Diabetics Doing Traveling Nursing with Samuel Foarde

[00:00:07] Rob Howe: Welcome to the Diabetics Doing Things podcast. We've been telling the amazing stories of type 1 diabetics all across the world since 2015, and we have over a thousand years of living with T1D on the podcast. The interviews range from incredible feats to everyday victories, and we celebrate them all just the same. Thanks for listening, and if you want to get involved even further, just send me an email at rob at diabeticsdoingthings.com. Hello and welcome back to another episode of Diabetics Doing Things. We are telling the amazing stories of type 1 diabetics from all across the world, and my very special guest this afternoon, I guess it's technically his morning because he works the night shift as a nurse, Samuel Foarde. Welcome to the show.

[00:00:56] Samuel Foarde: Thank you very much, Rob. Thank you. I'm super stoked about this. I've really been looking forward to it.

[00:01:01] Rob Howe: Yeah, really excited to have you on. And you're calling from Tacoma, Washington. So a big shout out to all of our West Coast listeners out there. We've actually had a couple of guests from the Seattle area. So Washington, well represented here in the type 1 diabetic community.

[00:01:17] Samuel Foarde: Sweet. Love it.

[00:01:18] Rob Howe: Cool. So Sam, let's dive in. Tell us a little bit about yourself today, and then we'll kind of dive into your diagnosis story and how you ended up as a member of this great community that none of us has to be a part of.

[00:01:34] Samuel Foarde: Right. No invitation required. No. So my name is Samuel Foarde. I am a Texas-born Florida native because I was raised in Orlando, Florida for most of my life. I am an emergency room trauma registered nurse. I did my training for emergency room in Orlando for two years. And for the last two years, I've been doing travel nursing work, which means that every three months I get to pick up and go somewhere new in the country that I've never been before to do emergency room. So I've been a registered nurse for about four years doing pediatric trauma, adult trauma, and just really trying to expand my scope as a professional. And it's been super fun. So, yeah, that's what I do.

[00:02:25] Rob Howe: That's exciting. I've met a few traveling nurses just like out and about over the past few years. But I never knew in that you never really get to dive in to talk about what their experience is like. So how many places have you been? Every three months, that's pretty quick. That's a pretty quick turnaround.

[00:02:45] Samuel Foarde: Right, and I've chosen to extend a couple of places just because if the hospitals love you and they really want to keep you and they appreciate your work, they'll choose to extend you. I've been to Orlando, obviously, for a contract. I've been to Austin, Texas to do my pediatric trauma. I really wanted a rural experience, So I went into the Appalachian Mountains where there is literally nothing. And I went to Tennessee and in the Middlesboro area of Kentucky. Very poor, very low resources. There's like no economy in the area. So to be an emergency room nurse there, you had to do the same job with half the resources. And it just was really eye-opening to have to perform the same job and just get people done, get them stabilized and keep doing your job without having much to do. So I really was craving that experience. So I spent like six months in the Appalachians, went back to Orlando for a little bit, and I just recently moved from Orlando to the Tacoma area. And it's been just wonderful. I've never lived west of Texas so this is like the furthest away from Orlando I could possibly get so yeah it's been good so far

[00:04:05] Rob Howe: that's very cool it's super exciting and I think obviously you get exposed to a lot of different parts of the culture and it's very neat

[00:04:14] Samuel Foarde: yeah no absolutely people are so different everywhere the culture is very regional like you said so you definitely get a taste of different injuries that happen different places in the country and uh you you get the full the

[00:04:30] Rob Howe: full spectrum there yeah this is sort of off topic for the podcast but uh i i found and in discussions with people from other countries so like in the u.s it's very you know we're pretty familiar with like oh yeah people from the east coast talk fast and have you know accents people in texas you know say y'all and like california they talk a certain way right uh you know in minnesota they have an accent like that's very common to us but then we think of a place like India and we're like oh everyone speaks the same language probably we like don't make those associations so I always find it interesting like how different we all really are even though we don't live that far away from each

[00:05:05] Samuel Foarde: other and we all speak the same language I know I mean Texas I mean I'm from Texas my family's from Texas Texas used to be its own country and we're very you'll see more Texas flags out than American flags. We are our own solitary place. But yeah, it's like you said, we could be in the same country, but it just feels like you're somewhere completely different.

[00:05:27] Rob Howe: Well, very cool. So let's dive into a little bit of your diagnosis story and kind of tell us how you came to join the type 1 diabetic family.

