#1553 Jordan Juice
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A series of conversations with Jordan Wagner, CDCES. In this episode, diabetes management in the hospital.
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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
Here we are back together again, friends for another episode of The Juicebox Podcast.
Today's guest is Jordan Wagner, a nurse, a diabetes educator and a person living with type one diabetes, and today we're going to talk about preparing yourself for being in the hospital with type one diabetes. The podcast contains so many different series and collections of information that it can be difficult to find them in your traditional podcast app. Sometimes. That's why they're also collected at Juicebox podcast.com, go up to the top. There's a menu right there. Click on series, defining diabetes. Bold beginnings, the Pro Tip series, small sips, Omnipod, five ask Scott and Jenny, mental wellness, fat and protein, defining thyroid. After Dark, diabetes. Variables, Grand Rounds, cold, wind, pregnancy, type two, diabetes, GLP, meds, the math behind diabetes, diabetes myths and so much more, you have to go check it out. It's all there and waiting for you, and it's absolutely free. Juicebox podcast.com, please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin.
This episode of The Juicebox Podcast is sponsored by the Omnipod five, and at my link, omnipod.com/juicebox you can get yourself a free, what I just say, a free Omnipod five starter kit, free. Get out of here. Go click on that link, omnipod.com/juicebox, check it out. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox, links in the show notes, links at Juicebox podcast.com today's podcast is sponsored by us Med, us, med.com/juicebox you can get your diabetes supplies from the same place that we do. And I'm talking about Dexcom, libre, Omnipod, tandem and so much more. Us, med.com/juicebox or call 888-721-1514,
Jordan Wagner 2:26
I'm Jordan, and I'm 31 years old. Had type one diabetes roughly 26 years now, growing up with diabetes, I was very fascinated by it, learning about management and all that that led me to diabetes camps. I went to Chris Dudley basketball camp in Vernonia, Oregon. That was a huge influence in my life, of getting me really interested in living a healthy life with type one, and that you can really thrive with it like Chris Dudley was my role model growing up, played in the NBA for 16 years with type one, and that led me to look at like the healthcare field, and I really did not know what I wanted to do with that. But when my uncle went into a coma from low blood sugar, when I was a senior in high school, went to visit him, his nurse was a male nurse, and at that point, I didn't know that guys were nurses, and so I chatted with his nurse and his his nurse told me all about the nursing field, and really encouraged me to to look into that. And so that's what I did. I looked into it, and ended up going to nursing school, became a nurse, and knew that I ultimately wanted to be a diabetes educator. And so after nursing school, I ended up going to couple different hospitals, but worked on diabetic and kidney units just to get that experience there, and that that gave me enough experience, after about five years, or four or five years, to feel comfortable, to to sit for the the the board exams, or the the exams to be a diabetes educator. And so did that pass the exams, and I've been a diabetes educator ever since.
Scott Benner 4:02
That's awesome. Chris Dudley, by the way, on episode 515 of the podcast, okay, there you go, he was on talking about his is that camp still going? Do you know
Jordan Wagner 4:10
it actually is? Yeah. So I don't know. I don't know exactly where it's at now, they had to move the location, but it was in Vernonia, Oregon for the longest time, and it was just the greatest. I worked there on staff for a little bit. I went to went there as a camper for five years. I mean, I have lifelong friendships from it and it, it set me up very well to understand that I needed to take care of this if I wanted to to thrive like Chris Dudley did,
Scott Benner 4:35
yeah. Had a big impact on you. Huge impact. Yeah. Excellent. Yeah. So you became diabetes. You became an RN, first, yeah,
Jordan Wagner 4:43
yeah, so. RN, so I'm a BSN. RN, CD, CES, wow, yeah, okay, e, i, e, i, o, a lot of letters, I know. And
Scott Benner 4:52
then how long have you been by practicing as a diabetes educator,
Jordan Wagner 4:57
about five years a profession. Really, I always tell people, it's really been like 26 plus years with my personal experience at type one, but five years officially, right as a diabetes educator, how
Scott Benner 5:09
do we find ourselves knowing each other? Trying
Jordan Wagner 5:11
to think here, I think I joined the Facebook group a handful of years ago, and I just started seeing that it was making such a big impact in people's lives there, and I started sharing started sharing it with people at the at the hospital, and so I think that's how we got connected, was just through the Facebook group and posts over the years. Well,
Scott Benner 5:30
Jordan, I'll tell you that I pay attention to what you put on social media. And you know, I know you through, obviously, through the Facebook group, but at the same time, when I see a person like yourself who is so dedicated and thoughtful about how they're helping people, and sees this whole thing, you know, in a way that I think is very clearly, when that person says that you think I'm doing a good job, I'm very touched by that. Yeah, sincerely. You know, if I see you put something online that says, like, you know, you should try this podcast or take a look at this. I think I might be, I might really, actually be doing something right here. It's the same feeling I have as when, you know, when I met Jenny and and, you know, the first time she said to me, I forget exactly how she put it, but she's like, Scott, you could do this professionally. And I thought, like, I was really touched by that, yeah, you know. And so it means a lot to me that this thing that we're putting out there, you're seeing it, you believe in it enough to tell somebody else about it. I really appreciate that. Yeah,
Jordan Wagner 6:31
well, and I truly do believe in this wholeheartedly. I mean, even implementing things from the podcast into my own management. And when I found the podcast, I was like, Oh, I've had diabetes such a long time I can handle this, so I don't really need to learn anything else. And that was such an arrogant way to go about it. But I get into the podcast, and I'm like, Man, this is incredible. And just implementing things I learned on the podcast, I mean, I'm getting my a 1c and the high fives, low sixes, like, for years now, awesome. And it's really cool. It's just a really cool thing. So I believe in sharing that, because there's not a lot of good education resources out there. And so this is something that it's, it's a free resource, and it just benefits so many people. So it's something that people should know about.
