#45 Sugar Surfing with Dr. Stephen Ponder
Ponder in the house!
Enjoy Scott's interview with Dr. Stephen Ponder, the author of Sugar Surfing, the widely recommended book about managing Type 1 diabetes in a more dynamic way. Dr. Ponder is a pediatric endocrinologist and Type 1 diabetic himself (since the 1960s). Dr. Ponder promotes a proactive approach to T1D care. Scott and Dr. Ponder discuss technology changes, micro-bolusing, and bumping and nudging.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
This the 45th episode of The Juicebox Podcast is brought to you by insolate. makers of the Omni pod the world's only tubeless insulin pump. Today's episode. Oh my Dr. Steven ponder, author of the book sugar surfing. I didn't know much about Stephen, a lot of you are hollering at me with emails and messages. You got to have Stephen Potter on the show. You gotta have a seat. All right. Well, here he is. I got him for you. All right. And let me tell you something. Thank you very much. I didn't realize how much I had in common with Dr. Ponder until he and I spoke but I really genuinely think you are going to enjoy listening to his ideas about taking care of type one diabetes. Episode 45 of the Juicebox Podcast with Dr. Steven ponder begins right now. I had this list of people I was hoping to interview for the podcast and before I could even get to Dr. Steven ponder, you guys wouldn't stop sending me emails about it. So I was like, Alright, I'll move him up on my list. Not that he was low on the list to begin with.
Unknown Speaker 1:01
Hello? Dr. Ponder? Yes, sir. Hey,
Scott Benner 1:04
Scott Benner.
Unknown Speaker 1:06
How are you?
Unknown Speaker 1:07
I'm doing good. Good.
Scott Benner 1:09
So I was I was saying as I was, as I was dialing your number, because we start right away. So your your life. I was saying that I had you on a short list of people I wanted to talk to on the podcast, but I couldn't even get down to you on the list. Not even that you were that far down. But I just kept getting emails and messages online. People are like, are you going to have Steven ponder on? Okay, geez, I'll do it. Leave me alone.
Dr. Stephen Ponder 1:36
very flattering. Thank you very much for sharing that with me
Scott Benner 1:38
appreciate it. No, really, I genuinely mean it. Before we get to why people are so anxious to hear from you could you just give me a little bit of a professional background and kind of what led you to where you are now?
Dr. Stephen Ponder 1:55
Well, I've actually lived with Type One Diabetes myself. Since March 1 1966. I became a pediatric endocrinologist after attending diabetes camp in the early 1980s, as a medical student, and basically decided that was the career I wanted to pursue. Even though I'd attended camp when I was younger, about 15 years earlier. It was it made a huge difference to me. And I knew that this was something that, for whatever reason, God gave it to me, I had the option to share what I knew and how I did it with others. And over the next than 35 years, I've I've dedicated one, anywhere from two to three weeks, every summer, working at that camp, and then eventually becoming a pediatrician, and then going on to become a pediatric endocrinologist. And then then dedicating the rest of my professional career to serving children with diabetes and hormonal disorders. And all along that same time working at the Children's camp and doing whatever outreach and advocacy and teaching I could do. And I enjoy teaching people not just resonance, which I'm currently doing right now in context of being a residency director, but also in teaching my patients in the clinic, but even more so recently with the book sugar surfing, and being able to reach a much larger audience in the form of a book. And even prior to that, using social media as an outlet to teach it's the medicine has evolved to the point Scott, where we have less and less time with patients, and there's more and more to know. So things seem to be going in opposite directions. And I had to have some way to do that to bridge that gap. So what I think brought me to your program today was the fact that over the last several years, I was using social media too, as an as a platform to teach patients, many people many which route my patients obviously were just people in general, the public, there was a an outcry, take all those that material and put it in one location. And through the power of crowdsourcing, we were able to do just that, myself and Kevin McMahon, my co authors I've worked with for 15 years and other projects related to diabetes and put that together in the form of the book sugar surfing. And since then, I've just been so amazed at how well it's been received. In the across the world. We've sold in 30 different countries. I've been able to attend or host host workshops from London to San Francisco and all points in between. So it's been a it's been a very enjoyable journey to share a little bit about what I've learned over the half century as I've had type one diabetes, well how
Scott Benner 4:54
much of how much of the way you manage your yourself With type one, it, I'm assuming it changed greatly over the decades because of, you know, technology. But I guess my bigger thought is did your did your overall theory about it change? Or did the technologies change and make your theories easier? Because, I mean, we're going to learn about this while we're talking about the ways that you see, you know, day to day management, and that they're probably significantly different than what most endocrinologist are telling people.