[00:05:37] Samuel Foarde: Oh my lord. Okay, so I was diagnosed November 22nd, 2009. I was in my first semester at the University of Central Florida, and I just changed my major to nursing, actually. I was going to be pursuing that. And for a couple of weeks, I just started kind of feeling strange. I remember what kicked it off my family and I we went to go see one of the Twilight movies in theaters I think New Moon was out there okay out at that time and so we were we went to go see New Moon and I always ate healthy I always sort of like drank water and did push-ups because I could I was pretty healthy kid I remember I ate like Sour Patch Kids from the movie theaters and a 32 ounce Dr. Pepper and And it was fine. But like the week following, I was like just feeling tired, drinking all the time, peeing all the time. And like I had been studying anatomy and physiology. And so I was kind of aware of what this could be. I'm like, God, do I have kidney disease? Like, do I have, you know, like I'm peeing all the time. Do I do like what's what's wrong with me? Whatever. And it wasn't until my vision started blurring over that I was like, oh, man, this is probably diabetes. Yeah, that's probably what this is. I was a cash register clerk at Universal Studios Orlando, which was my first job in college. And literally, my vision was so blurry, I couldn't see past my register. It was all blurred colors and shapes. So they sent me to the health services, and they checked my glucometer. And their glucometer maxes out at, like, I don't know, 400. And so I maxed their glucometer out. They're like, oh, we want to send you to the emergency department. I'm like, no, no, no. I'll drive home. I'll clock out early. So my mother took me to a nearby emergency room, checked me into triage, and my blood sugar was like, I don't know, 572. And I'm like, and the triage nurse was just very nonchalant about it. He was like, so have you ever had diabetes before? Do you have diabetes? I'm like, no, would I look this freaked out if I had a history of diabetes? Come on. My mom was just like, she had no idea what was going on. But yeah, and then I just ended up being hospitalized for a couple of days and then getting out. And it was like during finals because, yeah, it was November. So I had to miss maybe two days of school and then go right back with my insulin pens that I just got and have no idea how to use and take my finals. You know?

[00:08:26] Rob Howe: And that's like such a – like finals, it's easy to throw around that term. But like you're obviously in nursing, like pre-nursing, right, at that point, your first year at school. Those are like really important tests for a lot of different reasons, right? Yeah. So you go back and like you're just like turned loose to the wild with your insulin pens and just kind of like, oh, hoping for the best here. Here we go. I was very similar. I was diagnosed on New Year's Day, my junior year of high school. So, you get those couple days after New Year's, depending on what day of the week it falls on, before you have to go back to school. So, the last four days of Christmas break, I was in the hospital, and then they let me go home from the hospital, and my mom made me go to school the next day. So, it was like, wow, okay, I didn't even get any benefits out of this.

[00:09:16] Samuel Foarde: I didn't get even vacation, come on.

[00:09:18] Rob Howe: Yeah, it was awful. But a couple more things I want to focus on from your story. First of all, like you mentioned, you were the one that noticed the symptoms and were sort of diagnosing yourself. So I always sort of wondered for people who are like medical professionals or studying to be so like, what's that like being being the patient and the like physician?

[00:09:41] Samuel Foarde: I mean, at the time I was studying to be an RN and it's so funny. I didn't even know I was in the ICU until I was actually working as a registered nurse because I was only 18 at the time. and I just like, oh man, I have this really spacious room. This is so comfortable. But no, I was in the ICU. So obviously I had my own room but I didn't even realize it at the time. It's really just every single thing you study in medicine, it almost always links back to diabetes. Like what could cause this type of cancer? Oh, if you have diabetes and what could cause blindness and kidney disease? Oh, if you have diabetes. Every single thing like disease can link back to having diabetes. So in my head, I'm just thinking, oh, crap, like, I have this now. This is the thing that I have. Like, I have diabetes. I have the thing I've been reading about, the thing you, like, gloss over in medical textbooks. Like, no, like, it's in bold right now because that's your life. So you just kind of have to say, okay, well, there's a lot of literature on this. People know about this. It's not like I don't have resources out there that I can help manage myself. So it's just, it's weird because you know, you know what is possible as a medical professional. And so you are that much more vigilant with yourself. I think if you do it right, I don't know if every medical professional with diabetes does that, but that's

[00:11:08] Rob Howe: certainly what I do. Yeah. And I think, you know, just having that heightened awareness of it, I think is, is part of it. And just knowing what can go wrong. It's interesting that you say, like, when you're learning about things like all of these different complications go back to diabetes because it's such a i mean like obviously like and even the term diabetes there's so much that can be associated with it like type 2 diabetes is type 1 diabetes like every person who's you know when you're diagnosed it's like oh yeah i know somebody who had diabetes and they got their feet chopped

[00:11:41] Samuel Foarde: off you know it's like oh awesome oh it's terrible that's like yeah my brother like endlessly he's follows me around with Wilford Brimley jokes. I was like, you know what? He doesn't have the same type I do, John. You know that he doesn't. Come on. I'm not taking Metformin. Really? Come on. That's totally a different type. It's different.

