Podcasts about dka

In this episode of Diabetes Dialogue, co-hosts hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, discuss significant developments in diabetes care from May 2025, including Medtronic's restructured business model, Sequel Twiist's technological collaboration with Abbott, and Breakthrough T1D's efforts to advance early detection of type 1 diabetes (T1D) through national screening initiatives. The discussion opens with news of Medtronic's decision to spin off its diabetes division into a standalone entity, currently referred to as “New Diabetes Company.” While the final name is forthcoming, the move is intended to streamline operations and accelerate innovation within the diabetes space. The hosts highlight the company's promising technology pipeline, including the forthcoming 800 series insulin pump with full smartphone control and plans for a tubeless insulin delivery system. Both experts express optimism that the independence may foster greater agility in product development, enhance accessibility, and maintain a focus on user-centered design, including for populations with visual impairments. Next, Isaacs and Bellini examine the announcement of the Sequel Twiist partnership with Abbott to integrate continuous ketone monitoring (CKM) into a hybrid sensor, which is expected to function similarly to the FreeStyle Libre 3. This device, still in development, will provide real-time data on both glucose and ketone levels—a critical advance for people with type 1 diabetes using insulin pumps, who are at elevated risk for diabetic ketoacidosis (DKA). While excited about the potential for earlier DKA detection, Bellini emphasizes the importance of cost-effective implementation and integration with existing pump platforms. The episode concludes with coverage of Breakthrough T1D's advocacy before the US Preventive Services Task Force to support routine screening for T1D autoantibodies. The goal is to identify individuals in early stages of the disease to prevent DKA and misdiagnosis. The hosts note that despite advancements in understanding T1D progression, many patients remain undiagnosed until presenting with DKA or are mistakenly classified as having type 2 diabetes. References: Medtronic plc. Medtronic announces intent to separate Diabetes business. Medtronic News. Published May 21, 2025. Accessed June 2, 2025. https://news.medtronic.com/2025-05-21-Medtronic-announces-intent-to-separate-Diabetes-business Sequel Med Tech. Sequel Med Tech to Integrate twiist Automated Insulin Delivery (AID) System with Abbott's Future Dual Glucose-Ketone Sensor. GlobeNewswire News Room. Published May 22, 2025. Accessed June 2, 2025. https://www.globenewswire.com/news-release/2025/05/22/3086535/0/en/Sequel-Med-Tech-to-Integrate-twiist-Automated-Insulin-Delivery-AID-System-with-Abbott-s-Future-Dual-Glucose-Ketone-Sensor.html Breakthrough T1D. Breakthrough T1D Submits Application to Make Screening for Type 1 Diabetes Part of Recommended Preventive Services in the US - Breakthrough T1D. Breakthrough T1D. Published May 21, 2025. Accessed June 2, 2025. https://www.breakthrought1d.org/for-the-media/press-releases/breakthrough-t1d-submits-application-to-make-screening-for-type-1-diabetes-part-of-recommended-preventive-services-in-the-us/

Video Version Only on HCPLive! In this episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, sit down with Steven Russell, MD, PhD, Chief Medical Officer at Beta Bionics, to discuss the latest real-world outcomes from the iLet Bionic Pancreas—an autonomous insulin delivery (AID) system cleared by the US Food and Drug Administration (FDA) in 2023. Russell outlines the iLet's fully automated design, which sets it apart from conventional AID systems by requiring no manual settings, carb ratios, or correction factors. The system determines 100% of insulin dosing, adapting continuously to glycemic trends without relying on user engagement. This autonomy makes the iLet particularly effective for individuals with suboptimal diabetes self-management or limited access to endocrinology care. New real-world data, covering 3,300 users from the first year of commercial rollout, reveal a mean baseline A1c of 8.5%—higher than the 7.8% in the pivotal trial and reflective of the broader U.S. type 1 diabetes (T1D) population. The iLet reduced glucose management indicator to 7.3%, yielding an average A1c reduction of 1.2%, more than double that seen in the pivotal study. Outcomes were most pronounced among those with severe hyperglycemia: users starting with A1c >14% saw average reductions of 7%, with low rates of diabetic ketoacidosis (DKA) and minimal increases in hypoglycemia (median time

Podcast summary of articles from the April 2025 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include ECGs in cardiac arrest, strep toxic shock syndrome, diabetic ketoacidosis, chest pain work ups, exertional heat stroke, and pulmonary embolism controversies.  Guest speaker is Dr. Matthew Carvey.

In this powerful episode, Risely coaching graduate Mary McCauley shares her story of being misdiagnosed with Type 2 diabetes when she was actually living with adult-onset Type 1 (LADA). From being dismissed by doctors to ending up in DKA and sent home with no insulin, her story highlights just how dangerous misdiagnosis can be. Mary opens up about the emotional toll, the turning point of finally receiving the correct diagnosis, and the journey of reclaiming confidence and ownership over her health. If you've ever felt dismissed, unsure of your diagnosis, or like something just isn't adding up, this episode will empower you to ask the hard questions and trust your gut. You deserve to be heard, supported, and correctly diagnosed. Quick Takeaways:Navigating misdiagnosis  The damage of stereotypes & importance of diabetes education throughout the entire world: medical bias is real  Impact of the gaps in our healthcare system on people living with type 1 diabetes How the right support can change everything Timestamps:[03:11] Mary's journey begins: The first signs that something wasn't right [04:00] “I will never know actually when this journey started or how long my honeymoon phase really has been.”[08:22] "I was labeled as non-compliant during that time." [10:05] “I still had never talked to an endocrinologist, like an actual endocrinologist, nobody had ever explained to me what all of this meant.” [10:44] “I went home and I didn't ever test my blood sugar again. Because that's what I was told.”[17:10] The ER experience: Misdiagnosis & dismissal[19:00] "I was losing my vision, what's happening?"[27:09] Finally receiving the correct diagnosis [29:53] “Being a LADA type one, it can feel a lot like you're in limbo.”[42:55] Advice for someone who thinks they have been misdiagnosed [48:09] "You don't have to suffer more to be valid." [50:58] “When we know better, we do better.” What to do now: Follow me @lauren_bongiorno and @riselyhealth on Instagram to stay in the loop when new episodes drop. Apply for coaching and talk to our team so you can reclaim the life you deserve. 

This week on the Inside EMS podcast, hosts Chris Cebollero and Kelly Grayson tackle a metabolic monster that every EMS provider needs to master: diabetic ketoacidosis (DKA). They kick off with a common (but critical) 911 scenario: a 19-year-old with a history of Type 1 diabetes, confusion, vomiting and a blood sugar of 500. Sound familiar? Kelly dives into the physiology of DKA, explaining how glucose can be sky-high while cells starve, triggering fat breakdown and ketone production that spirals into life-threatening acidosis. The hosts hit the must-know pathophysiology, signs and symptoms (hello, Kussmaul breathing!), and what providers often miss — like dehydration, vomiting and abdominal pain. They break down how to spot DKA with capnography and EKG changes, especially when hyperkalemia mimics a STEMI. From EMS management tips (don't shut down those fast respirations!) to fluid resuscitation caveats, this is a crash course in saving DKA patients before they crash. Whether you're running calls or managing chronic patients, this episode arms you with the clinical know-how and common-sense insight to handle DKA with confidence. Memorable quotes  “We're starting to see more increasing calls for type one diabetes, insulin-dependent type two diabetes ... and we need to be able to understand what we're doing. — Chris Cebollero “One of the big clues in the scenario is the vomiting. Lots of DKA patients will have vomiting and abdominal pain.” — Kelly Grayson “A lot of times, these hyperkalemia patients and these acidotic patients are going to be handled just fine by correcting their fluid deficits and correcting their glucose with an insulin drip. Just getting their glucose back down to normal level is going to manage the lion's share of the hyperkalemia.” — Kelly Grayson Enjoying the show? Email theshow@ems1.com to suggest episode ideas or to pitch someone as a guest!

In this jam-packed episode, Dr. Jeremy Pettus and Dr. Steve Edelman team up with special guest Dr. David Ahn to break down the latest and greatest in diabetes technology for 2025. From extended-wear CGMs to fully automatic hybrid closed-loop pumps and dual-hormonal systems, this episode is your complete guide to what's available now and what's coming soon. Whether you're on MDI, using a pump, or considering a tech upgrade, this conversation will help you navigate the expanding world of devices—and find the right setup for you.Key Topics:Extended-Wear CGMs: The Dexcom G7 now lasts over 15 days—and the Eversense implantable sensor lasts a full year.Over-the-Counter CGMs: Learn about Dexcom Stelo and Abbott Lingo, designed for people without diabetes.New Pump Launches: Including Tandem Mobi, Beta Bionics iLet, Sequel Twist, and Medtronic's MiniMed™ 780G with Simplera Sync sensor.Medtronic Simplera Sync: What to know about its U.S. launch, wear time, and integration with the 780G system.Dual-Hormone Systems: Explore how glucagon is being used alongside insulin to prevent lows and simplify diabetes management.Ketone Monitoring: Continuous ketone sensors are on the horizon, and they could change how we detect and prevent DKA.Improved App Integration: Discover updates in CGM and pump interfaces for iPhone and Android, including Libre 3+ and universal app platforms.Customizing Your Combo: Why matching the right CGM with the right pump (or sticking with MDI) is more doable—and more important—than ever. ★ Support this podcast ★

Behind the Scenes of Pediatric Critical Care with Dr. Rana ShamiIn this episode of The Pediatric Lounge, hosts Herb and George bring on Dr. Rana Shami, the medical director of the pediatric intensive care unit at Inova Children's Hospital. Dr. Shami discusses her journey from the American University of Beirut to leading a premier PICU in Fairfax, Virginia. She shares insights into the challenges and innovations in pediatric critical care, such as the use of high-flow oxygen and bedside ultrasound, as well as the critical importance of multidisciplinary teamwork. Dr. Shami also talks about the growth of their PICU fellowship program and her advocacy for early diabetes screening to prevent DKA. The episode illuminates how pediatric ICU care has evolved and the ongoing efforts to improve patient outcomes through simulation education and data-driven approaches.00:00 Introduction to The Pediatric Lounge00:28 Sponsor Message: Hippo Education01:08 Meet Dr. Rana Shami: From Beirut to Fairfax01:30 Dr. Rana Shami's Journey in Pediatric Critical Care05:46 Legacy of Dr. Steve Keller in Pediatric Critical Care11:26 Advancements in Pediatric Intensive Care15:36 Challenges and Innovations in Pediatric Care21:42 The Role of Technology in Modern Pediatric Care30:06 Personal Stories and Reflections in Pediatric Care31:48 Using Data to Improve Healthcare33:25 The Power of Tableau in Data Visualization35:48 Leadership Style in the PICU39:25 The Role of Simulation in Medical Training42:35 Launching a PICU Fellowship Program47:18 Telehealth and Remote ICU Work51:16 Advocating for Pediatric Health56:27 The Parent Wise NGO59:19 Concluding Thoughts and FarewellSupport the show

In this episode, Dr. Mark talks with Kristen, who was diagnosed with type 1 diabetes at age 17—just months before graduating high school. The adjustment was rocky. Fear of lows led Kristen to stop taking insulin entirely during her honeymoon phase, and eventually, she ended up in the hospital again with DKA. That second hospital stay marked a turning point. Kristen began to accept her diagnosis, change her mindset, and reframe how she saw insulin—not as something to fear, but as something that keeps her alive and thriving. Now 19, Kristen is learning to trust technology, navigate new challenges with her Medtronic 780G pump, and even planning to get SCUBA certified—without letting fear get in the way. Her story is one of resilience, reflection, and reclaiming freedom with T1D. Grab your FREE copy of the Diabetes Sucks and You Can Handle It audiobook HERE.

It's In the News.. a look at the top headlines and stories in the diabetes community. This week's top stories: Eli Lilly will start a lcinical trial for tirzepatide for people with type 1 diabetes, more details on Dexcom's 15 day G7 sensor, Ozepmic pill form tested, type 5 diabetes identified and more! Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Learn more about Gvoke Glucagon Gvoke HypoPen® (glucagon injection): Glucagon Injection For Very Low Blood Sugar (gvokeglucagon.com) Omnipod - Simplify Life Learn about Dexcom   Check out VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode transcription with links:   Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and every other Friday I bring you a short episode with the top diabetes stories and headlines happening now. XX Our top story this week.. Eli Lilly takes the first steps toward getting tirzepatide approved for people with type 1 diabetes. Tirzepatide is sold under the brand names Mounjaro for type 2 and Zepbound for obesity. The main purpose of this study is to find out how well and how safely tirzepatide works in adults who have type 1 diabetes and obesity or are overweight. Participation in the study will last about 49 weeks. Official Title A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study Evaluating the Efficacy and Safety of Tirzepatide Once Weekly Compared to Placebo in Adult Participants With Type 1 Diabetes and Obesity or Overweight This is a big deal because, even though many people with type 1 are able to get a prescription for tirzepatide, it's not approved for T1D and so insurers won't usually cover it.   https://clinicaltrials.gov/study/NCT06914895 XX The use of drugs like Ozempic, Wegovy and Zepbound in people with type 1 diabetes has risen sharply over the past decade, a new study finds, even though there's little information on the drugs' safety and effectiveness for the condition. The family of medications called GLP-1 receptor agonists includes drugs like Wegovy, Zepbound, Ozempic, Mounjaro and Victoza. But the clinical trials of these medications specifically excluded people with type 1 diabetes, who are dependent on the hormone insulin to survive because they can't make enough of their own. Drugmakers feared that using the GLP-1 medications with insulin might raise the chance of dangerously low blood sugar events, or hypoglycemia, and were unwilling to take the risk of studying them in people with type 1.   For the study, which was published last month in the journal Diabetes, Obesity, and Metabolism, researchers at Johns Hopkins University reviewed the medical records of more than 200,000 people with type 1 diabetes from 2008 to 2023. They grouped the data in three-year periods, starting with October 2008 to September 2011 and ending with October 2020 to September 2023. GLP-1 medication use spiked, as well. Among adults with the highest category of obesity, about 4% used GLP-1 medications in 2008, and 33% did by 2023 – an 800% increase. But these are anecdotal reports and may not reflect instances in which people have side effects or complications like low blood sugar, which can be life-threatening. But Shin says what's really needed is information from randomized, double-blinded studies, in which participants are followed forward in time and given either a drug or a placebo. https://www.cnn.com/2025/04/09/health/glp-1-type-1-diabetes-study/index.html   XX Later this month the FDA will conduct a final meeting regarding a new, investigational compound (sotagliflozin) soda-GLIFF-a-zin that has been shown to Improve QoL and Reduce Long-term Complications for people with type 1 diabetes (T1D). The patient advocacy group Taking Control of Your Diabetes (TCOYD.org) is working to inform the T1D community about sotagliflozin - and to encourage people to sign a Change.org petition directed towards FDA.  Last fall, the FDA declined to approve sotagliflozin due to concerns about a potential increased risk of diabetic ketoacidosis (DKA), despite this being a condition that people with T1D on insulin face and manage daily. While TCOYD respects FDA's caution, the group stands by T1D patients and their physicians who, as a team, balance risks and benefits every day. https://tcoyd.org/petition/ XX Dexcom receives FDA approval for it's G7 with 15 day wear. We have an interview with Chief Operating Officer Jake Leach coming up on Tuesday – we talk about the planned roll out of this sensor, what else has changed, and the fine print in the press release – it says    “A study was conducted to assess the sensor life where 73.9% of sensors lasted the full 15 days. When using the product per package labeling, approximately 26% of sensors may not last for the full 15 days.   https://investors.dexcom.com/news/news-details/2025/Dexcom-G7-15-Day-Receives-FDA-Clearance-the-Longest-Lasting-Wearable-and-Most-Accurate-CGM-System/default.aspx?utm_source=www.diabetech.info&utm_medium=referral&utm_campaign=dexcom-g7-15-day-sensor-gets-fda-cleared-but-will-it-actually-last-that-long   XX Glucotrack is joining something called  FORGETDIABETES bionic pancreas initiative, - this is an European Union project that aims to develop a long-term automated insulin delivery system for type 1 diabetes patients. Glucotrack's Continuous Blood Glucose Monitor (CBGM) will be integrated into the system to provide real-time glucose readings. The initiative's goal is to create a bionic invisible pancreas that eliminates the need for therapeutic actions and reduces psychological burden.   The architecture of BIP encompasses a ground-breaking, lifelong lasting implanted ip glucose nanosensor; a radically novel ip hormone delivery pump, with unique non-invasive hormone refill with a magnetic docking pill and non-invasive wireless battery recharge; an intelligent closed-loop hormone dosing algorithm, optimized for ip sensing and delivery, individualized, adaptive and equipped with advanced self-diagnostic algorithms.     Pump refilling through a weekly oral recyclable drug pill will free T1D subjects from the burden of pain and awkward daily measurement and treatment actions. Wireless power transfer and data transmission to cloud-based data management system round-up to a revolutionary treatment device for this incurable chronic disease. key feature of BIP is to be fully-implantable and life-long lasting thanks to novel biocompatible and immune-optimized coatings guaranteeing long-term safety and stability https://www.stocktitan.net/news/GCTK/glucotrack-to-participate-in-forgetdiabetes-a-prominent-european-cjjldjb0dq7h.html XX A newly recognised form of diabetes, called Type 5, was announced this week at the World Congress of Diabetes 2025. A global task force will investigate this less-understood condition, which differs from Type 1 and Type 2 diabetes. Type 5 diabetes affects people who are underweight, lack a family history of diabetes and do not show the typical symptoms of Type 1 or Type 2 diabetes. The condition was first observed in the 1960s and referred to as J-type diabetes, after being detected in Jamaica. It was classified by the World Health Organisation in 1985, but removed in 1998 due to lack of physiological evidence. At the time, experts believed it to be a misdiagnosed case of Type 1 or 2 diabetes. New research has since confirmed that Type 5 is different. https://economictimes.indiatimes.com/news/new-updates/a-new-type-of-diabetes-has-been-found-by-scientists-and-it-doesnt-show-the-typical-symptoms-of-type-1-or-type-2/articleshow/120276658.cms?from=mdr   XX Oral semaglutide cuts major heart risks in people with type 2 diabetes by 14%, offering a powerful pill-based option. A new clinical trial, co-led by endocrinologist and diabetes specialist John Buse, MD, PhD, and interventional cardiologist Matthew Cavender, MD, MPH, at the UNC School of Medicine, has demonstrated that the oral form of semaglutide significantly lowers the risk of cardiovascular events in individuals with type 2 diabetes, atherosclerotic cardiovascular disease, and/or chronic kidney disease. Results from the rather large, international trial were published in the New England Journal of Medicine and presented at the American College of Cardiology's Annual Scientific Session & Expo in Chicago, Illinois.     The effect of oral semaglutide on cardiovascular outcomes was consistent with other clinical trials involving injectable semaglutide, but more trials are needed to determine if one method may be more effective than the other at reducing major cardiovascular events. https://scitechdaily.com/new-pill-form-of-semaglutide-shows-major-benefits-for-people-with-diabetes/ XX April 14 (UPI) -- The U.S. Food and Drug Administration on Monday warned consumers and pharmacies that fake versions of Ozempic, a drug to treat Type 2 diabetes, have been found in the United States. Novo Nordisk, the Danish-headquartered manufacturer, informed the FDA on April 3 that counterfeit 1-milligram injections of semaglutide were being distributed outside its authorized supply chain. The FDA and Novo Nordisk are testing the fake products to identify whether they're safe. Patients are asked to obtain Ozempic with a valid prescription through state-licensed pharmacies and check the product for any signs of counterfeiting. People in possession of the fake product are urged to call Novo Nordisk customer care at 800-727-6500 Monday through Friday from 8:30 a.m. to 6 p.m. EDT and report it to the FDA's criminal activity division's website. Side effects can be reported to FDA's MedWatch Safety Information and Adverse Event Reporting Program (800-FDA-1088 or www.fda.gov/medwatch) as well as to Novo Nordisk, at 800-727-6500. https://www.upi.com/Health_News/2025/04/14/FDA-fake-Ozempic-drugs-Novo-Nordisk/6841744666854/ XX Can a digital lifestyle modification program reduce diabetes risk? A new study shows that the lifestyle intervention significantly reduced 10-year diabetes risk among prediabetics by nearly 46% and increased the diabetes remission rate, highlighting the importance of lifestyle changes. However, the study was not a randomized trial, and participation in the lifestyle intervention was voluntary, which may introduce selection bias. The study evaluated 133,764 adults, categorizing them as diabetic (7.5%), prediabetic (36.2%), and healthy (56.3%), based on fasting glucose and HbA1c levels. https://www.news-medical.net/news/20250414/Digital-lifestyle-program-cuts-diabetes-risk-by-4625-in-prediabetics-study-of-130k2b-adults-reveals.aspx XX Chrissy Teigan is speaking out about her son's type 1 diagnosis – teaming up with Sanofi to encourage people to screen early for Type 1 diabetes.   Teigen got a crash course in the risks of undiagnosed Type 1 diabetes when her 6-year-old son, Miles, was hospitalized with complications of the autoimmune disease last year. The family knew nothing about Type 1 diabetes when Miles was diagnosed during an unexpected medical emergency, Teigen said in a Tuesday announcement. “We were confused and scared when Miles was first diagnosed,” she said in a statement. “There is no doubt in my mind that knowing in advance would have made a positive impact for Miles, me, and our entire family. I want everyone to hear me when I say: stay proactive and talk to your doctor about getting yourself or your loved ones screened for type 1 diabetes today!”   Teigen shared her family's story in a two-minute video on ScreenForType1.com, a Sanofi website that discusses how to get screened for the condition. Miles' diagnosis made Teigen feel like she “went from a mom to a doctor overnight,” she said. That experience is why Teigen said she is “begging you: Do this one thing, and screen yourself and your family for Type 1 diabetes.” https://www.fiercepharma.com/marketing/sanofi-signs-chrissy-teigen-diabetes-screening-campaign XX Dr. Richard Bernstein – best known for his advocacy around low carb diets for people with diabetes – died this week at the age of 90. Born in 1934 in Brooklyn, New York, he was diagnosed with type 1 at age 12. In the 1970s he adapted a blood glucose monitor for home use and helped pioneer home glucose monitoring. He published multiple books on Diabetes including the #1 selling Diabetes book on Amazon.Com “Dr. Bernstein's Diabetes Solution: A Complete Guide to Achieving Normal Blood Sugars” and “Diabetes Type II: Living a Long, Healthy Life Through Blood Sugar Normalization”.  He practiced and saw patients right up until his death.

It's In the News.. a look at the top headlines and stories in the diabetes community. This week's top stories: Learning more about the FDA letter sent to Dexcom, news from ATTD including a bihormonal pump from a Dutch company, time in tight range update, more studies about using insulin and GLP-1 medications, eating chili to prevent gestational diabetes (really!) and more..  Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Learn more about Gvoke Glucagon Gvoke HypoPen® (glucagon injection): Glucagon Injection For Very Low Blood Sugar (gvokeglucagon.com) Omnipod - Simplify Life Learn about Dexcom   Check out VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode transcription with links: Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and every other Friday I bring you a short episode with the top diabetes stories and headlines happening now. XX Our top story this week: Dexcom Dive Brief: A warning letter posted Tuesday by the Food and Drug Administration revealed quality control issues with Dexcom's continuous glucose monitors. The FDA raised concerns with a design change to a component used in the resistance layer of Dexcom's sensors. The sensors with the new component were less accurate than those with the original component, according to the warning letter. Dexcom has ceased distribution of G7 sensors with the component, but the company's response did not address affected G6 sensors. J.P. Morgan analyst Robbie Marcus wrote in a research note Tuesday that the letter concerns a chemical compound that the sensor wire is dipped in. Dexcom began producing the compound internally to add redundancy to its supply chain.   Dive Insight: Dexcom Chief Operating Officer Jake Leach said in an interview with MedTech Dive last week that the company does not expect the warning letter to affect future product approvals, including a 15-day version of its G7 CGM, and there's no need yet to recall products. Dexcom has submitted the device to the FDA and anticipates a launch in the second half of the year.   Marcus, after speaking to company leadership and a quality control expert, wrote that many of the issues outlined in the letter could be addressed quickly. He added that the warning letter could explain minor delays in approval to the 15-day sensor, but Dexcom is still within the 90-day window for a 510(k) submission.   “While there's always a risk this could impede future product approvals,” Marcus wrote, “we do not expect this to materially delay the 15 day G7 sensor approval.”   The warning letter followed an FDA inspection last year of Dexcom's facilities in San Diego and Mesa, Arizona. Marcus wrote that after the FDA requested additional information and a separate 510(k), Dexcom stopped in-sourcing the compound and reverted back to the external supplier.   Dexcom's devices were misbranded because the company did not submit a premarket notification to the FDA before making major changes to the sensors, according to the warning letter. The sensors with the changed coating “cause higher risks for users who rely on the sensors to dose insulin or make other diabetes treatment decisions,” the letter said.     The FDA raised other concerns in the warning letter, including procedures to monitor the glucose and acetaminophen concentrations used in testing of the G6 and G7 CGMs. The FDA also cited problems with Dexcom's handling last year of a deficiency in its G6 sensors with dissolved oxygen content values, a key input for measuring blood glucose levels. https://www.medtechdive.com/news/dexcom-warning-letter-cgm-coating-change/743597/ XX Lots of studies and info out of the recent ATTD conference. One highlight that has been sort of under the radar: a Dutch company has been using a Bihormonal fully closed-loop system for the treatment of type 1 diabetes in the real world. This is a company called Inreda (in-RAY-duh). The Inreda AP® is an automatic system (closed loop) and independently regulates the blood glucose level by administering insulin and glucagon. The AP5 is certified in Europe and is being used in multiple studies and projects. The AP®6 is currently under development. https://www.inredadiabetic.nl/en/discover-the-ap/ https://pubmed.ncbi.nlm.nih.gov/38443309/ XX Let's talk about time in tight range. If you follow me and diabetes connections on social, you likely saw a video I made about this – it blew up last week. If not.. time in range has been a metric for a short while now.. in 2019 there was a consensus report advising a goal of 70% of time in the 70-180 mg/dL range for most people with type 1 diabetes (T1D) and type 2 diabetes (T2D), with modifications for certain subgroups. Recently we've been hearing more about 70-140 mg/dL — for longer periods as “time in tight range (TiTR).” At ATTD there was more talk about calling that range TING, or “time in normal glycemia.     There's a great writeup that I'll link up from the great Miriam Tucker on Medscape about a debate that happened at ATTD. On March 22, 2025, two endocrinologists debated this question at the Advanced Technologies & Treatments for Diabetes (ATTD) 2025. Anders L. Carlson, MD, medical director of the International Diabetes Center (IDC), Minneapolis, took the positive side, while Jeremy Pettus, MD, assistant professor of medicine at the University of California San Diego, who lives with T1D himself, argued that it's too soon.   https://www.medscape.com/viewarticle/should-time-tight-range-be-primary-diabetes-goal-2025a100073q?form=fpf   XX Sequel Med Tech announces its twist pump will be firs paired with Abbott's FreeStyle Libre 3 Plus. The twist has FDA approval for ages 6 and up and is set to begin its commercial launch by the end of June. The pump—designed by inventor Dean Kamen's Deka Research & Development—also incorporates the FDA-cleared Tidepool Loop software program, to record CGM blood sugar readings, make predictions based on trends and adjust its background insulin levels accordingly. https://www.fiercebiotech.com/medtech/sequel-med-tech-connects-twiist-insulin-pump-abbotts-cgm-ahead-market-debut XX Dexcom's longer-lasting CGM sensor looks promising, based on study results presented at the conference. The trial showed that the new 15-day G7 system is slightly more accurate than the current G7. The accuracy of CGM can be measured using MARD (mean absolute relative difference), which shows the average amount a CGM sensor varies from your actual glucose levels (a lower number is better).  The 15-day G7 has a MARD value of 8.0%, about the same as the Abbott Freestyle Libre 3. The Dexcom G7 15 Day is awaiting FDA approval and is not yet available in the U.S.   XX Little bit of news from Modular Medical.. they plan to submit their patch pump to the FDA late summer or fall of this year. The MODD1 product, a 90-day patch pump, features new microfluidics technology to allow for the low-cost pumping of insulin. Its new intuitive design makes the product simple to use and easier to prescribe. It has a reservoir size of 300 units/3mL. Users can monitor the pump activity with their cell phone and do not require an external controller. The pump uses a provided, single-use, disposable battery. Modular Medical picked up FDA clearance for MODD1 in September. The company also raised $8 million to end 2024. Its founder, Paul DiPerna, previously founded leading insulin pump maker Tandem Diabetes Care. DiPerna invented and designed Tandem's t:slim pump. By developing its patented insulin delivery technologies, the company hopes to improve access to glycemic control. Its founder, Paul DiPerna, previously founded leading insulin pump maker Tandem Diabetes Care. DiPerna invented and designed Tandem's t:slim pump. https://www.drugdeliverybusiness.com/modular-medical-announces-12m-private-placement/ XX More from attd – type 2 news? https://www.drugdeliverybusiness.com/biggest-diabetes-tech-news-attd-2025/ XX Another study that says people with type 1 who use a GLP-1 medication get better outcomes. In this study, those who use GLP-1 with insulin are 55% less likely to have a hyperglycemia-related ED visit, 26% less likely to have an amputation-related visit, and 29% less likely to have a diabetic ketoacidosis (DKA)-related ED visit in the following year compared to those on insulin alone. Although they are not approved for T1D, some patients may receive them off-label or for weight control. Pretty big study for an off label drug: compared 7,010 adult patients with T1D who were prescribed GLP-1s and insulin to 304,422 adult patients with T1D who were on insulin alone.  It is important to note that the rates of new diabetic complications in one year for both groups were around 1%, indicating that these are uncommon outcomes regardless of medication use. https://www.epicresearch.org/articles/some-diabetic-complications-less-likely-among-type-1-diabetics-on-glp-1s   XX Early research here but exposure to antibiotics during a key developmental window in infancy may stunt the growth of insulin-producing cells in the pancreas and boost risk of diabetes later in life The study, is published this month in the journal Science, it's a study in mice. These researchers are working off the idea that when while identical twins share DNA that predisposes them to Type 1 diabetes, only one twin usually gets the disease. She explained that human babies are born with a small amount of pancreatic “beta cells,” the only cells in the body that produce insulin.   But some time in a baby's first year, a once-in-a-lifetime surge in beta cell growth occurs.   “If, for whatever reason, we don't undergo this event of expansion and proliferation, that can be a cause of diabetes,” Hill said.   They found that when they gave broad-spectrum antibiotics to mice during a specific window (the human equivalent of about 7 to 12 months of life), the mice developed fewer insulin producing cells, higher blood sugar levels, lower insulin levels and generally worse metabolic function in adulthood.   in other experiments, the scientists gave specific microbes to mice, and found that several they increased their production of beta cells and boosted insulin levels in the blood. When male mice that were genetically predisposed to Type 1 diabetes were colonized with the fungus in infancy, they developed diabetes less than 15% of the time. Males that didn't receive the fungus got diabetes 90% of the time. Even more promising, when researchers gave the fungus to adult mice whose insulin-producing cells had been killed off, those cells regenerated. Hill stresses that she is not “anti-antibiotics.” But she does imagine a day when doctors could give microbe-based drugs or supplements alongside antibiotics to replace the metabolism-supporting bugs they inadvertently kill.   .   “Historically we have interpreted germs as something we want to avoid, but we probably have way more beneficial microbes than pathogens,” she said. “By harnessing their power, we can do a lot to benefit human health.”     https://www.eurekalert.org/news-releases/1078112 XX Future watch for something called BeaGL - created by researchers at the University of California Davis and UC Davis Health who were inspired by their own personal experiences with managing T1D.   BeaGL is designed to work with CGMs and has security-focused machine learning algorithms to make predictive alerts about anticipated glucose changes, which are sent to a device. In this case, a smartwatch. The end goal is for BeaGL to be completely automated to reduce the cognitive load on the patient, particularly for teens. It's still in research phase but six student with T1D have been using it for almost a year.     https://health.ucdavis.edu/news/headlines/with-ai-a-new-metabolic-watchdog-takes-diabetes-care-from-burden-to-balance/2025/02 XX Investigators are searching for a way forward after two long-term diabetes programs were terminated following the cancellation of their National Institutes of Health (NIH) funding, the result of federal allegations that study coordinator Columbia University had inappropriately handled antisemitism on campus. The programs include the three-decades-old Diabetes Prevention Program (DPP) and its offshoot, the Diabetes Prevention Program Outcomes Study (DPPOS). “We are reeling,” said David Nathan, MD, a previous chair of both the DPP and the DPPOS and an original leader of the landmark Diabetes Control and Complications Trial. Nathan is also founder of the Massachusetts General Hospital Diabetes Center in Boston, one of the 30 DPPOS sites in 21 states. On March 7, the Trump administration cancelled $400 million in awards to Columbia University from various federal agencies. While Columbia University agreed on March 21 to changes in policies and procedures to respond to the Trump administration's charges, in the hopes that the funding would be restored, DPPOS Principal Investigator Jose Luchsinger, MD, told Medscape Medical News that as of press time, the study was still cancelled. https://www.medscape.com/viewarticle/diabetes-prevention-program-cancellation-colossal-waste-2025a100076h XX XX Type 2 diabetes may quietly alter the brain in ways that mimic early Alzheimer's. This was only an animal study – but researchers say the high comorbidity of type 2 diabetes (T2D) with psychiatric or neurodegenerative disorders points to a need for understanding what links these diseases.   https://scitechdaily.com/how-diabetes-quietly-rewires-the-brains-reward-and-memory-system/ XX Eating chili once a month when you're pregnant seems to lower the risk of developing gestational diabetes. This is a real study! While chili showed a link to lower gestational diabetes risk, dried beans and bean soup had no significant effect, even among women who ate them more frequently. Some studies suggest that diets high in beans and legumes, including the Mediterranean diet, reduce GDM risk. While studies link beans to lower diabetes risk, their specific impact on GDM remains unclear. This study analyzed data from 1,397 U.S. pregnant women who participated in the Infant Feeding Practices Study II, conducted between 2005 and 2007. Chili consumption varied significantly by race, education, household size, income, supplemental nutrition status, and region. Non-Hispanic Black mothers consumed the most (0.33 cups/week), while those with higher income and education levels consumed less. Regional differences also influenced chili intake. One possible mechanism for chili's effect is capsaicin, a bioactive compound found in chili peppers, which has been linked to metabolic benefits in other studies. However, further research is needed to confirm this potential role in GDM prevention. Dried bean and bean soup consumption had no clear association with GDM. The study highlights limitations due to self-reported dietary data and the need for more detailed dietary measures. https://www.news-medical.net/news/20250317/Could-a-little-spice-in-your-diet-prevent-gestational-diabetes.aspx XX