Scott Benner 7:13
I'm gonna let you add to that resource. So I, if I let you, I mean, I'm, I'm gonna send you a note Jordan, and say, Hey, would you like to make a series on the podcast? You tell me what you want to talk about, and then come on and speak about it. So you you did. You sent a great list, and we're going to record a few times and put together a short series with you so that people can get you know, from your perspective, what might be important for them to pay attention to? Yeah, absolutely. Yeah. Where do you want to
Jordan Wagner 7:41
start? Yeah. Well, I think for this one right here, really want to talk about diabetes management in the hospital. That's just something that a lot of people might not have a lot of experience with outside of being diagnosed with diabetes. I know a lot of people being diagnosed with type one end up being in DKA when they're when they're diagnosed, and that's a very traumatic experience, potentially, but that also could be your only experience with going into the hospital. And so I think there's some things that I've seen as an inpatient educator that could be helpful for people to understand about going to the hospital, different situations, scenarios that may come up outside of that initial diagnosis. And so that's kind of what I really wanted to dive into here today.
Scott Benner 8:22
I'm happy to so we're talking about, you've got type one now, and you find yourself back in the hospital for some reason. Exactly, yeah, exactly. How do you manage that scenario? Right?
Jordan Wagner 8:31
Exactly, yeah. I mean, one of the biggest things I could start off by saying is that hospitals are unpredictable depending on what size hospital you're at. You know, you come in and maybe you need an MRI or something like that. You could be waiting for days to get that MRI, and you might need to be NPO, so nothing by mouth for the particular MRI. And so, you know, how are you going to navigate that, with your blood sugars going to something where you're not supposed to be eating or drinking, and then to find out at the end of the day, oh, a trauma came in and you've been bumped and you're gonna have to do this again tomorrow. So there's a lot of situations like that that come up, and the unpredictability can be really challenging.
Scott Benner 9:11
What usually happens then? Do they just keep people's blood sugars higher without
Jordan Wagner 9:15
a doubt? Yeah. So one thing I like to tell people is that a hospital is not there to fine tune the diabetes. It's there to stabilize it. And essentially, they care that you're in a safe spot. So from a doctor's perspective, if your sugar is 250 for multiple days at a time, you might not feel great at that, but they're looking at it and going, Oh, well, this person's not going low. They're not going crazy, crazy high, so we're good with that. So they're going to intentionally run you a bit higher. And you need to be you need to be aware of that. So I think as a type one, if you do have that tight control, you know you want tighter controlled blood sugars, you have to communicate that you may receive some pushback. That's something. Thing you have to be ready for, which I think is helpful when you have someone there to advocate for you, someone who knows your diabetes well, who can be there to advocate because we don't know the situation of why you're in the hospital, right? I mean, this could be a planned surgical procedure. You need to be in the hospital. Maybe you have, like, appendicitis, but, you know, there's accidents, right? Well, you could be driving down the road, have a car accident, you have type one diabetes, and now you're in the hospital as a type one you don't need to prep for every possible situation, but just have a general idea of going into potentially tough situation, like, what? What are you going to do, like, just maybe the thought exercise of, like, walking through this in your mind, like, come up with a plan. Because
Scott Benner 10:46
what happens real, real world. What happens is that somebody says 250 is fine, but if it happens to be 300 that's not so bad. Either you're sitting there feeling terribly or maybe you're, you know, I always think of it in a slightly different way, like, maybe you're a person who's already got like, an eight and a half or nine, a, 1c, and then you go to a hospital and see that the hospital was perfectly fine with your blood sugar being 250 then you go home thinking, like, well, I don't know why I'm trying so hard. 250 is okay. Diabetes comes with a lot of things to remember, so it's nice when someone takes something off of your plate. Us. Med has done that for us. When it's time for Arden supplies to be refreshed, we get an email rolls up and in your inbox says, Hi, Arden, this is your friendly reorder email from us. Med. You open up the email, it's a big button that says, Click here to reorder, and you're done. Finally, somebody taking away your responsibility instead of adding one. Us. Med has done that for us. An email arrives, we click on a link, and the next thing you know, your products are at the front door. That simple, US med.com/juicebox, or call, 888-721-1514, I never have to wonder if Arden has enough supplies. I click on one link, I open up a box, I put the stuff in the drawer, and we're done. Us. Med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and the Dexcom g7 they accept Medicare nationwide over 800 private insurers, and all you have to do to get started is call 888-721-1514, or go to my link, usmed.com/juicebox, using that number or my link helps to support the production of the Juicebox Podcast. Today's episode is brought to you by Omnipod. Did you know that the majority of Omnipod five users pay less than $30 per month at the pharmacy? That's less than $1 a day for tube free automated insulin delivery. And a third of Omnipod five users pay $0 per month. You heard that right? Zero? That's less than your daily coffee for all of the benefits of tubeless, waterproof, automated insulin delivery. My daughter has been wearing an Omnipod every day since she was four years old, and she's about to be 21 my family relies on Omnipod, and I think you'll love it, and you can try it for free right now by requesting your free Starter Kit today at my link, omnipod.com/juicebox, Omnipod has been an advertiser for a decade, but even if they weren't, I would tell you proudly, my daughter wears an Omnipod. Omnipod.com/juicebox Terms and Conditions apply. Eligibility may vary. Why don't you get yourself that free starter kit, full terms and conditions can be found at omnipod.com/juicebox,
Jordan Wagner 13:43
exactly, yeah. It sets up a really poor example, yeah. And in my opinion, and you know, as an educator, I'm always advocating for tighter controlled glucose levels. I see it from the doctor's perspective too. Like, yeah, they are managing a lot of tough situations. And like, for example, my hospital is a trauma one hospital, huge, 700 plus bed hospital, so a 250 blood sugar is pretty low priority for someone who might be having, like, a potentially fatal heart attack, right? So I get it from both sides, but I think the type one advocacy is going to be huge and making sure your blood sugars are well controlled in the hospital.
