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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends and welcome to Episode 477 of the Juicebox Podcast.

On today's show, I'll be talking with Marina Nitze. Among other things, Marina is the former senior adviser to the US Chief Technology Officer at the White House. She was the chief technology officer and senior adviser to the Secretary of the Department of Veterans Affairs. She is passionate about improving America's child welfare system, the developer of test tackler and she has type one diabetes, I quickly realized how much I love Marina as we were talking, and I think you'll enjoy the conversation as well. Please remember while you're listening, 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 healthcare plan, or becoming bold with insulin. At the end of this episode, I'm going to tell you the power of story. If after this conversation ends you're interested, you can learn more about Marina at tasktackler.com or MarinaNitze.comm links in the show notes

this show is sponsored today by the glucagon that my daughter carries g vo hypo Penn. Find out more at G Vogue glucagon.com forward slash juicebox to learn more about the blood glucose meter that my daughter carries. And let me tell you something, it is the most accurate blood glucose meter I've ever seen in person and that's no BS. Go to Contour Next one.com forward slash juicebox and learn about the Contour Next One blood glucose meter.

Marina Nitze 2:02
Hey Scott I'm Marina Nitze. Nice to meet you.

Scott Benner 2:06
It's nice to meet you too. I have to say first of all, when I reached out to you it was because people asked me to and that I guess they had heard you somewhere else. They were like you have to get this person on the podcast. I was like, Okay, so now this is me sheepishly sending an email like or a message somewhere. I'm like, Hey, would you come on the podcast? And you're like, I know the podcast is like, oh, that put me in a good feeling in my chest. I felt puffed up a little. But then you big time me when you sent me your calendar. I was like, ah, she knows how to do this. Usually, I'm the one who sends out calendar like so I was like, You figured out how to work around my schedule. And you were like, here, here's my schedule, figure out where it sounds like she does what she's doing.

Marina Nitze 2:48
But then we have the double zoom links, so that but we navigated that successfully

Unknown Speaker 2:52
go to look at us.

Scott Benner 2:55
We were able to create two zoom links and then choose one. Absolutely amazing

Marina Nitze 3:01
pandemics skill. These are key pandemic skills.

Scott Benner 3:03
Why I have to tell you that prior to COVID, I was using zoom and loving it. And I was in a panic when everybody found out about it. I thought oh, they're gonna ruin my thing. But luckily, that didn't happen.

Marina Nitze 3:16
Yeah, it seems like they just strengthen it. The one thing zoom is missing is a popcorn feature. I don't know how many large group meetings you're on. But when they're like, Oh, just pass it to the next person. Like then you spend the whole time being like there's 35 people here. How am I supposed to keep track of who's gone and who hasn't? Oh, no

Scott Benner 3:30
kidding. Oh, that's interesting. Now I only ever do it one on one or sometimes, you know two people at a time. But yeah, I only use it like this and for audio, but it's been terrific. For me. That's not the point of any of this. So I guess let me just start by asking how old you were when you were diagnosed with type one.

Marina Nitze 3:48
I was nine years old in 1994 94 2004 1424

Unknown Speaker 3:50
minus 321 years ago.

Unknown Speaker 3:57
26 years ago. Oh

Scott Benner 3:58
my god. I'm never gonna get this stuff. Right. Okay. Did I submit accurate? No, I let's not let's not take time to figure out what I did wrong. 26 years ago, you were nine years old. Now. I can do this that makes you 35. Yeah. See? Now you're impressed. Right now you're like, how do I get out of this? So so you're nine years old? A long time ago? Are you regular an MPH?

Marina Nitze 4:25
Oh, yes. And I think like lenti is that maybe we call them regular NPH. And then somewhat even longer acting on a need mix all three.

Scott Benner 4:36
That sounds like a lot of fun. who managed that for you?

Marina Nitze 4:39
Primarily me from the beginning. I had a care team that was really kind of empowered about getting the kiddos responsible for their own diabetes care which in retrospect, I appreciate a lot. No kidding.

Scott Benner 4:51
So but in fairness and for clarity for people who are more newly diagnosed now in here in 2021. You were just kind of like What were you doing drawing up some insulin and shooting it like couple times a day?

Marina Nitze 5:04
Yeah, we we have a lot of structure then. So you test at certain times, and you had to have a strict number of carbohydrates per meal at a certain time. And so my care team would then adjust that accordingly. So I was in charge of counting the number of carbs to get to my set number, which I want to say was something like 30 at lunch, and then having my three o'clock snack of 15 grams of carbs. And yes, you drop the insulin and take it, but it was a very structured day, the goal being that by the time you checked with your meter, which at that time, took like 45 seconds to give you a reading, with a giant drop of blood. The goal was for you to be like back in range by the next meal, but you really have no insight into kind of what you were doing in between meals.

Scott Benner 5:43
So you drew up a predetermined amount of insulin, injected it. And then we're sure to eat a certain amount of carbs at certain times, and then hacked into yourself at the end of the day to make sure you were still alive with one blood test. Yes, wow. That's something Do you look back on that and think that seems really primitive? Or was it? Or what is your perspective of it's that you lived through it?

Marina Nitze 6:07
I think, more primitive seemed later. So when I was like, 910, it made sense to me, given the tools that we had that checking blood sugar at certain meals, and having and following the structure made sense. What seemed more primitive was like teenage years when there's like a pump. And then you're kind of left to navigate the like, any number of carbs, and any amount of you know, fat with the carbs, which I don't even think was a thing that was conceived of when I was a teenager around like, you know, you need a longer Bolus for pizza than you would for something fast acting. Yeah, I think that was, that seemed a little bit crazy to me, relative to my like, overall time with diabetes.

Scott Benner 6:45
So that's interesting for people to hear. Because in the beginning, when the outcomes aren't really well tracked, right? Then, if you set up rules and follow the rules that feels like you're doing everything perfectly, is that right? Right. And then then you start getting more insight. But the tools aren't quite there yet. And then it seems kind of harried and, and senseless. Yeah, it

Marina Nitze 7:08
felt like if I were looking back with 2020 vision, having a pump, and that level of freedom without a CGM, I think is probably what felt like, more haphazard, looking back on it, because like I remember very clearly making, I guess it wasn't Excel was Excel, even around then, like a chart for my endocrine team. When I was like 11, or 12, I wanted to stop taking a shot at lunch at school. And so I made like a very detailed chart showing like my average numbers, three o'clock, and there were something like 125, or something. And I was arguing that was close enough to 120, that I should be able to skip my lunch shot. I don't think there was no, not that level of data and structure when I was a teenager, because I was eating whenever whatever. And then there was not that sort of consistent data to work back from so I can think I think about it that way.

Scott Benner 7:58
What's what was the measure of success then, like not passing out?

Marina Nitze 8:03
When I was first, like nine through like, up till the teenagers, I think the measure of success, it was definitely still a one see. And that was back, you know, they had to do it, like a blood draw and wait, like days for them to call you back with it. But my team then like really tracked your blood sugar log, which was this little like, many, I don't know that everybody uses them today. But it was like a packet of paper that you'd carry around with you with your meter. And you'd write in each time and the number that you were, and the goal then was like all of your numbers at your key testing points should be under 120. But obviously not low.