Harnessing EHRs to Unlock the Cure for Type 1 Diabetes: A Candid Discussion with ExpertsThis episode, sponsored by Hippo Education, explores the potential role of Electronic Health Records (EHRs) in finding a cure for Type 1 Diabetes (T1D). Hosts are joined by Chip Hart from PCC and Dr. Dan Feiten from Office Practicum, both leading experts in pediatric-focused EHRs. They discuss their personal connections to T1D and the importance of identifying potential cases early, even before DKA develops. The conversation delves into the impact of family history and the need for better communication and education among pediatric clinicians. The experts emphasize the importance of integrating care plans, population health management, and the role of technology in achieving better outcomes. The discussion also highlights the challenges in the current healthcare system, including billing, insurance, and the need for more proactive strategies in pediatric care.00:00 Introduction and Sponsor Message00:40 Meet the Guests: Chip Hart and Dr. Dan Feiten01:38 Personal Stories of Type 1 Diabetes06:04 Redefining Type 1 Diabetes09:46 The Role of EHR in Managing Type 1 Diabetes16:38 Challenges and Opportunities in EHR Data38:54 The EHR Guy's Frustration with Inefficient Forms39:39 Pragmatic Approaches to Care Plans and Protocols40:27 Challenges in Managing Type 1 Diabetes in Families41:18 The Role of Pediatricians and Endocrinologists43:17 Communication Gaps in Diabetes Care44:40 Insurance and Accessibility Issues45:25 The Importance of Pediatric Leadership and Collaboration47:44 Advocating for Better Screening and Resolutions at the AAP01:00:30 The Future of Diabetes Monitoring and Technology01:08:00 Closing Thoughts on Pediatric Care and EHR SystemsSupport the show

It's In the News.. a look at the top headlines and stories in the diabetes community. This week's top stories: Sana announces beta cell transplantation without the need for immunosuppresion drugs, Modular Medical teams up with Nudge BG for a brand new completely closed-loop system, the FDA moves forward to crack down on compounded Ozempic and Mounjaro, Dexcom and Abbott bury the legal hatchett for a while, and more.  Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Learn more about Gvoke Glucagon Gvoke HypoPen® (glucagon injection): Glucagon Injection For Very Low Blood Sugar (gvokeglucagon.com) Omnipod - Simplify Life Learn about Dexcom  Edgepark Medical Supplies Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode transcription with links:     Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and every other Friday I bring you a short episode with the top diabetes stories and headlines happening now. XX Big news from Sana Biotechnology. Their first in human study of islet cells without any immunosuppression appears to be a success. This is very early and hasn't yet been peer reviewed and published.. but after four weeks, there were no safety issues and the transplanted beta cells were producing insulin. Sana's CEO says  “As far as we are aware, this is the first study showing survival of an allogeneic transplant with no immunosuppression or immune-protective device in a fully immune competent individual. Safe cell transplantation without immunosuppression has the potential to transform the treatment of type 1 diabetes and a number of other diseases.”   I've reached out to Sana to get more on this.. love to talk to them soon.   https://www.bakersfield.com/ap/news/sana-biotechnology-announces-positive-clinical-results-from-type-1-diabetes-study-of-islet-cell/article_d0390fd6-99cb-53bd-b04d-9337121e01bf.html XX FDA says no for sotagliflozin as an adjunct to insulin therapy for glycemic control in adults with type 1 diabetes (T1D) and chronic kidney disease (CKD).  Studies showed a meaningful reduction in A1C but a meaningful increase in DKA. The FDA first rejected this in 2019 and was resubmitted last summer. But The advisory committee voted 11 to 3 against the approval of sotagliflozin stating that the benefits of sotagliflozin do not outweight the risks in adults with T1D and CKD. Sotagliflozin is currently approved under the brand name Inpefa to reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visit in adults with 1) heart failure; or 2) type 2 diabetes mellitus, CKD, and other cardiovascular risk factors.  According to Lexicon, Inpefa will continue to be manufactured and made available to patients. https://www.renalandurologynews.com/news/fda-denies-approval-of-zynquista-for-type-1-diabetes-and-ckd/ XX Two companies we've been following are teaming up.. Modular Medical has an FDA clear patch pump and Nudge BG has an adaptive full closed loop. They've announced a new partnership agreement. From the release: Modular Medical's easy-to-use and cost-effective MODD1 insulin pump technology. Our combined system is intended to nudge blood glucose by making small changes to insulin delivery based on estimated glucose inputs from a continuous glucose monitor." Familiar name to some of you, Lane Desborough is the founder of Nudge BG. He says this will be a fully automated system, no mealtime bolusing needed.   https://www.accesswire.com/957703/modular-medical-announces-licensing-and-partnership-agreement-with-nudge-bg XX Beta Bionics filed for an initial public offering on Monday. The company did not disclose the number of shares it will offer or the price range. Beta Bionics plans for shares to be listed on the Nasdaq under the ticker symbol “BBNX.” The Irvine, California-based company makes an insulin pump called the iLet Bionic Pancreas, which was cleared by the Food and Drug Administration in 2023. Beta Bionics plans to use the proceeds to grow its sales and manufacturing infrastructure and develop new features for its device.   https://www.medtechdive.com/news/beta-bionics-insulin-pump-files-ipo/736805/     XX Tandem Diabetes Care, Inc. signed a multi-year collaboration agreement with the University of Virginia Center for Diabetes Technology (UVA) to advance research and development efforts on fully automated closed-loop insulin delivery systems.   There's a long history here – UVA is where the Control IQ algorithm was developed.  This agreement seems to keep the team together for another decade. https://www.businesswire.com/news/home/20250107162995/en/Tandem-Diabetes-Care-Enters-Multi-Year-Research-Collaboration-with-UVA-Center-for-Diabetes-Technology-for-Development-of-Advanced-Insulin-Delivery-Systems XX New study says insulin is still the best treatment for gestational diabetes, compared to oral glucose-lowering medications. Metformin and gluburide are being closely looked at since they're easier to administer, less costly, and have better acceptance among patients. But this study says insulin was a bit better – slight more babies were born larger for the metformin group, and more moms had hypoglycemia. https://www.medpagetoday.com/obgyn/pregnancy/113651 XX In its Citizen Petition to the FDA, Novo Nordisk argued that there is no clinical need to allow compounding for liraglutide, the type 2 diabetes injection it sells as Victoza. Novo Nordisk last month filed a Citizen Petition with the FDA asking the federal agency to exclude its type 2 diabetes injection Victoza (liraglutide) from a proposed list of drugs eligible for compounding. https://www.biospace.com/fda/novo-launches-citizen-petition-to-block-compounded-victoza XX Bit of an update on compounded terzepatide and semaglutide. The FDA is allowing a grace period of 60 days before starting to enforce the end of allowing compounds of Mounjaro. Meanwhile, semaglutide remains on the FDA's shortage list for several dose strengths, though all doses have been reported as “available” since late October 2024. Compounding pharmacies, especially larger 503B “outsourcing facilities,” maintain they provide an essential public service by offering lower-cost versions of medications that can cost over $1,000 per month. Many insurers still refuse to cover brand-name GLP-1 products for weight loss. Yet  the FDA has reported hundreds of adverse event reports allegedly linked to compounded versions of these drugs, which do not undergo the same rigorous manufacturing inspections and clinical testing as approved brands.   https://www.drugdiscoverytrends.com/compounders-and-drugmakers-clash-over-compounded-weight-loss-drugs-with-fda-in-the-middle/ XX Interesting story here.. this study says a fecal transplant can help people with type 1 and severe gastroenteropathy. The researchers say diabetic gastroenteropathy commonly affects individuals with type 1 diabetes, causing debilitating symptoms like nausea, vomiting, bloating, and diarrhea; however, treatment options remain limited. Researchers conducted a novel clinical trial to test the benefits of FMT in adult patients with type 1 diabetes and severe symptoms of gastroenteropathy, who were randomly assigned to receive either FMT or placebo capsules as the first intervention. After four weeks, Compared with placebo, FMT led to significant changes in the diversity of the gut microbiome. https://www.medscape.com/viewarticle/fmt-shows-early-success-type-1-diabetes-bowel-issues-2025a10000bg XX A couple of weeks ago, listeners told me that the Dexcom geofencing issue we reported on seems to be resolved. Dexcom is now confirming this. Previously, if you had an issue with Dexcom G7 outside of your home country, you couldn't reinstall or use the app without customer support. As of last month, the geofencing issue has now been resolved with the latest Dexcom G7 2.6 app update. Can I travel with my Dexcom G7? | Dexcom XX Abbott and Dexcom settled all patent lawsuits related to continuous glucose monitors (CGMs). The two competitors, who lead the U.S. market for CGMs, agreed on Dec. 20 to resolve all outstanding patent disputes and not sue each other over patents for 10 years.   Dexcom and Abbott previously reached a settlement in 2014 related to their diabetes devices, which included a cross-licensing deal and an agreement not to sue each other until 2021. After that agreement expired, the companies filed a volley of patent lawsuits. https://www.medtechdive.com/news/abbott-dexcom-settle-cgm-patent-lawsuits/736300/  

$5 Q-BANK: https://patreon.com/highyieldfamilymedicine Intro 0:30, Diagnostic criteria 2:02, Type 1 vs type 2 diabetes 5:43, Metformin 6:57, Sulfonylureas 8:36, TZDs 9:09, DPP-4 inhibitors 9:54, GLP-1 agonists 10:39, SGLT2 inhibitors 12:39, Insulin 14:08, Diabetic ketoacidosis (DKA) 16:32, Hyperglycemic hyperosmolar syndrome (HHS) 23:07, Microvascular complications 25:06, Macrovascular complications 33:07, Practice questions 34:46

Type 2 diabetics can present with a DKA associated with SGLT-2 inhibitors.  And it may be euglycaemic.  So be wary.     Check out the Prescriber Update, Vol 45, No 4, Dec 2024 Check out the Stat Pearls page on DKA Lizzo JM, Goyal A, Gupta V. Adult Diabetic Ketoacidosis. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560723/    www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

In this special 3-person episode, I'm speaking to Sharon Harrison-Barker and her son Lewis. Lewis's son Marty was just 10 months old when he was rushed to hospital in DKA in 2017, plunging the whole family into crisis and shifting the dynamic of the family forever. Today Marty is a happy, healthy 8-year-old, but those days in the hospital were the some of the worst of dad Lewis and nan Sharon's lives, as well as their respective spouses. The weeks and months after his son's diagnosis remain a blur for Lewis, and it was the concerned words of a stranger that prompted him to seek help for his mental health. In this chat, Lewis opens up about how from the moment he received the initial call about his son's declining health, he completely shut down. ‘It sent me into self-preservation mode. I felt like people didn't need me to be emotional, they needed me to be functional.' In this episode we hear two different perspectives of the same very difficult experience. Nan and dad tell me how Marty's diagnosis has changed them as a family, sharing some of their memories with each other for the very first time. Their relationship is a testament to how clear communication - as well as boundaries - have allowed Marty to thrive through nursery, school and now as a big brother, but have also helped Lewis and his wife Steph to meet the ever-evolving needs of Marty's condition alongside their own as humans, parents, and partners.CONNECT WITH SHARONSharon's Instagram.CONNECT WITH LEWIS Lewis's Instagram.JOIN THE TYPE 1 ON 1 COMMUNITY:We've got an Instagram account! Come and say hi @studiotype1on1.SPONSOR MESSAGE:Thanks to my episode sponsors Dexcom.Pioneer and leader in Real-Time continuous glucose monitors,Dexcom's goal is to simplify and improve diabetes management for every possible person with diabetes.They have a choice of systems, so you can find the right one for your lifestyle at https://www.dexcom.com/

Contributor: Travis Barlock MD Educational Pearls: What is the ST segment? The ST segment on an ECG represents the interval between the end of ventricular depolarization (QRS) and the beginning of ventricular repolarization (T-wave).  It should appear isoelectric (flat) in a normal ECG. What if the ST segment is elevated? This is evidence that there is an injury that goes all the way through the muscular wall of the heart (transmural) This is very concerning for a heart attack (STEMI) but can be occasionally caused by other pathology, such as pericarditis What if the ST segment is depressed? This is evidence that only the innermost part of the muscular wall of the heart is becoming ischemic This has a much broader differential and includes a partial occlusion of a coronary artery but also any other stress on the body that could cause a supply-and-demand mismatch between the oxygen the coronaries can deliver and the oxygen the heart needs This is called subendocardial ischemia What else should you look for in the ECG to identify subendocardial ischemia? The ST-depressions should be at least 1 mm The ST depressions should be present in leads I, II, V4-6 and a variable number of additional leads. There is often reciprocal ST elevation in aVR > 1 mm The most important thing to remember when you see subendocardial ischemia is…history Still, keep all cardiac causes on your differential, such as unstable angina, stable angina, Prinzmetal angina, etc. Also consider a wide array of non-cardiac causes such as severe anemia, severe hypertension, pulmonary embolism, COPD, severe pneumonia, sepsis, shock, thyrotoxicosis, stimulant use, DKA, or any other state that lead to reduced oxygen supply to the subendocardium and/or increased myocardial oxygen demand. References Birnbaum, Y., Wilson, J. M., Fiol, M., de Luna, A. B., Eskola, M., & Nikus, K. (2014). ECG diagnosis and classification of acute coronary syndromes. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 19(1), 4–14. https://doi.org/10.1111/anec.12130 Buttà, C., Zappia, L., Laterra, G., & Roberto, M. (2020). Diagnostic and prognostic role of electrocardiogram in acute myocarditis: A comprehensive review. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 25(3), e12726. https://doi.org/10.1111/anec.12726 Cadogan, E. B. a. M. (2024, October 8). Myocardial Ischaemia. Life in the Fast Lane • LITFL. Retrieved December 7, 2024, from https://litfl.com/myocardial-ischaemia-ecg-library/#:~:text=ST%20depression%20due%20to%20subendocardial,left%20main%20coronary%20artery%20occlusion. Summarized by Jeffrey Olson, MS3 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

On this month's EM Quick Hits podcast: Ross Prager on TEE in cardiac arrest, Justin Morgenstern on nebulized ketamine for analgesia in the ED, Hans Rosenberg & Krishin Yadav on standardizing cellulitis management, Mathew McArther on latest studies on subcutaneous insulin protocols in DKA, Jennifer C. Tang on documenting differential diagnoses medicolegal tips...

When you meet Abi Woodliffe-Thomas, you meet a thoughtful, articulate, intelligent and confident 25-year-old. But for more than a decade, Abi carried her type 1 diabetes in secret as her ‘biggest insecurity' - hiding it from everyone in her life.Abi went through a traumatic diagnosis at the age of just 12, and the experience immediately plunged her into intense feelings of shame around the condition. Still in the hospital bed in recovery from DKA, Abi was also told she would have to give up her beloved acrobatic gymnastics, which she was already devoting 25 hours to each week.Determined to prove the nurses wrong, Abi returned to training the very next week, and channeled every emotion into her sport. She went onto compete at an international level, all the while keeping her condition out of sight.Now retired from gymnastics and working as a performance nutritionist, the weight of what she'd been carrying for so long was released when Abi wrote an article about her type 1 diabetes for her friend's website.Since her diagnosis Abi has overcome so much, both professionally and personally, and is tentatively hopeful about walking a different, more open path towards acceptance - one conversation at a time.‘I do still find it difficult to say the words, oh, I'm diabetic or oh, I've got diabetes. But I think it's really helped talking about it and I think life would look very different if I'd spoken about it from the beginning. But it was my way of protecting myself. I know now that anything is possible, even with a pancreas that doesn't work.'CONNECT WITH ABI:Say hi to Abi on Instagram. Take a look at her professional profile, Happetite.JOIN THE TYPE 1 ON 1 COMMUNITY:We've got an Instagram account! Come and say hi @studiotype1on1. SPONSOR MESSAGE:Thanks to my episode sponsors Dexcom.Pioneer and leader in Real-Time continuous glucose monitors, Dexcom's goal is to simplify and improve diabetes management for every possible person with diabetes.They have a choice of systems, so you can find the right one for your lifestyle at https://www.dexcom.com/

Show notes at pharmacyjoe.com/episode964. In this episode, I'll discuss subcutaneous insulin therapy for patients with low to moderate severity DKA. The post 964: The SQuID Protocol for DKA Treatment - Sounds cool but how well does it work? appeared first on Pharmacy Joe.

On this month's EM Quick Hits podcast: Ian Chernoff on the often elusive diagnosis of traumatic coronary artery dissection, Anand Swaminathan on proper use of insulin in DKA and in hyperkalemia, Brit Long and Hans Rosenberg on mesenteric ischemia pearls and pitfalls in diagnosis and management, Dave Jerome on recognition and management exercise-associated hyponatremia and heat illness and Jesse McLaren on the Queen of Hearts AI model in helping identify occlusion MI on ECG... Help Support EM Cases by Giving a Donation here: https://emergencymedicinecases.com/donation/

In this episode, Lisa shares how her son, Hudson, was diagnosed with Type 1 Diabetes at the age of 20 (9 years after her daughter Juniper was diagnosed)  by playing a silly little game at home. We'll see if they ever play that game again.We chat about the the vast difference in catching a diagnosis early versus in DKA, going into a second diagnosis with a solid foundation of knowledge this time, how the hospital barely let them leave with a prescription for insulin, the difference in a toddler and adult diagnosis, the things they wish happened at their very first end appointment with T1D that lasted all of 20 minutes, and all the amazing things Hudson is doing despite living with T1D. Hang out with us on Instagram:Spill the T1D - @spilltheT1DKeary - @graceandsaltLisa - @thepoolgang_

In this episode: Diabetic Ketoacidosis (DKA) is a severe and potentially life-threatening complication of diabetes, yet it is more common than people think, especially upon diagnosis of diabetes. In this episode of the Taking Control of Your Diabetes podcast, hosts Dr. Jeremy Pettus and Dr. Steve Edelman, both endocrinologists living with type 1 diabetes, provide an in-depth exploration of DKA. They discuss the science behind ketones, why the body produces them, and how they can become dangerous in people living with diabetes. The doctors share personal experiences with DKA and offer valuable insights on recognizing early symptoms, the importance of regular ketone testing, and effective at-home treatment strategies. They also delve into the latest advancements in ketone monitoring technology and discuss certain diabetes medications that may increase DKA risk.Key Topics: What are ketones and what purpose do they serve in the body?Ketogenic diet vs diabetes: what's the difference?DKA risk mitigation and the best ways to go about itDo high glucose levels equate to having DKA?How common is DKA among diabetics and who is at risk?What are early signs and symptoms of DKA?When should you check your ketones?How to measure the important ketone that identifies someone in DKA?What are the different types of ketone meters out there?What are the different levels of ketones and what do they mean?What are some ways you can treat yourself at home?What are the cornerstones of DKA prevention and relief? ★ Support this podcast ★

In this episode of the Saving Lives Podcast, Eddy Joe delves into the latest research comparing balanced electrolyte solutions to 0.9% saline for treating diabetic ketoacidosis (DKA). Discover how BES could potentially revolutionize DKA management by speeding up recovery and reducing complications. Tune in for an in-depth analysis of the study and its implications for clinical practice. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. If you're in the US, you can order A SIGNED & PERSONALIZED COPY for $29.99 or via AMAZON for $32.99 (for orders in or outside the US). Ebook versions are available via AMAZON KINDLE for $9.99, APPLE BOOKS, and GOOGLE PLAY. ¡Excelentes noticias! Mi libro ha sido traducido al español y está disponible a traves de AMAZON. Las versiones electrónicas están disponibles para su compra for solo $9.99 en AMAZON KINDLE, APPLE BOOKS y GOOGLE PLAY. Citation: Szabó GV, Szigetváry C, Turan C, Engh MA, Terebessy T, Fazekas A, Farkas N, Hegyi P, Molnár Z. Fluid resuscitation with balanced electrolyte solutions results in faster resolution of diabetic ketoacidosis than with 0.9% saline in adults - A systematic review and meta-analysis. Diabetes Metab Res Rev. 2024 Jul;40(5):e3831. doi: 10.1002/dmrr.3831. PMID: 38925619. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

Show notes at pharmacyjoe.com/episode949. In this episode, I'll discuss subcutaneous insulin for the treatment of diabetic ketoacidosis (DKA). The post 949: How well does subcutaneous insulin work for DKA treatment? appeared first on Pharmacy Joe.

This past winter, Dr. Rich Griffey, healthcare quality leader from Washington University School of Medicine and Emergency Medicine, came to present grand rounds on a new way to care for patients with mild to moderate DKA, which they call the SQuID protocol. This talk serves to inspire us to look even at some of our well established conditions and see what we could do differently, as well as appreciate the value that healthcare quality improvement integrated with research methods and implementation science thinking can do when they all come together for the improvement of patient care. Come be inspired with us! CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com   WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs   Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs  

Brianna continues discussing the challenges of managing her son's type 1 diabetes post-DKA and the support systems involved. Learn about the Medtronic Champions JUICE CRUISE 2025 Screen It Like You Mean It Eversense CGM This BetterHelp link saves 10% on your first month of therapy Try delicious AG1 - Drink AG1.com/Juicebox I Have Vision Use code JUICEBOX to save 30% at Cozy Earth  Get Gvoke HypoPen CONTOUR NextGen smart meter and CONTOUR DIABETES app Learn about the Dexcom G6 and G7 CGM Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Learn about Touched By Type 1 Take the T1DExchange survey *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  How to listen, disclaimer and more Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find the show and consider leaving a rating and review on Apple Podcasts. Thank you! The Juicebox Podcast is not a charitable organization.  

In today's episode, taken from live recordings at PREMIER 2024, we dive into an increasingly common treatment for type 1 diabetes: hybrid closed loop insulin pumps. We'll begin with a brief overview of traditional insulin pumps and explain how hybrid closed loops are different. The core of our discussion will be centered around three case studies, illustrating potential scenarios you might encounter in a pediatric emergency department and how to manage them effectively. With NICE's recent technology appraisal advocating for universal access to hybrid closed loop systems for all type 1 diabetes patients, it's crucial to understand these devices. Over the next few years, you'll likely encounter these systems frequently. We'll cover the essentials of how these pumps work, their benefits, and potential issues that might arise, such as connectivity problems, cannula issues, and handling intercurrent illnesses. Join us as we explore the revolutionary impact of hybrid closed-loop systems, which offer better glucose control and significantly improve the quality of life for those with type 1 diabetes. Dr Nicola Trevelyan has been the Clinical Lead for the Paediatric Diabetes Service in Southampton for the last 20 years. During this time, she has seen huge changes in the management of CYP with diabetes.  She has been involved in several large multicentre trials for paediatric diabetes,  helping to better our understanding of how best to use new technologies in diabetes management in children and move forward access to new treatment technologies.  She was one of the founding committee members for the Assoc of Children's Diabetes Clinicians (ACDC) in 2006 and has been on working parties for BSPED helping evidence base and re-write the national DKA guidelines in 2020 and for the National Paediatric Diabetes Audit.  For the last 4 years, she has been on the Clinical Advisory Group for the RCPCH Quality Improvement Programme for Paediatric Diabetes. 

As Coach Neil says, this is the episode he needed when he was first diagnosed. If you've been diagnosed with type one diabetes, type 1.5, or LADA within the past 12 months, or are a parent of a child with T1D, this is a must listen. But even if you were diagnosed years ago, you will get something out of this conversation! Coach Neil and I are sifting through all the misinformation and information overload to get you EXACTLY what you need to know in order to thrive with diabetes. Time Stamps:  (05:05) Neil's diagnosis story while in the Airforce (07:35) Avoidance mindset vs. perfection mindset(08:34) Lauren's diagnosis story as a child(10:12) “The' fighter mentality' doesn't work either”(11:08) “There's nothing you did wrong”(14:54) “A lot of our success will come from our relationship to T1D”(16:09) Our best mindset advice(17:02) How to find balance and avoid yo-yo-ing(19:36) The honeymoon phase and tests we recommend (21:20) The pancreas and insulin - what you need to know(25:47) Going to the endocrinologist (26:26) DKA(29:54) The role of healthcare & expectations (32:20) Diabetes stats (34:00) The birth of Risely (35:14) Blood sugar, A1C, time in range targets (37:06) Neil's low story(39:10) Lauren's never-before-told juice story (48:55) A1C: what is it?(52:02) Let's talk nutrition (55:45) Bolusing strategies(59:06) Insulin sensitivity (01:00:10) The role of movement(01:03:30) Have grace with yourself in the learning curve (01:06:04) “When you don't feel like you're working with T1D, it drains you”(01:07:03) “The life you deserve is attainable.”(01:08:23) How Risely can support youWhat to do now:Follow me @lauren_bongiorno and @riselyhealth on Instagram to stay in the loop for when new episodes drop.The doors are open for our Decide and Conquer Group Coaching Program for T1D women. Apply now and talk to our team HERE. We are here to support you in your diabetes journey.Learn more about our 1:1 coaching programs HERE. Learn more about TempMonitor HERE  Buy TempMonitor HEREDisclaimer: Nothing you hear on the Reclaim your Rise podcast should be a substitute for personalized professional medical advice. Please always consult your physician or other medical professional before making any changes to your diet, insulin dosages, or healthcare plan. 

The JournalFeed podcast for the week of May 6-10, 2024.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Tuesday Spoon Feed:Utilizing oxygen, rather than room air, for patients with intermediate-risk acute PE may be helpful even if patients are not hypoxemic. We'll need a study (but not this one), for further information.Thursday Spoon Feed:Sodium-glucose cotransporter 2 inhibitor (SGLT2i)-associated ketoacidosis (DKA) had delayed resolution compared to type 1 diabetes (T1D)-associated DKA despite often being “milder”. This could be due to significantly lower insulin doses given in the setting of the lower plasma glucose levels often seen in this population.