[00:12:03] Rob Howe: But at the same time, major shout out to Wilford Brimley, the face of diabetes for all time. Correct. For a year of advertising,

[00:12:13] Samuel Foarde: bring it into the public eye, Wilford. Thank you. Thank you very much.

[00:12:16] Rob Howe: Yeah, both for Musta. I don't know if he's done more for mustaches or for diabetes, but, um,

[00:12:21] Samuel Foarde: that's the point. I have no idea. He's probably good PR for both.

[00:12:24] Rob Howe: We owe him a lot. Um, so kind of going back and, you know, you find yourself, you're at school, you're taking, uh, you got your insulin pens, what you're going through and studying to be an RN, what, you know, what, what were your challenges? What, you know, were your other pre-med friends like interested in being a part of that? How did you manage it? Was it pretty easy? You mentioned being pretty healthy and made good dietary choices and were pretty physically fit growing up. Did that help? What was it like in the early days?

[00:12:58] Samuel Foarde: Well, in the early days, it was a huge learning curve because my first job, I worked as a cashier, but it was in the candy shop. you know and so I was literally just freshly diagnosed back at work and surrounded by pounds of fudge and marshmallow popsicles and lollipops and like bulk candy in every single variety and I'm telling you I was sweating just standing there surrounded by stuff that all of a sudden I couldn't eat like I never had a sweet tooth before my diagnosis but once I was told I couldn't have it, something changed in my brain. It was like I had to ask to be removed from the candy shop because it was just, it was so weird. Although I did have a pretty easy transition, just being an adult and having a more mature mind. As compared to people who started their diabetic journey earlier on in life, I was able to comprehend and understand more solid cause and effect. I was able to make good dietary choices. And, um, uh, but it was hard. It was just like before every single huge test, I would have this giant calzone from Sbarro at the UCF cafeteria. And like, I couldn't do that anymore. I couldn't do that anymore. I was like, God, that's my lucky calzone. How am I going to make an A on this exam? Damn. Ah, what am I going to do? Um, so I had to change, I had to change all of that and I didn't really know anybody medical. I was kind of still in my pre-nursing stuff and I was just figuring it out on my own. I think my mother figured because I was 18, she kind of could give me full autonomy with my care. Right. Which, you know, I, I, which I loved, but, um, I didn't realize how much emotional support I needed during the early years of my diagnosis. Cause she would still bake cookies. She would still have all the sugary stuff. she would because she's a country woman you understand she has to have baked goods she has to have really rich stuff in her house and it was it was deadly it was just i didn't realize how how uh easily i could be tempted in those early years so my blood sugars were crazy high and you know just i didn't know how to how to manage uh for sure um so definitely definitely

[00:15:23] Rob Howe: different well and it's interesting too like uh when you're younger and for me specifically i my i always go back to my own experience because that's what i have but the the amount like because i used to play college basketball a little and a little bit in the pros so my like fitness regimen was pretty unreal i would work out four to six hours a day pretty much every day so i could eat whatever i wanted and i still was going to be at a calorie deficit for the most part so i remember eating like entire pizzas and chipotle burritos like all the time and i'm a big guy and uh yeah yeah like and but then i could like i would give myself you know only like 14 units of insulin for an entire pizza and a chipotle burrito with everything in it and like no problem pass it through it's like now i think about today where i eat a very like regimented like almost carb-free like you know good oils like vegetables and i'm like very conscious of what i put in my body i think about like trying to eat that amount and like what that would do to my blood sugar today and it's like oh my gosh like you know my you're you're just so unaware of even before like you said you didn't have a sweet tooth before but after you know just just wanting to be able to do that and having the option to before uh and and then that gets taken away you know you're not able to make those decisions as much or, you know, as freely without consequences. And it makes you

[00:16:50] Samuel Foarde: kind of want to do those things. Exactly. Poor self-control. Deadly combination having diabetes with poor self-control. That is not, doesn't work out. Oh, it's tough. And it's like, it's almost

[00:17:02] Rob Howe: punishment, right? Because, you know, you have this thing that you have to manage and then you have to be really disciplined about it. And then, you know, sometimes you wear out. You hear people talk about diabetes burnout you hear people talk about uh you know having struggling with you know carb counting and you're injecting and because it's just it's hard to kind of shoulder that weight and but the other thing too and i'm struggling not to lose my train of thought here because i'm thinking about baked goods but as you um you know as you evolve as a um as a type 1 diabetic and you sort of get get the hang of things you have to grow up really fast if you're younger and i think you mentioned this for like you're 18 and your mom was like letting you be autonomous but you know some of the kids that i've met four or five you know all the way up to 12 years old like it's sort of forces you to grow up really quickly and at 18 even though you're a quote-unquote adult like you get to live a pretty carefree life for some period of time especially if you're at college or hanging out with friends or whatever and then all of a sudden you have to be really grounded in making those decisions. So what was that like? What was that like for you? Like coming into your, you know, college formative years, like having fun? Like, how did diabetes play a part in that?

