Secretly Incredibly Fascinating - Diabetes

Episode Date: October 21, 2024

Alex Schmidt, Katie Goldin, and special guests Dave Holmes and Craig Stubing explore why diabetes is secretly incredibly fascinating.Visit http://sifpod.fun/ for research sources and for this week's bonus episode.Come hang out with us on the SIF Discord: https://discord.gg/wbR96nsGg5

Quick programming note before this episode starts, I got asked if people need to hear the recent CIF episode about insulin in order to understand this episode about diabetes. No you do not, they totally stand on their own. Or you can go back to April and hear that insulin show first. Either way, enjoy. Diabetes. Known for being a condition. Famous for being two types of conditions.

Nobody who does not have diabetes thinks much about it, so let's have some fun. Let's find out why diabetes is secretly incredibly fascinating. Hey there, folks. Welcome to a whole new podcast episode, a podcast all about why being alive is more interesting than people think it is. My name is Alex Schmidt and I'm very much not alone. I'm joined by my co-host Katie Golden. Katie, hi. Yes. Hello. It's me. And we are keeping it quick because we have wonderful guests joining us as well. Introducing them one by one. You know him as the host of Troubled Waters. You know him for his writing and hosting and so many other wonderful things. Dave Holmes rejoins us. Hello, Dave. Hello, Alex and Katie. How are you? Doing great. We are recently fresh from being in Europe. That was fun. Katie's usually there, but I was there too. I'm still fresh and in Europe.

You are fresh and in Europe. Where were you, Alex? We did a London episode together and also with our buddy Robin Ince at the London Podcast Festival. I love Robin Ince and I love the London Podcast Festival. Did you get a Robin's Egg Blue coffee mug? Yes. We did, it's lovely, I love it. Yep, I cherish mine. Yeah, I did not check if it is dishwasher safe and proceeded to turn it into a white mug.

Oops. Oh no. So, whoops. How are you gonna make a coffee mug that's not dishwasher safe? Yeah, well, what do you do? Wow. All right.

Different cultures, you know. You'll know. And we are also thrilled to be joined by a new guest and someone who is, among many other things, the CEO of the Beta Cell Foundation. Very happy to be speaking to Craig Stooping. Hello, Craig. Welcome. Hey there.

So happy to be on the show. Yeah. And Dave helped bring you along, especially because we have a topic suggested by many listeners including Sam Skinner 13, Keru Sita, and also people who were enthusiastic about our episode a few months back about insulin. They said, please do a whole nother episode about the separate topic somewhat of diabetes. And we always start with our relationship to the topic or opinion of it. Dave and Craig, would either of you like to talk about your experience with diabetes? Yeah, I've had type 1 diabetes since January 2001. I was 13 when I was diagnosed. I guess later in life I learned from my mother that they didn't know if I was going to live when I was diagnosed. Like I was in the hospital when I was diagnosed.

No one ever really, no one ever told me really how bad it was. I just kind of woke up one day in the hospital and was fine. And I've been fine ever since, which is great. Okay. Yeah. That's how I got diabetes. And was fine, and I've been fine ever since, which is great. Okay. Yeah, that's how I got diabetes. It sounds like it's been a very straightforward experience since that, at age 13. Like you were suddenly in the hospital and then diagnosed and it's been relatively straightforward. I mean, we'll probably get into how not straightforward diabetes is, but I've... Yes, totally.

In the sense that I've had it and it hasn't gone away and that's just kind of been a part of my life that I've tried to find ways to make it less burdensome, I guess. Which is a balancing act. Yeah. Thirteen is already a real tough age. You're already dealing with so many things, so many new emotions, algebra, and then to kind of throw them like, hey, by the way, you just have to deal with this for the rest of your life.

See you, kid. Yeah, it's definitely pretty. Looking back, I'm kind of surprised I was mature enough to keep myself alive. Luckily, I had doctors and parents and a support system, but I don't know if it really hit me at the time that it was like, oh, you have to do this thing now. You have to literally keep yourself alive. You have to be an organ for the rest of your life. If you screw up, that could be game over.

All day. Every day. And all night. And all night. Yeah. All night makes it sound like a party. That's good. You know? Sure. I mean, yeah. Being alive is a party. You know, that's a good way to look at it. Yeah, it can be, certainly. But I will say the best part, there's not really a lot of good things that come from having diabetes,

but meeting people like the illustrious Dave Holmes has definitely been a highlight that I don't think we probably ever would have met. Our paths may never have crossed. I was diagnosed in, I think 2015. So I was, you know, in my 40s, in my early 40s, I had had a regular doctor's appointment where, you know, the doctor took blood and did the battery of tests and whatever and my my blood sugar was slightly elevated and because I was at that time in my late 30s my general practitioner said what you have is the beginnings of type 2 diabetes which is more a situation of insulin resistance

in the body than the pancreas not being able to create insulin. And so he put me on medication, which was metformin, which made me super sick a lot. And I would just randomly vomit, which we don't love to do. And it would be one of those things where everything would be fine. And then all of a sudden my stomach was like, oh no, we have to, we gotta barf. And also my blood sugar, which I was testing constantly, wasn't really changing. And so he put me on more medication,

which made me a little sicker. And then I finally said, something is not right here. And I couldn't get a referral to an endocrinologist, which is a doctor who specializes in conditions like type 1 diabetes, to go and get the proper testing. So I changed my insurance so I could do a PPO so that I could see an endocrinologist without a referral. Oh my God.

