#1826 Re-thinking Control IQ Plus Technology
Optimization of Control IQ technology , emphasizing correction factors as primary levers and the importance of fresh setting calculations when switching between insulin pumps.
Companies that Support Juicebox
Key Takeaways
- The Power of the Correction Factor: In Tandem's Control IQ system, the correction factor is the most critical setting to optimize. Strengthening this factor makes every five-minute automated delivery and the hourly auto-boluses more aggressive, leading to better time-in-range.
- Avoid Legacy Settings: When switching between different pump systems (e.g., Medtronic to Tandem or Omnipod), do not simply transfer your old settings. Recalculate fresh settings based on current total daily insulin needs to give the new algorithm the best chance of success.
- Settings Drive Success: Research indicates that stronger, more "tight" settings generally lead to improved outcomes. Users should prioritize accurate correction factors over minor tweaks to basal rates or carb ratios.
- Autonomy Predicts Success: Success with type 1 diabetes is strongly linked to a user's genuine interest in their health and their willingness/autonomy to adjust their own pump settings as their needs evolve over time.
- Simplification is Art: Effective diabetes management doesn't require complex 13-page papers; it often boils down to simple strategies like accurate pre-bolusing, understanding food impacts, and using features like "Sleep Activity" mode to target tighter ranges.
Resources Mentioned
- Tandem Mobi & Control IQ: tandemdiabetes.com/juicebox
- Dexcom G7: dexcom.com/juicebox
- Cozy Earth (Code: JUICEBOX): cozyearth.com
- Juicebox Podcast Website: juiceboxpodcast.com
- Wrong Way Recording: wrongwayrecording.com
Introduction and Dr. Laurel Messer's Background
Scott Benner Friends, we're all back together for the next episode of the Juice Box podcast. Welcome.
Laurel Messer Hi, everyone. I am doctor Laurel Messer. I'm vice president of medical affairs at Tandem Diabetes. But even more importantly, I am a fierce advocate for people living with diabetes. I have worked in diabetes technology for over twenty years, and I'm so thrilled to be on this podcast today with Scott.
Scott Benner If this is your first time listening to the Juice Box podcast and you'd like to hear more, download Apple Podcasts or Spotify, really any audio app at all. Look for the Juice Box podcast and follow or subscribe. We put out new content every day that you'll enjoy. Wanna learn more about your diabetes management? Go to juiceboxpodcast.com up in the menu and look for bold beginnings, the diabetes pro tip series, and much more.
Scott Benner This podcast is full of collections and series of information that will help you to live better with insulin. 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 bold with insulin.
Scott Benner This episode is sponsored by Cozy Earth. You can use my offer code juice box at checkout to save 20% off of your entire order at cozyearth.com. Everything from the joggers that I'm actually wearing right now to the sheets I sleep on, the towels I use to dry myself with, and whatever else is available at cozyearth.com. Just use the offer code juice box at checkout.
Scott Benner Today's episode is also sponsored by the Tandem Mobi system, which is powered by Tandem's newest algorithm, Control IQ Plus technology. Tandem Mobi has a predictive algorithm that helps prevent highs and lows and is now available for ages two and up. Learn more and get started today at tandemdiabetes.com/juicebox.
Scott Benner The podcast is also sponsored today by the Dexcom g seven, the same CGM that my daughter wears. Check it out now at dexcom.com/juicebox.
Laurel Messer Hi, everyone. I am doctor Laurel Messer. I'm vice president of medical affairs at Tandem Diabetes. But even more importantly, I am a fierce advocate for people living with diabetes. I have worked in diabetes technology for over twenty years, and I'm so thrilled to be on this podcast today with Scott.
Scott Benner Thank you so much. I have to tell you, you know, I shared this with you before we started, but I just saw something you posted on LinkedIn. I found it interesting, and I reached out to somebody I know at Tandem. And I was like, can I get Laurel on the podcast? And they were like, let's find out. So here you are.
Laurel Messer Absolutely. And that answer is always yes, by the way. Because if I get a chance to talk about my work and why I'm doing it and talking to the people that I do it for, it is always a red letter day. So this be assured, this is the highlight of my day today.
Scott Benner Oh, well, thank you. I will say the same in return. Although, I did feed my chameleon today and it was exhilarating watching him shoot his tongue across and pick up that bug. This is definitely beating that. So tell me, how did you get into this work? Like, what did you I actually, I'll ask a a slightly farther back question. Coming out of high school, going into college, what did you think you were gonna do? What direction had you taken then? And where did how did you get to this point?
The Journey from Broadway Aspirations to Nursing
Laurel Messer Sure. So number one career aspiration was to be on Broadway. I wanted to be in the musical Cats. But it turns out you need to be able to sing, and you need to be able to dance and act, and I can't do any of those. So restricting. My my, like, first high school dream was crushed.
Scott Benner Okay.
Laurel Messer And so I ended up going into, research. I wanted to do, like, genetic counseling or something like that. And I ended up in a lab where I was working with mice and then with cell cultures and then eventually with humans. Yeah. And I looked around and I realized that nurses were doing the majority of the work with people living with chronic conditions. I realized that nursing like, nurses are who meet you where you're at when you're in active crisis. So I went back to school. I have, like, four degrees, but I went back to school for nursing. And the first job I got out of nursing school as my second degree was with a famous pediatric endocrinologist named doctor Peter Chase who hired me over the phone. I have no idea why he was so bold to do that. And he said, I need you to come and run my diabetes technology trials. And I'm like, well, I mean, I know about diabetes, but I don't know what you mean by technology. And so I show up on day one, and we're talking about CGMs that were blinded and had cords attached to them and had plastic shower bags. And I just immersed myself in this to this diabetes technology world. And I'm thinking, it's not Broadway, but it's deeply meaningful. And I I like, on day one, I see how technology can change the lives of people living with diabetes. So I have no regrets, but if Broadway ever called, we would have some competition.
Scott Benner Is Kat's even running? It's not running anymore.
Laurel Messer I don't know, Scott, but it's really important that it stays in our collective, consciousness forever.
Scott Benner I think it's important right now for you to commit to, at the end of this episode, just singing a a stanza from your favorite cat song for us.
Laurel Messer Yes. I will 100% not do that, but thank you.
Scott Benner Well, if you tell the people you're going to it, they might listen till the end.
Laurel Messer Okay. Well, I mean, I'll yeah. I'm a little caught off guard. I'll have to see where we go with this.
Scott Benner My god. Well, okay. So you get this job, and you get brought into the world. Yeah. And I guess what captures you about it? Like, is it is it the helping? Is it the new frontier kind of feeling? Like, what what got your imagination going?