Scott Benner 14:20
I mean, the reason it's happening, it's not unreasonable, but it's also not valuable as an answer to you, the person whose blood sugar is that high, absolutely, yeah, oh, absolutely. Seriously. Like, if you're in a car accident and one medic shows up and one guy is worse than you are, I understand them going to him first. That's not helping you, and if you died later, the post mortem on that would be, well, I helped the person that was more direly in need. And everybody would go, Well, that was the right thing to do. Yeah, there's a difference between what the system can manage, what other human beings at a hospital can, you know, reasonably accomplish in a in a shift, and. And what you need, deserve and require, absolutely. Yeah, so you need to be the one who says, Look, you got me a 250 here, but I'm not okay with this. And what would you say then, like, what if you didn't, like, there's a difference between, like, if that happened to my daughter and I was there, I'd say, Look, you know, we just need to move this here and move this here. But what if move this here, but what if you just don't know what that thing to do is, you know, you don't want a 250 but you don't know what to say next? Yep.
Jordan Wagner 15:29
So that's where I think the planning ahead comes, comes into play here. So give me an example here. So I had surgery back in July. I didn't have to get to admit it to the hospital, but it was a hospital like scenario, the surgery center, I created a full page document outlining what I wanted to have done with my blood sugars, where I was comfortable, at my Dexcom information. So I gave my phone to the surgical tech, the RN there, and he had that and knew my phone password so he could always access the Dexcom. And then I had my wife, I had her trained up on my pump. And I know a lot of other people in this group have done that too, where they've trained a spouse on how to use a pump. And I presented that outline to the providers there so they had a clear understanding. So
Scott Benner 16:19
Jordan, did they listen to you because you're a professional? Do you think it's possible? Yeah, you're not gonna know that. Honestly,
Jordan Wagner 16:26
though, most people don't come in with a plan like that. Whether
Scott Benner 16:28
I was a professional or not, if I had a plan like that, people would be like, Ooh, this is fancy, and probably listen to it.
Jordan Wagner 16:33
They would most likely, you at least have a much better shot of them actually listening to it. Okay, if you have something typed up like that. And so I suppose it could be a smart idea to have a little something typed up. Like, it doesn't have to be the nitty gritty, but like, hey, if an accident happens and I'm hospitalized, I prefer my blood sugars to be in this range. This person is my go to if I'm not able to handle my pump or my my diabetes, things here, and then you just maybe carry that with you, right, keep it in your little bag, and then you've got that there. So then it's not that you're just getting hospitalized, and you go, Oh, crap. I don't know what I need to do. You've got you're like, I've already had this typed up and, like, maybe we can change a little thing here and there, but I've got a plan, and then you can present that to the doctor, yeah? Because
Scott Benner 17:19
if you're not pre prepared, then it's not a thing you're going to be able to do in the moment, right, right? Exactly. Yeah. Okay, yeah. I guess you could even keep it on your phone too, like in a Notes app or something like that, absolutely, and make sure that, like you're, you know, the person you're, whoever your person is in that situation, has access to it as well. Yeah, yeah. So what do you think needs to be on that, on that document?
Jordan Wagner 17:41
Sure. So I would say that if you're using insulin, you should have all of your your settings there well, so whether this is the pump or if you're on MDI, so multiple daily injections, have your long acting dose there, your meal time, doses, your correction factors, and have that easily accessible. Because here's another scenario that can come up. You've got a patient going, I don't want to be this high. I don't feel good. And the doctor goes, Okay, I hear you. We'll increase your insulin. It's not uncommon for doctors to make substantially large increases to insulin. Honestly, I think it's just maybe even a lack of understanding sometimes. I mean, if you say you have like a hospitalist doctor, they're a general doctor. They're very intelligent people, but they are managing so many different conditions that they might not have the expertise in insulin dosing. And so maybe you go, I need a little bit more Lantus. Well, a little bit more Atlantis to them, could be 10 to 15 units. And then all of a sudden, you're flat on your face the next day. So you actually
Scott Benner 18:40
talk a doctor into helping, then they do the wrong thing, then everybody gets scared, and now you're back to where you started, probably
Jordan Wagner 18:45
worse off you got it, yeah, all right, yep, okay, so having your baseline settings, that's gonna give them something to work with. Here's the other reality, too. A lot of people report their settings and they're not actually accurate. What I mean by that is, maybe I come in and say, oh, yeah, I take 25 units Lantis, but I haven't actually been doing that for a long time. It's just what's prescribed. So the doctor sees that, right? And then they're they're going to automatically, probably reduce your basal by about 20% so you'll be at 80% of your home dose. And so if you actually are following your prescriptions and taking what you report, you could be running high to start because they're playing it safe and reducing your basal rates there,
Scott Benner 19:28
right? You know it always, I mean, always shocks me when I say to somebody while I'm I'm interviewing them, I'm like, Well, what's your basal rate? And they go, I don't know. I have to look. I'm not that involved in ardent settings anymore. And I know ardent settings, yeah, not saying I'm special, but, like, it just, it's such a I mean, it's just your basal and, like, yeah, just know it, you know what I mean, like, because also for day to day, if you're not in the hospital, for day to day, remembering that, you know, I don't know you changed your basal from. 1.1 to point eight, five, and hey, I've been high for a couple of days now. Like, maybe just having that number in your head would make you think, Oh, yeah. Like, I've made my basal different before. Maybe I should put that back. Now, you
Jordan Wagner 20:12
got it. Yeah, that's and that's like that total, the whole idea of the basal testing, like, you got to know your your baseline before you're hospitalized. Because you get hospitalized, everything is going to get thrown out the window potentially. Who knows what's going on? Your body is going to be stressed out. It's already going to be running a little higher. Doctors might not be giving you enough insulin, so you have to understand your baseline. Yeah, and that's where taking the principles of this podcast and other episodes are going to be so important, so that time that you do get into that somewhat emergent situation, or you're in the hospital, you have a solid baseline to look at and then work with. I think
Scott Benner 20:50
it's important to say too, like, nobody wants to think about like, Oh, I'm gonna end up in the hospital one day. But the truth is, it might not be today, and it might not even be, you know, I don't know when it looks gonna be. You're all gonna end up in the hospital at some point, right? Be ready for. Be ready for. I mean, this whole diabetes thing is about, it's so funny that pre bolusing is such a big part of it, because pre pairing is really the core of the whole thing. Like, you just have to be ready and know what you're talking about, so that you're not, I don't know, so that when the fight starts, you don't find yourself diving behind a rock because you don't know what else to do, like you you need to know what you're going to do when the hands start flying. Like that's kind of the way I think about it. So absolutely,
Jordan Wagner 21:31