Yeah. On top of everything else you're dealing with, just like, ah, here's bureaucracy. Yeah, yeah. And so I changed it. I made an appointment with an endocrinologist who had just opened his practice in Los Angeles. I think I was the first or the second patient that he saw ever after moving to Los Angeles

at the very first of the year. And he's still my endocrinologist to this day. And he ran the tests and was like, no, you absolutely have type 1 diabetes. And it was early enough that I did not to this day and he ran the tests and was like, no, you absolutely have type one diabetes. And it was early enough that I did not have to go to the emergency room. I was in what's called the honeymoon period, which maybe we'll get to. But, you know, immediately I needed to go on insulin. And so I did. It's type one is one of those is a condition that about

half of cases are diagnosed from by the age of 13, and the other half could be the whole rest of your life. People get diagnosed in their 70s and 80s. But yeah, I'm coming up on 10 years. Yeah, before digging into researching on this, I did not know it could work that way. I feel like people really think of type 1 as being just in children, like when it first pops up. Yeah.

But now there's kids who are getting type 2 diabetes and there's always been adults getting type 1, but because of that, I don't know, that misconception that leads to people like Dave Holmes barfing his brains out once a month, unnecessarily. Yeah. And you know, and I will echo Craig's sentiment. When I was diagnosed with type 1 and when it was obvious that I would have to go on insulin and all that, the diabetes educator who works with my endocrinologist said, go out and find a community.

Get on Meetup, go and meet other adult type 1s. And I was like, I and meet other adult type ones. And I was like, I don't want to do that. I just thought, I'll be fine. I don't need to. And then life with it is very challenging, especially at first. And I would say especially when you're an adult

and you're kind of set in your ways and you're maybe more aware of your own mortality. And so I had a couple sort of close calls with low blood sugar that were scary. And I thought, okay, maybe I really should go and meet people. And so I went to an adult type one diabetes happy hour, and I met the great Craig Stubing,

who has a type one diabetic running group, and I like to run. And so we got out on the road and became friends. Which was not only fun, but hugely important and beneficial. How you learned everything you know. It's how I learned literally everything I know. And there's still so much I don't, but everything I do know.

The meetups are just cram sessions about general knowledge, learning about history, astronomy. I remember meeting Dave, and you must have been just diagnosed with type 1, right? Yeah, it was within the first month or so. Because you didn't know anything. Nothing. And I remember you emailing me afterwards,

asking all these questions like, I need to go for a run. Should I eat an apple beforehand? I specifically remember this apple. Yeah. And then we would meet up for runs and you would bring everything you owned with you. Yes. His pockets were out to like the side full of fruit snacks and test strips. Yeah, weighed down by glucose gels and tablets and whatever. Yeah, like a bandolero belt of things. Yeah, because, okay, so food makes your blood sugar spike, specifically carbohydrates make your blood glucose spike.

Insulin brings it back down. Insulin plus exercise brings it down very rapidly. And when I first went on insulin and my blood sugar began to be in a healthy range, I was like, oh cool, I'm fixed and this is great and whatever. So I remember I gave myself four or five units of insulin. I ate lunch and then like an hour later, I was like, I'm gonna go for a run. And so I went for a run and I had a glucose monitor on me,

which I also still have now. And I was like, you know, I was at a pretty healthy level and I'm running, running. And it was sort of an out and back thing. And I got to the furthest point and I heard a terrible alarm coming from my phone, which communicates with the glucose monitor, and it indicated that I was going down very rapidly and like into an unsafe level. And I'm real stupid.

So I didn't bring any, this is before I got paranoid, I didn't bring any glucose gels or tablets or quick fixes with me. I had no money in my pocket. I think this is a time before Apple pay. I learned that day that I can sprint two miles because I like sprinted home as fast as I could and like drank a gallon of Gatorade. And I was like, you know, terrified for my life because I was, you know, by that time, down into like the 40s, which, you know, if your blood sugar level is like in the 30s, you can kind of start to, you know, lose consciousness, which you don't want to do.

No, not a good idea. You don't. Yeah. Yeah. But I mean, you're not, you weren't stupid, right? Like this is, it's not something that- I was very stupid. That was stupid. Well, I mean, I think it's just like when you are presented with a completely life altering diagnosis like that where it's like, okay, now I have to change every single routine

that I have, that's going to take a while to figure out. Yeah, for sure. For sure. And, you know, and luckily there, you know, there was a while to figure out. Yeah, for sure. For sure. And luckily, there was a community, and I was able to literally ask people questions like, how do you have dinner? Just basic stuff that you have to learn how to do. Is peeing the same now? Do I pee out of the same area?

What goes on there? Totally. So yeah, thank God I had Craig and the Type 1 Run gang. Yeah. Craig, how common is an organization like yours where people can meet up for something or other as diabetics, whether it's camping or running or anything else? When we started Type 1 Run, there really wasn't. And that's kind of the reason we started it. The only way to kind of meet other people with Type One was through fundraising events,

you know, walks or bike rides or runs. And a lot of us, because we were in our 20s at the time, we didn't want to have to fundraise $500 to go run a half marathon with a couple other people. We just didn't want to spend our money on that. Why can't we just meet up and just do it ourselves? And so that's what we started doing. And other people saw what we were doing and opened up other type one run groups around the world.

