#1894 Four chats live From ADA
Learn about SugarPixel
Four separate short conversations, one booth. This isn’t one long interview — at his first ADA, Scott recorded four quick (~10–15 minute) chats back-to-back at the Sugar Pixel booth: Lane Desborough on creating Nightscout, Madison Smith on smarter MDI, Kenny Fox on DIY Loop, and John Sjolund on Luna’s overnight automation. Each stands on its own; the throughline is the people quietly building the tech behind modern diabetes care.
The Engine Behind the Room
Welcome from ADA: inside the SugarPixel booth 0:00
Hello, friends, and welcome back to another episode of the Juice Box podcast. Today, I'm bringing you audio from ADA. So I sat down with a number of very interesting people at a booth at the American Diabetes Association Scientific Sessions where I was a guest of SugarPixel. At the SugarPixel booth, I interviewed these people. Top of my head, no preparation whatsoever, Some really, really interesting people.
Lane Despero. You're gonna learn more about him. You're gonna learn more about Scott Johnson and Blue Circle Health. You're gonna hear from a gentleman who's making a new product that is very exciting. Kenny Fox from Fox in the Loop House and I had a great conversation and so much more.
These are short conversations, ten, fifteen minutes at a time. I'm gonna put them all together right here for you. You wanna know what it was like to be at ADA? This was my experience. Nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise.
Always consult a physician before making any changes to your health care plan or becoming bold with insulin. And if you'd like to support me by buying a SugarPixel, please do it at my link, customtype1.com/juicebox. Go get that brand new SugarPixel.
Lane Desborough: teaching insulin to talk to glucose 1:26
Everybody. I'm here at the Sugar Pixel booth with Dane Despro. I always think your name should have an x at the end of it every time I say it, by the way. Lane is a pretty spectacular guy. I'm gonna let you, learn about him through his words.
So, Lane, can you tell me how you find yourself at ADA and a little bit about your your time with diabetes?
Sure. So sixteen years ago, my awareness of diabetes was it had something to do with glucose and insulin. That was my level of understanding of of diabetes sixteen years Sixteen years. And then, my son was diagnosed, and I climbed a pretty steep learning curve after that.
Wow.
I didn't even know I knew insulin did something to glucose. I didn't even know whether it made it go up or down. That's my level of understanding.
And your son's diagnosed. You throw yourself into it. What's your background? Why did it work
out for you?
So my background is engineering, chemical engineer, and in various engineering disciplines, you specialize. So Mhmm. Specialized in what's called process controller automation. So these are the brains of oil refineries and chemical plants. So Okay.
There's not a bunch of people going around turning knobs and looking at dials. There's computers doing that.
Right.
And this is what immediately drew me to a realization that why don't we do this with insulin and glucose? If I can twiddle or if I can use computers to control chemical plants, why can't we use computers to control blood glucose?
So how what do you do with that knowledge? Where do you throw your your effort? I mean, I I don't wanna speak for you, but I make a podcast today about diabetes because when my daughter was diagnosed, I wanted to help, and I took what I thought were my skills and put them in an area where I thought they would work. I'm assuming you did the same thing, but how did you figure out where to start?
Yeah. So, I was curious about the whole how does this work? I've got it I I knew about CGMs. I knew about pumps. At the time, sixteen years ago, they weren't really connected to each other.
Okay. So and this really surprised me that, okay. There's here's a device over here. It's like the speedometer on your car Right. And there's the gas pedal down there, like the insulin.
Met. Yeah. They've never met, and and I know how to do that. Like Right. That's my that's my superpower.
Okay.
So that immediately got me interested in, has this been done before? Are others doing this? And I discovered fellow chemical engineers who were five or ten years ahead of me already on that path in a research capacity.
Okay.
So at, at universities doing this.
Mhmm.
And and I thought, well, maybe I can contribute my industrial experience doing that. And so one thing led to another, and I wound up about nine months after my son was diagnosed working for Medtronic. Okay. So in a complete happenstance, accidental But you
just switched jobs and threw your effort
looked at it of why would I work on something trivial like the world's energy problem when I can work on something more meaningful to
Help your son.
Help my son.
Yeah. And
so I was like, that's when I got my calling. It's like, oh, that's why I have twenty five years of experience. I can go use that to something much more purposeful for me.
Oh, that's lovely. That it felt that way to you. Like, I've been
preparing And still feel that way.
I've been preparing for this.
And and what I would say is that that mantra, that that goal, I've I've done different things over the intervening sixteen years, but it's always with that goal of how can I leverage my skills and experience, such as they are to, further the availability of Right? Of these transformational therapies like automated insulin delivery.
Do you think most people online know you for Night Scout?
Well, that was one of my side projects. Yes. So yeah. So maybe they do.
Yeah. Yeah. But what so what did you what did you do? I guess, let me ask you instead. What what did you do at Medtronic?
How long were you there, And then what did that lead you into after that?
Well, so one of the things going back to at the time, CGMs, if you wanted to see the CGM value, you had to look at the pump. Do remember the Yeah. The pump had the little display on it? Then so so here, Hayden was 10 years old at the time and we were still going into his bedroom three times a night to see if he was still alive. Right.
Yeah. Right? Dead and bad and and so
Good times.
And and at the time that I that he was diagnosed, I was working for GE Energy. And GE Energy, they monitor a thousand gas turbine power plants around the world. So Saudi Arabia, the jungles of Brazil. So so I was the product manager of this remote monitoring center. And I thought it's crazy that I can monitor a gas turbine in Saudi.
Right. And I can't see my son's blood glucose 20 feet away in his bedroom. Like, there's no technical limit to that. Right. Because we're doing far more difficult things to get this telemetry back.
Sure. So that's really what precipitated NightScout
Okay.
Was this realization that there was no technical, limitation to to doing this. And that's the thing
you did on the side.
And that I did that on
the side. At home. Okay. I I have to ask you. Once you have it and it works and you think this is a great tool, people will use it, how do you get it to people?
You just give it away a little bit and think, alright. It'll make its way around. Like, are you stunned at how far it's gotten in the I have a phone right now, and I I have it on mine. So, you know
How Nightscout was born: crawling through broken glass 6:36
So I was really shocked. I I thought and at the time, the there was so much technical difficulty in setting up NightScout. I thought there'll be three people in the world who will, how it would look classified or characterized as crawling through broken glass or learning Swahili. Like, don't if and I didn't realize there were a whole bunch of people who would be willing to crawl through technical broken glass and learn obscure things To make it happen. To make it happen.
Yeah. And that that all got progressively easier. Now it's like a one click install.
Right.
But that's I I really thought that what we were doing with Night Scout in terms of adding value to the community was showing an unmet need. Okay. Because at the time, like, I was wearing at Medtronic, they said, we've seen no customer research. Our marketing department hasn't said there's a need for this. They're like, I'm telling you there's a need
for this. Nobody wants a show. Like, I want it.
Exactly. I'm telling you, my wife, cold dead hands, Geraldine Heston, kind of attitude to take away Night Scout.
Yeah. It was No kidding.
That was it was that powerful. Do you
so do you feel like you're because of your personal experience, you found a way to be ahead of the curve of where the industry is? So it's funny
you say that because I I had a talk with the then president of Medtronic one time, and I said, I want you to understand that I'm kinda like an alien from the future. Mhmm. There are people like me, but they would not voluntarily come into this essentially backwater of technology Yeah. Called medical devices unless they had a personal motive for doing so. Right.
And that's really the way I felt. It it was so frustrating to me just how conservative and and blank sheet of paper and we need to go to primary research. So that was really, I think, what triggered me to say we are not waiting. It's like Right. We don't need to wait.
Like, all these other industries have already done this before.
Yeah. It's wonderful.
We just steal from them, you know, proudly found elsewhere.
Yeah. Yeah. And, yeah, proudly found elsewhere and make this happen. I tell people all the time that I mean, my daughter's gonna be 22 soon. She's diagnosed when she was two.
So we've been at this twenty years, And there was a long stretch of time where just someone putting out a new meter, even though the MARD wasn't any better, like like, the meter didn't do anything differently. You just looked a little and you were like, oh my god. We got a new thing. That was advancement back then. And then all of a sudden, I don't know I don't know.
In my world, it was, I guess, Dexcom. Dexcom started, and then they figured out a way to kinda get through the FDA a little faster, and then the innovation started happening, and everybody kinda piled on innovation now. And then you look back and you think, those meters are like the equivalent of boiling needles and peeing on strips Yeah. In in a twenty year span. And now, I guess, what I'd love to ask you about next is, now that things have sped up so much, it's not gonna take twenty years for us to get to the next thing.
So what's gonna make our CGMs and our pumps look like peeing on sticks in the future? Do you see anything out there?
So I I think one way to answer the question is the physical like, how do how are these gonna look physically in the future? Right. And that's what that's what most people think of. And so is it gonna be a one one device or a
Smaller or thinner or a
thinner or purple or Yeah. Like some Right. Some physical attribute. And I I think we'll continue to see some advancements there, but honestly, that's that's not what's is interesting to me as what we're doing with the algorithms in
what I want. Yeah. Yeah. Like, I I want the data to come in and instead of it being a fixed set of if this, then that, it's if this, then that, and then something else thinking about it, and then changing if this, then that. Right?
And I
think I I I have no technical mind, but that's the idea. Right?
A thinking disease: lifting the cognitive burden 10:17
Oh, a 100%. So and this is where I think people who don't have diabetes and they think, it's the physical part of the disease that's so hard. Mhmm. Finger sticking or infusion sets or wearing all this stuff. But there's this cognitive burden.
Right? It's a thinking disease.
Yeah.
Yeah. It is you you are never not thinking about your diabetes Mhmm. And it's consuming, resources in your brain that would otherwise, be for a
better purpose.
So so I think that's really where the opportunity is is to how do we allow people to just live a more, enriched life and
not have to worry about it. I imagine it would not surprise you to hear that I have a little estimator on my website that I built. Right? You put in your carb ratio, your sensitivity. You can put in your current blood sugar.
It applies some Warsaw math to it. Carbs, fat, protein, if you want, you can tell it which direction your your CGM is moving in and your current blood sugar insulin on board. Hit a button, and it'll say to you bolus this much now and this much later. Three bolus about fifteen minutes. Make this next wave last four hours.
It is the most popular page on my website. Wow. I have never shared it publicly with anybody. Wow. I All word-of-mouth.
But to your point, what what is it doing? It's just relieving someone's burden
Mhmm.
Around a meal. That's all it is.
Yeah. And and is it like, this is what happens with with people who don't have diabetes. That's what their endocrine system is doing. Sure. Right?
You're having the cephalic response, the Pavloni. Like, you're anticipating dinner, your, or lunch in our case, and it's already secreting, insulin getting ready for that. Like, that's like, we're not thinking about it. Now when that loop gets broken Mhmm. You have to think about it.
So based on something you said earlier, I
wanna ask this next question.
You are at Medtronic, you say this is important. People go, we don't think it is. Is that happening now? Are there a group of, you know, rebel fighters out there working on stuff and the companies are saying we don't see this, or do you think everyone's on the same page now?
I think that's been that's a great question. There's been an evolution of what do we do with this people with diabetes community. Right. How do we how do we understand what they're doing, what their needs are? Yeah.
So that's that's one of the things that drives these companies. The other one that really bothers me is this feature function checklist battle phase. Like, oh, they have a dual wave bolus calculator. We better have a dual wave bolus calculator. They have an exercise mode.
We better have an exercise. And a lot of those features aren't actually helpful
Now you're being able don't actually use
them. Yeah.
I used to like when they're like, we have a food library. I'm like, no one cares about that. Exactly. Yeah.
So so that's I think those those are sort of two tensions of driving. It's like, we need to keep up with the competition
Right.
But, we should be paying attention to what the unmet user needs are.
Yeah. I I'll share with you that because of what I do and for how long I've been doing it, the amount of people who have come to me and said, I have an app, and I always think, don't care. Yeah. I don't care. Your app is no one's it it adds to the burden.
It doesn't take away from it.
Yeah. The perfect app is no app.
Even if it's great, it does it still adds. Now I gotta open the app, and I gotta do a thing. Oh, you just log your and I'm like, no. That that you don't understand what it's
like to live
with this if that's how you built this.
You know?
When I was at Medtronic, they brought in somebody from IDEO or one of those companies that does design. Yeah. And they were talking about making the app sticky and more of and it's like, you're missing the point. Like, the best app is no app. Like, don't want people engaged with their diabetes app eight hours a day.
You failed if that's the case.
Yeah. So do you so a lot of companies are talking about, one day, we're not gonna have to put in our carbs. Like, do you think they're gonna get to that? Because don't aren't they more restricted by just I mean I mean, listen. Why does Loop you know, why is Trio?
Why are these things out ahead? Because they don't have to go back to the FDA and say, is this okay? And you don't get one CEO who's risk averse and one who's a little less and everything. So, I mean, is that in your opinion, is the DIY community gonna stay ahead in that?
I think it will. The one of the point about getting to full closed loop, because I think that's what you're asking. Yeah. Right. If we don't have the current carbs anymore, we don't have to do hybrid closed loop.
We don't have to do a meal announcement, which is the number one most burdensome thing. Right? Like, three times a day, there's a huge mental burden of I am now doing carb count and pre meal bolus and
It becomes more and more evident to me as my daughter gets older and transitions away from being a child, and I'm watching her be an adult in the world living with diabetes. If if you ask me what she needs most, she needs the alleviation of decision making, like, I think.
A 100%. Yeah. And it's it's kinda one of these things that people go through various phases in their life where they might have the headroom at a certain point to be able to Mhmm. Contribute those decisions, but there's, like, new parents or new jobs or stressful jobs or puberty. Like, there's other priorities of their life.
So how do we help people as they're going through these various phases of their life to still be safe in Yeah.
Safe, healthy, and as uninvolved as possible is what I would is what I would wish.
Sort of at the the top of Maslow's hierarchy of needs. Like, instead of, like, worried about the primal Yeah. Base things, like, how can I self actualize because I don't have to worry about all this other crap?
Other stuff. Yeah. Yeah. So is that what are you involved in right now? Like, how do you spend your time sixteen years later after you've done these other things?
So I love my job. I before describing what it is, I just some some people say like, Lane, you're working on the weekend. It's like, no. I'm like, I'm playing on the weekdays. Yeah.
It's so fun. Yeah. I joke that I I love recreational math. Like, some people do recreational chemistry. I do recreational math.
Right. And I just love the algorithms, the data science, the analysis of the data because it's a data disease as well. Right? It's all we get to all this data streaming in and and sometimes that's confusing to people. It's intimidating to people.
Show the path, then scale it: DIY, the FDA, the bottleneck 16:20
They don't know how to act with it. But what I would say I'm what what I am doing right now, and this gets a little bit to the DIY community and one of the things when I did Night Scout, I I stopped. I stepped away from Night Scout as soon as it was launched for a couple of reasons. But one of them was I really felt we had we had shown the path. It's like, there you go, device companies.
It's your job to scale. Right. Right. It's like the field of dreams model. If we build it, they will come.
Like, there it is. Yeah. We've done our thing. Now you go do it for everybody. Right.
And and so Dexcom share and follow happened soon after that. But Yeah. I was talking with somebody at d data the other day that here we are sixteen years later, there's really nothing like NightScout from, integration of insulin and see it's like
I still hear people complain about it when they're using a retail system. Like, why can't I see this stuff?
Like, my my wife, was a school nurse for many years. So 25 students under her responsibility. She was the diabetes expert, so, like, six schools at lunchtime.
Right.
She's getting pink. And and so she'd get a text and she she had something like 12 people on Dexcom follow or or kiddos. And the very first question she asked is how much insulin is on board? Like, it's not helpful for me to know Yeah. That their blood glucose is 200.
If they've got, you know, tons of insulin on board, that's a different thing Yeah. Than if they have no insulin on board. So that was frustrating to me that we're not seeing the scaling of these, pioneering things that the DIY community is doing, whether it was Night Scout or or Loop or Trio. So that's what I'm focused on now is how do we get scale? How do we get these, incredible technologies, whether they're coming from the DIY community or even from sponsors or sponsors is the FD word for device manufacturers.
Okay. It's taking them ten to twenty years from conception to wide scale of these. Yeah.
It's time. Need to. It's a lifetime.
It really is. Lifetime. I mean Yeah. Yeah. And it takes the same amount for gen twos.
So so like the the second generation of an algorithm, it's on the same track as the first generation. Yep. So it is incredibly frustrating to me and I recognize this as a bottleneck or constraint in the
A venture.
In the commercial regulatory flow
Yeah.
Path and I said I think I have a solution to this.
No kidding.
And that's what I went to the FDA and the Helmsley Trust a year ago
Right.
And said all of those innovations that are happening over there and that are happening in companies, they're running into a a a like, just imagine a flow of value. There's a pinch in the pipeline down here, a bottleneck. And if we could relieve that bottleneck, we can get faster scale.
Laina, how about you come on the podcast, and we'll talk about the rest of that? Would that be okay?
That would be fantastic.
“I didn’t know I was dying”: Scott’s thank-you to Lane 19:02
I'm gonna share something with you before I let you go. But, everybody who's listening, if you enjoyed that, we'll we'll have Laina on to do a a longer because I I'm sitting here thinking, I feel like we could talk about this for a couple of hours. So, but I wanna share something with you that you don't know. It's a thank you. So when I started doing all of this, I had just like everybody else said, no context for it.
