#1743 Penny Drop - Part 2
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Liesl wirks for DAFNE, 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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Scott Benner (0:00) Hello, friends, and welcome back to another episode of the Juice Box podcast. (0:13) This is part two of a two part episode. (0:16) Go look at the title. (0:17) If you don't recognize it, you haven't heard part one yet. (0:20) It's probably the episode right before this in your podcast player.
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. (0:44) My diabetes pro tip series is about cutting through the clutter of diabetes management to give you the straightforward practical insights that truly make a difference. (0:53) This series is all about mastering the fundamentals, whether it's the basics of insulin, dosing adjustments, or everyday management strategies that will empower you to take control. (1:03) I'm joined by Jenny Smith, who is a diabetes educator with over thirty five years of personal experience, and we break down complex concepts into simple, actionable tips.
Scott Benner (1:13) The diabetes pro tip series runs between episode one thousand and one thousand twenty five in your podcast player, or you can listen to it at juiceboxpodcast.com by going up into the menu. (1:31) This episode of the Juice Box podcast is sponsored by Omnipod five. (1:35) Omnipod five is a tube free automated insulin delivery system that's been shown to significantly improve a one c and time and range for people with type one diabetes when they've switched from daily injections. (1:46) Learn more and get started today at omnipod.com/juicebox. (1:51) At my link, you can get a free starter kit right now.
Scott Benner (1:53) Terms and conditions apply. (1:55) Eligibility may vary. (1:56) Full terms and conditions can be found at omnipod.com/juicebox. (2:02) The podcast is also sponsored today by US Med, usmed.com/juicebox, or call (888) 721-1514. (2:12) You can get your diabetes testing supplies the same way we do from US Med.
Scott Benner (2:17) I said, here's what I really think. (2:18) I think if you go on an algorithm, you'll be able to sleep better. (2:21) And I think and I think you won't know how much that's gonna change your life until you've had it for a month.
Liesl (2:27) Yeah.
Scott Benner (2:27) And then I I and I stopped myself and I said, and here's another thing. (2:32) Let's be more honest. (2:33) I said, there are days, chunks of my daughter's day where she boluses for her food, and then she goes off and does something. (2:41) She goes to class where she sits with her boyfriend or she, you know, goes out with her friends. (2:47) And because an algorithm is making changes to her insulin during that time based on her data, she doesn't really pay that close attention to her diabetes.
Scott Benner (2:57) Mhmm. (2:57) And and it's not that she's not aware of it. (2:59) It's not that she won't do something if, you know, if something really comes up or whatnot. (3:05) But she doesn't have to, like, go, oh, no. (3:07) It went to one twenty.
Scott Benner (3:09) I got a bolus or it's gonna go to one fifty. (3:12) Like like yeah. (3:12) Like, you know, she goes to one twenty, and the damn thing gives her insulin. (3:16) Then and then it stops. (3:18) Right?
Scott Benner (3:18) And and then, you know, and then if she tries to get low, it stops again. (3:21) I was like, so in my mind, when you're asking me, should I get a pump? (3:26) I think yes because Mhmm. (3:29) Of what it lifts from you that you can't really quantify, and you won't know until it happens. (3:36) Anyway, I wonder
Liesl (3:38) what Some it shoulders some of the burden for her, doesn't it?
Scott Benner (3:41) Oh, I mean, I'll it it when you sit in a conversation like this and go back to 50 calories today, a 100 tomorrow so that you'll die more slowly, well, it's doing more than shouldering the burden. (3:53) Right? (3:54) Right. (3:54) Like like, right, if you if you have if you have that kind of context when you're thinking about it, it's magic. (4:00) If you were diagnosed a year and a half ago, it's shouldering the burden.
Scott Benner (4:04) Yeah. (4:05) So your perspective has a lot to do with what you see it as a part of these con what I like about these conversations is that I hope to alleviate some of the the mental anxiety that people have and the burden that they have Yeah. (4:17) Because they live in a modern society where they're accustomed to everything kinda working the way it's supposed to and, diabetes then feels like it's not. (4:24) But I'm telling you just and say to yourself, holy shit. (4:29) I'm getting away with something here.
Scott Benner (4:31) Yeah. (4:31) You know? (4:32) Yeah.
Liesl (4:32) I I still think it's important for me as a health care professional and just as a person to recognize that I need to be careful that it doesn't come across as, well, I know you've got type one, but you should be grateful you've got the tech because there was a time when it wasn't available.
Scott Benner (4:49) Yeah. (4:49) I know. (4:49) I don't I wouldn't say that to somebody, but I do think it's important that they understand it.
Liesl (4:53) Yeah. (4:54) Yeah. (4:54) And and I and I know that you wouldn't do that, but I I just just say that people understand that just because the tech's there doesn't mean that I would expect somebody with type one diabetes to be a whiz at it just because the tech is there. (5:05) Yeah. (5:05) The tech is great.
Liesl (5:07) And as we've said, it takes some of the burden away, but you've still got that wet towel draped around your shoulders.
Scott Benner (5:13) Yep. (5:13) And you still
Liesl (5:14) have earlier. (5:15) So
Scott Benner (5:15) You also still have the rest of what Daphne's doing for people because that technology is basically useless if you don't understand glycemic load, glycemic impact, how to change your settings, you know, how to bolus for fat in your food. (5:28) Like, if you don't have those ideas, it's still gonna seem chaotic. (5:32) Yeah. (5:32) Yeah.
Liesl (5:33) Yeah. (5:33) And I think that's a really good point, Scott, because when we look at our data every year, we've looked at our we look at our that we call it our key performance indicator data. (5:42) So it's what happens to people's h b a one c when they've done a Daphne course a year later, their severe hypo rates, their DKA rates. (5:50) And I guess I thought that once people had the CGM and the tech that they would have a lower h b a one c before they did the course anyway, or they wouldn't have as much DKA. (6:02) There wouldn't be so many severe hypos.
Liesl (6:04) But what we're seeing is that people are coming in with the advantage of the tech already, but they're still achieving the same degree of reduction in their h h b a one c than they were when everyone was doing finger pricking. (6:17) They're still seeing the same reduction in severe hypos, the same reduction in DKA. (6:22) So that just goes hand in hand with what you said, which is if you give somebody the tech, they can achieve a lot. (6:28) But you give them the tech and the education, and it's it's boundless what they could achieve. (6:34) You know?
