A rom com that teaches you about type 1 diabetes without ever feeling like homework. In this episode, Dr. Denise Millstine chats with author Cynthia Timoti and nurse practitioner Mary Boyle about “Salty, Spiced and a Little Bit Nice,” a warm, funny love story rooted in Timoti’s real life experience raising a child with type 1 diabetes. Together they unpack the book’s authentic portrayal of diagnosis, daily management, cultural expectations, and the power of supportive relationships, showing how fiction can illuminate chronic illness with heart and clarity.
What happens when a romance novel becomes a doorway into understanding type 1 diabetes?
In this warm and insightful episode of Read. Talk. Grow., Dr. Denise Millstine sits down with author Cynthia Timoti and Mayo Clinic nurse practitioner Mary Elizabeth Boyle to explore Salty, Spiced and a Little Bit Nice, a rom‑com inspired by Timoti’s real‑life experience parenting a child with type 1 diabetes. Together, they unpack the novel’s authentic portrayal of diagnosis, daily management, cultural expectations, family dynamics, and the emotional landscape of chronic illness, all while celebrating the resilience, independence, and joy woven through protagonist Ellie Pang’s journey. Blending medical expertise with storytelling, the conversation highlights how fiction can illuminate complex health experiences with empathy, clarity, and heart.
This episode was made possible by the generous support of Ken Stevens.
We talked with:
When she’s not writing, Cynthia can probably be found attempting to make a dent in her TBR pile (which seems to mysteriously grow at an alarmingly fast rate), hunting for the perfect cup of bubble tea, and adding to her collection of pretty notebooks that she almost certainly will never use. She lives in Melbourne, the best city in all of Australia (no, she’s not biased) with her non-reader husband and two fantasy-and-dystopian-reader sons, who are both now taller than her.
Purchase Salty Spiced and a Little Bit Nice:
Dr. Denise Millstine
Welcome to the “Read. Talk. Grow.” podcast, where we explore health topics through books. Our topic is diabetes mellitus type one, and our book is “Salty, Spiced and a Little Bit Nice” by Cynthia Timoti. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine.I am so excited about my guests today.
Cynthia Timoti is an Australian author of multicultural romantic comedies known for their heart, humor and sharp cultural insight. Her debut novel is “Salty, Spiced and a Little Bit Nice,” and it blends romance with themes of family expectations, chronic illness and identity, and has been praised for its warmth and authenticity. Born in Jakarta and now based in Melbourne, Cynthia writes stories where happily ever after’s are always guaranteed.
Cynthia, welcome to the show.
Cynthia Timoti
Thank you. Thanks for having me. I'm very excited.
Dr. Denise Millstine
Mary Elizabeth Boyle is a nurse practitioner at Mayo Clinic in Arizona, specializing in endocrinology with a focus on diabetes and metabolism. She provides comprehensive care for patients with type one and type two diabetes, including advanced diabetes management and continuous glucose monitoring. She's been an integral member of the Mayo Clinic Diabetes Care Team in Scottsdale for years.
Mary, welcome to the show.
Mary Elizabeth Boyle
Thank you for having me.
Dr. Denise Millstine
Mary and I know each other. I have her phone number on speed dial for my patients with extraordinarily high blood sugars, so it's fun to work with her on this project. “Salty, Spiced and a Little Bit Nice” is a modern romance novel featuring financial expert turned healthy baker Ellie Pang, whose diagnosis of diabetes type one in childhood led her to learning about making delicious low‑sugar desserts, all while maneuvering under the thumb of her meddling mother, who does not always have her best interest at heart. Ellie was heartbroken by her brother's best friend, Alec, as a teenager, who, of course, this being a romance, surfaces while Ellie is trying to find her feet and independently start a new life.
Okay, you both know how “Read. Talk. Grow.” works; we discuss books that portray health topics in an effort to better understand health experiences through story. In this case, we're talking about type one diabetes.
Cynthia, tell us your inspiration for the book.
Cynthia Timoti
This goes back six years ago now during COVID. So during the pandemic, we in Melbourne had a lot of lockdowns, and during one of those lockdowns, we noticed that my son, my youngest son, who was almost seven at the time, he began to be very thirsty a lot of the time. And then he went to the toilet very often. He would go at night, he would wet the bed, and then we were wondering what is wrong because he's almost seven. He doesn't wet the bed anymore.
So we took him to the GP, to our doctor, to have him checked, to have a blood test. And when the results came back, we were told that he had type one diabetes, which was very shocking because we didn't have a history of type one diabetes in the family.