yeah. And speaking of the Pre Bolus there, so it's also not uncommon to be dosed with insulin after you've eaten your meal in the hospital, depending on your nurse, there might not really be that sense of urgency. So I've seen patients type ones eat a full meal. The nurse gets to them 3045, minutes later with their insulin, yeah. And then, you know, they're 350, 400 the next time, right? And then, if that's not done, well, you might have the doctor going, Wow, we don't. We do not have enough insulin here. And then bump up the insulin too much, and now you're low again, and you get stuck in this roller coaster mode here. So it's like advocacy, right? Being prepared. Those are some of the biggest things that could really hit home there. And then, as far as the like, the meals, you should probably have a conversation with the nurse and let them know, like I am a reliable person, if you're not struggling with, you know, nausea, vomiting, let them know that you can keep your food down and that you want your insulin 15 minutes ahead of time, even five minutes ahead of time, just just before you eat the food. Because in the hospital, most nurses are going to err on the side of, let's make sure this patient can actually eat the food before I give the insulin. Yeah, they're trying
Scott Benner 22:43
not to make more problems for them, functionally for themselves while they're working
Jordan Wagner 22:48
absolutely Yeah, and like, low blood sugar for a lot of people, seeing as, like, the absolute worst possible thing in the hospital. Like, it's, I've seen it before, where a patient goes low one time they're like 65 they barely felt it, not a big deal. But the doctor says, you know, we're gonna hold you another day to make sure that your blood sugars are stable
Scott Benner 23:07
while we make it less stable. Yeah. Also don't disregard the fact that that food coming from the cafeteria the hospital is garbage food. Oh, it is bad, right? So there's gonna be that impact as well. You know, you said something a second ago that I wanted to expound on, and I've had a number of experiences around this. Yeah, when you start off a medical procedure, I find it is very worth spending two minutes establishing with the physician that you are a solid person who understands the situation, absolutely not a cocky thing, not like I've been doing this forever. You don't need to tell me, like, just say, Look, I understand that you meet all kinds of people, but I want you to know this, my daughter's a 1c has been between five, two, and I forget what you know, 6264, whatever, for a dozen years. We know what we're doing. We know how to take care of these meals. I know how to keep her blood sugar stable. You tell me she can't eat overnight. I got no problem. I can bring her in with a stable blood sugar in the morning without her having eaten. We're here now. You want to put her under for 10 minutes. Don't worry, she's going to be okay, like, that kind of stuff like and give them a few examples of what you mean, what I've learned, I think, is that it doesn't take long for you to get across to them that not only do you know what you're talking about, but you might know better than they do, which I've actually seen it bring comfort to them.
Jordan Wagner 24:33
No, it's true. It can bring comfort there. And I like what you said that you you're giving them some examples, because a lot of professionals, health healthcare professionals they work with, like, they want the data, right, right? So if you're saying, Oh, here's my a 1c is, you do see people come in and, like, not want to talk with me, or one of the doctors, because they they say they know what they're doing, but then you look at their information, you go, respectfully, yeah, your a one Cs are eight to 11. Percent for I can see at least five years here. Well, I think
Scott Benner 25:02
what that could be sometimes is people saying, like, don't look at me, because I don't want to have to explain to you that I'm not doing as well as I would like to be, or that you would like me to be, right? And, you know, it kind of brings me to my next point, which I think I've made on the podcast number of times. But like, I grew up with a lot of friends who were police officers, yes, and these are guys that, if you knew them personally, they're just lovely people, right? But every day at work, everyone's lying to them all the time. So true, yeah, and then, except for the people who aren't, and then how do you figure out who's who, right? And I wonder if, if I'm a physician, and what I'm, first of all, I'm working in a hospital. This is a place where people come in emergent situations, right, right? And not just because you got hit by a car, but because something in your body broke down, or doesn't work, or something like that. The people they see with diabetes are not, generally speaking, the healthiest. On top of it patients. So then they start thinking, that's how everyone is, right? You start generalizing whether you want to or not, yep. And then you come in with your five, six, a, 1c, and like, I've been listening to Juicebox Podcast for a dozen years. Like, watch me do this. That's not what they're gonna think. And they co mingle, type one and type two together immediately. Big time. Yep, right? So now you're just a person with diabetes, and most of the people I know with diabetes that come in this hospital don't know what they're doing, so you don't know what you're doing, so I'm not going to listen to you, and you get written off before anybody speaks a word.
Jordan Wagner 26:26
It's so true, and that's why I think having that conversation is important. You know, physicians can be very quick in and out of the room, and so letting them know like this is important to me. I need to discuss this with you is going to be very important. You have to do that early on in your hospitalization, because I've also seen it where patients have a low A, 1c, and the physicians thought is, Well, surely this is false. Let's see if they have some like hemoglobin disorder, or maybe they have some kind of liver disease going on. The way,
Scott Benner 26:55
I try to think about that Jordan is like, imagine how many people they've seen that they can't believe that you're taking good care of yourself. So true. Yeah, their experience is so great that when you walk in there with your six and a half, even a seven probably, right. Like, like, they're like, well, this had to happen by mistake. Like, you know what I mean? Like, and we see that with regular endocrinologist appointments. I see it constantly. People find this podcast. They get their stuff together, right? They go back three months later, and they're like, go ahead, give me the needle, because they're dying for you to get that a 1c back. It comes out. They're super proud of themselves. They've been working super hard for three months. They roll out their lower, more stable, a 1c and the doctor goes, we got to cut your insulin back. You're getting low all the time. I've heard stories directly from dozens of people, probably more, who will say to the doctor, no, no, listen, here's what I figured out. Like, here's my they'll show them graphs like, I'm not getting low, and the doctors can't bring themselves to believe it, because they're so indoctrinated in what they've seen all these years. And you know, so
Jordan Wagner 27:59
true. Yeah. And I mean, building on top of that, you just said the graphs there, if you have a CGM, continue to wear that CGM in the hospital, because that's that's cold, hard evidence, for lack of better words, that that things are in control there. I mean, you could show them a clarity report of the last 90 days, or whatever it is, to show them that you're in control. But also that's going to help with even treatment decisions, yeah, because in the hospital setting, we're only using point of care testing, right? We're poking your finger. We're seeing where your blood sugar is at. If I can come into someone's room and see that they have a CGM on and I'm like, Oh, great, I can look at this graph and see and pinpoint where there's problem times. And maybe we need to adjust the food they're eating, or maybe we need to adjust their insulin, and that's something that you can report back to the doctor there. So whatever you do, keep that CGM on. Same goes for the insulin pump, truly. But I will also tell you that you're going to see some pushback from some of the doctors not wearing a pump or even a CGM. It could be both, but it's going to be way more heavy on the pump side.