My daughter was two. I was a stay at home dad. I genuinely felt like I was killing her most days. I did not find what the doctors were telling me to be helpful, and I am not a reader. I'm sorry to say out loud.
So I broke diabetes down myself, and I eventually came up with what I knew were, like, the rules. If I did this stuff, I got the outcomes I wanted. And I did a thing that a lot of people around the world do now. I I I kinda coined this idea of bumping and nudging blood sugar. Uh-huh.
And I would use temp basal increases and decreases. Sugar surfing. I would to manipulate the blood sugar. Right? I didn't know Steven.
I mean, I just I'm in my house like a mad scientist trying to figure this out. Right? But my understanding of what I was doing did not open up completely until I got night scout. And my daughter went on loop. And then when I saw the thing doing what I was doing, I thought, oh, I was doing the right thing.
And it was the first time I felt comfortable and confident that I wasn't just making it all up. You know what mean?
That's fantastic.
It was just wonderful. Like, watching on Night Scout, watching Luke take away and give and bolus and knot and everything, I was like, oh my god. I've been doing that for a decade. And then you know what happened next? I slept through the night.
I And people don't appreciate what it's like to sleep through the night. It's and I didn't know I was dying. And if I if we get off camera and I show you a photo of myself before then, my body was given out. I wasn't sleeping at all. I was in a terrible situation.
I had no idea. Wow. Anyway, what you did Well, thank you. Really made a
big difference.
No. Seriously. It really and I see other people walking. I'm gonna try to interview some of them today. I see other people walking around this room that I don't think half of these people know, and they don't realize how they're driving the engine behind a lot of what's going on in this room.
So I really do appreciate your time.
A village. Everybody's bringing their their skills Sure enough. To to the fight. Diabetes is the enemy.
Yeah. Maybe that's really what this this couple days is about. So thanks again. I really do appreciate it. Thank you, everybody.
And thank you to Sugar Pixel for making this possible. Take care. Why don't you start by telling me a little bit about you? Who are you?
Madison Smith: a CDE with type one, smarter MDI 21:31
Great. So my name is Madison Smith. I live in San Diego, California. Mhmm. And I currently work as the therapy chief engineer for MDI systems at MiniMed.
How do you remember that? You're the therapy chief engineer.
I've gotten used to saying it, but it's quite a mouthful.
What does it mean? What what does the job mean?
I I would say that my role is to help make sure that we're engineering the products that make sense once they get into patients' hands. So how is it actually gonna be used, to help best manage the way that they wanna manage their diabetes? Right. Does it fit into the way health care teams want to introduce and use technology and and
So we don't want there to be some, like, high minded idea that when it gets out into the real world, it doesn't really do the things that people intend.
Right.
Okay. So what what what exists right now that you're working with that you think actually does help people in the real world?
So I so I work on MiniMed Go or MDI systems.
And
so I think historically, when you were looking at what it takes to manage MDI, you I mean, you have pump, which I would say is the gold standard, you saw, algorithms being developed and so much sophistication.
Mhmm.
And then the kind of the alternative on MDI, which more than seventy percent of people living with diabetes are still on MDI therapy.
Sure. Yeah.
We're like in the dark ages of pencil and paper and calculator.
Get the benefit of all these things that we've learned because they're MDI. They prefer to be MDI usually, or is it access sometimes?
I think it depends. Right? Sometimes it's access, sometimes it's cost. And in my case, which we didn't even cover this yet, but
I Do
you have type one?
I have type one.
Okay.
And I just have a strong preference to be on MDI therapy.
Mhmm.
But I kept always feeling like I was being pushed towards a pump because that's where I had calculator support. It could track how much active insulin I had, and so all those features that would kind of push me towards a pump, but I really preferred MDI.
How long have you had type one?
I've had type one since I was 16 years old.
Okay. And you're 25 now.
I wish. Okay. Not quick.
So you've had it for a while.
I've had
it And for and you prefer MDI, but as things progress and get better, did you have the feeling of, like, oh, I'm being left behind with my health?
Yes. So I kept I mean, I was finding myself being pushed towards a pump. Yeah. But then when I learned about the InPen and now these smart connected devices that can track active insulin, that can help inform dosing decisions, and really offered the things that I was looking for out of pump therapy, but let me be on MDI
Yeah.
In a more sophisticated, like, raise.
It's exciting.
The locked door and the unplugged iron 24:28
Like, I keep thinking, like, why did we leave MDI in such, like an example I give is, like, how often have you left the house and you can't remember if you've locked the door Mhmm. Or you can't remember if you've unplugged the iron. And in all those cases, you can go back and you can physically check and see that the door is locked Right. Or you can see the iron's unplugged. And then we have this medication that we have to take four or five times a day Yeah.
That has serious consequences if you miss it or if you double take it, and there was no way of knowing. If you took it, how much you took it, what time you took it.
Yeah.
And so now having that more smart informed connected technology is what
So do you use the what pen do you use?
I do I use an in pen
You use the in pen.
With the MiniMed Go system.
And MiniMed Go means InPen connected to one of your two sensors?
Correct.
Which one do you use?
I'm currently using the Instinct. Okay.
And the other one is
Simplera? Simplera.
Okay.
So we have a choice between the two sensors
Right.
And the options.
And I do understand it works with Dexcom, but it the data is lagged?
That was with our prior system. Okay. So Dexcom data could come in, but it was on a a delay.
A delay. Right.
So now with the two sensor options we have in our portfolio Works. They're connected directly to the app, and they're in real time.
Yeah.
And that piece alone has also helped us to develop more informed, actionable, sort of decision making.
It's a smoother process in general with both of your sensors.
Yes. And I because we're, for the first time, actually looking at not just sensor glucose values Yeah. But also the other part of what it takes to actually manage diabetes, which is insulin. So when did you take your last dose? How much of that dose is still actively working in your body?
Mhmm. And so instead of just, let's say, notifying you because your glucose is rising quickly or you've crossed some threshold, we can look at your glucose in the context of how much insulin you have on board, let's say. And maybe there's actually, we see more than 50% of the time when you were just if you just used a threshold based sensor glucose alert, there was no action to be taken because they've just eaten a meal and they've taken the insulin for it, or you've just corrected that high blood sugar and you need time for the insulin to do its job.
Right.
And so what this system does is actually reduces the, let's say, the alert fatigue
Yep.
And waits to find the right opportunities to alert you when there's action to be taken and then tells you what you need to do.
Now would be a great time to
Yeah.
To do something. Yeah.
So you've lived so long with MDI and nothing like this.
Mhmm.
And now there's all this data in the world. Mhmm. Did it actually benefit you? Like, having the data, having the the automation, like, can you just from your personal experience, has it improved your a one c, your time and range, anything like that?
It has. I mean, it's improved my my overall glucose control. I would say, in a lot of ways, we had the I had the capacity to do the decision making that I was doing. Right. But now I get to be more hands off and wait for the system to identify an opportunity.
And when that opportunity comes, I take action. And so I'm say, like, I think about it less. I check less because I know that it's monitoring in the background, and when I need to do something Right. It engages me. So the less time I get to spend less time thinking about diabetes and all
the stuff. Of the of the benefit of the data and of the automation that comes to the impact. That's pretty awesome. Like, has it, like has it, like, personally alleviated anything for you? Is it made like, is it a measurable difference in your life, or is it just a nice thing and my health's better and I don't think about I I I don't know what I'm asking
you exactly. I mean and I also don't know that I mentioned this part, but I'm I'm a certified diabetes care and education specialist, a nurse, and I think that, you know, from a professional standpoint, you would think I have it all together. Right? Well But, like, I No.
I've interviewed enough people. I know that's not the case.
Well, exactly. Yeah. Yeah. That's where I'm going. Right?
So, like, I'm still a person living with diabetes, and and I it's not perfect. With everything diabetes comes with. Like, I can know the information, but it doesn't mean
You'll do it. Yeah. Yeah.
They do what I say, not what
I do.
Everyone says that for a reason. I I used to have this, thing where I'd always wonder, like, why would my daughter, like, ride her pump out to the last possible second? Like, right now, I'd be like, why don't you just change it a little sooner? You know, you know, it'll be it'll be helpful, blah blah. And I mentioned one time to a friend of mine who's had diabetes for, like, almost forty years.
Mhmm. And she's also a therapist. And I said, you know, it's so frustrating. Like, I know if she just changed it a little sooner, she did this a little sooner, she'd have such better outcomes. And that therapist with almost forty years of diabetes living said, oh, I do the same thing.
Yeah.
And I said, why? And she goes, I don't know. Yeah. That that was sort of it. Right?
It's it's the living with it everything. So anything you can do that makes it not have to be front of mind Right. But is still getting the benefit Yeah. Of of all this data that's available. Yeah.
That's listen. I'm a huge fan of the MPEG.
I was
really I million percent because I believe exactly what you're saying is that a lot of times, places like this, these people we get to meet, it's lovely, but they are not exactly an accurate slice of the population. Right. And a lot of people don't wear pumps. Exactly. A lot of people.
And they don't not deserve to have what they could get out of all this. So, you know, I mean, if you were to if you were talking to a person who is you in the past Mhmm. Like, how would you talk your old self into trying something like this sooner? Because why because you didn't do it for a long time. Right?
But also Impen
It wasn't around when
I was first diagnosed. Right?
Newly diagnosed and overwhelmed: easing into it 30:31
But I would say so it well, I come back to especially, like, newly let's say you're newly diagnosed Mhmm. And I've been newly diagnosed, and I've also been the nurse educator sitting down with families that are newly diagnosed.
Sure.
And it's completely overwhelming.
Mhmm.
You've been kind of given this diagnosis. In my case, I didn't even know what diabetes was, and now I'm being told I have it.
Yeah.
And I'm being given a vial and a syringe and, like, okay. Give yourself your first injection. Oh, and by the way, here's how insulin works, and this is when it spikes and it peaks, and you can do this and don't do this, and here's the formulas, and it's, like So much. Overwhelming.
And then and then would you like to stick a thing to you? Do you wanna get a CGM? Do you wanna get a pump? And you I listen. I hear from people all the time.
I I don't know how well you know what I do, but I've been making my podcast for twelve years. Right. I've interviewed nearly 2,000 people.
Wow.
Over and over again, they'll say the same thing. When my kid was first diagnosed, when I was first diagnosed, I didn't want anything on me. It felt weird. I didn't wanna be a robot. Often, they'll come around
Right.
And realize the benefit of it.
Sure.
But in the beginning, like you're saying, they're being told all this stuff, all this terminology they don't understand. They're the shock of the trauma of what's actually happening to them. Let's not forget they might have crazy brain fog from high blood sugar. There's a lot going on. And they start off but often they start off the way they start and then never reassess it again.
Right.
And that that that to me is is kind of a shame that that, you know, you almost you almost walk the path you're upset on.
Yeah.
You know what I mean? So so back to it. What what do you tell that person?
Well, I I think that there's just so much to like, there's diabetes experts for understand. And so if you can have a system that is you know, your health care team helps inform how it should be let's say your therapy settings, how it should be configured. But your day to day interactions are you have a sensor that's telling you what your current glucose is. You're choosing your meal type, your meal size, or if you carb count, you can put in carbs, and it's recommending the dose.
Yeah.
But it's doing all that, you know, the informed decision making behind the scenes. So I I just think that there's a big opportunity to to give more support to the person to to allow you to kind of ease into the education, so to speak. Because as an educator actually, there's there was a study cited that people only retain about 30% of what they first learned.
It's 20% more than I remember, but go ahead. That's awesome.
And so imagine I mean, I've been the person that then goes home and you're kind of lost and confused, and you're hoping you're remembering everything and doing it correctly.
Yeah.
And then as an educator, you're hoping this family can go home safely. And
And then how do you start to walk them through the whole process slowly. Right?
But if we could have these I mean, I would just love to see these tools being used. Like, the more visibility we have, people can be aware of them, know that they have access to them, and then if it could be used as a tool even early in diagnosis
Yeah.
To not put so much pressure on the patients or the persons with diabetes and the family to be these experts going out the door on day one.
Yeah. In pen, the the whole MiniMed goes system, like, it's a great entree where you get the health benefit without all of the burden of, like, what's all this stuff? Why do I have to remember all this thing?
Yeah.
So you'd go back in time and tell yourself, get an in
pen? Yes. I would tell my my health care team, give me an infinite diagnosis, not make me start with a violent syringe and kind of
Listen. You're preaching to the choir.
I don't understand the concept of, like, make them struggle so they really understand it. Then we can give them a CGM. Like, I don't I don't don't get that. I think it's old it's probably older thinking, and I don't not understand it. But, you know, I I I've had people say to me, what if it all disappears?
I'm like, if it all disappears, we're in a
lot bigger trouble than that.
So don't worry about it. Like, I think you're gonna be okay. I like the idea of listen. You can't minimize like, joking aside, you can't minimize the the information and the education that comes back from wearing a CGM. Yeah.
You learn about diabetes so much more quickly wearing a CGM. Mhmm. So much more quickly. I using the the Impen app. So you can see I put insulin here.
I did this. You know, like, You
start to see how
starts to just make sense.
Impacts the glucose, how meals impact
the blood. Information helps you make better decisions personally and with your diabetes care. Exactly. And it's it's to me, it's all just better. Okay.
And then everything that's being collected too goes into reports that then you can bring to the health care team. And instead of sitting down and feeling like, you know, it's 21 questions and
you're thinking here? Do you remember what you ate last Saturday? I don't remember what I had. Yeah. Right.
For breakfast. Yeah. And you want me to remember why my blood sugar went high two weeks ago. I don't you're gonna try to use that to make a decision around my therapy. So having that full picture
Yeah.
I also feel like you can get to the more meaningful conversations that'll actually help address, is it a behavior, is it an education, or is it a a settings change? Right. And it's not always a settings change.
It's awesome. Right. Now I really do appreciate your time and your insight. Thank you so much. You're delightful.
You should come back sometime Okay. On the regular podcast, not when we're here at ADA I'd about this more.
Thank you so much.
Thank you
so very much. And thank you so much to Sugarpixel for making all this possible. Thanks so much, guys. Bye. Kenny, how are you?
Kenny Fox in the Loop House: laid off to helping full-time 36:39
I'm good, Scott. Nice to see you in person for the first time.
Never met Kenny in person. But it's crazy.
This is your first conference.
So I have. This is my first ADA. It is massive, and I cannot believe all these people are here. It's my first as well. You've never been before either.
I have not. Yeah. So let's find out a little bit about you. First, do you have kids with diabetes?
I have four children. One, my second child, Tessa, has just turned 13, and she has type one. She's had type one for going on almost eight years or at seven and a half years, I think.
Eight years. Yeah. And what does she do for her management?
So she's using the DIY loop system, and we've been using that since about six months after diagnosis. Okay. Yeah. She got started with injections and a Dexcom, and then immediately got the the pods. And about a month later, we started looping.
So she's been looping with an Omnipod for years?
Seven years. Yeah.
Okay. And you I know you because you came on to JuiceBox to talk about your knowledge of how to loop.
Seven times.
Yes. Well, you've been on a lot. Yeah. Kenny's been on episodes called Fox and the Loop House if you wanna listen. They're fantastic.
But why do you know so much about loop? Like, why are you the person to talk to about how to actually use it day to day?
I think part of it is I'm a technology person by trade, and I've always been attracted to how do we use technology practically in our lives. So when I worked at a credit union, it was all about, okay. We have this tech, how to and then and understanding how someone did their job and figure out how to apply it. Mhmm. Just streamline their life, basically, their day to day job in technology.
And so when Tessa was diagnosed, my go to was I need to understand the mechanics, the flow, the workflow, and that's just how I coped was part of it, was just understanding diabetes mechanics. And by trying to look all that stuff up, I found all the DIY apps, all the information, and then I ended up looping. And then from there, it was all just like I basically treated Tessa's diagnosis like a like a game or a problem to be understood because that's all I knew how to do once I could see the data.
So are you telling me that at her initial diagnosis, you felt a little hopeless or like, you weren't helpful?
Yeah. It was very overwhelming at first, but for us, my wife understood diabetes. My sister-in-law has type one diabetes, and so she knew to check my daughter's blood sugar when she started getting cranky and losing weight and I need to go to bathroom. And then not wanting to eat dessert was actually when we got figured that one out. And so she tested her blood sugar.
We had a meter in the house from before
Yeah.
And found out she was diabetic. And all my wife said is pack a bag. My sister had to stay the night a few nights, and Tessa has type one diabetes. And I'm like, I don't know what that means.
Right.
So I took her to the ER. They, like, moved us up the chain. They saw her blood sugar and immediately told the guy who popped his head in that she's next. And so I go, I the severity hit me. And then as she's sitting there, I just tried to keep her calm, gave her a a movie to watch on her iPad, and I'm, like, googling what is type one diabetes and how do we fix it.
So What
was the movie? Do you remember
it? I don't. Actually, I should ask Tessa if she remembers.
So the movie that we ran over and over again when Arden was diagnosed, that my wife can't watch it. It makes her sad, But it was sky high. So but my daughter will watch it still. So sky high on a on an iPad or a I maybe not even. Actually, I'm pretty old.
It was a compact DVD player that we played sky high
on over the did period. You have to watch it?
I mean, it was countless. It's all we had. It just ran and she was two. So it just ran over and over and over again.
But Tessa was five and a half, and our process was we got diagnosed, and we were only in the ER for two or three hours. And they said gave her a couple injections and said, go home. We'll see you tomorrow in the afternoon, and we had a four hour session with our
That was that.