[00:18:15] Samuel Foarde: It really kind of made me really cautious, almost. I mean, I mean, getting into nursing school is a really rigorous process. Any RN will tell you that nursing school is hard to get into. So I didn't have much of a social life in college. I was busy studying. I was busy putting my nose to the grindstone, didn't go to parties, any of that. But, you know, I want to say that I kind of let myself just have fun at the moment because I worked at a theme park. You know, I was surrounded by really fun people as a result of that. And they like to go out and they like to drink alcohol and they like to, you know, have theme park food, which is probably the worst in existence for you. and so I really I didn't restrict myself too much really but I was always on my feet I was always active kind of like you were with the basketball it was just it was really easy for me to burn sugar really quickly but still it was I think my blood sugars didn't truly get under control until after the first year after my diagnosis after I kind of was seeing my first couple A1Cs and my endocrinologist was like, you know, you should probably cut that out because it's going to be a wrecking ball to your kidneys in a couple of years. So yeah, it wasn't, it wasn't too terrible. It wasn't a terrible experience, um, aside from the fact that I had to figure it all out by myself.

[00:19:45] Rob Howe: And that's, that's a big part of it too. And I want to talk about this a little bit as a medical, from a medical like background because bedside manner at diagnosis, I find having spoken to, you know, almost seven 75 diabetics on the podcast now, and, you know, countless others in person, like those first few moments after you're diagnosed in those first few weeks are so critical to how you view the disease and the relationship that you have with it. So for you, you know, I don't know how much education you got in the hospital or how much you remember in that, but also then being out on your own with the insulin pens and just having to make those calls for yourself. do you think it was beneficial to have to figure it out on your own or would you have benefited maybe from a little bit more education a little bit more uh oversight and help uh at the at the

[00:20:38] Samuel Foarde: start i you know you you do study and you do understand but applying it to your own daily routine completely different my experience at the hospital i had like a really kind of non-involved night shift nurse. I remember, I, I remember my insulin drip was beeping and it was like beeping for two hours and she never came in to turn it off. I was like, okay, not going to be, not going to be your kind of nurse when I grow up. Uh, not going to do that. Uh, my day shift nurse, Eric, I still remember him. He was very kind, professional. Um, he made a remark that I didn't drink all of the milk on my meal tray. And he's like, why didn't you drink your milk? I said, well, it has like 20 grams of carbs on it. Like I can't, I can't eat carbs now. I was sort of like locking my brain down. Like I couldn't eat carbs because I couldn't be discharged until my blood sugars were okay. Um, and I remember my mother, and this is so embarrassing, um, and I should have known better, but my mother felt bad for me because I was in the hospital and every mother kind of just sort of goes into mama bear mode. And so she went out and bought me a bacon, egg and cheese mcgriddle from mcdonald's and brought it to my room and so not thinking and just wanting to like appease her to like calm her down i ate it and the tech who checked my blood sugar was like not expecting it to be like i don't know 360 or something obnoxious and she's like oh my gosh i have to call the doctor your blood sugar is so high now i'm like oh oh gosh i don't know why i don't know why that would be that's so strange that's so strange but you know like she just wanted to uh she i was like oh shoot yeah because it's it's literally um a cake injected with syrup yeah my blood sugar is gonna be gonna be uh astronomical i do remember my last day i had to wait for a diabetes educator quote unquote diabetes educator to come and talk to me before i was able to be discharged i waited probably like two and a half hours for this guy to show up and all he was was just a registered nurse I don't know who maybe like took a class on diabetes once maybe a couple years ago and all he did was explain like how to deliver shots into my belly and that was it super super disappointing I'm like you know what dude I could have just I could have been out of here like hours ago waiting for you really and I think the first shot I tried to give myself, I missed my abdomen and stabbed myself in my finger on accident. And I'm like, oh, well, if that's not a bad omen, I don't know what is. Yeah. So yeah, that was my hospital experience. But more to your question, I think I could have benefited from a little more structure. All the textbooks I read, all the preparedness that I had, I just needed more guidance. I think I liked figuring it out on my own because it made it mine and I did most things on my own, but I, I probably could have humbled myself to some professional advice if I had known to seek, seek it out myself. So yeah, that's what I'll say about that. And it's one thing to say, you know,