Scott Benner 8:34
Right. When if that happened, how did that translate a one CD? You remember?

Unknown Speaker 8:40
I don't,

Unknown Speaker 8:41
that's a really good question.

Scott Benner 8:43
I'm interested but how much of it was well meaning? And how much of it actually worked out? You know what I mean? It's

Marina Nitze 8:50
Yeah, yeah, you're totally right. I don't remember I don't really remember thinking of it once too much until I was a teenager. I do remember thinking a lot about my individual numbers in the glucose log. But then, like, if a number say was starting to creep up above 120, I understood that then there were kind of two things that you input, you either increased one of your three insulins, right earlier in the day, or you would adjust your like carb count on to I felt like maybe there were simpler math than

Scott Benner 9:20
the pumping nowadays, versus when you first got a pump? Is it a fairly similar experience? like nuts and bolts wise, has anything really changed very much.

Marina Nitze 9:33
You know, it's I got my first pump in 1996. And I've been pumping ever since.

Unknown Speaker 9:41
The size of it, I

Marina Nitze 9:41
don't know that's changed very much. I was on a Medtronic pump for forever. I've only switched Omnipod in the last year. And so the pump size seems the same to me. Although maybe if you held mine up from 20 years ago, I would feel differently, but the insertion definitely like got way better. I mean, it used to be a little bit like jamming or One and a half inch thumbtack into yourself. And I still have scar tissue honestly, for my teenagers that I do not have like now as an adult, I think they've improved that a lot.

Unknown Speaker 10:09
Is that physical or emotional that scar tissue?

Marina Nitze 10:14
But I meant physical. Yeah,

Scott Benner 10:16
no, I understand. Wow, that's really crazy. Okay, so. So you're listening unless you're just really good at representing yourself online, you seem like a fairly accomplished person for your age. So, or you're an amazing writer? We'll find out in a second. But I think it's the former. And so what was your mindset coming through high school? and graduating thinking? I'm assuming thinking about college, did you know what you wanted to do?

Marina Nitze 10:44
I did, but I didn't know that there was a word for it. So I loved even from the time I was very, very young loved business process engineering, I love seeing a problem and like solving it, delivered on those logic puzzles, you can buy them kind of in the airport, and it's like St. Susie sitting next to Bob, but like, isn't sitting next to Susie and then you have to put the X's and O's.

Scott Benner 11:03
That's when Scott puts the puzzle down.

Marina Nitze 11:06
Okay, I upset to this day like I obsessively loved those those logic puzzles. And so I wanted to be and when I was in high school, I referred to it as being an efficiency consultant. And I went on to call myself an efficiency consultant. For a little period of time, I was the only Google result for efficiency consultant. And I know that because if you've noted like the dummies books series, like knitting for dummies, whatever for dummies, I got reached out to by them to write business efficiency for Dummies. And the pitch literally said, like they were googling the term business efficiency, and I was number one search result. Now today, that is definitely not true.

Scott Benner 11:45
That is how I got on the Katie Couric show. Because they were looking for a stay at home dad near New York, and they googled stay at home dad, New York, New Jersey, Pennsylvania, and my blog popped up so I got to be on television.

Marina Nitze 11:59
That is amazing. People under still, to this day underestimate SEO, I think you gotta you gotta find your keyword.

Scott Benner 12:05
Not me. I love SEO. I it's it's a large portion of the reason for the popularity of the podcast, and you have to put effort into it. It's not easy. And it's weird to understand. And I and I, I am I'm proud of myself. I do not write to SEO. Like I don't sit down and say I'm going to say something in writing now that I know will drive people because of the words I use. I do it. Like I think if my content draws that it draws. And if it does, if it doesn't, it doesn't so but yeah, that's I'll never forget, like turning to the producer and be like, how did you find me? She's like, I just googled these words. You're the only one that came up. I was like, Oh, well, then let's get me the makeup. Yes. Very odd experience. But I but I hear you say you were calling yourself something based on your Now let me ask you and try to be honest, if you can love of the process, or strange baked in type A does need.

Marina Nitze 13:06
I tell you, you can't see me I'm literally drinking out of a mug that says type A on it. So I definitely I'm an INTJ to the core, which is like the Myers Briggs mostly says you being type A so part of it's definitely my personality. But I think maybe if it is your personality, then that's the work that you're drawn towards. And you get the most joy out of

Scott Benner 13:25
Yeah, no, I agree. I think it ends up being but you're my wife is incredibly good at what she does. And you and she probably have very similar personalities. And it's the kind of work that people who don't feel that way about precision, and getting things accomplished getting them accomplished correctly. Like that sort of stuff. If you watched one of those people watched my wife work for 15 minutes, you'd think to yourself, like, Oh, I would do anything to this, like, please get me away from this. But she loves it. And she's amazing at it. And I imagine this is similar for you. So

Marina Nitze 13:56
yeah, I describe myself as someone who loves lists and finds comfort in lists. Like if I'm feeling stressed out, I will resolve that by making a list. I know many other people, including my very beloved husband, who the list makes him more stressed. Right. And so it's just acknowledging that we all have different work styles.

Scott Benner 14:13
Can I ask you a question before we get too deep into this? Do you mind? Do you mind being like a therapist for me for a second? Absolutely. If I said, Let's pretend you and I were married for a second. And you saw that I have no desire to follow a list. I keep one because I'm an adult and I have things to do. But if the 10th thing on the list suddenly becomes the most important thing to me, I'll abandon the first thing on the list and then do the 10th thing on the list. Like I'm very flexible about how I handle my days that bleed into my weeks to bleed into my month. Is that maddening to you or do you just see that as a style?

Marina Nitze 14:49
I used to that is a style and it's a style that you can accommodate. Like for example, even though I'm very type A, I also procrastinate and recognize that about myself. I find Ways to be the most productive in my procrastination, for example, I've learned that if I see tasks that are due, in two days, I'm more likely to do those than I am to do the task that's due tomorrow, what you think about it is a tricky way to keep those tasks that are due in two days from ever becoming overdue, right? Because they're still getting done ahead of time. So finding like tricks about the way that you work that way I would, and then exploiting them, is what I would recommend

Scott Benner 15:25
to teach people how to do that, or is that just something you do for yourself?

Marina Nitze 15:29
I am increasingly, I have a task app that I built for myself 10 years ago called task tackler. And I'm just now about to like make it available for other people to use. And so it may be a platform that I can, it's built the way that my brain works, acknowledging that most other brains don't work this way. But if there's like 1000 other brains that work the way that mine does, and those people can't program their own task apps, I hope to bring them some

Scott Benner 15:55
relief. I would imagine that some people listening think that I set that question up knowing what you're going to answer, but that would not be the truth. So I've just googled now to find out, and now you're thinking, Oh, my God, you didn't even read like the first page of my website. Probably. I apologize. I like not knowing too much about the people I'm about to talk to

Marina Nitze 16:14
you. I am not judging in the least

Scott Benner 16:16
Thank you. Well, if you want to judge just say it out loud, so everybody can hear it. That's fine. Wow. So you're gonna make this like a, like a public thing. Optimize your mood at relevant task details. Cool. I'm sure there. Will it have applications outside of business? Is it just everyday life? But well, it's

Marina Nitze 16:33
just everyday life. I mean, I literally like I have tasks related to diabetes. In it, I have tasks related to being a good godmother, like it really is pretty helpful. You can use it for whatever it's going on.