Welcome to PTBN Pop's Video Jukebox Song of The Day! Every weekday will be featuring a live watch of a great and memorable music video. To celebrate the 75th birthday of the legendary Billy Joel, all of the songs this week are by this iconic singer and songwriter. On today's episode, Steve Riddle is watching, “Why Should I Worry?” from 1988. The YouTube link for the video is below so you can watch along! https://www.youtube.com/watch?v=Jb7kJ-j_dKA

TIME STAMPS: 01:04 INTRO TO KETOACIDOSIS: A state of CONFUSION, FATIGUE, WEAKNESS, & NAUSEA caused by an overproduction of acids resulting from PROTEIN CATABOLISM (very bad, very scary!) 04:04 Who all should be concerned about diabetic keto acidosis (DKA)? 08:08 WARNING SIGNS that you may be headed for DKA. 11:55 INSPIRING LESSONS LEARNED from attending the 2024 NPC Emerald Cup! 13:03 Make-up & hair-style tips for bikini competitors. 14:05 Why competitors should make eye contact with the judges when they are on stage. 15:05 Confidence & stage presence. 17:21 Sarah's go-to “mostly animal-based” NOOTROPIC KETO COFFEE recipe! 23:20 “Take away the dross from the silver and the smith has material for a vessel.” Proverbs 25:4 (one of my favorite proverbs for cutting) 24:00 Does God approve of the CARNIVORE DIET?! https://www.youtube.com/@CarnivoreJosh 27:02 Answering a question on how to GAIN WEIGHT on the CARNIVORE DIET (bulk). 30:49 SUPER SERMON: SUFFERING (1 Peter CH1-5) - 4 KEYS TO SUFFERING FOR CHRIST “The God of all grace, who called you to his eternal glory in Christ, will himself restore, establish, STRENGTHEN, and support you after you have suffered a little while.” (1 Peter 5:10) Do you like RIBEYES? Search Carnivore Coaches Corner (the #1 bodybuilding podcast in England) on any platform for our NUTRITION PODCAST co-hosted with Coach Mark Ennis! SUPERSET Coaching membership inquiries: https://calendly.com/ssyl/meet-greet Information on The Open Natural: https://www.theopennatural.com/Home

This week, managing type 1 diabetes into your 70s is a bit of uncharted waters.. While thankfully more and more people are living long with T1D, that wasn't always the case. I'm taking to Dianne Mattiace who is in her early 70s and was diagnosed as an adult, 30 years ago. She was the first person in the US to use the Eversense CGM when it was approved in 2018 and she's still using it today. She answers your questions about this implantable CGM, why she's stayed with it and what else she does to manage in retirement and beyond.   This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. More about Eversense here Our previous episodes about Eversense here  Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Learn more about Gvoke Glucagon Gvoke HypoPen® (glucagon injection): Glucagon Injection For Very Low Blood Sugar (gvokeglucagon.com) Omnipod - Simplify Life Learn about Dexcom  Edgepark Medical Supplies Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode Transcription:  Stacey Simms  0:00   Diane Matisse. Thanks so much for joining me. Welcome to Diabetes Connections. It's great to talk to you. Dianne Mattisse  0:04   Thank you so much for having me. Yeah, let's Stacey Simms  0:07   jump right in. Let's start with your diagnosis story, because you were initially misdiagnosed, right? Take me through what happened? Yes, Dianne Mattisse  0:15   I was 40 years old. And my family history was type two diabetes. And they actually, as soon as you say that to a physician, and it was a general practitioner, it was not an endocrinologist, they automatically just put that label on me and said, you know, you're another type two in your family. It went on for about three months. And I actually was in the honeymoon phase, which now was not even recognized back then. But I, it was at the time where you're making enough insulin to keep you from going into DKA into ketoacidosis end up in a hospital, but not enough to make you feel well, so my blood sugar's were still rising, the medication they had me on wasn't working. And finally, after, I think about three or four months, well, during that time, I saw an endocrinologist. And he also was doing a lot of testing, even the C peptide, which is now a diagnosis tool wasn't able to be done where I lived, they had to send it out to a lab in Atlanta. So once that was kind of established, he admitted me, and started me on insulin and, you know, multiple injections per day, Stacey Simms  1:35   why did you What led you to actually seek out an endocrinologist? Dianne Mattisse  1:39   I was not feeling great with the general doctor treating me and I just kept getting worse and worse. And I was taking oral medications, they weren't all these designer meds that they have now for type twos. Back then it was couple pills. So I was I would call them increase the pills. And as I was increasing the pills over the three or four months, so was my blood sugar increasing, and I kept losing weight. And I'm thinking, well, this is a great diet I'm on I was eating better. But my blood sugar's were going into the three hundreds. So finally, I had been in the medical field before that, actually, it was in the medical field at the time, I was a controller for a nursing home company, but it didn't really have access to a lab or anything like that. I was actually the Regional Controller. And I was on the financial side, right? So I actually went to a lab got my blood sugar taken. I didn't even think to buy a meat or anything like that, which I should have, but I did not. And I kept seeing my blood sugar's go up and up and up. And so I finally just on my own said, I'm gonna go to an endocrinologist. And as soon as I went, he told me, I think you're a type two. And type one, I think you are type one, misdiagnosed as a type two. And let's do some testing. He started he did the C peptide, sent it out, did a bunch of other tests. I have no no recollection. Now, it's been 33 years of what else he did. But over that weekend, so that was like a Friday over that weekend, I just be compensated more I started getting muscle cramps, I called him and he said, go to the hospital Monday morning, seven o'clock and bring a bag you're being admitted. So I did. And he said, I was really on the brink of going into diabetic ketoacidosis. So it was really, really just, you know, it's good that I went to the hospital that morning and got on insulin, I think but I think a lot of people when they're diagnosed after 40 or 35, I just talked to somebody the other day who was diagnosed at like 55. And I think the older you get, the less they even think it just automatically think you're a type two. Yeah, yeah, Stacey Simms  3:58   it's something like half of all cases of Type one are occurring and people over the age of 20. But as you say, once you're over 20, many doctors don't know that it could be type one. I hear a lot of stories of Pupil misdiagnoses type two who have type one of a lot of people who have lotta, you know, latent autoimmune diabetes in adults. I don't hear a lot of these stories happening in the late 1990s. Or prior to that time period. Did you ever talk to your endocrinologist? Like, I don't want to say he was cutting edge because it was pretty obvious you were suffering, right at that point. But it is interesting that this was 33 years ago, and somebody finally got it right. Dianne Mattisse  4:41   I think I was just so sick. By the time I actually went to see him and I had lost about 40 pounds. By that point. He looked at the amount of medication oral meds that I was on, and I think it had been about a period of three months and I kind of was keeping track of the blood sugars on a piano And a little notebook back then, that we had. And he looked at that and said, you know, you're you're decompensating, you're not doing well on any of these meds, the amount of weight I had lost. And I was young, younger. So I wasn't. I mean, I was losing muscle mass, but it wasn't as noticeable if I had been 60 or 70 years old. And he said, You're losing muscle mass. And you're just feeling so bad. I mean, I remember going on a trip with my husband. And we went to the Statue of Liberty at that point. It was you were able to go up the stairs and go into the statue. Yeah, well, we actually went with some family members. And this is before I actually was on insulin about a month before. And I remember going up three steps, and turning around and telling my husband, I can't do this. Oh, wow. And we had always, I had always been going to the gym be doing aerobics. Back then more of a runner than walking. Walking is more popular. Now. Of course, you know, less on the joints and everything. But I was a runner back then I was into aerobics. I was very athletic skier and, you know, snow ski or water skier. And he looked at me and said, What do you mean? And I said, I can't do it. I'm out of breath on step number three, I need to turn around. So that kind of pushed me to figure out. And now when I look back at those pictures of what I look like, I'm like, I actually looked very, very sick. I mean, that weight for me was not a normal weight ever in my life. Maybe when I was 10. Stacey Simms  6:45   For a lot of weight, I Dianne Mattisse  6:48   think I weighed 103. And I mean, I think I weighed more than that. Honestly, in fourth grade. Yeah. Stacey Simms  6:53   Wow. Especially for somebody athletic. That's really tiny. Right? Right. Um, Dianne Mattisse  6:59   you know what it is? It's it's denial. Oh, because nobody in my family. I mean, my family thought I look great. You're, you're on a diet, you're doing great, everything's good. But they didn't know how I was really feeling you know, health wise, I felt horrible. And weak and, and constantly thirsty, and constantly urinating and, you know, in the bathroom all the time and starving me, you actually are starving your body. And it's just the worst, it was a thirst. When I describe it to people, it was a thirst that no matter how much you drank, you could never make it go away. It was just something that was there all the time. So I mean, it was very, I was very lucky to find the right endocrinologist that, like you said, was a little bit of ahead of time, and kind of just said, You're a type one. You're not a type two, there's just no way and immediately hospitalized me and got me on track. So Stacey Simms  8:00   I'm imagining that you did go home with a meter this time. Do you mind taking us through your technology journey because we're here to talk about you know what, you're one of the first people to use the ever since Dianne Mattisse  8:12   I was first I was the first person implanted in the United States with the ever since and my doctor who is in Opelika, Alabama was the for about Columbus, Georgia. And he has an office in OPA Leica. He was the first person to be sort of the first physician to be certified. Wow, the technology. Let me tell you technology now. I always say this if you have to have a disease and a chronic disease. I'm so happy now that I have all of the help and see GMs I had actually left the hospital with a meter. And it was like, I think he had to wait two minutes for it to actually read. You know, your drop of blood. It had to be a much bigger drop of blood and all that. My doctor at the time would not there were pumps, but they were obviously much larger. And the CGM, the first CGM that I had was I had to go to the hospital and have it put on and I wore it it was a big box and I had to wear it for seven days. Then go back to the hospital. They would take the recording out they would review and and print everything, send it to my endocrinologist and then I had to go back to the endocrinologist for a report. So it only took a week of my life and of course, like anybody else I was sure that I was doing everything right and trying to have good read, you know a good recording done. So I would get a good report when I went there. Now I had changed my my original endocrinologist had a family tragedy with his son, so I had to change endocrinologist. And I thought I had a really good endocrinologist. But for some reason, she didn't really push me with the CGM. So I really pushed that. And I have been on all of them. I've been on all of the 10 to 14 day ones I've been on. Like I said, the original one that had to wear for seven days. And honestly, the last one, not the last few years before I went on, ever since I did not, they didn't get along with my body. I mean, I had too many alarms. I had too many failures. I had skinny rotations, I had just inaccuracies. And I finally said to myself, I'm not being compliant because of it. So I just started doing more meter checks. And I tried to manage my diabetes, which I could not I mean, to be honest, I was thinking I was compliant when I when I moved to Alabama and got with my physician now, my endocrinologist. I was not I was not being compliant, because I didn't have a CGM. So I mean, it's almost impossible to stick your finger every five minutes. I was gonna say do Stacey Simms  11:19   you think the right word is compliant, though? I mean, you were trying, right? It's not like you were in your like, I hit that non compliant page. I Dianne Mattisse  11:27   was right. You're right. I was trying. But now that I look back, I'm like, I should have. Well, there was nothing like ever since before I got it. So it was funny thing. My husband heard about it. I actually moved to Alabama a year earlier than my husband he was working down there want to do is finish his job for another year. And so I moved to Alabama, because we bought a house on the spur of the moment. We're on a visit up here. And so yeah, we weren't it wasn't a plan. It was not a plan. We just did it. So when I came up here, I did not have a physician here. I didn't even have a primary. But I did have a pump and I needed to get my supplies. So I I actually called there's only two endocrinologist in Auburn, Alabama. And that's about a half hour from where I live. So one of them wanted me to have a referral. But I didn't even have a primary yet. So I called the other one. Because I needed to get my insulin and my supplies. And they gave me an appointment. And it was funny. I went in on a Thursday to see Dr. Baliga. And he looked at me and said, This is my you know, I'm a new patient started talking to me about the ever since. Have you ever seen it? Have you ever heard about it? And I said, you know, it's funny. My husband saw something on the news about it a few months ago, and he mentioned it to me, but I hadn't seen anything else about it. So he started telling me about it that it was something that was placed under the skin. You wore it for at that time, it was 90 days now it's 180 days. And I said well, let's let's do it today, because he made it sound so wonderful that you wouldn't have to be doing, you know, I would know something every five minutes, I would know if you know and I was familiar with other products that gave you arrows, whether you're going up whether you're going down so you can kind of fix things as you're going along. I didn't have that right now. When I went to see him so I'm like, Ah, it sounds great. He goes well wait, we we haven't got he was at the FDA had certified it. He was certified, but they had to bring the team from Atlanta at the time. So he says but we can do a Tuesday. And I'm like, Okay, I can't wait. I mean, I was so excited. So I had it placed on Tuesday four days after I saw him and I'm now on number 24th sensor and it has been actually so life changing for me i One of the main reasons I was so anxious and happy to hear about something like that is because I was having severe low blood sugars at night and nothing not to wake me up. I mean I My husband actually would call me every morning at 839 o'clock to make sure I had made it through the night that I was still alive. So it was a horrible really way to live and I was having multiple sometimes multiple low blood sugars during the day and or blood glucose during the day. And then I would treat them and then I would go up and down you know so it was it was just up and down cycle and you don't feel well with that at I don't anyway most people don't because you you know you now you have to fix this and you know hope that it fixes that. So once the I got on ever since that disappeared, basically disappeared from my life, I maybe have one, low blood sugar, maybe once every two months now, I have a very, very low percentage less than 1%, every 90 days. So it's amazing to me how technology has changed my life and made me feel like I can actually live kind of like a normal life. I need it. And I also was never really addicted to looking at my phone all the time, like a lot of younger people do. And you know, I don't do a lot of selfies and but now, I mean, I do sit at the table and have my phone there because I want to see what's going on. And if I'm out to dinner, I put it there. And I want to see if it's going down, is it going up? And it gives me that you know that that safety net of, I'm not going to go high, and I'm not going to go low. Do you mind if I ask Stacey Simms  15:57   what other technology you're using because the CGM alone isn't going to prevent lows. Dianne Mattisse  16:02   I have an insulin pump. I don't have the loops. I don't use that because I have the CGM that I 100% believe in and, and love it. I do have a meter. And I do have to calibrate the Eversense once a day, which to me, gives me that feeling of security and safety that I am getting good numbers throughout the day. And if something's really off, you know if it feels like it's off, I will check with my meter. But I use the meter a lot less to be honest, I you know, I really trust you ever since. And I mean, it's been it's proven to me because many times the meter and the ever since will have exactly the same number, or within a few a few numbers. And that makes me feel so much better. Right. Stacey Simms  16:53   But you use you use a pump. That's just I wouldn't call it a dumb pump. But you don't use an automated system. I Dianne Mattisse  16:59   don't use the loop. I don't use the automated system. It has the capability. Okay, but but I don't I just that's not an important factor for me, right? Stacey Simms  17:10   I mean, I'm just trying to be clear for folks that you know, we're listening, you know what you're using in right with, I mean, my son, it's funny to look at technology because he was diagnosed in 2006. So we went, you know, shots and meter, and then DME pump and meter for forever. And then CGM pump your meter to calibrate like you say, and now in 2020, he went closed loop. So he's got a pump that communicates with the CGM. So it's just wild to see how it all works. All right, all the questions people have about ever since tell us about the insertion and the removal, because a lot of that makes a lot of people uncomfortable to think about. Dianne Mattisse  17:49   Right, right. I think the placement of the ever sense has, I think a lot of people think about it as a surgery and as this and that, it really is such a tiny little, maybe just a tiny little incision, not even as big as your pinky fingernail. And they actually, you know, they numb you, of course, and then they put the little the little sensor right under the skin. I mean, you can actually kind of feel it through the skin, you know, which is helpful when you're placing the transmitter. And it doesn't. I mean, honestly, it doesn't hurt at all, I'd rather have that done and then have my teeth cleaned, to be honest. I mean, it's it's really that simple. And I've had, like I said, I'm on number 24. And it's really nothing the removal is the same thing. It takes maybe the insertion the longest part of the insertion or the placement is getting the Lidocaine to numb the area, you know, they actually do it in a very sterile way comes with a big sterile cape. And you know, you're laying on the table and they clean the area very well. I've never had an infection I've never had any what I would call any bleeding I mean it might bleed a little tiny bit, but they cover it with steri strips, there's no stitching, there's no you know, there's nothing like you have to go back and have surgery looked at it or anything like that there's no stitches or anything like that. So the removal my physician has always used an ultrasound for removal. So I think that has become very popular because I belong some a lot of these pages that people talk about it and I can actually feel mine because it really is right under the skin and but I think the ultrasound kind of helps them know exactly where the end is. Because listen, there's you're putting it under the skin, it could move a little bit it could you know turn or whatever, right so I've never really had any issues. I mean, you hear horror stories from people who have never even had it, which really is quite annoying, because I think it's just like slamming a restaurant, if you've never eaten there, you know, just and I think the greatest thing is that we have a choice. Now, it might not be for everyone. But it is something that for people who get these severe irritations or allergies to certain products, you know, with some of the 10, the 14, ones, 14, day 10 to 14 day CGMS. And also, I think a lot of people worry about getting it knocked off. And the cost of it, were this the transmitter, which where you were on the outside, if it comes off, you know, you just stick a new adhesive on it and stick it back on. The other great thing is, you know, we live by a lake and we have a boat. And if I want to go swimming, I take my transmitter off, I get into the water. And I don't have to worry about anything, I don't have like a permanent thing going into my body a permanent or fish going in, you know, which always kind of bothered me going into a pool or going into a lake or something like that. This is once that heals up after a couple of days, there's nothing really on the outside plus it you know, the great thing about ever since also is it uses a different kind of technology. It's not the same technology as other CGMS use. So I believe and this is personally my opinion, I believe that it's much more accurate because of the type of technology that they're using. It's very advanced, Stacey Simms  21:47   you being the way the sensor reads. Yes, the way the sensor reads. And you said you had a lot of irritation from the other CGM. You don't have any irritation with the adhesive that the transmitter sticks Dianne Mattisse  21:59   on at all. None at all. None at all. The little adhesive ups the little adhesive that we put on the back of the transmitter is very very skin friendly. Very skin friendly i and I'm fair and I have blue fair skin blue wise, so I have had pretty severe irritations with other CGM said I had to move them around and try different things and try different products under it. Also products to keep them on, which haven't had to do that either. You know, this kind of stays on? And I don't really think about it. I mean, I think more about checking my phone now than I do thinking about having the sensor. So tell me again, Stacey Simms  22:47   this is your 24th Yes, sir. How long will this one stay in? Dianne Mattisse  22:54   Six months, not? Well, it stays now up to 180 days or up to six months. beginning it was up to three months. And I do know that the FDA is working on the approval for the what 365 Day, which we're all looking forward to that. What I mean, I love going to my doctor so I'm like, you know, I we always kid around. So you know, we have to stop meeting like this. But yes, I mean, it's a it's going to be quite awesome for a lot of people to get it for one year because I do go to my doctor every three months to get prescriptions for the other supplies I need and insulin and things like that. But some people only go to see their endocrinologist or their primary doctor only once a year to manage your diabetes. Stacey Simms  23:49   In the six months, I'm just trying to you know, I'm trying to picture that you think that all the different the CGM changes that would happen within six months. Have you had any issues any reason to go back to your endo and say take a look at this get out the ultrasound machine or is it smooth sailing for you? Dianne Mattisse  24:05   I haven't had any issues for several years. I mean, we're going on six years this July that I've had it the greatest thing is which I've never used the most recent products I'm not sure but but the ever since has an online or on your phone whole picture of what's going on. So I'll tell you how long you're you know how much time you're in. It will tell you exactly the percentage time and range and it also will tell you seven days, 14 days, 30 days, 60 days, 90 days so you can actually see and it will also tell you what your estimated A1C will be it will tell you what percentage is low you're in the low area what percentage you're in high so it gives you all kinds of information. The greatest thing is my doctor has that information also. So if I make a call to him, and I say, you know, I'm not doing well, something's not right, I can't get the sugars down and, and it's not the pump I, you know, I've moved it, I've changed insulin, all that thing, all those things, then he will go on there and say this is what you need to do. But this is what we need to change around, you know, because it's all based on the insulin that you're getting and the activity. It's nothing really I don't feel to do with the CGM. Right? So with the sensor, so I haven't ever had to call him and say, I think it's a sensor. I think most of the time, it's just been the amount of insulin. Or maybe I'm sick. You know, maybe if I have an illness that's not, you know, I had or I made a couple months ago, I had take a steroid shot my wrist. And that just blew me out of the water. So I called him and he was like, Okay, this is what we need to do for two days, you know, so the CGM? No, I mean, I find no fault with that. I mean, I think if the built in protection there is if your meter reading when you put in your calibration in the morning, which I do mine in the morning, you can kind of set it up to do whenever, but I always want to do it first thing in the morning, because I want to know where I'm starting anyway, my day, is it going to be good, bad or ugly that day? So I put my calibration number in there. And if it's, let's say it's off, it's off by 30 or 40 points, you know, you, the sensor itself will tell you something's not right. And it will actually ask you to do another calibration in another hour or so. So, to me, it's, it's kind of a safety check. So that I don't worry about it going off, and being kind of crazy on its own. Because, you know, if something like that happens, and I'm sure with technology, everything has, you know, kinks in it. They you would call the customer service, they have great customer service. And they can actually do a lot with Reese not resetting it actually totally, but figuring out if it really is the sensor really is you. I've had to do a reset on the sensor maybe? Stacey Simms  27:20   Sure. Um, I'm curious, you had mentioned you're in some groups, and I'm sure you know, people who also were there ever since and a lot of people who are interested in it. What's the first question people ask you about it? Like diabetes people? Dianne Mattisse  27:35   How about how is the insertion? How is the placement? Does it hurt? Does it scar does it? How is the surgery? You know, they all like to think it's surgery and everything? Because listen, when you're thinking about that you're thinking about, I don't know, maybe they're thinking of a transplant or something. But it's a very simple thing. And there's a lot of other medical procedures now that use these placements under the skin. There's hormonal ones. I know there's a testosterone one, I think there's an there's one for birth control now. So it's it's, you know, very upfront technology that's being used a lot in medical treatment. So it's not anything, you know, that people should be afraid of. I mean, this is an advanced, very advanced product, I think, and simple life is so much simpler with this, you know, just, I mean, once every six months now you go in, I mean, you're it's 15 minutes, and you know, I mean, the 10 minutes, I'm waiting for the Lidocaine to work. That's, that's the biggest thing. Stacey Simms  28:44   Do you have scoring? Do you have a scar on other very Dianne Mattisse  28:46   fair, like I said before, and I don't scar and usually the FDA requires that they switch arm to arm every six months. So like, they'll do the left arm and then they do the right arm. So in that meantime, I can't even like when I go back to have the removal. If if the sensor has already expired, like but I usually try to go a couple days before. If it's expired, of course, it's not going to have a reading. And then, you know, I have to really figure out where it is because I don't see the scar anymore. There is actually I think it's so tiny that it heals up. I mean, you're supposed to leave the bandaging and everything on instructions or five days. Usually, it's healed up in about two or three days completely healed. You can't even really see anything. So I mean, some people would scar I would imagine, but I mean, I think you have that's the trade off or having a totally accurate CGM. That's easier. That's less expensive than things that are failing and you have to replace all the time I mean, for me, it's, it was never I never thought twice about that. I may be by my age, I have a lot of scars anyway, from falling, and it's like, you know, I'm not worried about having perfect skin anymore. So, but no, actually, because I'm fair. I, I did think about that, but but only for about two seconds. Stacey Simms  30:25   Well, you know, and if you don't mind, um, you know, I'd love to talk about aging with type one. I mean, you know, it's different. Life is different from 20 to 50. Certainly, you've mentioned like, you don't run so much anymore, you know, so I don't want to make a whole Pash of like we all know we're getting older. For lucky, we know we're getting older as like, but you know, years and years ago, people weren't living past 50 type 1 diabetes, let alone 70. And I have listeners in their 80s. And we know people in their 90s with type one. So it's a pretty wild. So I Dianne Mattisse  30:58   73. It's changed 73. My A1C is 6.6. I'm so proud of that. Because when I first got the Eversense inserted, it was in the mid nines or a little bit higher. It wasn't 10, but it was in the night. So I've made tremendous strides in getting it down being healthier. And I'm just very proud of that. Because you know, I would like to be in the fives but I, you know, I'm fine. My physician is fine with it being in the sixes, getting rid of the low blood sugars was a huge thing for me because many, many people die in the middle of the night from having a low blood sugar. And that still happens to people and really with CGM and all these choices, it shouldn't happen. And the fact that the CGM gives me this vibration, I know all anywhere, anytime, if I'm out eating, if I'm in bed sleeping, I know I'm going to get a vibration that's going to tell me what's going on. So that has really helped me be happier in my life. I think I worked 25 years in health care as administrator and then 25 years is real estate. Now I'm retired but I do a lot. I have a charity I'm treasurer for up here in Alabama, that does art. We provide art classes and projects for kids in the schools here, elementary schools and some high schools. I have a little word working business with my sister here, we make maps of the lake and we sell to all the little stores around here and everything. And I keep very busy, I also do a transaction. I'm a transaction broker for my son who's a broker in Florida. So I do a lot of paperwork online for him. So I keep very busy. But the fact that I'm getting older, you know, and I know people will say this, you talk to anybody old, your mind is still young, you still look you know, when you look in the mirror, you go Who is that old lady, but when you when you when you feel good, and I feel so much better with a normal blood sugar. I don't feel like I'm that age, you know, I mean, I I enjoy traveling, I traveled to Florida quite a bit because of a lot of relatives and friends still down there having been there for a long living there my entire life basically. And I feel comfortable traveling by myself, which is a huge thing. Because I can tell you 10 years ago, I did not I mean, I always wanted to have my husband or my son or somebody with me. So that getting old and having diabetes. And I've been very lucky because I don't have any side effects. I don't have any complications from having diabetes for so long. I mean, on one hand, I was very lucky, I didn't have to go through puberty or childbearing. So I got it when all that was done, had my children and everything. But on the other hand, you know, 33 years when I think back 33 years is a long time to be dealing with a chronic disease 24/7 And I don't think anybody really understands that it is a full time job. It is something that is with you 24/7 You cannot forget about it even for a day. I mean, it's dangerous if you think you can, but you just can't. But getting older. I just like to I'm so excited to see all the things that have have come from diabetic technology, all the opportunities that we have now. I love being part of the ever since group of people because honestly I never knew anybody growing up, you know, during when I was diagnosed at 40 I never knew another type one. I felt very isolated and kind of depressed about it because I'm like, even in my family, they didn't really acknowledge it because Nobody had the knowledge about it, they knew a lot about type twos and you should lose weight, eat better and exercise, but they didn't really know much about why I was a type one or how I was managing it or how encompassing it was to your life. So I think just having better communities, among us is has helped tremendously for me. And the ever since has just been, like I said, before, life changing for me, no matter what age I would have gotten it, I think it's just the best product because it's the easiest product to use. And I've used them all, I mean, you can't name one that I haven't used and, and I've gone through the progression from when they had to put it on the hospital until the very newest ones. And nothing really, my body didn't like them for whatever reason. But getting old is great. I just look at it and go, I have friends from first grade still, that I see when I go down. And I'm like, you know, and they, you know, most of my close friends know when everything and they, they are very supportive, but they don't really understand it. So now that I understand it better. I'm okay with that. I mean, I think age has just made me feel like, Hey, I am so lucky to be here and feel as good as I do can be as active as I want to be. No, I don't run anymore, and I don't ski anymore. I last skied when I was 65 And I'm like, hey, that's it. I'm done. I'm not doing that anymore. I you know, I got away without ever having a broken bone or anything. Or last time we went, you know, I went with a bunch of younger girls and, and family, bunch of family. And and I'm like, Hey, I'm skiing is good as he's 40 year olds, but I'm not risking it anymore. Yeah. Stacey Simms  36:45   So I meant to ask Do you know is ever since covered by Medicare? I can look that. Yes, I Dianne Mattisse  36:49   did. Absolutely. Now the first couple years, it was not. And my husband I made that decision to pay out of pocket. But yes, it is covered now. That's great. Yes, right. covered. And it covers the insertion and the removal for the physician also, which I think some of the other insurances don't but but yeah, that was not the deciding factor for me. I mean, we paid out of pocket, and and we just knew it was going to be the best thing for me. Stacey Simms  37:18   Good to know, though. I mean, it's really interesting, again, with a lot of my older listeners, you know, and as we are so excited that people with type one are living to Medicare year and beyond, right, it's really important to look at these things. It is it's a deciding factor for a lot of people. Yes. Okay, before I let you go, Diane, how did you get hooked up as an ambassador? I mean, it makes sense. You're the very first patient in America. So I guess it's kind of a dumb question that everybody wants to speak out, you know, right? Dianne Mattisse  37:42   Well, I never Well, okay. So like I said, I never really was in a group of people, I didn't really even have anybody. You know, nobody in my family, nobody to talk to. So the team came from Atlanta, when I had my first insertion, placement, they'd like you to lose placement. So when I had my first placement, the team from Atlanta came, and that was six years ago, this July. So the person who is head of the sales now I believe, she was on that team, and she came in, and we kind of hit it off. And then I think it went on for about, I think six months later, they decided to get a group together, and call them the patient ambassadors. And that's when that is before a Sensia actually got began, began to be involved in the marketing. So that was when Sen. psionics was doing it. So this person picked eight or nine people. And we still have, I believe, four or five of the original ambassadors, and now it's more demographically varied. You know, we have young, I obviously, I'm the older person, you know, but it is good, because I think it's, you know, it shows that it's for everyone. I mean, there's not an age barrier. And there's not a weight barrier. There's not any kind of barrier, except you have to be a type one and you have to want this device. And it's just but that's how are we got hooked up and we kind of it kind of slacked off a little bit when we became the marketing went over to a Sensia. And they had that agreement with a Sensia. And then they picked four or five of the original people and and you know, we're still very close, we have our own little group chats and things like that. So and it's good because now I know if I have a question or if they have a question we can get with each other. It's it that is the greatest thing. I think younger people or anybody now, Facebook has pages, you know, people like you who are spreading the word. I mean, if there had been This, I think I would have felt so much better. I mean it I'm almost getting teary here. But I think I would have felt so much more inclusive, then than I felt for many, many, many years. So I think that you're doing a wonderful thing by spreading the word and helping people and sharing. And I think you know, somebody like your son, who's 19 is going to have a whole different experience with this than I did. And, you know, because you just by 40, you've gone through all those teenage angst and everything but and I was done having children everything, but then it's like, what the heck now? i What is this, you know, coming on, and I was healthy at that time. And I'm like, What did I ever do? Never did drugs, never smoked. Never, you know, there wasn't all the information about immune system, autoimmune and it runs in my family. We have so much autoimmune disease, but not type one. Yeah. So but the patient ambassador, it's a greatest group, we have a blast when we get together. That's awesome. Well, Stacey Simms  41:10   doing the show is truly a privilege for me, you know, getting to talk to people like you and learning so much. I really appreciate it. Diane, thank you so much for joining me. I hope we connect again soon. So Dianne Mattisse  41:21   and I hope you are very good at that editing.  