Yeah. Oh, that's cool. Yeah. Now there's lots of people who do like kind of the meetup type of thing. Like, oh, we're gonna have a, come to this bar at so and so day and just hang out with other diabetics. So it's this whole grassroots thing now of people wanting to kind of build this community.

Yeah. I think as much for themselves as for other people. Community and the sharing of information is super beneficial to our health. It's not a cure, but it does help. I am healthier because I have community. You want something a little more quotidian than a once a year $5,000 gala.

Yeah, yeah. I literally want to sit down and eat a plate of chicken wings with somebody who is going through the same thing. Yeah, which could also be $5,000 of chicken wings. Yes, it could. It depends. It depends. And thank you both for all this. I there's actually no stats and numbers section this week, because it's very numerical throughout. So we have a couple of big takeaways about diabetes on this show. And the first one we've already kind of started delving into because takeaway number one, there are far more than two types and situations of diabetes. And some folks might not even know that there's a type one and a type two or what has been

called juvenile and adult onset. And some folks might not even know that there's a type one and a type two or what has been called juvenile and adult onset. It turns out there's several types and experiences beyond those. And I think that's amazing. It's just fascinating that the disease is so multifaceted. Are you telling me biology is complicated, Alex? I know. And Katie, if you start looking into stuff like animals and biology, you might take an interest in it. Sounds boring. Check out the Creature Feature podcast, folks. There's type one and two, and one number there is 90% or more. Apparently, that's how many reported U.S. diabetes cases are type two.

percent or more. Apparently that's how many reported U.S. diabetes cases are type 2. The Cleveland Clinic says up to 10 percent of patients are born with type 1 and often present early in life. Type 2 often presents in adulthood. As we've said, that timeline can be the other way. Both are going on and there's tens of millions of Americans with diabetes. It's very common. It turns out there's also a subcategory within type one, which the Cleveland Clinic says is not an official medical diagnosis, but it's often called brittle diabetes. I had not heard of brittle diabetes, but apparently it's a case with large swings between high and low blood sugar that can be caused by a combination of diabetes with other physical or mental conditions. And there's a range of treatments for that,

everything from going strictly gluten-free to having the pancreas surgically removed, depending on what's best for that particular patient. I didn't know about brittle diabetes. What does removing the pancreas do, right? Because it seems like you need it. And I wouldn't like, my first thought wouldn't be like, yeah, take this organ out of me. But what does that do to help in that situation? Yeah, it's apparently for people who their pancreas is just operating in such an unstable way that it would be easier to completely not have it and then be on a regular course

of treatment that's more predictable. I see. So because like if you're trying to use say insulin injections or a pump and then, but your pancreas is also contributing sometimes, but not always, then it makes it hard to like treat it because you might give yourself insulin, but then your pancreas is like, all of a sudden like, hey, me too, actually. And then that would cause too much. Yeah, just seeking sort of stability with it is the goal. Sounds like a scam to get free pancreases.

Raise that Springfield Monorail guy in a straw hat, trying to get as many pancreases as possible. You got to catch them all. Pancremon. Pancremon, yeah. The pancreas produces a ton of hormones besides just insulin. I think when you have type 1, you lose out on like seven different hormones, something like that. One of them is amylin.

Have you heard of amylin, Dave? I have not. That's a hormone that makes you feel full. Oh. I don't know if you, like me, are just hungry all the time or feel like you could just... I could always eat. Yeah, that's kind of how I am. Whenever anyone asks, you want to get some meat, I'm like, yeah, I can eat and I can just keep eating. And it's like we don't have that hormone that kind of tells us we're full.

So we're like dogs? Yeah. Yeah. I was going to say kind of like how like, you know, like Ozempic and those drugs work, you know, they tell you you're full. Like we also don't have that. And so we're just always hungry. So I know people who have had amylin supplements, I guess. I think it's like a weekly shot or something to help them not feel hungry all the time. Interesting. But it's like another thing to get.

Yeah, so. So interesting. Insulin's the big one, you know, but there's, I'm sure, a ton of other things that have all these micro effects on our body that just kind of screw us up a little bit more, but we don't really worry about it because it's not something that's going to kill us. Right.

Right. That's like the number one priority and then it's then kind of- It's like don't die and then like- Yeah. Don't be hungry all the time is number two. Right. It's on the list. That is really interesting.