Scott Benner 16:43
Nice. Task isn't always going to be task. tackler calm.

Unknown Speaker 16:48
Yes. I mean, presumably,

Scott Benner 16:50
unless you get crazy and you're like, well, you just said SEO is important. You're not gonna start changing now you're

Marina Nitze 16:56
for 10 years. So I'm, it's it's a little weird to SEO could persuade me to call it something else. I only comms I

Scott Benner 17:04
have a, I have one episode of this podcast that was driven by SEO. And then it didn't end up going anything like I thought it was going to go.

Marina Nitze 17:17
Can you tell me what that

Scott Benner 17:18
was? I would be happy to I'm now telling everybody at the same time. So it's the one where I had the paramedic on to talk about how they handle emergencies, such as situations with people with type one. And I did that because Type One Diabetes tattoos is an incredibly powerful SEO search term. So everyone does it. So I get this, I get this person on. And like I just said, I don't plan ahead. So I tell her what she's gonna do. And she's excited to do it. She comes on. And I asked my question, which I will admit, I thought was a leading question about like, Hey, where's the best place to put your type one diabetes tattoo so that, you know, emergency medical people see it? And she goes, I don't recommend those. I was like, Wait, what? So we ended up having an amazing conversation, and she explained everything to me. But in her professional opinion, if you want people to know you have type one diabetes, getting a tattoo of it is the least effective way to do it. And I said, Well, what if you put it right on your wrist or on your arm she has now she was I don't know what you think I'm not looking at your tattoos while I'm trying to put an IV in you. And I was like, oh, and then she explained the whole job. And I was like, that makes a ton of sense. not what I expected for my SEO like my big SEO campaign, but it ended up being a really amazing interview.

Marina Nitze 18:36
Or you get that type one tattoo. It seems to me that that podcast is what you would actually want to land on if you're researching them. And if they're not effective, and you're tattooing yourself,

Scott Benner 18:44
I agree I also think it probably pissed everyone off that already had one like I even said like what about your chest? Like What about here? She's like, she started saying like, there's some places that might be a little better but she would not guarantee it. She was we're ripping your clothes off sometimes. And putting in lines and she goes we're not we're not reading your tattoos. And I was like, Oh, well she's like a necklace or a bracelet. I think bracelet was the best. And then maybe a necklace with a medallion on but we have bracelet was the best if I recall. Anyway, it did not go anywhere near see the one time I tried to do something like really pointed it just I was like I forget it.

Marina Nitze 19:20
I think I've heard of people that tried to get Do Not Resuscitate tattoos and they're ignored in any way. Go. Yeah,

Scott Benner 19:25
yeah. That's not a legally binding contract. I

Unknown Speaker 19:27
don't, apparently not.

Scott Benner 19:29
Can you imagine you're just an emetic, you're like, Oh, wait, no, this person has a tattoo says they don't want to be saved. I guess we'll leave now. Like, I mean, how would that work? You know? Okay, so what do you end up going to college for

Marina Nitze 19:42
political science, which you might think was connected to my later working in federal government, but they had absolutely nothing to do with one another.

Scott Benner 19:50
Okay, well, let's find out why that is. So you do an undergrad in political science? Is that all you did? Or did you do any continuing education

Marina Nitze 19:59
after that? I actually did not finish college, because I was too busy working in my company making efficiency application.

Scott Benner 20:07
Wow. Okay, so you start a company while you're in school.

Marina Nitze 20:11
I actually started when I was 12. Making, I made professional websites for different soap opera celebrities. And then I've gone on to build like websites for like family, friends, companies and things like that. And when I was in college, I was getting hired by actual company, it was the right timing, right? It was like just when they the World Wide Web was coming out. And lots people didn't have any website at all. They maybe had like an AOL keyword. And so I was it was really nice timing where they were willing to hire anyone to come and build their application. And then I got to take my logic skills, right, where I watch their current process and their current dot matrix printer and there as 400, and their chalk board or whatever they had going on, and then build an application that helped their business work better.

Scott Benner 20:54
Anybody from General Hospital?

Marina Nitze 20:56
Oh, yes. General Hospital, it was my favorite soap opera net. And Alexis, the couple was my first website.

Scott Benner 21:03
No kidding. Do you know there's there was a character named after my daughter on general hospital because of this podcast?

Marina Nitze 21:10
I did not know that.

Scott Benner 21:11
There you go. I don't know how to, like rightly so. Well, I get a message one day from a woman who says that, um, that, you know, the podcast is helping her I think she has questions or something, we end up on the phone, we're chatting, I'm like cleaning the house. And you basically if you're talking to me on the phone, I'm cleaning the house. And, and she's going online, and I bring up that I wrote a book. And I felt so silly later, because she's like, Oh, I'm a you know, I'm a writer too. But she never really says, like, in what? Like capacity. And then we kind of bumped into each other again, like online and I set her up to be on the podcast. And it turns out, I'm trying to pull it up so that I can find it. Exactly.

Unknown Speaker 21:51
She character's name is artist.

Scott Benner 21:54
So the character's name will be like, it's like she was like a district attorney. So it was like Ada Arden. And, and, and the woman's name was Kate Hall. I'm looking it up. Now this happened back in like 2019. So I have like a little clip on my website of, of the actors, like using my daughter's name and in a scene and everything. But it turns out that Kate Hall's like, you know, not just a writer, she's like the head writer, General Hospital. So

Marina Nitze 22:19
that is an awesome story. Wow, Arden was probably doesn't appreciate like how cool it is. I mean,

Scott Benner 22:24
she's, she smiled, and she was like, that's really nice. And then she should, like she showed a friend and then she was sort of done with it. But it was a it was really I thought it was an I thought it was just an amazing indication of the show, honestly, like did the podcast that helps somebody so much that you know, that they felt compelled or desirous of doing something nice like that? I just thought was really sweet. Yeah, that's awesome. Yeah. And I grew up when I was younger, coming home from school and watching General Hospital with my mom in the afternoon. So I know all about Luke and Laura, and a lot of other things that I'm not embarrassed to say.

Marina Nitze 23:03
Yeah, good for you. Watch it. I don't I'm not as religious these days. But I still I still keep playing.

Scott Benner 23:10
But you're 12 years old making websites for people. And what does that lead you to like after you kind of like, drain that? Well dry where do you go next?

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Marina Nitze 26:08
I would say rather than like one well going dry, like they sort of kind of worked in parallel. So for example, it's websites, but then like, I wanted to make soap opera games like hang man or trivia games and things. So I had to learn how to program to make those games online. And once I had that skill, then you know, when you run into the local business, or a friend's parent, or whoever it may be needs a website, then I can do that. And then I could do more than just the website. But they'll like applications that actually work for their company.