Dr. Stephen Ponder 5:26
Correct? Yeah,
Scott Benner 5:27
yeah. And I think you're gonna see, as we're talking back and forth, that it's a lot, the way a lot of what you're gonna say is going to be things that I'm doing, but they're things that I had to suss out on my own over time and toil, you know. And so so you, first of all, you're diagnosed in the 60s, or you even were even testing every day in the 60s? Or was it just
Dr. Stephen Ponder 5:48
how did that do that? Back in that era, and I mentioned some of this, it's a discussed in the book. Back in that era, all we had were urine testing, we could do blood testing, but it usually involves a sharp Lance, not a lance set, but a lance that they would shove into your finger, typically a thumb and get a large sample of blood and knockouts. And then they would send that to the lab, or they would just simply draw something from an arm vein. And that one single blood sample, presumably done fasting, when you came in, was meant to be a reflection of how well controlled your, your blood sugar was. So we routinely used urine testing. In fact, there's an image of that, that my mom kept in the book. And I had, I still had that book, her the very first logbook that I had, which was basically a ring binder that she had bought at the store, and used a ruler and a pencil to line out the various times of the day that urine is being tested. So we checked anywhere from about four to five times a day urine test, and then like anyone else out there listening over time, sometimes that behavior falls off. So over the following years, it would become less and we would sometimes just check once a day, sometimes, sometimes not at all, but my mom is pretty diligent about making sure that if I go off track that, that I check and it became kind of my routine every morning to to get a sample of urine in a cup and, and take a few drops out and put it in the clinic Test, test tube and drop a tablet in there, watch it boil with some water, and in turn different colors and hope that I had a blue color and not a not a brown or green or worse than orange, that would indicate lots of sugar in there. So that's what we did until 19, eight in the late 70s, early 80s. And by then I was already just starting medical school when that happened, when home blood glucose monitoring came about. And I my first meter weighs about a pound, I still have it sitting across the room. It was a Dexcom. I mean, I mean at Ames spectrophotometer type meter. And so and it took about three or four minutes to check your blood sugar, you had to get a huge sample of blood, you had to let it sit on a pad for a period of time wash it off under the sink, let it dry, and then you need to read it visually. And it was a shade of gray at that point, it wasn't in the colors like you had in the test tubes. And then or put it in this machine where it would give you an estimate based on a needle that will move back and forth as to how much blood sugar how much sugar was in your, in your blood. So we come so much further now and anybody listening to this will think that's just ancient history because tests are all done now with about a microliter of blood with a very tiny sample us from Atlanta that you barely feel when you when you poke yourself, and you get it in five seconds. But it wasn't beginning to all this. And it was by today's standards, pretty barbaric. Yeah, and
Scott Benner 8:43
it's not really that long ago, honestly. I mean, you know, the 60s, probably seem a little longer to go to some people than it does to others, but you're talking about really just seeing a meter in your home in the in the 80s in the early 80s. That's, you know, 25 years, that's not a that's not a that's not a big stretch. The the leaps that get made now are they're so grand, I mean, they they really do appear to just jump forward and big chunks. And so are you one of that technology are you using now for yourself personally, and and what do you talk to people about using for themselves?
Dr. Stephen Ponder 9:16
Well, you know, my technology has been over the years, it's gone back and forth. I was on an insulin pump from the very early days in the early 80s. One of the earlier pumps for approximately 30 years, I was an insulin pump and then I decided to take a break for a while this is around the time that I started using continuous glucose monitoring and my first monitor was actually I tried the Medtronic products earlier in the in the in the late 90s early 2000s and found that not to be very comfortable, I just didn't like wearing them because they were uncomfortable because of the size of the sensor. But then when the avid navigator came out in 2008 I latched on to that fairly quick quickly and I was working at the time with at JJ di and sand in, in San Jose. And I was befriended with Bruce Buckingham and his staff and they advised me that a navigator was a good sensor to use at that time. So I did that. And Jen block who was Bruce's research nurse at wanted to write up wanting to write actually a CGM manual. And she asked me if we wanted to do that together. And I told Jana said, Well, she had already done one, a brief one. And I said, Well, let me just wear this for a while. And so I think we kind of drifted away from each other over time. But over the last, you know, seven years is the period of time I've been using a sensor on and off with a with an insulin pump, and I use an old deltec I have a couple of old deltec pumps, which are not even on the market anymore, but they work perfectly fine. And I have other old pumps that I've accumulated through the years. So to me, the pump is not so much the big deal as the pump operator and that's the principle I kind of live by. So right now currently, I'm using an insolent and Lantus. In fact, I have some CJ o in the in the refrigerator. I'm going to try to try this out. Oh really. And then yeah, and then also the my CGM and I'm wearing a Dexcom right now. In fact, in the process of getting upgraded to a G five fact as of this morning, I was paying for my G five upgrade. So I that's that's my technology, and I have a telecare meter to calibrate it with and I helped create the telecare device a few years ago with Kevin, Kevin was the inventor of the technology, it eventually became telecare. And that's how I, he and I began, our collaboration is doing a lot of research and in that area. So those are my Those are my tools. But honestly, honestly, Scott, it doesn't, I could use information from any sensor. Because I get somewhat agnostic to whether you know the brand name where you get your items, I do think most people would believe that Dexcom is a superior product. And I thought that's what you'll hear from most people in the field over Medtronic, Medtronic is making some very good advances. And then you have Abbott that's coming out with a Libra in Europe. That's also very exciting. So all these companies are racing to, you know, to better each other. And the benefit is to all of us patience, but not so much in terms of the technology. But we need to know how to use this technology. And the book sugar Surfing is really a how to manual on how to do that. It's not, it's not specific about any particular technology. And I always have to make that clear when I'm talking to people because if they if they're not familiar with the book, they'll think I'm endorsing a particular way of life, a meal plan a certain age group pumped versus non sugar serving is totally agnostic, whether you use a pump or whether you take shots, whatever meal plan you choose to eat, how old you are. None of that none of that matters. Sugar syrup is really a how to approach to make better decisions based on having information in the moment. And it challenges the old theory of management, which I adopted and was taught early on, which was static care, static management, you look at things on a spreadsheet and make decisions based on the past as opposed to dynamic management, or making decisions on things that are happening as you speak. And that's what I think you allude to that you've evolved to, and many others that are probably listening to this have been doing for a while. They just didn't have anything to call it like sugar surfing.
Scott Benner 13:22
Yeah, you know, what I find is the most difficult because I talked to a fair amount of people too and and just a couple of different moms this week, actually. And what I found when I was talking to them more more than anything they had been in the in the world of Type One Diabetes for a while now. They had figured out I think what they need to do, but because the message from their endocrinologist is so opposite of what they've seen to be the truth, no one has the confidence to just kind of throw away what they're being told by their doctor and, and do what they what seems to make sense to them. And so, you know, sometimes when I talk to people, all I'm really doing is all I really am is I'm like the bad friend behind you. It's like, Look, if we don't get arrested tonight, like what's this worth? Let's just try, like, you know, like, let's like, let's go crazy today and see what happens. And by crazy all i mean is, let's Pre-Bolus a little bit for meals. Let's um, you know you have a glucose monitor. So let's lean on it a little bit. Let's be a little you know, every everyone seems to err on the side of caution with insulin. I prefer to be a little bold with insulin. You know, like let's let's be a little heavy handed with it. Because I genuinely believe that it is much easier to stop a falling blood sugar and get it to stay balanced than it is to affect a high blood sugar. I think it once your blood sugar gets, you know, over 250 honestly, and then once you're seeing spikes when people spike they really spike and you know 250 300 over 300 you're now you're talking about probably needing more insulin than you think you do. But still erring on the side of caution and then waiting 90 minutes to see that Oh, I'm really only down to like 250 now and then needing to Bolus again by the time To take care of a high blood sugar, sometimes it's five hours. And that just seems Yeah, yeah, that seems horrible to me.