Join us as we talk about our experience at the 18th Annual Diabetes Technology Meeting in Europe (ATTD 2024). In this podcast, we'll be unpacking our favorite lectures from the event, which hold some very exciting data and insights. From cutting-edge advancements in diabetes technology to the latest developments in medications, we'll cover it all. Tune in as we explore the forefront of diabetes innovation and share our experiences from this meeting!In this episode, we will talk about:What updates are happening in diabetes technology? What are updates in diabetes medications? What is new with CGMs and Type 2 Diabetes? What is the silence all alert on your Dexcom G7? What is a continuous ketone meter and when is it coming? What is the most common cause of DKA in type 1's? What is time in tight range? What is Tzield (data information)? What is the new data on Afrezza? What is new information about SGLT2 inhibitors? What data information came out regarding Mounjaro? Show notes:Diabetes Technology Podcast - https://tcoydthepodcast.transistor.fm/47TCOYD Video Vault - https://tcoyd.org/tcoyd-video-vault/TCOYD Live PLUS Diabetes Technology https://tcoyd.org/live-feb-2024/?  ★ Support this podcast ★

In this heartwarming episode of We Are T1D, Mike and Jack sit down with Maria, a familiar voice from the community who always engages with the podcast's wins and struggles. Maria, a healthcare assistant and a Type 1 diabetic, shares her story of diagnosis, which includes a surprising revelation of fruity breath leading to a DKA diagnosis, and the steep learning curve of managing insulin injections. As they delve into the intricacies of shift work with T1D, Maria reflects on the challenges and strategies she employs to keep her blood sugars in check amidst the unpredictable routine. The conversation takes a humorous turn with tales of injection mishaps, including the perils of biting off needle caps and more! Listeners are invited to join the banter as the trio discusses the pros and cons of different CGM sensors, the struggle to keep them adhered during sweaty gym sessions, and the surprising shortage of alcohol swabs that once accompanied the sensors. Maria also shares her approach to carb counting (or the lack thereof), the importance of considering future activities when dosing insulin, and the therapeutic effect of a well-timed hypo snack. The episode culminates with Maria's sage advice for those newly diagnosed with T1D, emphasizing the strength of the online community and the wealth of resources available. Follow The Podcast https://www.instagram.com/wearet1d Follow Mike https://www.instagram.com/t1d_mike Follow Jack https://www.instagram.com/t1d_jack Connect with Maria https://www.instagram.com/t1d_maria_greenwood Join the conversation at https://wearet1d.com Don't forget to Subscribe/Follow, Rate, and Review to be part of our vibrant T1D family. Share your stories, laugh along with ours, and let's navigate the ups and downs of T1D together. Stay strong, stay informed, and keep sharing those hypo stories with a side of ketchup (weighed or not)!

Make sure to follow this week's guest Mark Sleboda on X at @MarkSleboda1 Find me and the show on social media @DrWilmerLeon on X (Twitter), Instagram, and YouTube Facebook page is www.facebook.com/Drwilmerleonctd   Announcer (00:06): Connecting the dots with Dr. Wilmer Leon, where the analysis of politics, culture, and history converge. Dr Leon (00:14): Welcome to the Connecting the Dots podcast with Dr. Wilmer Leon. I am Wilmer Leon. Here's the point. We have a tendency to view current events as though they occur in a vacuum, failing to see the broader historical context in which events take place. During each episode of this program, my guests and I have probing, provocative, and in-depth discussions that connect the dots between current events and the broader historic context in which they occur. This enables you to better understand and analyze the events that impact the global village in which we live on today's episode. The issue before us is the ongoing conflict in Ukraine and why does the United States keep throwing good taxpayer dollars after bad. To discuss this, we are joined by my guest Mark Sloboda. He's a Moscow based international relations and security analyst. Mark, as always, welcome back Mark Sleboda (01:18): Dr. Leon. Thanks for having me. It's always an honor and a pleasure to be on connecting the dots. Dr Leon (01:23): So it's been reported that an attack on a convoy of Ukrainian military equipment in the esque people's Republic was carried out with the use of short range ballistic missiles. And it also seems as though with all of this hand wringing in the US Congress about funding for Ukraine, all the US and NATO is doing, or seems to be doing, is sending more targets for Russia to destroy your thoughts, mark. Mark Sleboda (01:52): Yeah, there's some rather dramatic developments really under-reported in the Western press that have very large implications going forward for the conflict in Ukraine. The current situation on the ground, I think the Western mainstream media has finally their propaganda narrative bubble has finally burst. Look, in a span of how short a period of time we have gone from Ukraine is winning to (02:34) Stalemate, it's a stalemate on the battlefield to, oh my God, we're losing to Nigeria with snow. I mean, that's the rather dramatic change in the propaganda narrative, and I think we can see it reflected in the political elite as well with the panic and desperation that is starting to sit in and become rather obvious among European leaders who really have the most to lose from this conflict, rather other than the Kiev regime in Ukraine itself. And this all occurs, these latest incidents in the final weeks of and the aftermath of the Russian breakthrough of the Kiev regime's most heavily fortified fortress city, these extensive defenses and fortifications trenches, concrete bunkers, pill boxes, networks of tunnels, layers of minefields, you name it, Inca, which is really quite close to Dan City, and a western journalist a couple of years ago already referred to it rather poetically if quite awfully as a knife pointed at the heart of Dansk. (04:10) They meant that in a good way. Another way, of course, looking at it was a Jack boot pressed to the neck of the people of Donbass because it is from aca and the settlements shielded behind it that the Ki regime forces brutally shelled the people of Dansk for the last decade pretty much regularly. They didn't shell military facilities, they shelled civilian areas with artillery, with cluster munitions, with pedal mines. And this was to punish the people of done bus for choosing wrong, for not accepting the overthrow of the government by the Westback Maan butch back in 2014, and with the intention with driving Russian ethnic people who did not accept the new Ukraine into Russia. That was the intention and one of the primary reasons for the Russian intervention in the Ukrainian civil conflict, not the only one. There were security concerns as well, but this was loudly voiced as well. (05:22) And when the Russians broke through it aga, they did it rather dramatically towards the end. It ended up much shorter than say the siege of Bach Mu, despite the defenses in a DKA being considerably stronger, and this is because of a sea change on the battlefield. The KI regime's initial a integrated Soviet legacy air defense network, the backbone of which was the formidable S 300 systems had been largely deteriorated at this point already a few months ago. And on top of what hadn't been destroyed, they were absolutely out of interceptor missiles for it, and there were none left in countries that are now part of the west former Eastern Bloc countries. Their supplies were all exhausted. So there was an attempt to put together a hodgepodge piece meal air defense system not properly integrated with using Western systems, but that has also been attributed away over the last few months. (06:35) Russia launched an extensive campaign over the winter, and that was a primary target of their missile and drone campaign. So in afca, Russia fully unleashed the fab guided glide bombs on these defenses. And these are old dumb munitions with smart glide kits that turn them into precision weapons being able to fire from air at a distance of tens of kilometers. And because these are bombs, not artillery shells, they have a considerably bigger payload. They come in 500, 1000 and 1500 kilogram capacities and they just annihilate. I mean, if the Ki regime turns, say what they did pretty much to every building in the city, turning it into a mini fortress that has to be individually stormed one fab bomb, and it's gone. And particularly at the larger end, the 1500, they have an incredibly demoralizing effect on anyone within the radius of experiencing the explosion, the concussion and the like. (07:57) And in the closing days of a dka, according to the Russian Ministry of Defense, they dropped over 500 of these, oh my God, on the fortresses in just the last few days, right? So that's why they collapsed so quickly and dramatically at the end and why there was such a route. And they're able to do this now because they can fly with a considerable degree of impunity over the battlefield because first, the Soviet legacy and now the Western Air Defense system sent us a replacement, have largely been destroyed. And immediately in the aftermath of Dfca, the Russian forces far from being exhausted, as many Western military analysts drinking their own propaganda Kool-Aid tried to claim claiming high casualties as they always do without evidence to back it up other than the say so of the regime in Kiev. Russian forces were not exhausted because they had not suffered any considerable attrition because they had been standing off and dropping an extremely large bombs from Sue, 30 fours from fighter bombers on ev dca, which is what did at least at the end the majority of their work for them once they were already ensconced in the outskirts of the city. (09:24) So they continued on fallback positions in the next line of villages that Kiev regime forces had retreated to and were hastily trying to dig themselves in because they had not built proper defenses. And for instance, Laska and Severna lasted two or three days, and as Russia moved on the second line of villages even further, and we faced a real breakthrough in the Kiev regime defensive lines at this point, the Kiev regime became desperate to try to at least slow down. We're not even talking stop, but to slow down the Russian advance to give themselves more time to hastily dig as the Western headlines have now been talking about what the Kiv regime needs to do to dig new trenches, to dig new fortifications. So they moved a large number of what air defense systems they had left elsewhere in the country into an area far too close to the battlefield. (10:32) And Russia at this point, not only of course, enjoys air superiority over the contact line, but they also enjoy drone superiority. And Russia has put a rather larger number of military satellites into the orbit in the last year, last few months that have started to come online. So they were able to track these air defense systems fairly well, and it's more than just three patriot launchers that have been destroyed. Also, one of the remaining older S 300 air defense systems, several NASS air defense systems supplied by the US and Norway, and also a number of books and smaller systems. By my count at least 11 air defense systems have been destroyed in the last two weeks over the area immediately to the west of F dca. And this is adding to the butcher's bill. Previously, the Kev regime has adopted a new tactic in several areas. (11:50) We saw it over the sea of, we saw it also in Belgo where that Ill 76 transport plane shut down the KI regime shut down its own plane full of prisoners of war A couple of months ago, if you remember forced to admit it, they've been sending in an attempt to try to stop the Russian dominance of the skies. They've tried to use essentially not mobile air defense systems in a mobile capacity to set up ambushes for Russian planes to instill a degree of caution and restraint. But that has proven very costly for them because they've also lost air defense systems in that way as well, because of course, Russia was actively hunting them down and despite their claims to have shut down large numbers of Russian aircraft, there is zero evidence providing this zero. I mean, and there have been plenty of evidence, for instance, of the Kev regime's own aircraft, remaining aircraft being shot down when they're shot down. (13:06) There is video footage, there is air wreckage and the like. So really questionable claims they may have sacrificed other than this, of course, the POW plane, which everyone noticed, but that was an undefended transport plane flying in what it assumed a mission of peace bringing POWs for an exchange. So they've lost a huge degree of whatever hodgepodge air defense they had left. Now, Forbes speaking just of the events in F dca, not of the rest of it, says that just in those engagements that the Kev regime lost 13% of its air defense capacity speaking specifically of the Patriot systems provided to it. And that's on paper because they're not acknowledging earlier patriot systems that have been shot down. So I would suggest that they have at this point lost far more. They probably have a number of patriot launchers in the single digits left in Kiev, for instance, possibly in Odessa. (14:22) But the implications of this going forward is that Russian use of air superiority and even now close air support over the contact line is going to dramatically increase because there is no air defense left to deal with them, which means the pace of Russian advances are going to increase. And this is when even Western analysts and Ukrainians are talking about rather large concentrations of Russian forces behind the lines that have been built up but not committed yet. And there is the suspicion that they're going to launch a large scale big arrow offensive sometime later this year. In fact, the Kiev regime has just in the past week evacuated the entirety of Harko region. Some 85 settlements ordered the civilian evacuation because they fear a big offensive in the harko direction in the coming probably months, perhaps weeks. Dr Leon (15:36): President Biden told us during his State of the Union address that Ukraine can stop Putin, Ukraine can stop Putin if we stand with Ukraine and provide the weapons that it needs to defend itself. That's all he says. In fact, there are no American soldiers at war in Ukraine. My question is, who's operating these US supplied Patriot air defense systems and are there US special forces trainers that are on the ground training these forces? Mark Sleboda (16:14): Okay, so first to the last point, Joe Biden is lying genocide. Joe is flat up lying and we know it because the Western mainstream media has told us already in the summer of 2022 in the New York Times and the Washington Post talking about unusually large numbers of US intelligence and US and European commandos on the ground in Ukraine. Then later we heard there were hundreds of uniformed US troops on the ground, again from the western mainstream media that were doing tracking of Western supplied weapons. Now, if that's really what they were doing, then they weren't doing a very good job because it was only weeks after that we heard that the West couldn't track these weapons at all. So I mean either they were completely incompetent or they are doing something else on the ground Dr Leon (17:15): On top of them. Wait a minute, are these also, aren't these the same stories that a lot of these weapons are showing up in other battles in other countries? Mark Sleboda (17:24): Yes. Yes. With the idea that a tithe essentially of Western weapons is being sold through corruption in the Ukrainian military and the distribution networks off because of the prevalent corruption in the country to pad their own pockets. And then I don't think there's anything question about that. The Western mainstream media has long reported about that. In fact, early on, CBS noted that some 70% of the weapons supplied by the west were not reading the front lines. This was early on in the conflict. So on top of those commandos, we now the Russian government has long complained that these high-tech systems supplied by the west from the US in particular the high Mars and multiple launch rocket systems in the Patriot air defense systems, as well as some French air defense systems, Polish crab artillery systems, British storm shadows, cruise missiles, that these are all being operated by western military specialists who are being sent there under the guise of mercenaries or humanitarian and aid workers and the like, because it is impossible to train the Kiev regime forces in such a short period of time to operate these advanced western systems. (19:09) The Russian government's been saying this for a considerable amount of time, but this was confirmed by no less a person than the German chancellor Olaf Schultz, who in an apparent spat back and forth with the French leader, Emmanuel Macron, and to the British as well, when the British were pressuring Germany to deliver the Taurus missiles, the context of Ola Schultz is we can't do what the British, the French, and the Americans are doing and have people obliquely. He admitted that the West had their military forces on the ground operating their systems and that Germany could not be seen as doing that. And this was reinforced in these leaked military calls from the German Air Force planning, a series of cruise missile attacks inside Russia with the expected to be delivered towards cruise missile system, at least expected by them. The political elites in Germany aren't saying that, but they also revealed that the German cruise missiles could perhaps be operated on the ground by the rather large number of Americans of people on the ground wearing civilian clothes with American accents, which of course is a roundabout way of saying US military personnel not in uniform on the ground in Ukraine. (20:58) So I mean, they just have to Dr Leon (20:59): Be curious from Kansas that are wandering the fields and the step of Germany and Russia and Ukraine. Mark Sleboda (21:07): Yeah, they're not wearing boots. They're wearing ballet slippers or figure skates or something, I guess. So that's a lie. Second of all, the Kim regime can defeat. Well, Ukraine can beat Putin, right? The childish way that western leaders and media try to demonize any opponent down to just one leader and so forth. But if that was true, if Western military aid in Ukrainian regime hands was enough to beat Russia, then what happened over their failed summer counter offensive that was armed trained, financed intelligence planned and war gamed out by nato, primarily US by the Pentagon, that's who did it. They failed. They failed badly. They were mauled. They never even got past the first of Russia's five echelon defensive lines and suffered horrible casualties in the process. No one denies that. So there is no indication that however additional tens of billions of dollars of aid are sent that the West will ever again able to build an offensive force like they did for Ukraine in the summer offensive because they simply don't have the weapons in inventory to replace everything like that. (22:50) They do have some things, they got plenty of Bradleys if they want. Obviously they're very reticent to allow the rather small number of Abrams that they've sent to be used in combat. Four of them have been destroyed after just appearing on the battlefield in the last week. But the rest of the Western militaries that supplied weapons, they're tapped out. France, Germany, Denmark, the United Kingdom, they've all said, we can't supply anymore because we've already dug past our stockpiles into our own military supplies and we can't replace these systems fast enough. For instance, one French Caesar self-propelled Howitzer, a total of 36 of these between France and Denmark were supplied to the Kiev regime for the course of that offensive. And they're practically through all of them, they have very few of them left because Russia's been hunting them down. And also they are subjected to considerable wear and tear, and they're not actually built for high intensity combat like this, much like the US' M triple sevens and the Paladins and the like. But it takes the French 18 months, the French military industrial complex, 18 months. 18 months Dr Leon (24:20): To Mark Sleboda (24:21): Build one Dr Leon (24:22): That's a year and a half Mark Sleboda (24:23): One Caesar. But we heard that they have shortened that time to 15 months. Oh Dr Leon (24:30): Wow. That makes me feel a whole lot better. You just mentioned the leaked recordings from the German Air Force, and is it a coincidence that after these conversations were leaked where the Germans were talking about taking out bridges in Russia with cruise missiles that Victoria Newland resigns because there are some who say that her name was mentioned in on these tapes and that the German Air Force officers were really talking about conversations either they had with her or ideas that she was presenting about these attacks inside Russia? Mark Sleboda (25:16): Yeah, there's a possibility there, and if that is the situation, then it appears that she was probably forced out by the Biden administration. But are I think there are other considerations in play. Victoria Newland, the Queen NeoCon of the us, she's married to Robert Kagan who is the arch NeoCon of the United States. Robert Kagan, his books, check them out if you're unfamiliar with his sinister work. I would say she has long dominated through several presidencies US policy towards Ukraine. She was instrumental in the actual Westpac, my Don pooch, if not the key architect of it. She was caught on recordings with then US Ambassador Jeffrey Piat, talking about how they needed to midwife this thing, bring then Obama's Vice President Joe Biden into midwife it picking the new Prime Minister of Ukraine, Arsen Ya from the leaders, the figurehead leaders of the Maidan, and then famously saying F, the when the idea that the Europeans might want someone else for Ukraine's next prime minister was presented. So I mean she's been instrumental and she briefly left office during the Trump administration and then came right back. She has been serving as under Secretary for political affairs, which despite the rather kafkaesque bureaucratic name is actually the third highest official within the US Department of War. I'm sorry, not the US Department of War, US Department of State. My bad. Dr Leon (27:23): I can understand the confusion. Mark Sleboda (27:24): I said the difference. Yeah, she a third highest official and she was actually operating as the second highest official just below the Secretary of State for about a half of year when Wendy Sherman, the previous Deputy Secretary of State stepped down. So she was doing the number two and number three job and it was widely expected that she would be permanently assigned to that position, a permanently elevated to Deputy Secretary of State. But we found out that just a month ago she was passed over for this position by Kirk Campbell. The Biden approved someone else, and Kirk Campbell is an Asia specialist. He's a specialist on China, which to my mind tells me that the Biden administration is tiring of this conflict in Ukraine and they're already looking past it despite the bad situation. Their proxy regime is in to China, which may indicate a planned change of policy or at least prioritization or at the very least an unwillingness to escalate further, I say may. Dr Leon (28:48): So does that mean then that the Biden administration is now following along the previous Obama administration's tilt towards Asia? Mark Sleboda (29:02): Yeah, that's entirely possible. I believe that's what the Biden administration always wanted to do. They wanted the Middle East to remain quiet and it was not a priority for them. That didn't go out down so well. Just a week before the October 7th, seventh launching of the all Axel flood operation by Hamas on Israel, Jake Sullivan was in an essay talking about how nice and quiet the Middle East was, which allowed the US to concentrate on other areas. Well, that didn't go so well then since then. But they wanted the Middle East to be quiet. They expected to finish off Russia quickly. They expected their sanctions to destroy the Russian economy, Putin to be overthrown, and because of the economic commiseration of the country Dr Leon (29:58): They wrong Mark Sleboda (30:00): And that they would now, their biggest concern would be dividing up Russia into smaller pieces and how to go about that. That appears to have been their plan. Okay, so not so good on the plan thing, but then they hoped they thought that would be finished quickly and then to pivot hard to China. I think that was always their plan to finish Russia off quickly, ignore the Middle East and pivot hard to China. And none of that, of course has gone according to plan. So with A and B having failed, they're trying to go to C anyway in very likely the months at this point that they have remaining to them. And I think that the passing over of Victoria Newland for that is a sign that the Biden administration is already lost interest, possibly due to inability to achieve their desired goals and is shifting to the next goals that they can't probably accomplish even more so I would say if they think that they're going to defeat China in some type of conflict off of their own coast in the Taiwan Straits and South China Sea. But anyway, I expect that Victoria Newland was extremely unhappy about being passed over. She was probably, she can see the bureaucratic writing on the wall that the prioritization is changing away from her reason for existence, which is fighting Russia. And I think that that probably at least as much if not more so played a role in her deciding to quit or being forced out. We don't know the real truth of that yet, although I imagine that she won't be able to keep her mouth shut forever on that score Dr Leon (31:51): Or her husband. So political reports that France finds Baltic allies in its spat with Germany over Ukraine troop deployment, that France is building up an alliance of countries to open potentially that are open to potentially sending Western troops to Ukraine. That Mark sounds to me like there's a lot of tension within nato. And going again back to President Biden State of the Union, he told us America is a founding member of nato, the Military Alliance of Democratic Nations, and that to prevent war, we've made NATO even stronger, which is the point that I was trying to get to about this element of his speech that we've made NATO even stronger, and now he also assigns or attributes Finland joining NATO as evidence of NATO's strength. It doesn't sound like, it doesn't sound like it's all good in Mark Sleboda (32:59): Yeah, I mean definitely. I mean, Hungary and Slovakia of course are the most egregious examples of this because they are completely against the proxy war now being fought on Russia in Ukraine completely. They won't have anything to do with it. But yeah, there are definitely, I think tensions and cracks emerging and a bit of a panicked blame game going on right now with different European countries all trying to blame each other saying You haven't done enough. And with Macron coming out now in the aftermath of the taking of a DKA coming out and openly talking about putting NATO troops on the ground, I think this is not something that is a secret, something that has not been discussed for, and something that contingency plans are not already in place to do in the future. They just aren't in a political situation to have it said out loud. Now, I think that's the real problem that Germany and other countries have. It's causing them, no one is ready to do it now, and the fact that it has been brought up now, they see as politically detrimental to them in their own countries Dr Leon (34:29): As in the farmers' protests in Germany, Mark Sleboda (34:32): Yeah, in Poland, yes, Poland. I mean there are protests across Europe, but also, yes, the fragile coalition government in Germany, the rise of the A FD, the alternative for Germany, the alternative for Deutsche Man, yeah, party in Germany. These are all blowback from the European involvement in the conflict in Ukraine, and they just did not need this. Now, I think Macron has pointed out two things. One is that levels of escalation in this conflict, red lines that we will not cross in terms of escalation have been passed again and again and again. I remember back in February and March of 2022 when Joe Biden saying that US tanks and jets us would never supply tanks and jets to Ukraine because that would mean World War iii, right? But US tanks are now burning in the urban agglomerations of the Donez region, and US F sixteens are supposedly on their way within the next couple of months to the Kiev regime. (35:55) So again and again, these lines have been crossed, and I believe this line will be crossed eventually, but not yet. The second point, and Macron pointed this out, what we once thought was unacceptable has become normal operations repeatedly during this conflict as they've crawled further up or down the escalation ladder, however you choose to look at it. And he also then made a point that when French troops might be sent into Ukraine, when Russian forces move on Kiev or Odessa, which is most likely some time away, probably more than a year, maybe longer than that. So yeah, I mean, right now fighting Russia has a lot of advantages on the battlefield, but big advances can still be measured in a handful of kilometers, a tree line, a small village. (37:04) The writing is on the wall in terms of the logistics of a war of attrition and everything, but I think there's still a lot of hard ground slogging into the future. Macron sees that as well, so they're panicking now. I think he's right that when Russia moves towards Kia or Odessa, there will be probably greater support for his suggestions, but we've already seen support from the Baltics. The Baltic leaders have come out and said, yes, we're ready to send the handful of troops that we have now, because if there's anything the Baltics country need is to come out on the losing end of this conflict, having sent their own troops to war with Russia and having a NATO either fall apart or turned into a toothless tiger as a result of this really, really bad geopolitical move to my mind. I mean, because they're of course the most vulnerable. (38:05) They've got large populations of Russian ethnic populations that they have been rather seriously politically and linguistically culturally repressing, particularly over the last two years, even trying to expel as many Russian ethnic people from their countries as they can, practically inviting some type of Russian backed efforts against those governments in the Baltics, really not a smart move, but also Poland has made the Polish foreign minister Sikorsky back again, by the way, has also seemed to suggest contrary to statements by the Polish president, that at some point down the line, Polish troops could be sent into Ukraine and also Canada. Trudeau has also volunteered Canadian troops as well in non-combat roles of course, because that's what you do with your military troops. You send them into a conflict zone Dr Leon (39:16): Very as non-combatants Mark Sleboda (39:19): Like trainers. First you have trainers and advisors, then you have non-combatants. We know the way this goes, so obviously there is already, and check the Czech president has also suggested he is a former NATO official himself, a very big hawk on Russia, and he has also hedged his words and seemed to suggest that Czech might be able to consider it. So these are countries who are already coming out and we're just past aca, which is really only about 12 kilometers away from Donis city, right? I mean, there's a lot more to come and the panic and desperation will increase, and I think Macron will definitely find more countries down the road when it becomes completely impossible to deny as it will become in the future, the writing on the wall that the regime cannot hold militarily. The New York Times has already talked about the possibility, and I think it's a very strong possibility of later this year cascading collapses along the Kiev regime's, defensive lines, not me, but the New York Times has raised that as is talking to anonymous western military intelligence analysts about the probable course of the Ukrainian battlefield over the next half a year. Dr Leon (40:51): We mentioned Sweden joining NATO and Finland has joined nato, and we know about the very strong and robust social programs that those countries have because they, up until this point, have had a position of neutrality in conflict, which means they haven't had to send the public resources over to a defense budget. Now that that seems to be changing, are we looking at Finland and Sweden as having to shift those resources? We now see more NeoCon policy as well as what we'll call austerity measures. Can we expect austerity measures to creep their way into social policy in Finland and in Sweden? Mark Sleboda (41:49): Yeah, inevitably, I think we've already seen it to a certain degree. They've already, of course, suffered heavy economic consequences from their own sanctions on Russia, probably more significant than have been experienced by the Russian economy. Finland in particular did a very good cross border business. I was on the Finnish Russian border just a year ago at kind of a wilderness vacation place on the border there, well, actually a couple of years ago before the conflict, but very nice, and it was normal to cross the border from Russia and Finland to go to the store, for instance. Someone had this better, someone had that better, and there was a great deal of cross border business that has immensely suffered as a result already hurting the finish economy. The Swedes have suffered the same thing, perhaps to a lesser degree without sharing an open border, but experienced it as well, and now, I mean they've exhausted a great deal. (42:58) Finland and Sweden have both provided outsized military resources to the Kiev regime already, and those resources like so much else, are largely gone. They're either up in smoke or filtered away in the Kiev regime's corruption, so on top of the Kiev regime, of course, loudly demanding more, more, they also have to replenish their own military stocks, and now they have to militarize their own borders, which were UNM militarized, particularly in the case of Finland, which has a very large border. It was demilitarized, it was not a militarized border. There was police presence, but it was not a militarized border that is now changing and of course, facing the prospect of Finland joining NATO and US forces on finished soil, Russia has reordered, completely changed military districting on the border there and provided tens of thousands of new troops to be placed on the border as having to potentially deal with US troops being stationed in Finland as defensive contingencies, Finland is going to bear an increased burden with military. I do not see how this makes them more secure than they were before. I mean, they weren't targeted with nuclear missiles, and now they will be. (44:36) I guess that is the price of joining the cool Western Kids Club in nato, which it seems that the Finnish political elite wanted more than not creating economic and military problems with their much larger southern neighbor. Dr Leon (44:57): I read a story recently that elite units of Ukrainian armed forces are discussing overthrowing zelensky. Is that a rumor? Any traction of that story there in Moscow and any insight into commanders and soldiers in elite units of the Ukrainian armed forces? They're dissatisfied with the reshuffling of the leadership and they're talking about ousting VMI Zelensky. Mark Sleboda (45:30): Yeah. When Zelensky got rid of zany, and let's be clear, this didn't happen because of his military failures on the battlefield. It was done for political reasons because he saw zany as a threat as possibly running for president himself for staging a military coup and the possibility there were plenty of signs that the US was actually for a time considering switching horses, which is why he forbade elections in Ukraine, citing the martial law emergency powers, and so that he didn't have to face zny in an election, which the polls say he would've lost because zany has more support in the country than he does now. He didn't only get rid of ny, he got rid of whole streams of top down to low level commanders who were seen as loyal to ny. There was a huge reshuffling or replacement of Ukrainian of the Kev regime's military leaders. As a result of this, there's a lot of embittered military people because of this. We don't need to look in secret telegram chat rooms to hear this discussion because Dr Leon (46:56): Regime, which is where this story was originally attributable, yeah, the Mark Sleboda (47:00): Story is sourced from here, but there have already been open public statements by Kiev regime, military commanders on the battlefield saying to the Ukrainian journalists, this is wrong. There was a list signed by hundreds of Ukrainian military commanders serving on the battlefield, a petition asking Zelensky to get rid of Ky, whom he chose to replace Zelensky, whom is known as the Dr Leon (47:38): Butcher, the butcher Mark Sleboda (47:40): By his own forces, not because of the opponents that he kills, but because of his careless attitude towards the lives of his own people. So they made an Dr Leon (47:54): That's not a good moniker. As a commander, you don't want your own forces seeing you in the light of butchering them. Mark Sleboda (48:04): Yeah, I mean, my military experience tells me that that would not be the type of military commander that I wanted. Certainly, and I seriously doubt that they do as well. Plus Sirki is actually ethnic Russian. He was born in Russia in the Soviet Union. His family still lives in Russia, and they're actually quite Russian patriotic, so it's a rather bizarre situation, and in many ways there's a lot of Dr Leon (48:30): Parallels. It makes for a tough Christmas dinner. Mark Sleboda (48:32): I don't think it makes for a Christmas dinner at all. I'm pretty sure, and there are definitely parallels with the US Civil War to be drawn there and with so many other families across Russia and Ukraine. But yeah, they've made demands of Zelensky public demands that they replace, that they bring back zany and get rid of ky, and of course that was ignored and large numbers of those commanders were replaced. But if they're discussing it openly and he's already taking this vengeful action against them, there's no great surprise that they are talking about it in what they believe to be secret chat rooms about taking it into their own hands. It's rather interesting, of course, that the Russian intelligence chose to make this public because if they have penetrated this chat room, you can be totally sure that the key regime's military intelligence, let's say Ka bov loyal to Zelinsky, has penetrated this as well, and by going public with it, Russia might be forcing Zelinsky hand to take action against these coup plotting, even if it's in the very nascent, we hate this guy, why can't we get rid of him? Stage of, shall we say, trash talk. It might be forcing Zelinsky hand to take action now, probably because Russia sees Zelensky and KY in charge of the key regime, political and military as far better for them than ny, whom was not a brilliant military commander, but perhaps not an entirely incompetent one either. Dr Leon (50:36): Switching gears, the cradle is reporting US proxies fear, Afghan style withdrawal from Syria. The Syrian democratic force is the SDF. They're fearing that their US patrons will abandon them in favor of closer ties with Turk, what's happening here with the US military, their Kurdish proxies occupying northeast Syria and fearing a Afghan like pullout. Is that a serious cause for concern? Mark Sleboda (51:13): I mean, that has been a serious cause for concern since 2016, right? The Kurds have been thrown different Kurds, but Kurds have been thrown under the bus by the US government after having been turned into proxies again and again by the United States in Iraq multiple times in Syria, previously against Turkey. Turkey Dr Leon (51:38): Going all the way back to HW Bush, Mark Sleboda (51:40): Yes, Dr Leon (51:42): Throwing the Kurds under the bus. Yes, Mark Sleboda (51:44): It's primary routine, which really amazes me that Kurds keep willing to be US proxies when they see the long history, not just of the US abandoning proxies like say in Afghanistan, but the US specifically abandoning Kurdish proxies before and abandoning these same Kurdish proxies. When Turkey advanced into northern Syria, they still, of course controlled northern Syria while the US illegally military occupies East Syria. They with just withdrew their forces and said, we're not going to defend you. Sorry. You should probably pull back or the Turks will wipe you up. I mean, that has already happened. The Turks regard the SDF as the YPG, the Syrian branch of the PKK, which is opposed to the Turkish government and fighting for the cause of a Kurdish ethnic nation state that would have to be carved out of parts of Turkey, Syria, Iraq, and perhaps Iran. They are the biggest ethnic people in the world that do not have a nation state. (52:55) And it was inevitable that at some point, if the US failed to overthrow the government in Damascus with their jihadi regime change, that they would at some point leave East Syria and they haven't done so yet. And despite the rumors to the contrary, I don't expect them to do so in the near future, but it is inevitable at some point is you can't maintain an open-ended occupation of a very large amount of territory forever, despite sitting on the Syrias valuable oil and wheat fields preventing the economic stabilization of the country seemingly out of spite geopolitical spite. If nothing else, you can't maintain this forever, especially with the increase in the number of attacks on US bases in Syria and Iraq from local resistance groups like Katai, Hezbollah who don't want the US occupying their countries, right, meaning Syria and Iraq. There's certainly a cost that has to be paid there, but the cost is still not extremely high, and Biden already being seen as responsible for the disastrous Vietnam style withdrawal from Afghanistan leading the Taliban to completely retake the country in rather embarrassing fashion. (54:40) He does not want to be seen the same role in Syria, I think certainly not in the next year. Perhaps if he wins reelection against all odds, then there might be a possibility in his next administration. But a word of warning, if we do see Biden moving troops out of Syria and Iraq, the reason would probably be that they intend to strike Iran and they're moving their forces out of the range of Iranian ballistic missiles that would target them if that happened. There's a history of us withdrawals preceding attacks elsewhere when the US pulled out of Afghanistan. We found out later from the US Secretary of State that withdrawing from Afghanistan allowed the US to provide the resources to the Kiev regime in Ukraine that they would not have been able to do otherwise. So it seems that they already had intentions towards that regard, so watch it. If Biden does pull out of Syria, it may not actually be good for the Syrians or for anyone else in the region. It might actually be a signal that the US intends to escalate towards Iran. Dr Leon (56:08): Is there a possibility in terms of signaling here that we look at, of course, Hamas in Gaza, Hezbollah is now talking about escalating in terms of coming through Lebanon. If this thing were to grow even more full, great even more bringing Iran in, you've got Ansar Allah in the game, does Syria get in the game as well? And so could the United States move out of Syria, be in preparation for a larger conflagration of that nature? Mark Sleboda (56:52): Yeah, I don't see that. First of all, I think the US and Iran are still doing everything possible to avoid direct conflict with each other, hence the stand down by Katai Hezbollah saying they wouldn't attack US military bases any further. And it is actually Israel who is talking about escalating against Hezbollah in Lebanon. I think the US and Iran are both doing everything they can to maintain their state's dignity and still dance around each other, avoiding direct conflict in the Middle East. That said, Israel is doing everything possible to incite conflict between the US and Iran, which makes that a non guarantee. But the Syrian government is in a very weak position economically. The US is still illegally occupying the entirety of the east of the country, including the country's oil and wheat resources. The country is, the government is unstable, it's economic, very hard times, and Turkey is still occupying the entirety of the north of the country, and they still have a hundred thousand jihadi under arms occupying those territories in northern Syria. And of course the US military occupation forces alongside the Kurdish YPG in East Syria. The Syrian government is in no geopolitical or military shape to contribute to a fight. I do not see this blowing up because no one wants to go to war with the US over Gaza. No one except for our sala. Dr Leon (58:45): Final question for you. The United States relative to Syria developing stronger ties with Toa, how can the US make Reproachment in this manner when Erdowan is so erratic and undependable? Mark Sleboda (59:05): Yeah, I don't think they can. Does Dr Leon (59:06): That make sense? Mark Sleboda (59:08): Yeah. I think Erdowan has become a perennial thorn in their side that they constantly need to keep appeased to prevent him from, shall we say, flipping into the bricks Eurasian camp, and Erdogan routinely plays the US and Russia off of each other to what he sees as his country's advantage. The US support of the Kurds in East Syria, of course, has infuriated him, as has the US withdrawal of the F 35 program from Turkey when Erdogan bought the S 400 Air defense system Dr Leon (59:50): From Russia, Mark Sleboda (59:51): Yes, from Russia, he also regards the US as at least being, if not complicit, then at least having knowledge of the coup attempt against him several years ago. Very bad relations there. The US cannot rely on Turkey and Turkey. Well, it sees itself as being betrayed by the United States. I don't see any ability to improve relations between the two until there is regime change perhaps in the United States, but more than likely it will require Erdogan passing on one way or another for a substantial change in Turkish US relations. Dr Leon (01:00:37): I know I said that was my last question, but this is my last question. Since you mentioned the coup in Turk a few years ago, Golan is still, I believe, somewhere in Pennsylvania at a property in Pennsylvania. Are you surprised that he has not been turned over to Turk as a way of appeasing erdowan, and do you think that Golan can be fairly confident that he's not going to be turned over as a fig leaf for better relations? Mark Sleboda (01:01:16): Yeah, I think the US constantly sees him as a bit of leverage. The US likes to keep shadow governments in place for just about every country in the world. Somewhere in the United States, leaders forces Dr Leon (01:01:30): The Shah's Sun is still roaming around Northern Mark Sleboda (01:01:32): Virginia. The Shah's son, Joe Biden just declared Yulia Navalny and then Yolanda, whoever she is, to be the new leader of the Russian opposition. You've got Juan Gau still out there. This is actually absolutely normal. There are entire communities outside Langley that are just exist of us backed shadow governments ready, waiting to be installed in foreign countries. But I have to say that I don't actually think the Golan movement had anything to do with the coup against Erdogan that occurred several years ago. This was almost entirely, once again, a military attempt to restore a kaist state in Turkey against Erdogan's Islamism. It was just sprung early by the Turkish government under what it believed to be controlled conditions, and then rather than admitting a secular Islamist divide in the country, they simply blamed it on a convenience scapegoat, which was the ING gong. I don't think that he actually had anything to do with that QI think that's just a rather vocal if unconvincing bit of Turkish propaganda that everyone has just played along with. So as not to anger Erdogan. In fact, the Russian president when asked about it a couple of years ago, when asked about their responsibility for the coup, his comments were pretty much to the point of if Erdogan says that's what happened, who am I to say otherwise? Dr Leon (01:03:26): Mark Sloboda, man, thank you so much. I always appreciate you carving out the time for me and for the show that you do. Mark Shada, really appreciate you joining me today. Mark Sleboda (01:03:38): Thanks for having me. Dr Leon (01:03:40): And folks, thank you all so much for listening to the Connecting the Dots podcast with me, Dr. Wiler Leon. Stay tuned for new episodes every week. Also, please, please follow and subscribe, leave a review, share the show. We're growing tremendously, but we can only grow as you allow us to follow us on social media. You can find all the links below in the show description. And remember, folks, that this is where the analysis of politics, culture, and history converge because talk without analysis is just chatter, and we do not chatter on connecting the dots. See you again next time. Until then, I'm Dr. Wier Leon. Have a great one. Peace. We're out Announcer (01:04:31):  

