They're all fairly uniform. (3:47) It's like ugly apples. (3:49) They don't put them out in the bag.
Jenny Smith (3:50) Right? (3:50) So all the chips are about the same size. (3:54) But in general, potato chips are about a gram of carbon chip. (3:57) And despite not talking about them, tortilla chips are about two, sometimes three grams of carb per chip.
Scott Benner (4:03) Oh, okay.
Jenny Smith (4:03) It's a little more dense, but just for potato chips purpose.
Scott Benner (4:06) Alright. (4:07) So I went and looked at ruffles just for fun. (4:10) And, yeah, total carbs, 15. (4:14) Mhmm. (4:14) Alright.
Scott Benner (4:15) So we look up and we say to ourselves, we're gonna have chips. (4:18) Now what do you think the biggest problem with chips is is that you don't eat 15 chips. (4:23) Right?
Jenny Smith (4:23) No. (4:24) No. (4:24) What's the what's the what's the Pringles fill kick? (4:27) It's once you pop, you can't stop.
Scott Benner (4:29) Oh, is that what they say? (4:30) That's awesome.
Jenny Smith (4:31) Think that's what they at least that's what they used to say. (4:33) It's like the Band Aid commercial. (4:34) Nobody knows anymore. (4:35) Right? (4:35) But, yes, I think you're correct.
Jenny Smith (4:37) Nobody unless they have the single serve bags, which is a very clear indication of what a single portion is.
Scott Benner (4:45) Mhmm.
Jenny Smith (4:45) Once you open that bag, it's very easy to keep grabbing.
Scott Benner (4:49) Yes. (4:49) I would think that is completely true. (4:51) I noticed this week we were away on vacation this week, and there was we sat at, like, kind of like a a bar and Mhmm. (5:02) Ordered, like, you know, like, fresh made chips from the bar. (5:05) I know for certain I ate 10 more when I was done by the time I was done with them.
Jenny Smith (5:10) I'm sure.
Scott Benner (5:10) Yeah. (5:10) They had, like, Parmesan cheese on top of them and, like, some like, they were
Jenny Smith (5:14) Those are some fancy chips.
Scott Benner (5:15) They were fancy chips.
Jenny Smith (5:16) Did you eat tomatoes with them, Scott?
Scott Benner (5:18) Jenny, I wanna tell you what I did this week. (5:20) You're gonna get me off track real quick. (5:22) Okay? (5:22) But in a previous episode, I what did I say? (5:25) I'd never had a tomato, and I've never had because I said I've never had salsa even.
Scott Benner (5:31) So I did I ate salsa this week. (5:34) And when there was a chunk of a tomato in it, I kept going. (5:39) So, technically, I've had a tomato now.
Jenny Smith (5:42) There you go.
Scott Benner (5:43) Was very, very spicy, and it was on a tortilla chip. (5:47) I just wanna point that out as well. (5:48) What else was there was something else this weekend I did. (5:50) I texted you about both things, didn't I?
Jenny Smith (5:53) You texted me the tortilla chips and the salsa, and I think you actually said salsa, check, or done or something like that.
Scott Benner (6:00) Yes. (6:00) I sent that back. (6:02) I said salsa, check. (6:03) And then Jenny sends back a picture of her salad that just literally has greens and a giant tomato in the middle of it that I know you probably ate like an apple. (6:11) I did that.
Scott Benner (6:11) Well, I also sent you a
Jenny Smith (6:13) Oh, you sent me a funny picture, which I didn't I forgot to respond to.
Scott Benner (6:17) It's a whole shelf of Velveeta cheese that I saw at the grocery store yesterday. (6:21) Just like it genuinely looks like a 100 maybe more boxes of Velveeta cheese covering four different shelves in different sizes. (6:29) I saw that. (6:30) Was like, that's funny. (6:30) I'll send it to Johnny.
Scott Benner (6:31) Okay. (6:31) So sorry about that. (6:33) Are
Jenny Smith (6:33) going Break down the to loaves chips.
Scott Benner (6:34) Yep. (6:35) So we're gonna we broke down the chips. (6:36) Right? (6:36) We know what the carbs are. (6:38) Why don't we say this time I'm gonna do something a little crazier.
Scott Benner (6:41) Let's say today that, you know, your blood sugar is a 150. (6:44) Right? (6:45) So you now you've looked up. (6:47) You're like, oh, I'm a 150. (6:49) I'm about to have 15 grams of chips.