Dr. Stephen Ponder 15:05
Absolutely. Well, you know, yesterday I was flying back from I was in Phoenix, I was speaking for Steve Edelman at TCU. And at the airport in Phoenix, I decided that I chose to have some chips, some tortilla chips. And those tortilla chips. You know, I took what I usually take for when I have Mexican tortilla chips, but they took more of a toll on my blood sugar. But it took me for the amount of carbs that I think were in that in those chips, it took me about 30 units of insulin did turn that trend to pivot back around. And had I been using static standard insulin to carb ratio of formulas, I would have just stayed high the whole time. And if I had waited, you know, the two hours to correct you would have taken six to eight hours to correct to correct a high, I tend to wait to see when things will shelf out or level out when I do a correction. So I want to taking seven units for the chips I another eight units and another eight more units. And as I kept pushing down the trend line, but it would go down to a certain level. And you've seen this too, how many of your listeners have seen zenas, you may drop down from a 250 and drop it down to 190. And it just kind of levels out at 190 goes straight. Rather than using a basil rate to do that I just take another insulin dose to drop that further. But I wait for that shelf to occur where you have at least several lines or things just level out, you feel okay, you don't feel like you're falling and you don't feel like you're rising either. But then once you shelf out like that, and you wait about 20 or 30 minutes, if you feel like doing that, then I hit it again and drop it further. And I just keep I keep dodging and bumping and dropping the line whether it's with insulin or on the on the flip side with with with carbohydrates. And it's usually smaller quantities of carbohydrates that are needed to raise up a 75 to a 90 than it is to obviously drop something from a higher level you're perfectly spot on on that. We all realize that the old formulas that we have just don't work and they've worked in a static thinking world and they're not bad, innately bad, but they're just static. And I think I don't try to poopoo anything I really try to just say this is the next generation it's a paradigm shift is I've been telling people that listen, that we need to move away from static thinking as much as we can, and move those that are ready. And that's many of your listeners from a static model to a dynamic model. And that's what sugar surfing really embraces. It's a more a little bit of an organized way of approaching what you and I, and I'm doing exactly the same thing you're doing. You know, I was noticing that when I see this, I'm seeing things I didn't see before by just simply checking blood sugar's five to six times a day, I was seeing a lot more interesting things about myself, you know, mysteries in some ways, why would certain things work on at one time of the day and different other times why on the same time of the day with the same food, you have different results on Monday that you would get on Tuesday. And so at some point, you come to the realization that diabetes is very chaotic, which I think we all kind of inherently know. But you can actually see it on a sensor screen. But it's also, you know, it can be quite unpredictable. But the only way to deal with unpredictability is have both hands on the wheel and be looking straight ahead, watch your dashboard and drive through it. And I had to deal with that every day, just I'm sure like you do, where what you think is going to work either works more than you expect. And you have to be prepared for that or doesn't work at all. And you have to double down on it or triple down on it like I did before and you can't
Scott Benner 18:34
wait to see. So my my theory is adjusted over time, obviously. And I started out with my daughter was my daughter's 11. Now Arden is 11 years old, but she was diagnosed when she was two. And so there was no I didn't have a glucose monitor than and I would just test at the oddest times to the point where my endo would be like God, her blood sugar seems really horrible. But our agencies not reflecting that. I'm like, Oh, no, I'm testing when you would tell people not to test, like 45 minutes after a meal, you know, because then she's like, Well, why are you doing that? I'm like, well, don't you want to know what's happening? Like, I want to see what's happening. And then so I wanted to CGM before I knew what one was. And, and after I got one. And it took me a little while to get past the fear too, because there is that fear of a low. But once I adjusted my thinking, excuse me, my voice just broke at 44 apparently, I'm going through some sort of a change. But once I once I got over my, my fear of the numbers, I guess, you know, once I stopped thinking of 75 as being like low and and you know, and started using words in my thinking like you were using just now like nudge and bump and those sorts of ideas. And that and then it just after that it was just something a couple years ago that my endo said to me she just offhandedly said, I wish people wouldn't be so scared of using insulin. And I don't know how to get that through to anybody. So I really adjusted my thinking now I will tell you that you know In your chips, you know, story. If Arden eats something, and we're fairly confident, we understand that we have the right carbs, just because you Bolus, that amount of carbs, by the way doesn't mean that it's going to work. And it also doesn't mean that your insulin to carb ratio is wrong, it just, it might mean for like you said, this time of day on this specific day with this food, this isn't gonna work. If I see, first of all, there's got to be a Pre-Bolus for me 15 minutes at the minimum. And, and that's just how, you know, that's for me, I mean, everybody would be different, but I can see where ardens insulin goes in. When it starts working, when it picks up speed almost. And when they add food, like I'm a big fan of letting the carbs and the insulin have their fight at 80 or 90, not at 150 You know, when they're going to push and pull on each other, let them push and pull it at so that if I really miss calculate, you know, a spike means 150, not 250. And at the same time, if after her insulins been in long enough that I can trust that it's doing what it's going to do. If her blood sugar is rising past 150 we readdress it, and I almost will tell you, if if I've made the correct Pre-Bolus. And I think that the insulins working, there's no real amount of time that I won't say we've obviously didn't use enough insulin, because I want to stop that. And I talked and I think about it in terms of enough insulin to stop the arrow and enough insulin then to affect the number. And and I don't I don't really know how to put that into words. But I have a feeling that over the next 40 minutes or so you're going to So does that make sense to you though?
