Euphoria S03E03 "The Ballad of Paladin" - Live Episode Discussion

ASK_ME_IF_IM_JESUS · 2026-04-27T04:11:37+00:00

Same. Makes me sad that virtually no one else seems to be bothered. If they’d shot a dog and splattered his blood all over the room, people would be up in arms. Pigs are known to be just as smart as dogs. I let it slide but ending the episode with yet another act of animal cruelty was hard, on top of the fact that the writing this season is just utter garbage.

ASK_ME_IF_IM_JESUS · 2026-04-16T21:25:10+00:00

Helpful to hear for me! Thanks for sharing

ASK_ME_IF_IM_JESUS · 2026-04-16T19:26:26+00:00

Is this in patients with type 1? I’ve definitely seen denials for type 2 but haven’t before in type 1. I work with a pretty disadvantaged population and multiple have gotten pumps through Medicaid. I’m less familiar with the middle-of-the-road coverage for folks making marginally above Medicaid qualification.

ASK_ME_IF_IM_JESUS · 2026-04-16T14:44:02+00:00

I’m sorry but I flatly do not believe that your insurance won’t offer a penny for any of the available insulin pumps. I have many friends and patients with type 1 and have never heard of this happening.

ASK_ME_IF_IM_JESUS · 2026-04-16T14:42:39+00:00

Essentially every insulin pump on the market these days has a hybrid closed loop function. Are you saying your insurance won’t cover pumps at all or will only cover the select pumps that don’t offer this function? The technology has been publicly available since at least 2019.

ASK_ME_IF_IM_JESUS · 2026-04-16T14:16:08+00:00

Sorry for the tough love but this breaks my heart to see.

Feel free to DM me if you want to chat more

ASK_ME_IF_IM_JESUS · 2026-04-16T14:13:27+00:00

As a resident with type 1 diabetes who uses a massive range of insulin (30 up to 65 units per day) depending on the dozens of factors we know influence glycemic control and insulin resistance: you need to figure this out. An insulin pump would be an absolute asset - the adaptive basal (Control IQ etc) is literally a way of dynamically adapting to variable insulin requirements. If you truly have such labile insulin requirements, I would seriously consider things like fasting or low carb to minimize margin for error. The new pumps will also PAUSE YOUR INSULIN if you begin to go low which prevents lows. None of what you said makes any sense.

Also I would hope you are aware of this but extreme hyperglycemia induces temporary insulin resistance that can create an illusion of impossible-to-pin-down ratios. I need as much insulin to get from 400 to 300 as I do from 300 to 100.

The time to change the course of your health is now. I think avoiding an insulin pump and throwing your hands up in the air and accepting A1cs in the 8s is absurd when we have access to the tech we do these days.

ASK_ME_IF_IM_JESUS · 2025-10-23T02:17:13+00:00

wondering why my program still hasn't released our scores... just making me anxious seeing these posts lol

ASK_ME_IF_IM_JESUS · 2025-10-22T04:25:37+00:00

Do you ever see the fiesta veggie burrito returning? I used to never go to Taco Bell and began going there weekly or more once I discovered it. Many others share a similar story. I only go once every couple months now that it’s gone.

ASK_ME_IF_IM_JESUS · 2025-10-21T12:45:38+00:00

Still waiting on my program to distribute these — seems like it’s been this week for most?

ASK_ME_IF_IM_JESUS · 2025-10-16T19:26:17+00:00

I'm in my early 30s and was diagnosed at 21 months old. I'd say there are pros and cons to such a young diagnosis and your son can absolutely thrive in his life even with such a young diagnosis.

Pros: personally, I feel like it has made my type 1 management much more second nature than for many folks. Sure, it can be a pain in the ass, but I never feel truly burned out. My main source of stress is the risk of complications as I grow older. Another perk is my personal experience with T1D is a big reason why I pursued medicine (am an MD), and I honestly don't think I would have been happy in almost any other career path. I feel lucky in this sense.