Liesl (6:35) It it just at least can double what they can achieve if they're given the opportunity. (6:39) And part of my job is to try and make sure that they get given that opportunity.
Scott Benner (6:43) Mhmm. (6:44) No. (6:44) It's wonderful. (6:44) Also, I mean, to be completely candid that the the human condition still exists no matter what level of technology you have or what level of of education you have. (6:54) And the the feeling that, like, our bodies aren't supposed to work this way.
Scott Benner (7:00) Like, you're not supposed to have to think breathe in, breathe out, you know, or, you know, you know, you you imagine if I said to you, look. (7:07) Hey. (7:08) Here's the problem. (7:09) Your heart's not gonna beat if you don't consciously think beat beat beat beat beat for the rest of your life. (7:16) You'd be dead in three minutes.
Scott Benner (7:17) You you you know what I mean? (7:18) Like and and the and you are asking people with diabetes to do that. (7:21) You're asking them to be to be a pancreas, to be aware of how a number of different systems work and how food and and exercise and stress and all, know, and everything else impacts those systems. (7:34) And the truth is is, like, none of us really understand it well enough. (7:38) No.
Scott Benner (7:38) And, you know, so you give them what what I have found is that there's there's, like, kinda hallmarks. (7:45) And if they have the hallmarks, they can do well. (7:47) Like and I mean that very simply, you know, understanding the impacts of their food, understanding how to time insulin against those impacts, understanding seriously how fat and protein impact their blood sugars, the you give them the autonomy to make changes to their settings that they don't feel like they have to wait for someone to tell them that their basil's not strong enough or not weak enough that they, you know, that they should bolus again. (8:13) That you don't saddle them with the idea that every if they bolus without food, it's stacking when that's not always true. (8:20) Like, great.
Scott Benner (8:20) Like, if you can give them those kinds of hallmarks, then most people
Liesl (8:25) Absolutely.
Scott Benner (8:25) Most people can make the rest of the leaps. (8:27) They can they can they can draw the rest of the lines themselves. (8:31) That's been my finding over and over again is that there's there's some basic fundamental foundational stuff. (8:38) And once you give it to them in a way that they understand it and hopefully they're motivated to do something with it, they have a lot of success after that.
Liesl (8:46) Yeah. (8:46) Yeah. (8:46) And I I had somebody on one of my Daphne courses years ago, and she said, look. (8:50) She said, I don't really understand how all of this works, but I don't understand how my car works. (8:56) She said, I just know where to put my feet and where to put my hands, and I trust it to get me from a to b.
Scott Benner (9:00) Perfect.
Liesl (9:01) So if I know what to do with Daphne, I might I don't have to understand the ins and outs of it as long as I know what to do when. (9:09) I know I'll get to where I want to go. (9:11) And I thought that was quite quite a good analogy of there's lots of things we do in life. (9:16) We don't understand how an airplane takes off the ground, but we trust that the pilot knows how to do it, so we just jump on board. (9:22) And she jumped on board with a Daphne course saying, I don't really quite understand, but I trust you, and I trust the process, and I'm just gonna get on board with it.
Liesl (9:31) And and I think that takes tremendous courage and a degree a huge degree of trust in somebody like me to be providing her with the right information.
Scott Benner (9:40) It's also thoughtful. (9:42) It's incredibly thoughtful. (9:44) And here's a secret that's not much of a secret if people are listening. (9:47) There's a lot about this I don't understand either. (9:50) And yet, there might be I I am I had to put this.
Scott Benner (9:56) I don't wanna sound like an asshole. (9:57) But, like, like, if there's a hierarchy to who's reaching people and helping people with diabetes, I've gotta be up in the top of it. (10:04) And there are plenty about it that I fundamentally, like, on a technical or scientific level, I don't I struggle all the time. (10:11) I say stuff all the time where I'm like, I don't really understand that. (10:14) But what I've learned is I don't it doesn't matter.
Scott Benner (10:17) Like like, what matters is understanding the fundamental stuff and being able to communicate it. (10:22) Yeah. (10:22) Yeah. (10:22) And and I don't need to be perfect or have, you know, a PhD level of understanding about, you know, a lot a lot of functions in the body, which by the way, I can't even pronounce little and explain to you. (10:35) Yes.
Scott Benner (10:35) And it and it and it it doesn't it doesn't matter. (10:39) Like, would matter if I was gonna be your surgeon. (10:42) Okay? (10:42) It would matter if I was gonna be teaching a course at at medical school. (10:46) It doesn't matter if I'm just the guy saying, like, look.
Scott Benner (10:49) When you eat a cheeseburger with french fries, there's fat in the fries. (10:52) And about an hour after you eat, you're gonna see a rise coming in your blood sugar, and that rise needs more insulin. (10:57) And there's a quick formula you can use to try to figure out about how much fat was in there and how that translates to insulin, and then you can put that bolus in Yeah. (11:05) And then the rise never happens. (11:06) Your blood sugar doesn't stay high for four hours afterwards.
Scott Benner (11:09) And you don't put in a bunch of insulin and get super low later and then take in a bunch of fast acting then it goes back up again, and then you lose your goddamn mind and you stop taking care of yourself. (11:18) Right? (11:18) Like
Liesl (11:19) Yeah.
Scott Benner (11:19) That that's the part I know for sure.
Liesl (11:22) And I think the frustrating thing when the thing that does frustrate people when they come on a Daphne course is there's so much that that we can't just say, do this plus that, and you'll get success with what you want. (11:34) Because it's so individual to the person, isn't it? (11:37) And you must know that in your experience that it's great to have a starting point and say, you know, try this for your fat, high fat, high protein meals. (11:45) But if that doesn't work and you see it doesn't work, you need to try a different proportion or a different ratio or something. (11:51) And and the same with exercise.
Liesl (11:53) Exercise is so individual that it's great to have a starting point, but there isn't a black and white set of rules that says do this and you'll be able to run a marathon or do that and you'll get through a game of football or something. (12:09) It it's so personal. (12:11) And I think that is it just shows that the more we understand, the more questions we have and the less we understand. (12:18) And if it wasn't that way, insulin would never have been discovered. (12:23) We never would have finger pricking.