Dr. Stephen Ponder 21:36
No, you're you're doing exactly what I teach. And and you're you're you're evolving like I evolved into this to I started doing the moves you were talking about at relatively higher altitudes just so I'd get a feel for how much insulin how much force a unit of insulin had for me, I call it micro Bolus. And I would I would practice that to the point where if I was on a straight line trend, I'd want to know what is a small amount of insulin I know that worked, I can measure that, can I can I actually get a reproducible, relatively reproducible effect. But I do I do one unit of insulin I was trading at 150 straight just to see. And I did that several times over a period of time. And I got an a feel for what my the sensitivity of the steering, if you will, would be on this vehicle. And the same thing went for carbs, I might be trying to get at 100 straight and you'd say why would you foul that up? Well, I want to see what four grams of carbs do. But I get a four gram glucose tab and I'd sit there and I could find that could an average bump that up about 10 points, and you're sitting still not doing anything to confound things you got to remember, you know, sometimes we're in going into a headwind, sometimes we have a tailwind, sometimes we have a Sidewinder setting something in between. So all these formulas, that's when they start failing is because if we're dropping, if our blood sugar's 120, and we're dropping straight down, that's very different than if we're going straight up. And we're going to get vastly different results in the old days before we really knew about this thought about this way in this in a dynamic way. But we would get all these different results and think it was something that matter with us or something gonna have the insulin or it decided the other thing, but the reality is, you have to know the directionality, the trending of your blood sugars to make the best, best informed consent, that decision about what you do, not to mention the food. And, you know, I had another fascinating example, this happens to me, it's probably happens to Arden every now and then you give her the dose of insulin, you watch that line, you wait for the band, as I say, which is about 15 or 20 minutes later, could be longer. And sometimes no band happens and you've taken the insulin, I've waited an hour, hour and a half and nothing happened. But I had to take a second dose to get that drop. But I could take the carbs that you know that we try to annihilate the two so you don't get much of a rise. But sometimes insulin just doesn't have the effect that you expect it to because there are more forces in our bodies that raise and lower blood sugar than just insulin, stress being one of them. And if you're being stressed or worried about something that alone will create enough of a hormonal surge in your body to offset some of these standard doses of insulin you and I might get for breakfast lunch or dinner
Scott Benner 24:04
that happens Little things like well, first I'll tell you a story that long before when Arden was a was a really a small baby like you know, four years old, there'd be moments where she'd get low, and it was low enough that it was panicky, and you couldn't get her to eat and I more than a handful of times. And this is hilarious, I would imagine to have watched but I've picked a fight with a four year old to get her mad to bring her blood sugar up. And it's worked almost every time I've had it and that was a that was a that was a you know, that was a really, I'm down to nothing here. You don't mean like I really needed to do something, but almost to get into a little combative, like yelling match with her. And then watch her blood sugar come up with no carbs. Nothing at all.
Dr. Stephen Ponder 24:48
Let me give you a suggestion. Maybe you've learned this since then. But this that's a perfect application for low dose or mini dose glucagon Yeah. And and you'd give her in her case you would give her full unit so the standard preparation you prepare for a full low and bumper up because classically we use that when I get phone calls from families about my three, four or five year old is low, but they won't eat anything. But they're not they're not they're not unconscious or anything or having a seizure. And so I said, well get your glucagon mix it up, like you'd give it the full dose but a whole, you know, 100 units of the value and in there just give one unit for every year of age between you know, two and 15 and, and then wait 15 to 20 minutes to recheck. and nine times out of 10 it works on the first attempt. And if it does, on the first attempt, give it a second time and it almost 100% works by the second attempt a typically raising them up to about 100 or 200 100. And 150 doesn't shoot them through the roof and they can nauseated like you would if you gave her a full dose.
Scott Benner 25:45
Yeah, in a real emergency. Yeah, and trust me, I haven't done that in a really long time. But it's just a great example that that, you know, like I said, I I have to Bolus when she plays sports that are competitive. But I don't have to Bolus when she's doing the same type of exercise, but they're not keeping score. Because her adrenaline doesn't kick in.
Dr. Stephen Ponder 26:04
Yeah, you see people do that. They'll they'll tell you the baseball game I had parents asked me to baseball games lectures go all the way up well, and he's all hyped up. He's all stoked to being out there. It's all excitement. That's what you know. And this came up yesterday, the other day at TGI Fridays, and I asked the same question, you know, it's, it's the basic fight or flight reaction that you heard about in high school is that, you know, we're getting this surge of hormones to prepare us for battle or to run away. And both of those demand more glucose for muscles. And so our bodies are hardwired to do that. And if we don't have diabetes, we have insulin to counterbalance that rise from going and becoming excessive. But in me and Arden and others, we have to sometimes deal with an over a huge surge, a tsunami of sorts of high sugar and fruit with no no food consumed whatsoever. And that's all just being internally created or released. Yeah,
Scott Benner 26:59
I just I just talked to a mom this weekend, and she was talking to me about, you know, just recreational Basketball League. And I told her when RM RM plays recreational basketball, I said 10 minutes before the game starts, I Bolus the equivalent of a juice box. And that way if for some reason she doesn't look on this game is particularly important. And she starts to get low. I I know I have something with me that'll that'll make it right again, without bouncing up and down. And at the same time, you know, sometimes it you can see the adrenaline pushes through that Bolus and you have to give her more and then the funny thing is the minute the game stops, and the adrenaline goes away, now you got to go find food because because now all this insulin that was fighting with that adrenaline now suddenly the adrenaline is gone. And I watch her drop. Sometimes it's just there's so much stuff that happens like that, that I don't think an endocrinologist has a fair job most of the time.