That was that.
It's pretty awesome. But when this is over, you realize, I don't know what I'm doing. I'm gonna dive into the thing that I'm maybe more adept at. It ends up being this do it yourself algorithm. And now I feel like there's nothing I couldn't ask you about loop that you wouldn't understand, and you have a business around it now as well.
Yeah. Somebody came up with a good name called Fox in the Loop House. So I grabbed that. And so a couple years ago, in October 2023, I got laid off from my job. And I'd been always thinking about trying to figure out a way to help people even more than I already had with all the years in the DIY community.
And I thought, well, I could I could probably do this. If I could do it all the time without stealing time from my employer Right. That would probably be more fair for everyone. And so once that happened, I took the severance and then made a plan to start rolling stuff out try to give it a go.
So now you're helping people virtually?
Or Yeah. It's all virtual. Okay. I mean, I guess if someone would come over to my house, we could do that, but it's all virtual. And right now, my I help people with building because I know people wanna help building when they get started.
And being a tech person, that actually was, like, the easiest part to do. So we set up the build if they wanna do that. And then mostly, it's, teaching you how to use Loop in your day to day life, but at the same time understand the the data so you know what settings to change.
Okay.
So there's a lot of application. I like to say I focus on teaching you how to adjust your settings, which is my focus. Mhmm. But in practice, you gotta know how to just live life, understand diabetes variables, and apply them to the system.
Yeah.
And so I do that in, two ways. I have created a video course essentially
Mhmm.
That we watch, once a week, and then you either join a group, and we do it through a group method where we meet once a week in small groups, or, you can do private coaching, and then there's some way to get help between in case you have a question come up.
Generally, how long does it take people to go from the build part to the part where they're comfortable enough to have the outcomes they're looking for?
Yeah. Building is, I got it down to about two, two and a half hours, but teaching how to use the system takes a little bit longer. I it's a seven week process is what I walk people through, and I would say that everyone that goes through it as everyone's been happy, and they feel very confident in what they're doing. But I would say there's about a third of people that when they finish, they still there was so much new stuff, just basic diabetes mechanics Sure. That they need to go back and refresh.
And so it takes them a few more months to either watch the videos again, or I have a membership on the back end if they wanna join and get some help and stuff.
Refreshing up till the comfort sets in.
Yeah. Yeah. They're adjusting their own settings by the time the seven weeks is over here and there. At least they're basal Yeah. And making some good adjustments in meals.
But a few people linger a little bit, but I'd say most people are pretty confident in changing their basil and carb ratios.
What do think what's the thing you see most people trip on? Where where do they get stuck?
“You’re not as special as you think”: recounting carbs 43:16
I would say a lot of the adults, it's counting food. So it's either they some of them don't want to enter all the carbs that are required because they feel like it's, like, oh, it's not healthy enough. I shouldn't be eating it or something like that. There's some fear around entering all of them food.
Do you think it's do you think that they're worried about the the the amount of insulin or then does the number scare them? It's both the amount of insulin and the calories sometimes. Okay.
So they feel like, oh, well, I shouldn't eat that. Then they don't wanna enter all of it. So they enter thirty grams, but it should be fifty. So there's a couple different reasons that my adults I try to put them all in the same group in my group coaching. And so I'm learning more about their hesitancy, especially if they've been diabetic for a long time.
I had one recently that told me, I was just told a piece of bread is 15 grams, and that's the only thing she's ever been told. So everything is, like, either 15 grams of bread or nothing.
Okay.
And so her counting was way up, and she eventually like, I had her had her adjust her settings, and then she's like, you know what? I looked at the package on this bread I'm eating. It's healthier bread than I used to eat when I was a kid, and it's 20 grams. And I looked up this other thing I have for breakfast, and I had oatmeal, and she had a pretty flat line. So once she she's like, it's amazing.
I enter all my carbs, and then I was okay. Yeah.
So you think if she doesn't take the time, in this example, if she doesn't take the time to just reunderstand things, she might go on like this forever.
Yeah. Yeah.
Yeah.
With that calibration, that forcing people to calibrate to count, you know, a lot of them pick it up after just, like, a week or so of really putting some effort in. Right. But they hadn't done it in a while. So I usually encourage people in general, like, if you just take couple days once a year and maybe kind of pretend like you're a brand new diabetic
Yeah.
Just reset. And especially for parents that have kids that are growing up, this is where someone get hung up is they were diagnosed at two, three, or four, and now they're eight or nine, and they're eating twice as much. And so I had one mom in my group recently realized that she she's like, I'm the problem because she thought the lunch she's packing her daughter was 35 grams, but she's now four years older than that, and she eats 55 grams for her lunch at school. Simply counting it all and the serving sizes, all of a sudden lunch was looking better.
Funny, isn't it? Because you're sitting here talking about it. It seems so obvious.
Right.
But it's not once life gets going and
people Yeah. You're rhythms.
You you find a rhythm, you get into it, and then you start thinking, oh, the pump doesn't work. This doesn't work. I this is just diabetes. Yeah. That's the one I find that mostly people fall back on.
This is their expectation. This doesn't go well. It's not supposed to. And I'm like, no. I think you're just maybe not putting the insulin at the right time or doing this or that.
It is really interesting to watch somebody do the thing they do and be able to step back from a dispassionate third party situation and look and go, oh, actually, what's happening here is you don't like thinking that you're not eating a healthy meal. So you're making a smaller number to lie to yourself into feeling better. It's really something. It's interesting you saw it that way.
Yeah. The the the most common situation I see is a combination of there's the mystery fat protein rises. They they're a mystery to someone else, but I understand kinda where they are once you break down what they're eating and the timing of them. And so over time, either themselves or their endo has increased their basal rates all day long. Yeah.
And so then they occasionally go low when they mix up their meals, or they're always going high when they eat more because it doesn't scale well when their meals change or when life changes. So the classic situation is someone comes in, we look at the data, and we end up scaling all their basal rates back a fair amount, making their carb ratios stronger. And then for loop specifically, we end up adjusting a few more things to make sure that the meals are properly tracked and managed in loop, but the the bulk of the success comes from modifying the basal rates and simplifying them. Some people have, like, ten, twenty basal rates in a day. Yeah.
Just getting a couple, like, a night like, a sleeping one and a daytime one, scale back the daytime one, make the ratio stronger, add and in some fat and protein carbs, and all of a sudden, poof, they're
It just works.
They're good. Yeah.
I love talking to you about this because you it just rolls off your tongue. And I use too many floury words to get to the same ideas, most of the time. But, I mean, I've been for years just telling people, like, it's timing, it's amount, it's understanding the impact of your food. It's kind of it, really. You know, be flexible.
Don't be afraid to knock the high blood sugar down. It it I appreciate the way you do it. So it's foxinthelouphouse.com?
Foxinthelouphouse.com. There's a couple free resources if you wanna check that out. I got a basal rate cheat sheet, kinda most common basal rates and kinda tips for why it's like that. And then there's another one around meal absorption time, which in loop, you declare how long a meal is supposed to be. Right.
And so I give, some bullet points on how you can pick the right absorption time, and there's in that one is a really important one for sleeping, is is a nugget around how we manage dinner or evening meals. They tend to be a little bit slow. Everyone struggles with going low before bed and then rising after.
Right.
So, I'll give some tips around modifying your absorption time and how you would count food in that same handout. So you guys can find that on my website.
Very nice. Give me one now. What's a tip that you like, if I walked up to you and I said I'm struggling with loop, where and I don't know. I'm I I don't know. I'm high three hours after I eat.
What what would you look at first?
Kenny’s four-step Loop framework: start overnight 48:31
So I always I have a framework I give people. It's four steps. And then we just I have to say someone, look at your graph and ask these questions, these things in order. And the first is well, I have a step zero that I'm building out. It's check your pod site because inevitably, the pump site's not working.
Right.
For some for a lot of things. So learning how to check that's good. And then first one is basal. And so we're always looking at the insulin onboard or the active insulin is what Luke calls it. Mhmm.
Overnight is what is the easiest. Kinda your three, four, five in the morning if you have a morning rise, kinda get before that.
Yeah.
Like, the flat spot when most meals should be chill and just kinda see where are you. If you're near zero insulin onboard and in your range that you've asked Luke to put you in, you know, 87 to 93 or a 100 to a 110, whatever it is, then you're probably good. And then I always just say, okay. That means your nighttime basal's probably fine. Mhmm.
But if there's lots of them, then we say, well, how do we how do we average those out to get to the rate that's basically working around that time? And then after that, it's a lot of that, the pushback comes. So what about the what about the rise at night after I go to sleep? Right. And because everybody has to crank their basil up for that.
And so, then we start talking about fat and protein for dinner. So it's really just a overnight basil. Daytime is inevitably for, like, I'd say ninety percent of people. The daytime basil is a little bit lower Mhmm. Than the nighttime one.
Some people, it's not true, but My daughter's opposite. Yeah. Yeah. Some people have kind of a stress of the day, and they end up going up a little bit.
Right.
There's different reasons why, but I always ask people to try either one rate or two and with a slightly lower one during the day. And then we kinda start entering meals well, and that's what I I thought I only had, like, couple minutes with people. That's what I would tell them is Okay.
You know,
pick one or two rates, one for sleeping, one for awake, and then, read my little handout on entering meals. Yeah. And then so you can enter some fat and protein, and you'll be good to go.
I'm smiling because, like, as you're talking through all this, it I when when I started doing this, I didn't know what I was doing. I had no idea about diabetes. I didn't know anything about it. Everything that I talk about on that podcast now is just hard to earn, like, through experience and hashing it over and over again, trying to figure out the basics. And the basics really are get your basal right.
You know, do this, do that, look overnight, find stability, take that into the daytime. It really is awesome to hear you talk about
it. It's a lot of fun now because it's, it helps me because I have helped people in the community. I think I had, like, seven or 800 Night Scout sites bookmarked in my browser at one point before I started this business. Really? Just looking at people's stuff or whatever.
Yeah.
And then now with meeting with people and getting to sit with them for seven or eight weeks and really digging into their settings, asking about their lifestyle, it's nice to see that these basics do apply to most everybody Yep. And then we can very quickly find the outliers. And as I'm working on documenting the more common outliers so people have a place to go in that Basal cheat sheet, to know where to where to start if they happen to be that special. But I tell everybody, you're not as special as you think, so please try and do basic settings and then kinda roll from there.
Yeah. When people tell me your diabetes may vary, I'm like,
not that much. Doesn't vary that much. Yeah.
Yeah. Yeah.
Well, I really appreciate you doing this with me. I wanna say just hearing you talk about how you used to help people just not you know, saw all those night scout things. I think people wouldn't know that, like, most of my daughter's health is because people came on to the podcast and shared their thing. Like, I got to build my understanding through talking to people. It sounds like you've helped build yours
Yeah.
Through helping people
as Very similar. Yeah. I saw what was working, and I just pinged a couple people in the early days of using Loop and be like parents that were struggling, and I'm like, hey. Can we try some of the stuff I'm trying? And then it evolved and grew, and then I'd run into really smart people in the community that would, like, enhance my understanding of how the algorithm works.
Right.
And then with a little bit of, like, okay. Fine. I'll go look at the code because I can. Mhmm. I'd start reading some stuff.
But mostly, I just found the smart people, and so it's a very community effort. And so I try to give back as much of that information as I can on my website or in handouts, and I do free free consultations. There's a button on my website to do that. You schedule forty five minutes with me. We'll talk about whatever you want about Loop, whether it's, like, diving into some settings or just, like, what is Loop like?
I'm not sure I wanna do it. We'll talk about anything you want, and then I'll just share my programs in case you're interested. And if you're not, that's fine. Like, no harm, no foul. I just really like talking to people.
It's awesome. Me too. Well, Kenny, thanks for joining me here at the Sugar Pixel booth.
Yeah, man.
You should
come back on the podcast again, we should chat some more. We do have plans, don't we?
We talked about doing, like, a little series of q and a or something
like that. Yeah. We'll figure
that out.
Well, thanks so much for doing this, and thanks to everybody for listening and visiting us here today at the SugarPixel booth. If it wasn't for SugarPixel, we wouldn't be able to do this. So check them out and, learn all about their new device. Thank you so much. Thanks again, Kevin.
Yeah.
We're all set. Alright. John, don't you introduce yourself because I'm super afraid I'm gonna mispronounce your last name.
John Scholland & Luna: automation only while you sleep 53:27
Thank you. My name is, John Scholland. Mhmm. Scholland, like, show time or something like that.
Okay. Okay.
What's that?
Where do you work?
I work for a company called Luna Diabetes. Mhmm. Started it about five years ago. I'll tell you more about it. It's about trying to help people that are using insulin pens, is most of us living with diabetes, how to get the get able to take advantage of automation.
That sounds crazy. So I can't wait to ask you more about that. But I first, let me find out a little bit about yourself personally. You have type one?
I have type one about forty years now. Forty years.
Have you always worked in the diabetes space?
No. I didn't I didn't think I would ever work in diabetes. I started my career in digital marketing and advertising. Really? So a whole whole new thing.
How did you make the shift?
You know, I just got frustrated that some of the products that I wanted were for myself or things that problems I had weren't being solved. And so I made a I made a cap for an insulin pen that told me when I took my last dose of insulin.
Really?
And I started showing it to people, people wanted it, and all of a sudden, I was a medical device entrepreneur.
So you don't work for Luna. You created Luna.
I created Luna. Yeah.
Oh my god. So this is the Okay.
Next one, second company upgraded in diabetes.
No kidding. Alright. So you just said something that, like, fucked my mind. How is an insulin pen gonna work as an like, of just tell me what the idea is because I don't even know. I don't
think I understand. So the first thing I was telling you about Right. Is we made it was called TimeSulin. Okay. And we made a cap for any insulin pen that told you when you last took your insulin dose.
Okay. We subsequently sold that to Bigfoot Biomedical and made a really cool product that then Abbott bought and the world hasn't yet seen.
Really?
So that's hopefully coming.
And it's as simple as when you uncap the pen, it what marks the time? And then so when you look again, oh, I last took oh, that's really kinda simple and brilliant.
That was the original product from a long time ago.
Okay.
And the stuff
So you sold you sold that off, and then you said, I don't wanna go back to work. I'm gonna invent something else, or did you have an idea?
There's a couple hop hops along the way. I worked for a CGM company for a while.
Okay.
But then, yeah, we came up you know, I was really I was early in building the do it yourself automated systems.
Mhmm.
And it just totally changed my life Yeah. Of of having these automated systems. And I was always frustrated that more people weren't experiencing it, more that weren't seeing it. I mean, at first, it was you have to build it yourself. It was hard.
There's a technical Yeah. Barrier to do it. Now, of course, you know, whether it's Tandem or Mimatronic or Beta Bionics, there's really great products that do it. But still so few people are willing to wear a pump. And I want more people to experience what it feels like when you live with diabetes, just be able to go to sleep and not be nervous, not be scared, not be stressed about it.
Okay.
And so Luna, what we've created, is about bringing the best of insulin automation to people that want to continue to use pens during the day.
I've been doing this a long time, John, and I normally think I know where people are going to go when they're explaining something, and I can't imagine how you're going to tell me this works. So please lay it
out for me as simply as you can. Yeah. So during the day, you use your pens exactly as you did before. If you're type one, you're taking your basal and your bolus. Type two, maybe basal only.
You might be using a GLP one. And before you go to bed, you fill it with rapid acting insulin. We've made the world's smallest patch pump.
Okay.
And when you're sleeping, it talks to your CGM. And if you need insulin to get you back to target, it will give you these microboluses of insulin while you sleep.
So is there an an like, an inset somewhere? Like, you're wearing a and then you just connect the pen to it? Nope. You fill it from your pen,
and then you you put it on. So imagine you're
starting to get there. So I'm wearing something you're wearing something on your body, and it knows everything that happened during the day. You put some insulin into it, and overnight, it uses that insulin to fight highs.
Yep. And it also helps with lows. And so there's some other tricks up our sleeve to help with lows. So
How does it help with lows?
We have some tricks up our sleeve for
doing that. You can say yeah. Okay. Yeah. You brilliant?
What happened? Did you know you were brilliant?
No. Look. It's just, you know, I've lived with diabetes a long time.
Yeah.
And I want more people to be able I you know, I was lucky. I got good health care, and I'm able to to get the medications that I need. Yeah. But so many people are having such a tough time with it. I feel obligated to try to come up with these ideas and try to make it happen.
So you just you've taken your experience of living it with so long and saying, would I like to happen? What would I need to happen? And then I listen. I see the same thing. It's easy to fit in these settings and think everybody uses an insulin pump, but a majority of people with type one diabetes do not use pumps.
Do not.
Right. And I listen. I don't know what you're running, if you have a pump or what you're doing, but, like, my daughter's using a DIY algorithm too. And they are they have been and are fascinatingly good for her health.
So great.
Yeah. Absolutely.
So So the real insight for us was the following is is we were looking at data from one of the pump manufacturers in their study. Yeah. And they ran a study where they were they had a group of people that wore their normal system. No automation. Mhmm.
And then automation only at night. They turn it on before they went to bed and turn it off in the morning.
Yes.
And what the data showed was that over 80% of the improvement to glucose happens at night when you're sleeping
Yeah.
Which is very dramatic. Right? So if you're wearing a CGM, during the day, you do about as well with a pen as you do with the pump. Mhmm. The pumps are are they don't do very much at and it just really changes at nighttime.