Moataz Hisham is a full-time engineer, part-time fitness coach and unofficial diabetes superhero for young people with type 1 diabetes in Egypt. Childhood in Alexandria was interrupted when Moataz was diagnosed with type 1 in 1997 at the age of 11, but his pharmacist parents quickly helped him to adapt to not only the physical challenges of type 1 diabetes, but the psychological difficulties too.Despite this incredible support and unwavering inner resilience, Moataz spent years hiding his type 1 from his friends due to misconceptions he faced from his peers. It would take until 2018 and a DKA experience for him to reach the final acceptance stage of what he calls ‘The 5 Phases of Diabetes'. Throwing himself into research, education and Crossfit, Moataz found new strength to open up about his condition. Using just his phone, he launched an online format called ‘Diabetips' from his son's bedroom in 2022 to share some of this wisdom. But in a very short amount of time, the platform evolved far beyond that bedroom. ‘Diabetetips Talks' is now a professional studio production in which Moataz interviews young people with type 1 diabetes to make sure children living with the condition can see themselves reflected, showcasing what he describes as ‘the unbreakable human spirit of young people living the diabetes journey'. This is such an interesting and inspiring episode. Moataz lights up when he talks about sharing stories with young people, empowering children with type 1 diabetes AND their parents to understand that ‘we are different, not less.' CONNECT WITH MOATAZCheck out Diabetips Talks on YouTube.Say hi to Moataz on Instagram.JOIN THE TYPE 1 ON 1 COMMUNITYWe've got an Instagram account! Come and say hi @studiotype1on1. SPONSOR MESSAGE:Thanks to my episode sponsors Insulet, the founders of Pod Therapy - only found with Omnipod.    Pod Therapy uses a tubeless, wearable and waterproof Pod that continuously delivers insulin for up to three days. Controlled wirelessly by its handheld companion, it allows you to personalise your insulin doses according to your own daily needs - no multiple daily injections and no tubes. Head to https://www.omnipod.com/ to find out more.

In this podcast, Dr Charlie Brower PGY-3 at the University of Cincinnati leads a discussion of a recent journal club article looking at the impact of a subcutaneous insulin treatment pathway for mild and moderate DKA. We explore the financial and operational impacts of this pathway as compared to traditional treatment with IV insulin

Contributor: Ricky Dhaliwal, MD Educational Pearls: What are DKA and HHS? DKA (Diabetic Ketoacidosis) and HHS (Hyperosmolar Hyperglycemic State) are both acute hyperglycemic states. DKA More common in type 1 diabetes. Triggered by decreased circulating insulin. The body needs energy but cannot use glucose because it can't get it into the cells. This leads to increased metabolism of free fatty acids and the increased production of ketones. The buildup of ketones causes acidosis. The kidneys attempt to compensate for the acidosis by increasing diuresis. These patients present as dry and altered, with sweet-smelling breath and Kussmaul (fast and deep) respirations. HSS More common in type 2 diabetes. In this condition there is still enough circulating insulin to avoid the breakdown of fats for energy but not enough insulin to prevent hyperglycemia. Serum glucose levels are very high – around 600 to 1200 mg/dl. Also presents similarly to DKA with the patient being dry and altered. Important labs to monitor Serum glucose Potassium Phosphorus Magnesium Anion gap (Na - Cl - HCO3) Renal function (Creatinine and BUN) ABG/VBG for pH Urinalysis and urine ketones by dipstick Treatment Identify the cause, i.e. Has the patient stopped taking their insulin? Aggressive hydration with isotonic fluids. Normal Saline (NS) vs Lactated Ringers (LR)? LR might resolve the DKA/HHS faster with less risk of hypernatremia. Should you bolus with insulin? No, just start a drip. 0.1-0.14 units per kg of insulin. Make sure you have your potassium back before starting insulin as the insulin can shift the potassium into the cells and lead to dangerous hypokalemia. Should you treat hyponatremia? Make sure to correct for hyperglycemia before treating. This artificially depresses the sodium. Should you give bicarb? Replace if the pH < 6.9. Otherwise, it won't do anything to help. Don't intubate, if the patient is breathing fast it is because they are compensating for their acidosis. References Andrade-Castellanos, C. A., Colunga-Lozano, L. E., Delgado-Figueroa, N., & Gonzalez-Padilla, D. A. (2016). Subcutaneous rapid-acting insulin analogues for diabetic ketoacidosis. The Cochrane database of systematic reviews, 2016(1), CD011281. https://doi.org/10.1002/14651858.CD011281.pub2 Chaithongdi, N., Subauste, J. S., Koch, C. A., & Geraci, S. A. (2011). Diagnosis and management of hyperglycemic emergencies. Hormones (Athens, Greece), 10(4), 250–260. https://doi.org/10.14310/horm.2002.1316 Dhatariya, K. K., Glaser, N. S., Codner, E., & Umpierrez, G. E. (2020). Diabetic ketoacidosis. Nature reviews. Disease primers, 6(1), 40. https://doi.org/10.1038/s41572-020-0165-1 Duhon, B., Attridge, R. L., Franco-Martinez, A. C., Maxwell, P. R., & Hughes, D. W. (2013). Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. The Annals of pharmacotherapy, 47(7-8), 970–975. https://doi.org/10.1345/aph.1S014 Modi, A., Agrawal, A., & Morgan, F. (2017). Euglycemic Diabetic Ketoacidosis: A Review. Current diabetes reviews, 13(3), 315–321. https://doi.org/10.2174/1573399812666160421121307 Self, W. H., Evans, C. S., Jenkins, C. A., Brown, R. M., Casey, J. D., Collins, S. P., Coston, T. D., Felbinger, M., Flemmons, L. N., Hellervik, S. M., Lindsell, C. J., Liu, D., McCoin, N. S., Niswender, K. D., Slovis, C. M., Stollings, J. L., Wang, L., Rice, T. W., Semler, M. W., & Pragmatic Critical Care Research Group (2020). Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis: A Subgroup Analysis of Cluster Randomized Clinical Trials. JAMA network open, 3(11), e2024596. https://doi.org/10.1001/jamanetworkopen.2020.24596 Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII

In this episode, Stephanie and Suzanne discuss DKA pathophysiology, causes, signs and symptoms, diagnosis, and management.  The critical care management aspects outlined include:1.  Replace fluids2. Supply insulin3. Replace potassium4. Supply glucose

Driving Pediatric Innovations: From Clinical Practice to Technological TransformationsDr. Rogu and Dr. Bravo dive deep into an engaging conversation with Dr. Dan Feiten, who shares his unique journey from being a disc jockey to the Medical Director of a large tech company. Dr. Feiten, who has three sons with Type 1 Diabetes, emphasizes the urgency to enhance pediatric healthcare delivery, particularly for conditions like Type 1 Diabetes. He highlights the modern tools and technology like RemedyConnect, which he helped develop to assist pediatric care. The theme of the conversation emphasizes the importance of innovation, education, and collaboration in the field of pediatric healthcare.ASK THE EXPERTS at The Barbara Davis Center for Diabetes THE 59TH ANNUAL PEDIATRIC POSTGRADUATE COURSE- NICKLAUS CHILDREN HOSPITALOFFICE PRACTICUM 00:00 Introduction to Pediatric Executive Development System (PEDS)00:33 Starting the Podcast and Introducing the Guest01:55 Dr. Dan Feiten's Journey from Disc Jockey to Medical Director05:31 Experiences with Mother Teresa and Decision to Pursue Medicine10:11 Establishing Greenwood Pediatrics15:13 Discussion on Private Equity in Healthcare19:33 Personal Experience with Type 1 Diabetes in Family25:17 Autoimmune Screening in Kids (ASK) Study29:25 Discussing the Challenges and Rewards of Diabetes Screening30:58 The Role of Research Centers in Diabetes Management31:31 The Emotional Impact of Chronic Illness Diagnosis32:07 The Flaws of American Healthcare Financing32:46 The Future of Disease Treatment and Prevention33:43 The Importance of Early Detection in Autoimmune Diabetes34:33 The Dangers of Diabetic Ketoacidosis (DKA)35:27 The Decline of Pediatric Care in Hospitals35:57 Introducing the Pediatric Executive Development System (PEDS)37:07 The Health Equity Problem in Diabetes Care37:37 The Long-Term Effects of DKA on Children41:54 The Power of Population Health in Managing Diabetes42:28 The Journey of RemedyConnect45:11 The Importance of SEO and EAT in Digital Marketing50:57 The Role of Office Practicum in Independent Practices54:22 The Potential of Pediatric-Specific Networks56:37 The Future of Independent Practices and Supergroups01:01:01 The Importance of Preventing DKA in Children01:01:41 Closing Remarks and Upcoming EventsSupport the show

In this episode we chat with an alum of Keeping it 100, Morgan, who opens up about her experiences living with type 1 diabetes. From her initial diagnosis at age 10 and the subsequent feelings of confusion to her struggles in adulthood, she offers a raw insight into living with the condition. Our conversation includes her unsettling journey of experimenting with a health guru's advice, ultimately leading her to DKA. Since then, Morgan has embraced an empowered lifestyle, working on both physical and emotional aspects of her health, and acknowledging the role her condition plays in her life. She emphasizes the importance of setting small, achievable health goals, being compassionate with herself, and seeking aid when required, marking her conversation as a must-listen for those living with or seeking insights on type 1 diabetes. SHOW NOTES: 00:00 Introduction and Welcome 00:45 Guest Introduction: Morgan Cornelius 02:12 Morgan's Journey with Diabetes 06:27 Impact of Diabetes on Social Life 09:44 Morgan's Struggle with Diabetes Management 16:25 Rebuilding Health and Wellness 25:19 The Power of Community and Support 30:36 Morgan's Current Life and Management 34:01 Final Thoughts and Advice Resources for this episode: Take our free quiz: http://needlesandspoons.com/quiz-optin Join us inside the Keeping it 100 Diabetes Coaching Experience: https://bit.ly/3E5TX5W Grab the Keeping it 100 Diabetes Journal: https://www.amazon.com/dp/B0BB5ZL6R8?ref_=pe_3052080_397514860 Check out our blog: https://bit.ly/3AkABcm Follow us on Instagram: https://bit.ly/3hMqhU9 Check out our free resource hub: https://bit.ly/3tF2tnC Try Skin Grip and use the code "LISSIE" at try.skingrip.com/podcast⁠ Check out our favorite products: https://www.amazon.com/shop/needlesandspoons_?ref=ac_inf_tb_vh *Disclaimer: Nothing inside of Keeping it 100 Radio or our resources is intended as medical advice. Always consult a physician before making changes to your insulin doses, diet or general wellness.