Scott Benner 29:01
If somebody told me to take that CGM off of art, and I'd be like, That is not happening. Like you're not taking that off of her. Because also, I think your point is awesome. Now you're settled, and you're in the hospital for a stay. They don't want to give you your insulin at the right time. And you can turn to them and go, Look, here's what happened. This is what I told you was going to happen. Like, my blood sugar went up like this. If we would have just put the insulin right here, that wouldn't have happened. Like, can't we try that? Yes, or can't I keep my pump on and we do this together? Like, I know you've got a bunch of people to help, and it's probably hard. What I'm thinking is, even if I'm a nurse who wants to do this with you, now, there's a cascading effect here. I'm going to give you your insulin 15 minutes before you eat. Minutes before you eat, but I'm not in control when the food comes Correct, right? And now I'm going to have to I got 20 other people to help, and I got to worry that I gave you insulin and the food didn't show up, and you're in that room by yourself with the door closed, and all the other stuff that comes with it. What if they vomit? What if they do this? What if all the things that I've seen happen in. The past happen. So you get into that what if situation, honestly, Jordan, the way you're describing it, and where the conversation is leading me, what it tells me is, is that if it's not a joint effort between the hospital and you, there's no way to actually accomplish this 100% it's gotta be, yeah, it has to be that, right? And by the way, there's a new nurse and a new doctor every so many hours, you're gonna have to have this conversation over and over and over again, just because you told the first person doesn't mean the next one's gonna understand.
Jordan Wagner 30:32
You have to. And then, as hard as this is stay patient, because depending on which doctor you see, and for lack of better words, I'll say a neurodivergent doctor walks in who might be very impatient and not wanting to talk to you, and has an agenda, and only is going to speak to that agenda right there if you're not patient and you have a little attitude, because you've explained this 10 times now that doctor might flat just walk out of the room.
Scott Benner 30:59
Oh yeah, yeah. The 10th time you say it's got to be like the first time you said it Exactly,
Jordan Wagner 31:03
yeah. So, and that's that's challenging, because you might be in pain, you might be feeling terrible from a high blood sugar. And getting back to the earlier point of advocacy, that's where having that special person there for you who can speak to your needs, who can speak to the situations going on. Maybe when you fully can't it's gonna be so important. So you need to have that set up ahead of time. We all
Scott Benner 31:25
have the practice of explaining to Dexcom why we need a sensor replaced, and having to do it a second time. You just take that experience and use it in the hospital. Exactly. I should say, first of all, like, Arden's experience with CGM is very good. Like, we don't get a ton of 'em replaced, but it is crazy. Like, you know, if they, if they happen, and, you know, I don't know, in January, you got a call and they ask you their questions that there's, I mean, this the poor guy on the phone. This is the questions he's got to ask you. And then, you know, three months later, another one, a year later, two more, five years later, you're doing it again, and someone asks you where you're putting, you know, where do you put your sensor? Like, are you following the whatever? Like, there is that feeling inside of you, it feels like I've told you this six times over five years, right? You haven't that person doesn't work there for for six months, probably, and they're just reading to you from a list. So like that practice that you have to use in that situation of just saying, Look, I've said this 1000 times, but I haven't said it to this person even once exactly, you have to keep that in mind. You have to find a way to advocate but you know, I hate the word advocate for yourself, because it makes me feel like someone's not doing their job. I know, but you have to advocate for yourself, and you have to do it in a way that makes the other person want to help you. Absolutely, I know that shouldn't be the way it is. But human interaction like you've got to play the game. You have
Jordan Wagner 32:49
to Yeah, you really do, yeah, just go into it with respect. And what I would say also is it's also okay to disagree with the doctor, so you are in charge of your own health. And so let's say the doctor goes, All right, we're going to increase your insulin. You're going up 10 units Atlantis or 15. You can tell them, like, No, this, that's going to kill me, yeah, or that's going to drop me really low. Like, can we meet in the middle and maybe do seven or something like that? It's it's okay to do those things again. You are in charge. And you can also refuse anything to right? So I don't know, maybe again, with the insulin increase or a different medication, you have the right to refuse a medication. Just because it's prescribed does not mean you have to take it. It's it's within your rights to say, No, I don't want to take that. Right now, yeah, and a lot of patients don't. They don't know that, they'll go in and say, Well, the doctor said I need to do this, and that's why I did it. If you are someone who's really in tune with your body and really knows your diabetes, chances are you know way more about diabetes than the doctor in the moment treating you, right? So use that experience. So Jordan, I'm gonna
Scott Benner 33:52
ask you a question that's probably difficult to answer, right? Because what you do professionally, but is it not the case that most adults with type one just sneak their gear into the hospital and manage themselves privately and quietly.
Jordan Wagner 34:04
Yeah, we definitely see that. And so I'll tell you, our hospital policy is, if we encounter that, we have to bring security up to confiscate the insulin or the whatever medication they're using. That's, that's what I'll say, is, that's the policy there. But does, it happen? Yes, I do. I have encountered that where people are doing that.