And then, you know, we started to go through all the tests, all the hospital visits and all that. And a lot of people, when we shared the story of him having type one diabetes, they were wondering what it is. So they were asking questions like, is that because he's had a lot of sugar? Is that because he's not eating healthy?
So there were a lot of questions. And people were not sure what’s the difference between type one and type two diabetes. I was actually trying to get my novel finished at the time, and it was a completely different story at the time. And then I thought, maybe if I gave my character the same condition that my son has, then it would probably help in a way, not to educate people, because I'm not a doctor, but just to raise a bit of awareness of what it is and how it's different from type two diabetes.
And my family actually had a history of type two diabetes because my mum had one. So I just wanted to share with some readers how it's different, what it is, and what caused it. And yeah, so that's what inspired it.
Dr. Denise Millstine
This makes a lot of sense when we see some of the scenes in the book, so I'm pretty excited to dive into them as we talk more. But first, Mary, tell us your reaction to the book and also what it's like to work in diabetes.
Mary Elizabeth Boyle
Well, Cynthia, I have to tell you, this was a very authentic book. The writing was lovely. I enjoyed how you intertwined the diagnosis of your son, and what, I mean is the diagnosis of diabetes, not particularly his story. And I didn’t know until I read the end what your inspiration was. But it brought in so many themes: the family, their thoughts, their worries.
How do we keep this young person safe? And then, of course, when the young woman says, “I've had enough of my family, it's time for me to spread my wings,” and off she goes. There was concern that she may be at risk for not being able to take care of her diabetes. But it was clear to me by how you wrote that she understood diet, exercise, the importance of staying connected with people.
And finally, I just loved how the love story was intertwined with the story. The diabetes wasn’t the whole story. It was like you made Ellie the central part of the picture, and oh, by the way, she has this disease called type one diabetes.
Cynthia Timoti
Thank you. That’s really nice to hear.
Dr. Denise Millstine
Big distinction. What’s your day like, Mary, working with people who have diabetes? What does that look like?
Mary Elizabeth Boyle
Well, you know, when I was working full time, I had a mixture of patients with type one and type two diabetes. And we know that the population data shows that 10% of the patients have type one diabetes. And as it turns out, type one is my favorite disease to manage because it is not more difficult than type two. But the patients don’t really, or can’t, take a break from managing their diabetes. It’s with them day in and day out.
I remember reading a statistic years ago that said the patients who are most successful managing their diabetes spend three hours a day or more. And when you think of the young child that you have now, growing, three hours of his day is a lot, because he's more interested in going to school and playing and eating snacks and just being part of a family.
And then when you segue to this young woman in the story; she had mastered how to manage her diabetes to the point of all the cool snacks and treats she was making. That resonated with me because it's the biggest piece of the puzzle that I know patients struggle with: What do I eat? This is too much work. I want this, and it's too many carbs. You know she found a way to work it into the meal plan. Which, if I had to ask you, is that what you did for your son with the special recipes and desserts?
Cynthia Timoti
Not as much as I did in the story, because we also thought that we wanted to try to normalize eating as much as possible. So we always tell him that you can have anything you want, as long as you make sure that you do the right counting for your carbohydrates, and then you put in the right amount of insulin. It doesn't limit you, what you can have.
So we do try to incorporate as much normal eating as possible. But yeah, every now and then, sugar‑free, he would enjoy. Yeah, he would love it if there's anything sugar‑free that he can have without worrying about the carb and insulin and all that.
Mary Elizabeth Boyle
I also wanted to congratulate you on the team of experts that educated you, your family, and your son. Because it was COVID and only the first responders were allowed to come to the office. And I remember meeting people at the local coffee shop where there was internet to help them get their continuous monitoring of the glucose set up or some other issues. Can you share with us anything in your experience about how your educational experience was with your son.
Cynthia Timoti
Yeah, we were quite lucky in our state, in Victoria, we've got a children's hospital called the Royal Children's Hospital in Melbourne. And when we were diagnosed, we were told to immediately come to the hospital, and we spent — I want to say probably three, four days at the hospital just for him to get familiar with.
We were doing injections at the time. We were doing MDI, so for him just to learn what the disease is and for us to get familiar with all the injections, all the terms, all the whatever we have to do to get by. Yeah. So it was quite tough because, like you said, it was only the first responders that were allowed out. So we were quite lucky that we had access to the educational team that were helping us understand what the disease was about at the time.
Dr. Denise Millstine
It truly is a whole new language, a whole new way of thinking and way of living. Let's dive into the experience of Ellie, who's the main character of the book. Cynthia, we meet her when she’s an adult. She has a pretty disastrous public event that goes viral on social media, and this leads her to examine the influence her parents are having on her life and really the control that they're exerting on her life.