Dr. Stephen Ponder 27:50
They don't need your your point earlier, your point earlier making I totally agree with you know, and I will let me go back and answer that question. Yes, I was taught just like anybody else was taught how to do this is very static, very, you know, preachy, almost. And this is the way to do it. And there's a formula for this. And we just got to find the right balance for you and all that stuff. And I was I was a purveyor of that of that information as well for the longest time until I finally realized I feel like I'm in a meeting here. I'm coming out. Yeah, you know, I yeah, I was like that. And I was, and I'm sure I taught people that way. Certainly, I had it. And I had a better understanding of what it felt to be low and high and all that kind of stuff. But I was still preaching the same party line that was coming out from lots of other endocrine centers. And it really wasn't until I started, you know, seeing things in a more dynamic fashion that I could realize it you know, much of our our management is what you just said your friend does the game Bolus, I mean, gives you bonuses for a juice box. It's it's basically you're being proactive, and and our management in a perfect world. Mine, any empowered adult is about half of what I'm doing is what I'm planning. The other half is what I'm reacting to that I couldn't anticipate or just happen so quickly that I have to do something about it. When you're talking about people Arden's age, when she's two, three and four, you're largely in a reactive mode, you can try to be proactive, but you're not always sure that she's going to follow through on what you think she's going to do. As we get older, we get more empowered, and we can at least balance it out to about a 5050. But I there's nothing I can do that begin to anticipate what's going to happen the rest of today. For example, all I know is what I prepared for. And that's the thing is to be prepared and a good sugar surfer is prepared. I've got my insulin and got my juices. I've got my, my fast acting's around, I'm prepared for anything that can come at me. And I just use either frequent blood sugar monitoring is some sugar service, do they don't use the sensor, or I just use the sensor trending, and I make a decision and I factor in what I've just done. What I'm doing right now and what I'm about to do, you're kind of living in the moment and that's why I call it dynamic diabetes management in the moment. That's what sugar Surfing is. And it's intuitive to many people listening to this as it's intuitive to you and intuitive to me that As you said, there's an inertia out there that we have to overcome both with physicians and with patients in read law in regards to insulin, there's this fear of insulin. In fact, I spoke to that, at the TCL Weide to a large group of adult providers about how they are so slow to introduce insulin to people who need it clearly needed in the type two world much less than the type one world. And then you have patients in the type one world who are afraid of insulin because they have one example. One example I they took one unit and they dropped real quick. And then they immediately rule out ever doing anything like that again, well, I understand that fear, if you try something once you get burned once and you will never want to try you're going to you're going to box yourself in a corner. And so at least the sensor gives you ability to get a feel at least early on of how sensitive your system is to insulin. You can micro Bolus as I call it, or micro dose, you know, if you're a kid, and you know, a 10th of a unit can be delivered through a pump, you got to be willing to do a little bit of experimentation with your eyes open, not recklessly, but with a purpose. And then, as I said earlier, practice at higher levels than trying to practice at normal levels just so you get a feel for the sensitivity of the system. And then as you decide to get better, you lower your average down to you know, I want to target I target, I pivot around 100. You've seen that picture, I showed
Scott Benner 31:16
you the pivoting, I started at 150 to 160. I just want to make sure I could just hone in on that level. And aim at that level. Because if you can keep yourself at 150 and affect a 150 then you can do it at 120. And then you can do it 100. And
Unknown Speaker 31:31
exactly.
Scott Benner 31:33
After the break Dr. Ponder and I will continue our conversation about sugar surfing and do not miss at the end of the podcast details on how you can enter a giveaway to win a copy of Dr. Potter's book. But first, before we do that, of all the insulin pumps in the world, how many of them are tubeless I mean, no tubing, no thing to clip to your belt that runs the whole deal and holds the insulin and then the tubing runs from that deal all the way to your infusion set up through your sleeve and down through your pant leg. How many don't have that, that that tube that gets caught and everything. Just one, just the Omnipod. That's it. The Omnipod is the world's only tubeless insulin pump. And they are advertising on today's show. And let's thank them very much. Thank you on the phone. I'm clapping for you, because I really appreciate you supporting the show. Moreover, I appreciate you making this pump. My daughter has been using it for years upon years upon years, and we have had nothing but success and happiness with it. And that's why I'm comfortable accepting the advertisement from insolate further on the pod system. Listen, you're gonna want to know more about the Omni pod. There's really only one way to do that you have to go to WWW dot Miami pod.com forward slash demo and they're in a couple of VC click boxes you put in your name and something else? I don't know exactly. And they're gonna send you a free nonfunctioning pod see how it works? There's absolutely, and you may have heard me say this before, but there's absolutely nothing set in stone here. You don't have any. You know what I mean? There's just no I can't think of the word Oh my god, what's the word? It's a simple word. And all right, listen. But if you really want to, you know, like, support the podcast, sure, you can go to that link I just gave you but if you go into the show notes and click the link there, then they're going to know you came from the show. And that's going to help them be like, hey, let's keep advertising on that Juicebox Podcast, which allows me to, you know, make the Juicebox Podcast. So if you're enjoying the Juicebox Podcast, click on the link, get a demo pod do it today. Oh, I just thought of the word I couldn't remember obligation. There's absolutely no obligation, which means like just because you get the demo pod. You don't really have to do anything after that obligation. What a simple word I couldn't think of one day I realized I had Arden's high threshold on her Dexcom set at 180. And one day, I realized I very rarely ever go over 180 and I started wondering, like, how much of that was my own expectation? Like how much of that was me reacting to seeing her blood sugar getting near to 180 and so I made it, you know, 160 and then I was like, wow, we're not really going over 160 very much. And then so I pushed it to 150. And now I leave it at 150 during school, because I don't you know, I don't want her to alarm constantly. But then I do monitor her remotely with with, you know, the app through the Dexcom and then but we'll Bolus for anything you don't even like if she's 130 at school, and she's been steady at 130 for an hour. We'll take a shot at that. 130 I tried to get her down to 90.