Right.
And so that was the really key thing of, woah. If you can give me 80% of the benefit of a tandem system or a Medtronic system at night, let's make that happen.
You you don't know me, I imagine, but, like, I've been making a podcast for a very long time, and I've been telling people forever, like, the first thing we wanna do is get your basal right. But then after that, we gotta figure out overnight. Like, get over you can steal so much a one c overnight is the way I think about it. Right? And then what you learn overnight about your settings often applies easily to the daytime, and then it takes you know, people don't they don't want a basal test.
They don't know how to do things. Their doctors don't help them with their settings very much. Right? Yep. And it just becomes so you figured out that that, and then I still can't do you have the device with you?
It's in my backpack over there. Gotta I gotta go up and get get
it for me? Sure. Of course. Can't imagine. We'll edit this part out of you walking over, but
I thought I had one in my pocket. I did. Yeah.
He's a wizard.
Can you hear what I'm saying? This man might be a wizard. Hold on a second. So
there's stuff in this box that I don't wanna show.
Okay. Sure. Keep out whatever you need to
so here it is. So this is the world's smallest patch pump, and you use it with a single use reservoir like this.
Okay.
So before you go to bed, you'll fill this up with, rapid acting insulin.
Mhmm.
It holds 20 units. The average overnight need for someone with type one so this is in addition to your basal. Right? Okay. So the average need is 1.6.
We put into up to 20. Okay. Connect it with this device. This is a there's an actual pump, and then you put it on your body.
How long does it stay on for?
Just while you sleep. That's it. Do you take it off in the morning?
Fill it, put it on at bedtime, get up in the morning, take it off, and it manages high blood sugars overnight, keeping your blood sugar down, giving you better stability, better overall a one c, better health. And you're telling me that there's a way that it might help with Lowe's, but you can't share with me what that is yet. Yeah. I mean, look.
If you if you're, yeah, if you're avoiding big boluses, if you have your basal titrated bowel, you are gonna increase your time and range. Yeah. You're just gonna every night, you just this is your reset button every night for diabetes.
Do you imagine that this will be an entree for MDI users that make them think maybe I should try an insulin pump, or do you think that people like, what is your finding when you talk to people? Do not wanna wear pumps but wish they had better control? Generally, it's
do not wanna wear a pump. Okay. And are there gonna be people that try this and say, wanna wear an Omnipod? Sure. And are there gonna be people that wear an Omnipod and say, don't wanna wear it twenty four seven?
Sure.
Maybe that too.
So this is sleep only automation. I know it's just it hasn't existed before. Right? You you you're either gonna go wear a pump and all the the cost and the complexity that that is. Yeah.
But great. I mean, pumps work. Or you're stuck with no technology, no help, and going to bed at night just going, oh, man. Am I gonna make it?
Yeah. It it always strikes me that way too. It's it's all this way or all that way. All or nothing ever in the middle. Right?
Nothing's standing. Yeah.
So we're creating this new therapy that sits in between, and and people are loving it.
And so and what is it how does it make the decisions overnight? Is it by talking to CGM, or is it also by knowing how much insulin you've had during the day, what your basal is? Like, the what is it thinking about?
So it's speaking to your CGM. Yeah. And then we have our we've developed our own algorithm, which is that determines how much and when to give insulin. Okay. And importantly, we like we've really rethought the experience of insulin pump therapy.
When you start the first time you use this Yeah. All you have to do is enter one thing once into the system, and then it starts learning about you. When you put it on at night, you don't have to take out your phone. You don't have to prime it. You're not you just fill it, put it on, take it off.
So it's super simple. There's no settings. There's no targets. There's no ISF. There's no carb ratios.
There's none of that stuff.
Is the brain inside of it, or do I have an
app on my phone? Brain's inside of it.
Inside of it. Yep. It feels like magic to me. Like like, seriously. And this all just came to you one day, you were like, you know what would be great?
And that's where this idea started.
How do you how do
you go from like, I don't imagine you I mean, maybe you are, but you're not a product engineer. Right? Like, what do you do when you have that idea? Like, where do you like, when you say to somebody, I need to build a thing, you'd how does that all work?
Yeah. So, I mean, now I've been doing this for a while. So so we're in San Diego. We have the most exceptional team of engineers that are have responsible for many of the products that you see around here. Sure.
So some of us, it's our fourth company together. We have a team of of just outstandingly committed mechanical engineers, electrical engineers, and get a team to do it. But it's it's hard. You know, there's clinical there's big clinical studies Yeah. Takes take cost a lot of money
to do it. Where are you at in that process?
We have about seventeen hundred nights of use of this. We just have some new studies starting next week. Okay. And so people are using it, and people are liking it. And we're on the path to launch it as quickly as we can.
Do you imagine running this business and doing the manufacturing and the or do you imagine selling it to somebody?
Never know. Yeah. Yeah. I mean, we're gonna we're I think we'll probably launch it ourselves.
No kidding. Yep. What's the time frame do you think?
As quick as we can. That's awesome. Know. Just sometimes it slows down. Yeah.
Doing as quick as we possibly can.
That's it. Where can people learn more about it?
Lunadiabetes.com is our website. Yeah. Go check out the product.
When you have more to share, would you come on the the full podcast and talk to me for an hour about it? And, like, sure. Yeah. Oh, that would be awesome. I really appreciate that.
I know you have to run. Like, people told me you're a little bit on a time crunch. Yeah. But but thank you so very much. That's awesome.
And thanks to SugarPixel for making this possible. Thank you, guys. That's awesome.
To learn more about the Sugar Pixel, please go to my link. It's in the show notes. Customtype1.com/juicebox. There's a brand new actually, there's two brand new SugarPixels. One with a big beautiful color screen.
The other one's more portable. They connect now in hotels. I know people wanted that as an addition to the SugarPixel. John brought it to you. Speaking of John, thanks so much to him and SugarPixel, the entire team for having me out at ADA.
We're also gonna get together at Friends For Life, meet us there if this comes out before Friends For Life. It's a very loud car going by. Won't be much longer. My studio is just about finished. If I could just stop going to these events, I'd have time to finish up.
Then no more noise. What else I got for you? Check me out on Facebook, juiceboxpodcast.com. We have a private group with over 85,000 people, and I think you would love it. Follow on Facebook.
Subscribe or follow in your favorite podcast app. Check me out on Instagram. I think that's all I got for you.
I hope you enjoyed this.
I hope you check out customtype1.com/juicebox. And, of course, I'll be back very soon with another episode of the juice box podcast. In fact, I believe coming up next week is the longest episode of the podcast ever. I think it clocks in two hours and forty five minutes maybe. See if you can make it to the end.
- Four separate short conversations, one booth. This isn’t one long interview — at his first ADA, Scott recorded four quick (~10–15 minute) chats back-to-back at the Sugar Pixel booth: Lane Desborough on creating Nightscout, Madison Smith on smarter MDI, Kenny Fox on DIY Loop, and John Scholland on Luna’s overnight automation. Each stands on its own; the throughline is the people quietly building the tech behind modern diabetes care.
- The heaviest part of diabetes is cognitive, not physical. Lane Desborough — the engineer behind Nightscout — calls it a “thinking disease,” and argues the point of good technology is to give people their attention back rather than add one more thing to check. His line: “the best app is no app.”
- MDI can be smart, too. More than 70% of people with diabetes use pens. Madison Smith — a CDE and nurse who lives with type 1 — works on connected tools (an InPen paired with a real-time CGM) that track insulin on board and time alerts to when action is actually needed, cutting alert fatigue without a pump. Ask your care team what smart-pen options fit you.
- Get back to basics, in order. Kenny Fox’s Loop check starts with the pod site, then basal: on a flat overnight stretch, if you’re near-zero insulin on board and in range, your night basal is probably right. He often simplifies people to roughly two basal rates (sleep vs. awake) and has them recount carbs honestly — stale numbers (“bread is 15 grams”) quietly break dosing. “You’re not as special as you think.” Confirm any changes with your team.
- Overnight is where the biggest gains hide. John Scholland built Luna around pump-maker data showing 80%+ of automation’s glucose benefit happens while you sleep — echoing Scott’s long-standing “get your basal right, then win overnight” approach. What you learn about your settings overnight often applies to your day. Work any settings change out with your care team.
- Sugar Pixel (CustomType1) — Episode host/sponsor — the glucose display device, now in two new models. Scott’s support link.
- Luna Diabetes — John Scholland’s sleep-only insulin automation — the world’s smallest patch pump, worn overnight only.
- Fox in the Loop House — Kenny Fox’s DIY Loop coaching — free 45-minute consults, plus basal-rate and meal-absorption cheat sheets. (Verify spelling.)
- MiniMed Go / InPen (Medtronic) — The smart-pen MDI system Madison Smith works on — links an InPen to a real-time CGM (Instinct or Simplera).
- Nightscout — The open-source remote-CGM project Lane helped create — the “#WeAreNotWaiting” effort.
- Juicebox Podcast Facebook Group — The private group Scott mentions — 85,000+ members.
#1893 Bolus 4 - Summer
A listener asked how to bolus for a summer barbecue. Scott and Jenny break down the loaded plate — hidden-sugar sides, fat-heavy meats, pool time — and why your best beats nothing.
Bolus 4 - Summer
Cold Open & Sponsors 0:00
Welcome back, friends, to another episode of the Juice Box podcast. We got a note online and said, could you guys do a bowl of sport for summer for barbecues? And here we are. While you're listening, please remember that nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan or becoming old with insulin.
If you're living with type one diabetes, the After Dark collection from the Juice Box podcast is the only place to hear the stories that no one else talks about. From drugs to depression, self harm, trauma, addiction, and so much more. Go to juiceboxpodcast.com up in the menu and click on after dark. There, you'll see a full list of all of the after dark episodes. Today's podcast is sponsored by US Med, usmed.com/juicebox.
You can get your diabetes supplies from the same place that we do. And I'm talking about Dexcom, Libre, Omnipod, Tandem, and so much more. Usmed.com/juicebox or call (888) 721-1514. The episode you're about to listen to is sponsored by Tandem Moby, the impressively small insulin pump. Tandem Moby features Tandem's newest algorithm, Control IQ Plus technology.
It's designed for greater discretion, more freedom, and improved time and range. Learn more and get started today at tandem diabetes dot com slash juice box.
Humidity, New Orleans & the Barbecue Request 2:13
Hippie. Cool.
Jennifer, it is summertime, I know, because I walked outside and it felt like I was swimming. So I just got back from New Orleans, which is a very humid place that I will probably never visit again because of the humidity. But I think the humidity has chased me home to New Jersey. I imagine you are, in the middle of it where you live as well. Is that right?
Yeah. We have had a fair amount of humidity the past few days. We've actually had some pretty nasty, like, thunderstorms and stuff. So it's you know, that comes through, and then it sort of pulls down. And this morning, we're sort of sitting at a very breezy cooler seventies, which is lovely
Very nice.
Compared to how it's been. I have, however, been in New Orleans in June twice.
Oh gosh.
And it is like, I love the city. Mhmm. I really do. I it's a fantastic, just fun vibe type of place. Fabulous food.
Oh, I had a, a shrimp po'boy that was it was just excellent, honestly, and the best Cubano sandwich I've ever had in my life Oh. While I was down there. Yeah. May
The la actually, it's funny. The last time I was down there, I also had a shrimp po'boy sandwich. So good. My husband and I had gone to listen to a jazz band at a place that also was, a restaurant, and that was what I was hungry for.
And it was Yeah. They somehow toasted that roll, but didn't make it greasy. Because around here, they mess it up all the time. Anyway, my point is when this weather arrives.
Yes.
Soda, hot dogs, hamburgers, barbecues, watermelon, potato chips, and the rest.
All the things.
Well, we got we got a note online and said, could you guys do a bolus for for summer for barbecues? And here we are. I want to, tell you what I'm gonna be doing today while we're picking this drum. I'm trying to make these easier on me. Create a little thing that is not online, but it's something I can use personally.
It's it's a kinda plain language search for foods, for carbs, and it goes to a little website run by the government called the Agricultural Research Service. It's the USDA. And they use something called the FNDDS. It's a database that provides the nutrient values for foods and beverages reported in what we eat in America, the dietary intake component of the National Health and Nutrition Examination Survey. So I have a little thing here where I can look one up, pick a size, add it to a plate.
It adds it up. And then for ease for our conversation, it actually then throws it into my estimator so that I can have my mind a little more on the conversation.
The Loaded Plate Problem 4:52
Yeah. Which but I think that that brings actually a really good point to begin with. When you attend something like a cookout or barbecue, whatever you call it in your region Mhmm. Right, You do end up with a variety of different things on your plate at one time.
Yep.
Right? Nobody just puts the burger on their plate without the chips and the potato salad and the coleslaw and, you know, the watermelon, like you and whatever else. You know? Lemon bars, it all ends up coming out, and you slop it on your plate. And then most people just start eating.
Right? Because sometimes they just eat multiple things on a fork at a time, and I'm like, can you really taste it? But that's beside
the point. A little bit of each?
He hit a little bit of each. I'm not that kind of an eater. I like single things. I don't like combinations like that.
Really? You don't ever mix this and that to get a different flavor?
No. If I want it together, I'm gonna make a soup, or I'm gonna make a casserole, which I don't do very often. I'd like things
Simple. Like, so you
can Separate.
You wouldn't you wouldn't mix, like, two jelly beans to get a different flavor?
Oh Alright. Well, I have done that. I I have to say that I've done something like that. But food is just like, one has one texture and, like, consistency, and another one is supposed to be I don't know. I don't like those things together.
I just don't.
We don't usually say stuff like that. That was interesting.
It's it's I don't know. And I like, I I've gone to many, many cookouts over the years.
Sure.
Right? And just I I guess I like the flavor of the thing that's there, and I don't wanna mess it up by Okay. Mixing it. Like, yeah, like, potato salad
she's making. We've we've we've hit a nerve for Jenny. She's not putting potato salad with a bite of a hotdog in case you're wondering. No. Okay.
No.
I don't like potato salad either.
Evaluate the Day: Activity, Swimming & Unknowns 6:52
I I listen. You know I'm not a mayonnaise person. So No. So what are we gonna do here? We have to think about the food.
We have to think about where I mean, this may be more than anything is evaluate yourself situation. Right? Like, where where are we at and what's gonna be happening as far as activity? How long is this day gonna be? Is there gonna be a number of different eating opportunities, which, you know, I always kinda think of a barbecue as I would still get ahead, stay ahead, but then use the opportunity for more food to help me be a little more aggressive in less so you know what I mean?
Like, there's always more food. So if something falls True. Catch it. The only and the real the linchpin is, of course, swimming. Let's talk about the Tandem Mobi insulin pump from today's sponsor, Tandem Diabetes Care.
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Swimming or any activity, you know, you think about, I don't know, if you're a bocce ball player, if you're a lawn dart, if you are
Volleyball. Yeah.
You know, volleyball outside, if you're a spike ball. God, my boys love spike ball.
Okay.
I think it's the coolest game. But any of these things or the beanbag toss, you know, whatever a cornhole or whatever people call it wherever you are. Yeah. Right? But there's active time is the purp the point.
Swimming being, I think, a little bit more when you have an insulin pump or when you use insulin because that's a navigation of possibly even removing it for the tube pump.
You know? Or losing connection to the CGM and your algorithm and everything else. Yeah.
Mhmm. So there is there is variability in this on top of that mixed plate of all the things that you've thrown together and the counting. Right? Yeah. The counting becomes a really difficult thing to do because most times cookouts are, let's say, at least three different families getting together.
Somebody brings something. Somebody brings another thing. You don't necessarily know what went into those other things because who knows?
Sneaky Sides: The Coleslaw Problem 11:19
It could be as simple too. It's like, I've seen sides come one way, and then as a simple example, another person will bring it, but they throw raisins all over it. And now there's a thing that Jenny, listen. I don't know. You're from Wisconsin.
Don't act like this stuff doesn't exist where you're from. I see
everything. Does.
I've been there. I know what's happened. You guys don't decry anything.
Yeah. Rice pudding. Rice pudding and bread pudding. Like, jam But imagine if there's, like, a said raisins.
Sorry. No. But if there's, like, a little salad. Right? And then but raisins are, like, prob like, you know, sugar.
Yes. And then you throw them on there, and you don't think twice because when you ate the salad, normally, it's this and then it's there. Also, I I have a a list of, like, 10 common staples, sides, and desserts from a barbecue, and every one of the sides is a concoction. The staples are are easy. They're usually you know, they're gonna be protein probably.
Or simple like a bun, which has a label, or you can guesstimate because you've read the label for a bun already. Yeah. You're right. The concoctions are I think about cole slaw, for example. Mhmm.
I love cole slaw. Mhmm. But when I started looking for my own recipes versus looking at my mom's recipe, there are many recipes that you wouldn't really know that there was sugar added.
Oh, okay.
So it looks like a very unassuming vegetable with fat. Mhmm. Right? Whereas it could have sugar added to it depending on what the flavor, I guess, profile you were looking for from that recipe.
Right.
And you would never guess that the coleslaw has
I I have to tell you, I'm I'm using Chatty PT right now today. So, you know, your mileage may vary, of course. But I I just got stunned to see that a cup of coleslaw could have 20 to 32 carbs in it and 14 to 24 grams of sugar. I never I I know it's not a thing. I not I would not have expected that.