So in the second chapter, she's going to confront her mother about this controlling nature, and she's thinking back to her diagnosis of diabetes. And she says, “My unexpected type one diabetes diagnosis completely redefined my life.” Will you just talk about the time of her diagnosis, how that happened, and how that was kind of a before‑and‑after moment for Ellie.
Cynthia Timoti
Yeah, sure. I guess in a way that was also a reflection on my son, because before the diagnosis, he was quite, I wouldn’t say careless, but he would have whatever he wanted in terms of eating and in terms of playing, exercising. And then after the diagnosis, we learned that we had to be a bit more careful. We had to watch what he was eating, not that we're limiting anything, but we have to make sure that we know how much insulin to give him.
So I thought that would be a good thing to put in for the character, because for us at least, it does represent a before and after. Yeah. So after, it was like a lot more limitations, I guess, but also being a bit more careful with what he's doing, what he's eating. So yeah. So I guess that's what I'm trying to portray in the scene with the character, a bit of a reflection of what actually did happen to us.
Dr. Denise Millstine
It's so interesting to me that Ellie was not doing well. I mean, she was having the symptoms that you had described. She's drinking a lot of water, having to go to the bathroom all the time, eating a lot of food. And it actually wasn't her parents, it was her friend's parent who was caring for her and was like, “Something is kind of disastrously wrong here,” and brought her in to get care.
Mary, will you just reflect on the diagnosis of type one diabetes, particularly when it happens in childhood? Is it a pretty common story where the symptoms are kind of explained away initially and not recognized, or what's been your experience with that?
Mary Elizabeth Boyle
Well, in children, yes. I think a lot of times, especially if it's happening in the summer or the early spring, most people say, “Well, it is hot outside,” and, you know, “I can understand why they're drinking more,” and they may have had an accident in the bed.
However, if it's happening in the time of year when you wouldn't expect that, some of the families may be more concerned. In the early age groups, I think it might be picked up sooner than it might be in the teenage or older adult groups, just because you kind of pooh‑pooh these symptoms. So I like to think about the part that in Cynthia's case, getting her child to the doctor because she noticed those symptoms, the child is in the home, she noticed, and they knew what was normal behavior. When you're diagnosed at a later age, you may not pay as much close attention.
Cynthia Timoti
We were also quite lucky because our doctor at the time, who we went to see, his son has type one diabetes. So he was very quickly saying to us, “Okay, you need to get a blood test because this is not normal.” And I've heard stories where some doctors, like you said, Mary, would probably say, “It's okay, it's normal during the summer months,” or whatever. So we were actually also quite lucky to have a doctor who knew, who had an instinct of what might be going on.
Dr. Denise Millstine
Yeah, but it takes that awareness and that sensitivity to kind of hear, “Oh, maybe this isn't just a hot summer month with the person who's playing outside or sweating outside and needing to drink more fluids.”
Mary, Ellie's parents blame the food she's been eating right after her diagnosis, saying it's because she's been eating this junk food. Did that have anything to do with her developing diabetes?
Mary Elizabeth Boyle
No, it did not. As most of us know, type one diabetes is an autoimmune process where the body destroys the cells of the pancreas, and there is usually not a family history. And it is frustrating to people because you always want to find a reason, why did this happen? So I like what Cynthia said, saying to her child, “Listen, you can eat what you want, you just have to account for it.”
But I also did want to say I have compassion for Ellie's parents, because I wonder what education they had when Ellie was diagnosed. Because so much of the dietary part is still misunderstood. And when I take care of type ones who maybe have had it 30, 40, 50 years, the first thing I inquire about is their diet. And sometimes they're like, “Listen, I've seen enough of those plastic models. I don't want to see plastic grapes or how much meat I'm supposed to eat. I want to eat this.”
So I make sure everybody sees a dietitian so I know how many carbs they're supposed to eat. And then I'll swivel the picture into the point of, “Can you tell me what you like to eat? And let's fit this into your lifestyle.” Dealing with adults is kind of challenging because by the time you're a certain age, you don't want to make any changes.
Dr. Denise Millstine
Or it's harder, or you know culturally it's more of a reversal of what you've become accustomed to. Absolutely. Cynthia, let's talk about Ellie's love interest, that's Alec. So from the time she's a very young girl, she pines over Alec and has quite a disastrous end to that interaction.
But then, this being a romance novel, he reenters her life when she's just overcome with stress from finding the storefront she's rented for her new bakery in a complete state of disarray. She trips over this collection of dog leashes. She lands on the ground. He comes upon her, and his first thought is that he's worried she might be having an episode of hypoglycemia. What is that?