The Human Element of Diabetes Technology
Laurel Messer Yeah. You know what it is? I think it's so diabetes is so front and center all the time. It's not something you take a pill for once a day. It becomes such an intimate part of lived experience. And so, you know, I had these families. So I work primarily in pediatrics. And I have these families who are drawing me into, like, the daily intimate details of their life managing diabetes from onset, from a year in, from five years in, watching children develop through adolescence and and having to figure out how to navigate this on top of all the other social pressures. So it was very quickly addicting human to human. Like, I feel so honored to be brought into someone's intimate journey of their life living with diabetes. And so if we wanna spend our day, you know, feeling like you make a difference, it's journeying with someone who's doing hard things. And people with diabetes do hard things all day every day. So, I mean, it was so quickly part of I want to help people on that journey even though I don't live with it myself.
Scott Benner Are you a caregiver at heart, do you find?
Laurel Messer No. No. No. I think about when my children were small. I'm like, oh, can you please just grow up?
Scott Benner Why do you like strangers better than your own children, Lara?
Laurel Messer Oh my goodness. It's a complicated question. I love my children. But just the like I said, it's just this human privilege to to come along on a journey. I can't always fix. I can't always caretake, but I can be witness, and I can listen, and I can learn something about people's experience beyond my own.
Scott Benner I wish you were just a regular interview because I would dig into your childhood and figure this out, but I don't have the kind of time to...
Laurel Messer And I have a therapist. It's it's really fine.
Scott Benner Have they explained it to you?
Laurel Messer I'm an empath. I mean, yes. I'm an empath. Okay. Hands down.
Scott Benner Well, I'm glad you are. It's a put you you know, life puts you in a good position. So you moved through that. And I guess, like, give me, like, kind of the quick step to how you get to your current, like, job and and and what led to what you wrote.
Laurel Messer Yeah. So, you know, I was a nurse by training at this point. I had an advanced master's in public health, but I wasn't the doctor. I wasn't the study investigator. And as we go, you know, progress through decades of research on CGM, and now there's smart pumps. And now the two are talking to each other, and now we're automating insulin delivery. I realized we were asking all the great clinical physiological questions, but we weren't asking the questions I was interested in, which was like, how does this impact the person with diabetes? What do they feel like when this system when they're wearing this system? How how is their lived experience impacted? So I I gravitated heavily toward more of these, like, quality of life questions. Finally, one of my career mentors just said, look. If you wanna ask those questions, you need to go get your PhD so that you are the scientist asking the questions. So I did. I went and got my PhD in nursing, and my entire dissertation work was spent researching the lived experience of adolescents using CGM. What makes them use it? What makes them not use it? What are some of the characteristics of what makes someone successful using it? And it's so funny because I probably paid $50,000 for that degree, and I'll tell you the secret of my dissertation. Turns out, if people find a technology to be useful, they will use it. If they find it to not be useful or too hard to use, they won't use it. There is my doctoral...
Research and Real-World Value
Scott Benner You're making me laugh because I know by now people who really listen are probably sick of me saying this, but there's a a really well considered person in this space and a person who I have a lot of respect for who, you know, made an announcement a couple years ago that they've been researching I think they said they've been researching something for ten years. They have big news about CGMs. And then they and they you know, it's like, you know, drum roll, please. And turns out if you set your high alarm at a number, you, stay under that number. And I said, yeah. I figured that out, like, six months into using a CGM. I was like, you you had to do a study afterwards just to get the rest of that together, did you? And I appreciate that part of life, but it just you what you just said is, like, you know, that makes everyone you know, we all are, like, online sometimes and see something, and it's like science says, and we're all like, yeah. Yeah. Yeah. We we all knew that. Thanks.
Laurel Messer We've been telling you that for years.
Scott Benner Smiling makes people around you comfortable. Oh, thank god. Yeah. Yep. So But So they use CGMs because they find them valuable. Yes. But why do they let's cut you a break. I'm sure you learn more than that. What is it they find value valuable about them?
Laurel Messer Yeah. I think they it's the peace of mind piece. It's the feeling like something is has their back. Mhmm. I think I I I wrote an analysis once that was called, like, best friend or spy, you know, like deep perspectives on CGM. Because it can also be used very much in adolescence as a tool, not for punishment, but for for adolescents feeling spied on by their parents. But the the places where it really impacts users are when they feel like, you know, they don't have to think about their diabetes all the time because something else is helping them. Yeah. And, really, that that helping piece of automated insulin delivery or CGM or insulin pumps, all of these technologies, they're useful when it works for the person. When they have to spend all their time troubleshooting it and, you know, it it not meeting standards, that's really when you run into this this diabetes burden, this burnout piece of things.
Scott Benner So the phrase, the juice needs to be worth the squeeze is basically what we're talking about here.
Laurel Messer Well, I think that's exactly right on the Juice Box podcast.
Scott Benner I was actually Absolutely. know, it's funny you would think that's why I said it, but it's actually because of this, guy that whose son used to play baseball, with with my son. And sometimes he would just in this very, like, Brooklyn accent go, help. The juice ain't doing very which just ain't worth the squeeze here. And I was like, no. I know. I've never heard that before until you said it to me. But no kidding. You know, I listen. I talk to a lot of people with diabetes, and and I, you know, I just said to somebody from a from a pump company today, no one wants a thing stuck to them. Yeah. Like, right? So you have to give them compelling reasons why they'd put up with that.
Laurel Messer Yeah. And I had, Scott, can I just tell you? Had a 14 year old say to me. I said, this is but this was back when I was in practice. I'm like, this is one of the best things that have ever come, you know, available to people with diabetes. He said, I don't care if it's the best if it sucks.
Scott Benner Yeah.
Laurel Messer And I'm like, well, that's that's very apropos. If you hate it, it doesn't matter how good it is.
Scott Benner It needs to work the way you tell me it's gonna work. Yeah. But, I mean, that really is it. Like, you set an expectation. Yeah. That's right. You just need to meet that. And, really, life's pretty much like this. You just you set an expectation you need to meet it. And once in a while, we can all be accepting of things once in a while not working out. The damnedest thing around, like, this kind of technology is that you're taking an inert object and sticking it into a real life person whose physiology is different from the next person. I think it's amazing how well they work on mass. And yet, if you're one of the people it doesn't work well for, it shuts off on the sixth day or it gives and you that that could literally be just as frustrating and maybe even more so than the unknown that you were experiencing before you put it on.