I've had clinical OCD since I was a kid and I've tested out various medications for that, which is obviously, so that's like a mental illness, but I used to have very little appetite. I wouldn't necessarily feel hungry. It was more just like, it's dinner time, I should eat. I would kind of just like eat when I knew like, or like, basically if I would forget to eat, just be like, I feel terrible. I guess it's time to eat. And then after I started taking medication for this, the OCD, it would have this like side effect of like, oh, okay, this is what people mean when they're like hungry. Cause like now I'm actually

craving food and I want to eat food. So I just find that really interesting that there are, there seem to be all these little details of when there's one thing, one issue that your body has, and then you either treat it or mess up that balance, all these little tiny factors that are basically telling us how to blink and eat and breathe. And we're not aware of it most of the time until something goes wrong. Yeah, and all this, it leads very well into another kind of diabetes that's a major thing,

which is gestational diabetes. And I think people often forget about it just because it doesn't have a number name and because it's not usually a chronic condition. Mayo Clinic says between five and nine percent of US pregnancies, so high single digits. The person who's pregnant develops temporary diabetic condition during that pregnancy. We think it might be related to hormonal changes. We also think if someone is pre-diabetic or approaching that, then they might be predisposed to it. A woman will need to do dietary changes or exercise or take insulin to adjust for temporarily being diabetic while pregnant. And according to the UK National Health Service, it's usually possible to halt treatment

shortly after birth. A few women it lingers and then usually women who have this get checkups just to make sure they're not. But that's a whole nother category of diabetic person. It's just not chronic. And it is a surprise for some pregnant women. Yeah. It kind of makes sense that hormonal, a huge hormonal change like pregnancy could potentially have this effect. Yeah. And I had never heard of it until a relative had it. I was like, oh, I didn't know that exists. And they said, yeah, but it like happens to women. And I was like, I'm usually not told about women's health in my life.

Interesting. Right, right. This has not been communicated to me very often by school. Okay. Do women pee? We don't know. It eludes scientists. We have to collect pancreases until we find out.

This leads us into a whole separate form of diabetes called neonatal diabetes, which is a rare form of diabetes in children. So not the mom, just the child ages six months or younger. And it's where they're not producing enough insulin. So that's similar to the cause of type 1. And according to Nationwide Children's Hospital, it is caused by one mutation in just one gene. That's what's called a monogenic disease. And so we can usually use genetic testing to see if they have it. It occurs in 0.001% of babies. So very, very rare. And apparently about half of those babies proceed to have chronic diabetes. The other half only experience this as babies, maybe with brief

recurrences later in life. But that's just a whole nother way this can present and happen. Wow. You know, actually, just this past weekend, I was at a wedding and a friend of mine came up and a friend of hers has a just had her first child and that child at 10 months was diagnosed with with type 1 and and I Which I guess could be this Which I of course did not know anything about, but it was immediately,

several adults I know have been diagnosed in the time since I was, several children of friends of mine have been diagnosed since the time that I was diagnosed. So I'm like, I'm used now to answering a lot of questions, probably wrong, Lee, but in this case, I didn't know really what to say because a child, that's

one thing, like, you know, your body's growing, but you basically, you know, you can keep a blood glucose monitor on you. You can calculate the carb content of what you're about to eat. And you know what the ratio is that will give you the number of units that you should put in. But like, units of insulin that is. But for like an 11 month old, I don't, how would a person know what the carb content of their breast milk is?

Wow. You know, a child who only weighs a few pounds, there's very little margin for error. You know, if I give myself a little too much insulin, I know that right away and I can have a juice or something. If I give myself too much, I can give more insulin or move my body or whatever. But yeah, I was like, I actually don't have any idea what to tell your friend. I mean, I hope I can point them somewhere.

I met like a six month old once. Really? Yeah. A baby, you know? And it was just so, I don't know, emotional, I guess, for me just to like see this kid. And they produce a, it's like a less concentrated insulin for very small kids.

I don't know what the ratio of this. It's like 10 to one diluted or something like that. It has to be cold all the time. But the story that really stuck with me was the parents would have to give it shots throughout the day. And the baby started to recoil from the parents and cry because it was associating the parent with the shot. So they ended up putting this baby on an insulin pump

so that it would be like one shot, one big shot, I guess, every three days and put a new one on. This insulin pump, this was the old Omnipod, which is a wireless insulin pump. It's still pretty big. I don't know. It's smaller than a deck of cards. On a kid's body. They just had this thing taped on so the kid wouldn't like... I mean, it's a baby, they roll around, they pull things. And so they didn't want

them to like rip these things off. So just this thing taped on this baby's arm. Like, yeah. That must be so heartbreaking. That must be, you're helping your child, right? By giving them the insulin injections, but the baby doesn't know that. All it knows is it's uncomfortable. And so that's got to be really tough. Yeah. Yeah. It's hard to ask a baby about any of this. You have to kind of check their genes. And that's new. We didn't do that before the last couple of decades. Yeah. Yeah. Just a tiny microphone. Like, so baby, how are you feeling? You know, man on the street, but with babies, like in the neonating unit. Never been done before. Right.

The last few to talk about are other types where we've tried to adjust the type numbers to define them. There's one called LADA, Latent Autoimmune Diabetes in Adults, which is possibly something related to what you have, Dave, where it's a rare form of type 1 diabetes doesn't develop until age 30 or later. And this often gets misdiagnosed as type 2. And according to Dr. Regina Castro of the Mayo Clinic, its nickname is type 1.5. Because it resembles one and two in some ways. Yeah, like a super slow onset one. Whereas when kids, when they get it, it's like very quickly their blood sugars kind of go crazy.

They just spike because they just stop producing insulin. Whereas this LADA 1.5, it's like a very slow decline. My aunt, my aunt Laura, was actually diagnosed with type 1 or 1.5 when she was 60 years old, like 20 years after I had type 1. She still takes so little insulin throughout the day compared to what I take. She's lucky in that sense. It's kind of like the training wheels for a time, right? And then slowly the training wheels kind of fall off and then you really have to manage it.