Cynthia Timoti
A hypo is when the person's blood sugar drops below a level that is acceptable and normal, like for a person. In Australia, we say it's below 3.9. But I think in America you use below 70. Mary, am I right in saying that?
Mary Elizabeth Boyle Yes. Yes, you are correct, Cynthia.
Cynthia Timoti
Yeah. So when somebody is having a hypo, like in the case of my son, he would tell me that he feels very disoriented, and then he feels very weak. And then he normally can't think straight, can be a bit cranky sometimes. So it can be dangerous, because when somebody's blood sugar drops very low, to the point of below 2.2, I'm not sure what that is, Mary, but somebody can be unconscious.
And in severe cases, they can actually die. So it is very dangerous. And with the case of my son and everybody else with type one, I'm sure that when he drops below that certain level, we have to give him some sugar to make sure that it goes back up.
Dr. Denise Millstine
Mary, why is there this difference in the levels that Cynthia is experiencing in Australia compared to what the numbers would be in the States. Is it a matter of the units that the blood sugar is measured in. And can you just give us a range of what an American listener might be looking for, for these hypoglycemic episodes.
Mary Elizabeth Boyle
Sure. So it's a matter of the metric system that I believe Cynthia is using, and the Americans never really adapted that into other parts of the world as well. So in the U.S., typically a low sugar is depicted as anything under 70. And most of the continuous glucose monitors have a reading of 55 where it cannot be turned off.
But what Cynthia was also referring to is when your sugar is in the 40s, you could have some neurological symptoms where you may not be able to speak, or you may feel numbness around your lips or your tongue. And there's always this term I used to hear; “the lights are on,” like the person's eyes are open, but they're just not there, and so having that quick‑acting glucose is really important.
And one thing I wanted to say, Cynthia, was what I like so much about how the management of the hypoglycemia was in the book. It was that it was positive from the standpoint that she knew what she had to do, but she got into a situation, I think, where alcohol could have been involved, and it kind of blurs the sensorium a little bit, which would not be for your son at this point.
The other thing too, is sometimes people who don't understand that hypoglycemia can occur even when a person is doing their level best to take care of themselves, it can be kind of like a stigma. And I never got that from this experience. And I was reading the book thinking, “Oh please, I hope hypoglycemia isn't going to be portrayed as a negative thing.”
And then segueing to the soon‑to‑be boyfriend’s experience, how supportive he was. And when you have a person with diabetes, the next best thing to a supportive family is a supportive significant other. And it just so happened that it worked out for… I shouldn’t say too many things about the story so I don’t spoil it for people that will read it. But it was truly just a very inspirational part of the book that I really enjoyed.
Cynthia Timoti
Oh thank you. It's really nice to hear that from an expert. But also, we were told in the first week that we were diagnosed, we were told that if you manage your diabetes well, there will always be a hypo in your life. It's a normal part of having good management of type one diabetes. I think that's what I was told, that you can have hypo, it's a normal part. So we don't see it as something negative in our family. So I'm glad you said that, Mary. That was really nice to hear.
Dr. Denise Millstine
Hey listeners, we hope you're enjoying this episode of “Read. Talk. Grow.” If you find our discussions helpful and insightful, please take a moment to subscribe to and rate “Read. Talk. Grow.” on your preferred podcast platform and don't forget to tell your friends to listen. Your support will help us reach more readers and those eager to learn about health through books. As always, feel free to drop us a line at readtalkgrow@mayo.edu with suggestions for books, topics or any comments. Thanks for listening.
Well, and of course the blood sugar is fluctuating. And so I think another way to say what you've just said is that if you're aiming for tight control, for excellent control, then you are at times walking this fine line, which means you might cross over that line a bit into the low blood sugar, and sometimes you cross that line into a high blood sugar as well. And the idea is to sort of figure out how to regulate that to the best of your ability. But it's not possible to always have the same blood sugar 24 hours a day because you eat, you have hormonal shifts, all these things are happening.
Mary, I wonder if you'll comment about the importance of exercise. What we see with Ellie is that she's learned this process of normalizing her exercise in the morning with a morning run that seems to help her, but then we see her later when she's unexpectedly having to walk in the hot sun. And actually, that extra amount of exercise, particularly paired with a little less access or a lot less access to food and water, now wreaks havoc on her blood sugar. Will you talk about the role of exercise and how that interacts with blood sugar levels?