[00:23:49] Rob Howe: now, I mean, looking back, I think at, you know, putting back in my own story, like being 16 and diagnosed 16 almost 17 like i probably wouldn't have you know wanted more oversight or more help because you couldn't tell me anything i was a 16 year old so i knew everything there was to know about whatever it was and i wasn't going to be considered otherwise convinced otherwise so you know i think it's just hindsight being 2020 you know i think it's always easier to say oh well if i had this maybe it would have been easier but it's it's cool to get a from a medical perspective as well. Right. Yeah. Absolutely. Uh, kind of in that same vein, have you as a trauma ER nurse gotten to encounter any, uh, any type 1 diagnosis, uh, in your time in the ER?

[00:24:39] Samuel Foarde: Oh my gosh. All the time, all the time, whether it's a new onset diagnosis or if it's people who come in DKA or having other complications with their diabetes, I seem to be the magnet for those patients and like my charge nurse without fail, I kid you not like, Oh, you're here for high blood sugar. Come on. I have just the registered nurse for you. He can take care of you just fine. They give me all the diabetic patients because they know that I love to educate. They know that I love showing off my pump. They know I am super passionate about it. And, um, it's, it's good for those patients to see someone who looks healthy, who, you know, has like, like struggled like they have and experience the same day to day stuff. And they can see someone who is a healthcare professional and is managing their blood sugars and still, you know, they're, it's a good reference for them to see. I think it's really hard for diabetics to find solidarity. They feel like they're always the sick ones. It's hard for them to feel connected, to feel like they're, they're not just the sick ones who have to, you know, stay indoors and they can't eat that. But when they see me in the ER and they're having an emergency or it's there like a repeat, um, a repeat visit for a DKA, uh, for whatever reason, it's, it's always nice for them to see, um, a registered nurse who's dealing with, uh, similar problems. And it's, I, I can tell it's good for them that they can be like, Oh, I could be like that. You know, I could, there's a way I I can, you know, have good energy and control my blood sugars. And I think, yeah, I just attract them. I attract them like every shift. I'll have someone with a diabetic complaint and they just send them to me. And I'm happy to do it just because education, especially with diabetes, is my thing and will be the focus of my graduate work later on.

[00:26:40] Rob Howe: Well, and it's interesting, too, you talk about solidarity. I think a lot of people, and you can probably speak more to this from your work in more rural areas, a lot of people with diabetes who aren't around others with type 1 or around other people who are living and thriving, as JDRF likes to say, living and thriving with type 1, it can be hard to be hopeful. you know it can be hard to to relate i think uh and you get to feel kind of alone and that's where you get into that burnouts phase and you start you know questioning things a lot more or wondering if you can do it and get a little bit more of that mental health depression aspect so uh you know what do you what do you see do you see that at all in different areas like what does it mean for you like not only as a medical professional but as a as a peer you go in there and what kind of reactions have you gotten from people when you're like, Hey, yeah, I'm your nurse. I know you're having problems with your diabetes. That's obviously why you're here, but Hey, I'm a type, I'm a type 1 as well. Uh, you know, what do you, what kind of reactions did you get?

[00:27:45] Samuel Foarde: I, a lot of people light up. Most of them, their eyes are just like, Oh, oh my gosh, really? Like you, you, you have it. Like, and I showed them my pump and like, I have the Omnipod, uh, insulin delivery. And most of them had never seen that before. I usually, uh, most of my patients are on multiple injection therapy or even the Medtronic. So they've never seen my method of insulin delivery before. They just, they have questions. And especially if they're kids, the parents are like, they're just through the roof because when you're a parent of a child with type 1, you fear for them being understood. And you always fear for them feeling like they're just the weird ones you want so badly for them to look up to someone. And so when I get the little kids, especially when they're new onset diabetics, the parents are over the moon about me talking about it and being passionate about it, because they see their kid in me, like, oh my gosh, my kid can be like happy and healthy and have good blood sugars and have a great career. And they can have all this ahead of them. Because in the back of most parents minds, they've told me, you know, They just they're afraid that this diagnosis would keep them back from realizing their full potential. And most parents can can relate to that fear, I think, regardless of whether your kid has diabetes. But in response to the rural areas, it's very poor, especially in Tennessee and Kentucky. Not only is the finances poor with regard to affording supplies and affording medications, doctor's visits, but the culture of appreciating and respecting your own health is also very few and far between. It's sort of this culture of, oh, yeah, well, he's sick, but whatever. Or they equate diabetes to, like, having asthma. Like, it's bad, but when it's really bad, then we'll go to the ER, you know. It's one of those sort of off-the-cuff things that people don't really consider. And that's a cultural thing. It's all about who you surround yourself with and the availability of resources to take care of yourself. And in those parts of the country, they just they don't have it. They don't have endocrinologists that they can see. They have to drive 90 minutes to Knoxville is the closest endocrinologist that they have. And, you know, they just can't afford insulin. I mean, you and I both know insulin is just like skyrocketed in price. even over the last couple of years. Even for me, it's gotten more expensive. So I can't imagine people who are poor, uninsured, and who don't have a mentality of healthy self-care. As a healthcare professional, it's an extra barrier to break through to them and say, okay, how can I get through to you that you need to set up a social support system that encourages you to take care of yourself. So yeah, it's different everywhere you go, but in the poorer areas, it's more of a challenge for me.