Liesl (12:24) We never would have CGMs. (12:25) We never would have the tech that we have. (12:28) And I really hope that at some point I have a family member with type one diabetes. (12:33) And when she was diagnosed, I cried for twenty four hours. (12:37) And my husband said, I don't know why you're so upset.
Liesl (12:40) Why you know about all of this? (12:42) You can support her with it. (12:44) And I just said, she's 11 years old. (12:47) She will never go to a party again without thinking how much do I have to inject for that muffin? (12:53) How much do I have to inject for that pizza?
Liesl (12:55) I said it's the loss of that carefree living that I was mourning. (13:00) Mhmm. (13:00) And I really hope that in her lifetime, she's able to say, isn't it quaint? (13:07) My auntie used to teach people how to manage type one diabetes, and now we're just cured.
Scott Benner (13:13) Yeah. (13:13) Hey. (13:14) Listen. (13:14) I'll take anything from cured to this box and this box talk to each other, and I don't have to think and it just works. (13:20) Like because I don't it's not if we know for sure about fat, for example, then, like, that could be a setting.
Scott Benner (13:28) And and why is it not? (13:30) And then because it is in some of the DIY systems, by the way. (13:33) In some of the DIY systems, you can say there's this much fat in my in my meal, and it it helps it to layer more boluses out over the the future. (13:42) So, again, back to what I was saying earlier is you need the pump companies to admit that that's functionality that should be looked into and tried to figure out and put in. (13:53) I mean, so put a little effort into that.
Scott Benner (13:55) And and by the way, at some point, they will ceiling out on what they're doing, and they're gonna have to move to those ideas to keep getting better, to keep making their money, to try to beat the other guy, which, by the way, is the only thing that keeps innovation going. (14:08) I don't know if you're a capitalist or not, but that's pretty much what keeps people moving. (14:12) Yeah.
Liesl (14:12) Yeah. (14:13) So And I and having that as an optional thing on a pump would be great because some people, they really do have an impact with fat or high protein. (14:20) Don't they? (14:21) Other people, it doesn't affect them in the slightest.
Scott Benner (14:23) It's crazy. (14:23) It some people are like, I've never done that before. (14:25) It's never been a problem for me. (14:27) I'm like, yeah. (14:27) Right on.
Scott Benner (14:28) Like but at least you know. (14:29) Like, that to me is the idea behind the podcast is that I'm gonna put all these ideas out there. (14:36) They might not all impact you or be important for you, but at least you know about them now. (14:41) And if it did end up being important for you, that's awesome because you can do something about it. (14:45) And if it didn't, then right on, then that's the thing you don't need to worry about.
Scott Benner (14:50) I don't love the I don't love I I just think people deserve all the information.
Liesl (14:57) Yeah.
Scott Benner (14:58) You know? (14:58) And then they can do what with it what they want or what they're capable of doing with it. (15:03) But it it would be wrong to hide it from somebody.
Liesl (15:05) Yeah. (15:06) And you've just you've just reminded me. (15:08) You asked me a question almost at the beginning of this about what are the light bulb moments? (15:12) What are the Yeah. (15:13) The moments when the penny drops?
Liesl (15:15) And I think talking about information, basic information can be a real penny drop moment as a you know, yes, high fat, high protein, that can be a real game changer for a lot of people. (15:27) For me, one of the main learning outcomes for people with on a Daphne course is just understanding how long it takes their quick acting insulin to start working
Scott Benner (15:37) Yep.
Liesl (15:37) And how long it keeps working. (15:39) The number of people who have said, now I understand why I had a hypo because an hour after my meal, I was I'd got a glucose of 17, and it should have been less than seven. (15:50) And so I gave an injection of quick acting, but now I realized that my quick acting still hadn't even peaked from my meal. (15:57) And so that understanding how their insulin works in real terms, in that relationship with their glucose, their carbs, and their insulin, that is a big game changer for people.
Scott Benner (16:08) Definitely. (16:09) Yeah. (16:09) So I I I say to all the time that if you if you threw me off a cliff and told me, help people with diabetes before you hit the bottom, I would yell back up, it's all timing and amount. (16:21) Yes. (16:22) That's it.
Liesl (16:23) Yeah. (16:23) Yeah.
Scott Benner (16:23) That's the whole thing. (16:24) By the way, the podcast should be six seconds long. (16:27) Here it is for everybody again. (16:28) It's about insulin timing and the amount of insulin. (16:31) It's about how much insulin you use and when you use it.
Scott Benner (16:33) That's the entire thing. (16:35) Is it as easy as why the way I just said it? (16:37) It's not. (16:38) But that is at the core of the that's your entire fight. (16:41) Yeah.
Scott Benner (16:41) It's timing and amount. (16:43) So, you get that right, you'll be that's that's the a one c you're looking for. (16:48) That's the variability you're looking for. (16:49) Now you have to get it right at breakfast, at lunch, at dinner, at your snacks, you know, for your your settings, for your, you know, you know, that your Basil uses all day long, you know, for your, you know, for your adjustments, you know, it it's but it's all but, again, at the end, it's just it's the right amount of insulin at the right time. (17:10) It's matching the impact of carbohydrates or body function against the insulin's ability to fight it off.
Scott Benner (17:19) It's kind of it. (17:19) You know?
Liesl (17:21) It's like having another job on top of your normal full time job, isn't it? (17:24) Well, I mean, like it's like having to run two jobs at the same time.
Scott Benner (17:27) It it it reminds me all the time of this is gonna be out of context for you, but there's a, there's a movie now that's getting pretty old with Brad Pitt in it. (17:34) It's called Moneyball. (17:36) And it's a it's about, it's it's not it's a real story about, an American baseball team that eventually, like, kinda bucks the system and goes towards analytics. (17:48) And they start deciding to find the value in players that look valueless in in a normal, in a normal Okay. (17:57) Setting.
Scott Benner (17:57) Right? (17:58) And so they go to this player whose arm is shot, who used to be a catcher, and he needs to throw the ball out. (18:03) And they wanna move him to a position where he doesn't have to throw very much, but he's never played it before in his entire life. (18:09) And they say to him, you know, the the one guy goes, we're gonna move you to first base. (18:15) And he get and the guy says, well, I've never played first base.