Right, Dave? Yeah, I would say, yeah, that honeymoon period or that sort of slow degradation of the quality of my pancreas or whatever happened while I was on medication for something else. And I guess I take more insulin now than I did when I first started, but not drastically much more, I don't think. There's a lot of research now, a lot of the research going in the diabetes cures, I'll put in air quotes, are really extending this honeymoon phase for kids who are diagnosed. So it's not gonna help me and Dave,

but if someone's diagnosed at 10, they can go on this drug that's like quarter million dollars for four shots or something, and it may extend your honeymoon for up to two years. May not. Which I guess, it's nice. It'd be nice to not have to deal with the full-fledged diabetes, but... It's a step in the right direction.

Yeah. Could be cheaper. A quarter million dollars. Yeah. It could be more than that. I can't really remember. I just remember it was a lot. I mean, it makes sense if it's a relatively new drug and then in a very small population, it starts out just like bonkers expensive. But it doesn't need to be, shouldn't be at least, I should say. But I wonder, so for the difference between type 1 diabetes and quote unquote type 1.5, is there like, do we know if there's if there's a genetic difference where the mutation, why do we have this difference where some people with type 1 have the onset as children versus

those who have the onset as adults? I've heard that at least with type 1, you have some kind of generally genetic predisposition and they can do lots of testing for this. But then there's usually some kind of environmental factor that triggers it in addition. I don't know. I haven't heard anything genetic different. I don't know if you've found something Alex with type 1 and 1.5. What I've found matches that, yeah, because apparently we only started to even describe something

that's this type 1.5 LADA in the 1990s. And a lot of our understanding of diabetes is beginning to change with genetic testing. And not that we think it works differently in general or something, we just are finding additional genes and additional situations with it. Apparently there's a whole set called MODY, maturity onset diabetes of the young. That's one name for more than 10 different subtypes of diabetes caused by other specific monogenic mutations. Names like HNF1-alpha, HNF4-alpha, HNF1-beta, like people are breaking down specific individual

genes that can change and cause a specific experience of diabetes. But I assume the effect in the end is the same, pretty much. It's just like how you got it. Exactly. And that's part of why we haven't noticed these until we started looking at individual strands of DNA. We said, yeah, they've got diabetes. And it might be one or two, but it's part of why we haven't noticed these until we started looking at individual strands of DNA. We said, yeah, they've got diabetes. And it might be one or two, but it's one of those.

And now we're finding there's interesting things about it. Yeah, I want to get my DNA tested now and see what's up. Also last one to mention here is another way we've tried to use the number system. There's a type 3C, but this is not very mysterious. It's diabetes resulting from damage to the pancreas or removal of the pancreas. And that's sort of a term we've coined for the results of illnesses like pancreatic cancer or parts of cystic fibrosis. It's just stuff that causes the pancreas to lead to diabetes in someone. And we know why. Like we can say, oh, it was

from this. Pancreas scammers who are trying to get your pancreas. Yeah. Pancreas collectors. Pancreas go. Yeah. You've got to be careful. It's weird that I feel like the diabetes community, maybe still, but definitely for a while, it's been very like territorial. Like the people who are like, oh, I have type one, I don't have type two. Oh, like some kind of gatekeeping?

Kind of, more just like, oh, I didn't cause this myself. Oh, right. A lot of that comes from the wrong stereotypes and stigmas of type two and all these other things. But I think there's always been a lot of, at least with the type ones, trying to remove the, I don't know, not the guilt, but just to make people not feel like they did it to themselves.

Oh, this happened to me. Right. My genes. I have the bad one. Yeah. I've been guilty of that myself. Because there is a stigma. And this too is a thing that you see on social media and whatever.

Somebody posts a picture of a big milkshake, and they're like, I'm ready to lose a foot for this one, or whatever. And it's like, okay, that's not helpful to anybody. And yeah, I mean, I just, you know, but I've definitely been, when I explain why I'm pulling a pump out or jabbing myself in the stomach or whatever, I do, like, I have taken pains

and probably still will to be like, I have type 1 diabetes, because there is this dumb perception that I do, like, I have taken pains and probably still will to be like, I have type 1 diabetes. Because there is this dumb perception that I like, skittled it into existence through my life or whatever. Right. But you're not wrong. I mean, you do have type 1. Yeah.

I kind of just, I kind of distinguish them as like, do you have diabetes or do you have like insulin dependent diabetes? It's kind of how I classify. I don't really care about how people got it, but it's like, do you need insulin to live or do you not? And there's definitely a gray area in there. But I think that's one way to help distinguish when you're trying to give people advice. Like the advice I would give someone with insulin dependent versus someone who's not insulin dependent might be different. And I feel like that's a more useful classification.

Yeah, for sure. I mean, I didn't tell people for years, you know, like I was 13, you know, my middle school class knew cause I was in the hospital and they sent me cards. But then in high school, I remember my freshman year biology, kind of like party, you know, where you're like preparing for your final and the teacher brings in like cupcakes and whatever. And I remember knowing we were going to have cupcakes, stopped at the nurse's office to

give myself some insulin before class because back then I wasn't allowed to carry my own insulin with me for some reason. Wow. Yeah. And went to class, ate the cupcake, and then halfway through eating this cupcake, the teacher just yells, Craig, you can't eat that. Like I didn't know. And I was just like, first, you're a biology teacher, and also let me do what I'm going to do.