Scott Benner (6:51) Hopefully. (6:52) Probably not. (6:53) So now you need to bolus for the number, the one fifty. (6:57) Right? (6:57) Right?
Scott Benner (6:57) Whatever your target is, you there's an amount of insulin that'll bring your one fifty that target. (7:01) That insulin goes in. (7:03) Insulin for the you know, if you're one to 10, right, 15 carbs is gonna be Right. (7:07) A unit and a half.
Jenny Smith (7:09) Right.
Scott Benner (7:10) And then, you know, we'll, you know, look at all the things. (7:13) Are we gonna be active? (7:14) Are we not? (7:15) I'm guessing if you're eating chips, it's possible you're gonna be inactive. (7:19) Chips are a sitting around thing, aren't they?
Jenny Smith (7:21) Unless they're served at, like, a picnic or a barbecue or, you know, that kind of thing, then maybe you're doing something after.
Scott Benner (7:27) Fair enough. (7:28) Fair enough. (7:28) So are we gonna be but is are chips a thing that you think activity would cut into, or are they gonna be a thing that are gonna be too sticky for activity to break?
Jenny Smith (7:39) They actually hold the activity from dropping you. (7:42) I mean, if you consider this this particular brand
Scott Benner (7:45) Mhmm.
Jenny Smith (7:45) This chip. (7:46) Right? (7:46) We have 10 grams of fat.
Scott Benner (7:49) Mhmm. (7:49) Yeah.
Jenny Smith (7:49) That's not light fat. (7:51) When we look at, you know, what's the total what's the total calories in this?
Scott Benner (7:55) $1.60 for the 15 chips.
Jenny Smith (7:57) One sixty. (7:58) So if you consider how many of the calories are coming from just fat
Scott Benner (8:04) Mhmm.
Jenny Smith (8:05) You're looking at nine calories per gram, which is 90 of these calories. (8:09) 90 of a 160. (8:11) That's more than 50% is coming from fat. (8:14) Mhmm. (8:15) Which means that they're going to be more let's call it stabilizing.
Scott Benner (8:20) Yeah. (8:21) Stabilizing. (8:21) Jenny's like, don't want it to be too positive of a word. (8:23) But yeah.
Jenny Smith (8:24) Yeah. (8:24) Yeah. (8:25) Yeah. (8:25) But more stabilizing. (8:26) So when you ask about activity, you may think, well, I am gonna be active after this, then maybe these will hold me a little bit better.
Jenny Smith (8:34) And I am not encouraging people to eat Lay's chips to be stable in exercise. (8:38) I just wanna make that very clear.
Scott Benner (8:40) Just being we're just trying to talk about the chips for a moment.
Jenny Smith (8:42) Just talking about the chips. (8:43) Yes. (8:43) But it's a good consideration now for those who aren't going to be let's say, you're lounging around and it's, you know, a cookout and you're just the one you like to sit in your lawn chair and talk to whoever's there. (8:54) Mhmm. (8:54) Then you might actually find that bolus thing just for the carbs, especially if you have more than just the 15 chips
Scott Benner (9:01) Mhmm.
Jenny Smith (9:02) You're likely to stay maybe stock Yeah. (9:06) Higher.
Scott Benner (9:07) I mean, this is also could be a situation where the chips are going with beer. (9:10) Right? (9:11) That could be another thing. (9:12) Yeah. (9:13) So anyway burgers
Jenny Smith (9:14) or yes.
Scott Benner (9:15) So but but anyway, let's taking it back to just I grabbed a bag of chips.
Jenny Smith (9:19) Mhmm.
Scott Benner (9:19) Understand what your activity is gonna be afterwards. (9:22) That could impact how much insulin you're gonna use. (9:24) Right. (9:25) Time of day sensitivity, other factors like that that we're gonna look at. (9:29) Now, pre bolus thing.
Scott Benner (9:30) Here's one where I mean, no person in the world I don't have diabetes, and I have so much compassion for pre bolus thing. (9:38) You have no idea, especially as, you know, my daughter gets older and I can see her, you know, becoming more and more, like, of a I don't know. (9:45) An adult, has more things to do. (9:47) Right? (9:47) Yeah.
Scott Benner (9:48) It's hard to remember to pre bolus. (9:49) I understand. (9:50) But you don't pre bolus a potato chip. (9:52) It's gonna grab you pretty quickly, and you're gonna be fighting with it then for hours afterwards.
Jenny Smith (9:57) So And that's frustrating given what we just talked about with the fat.
Scott Benner (10:00) Yeah. (10:01) Yeah.