How about that? Yeah.
So but as you said, concoctions, a 100%, you're correct. Someone's concoction could have been their grandma Sue's best recipe for something or another, and all they're doing is following the recipe. And they don't have diabetes, so they bring it, and they put it down. You think, oh, good. Cole slaw.
Like, that's a kind of almost not a freebie, but, gosh, that's really low carb. I could have a half a plate of that and
I swear I wouldn't I wouldn't have guessed it. The the one that I know is sneaky sneaky is, like, baked beans.
Oh, yeah.
There's a ton of sugar in baked beans. Right? And a lot of people will throw, like, kobasi into it or something like that to if you're gonna get a bunch
of fat.
Yeah. Bacon, you're gonna put your fat on top of all that. Hey. And I wanna apologize to you.
Oh. Why?
Top-10 Desserts & Lemon Bars 14:05
Top 10 desserts. Number 10 was lemon bars. When you said lemon bars earlier, I was like, what kind of a, like, crazy, like, hole was lemon bars? Like, it's not a thing I would ever think of. But
Lemon bars have been at every family function I have ever been to, even even nonfamily, even the neighbors. Really? Yeah. You know, I grew up on Lake Michigan, and we always had our neighbors had a charter fishing. Yeah.
And they always did a trout boil in the middle of summer. And lemon like, there were probably three different types of lemon bars at this party.
I'm assuming that's all sugar.
Oh, it's a good amount of
sugar. I'm gonna make them and bring them to something because I'm gonna be like, I've never made these before. I don't know what they are, here. Because I've never seen them at one thing ever.
And you don't wanna make them when it's really, really humid outside. So just as an like, I'm sure recipes will never tell you this. This is my grandma's recipe. But her recipe specifically states to not make them when it's humid outside because something happens with the way that it gets cooked, and they they they will they taste funky. They they end up tasting like rancid.
Oh, okay. Gotta keep them cool. Okay.
You gotta yeah.
There's a tip you didn't know you were getting today. Keep your lemon bars refrigerated. I wonder what's in that. That's just neither here nor there. I I actually did a a quick look at peach cobbler, and my god, like, it's got all the carbs in it.
Yeah.
Under-Bolusing & Chasing Highs 15:29
So so are we gonna run into this situation where what do you think happens more commonly? Is that no one realizes that a cup of peach cobbler has somewhere between sixty and ninety carbs in it, and they under bolus for it, get real high, and then try to crush the high, and that's how they end up low? Or do you like, I guess I
think it's I think it could be a bunch of variables that or the high creates enough where they're frustrated, but then they get active and they didn't remember that they were gonna get active. Or gosh. It's just like, gosh. Let's go play a basketball game, you know, in the driveway right now. Yeah.
And I just took three units to correct this high. I didn't know who I was gonna play. And keeping all of that clear when you're just trying to enjoy time with friends and family
Yeah.
It's it's difficult. I will a 100% agree with the frustration around this type of planning. And in general, you can I would say do the best that you can
Mhmm?
With the foods that you know that you're gonna eat. Kids I think kids tend to be maybe a little easier because easier in the realm of the food because they often have more consistent food preferences.
Yeah.
You go to a party and you can say, well, my child is gonna want the potato chips. They're gonna want a hot dog. They're gonna want maybe some carrot sticks with ranch dressing and probably the watermelon. Right? And then they'll like a dessert.
That's fairly simple comparative to an adult who sees the smorgasbord and is like, god. I haven't had that in forever. Baked beans, man, when was the last time I had bee and it all was on the plate.
That is what happened. Right? Yeah. It's I haven't seen this forever. And then before you know it, then you're you realize why those paper plate companies make those ads that are like, look.
It holds up even when it gets wet. So what they really mean is when your sorry ass load overloads it with food, this thing's not gonna break. Oh, I see. I never thought of it that way. I'll tell you, just did something.
This is just me doing something here, but I wanna tell people because it's kind of interesting. Right? So I just said to chat GPT, I'd like to know I just said, nutrition details for coleslaw. Gave me a little breakdown. And then I all I said was peach cobbler next, and it gave me the breakdown for that one.
It it it estimated the carbs in peach cobbler between sixty and ninety. Right? And then I went to this this thing I built that is just pinging the f that serve it's the f n d d, the the agricultural thing from the from the government. Right? And they use they basically use surveys, like, to like, for items that it it's not like, it's not how do I mean this?
It's not like it's not like Heinz ketchup one tablespoon. We know because it's on the label. It's I just typed in peach cobbler. That's it.
Mhmm.
And I went down to the surveyed peach cobbler. I picked a cup, and it's guessing the total carbs at 82.4. And 4.3 fiber, 41 grams sugar, 5.6 protein, twenty one seven fat. And the CHACHEBT guess was 60 to 90 carbs, 40 to 70 sugar, two to six fiber, 12 to 24 fat, 48 protein. I mean, it's not perfect by any stretch of the imagination.
But if you're
But it gives you a ballpark.
Yeah. And if you're really lost, Jenny, this is way better than, oh, I don't know, 20. Yeah. Because, you know, isn't that people's number? It's 20 or 40.
Right? People go 20 or 40? Thanks. Yeah. This is the look of Jenny's face.
Funny.
“It’s Always 45 Carbs” & the 15-Gram Era 19:17
Yeah. She's just like, I've I've helped so many people. I this is exactly what they do. Arden has a go to. Her go to for a meal that she's not sure is 45.
Yeah.
She just goes, it's 45 cars. It's never 45 cars. Which is
interesting from her perspective because she was so very little that she doesn't really have a background base for the for the consideration of 15 as a carb. Right? Yeah. My education when I started out was truly the where each carbohydrate was 15 grams.
Okay. So
you used slice of bread was 15. An apple was 15. Your cup of milk was 12, but, technically, it was rounded to 15. So it was really kind of portion based on putting all the carbs in one food group and saying 15 is a single serving of a carbohydrate food. So it's interesting that hers is 45 when in her brain, she probably mathematically is subconsciously even figuring out, like, how much food
Yeah.
That is. I see her
do 45 with a 20 follow-up if it doesn't work. That's sort of how she does it. Hey. Do you think that that 15 back then I don't wanna talk to about, like, you're old. But, like, back when you were doing it, do you think that was accurate, or was it just the that was the ballpark of the day?
It it was the best accuracy that you could get based on a consistent meal plan type of idea. Mhmm. So you were given truly what is sliding scale insulin. Right? I was using our insulin, not rapid insulin.
Our insulin was taken twice a day, mixed along with an intermediate acting insulin that had a peak and then flowed down. Right?
Yeah.
So my our insulin's purpose was to cover a certain amount at a mealtime. So I had very specific, I mean, I could tell you I had two starches, a fruit, of two one to two vegetables because, you know, they were free, and I could eat as many cucumbers as I possibly would.
Let's go.
I think I've told you the cucumber story before. And then I had two proteins and two fats.
Okay.
Like, those so I was portioned at each meal because of the dose of insulin that I was being told to take, and it was supposed to cover that. So I think that 15 was a good enough estimate to get you to be consistent with a single portion of a food is about this many grams of carb. And I still remember when I started actually counting carbs. That visit with my dietitian was it was super exciting. Like, I could finally, like, take insulin for what I wanted to eat, not what my thing told me I was supposed to be
Where’s the Fat? Hot Dogs & Burgers 22:19
eating. Okay. Jenny, is there a lot of fat in a hot dog?
Depends what kind of hot dog you eat.
Beef hot dog?
Beef, pork, whatever kind. I you know, they're more homemade Yeah. And depending on the leanness of the meat that it's made with. But in general, hot dogs, sausages tend to have a fair amount of fat in them.
Why did I not think of that?
Even hamburgers. Hamburgers could depending on the lean, you know, quality of the ground beef that you're using.
Yeah.
I mean, who doesn't want? I don't I don't eat beef. So but I don't want it. But people want a juicy burger.
Where do
you think the juice comes from?
Oh, the juice is the fat. Yeah. Yeah. Yeah. That's why people yell at me when I, like I mop the fat out of food when I'm cooking it, everyone's like, stop.
And I'm like, no. Yeah. I won't
be In college, I used to take a napkin when we go to the pizza place. I'd take a napkin and, like, lay it on the top of the pizza. Oh, I can't all of the pizza.
Jenny. People really don't like it when people do that. Don't don't.
Well, Jenny did that. And I am alive to prove that clearly it made a difference.
Building the Plate 23:28
I gotta be honest with you. I would a 100% do that. I just threw a plate together of a pizza cobbler, a hot dog, tortilla chips, and let me give it a bun too. Hold on a second.
And what about, like, a bean salad or
Okay.
Baked beans?
Oh, yeah. Okay. Let's do that too. Hot dog bun. Let me just throw a bun on here.
Just gonna use roll white hot dog bun. One hot dog bun at the plate. People are gonna be jealous of this thing. It's pretty great. What'd you say?
Baked beans?
Baked beans.
Alright. Hold on a second. Baked beans. You wanna use tops? You know that company?
I don't Bushes?
You know bushes? Bushes. Well, there you go. Bushes. Half a cup sound good to you?
Sure. Sounds good.
Add to the plate. Let's look at the plate.
I'm trying to think of something else that would be
Well, wait. But think think we'll add something. But first, 4.4 ounces of baked beans, one white hot dog bun, an ounce of tortilla chips, one hot dog, and 8.8 ounces of peach cobbler. Top of your head, how many carbs are we at?
I'm missing something. And so I've got the baked beans and the bun and the peach cobbler.
Mhmm.
What else was on the plate?
A roll and a hot dog. Yeah. The tortilla chips?
Oh, the tortilla chips. Yes. Because you didn't do a roll and a hot dog bun, did you?
I did. No. I did. One a hot dog bun. Yep.
Not a
roll.
So the hot dog bun, the hot dog, the chips, baked baked beans, and the cobbler.
I'm gonna say one I'm gonna say one fifty. And I'm going
Jenny, you're a genius. I this has 153.4.
Woo hoo.
Yeah.
I'm pretty good.
I swear to god. Like, I I thank god this is a job. I don't know what you would do. What what you were gonna add something else. What else did you say?
Oh, I was gonna say some type of, like, a vegetable. Right? Which, again,
would fun. God. Give me
Why not? For fun. And, you know, to to make, I guess, proof in what might not be considered, let's throw in some coleslaw, like, half a cup of coleslaw.
Okay. Well, first, I'm gonna do one thing for me. I'm gonna do a deviled egg. Oh my god. Love it.
Eat oh my god. I love deviled
egg. I do I am a deviled egg person. I I enjoy this. Okay. Hold on a sec.
Cole slaw, Stone Mills, Jenkins, Hans Kissel, rice. They're Walmart store's brand. Let's do Walmart. Okay? Should
we do
half a cup or one ounce?
Let's do a half a cup.
Half a cup. Add to the plate. You said one other thing. What'd you say? I cut you off when I started talking about deviled eggs, Or were you just gonna
say I was I was just gonna say some type of vegetable, like, like carrot sticks and dip or something. But, again, that's not very much, carbohydrate. It's okay. You might have a carrot. Coleslaw.
Well, hold on. For you might have a carrot. Raw carrot, one single serving bag is 2.8 ounces.
Great.
Okay. And
we Must be the baby carrots.
I think so. That put the plate up to a 176.4.
Mhmm.
So now
Right? So now you're counting 20 grams for something when really
Yeah. You're like twenty forty five. Yeah. Yeah. Yeah.
And then the lady, you're like, I'm 300. Diabetes is stupid. But die but let me say this. Diabetes is stupid. But It is.
Yeah. Correct.
Yes. It's
stupid. So I'm gonna send this over to the estimator
Oh.
Just to give it a little look. Why don't you give me
And that was just carbohydrate. We didn't even take into consideration this isn't terribly high protein meal. Honestly, it's just the hot dog part of it. Right?
And then has the protein as 33, the fat is 73, and the carbs is one seventy six.
But look at look at the fat.
Yeah. I know. Oh, that's what I'm saying. But but give me a car give me a carb ratio. Give me a carb ratio of a 15 year old boy.
Running the Numbers: Ratio, Target & Pre-Bolus 27:36
Top of your head.
Oh my god. Could be, like, a one to five or a one to seven.
Let's go seven.
I mean
What would his sensitivity be?
It could be really resistant. Could be 30. I would say 30 or 40.
I will say 40. What do you what what are we gonna target on a day like this at the barbecue? You wanna target, like I mean, I would I always just target 80. I I'm just gonna be honest. But, like, what what what do you think most people are out You there
know, as the when this question came in, it also included the consideration for the active time. Right? Considering all
the exercise yard games, boating. Yeah. Yeah. Right.
All the things to the picture. So if you're really aiming with all of this food in the picture picture and the insulin that would go along with it, I would say aiming for a one twenty would be a safe place to aim. Okay. Still a healthy number. It's not high.
Mhmm.
And it allows you enough wiggle room if and when blood sugar is dropping
Yeah.
Especially if it's dropping fast that you can catch that easier.
I'm gonna make the current BG one twenty just to kinda keep all things equal. I'm not gonna put insulin on board. I'm gonna say there's a stable arrow. Okay. This
I'm gonna plug my computer in because it's gonna die.
Go ahead. Go plug your computer in. So the the the the little app that I made for myself actually caps insulin at twenty five units. It won't let it
It caps insulin?
Yeah. At twenty yeah. It won't let it go over. So I'm gonna have to, like I'm gonna move the cap to a hundred just so I can, like, so I can get its answer. Oh my god.
Yeah. So it says, the the initial bolus would be about 25.1 units. Mhmm. And it's looking for a wave, like a Warsaw bolus over eight hours of 5.64. The theoretical requirement, it believes, to be 30.78.
And it would like to see a twelve minute pre bolus. Only twelve? Jenny's like, for a year. So but but well, all within the the guides of Sure. Yeah.
Yeah. So I think that if you know, I mean, you could run a bunch of different ratios through here in sensitivities to give people a different idea, but I'm just a like, listen. I made this there's this thing on my website, and I it's just there it's there for your education. Like, what I think about that is you can see that, put in what your carb ratio is. I mean, say you're, you know, one to 10 and your sensitivity is it's easier.
You're I don't know. It moves you 70 points. Right?
Right.
And then redo it again. That changing it to one to ten and seventy takes the initial down to 17.6, and the extension still is eight hours, but 3.94, 21.55. I find that to be just an an interesting way to understand how the insulin works. Even if you just, like, said, okay. Well, I'm just gonna take, you know, I'm gonna take the fat down to 50 just to get an idea, and all of a sudden another unit comes off.
And then, you know, like, blah blah blah. Right? It's an interesting way to learn about it is my point.
I think in the in this context too, this whole idea of a day out, cookout, active time, running around the yard, doing a whole bunch of things. Right? And even in this context, I think many adults are going to be a little bit more active too. So not just considering kids activity, but adult activity. Right.
You may be maybe you have you're having a pool party. I guarantee you're probably gonna be in and out of the pool. Mhmm. Or maybe you've got a a volleyball, or maybe you are awesome and you've got sand volleyball right in your backyard.
That'd be awesome. Whatever you need. That would be awesome.
Right? So I think in both context of of ages, it's appropriate to consider that extra amount for fat. Mhmm. That it's telling you to potentially extend over the course of several hours. Could you knowing what you know historically helps about your
I feel like I know what you're gonna say, but go
ahead. Impact with fat Yeah. And your impact with activity. Could you potentially bolus for the food and then let the active time that you know is coming possibly
hit enough
to cover the rest Yeah. You may do that. It may work out totally fine.
Right.
Again, historical view is always helpful to be able to say what were.
But this is just it's listen. We call it a we call it a barbecue, but this is also taking a kid out to the park and snacks and whatever. But it's an interesting it's an interesting mix of a lot of carbs and a lot of movement at the same time.
Mhmm.
Because I think you're I'm a 100% right. There's a high chance you're not gonna need nearly all this insulin.
Pool Time vs. Your CGM 32:33
Correct.
Yeah. And and so if it's your first time, then count it, understand it, be ready for it. But Jenny makes a a great point. Like, hit the carbs, see what happens, maybe the activity will make up the rest of it. Also, I I think I wanna say again, water blocks Bluetooth.
You jump in the pool, your CGM stops being a valuable part of your decision making process. Yes. And that is where a lot of problems pop up for people.
Mhmm.
Because there are you a lot of you are gonna be accustomed to, oh, the algorithm will, like, take away this or do that or it won't bolus or it won't basil for a while because of this. Not if you're in the pool. It's just gonna happen. You know?
Correct. So I I think building into this not only the idea around awareness of what you're actually eating and using a tool even in this case to possibly look some things up that may be out of the ordinary for you.
Yeah.
And then consider the active time, knowing what you know about activity and food and how that's hit you in the past can be beneficial. But then building in a safety parameter to be able to say, well, how often should I actually get myself out of the pool or get myself my son or my daughter or child out of the pool to actually do a finger stick, quite honestly.
Yeah. Now you gotta you just it it it hits you real fast too when
it happens.
Like, especially those little kids, it just you tank out of nowhere. And that's where that's where this becomes even more interesting and why somebody probably asked about it. Because the I would imagine what I see happen is that the fear overwhelms the reality of the carbs. And everyone's probably erring on the side of caution and then running into higher blood sugars later and Mhmm. Being just, I mean, it it just Jenny, do you know you don't have and I I hope you never do, but you don't have a kid with type one.