And I had to like, no one in the class knew. I wasn't, like, show and tell on the first day. We're like, oh, you know, this is my broken pancreas. And then from then on, I was like, I'm not telling anyone. And then it's just, like, not worth the, like, I don't know, the embarrassment, I guess, of your teacher, like, yelling at you

while you're eating a cupcake. And through college, the embarrassment, I guess, of your teacher yelling at you while you're eating a cupcake. And through college, after college, I didn't tell anyone. And I think once you don't tell someone, it's like every time. It's like when you don't know someone's name and you're like, oh man, it's too late to ask. Exactly. Like if you're on a date, right? You say it on the first date?

Oh, I have diabetes. And then they're like, oh, you know, I'm not gonna see this guy again. But then if it's like the third date, you're like, oh yeah, you know, that's why I go to the bathroom before we've been going to dinner so I can give myself this shot. You know, now it's even more awkward.

If you could work it into a pickup line, like, you know, are you insulin? Cause I could use a shot of you, baby. Then maybe it's a good thing to do early on. Yeah. Maybe. Right. We can workshop that.

Yeah. Wow. I like it. Did you have that whole street? That's amazing. That's a very good line. That was pretty good. That was pretty good.

I lie a lot when I'm dating people. No. That's pretty good. I lie a lot when I'm dating people. Right, also not true. Yeah. I know we're kind of talking about like US society and it may be different depending on culture, but I think there's a lot of, I don't know, just like a weird relationship people have with chronic illness, with diseases where it's like kind of there's this maybe it's because people fear

having something or maybe it's like this our society has this very like if something bad happens to you maybe you did something to deserve it as kind of like a self-insulating thing of like I don't want something bad to happen to me so I want to be a good person so nothing bad happens to me but I think there's also on the other end of the spectrum of caring, it's like maybe people would sometimes be like that teacher, like, oh my God, you can't eat that, like kind of infantilizing. No, I'm like, I know how to deal with something that I've been dealing with my whole life, but thank you. Like, hard to come out to people about it when you're not assured that people are going to be chilling normal about it. I think that comes from our like cowboy,

pull ourselves up by our bootstraps kind of thing, right? Like, like you are responsible for yourself and you know, it's not up to society to help you. Like if you can't make insulin, you got to go figure it out and go to the insulin mines. Go to the insulin mines. Start mining yourself some insulin. Yeah. It is so funny to me, by the way, that we use the expression, pull yourself up by your bootstraps. And it's just become normalized to mean resilience or grit or gumption or whatever. But it's like literally the expression describes a thing that is not possible to do. You can't do it.

That was the original point of it. Yeah, that was the point of it I thought originally is like you can't do it. That's the point. Yeah. It's physics. But it's like, but it's, but it's, that's just what we do now.

Like that is how much we've like mes That is how much we've mesmerized, we've hypnotized ourselves in America into feeling like we have to be self-reliant to the point of literal impossibility. Yeah. Yeah, it's like, hey, here's a cautionary tale about not expecting too much in terms of self-reliance. It's like, aha, I'll use that

to make people be more self-reliant. Yeah. And thank you all so much for sharing so much about your tales and stories with us. And we have another whole takeaway about some of the history of it. We're going to take a quick break and then do that takeaway. So we'll be right back. muscular animal citizens of River City. Featuring Justin McElroy as Axolile, the firefighting axolotl. Clint McElroy as Roger Moore, the debonair cow of mystery.

Griffin McElroy as Navy Seal, the raw seal that has never served in the armed forces. And Travis McElroy as every other swole critter in River City. This swear-free, Saturday morning cartoon inspired story airs every Thursday on MaximumFun.org or wherever you get your podcasts. I'm Emily Fleming.

And I'm Jordan Morris. We're real comedy writers. And real friends. And real cheapskates. We say, why subscribe to expensive streaming services when you can stream tons of insane movies online for free. Yeah, as long as you're fine with 25 randomly inserted, super loud car insurance commercials.

On our podcast, Free With Ads, we review streaming movies from the darkest corner of the internet's bargain bin. From the good to the weird to the holy, look at Van Damme's big old butt. Free with ads, a free podcast about free movies that's worth the price of admission. Every Tuesday on MaximumFun.org or your favorite pod spot. And we are back and we're back with takeaway number two. We learned that there are multiple kinds of diabetes less than 100 years ago,

and we discovered type two after type one. I guess that makes sense with the numbers. One would become before two. If it's the number order. Yeah. That's right. And kind of by accident, but it makes sense. Yeah. That's right. Kind of by accident, but it makes sense. Yeah. But that's interesting to me because so many more people have type 2 diabetes versus type 1,

correct? Yeah. That's correct. A lot more. Yeah. And we just theorized the thing that causes type 1 where you're deficient in making insulin before we theorize the insulin resistance that is going on with type 2. So did we just assume everyone that had type 2 diabetes also had the same kind of diabetes that type 1 diabetics had? Yeah, the conventional wisdom was that just people had different levels and experiences of not making enough insulin.