We're talking about raising kids with type 1, the journey to diabetes independence, and educating around the use of emergency glucagon. We're bringing you a panel discussion from Moms' Night Out Frisco! We have terrific speakers at our Moms' Night Out events but we also have some panel discussions. This time around it's Stacey and Cami DiRoberto. Cami's daughter, Maci, was diagnosed with type 1 at age 7 in 2017. She and turned 13 just after our conference back in October. Couple of quick housekeeping notes: this was presented and recorded as a hybrid Zoom and in person presentation – Cami broke her arm and was unable to attend in person. Her audio is fine, but Stacey's recorded through the computer mic and isn't up to our usual standards. We're providing the transcript below. Cami is a Gvoke ambassador and this panel was sponsored by Xeris Pharmaceuticals, the company that makes Gvoke. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Note: Gvoke is a prescription injection for the treatment of very low blood sugar in adults and kids with diabetes ages 2 and above. Do not use if you have a specific type of adrenal or pancreatic tumor, starvation, chronic low blood sugar, or allergy to GVOKE. High blood pressure, hypoglycemia, and serious skin rash can occur. Call your doctor or get medical help right away of you have a serious allergic reaction including rash, difficulty breathing, or low blood pressure. Visit www.gvokeglucagon.com/risk for more information. Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Take Control with Afrezza  Omnipod - Simplify Life Learn about Dexcom  Edgepark Medical Supplies Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode transcription:  Stacey Simms  0:05 This is Diabetes Connections with Stacey Simms. This week talking about raising kids with type one, the journey to diabetes independence and educating around the use of emergency glucagon. I'm bringing you a panel discussion from moms Night Out Frisco. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Welcome to another week of the show. You know, we aim to educate and inspire about diabetes with a focus on people who use insulin. I'm your host, Stacey Simms and my son was diagnosed with type 117 years ago this week right before he turned to he's almost 19 years old. He's a freshman in college and he's far from perfect. I'm far from perfect but cannot believe how far we have come at our moms night out events. We always have terrific speakers. Coming up for our Charlotte event. In February we have Sarah Stewart Holland. She is the co host of pantsuit politics, and her son was diagnosed really not too long ago. She went through that very publicly, and just going to be sharing her story. Our other speaker is Madison Carter. She is a local TV news anchor who lives with type one herself. But we also have some panel discussions at these events. This time around you're going to hear me and Cami de Roberto hammies daughter Macy was diagnosed with type one at age seven in 2017. She had her birthday just after our conference, which was back in October a couple of quick housekeeping notes. This was presented and recorded as a hybrid zoom and in person presentation, kami broke her arm and was unable to attend in person. Her audio is great, but mine recorded through the zoom. And it is pretty rough. My amazing editor John has worked his magic the best that he can. But I'll be honest with you my side of the conversation is not up to what I think our usual standards are around here. I will tell you though, I'm putting a transcription in with this episode. Wherever you're listening, you should be able to scroll down on the podcast app and see and read what you're listening to. If there's any confusion about my side of the conversation, you can always head over to diabetes connections.com and click on the episode homepage to read it as well. Also, Cami is a Gvoke ambassador and this panel was sponsored by Xeris pharmaceuticals, the company that makes Gvoke you know I like my full disclosures around here. But they made this really easy. This is a genuine Parent to Parent conversation. And it's mostly about independence. You know how you get from a kid who's totally dependent on you to a young adult that you you can send off on their own. And one more thing about mom's night out the early bird special for our next event in Charlotte has ended but I'm gonna give you a promo code right here just use m n o mom's night out m n o 30 to save $30 off Charlotte registration. Alright, that is a long enough introduction. The panel is up next and since I just told you about CAMI I took out the introduction that I gave at the event and the big lead up so we're going to just jump directly in right after this important message. Gvokeis a prescription injection for the treatment of very low blood sugar in adults and kids with diabetes ages two and above. Do not use if you have a specific type of adrenal or pancreatic tumor starvation, chronic low blood sugar or allergy to Gvoke High Blood Pressure hypoglycemia and serious skin rash can occur. Call your doctor or get medical help right away. If you have a serious allergic reaction, including rash, difficulty breathing or low blood pressure visit Gvokeglucagon.com/risk. For more information. I think everybody has heard my family's diagnosis story. My son was going to the strip before he turned to one can tell us a little bit about Macy's diagnosis.   Cami  4:01 Yeah, so Macy was diagnosed in second grade. It was the tail end of her second grade year. I'm sure like many of you, I was completely ignorant about type 1 diabetes. I knew there was a type one I knew there was type two, I really didn't know the difference. I knew one kind of struck children, but I was completely ignorant. So it was like the last week of her second grade year at school and we had just moved back to California from Arizona actually. So we were kind of transitioning and all in all areas of life. And she had three bedwetting accidents in a matter of three weeks. First time she was at my mom's house, like having a little sleepover with me. And my mom called me the next morning and I called and checked in. Hey, how was everything? You guys have fun last night? She said yeah. She said we're just we're cleaning up to today. Macy had a little accident and I was like, well that's really weird. She hasn't done that in years. But that's so weird because it's not totally outside of the norm for a seven year old little girl you know it could happen so that was weird, but a week later happened again and I was like, Okay, are we drinking too much water before we go to bed? What's happening? Let's let's really so I started to pay more attention happened one more time a week later on, I was like, something's wrong. The red flags, you know, we're going off. And so it was a party it was because it was the last week of school. It was a party at school. And I woke her up and saw that she had had an accident and it kind of laid some towels down and changed your sheets. And I said, Oh, honey, I said, You had another accident. I said, I think we probably need to get in and see a doctor now. I said, Do you feel okay, you know, in my mind, I was hoping like bladder infection or something like that. But somewhere in the depths of my mother's instinct, diabetes flashed across my brain. And i i To this day, I don't know why. So I was sort of praying that it wasn't gonna be that, but I didn't really even know why I was thinking that it was all very blurry and confusing. But she said she felt fine. She wanted to go to school. So I said, okay, and I made an appointment with her pediatrician that afternoon. So I picked all three of my kids up from school that afternoon, and the four of us had at the end of the pediatrics office, and she checked it out and you know, took her vitals and sort of a physical exam. And she said, I think she'll show your daughter fine. She said, I think she's growing. It's hot outside, you know, but she's fine. And I said, Okay, I said, we'll upgrade nose and I said, Can you just indulge me? And could you check for diabetes. And I swear to you, I still don't know why I felt so convicted to request that. But I did. And she did sort of begrudgingly. And our blood sugar came back at 323. I'll never forget time kind of stopped in that moment. Doctor came back after the nurse came in and prick Macy's finger, you know, she left when three, the four of us were playing I Spy in the room. And like 1015 minutes later, so kind of like now that I look back and inordinately long time, the doctor kind of knocked on the door and up and said, Hey, Mom, can you come out in the hallway for a second? So I walked out. And she had the landline kind of cradled her shoulder and she she was clearly on hold when she said I am so sorry, I don't really know how to tell you this. But you're right, your your daughter has diabetes, and you're going to be heading to the hospital for a couple days. And you know, here's my office, if you want to make arrangements for your other kids, and just the world just kind of stops for a second. And in that moment, I didn't even know what I didn't know. I mean, I'm sure many of you can share that sentiment. It's just confusing. You don't even really know what you're about to deal with. But that was how she was diagnosed. And then off we went to children's Fortunately, she was, you know, we avoided DKA, which I'm so grateful for, like I said her blood sugar was 323. So they actually sent us home and called us when a bed was ready for her. So we were able to go home and pack a bag and kind of try to be positive and find some sanity for us. But also,   Stacey Simms  7:34 we were so lucky, our pediatrician, I called them similar symptoms. And she said, You have never seen diabetes, can anybody under the age of two to provide your program and so we can move on out. And we had such a incredible start to the families today because of that very smart pediatrician didn't let it get to be a routine thing. Can you talk a little bit of you mentioned your other children. This could be a whole separate discussion unto itself. But to talk about the impact to your to your family,   Cami  8:03 if you can believe this, at the time she was diagnosed, we were literally living through a kitchen remodel, my whole dining room was set up I had like a hot plate and we had moved our refrigerator was like an all the way by the front door. Our house was an absolute disaster. And of course, we needed to figure out our new sort of diet plan as well after all this. So kitchen remodel and type 1 diabetes diagnosis were not ideal at the same time. So my husband Tori and I were in the hospital for two nights. And fortunately, we have a big family here. And so we had my sisters in law and my brothers and I mean, we had all kinds of family that came and stayed with my kids. But those first nine to 12 months were really particularly rough on Macy's, little sister Emma, they're they're really close in age, but 14 months apart. I think it's so confusing. She was six at the time. And I think she was terrified. And so much attention goes to managing it's in those early weeks, months, gosh, even the first year who you're still trying to figure out what your cadence for management is, you know, how often are you going to prick your finger and where and when and how do you leave the house and make sure you have everything that you need. I mean, there's so much it's like everything else stops and all you can do is focus on how to make sure this child of yours stay safe. And so I think there there definitely was an impact on my two younger children because all the focus was on me so we worked really hard on my husband and I like taking turns to like take the other two and do kind of go do special things and get them out of the house. But that was tricky for a while. That was definitely tricky, but we encouraged my other two kids to like prick their fingers and hey, let's all check our blood sugar. So we did a lot of that in the first couple months, which was kind of fun. My Anna Macy sister was not not a fan of the prep but my son was like all about it. He was doing it to my sister so that was super cute.   Stacey Simms  9:53 It is hard it still works to this day. I don't want to seem genuine so like self promotion machine like I did talk to my daughter went off tests. It is one of my favorite episodes. It was just last year. It's part of the sequence and it's okay to acknowledge that what helped me was just really honest. Aisha Nina, she's 22 She is really got an interesting perspective. It's been a while to see she was fine with me was diagnosed and she's very honest. And she still has some hard feelings about it. But she's an adult to, to acknowledge why it was the way it was. And she's also it was a lot of fun to talk about that damn Calgary, Kimball. Because my son was diagnosed who for the first time all that disrupted Alright, so I'm gonna ask him, I'm gonna put my own two cents in real quick. So we're gonna talk about that what was going through your head when Macy was diagnosed? Right and talking about your concerns and views for the future? Here's how. I don't want to say dumb. Here's what I didn't know about diabetes. So my little 23 months old. My first question for the endocrinologist was, don't I have to be shuffling his feet and put his toenails differently? I was like   something is like, okay, no, it's got to be like that. I mean, we're talking about bigger fears. But you know, that's where I started out.   Cami  11:27 Yeah, I'm not too far off. My first question was, was she going to have to like wear on her body because I didn't want her tiny little frail body like Mark with devices. I was like, am I Heartland my, my mind went immediately, like pacemaker I'm like, can we get this stuff inside, so we don't have to, like be visible about the so my first little vanity, which is a concern, you know, I didn't want her to have to wear stuff. And they were like, now there's, there's no pacemaker type machine. That's gonna. I mean, it's amazing how quickly I got past that. I mean, we were we had we used to call it a power packs. And so you know, the more visible we could be the better. So we got past that. And thankfully, I think we might even touch on this a little later. But she's super open about her devices. And when people ask her and said that, so that was great. But yeah, my initial thought was, oh, my God, oh, my gosh, and and it really wasn't until I got home, Stacy that I realized the 24/7 hour nature just and actually, I remember, I think it was day two, and we were on lunch of day two. So we had checked in like late afternoon on I think, a Thursday. And so we had dinner at the hospital. And then we had breakfast at the hospital. And so we were working on lunch at the hospitals for our third meal. And the nurse comes in and says, okay, so it's time to, you know, let's do our carb counts and let dial up our insulin, we know what our ratio is. And we were like, Yeah, we got this and I looked at when I went, hey, just to like, be clear, I go, we're not this isn't like, Bro. This is like, like, while we're in LA, oh, we're gonna, this is gonna level out. We're not gonna have to do this all the time. Right? And she was like, yeah, no, this is basically, this is how we have to do meals. Wow. So that was a moment to   Stacey Simms  13:05 Yeah, we're here in order to talk about dealing with loans preparing for loans. Do you remember when you realize, because when you and I were talking, I'm gonna ask you to some of these things I have the answer to so Don't be coy. I didn't think about this for a while but used to think about this in the hospital already. When they started applying with us. Right. It   Cami  13:24 was discharged day. And it was our last meeting with the diabetes educators who were fabulous. By the way. They were wonderful contents. Yeah, it was our last day. And so we like our final meeting. And you know, Macy stayed in a row and just touring and I went into the diabetes education room. And they kind of did like an overview. And then they said, Okay, and there's, you know, there's one more thing that we need to make sure we go over with you. And that's, you know, what we call severe lows, and they pulled out the red glucagon emergency kit. And they said, You know, sometimes you can have too much insulin or too much activity. And, and it doesn't happen very often. But, you know, sometimes it can happen, and you need to be prepared to use this kit. And I was like, what? Can you pause for a moment? And let's just rewind a minute. What do you mean, and that was a massive moment in time where I realized, so this medicine that you're telling us, we have to give her, and we have to decide how much to give her to keep her alive, if we give too much, could also be fatal. And, boy, that was a poignant moment. And I'm sure one we could all share and pause on because that is the reality. But yes, that was when we left the hospital and I was absolutely terrified, terrified about severe lows.   Stacey Simms  14:42 I want to just get to the other question before the one in terms of like, do you have those fears, but you you still want him to lose their life? You still want them to be independent? I mean, your seven year old so you're going to immediately send her off to be super independent. But how did you Once the engine, you know, I hesitate to see how did you get the cast that but how did you move forward with that?   Cami  15:05 It was difficult, um, you know, that was sort of the age, you know. So we're now heading into third grade and I remember I had this like special lunchbox for her that whenever she ever we would leave the house, we go anywhere and had all of our staff had had her with an emergency kit and had her sugar it had her testing all the stuff. We all we all have that. And I remember there were a couple of times where Macy got invited to have playdates at some friends house. And again, we kind of knew what the school kind of knew newly back in California, so I didn't know everyone yet. And she had a couple playdates. And so I sent mom would text me and say, Hey, Mom, you know, so and so wants to know if Macy can come over after school and play. And so I would respond and say, yes, she would love to however, I just need to make sure you understand BCS type 1 diabetes, and this can mean this and you know, she's, she's on it, but I really need you to just have your phone with you all the time. And I will tell you, it was challenging because we didn't get a lot of repeat invites. And then and then I would go over how to use that glucagon emergency kit, because I was scared. I mean, what if, what if they're out jumping on a trampoline? And God forbid, that's her first low. I mean, so I felt like, I had to do that. But it was really tough because I didn't want to and I think her social life. So you know, then I I tried to include an invite over to our house. So I did you know, slumber parties. That was a whole nother chapter to get through. But we did them in our house. You know, we didn't have in our house for a long time. But as long as I had a willing person on the other end, I allowed me to go do those things. As long as I had a mom or a trusted, you know, dad or trusted caregiver. On the other end, I really tried to give her that opportunity to go and be away from me. Like frankly,   Stacey Simms  16:38 it was interesting. He was a two year old, my son. We taught him some things. And I know we're gonna talk about that a little bit later. But did you start teaching Macy to do her own care with like with supervision, pretty much   Cami  16:51 immediately, immediately. I have videos of her coming home, like five days after the hospital and going okay, here's Macy, she's gonna give herself her insulin injection, and I'm videoing her and she's smiling on the couch. And so immediately, I mean, we really, and I don't know why I certainly could not have possibly had the foresight to know that that was important at the moment. I don't know why we did that. But I'm glad we did. I mean, Stacy for you. I mean, he was so young. How, at what age? Did you start giving him independence? Or or? Yes.   Stacey Simms  17:25 Everybody curates differently.   Unknown Speaker  17:27 I noticed, you know, I   Stacey Simms  17:28 jokingly call myself the world's worst diabetes mom, but slight. And I, we always wanted to raise our kids to leave home. And if it's about them, and you know, everybody, everybody's different. But when he when we both worked full time, so my kids were both in daycare, and we're, we're the luckiest people, I think when it comes to the type one things that happen. And so when I brought him back to daycare, the manager was like, oh, yeah, I used to be a minute, I can get injections. And I was like, Can you sleep here because I don't want to give you the money. And then go, actually, the whole team here started learning how to do it. And once he got an Insulet, on six months later, everybody was like, Yeah, I'll check that out, you know, and two of the ladies there became nursing students, not because of him, but like he was just cool. He didn't have a desk calm because this was 2006. He didn't get a desk until he was nine. And so we decided that when he was going into kindergarten, which honestly was one of the most terrifying things for me, like that was a hard, hard transition. Because we've had it so good at daycare, we told preschoolers, as we called that, like, hey, we want Benny to know how to check his blood glucose and muses, champions to kindergarten. And so we're going to teach him that at home. And can you help us out a daycare? And if your kids have ever been in daycare, like that's where they are independent, they come home, they would do anything for being going to calculus and the dude helping us a four steps. So let's do one. He talked to him, like, boys took their own leadership when kindergarten things like demonstrated I was able to do it so that once you could do that, and he always knew, officially, I have to show my there was always a responsible adult, he wasn't just doing that. So that helped us because in our neighborhood, first grade is when people start going playdates pretty much by themselves. And so we would line up, no Dexcom. But people have to call me and be like, Here's what a meeting person and I'm going to be helping from the dose and I want everybody in my neighborhood a person, which is really fun. And that's what I believe is really good friends with London because we get the case. Every evening on the counter for the kids, I don't know it's like after school.   I could go on and my answer to that question is very gradually, every year he did something else that is more leading more and more towards independence. Was the blood sugar perfect? Absolutely not. But that's the trade off I think sometimes. Alright, so we come back to our stuff we're talking about. Do you have any lessons you learned that can help other moms with, you know, similar aged kids just starting out?   Cami  20:14 I think probably, and again, not not because I did this, because I knew what I was doing. But as it turns out, we gave me see the confidence or Macey develop the confidence to be really open about her diabetes. Um, there's actually an influencer, who she's now a PA, some of you may follow her. But she's, she's a PA, she has type 1 diabetes, and she just had chant twins a couple years ago. But anyway, she did this whole post online, maybe three years ago, something like that, about the importance of teaching your kids to be confident about this, and to talk about it enough to be embarrassed about it. Don't go into the corner and trick your finger. Don't try to hide all your stuff. Because what she found she was talking about her own experience when she was younger, she said, there was so much curiosity among kids about what you know what, what is going on? What are you doing over there? And why are you freaking out? You know what's happening? And she said, When I tried to hide it, that's when people really got curious. And it became kind of this big thing. And she said, as soon as I was like, Oh, I'm pricking my finger, because I have type 1 diabetes, and I just need to know my blood sugar. They were like, oh, okay, no big deal. And when she said that, it resonated with me, because I feel like we did that, again, by the grace of God, not because we knew what we were doing. But, you know, we really encouraged me see, to talk about it. And to educate people, I said, you know, you have this for better or for worse. And it's kind of your responsibility to talk about it and to educate and to kind of be an ambassador for this. And if you see someone else who has come on, welcome and introduce yourself and say, Hey, like, like your next column. And so to be open about it, and to embrace it, I really think it's helped or to just be confident and to accept it. And I, you know, it's easy for me to say, because my daughter was seven at the time, I think if you have a diagnosis, when you're you know, on stage, it may be for you to a little bit like that, if you have a diagnosis with a 16 year old boy, man, I think that would be really, really challenging, because you just might not have that same response from him or, you know, 15 year old girl. So I think that's difficult, but to the extent possible, I really think that's invaluable. Probably one of the most valuable components of Macy's type 1 diabetes life is that she's not embarrassed about it. It is what it is that she wished she didn't have it. Of course she did. But it is what it is. I would say that's probably my number one piece of advice,   Stacey Simms  22:21 I think to you, you kind of as I said, we were very lucky. Betty is extremely outgoing, don't know where to get stuff from. And she nearly it was never shy about diabetes, daughters Natori introverted. And I would worry, I think it would be different, but I worried about her in middle school in high school, it would have been a different experience. I think, overall, they're just different kids. Yeah,   Cami  22:43 I mean, I think as they get older, you know, Macy's in eighth grade, right for 14, and college scares the heck out of me. I mean, when she goes spent the night at a friend's house, where I know the mom very, very well. And five minutes away from me, that's one thing, but I'm terrified of college, and her leaving the house, we're doing everything we can to prepare her. But I'd love to hear a little from you. Well,   Stacey Simms  23:08 you know, I'm gonna start by my mother gave me advice a long time ago, especially when he was really little, which is don't borrow trouble. Like there's enough to worry we have in front of us. So when he was two, she was like, don't think about college yet, but you'll get there. So I won't say don't think about just obviously, your top two. But that kind of helped prove a little bit. But I will say and we touched on this a little bit. The gradual independence that we gave Benny really helped us. I mean, it helped him, but it helped us. So our diabetes educator who is just an amazing woman recently retired, she has two adult sons with type one, one of whom was in New chronologist now, and she told me that the first time we met her, I said, like, oh, you know, do you have any advice? So that what can I basically I was like, How can I not mess this up and make him a good person and a healthy adult. She's like, why we can't tell you how, but I can tell you what not to do. She said, I just taught an 18 year old who's had this for a long time how to get insulin shot, because he had never done it. And he's going off to college. And she's like, don't do that. Don't do that. And you know, we all know that families don't want to pass judgment. I don't know what's going on. But I just was like, Okay, we've got a long time to get into the printer. So what we did was at the beginning of every school year, I would say, Hey, how you want to manage diabetes this year? What's your goal? And so I didn't give him that choice in kindergarten because I was ticked like I said, I was terrified. But in first grade, he said he wanted to eat lunch by lunch at the cafeteria once a week, at least. You know, by fifth grade. He was like, I don't want anyone ever checked in with the nurse because we live in North Carolina where they don't have full time school nurses. So we had a nurse at the office maybe two days a week. We had amazing staff who were like very caring individuals but didn't really know who diabetes. So that's another reason why I taught him to check his blood glucose. Because Jeff's calm which was not just been scheduled this time. So don't shut down we got we got Dexcom we had no Sherawat follow. So I mean we do is at the time he was supposed to pick us up and even just look at the steps. So he's your team didn't really change very much. But fifth grade was I don't want anybody looking over my shoulder anymore. I'm just going to Joe's gonna be compromised. Because I don't know about you guys but Middle School fifth, sixth, seventh eighth grade Marines like Whovians. So I do anything that I need a thumbs up to your teacher, that you gave yourself insulin for lunch. And he was like, Cool. Mr. Parker said, we're good to go. Then Middle School, he's like, I'm not checking in with anybody. I'm on my own. But I want you to text me every day before lunch. You're young, you're bolus. Oh, how wonderful. You would think how wonderful and you want to do bolus every day of that we just want to run with it. And we also talk, a little wonder, but we also have the same conversation starting in middle school about how are we going to manage Dexcom share, because I have a very funny Facebook post that I pulled out for the second book. And it's one of the first to share, he went on a field trip. And I was like, how do people do this? This is the worst thing that's ever happened to me. I have to look at these numbers all the time. Oh my god, this is overflowing. I need this. So I sat him down and I'm like, but if you read above this number for this long, I will text you if you're below this evergreens, Islam, I will text you and we went every year we changed that. By the time he was a junior in high school. I turned off the high alarm senior here, which was our independence here. I was like, okay, but the junior senior high school, I am not going to help you. And once you really, I turned off my love. The real turning point for us was that when he was 16, he went to Israel for a month with a kid, not at the biggest scale just because of regular sleepaway camp. And when he didn't Well, and came home, I said, What am I supposed to do now? Like you're done? I'm done. You're cooked. When you say now your customer service. And we went to camp this summer where he was a lifeguard. And he said, we're done. Like off with follow. So I don't follow. Kids, we're doing this before sharing follow up. You're like, right,   Cami  27:12 is to allow anyone to follow him.   Stacey Simms  27:15 Know that he's following him right now. But I know in the heads of the question, I'll ask him. In the past, he's had friends follow him, friends with him without diabetes. And that's fine. He's young. He has a roommate. He's not alone. I'm sure. My concern right now is more about highs than lows, because he's just kind of doing the minimum. I do like index complexity. But you can see the back end look. I'm gonna talk to him about it, because I figured he's a busy freshman figuring it out. Yeah. So again, we all hear differently. And because I feel him in one cameo, and I'll wrap it up in a second. But because we took all those steps to independence, already, we had really bad diabetes experiences. He's been low on sleepovers. He's been high on sleepovers, he has had his infusion sets come out. He's walking on insulin at restaurants. He walked across my neighbor's lawn to our lawn that intersect without telling anybody at four o'clock in the morning because he was low and didn't like the juice selection. Do you realize   Cami  28:19 that follow over   Stacey Simms  28:21 when they're 62. Right? So we've got a lot of time to make a lot of mistakes and realize like he's a tough cookie. So it's really yeah, we've done it all. Okay, so um, but Matt, what's your question for me? I want to ask you to county before we move on, you mentioned the Congress and things and it's tough on their stuff. And I mean, everything stuff. My daughter's maybe like, can you complain to me, too? Am I the guide a little easier, she's older and she doing 13 to 14 is like when they're really pushing you to make them more independent here to them more.   Cami  28:56 You guys. Yes. So for her birthday, last year, her 13th birthday, she had all these friends that did some these like elaborate parties and all these things she could mom, all I want is I want to go to the mall with my friends. I don't want you hiding in a coffee shop down the street. Property, I want you to drop me and my friends off and leave go back home. All you when we're ready to be picked up. So I dropped her off. And that was what she wanted for her birthday. They went out to dinner. And you know, they I think they were there maybe four hours. But she literally asked for independence for her birthday. You know, we also take advantage of this technology. So she she wears an Apple Watch. So even at school like you know, if we see we're on a chain actually, it's my husband and I and Macy and then they have an iPad in the school office, that some chain so we're always watching her numbers. And if she goes really high, you know, we kind of have to kind of have thresholds like if she's too high for too long, then we're like Amy see, are you having insulin? If she goes low, he may see or you know, are you having sugar so we've kind of got this cadence of communication. And I think because we've so to hold her accountable, it's been easier to allow her to be more independent. Because she and we'll talk about this, I think in a few minutes, Didi like, you know with low she communicates mom and having sugar mom I know I'm high I'm gonna give myself three units. So that's great you know she she communicates but back to your point a few minutes ago there Her brain is also gone because she's 13 and this junior high where it's just like, sometimes we'll be on dessert already through a meal and I'm like, oh Macy bullet strike. She's like, Oh, I forgot. I'm like, provide like we've been doing this for seven years every time you put a morsel of food in your mouth?   Stacey Simms  30:34 Yeah, that's a change. Yeah. I do want to talk about, we're gonna change gears a little bit and talk about severe blows. I noticed people very nervous. I do want to say this is meant to be educational and not scary. But CAMI is going to share some stories. But I do need to say that definition realize that severe lows occur when blood sugar gets too low for your body to function optimally, and requires immediate health to recover. It is really important to be prepared for the unpredictable. And I joke around a lot. But we do take this very seriously in the afternoon students of preparation when I think of the Ford Academy, because you had unfortunately not experienced with us.   Cami  31:16 Yeah, so Macy's had three severe love, none of which happened in the first like four years of her diabetes diagnosis, which was, you know, wonderful, because we never had to use the red mix kit. I don't know if I even would have been able to do that in a moment of panic. And as I walked through the story, I think this will make more sense. But initially, when we were informed about severe lows, what they could look like what they were, I was so terrified, it was like this taboo that I almost didn't even want to think about or talk about, I knew it was there. And I acknowledged it but I just wanted to do everything I possibly could to never ever, ever have to even get into that realm of a severe low and say. And things changed for us a little bit, to be honest, when I learned about Gvoke and how it could be used. So let me walk through, you know, our severe lows and kind of how those played out. So the first one was a few years ago, and my husband was traveling, he was out of town. And so it's just me in the kids home and I tried to eat pretty low carb, but for whatever reason, this pasta night, so I made some pasta. And Keith and I were eating and Macy bolused for her entire plate of pasta, and then eat about half. And then when I was jumping, kind of like a trampoline this like Airtrack thing we have in our backyard at the time, my son was really into like learning how to do flips. So he was like, Macy, come on, let's go out. Let's go out jump on the Airtrack. And so they were out and my daughter and I were kind of inside. I think we were watching a movie or something. So all was quiet, everything's fine. Kids were having fun. It was just a regular night. And then I get the alert on the Dexcom. And it's 50 to two arrows down. And right at that moment we see blast through the front door. She's like Mom, I feel really low. So I'm like okay, so I get her some apple juice. I think we actually use the little gunk, she doesn't like apple juice. So we give her some gummies waited a few minutes. And then then the reading said low we prepped and it was extremely, she was really low. And I said Macy. You can keep pounding sugar I said or we can pull out your G book right now. And she was like, let's just do the G book.   Stacey Simms  33:08 Hey, this is Stacy jumping in. Just to give a little bit of an explanation. Here. Hypoglycemia is defined by level one glucose lower than 70 milligrams per deciliter, and greater than or equal to 54 milligrams per deciliter level to glucose lower than 54 milligrams per deciliter. And level three is a severe event characterized by altered mental and or physical status requiring assistance. This level of hypoglycemia is life threatening and requires emergency treatment, typically, with glucagon. Now, back to kami. And   Cami  33:45 so we were in that moment, I gave her a choice because she, in the absence of intervention, she was going to pass out and she was headed down. And so we injected G voc. And within a very few short moments, she started feeling well and recovered. I think she got up to about 180 and then ultimately leveled out. That's it. That was experience. Number one. Tell us about Jimi Hendrix. Number two was a little bit kind of the same, but kind of different. Again, my husband was it was during a period of time where he was working on something and so he was traveling quite a bit. So it was after dinner, I had to open like 839 o'clock at night. We were actually all up in my room. And my when my husband travels or just forgotten early on, all my kids get to have a slumber party in my room. So Macy and I were reading I think I had one on like a blow up mattress on the floor. And we were watching a movie and just kind of his quiet moment. And the Dexcom alarm goes off. And it's super low reading. And so it was we treated it the same way where we tend to treat with sugar first. And we had no we had no idea. She was I think she was 49 Two arrows down and she had like three and a half units of insulin on board. To this day, we still don't even really know what happened. And so she had sugar continued to drop, we pricked her finger, and she actually that time said, Mom, I want to use Gvoke and so We have several of them. And so we opened it, she actually injected it herself into her the first time I did it in her arm. Second time, she gave it to herself right in her thigh. And same recovery scenario. It was amazing. It worked really quickly. And I knew that it was going to give her what she needed, so that we avoided that biggest fear.   Stacey Simms  35:19 Stacy here again, just jumping back into give this disclaimer, it's really important to understand that Individual results may vary. And you've always got to consult your healthcare provider.   Cami  35:28 Right? I mean, think of severe hypoglycemia, you think of someone on the floor on that worst case scenario? I mean, really, that's what you're thinking, think of incapacitation? And I mean, is my child going to lose his or her life, I mean, that that's really what we've kind of been trained to think about severe low, and there was sort of this paradigm shift for me in my mind about using glucagon, not to say that you use glucagon every time you have a low, not at all, you know, always, of course, treat with sugar. But there are scenarios given the way technology has progressed, we know when someone is headed for disaster, we can prick a finger, we can look on it next time, we can look at their symptoms. And we know that in the absence of intervention, something bad's gonna happen. And with G voc, you can use that to ward off that unimaginable moment of someone passing out. Actually, that's a perfect time to bring up the last time she's just a little over a year ago. She was at a slumber party. That was a birthday party 13th birthday party. I know the mom quite well. She's one of those very supportive moms that you just want to hug and say thank you for understanding and for taking this on and sleeping with one eye open when my daughter spent the night at your house, they had gone out to dinner, they went to PF Changs. And so she had shared a bunch of food with our friends. And they've gone back to the house and they were all getting ready to go swimming. And Macy got a LOW Alert ello w. And I was like, oh, okay, and so we stayed on the phone. And she said, Yep, she just administered it, and she feels fine. And, you know, call you back in a few minutes. She knew she needed it, she was afraid she was gonna pass out. And she administered her Gvoke, her blood sugar popped up within a few short moments. And she never had to experience the full blown incapacitation, that gives me such comfort, knowing that she knows how and when to use that. Because you don't know when it could happen. as vigilant as we all want to be they happen. And so knowing that she has the confidence to pull that out and know when she needs to use it is a massive source of comfort for me. And we're   Stacey Simms  37:20 going to start wrapping up in just a couple of minutes. And I have another quick question for you can we but I want to share, we need to set the amount of comfort, we'd have not had to administer anything that wouldn't have gone. I would have liked it in a few places. We've been to some external markers, that red box here. But one of my proudest parenting moments, wasn't even there for freshman year of high school being wrestled in high school for a couple of years. And we didn't do this in high school, but the sports teams to travel now love them. And they fundraise and they say right hotels and I, I had an instance where I was, you know, still following me as a freshman, and I couldn't reach him. So I called the teen mom. And she was like, Oh, he's actually my son tonight. Like, I'll ping them. And of course, he just wasn't looking at his phone. And he was like, I was laying on me. That's kind of mine. Fine. But he came home though. I said, What would you have done? Like, let's talk this through more, because now I am thinking about more. You know, how do you manage that he's like, Oh, my gosh, luck is anytime I'm with new people overnight between summer camp and wrestling and sleepovers. Anytime when we meet people, I take out the G book United type 1 diabetes I'm going to be and this is the other thing I'm not drinking, if I'm passed out or I'm slurring my orders or anything like that, I'm actually Lucky's like, call the coach then use this and he shows them how to use it as well. Like I really don't want another 15 years of administering. Yeah. But at the same time, I was really proud. And then I said, Well, do you ever like Does anybody ever gets to change rooms? Because of the hammer because of the BB? And he's like, Oh, my God, Mom, I already see what works, you know. But I was really so my one of my last questions who can be here as I don't have a child who has used this? You would like you said, you were there the first time there was another adult there the second time she used it, but have you been talked about? Like, how is it helping? The chief? She fearful? What is she doing? She think about it? You   Cami  39:11 know, I've asked her? And she said she just feel safer? Because she knows that there. She's not scared of it. And to me that's everything because there's a lot of fear involved in this disease, fear of your client, my blood sugar is too high. What's that going to cause in the in the future? I mean, we're we're constantly you know, trying to mimic them an organ, a human organs. You know, there there's a lot involved in that. So just knowing that that component, that fear factor part of it, she's got a plan. She believes she's covered. If she gets to that point, and we do everything possible to avoid it, of course, like all of us do. But if God forbid it happened again, she'll know what to do. And that's amazing that Benny educate other people. I think that that's huge because sort of like wearing your seatbelt right? We we don't put our seatbelts on every day when we get in the car because we think we have a high probability of getting a new car accident but what if we put our seatbelts on? It's the same kind of concept   Stacey Simms  40:09 you're listening to Diabetes Connections with Stacey Simms. Big thanks again to CAMI for zooming on in again, she broke her arm just before the event. And I give her so much credit. I had a crowd to talk to. But she was basically just looking at herself. You know how Zoom is. So I really appreciate that. Kami. Thank you so much. We did take some questions after that last comment of camis. I know it ended a little bit abruptly, but the audio really fell off. After that. There's only so much that John can do with his editing magic. If you liked what you heard, please share the episode. And please join us for mom's Night Out Charlotte in February. And for our other three stops in 2024. I am scheduled to share those locations this week. As you're listening I may have already done it. So please be sure that you're following me on social media. You can always reach out though Stacy at diabetes dash connections.com I will say there was one city that we heard the most comments from and that is on our list. So definitely let me know if your city or a place you cannot get to is on the list. Definitely ping me for 2025 We are listening to you. And we are I mean I'm going forward with this full steam ahead in probably four events a year until I don't know until people stop coming. Thanks again to jump you Candace, my editor and a big thanks again to Xeris for all of their support. I'm gonna read that important safety information one more time. Gvoke is a prescription injection for the treatment of very low blood sugar in adults and kids with diabetes age two and above. Do not use if you have a specific type of adrenal or pancreatic tumor starvation chronic low blood sugar or allergy to Gvoke High Blood Pressure hyperglycemia and serious skin rash can occur while your doctor or get medical help right away. If you have a serious allergic reaction including rash difficulty breathing or low blood pressure, visit Gvoke glucagon.com/risk For more information, I'm gonna link all of that up and the link in the show notes. And Stacey Simms. Thanks so much for joining me. I'll see you back here soon. Until then be kind to yourself.   Benny  42:14 Diabetes Connections is a production of Stacey Simms media. All rights reserved. All wrongs avenged.