Scott Benner (18:18) Well, the guy turns to the other coach and goes, it's very easy. (18:21) We'll teach you how to do it. (18:22) Tell him. (18:22) And he tells the other he tells the other coach. (18:24) He goes, tell him.
Scott Benner (18:25) The guy's name's Wash. (18:26) He goes, tell him, Wash. (18:27) And he goes, it's incredibly difficult. (18:29) And, like and so and and I and so while the one guy's going like, it's easy. (18:34) It's just we'll teach you how to do it.
Scott Benner (18:36) And then the other guy's like, I mean, I don't know, man. (18:38) Maybe we could figure it out, but probably not. (18:41) And I feel like that's how I'm talking about diabetes sometimes. (18:44) I feel like I'm the guy who's like, we'll just move you to first. (18:47) And then somebody else comes along and goes, it's incredibly difficult.
Scott Benner (18:50) But I think it's doable. (18:53) Like, I've seen it enough times. (18:54) And by the way, that was the leap for me. (18:56) I I I'd love to meet the person who figured out the Daphne thing one day because I I was like, look. (19:04) I'm not in this space.
Scott Benner (19:06) I'm not a doctor. (19:07) I'm not a I'm I'm in no way connected to the the technical or professional aspects of diabetes. (19:13) Right? (19:13) Yeah. (19:14) My daughter gets type one in 2006 when she's two years old.
Scott Benner (19:19) I am following what I am being told, and it is not working. (19:23) And I'm becoming overwhelmed, and she's becoming sicker. (19:27) And I'm a 100% sure I'm killing her most days, and I'm probably right. (19:31) And I I look to the people who are supposed to be telling me what to do, and I I come to the conclusion that I don't think they're gonna help me. (19:38) I don't think it's because they don't care.
Scott Benner (19:41) I don't think it's be I just think that whatever it is that they're programmed to say is not helping me.
Liesl (19:47) Yeah.
Scott Benner (19:47) So I dig into my daughter's health and become as much of an expert on all the aspects of it as I can. (19:54) And when I get to the edge of my understanding of it, and I start, like, interviewing other people and trying to find out their understanding of it to kinda, you know, bring together ideas. (20:03) And one day, it just hits me. (20:06) I've got my daughter's a one c in the low sixes now. (20:08) I've had it in the fives, and I know what to do.
Scott Benner (20:12) I'd never quantified it. (20:13) I never wrote it down. (20:14) I'm not as smart as your your grandmother who had the the or, you know, who had the had the list. (20:18) I don't I nothing was written down. (20:21) I just had come to the conclusion that there was a certain number of things that I did.
Scott Benner (20:24) And when I did them every day, her blood sugars were stable, and we had outcomes that we were looking for. (20:30) And so by then, I had the podcast, and I just sat down one day against my nature and wrote down the things that I thought helped people that helped us. (20:41) And then I said I I said, I think this is universal. (20:45) It's not exact. (20:46) Like, don't get me wrong.
Scott Benner (20:47) Like, you can't just do exactly what I do the way I do it, and it's gonna work for you. (20:52) But it's foundational enough that you can adapt it to yourself. (20:56) And Yeah. (20:57) When I started sharing it like that, get a lot of pushback from people, by the way, who said it was dangerous and it was gonna hurt people and blah blah blah. (21:04) And then just a lot of, like, you know, people, you know, toeing the company line.
Scott Benner (21:09) And, we don't talk about it like that. (21:11) I think back then, they were still aiming for an a one c that was eight. (21:14) Were They telling you if you had an eight a one c, you were doing well. (21:17) And and I was like, I don't think that's right. (21:20) You know?
Scott Benner (21:21) And so I shared my thing and then people actually, I you don't know this, but one of the you know, when I very first started writing a blog, like, one of the first pieces of correspondence I got back from a reader that said that the blog was valuable from them was from a person from England who said that Really? (21:38) Yeah. (21:38) She said her and her daughter have been finding a lot of value in the things I've been sharing on on my blog. (21:44) And, and then from there, it just kinda grew and grew and grew. (21:49) But it's not growing from my understanding.
Scott Benner (21:52) It's growing, I think maybe my my understanding is the seed of how it started, but then I had to keep bringing in other voices to try to add on top of it. (22:01) You you know? (22:02) Yeah. (22:02) And then making it and but then back to what we were talking about earlier. (22:06) That's all nice for me and my kid.
Scott Benner (22:09) But if you can't find a way to get it to other people, then if a tree falls in the woods, did anybody hear it? (22:16) Right? (22:16) So, like, then then Yeah. (22:17) Then your job becomes getting it out to people without letting it die. (22:22) Like, so you have to, like so right?
Scott Benner (22:24) Because at some point, that pump company was like, we got a pump. (22:26) This is it. (22:27) Now go out there and sell it. (22:28) Make sure people can get it. (22:29) Put it in their hands.
Scott Benner (22:30) And then they stopped innovating. (22:32) So if you innovate and sell and innovate and sell and keep doing that, that to me is the way you reach more people. (22:39) And I think I I'm sorry. (22:41) I think the more people that we reach, the better chance we have that doctors and and clinicians will will understand that there's a an elevated expectation from people and that they need to meet it. (22:52) Sorry.
Scott Benner (22:53) That was my whole thought.
Liesl (22:55) No. (22:55) No. (22:55) I and I think one of the things that you notice if you being a Daphne educator and being on Daphne courses is the relationship that that I have as a Daphne educator with the people that do the course is different. (23:09) It's changed then forever because they become more familiar with me as lethal and not somebody in a uniform sitting on a desk telling them what to do. (23:20) And I understand more about their lives, how they live with diabetes, what the the challenges are for each person as an individual.
Liesl (23:28) And then they get to meet a doctor on a Daphne course. (23:31) And where they will always say, I only come to clinic to get told off, suddenly they meet human beings who are health care professionals. (23:39) And so there's that mutual understanding and the realization that we're doing what we do not because we like to be bossy, but because we genuinely care and we genuinely have and are working hard to understand, to have empathy, to liberate people from that sense of guilt, and to give them information so they can live their best life. (24:07) Isn't that just what we want for everybody? (24:09) Whether they've got diabetes or not, whether they've got arthritis or not, whether they've got any other kind of life limiting condition or potentially life limiting condition.