Scott Benner 34:24
I mean, I've seen it with my friends. You know, when I was younger, friend of mine ended up in the hospital, calls me up and says, Listen, I need you to go to my house, get my syringes, get my insulin, get my whole kit and sneak it in here for me, because they're not helping me. Yeah. And he's like, and I can't get it accomplished. And then you're like, Okay, you know? So I brought him his stuff and he he hid it in a bag and kept it with him, and if his blood sugar got too high, he brought it back down again. Yeah. I mean, I see all the reasons why that's not a good idea. Like, don't get me wrong, and I'm not advocating for that. I'm advocating for you, setting it up with you. Or with a provider, right? Have
Jordan Wagner 35:01
that conversation, right? Get it straight. But yeah, I mean,
Scott Benner 35:05
there are going to be times where people are just, you're not going to get through to somebody, or maybe you're just not going to be a good communicator, like, maybe you'll just be in the moment when you're like, saying, like, I know what I'm doing, just shut up. And somebody's like, Oh, you're crazy. And then that's the end of the conversation. Yeah, it's tough. Also you have to open up for the possibility, and this is hard, but for some people listening, you might not know what the hell you're talking about. It's true. That's a tough one. Go take, you know, steel man, the doctor side of this. Now is it I got somebody standing in front of me ranting and raving that they know what to do? I look back at their records, they're they got a nine, a, 1c, for the last 10 years. That's not exactly indicative of knowing what to do. And now they're telling me, Don't listen to yourself, doctor, listen to me. And right? You believe in yourself because you think I'm doing great. Maybe that's what you think you know. So,
Jordan Wagner 35:52
right, right, you know. And there's, there's situations too, that despite having flawless control at home, that just, are you gonna throw you for a loop in the hospital, like, for example, steroids come into play all the time, right? That's gonna really, really throw your blood sugars up, especially if, like, let's say you're having an acute, uh, asthma attack, right? Or someone with COPD, they might hit you with some insanely high dose of the steroids, and you're, if you're not prepared, like, your sugar could go to 600 or more, right? And so in those cases there, maybe you do need to have the expertise of, maybe, like, an endocrinologist. So some hospitals are going to have endocrinologist in the hospital. That's not every hospital. Some hospitals have diabetes educators. Maybe it's like, that's the time we go, Hey, can we request the endocrinology team or the diabetes educator team to come on board my case and help out with this? Another scenario we see a lot is tube feeds. That's not something most people encounter on a daily basis, right? Maybe you're not able to eat by mouth for some reason, and they have a tube down your nose into your stomach. That's a lot of carbohydrates that you might not be used to having, and that's going to really throw off your insulin needs and
Scott Benner 37:06
hitting you differently than it normally hits you. So yeah, I mean, there are going to be times where it's not lost on me that if, you know, if my, if my kid went to the hospital and she ended up with like, 150 175 blood sugar for three days, but she wasn't low and she wasn't super high. I would say, You know what, it seems like everybody did a good job here, right? Yeah, you know what I mean? Like, I think it's like you're talking about two, 250, I feel nauseous now because my blood sugar is this high, nobody's doing anything about it. No, we're not doing simple things like, you know, trying to time our meal insulin, right? I think you fight the fight where the fight can be won and where it's safe for people. But I also would ask doctors to really remind themselves that high blood sugars are not a conducive scenario for healing.
Jordan Wagner 37:50
It is not at all right. I mean, the infections go they go way higher. The wounds don't heal. We have to have tighter control, and that's where I mean, I I personally advocate for the patients a lot of that we need this tighter control. And like Scott, like you said earlier, what is that teaching a patient who has an A 1c of eight, nine, and now we're at 250 all the time, and the doctors are saying, Oh well, we're okay right now. You're not having lows. We're working on your blood chairs a little bit. That's going to teach that person that, oh, well, 250 is not that bad. And like you said, then it turns to 300 and if we take the conversation
Scott Benner 38:25
around away from the individual and apply it to the greater good, I think that's the most important part of this conversation. So it's almost like the economy, like, you know, yes, this hurts, but if the whole thing gets better, you got hurt, but it's better going forward, right? And I think that that happens with diabetes all I mean, I think anybody who listened to the Grand Rounds series knows how I feel about it, but everything starts at minute one for every new person with diabetes, right? Yeah. And so going into the hospital is a new minute one, because it's an experience you've never had before. And if somebody is in that hospital who's already been told, Hey, listen, we're shooting for a seven, a, 1c, but yours is eight and a half. You're doing great. I know you're trying like so now all of a sudden, ADA says seven, you're hitting eight and a half. The doctor's trying to give you the benefit of the doubt, or doesn't know how to help you. So now you've been told eight and a half is okay. Meanwhile, Jordan's running around with a high five, low six, and so is my kid. And anybody else listen to this podcast, probably right. So you're at an you're an eight and a half, when you could be at a six, but instead, a person of you know that you're going to respect a doctor, somebody who went to school knows more than you. In your mind, that kind of thing has told you eight and a half is okay. We're shooting for seven, but eight and a half's okay. Then you go into the hospital. And you realize, man, they got my blood sugar 50 points higher than I got it right. They must know what they're talking about. And if you're not all tied into all of this, you could easily rewire yourself into thinking that that's okay without a doubt. Yeah, and it's rewiring the doctors who are saying. Saying, hey, when she left here, she was fine, so I guess it was cool that her her blood sugar was 275 while she was here, because she did. It's okay. It's such a slow slippery slope of like, just keep accepting a little worse. Just keep accepting a little worse, a little worse, a little worse, until you get to the point honestly, like, apply it to anything. 20 years ago. You know, if I would have told you that in it, that an entire generation of human beings could be captured by moving their finger up and down to see pictures, you'd go, that's insane. That'll never happen, right? But we did it. We slowly got everybody there. You can slowly get better or slowly get worse, right? And I just think that when you're presented with this is okay, your brain doesn't say, Oh, this is okay. I'll shoot for better. It's this is okay. I'll try a little less, and as it slowly drifts away, I'll just keep moving the line that I'm okay with absolutely, yeah. I think that's one of the biggest problems for people living with diabetes, not getting good information and good tools early enough on.