[00:30:43] Rob Howe: Yeah, that never even occurred to me. So I'm really glad that you brought that up, that mindset of health. I think now, I mean, all the statistics say there's more obese people in the US, especially, than there ever have been. It's like almost 60% or something ridiculous. but also you don't realize like what like certainly there's a lot of junk in food there's a lot of advertising that's you know and and massaging of messages about low fat versus sugar versus sugar substitutes and fast food and things like that that have played a part of that but also it's just the mindset of like not prioritizing your health and i guess that never really occurred to me as it relates to diabetes because yeah insulin is way expensive and way more expensive than it was even 10, 12 years ago back when I was diagnosed. I think there's an organization called T1 International. We had Elizabeth Rowley, who's the founder of that, on the podcast, I think episode six or seven. And she's amazing. And the work that they do at T1 International to fight for global insulin reform is astounding. But when you look at the numbers, it's like 1,000% increase in insulin price over the last 10 years, or maybe even less time. And for people who are uninsured, they feel the weight of that heavily. And there's limited access to programs. Again, I think Lilly has a really good non-insured insulin assistance program. But if you're not prioritizing your health, you're not going to go through that pretty exhaustive application process to make that happen. Right.

[00:32:29] Samuel Foarde: Right, absolutely.

[00:32:30] Rob Howe: So when you find yourself working to break through to those people, anything that works? Because I imagine you have to approach it gently and with care, obviously. So what would you say to somebody in that position, and how would you get them to maybe come around or see the light, as it were?

[00:32:54] Samuel Foarde: It really depends. Because like I said, I do pediatric nursing as well. Every child has their own stage of psychosocial development. You have to approach each child differently. So children, you kind of, you don't want to scare the children because you don't want to make them feel like, oh, you're going to get your arm cut off, Jimmy. No, I mean, that's not, you don't do that. But you kind of have to approach it with, you know, what do you know about diabetes? Because a lot of times they just live their entire lives with these misconceptions about what they think it is or they think the way they're managing it is the most they can manage it. And they lock their brains into this life where they think they are finally okay. And okay is passable for most kids because they have social lives. They have school. They have everything else they need to be worried about. So for them to feel okay about their diabetes, wherever that really may be from the medical standpoint, is where they're going to stay. So you just sort of like interview them. You interview them, you interview the parents, and you get to know where they are in their diabetes understandings. And as the nurse, you can kind of, you know, dispel some myths, you can re-educate, you can tell them about new treatments, you can really encourage them to communicate with each other to see how best they can do that. And actually, my undergraduate research, I'm not going to talk too much about this just because it's a thesis and there's not enough time, but I wrote my undergraduate thesis about adolescents with type 1 diabetes and how their social support systems impacted their household stress and how that household stress impacted their metabolic control and their outcomes. And I did this huge review of the literature and found like a lot of really interesting things that have not been researched yet. But basically what you have to, you have to tailor your approach to teenagers, especially because like you said, you know, when you were 16, no one could tell you anything. You were completely autonomous. You wanted to be left alone. And if I was an RN telling you, you need to do X, Y, Z, A, B, C, you would probably reject that almost immediately because you didn't have to do that. But some adolescents, they need more guidance, and they're more accepting of that. And so you kind of have to identify the learning needs first, and then you can intervene with the family as a unit. Because most kids, they're completely dependent on their caregivers, whether that be their grandparents or uncle or whatever, mixed families that we have now. And then you can sort of push through. So it's different for everyone. I think adults, you can kind of talk more straightforward and just say, you know, what do you know? Okay, you know that you have these resources. If you have a car, you need to drive to the health department and get these resources. Or you need to see a doctor, you know, at the very least every six months for checking your feet and all this other. So the short and long answer is it's different for everyone, but you have to identify what their learning needs are first.