Scott Benner 26:35
And you still have this skill, like if I told you that their episode that went up the other day was about how to count fat and to Bolus for fat. And then there's an actual mathematical equation that goes with it. If I said to you, here's this equation, can you turn this into an online app? Like Could you do something like that?

Marina Nitze 26:53
Absolutely. Let me know if you need it. Are you

Scott Benner 26:55
serious? That's I wasn't asking. I was just amazed that you could do something like like that was a an idea I had while I was talking to the person. And I thought, well, that would be amazing, because then instead of this kind of difficult math that you have to do around this, this these fat calories. You could just put in a couple of numbers and be done. They could tell you like this many units over this many hours. And that would be it. And I was like that seems

Marina Nitze 27:20
I mean, you loop right around? Arden does Yeah. Yeah. There's an app fpu mod of loop that you can put in fat, and it will change your loop calculation.

Scott Benner 27:30
No kidding. Yeah, I don't think I pay very little. I shouldn't say this, but I don't pay much attention outside of my out of outside of my bubble. I guess I say this on the podcast once in a while. But I'm incredibly concerned about appearing to steal anyone's idea. So I don't like to know anybody's ideas. And I also think it drives me towards being more differently innovative about diabetes, that makes sense or not. So for sure, yeah. Okay. So you just keep growing basically, like you're, you're a person who learns how to do a thing, which leads them to another thing that leads them to another thing, and it just kept going and going. So but you still went to college? But how does how does something become so successful that you're like, I don't need to finish college? Well, I

Marina Nitze 28:14
think for me, it was a gradual thing. It was like I'm just I'm so busy. I can't like meaningfully do college and complete my paying work. And my paying work seems pretty important. So I'm going to just take, you know, one semester off, and then it's like, I'll just, I'll go back next semester. And then I moved to a different state. And then I was like, oh, I'll go back, you know, next year, and then it just kind of keeps piling on.

Unknown Speaker 28:33
So your parents

Marina Nitze 28:34
so far has not held me back in any way. So I'm not wildly persuaded to go back. Yeah, I

Scott Benner 28:39
mean, I don't listen, it doesn't matter to me. I took one college credit ever in my life, and I have the most popular diabetes podcast on the planet, so I'm okay. But, but at the same

Marina Nitze 28:49
time, okay, you're okay. That's

Scott Benner 28:52
the only thing I would say that through my 30s maybe my late 30s, early 40s. I did have that like feeling of like, I really should have gone to college. And I didn't know why I felt that way other than it felt like I let myself down or something like that. Meanwhile, didn't seem to matter for me. But did you have living parents that you had to tell you were not going to college? Amer

Marina Nitze 29:14
I, I it wasn't really a conversation. I don't know. Nobody. Nobody's upset with me. Nice.

Scott Benner 29:21
Is this do you think this is based on a lifetime of like, she's always doing the right thing? She'll be fine.

Marina Nitze 29:28
Yes, I think that that probably like I've always been a little bit outside the box, but effectively so I guess I've also with the exception of working the federal government never had like a real job. I've always worked for myself. And so I am pretty comfortable doing that. And I think other people are just used to me kind of going my own way.

Scott Benner 29:47
Yeah. I if I had to work for people again, I would be making me cry. I would cry. He really would. I very much like being able to set my own pace and and and I like to have I like being able to have ideas that I know if I went into a room and tried to discuss with four people, that they'd shoot it down, and that I just get to go, I'm gonna do that anyway. I like that a lot, actually. Okay, so you're on your way, you're doing a thing You just said you ended up working for the federal government at one point, what were you doing there?

Marina Nitze 30:19
Yeah, I was a senior adviser on technology to President Obama in the White House. And then I was the Chief Technology Officer for the Department of Veterans Affairs for five years after that.

Scott Benner 30:29
What is the Veterans Affairs job consist of? What are you trying to accomplish?

Marina Nitze 30:34
I was told on my first day of work that my job description was to redefine the art of the possible of how America honors and serves its veterans. So you know, no biggie. In practice, a lot of my time over those years was about bringing new technology talent into the VA, but really primarily shining the light on the experiences of real veterans, going out and sitting with veterans that are experiencing homelessness, who needed VA health care, but couldn't enroll and understanding like, what were the specific obstacles they are facing? And how could we as the VA, remove those obstacles?

Unknown Speaker 31:09
Did you come to any conclusions in your time, there

Marina Nitze 31:12
are quite a few. And actually, it's kind of cool. The VA right now is being lauded as really effectively delivering vaccines to veterans and their caregivers. When I was there, there actually wasn't a database of veterans. That might sound crazy, there were 64 different ones. And so we set out a course and a vision of like, what would it be like, imagine if a veteran could update their address in one place, and like the VA knew about it. And so it's pretty cool to see the groundwork that we laid in 2013 now mean that in the time of a national pandemic, the VA can really effectively deploy and serve,

Scott Benner 31:45
how much of the, how much of bureaucracy gets built, because people come and go and have new ideas. And instead of either working with what they have, or starting fresh with something, they end up just building a sunroom on the side of it and keep going like is that? Is that how it gets confusing like that?

Marina Nitze 32:04
Oh, I think it's a ton of it. I used to keep a chart on my wall in the office of like, people's beliefs when they first came in from the private sector and join my team relative to their beliefs in six months. And I think part of it is coming in and not understanding what was there before. But I think part of it is also coming in with a belief that like, your new thing can be exempt from the rules, or you can get like a waiver. Or if you just build a kind of over in the corner, nobody will notice it. And that's not how government works. Government is designed, designed to not change very quickly and to be very risk averse. And so my advice always when people are coming into a government situation is you have to understand the real rules like why is this the way that it is? And how can you change the fundamental rule or law or form behind it? Because that's how you make real lasting change. You're kind of innovation that you stick on the side? Would you say like a sunroom? Yeah, they'll just bold like there's there's a full bulldozer fleet that is designed to look for some rooms and bulldoze them.

Scott Benner 32:58
Okay. So is this in some way similar to how people get told to care for themselves with diabetes, like that you're standing in front of a doctor who's, I don't know, 60 years old, and somehow his sweet spot and diabetes was 1986. And because there's still some people who get diagnosed, they're like, they're there on a sliding scale. Like that actually happens, though, and

Marina Nitze 33:21
hear about that, or they're, they're told, like the right balance is 50% or less 50% basil, independent of what they eat, or what their basil doesn't matter,

Scott Benner 33:28
yet, no one ever discusses that their carb ratio might have something to do with the glycemic index or a load of their food, like, nothing like that. Like it like those ideas. So you get you end up getting that doctor, right. And then he starts you or she starts you in 1984 with your diabetes. And then there's no one there to, to do anything about it. So that's just the path you're on. And isn't that sort of, is that kind of bureaucracy to? Like, get like, at some point? Shouldn't every doctor in the world just get together bulldoze the whole thing and start over again?