Liesl (24:19) We just want them to live the best life they possibly can, and that's why we work in diabetes. (24:25) Because you either come and work in diabetes and you get spat out really quickly because it's not your thing, or you get sucked into work in diabetes and you realize you can't get out because this thing that I hated when I was a staff nurse on a ward suddenly became my be all and end all. (24:42) And that yeah. (24:43) I'm I'm in it for life pretty much.
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Scott Benner (27:06) Can there not be or should there not be, or maybe there is, a Daphne course for doctors? (27:11) Because it occurs to me that any reasonably intelligent physician with a tiny bit of a heart who heard the last hour of our conversation wouldn't pull somebody into a room and and scold them. (27:24) And so, like, is is maybe that not a place where Daphne could could be valuable?
Liesl (27:30) We do that already. (27:31) So we've been training doctors to become Daphne doctors since Daphne started in ninety nine, two thousand when it was rolled out. (27:38) And that's what I was doing this afternoon before the podcast. (27:41) I was doing a a Daphne doctor workshop. (27:44) And so we get them to carb count so they understand what that's like.
Liesl (27:49) We will often talk about the language that's used. (27:51) And one of the doctors on the course today has been in diabetes for about a year, and her comment was, I'm already speaking to people differently. (28:01) I'm not telling people what to do. (28:03) I'm asking them how they are. (28:05) I'm asking them what they would like to be different about their life with diabetes.
Liesl (28:08) I'm asking them what their challenges are. (28:11) And she's only been in diabetes a short time. (28:13) And so everybody that she ever sees in the length of her career, which could be another thirty or forty years, is going to benefit from her having that different approach because she's done her DAFNI training, and she's out there now understanding a lot more. (28:30) I wish she very proud of that.
Scott Benner (28:31) Yeah. (28:32) I I would be as well. (28:33) I just had a 16 year old boy tell me the other day he wants to be an endocrinologist, and I thought, oh, he understands diabetes the way I talk about it. (28:40) He might be an endocrinologist one day and talk about it like that to people. (28:43) Yeah.
Scott Benner (28:43) And and I think that's just it really it's fabulous. (28:47) You know, there there's
Liesl (28:48) Yeah.
Scott Benner (28:48) It could be nothing better. (28:49) It's sad that, you know, it takes so long to change things in society, but there's nothing you can do about that. (28:56) So this is this is what you do. (28:57) You plant a lot of seeds. (28:58) You talk to a lot of people, and you wait for that stuff to grow.
Scott Benner (29:01) And and, hopefully, things move in a better direction, and, generally speaking, they do when people like you are out there doing what you're doing.
Liesl (29:07) Yeah. (29:09) I'm not perfect. (29:10) I have had a situation with somebody where I and, again, it's a family another family member with type one. (29:18) And I said to her, what's the one thing you could do differently that might make things different or might improve things? (29:27) And she just looked at me and said, why can people not just say, well done?
Liesl (29:34) Well done. (29:35) You're doing the best you can today. (29:36) And well done. (29:37) You did the best you could yesterday. (29:39) Mhmm.
Liesl (29:39) And well done because tomorrow, you'll do the best you can do tomorrow. (29:43) And I just thought, of all the people that per that she knows, I should be the one not to ask those questions of. (29:50) What's the one thing you could do differently that might make it better? (29:54) You know, really, I should have just said, well done. (29:57) You're doing your best every day, and I know that.
Scott Benner (29:59) Yeah. (29:59) You're So I you're trying to get still
Liesl (30:02) get it wrong.
Scott Benner (30:02) But but let me let me stick up for you for a second. (30:05) Right? (30:05) So you probably don't see this person that often, and you probably saw that they they made an advancement. (30:10) You thought, if I can get them thinking in this direction, they'll make another one. (30:14) Is that about right?
Liesl (30:15) It's it's because my personality is a fixer. (30:18) I like to be a fixer. (30:19) That's the thing.
Scott Benner (30:20) You know my I I hate to say that part one of my favorite things about this conversation is that when your voice gets a little higher, you sound like, Sharon Osborne when she was younger, which is delighting me. (30:30) Do
Liesl (30:31) you know the funny thing? (30:32) So that she's from Birmingham, isn't she?
Scott Benner (30:34) I don't know. (30:35) I just know that you sound like her sometimes.
Liesl (30:38) Well, I was born in Birmingham, and I haven't lived there since I was three. (30:41) But maybe I'm a bit like my mom, and when I get excited or passionate about something, a little bit of a brummy twang comes out in what I'm saying.
Scott Benner (30:48) Yeah. (30:48) I so much want you to yell, up.
Liesl (30:52) Aussie. (30:52) Exactly. (30:54) That's awesome.
Scott Benner (30:55) Oh, is there anything that we haven't spoken about that you want to? (30:59) Anything that we missed or skipped over?
Liesl (31:02) Goodness. (31:03) We've covered so much, haven't we, Scott? (31:05) We've talked about so much. (31:08) I just the value of education for people with diabetes. (31:12) It's what they deserve, and it should be an entitlement.
Liesl (31:15) That's what I believe very firmly if they if they want it if they want education, they should be able to have it.
Scott Benner (31:21) Yeah. (31:21) No. (31:22) I I agree. (31:22) I I think in any way we can get it to them is important. (31:25) I I will tell you that the, I was just having this conversation, with my actually, with my my nephew.
Scott Benner (31:34) He's in college. (31:35) And he needed to interview people about media, but he had to interview somebody over 50. (31:39) So it ended up being me. (31:41) I wasn't thrilled that I was the right one for that. (31:43) But but, you know, he's asking me about how things have changed about how I consume television or movies and stuff like that.
Scott Benner (31:50) And I found us getting off of a little bit of a he asked about the podcast a little bit. (31:55) And I said, you know, what's interesting is that before the cell phone, the podcast wasn't really possible.
Liesl (32:03) Yeah.