Moving to Tandem and Product Design
Laurel Messer Yeah. I appreciate that. And kind of getting to your other question of how did I end up where I am, I left academia because I had an opportunity at Tandem. One of the things that compelled me was what you just said. Like, I spend part of I I do a lot of different jobs within Tandem. But one of the things I do is I spend time in our product pipeline, and I say, okay. If you make that product decision, here is how it is going to impact the person on the other end. This is how the lived experience with a person with diabetes is going to change because of that decision you made. And usually, it's for really, really good decisions, but other times, it's like they didn't quite have that perspective of how for many people, certain product decisions are not going to be ideal. And so I think bringing that perspective, again, that people with diabetes have taught me, if I can bring those into early product development, that's how we get to products that really are life changing and we can set appropriate expectations for and then deliver on them.
Scott Benner It's valuable too not to believe, like, from a marketing or a business perspective that you're gonna make something that everyone's gonna like. Yeah. You know what I mean? Like, I I'll tell you. I think the Moby's a great example, and I'm happy to be candid. Like, I have met people who have told me the Moby is the greatest pump they've ever used. They're incredibly happy with it. They couldn't possibly be more happy. And I've met people who said, oh, I saw it. It looked a little big to me, so I skipped it. How are you supposed to take those two people and then make them a thing that they both, like, are gonna go like, oh, that's perfect. Yeah. The way technology sits right now today, I don't think you can make things small enough for everybody to like because I think that has something to do with it. There's form factor, the way you have to carry it. You know, there's a lot to it. I guess my question would be using continuing to use Moby as an example. Like, how does it end up looking like it looks? Like, how does anything end up being what it is at the end? Like, it's you start with an idea. Right? Like Yeah. Is it about just, like, well, we gotta put liquid into it. It's gotta have, like, electron is that is that kinda how it goes? And and how do you how do you help with that?
Sponsorships: Tandem, Dexcom, Cozy Earth
Scott Benner This episode is sponsored by Tandem Diabetes Care. And today, I'm gonna tell you about Tandem's newest pumping algorithm. The Tandem Mobi system with Control IQ Plus technology features auto bolus, which can cover missed meal boluses and help prevent hyperglycemia. It has a dedicated sleep activity setting and is controlled from your personal iPhone. Tandem will help you to check your benefits today through my link, tandemdiabetes.com/juicebox. This is going to help you to get started with Tandem's smallest pump yet that's powered by its best algorithm ever. Control IQ Plus technology helps to keep blood sugars in range by predicting glucose levels thirty minutes ahead, and it adjusts insulin accordingly. You can wear the Tandem Mobi in a number of ways. Wear it on body with a patch like adhesive sleeve that is sold separately, clip it discreetly to your clothing, or slip it into your pocket. Head now to my link, tandemdiabetes.com/juicebox, to check out your benefits and get started today.
Scott Benner The Dexcom g seven is sponsoring this episode of the juice box podcast, and it features a lightning fast thirty minute warm up time. That's right. From the time you put on the Dexcom g seven till the time you're getting readings, thirty minutes. That's pretty great. It also has a twelve hour grace period, so you can swap your sensor when it's convenient for you. All that on top of it being small, accurate, incredibly wearable, and light. These things, in my opinion, make the Dexcom g seven a no brainer. The Dexcom g seven comes with way more than just this. Up to 10 people can follow you. You can use it with type one, type two, or gestational diabetes. It's covered by all sorts of insurances. And, this might be the best part. It might be the best part. Alerts and alarms that are customizable so that you can be alerted at the levels that make sense to you. Dexcom.com/juicebox. Links in the show notes. Links at juiceboxpodcast.com to Dexcom and all of the sponsors. When you use my links, you're supporting the production of the podcast and helping to keep it free and plentiful.
Mobi Design and Customer Input
Laurel Messer Yeah. Well, you know, that's an interesting one. The form factor piece of things, this all happened before I came to Tandem. So I've been at Tandem three years. The Tandem Mobi had already been in development for a long period of time. But, you know, it's one of those things with every product both at Tandem and outside of Tandem. I'm like, oh, well, I have an opinion on that. Sure. There's there's always a lot of good reason things look the way they do, they design the way they are. And, you know, for Tandem Moby, that's been in development a really long time. One thing I asked about when I got to Tandem, I said, why do you have to see the the vial? It makes it look like a medical device. And what they said was when they were, talking to people with diabetes, they said it was really important to them to want to see the cartridge itself. So they intentionally you know, if you look at a tandem Mobi, you can see the, the insulin cartridge, and that was because people with diabetes had spoken into the design saying, we do want to see that. You know? And you can cover it up. You can bedazzle it. People do incredible things to their Moby. I do think, you know, asking people with diabetes is one of the most, like, important sources of information for when you're making product design decisions.
Scott Benner I agree. I'm glad to know people are doing that too. I I have the same feeling when I do ever jump on a website and start using it and think, did the guy who designed this ever try to use it? Yeah. Yeah. Like Yeah. Like, I know it works, but Yeah. Geez, this could have been done 10 better ways, I feel like. You you know? Well, that's really that's interesting. So okay. Yeah. So now I'm gonna just fast forward a little bit. I feel like I know who you are, and I feel like I know what kinda got you here, which is great. But I wanna leave the rest of the time, you know, for the for the paper that I saw. Rethinking Control IQ plus technology, simple strategies for easy optimization. Like, what what gets you to think about that? I mean, you didn't do it yourself. There's a lot of people's names on this paper.
Scott Benner So friends, I just placed my order at cozyearth.com. They're today's sponsor, and I'm here to tell you about them. Use my offer code juice box at checkout when you buy, and you'll save 20% off of your entire order. That's everything in your cart at cozyearth.com. Save 20% with the offer code juice box. Now why am I excited? Well, I just ordered the cozy earth blanket. It's the viscose bamboo blanket. I'm super excited about it. It looks comfy as can be, and it's gonna go so well with the sheets that we already have from Cozy Earth. Now, yeah, I'm a bit of a a Cozy Earth convert, I guess. I'm sitting here in my joggers. I used my towels coming out of the shower this morning. I slept on my sheets last night. Slept like a baby, by the way. Cozyearth.com. They pretty much have everything you want. Use the offer code juice box to save 20% at checkout on skin care, women's and men's clothing, bath and sleeping accessories. And don't forget, Valentine's Day is coming up quickly. Get those pajamas. Cozyearth.com. Use the offer code Juice Box at checkout to save 20 off of your entire order.