Dr. Stephen Ponder 34:23
Yeah, you know, you're doing that to micro Bolus. And yes, I do that all the time. You know, if I was out working in the yard or playing in the backyard with my dog or something 130s that's rockin I'd find out and I'll adjust those limits. And I think that's another thing that we keep. Everything's plastic everything's adjustable in these in these devices and I routinely reset my limits based on what I'm doing. It's like when I'm driving my car through a narrow concrete barriers I don't leave the cruise control on sit back with one hand on the wheel. You know, I sit down and focus and want to I just you know, you have to adjust to the situation again, dynamic thinking and so a lot of people leave those those alarms set to tight or too loose, and they need to be understanding they can move as much as they want, just as the doctor put them in there doesn't mean you have to leave them at 180. You can you can widen them or narrow them as you need to. And I would say this,
Scott Benner 35:13
and I genuinely believe what I'm about to say. If you make your margins too big, then when you find yourself reacting, then you're always reacting to an emergency. I Oh my God, I'm too high. Oh my god, I'm too low, if it could, because what you and I are talking about right now may seem like a lot of extra work to people, but I find it this is gonna sound crazy. And alarm going off for to look at Arden's blood sugar, actually, I find it easier. This is gonna be I know this is gonna sound strange to people, I find it less strange, less, there's less
Unknown Speaker 35:48
drama,
Scott Benner 35:50
and less stress. And I find it easier to keep Arden's blood sugar in tighter control than I would define it in wider control. Because once you're in that space, it is just bumping and managing a little bit and like, Hey, here's a juice box. But please only take four sips of it, you know not, don't just drink the whole thing blindly, because you're a little low. And so if my expectation is that we're going to be bumping and nudging periodically throughout the day, then there are very few panic situations. Like I just looked back at our 24 hour graph a minute ago Arden's only been over 150, twice in the last 24 hours, once was a spike. And I know it was from food, and once only lasted about 20 minutes, it was just the tail end of something that I kind of didn't catch, right? She also wasn't low for the last 24 hours. And so once you find that space, and you really are comfortable moving in it, it's actually easier because you're not stressed out like oh, my blood sugar is too high, or my son's budget orders too high, or it's too low, or I'm killing them. Like I hear that from parents all the time. Like every time I see their blood sugar high, all I can think is Oh my God, I'm killing them. I'm killing them. And, and so I would rather have the stress of, you know, if one thing is going to stress me out, I'd rather be stressed out that 90 seems like it's possible that that could get low quicker. But I think that what people would notice is that once they get down to that number, there aren't going to be a lot of drastic drops and falls. Because you're going to know how to live at that space. There is genuinely no difference between being able to keep your blood sugar steady at 90 and keeping it steady at 150.
Dr. Stephen Ponder 37:21
Well, you know, I wrote about this a while back, you probably repost this one that you're you're in what I call the glycaemic slipstream, and it's totally at I mean, I'm there right now, I'm 96. I've been trending straight for the last several hours. And I use the slip seems kind of exotic term, but I try to explain to the kids, it's like, imagine if you have your pet hamster and you're sitting down on the floor, you want to keep them near you. You just as long as you can put your hand out there and nudge that hamster back towards you. And don't let it get across the room, we have to get up and go fetch it and bring it back or go up here, grab it under the couch. It's not much effort to keep that hamster nearby. As long as using little nudges and bumps with your hand. It's always
Scott Benner 37:59
within reach. Yeah, always,
Dr. Stephen Ponder 38:01
always keep it within reach. And when it gets out of reach, and then think about the extra work it takes for you to get up, go over there, look for the hamster go find it and all that stuff. And I use a lot of metaphors and teaching kids that they they can relate to that. But you're exactly right. If you're in that that slipstream that, that that easy range that you don't need a lot of just a little maneuvering, just your micro thrusters basically up and down to stay along the line you want to go. And when you're then when you're faced with whatever challenge whether it's by a basket of chips, like yesterday at the Phoenix airport, or if you want to have that hamburger or whatever she likes to eat, that may be challenging, but you're ready for it, and you plan ahead for it, and you go do it, I don't think anybody should be denied doing what they want to do. Because my goal for anybody with diabetes, to have a normal life not to have a normal agency, I mean that that can come with the other but you should order them appropriately. It's about living a normal life and doing the things you want to do. And just finding the best choices you can make to make that possible. If it slips away, there's no guilt in that there's no guilt in my foot, my blood sugar went up to 180. Last night, I just dealt with it and the fact that I can take it take it on and bring it down just like you and Arden can that says a your sugar syrup or supreme I can tell that. But that's what it takes. And people can do that they have to let go of a lot of old baggage that people like me, in the past gave them in terms of what diabetes is, you know, it's I used to it's called learned helplessness. We teach people to fear this disease for certain reasons. And I think we kind of part of our brain understands why we don't want people to be reckless, but at the same time we disabled people if we go too far with it, and we routinely go too far with it as an institution. So that's my criticism of my own profession, that we are too paternalistic about it. We don't give people enough our make their own decisions. And there are a lot of people out there who are fully capable of making those decisions and doing them very prudently. And sugar surfing was just a way of putting all that in one place for people to it. There are no graphs or charts and it's just annotated images and a while through how you can find your do your own discovery. And you're doing that you've been doing that and and you and many other people, I, I, somebody told me that, you know, what is sugar serving? Well, I didn't Bill Gates didn't create the computer. He didn't create computer languages, but he made Windows and Windows changed computers. And I think this could be in my mind kind of like Windows is to, to how we started the topic became more engaged with computers and writing code and everything and using dos back in the old days, that that's kind of how I see shoulder surfing, it's dynamic as well, and allows you to individualize your diabetes, which is what we say, We want people to have individualized control, let's let's give it to them, you know, they need to free our people here, guy. That's what we need to do.