Jenny Smith (10:01) For sure. (10:02) But if you go back to some of the nutrition episodes that we did Mhmm. (10:07) You'll understand that the more processed something is like, we're not talking about this being a baked potato with a spoonful of butter on top.
Scott Benner (10:16) Right.
Jenny Smith (10:17) We're talking about something that's, like, processed potato flakes.
Scott Benner (10:21) Maybe.
Jenny Smith (10:22) May maybe. (10:23) Yes. (10:25) It started out as a potato at some point in its life, and now we have something that's a chip. (10:31) It's flavorful. (10:32) It's got fat.
Jenny Smith (10:33) It crunches. (10:34) It's got salt. (10:35) They do it the right way. (10:36) That's why you don't just eat 15 of them. (10:38) Yeah.
Jenny Smith (10:38) But in the long run, you have a two sided effect here. (10:43) If you don't pre bolus, you are going to get a rise eating again just the potato chips, but then you may have a lingering effect from the fat. (10:53) There's not a heck of a lot of I mean, I'd almost call these void of protein. (10:57) There's nothing valuable protein wise here.
Scott Benner (10:59) Yeah.
Jenny Smith (10:59) But the fat definitely is gonna linger.
Scott Benner (11:02) Mhmm. (11:02) Yeah. (11:03) I mean, potatoes, vegetable oil, canola, corn, soybean oil, and or sunflower oil, salt. (11:09) Mhmm. (11:09) That's it.
Scott Benner (11:10) So it's more of the processed nature of it that's
Jenny Smith (11:13) It is.
Scott Benner (11:14) Yeah. (11:14) And then you're getting the fat from the
Jenny Smith (11:16) oils. (11:17) Yes.
Scott Benner (11:17) Okay. (11:18) Alright. (11:18) So you process the potato, that makes it more difficult for your body to process. (11:22) You add a bunch of oil, it slows down your digestion, makes it even more difficult again. (11:27) Then you run into the idea that when you get to 15 chips, you're like, that was a nice appetizer.
Scott Benner (11:32) I'm gonna just grab a handful of chips next time. (11:35) And now you're doing the blind, like, 45 carbs. (11:38) What is 45 everyone's number, by the way? (11:41) Yeah.
Jenny Smith (11:42) I kind of funny. (11:43) It's they're round numbers. (11:44) If you look at enough records like I do
Scott Benner (11:47) Mhmm.
Jenny Smith (11:48) You'll definitely be able to see sure. (11:51) Some things are even five, ten, 15. (11:54) Most things are not.
Scott Benner (11:55) Mhmm.
Jenny Smith (11:56) Most things are, like, eighteen, twenty three. (11:59) 28 is a very common carb count on lots of different foods.
Scott Benner (12:04) Yeah.
Jenny Smith (12:04) Right? (12:05) But you can definitely tell
Scott Benner (12:07) Mhmm.
Jenny Smith (12:08) That, this was just an estimate. (12:10) It's like, 45, 45, 45 for each meal. (12:13) No. (12:14) Probably not, but good guess.
Scott Benner (12:16) Arden's give up number is 45. (12:18) So I wonder how many other people's is just like, this is 45. (12:21) I saw her do it yesterday, and I thought, this is not 45. (12:24) This is probably more. (12:26) But moreover, the bigger problem was is that it was a sit down bolus eight, five minutes later.
Scott Benner (12:31) And I was like, this is not gonna go well. (12:34) And in the end, hours later, that bolus missed by four units, I think. (12:40) That's a fairly sick significant amount. (12:43) Yeah.
Jenny Smith (12:43) Yeah. (12:43) Yeah.
Scott Benner (12:43) So, anyway, I'm not telling you to like, I know people are like, look. (12:47) I don't count my carbs, but, like, you gotta guess you gotta guess right. (12:50) So I think Fairly close. (12:52) Yeah. (12:52) Yeah.
Scott Benner (12:52) So pre bolus these chips if you can because if not, you're gonna fight with them and maybe be honest with yourself about how many you're gonna eat so that you can get that insulin in upfront.
Jenny Smith (13:02) Right. (13:03) Yeah. (13:03) Absolutely.
Scott Benner (13:04) Do you have a favorite potato chip?
Jenny Smith (13:06) Like, brand wise, nothing.
Scott Benner (13:07) No?
Jenny Smith (13:08) Well, I can't actually say it was probably two weeks ago we were gonna get some food to have at the pool for an evening dinner and, like, swim.
Scott Benner (13:18) Mhmm.