Rethinking Control IQ Optimization
Laurel Messer Yeah. I have, like, world class HCPs on this paper from all over the world, but this was probably a brainchild of mine from the last few years. So remember, back when I was at Barbara Davis Center working in pediatric diabetes, I founded a program called the Panther program. And the majority of our time was spent helping HCPs and people living with diabetes understand the differences between devices. So I was very much in the weeds of how every single device works. I still am in the weeds of that, honestly. But trying to simplify this so that people understand the technology they're working with. And then when I came to Tandem, I realized being on the inside, even I had some misconceptions for how Tandem worked even though, honestly, I'd been using it for years before it was even publicly available. I was using it in clinical trials. Mhmm. And I realized that after a product has been out for, you know, five plus years now for Control IQ, there's still a lot of misconceptions about what it is, how to use it, and, much of that was because we've learned it in the last five years. And so I wanted to take an opportunity. It's I'll be honest. It's a long paper, and there's a lot of sections, but I think of it as, like, a primer. So if you just need to know the basics, read the basics part. If you are a person with type two diabetes or a doctor who works with specialty, like, new onset pediatric patients, there's a section for you too. This is not a paper I expect people to read front to back. I want them to take the section that is most meaningful to them and then use it in their practice. Okay. But if I had to give, like, a one liner about what this paper is about is that Control IQ can be used much more simply than I think it's it's typically talked about out in the world.
Scott Benner Well, how do you think people are using it that's more difficult, and what could they change?
Laurel Messer So when we when we teach people about Control IQ, we're like, oh, you can change basal rates. You can change carb ratios. You can change correction factor. And that's fine, but it doesn't give a person very much guidance about how to do that well. And so one of the, first things I did when I came to Tandem three years ago was did an analysis to say, look. What settings are associated with better outcomes? Scott, I really like on your website, you have this, like, setting simulator where people can kinda play around with what doses should I be using because I kinda did the same thing with Control IQ users. And what I found was this is, again, like, doctoral level research that's boiled down to a very simple fact. Stronger settings lead to more time and range. Uh-huh. But what was unique about Control IQ, and this is a big message in the paper and what I wanna get out to everyone out there, is because it works a little bit differently than other systems, you're gonna have to remember correction factor as the most important lever to pull. And I can confidently say that's not true of any other system, which is why I want to make sure that people know that. When they give when they set themselves a really strong correction factor, what they're doing is they're changing every aspect of Control IQ plus automation. So that every five minute insulin delivery is impacted to be more dynamic. The auto boluses that the system gives on top of that once an hour, they are made more aggressive. And then if the user is bolusing and they give a correction dose, that is made more aggressive as well. So one of the key points of simplification is don't worry about all the settings, and don't worry about tweaking it every hour or two hours. Just make sure your correction factor is super tight, and you're gonna see an improvement in time and range. And the data indicate it does not seem to be a large trigger of hypoglycemia in the same way that some other settings could cause hypoglycemia.
Simplifying Diabetes for Mass Impact
Scott Benner I don't know how well you know the podcast, but this is my twelfth year making it. I am up to I'm over 1,800 episodes. I'm telling you all that so that you know that prior to that, I wrote a blog about diabetes too. So February, I started writing the blog. February, I started making the podcast. And I can tell you right now that by the time I got 200 episodes into the podcast, it's when I made the pro tip series because I said to myself, there are things, and I know if I do them, my daughter's a one c stays in the low sixes, the high fives. Right? And they're not incredibly difficult things. And Yeah. You keep talking about, like, there's this this you know, there's a paper. Here it is boiled down. I kept thinking the same thing. Like, I could hand somebody your paper. I don't know what's gonna like, they're gonna go, okay. And I felt the same way about, like, you know, like, about what I was doing. And I and I kept thinking, like, I need to somehow, like, distill diabetes down into t shirt slogans. Yeah. And then teach people, like, you know, here's the slogans. Here's when you might notice them being important. I I have to tell you, like, I I hope this doesn't come off as pompous. I certainly don't mean it that way. I believe I've impact tens of thousands, if not hundreds of thousands of people's lives with diabetes by telling them that if your blood sugar's too high, you probably need more insulin. And if your blood sugar's too low, you might have used too much insulin.
Laurel Messer Do you have a doctorate? That sounds like doctoral level research.
Scott Benner Well, yeah. Yeah. Again, like, you might think I took ten years and $50,000 in a in a in a room full of people to figure this out. And then in the end, what I learned was it's all timing and amount. Yeah. Like, everything about diabetes is using the right amount of insulin at the right time. It doesn't I don't care if you're MDI. I don't care if you're on a static pump, and I don't care if you're on an algorithm. Like, if your settings are wrong going in, you're gonna get junk back out again. And you have to understand the impacts of your food so that you can meet it with insulin, and that's really the whole thing. Yeah. How do you get that thought into someone's head? I used the podcast. Like, right. I I have to tell you, like, we've only been talking for twenty one minutes. I've already tasked my Gemini to take your paper and turn it into a tool to an interactive tool to help people.
Laurel Messer Amazing.
Scott Benner I'm not gonna do that because that's your thing, but you should do that. You see what I'm saying? Like, you Absolutely. Like, because I'm looking at your paper. You're 14 keystrokes away from somebody logging onto a web page and talking to your paper. Yeah. And I just think that's that's what you need. Like, you need you need this stuff to be available for people and meet them. I hate saying meet them where they are because it really feels like you're being pejorative to people. But, like, people have impacts of life, of health, of time, of finance, of all these different things, and they do not I used to think it was because they didn't care enough to do the work for themselves, but now I after doing this for so long, what I believe is is that just life is hard. And and somebody just needs to tell me my blood sugar's high here, like, why? Mhmm. And that's it. Like, you know, it's because you don't know about the fat impact from the cheeseburger and fries you just had. Yeah. Here's a way to cover that. And and there. Now go go, you know, go forth and do your best. So do you have any plans for this information? Like, what are you gonna do with it? Because now you did it. It's here.
Bridging the Gap Between HCPs and Patients
Laurel Messer Yeah. I know. Now that I got the the paper published, we're kind of thinking about ways to make this practical, digestible, available for people. Your, you know, your pro tips idea is excellent. It reminds me reminds me of Van Gogh. He says great the great artist is the simplifier. And we don't need a 13 page paper to talk about simple Control IQ use. We need the top three tips, which are going to help people, you know, both in the moment, but also as they're making settings adjustments. So I'm thinking of how to distill this down and boil it into something tangible and useful, both for HCPs who honestly have a really hard time differentiating between systems, but also for people with diabetes and people using Control IQ Plus.
Scott Benner And you know why that's so necessary? Do have any idea how many people tell me that they go to a doctor's office and they say, hey. I wanna get an Omnipod. And the doctor goes, we don't support Omnipod here. We support Tandem. Or, hey. I wanna get a Tandem. They go, oh, we don't support Tandem here. We support Medtronic or vice versa all over the place. Yeah. And I used to think, like, how long would it take? You know, then you you push the doctor. What do you mean? Well, I don't have any experience with the Medtronic pump, so I don't know how to talk to you about it. Mhmm. Do you have a Saturday afternoon in the Internet? Couldn't you go teach yourself that? Like, is that and then I learned that that might be too big of an ask. You know?