Marina Nitze 34:03
Yeah, I think it is bureaucracy. And then you think about like, how do you fix that? Right? Because at some point, that doctor got licensed and isn't allowed to see a bunch of patients and put them on a sliding scale today, right? So like, what framework has allowed that to happen. And then you look at other things like our whole healthcare system, why is type two diabetes exploding, and people are getting worse and worse, you know, the VA spends more now on amputations due to diabetes, and to combat wounds, which should make someone raise an eyebrow like, but we keep using the same old advice of like, we'll just have another STL to inhibitor. And I think we need to fundamentally rethink how we're treating diabetes, type one and type two. As a country,

Scott Benner 34:42
we live in a world where I think we just experienced I think this is something that people don't say out loud over the last year and you know, but I don't think I mind because it seems to me to make perfect sense. But throughout COVID no one ever was like, hey, if you were healthier, you might not get as sick. He gets sick. Like we we never say that, that people like we never like that's it's always, it's always, like you said like something bad's definitely gonna happen to you. And we'll see if we can't stop it from killing you. Like that always seems to be the way we do things instead of getting in front of them. I know that's a very simple idea that is pretty obvious to people. But we never talked about it like that, like prevention, I guess.

Marina Nitze 35:23
I wish we talked about prevention a lot more and then look upstream. Like I think it's wildly unfair to blame individual people for their own health outcomes. And we have to consider like the environment that they're in. So if we have corn subsidies that make cheap processed foods that are worse for your blood sugar, cheaper and easier to access than other healthier food, if we limit what you can get on food stamps, if we don't allow food delivery for healthy food, but we allow it for, you know, super processed food, the contents of school lunch menus, the contents of hospital meals, frankly, I had my appendix out last May in the hospital, and the nurse just straight up told me there was nothing on the menu that I could eat as an diabetic. And I was like, Well, okay, um, you know, we need to change those sorts of environmental variables. For people,

Scott Benner 36:07
I'm thrilled you said that, because that is exactly how I feel. And that would have been the rest of what I said, which is, you can't you, you can't take a baby, and lock it in a room with a bag of heroin and a bunch of needles and cocaine in that corner. And, you know, 13 pot plants and some psychedelic mushrooms over here, and then later go, I can't believe you couldn't avoid drugs. Like it's, it's it really is what we do with food. And a lot of other things, too. It's just, you know, I spent most of my time discussing on the podcast, how to manage insulin, and how you can use insulin dough, you know, combat spikes, and prolonged highs and things like that. And I am totally not a person who tells people how to eat, I don't care how you eat, my daughter eats what I would consider a fairly American, you know, lifestyle. So it's not like, we're over here counting macros, and, you know, telling everybody else, it's going great, you know, and I haven't chicken to like it, you know, we're fried chicken too. So I don't, I don't care how people eat, I think it's up to you. And then I just want you to know how to use your insulin after that. But fundamentally, most people don't seem to understand that processed food or foods that aren't real, are really difficult for their bodies to process. And to get out the other end without leaving on you poor health outcomes. Wait, you don't want etc? And that's, I don't know if that's education, where a fits opportunity? Or if it's not a little bit of both? It sounds like you think it's a little bit of both, right?

Marina Nitze 37:38
Yeah, I definitely think like there's a lot of there's a lot of government incentives, their subsidies, they're thinking about, like, how dietitians are trained. What is my plate look like? And then you're right, like, what are the standards of care for diabetes? And how do we update those given today's faster insulins CGM, and knowing what we know about standard deviation, which is a number you couldn't even calculate when I was diagnosed? Yeah. And now that's a number I keep, you know, very close eye on.

Scott Benner 38:04
So So let me ask you a question. Because this is your, I didn't expect any of this to go like this. Well, I'm having a good time. So it is my I have, I have a macro goal and a micro goal for the podcast. So every day, I just tried to put out good content that I think people will enjoy, that will help them live with Type One Diabetes better in some way. And my pullback goal is that I want this idea of being flexible with your insulin, being aggressive, not you know, abiding by high blood sugars, not staring at three hundreds for six hours going, it'll come down, like you know, stuff like that to become so the norm, that it's how people are taught. But I, I can't really affect that from here. I mean, I can, but I can't reach enough people to make it happen. So my question is, if I took you and made a, you know, another job where you were in charge of that, how would you impact the health care system to talk to people specifically about diabetes in a more proactive prevention way?

Marina Nitze 39:05
I have a very specific, wonky answer for you, which is I would change the way that Medicare Advantage star ratings work. can I explain that Julie's? Okay. So right now, Medicare Advantage is a kind of Medicare, where the federal government pays an insurance company a certain amount of money every month for you, Scott, and they're gonna pay that amount of money, no matter what happens to you that month. So your insurance company, the idea is, is now incentivized to keep you healthier, because if they can get you fresh produce, drive you to the doctor, make sure you're refilling all your prescriptions on time, then you're less likely to be hospitalized that month, and then the insurance company gets to actually pocket that amount of money that month that they receive for you instead of going in debt, sending you to the hospital with ambulance rides and surgery and whatnot. And right now, Medicare Advantage has a lot of diabetes related measures and it gives doctors more money. per per patient per month, the more of these measures that they hit. And the measures include making sure everyone's diabetes is on cholesterol medication, no matter what else stressed, you have diabetes, you're on cholesterol medication, making sure everyone is on high blood pressure medication, making sure a once he is under eight, things like that. And I would really like, Look, this is the heart of like payment and healthcare in America, how can we change those measures so that they're more aligned with your actual health care outcomes and enjoying a successful life with diabetes? And not? I mean, I don't know 8%, I wouldn't feel good at 8%. And that shouldn't be the goal, to my mind. And if we want to change the incentives of the healthcare field, we have to change where the money is directed.

Scott Benner 40:41
And is there a way to do that within the system now? Like, where would the system have to be completely revamped to support that?

Marina Nitze 40:48
I think if you got enough of a coalition to support and you do it incrementally, maybe we could change the Medicare Advantage star rating from an A one C of e to 7.5. And then we could bump it down a little bit more and give those doctors and those patients more tools like you provide right to help get those numbers more in check. I don't know that a lot of diabetics know how to really address a 300 quickly or know that there's no muscular injections or know the impact of low glycemic index foods on how they may Bolus for one food over another. And I think there's a lot of these tools that can be taught and people deserve. We can all make our individual health choices, but people deserve to have a full menu of options.

Scott Benner 41:27
Yeah. So I think that the the least common denominator way that we do a lot of things. I think it's lazy. And I don't think it's even true. Like I think the I think the messaging is, and this is the you know, the example I frequently use, I think the messaging is if there's 20 kids in a class, and three of them are brilliant, and 14 of them are average, and three of them are struggling. Well, we don't want to, we don't want to leave the three behind who are struggling. So we'll, we'll bring the entire course level down so that they can keep up with it. And in my mind, what that does is it eliminates the idea that the other 17 kids might Excel. And so I think we do that with health care, but it's around they do it around safety. They say well, we can't you know, we can't tell people how to Bolus, you know, aggressively, they'll kill themselves. But that doesn't happen. It's just what people say. It's the and I think they say it because they don't know how to explain it. And if they say that they can't explain it for safety reasons, then they'll never get called out for not really understanding it to begin with.