Mary Elizabeth Boyle
Yes. So we all understand how important exercise is, but it's challenging for the person with type one diabetes. Mainly because sometimes they'll try to let their numbers run a little higher so they can bring it down more gently. Sometimes if your sugar is above a certain point, your providers don't want you to be exercising. But each person has to figure out when is their time that they want to exercise; whether it's early morning, late afternoon, and also keeping in mind that sometimes it's a good idea to start with a little bit of carbohydrates in the system.
Some patients are on insulin pumps and things of that nature, so they have to be aware that there are many things that they have to consider. And in all the meetings I've gone to, it's the big question mark that I hear from experts around the world, managing your diabetes and figuring out the right kind of exercise for our type ones is difficult.
But I keep attending different meetings just to get a different thought. And some proponents say yes, do this. Others say no, don't do this. And I'd be curious from Cynthia’s standpoint, how did you get the exercise for your son in terms of, you know, I know they have it at recesses and things of that nature. Does he like doing it during the day? Does he like doing it before school, late in the evening?
Cynthia Timoti
He normally does it during the day, mostly during school, I guess. Like you said, it's different for everyone I guess, and it's also different depending on what sort of exercise he's doing. So some days when he considers a lot of running, he's into athletics and swimming as well, so there are days when he does his athletics and then we'll find he will crash at night after a long day full of activity.
But also sometimes he might run a bit high. So it sort of varies and it depends day to day and also depending on what sort of exercise he's doing. But yeah, we do encourage him to do a lot of exercise, not a lot, but he's a very active kid as well. So exercise is always good for everyone. But, you know, we do encourage him to be quite active instead of just… he's into gaming as well. So instead of just sitting around at home, you know, staring at the screen.
Mary Elizabeth Boyle
Oh my goodness. Yes. Yeah, that’s excellent, staying busy. And with using the continuous glucose monitoring, you have an idea where his glucose is when he starts the exercise. And then every 30 minutes he keeps an eye on it. Sometimes with my older patients, they would tell me that when they weightlift, their blood sugar would go up a little bit, and when they ran, their sugar would drop.
So they'd start their day out with a little bit of weightlifting so they would have a little bit more of the higher sugar, and then they'd start their exercise. But always having that extra glucose on board, whether it be in the form of juice or Skittles or some sort of candy.
The nice thing about the continuous glucose monitoring as well is that your son can connect with you and your husband, family members, and also with the provider so that other folks can watch what's going on. If they notice, in terms of the family member, that's a commitment that you make. Is that something that you do to watch his glucose control.
Cynthia Timoti
Yeah, absolutely. With the CGM that we're using, I'm able to follow him on my phone, and so does my husband. And whenever he's away or he's at school, we're able to see what his numbers are. And it also gives us peace of mind knowing that he's okay.
And, you know, whenever he's… because he's been to sleepovers and all that. So it's also good to know that he's… so he's been to school camps where he's crashed at two at night because he's had a very active day. And we've had school nurses calling us saying, “This is what's going on. What do we do?” It's a lot of peace of mind for us knowing that it's okay, somebody’s looking after him. So yeah.
Dr. Denise Millstine
Mary, your career, you're in the later part of your career. And so you have seen these CGM technology just come to even exist. I mean, when you started, people were checking their blood sugar really only by the old school, “you prick your finger, you put it on some sort of testing strip, you plug it into a machine, and that gives you a single point in time.”
But you have to actually take an action to learn what your blood sugar is at a given time. And I wonder if you'll tell our listeners in a little bit more detail: What is this CGM? What does it look like? And how is it working such that you're able to see, or your parent or loved one is able to see, what your blood sugar is literally moment to moment.
Mary Elizabeth Boyle
Yes. And I can still recall in the middle of the 1980s when we did have the blocks that looked literally like a brick, the first glucose monitor that came out, and then the strips. And if you sprayed it hard enough with water, everybody's sugar was 80 to 120. And we thought, “This is magical,” only to figure out that that was not going to work.
So fast‑forward, the sensors have gotten better. There is one that is the size of a nickel, one that's a little closer to the size of a quarter. Almost anybody who is interested in their glucose control, whether you're a person with prediabetes, type one, or type two diabetes, can get a sensor if you're interested. They are very easy to put on. You connect either to your Apple phone or your Android phone.
And one of the most wonderful things that's coming out since we are talking about type one diabetes, is there is now a drug that can be used to stall a person from going from stage two, type one diabetes to full‑blown diabetes, called teplizumab or Tzield. And we've never had anything like that in our history.
And so when you have a person with type one in the family, whether that be the mother, the father, or one of the children, maybe an aunt, uncle, even a grandparent, I ask people to get their antibodies checked. These are the autoimmune antibodies that can tell you if you might be a person that will go on to develop type one diabetes.