The Barbecue From Hell — and Doing Your Best 34:31
But No. You get up in the morning, 08:00. It's July 4. You gotta pack everybody up. You already wanna just you just wanna go back to bed already.
And then you gotta drive an hour and a half to your sister in law's house. You know you hate her. And then and then and they got a pool and their one kid is weird, hits the dog and you're like and it's a thousand degrees outside. You drag your ass there and you drag all the shit out of the car and then you look over, your mother-in-law is looking at you and she hasn't liked you in twenty five years. You feel it.
And and and then the kids say, I don't know how they run around and then your brother-in-law is talking and he's blowing smoke in your face. You're like, oh my god. What's happening? I just wanna get out of here. And then you eat the coleslaw and the thing and the kid and then he's disconnected from the blah blah blah.
And then the afternoon happens, everyone plays music you don't like. That happens too. You're sweating, nuts are sticking to your leg, Jenny. Then you climb your ass back, you finally go in the pool because you're like, alright, I'll be a person for a second. Dad, dad, oh, okay.
Back out of the pool again. This has my pod fell off. This is happening. He hit me. Blah blah blah.
It's 08:30 at night. Couple of people light some fireworks, almost kill three of your nieces and nephews. You drag your ass back into your car. You drive in the hour home. Your wife is yelling at you the entire time.
You say, and this is a quote from me, I didn't even wanna go to this. And then and then you get home and spend six hours with a low blood sugar overnight. Yeah. It's exhausting. It really is just terrible.
So I don't listen. Yeah. For me to be honest for the first time, I don't know what you should do. Like, I can tell you what the carbs are and the fat is and what the math would tell you, but then there's the rest of it. I don't know.
Some of you are gonna be more or less active than others. Some of you are using automated systems. Some just do your best. Get out there. Swing your hands.
Hope for the best. That's all. I don't know what
you said.
You know?
No. I think that's a great it's a great point, honestly. It's you do the best that you can in a situation like this.
Mhmm.
And even if it is the best that you counted 20 grams when really it was 50 grams, well, at least you counted something and you put it in.
Right? Something. Yeah.
Some something that I actually thought of as you were talking about what I'm
I thought you were gonna say it. As you talked about your nuts sticking to your leg, I thought you were gonna say, but go ahead. Keep going.
Well, you know, it depends. Your breasts can stick to your body too. I just think it can go both ways for these people. You
know when you lift them up and you just wipe underneath and keep going. Yeah. There
you go. Make it fair. But I was thinking about the fact that, one, this scenario sounds like it's something you have clearly lived through, and this is
I was just thinking, I hope my sister-in-law doesn't hear this.
At all. And I'm so sorry that you've had nastiness like that. I certainly have as well. So it's Yeah. Yeah.
Cover the Carbs, Pack the Go-Bag 37:25
Just you. But in all of it, I was thinking back to the consideration of that bolus. And what made me take pause in terms of the possible highs is that while you may not be considering the fat
Mhmm.
At all, you have under covered the carbs. So if the best thing that you can do is just count and consider the carbohydrate part of this, then consider it almost fully.
Okay.
Because if you're not thinking about the fat or the protein or the six plates of the barbecue meat that your child loves to eat, then at least you've covered the carbs and the activity factor, like I said before. It may hit well enough on the rest of that Mhmm. Without the undercovered initial carbs creating a stable two fifty or 300 that now even the activity isn't hitting because it was so completely undercovered.
Yeah.
Does that make sense?
It does. And nothing we talked about here wouldn't work for an adult either. Right?
Right.
Yeah. Also, I'll tell you a personal preference. I'd like a nice new site on before something like this. Like, I don't wanna I don't I don't say change the site and leave because sometimes a new site doesn't go well. But I love the the site the day before so it's working really well on a day like this.
I try to plan stuff around that, like, you know, bring extra supplies. Listen. I swear. I from running that Facebook group, most of y'all do not bring supplies with you. You have to Right.
Please bring supplies with you. You are just gonna find yourself online going cons I'm I'm in Biloxi. Does somebody have a CGM? Like, they're no. They don't.
And and bring one with you. Okay? Bring
it. Everyone should have a t one d to go bag.
Yeah. And I don't be Yeah.
Parked next to your door. It goes with you out the door. You don't remove things from it unless you literally have to remove something from it.
And then you replace it.
And then you replace it, and it comes back home with you.
Insulin pumps, Dexcoms, Libres. Have please have a glucagon with you. Batteries, chargers, Drinks. Literally That is is stuff for low blood sugars. And then, of course, you know, take it to the you know, when you get to the house, put it somewhere air conditioned.
And, of course, you'll leave and forget it and have to turn around and come back and get it. So that's a 100% gonna happen too, Jenny. Not that that's happened to me 10 times, but wait. Where's your bag? Where's your it's okay.
It's okay. We'll go back.
It's only two hours away.
Right? It's fine. It's okay. I'm gonna have to go go put a password on this little tool that I made for myself so nobody, like, digs around the website and finds it because Oh. I don't know if it's a thing.
I want no. No. If it's a thing, I'm I mean, it works great, but I don't just go to the Just
send it to me. I wanna try it.
Yeah. He's like, oh, great. Yeah. Everyone of those things, yeah. Sure.
The two of you keep it. You I mean, you can go to the website for the USDA. I think it's searchable. But point being listen. It's a it's a it's an AI world.
They have a API. Go ask your favorite, you know, chatbot, whatever. You know, does the USDA have a carb lookup API, and can you build a little tool for me so I can blah blah blah? You'll have it in five seconds. I'm not a genius about this.
It's not it's just not that hard anymore.
It's not that hard.
The world's opening up, Jenny. Okay. Thank you. Go to your party.
No. Thank you.
Please don't blow your fingers off, and don't drink and drive. And that's all I got for you. Bye.
Sounds good. Thank you.
A huge thanks to US Med for sponsoring this episode of the juice box podcast. Don't forget, usmed.com/juicebox. This is where we get our diabetes supplies from. You can as well. Use the link or call (888) 721-1514.
Use the link or call the number, get your free benefits checked so that you can start getting your diabetes supplies the way we do from US Med. Today's episode of the Juice Box podcast was sponsored by the new Tandem Mobi system and Control IQ Plus technology. Learn more and get started today at tandemdiabetes.com/juicebox. Check it out. Alright, guys.
I'm out of here. Do me a favor. If you need or want anything that is sold by one of the sponsors, please use my links. When you do that, you are supporting the production of this podcast, helping to keep it free and plentiful, and you're just helping me out. I pay my electric bill with this money.
I keep the podcast going. I'm not saying buy something you don't want, but I mean, if you're getting an Omnipod, then go to my link. You know what I mean? That kind of thing. Thank you so much for listening.
I'll be back very soon with another episode of the Juice Box podcast.
- Cookout sides are sneakier than they look. The “concoctions” — coleslaw, baked beans, potato salad — often hide added sugar you’d never guess. When you don’t know what went into grandma’s recipe, a quick lookup (a chatbot or the USDA food database) beats a blind “20 or 40.”
- A loaded barbecue plate adds up fast. Scott and Jenny built one realistic plate — hot dog and bun, chips, baked beans, peach cobbler, coleslaw, a deviled egg — and it landed around 175g of carbs with a heavy load of fat. Counting something close beats eyeballing it low.
- Cover the carbs first. If you only get one thing right, get the carbs — fully, not halfway. Under-covering them is what strands you at a stubborn high that even a day of activity won’t pull down. Fat and protein matter, but the carbs are the floor.
- Let the activity do some work. Pools, yard games, and a long active day can mean you need noticeably less insulin than the math suggests. Reasonable play: bolus for the food, aim a little higher (around 120) for wiggle room, and let movement help — remembering water blocks Bluetooth, so your CGM and algorithm go dark in the pool.
- Pack the bag and forgive yourself. Everyone should have a grab-and-go T1D bag by the door — pump and CGM supplies, glucagon, fast sugar, chargers — and yes, you’ll still forget it sometimes. As Scott put it after all the math: do your best, get out there, and hope for the best. A barbecue is carbs and chaos at once; perfect isn’t the goal.
- US Med — Where Scott’s family gets diabetes supplies — an episode sponsor. Or call (888) 721-1514.
- Tandem Mobi — The compact pump with Control-IQ+ technology — an episode sponsor.
- USDA FoodData Central — The free government food & nutrient database Scott uses to look up carb estimates for unlabeled foods.
- Diabetes Pro Tip Series — The fundamentals behind this episode — pre-bolusing, fat and protein, and settings.
- After Dark Collection — The stories no one else talks about — referenced in the intro.
#1892 You'll Get Used to It - Part 2
Part two: after years coded as type 2 — fighting for a pump, scary lows, lasting damage — she takes charge, turns her numbers around, and makes her case for antibody testing.
You’ll Get Used to It
Cold Open & Sponsors 0:00
Hello, friends, and welcome back to another episode of the Juice Box podcast. This is part two of a two part episode. Go look at the title. If you don't recognize it, you haven't heard part one yet. It's probably the episode right before this in your podcast player.
Nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan. If you're new to type one diabetes, begin with the bold beginnings series from the podcast. Don't take my word for it. Listen to what reviewers have said.
Bold beginnings is the best first step. I learned more in those episodes than anywhere else. This is when everything finally clicked. People say it takes the stress out of the early days and replaces it with clarity. They tell me this should come with the diagnosis packet that I got at the hospital.
And after they listen, they recommend it to everyone who's struggling. It's straightforward, practical, and easy to listen to. Bold Beginnings gives you the basics in a way that actually makes sense. Today's episode of the Juice Box podcast is sponsored by the Eversense three sixty five. You can experience the Eversense three sixty five CGM system for as low as $199 for a full year.
Visit evercentcgm.com/juicebox for more details and eligibility. This episode of the juice box podcast is sponsored by the Omnipod five. And at my link, omnipod.com/juicebox, you can get yourself a free what I just say, a free Omnipod five starter kit. Free. Get out of here.
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Coded Type 2: The Pump & Mounjaro Fight 2:23
Uh-huh. For the first time?
Mhmm.
How did they get me approved for Mounjaro? Since I'm a type one diabetic, they relying to my insurance for four years.
Your doctor's office then? Mhmm. Okay.
Yeah. Because when I finally pushed, I've been on a pump for almost exactly a year, actually. It might be a year, like, this week. I had to fight tooth and nail to get on a pump, and it took, like, six months to get it approved because my insurance was like, you're you're a type two. Like, you've been coded as a type two all of this time.
We're not giving you a pump. And I, anyway, threatened to do my doctor. I was like, but lying.
But there are plenty
of people who I know.
Who get pumps as type two.
Grab a pump. I know. Yeah. But it was a big issue. It was a big issue.
And so I think that's how they were able to get me on Mounjaro, which I just try not to look too closely at that. Like, someday, someone at that insurance company is gonna be like, wait a minute.
You know what they say?
Plus one is not equal to. So I'm just hoping nobody catches it.
Yeah. Yeah. You know what they say. Ask me no questions, and I'll tell you no lies.
Exactly. Yeah. I just kinda, like, I just kinda quietly pick up my Mantra every month and just hope no one notices. Thank you. Because it's working really well for me.
And I am still at honeymoon. I do still have some low CPAP ties. So
Mhmm. Wow. How much weight have you lost on the GLP?
I don't know. You know, I didn't really so after I started after the hospital visit and I started taking insulin, my weight went back up. Not all the way back up. Mhmm. But it started going back up, and it really wasn't until I started that GLP in 2022 that's when really the heavy weight was.
So maybe 60 or 70 of the pounds.
And is that That
has been very slow. It's been very slow.
Well, you're me. That's awesome. But are you are you able to talk about it without, like when I ask you how much weight did you lose, is that triggering for you? Or like
Not anymore, no.
No. It would have been at some point though.
Yeah.
Yeah. You'd have been yelling at me about the patriarchy by now if I would have brought that up at a certain point of time. Like, I understand. Okay. Alright.
I know how you are. Goddamn white men. Like, what? I know that's it's just a rabbit hole of complaints.
You're not you're not wrong.
You're not wrong. I'm not wrong. I by the way, I I've I'm on a roll today. I interviewed somebody earlier today. And, like, based on, like, six minutes of conversation, I was like, what do you like?
And I picked out, like, what I thought they did for a living, and she cracked up laughing. She was like, my god. You're so close. I'm embarrassed. And I was like,
get That's help
so funny. But but but but so the the GLP, you said you really it's really helping you. Like, can you contextualize for people? Like, take a take a detour here and tell people what it's done for you. What do you think it's still doing?
Well, so the reason I was put on it wasn't actually for weight loss. That's just like a nice side effect. It's how I see it. Mhmm. The way I did have one, there was one NP.
Because like I said, that's an old Endo. It was a revolving door. People, like, quit every three months at that office. So because I saw a new provider almost every single time, which is I think how I also got lost in in the shuffle part of it. Not that that excuses them.
And she this is one good one. She was like, listen. There's these new medications, these GLP ones. There's some preliminary studies showing that it can help protect the remaining beta cells that you still have that are functioning.
Mhmm.
And it can kinda prolong this honeymoon phase and which I didn't even fully understand what that meant at the time, so nobody could explain it to me. But I was like, okay. There's these cells, and they're dying, and this will help them die slower. She was like, yes. And you might lose some weight.
And I was like, great. I've had a problem losing weight my whole life unless I'm literally starving myself. And so that was my motivation, and that still is my motivation. I mean, somebody could tell me tomorrow, like, you can't be on this GLP one anymore, and I'd be upset about my beta cells, not about any potential weight implications, if that makes sense.
Okay.
And so I think that's why five years in, I am still honeymooning. I mean, I have to be because I still have I think my c peptides were at, like, one or 1.5.
Yeah. I mean, you're not you wouldn't be the first adult who told me that they think that Bounjaro is, like, stretching out their honeymoon.
Impatient With the Honeymoon 6:41
So absolutely is. And, you know, at a certain point, when I finally took the bull by the horns and figured this will die these thing out, I was kinda mad about it. I was and I even asked my new endo. I was like, can I just like, what can I do to kill my beta cells faster? And he looked at me like I grew horns.
And he was like, why would you ask that? I was like, I'm not trying to sound ungrateful. I'm sure every other type one out there would love to trade places with me and still be in their honeymoon, but I'm ready to shit or get off the pot. If I understand this correctly, it's only gonna get worse. It's never gonna get better.
And I kinda like I'm tired of being in this honeymoon phase because it is hard. Like, day to day
Changes.
I don't know. Like, is this gonna be a really insulin sensitive day? Is this gonna be a really resistant day? How much insulin should I put in my pod this time? Am I gonna use all the units or, like, none of the units?
And, like, that part is a little frustrating, and he was he talked me off the ledge, He was like, we're not gonna do that.
Yeah. In a world where we're trading one problem for another one, let's stick with this one longer.
Right? Right. And so I'm I'm I'm fine now. I just I had a momentary. I was like, I'm sick of this.
Let's just kill them all the way and be done with it.
Let's get to the bad part. Can we?
Yes. Yes. Let's get to the bad part faster because then I can tackle it, and I can deal with it and move on.
I agree. I mean, listen, it's not a crazy thing to say out loud. I mean and it sounds like he did a good job of being like, oh, slow down. Yeah. Yeah.
Yeah.
Yeah. Yeah. I'm yeah. I got past it. Yeah.
It Got Worse: Scary Lows, No Supplies 8:09
So so this continued. My AMNC continued in the eighths until May 2024. And something about, like, May to September of twenty twenty four, my diabetes got a whole lot worse. And you can see a trend of, like, a huge drop in C peptides at that point even though it still happened. Mhmm.
There was a big drop. I still was not on a CGM. I was lucky if I tested my blood sugar even once a day. There was no mention of a pump. I still had never met with a diabetes educator.
I didn't even know that was a thing. I didn't know to ask for that.
K.
I had never been given any kind of training, no crappy little book that you get in the hospital, like, nothing. And I started experiencing really scary lows for the first time. I didn't even know that's what was happening. I had two experiences where I was out with my daughter, and it's just her and I, and I had absolutely zero supplies with me. No meter, no sugar, nothing, and had really scary lows where, like, by the time I got myself home and tested, I was still, like, in the forties and fifties.
Okay. I didn't even know that's what was happening.
Couple questions, may I?
Yeah. Mhmm.
Why are you not carrying a meter in your supplies with you? Is it because you don't want to or you don't know that it's even important?
That was still during the phase where I didn't even know this was important.
Okay. And then the other part I always like to ask anybody who finds themselves in this situation, contextually, not to blame anybody. But did you know you were hurting your long term health?
No. I did not. Okay. I know now, and I'm pissed. I'm really angry about it.
Good.
Lasting Damage & Dismissive Care 9:50
Yeah. I have to take I have, like, some permanent damage to some organs and, like, some nerve damage.
You do already? Yeah.
Yeah. I'm really angry about that because, again, now that I know how to read my own labs very proficiently
Mhmm.
I see it. And I see all the warning signs, and I see I had microalbumin in my urine, and I had protein, and I was probably in DKA more than once. And nobody told me. And They would walk they I would walk into the appointment, and they would say, yeah. Her a one c is still a little high.
Like, how often are you testing? And I'd lie. And I'd be like, oh, you know, I'm testing before and after every meal. And they're like, what's your they never downloaded my data. Mhmm.
They were like, what's your average blood sugar? I was like, oh, most of the time when I test, it's one fifty. They were like, okay. Well, you know, keep chipping away at it. That's it.