Jenny Smith (13:20) So I made some sandwiches, and the boys always they they want chips. (13:24) Like, if they could pick, they would have picked chips probably every single day of their life because, you know, who wouldn't? (13:30) So I stopped at the grocery, and I did pick up I think it was the Boulder brand.
Scott Benner (13:35) Boulder?
Jenny Smith (13:36) Because they're made with avocado oil.
Scott Benner (13:39) Oh, okay. (13:41) Does that did you eat any of them?
Jenny Smith (13:43) I did. (13:43) They were they I mean, from a potato chip aspect, I don't like something that's gonna melt in my mouth, and they, like, they tasted
Scott Benner (13:51) They crunched.
Jenny Smith (13:52) They crunched, and they had, like, substance to them.
Scott Benner (13:56) Mhmm.
Jenny Smith (13:57) So, yes, avocado oil or I know there are some brands that use, olive oil as well.
Scott Benner (14:04) Okay.
Jenny Smith (14:05) But I think that was the brand that I got, if I remember correctly.
Scott Benner (14:08) Okay. (14:08) Alright. (14:09) Alright. (14:09) There Jenny's endorsing.
Jenny Smith (14:11) There there you go. (14:12) Jenny ate potato chips. (14:13) That's what you can call this episode. (14:14) Alright.
Scott Benner (14:15) I'll see you later.
Jenny Smith (14:17) Thanks.
Scott Benner (14:26) In each episode of the bolus four series, Jenny, Smith, and I are gonna pick one food and talk through the bolus thing for that food. (14:35) We hope you find it valuable. (14:37) Generally speaking, we're gonna follow a bit of a formula, the meal bolt formula, m e a l b o l t. (14:45) You can learn more about it at juiceboxpodcast.com/meal-bolt. (14:51) But here's what it is.
Scott Benner (14:52) Step one, m, measure the meal. (14:57) E, evaluate yourself. (15:00) A, add the base units. (15:02) L, layer a correction. (15:06) B, build the bolus shape, o, offset the timing, l, look at the CGM, and t, tweak for next time.
Scott Benner (15:15) In a nutshell, we measure our meal, total carbohydrates, protein, fat, consider the glycemic index and the glycemic load. (15:24) And then we evaluate yourself. (15:26) What's your current blood sugar? (15:27) How much insulin's on board? (15:28) And what kind of activity are you gonna be involved in or not involved in?
Scott Benner (15:32) Do have any stress, hormones, illness? (15:35) What's going on with you? (15:37) Then a, we add the base units. (15:39) Your carbs divided by insulin to carb ratio, just a simple bolus. (15:44) L, layer of correction.
Scott Benner (15:45) Right? (15:47) Do you have to add or subtract insulin based on your current blood sugar? (15:50) Build the bolus shape. (15:52) Are we gonna give it all upfront, a 100% for a fast digesting meal, or is there gonna be like a combo or a square wave bolus? (15:59) Does it have to be extended?
Scott Benner (16:01) Offset the timing. (16:02) This is about pre bolusing. (16:04) Does it take a couple of minutes this meal or maybe twenty minutes? (16:08) Are we gonna have to again consider combo square wave boluses and meals? (16:13) Figure out the timing of that meal.
Scott Benner (16:15) And then l, look at the CGM. (16:18) An hour later, was there a fast spike? (16:20) Three hours later, was there a delayed rise? (16:22) Five hours later, is there any lingering effect from fat and protein? (16:26) Tweak.
Scott Benner (16:28) Tweak for next time, t. (16:30) What did you eat? (16:31) How much insulin and when? (16:33) What did your blood sugar curve look like? (16:36) What would you do next time?
Scott Benner (16:38) This is what we're gonna talk about in every episode of bolus four. (16:43) Measure the meal. (16:44) Evaluate yourself. (16:45) Add the base units. (16:46) Layer a correction, build the bolus shape, offset the timing, look at the CGM, tweak for next time.
Scott Benner (16:52) But it's not gonna be that confusing, and we're not gonna ask you to remember all of that stuff. (16:57) But that's the pathway that Jenny and I are gonna use to speak about each bolus. (17:05) Hey. (17:05) Thanks for listening all the way to the end. (17:07) I really appreciate your loyalty and listenership.
Scott Benner (17:10) Thank you so much for listening. (17:12) I'll be back very soon with another episode of the Juice Box podcast. (17:16) The episode you just heard was professionally edited by Wrong Way Recording. (17:21) Wrongwayrecording.com.
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