Marina Nitze 42:30
I think the risk frameworks are all pretty perverse here. So you have an endocrinologist who is arguably afraid of being sued for your really bad hypo glycemia event, but will never get sued. If you have complications from being high or even tech, you failed a test because you were 300 for so long that you had brain fog. But then you meet other health professionals like an ophthalmologist who could look at an A what your endocrinologist might say, oh, you're 6.5 a one see his thumbs up and you know, ophthalmologists will look at it like, Oh, we got to tighten this up. Because I want to prevent you from complications are you talk to an obstetrician for a pregnant diabetic, and they're upset at any blood sugar over 100. And it's a totally different framework, but they're their risks, they're worried about you and your baby. And so I think a lot about how do we align these risk frameworks more that the risk can't just be about going low. And there's also steps toward that, like, I don't suppose you recommend people get super aggressive with insulin tomorrow, if they kind of barely understand how it works today, like there are steps in that direction,

Scott Benner 43:28
you don't start off at the ninja level, you you in my mind, it's you understand what basil is for, you get it set up, well, then you start understanding how to Pre-Bolus your meals. And then you begin to understand the different impacts of foods. And then you go from there you go, you stay flexible, you understand that fat might keep carbs alive in your system longer you like start building on it. But in the beginning, in my mind, the core of it is basil Pre-Bolus saying glycemic load index, if you can get those three ideas, right, that's an A one c somewhere in the sixes with very few lows. But you don't yet I don't, but you can't just have your your your basil can't need to be 1.5 an hour, but it's actually point six. And you usually try to correct the high with two units, then all of a sudden, you're like, I'm gonna use seven. Like that's not, it's not what we're talking about. Like there's a there's a balance. And I think it's why it works in podcasting, because you don't need to understand that all in one day. And you get to kind of like listen through it, hear people talk about it, and go and then find what's applicable to you and what isn't, and then set it in place. Now are there going to be those three kids in the class listening to the podcast who never quite get it? I assume Yes. But I pride myself on talking about it in a way that I think everyone can understand it. I think that's valuable across the board. But I also am just not the kind of person who is willing to let 17 people's health slip because three people might not understand what we're talking about. But I don't think that's valuable.

Marina Nitze 44:58
And it's like what we're talking about earlier. We're like you and I have different personalities with lists, but we find ways to make them work for ourselves. You know, I totally believe that there are some people that love regimen and they can MBI routine, like the same as I was on when I was nine or 10. Like might work just fine for them today, they like eating the same amount of meal at different times different day. And they like that regimen. And that's great. There are different people that are super confident, like sugar surfing with like, large amount of carbs, and there's lots of space in the middle. And also we have different bodies I have, I am super, super insulin resistant in the morning, to the point that I do not eat breakfast, I haven't eaten breakfast for 22 years. And that works for me, I have coffee, you know, totally happy that someone else may need breakfast. And they absolutely need to find a different way for that to work. And we all have to kind of work work within those frameworks, right?

Scott Benner 45:44
So my idea of infiltrating from the outside the healthcare system isn't really going to work because they're not incentivized to teach people these things.

Marina Nitze 45:55
Well, unless you get your listeners that grow up and go to medical school, and become doctors, like there's a long game here. So we

Scott Benner 46:01
do have a few people who are becoming nurse practitioners, I have made a couple of CDs, which they don't call them CDs anymore, but I am not willing to learn the new acronym, so. But I have a few people who are becoming CDs, there are a number of people who are who find this podcast through their doctors direction, which I think is very progressive and amazing. So you're saying I might have an impact that I don't, I'm not gonna get to see what you're getting on here. Right?

Marina Nitze 46:28
You're definitely having an impact. And it's like, there's a lot of levers in the system. And if you can start influencing other diabetics to even just understand what's possible, I think, you know, knowing what is possible, even if you maybe make offset choices for your own lifestyle or activities or whatever, we should all know that we are entitled to have like normal non diabetic a one sees and experience like not having the the roller coaster of Oh my God, I'm crashing low and then I overtreated enough. Now I have brain fog. Because I'm high and I feel like crap all day. You know, we should have, we should know that there are ways in a different direction to me. And we all have different ways to get there. And not everybody's going to choose to do that work.

Scott Benner 47:10
And that's, by the way, if that happens, that happens, I don't feel encumbered by everyone's health. But you should at least have the opportunity to know that thing exists and make a decision for yourself as to whether or not you want to implement it or not. But you shouldn't be told that you're a one sees, okay, because it hits some arbitrary number that was set by a board of people who don't have diabetes. And that's just how the doctor ends up getting paid by somebody if you're a once he comes in under a number like that's not health, like I very clearly on the podcast, I say that most doctors give, do not die advice. And they give it the exact reason you brought up earlier because if you die today, it's their fault. And if you die 12 years from now, it's your fault. And that's what they want. They want the fault to be with you not with them.

Marina Nitze 48:01
Yeah, and we have other numbers like an A one C is a measure, right? And you and I both know, but when you and I both have enough tools that we could game it if we needed to. And there's other measures that you want to take into account too, like a standard deviation if you have an ANC of 5.5. But it's because you're 40 halftime and 200 other half the time like and you're at standard deviation 60. You know, you're probably way worse off than someone with a one to six,

Scott Benner 48:24
you're screwed and the doctor gets paid. And that's Yeah, that's not the way to go. So I noticed you're not in government anymore. Was it exhausting? And was there was there something fulfilling about it that you would like Could someone get you to go back?

Marina Nitze 48:44
It was absolutely exhausting. It was also like the most impactful amazing scale of work ever. And I was a political appointee. So I got kicked out with the with President Obama the same day that he left, but I actually work in foster care reform now. So I do I would say I caught the public sector bug. I'm just in a different part of the organization at the moment.

Scott Benner 49:05
Okay, what do you do for that?

Marina Nitze 49:08
I similarly, I work with different states doing business process reengineering, to help them, find family for kids faster, and help get those families approved for kids to live with them faster.

Scott Benner 49:19
So the kids get out of homes and into out of like foster home institutions and get into real into single family homes.

Marina Nitze 49:27
Now, the goal for me is always if a kid has to be taken away from their parents for health and safety reasons, and they should be placed with an adult that they already know and trust, whether that adult is their grandmother, their baseball coach, their moms, or their friend's mom. And then we should resource that family in that placement so that it stays together so that a kid if they do have to enter foster care doesn't have to move around a bunch. What happens today is you know, you're taking your place in a home that is generally a very poor match with strangers and then you move 17 more times, and then we act confused why you're acting out and you're not doing well in school. Do kids

Scott Benner 50:00
become commodities in that system because the people who take them in are paid to have them,

Marina Nitze 50:05
I have seen a lot less of that. But you do have to keep in mind that like in a group homes, there is a huge financial incentive for group homes to be full. And they there's a lot of money to be made in a group home environment, I think there's a lot of wiggle room in the middle like we need to acknowledge, like, there's so much stigma from a Little Orphan Annie around paying a foster parent anything. But we need to acknowledge that if we don't have any in between space, then the choices are just you're in a foster in his traditional foster home where they only get reimbursed for your kind of food and clothing. Or you're in a group home, where we're paying a full time staff to take care of you. And there's definitely some middle ground where we could pay an experienced foster parent to help a child with a higher level of needs. But stay in a home environment

Scott Benner 50:48
is that is the concern that when you pay, then some people take advantage of the system. But isn't that usually far fewer than who are actually doing good with the way it works?