You do you I'm gonna use some harsh language, but I wanna make sure that I understand. Is it your intention to tell me that you think that these people were looking at you and going, it's just another fat person that doesn't take care of themselves, and we're not gonna try because it's not gonna matter? Yeah. Yeah. That's the that's the care you feel like you were getting.
Yeah. Okay. I'm sorry. Absolutely. I'm just sorry you even said it out loud, but but I appreciate No.
That wasn't I didn't find that harsh at all. I found that honest.
Cool. Alright. Well, I I oh, listen. I mean, somebody's gotta point this out. Apparently, it's me.
I don't know how that happened.
Uh-huh. Yeah.
“I Wouldn’t Have Wasted Four Years” 11:15
I somebody said to me the other day, he's like, so weird, isn't it, that you don't have diabetes? And I was like, I know. I think that a lot. I I really do. Like, of all the people who could've settled into this position, like, how in the hell?
You know what I mean? Why wasn't it one of you guys? And some of them must
be pissed
at by the way, Mary, some people still gotta be mad, don't you think? Don't you think some people turn on and go, hope that this is the popular diabetes podcast made by a guy who doesn't have diabetes? Awesome. You you know people are pissed at me somewhere. Okay.
I don't know. I hide in here. I can't I don't really know if any of you exist. Although I'm going out in the world, I'm going to a talk this weekend. Oh, first of I'm doing a talk tomorrow
That's exciting.
In a hospital, and then I'm gonna I'm driving to Atlanta, and I'm gonna go do a talk in Atlanta.
I love that you do stuff like that. I think that's really important.
It's gonna be fun. And we'll meet a couple 100 people and and say hi, and then I'll have lunch. And then I'm gonna go look at I talk all the time about, like, I should move south. Right? I'm actually gonna go look at a couple of houses on my way home.
Good for you.
Yeah. It's kind of a working fun trip. Scotty doesn't get out here often enough, so I'm gonna take a few days.
Go ahead. If you should. Yeah. You you've more than you've more than earned that.
Well, that's not why I'm doing this. I'm doing this so that I can keep the electric on, and so that you guys can be healthier. I mean, listen.
Here we go.
I gotta tell you something. A web page about type one diabetes and menopause is not gonna draw a lot of traffic to my site. I'm certainly not gonna make any money off of it. If that if you don't hear me say that out loud and think, this guy must really care about us, you're out of your mind. Because, like, there's there's no one no one making content makes content they don't think that they can't get clicks off of.
I'm constantly running around making content for big 12 people. I'm like, here. Yeah. I think you'll love like, this is really gonna help the people. It's gonna help.
I I look at the the sign language page for the bold beginning series all the time.
It does Oh, that you did like
a few clicks a month. And I think
But but it's so important. Yeah. Yeah. Yeah. No.
That's what I love about this podcast and and about you is it's it's just so genuine and so natural. And I don't know. We don't deserve you. No. You're a national treasure.
First of all, you're very kind. And and mostly people just heard how I cook one saving you, man, pivoted the whole thing right onto me, which I'm not gonna lie to you. I did. And I'm just I'm so good at. It's hard not to do sometimes.
You know what mean? Okay.
It's your prerogative.
I've got skills, Mary. They're not all fantastic. No. It really I will later, I'll listen back to our episode at some point. Right?
And and what I think people from the outside will see is like, well, that was self serving or this was that. Like, I'm really doing these things because I think they're making points to people listening Yeah. Which will end up moving them in a certain direction that will help them.
But Well, listen. If I had like, that's why I'm here today. It sounds so trite, and everybody says this, but it's because it's true. If I had listened to a podcast like this with somebody like me back in 2021, I wouldn't have wasted four years of my life
Yeah.
Damaging my organs.
Yeah.
So if one person listens to me rambling with you Mhmm. And has benefited, like, that's that's the goal.
That's how I see all this, actually. So I'm I'm happy for you to add your story to it. But, anyway, I'm sorry. I I No. That's okay.
I did waylay you. I apologize. This episode of the Juice Box podcast is sponsored by the Eversense three sixty five. Get three hundred and sixty five days of comfortable wear without having to change a sensor. When you think of a continuous glucose monitor, you think of a CGM that lasts ten or fourteen days.
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Taking Charge & Finding the Podcast 16:23
No. No. No. It's okay. Well, so just to kinda wrap wrap it up.
So, September 2024, I started taking this all seriously. I actually did join and I'm not gonna talk much about this. This is not why I'm here. I did join a a diabetes coaching program that I found online.
Mhmm.
Did that for a few months. It was like a crash course. Learned a lot of basics. Confronted my endo. We duped it out.
I demanded a CGM. I demanded a pump. Anyway and I and I started sort of this this journey that I'm on now, and I didn't even discover your podcast until literally about I think it was April of last year. Somebody had a birthday party. Somebody you know very well at a birthday party told me about the podcast.
And so, like, the too long didn't read.
Already been
a really good hour in.
Hold on a second. Somebody that I know well at a birthday party told you about my podcast.
Yeah.
Is it somebody I'm related to?
No. No. No. No. It's somebody who's been on the podcast, and he's very active in the Facebook group.
Ryan Hodges?
Ryan. Oh, you said Arizona. I should have guessed Ryan. Yeah. Actually, may I say this right here?
Because I don't know where this else will ever come up. Ryan is gonna come back on the cruise and help me with some stuff, and so we're gonna share a cabin together. So Ryan and I are gonna get to know each other pretty well.
Oh my god. Yeah. That's amazing. And he told me last year that he was going on the cruise. Okay.
So let me tell you how I met Ryan. So he okay. I have a neighbor in my neighborhood. We're friends. She has kids.
We have kids. We're at one of her kid's birthday parties. Ryan is her stepsister's husband.
Okay.
And he was there at the party, and I was there at the party, and he saw me. I didn't even have a CGM at this point. Or maybe maybe I had a CGM. I had a CGM. I didn't have a pump.
And so he saw me, like, take out my pen because I was gonna eat a hot dog. And he was like, oh, are you diabetic? And I was like, yeah. He's like type one or type two? I was like, actually type one.
And we got into this chitchat, and I was really I still I kinda hate when people ask me when I was diagnosed because when you say you were an adult and not a kid, people get confused. And it stresses me out and makes me kind of panic. And and so I think I might have even lied about how long I had been a diabetic to him because I was like, I was so embarrassed. I'm better about that now when people ask me. I'm like, was in my thirties.
You know? And he's like, oh, what pump are you on? I'm like, oh, I'm just MDI. Like, you know, I'm trying to get on the Omnipod, and I just did this coaching program. I've got my a one c down, and and he's like, have you listened to Juice Box?
And I was like, what's that? And he tells me about it. He tells me about the cruise, and I started listening, I think, that day. And, yeah, here we are. I've listened to almost every episode you've produced.
I started in the mid hundreds
Mhmm.
And I've skip I've skipped very few.
What the Podcast Changed 19:13
Well, that's really crazy. Mhmm. Can I Yeah? Can I ask you to contextualize something for me? Because you're in the middle of something that's pretty new.
And this isn't I'm saying this to you because I don't want you to feel that I'm asking you this, but also for the people listening. Like, I'm not asking you to tell me, like, why I'm so terrific. I'm asking you, like, what helped you? Like, what struck you? What made sense?
What led you to something? Were there because there's something about how it's made or how much is available or how it's structured online or, like, can you help me understand how it helps you?
Yeah. I listen on Spotify. When I had found the podcast, I, you know, I had already got wrapped my arms around a lot of the basics that you go over in, like, bold beginnings and the the pro tip series. And, you know, my amnesty was starting to come down, but I still listen to all of those series. And I was like, oh, that actually was explained in a way that's a lot more simple than the way it was just explained to me.
Oh, okay. Kinda reinforced what I've been learning. And for me, it's like, I love listening to people's stories. I think everybody has a story, and everybody has a journey, and everybody is interesting. And being able to listen to these episodes, whether they're the tactical ones or whether they're people storytelling, I I find it really comforting to have a way to connect back to the t one d community consistently and to hear stories that I can relate to even if somebody's experience or journey is very different from mine.
Mhmm. So that's what I that's what I like about it. And I I have a poor group of friends now who have type one diabetes and with ourselves with diabetes and, like, being able to con like, connect to them and talk to them and share stories with them consistently is extremely important and helpful for me. And this podcast is almost a continuation of my diabetes.
Okay. So like, a a
You're my Diabesties, Scott.
Oh, thank you. No one's ever said that to me before.
That was really teasing, but it's true.
No. That that made me feel nice. No one's ever said that to me before.
I think I told you before you recorded. I was like, you don't know me, but you're my friends. Because I've listened to you talk for so long.
Because I don't want you to murder me. I'm gonna say we are friends. It's okay. Don't worry.
Don't worry.
So, basically, you you got some basics, then you had them reinforced, but also simplified, and then Yeah. Community and, like, kinship digitally. Those are kind of the things it did for you. Okay. Mhmm.
That's
awesome. And it's good and it's good reminders. You know? Like, if I have just listened to a podcast that day, I'm less likely to forget to prepos before dinner because it's gonna be on my mind.
So that's the one thing I'm I'm over and over again, like, happy to hear about because, like, it it's such an unintentional, like, benefit of the podcast. Meaning, like, there's no there's no world where I sat down and said, oh, if I give people a touch point, it'll help them stay more involved. I'm sure that would have been obvious had I, you know, I don't had know, I paid attention to like my eleventh grade psychology class. I'm sure that would have been like made, you know, made sense, but it's not a thing I planned. And when people report it back all the time, I'm always very like happy about that because of the way they often talk about it, which is when I'm when I was before, like like, overly focused and, like, burning out on it and not having good outcomes.
But now I feel like I'm aware of it, but it's in the background and it's happening, and I'm on top of it, but not in a way that makes me feel like it's overwhelming. Is that a
100 yeah.
Yeah.
100%. That's where I am today, for sure.
Help Me or Move Out of My Way 22:56
Awesome. That's a quick to get there too in in a year.
Well, you know, I'm pretty I'm pretty driven once I get my head on my ass. I like to do things fast. Once I make once I make a decision, you can help me or you can move out of my way. Right. It just took me longer than usual to make the decision to just take responsibility for this.
It's awesome.
And I and I'm happy to share that now, as of today, my a one c is 5.5.
Woah.
My time in range is almost a 100%, and that's between seventy and one sixty. I'm thinking of bumping that one sixty down, and my standard deviation is 18.
Holy crap. I'm so
good at this.
This is all I heard when you said those numbers. No. I'm just kidding. That's a lot of hard work from you. That's that's really well No.
Seriously.
Sure is. And and it's not just because I'm I mean, I'm sure part of it is, like, I have friends who have had diabetes since they were kids, and their numbers don't look like this. And so I know as I age, like, this will get harder, but it's not just because I'm in my honeymoon. Like, I I work really hard this every single day.
Yeah. No. I I would I I try very hard. Anytime people celebrate with me, I try very hard to remember to say, like, that's a lot of hard work done by you. Very well done.
Like, because a lot of times people will wanna give me credit and I'll just be like, look, I said the stuff and all, but, like, you had to go do it. You know? Like, it's it's a lot of hard work. It is really well done. Congratulations.
That that must be a long
Thank you.
Now is it
It does.
More Than Diabetes: Her Son’s Turnaround 24:26
Is that is that success? Is that translating over to other parts of your life? Are you feeling more confident in other ways? Or is there Yeah.
Is it like
a like a human learning experience that's coming from it? I'm I've never asked anybody that before, but just occurred to
a really interesting question. You know? Yes and no. Back when I was in the thick of figuring out type one diabetes and and how to get my A and T down and how to have tighter control and all of these things, We were also in the middle of the worst two years of our son's life that he's had. Okay.
Things for him are extremely challenging and really scary, and there were some pretty serious real world consequences that were making their way into our home. And and so and I had just started my MBA program on top of working full time, and, like, my home life was was un unraveling. Yeah. Just desperately clawing at anything I couldn't to help this child. And so, again, diabetes was, like, the eighth thing on the list of things for me to be stressed about.
And now all of a sudden, I have this enormous mental load to deal with, and I was really, really, really angry. Because I hadn't I hadn't confronted my anger or my grief yet about being type one until I actually understood what it meant and, like, the foreverness of it. So that was really hard. At the beginning of last year, I was dealing with a lot, and I was very burned out, and the mental load felt impossible. And it feels really good to now to have fought through that Mhmm.
And to have just gritted my teeth and and gotten through it and gotten over it and to now be in a place where diabetes is the fifth most stressful thing on my list because I've learned how to control it. And and we happen to be we had a huge with our son just a few months ago, and he is now in an amazing place and, like, thriving and doing better than he ever has. And so, yeah, just a lot of things right now are going really well. If you had talked to me three months ago, probably would have sounded a lot more pessimistic. But Was it medication?
What'd you find out? Is it a medication, or what'd you figure out?
Mhmm. Yeah. He's he's been medicated for many, many years, but, it was the correct diagnosis and the correct medication. This is when we realized he was bipolar. Mhmm.
So there was a serious mental disorder that had gone undiagnosed that the autism never explained, and I had to call 30 psychiatrists in the county to find one who was willing to evaluate his age, and that's how worked.
Good for you. That's awesome. I did you hear the lady that was on whose daughter was bipolar? And they it took them a long time to get the medication right, and she was so thrilled because there was such an improvement with the medication, but it wasn't like what she would have considered all the way there. But it was good enough that she felt like she could move forward with the girl's life, or the black I can't remember.
A girl's life maybe? Is it? And then they she said, well, now we're gonna try to address her weight, so we put her on a GLP. And a lot of the other bipolar symptoms, I know bipolar is probably not, like, the correct terminology. But, like, symptoms went away with the GLP.
That's really interesting.
Did you hear that one?
I don't remember. I remember that episode. I don't remember that detail. My son is a little bit underweight, though.
Yeah. No. No. No.
Keep weight on him, so I don't but that is really interesting.
All I took from her statement was something about maybe there was a reduction in in inflammation in the kid.
Inflammation.
Yeah.
You know? And we did go down the whole, like, pans pandas rabbit hole with him. Mhmm. And he did not have a single marker for, like, body inflammation, brain inflammation. We tried some medical for that, and it didn't really do anything.
We had tried that child had been on every antipsychotic that exists for his age. He had been on every mood stabilizer that exists for that age. Mhmm. And nothing had truly ever worked until this medication will be done now.
Okay.
And we're thrilled. We're thrilled. And it was kinda interesting. His his psychiatrist who I I mostly have appointments with his psychiatrist. Right?
Like, comes, and then he'll be like, hey. And then he goes off and plays. Like, he doesn't he doesn't wanna talk to this guy. And I remember because his, like, can't evaluate rates, he just prescribed. So we had to go get evaluated somewhere else.
And he was like, so how are you feeling? Because a lot of parents, like, getting a diagnosis of a serious mental disorder can be really heavy. And I was like, are you kidding? I am thrilled. I am ecstatic.
I couldn't be happier because this is identifiable, it's diagnosable, and it's treatable. And the treatment is, like, a very old, long standing, safe, low side effect medication that he can be on for the rest of his life if it's working for him. I was like, I'm thrilled. I said, I I have a chronic disease. I'm a type one diabetic.
I'll I'll be on insulin the rest of my life. This is no different. And that's how we talked to him about it too. You know? Like, the other day, he was watching we're watching survivor as a family, and there's all these pharmaceutical commercials.
And he's like, why does anybody take medication with all these side effects? And he's like, wait. I take medication. I was like, yeah. Take take a step back.
And I was like, I, you know, my body doesn't make insulin, and so that's what I take. And your body doesn't make x y z, and so that's what you take. And, like, the medications we're on are not those medications. It's gonna, like, give you rectal bleeding or whatever it is they talk about. And he was like, oh, okay.
Your rectum will bleed from your eyes. How's that gonna happen? Right. I I the I'll tell you what. Of those commercials, I get why they're supposed to list the side effects in
Of course.
The one thing that I never understand is, you know, it doesn't matter what the drug name is. Right? Like, just let's just say it's Trulicity. And and they'll say, if you're allergic to Trulicity, don't take Trulicity. And I'm like, is that a really a thing we have to say?
Like like,
is Mhmm. Like, right? How do you know you're allergic to it if you've never seen it?
I don't like, are there people out there who are like, oh, I'm allergic to it, but I'm just gonna keep going. Like, I don't like, maybe there is, but, like, that like, I understand the other side effects. Like, if you don't, you know, if if you don't want your if you don't want your asshole to bleed out of your eyes, then don't take it. Like, okay. Thank you.
If you're if I don't know. That does that sentence doesn't make any sense to me. If you're if you have I forget exactly how they put it. It's not allergic. It's if you have something with the drug, don't take the drug.
And I'm like, that really seems like common sense to me. But Oh, yeah.
It's like if there's a sign by the wood chipper, don't stick your hand in the wood chipper. It's, you know, it's a liability. It's just a it's a liability issue. That's all.
The funniest thing mean. I don't know. I laugh every freaking time for every drug when they say that one line. I'm like, yeah. I got it.
Thanks.
Me too.
Awesome. Oh my gosh. Is there anything we didn't talk about that we should have or anything that I've skipped over or didn't get to?
A couple things. Go ahead. If you got a few more minutes.
I got minutes I just don't wanna miss. Okay.