Scott Benner 40:43
You know, it's funny when you talk about that, like, I've been handed literature over the years. And and I'm not a I'm not the brightest person you're ever gonna meet. But But I'm doing okay. And I've been I've been handed literature over the years, and I've looked at it and thought, I don't I, what is this? You know, like, what do I what's the glycemic index? What's this? What are you telling me about, like, right now, like, my kid just got diagnosed with Type One Diabetes, I don't even 100% know what that means. But if someone would have said to me, You know what, try to keep it as steady as you can. And if it's going up, or if it's high, you don't have enough insulin. And if it's low, or dropping too fast, give too much insulin, like if they if someone could have over simplified it for me a little bit, instead of making it sound scary, and mathematical. And you know, and I see people still like, I wish I could help. I said to someone the other day, I don't do any of the things that you probably think I do. I've never once given a logbook to an endocrinologist. And my daughter's a once he has been right at sex for the last two years. She doesn't have a lot of lows, maybe one a month. You know, her graph is not Rocky, you know, don't get me wrong Sunday, sometimes your your infusion set starts going bad before you expect it to and, and then you know, you get a little high for a while and you have to you have to fix it. But But you know, I don't hand in logbooks. No one's ever downloaded my meter. You know, I never taken a class with a dietitian, I just try really hard to keep our blood sugar steady, you know, with with food and with insulin. You know, I had somebody say to me, you know, recently, and it's a great interview with a woman named Beth. her son's blood sugar was always 200. And she started getting into a position where that was comfortable for her. And so they they stopped trying, I think they stopped trying. But as you talk to them, you could tell they thought they were still trying. But as we spoke together, she realized she wasn't. And in the end, I just said her. I'm like Bethlehem. And I'm not in the I'm not the advice game here. I said, but if your blood sugar's 200, you're not using enough insulin. I don't really think it's much more difficult. You know, and so use some more and see what happens. And she did. And now everything is actually much better for so that's good. No, good. Yeah. And that's what you're, you know, reactive, to say the least, right? Because it is difficult to sit around and imagine all of the processes that are happening inside of my body right now. But they are probably too numerous to count. And so every time you get up and move, or get stressed out or depressed or sad or happy, or eat something or drink something, or trip and fall, Arden got hit in the knee with a softball three weeks ago, her blood sugar was high for three days. Yeah, you know, and so and you can't just sit back and say, Well, okay, I guess my blood sugar is gonna be high for three days, because I got hit in the knee with a softball, you have to do something about it. You know, you can't just say, you can't just say, well, I'll wait two, three months and go back and see what the end. Oh, thanks.
Dr. Stephen Ponder 43:45
You know, back to your point about how we teach it. It's interesting, we teach how we teach diabetes and versus I think it's a practical skill. And that's what you're demonstrating. You're looking you're approaching it as I do, which is a skill. If I were to teach you how to play golf, but actually teach you how many, you know, meters per second, the golf club needed to go through the ball and how what angle you stood at, you'd look look funny at me, you know, you just get out there, you'd take your stance, I'd probably position you and I've watched you hit a few balls and you had to go hit about a few 1000 balls. As you got better. Just like when I played tennis had to do the same thing. I aimed at a certain part of the court, we had carpets and mats and we put so I could serve to the backhand corner. And so those are all just integrative holistic type of, you know, acts that I did. And in a way that's what we're doing. Now with diabetes, we have a certain skill set, we know how insulin works, we know we have the ability now to see it the action with a CGM or frequent monitoring. And we know the basics of how certain foods work in fact, you know, your top 10 lists for art and you know, I always advise no the top 10 lists for all your breakfast lunch and dinner sitting you know, the glycaemic fingerprint, generally speaking of those meal products that when you do feeder, but that's how we teach people to do sports. We have them just watch practice. You know, we'll demonstrate for them as well. But with with diabetes, we made it a numbers game, as you said, and it just doesn't work and it doesn't work, you know, the world is the body is too flexible, and it's always in constant motion, and it gets you halfway. And I don't want to totally disregard the standard formulas that we issue to people. But I tell people, they're just a starting point. And they're just what you throw down there. And then you make decisions based on the situation. And other factors that only you will know, because it's your child or your body, that sort of thing. And that's again, that's that's the independence that being a sugar surfer provides you.
Scott Benner 45:39
Yeah, and I think you're right, I think it is a starting point. I think that's why it's given that way. But what I would further say about that is, then there's too much time in between when you're given that starting point. And when you're given the next steps, you know, and and how much of that do you think is I always imagine it's least common denominator medicine, like you don't you see, if you see 10 families in a day, you don't know their backgrounds, you don't know, you know, you don't know what they're good at what they struggle with, you know, that kind of thing. So you have to do you see doctors doing that like taking things down to the lowest common denominator, so they don't overwhelm a person, but doesn't that end up leaving a bunch of people behind then who could have accepted more and would have understood better?