Jordan Wagner 41:10
Oh, without a doubt, yeah. And I would say from the hospital doctor's perspective, there's such a culture of, am I gonna get sued over this? You end up having doctors wanting to play things safer, to avoiding those critical low blood sugars, and in the immediate setting again, running 202 5300, that patient is considered safer than if their blood sugar dropped way too low. I think there's just a lot of things floating around on the doctor's mind. I mean, some of my doctor friends. You know they're seeing 2030 patients a day, oh, yeah, in the hospital. So they also don't have a ton of time to spend with everyone there, right? Not every
Scott Benner 41:48
one of your doctors is running around with 145 IQ and can keep 75 balls in the air all at one time. And remember to say to you at the end, hey, listen, we're gonna keep your blood sugar a little high here, but let's remember that's not okay. And as soon as we get you out of here, we need to put it back here. Yes, it's for this moment. It's not forever. I take your point like, how am I gonna even remember to say that in that scenario? Right? I'm only aware of it for having had all of these conversations. You know, after the fact, I have the benefit of talking to somebody who also has the benefit of hindsight. And so they can say, you know, when I look back over my life, this is how I slowly drifted to this place. I don't know how I'm supposed to explain that to an ER doctor who and then tell them at the end of the you know, at the end say, don't forget to tell them that. Hey, listen, this is just for during treatment times, but we're gonna put it back. And do you know how to do that? If you that? If you don't let me explain to you about pre bolusing and getting your setting
Jordan Wagner 42:46
like they can't do that, right? No, they won't do that. I mean, they really won't.
Scott Benner 42:50
They wouldn't or couldn't. It doesn't matter, like they Yeah, not gonna
Jordan Wagner 42:54
happen. It's not gonna happen, yeah, not, not in an inpatient setting. I mean, I've been in rooms with doctors before, and I assume it's just like I said. They're they've got other things going on. They're busy. And the patients get rid of the discharge, and they go, all right, make sure you take your insulin for your food, you know, make sure you're counting your carbs. Try to keep your blood sugar, you know, like under 180 or whatever, and all right. And then follow up with endocrinologist in two to three
Scott Benner 43:17
weeks. They say the banal crap that doesn't lead anybody to success, right, right? But they're covered. Yep, they covered their basis. Yep, for sure. Yeah. Listen, I've been upset about this for 20 years. I've told this story before, but I was in an elevator once at a blogging conference, and I just said to this person who had an incredibly popular blog, why do you talk to them like that when you know that's not true? And that person just said, it's not my job. I'm not sticking my neck out for this. And I was like, Oh, awesome, great. I was like, I'm gonna just go tell them how I take care of this, right? That person said to me, You shouldn't do that. And I was like, I'm going to, I get it. Like, I do get it. And also, by the way, I wasn't being asked to write a blog or make a podcast while I was helping you in the ER, like, like, you know, like, right? Is a different situation, but that's why, you know, maybe there are just some difficulties in life that are only able to be tackled in hindsight. Like, maybe there's just some stuff we can't actually get ahead of for reasons that are too complicated to fix or even understand. Maybe, I
Jordan Wagner 44:17
mean, it's a possibility. I mean, I think it's really important to learn from the past. Yeah, right. So if you had a poor experience in the hospital, learn from that. Maybe write down your thoughts so you can reflect upon it, and then if it happens again in the future, you have a different idea of how to go into the situation there. Well,
Scott Benner 44:36
Jordan, I want to make sure that you have out all your thoughts before I give you my big idea. In case there's a doctor listening. But do you have everything out?
Jordan Wagner 44:42
Yeah. I mean, there's a I want to just say a few more things, a couple topics I wanted to hit real fast, but going back to the surgery stuff, real fast, anesthesia is going to impact people differently. And what I mean by that is, some people detox it really well, and some people don't, upwards of roughly. 40% of the population have that MTHFR gene mutation, also known as the mother effer gene, and that is going to impact your ability to detox from anesthesia. So let's say that you have that gene mutation, you aren't able to detox anesthesia. You could feel really awful for three to five days where you're throwing up after the surgery. So that's going to require some adjustments to your your insulin dosing if you're on a pump, temporary basal is going to be a really good thing to look at. You may need to reduce the amount of insulin that you're getting so that you're not having lows that then you can't treat because you're so nauseous, that's something to think, to think about. Now, I never thought of this until I had the surgery myself, but they had to intubate me during my surgery because it was on my nose. But I woke up. My throat was so incredibly sore that I didn't want to eat food for for a while, and so again, I had to look at my insulin dosing there, reduce it at some times so that I wasn't having those low blood sugars. So there's those kinds of factors there that maybe you don't think about until you've been through it. Okay, like you said, the hindsight learning from the past. So maybe you learn from that you move forward and approach you differently next time, yeah,
Scott Benner 46:20
yeah. I've been under a number of times. Never have any trouble. And I just had a procedure where I was out for 45 minutes and I wasn't vomiting, but I felt like crap for about four or five days afterwards, yep, and I think they that anesthesiologist used a different cocktail than what I'm normally getting, and it really wrecked me for a while. I felt crappy for days.
Jordan Wagner 46:42
Yeah, and steroids are really common to use in that process. I had requested that no steroids be used during my procedure. That was helpful, but it's very common if you get a large dose of steroids in conjunction with anesthesia, so then you come up and it's a weird combination. So again, to tie this all back together. Having that person there to advocate for you throughout your hospital stay is like going to be one of the greatest things possible. Yeah, yeah, 100%
Scott Benner 47:09
I and it's listen. It's tough to have all the information you need and make sure there's somebody there with you, but again, I just think just be as pre prepared as possible. That's it. Yeah. Jordan's initial idea of having this all written down ahead of time is just, you know, I mean, it couldn't, it couldn't be a better idea. And put it on your calendar, like, every year, like, Hey, sit back down and make sure my emergency sheet is updated. Absolutely take 10 years to change your settings and or something like that. Yeah,
Jordan Wagner 47:38
yeah. That's a good way to do it, man, put in your calendar there and make sure it's, like, on a yearly basis, we have a, like, a go bag, like, if there was a major emergency I needed to go, and we just updated ours, not that long ago, updated all the diabetes supplies. It's a similar concept, right? Yes, it's being prepared for a situation before it happens. It's stuff
Scott Benner 47:55
that's not fun to do that one day you'll be super happy you did it absolutely, yeah, 100% anything else that I that?