So part of the interest in type one for me is, once a child is diagnosed, and I think Cynthia, in your son's case, he did not end up getting the ketoacidosis that develops when sugar is really high for a period of time, but other children and some adults are not as fortunate.
So if you know, let's say, if there's type two or a family member with type one, and that you've been told that you have one or two of the autoantibodies, having this person check their glucose even on a quarterly basis, the family and the providers are going to know so that we can prevent this child from suffering, as well as the family, because it is a family problem and culturally, families stick together to try to help each other cope.
So I'm a big proponent of the continuous glucose monitoring. Cost is not an issue like it was so many times before. And if you connect with your provider, if it's someone that is very familiar with diabetes, they can help you, or certainly through the American Diabetes Association. Oh, and Cynthia, will you help me with the name of what we call the Juvenile Diabetes Foundation for type one?
Cynthia Timoti
Yes. So it's now called Breakthrough Type 1D.
Mary Elizabeth Boyle
Yes, Breakthrough Type 1D. And I wanted to emphasize that people with type one can be infants all the way up to 80‑plus years of life. We used to think it was people under the age of 20 type one, and anybody older was type two. But we now know that that isn't always the case.
And I have uncovered patients who were told they were type two, and then when I do a little family history, I realize that their grandpa may have been a type one and they had the antibodies. It's not always a difficult thing to talk about, but it can help the person know that if we do some preemptive reeducation, maybe we can keep them out of the hospital, out of the emergency department and home where they are comfortable and safe with their family.
Dr. Denise Millstine
We no longer always have to wait for these extreme symptoms and even cases of the high blood sugar. Cynthia, you made a reference to counting carbohydrates for treatment. And there's a scene in the book where, so Ellie and Alec are really in tension. I mean, this is romance; there's going to be conflict. They're in tension the whole time. I mean, we knew there was going to be a happily‑ever‑after, Mary, so I don't think you spoiled it for anybody.
But in the tension, they're constantly trying to jab at each other and then do something nice for each other. And so one morning, Ellie comes down, she's staying with Alec because she's new to the area, she comes down and he's made her these whole‑grain pancakes. And so in the book, she says she's doing some mental calculation about the carbohydrate content of the meal to adjust her insulin pump.
Cynthia, what does all that mean? What is she doing in that scene?
Cynthia Timoti
So this is what we do in our family. And maybe Mary, later you can tell us if it's right or not, if it's the correct way of doing it or not. So usually in meals where we… because if you've got packaged foods that you're eating, there's usually a nutrition information label on it. And then you can see how much is the cup, how much you have to put in based on what you're eating.
But at home, when we're cooking something that doesn't have a set amount of carbohydrate in it, we often have to sort of estimate what sort of carbohydrate amount that he's having and then how much insulin we're giving based on that. So that's what I was trying to convey in the scene, just trying to estimate how much she should be giving herself in terms of insulin. But yeah, Mary, I don't know if that's the correct way of doing things.
Mary Elizabeth Boyle
It is so correct, Cynthia. You know, there's no wrong way to manage a person's diabetes. But I will tell you that it is difficult. And back in the day, we used to pray for, is there just a magical picture that we could take of what the food looks like and it would tell us approximately how many carbs and as it turns out, some of the continuous glucose monitors will now be able to; you take a picture before you eat, and then you can look at your two‑hour post‑meal blood sugar and say, “You know, I guessed correctly.”
I was talking to a dietitian yesterday, and she said it really works well if you have the grapes here in one area, and then you have your cheese sandwich here, and maybe something else that's easy like a glass of milk. But when you have something like lasagna or a bowl of pasta, it's hard to estimate.
So, I always say to people, it's important, if somebody really loves pasta, that you never take that away. If they really love rice, that you never take it away. But you say, “How much are you eating? Can we measure it? And how much rice is the amount for one serving of carb?” And then you modify it.
And the cool thing about working with your young son who's growing is, as he grows, he's going to be able to eat more. And the more active he is, he can eat more than he could if he wasn't as active.
And then you segue to a person with type two diabetes, and our eyes are always bigger than what they should be in terms of what we're eating. We sometimes have to say, “Now you're eating that full cup of pasta, but the activity in your life isn't measuring up as much. Can we either do more activity or cut back a little here.”
And through the glucose sensor, then I'll say, “Now do an experiment of eating one cup of pasta, and then maybe do two‑thirds of a cup the next time.” And then they'll say to me, “Well, I didn't really like to do that, so I made this adjustment and this works better for me.” And I'm like, “Perfect. I don't have the answers either.” But it's trial and error.