Laurel Messer Yeah. I mean, the the time and capacity of HCPs is limited, But we we also know that's a problem, though, because, you know, historically, people have, you know, seen HCPs as gatekeepers. They say, oh, you're not a good candidate for blank, for an insulin pump, a CGM, an AID system. And what's cool is that from all across the industry, every major manufacturer, more and more data come out that show, like, most people can use these technologies safely and effectively. And I think many of our, you know, I'll be honest. Early in practice, I would I would say, oh, I'm concerned. I don't know if we should put that patient on a pump. They might go into DKA. And I think when we got AI when we got automated insulin delivery, that note probably should have been revised. But even in my own narratives, I'm thinking there's no longer this thought of who's a candidate. It's everyone is a candidate. It's finding the piece that's going to to work the best for them. Yeah. But, yes, it is it is a hard, hard challenge to solve all the things HCPs need to know. So if we can give them, you know, the bullet points, it's gonna equip them to do their job better.
Scott Benner So scary to think that we used to work on a model where if you said something to a doctor, that's what people got told for twenty years afterwards.
Laurel Messer Yeah. I mean, yeah, that's true. Do you know how hard it was to, like, to break people of, like, I don't know, 15 carbs, fifteen minutes as an example? Many still don't know that that's not great advice. Yeah. So if anyone listening still is giving 15 carbs and retesting at 15, go ahead and reduce that number, especially if you're on an automated insulin delivery.
Educating on Pre-Bolusing and Expectations
Scott Benner Listen to my podcast. I'll explain it to you in eight seconds. Also, you know, as much as people like this podcast, in the end, I think that I've won over most of them by telling them how to pre bolus their meals, which should not be a thing. No one should leave their endocrinologist's office thinking that pushing the button and starting to chew happen at the same time. That's insane. How do you either educate physicians so that they go out into the world and spread better information? Or how do you find people who are already out in the world or past that that sticking point and are out there fighting with this this all these technologies. Like, I know you work for Tandem, but, like, listen. Between you and me, they all work pretty well. It ends up being settings and timing and your understanding of food, and there really isn't much more to it than that. Yeah. And so, like, do some of them work better for some people? Yes. Or some of them are more aggressive or some of them are, you know, less input. Like, I mean, can't tell you how many people came up to me recently to show me their eyelet pump at this event I did. And, like, know, like, has and by the way, that was an interesting thing there. Like, I met a few people who were like, I don't really wanna be involved in this. Yeah. Like and you you're not gonna talk them into being more involved in it. They've decided that this is their level of, you know, of of touch points they wanna have, and they're comfortable with it. Like so, I mean, I'm looking I I know this is it probably sounds insane, but I already have a pretty nice model for your your embeddable tool online. It's got a it's got a type one and type two side. It's got a physician side and a patient side. It's got a nice little thing here where you can change your daily dose to see how to set up the the this is what you need. Perfect. I'm seriously I'll tell you what. The world changed about three months ago. Like, I I I'm talking to you and coding this at the same time. If I showed you what I just did when we got done, I'm gonna tell you right now, you could do it yourself. And then let Tandem put some money behind it. Yeah. Let them get off their butts and do something. I'm calling them out right now.
Laurel Messer Yeah. Now I want everybody to do stuff like this. Yeah. No. I think anyway so I love the idea of coding a tool, Scott. I love the idea of making this more tangibly available. And I think the timing piece is really important. Some people need this information upfront. Some people need it when they realize their settings aren't working anymore. Mhmm. Some people need some guidance even in the moment. You know, it's interesting. You're talking about bolus timing. I'm talking about food for insulin. One of the really cool things I'm always thinking about the user who does struggle to maintain adherence to ideal bolusing habits, etcetera. We had such great data in our type two study with Control IQ plus where people were you know, they were doing some simplistic variances of bolus thing, like small, medium, large meals, thirty, sixty, 90 carbs, where they're not, you know, precisely calculating and weighing, etcetera. And they did just as well as the people who were precise carb counting. Who did just as well as the people who were just putting in some fixed units. And I think when I see these things, I get excited about opportunities to reduce some of the cognitive burden. It doesn't go away entirely, but there are strategies to help. You know, like the term meeting people where they're at? I kinda love it because if we can't get them if they're not able to change what they're currently doing, we can give them strategies that will work for them. And that really excites me as an educator.
The Future of Closed-Loop Algorithms
Scott Benner Yeah. First of all, thank you for looking around my website. I appreciate that very much. Yeah. I I I keep I keep saying, like, this far are we off from this kind of stuff being right in the pump? Like Oh, sure. Like, we we gotta be closer to that. Right? Like, we're like, isn't the pump gonna be able to think a little more, or can you just plug it into something that thinks for it and then downloads, like, adjustments to it? I mean, it's Yeah. At this point now and, Laurel, I don't wanna mix the message here. Okay? Because but I've seen people online drop their Dexcom graph into a chatbot and say, hey. With no other like, not not this is my sensitivity. This is my nothing. Just like, do you see what's going wrong here? And it's oddly right about what they did wrong. Yeah. And you know what I mean? And then suddenly, you give them you give it access to, your insulin sensitivity, your carb ratio, stuff like that, and it it's all I keep trying to I'm sorry. I feel like I'm all over the place, but I've been trying to tell people forever. These pumps, they're magical, but they're working off of a few really basic mathematical principles. They're not that complicated on the inside. And, you know what I mean? Like, I just feel like I'm not saying you have to make them more complicated, but I hate that people go out into the world. They get it set up by somebody. I think what's happening is I'm not speaking for you. Is that the doctor that was told 15 carbs fifteen minutes is now in charge of putting you on a pump. Mhmm. And they've been over baseling people for fifteen years because people don't bolus correctly for their food. And then they get worried that that like, you just said earlier, like, the machine will make you low. Like, we're afraid. Like, people have to be super smart to use these things. I also don't find that to be true. Yeah. They set you up with bad settings, set you on your way. You have a slightly better outcome than you had before. They call it a win, and they never talk about it again.