Scott Benner (32:03) Like, right? (32:04) So the cell phones came, and then suddenly there was a place to send the audio to. (32:08) But it really didn't take off until data became cheaper because Yeah. (32:13) People couldn't afford to download an episode of anything because you used to pay for your data by I forget how you did it. (32:18) But but it was expensive, right, to download something.
Scott Benner (32:21) And when data became kinda ubiquitous, then all of a sudden, people could share their their thoughts. (32:29) And I said, and then it and and then you think, well, that's great. (32:33) Until then everyone realizes that's possible, then they flood the area again with with, you know I mean, listen. (32:39) I'm sure everybody's podcast has value, but, like, a lot of information that maybe isn't as valuable, then it becomes confusing to the consumer, then they don't know how to parse through it. (32:49) And then I could hear him, like, getting a little, like, numb in his head, and I said, how many times have you sat down in front of Netflix and scrolled through it for an hour but never watched a movie?
Scott Benner (32:59) And he goes, a lot. (33:00) And I was like, right. (33:01) I was like, so is that much choice good or bad because you didn't watch anything? (33:08) And I he just froze. (33:09) And, and I was like, so I said, yes.
Scott Benner (33:12) Because he asked me how like, he asked me about the distribution of the podcast. (33:16) And I said, so, yes, the distribution is the only thing that made it blow up, but it also let everybody else who could figure out how to sit in front of a microphone do it too. (33:25) And then it puts me in a position of having to, like, persevere through that to get to the other side to continue to reach people. (33:32) I was like I was like, there and, anyway, my point to him was there's no perfect answer to your question. (33:37) Because he his question was, you know, should we all be going to the theater still or streaming better?
Scott Benner (33:43) Like, you know, what what do you find more valuable? (33:45) And I and I said to him, I was like, you're not that's not the question. (33:48) I was like, the question is what's gonna win? (33:50) What ends up being here when it's over? (33:53) You know, like, what is it that we end up settling on that we end up building on for the next thing?
Scott Benner (33:58) And I just I keep thinking about that since I've been talking to him about the, like, the diabetes aspect of it. (34:03) Like, what do we what have we settled on that helps people, and how do we build on it to try to get to the next thing, to get to the next fight, to see if we can fight through it, to see what perseveres comes out the other side. (34:15) How do we build again on that over and over? (34:18) I'm super excited for it to be I mean, I really I I don't know. (34:25) Like, I'm I'm the wrong person for this idea, but I'm seeing people right now using AI for their diabetes in ways that is really fascinating me.
Scott Benner (34:34) I don't know if you've seen people do this or not, but I'm starting to I've done it on the podcast once or twice. (34:41) I probably will do it a little more with people, but I watched somebody do it online recently where they were having trouble with their insulin, and they just they were at wit's end. (34:51) They didn't know what to do, and they just started feeding their their their graphs into, one of the AI models and then having a live conversation with the AI model. (35:01) And the I the person flat out said in their post online, I didn't even know if it was right, but I was so screwed I had to try something. (35:09) And then they tried it, it worked for them.
Scott Benner (35:12) And I was like, that's fascinating because I that I find that's how people get to the podcast. (35:17) When I was talking to my daughter's friend the other day and trying to help her through her thing, I said to her, try to imagine where a person has to be to say, I'm gonna turn a podcast on and listen to it about my health. (35:30) I was like, imagine how lost you have to be to make that decision. (35:34) Right? (35:34) Because that is not a that's not a on its face, that's not a reasonable decision to make for somebody who doesn't know me or doesn't know what's here or anything else.
Scott Benner (35:42) Right? (35:42) I was like, that's how lost people are when they're walking around. (35:45) They're like, maybe a guy will tell me. (35:47) Maybe my AI will know what to do with this graph. (35:50) And and, anyway, like, you're now seeing the AI does seem to know what to do with the graph.
Scott Benner (35:55) I don't know if you've done this, but I've had people go ahead. (35:58) Go ahead, please. (35:59) What were you gonna say?
Liesl (36:00) And I've not because I don't work face to face with, people with diabetes anymore. (36:04) I'm kind of more in the background. (36:06) So watching somebody use AI for their diabetes is not something I've seen, but I do know that there's more and more reliance on apps. (36:16) And one thing I like about your podcast is that it's people talking. (36:20) And if we're not careful, people are gonna lose that peer support from talking to other people who either have type one or have family with type one because it's all gonna be about an app on their phone and the technology.
Liesl (36:34) And I don't think you can divorce that personal connection.
Scott Benner (36:39) Allow me to be hopeful. (36:41) Allow me to be hopeful. (36:42) Maybe the technical side of their life will become so unencumbered or that they can spend more time on the community side. (36:49) Yeah. (36:49) That would be lovely.
Scott Benner (36:50) I hope so. (36:51) Yeah. (36:51) I saw, oh gosh. (36:53) What was I gonna tell you? (36:55) Jeez.
Scott Benner (36:56) The thing, the thing, the thing, the thing. (36:58) Oh, Scott. (36:59) This is terrible. (37:02) It was with an AI. (37:04) Oh, shit.
Scott Benner (37:06) Lisa, look what happened. (37:08) My age got caught up with me there.
Liesl (37:10) Oh, don't worry. (37:10) It happens to me all the time.
Scott Benner (37:11) Yeah. (37:12) Yeah. (37:12) I'm so disappointed. (37:13) I had one last thought, but that that's also a misnomer because I could just keep talking forever, so I don't really have one last thought.
Liesl (37:19) I could talk to you all night. (37:21) So
Scott Benner (37:21) Well, you're very good at this. (37:23) I was gonna say you're, you're you're chatty as hell. (37:25) It's awesome. (37:26) Do you have, you you've mentioned a couple of people in your life that have type one that are in your family. (37:32) Is there other autoimmune in your family?
Scott Benner (37:34) Do you have any autoimmune issues?
Liesl (37:36) No. (37:37) Nothing? (37:37) None at all.
Scott Benner (37:38) Celiac, thyroid, you don't see it through the family?
Liesl (37:42) Nothing. (37:43) No. (37:43) And and you know what? (37:45) I think the biggest lesson I learned when I got really upset when this family member was diagnosed. (37:52) And it just goes to show how you cannot however much you know, you can't divorce emotion from the situation because I was in tears talking to my husband, and he was a bit flummoxed as to why I was so upset.