This episode title is a bit misleading (sorry!) because Benny is actually marking 17 years with type 1! He's away at college and while I hope to talk to him for the show soon, we just couldn't swing it in time for his actual diaversary. To mark the date, we're going to replay the first time I talked to Benny for this podcast – which I did along with my husband and my daughter back in 2016. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Find out more about Moms' Night Out - we have announced FOUR LOCATIONS for 2024! Use promo code MOM30 to save $30 off any city This is a longer episode, so I wanted to break it down a bit - and a full transcription is below. 00:00 2023 Stacey introduction, talks about Benny's 17th diaversary 03:55 2016 Stacey explains how the order of interviews and a few housekeeping notes 05:22 Slade 24:27 Lea 40:42 Slade (part 2) 1:12:15 Benny 1:26:07 2023 Stacey wraps it up   Please visit our Sponsors & Partners - they help make the show possible! Take Control with Afrezza  Omnipod - Simplify Life Learn about Dexcom  Edgepark Medical Supplies Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode transcription below - our transcription service doesn't speak diabetes perfectly, so please excuse any mistakes. Thanks! Stacey Simms 0:05 This is Diabetes Connections with Stacey Simms. This week is my son's 17th diversity 17 years with type one to mark what's really his entry into being a young adult with T1D. He's almost 19 We're going to take a look back at when he was a lot younger. We've got a replay of the first time I talked to Benny for this podcast back in 2016. It's a conversation that also includes my husband and my daughter. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Welcome to another week of the show. I'm your host, Stacey Simms. And you know, we aim to educate inspire about diabetes with a focus on people who use insulin. I am not great about remembering Benny's exact dye aversary. And most of the reason why is because his diagnosis was very, it was prolonged, I would say it really only took a week, maybe a week or a couple of days from the time that I called our pediatrician and said, I don't like what I'm seeing Something's really wrong to an actual in hospital diagnosis and, and all the education that goes with it. But we had so many bumps along the way. And I've told these stories before, you know, a fasting blood glucose. That was normal, it was 80. And that was on a Monday. And then some subsequent diagnoses of things that we now know were just symptoms, you know, infection, things like that, that they treated, and we thought, yeah, we got it. And then finally, the A1C results, which came back five days after that initial fasting blood glucose, which is when they sent us to the hospital, all of that to say I remember the days of the week, Monday was the pediatrician Saturday was the phone call to go to the hospital. But I never remember the actual dates. Social media memories usually remind me and sure thing they came up this morning. So I'm recording this on Benny's actual 17 year diver serie on December 2, December also means and I need to tell you one quick thing about moms night out that the early bird special for Charlotte is over. I do have a promo code for you that you can use on the regular price to save $30 off. And that promo code is m n o 30. Mom's night out m and o 30. You'll save $30. With that I will put a link in the show notes. You can always go to diabetes dash connections.com. We have a mom's Night Out tab as well there now. If you go there we are announcing our next cities this week, I may have already done so. So follow on social for that announcement or click on over to the website, click on the mom's side out tab. See the new cities registration is not open for them. But you can sign up to be emailed directly when registration does open. And for more information. All right. I am hoping to talk to Benny for a new episode soon. As you know he's away at college. And I cannot wait to get that kid home for winter break. As this episode goes live. I think he's coming home in about 10 days, not that I'm counting diabetes, while he's been away has been fine. But I've tried really hard not to ask him a lot of bout it other than once in a while like you're doing okay. Right? Because we don't follow his Dexcom anymore. And I really don't know much day to day. You know, he's reordered supplies with me. So I know he's he's doing that kind of stuff. I can't wait to talk to him more. I will let you know when we're going to be taking questions for that episode, we'll post to the Facebook group for that. These conversations you're about to hear were recorded in fall of 2016. Benny is in sixth grade, his voice hasn't even changed yet. Oh, my goodness, I left in the original introduction, which gives more context. But I also want you to know, this is a much longer discussion than I remember. So I'm going to do more comprehensive shownotes with some time codes, if you want to kind of jump around on this episode and pick and choose where you want to listen. So here we go. My family's thoughts on one decade. Remember, this is seven years ago with type one. Stacey Simms 03:55 This part of the podcast is usually where I interview somebody else get them to share their story and their thoughts about living with diabetes. This is different. This is my family's story. And let me tell you, this is what I've done my entire career, talk to people interview people since before I even graduated from college. And these are the toughest interviews I've ever done. I was so nervous. But they were they were wonderful. And I was just thrilled that they agreed to even talk to me. My husband and my daughter are really not front and center. Attention people. I don't know how they live that way. But here's how it's going to go. You're going to first hear from me and my husband Slade. And then you'll hear from Leah. We're in the middle of that interview. I'm going to pause the conversation. And then you'll hear Leah's interview, because I had maybe the most Frank, honest and open conversation about our brothers diabetes that we've ever had. And then we'll wrap that up and you'll hear more from me and slay And then finally you'll hear from Benny. Oh my gosh, that kid, if you have a middle school boy, maybe you'll understand that conversation was, let's say it was interesting. There is a bit of overlap in these conversations as you'd expect. I mean, there are some events that we all talk about. So you'll hear about those things more than once, that sort of thing. Okay, here we go. I'm really interested to see what we talked about today because Slade doesn't really talk about Benny's diabetes publicly. I mean, of course, you you're very, very involved, and you talk about it, I'm sure with friends, and things like that. But it's not like you are front and center at functions. And, you know, that kind of thing over the years, I don't Slade 5:41 have a podcast, Stacey Simms 5:43 I could help you set one up. But I've been told in the past, I speak enough for everybody in the family. So I'm really interested to hear what you have to say if your conversation matches mine. Alright, so let's start 10 years ago, Ben, he was diagnosed with type one. He was not yet two years old. And Leo was just had just turned five. What I remember vividly is the month before he was diagnosed, when I was working at WB T, doing morning radio, you got the kids every morning. So you used to text me, like 730 or seven o'clock every morning and say, you know, kids are okay are off to daycare or you know, here's a funny picture. And you texted me one day and said you are not going to believe the amount of pee that came out of this kid. Do you remember that? Like the mattress is soaked in the floor was wet. I Slade 6:35 remember one morning, getting him out of his crib, right? And the entire mattress was soaking wet. Like everything. All the blankets were wet. The pillow was where the entire mattress was. So it was I'm like it didn't make any sense to me. Stacey Simms 6:53 Right. And you know me at work. I was kind of thinking when you trade off like we did because sleep had a restaurant for many years. So I had the kids in the afternoon and in the evening when he was working. And he had the kids every morning because I used to do a morning radio show that started at 5am. And I just remember thinking, not on my shift like you gotta fix Slade 7:14 which I did right away. Of course, drying the mattress out trying to figure out what happened, but we Stacey Simms 7:19 kind of thought it was a one off. Oh, yeah. Because it didn't happen again for a while. Yeah. And then it happened to get about three weeks later. Well, Slade 7:25 we noticed I think from that point on over the next couple of weeks that he was drinking a tremendous amount of liquid for a 18 month old or 20 month old. It was you know, and he would suck down a little 10 ounce sippy cup in like, you know, 15 or 20 seconds. It was absurd. Stacey Simms 7:45 So the the mattress wedding thing was in October, I think late October or something. And then of course, there was Halloween, which I'm sure didn't do him any favors. That was the year the kids dressed up. But it was the only matching costume we ever did. Leo was Ariel and Benny was flounder. And then, at Thanksgiving, we had family photos on the Friday of Thanksgiving that year. And then we went to the lazy five ranch. And I've told this story before one of my brothers was here, right brother David was there, right? And I posted that picture recently on Facebook of David and Benny with a giant glass of orange juice. And then we went to the lazy five ranch and of course Benny couldn't he was still in diapers and he was soaked and he was just laying down and he was exhausted. He felt like garbage. And then that Monday, we went to the pediatrician that Monday right after Thanksgiving, right? And Slade 8:37 then I mean, I think they did a fasting glucose and a few other things. And they thought he had a urinary tract infection knew and I already had suspicions that it was something more like it didn't make any sense. Yeah. And then it was a few days into an antibiotic for what they thought was a urinary tract infection and there was no change. And so his outward symptoms continued to be the same right where he drank tremendous amounts of water and liquid and was always going to the bathroom. Stacey Simms 9:08 Well on that Monday when we went to the doctor his as you said his fasting glucose was normal. It was 80. And then they did a blood draw. They must have found something in his urine, right? They must have found sugar in it because I remember they did a urine test to do a urine test on a kidney. They didn't Slade 9:24 remember that we had to kind of push for them to do an A1C like they it took a week or so. Yeah, Stacey Simms 9:30 but we didn't ask for A1C We just asked for a blood test. I didn't know what we were asking for did I remember holding you had to hold him down? Yes, I did have to hold them down Leah was in the hallway Leah remembers that remember some screaming? Slade 9:40 It wasn't exactly pleasant. Stacey Simms 9:44 Yeah, and then he did that they said I had a urinary tract infection. And I remember when we treated it he seemed to feel better once a day right just from the urinary because he did have one but you know job raucous or pediatrician friend down the street said to me Why would a healthy two year old boy have a urinary You're trying to keep keep looking. So I was convinced at this point that he was he had contracted a fatal disease. I was on the internet. I was looking at all sorts of horrible things. I thought he had kidney cancer. I really did. I was so scared. And then he seemed to feel better. And then on Saturday, they called us and David was still here. And they called us on Saturday and said, like it was an emergency get to the hospital. But they wouldn't. They didn't tell me why. Well, they did tell they thought they told me why because they told me his blood sugar was like, you know, 700, or the A1C correlated to, you know, I don't know what it was. But I remember thinking, He's fine. He looks fine. He's doing okay. Why do we have to rush to the hospital? But we did. Slade 10:33 Yeah. But I remember during that week that we kind of, we were guessing that it might have been diabetes? Stacey Simms 10:42 Oh, well, yeah. Because most people and you know, the symptoms matched perfectly. But I think it was the fasting glucose being kind of normal that threw me off. And I of course, went to worst case scenario, Slade 10:51 you went, you definitely went deeper. But you know, still concern. Yeah. Not knowing. And it's, it's a scary thing, when the doctor calls and says, Take your kid to the emergency room. And you go while he's walking around playing with some toys, he's just fine. So and then, of course, it's just a, it's a crash course. Right? You get admitted in two days later, you're out and you have diabetes and have to live with it the rest of your lives. Stacey Simms 11:19 Oh, you know, one thing I forgot is, when we took him to the pediatrician that first time on the Monday after Thanksgiving, when I called, we knew just enough to say he's got the symptoms of type one. We knew that much that the pain and the drinking, because of all the stuff I'd done with JDRF already and in Charlotte, and my pediatrician, Dr. Scott said, I've never seen it in anybody younger than two. Right, bring him in, and we'll rule it out. And thankfully, you know, they took us seriously because I've heard some nightmare stories of people that don't. But what's funny is, here we are 10 years later, almost every time I go to that pediatrician, and it's one of these big practices with like eight doctors, they all look at Benny's chart and we go in, they say, oh, like he was the youngest one we saw at that time, you know, and now of course, there's lots of kids that are diagnosed younger, unfortunately. But for that practice, it was it was unusual. It's pretty unique. Slade 12:07 Yeah, I just I just distinctly remember that we had to push a little bit. Yeah. To get them to think in that direction. Stacey Simms 12:15 Oh, when he walked in with AD, yeah, they tried to figure out something else. So Slade 12:19 I mean, I think all that really says is, doesn't matter what the age or what you're thinking, you have to be your own advocate, you know, in some way, shape or form, if you're not your voice, then there's an opportunity to miss something. Right? Not get a good look at it. So I think that I think that not going down the you know, the rabbit hole right? To something considerably more catastrophic. And trying to rule that stuff out. You have to, you have to ask and you have to instruct and you have to, you know, your medical team, you have to be part of the conversation, right? You can't just tell me what to do. Stacey Simms 13:04 But it's hard to in some ways, because you don't know what you don't know. But you're I agree with you. You have to we've learned this for many years. Now. You got to push you got to be your own advocate, you got to ask questions. But, you know, if I didn't know, peeing and drinking was a sign of type one, I don't think I would have known what to ask the doctor. Right. But Slade 13:19 I also think that that I don't think doctors are offended by that. I think that that helps them do what they're trained to do is help. Help people get better. And if you're not engaged in the conversation, it's a one way street. Yeah. It Stacey Simms 13:32 would help. Alright, so we're in the hospital now. And I remember he had those things. What are those things called all over you with a stick you the sticky things I had like an Slade 13:41 EKG monitor, right, and he kept pulling Stacey Simms 13:43 them off? Slade 13:44 Yeah, that couldn't have felt good. Stacey Simms 13:48 That was like when we first started using the Hulk analogy, because he was like the baby Hulk pulling everything off. Slade 13:54 Well, it's interesting, and he doesn't have any idea what's going on. Stacey Simms 13:57 But that night, we took turns, you know, you went home. I stayed. And they pretty much didn't tell us until the middle of the night that he had type one. They kind of I think everybody thought we knew. And finally I asked if they had a diagnosis. And they said, Yeah, he's got they would like yeah, he's got type 1 diabetes. I mean, they were nasty about it. But I think everybody thought someone else had told us along the way. Slade 14:19 We didn't see Dr. Werner alto second day or the next day. Yes. We Stacey Simms 14:23 went in on Saturday morning or Saturday, mid morning. We saw nurses and hospitalists there was that one horrible woman. She came in and she smelled. She didn't say anything to us, like not Hello, how are you? I'm so and so she came right in and smelled him. And now I know it was for fruity breath. Right? So when she came in, she smelled him. And you know, I am of course very calm. I said, What are you doing to my son? Who were you? She kind of explained but she kind of left us like you're not coming back and just I don't know what I said. I'm sure it was very nice. But yeah, that night we met the hospitalist. And that was when that was when he said to me, who stays home with Benny, not our endocrinologist, but but just a hospitalist, a doctor who sees people in hospital. And I was already panicking because I had my dream job. And I had health insurance. You had a restaurant you owned a restaurant is that like you can untangle from that pretty easily? You know, I'm closing the doors. When Slade 15:21 we tried to untangle from it, it took a long time. Stacey Simms 15:25 And I was terrified because it couldn't really quit. I wanted to quit my job. But I had to health insurance and I really didn't want to quit my job either. So we said who stays home with Benny? I said, nobody really nasty. And then I burst into tears. And you weren't there. And Vinnie, do not remember you were not there. He was another night. And then then he put his kidneys awake. He's 23 months old. He puts his arm around me. He says it's okay, Mommy. I was like, Dude, you better get your stuff together to myself. You bet this is your 10 year old is comforting you this is not how it's supposed to work. And that was a big turning point for me. And like the guy was great. He said, I'm sorry. He said, What I should have said is what's your situation? He's like, I'm just trying to help you acclimate? And he told us even go back to daycare. And he you know, nobody said no to us. They'll try to help us figure out how to make it work. But that moment was a big turning point for me. Slade 16:14 I don't think I had any big turning points. I mean, the only thing that I realized was, you know, when we finally did come home, and you know, I went grocery shopping. Stacey Simms 16:26 Oh my god, wait. So hold on. Let's get there. So we met Dr. V. The next morning on a Sunday. And he came in and I remember him coming in and saying hi to us and being great. But getting right on the floor with Benny. Yeah, Slade 16:39 and what I remember. And and you have a better memory than I do. But what I remember is him saying listen, based on where we are today with treating this. There isn't any reason he shouldn't have the exact same life he would have without diabetes that he has with diabetes. I mean, that was that was that just set the tone? Right? Stacey Simms 17:00 Yeah, it really did. And I remember, thank you. I will anyway, I remember, like my first questions to him, because what do you know about diabetes? Right? You know, type two, I remember thinking and asking him like, do I have to cut his toenails differently? Like? He was like, Oh, I could see, right? Yeah, take a deep breath. And like, this lady is gonna be fun. But he got right on the floor and met Benny and I don't think he had kids at that point. He did not. Yeah. And he was terrific. But I interviewed him. I said to him, you know, I'm glad to meet you. But you know, I don't know anything about endocrinology, or endocrinologist, or endocrinologist in this town. Right? Of course, I want to make sure that my child has the best. So I asked him a million questions. And he was great. He was really great. Yeah, Slade 17:49 I just think he set the tone that said, hey, what you're going to deal with is lifelong. And then that's the way it is. But it's not life threatening. Yeah. Doesn't have to be life threatening, right? Stacey Simms 18:03 He didn't he didn't come in and tell us a cure is around the corner. He talked a little bit about the artificial pancreas. I remember because I asked him about technology. He he did say that they were one of the first practices in the country that routinely gave pumps to toddlers, because this was 2006. So that wasn't happening all over the place that he thought that Benny we know down the road, we would talk about that. But he was not overly he didn't promise anything. Slade 18:30 No, actually he did. He promised us Benny would have a normal life if he took care of himself. Right? Well, that's true. It didn't make that that's Stacey Simms 18:36 true. And that was very reassuring. And he has been consistent in these 10 years. He said, The three things that he says at almost every appointment, I'm pretty sure he told us then, which was he wants to make sure that he can live a long, healthy life he's supposed to, that he has, he feels good, and can enjoy life right now. And that we find a way to make diabetes fit into what he wants to do, and not the other way around. And we've been able to do that pretty much. It's not you know, when people say, Oh, diabetes can't stop you. I mean, some of that I, you know, I shake my head a little bit or I raise an eyebrow because, you know, obviously diabetes definitely can slow you down. And there are days when it can stop you. That's okay. I mean, you know, when you break your leg, it's gonna stop you. You know, I you know, it's I know, it's a mindset more than a truism. But, you know, I think we've had a pretty realistic look at it. Yeah, I Slade 19:27 think you as you go through, particularly growing up, and there's, you know, there's minefields everywhere, right? It's just one more minefield, right? I mean, it's something else, you have to navigate it and it gets added into your routine added into the way that you think. And it's, yeah, it's a it's a burden because it's different than what a lot of your peers have to deal with. Is it a burden in it in that it can be a roadblock to accomplishing something you want to accomplish? like you and I think that way, I don't think that's true. Stacey Simms 20:02 We try not do not it's not a not a dead end road, you can make it that way. Well, it can be a roadblock that you can overcome, right. But it shouldn't stop you in your tracks. Slade 20:11 You can do a lot of what was me? Well, yeah, well, that's different, right? You can do a lot of what was me, but there isn't. There's a, there's a roadmap to accomplishing what you want to accomplish with diabetes. All Stacey Simms 20:24 right. Speaking of routine, let's talk about that grocery store. Slade 20:28 That was hysterical. So, you know, of course, you know, when you talk about diabetes, you talk about carbs, right. And as you load your body up with carbohydrates, you need insulin, Stacey Simms 20:38 oh, and I should add, we were put on a carb counting regime or a carb counting routine. Immediately. We didn't do any eat to the insulin, it was all give them as many shots as you want, right? And count carbs and dose him that way. Right. I mean, obviously, at first, we tried not to give him a lot of injections. But we were some people go on different routines at first, right? We weren't, we were all carb counting from the beginning, Slade 21:00 right? But it's really all about, you know, the basics of understanding how to take care of yourself is you have to know what you ingest, right? You have to know what you eat. And you can give yourself insulin to help your body, right, continue to move forward and act the way it should act right by adding an insulin. So we're like, you know, maybe we should really go low carb or no carb. So I went to the grocery store, I think I spent two and a Stacey Simms 21:30 half hours. That's what I was gonna say. It was definitely two hours. And Slade 21:34 I it's I think I know the label of every item in the grocery. But I just went and bought everything that was low carb when he came home and put it in the cupboards and put in the refrigerator and he loved some of the food and fed it to him for a few days and then realized we were feeding him fat. Yeah, Stacey Simms 21:50 we did two weeks almost of Atkins, basically. And I lost about six pounds. It was, I'm sure that had nothing to do with being crazy. But yeah, I mean, we went from eating, moderate. Everything in moderation and pretty healthy. I mean, our kids were five and not an almost two. It's not like they were drinking soda and McDonald's all the time. But we were eating things like oatmeal for breakfast and pancakes and stuff. And we went to eating sausage. And I don't it was ridiculous. Like everything Slade 22:19 was a lot of me. Yeah, it was a lot of meat and a lot of cheese. And we realized is we're just gonna, we're just eating fat, and we're gonna kill him. So after a couple of weeks, I actually threw a bunch of that stuff out. But Stacey Simms 22:29 the turning point for me or the final straw was when you were like, how about pork rinds? That's a good snack. He's doing we're Jewish. I mean, we don't keep kosher, but I don't remember. I was like, that's, I know, many people enjoy pork rinds. I'm not. I don't, I bet he would love them. Now. You can find some things, I mean, olives, beef jerky, Slade 22:56 just remember kind of throwing it out and go, that's it, we're just going to, I'm going to feed him the way we would normally feed him. And, and we will treat him medically the way that we are given the tools to do it. And that's what we're gonna do. Stacey Simms 23:08 And we also counted every carb tried to do it exactly. I think it's I think the whole thing, we figured it out two hours of routine to our day, because we had a yellow legal pad, right, we wrote everything down. We've got all the food, the dosage, the routine, but we were counting carbs, and ketchup, and green peas. And I mean everything because that's what we were told to do. Right. And I remember going for a follow up, when you go for free first followed two months later, one month later, and there was a mom and dad was like, really? This is excellent. But you do not need to do with the two cards that are in the ketchup. Well, Slade 23:40 I still think actually, that's kind of important, because you need to understand that it's out there. You need, I mean, their cards, you're ingesting Stacey Simms 23:47 what we need, and we needed to do it then to learn. Yeah. Slade 23:49 And that's what happens is you learn you know, kind of what carbs are, where they are, where they're hidden, how your body reacts to them, particularly how Benny's body reacts to them. And then it's really kind of an art at that point, right? It's not really a science. I mean, there's all kinds of ratios and logarithms and all that stuff. But it really comes down to everyone's body is a little different. And it's it's much more like juggling right than it is like anything else. Stacey Simms 24:27 I'm gonna pause my talk with Slade here and bring in our daughter Leah. She's three years older than Benny four years ahead in school because of where their birthdays fall. And about 40 years older in maturity right now, you know, it's okay to say that I was so happy she agreed to talk to me about this. And this might be the best discussion we've had about her brother and diabetes. I will say I remember a few things a little differently. But this is her story. Alright, so let's start at the very beginning. I when I talked to dad, we talked about when Benny was first day He noticed and one of the things that I brought up was when we had to take the first blood draw. You were outside of the doctor's office. Do you remember that? No, Lea 25:08 I remember the electrodes, but and him always pulling them off. But I don't remember the blood draw. We Stacey Simms 25:13 because you went to the pediatricians office with us. And he was screaming his head off, and you were in the hallway. Because you were just you just turned 508. Lea 25:21 I think I do. Remember I was playing with my LeapFrog. And I was sitting in the hallway. And I was like, I would hear screaming, but I'd be like, Oh, it's whatever. It's fine. I'm gonna play my game. Stacey Simms 25:33 And then we went when Benny was in the hospital. You remember the electrodes and Uncle David was with that Lea 25:38 was funny. I mean, because I didn't understand what was going on. So it was funny, because he had electrodes all over him. And he would just like, pull them off. So they couldn't do anything. And I mean, he was crying and like, you were very frustrated. And I'm just laughing because I had no idea what was going on. Stacey Simms 25:52 And then the next day, we actually went ice skating. It was our community ice skating thing with when we were making the temple. It was like our first time though, into the ice skating rink. Lea 26:01 Did the rabbi go, Stacey Simms 26:03 I don't think they had the rabbi yet. It was just us. And you were very little. Okay, so you remember, okay, so what do you do you remember, like, what kind of things you remember from when you were little. Lea 26:14 I remember very general stuff. I don't really remember like specific instances. Like when he was first diagnosed, I didn't think anything was wrong. But apparently he was like, drinking too much and peeing too much. And I was just like, Yeah, whatever. Because I was not the biggest fan of my little brother. And I remember, as he got older, and I think it was more, I was less of like a small child and more of like, preteen, I was very upset because he'd always get so much attention, which now it's like, you get it, because it's an awful horrible thing and all blah, he needs all this stuff. But as as a small child, it was like, pay attention to me, Mother, I exist to you have a second child who was actually your first child. But you know, it was cool. I was an only child for four years, which was a wonderful thing. Stacey Simms 27:03 It was like, almost three years. Before, it was three Lea 27:07 years. Like for almost four. Stacey Simms 27:10 It was almost three, it was three U turn three, November, whatever. And then he was boring. Okay, very similar. But I remember a lot of when you were very little as you were a big helper. Like when he was first born, you would help me with the help with the baby, you would help with diapers, you would read to him every night, you know, to get sick of him all that stuff. And the same thing with diabetes. You wanted to learn how to do everything. You guys would give shots to the stuffed animals. Lea 27:35 Oh, yeah. The Little Bear and there were like little patches on it. Yeah. That's Rufus the bear with diabetes. Oh, that's fun. Stacey Simms 27:44 That's nice. And right. So you would do that. But you were very helpful to me in the backseat of the car. Because when you have a kid in a baby seat, basically, right, he was in front facing. I don't remember what the requirements were now. But like, you'd have the three point harness the five point harness those kinds of chairs. And so you were next to him? And if he was low, you you actually checked him once or twice for me when you were like five or six years old. You did? And then yes, and then you but not often, but you were very responsible. And you were like I'll do and usually I would pull over if I needed to like if dad wasn't mad. That's I mean, it wasn't making you do it. But you did it once or twice. But you were always willing and helping me the juice boxes and stuff like that. So much Lea 28:23 has changed. Stacey Simms 28:27 But then as you got older, like you said, it became more of a why? Why him? Why are you giving all the attention kind of thing? Lea 28:34 Because I never, I mean, until now I never really fully understood what, like, why he got so much of the attention. It was always just like, you spent so much time like talking to him talking about him, like calling people about it. And just you had all this you had like Lantis and Hume along, whatever all that stuff is just words that I hear around the house. But you had all of these packages shipped, like every couple of months or like, whatever you would go to these conventions and the walks and it was just like, well, let me do my walk, Dude, where's the layup walk? Stacey Simms 29:09 Do you think we should have done a better job educating you about diabetes? Because I feel like we did tell you it's Lea 29:14 not that I wasn't. It's not that I didn't really understand what it was it was just that like, I was a child. And I still am a child, but it's like, pay attention to me pay attention to me. It wasn't that I didn't know that it was some awful thing that he like needed to have all this attention because I knew that it was just like, why can't I also have attention? It wasn't like I was trying to take it away from him. It was just like me to say him. Stacey Simms 29:37 What would your advice be to parents listening to this who have a kid with type one and other kids who don't in the family? Lea 29:43 Well, you certainly don't have to. You shouldn't like take attention away from a child with diabetes just because one of your other children is feeling a little like left out but that doesn't mean that you can be you can totally ignore that child because they're still like They're your child. They're there, they need you. But it's, I think it would be better if you if someone explained to me that, like, if you'd like sat me down, and with Benny, and been like, this is what's happening, blah, blah, blah. This is why we give them so much attention. It's not that we don't love you. And just something like that. And sure, I probably still want to complain, but whatever. Like, it's fine. Stacey Simms 30:23 So like, the little things that we tried to do, like weekends away, or just you and me stuff like that, like spending, Lea 30:29 spending a weekend with my dad or with my mom, like, that's great. Because it's, it shows like, sure you spend basically every second of every day worrying about this other kid. But you still have time for me, which is pretty awesome. Stacey Simms 30:43 So tell me about camp a little bit, because this is something that you and Benny share that you do not really share with me and your dad. You I don't know if you remember, but used to come home from camp. This is the regular summer camp slip away for about a month. And tell Benny, it's gonna be so great. You're gonna love it, you know, can't wait. So you would go and I would always think there's no way. There's no way and you were ready to go when you were eight. And when he was eight, I was not ready for him to go. But we sent him anyway. What? Do you remember why you want them to go? Did you just think he would have fun? Lea 31:14 Well, I mean, when he first went, what unit like, well, how old was I? When he first went? Stacey Simms 31:21 Well, he was bony one. So you would have been three years older than that. I don't know how we can never keep track of those things. Well, he Lea 31:26 was like eight when he when he was eight. So I would have been like 11. Yeah. So at 11 It was still very much like it will because because of the fact that he's had diabetes, and we've known for so long. It's just kind of part of our lives. And I don't think of it as like this huge deal. Like it's just something that he just has to deal with him. It's like whatever, because he's a normal kid. It's not like, it's not like some other things that people can get where like you see, like, what you see the symptoms or you see, like the damage that it does, it's just sort of something that you have to deal with. And it's just like, whatever. So, I mean, it never even occurred to me that like he wouldn't go to a sleepaway camp, because that was just like, oh, yeah, it's like, Andy has diabetes. It's like, he's got brown eyes. He's got diabetes, like whatever. So, I mean, it was it was just, like, such a fun place to like to go and to get away. And it was, like, you get to do so much there that you don't really get to do at home. And it was never, it was never about him. Like, oh my gosh, he's my brother. I love him so much. I want to come to camp. It was like, I want you to experience this wonderful place. But it was it was never, it was never about the diabetes. It was just about him wanting to like go, Stacey Simms 32:37 I don't think he ever would have gone if you hadn't been so excited about it. Because that was part of the reason I wanted him to go because you liked it so much. That was wonderful. Yeah, he's really has a good time there. I mean, I'm so glad you had such a great experience to Lea 32:50 take my place. Okay, Stacey Simms 32:52 okay. All right. So that was great. I can't Unknown Speaker 32:55 go anymore. Yeah, Stacey Simms 32:56 you're too old for camp. Now. That stinks. No, Lea 32:59 but I can go back this summer if I wanted to. Next summer next summer. Yeah, but I don't think I would I might be counselor, be counseling Stacey Simms 33:06 keep your brother in line on the different side of the camp. Okay. Has since since Benny was diagnosed, I know you've met other kids with type one. But you don't come to conferences much. So it's not like this is a hey, it's a type one atmosphere, you know, other than the walks and things? Do you feel that? First of all, have you ever talked with someone and I haven't really been asked this question. But like, do you feel like knowing about Benny's diabetes has maybe helped you get to know other kids with type one better? Lea 33:38 Not really, I mean, most of the people that I talk to, like kids my age, or adults or kids Benny's age, it's always, like, that's just sort of a thing that we both know about them that they have diabetes. And it's we don't, I mean, the most that we would ever talk about is like if they were low, or if like they had to bolus for something, and it would never be like a big deal. And most of the time, we would just talk about like, other things, just because, I mean, for me, I'm just so used to my brother having it. And for them, they have it, so they just kind of have to be used to it. So neither was ever make a big deal out of it. And it's just kind of like whatever, Stacey Simms 34:11 it would be kind of weird. For teenagers, you'd be like, so tell me about your type 1 diabetes. Lea 34:18 You wouldn't. I mean, you can certainly have a conversation with somebody else about it if you don't have it yourself. But I mean, unless you're like you're very new to what diabetes is. It's generally not a big deal. Like if you're talking to somebody who has diabetes, you generally know they have diabetes, and that's why you're talking to each other. So it's never really like a major point of discussion. If that makes any sense. Got it. Did Stacey Simms 34:47 you ever have a moment where you were scared with Benny? Lea 34:51 There was I was like, it was like five minutes where you first showed me an epi pen like in case he got like really low. Oh, the glucagon, glucagon. It's an epi pen. Stacey Simms 35:05 But it's okay. But it looks like the same thing. Lea 35:07 It does the same thing. And I remember like you came up and you showed me and it was like, this big red needle or whatever. I'd never seen anything like it. And you're and you explain the whole thing to me. Like if Benny gets really low, or this happens, or if he passes out, you have to stab him in the thigh with this giant needle. Like, if nobody else was around, you have to do it, or he's gonna die. How old was like nine, five? Stacey Simms 35:30 No, I don't think I'm kidding. I don't remember how Lea 35:35 it was before I turned 10. I remember this. And I was just like, What on earth is this? You want me to stab my brother? If he's like lying on the ground? But and you're like, keeping it in the cabinet downstairs? And it's like, what is this? But I mean, other than that, it's pretty much been totally normal. And Stacey Simms 35:52 it's funny because some of our babysitter's we found because of diabetes, and you've learned to be really good friends with them, which is pretty cool as you've gotten older. Yeah. But Lea 36:01 it was never because of their diabetes. It was just like, oh, you know how to take care of yourself. You can take care of our child. Well, it Stacey Simms 36:07 was for us it was for you had nothing to do with it. What do you care if they had diabetes, it was just one of those things that we felt, we just fell into these great, we found great people. And, you know, like our neighbor, Christina, who was diagnosed as a young adult, and now she's family friends, which is really nice. She's pretty awesome. She is pretty. So family is pretty awesome. Do you worry about Ben growing up with diabetes or being an adult with diabetes? Now? Have you ever even thought about it? Um, Lea 36:29 I'm not worried for him. Not, not with him being able to take care of himself because he's totally capable. I'm just worried about like, what other people might say about it. Because when, because, people when you hear diabetes, you think of like, generally what people think of diabetes I think of as normally type two, which you can get, which is like, generally related to like obesity, or just being overweight and not healthy. But he has type one, which is totally different. And I just, I don't know, kids are mean. I mean, really, kids are kids are mean. And I don't know, I'm not worried about him. I'm worried about everybody else. Stacey Simms 37:06 In what they're gonna say that you'll beat them up if they're meeting of course. Alright, let me just make sure before we start, people had questions. I think they were mostly for Benny, but somebody did so offended. Will do me a question. It gets all the attention. I Lea 37:21 know. Isn't it? Great? Let's see if all this it's okay to complain about your sibling getting all the attention. I think that's a great point. Stacey Simms 37:30 Definitely. It's okay to complain better than season. Lea 37:34 See thing. Don't hate your parents. They're just trying to keep your other sibling alive. Oh, Stacey Simms 37:40 this was an asked these questions. I would love your daughter's perspective. Did it cause her to be jealous? attention seeking, seeking? And how does it feel to have to worry about him? Or do you worry about him? Well, Lea 37:52 I'm gonna go with the second part of this because I feel like I've already addressed like the first part of this question, but I don't really worry about him. Like at all. It's always I know, you and dad worry about him all the time. Because it's like, what if he's not bolusing? What if he's really high? Like what's going on? But I'm just like, whatever, you can take care of himself. You won't let him die. It's okay. There's a hospital down the road, he'll be fine. I mean, I probably should worry just a little bit more than I do. But it's just, it's part of my life. It's part of his life. It's just, it's something we have to do. Well, I Stacey Simms 38:23 think what we tried to do was to make you aware, but not to make it your responsibility. I just never felt like it was your responsibility as a kid, everybody. And if you remember when he got on the bus, he was in kindergarten. So you were in fourth grade. And people a lot of people said to me, Oh, well, it's what a relief that he's on the bus because even though you can't be with him, Leah's there and she can take care of. And I never felt what I told you at the time was, you don't have to worry about his diabetes, just take care of him as a sister and brothers should take care of each other. We told him that to like, if somebody's picking on you, he needs to stand up for you. And vice versa. If you get sick, he needs to holler for help. You know, it's just that kind of stuff. It was never diabetes specific. And I know you guys looked out for each other all the time, or didn't you sit next to each other all through elementary school? Lea 39:08 No, for one grade, Stacey Simms 39:09 I think Did you really say that? I was kidding. No, Lea 39:11 I think it was no, I remember because I was in like fourth grade. So I was I was like, slowly like into like the cool part and like the back of the bus. And I was really excited about it. Because like me and all my friends. We sent like the ferry back and it was like, Oh my gosh, we're so cool. We sent back the bus. But the bus driver, it was Ben he was in like second grade or like, I Stacey Simms 39:30 don't know, I remember this. This was in kindergarten. We foster going to school to major sit together. Lea 39:34 He sat in the very front row, right? They were terrified right behind the bus driver because they were like, what if he like passes out? What if he goes totally insane where he doesn't have any food. And so they made me sit with him? Because I was at SR and like, I knew that they were olders I knew it was going on and I could like call like my mom because I knew your phone number. And I was very I was very upset. But you did Stacey Simms 39:56 that for like a week or yeah, I've been told Does Yeah, there was no, yeah. And then you were like, Mom, we need to address Lea 40:04 this. We have an issue. That's Stacey Simms 40:06 great. I forgot all about that. And he was happy to see you go to Yeah, we Lea 40:10 were both like, Go away. Get away from because my brother like he couldn't talk to females on the bus because they're like, why is your sister with you are like really awkward because like, he was like in kindergarten and I was like a cool fourth grader, not really. And so, and I was just upset because I was like, I want to go sit with my friends. Now. I don't want to do my little brother like ill. Stacey Simms 40:30 And on that note, thank you so much, sweetie. This was great. No problem. You're listening to Diabetes Connections with Stacey Simms. I am so proud of her. Even though I was biting my tongue a bit. I mean, we explained diabetes a lot with her. I am sure you know that, you know. And yes, she knows an epi pen and glucagon are not the same thing. But wow. That was that was nice for me. That was really great to talk to Leah. All right, let's go back to me and Slade. And when we left off, we were started to talk about how we try to make diabetes fit into our life, rather than making life revolve around diabetes. Before before we left the hospital, though. We had a long planned event with our congregation. That that year that summer, we had also decided to help start our temple, right. That was that summer and then this this winter, this happened. But we had a an ice skating. I had planned an ice skating event in downtown Charlotte for the Sunday the day after Benny was diagnosed. So we were still in the hospital. And we talked about it and you said you should go right. And I didn't take Leah. And so you went to the hospital that day, we traded off. And I took Leah to the ice skating rink and I was really nervous. And I was really kind of upset about leaving him in the hospital. I'm so glad I did that. I'm so glad I did that. Because it showed her that life goes on. It kind of convinced me that life goes on. It was a great fun event. And our friends and our community were amazing. They were just amazing. It was so supportive of me. And they made sure we had fun. It was great. I'm so glad we did that. That was cool. Slade 42:17 Yeah, I think that kind of sets or maybe not on purpose, but kind of set the tone for how are you we're trying to normalize we we work really hard and normalizing our lives. In fact, we live our lives first and treat diabetes second, almost, right, because it's just part of what you have to do. It's kind of like you have to put your shoes on if you're gonna go outside, right. So you have to treat your diabetes when whenever you're out and about so. But I think that kind of set the tone for it, right? I mean, because you can you can get into a dark place if you don't. Stacey Simms 42:50 Well, and Dr. Dr. V. also told us probably that day, or the next day, don't buy him a pony for checking his blood sugar. Right. Don't reward him unduly because this is not going away. Yeah, it's not like, you know, oh, boy, I Slade 43:04 think you started looking at ponies Stacey Simms 43:06 I would have looked at I was looking at Porsches looking at everything. It's really funny. You know, it's it's interesting to when you talk about life goes on. I think we put him back in daycare, right? Three days later? Slade 43:19 Well, we're very fortunate. Was it three days high? It Stacey Simms 43:22 was very soon, probably within a week. And we were lucky. Slade 43:25 But we were very fortunate in that the people who are the managers at the daycare center, had had some experience, and then took it upon themselves to go and get more training. Yeah, it was crazy. So we were really fortunate, but that that wasn't common than it was only 10 years ago isn't common, but it's very common now. So I think the challenges that people have about daycare are they're much easier barriers now than when, even just 10 years ago. Stacey Simms 43:56 I would say that there are more resources to help. But I think that daycare is a huge challenge for a lot of people. I don't know how lucky we were. Slade 44:06 Well, no, I don't disagree that it's a huge challenge. But it's there are more and more kids that are diagnosed that come through the doors at daycare centers, and they are their experience level is much higher than it was 10 years. Stacey Simms 44:19 Well, what happened with us was there was a family right before us with a little girl and the mom was a teacher and a nurse. It was crazy. So she had made a whole guide book for them and came in and trained a few people. And so when we brought Benny they knew more than we did I wanted him to sleep there. I kind of did no no. And and Rebecca who was the manager who really just became part of the family for a while. And one or two of the teachers, as you said they did more training. I sent them to one of the JDRF training days and they learned along with us they were absolutely amazing. Then that little girl moved just like three days after we came back from the hospital so they weren't even there. And then the other thing I remember, I should probably stay chronological but I'll skip ahead We had a planned trip with my friends, my college roommate with Beth and Dave, to Las Vegas in. Slade 45:06 But you know, back to the daycare thing, I think the key, the key to that is, and it's kind of the way we've always dealt with it is, our objective is when we put our son in the care of somebody else, particularly early on, our objective was to make them feel as comfortable and as confident as possible, that they that they could take care of them there or, you know, we didn't put pressure on them to say, you know, you were worried you're not going to be able to, or we were scared parents, we let them know that, you know, it's if you have to dial 911, you dial 911, it's okay, you do the best that you can with the tools that we're giving you and the tools that you have. And I think that that's, that's a hard hurdle for people to get over. But I think if you get over that, you get a lot more help. Right, and you get a lot more people who, when they're when your child is in their care that they feel confident, we all know that feeling confident, no matter what you're doing, helps you perform better. So we really worked hard at trying to instill confidence in the people that were at times across the years taking care of our son. Stacey Simms 46:16 I think we were also the beneficiaries in a weird way of less or no social media. You're not on Facebook a ton, and you're not in all these diabetes groups. But I think if if I had been when Benny was diagnosed, my outlook might be different. Because some of them have 1000s and 1000s of people in them and everybody's experience is different. And you know, it is on Facebook, you only see the best and the worst. And people post a lot of nightmare stories that other people assume are the norm, and they're not. And I think I would have been more frightened, I would have loved the support. I mean, we had nobody up here for the first couple years. We didn't know anybody. But I think that that that has added to I don't want to do a whole thing on social media here. But I think that has added to some of the fear was, Slade 47:01 I think that and because social media wasn't as prevalent as it isn't, it's the same thing, right? You believe half of what you hear and less than what you read, right? I mean, it's you have to make decisions based on your own experiences. And it's okay to view other experiences and see how they might, might influence what you're doing. But you can't, you can't say it happened to that person. So it's going to happen to me. Exactly. Stacey Simms 47:26 And I will say he was great. I mean, he had highs, he had lows, he was always safe and happy, which as you know, if you listen, that's my goal is not perfect, but safe and happy. And the one time he went to the hospital was Was he he just got his thumb caught in the door. You remember he did Slade 47:41 the same thing that other people do at daycare, they get hurt falling down, you know, somebody threw a block at his head, right? I mean, that's the same kind of stuff. And you Stacey Simms 47:51 needed stitches. That was the one thing. And I was so nervous, because that wasn't too long after diagnosis, maybe a couple months, and I'm still nervous, because my oh my gosh, how are we gonna manage diabetes? Fine. It Slade 48:01 was fine. It was easy. Stacey Simms 48:02 It was easy. So the next big thing that happened in terms of life goes on was we went to Las Vegas with my college roommate. And I called my mom because she was going to come watch the kids and my parents lived in Florida. And I said, you know, I don't know if we should do this, you know, should we stay? And life goes on. You have to go you have to go. She said, You know, this is not you know, I'll do it. I'll do it. So as we started talking about she said, but I can't give them a shot. I got it. And you know what? I think she would have if she had to she would have right? Yeah. But we were very fortunate one of the girls from daycare, who was as she was trained to be a nurse, right? She was nursing student, Kristen. She was so she came over. I met her she stayed here. But she came over and did all the insulin at the weekend. And you know and mom called us a ton we were in was the Aladdin was it? It was it was the end of the Aladdin right? Because they Slade 48:59 Yeah, it wasn't. Oh, yeah, it was yeah, they return it they were tearing Stacey Simms 49:03 down around us. And so I remember distinctly like taking a call from her getting in the elevator on the Aladdin and losing the call. And then she called me back. So when we when we mean it, but we had a great time. Slade 49:15 Was that before the show we went to what show the show when Dave Stacey Simms 49:19 No, that was that was months after the show was the following weekend. It's what you tell us. Okay, so when you tell I'll tell the story. So one week after diagnosis. We're so fortunate. My brother in law David Slate's brother says four older brothers. And David is closest in age to him. So David was staying us for like a month after Thanksgiving. It was great. He was in between jobs. And he's just so close to my kids. It was wonderful. Unfortunately for him, he was here for diagnosis. So we had tickets to spam a lot. Me and you that following weekend. So again, David's like go go I've got it. I mean, David knew just as much as we did at that point. Yeah. So we get three numbers into spam a lot. I mean to know if it was that lady of the Like, I don't know where that is, or maybe I made it up. And, you know, in the phone rings, so you go out to take the call and like 15 minutes later yeah, it wasn't because I saw three numbers I think you saw like, and I went out to see what was going on. And he thought, you know, when you think about how you dose a little kid, he was 27 pounds. He was 23 months old, and he got like little puffs of insulin. But we were using syringes, right? So he would get like a quarter of a unit or you tried to estimate a half a unit and I think he was supposed to get a half a unit and David gave him six units or something like that. Or two, you couldn't have taken two units. I mean, he had this tiny little dose and David thought he gave him four times as much right? So we couldn't figure it out. So we just said forget it. We went home. As I remember Slade 50:43 on our way home. We were driving home and he had it under we never stopped him. Did we? Yes, of course. We Stacey Simms 50:49 came home. Okay, we we didn't come home. I thought we went right to the NATs house. Okay, so he's but But what happened? Is we checked or he checked. Isn't that funny? I can't remember either. We're getting old honey. So he checked or we checked and his blood sugar never felt right. He was perfectly fine. He was like, I'll make it up. He was like 150 all night. I mean, never fell. So he couldn't have possibly either do injection? Or he never miscalculated, right? Or, or Benny snuck a pizza in the middle of the night that we didn't know about. And so we were on our way home, right. And a friend of ours had had a holiday party going on that night. We're like, I will just go there Slade 51:22 just fine. So the we left the show early, right. I mean, we're 20 minutes into the show. We laughed. We're driving home talking back and forth with David and realized he was fine. So we kept going went by the house and went to a friend's holiday party. Stacey Simms 51:35 We're terrible parents. No, we're not. I don't think we're gonna terrible parents either. That's really funny. Yeah, and that we never saw spam a lot. No, I still haven't seen it. Slade 51:48 I mean, I want to I don't know if I could bring Benny Stacey Simms 51:55 All right, um, I promise we won't go year by year, day by day through the 10 years. But just a couple of quick things about the Look at me. Like, are you sure? Slade 52:06 I don't have a good enough memory to do that, please. Stacey Simms 52:10 Benny, God has insulin pump. We talked about that with Dr. V. Right from the beginning. And he got his pump. We went to our educator to Lynette Right. And, and we said, I remember saying give me the one that's easiest for me to use, and will be the best for him. Because I was really scared of how complicated it was gonna be. And we wound up with the atom is 2020, which is what they had back then. And I showed it to Benny, and he threw it across the room. Got Slade 52:40 your hand and chucked it. Stacey Simms 52:44 Maybe this won't work out so well. But he was two and a half. You know, we kind of explained to him what the deal was. And you know, this will be a big shot every three days. But not all the shots in between that by this point. He didn't care. You could give him a shot. Slade 52:55 He would just stick his arm up like shot, he raised his arm you give me I put his arm down. He Stacey Simms 52:59 didn't care at all. At that point. He was so so good. And so used to it. But that night when he had the pump, because we had the sailing trial for a couple of days, he said, I said do you want it? I didn't know he was gonna sleep in. So I kind of said, Do you want me to take it off? And he said no mine. And that was it. He loved it. He's just he wouldn't give it up after that. So that was really good. And we had a little trouble with the very first inset we ever did. We had a capillary, there's a lot of blood member and then we weren't sure it was going to work. And we like geniuses, we decided we were going to go away to start the pump. So we went to my parents house where this was in the summer. So you I went to my parents house for a week, because when you start an insulin pump, and they probably still do this now you have to check every three hours around the clock for the first couple days to get the level, you know, close to right. I'll go with, I'll stay with my mom. My parents spent the summers in New York at that point. I'll spend the summers spend the week in New York. And then my mom can spot me with the kids. It'll be great. I'll sleep when I sleep. And you had a golf tournament with Bill in Vermont, in Vermont. And I said, Oh go I can do this. Go ahead. And you know, I'm fine. I'll be with my parents. So I remember thinking when we first had that bad inset, this isn't I'm never gonna get on a plane. This is not working. And I remember we changed it and he was, you know, we've checked in right before we got in the car to go to the airport. And luckily it was fine. So I was much calmer. We were crazy to do this Slade 54:20 as well. And I remember I was in Vermont and I don't know if I think I was supposed to pack up the diabetes supplies. Stacey Simms 54:29 I don't know. That guy was yes, you packed all the diabetes supplies and I for the record. Slade is fastidious, he is an excellent Packer. Usually what happens is I put out clothing and then you pack it. Yeah, I mean, he's really, I would trust him more than myself in terms of remembering things. So I'll give you that much credit. Yeah, well, you blew this one. Oh, I forgot to add Slade 54:51 the cartridges that you refill and then put back in the pump. And I'm in Vermont and you we're scrambling, we're on the phone, you're scrambling trying to figure out what to do. And Bill had a good friend whose son had type one. And he was on a pump. We had no idea if it was the same. But like, he calls them at like eight o'clock at night, we go to his house, he gives us a couple of cartridges. I mean, it was really, and we were ready to drive back to Manhattan, right? Or back to New York, to bring it to you. And you guys had figured out another way to Yeah, Stacey Simms 55:27 but it was really funny. Because again, before Facebook, yeah, I probably could have put out a message and said, Does anybody have this within 30 miles and somebody would have helped me out. So what happened was, we went to change the cartridge, and I'm all proud of myself, because I've got it all laid out, and I'm calm. And so we had a good start to the pump. We really, we didn't need a lot of adjusting for whatever reason the dosing worked out pretty easily pretty quickly. So when I went to change the cartridge, I was feeling maybe overconfident. So I had everything else spread out everything right. And I realized where the cartridges were the cartridges. So I called our endocrinology office, and I called our educator and the endocrinologist called back first and said, You need a luer lock needle, and what the heck and you can't get it at a pharmacy. So my dad is gone. I'm going to the hospital. And he goes to get the luer lock needle so he can say you can screw it on to the cartridge and I had insulin I had an insulin vial. So then Lynette our educator calls me back, she says, We're gonna MacGyver this thing. And she teaches me over the phone, how to, you know, open up the cartridge had to make sure that you have enough space in it and and then we just injected the insulin and it was a regular needle. So she was really helpful, and she was so happy to do it. She was fantastic. I also had called the Animus, and they couldn't do anything that night. But the next morning, they came to my mom's house in rural Westchester County, which if you're not familiar with Westchester County, there's like old she is less than I said rural Westchester County it is what is it? It's not like there are farms there. I mean, they're like Ralph, Lauren owns a farm. But what I mean is they're tiny roads, they're not well marked. I can't say that. It's Slade 57:11 like any other street it has. Your house has a number in his street name, I find it to be very confused. Like it was unmarked land and her whole western neighbor fought Stacey Simms 57:20 with machetes to get to my mother's. I was impressed that they came over the next morning, and they gave me different cartridges, different sam