[00:36:07] Rob Howe: and then you can intervene. That's great. And I think very simple and sticky. You can understand how that really stays with you. It's a learning issue. It's an awareness issue first, and then you can go in and really start to get to work. As a medical professional, but also as a type 1 diabetic, as we kind of go forward into the next few years, next decade to 20 years or so, I do believe it's the best time to live with type 1 diabetes if there is such a thing right now, just because all the technology that's coming out, the things that have been in human trials for a while that are starting to get approved. What are you most hopeful for in the world of type 1 diabetes as a medical professional and as a type 1? Well, I mean, of course, more

[00:37:04] Samuel Foarde: affordable insulin. As you said, one of your guests is already working and doing fantastic work with that. I love that. And this improvement of modalities. I mean, we've heard about the cure forever. My endocrinology, every 10 years, and I'll be the next five years, and it will likely be the next five years for the next 25. But what I'm excited about is bringing education to the light. From my perspective, I want people to have more conversations about type 1. I want them to be able to have freer access to educational supplies to, you know, if they need their CGMs or if they need the Omnipod, which I personally think is just wonderful. I want to see that in the next couple of years. I want to see people being able to at least have the resources in lieu of a cure. I want them to be able to have the resources that they can communicate with other diabetics freely, have a platform that they can speak, you know, for parents to just have their own platform and they can have the supplies that they need. Too often I see, you know, parents who are going to the black market to buy their insulin because they just can't afford it otherwise. And that's obscene. That's just completely unacceptable that we as a community are able to see that. So I want to see that done away with personally. And I think I would like to see less admissions to the ER for DKA. You know, I want to see people coming in and them talking about their type 1 diabetes as a secondary reason. I don't want that to be the reason that they're in my stretcher. You know, I want it to be something else. So those are the kind of things that I would like to see.

[00:38:54] Rob Howe: No, I think all really great points. And I think, you know, affordability of insulin and access to insulin is something that I'm glad is getting more attention. But there's just so obvious that there's so much work that needs to be done. And I'm glad that there are, you know, better, stronger people who are leading that charge and happy to be a part of that as well. But you mentioned something about a lot of DKA patients coming into the emergency room. I think earlier you mentioned that you got that a lot and then just now as well. What – when you – I mean without diving too in-depth into like specific cases maybe, but what do you find the reasons for that are? I imagine it's not always like a faulty pump or it's not a – is it a long period without insulin? Is it just gross mismanagement or lack of awareness education about what specific actions are doing to the body? Is it just children without the right oversight? What do you see when you see those DKA patients come in?

[00:40:01] Samuel Foarde: Most of it is they don't have their insulin with them. They are oftentimes rationing their insulin. So they're supposed to be taking 25 units of their long acting, and they are only taking like 10 for that day just because they have to ration out their insulin and it's a combination some of it is they have the insulin but you know I there was a patient who drank you know warm milk with sugar dumped in it you know every night before he went to bed and he just like shot his sugar up to I don't know it was like 1400 his blood sugar was when he came in only because it was just, it's a combination. It's just people, like I said earlier, they get locked into this routine that they think is okay. And once you have that justification in your brain, that's how you keep yourself. So you can worry about other things in your life. Diabetes often gets put on the back burner as something routine, as it is for most of us. It's a part of our routine. But it is mostly because they cannot afford to have the kind of insulin and the amount of insulin they need to cover their blood sugars day to day. That is the root of most of our DKA admissions into the emergency department.

[00:41:21] Rob Howe: Wow. I mean, that alone, that's astounding. I mean, I think that story needs to be out there. I never would have guessed that that's what it was, whether rationing or just like lack of access. Like, and I think shame on, I'll say this lightly, because I think there's a lot of really active, really good messages within the type 1 community of which I'm a part of. But there's not as much communication of, you know, between the people who are not necessarily alike. Because I think there's a lot of us who are very active, very positive message, and that's excellent. And I think that's like there are more people now doing that than I've ever seen before. And I think that's a great trend. But we're not talking to everybody. We're sort of in our own little bubble. And I want to expose those stories. I want to talk about those people who are taking less insulin than they should be taking because they can't afford it or because they are afraid of going too low because of one thing or another. And I think those stories don't get told because those people aren't shouting those things from the rooftops. So inherently, they're going to be a little bit more closeted. But there needs to be a greater awareness of that. If we're going to really do like you said and start by adjusting the learning, we've got to create awareness among the Type 1 community.