Marina Nitze 50:59
It is the concern and I would say it's far and away. It's people that are doing good, good work. And they're really, really sticking their necks out for these kids. I mean, nobody is getting no individual foster parent is getting rich. If you look at the foster parent rates,

Scott Benner 51:11
it's barely covering the cost of a kid's shoes and clothes. If you put them with people that they know previously, does that physically make them more likely to stay together as a unit long term?

Marina Nitze 51:23
astronomically? Yes. And how astronomically better outcomes in terms of high school graduation not being pregnant or not, you know, parenting before they're ready. finishing college, getting education, employment, making the same amount as their peers. I mean, the the outcomes for foster kids are just abysmal right now.

Scott Benner 51:44
What, um, where's my question? I had a question, oh, once a child's removed from their natural parents, what's the likelihood that they'll go back? And is it usually a good situation where it's

Marina Nitze 51:57
about 5050 likelihood that they'll be reunified. And there's a lot of hoops that parents have to jump through to get their kids back. A lot of hoops. So, while some kids do come back into care, I would say that there's a lot of focus on reunification. And to make those successful, a lot of our focus needs to be on wrapping around supports around those birth families, like a story I tell all the time is we very regularly take, you know a mom or dad, they can't afford daycare, they're working really hard. They leave their kid home alone, because they don't have the money for daycare, some neighbor calls in a neglect report because the kids have been left home alone. We remove the kid we create tremendous trauma to this family and we placed them with strangers. And then we give those strangers money for daycare. Yeah,

Scott Benner 52:39
it could have given the parents for the daycare.

Marina Nitze 52:42
Yeah, we could have I put daycare in originally and kept a family together.

Scott Benner 52:46
When I don't want to be cynical. But when people don't get through the reunification process, is it sometimes because they're I don't want to say happier. But I guess happier is the word. Are they happier that the kids not with them anymore? Does that happen?

Marina Nitze 53:02
I wouldn't say that I would say some people have deep struggles with drug addiction and with mental health challenges that as a society, we are not doing a great job of helping them remediate. And a lot of people try what I see are birth parents trying and trying and trying and jumping through tremendous hoops to get their kids back. How do you help?

Scott Benner 53:21
So it's just very interesting that you that you said mental health and drugs is like your example. So it are those two things, drivers behind problems and a lot of sectors of society.

Marina Nitze 53:35
I use, I work in veterans and I work in child welfare, I would say like in those three spaces, like they can be very problematic.

Scott Benner 53:42
Can you help people when they're in those scenarios, like, that's always the like, I know you the goal would be to win that you would want to and I would want to if you put me in charge as your magic wand me I was like, I definitely be like I'm gonna help these people. But I've also interviewed people who are bipolar, for example, and you're talking to them One moment, and everything's right. And then you talk to them three days later, and you're like, well, that's not the same person I spoke to three days ago. And I don't know, like, how do you? How do you help people in that in those scenarios? When they're gripped by something other than themselves, I guess if whether it's a mental illness or if it's drugs, something that's outside of their control, I guess, I don't know if I'm using the right word or not. But that's how it feels. It feels like an outside driver to me.

Marina Nitze 54:32
I think there are a lot of successful treatments for mental health and for drug addiction challenges, but we need to make them available to people and we need to make them available people where they are. And I actually mean that quite literally in the sense that if I if I say you know okay, I've taken Arden from you and to get her back you need to go to therapy. Four times a week. Therapy is two and a half hours away from you. And you can only get there by bus and I'm not getting a bus pass and then I also by the way need you to visit her at In order to account for court visitation, and then I also need you to get stable employment and stable housing, and I'm not going to help you with any of those things go while you're already struggling, potentially, you know, presumably deeply struggling if you've had your children removed, like there's even missing things about, like, how many providers are at bus stops? Like, we don't know that that isn't tracked. And that might seem like a very, very basic thing. Do we send reminders to birth parents about court dates, you know, like, they may not have a Google Calendar like yours in mind that is so full that, you know, we're getting alerts every five minutes. And we I think we really could do a much, much better job as a system of helping parents to succeed and not set them up for failure

Scott Benner 55:37
is a is a big part of helping people not judging them.

Marina Nitze 55:42
I think so absolutely. You have to give everybody like a really fair chance at succeeding, and you have to really recognize that not everyone is starting from the same point on the course,

Scott Benner 55:52
I have to imagine, too, you have to not apply your judgment of success to their lives as well. Like, like, if if I don't either, so I'm not sure what I mean here. But there seems like there's a whole section of, of our culture, who wants everything to be perfect for everybody. And which is a lovely idea, except that when something could be perfect for another person, and it might not be perfect to you. Is there? Is there a problem there? Where we're trying to get people to something that they're just unaware that even exists? Or couldn't get to even if they knew it was there? So it makes sense?

Marina Nitze 56:32
Yeah, I'm not sure where you're going, I would say it's less that they can't get there. And it's more that there are different standards for communities and for families in different places. And it's wildly unfair and judgmental, to hold everybody to one standard. Like as a quick example, many states require foster parents to include like grandma's or Auntie's that are taking you in, to have recycling, to have a working oven and stovetop, to have the right quote, unquote, number of windows in your bedroom, which fits for a standard colonial home. But Native America, I live in a colonial style home. But for a Native American long home, they have the quote, wrong number of windows in their bedrooms. And when you just have a lens that the whole world looks like my world, you miss those things. And then you start, you know, traumatizing and separating families, because you're not there understanding that they have different and perfectly acceptable homes, they just are shaped a little bit differently.

Scott Benner 57:27
Is the windows thing for egress during fires and other emergencies? Is that what that's for? Yeah, I couldn't imagine any other reason. Like, that's the only thing that popped into my head. So. So then this thing, that we're taught this big idea around foster care. And if you switch real quick and talk about, you know, health care, or diabetes care, it is all really arbitrary rules that have been slapped on top of other things, because at some point, because at some point, some kid died in a fire, right, and the fire was on one side. This is like when I rented my first apartment with my wife, we were signing the contract. And it said explicitly on the contract, that you could not swim in the pool with an open wound. And that made me and that made me look at the woman. And I said, how many people try to swim in the pool with open wounds? Because my brain said if it's in the contract, it's a problem. It's something they've come up with before she goes, Oh, it's happened a number of times. And I laughed, because I thought it was funny, except that there's some kid who doesn't get placed in what would be a good foster system. Because 20 years ago, there was a fire on the east wall. And that was the only window in that room. That's the truth. Right?

Marina Nitze 58:41
Correct. Yes. And we really need to rethink fundamentally, what these rules are and how we can make them more flexible. The goal is that you can escape from a bedroom in an emergency. I'm okay with that goal, but I'm not okay with counting the number of Windows.

Scott Benner 58:55
Yeah, you know, I don't know if I've said this before. on here. I'm sure I have at some point. But there's this little parable about a girl making a pot roast with her mom, and the mom.