Send us a Text Message.In this episode, Dr. Sugerman discusses Diabetic Ketoacidosis (DKA) in pets and shares a real-life case of a dog named Ranger. He explains the role of insulin in managing blood glucose levels, the significance of ketone bodies, and the process of diagnosing and treating DKA. Dr. Sugerman also discusses the prognosis and aftercare for pets with DKA. Tune in for an informative and educational episode on DKA in pets.In this episode you will learn:What diabetic ketoacidosis (DKA) is and how it affects the bodyA real life case seen by Dr. Sugerman and understand his thought processes during the diagnosing phaseHow we treat DKA patients and the importance of hospitalizationPotential prognosis for DKA patients and what their post-hospitalization future may holdSupport the Show.Connect with me here: https://www.vetsplanationpodcast.com/ https://www.facebook.com/vetsplanation/ https://www.twitter.com/vetsplanations/ https://www.instagram.com/vetsplanation/ https://www.tiktok.com/@vetsplanation/ https://youtube.com/@Vetsplanationpodcast https://www.youtube.com/playlist?list=PLVbvK_wcgytuVECLYsfmc2qV3rCQ9enJK Voluntary donations and Vetsplanation subscription: https://www.paypal.com/donate/?hosted_button_id=DNZL7TUE28SYE https://www.buzzsprout.com/1961906/subscribe

It's In the News, a look at the top stories and headlines from the diabetes community happening now. Top stories this week: lots of news from the EASD conference, including info from Dexcom, Vertex, and more, the ADA issues new guidelines for CGM use at school around caregivers' ability to follow, a new study says women should be screened at a younger age for type 2 diabetes, and congrats to Lauren Dahlin, who lives with type 1, for qualifying for the Ironman race in Hawaii. Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Take Control with Afrezza  Omnipod - Simplify Life Learn about Dexcom  Edgepark Medical Supplies Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and these are the top diabetes stories and headlines happening now XX In the news is brought to you by Edgepark simplify your diabetes journey with Edgepark XX Lots of news out of EASD – the European Association for the Study of Diabetes happening this week. Including, a new trial finds that antiviral medications, when given soon after a child is diagnosed with type 1 diabetes, might help preserve those vital beta cells. The team followed 96 children aged 6 to 15 who were all diagnosed with type 1 diabetes within three weeks prior to their enrollment in the study. The children were randomly selected to receive either the two antiviral medicines or a placebo for six months. After one year of follow-up, the researchers found that C-peptide levels remained "significantly higher" in kids who'd gotten the antiviral treatment compared to those who hadn't. That suggests the treatment helped shield the child's pancreatic beta cells from destruction. While C-peptide levels dropped a full 24% in children who received the placebo, it fell by just 11% in those who got the antivirals, the investigators found. On top of that, 86% of kids who'd gotten the antivirals still produced their own insulin at a level that makes treatment with supplementary insulin easier, the team said, and is also known to be linked to lowered risks for diabetes complications. The treatment appeared to be safe, with no severe side effects noted. According to Mynarek's team, their research supports the notion "that a low-grade persistent virus infection is an underlying disease mechanism, and that type 1 diabetes may be prevented by development of new vaccines." The researchers concluded that "further studies should be done at an earlier stage in the disease process, to evaluate whether antiviral treatment could delay the progression of beta-cell damage leading to clinical type 1 diabetes." https://consumer.healthday.com/type-1-diabetes-2665779376.html XX Also at EASD, an update on once a week insulin icodec for the treatment of type 1 diabetes. While several other studies have investigated once-weekly insulins in type 2 diabetes, this was the first data to be presented from a large-scale phase 3 study in type 1 diabetes. The study, ONWARDS 6, included 582 people with type 1 diabetes who received either insulin icodec or insulin degludec. Participants had an average age of 44 years and an average diabetes duration of 20 years. Both the icodec and degludec group received basal insulin in combination with mealtime insulin (insulin aspart, or NovoLog) over a period of 57 weeks. Overall, participants treated with once-weekly icodec and once-daily icodec had similar reductions in A1C of -0.5%, suggesting that this new insulin may offer another option for treating type 1 diabetes. What were the key findings? This study showed that insulin icodec was effective at reducing A1C in people with type 1 diabetes, although icodec did lead to higher rates of hypoglycemia compared to degludec. Researchers are still investigating some questions related to the hypoglycemia events that occurred in this trial, such as how the time of injection and exercise may affect hypoglycemia. https://diatribe.org/once-weekly-insulins-type-1-diabetes-latest-research-update XX XX Vertex Pharmaceuticals says a third type 1 patient no longer needs insulin after it's investigational stem cell-derived therapy VX-880, being assessed for type 1 diabetes. Two patients who had been followed for at least 12 months likewise met the study's endpoint of the elimination of serious hypoglycemic events (SHE) between 90 days and 12 months. Tuesday's results follow an earlier data drop in June 2023, detailing the first two patients that achieved insulin independence and met the study's primary endpoint. The first patient achieved insulin independence 270 days into treatment, lasting through month 24 of the follow-up. The patient had type 1 diabetes (T1D) for “nearly 42 years,” according to Vertex's announcement, and was taking 34 units of insulin daily. Insulin independence came on day 180 for the second patient, persisting through 12 months of follow-up. The patient had T1D for 19 years and was taking 45.1 units of exogenous insulin daily. This patient had to restart insulin treatment at month 15, though at a much lower daily dose of four units. The third patient stopped needing insulin at 180 days of treatment, which happened after the data cut-off, according to Vertex. Aside from insulin independence, the new data from the Phase I/II study showed that VX-880 induced islet cell engraftment in all participants in parts A and B of the study at 90 days. In turn, these patients are now capable of endogenous glucose-responsive insulin production and demonstrated better glycemic control across various measures, including HbA1c and time-in-range. Before receiving VX-880, all enrolled participants had long-standing T1D and showed no signs of endogenous insulin secretion and required 34.0 units of insulin per day on average, according to Vertex's announcement on Tuesday. All patients also had histories of recurrent severe hypoglycemic events. An investigational allogeneic stem cell-based therapeutic, VX-880 works by delivering fully differentiated and insulin-producing islet cells, in turn restoring the body's glucose-responsive insulin production capabilities and boosting glucose control. VX-880 is designed to be delivered via an infusion through the hepatic portal vein. Patients need to be on an immunosuppressive regimen to receive the candidate. Vertex's T1D program also includes VX-264, an investigational therapy that encapsulates stem cell-derived islet cells in a protective device to be implanted into the patients' bodies, according to the company's website. Because the device is designed to shield the therapeutic cells from the body's response, VX-264 is being studied without the use of immunosuppressive therapies. https://www.biospace.com/article/vertex-touts-promising-data-for-stem-cell-based-type-1-diabetes-treatment/ XX I mentioned Dexcom's presentation at EASD in our long format interview earlier this week.. One of the company's studies, for example, recruited insulin users in the U.K. to test out the Dexcom ONE device, which offers a more simplified interface compared to the company's flagship G-series sensors. Though both Type 1 and Type 2 patients joined the study, Dexcom specifically singled out its results in the Type 2 population: The group saw their average HbA1c levels drop from a baseline of just over 10% to 8.5% after three months, then down to 8.3% after another three months, according to a company release. The data marked the first real-world study conducted on the Dexcom ONE CGM, Leach said. Another study presented at the EASD conference this week verified the use of the G7 sensor in pregnant women with Type 1, Type 2 or gestational diabetes—making Dexcom's G6 and G7 devices the only commercially available CGMs backed by clinical data for use during pregnancy, the company said. That group makes up about 10% of all pregnancies, he said, and “whether you're on insulin therapy or not, just the benefit of having a Supported by those findings, Dexcom said in the release that it now plans to make the G7 sensor available for use with Tandem's t:slim X2 insulin pump in the U.S. and “multiple markets across Europe and Asia-Pacific” before the end of 2023. https://www.fiercebiotech.com/medtech/easd-dexcom-cgms-notch-wins-among-type-2-and-pregnant-users-and-7-year-real-world-data XX Metformin may lengthen the time until insulin initiation, lower fasting glucose and improve neonatal outcomes for pregnant women with gestational diabetes, according to data from a randomized trial. In findings presented at the European Association for the Study of Diabetes annual meeting and simultaneously published in JAMA, researchers compared glycemic, maternal and neonatal outcomes for women with gestational diabetes randomly assigned up to 2,500 mg metformin daily with those receiving placebo. The metformin group had a lower mean fasting glucose at 32 and 38 weeks of gestation, and the offspring of women receiving metformin had a lower mean birth weight than the offspring of those receiving placebo. Metformin reduces the likelihood for large for gestational age among offspring of women with gestational diabetes. Infants from mothers in the metformin group had a lower mean birth weight than offspring of mothers from the placebo group (3,393 g vs. 3,506 g; P = .005). The percentage of infants born large for gestational age was lower in the metformin group vs. placebo (6.5% vs. 14.9%; P = .003). Mean crown-to-heel length was shorter in offspring of mothers from the metformin group compared with placebo (51 cm vs. 51.7 cm; P = .02). “Caution should continue with metformin and small for gestational age, especially in those where small for gestational age may be more likely, so those with hypertension or nephropathy,” Dunne said during the presentation. https://www.healio.com/news/endocrinology/20231004/metformin-provides-glycemic-neonatal-benefits-for-women-with-gestational-diabetes XX More voices are calling for more screening for type 1 diabetes. About 85% of people with type have no family history. Various research programs are going on worldwide to establish the best ways of implementing universal screening, including programs in Germany, the USA, Israel, the UK, and Australia. A new program (Edent1fi) has just been funded that will include multiple new European countries, including the UK, Germany, Poland, Portugal, Italy, and the Czech Republic. "These are all research programs. The next steps before universal screening for type 1 diabetes becomes general policy will require guidelines for monitoring and endorsement of screening and monitoring guidelines by applicable societies," explains Dr. Sims. This will also be helped by broader access to disease-modifying therapies to impact progression and the need to start insulin injections. Screening for adults, who can also develop T1D, is less well studied. Although optimal approaches have yet to be elucidated, this population will also likely benefit from identifying early-stage disease and the advantages of education, monitoring, and access to therapy. https://www.news-medical.net/news/20231003/Universal-screening-A-game-changer-in-early-detection-and-management-of-type-1-diabetes.aspx XX As I mentioned briefly in my last episode, one of the winners of this year's Nobel prize for medicine has lived with type 1 for almost 60 years. Dr. Drew Weissman and Katalin Karikó won the Nobel for their work on the COVID-19 vaccines received a Nobel Prize of Medicine. Karikó and Weissman met by chance in the 1990s while photocopying research papers, Karikó told The Associated Press. Weissman was diagnosed at age 5 and I'll link up a great interview that Mike Hoskins posted – he used to write for DiabetesMine. http://www.thediabeticscornerbooth.com/2021/02/we-can-thank-this-researcher-with-type.html?m=1&fbclid=IwAR254vGL8G0aU3uUnvfHbJa79WCiFgS8ihMgHMf0V2hK2QYJBLaa9zwMn7U XX Should women be screened for type 2 diabetes at a younger age than men? A recent study published in Diabetes Therapy explores this hypothesis – there's a lot here and I'll link it up, but they examine the theory that menstruation can throw off an A1C. Women with diabetes between 16-60 years of age have an increased mortality risk by about 27% as compared to diabetic men of the same age when both are compared to the general population. Women lose an average of 5.3 years from their lifespan with diabetes as compared to 4.5 years for men. The study comprised two cohorts. The first included over 146,000 individuals using a single HbA1c reading at or below 50 mmol/mol obtained between 2012 and 2019. The distribution was replicated using readings from a second cohort of about 940,000 people, whose samples were analyzed in six laboratories between 2019 and 2021. The mean HbA1c level in women at any given age corresponded to that observed in men up to ten years earlier. These findings were corroborated with data obtained from the second cohort. An undermeasurement of approximately 1.6 mmol/mol HbA1c in women may delay their diabetes diagnosis by up to ten years. Ten years in which they weren't being treated. https://www.news-medical.net/news/20231004/The-cut-off-for-HbA1c-based-diagnosis-of-diabetes-may-be-too-high-in-women.aspx XX Commercial – Edgepark XX XX Very recently, the Americans with Diabetes Association released updated CGM guidance for use in schools. The link to the new guidance is below. This came about after discussions with stakeholders, including myself and Attorney Roswig. Be clear, this was revised because of the discussions and “rallying” of families impacted, where in some cases schools were pointing to certain flaws in the language in the prior guidance. While this new guidance may address your CGM issue with your particular school, the new guidance, in our opinion, still needs work. Please know that this work will continue. If you have any more specific questions, please contact me and I will attempt to address the same. Thank you for your patience, thus far, and anticipated trust and patience going forward. https://diabetes.org/sites/default/files/2023-09/cgm-final-9-22-23.pdf?fbclid=IwAR1t4cpPUSmDoitWiH2hSgNnXWdeYQjPW4rlewjWkWHiOYWc65HX8ub74Yo XX have to show everyone and show myself that this doesn't change anything,” said Lauren Dahlin about her diagnosis with type 1 diabetes (T1D) at 26 years old in 2017. Today, she's a true athlete who has competed in nine Ironman races — consisting of a 2.4-mile swim, a 112-mile bike ride, and a 26.2-mile run. Completed within about 14 hours! This past summer, Dahlin competed in the annual Ironman in Lake Placid, NY. The event came with a lot of pressure because placing within the top 24 racers meant qualifying for the biggest Ironman event of all: the World Championship in Kona, HI. She did it. Dahlin placed 9th amongst about 600 other female competitors — becoming one of the first women with T1D to qualify for the Ironman in Kona, HI. Happening next weekend Oct 14th Here's a closer look at Dahlin's journey from diagnosis to rockstar competitive athlete. Diagnosed just days before a potential DKA coma “I couldn't even walk half a flight of stairs without getting extremely winded because I was so far gone,” explains Dahlin of her pre-diagnosis symptoms. “The clinic gave me an inhaler for asthma and sent me home!” Dahlin saw six different providers before someone finally gave her the appropriate diagnosis. They even performed a full-blood panel workup and didn't diagnose her T1D. Eventually, Dahlin went to the emergency room in Boston, where she lived, and the staff told her she was experiencing diabetic ketoacidosis (DKA). She then spent ten days in the intensive care unit learning about her new life living with T1D. “I was bummed that the doctors hadn't caught my diagnosis earlier because there were a lot of clinical trials happening in Boston that I could have been a part of.” Regardless, Dahlin didn't want to slow down — within one month of her diagnosis, she signed up for her first half-marathon. https://t1dexchange.org/ironman-world-championship-type-1-diabetes/ XX That's In the News for this week.. if you like it, please share it! Thanks for joining me! See you back here soon.  

This is a bitesize episode of 'The insuleoin Podcast - Redefining Diabetes'. Each week we'll take a look back into the archive of episodes and get you to think and reflective once more about some of the things we've learned over the past few years. In this week's BITESIZE:Unresponsive with DKA. Tips for newly diagnosed. Don't be afraid to fail.To hear the full episode check out episode #92: “Unresponsive & Taken Into Hospital”: Listeners' Stories & Questions. Hosted on Acast. See acast.com/privacy for more information.

Insulin EM Pulse PodcastThis is the next episode of our Push Dose Pearls miniseries with ED Pharmacist, Chris Adams. In this ongoing series we'll dig into some of the questions we all have about medications we commonly see and use in the ED. This episode again focuses on insulin. Should everyone with hyperglycemia get regular insulin? Is IV better than subcu? We'll answer these questions and more as we discuss the latest recommendations for managing hyperglycemia and DKA in the ED.  Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and Assistant Professor at UC Davis Resources: Hardern RD, Quinn ND Emergency management of diabetic ketoacidosis in adults Emergency Medicine Journal 2003;20:210-213 Schwartz X, Porter B, Gilbert MP, Sullivan A, Long B, Lentz S. Emergency Department Management of Uncomplicated Hyperglycemia in Patients without History of Diabetes. J Emerg Med. 2023 Aug;65(2):e81-e92. doi: 10.1016/j.jemermed.2023.04.018. Epub 2023 Apr 26. PMID: 37474343. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

The endocrine system consists of a network of glands and organs throughout the body and is responsible for a range of bodily functions. Through the release of particular hormones, the endocrine system provides signals for organs and tissue that tell them what to do and how to function. As a result, endocrine disorders, such as diabetes, hyperthyroidism, or hypothyroidism, are often quite complex and need to be given special care and attention by healthcare providers. For today's episode, we welcome back Dr. Andrew Jenzer to talk about endocrine disorders and how to manage these conditions when treating patients as an oral maxillofacial surgeon. Tuning in, you'll hear Dr. Jenzer provide a detailed breakdown of common endocrine disorders, like diabetes, and how to manage complications that might arise from these disease states. Dr. Jenzer unpacks the differences between type one and type two diabetes, how to assess patients on a case-by-case basis, and what to consider when treating them. He also discusses the symptoms of hyperthyroidism and hypothyroidism and the physiology of the thyroid and shares his advice for avoiding unnecessary supplementation of steroids. For a comprehensive breakdown of the most common endocrine disorders, the symptoms associated with them, and what to bear in mind when treating patients, be sure to tune in and hear all of Dr. Jenzer's pertinent observations and insights!Key Points From This Episode:Introduction today's topic: endocrine disorders and management.A comprehensive breakdown of type one and type two diabetes as endocrine disorders.Questions to ask patients about how well-controlled their diabetes is.Instructions on managing a patient based on their blood sugar.Diagnostic tests that definitively diagnose diabetes.Insight into how to manage diabetes.An overview of the negative scenarios that can occur in a patient with diabetes.When and how severe dehydration occurs in diabetic patients.Instructions on how to rehydrate patients and the recommended fluids to use.The similarities and differences between Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS) and how to address and treat them.A warning on the rare possibility of cerebral edema in patients with DKA or HSS.Ensuring you do due diligence on any medications your patient may be on.Why it's always recommended that you consult your patient's endocrinologist.Why patients will sometimes have more than one endocrine disorder to be managed.Information on steroids and how to avoid unnecessary supplementation for patients with endocrine disorders.Links Mentioned in Today's Episode:Medicine Review: Cardiology (with Dr. Andrew Jenzer) — https://podcasts.apple.com/sk/podcast/medicine-review-cardiology-with-dr-andrew-jenzer/id1535284898?i=1000614877276KLS Martin — https://www.klsmartin.com/en/ KLS Martin Bien Air implantology — https://www.klsmartin.com/en-na/products/power-systems/bien-air/KLS Martin Headlights MedLED® — https://www.klsmartin.com/en/products/headlights/KLS Martin Surgical instruments for dental and oral surgery — https://www.klsmartin.com/en/products/surgical-instruments/instruments-for-dental-and-oral-surgery/Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Or

On this podcast episode, I discuss bexagliflozin pharmacology, adverse effects, drug interactions, and much more. I wasn't wowed by the A1C reduction of this medication. I get into the specifics on bexagliflozin in the podcast episode. SGLT2 inhibitors like bexagliflozin increase the glucose in the urine which can facilitate the growth of bacteria and fungi in the genitourinary tract. Limb amputation and euglycemic DKA are two rare, reported adverse effects to be aware of with the use of bexagliflozin.