Liesl (38:05) And through my tears, just said, thank god I'm not a cancer specialist nurse because then she might have got cancer.
Scott Benner (38:12) Oh.
Liesl (38:13) Now how irrational is that? (38:15) It doesn't make any sense at all. (38:17) Yeah. (38:17) But it was just this whole, oh my god. (38:22) This somehow, is this my fault?
Liesl (38:24) Of course, it's not my fault. (38:25) It's just bloody bad luck. (38:28) But it it just taught me the family members of anybody I've ever met who's got type one diabetes will perhaps have gone through emotions, irrational emotions, which I would have laughed at if I hadn't experienced it myself. (38:43) Thank god I'm not a cancer specialist nurse. (38:46) I'm a diabetes specialist nurse because she's got diabetes and not cancer.
Scott Benner (38:50) Well I
Liesl (38:50) mean, that just doesn't make any sense, but that's genuinely how I felt on that day.
Scott Benner (38:55) The unseen stuff, like, unseen psychological stuff is fascinating. (38:58) Like, imagine you you I go out to dinner with my family, and I sit down, and it is in the my daughter's 21 now, but it's still in the back of my head. (39:07) Like, is she gonna pre bolus for this? (39:09) Has she bolus? (39:09) And I haven't noticed because now it's on her phone, and I can't really tell.
Scott Benner (39:12) You you know? (39:13) And now you're all sitting there, and all you wanna say is, hey. (39:17) You bolus. (39:18) Right? (39:19) But you don't wanna put that on her because, a, if she forgot, that's on she doesn't need to feel like I'm watching her.
Scott Benner (39:26) And if she didn't forget, she doesn't need to feel like nobody trusts her. (39:29) But yet in the silence when nobody says, hey. (39:32) Did you bolus yet? (39:33) Everyone at the table knows that everyone else is thinking about it. (39:37) Yeah.
Scott Benner (39:37) And it's and it's in the background. (39:38) It's not right on the front of your head. (39:39) It's in the background, but there's an when I've noticed that every time I sit at a restaurant, until I know my daughter has bolus for food, I'm on some level a tiny bit uptight or or on guard or something. (39:54) I don't even know really how to put it. (39:56) And the minute I realized that she's done it, it's lighter.
Scott Benner (40:01) And I wonder if it doesn't feel that way to her as well. (40:04) You know what I mean? (40:06) Like and and that's the kind of little stuff that if we sat here long enough and talked and talked and talked, we could sit and make a list of a million things like that. (40:15) And Yeah. (40:16) And those things are happening to you all day long whether you're the person with type one or the or somebody that loves them.
Scott Benner (40:22) It just it it's unfair. (40:24) There's that it's the wet towel. (40:25) Like, I swear, I've never thought of that wet towel analogy before in my life, but now I realize it's like it's it's like, you know you know those, like, thin clingy, like, sarongs that you women, like, wrap around the the beach. (40:36) It's like that thin material, but cold and wet and just laying on top of you. (40:42) A little shitty.
Scott Benner (40:43) You know? (40:44) Like, and you can't make it go away. (40:47) But, again, I have seen people with diabetes get together in a room, and I watch that feeling. (40:52) It looks like it lifts off them. (40:54) So
Liesl (40:55) Yeah. (40:55) Yeah. (40:56) And and actually, until you said that out loud, I think I recognize that, and I'm conscious of it, but I'd never been properly conscious of that feeling of of sitting and waiting. (41:06) And once you know that they're bolus, the meal can start, and you can all enjoy it. (41:11) Yeah.
Liesl (41:12) And the other thing, you mentioned something. (41:13) We're talking about emotions. (41:15) One of the things that we ask our DAFNI course participants is about we ask them three very specific questions. (41:23) And we ask them to quantify how overwhelmed they feel by the responsibility of diabetes, how alone they feel with their diabetes, and how much they feel as if they're failing with their diabetes. (41:36) And what we see at the end of that five day course is they've gone from scoring a five or a six, which is what you don't want them to feel.
Liesl (41:46) A five or a six is that it's a serious problem or a very serious problem. (41:50) And at the end of five days, they're scoring a one or or a two, which is it's not a problem or it's a slight problem. (41:57) So to see that impact on somebody's psychological health in just five days is phenomenal. (42:04) But when they fill in the forms a year later, they've maintained that psychological benefit. (42:10) And I don't know any other intervention in health care, be it a tablet or physio or anything else that can achieve that improvement in five days and maintain it a year later?
Liesl (42:24) And even though as an educator, I always knew that was the case. (42:27) I never had the evidence to back it up. (42:30) Now we ask the participants to answer these questions. (42:34) They answer them on their own away from anybody, so there's no coercion. (42:38) And now we can quantify exactly what that improvement is.
Liesl (42:42) And that makes me emotional every time I look at that data because behind the data is a real person with a family who's living a different life because that emotional burden has got less. (42:56) And that to me is is truly what it's all about.
Scott Benner (42:59) You know what the data helps you with too is it helps you stop wondering if it's true. (43:04) It allows you to believe it's true and press forward.
Liesl (43:06) Yeah.
Scott Benner (43:06) I did a thing a few years ago that helped me a lot. (43:09) I did a, there was this really this lovely girl that people reach out to help me all the time. (43:14) They're like, I you know, the podcast helped me. (43:16) How can I help you? (43:17) And at one point, there was this grad student, and she's like, how can I help?
Scott Benner (43:22) And I said, I wanna do a survey to see if the podcast actually helps people. (43:26) And I don't know how I don't know how to do that, so you go ahead and do it. (43:30) And she put a survey together, and we actually got 1,200 people to take the survey. (43:34) 1,200 listeners to take it, which was is a pretty big data set.
Liesl (43:37) A great number.
Scott Benner (43:38) Yeah. (43:38) And, it turns out that the podcast helps them significantly more than their doctors do or anything that they found print online or etcetera for their diabetes. (43:47) And I don't I mean, it's somewhere the data somewhere that from the thing, but the point is that it didn't matter because it let me what doesn't matter is that that I can't quote it to you anymore. (43:58) What it did for me was what was most important. (44:01) It took this thing that I thought I was seeing, that I believed was true.