And that was the whole situation, was the conventional wisdom. And we only started changing that in the late 1930s, but really more like the second half of the 1900s. So it's pretty new information. It's new information. And it's not a new condition. And now I'm going to immediately get out over my skis. But my understanding is that, I mean, there's obviously, it is mostly genetically predisposed to type two. However, processed foods can spike your insulin and that can- Spike your bludger. Not wear your pancreas out.

Or you mean spike. Spike your bludger. Spike your bludger. Which causes more insulin to come out. I know what you mean spikes. Spikes your blood sugar. Spikes your blood sugar, yes. Which causes more insulin to come out. I know what you mean. Which causes more insulin to come out, which sort of can create a condition in which your body becomes resistant to the insulin because there's constant peaks and valleys. From what I understand, we are seeing more activated cases of type two diabetes because in American culture in particular, we rely so heavily on ultra

ultra processed foods, which have this effect on people. Yeah, that's right. Yeah. And it's not just like Oreos, right? Like, oh, we'll just avoid the sugary food, but sugar is in basically almost everything that has been processed. It's in bread, it's in peanut butter, it's in milk, added to everything.

So to be able to find food in the grocery store that didn't literally just come out of a chicken butt and like find something that's like not got sugar added to it is almost impossible. Yeah, well, and it's not just sugars, it's, you know, crazy chemicals, which, and again, this is, I might be talking completely out of my ass, but eating these things will not itself cause type two diabetes. There still must be a genetic predisposition to it. It can just be activated or the activation of it can be whatever, sped up by the eating of

ultra processed foods. But our Puritan roots, I think, make us search for a personal failing that caused a physical condition. Yeah. Right. Yeah. And this all involves just how long it took to understand the pancreas and insulin at all. The past CIF about insulin, we talk about Canadian researchers in the early 1920s who make insulin available to patients as a treatment in a totally revolutionary way.

From their medical researchers say, now let's analyze this miraculous treatment that we have created. And the key researcher there is a British doctor named Harold Hemsworth, who was born into a working class family in Yorkshire in 1905 and was pulled out of school as a teenager to get put to work in a textile mill. He also fell ill with a series of diseases. And then he overcame all that, trained himself enough in medicine through correspondence courses to blow away the entrance exam for medical school. And by the 1930s, he was a leading medical researcher and specifically working on the new field of insulin. He was like, let's study the most cutting edge thing.

So he really proved Himsworth. Very good. Do you know how hard it was for me not to interrupt you to say that? Folks, I cut out a lot of applause. We all took a break instead. Harold Himsworth is the first person to basically figure out that there might be multiple reasons for diabetes, not just a deficiency of insulin, but resistance to insulin. And he learns that by studying how patients respond

to it, also by measuring their blood glucose level after urinating, also testing the amount of sugar in their urine. And in the 1930s, he theorized that there might not just be a deficiency of insulin, but also quote, the inefficient action of insulin. He did that in 1939. And most of the medical community opposed it and said, no, I think it's just this thing where like people have different levels of not enough insulin and it happens earlier or later in life and who knows? They said, nice try, but you haven't disproven the main theory yet. It's hard to change the paradigm.

And according to University of Bristol professor Edwin Gale, we then had other researchers put all the pieces together. And one weird thing is a key piece of it came from a team of pseudoscientists who were accidentally right about diabetes specifically in the process of being wrong. I mean, if you're constantly saying, have you tried rubbing onions on your feet like at least one time it will be correct the correct solution like you know i don't know what yet i don't know what onions have cured yet but something surely the pseudosciences this was a 1940s team in new york that thought we could classify all human body shapes if people have heard the terms ectomorph, mesomorph, endomorph, for

a few decades that was considered medical science. They thought that people have body shapes that they called somatotypes. They had a bunch of false beliefs that we can categorize all human body shapes and also that corresponds to personalities, and none of that was true. But along the way they happened to do an experiment on can we find the somatotypes of diabetic people. They were like, if we analyze diabetic people's body shapes, will we find anything? And they didn't really, but they accidentally found that there's one broad group of diabetics who tend to be younger and thinner, relatively low blood pressure and present diabetes early in life. And then a second group that's older, heavier, relatively high blood pressure presents later in life. And they don't know why they're

finding this, but they call those groups type one and type two. Well, you're shaped more like a one, so we're going to call you type one. And you're shaped like a one, so we're going to call you type one, and you're shaped like a two. Well, more like a zero. I mean, if you're very heavy, you might be more, you might be rounder. Right. One robot on the team says one and zero, one and zero. You know, the whole ectomorph, mesomorph, et cetera, like, gay men are still doing this. Twinks, otters, bears.

And there are entire personality types that people ascribe to all of those physical body types too. So that hasn't completely died out. Just FYI. Yeah, and this accidental find by those guys, it just happened to be some useful terms for actual scientists doing actual medical discoveries. In the 1950s through the 70s, people figured out that there are insulin receptors in cells. They started discovering that there's relatively high amounts of insulin in the bodies of some

people with diabetic symptoms, which it turns out were type two. And then also people rediscovered Harold Hemsworth's work from the 1930s and said, oh, this is a very useful theory to explain what we're finding. And so then from there, we put it all together, like new science and Hemsworth theories explained that there's these two predominant types of diabetes. And the one we knew about first, it happened to get called type one by those pseudoscientists. And people said, these guys are not totally discredited yet and we can use the names. Just the names are fine.