Marina Nitze 59:05
I love the one from Reader's Digest. I

Unknown Speaker 59:07
tell people,

Scott Benner 59:08
I just I think it's it's so insightful. And it's it's what I use around diabetes to tell people like, there's no way to do something. I know, you think there's a rule? Because you heard somebody say, and then you went on Facebook and somebody said, Oh, that's what my doctor said to and they're like, Oh, I heard at one place. And her doctor said it, obviously a role. I wish people understood the freedom that I have in the way my brain works. I am not encumbered by what any person who came before me thought. And I think, you know, we could dig into that I grew up adopted and I was brought up in a lovely home with wonderful people, but I may have been a little I may have been a little more intellectually strong than they were. So I was always figuring out my own things. But more importantly, I was never relying on what they said to me to figure things out. I was always looking for my own answers. And I just I'm such a big fan of looking for your own answers. And, and this just seems like what we talked about all the time, but there are people look at you, you're out there like there's somebody out there right now going I have a seven, three a one. See, I'm winning, because somebody said a number for reasons you brought up earlier. And meanwhile, a 731 C is terrific. But there's more room under that, and a way to get to it and no one's ever going to tell it to you. Yeah,

Marina Nitze 1:00:30
my I'm not here saying anyone with a seven three a one C, you know, Dad, I'm saying that I want them to know that there are other tools out there that they could leverage that don't mean they have to give up, you know, their life or they have to like follow a clock. There's ways they can do it that work with their lifestyle, exactly how I feel. And

Scott Benner 1:00:46
this whole, the last five or six minutes of this conversation have made me angry, not at you. But can you imagine if I was like I'm mad at you. But just that whole idea. That arbitrary nature of things is is bothersome to me that we have rules we follow for reasons that don't even exist anymore? Or maybe we're never good reasons to begin with or just stop gaps for somebody. I really want people to think about that. Like how many things do you do in the course of a day that are senseless? And they seem utterly, like they're the most important thing that ever happened? Oh, my gosh, so how do you Okay, so now you you recognize that? And I don't know what you do? Like, I don't understand how to fix anything, doesn't it feel like we're just building on top of that? Like, like, how do you how do you start fresh with things?

Marina Nitze 1:01:40
It's definitely frustrating. And I think it does this sort of stuff. It's one person at a time and and helping one person learn that, oh, that is a tool that could work for me or that person sounds like me, I could learn from what they're doing. And just again, knowing that there's hope, I think I spent a long time having diabetes thinking that 6.5 was like the holy grail, and he couldn't do any better. And I'm really grateful to know differently now. And I want other people to know that too.

Scott Benner 1:02:07
Well, I how do I not have you on Twitter? What did how did this happen? You know, I only know you by your little picture. Like when someone likes when somebody said your name to me. I was like, I don't know who that is. And then as soon as I looked for you, I was like I know that face. Isn't it weird how social media works? I'm like, that person I'm aware of. Then you look into what you do. And I'm like, but I don't know about any of this. So how did what you were on another podcast? Right? But you weren't talking about diabetes? You just brought it up at the end? Is that what happened?

Marina Nitze 1:02:37
Yeah, it was a podcast called people I mostly admire from the Freakonomics team. And we were talking about sort of my career path around the federal government. And then Steve interviewed me a little bit about type one diabetes in my experience that with that,

Scott Benner 1:02:54
Isn't it weird how that and then someone who listens to this pocket a number of someone's listened to this podcast heard you on that? And I got immediate notes, please have this person on your podcast. And I was like, I'm on it. Like, like, geez, I felt very pressured. I'm not gonna lie to you. When the third email came, I was like, I'll do it. Okay.

Unknown Speaker 1:03:12
And you were very kind of those people. Well, you

Scott Benner 1:03:14
were very nice to answer back so quickly, because I have to admit, like, once I found you, I was like, she's not gonna answer me

Marina Nitze 1:03:22
have the most streaming diabetes podcast? Why would I not write back? I don't know, I

Scott Benner 1:03:26
feel I, you know, I don't know. I didn't grow up

Marina Nitze 1:03:30
like an imposter syndrome. I

Scott Benner 1:03:31
didn't grow up with a ton of self confidence is, my guess, is the real answer. But no, I was so thrilled like, and you don't ever want to like, it's a weird note to send. You don't say hey, by the way, I'm here am I you know, like, but you have to sometimes there are people I've gotten on this show, by sending them the downloads to the show. And it's the only way you can get them because they're more sought after. And they you know, you didn't do that. But, but they're sought after and they don't waste their time. They don't they don't do things that nobody hears, you know, which makes complete sense. This was really good. Did I not bring up anything that I should have?

Marina Nitze 1:04:10
I it's your show. I feel

Scott Benner 1:04:13
you're not holding anything inside right now. You're like, I can't believe you didn't lead me to this point. Yep. Thank you so much for doing this. I don't remember where I heard the pot roast story or whatever it's called, initially, but I did write about it in my 2013 book, titled Life is short laundry is a turtle Confessions of a stay at home dad. And I'd like to read that passage to you here. When I first became a stay at home Dad, I thought about certain tasks that I was performing in very gender specific ways. Eventually, my new life helped me to understand that there is no such thing as a woman's or man's task. When it comes to raising family, only parental responsibility. This topic reminds me very much of an old anecdote about pot roast that I've heard told over the years. I can't remember where I first heard it. But it makes the point that you should question what you know. The story goes that while preparing dinner one evening, a mother cuts the ends off of a pot roast she's about to put in the oven. Her daughter sees the cuts made and asks the mother why she removes the ends of the roasts. The mother thinks for a moment but doesn't know why she always makes those cuts. She tells her daughter that if she wants to find out she should call her grandmother and ask her since she is the one who taught her mother the method. The girl calls the grandmother, but she doesn't know either responding only that she did so because their mother did. still not satisfied the girl contacts her great grandmother by phone to get the answer for which she is so desperately searching. The woman answers the phone she is old and wary and has to think for a few minutes before she can recall the answer to the girl's question. Suddenly, the great grandmother remembers why she cut the ends from all of those pot roasts so many years ago, and says, Oh, that's right. I cut them off because my pain was so short that they didn't fit. So whether you're a bureaucrat making up rules as to who can serve as a foster parent, or a doctor telling people how to Bolus for their food, or anything in between. You really should stop once in a while and ask yourself, why do I say the things that I say? Is there really a reason? Or am I just repeating something that I heard someone else say?

A huge thank you to one of today's sponsors, g Vogue glucagon, find out more about chivo hypo pan at G Vogue glucagon.com forward slash juice box, you spell that GVOKEGL Uc ag o n.com forward slash juice box. Thanks also to the Contour Next One blood glucose meter. Learn more at Contour Next one.com forward slash juice box you may be eligible for a free meter, you are going to want to look into the test trip savings program. You want to find out about the most accurate blood glucose meter I've ever seen. It's not just accurate, it's super easy to hold. Super easy to use. It fits well into your life. If you're enjoying the podcast, please subscribe or follow in the podcast player that you're listening in right now. If you're listening online, please consider listening in a podcast player they are free and very handy. But last if you're enjoying the show, share it with someone who you think will enjoy it as well. Thank you so much. I'll talk to you soon. Find Marina at Marina and Itsu calm ma rinnitze.com and her app task tackler is available at task tackler.com