And a lot of the artificial‑intelligence apps that are coming out are really going to be helpful, in terms of you roll up to a grocery store and you say, “This is what we want tonight,” and it pulls up all the ingredients and you can see how many carbs. Or if you're going to a new restaurant and you're like, “Is there anything there I can eat?” If you're a vegetarian or a flexitarian or a pescatarian, you always want to know what's available.
Dr. Denise Millstine
It's so great because I think in the past there was this tendency to eat some packaged foods because the nutrient label is on that. And now we have technology to help people eat healthier foods, home‑prepared foods, but also still be able to count these carbohydrates.
This is probably a good point to talk about glycemic index. Cynthia, what is that? I think Alec looks up some low‑glycemic‑index recipes for Ellie.
Cynthia Timoti
Yes. So low‑glycemic‑index food, or low‑GI foods, are foods that will not spike up your blood sugar as fast. So things that are not low‑GI, like Skittles or your ordinary candy, it will spike up your blood sugar really fast, and then you will crash really fast as well.
Whereas with low‑GI, it will bring your sugar level up in a steady way. And that's better for people with type one diabetes because you don't get that hypoglycemia, and then you don't get the hypo after. So it's always preferred. I guess, Mary, would that be your experience.
Mary Elizabeth Boyle
Yes. Yes, it definitely is, Cynthia. And sometimes people don't always understand that when they're telling me stuff. And so let's say, you know, “I know I'm supposed to eat brown rice, but I don't like the taste as much as I like white rice.” And I'll say, “Well, what does your sugar look like when you eat white rice compared to brown rice or pizza or different types of foods?”
And while I may not always use the words “glycemic index,” I'll pretty much say, “What is it that you want to eat? And what have you noticed that keeps your blood sugar nice and steady?” The other thing that helps too is matching protein with your carbohydrates, instead of just eating a whole carbohydrate‑laden meal. And that's really, really helpful.
If you have the time to do meal prep, and so many people do that on Sundays for the whole week, and some like go to the cafeteria and try to figure it out on the fly, and it's difficult.
Dr. Denise Millstine
And what's the insulin pump that she's using, Mary. So Ellie is dialing into her insulin pump. There's a scene where the reservoir on her pump is running low. There's also a scene where she and Alec change the insertion of her pump. Can you talk about some of those details of the insulin pump in terms of what it is, how it's used, and what people need to manage when they have a pump?
Mary Elizabeth Boyle
Yes, so an insulin pump is a device that delivers a small amount of insulin in the background, which we refer to as the basal. And it's typically the rapid‑acting insulin. And then we figure out how much bolus they need to cover the food that they're eating based on an insulin‑to‑carb ratio.
So we fine‑tune these insulin‑to‑carb ratios. Maybe we start out with one unit of fast‑acting insulin, something like Novolog or Humalog to 15 grams of carbs. But over time, with these fantastic insulin pumps, we've noticed that the insulin‑to‑carb ratio comes down nicely because these pumps have gotten better. And we can estimate the basal needs of somebody; meaning how much insulin you need in the body to keep a person alive.
But what we have to figure out is how much insulin to cover the food. And so there are so many cool algorithms that you can work with. And it's an amazing tool. But the family needs to be well‑educated. The person needs to be well‑educated. And with the infusion sites, there can always be issues and problems. So keeping a close eye on that.
Dr. Denise Millstine
And it's literally, I think of it as looking like a pager. Maybe that's an old‑school pump, but it looks like an old pager from the 1990s, and it has a cassette of insulin liquid in it. Is that right?
Mary Elizabeth Boyle
Yes, it does. And some of the pumps are thinner than that now, and some are actually pods. There's one, it sounds like that maybe what your son is using, the Omnipod then.
Cynthia Timoti
No, we're on Tandem t:slim, which is the one that's still connected to his body with plastic tubing. But yeah, we've been looking at the pod, so maybe one day.
Mary Elizabeth Boyle
And the cool thing, as you know, Cynthia, is he has this tool now that can help him replace the insulin that he doesn't make. But it's truly amazing, especially if he's swimming, if he's doing all his different sports, how he manages that. It connects also to the continuous glucose monitor, and it delivers insulin precisely at these tiny, tiny doses.
And what I like too that is so cool about the companies, you can switch pumps around as he gets older. Sometimes I would see people use the Omnipod when it's time to go to the beach, because then they didn't have to have all this tubing. If you're a young mother who has a baby and the baby keeps pulling out the tubing, you might want something a little easier that someone wouldn't pull out by accident.