Strength Training & Falling Insulin Needs 31:33
So okay. So one thing I wanna talk to you about, I want your opinion on is something has been happening the last two months, and I'm really freaked out about it. It's a good thing, but it Mhmm. You know, I don't trust good things that happen. They freak me out.
So I've started strength training, which is a very generous way of defining what I'm actually doing on my own.
A pile of books across to our part. Yeah. Yeah.
I'm like I'm like doing, like, pre weights and, like Sure. You know, body for, like, twenty minutes, and I just I'm just trying to get some I have a tone and a loose skin, and I'm just trying to tighten things up and increase my strength and, you know, be able to still pick up my kids and all these things. So for about six weeks, I've been at least twenty minutes a day, like, five days a week. I've been doing the strength training, and in that exact same time frame, my insulin use has gone down by 33%.
Okay. I mean
Which is wild to me. And I'm like, I know that, like, strength training and, like, weight lifting for diabetics can be really great, and it can increase your insulin sensitivity, but, like, that seems extreme. I'm not mad about it. I'm just like, when's the other shoe gonna drop?
Well, no. No. But if if I mean, there's probably a a blend of things there. So you're you're on have you upped your GLP in that time frame too?
No. No.
Okay. So you you started strength chain which may be what means, like, dumbbells and, like Mhmm. Pull downs and just some basic,
like Squats, lunges. Okay. Yeah. Yeah.
And your insulin needs went down how much?
33%. I I went from averaging thirty units a day total across basal and bolus to, like, 18 to 20 a day.
No kidding. Yeah. That's awesome. And have well, have you been losing weight during that time?
No. In fact, a few weeks ago, realized I had gained five pounds, which talk about triggering. I absolutely panicked. And I even had a moment where I was like, I should stop taking insulin and drive my numbers high so that I can lose that weight. And then I very quickly told my wife and my therapist that I was having those feelings.
Mhmm. So you stopped.
Me accountable.
Good for you.
And then I realized two things. One, it was the week before my period. And and and two, I think I'm putting on muscle.
Yeah. I mean, I've I so I've had the same experience after, like, having a lost weight on the GLP. And then I got like, and you're so tracking the number, like, because the number means you're losing fat. Like, there's kinda like that whole thing. And then I got down to a point where I was like, god, I'm I'm actually pretty thin.
Like, let's start moving in the other direction.
Mhmm.
And I added, like, you know again, I'm not like I'm not training for mister Olympia or anything like that. Right? Like, know, trying to ride a bike, go for more walks, rowing machines.
Yeah. I ride bikes too. Yeah.
And and the other thing I did was I added I don't eat enough fiber in my diet, so I add, like, fiber tablets to my day. That has it makes me retain water. So, like, I had to watch the number climb from that. I had to watch the number climb from the from the, you know, the resistance stuff. And it at first, it's a panic because I was trying to lose weight.
And then to see the number go the other direction makes you feel like, oh god. Am I gonna like, am I gonna be 70 pounds heavier the next time I look up? I lost 70 pounds. You know, I put three on and they're all gonna come back. But then it took me me a little bit to realize, like, I'm like, oh, no.
I'm just I'm gonna gain probably five to ten pounds from this very low weight, but my clothes don't fit any differently. I don't look any differently. It's just it's a structural improvement. Yeah. And that's how I that's how I chose to think about it.
Yeah. On And my clothes are fitting better, and, like, things are toning. I put on muscle really, really fast. Awesome. Something about my genetics that's always which I used to hate when I was younger.
So I was like, I don't wanna work out. I don't wanna get bigger. But now I'm like, hell, yeah. I wanna be a strong lady. I wanna put on the muscle.
I just have to not panic when I get on the scale.
Arden went to the gym with her boyfriend twice last week, and she's like, I don't wanna get too jacked. And I'm like, I don't think you're in any like, you know, I I don't I don't think there's any real concern about that. I said, just keep doing what you do, but I think you're
fucked. Yeah.
I don't wanna get too jacked. I'm like, like, I don't think that's gonna happen. But, you know, you're fine. That's awesome. I mean, listen.
I I have to tell you, like, I would just take it. I don't I don't know. I can't sit here and tell you. I mean, honestly, you should probably just ask, you know, a large language model or Google it. But, like I have.
Yeah. I
have. And it has said, like, thirty three percent's a little extreme, but, like, maybe? I'm like, okay.
Well, I
mean Whatever. We'll see what happens.
Yeah. Truth be told, like, are you are you eating differently and you don't realize it too? Like, there maybe there's something else happening you don't realize.
I I mean, I I've been trying to increase my water intake to go right along with the exercise, and my stress levels have come way down. Good. I can have little slumpings to do with it.
Oh, there. See? Now that's a great example. Right? That I didn't think of that, but I'll use my
son. Connected?
I'll use my son as an example. Like, if he doesn't move, he turns into a, like, like a caged tiger. And then if he doesn't move long enough, then the tiger gets angry. Like, you know what I mean? Like, so first, starts pacing, like, you know, it used to be, you know, got when he was younger, he had baseball.
And then as he and he graduated from college and didn't have baseball anymore, and he's like, we're like, hey. You need to find an activity, my friend. Like, you like, you know, go and so he started playing basketball. Like, he goes out. He probably once it's warm out, he's probably playing basketball, like, four nights a week at a park or something like that after work.
Goes and plays golf. Like, you know, taught himself to play golf so he could go play golf and and and that kind of stuff. And when I see him doing those things, personality wise, like stress, all that stuff, he he lightens right up. And if it if the weather goes crappy for a week and he can't go play basketball, you can see him get, you know, tight, I guess, is the way to put it. And Yeah.
And and he's not nearly the only person I've ever heard talk about that. So if your exercise I mean, listen. I don't know the numbers on this, but, like, every bro podcast in the world will yell about this. Like, that that exercise is is more effective for depression than an SSRI. I don't know if that's actually true, but people say it all the time.
And colloquially, people who work out a lot believe their mental health is better. So if you're just lowering anxiety or lowering stress, that could be putting down significantly your insulin needs.
Yeah. And I I mean, I'd say the bulk of my stresses could decrease is just how incredibly well my son is doing right now compared to January. And I I absolutely feel better.
So those are those things overlapping the timeline of you Yeah. Your son got better off? So you had more free time, so you started working out, and then your insolence went down.
Yeah. I think so.
Such a great example of, like, not you know, that very often, we don't know why things are actually happening. Like, put a great example of that. And by the way, we could be wrong about that. It could end up being something else, but that is a reasonable consideration, I think.
Yeah. I think so too.
Yeah. Good for you. Your life got better and you're happier.
Autoimmune Family History 38:55
Yeah. For sure. Yeah. One thing you haven't asked me about, so I'm shocked, Scott. I'm absolutely shocked.
What what have you not asked me that you ask everybody?
Wait. I ask everybody or I ask lesbians with babies?
No. You ask everybody about their family history. Oh. Autoimmune family history.
Well, you said though you you said you said people have type two. There's Hashimoto's. Like, I felt like you went over it, but was there more?
There is more. There is more. That's I was just I was prepared. Talked to my mom yesterday. I made a list.
I want alright.
I'll take that before you go, but I just by the way, like, there's a lesbian couple that's on one time, and the way they inseminated each other, it's like, I should stop making the podcast. I've done it. I was like, I should just run this one over and over again. This one's awesome. So but I I but, you know, you just went to the doctor.
It sounds like that's sounds boring.
Yeah. We just went to the I mean, but I we we both, you know, pushed the syringe at the doctor's office.
These girls simulated intercourse and then did it themselves.
Heard of that. Heard of that. Your your chances are a lot higher in a doctor's office, and it's quite expensive. So we went the medical route.
Okay. Yeah. Yeah. No. I mean, listen.
I I don't know. Well, there's a lot in there I don't have any personal experience with, but but yeah. Yeah. I when she told me, I was like, really? And she goes there.
She started explaining. I was like, okay. So okay. Well, what else is in your family then?
Okay. So we type one in Hashimoto's. My mom has Hashimoto's and Crohn's disease.
Mhmm.
My brother has ulcerative colitis, which is a little on the fence. They're like, some people say it could be autoimmune. I think if that's one of those, they don't really know. My brother has psoriatic arthritis, my other brother. My grandmother had narcolepsy and rheumatoid arthritis.
Oh, you didn't tell me you were Irish.
Yeah. Well, actually, like
Irish English? Like,
I mostly, like, Scottish, Irish, English Okay. German. Almost a fifty fifty split. That's why I put on muscle. So fast.
That comes from German farmers.
Yeah. Let's just say that part of the world. Okay. Here you go.
That part of the world. Okay.
Okay. I got it. Oh, I'm looking. Yeah. I didn't really look at I see your picture now.
You're very Caucasian. I see it.
Yeah. Yeah. Yeah. I'm very white. My skin glows in the dark.
Oh, yeah. I see your is that your
I don't pan.
That's not a married last name. That's your last name. Right?
That's my last name. Yeah. My wife took my last name.
Okay. Oh,
I shouldn't have said that. Whatever. I don't care.
Well, that's okay. Like, you want me
to I've take it got no. I've got a bunch of, like, aunts and uncles and cousins with other random, like like, autoimmune pancreatitis and sarcoidosis. And then my wife, just for fun, and she obviously, we're not related, so this isn't exactly irrelevant. But she has psoriatic arthritis, rheumatoid arthritis, fibromyalgia, and lupus. Dear lord.
Yeah.
That's a lot of thought. And you guys both got
That's awesome.
Over it a couple times, you said, too. Did that make anything worse? Does anybody have long COVID?
Perhaps. Yeah. Per perhaps. Yeah. She you know, she's on so many different treatment plans for these pretty serious autoimmune disorders that it's like, meh.
Yeah. I don't
know if there's anything additional she could be she could be doing for long COVID, but but, yeah, she's really she's extremely resilient and strong.
Okay.
Yeah. I like to hide behind her comma, and I like to hide behind her auto means, this first. It's pretty easy to do.
You may think I'm trouble, but look at this one. A problem. Me feel like nothing's going wrong over here. Well, I appreciate I appreciate you sharing that extra stuff with Thank you very much. I am not surprised that that part of the world is makes people like that for sure.
So Yeah. That's something else though, isn't it? It's I mean, so much you know, it just it just sucks. I you know, obviously, my my wife is like English and Irish and and, you know, my daughter's got other issues too. And it it sucks to watch somebody have to live with all that stuff.
You know what I mean? Like, it's people Yeah. Are tough and they'll joke through it and everything, but you're very nice if nobody had to.
It's a lot. Yeah. Yeah. It's definitely a lot. And you know, I we were concerned about, you know, we're watching our son for signs of anything that my wife has because she gave birth to him.
And we've had our daughter in trial net for the last two years.
Mhmm.
So I am very concerned about her possibly getting type one in the future. So so, yeah, she gets her lab work checked every year. Last year, there were a couple concerning markers, and she has an endocrinologist too. So her her endo is also checking her full thyroid panel every year, all of the diabetes markers every year, all the celiac markers every year. And she had a couple concerning levels and symptoms last year, but then this year, all her levels are fantastic and, like, completely normally in range.
So I'm I'm holding out hope that that she won't become type one. And so okay. So something really interesting. So my grandfather might have been a lotta type one. This is my mom's dad.
He he it was just called diabetes. Mhmm. Like, they're you know, like, type lotta wasn't even introduced until, like, 1993, I think, and he was diagnosed in the eighties. And all I know is he tested his blood sugar before and after every meal, and he couldn't eat until fifteen minutes after he had taken his insulin. And I don't know.
I just and he was diagnosed as an adult. So I just wonder. I think people, as he got older, just assumed he was type two, but I don't know. He needed a he needed a lot of insulin, and he really took care of himself. And he ate very low carbons.
Like, I just I wonder if anybody had ever tested him for for a lot for type one when he was still alive. I wonder if that's what he would have had. And then his dad, because my great grandpa was born in 1893, he died at 49 in 1942 from diabetes complications. And I wonder too. Was that lot of type one?
Because they certainly wouldn't have been able catch that, I don't think.
Yeah. Then I'm you're never gonna know, isn't it? It is Yeah. Isn't the
same to one word about. I yeah. I just want I wonder. Like, am I the first one, or am I just the first one had access to blood tests?
Yeah. No. I know. I heard you say that before that it's it's it's something you wonder about. Yeah.
I don't know. But listen, probably. You you know what I mean? Like, probably, that's what was going on, and they just didn't know what this I mean, listen. You were diagnosed in the February, and it sounds like you they they barely could tell you what was going on with you.
Now you tell me about guys in the eighteen hundreds. Trust me. They didn't know. You know what I mean?
Exactly. Yeah. Yeah. Yeah. So
It it it mean, in the end, it's all very understandable. Like, I mean, it's no one's fault. Like, you can say, oh, it's the system or, you know, they should know or whatever. But I just think in the end, like, this is just how it works. You know I mean?
The One Blood Test She’d Never Skip 45:57
Is.
Although I I do feel like, my soapbox, if I could choose a soapbox to get on and let like, when it would be I I don't think anybody should ever be diagnosed with type two diabetes without having their type one antibodies tested. With the rate at which type one is accelerating and across all populations, that is a hill I will die on. I don't care about the resources. I don't care about insurance policies. It's a blood test.
Mhmm. It's a really simple blood test, and I don't think there's an excuse for anyone to be diagnosed. And and I have since made my dad and brothers go get all their antibodies tested just to triple check that they really are type two, and they aren't. They don't have any antibodies.
But,
I was like, don't trust your doctor. Go ask for this. Go Gotta be your own doctor these days.
Right? No. I I
Yeah. I You do.
I'm glad you did that for certain. And, you know, if you wanted me to be manned at a part of it, I would just say, like, don't look at people and just guess their entire medical history by their weight. Yeah. Like, you know, like, that's just sort of ridiculous. So, I mean, if you wanna I'm not saying that there aren't some physical attributes that could get you moving in a direction, But you can't let it make the decision for you before you even stop and think about it.
It just Yep. Doesn't make any sense either. Because look what it did to you. And and by the way, and you were lucky to get out of it so quickly. I know you're pissed about four years, but I've talked to plenty of people who were treated much longer than that, you know, with with the wrong diagnosis for a lot of different things.
And it always ends up being just somebody somewhere along the way just, you know, make the snap judgment and put them on a path. And, I mean, you've you've talked over and over again today about, you know, I was doing this, but I didn't know. Or I was doing that, but no one told me. Like, I'm I'm just a big proponent of, like, the way you get put on the path in the beginning has a lot to do with where you are, not just a month from now or a year from now, but thirty years from now. And so it's really incumbent on the people who see you first to get you going in the right direction.
And instead, what you got was, you're fat, go lose weight. Mhmm. Yeah. So anyway, I hope people in the medical community listen to this, but I I don't
Me too.
Yeah. Hopefully, they will. Alright. Mary, thank you very much. This was terrific.
I don't know what to call this, but we'll figure that out later.
Thank you so much. I really appreciate it. It was really, really fun talking to you.
You had a good time? That's great. Excellent. I did too. Hold on one second.
Okay? The podcast episode that you just enjoyed was sponsored by Eversense CGM. They make the Eversense three sixty five. That thing lasts a whole year. One insertion.
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Omnipod five is a tube free automated insulin delivery system that's been shown to significantly improve a one c and time and range for people with type one diabetes when they've switched from daily injections. Learn more and get started today at omnipod.com/juicebox. At my link, you can get a free starter kit right now. Terms and conditions apply. Eligibility may vary.
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- Adult-onset type 1 is often coded as type 2 — and that coding follows you. Mary had to push hard for months just to get a pump approved because insurance had her on record as type 2. If you were diagnosed as an adult and the label doesn’t fit, getting the diagnosis (and the billing code) corrected matters for access to tools.
- GLP-1 medication and the honeymoon. Mary was prescribed a GLP-1 partly on early evidence it may help protect remaining beta-cell function and stretch the honeymoon phase. It’s an evolving area — worth a conversation with your endocrinologist about what’s known and whether it fits your situation.
- Carrying low supplies isn’t optional. Mary had frightening lows while out alone with her daughter and nothing on hand to treat them — partly because no one had ever told her it mattered. Always carrying fast sugar and a way to check is basic safety, especially early on.
- Strength training can change insulin needs quickly. Within weeks of starting regular strength work, Mary’s insulin needs dropped sharply — a reminder that exercise (and lower stress) can raise insulin sensitivity. Flag big changes like that to your care team so settings can keep up.
- The blood test Mary wishes everyone got. Her hill to die on: no one should be diagnosed type 2 without antibody testing (GAD65, IA-2, islet cell) to rule out type 1 — it’s simple and inexpensive. This episode also speaks honestly about her recovery from disordered eating; it’s a sensitive topic, and if it resonates, support is available (in the U.S., the National Alliance for Eating Disorders helpline).
- Part 1 — Mary’s Story Begins — The first half: the misdiagnosis years, before she took charge.
- Eversense 365 — The one-year implantable CGM — an episode sponsor. As low as $199 for a full year (eligibility applies).
- Omnipod 5 — The tubeless automated insulin delivery system — an episode sponsor. Free starter kit at the link (terms apply).
- Bold Beginnings Series — The newly-diagnosed starting point — where Mary got her basics.
- Diabetes Pro Tip Series — The settings-and-timing fundamentals Mary leaned on.
- TrialNet — Free type 1 antibody screening for relatives of people with T1D — Mary’s daughter is enrolled.
- National Alliance for Eating Disorders — Helpline and support — this episode touches on recovery from disordered eating.