Jordan Wagner 48:02
No, we covered everything there. I'm sure I'll get off this and be like, Oh, I forgot that. But that's
Scott Benner 48:06
okay. You're gonna come back tell people what we're gonna talk about next time. Yeah,
Jordan Wagner 48:10
so there's a couple other things I'd like to talk about. One of the big things would be like, how, like, nutrition and stress impact blood sugars there. Definitely wanna look at how Ultra processed foods are really hurting the health of people in this country and in the United States, eating a healthier diet without diving too much into it can actually really help with your insulin sensitivity and things like that. Okay, we'll look at different CGM and how that can compare to blood sugar checks and why there's some inaccuracies at times. There's quite a few things that can throw CGM off. So that would be something to look at, for sure. So we'll dive into a few different things there. Yep,
Scott Benner 48:46
just know that I if you enjoyed listening to Jordan, I just said to him, You tell me, if I gave you a series to talk to people about diabetes, what would you want to tell them? And he put a list together, and those are the things we're talking about. So yep, that's what you're going to hear in other episodes. Now, Jordan, if you have a minute to hear my big idea, hear my big idea, let's do it. Okay. So I don't wanna give away too much about how I do things, but I guess I'm gonna have to to say this. So I was telling Jordan before we started recording that I keep a list of all of the repetitious questions that are asked by people in the Facebook group, and then we pre create content for you so that we can answer those questions with that content. So instead of waiting to the moment when you say, like, I don't understand this, and then somebody having to sit down and, like, dump their thoughts out to give it back to you, which is good, we still see that happen through the community. People give their lived experiences, but somebody from the podcast, or you know me, or somebody who's helping with the Facebook group will also come and say you should try this episode. It has that information. Or here's a blog post that explains that that comes, not by mistake, that's a life lived helping people with telling. Bone diabetes and keeping track of that information in a repository somewhere, so that it is accessible. That's awesome. And what I found myself thinking was so again, this is going to be a bigger idea, but as the world gets more automated, we're going to lose more and more of those people who have been doing things forever, who just know how to do it and how it works best, and what needs to be addressed, and what's kind of bull. You know, sounds nice, but doesn't really help anybody like they're gonna have those ideas, and I am just a large proponent of people sitting down and talking into a microphone and then taking that audio and making it into a transcript, and then feeding a large language model with that transcript. Oh, that'd be crazy. And I'm telling you that if I was a hospital, I would hire three dorks. I would stick them in a corner, and one of those dorks would be in charge of you coming in and just telling your story as the RN, telling your story as the nurse, telling your story as the doctor, the things that you think are important, over and over again, and feed that large language model with everybody's lived experience. Wow. And then one day you'd have a prompt in front of you, 25 years from now, when people are still nurses, except that we've lost all the people who had the job for 40 years, and you know, knew what to do in the right situation, and everybody learned from them. And you could sit down at a prompt and say, This is what's happening right now. Here's this patient, like, what do you think I should do? And instead of, it's not the internet that's being asked, it's every person who's ever worked at that hospital and shared their experience. To give you a list of ideas of what to look into. I mean,
Jordan Wagner 51:43
that's incredible. That would be really incredible.
Scott Benner 51:45
I am telling you, I think it's a huge I'm literally trying to talk my son into starting a business where he just goes to other business and captures thought leaders ideas. I think it's, I genuinely think, instead of like, waiting for the Internet to give you the answer, or waiting for just a generalized, large language model to go out on the internet and pull back in the answer, like, why not get people who you trust to tell you what their experience was? And then one day you'll just have this, the hospital will have a, you know, I don't know, a pool of information, and then you can, you could, if you want, put a group of doctors in charge of it, to go look at it and say, You know what that part? Let's take that out, somebody to review it. And to, I don't, I'm telling you, man, it's a great idea. No one's going to listen to
Jordan Wagner 52:34
me. That is a great idea that, I mean, that would help a lot. Honestly, it would
Scott Benner 52:39
work for and it would work for anything, but it would work so much better in healthcare, because, like, if you want a bicycle shop, it would work, but it wouldn't be that valuable. But, like, but in healthcare where you have these doctors who just know this stuff because they've done it so many times, right, or you have a nurse who just has this information that was not taught to them in nursing school. That isn't a thing that's written down anywhere they just know works like that's the stuff that you need to keep and I think amplify. I'm behind the scenes doing it for all of you guys. Like my last gesture. I want my last gesture to be that when I'm done with all this Juicebox podcast.com, is just a prompt where you can ask questions, and you'll be asking it of everybody who's ever had a conversation on the podcast.
Jordan Wagner 53:29
I mean, it's, it's, that's such an incredible idea. Yeah,
Scott Benner 53:32
and it'll work. So I think it would. Yeah, no. 100% it absolutely will anyway, matter of just creating it. I know this isn't a patent, but don't steal my idea.
Jordan Wagner 53:41
There you go. All right, I won't hold on one second.
Scott Benner 53:51
This episode of The Juicebox Podcast is sponsored by the Omnipod five, and at my link, omnipod.com/juicebox you can get yourself a free, what I just say, a free Omnipod five starter kit, free. Get out of here. Go click on that link, omnipod.com/juicebox, check it out. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox, links in the show notes, links at Juicebox podcast.com. The conversation you just enjoyed was brought to you by us. Med, us. Med.com/juicebox, or call 888-721-1514, get started today and get your supplies from us. Med, thanks so much to Jordan for spending his time with us. If you're enjoying Jordan on the podcast and you'd like him to come back, go find him on Instagram, the diabetic murse, and let him know how much you enjoyed him on the show. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox pod. Podcast, if you're looking for community around type one diabetes, check out the Juicebox Podcast. Private Facebook group. Juicebox Podcast, type one diabetes, but everybody is welcome. Type one, type two, gestational loved ones. It doesn't matter to me, if you're impacted by diabetes and you're looking for support, comfort or community. Check out Juicebox Podcast, type one diabetes on Facebook, the episode you just heard was professionally edited by wrong way recording, wrongway recording.com,
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