And they accidentally did a survey that's useful. So that's cool. So that's why we have the name type one and the name type two. I never knew that. I had no idea. Very accidentally correct. And then the rest of it is just like, you have an apple body shape and therefore you have the personality of an apple.

Yeah, like I think it's my mom told me that when she was in school, she was told that ectomorph endomorph stuff as like at least semi factual. And it's just not really anything. People are just different shapes. Yeah. I don't know what that, I don't even know what that means. One of them's like a long thin person and the other one's like, it's like when we were talking the other day about that Bugs Bunny cartoon where he's on a desert island and one guy looks like a hot dog and one guy looks like a hamburger. It's like that kind of thing.

It's the candelabra and then the clock from Beauty and the Beast, you know, the classic pair. Yeah. I know Mesomorph is like big and muscly because Diane called someone a Mesomorph on Cheers. And I went with it. There you go. Right. A show from recent decades. Yeah. This has been bouncing around until very recently.

So those guys helped name the diabetes without understanding it really. How different would Tinder look like if we had retained those things? Like, well, I'm a romantic mesomorph looking for love from a friendly xenomorph. Looking for love. Folks, that's the main episode for this week. I want to say a huge thanks to our guests, not just for spending time with us, also for so warmly and openly sharing their experiences with this condition. Dave Holmes is the host of Troubled Waters. He's an editor at large for Esquire and has done so many other wonderful things. You also heard him on the previous CIF episode about SKA music. Really glad he could come back.

And so glad to meet Craig Stubing. Again, he is the CEO of the Beta Cell Foundation, which is for people with type 1 diabetes and also for messaging about diabetes in general. Linking their website, also linking their podcast that he makes. If you want to hear even more about this topic from someone who has it and lives with it, that's a great show to listen to. And welcome to the outro, with fun features for you, such as help remembering this episode with a run back through the big takeaways. Takeaway number one, there are far more than two types of diabetes.

Takeaway number two, we learned there are multiple kinds of diabetes less than a hundred years ago, and we discovered type two after theorizing type one. And along with both those giant takeaways, so many numbers this week and personal experiences about this condition and the range of amazing ways We are still learning about it to this day Those are the takeaways also I said that's the main episode because there's more secretly incredibly fascinating stuff Available to you right now if you support this show at maximum fun org

Members are the reason this podcast exists and troubled waters exists in so many other shows you right now if you support this show at MaximumFun.org. Members are the reason this podcast exists and Troubled Waters exists and so many other shows so members get a bonus show every week where Sif explores one obviously incredibly fascinating story related to our main episode. This week's bonus topic is Elizabeth Hughes and her unique role in the history of secrecy and publicity about American diabetes. Visit sifpod.fund for that bonus show, for a library of almost 18 dozen other secretly

incredibly fascinating bonus shows, and a catalog of all sorts of Max Fund bonus shows. It's special audio, it's just for members. Thank you to everybody who backs this podcast operation. Additional fun things, check out our research sources on this episode's page at MaximumFun.org. Key sources this week include many digital resources from medical institutions and hospitals because we're not doctors, we're just looking up what doctors say and providing it to you the best we can. Those doctors include the Cleveland Clinic, the Mayo Clinic, Nationwide Children's Hospital, and more. Also for that history of Harry Hemsworth and other researchers, we looked at the International

Journal of Epidemiology, a piece there by the University of Bristol Professor Edwin Gale. Also another piece about the history of this by Stanford Professor Gerald Rieven. That page also features resources such as native-land.ca. I'm using those to acknowledge that I recorded this in Lenapehoking, the traditional land of the Munsee Lenape people and the Wappinger people, as well as the Mohican people, Skatigok people, and others. Also, Katie taped this in the country of Italy. Dave and Craig each recorded this on the traditional land of the Gabrielino or Tongva and Kich and Chumash peoples, and I want to acknowledge that in my location, in Dave and Craig's locations, and in many other locations in the Americas and elsewhere,

Native people are very much still here. That feels worth doing on each episode, and join the free CIF Discord, where we're sharing stories and resources about Native people and life. There is a link in this episode's description to join the Discord. We're also talking about this episode on the Discord, and hey, would you like a tip on another episode? Because each week I'm finding is something randomly incredibly fascinating by running all the past episode numbers through a random number generator. This week's pick is episode 106 that's about the topic of rats. Fun fact, the Canadian province of Alberta considers itself statistically free of rats.

So I recommend that episode. I also recommend my co-host Katie Goldin's weekly podcast, Creature Feature, about animals, science, and more. Our theme music is Unbroken, Un-Shavin' by the Boodos Band. Our show logo is bybroken, Un-Shavin' by the Boodo's band. Our show logo is by artist Burton Durand. Special thanks to Chris Souza for audio mastering on this episode. Extra extra special thanks go to our members. And thank you to all our listeners. I am thrilled to say we will be back next week with more secretly incredibly fascinating. So how about

that? Talk to you then. Maximum Fun, a worker-owned network of artist-owned shows supported directly by you.