Scott Benner (44:05) It proved it to me enough that I could stop wondering about that part of it and just push forward. (44:11) And it really it really did allow me to to you know, because I'm not a I I mean, I I I joke around and hear a lot, and I think I try to keep this entertaining so that people will listen about their diabetes, which is not a thing I think most people are inclined to listen to. (44:24) And when I joke around, I think there are times that I can come off like a dumbass because I'm but I I'm not I'm not a I'm not a, like, a crazy narcissist who's just, like, every time I see something, believe it. (44:36) I'm like, yay. (44:37) I'm great.
Scott Benner (44:37) And, like, and I move forward. (44:39) Like, I really wondered, like, is this actually doing what I think it's doing for people? (44:43) Like, I believe it is, but I don't have the ability to just, like I don't know. (44:49) Like, to just take it on face and go. (44:51) And that data coming back was really helpful to me.
Scott Benner (44:54) And I think Yeah. (44:55) You know, same for you is, like, you can say, look. (44:57) Because when you said the thing about the first five days and their score goes up from day one to day five, my follow-up question before you told me about the year after data, my follow-up question was gonna be, but yeah. (45:08) But does that actually matter in the long run? (45:10) Like, or are you just talking them into believing they can do it and they get home and they can't actually do it?
Scott Benner (45:15) And Yeah. (45:16) You know, and that there's your answer. (45:17) And so beautiful. (45:18) Yeah. (45:18) Then run around yelling Daphne at people.
Scott Benner (45:20) You know what I mean?
Liesl (45:21) I do. (45:22) My friends that my friends will be, if if they if they listen to the podcast, they'll be like, well, she was in heaven because she was talking Daphne basically for an hour and a half. (45:30) So she's absolutely in heaven because, yeah.
Scott Benner (45:33) That's Very good.
Liesl (45:34) That's what they know me for.
Scott Benner (45:35) Well, it's like, can't I can't thank you enough for reaching out and for sharing all this. (45:39) I think this has been a really terrific conversation. (45:41) And, I I is there anything if people in The UK, if they don't like, how do they reach, like, a Daphne course if they Yeah. (45:49) If they want it?
Liesl (45:51) So we we delivered Daphne is delivered in a 117 different centers and over 200 locations in The UK. (45:57) So if anybody is interested in coming on a Daphne course, they just need to go to our website, www.daphne.nhs.uk, and it will show you where there's a Daphne centre in their area. (46:09) And it may be that they already have their diabetes care in a DAPHNE service. (46:14) And if they don't, they can ask their GP or their service to refer them to somewhere that does deliver DAPHNE so that they can access a course.
Scott Benner (46:22) Well, you asked before we started, like, said, before we started recording, you said, like, if I use any, like like, British colloquialisms that don't make sense, just stop me. (46:31) And I have to admit, like, I'm just gonna call this episode penny drop, but is that but I don't know I've never heard that before in my life. (46:37) So
Liesl (46:38) Have you not? (46:39) No.
Scott Benner (46:39) So, anyway, that's that's what your episode's gonna be called.
Liesl (46:43) Thank you.
Scott Benner (46:44) Yeah.
Liesl (46:44) I've really enjoyed talking to you today, Scott. (46:46) Thank you so much. (46:47) And as you know, I can as you now know, I can talk about diabetes till the cows come home. (46:51) And, having a conversation with somebody else who's in the same position is is really lovely. (46:57) I've really enjoyed my afternoon.
Liesl (46:58) Thank you so much.
Scott Benner (46:59) No. (46:59) Me too. (47:00) The feeling's mutual. (47:01) Hold on one second, please. (47:07) A huge thanks to my longest sponsor, Omnipod.
Scott Benner (47:11) Check out the Omnipod five now with my link, omnipod.com/juicebox. (47:16) You may be eligible for a free starter kit, a free Omnipod five starter kit at my link. (47:24) Go check it out. (47:25) Omnipod.com/juicebox. (47:27) Terms and conditions apply.
Scott Benner (47:29) Full terms and conditions can be found at omnipod.com/juicebox. (47:34) The conversation you just enjoyed was brought to you by US Med. (47:38) Usmed.com/juicebox or call (888) 721-1514. (47:44) Get started today and get your supplies from US Med. (47:58) My diabetes pro tip series is about cutting through the clutter of diabetes management to give you the straightforward practical insights that truly make a difference.
Scott Benner (48:07) This series is all about mastering the fundamentals, whether it's the basics of insulin, dosing adjustments, or everyday management strategies that will empower you to take control. (48:17) I'm joined by Jenny Smith, who is a diabetes educator with over thirty five years of personal experience, and we break down complex concepts into simple, actionable tips. (48:27) The diabetes pro tip series runs between episode one thousand and one thousand twenty five in your podcast player, or you can listen to it at juiceboxpodcast.com by going up into the menu. (48:51) Hey. (48:51) Do you need support?
Scott Benner (48:52) I have some stuff for you. (48:53) It's all free. (48:54) Juiceboxpodcast.com. (48:56) Click on support in the menu. (48:57) Let's see what you get there.
Scott Benner (48:59) A one c and blood glucose calculator. (49:01) People love that. (49:01) That's actually, I think, the most popular page on the website some months. (49:05) A list of great endocrinologists from listeners, that's from all over the country. (49:10) There's a link to the private Facebook group, to the Circle community, and, we have a a fantastic thing there.
Scott Benner (49:16) American Sign Language. (49:18) There's a great sign language interpreter who did the entire bold beginning series in ASL. (49:23) So if you know anybody who would benefit from that, please send them that way. (49:27) Just go to juiceboxpodcast.com and click on support. (49:30) While you're there, check out the guides like the pre bolusing guide, fat fat and protein insulin calculator, oh gosh, thyroid GLP, caregiver burnout.
Scott Benner (49:39) You should go to the website. (49:40) Click around a little bit on those menus. (49:42) It really there's a lot more there than you think. (49:44) I can't thank you enough for listening. (49:46) Please make sure you're subscribed or following in your audio app.
Scott Benner (49:49) I'll be back tomorrow with another episode of the Juice Box podcast.
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