[00:42:54] Samuel Foarde: Right. No, absolutely. 100%. Yeah, I mean, a lot of times the emergency room gets all the people who just they don't have what they need. And a lot of them feel shame. A lot of them feel ashamed because they can't manage their condition. They just feel like they are a personal failure because they can't manage their blood sugar. And everyone is constantly telling them, you know, well, that's your fault. It's because you eat this. It's because you do X, Y and Z that you shouldn't be doing. And so, you know, we know diabetics are twice as prone to depression, but when you literally can't afford it, you just feel like that's your fault too. So it just, all the patients I talk to, they talk about how they're in this downward spiral of depression and they figure, you know, they're just done, they're done trying almost in a way. Even if they had the resources to take care of themselves, they're so ashamed of how they've treated their bodies that they're locked in this cage of depression. and it's awful for their outcomes and for their quality of life.

[00:44:02] Rob Howe: Well, there's a lot of good work that can be done, and I'm glad that we have people like you out there leading the charge on the front lines in the ER, and that there are other people who we can help spread this message and create more awareness and more education, because that's what it's going to take.

[00:44:21] Samuel Foarde: Right, absolutely. That is why we're here. That's right. The registered news and everyone else doing their part to keep the message positive. That's right.

[00:44:29] Rob Howe: Yeah, 100%. Sam, I asked this question to all my guests. So I'll ask it to you because I'm just not as creative sometimes at the end of a long interview. But if you were – here's the context. You're in an airport. The gate is going to close in 30 seconds, and you can't miss the flight. Like, you know, whatever it is on the other end, you've got to get there. But you run into someone who's either struggling with their type 1 or has been recently diagnosed. What's the one thing that you tell them in that 30 seconds?

[00:45:07] Samuel Foarde: Well, I give them my phone number. I give them my phone number or my email or something because I love reaching out to other type ones. It helps me more than I give it credit for. if I have 30 seconds I said you know I want to talk to you about this I want to hear your story I want to dispel the myths that you believe I want to help encourage you and create a positive bubble around you mostly because you know I don't want to see you in my emergency department but you know I want I want to feel like I'm contributing to you so yeah I would scribble down my phone number like stuff it in their pocket and then run to the gate that's what I would say

[00:45:47] Rob Howe: yeah i love it because there's there's two types of answers there's one there's people who try to make the most of that 30 seconds right there and then there are people like you who just like break the whole frame and they're like no i'm taking control of this i'm either going to forget my flight or i'm going to give them my phone number or whatever it is i love it right yeah absolutely uh in the in the same uh in the same vein of staying in touch with you uh where uh where can our listeners find you online to reach out and potentially follow you?

[00:46:17] Samuel Foarde: So I am on Instagram. My Instagram is sir underscore registered underscore nerd. So instead of registered nurse, it's registered nerd because most of my Instagram is 90s nostalgia with 90s fun, colorful shirts and all that other. I'm practically a little cartoon character there. So yeah, you can follow me on Instagram and just keep up with my stuff there. They can message me on there, reach out. And I would love to just meet more of the community. As an RN, I feel like with the technology and the social media we have, our influence and our reach can be global. And the good we can do can be global as well. And so I would really, yeah, love if people would come and talk to me and we could be friends.

[00:47:09] Rob Howe: Well, I love it. We will include a link to your profile in the show notes when we get this published. And, you know, really, I couldn't agree more. Like there's, I've seen in my own life, the benefit of getting more involved and having more conversations like this in the type 1 world, like my A1C is lower, I have better habits. I know others will benefit from it as well. And I think like just what you said, the registered nurse community, you know, really being out there and able to impact people through social media, which we're all connected and using anyway, can only have a positive effect. So I just love the idea that of a network and a united front of people who are helping educate others and help others. It just makes me very hopeful.

[00:47:59] Samuel Foarde: Yeah, that's what we're here. I mean, in the emergency room, we're about treat them and street them. You know, if you have an open airway, you're good. If you have a pulse, you're good. That's the emergency mentality. But for registered nurses everywhere, a part of our license is absolutely education. And education feeds into prevention and that leads into better clinical outcomes. And that's our responsibility of our licensure as registered nurses. And so getting the opportunity to do that, I feel completely fulfilled in my career and in my choice to be an RN. So thank you for giving me the venue to do that and the platform to just speak about my experience. That's awesome of you.

[00:48:42] Rob Howe: Well, that's what I'm here for. It's my favorite thing. So I'm really glad to have the opportunity. Awesome. Well, very cool. And Sam, thanks so much for coming on the show. I can't thank you enough. I had no – this went so much more in-depth and so much more – touched on more issues than I ever could have expected. So thank you for just a kick-ass interview, man, really.

[00:49:08] Samuel Foarde: Awesome. Well, thank you, Rob, for having me on. And I look forward to more podcasts. This is wonderful work. So keep up the good work yourself.