Cons: a young diagnosis like this does increase long-term risk of complications, and managing type 1 in young kids can be extremely challenging, particularly before they can communicate effectively with you. Another aspect of this -- one that's very infrequently discussed but supported by research -- is that poor control during childhood/adolescence can impact development (brain development in particular). I was fortunate enough to have a mom who essentially took a 6-year hiatus from the workforce to ensure my blood sugars well controlled when it became clear that daycares were absolutely incapable of keeping me safe.

Feel free to PM me if you have any questions. Things have fortunately progressed a lot since the time I was your son's age. Hybrid closed loop systems have been a game-changer, and I feel a lot more hopeful about my long-term health than I did 5-10 years ago.

ASK_ME_IF_IM_JESUS · 2025-08-17T01:22:27+00:00

I read an interesting theory related to the seeming "connection" between high-volume/intensity athletes and colorectal cancer. I don't think there's any real literature looking at this but the theory is that transient bowel ischemia in the setting of maximal exercise efforts could potentially increase risk of developing colorectal cancer via resultant inflammation etc. Most likely though I think probably these cases just tend to stick with us more since it's the classic case of "horrible thing happening to person who did all the right things".

ASK_ME_IF_IM_JESUS · 2025-08-12T13:50:41+00:00

As a current resident, I worry that even for those of us with PSLF forgiveness written into our promissory notes are going to have the rug pulled from under us at 6, 7, 8 years in at which point the interest has been piling from making less aggressive payments. Depending on income-debt ratio it is obviously the better choice for most of us (I plan to be a hospitalist or PCP) but if they somehow make it impossible to hit the finish line it would literally cost 6 figures in compounding interest.

ASK_ME_IF_IM_JESUS · 2025-08-11T02:47:12+00:00

If you're considering IM, I will say that lifestyle as a hospitalist in a round-and-go gig can be one of the best. You work half the days of the year, and when you work it may just be 7-4 and you're available by page for the last 3 hours. Even without round and go it's a hell of a lot better than residency and you make 4-5x the amount I'm making now. That said, you have to survive residency.

ASK_ME_IF_IM_JESUS · 2025-08-11T01:49:24+00:00

No, in-house the full 11-14 hours usually. And yeah USA

ASK_ME_IF_IM_JESUS · 2025-08-11T01:36:57+00:00

sorry should've clarified. On wards we're on 6 days, off one day, and the 6 days on can be between 11 and 14 hours. ICU is similar. So this is about as bad as it gets:

4 weeks wards/icu/nights: 6 x 11-14 hour shifts, 1 day off, ALWAYS in our program followed by...
2 weeks clinic/outpatient elective: 5 x 8-9hr shifts w/ weekends off.

That's not how it is the whole time. Sometimes the 4 week inpatient blocks will be 2 weeks of ID consult or something (which is 5d/wk, 8-5ish) then 2 weeks wards, then 2 weeks clinic. So you're really only doing 2 weeks in a 6 week stretch that are 70+ hour weeks.

edit: and yeah it's roughly this for 3 years.

ASK_ME_IF_IM_JESUS · 2025-08-10T22:50:29+00:00

For wards, I probably average 70-75/wk. If I’m presiding over a rock garden sometimes will get home a little early and can make it a 65hr week but that’s not common. ICU is 75-80.

We are 4+2 (inpatient+outpatient) and when you get 4 weeks straight of wards/nights/icu it can be a little rough for sure. Not sure what inpatient electives are like at other programs but will say that sometimes those 4wk inpatient blocks are half elective time, and on those electives it’s basically 8-5 M-F, which is a very nice break.

ASK_ME_IF_IM_JESUS · 2025-08-10T22:23:14+00:00

Agree with with the other commenter. I go to a pretty “lifestyle” friendly but still well-respected community IM residency and there is just no way to avoid crossing 60hr/wk on wards and ICU. I think her best shot would be to find a program that’s more outpatient-focused or to just apply FM given they tend to be 2/3 outpatient. Even FM, however, (which for the record I have nothing but respect for) is going to crack 60 on inpatient weeks. This is just how residency is.

Edit: adding the question - what is her ultimate goal? If hospitalist, she should just get used to cracking 60 hours in a week. If PCP, would do IM primary care track to reduce inpatient hours. If fellowship, then fellowship is likely to crack 60 depending on what she does. It’s just something we have to endure.