Laurel Messer Yeah. Yeah. I mean, you're you're describing classic therapeutic inertia. You know? It's like, it's good enough. It's not perfect, but, you know, we we did something here. And I do think you're right that there's ways to automate that. But, Scott, I think you actually I think we all wanna think even bigger than that. We should be getting to the place where you have a system that does not require you to be tweaking basal rates and carb ratios and targets. Well, yeah. You Go ahead. do that. Yeah. I mean so and that's really that's, you know, the future of fully closed loop. This is something you know, JDRF back in the day and Aaron Kowalski set this vision for having this eventually a fully closed loop with one or two hormones. I don't know. But I think we are closer than we've ever been. So I'm kind of the way I see this in my brain is I think Control IQ plus is one of the best algorithms out there. I can give you tips about how to make it better. But in five years, I don't wanna give you a single tip on our system. I want an algorithm that is continually adapting to do it itself. Yeah. And so this is a paper I don't wanna write again in five years.
Comparing Automation to "Vibe" Management
Scott Benner No. This is the Yeah. We want we want someone to open up a a app on their phone, and the app has one button. Says, let's go on it. And that's it. Yeah. If what algorithms are doing now is working so well, and I really think it is. I think it's working incredibly incredibly well. Like, going back to you know, going back all those years ago when somebody came on the podcast and said, Scott, why don't you put your daughter on loop? And I was like, what? What is that? And and I tried it, and then I was like, oh, that thing is doing all the stuff I've been doing. Like, you know, temp Basil here, reduce this, up that, put some in, take some out. Like, I was doing that forever. Like, I also wasn't sleeping, and I was going out of my mind. But that's Anyone can be a pancreas if they have a you know, don't have a full time job or anything sleep. Yeah. I yeah. It's really not that hard. Sleep. Not that complicated. I I tell people all the time that through the Night Scout app, I get to watch the loop work. Yeah. And then it it almost reinforced me. I thought, oh, I was right. Like, I actually felt like that. Was like, oh, god. It's doing what I was doing. Yeah. And then, you know, obviously, you know, everybody's got an algorithm working for him at this point. And my gosh. Like, it's still not doing anything all that complicated. All I keep thinking is is what if you just had a little bot in that app that was just constantly assessing and turning those same knobs again, like, on a, like, on a micro level of what it's doing now? And I I mean, there's gotta be a point where if you collect enough data, then you can make parameters that will work for most people and that and that's gotta be it. Right? Isn't that the I I don't know anything. By the way, I barely got through high school, but isn't this I'm right. Right?
Laurel Messer Yeah. Absolutely. Okay. I think that so this is what I you know, I'm learning on the inside being at a company. You can invest dollars and time and development into that type of, you know, engine that helps recommend settings, or you can work on the next algorithm that's going to automate it entirely. Mhmm. And so I I think sort of the way we're thinking about it at Tandem is we are putting all our resources into future algorithmic development that's going to be fully closed loop. And as a second effort, I'm gonna tell you in five bullet points, you probably need a stronger, correction factor. That's something you have to remember as a correct, Control IQ user. I'm telling you that if you're bolus ing regularly, turn on sleep activity all the time, and you're gonna see a tightening of that target. So, like, I think there's ways to give people some practical information and put your development resources into the future of automation, which is gonna be fully closed loop.
Utilizing AI to Decode Experience
Scott Benner Do you know how I made that bolus estimator? No. I took all the episodes of the podcast that deal with management. And I just fed it to an AI, and I said I need you to pull out all the important things about this because that this is what I wanna do with it afterwards.
Laurel Messer That's amazing.
Scott Benner And that was it. I don't know the first thing about coding. I don't know. I'm not a doctor. I see you're certain no one listening should listen to me. Nothing here in the Juice Box podcast should be considered advice medical or otherwise. I'm an idiot. Like, be be clear about that. Okay? I had these ideas in my head. When I did them for my daughter, her a one c stayed in the high fives to low sixes. I recorded my thoughts. I did it with a CDE who gave me, like, her perspective while we were talking back and forth. And over a decade, I hear back from genuinely countless people who have been able to listen to something we said out loud without any techno without any it's not written down anywhere. There's no charts. There's no graphs. It was a vibe. Right? Like, here's the vibe of how I do it. Here's the vibe of how I think about it. Like, oh, you know, are you having trouble bolusing for something because you're afraid you're gonna get low? You should trust that what you know is gonna happen is gonna happen. Like, literally, with that kind of, like I teach. First of all, I don't teach anybody anything. I share how I do my thing. But the way I talk about it is just the way my brain works around it. And then I kept thinking, it's all there. It's in the podcast. But it can't be pulled out because it's not numbers and graphs and letters. Right? Like, it's it's vibe. And I thought, well, I guess it's stuck there forever, it will only ever help the people who are listening to it, who jive with it, who can pull out the meaning and apply it for themselves. Right up until AA got so good about a year ago. And then I thought, oh, no. I can pull it all out of there. And so then I pulled it out. I did, I just did a deep research dive on my own content. I taught the LL about the content itself. Then I had to go out to the Internet and fact check and QC it till the cows came home. And then I brought it back, and I said, these are the rules about how to take good care of yourself with diabetes. What if we if I built an estimator to teach it to other people, what would they need to know? And it's like, well, it needs to know this and this and this and this and and this, and then you put these numbers in here, and we have to take the Warsaw method into account, blah blah blah. And here's the answer. And six weeks ago, I sat down I'm now doing these episodes called bolus four, where we just sit down and walk through how to bolus for an item.
Scott Benner Oh, wow. And people find it really valuable. It just it kind of, you know, contextualizes it and and makes it more colloquial and everything. But we did one recently where I took this concoction. Found online this this recipe. And the girl I do it with, Jenny, she's a CD, CES. She's got type one diabetes for, like, thirty seven years now, Jenny does, and she's a nutritionist. And I just said all I did was gave her the link to the recipe. And I was like, I want you to use, this carb ratio and this sensitivity factor and tell me how to bolus for this. And we did it together back and forth. And while she was doing it on paper and in her head, I was doing it with the estimator, and it came up with the exact same bolus. Wow. It was really awesome.
Recalculating Fresh and Fighting therapeutic Inertia
Laurel Messer That's incredible. Yeah. What a great use of technology.
Scott Benner Yeah. Well, listen. What am I I it seems so complicated, but it's not. Right. There are so many people running around who I mean, listen. Every one of these pump companies is getting calls all day long. The thing don't work. It don't work. You told me it was gonna work. I didn't doing the right thing. And I'm like, these poor people, it's set up wrong. They're putting their insulin at the wrong time. They misunderstand their the impacts of the glycemic index of the food, whatever. Like, it's Yeah. It's not difficult stuff.