Dr. Denise Millstine
Interesting. Cynthia, there's a scene in the book where Ellie's pump is running low, and so she has a backup plan, and those are injections that she's carrying with her to the restaurant. Will you tell our readers what those are and kind of why she is using that at that point.
Cynthia Timoti
So when this in the scene. So Ellie is using an insulin pen to inject insulin manually into her body, which is what we had when my son was first diagnosed because we didn't have the pump yet at the time. We were always told that whenever if the pump fails or if you know the insulin is low in the cartridge, that is our backup plan to inject the insulin manually into his body with an insulin pen and then there's a small syringe that is attached to the pen.
What's interesting is I actually just had a conversation with a friend who's also a type one diabetic, and she's an adult. She's like a 40-year-old woman, and she was reading my book and she got to that scene. And then she said, that is so true, because she's had that instances where she's had to inject herself with an insulin pen in public, and there are people who are not impressed, I guess, with somebody injecting themselves in public.
But yeah. So going back to your question, it's a backup plan that we were told to have whenever the power fails or if there's not enough insulin, it's just to have an insulin pen with a syringe. And then that's how you inject insulin into your body manually.
Dr. Denise Millstine
Well, Cynthia, you perfectly set up my next question for Mary because I think this is the most heartbreaking scene of the book, which is how this person that she's out to dinner with treats her when first he finds out she has diabetes and then is disgusted when she has to do her injection with the pen. Mary, we talk about that response and how somebody who's living with diabetes and needing to use insulin might respond if somebody is treating them like that.
Mary Elizabeth Boyle
Yes, it was disappointing reading about how the other person treated her, especially when that happened. And sometimes I think you have to do something like that at the table. You could certainly get up, go to the bathroom, come back. But the reality is it's a normal thing to go through. And I've had patients tell me stories about what have happened.
And one patient in particular shared this very interesting story. He was dating and he was trying to figure out who would be the right match for him. So he would take him out to lunch and produce his insulin pen and put it on the table. If the partner, the person that was with him, made it through lunch, that was a person that got the second date and I found it kind of amusing.
And he says, this is not funny. This is important. I have to find out who is going to accept me. And I said, well, wouldn't you want to wait a little bit longer just to see if you connect on different angles? And he goes, this is my life. You take it or you leave it. And I found that was so amazing that he said that.
There have also been other stories that have come along. When a provider says to a young man who's getting married, you know, you may have difficulty having children or your life may not be long in this world because of the type one diabetes. And this young men actually came in to talk about it. And I said, I'm not sure who told you that, but that is not true, you have the chance to live the long life the same as anybody else. You might have to work harder with the current disease that you have, but all of us will get something in this life that we actually have to deal with. And he was at the point prior to seeing me, he was going to meet with the girlfriend to cancel the wedding based on what the provider would told him and this was only 20 years ago.
So I think moving forward, when you hear that you have prediabetes, type one, type two diabetes, it is not the end of the world. It's not pleasant to have something like this. But there are many, many things and great providers who can help you and your family deal with this disease.
Dr. Denise Millstine
And there should be no shame in managing your condition. I love that the wisdom in that Mary so much. Cynthia, maybe you can close us out with some wisdom for listeners who care about somebody with type one diabetes, anything that you want them to take away from this story, this episode as advice or, or just some reflection from your own experience and from writing and having readers read your book.
Cynthia Timoti
As a carer I guess just make sure that you look after yourself as well. Because as a parent, having a type one diabetic son, it's hard for us, but it's harder for them because they have to go through it in their life. But it's 24/7 for all of us in the family, and that can lead to burnout really fast, I think. So, I think just make sure that you look after yourself. Definitely look after your loved one with type one. But also make sure that you, you know, be kind to yourself as well.
Dr. Denise Millstine
I love that, thank you so much. This has truly been my pleasure to talk about “Salty, Spiced and a Little Bit Nice” by Cynthia Timoti. Listeners should go out and read this book right away because it's about so much more than diabetes. Thank you both for being here with me.
Cynthia Timoti
Thank you so much for having me.
Mary Elizabeth Boyle
Thank you.
Dr. Denise Millstine
“Read. Talk. Grow.”is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
Visit our show notes to see the books discussed today and for links to other health education materials. Follow us on social media like Instagram and Facebook or reach out directly to our email readtalkgrow@mayo.edu with suggestions for books or topic ideas. We'd love to hear from you.
This podcast is for informational purposes only and is not designed to replace a physician's medical assessment and judgment. Information presented should not be relied on as medical advice. Please contact a health care professional for medical assistance if needed for questions pertaining to your own health.
Keep reading everyone!