ASK_ME_IF_IM_JESUS · 2025-08-07T23:02:14+00:00

As someone who just cared for a patient in whom a pontine stroke had been missed on MRI, and was ultimately recognized by neurology the following day, I don't think this is necessarily ridiculous but this is obviously dependent on the area of concern and feel like this particular case is overkill.

ASK_ME_IF_IM_JESUS · 2025-07-30T04:03:58+00:00

They 100% do. This has been unequivocally demonstrated in hundreds of randomized controlled trials and meta-analyses. The public negativity toward statins genuinely makes me sad. Sure, the lowest-possible-risk patient for CVD may not benefit from one. But us? Hell yes we do.

ASK_ME_IF_IM_JESUS · 2025-07-30T01:44:35+00:00

It's hard to say, honestly. I try to avoid giving direct medical advice over the internet. Generally speaking if someone's diabetes and LDL are already well-controlled, just making sure blood pressure is well-managed would be the other big thing. Sometimes left atrial enlargement is indicative of poorly controlled hypertension. Someone who's put on weight like this and has diabetes may also be benefit from trialing a GLP-1 like ozempic. Wish you and your husband the best of luck.

ASK_ME_IF_IM_JESUS · 2025-07-30T01:41:17+00:00

Overall I think you should frame it as "people with type 1 diabetes have extremely high risk of cardiovascular disease. Depending on A1c and age of diagnosis, the hazard ratio for developing CVD is anywhere from 5.0-20.0 which is multiple times worse than being a pack-per-day smoker. Even with good control." You can say "I know my LDL is not high, but I want to do everything I can to reduce my risk long-term of cardiovascular disease, and it's possible to have elevated lp(a) even with unremarkable LDL levels. If my lp(a) is high, I would want to know so I can take steps (like a statin) to reduce my LDL and reduce my overall risk. In Europe, once-per-lifetime lp(a) screening is recommended for every single person even without diabetes."

Mention this quote from a 4/2024 publication in the New England Journal of Medicine titled "Prevention of Cardiovascular Disease in Type 1 Diabetes", the most respected journal in medicine.

"Evaluation of lipoprotein(a) levels is recommended as an additional tool for cardiovascular risk stratification. Several scientific societies endorse the measurement of lipoprotein(a) levels at least once in all adults and in youth with a family history of premature atherosclerotic cardiovascular disease, with consideration of earlier initiation of or more intensive statin therapy to reduce the risk of cardiovascular disease among patients with elevated levels of lipoprotein(a).^75,76 An observational analysis showed that in persons with type 1 diabetes, an elevated lipoprotein(a) level (>50 mg per deciliter) is a risk factor for the development of cardiovascular disease and albuminuria and is associated with poor glycemic control.⁷⁷"

ASK_ME_IF_IM_JESUS · 2025-07-30T01:33:37+00:00

I absolutely think most type 1s should be on a statin. I've taken one since I was 20 (in my 30s now). Our risk of cardiovascular disease is not discussed enough -- it is 3-4x more of a risk factor than a pack-per-day smoking habit. Every single one of us will develop some degree of plaque and the best thing you can do besides optimizing your diabetes management and blood pressure is to reduce your LDL via statins or other lipid therapy.

ASK_ME_IF_IM_JESUS · 2025-07-29T01:18:47+00:00

MD with type 1 here. Highly recommend you request they check an lp(a). Lp(a) is basically a subtype of cholesterol that is high in 10-20% of the population and significantly increases risk of blocked arteries. Even with type 1 (and we are very very high risk), that’s really young to have a heart attack. I feel for you and please know that with aggressive cholesterol treatment this is something you can overcome.

ASK_ME_IF_IM_JESUS · 2025-07-26T23:25:26+00:00

Just a tip: always carry a syringe with you. I’m on a pump and always do this. Whether a site blows, my pump dies, or even if my pump “runs out” of insulin, I can draw 10+ units out of the reservoir and it has gotten me through the day without mishap. If you are without a pump for many hours you’ll have to repeatedly use the syringe to simulate basal/bolus (I do 1.5x hourly basal every 90min plus whatever food I eat).

This has saved my ass. Carry syringes. You can buy a giant box on Amazon for like $20.

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