Laurel Messer So You know what's interesting? That really brings to light one of the things we're struggling with is it's very common, especially when people are going from one system to another system, they're often just transferring their settings. So, you know, you go from a Medtronic pump to a Control IQ. Mhmm. You just pop in the same settings that you had over there or an Omnipod to Control IQ. And what you realize very quickly is that because all the systems work a little bit differently, this is setting you up not for success. What you're doing is you're you're almost you would have been better if you were coming from MDI and estimating new doses. And so one of the things I'm really pushing, I think it's in this paper as well, is, like, do not use legacy settings across systems. Go ahead and calculate based on your current amount of insulin you need. Like, create those settings new because when you do that, you're giving the system such a better chance to work than, like, taking all of these things that are, like, inappropriate in the new system that worked fine for the other system. Even people who are frustrated with their devices, this is tandem agnostic. But, like, if you're unhappy with how your pump is doing things, recalculate settings because it's gonna give it a fresh start in in kind of its automation piece.
Scott Benner I did a private event a couple weekends ago where I spent a couple of days with, like, a group of about 400 people. Most of them have type one diabetes. And I think I spent most of my time just sitting with people going, okay. Listen. Just start over. Like like, let's make sure your settings are right. Put them back in and start again. Just reset the thing. You're it's...
Laurel Messer It's so simple, and it's so impactful. Yeah. And the one last piece I'd say about Control IQ is one of the common calculations for correction factors, you take the number 1,700, and you divide it by total daily insulin. We know with Control IQ, you can go stronger than that. Do 1,500 divided by TDI, 1,600, but make sure you're recalculating fresh because you're going to just see a lot of those problems from legacy settings evaporate.
Real-Time Optimization
Scott Benner I'm gonna read something. He's gonna freak you out. Okay. I've expanded the Control IQ plus optimization assistant to fully incorporate the core clinical teachings from the paper. Physician mode now includes focus on three pillars of optimization, basal, insulin to carb ratio, and correction factor using the paper's recommended seventeen hundred total daily dose and four fifty total daily dose formulas, user mode. It it's I it already like, everything you know, it already knows about your paper. It's fat. That's amazing. There's a slider here where you move your total daily dose already. Yeah. And it's optimizing in a dashboard, changing your basal, changing your car ratio, your correction factor, and it's showing you on a graph where your graph works now and where it'll work with the the updated settings.
Laurel Messer Oh my god. We gotta talk about this offline.
Scott Benner I know. I know. I'll show it to you. People, you know, people come up and they're like, I don't know what's going on. Like, look at my graph. And I said, well, you know, sometimes I go I it just looks like you don't pre bolus your food. And then and then I I would, you know, I'd open my phone up and I would take out the little thing that I built for myself. And I'm like, how much do you weigh? And then we'd look and I'd say, well, your settings look close. Like, I wouldn't start monkeying with your settings. They look close. I'm like, I would just start pre bolus. Like, do it for a week. Like, promise yourself you're gonna pre bolus for a week, and let's see if this gets better. And as and if it doesn't, then fair enough, then look back at your settings again. Right? Because, you know, that's not the it's not the be all end all of settings, your your weight as a starting point, but it's Pretty close. Gets you there, you know? And then there were some other people where I I would like they'd say, oh, look at my graph. Look at their graph. I put in I go look to their what their settings should be, like, baseline. I'm like, my god. Your basil's way off. Like that and then you can go back to the graph and go that that's why you're high all, like, in these hours here. Like, you did pre bolus your meal. Your carb ratio did work, but not quite well enough, then you just hung forever. Yeah. And and I said, if you bolus this right now, would you come would you go down and bounce back up, or would you go down and stay down? Yeah. And they were like and one lady said, well, I would go down and I bounce back up. And I was like, that's basil. And, like, just simple, like, ideas like that. And you can just see them light up because Yeah. Oftentimes, they've had diabetes for decades. Mhmm. And they don't know what they're doing. You you you know what I mean? Like, they somebody set them on a path.
Clinical Empowerment and Takeaways
Scott Benner We did a series called Grand Rounds a few years ago where I reached out to my Facebook group. I reached out to them and I said, tell me things that you were told a diagnosis that were helpful and things you were told a diagnosis that were not helpful or even detrimental. Yeah. I got back I don't wanna lie, but I think I got back, like, 80 or 90 pages of returns from people. And all we did was synthesize them down, collect them up under categories, like, put them all together. And then I built basically, like, a rule of thumb list for doctors at diagnosis. And then we put together an eight part series about it. Right? Like, what to say and what not to say. Yeah. Like, the cure the cure is in two years. Well well, yeah. Little things like that or, like, because what I think the doctors don't understand is sometimes you say something on day one and two years later, that person still thinks that's a rule. Like, here's one for you. We're gonna put your settings in your pump that you should say the rest of that. They're going to change over time. Like, not like this is it forever. Right. But people don't people take it very especially when they're in that, like Yeah. Freshly diagnosed thing. Everything you say is is gospel. Right? Literal. Very literal. Exactly right. And so, like, you know, we put that whole thing together, and you know what it turns out? It's like, it's a lot of common sense if you're looking at it from the outside, but I could also see how doctors wouldn't know to say some of those things or not say some of those things.
Laurel Messer Yeah. And you know what's also interesting, Scott? I I think clinicians may sometimes, they come in to do a job, they're like, oh, I'm gonna change your settings, and there you go. They don't take it to the next level of, let me teach you how I'm doing that. Let's let's think about how insulin works and how we can sort of do this together, and you can do it on your own as well. You know, it's it's very often you you see a a person with diabetes come in for a clinic visit, and their settings haven't changed since the last time we saw them. But in the meantime, they gained 10 pounds and shot up two inches, and it's like, well, hold on a second. Yeah. You know, I think we could do a better job of empowering people with diabetes to say, you don't have to go to med school, but you can know with Control IQ that your correction factor can has has a lot of room to move. You're growing. Your carb ratio needs to be stronger. Mhmm. You're high. Go ahead and make your basils tighter. Like, we can empower people with diabetes with this knowledge, and we just haven't, I think, done it in a systematically advantageous way.
Scott Benner I'll I'll tell you that what I've learned doing this for all these years is that from for my money, two best predictors of success, I think, are genuine interest in your health and Uh-huh. The autonomy to make changes to your settings. Thoughtful. Yeah. That's it. And and by the way, I recently, just in the last week or so, I've been putting together like, just told you about the grand rounds. I've been putting together I have 72 comments so far working on predictors of success. Like, what do you find to be good predictors of your success with diabetes? And we'll we'll put together a series about that to talk to people about, you know, because in the end, what that means is people who do x find their outcomes come out better. And and, like, I just think that that kind of stuff is is important. But but moreover, if my point was is I don't care how long that predicts the success series ends up. I'm gonna tell you right now, understanding your settings and having the clarity and knowledge to make changes to them, that predicts success with type one diabetes. My weight my weight changed, my activity level changed, I went on a different pump. I just been doing this for a while and things aren't going the way I want. People who can change their settings and aren't waiting for a doctor are gonna do better because most of the time and by the way, I'm a listen. I think there are a million great doctors out there. I'm certainly not bashing anybody. But the the number of times I've seen somebody go to a doctor with a low blood sugar at 2AM, and the doctor turns their basal down at 01:00. And I think, why don't you go back over the last six hours and see what happened with the insulin before you start making decisions about what happened at 02:00? Then they mess up their basal at 01:00, And then that messes up something else. Then they go back again, and they mess it up again somewhere else. And then before you know it, you have 17 different settings, and none of them And they're all just addressing the last problem you made.
Laurel Messer Yeah. Yeah. Yeah. That is so apropos. That is exactly how it works. Yeah. And then you and then you're sitting there in front of the electronic medical record, and you're like, I have to put all of these in? Holy moly.
Scott Benner And then you bump into somebody who knows what they're doing, and then they're trying to they're trying to untangle this disaster.
Laurel Messer Exactly. And that's again, like, start fresh. Good grief. Yeah.
Scott Benner See how I brought it back to that. Exactly.
Laurel Messer I see how you brought it back. That was incredible.
Scott Benner It's not my first day, Laurel. I've been doing this a while.
Laurel Messer Not mine either. I appreciate it. Yeah. What am I not asking you about all this? Like, what do you want people to know? Like, thinking back on that paper, like, what should their takeaways be? More importantly, should you and I be doing a small six part series on the takeaways in this?
Laurel Messer 100% we should be doing that. The the takeaway again, I I I I love this phrase. Control IQ can meet you where you're at. It you know, if you are not able to bolus perfectly, you know, preprandially, this auto bolus really helps cover you. If you don't know how to get better control, this correction factor is your secret sauce. If you bolus all the time and want a tighter target, use sleep activity. And then if there's you know, if you're a child, if you're pregnant, if you're type two, if you're new onset, there's all these different clinical clinically relevant tips in there. And they're not from me. They are from world class physicians who've been doing this for years and years. And so it's like, you're supported, but we can give you some basic tools to do on your own. And at the end of the day, Control IQ is so adaptable. It can meet you where you're at. So that's the takeaway on the paper.
Scott Benner Okay. So I'm gonna tell you that I think if you're interested, what you should do is take all of your knowledge that you have around this, break it into categories Yeah. And that you think we could that you could explain well inside of a thirty minute conversation, and that's how many, like, little sections we should make about this.
Laurel Messer Perfect. I'm I'm game.
Scott Benner Awesome. Because it just it's going to help people. Because for listen. For every person who, you know, says, oh, just give me a tool or tell me the the math or something, I'm gonna tell you that it's my expectation that there are 50 times more people who will never intersect well with that information that way. And this conversational way really works for a lot of people. I really do think it's a it's a great idea, I'm I'm I'm happy to hear that you might be interested because the truth is is I didn't know if you would be or not. Like, I just...
Laurel Messer Oh my god. I love talking about this stuff. I get really passionate about simplifying things for people. That's why I have a Van Gogh quote on my on my wall. But, yeah, these are I want to give anybody simple information that's going to help them on their diabetes journey in an easier way. So 100%, am in.
Scott Benner What's the van Gogh quote?
Laurel Messer The van Gogh quote is the great artist is the simplifier.
Scott Benner That one. Okay. Yeah. Yeah. Yeah. I mean, that speaks deeply to why I do what I do and what I want people to know.
Scott Benner I you know, it's funny from two completely different perspectives, you and I are doing the exact same thing. A 100%. And and I think there's it's gonna take it takes many vehicles and ways to do it. Yeah. And I yeah. I I'm so appreciative of what you do. And that's one of the beautiful things about the diabetes community is there's so much crowdsourcing. There's some there's some concern with that too, but in general, I think people with diabetes learn from other people with diabetes so so well. And I think that's one of the most beautiful parts of this community that's very different than many other medical communities.
Scott Benner Yeah. When we get off, I'm gonna tell you a a quick story about somebody that I I it's already been in the podcast, so people don't need to hear it again from me, but, to to kinda solidify that point. So you feel like we've done a good job with this conversation?
Laurel Messer 100%, Scott.
Scott Benner We're gonna keep talking then. So we're gonna I'm gonna shut this off so nobody else they can't hear anymore, but we're gonna talk about how to do this moving forward. And I'm gonna tell I'm gonna tell you that story. Thank you, Laurel, for doing this. I really appreciate it.
Laurel Messer Oh, 100%. This is great. Thank you, Scott.
Scott Benner A huge thank you to Cozy Earth, a longtime sponsor. Cozyearth.com. Use the offer code juice box at checkout. You will save 20% off of your entire order when you use that code. Don't let me down kids. Head over there now. Get yourself some joggers, some towels, some sheets. Save yourself some money. Support the podcast. Make your life beautiful and comfortable all at the same time. Cozyearth.com. Use the offer code juice box at checkout. Dexcom sponsored this episode of the juice box podcast. Learn more about the Dexcom g seven at my link, dexcom.com/juicebox. 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. Okay. Well, here we are at the end of the episode. You're still with me? Thank you. I really do appreciate that. What else could you do for me? Why don't you tell a friend about the show or leave a five star review? Maybe you could make sure you're following or subscribe in your podcast app, go to YouTube and follow me, or Instagram, TikTok. Oh, gosh. Here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page. You don't wanna miss please, do you not know about the private group? You have to join the private group. As of this recording, it has 74,000 members. They're active talking about diabetes. Whatever you need to know, there's a conversation happening in there right now. And I'm there all the time. Tag me. I'll say hi. My grand rounds series was designed by listeners to tell doctors what they need, and it also helps you to understand what to ask for. There's a mental wellness series that addresses the emotional side of diabetes and practical ways to stay balanced. And when we talk about GLP medications, well, we'll break down what they are, how they may help you, and if they fit into your diabetes management plan. What do these three things have in common? They're all available at juiceboxpodcast.com up in the menu. I know it can be hard to find these things in a podcast app, so we've collected them all for you at juice box podcast dot com. If you have a podcast and you need a fantastic editor, you want Rob from Wrong Way Recording. Listen. Truth be told, I'm, like, 20% smarter when Rob edits me. He takes out all the, like, gaps of time and when I go, and stuff like that. And it just I don't know, man. Like, I listen back and I'm like, why do I sound smarter? And then I remember because I did one smart thing. I hired Rob at wrongwayrecording.com.