Dr. Stephen Ponder 46:21
It does, if you're being seen a bad practice, it's not terribly sophisticated, everything will be cookie cutter out like that your rights, you know, in a lot of sophisticated intergroup practices, they're going to hopefully, have an educator or the doctor himself or herself will know this. And they will, they will say this is a really sharp individual, a sharp family, we can really push them a little bit. And we can give them some fairly advanced concepts pretty quickly once we get them past their survival skills. Yeah. So yes, indeed. But if you're just everything's a standard formula, and unfortunately, a lot of type ones are still managed by by primary care people. That's what you're going to be stuck with. And even some of the specialists will, you know, if they don't get to know you well enough. Or if you're in a group practice, where you'll feed this different specialist these two each time within a general, you know, intercurrent practice, that can be challenging as well. So yeah, you can throw you off your rhythm. Absolutely. Yeah, it
Scott Benner 47:14
just, it really is. It's such a shame, it's one of the things that I feel, like burdened by when I look back into the community, because what you see online, like a lot of the people online or newer diagnostic, they're looking for information. And so you know, you don't see a ton of people around, we've been around for a long time. And you know, and I think that's fantastic, actually, I think being able to come to the internet, find the information you need, and then get back to your life. using that information. I think that's kind of the beauty of it. You know, we
Dr. Stephen Ponder 47:43
don't we don't teach people. The problem is we don't teach people as much as they need to be taught and with the explosion of more knowledge that needs to be shared, you know, and things like cure surfing, for example, there's still so much static thinking going on out there, there's less time, our visits have been called down to 20 minute encounters, which are largely going over medications, filling out forms, collecting data. And then in terms of teaching, there's very little done unless you arrange for a separate visit with a diabetes educator, which then maybe weeks ahead, and that may not fit somebody's schedule. And so most people do go online, they go to books, they go wherever, or they get advice from friends and family, which may be obviously not correct in some cases, as well. But what to do, and that's where we wind up where we're at. That's why there's not been any significant improvement in overall diabetes control, in spite of all these wonderful medications and devices that are out there, because we're not spending time on what really matters, which is good professional training and support. Because that's not something that the system pays for very well, it will pay for a new sensor that you get, if you're properly covered will pay for a pocket, if you have certain coverage will pay for a lot of your medicines, but it won't teach you how to use those medicines or those devices, to your best ability, if you like to, well, in a sense, think about this way. You know, when you buy a car at the car dealership, do they teach you how to drive? So they assume you kind of know how to do that whether you do or not. And so that's we're kind of set up like a car dealership, you know, we're not teaching people how to do this. We're just giving them this, this information. We, you know, we have educators, thank God. But that means education is really it's been slipping the last few years. And because big insurance insurers and hospitals are not seeing their value, and I think they're incredibly valuable. But education programs across the country have been faltering, because financially they're not considered. They're considered somewhat of a loss leader. Even though in my opinion, it keeps people out of the hospital, it keeps him out of the emergency department improves the overall level of control. But getting administrators to buy into that sometimes is a long haul.
Scott Benner 49:50
I think that it says a lot and this is I'm using myself as an example but I hope it doesn't seem boastful because I don't feel that way about it but in a system Where I probably get more correspondence from people who say things like, thank you for sharing this because my son's day, once he came down a full point, I think it's because of what you said, or in a situation where I can spend 10 minutes on the phone with a mother of a four year old, and stop all the spikes on his on his graph, in 10 minutes worth the conversation, you know, when when that's a more viable way to get to good information than going to your doctor, then things are so messed up that I wouldn't even know where to begin to fix them. You know, I mean, like, how is it possible that you have a lifelong, serious disease like diabetes? And someone who's had it for a year probably knows better than the person who you are taking direction from? Like, I don't? It's hard. It's true.
Dr. Stephen Ponder 50:48
Yeah, you're absolutely right. You're absolutely right. And it is true. Your doctor, and I trained doctors, I know that the residents, I train, they know what diabetes is, but they can't even begin to address some of the things I'm talking about no graduate, and they'll become, you know, the board certified pediatricians. Now, I'm not training fellows. But even the fellows, you know, they're, they're mentoring under there. They're the people that are training them, who may have a certain attitude. So you can see where this you know, once one cycle begins another cycle. And I know a lot of immigrant fellows, of course, it tends to attract people like myself with diabetes. So we have a particular insight one of my partners has type one diabetes, who's a evento. But But even we look at things a bit differently. I you know, even the dynamic thinking thing that didn't, that didn't come on to me until relatively late in the game, you know, I was still a static thinker, static manager. And for the longest time, so part of my long term vision for what I want to do with sugar surfing, is Kevin and I really want to change that do a paradigm shift on how we manage diabetes. And and part of this discussion revolves around that is how do we get people to think outside the box and not in their little bubbles and say, you know, insulin can be used at different times that stacking insulin, which is a dangerous term that uses a dangerous way is not necessarily a bad thing. if done properly done with eyes open,
Unknown Speaker 52:09
I do it every day,
Dr. Stephen Ponder 52:12
every day. Yeah, that's, and that's what happens. Yeah. And the other thing is, you know, braking, if you overdo it, and your brain have to break it with some cards, right? Think about this, when you think about this, it makes perfect sense. An artificial pancreas whenever that device or that technology is fully developed, will not just be a device that gives you exactly how much insulin you need, you need, it'll be a device, it'll also give you a counter balance, which will be right now glucagon, something that would that would raise a lowering a low a low blood sugar, because the dose of insulin it gave you was more than you needed them. Yeah, because the machine does not know what you're going to do. And that's what I tell people in workshops is, you have at least the ability to look forward into time at least make some plans, the machine can't do anything but react, it's all it is. And right until they get until they get materials or drugs that work so quickly, that it can react as fast as you can act, you can act and then we'll be at an okay place. But right now, those do not exist, you know, and and so when but that that could change in the distant future. But I'd rather do what we can to help people now with what we know. And sugar servings is an approach that works for a lot of people. It's not, it's not for everybody. And there's still a lot of people in this world, who still, you know, struggle with, you know, with dynamic thinking in terms of diabetes, and would be more comforted, at least for the time being with a static approach. But my vision, and Kevin's is to change the paradigm of how we teach diabetes and offer more people these options that you and I have been doing in the shadows for the longest period of time,
Scott Benner 53:45
you will see while you were talking just about my guy came up with a question for you, you almost you almost answered the whole thing. But if if I gave you the the power gave you a magic wand, would you bring into existence an artificial pancreas or smart insulin? If you can only bring one? What do you think, oh, what do you think is a better answer?
Dr. Stephen Ponder 54:05
Well, I think that I see where you're going with that question. The Smart insulin is one that that that goes becoming less active, based on the level of blood sugar in the body. It's to me I like the most elegant solutions for things. So if it was a magic wand and we had a as you say, smart insulin that would stop working, when you got below, you know, 675 or 80. And it was activate whenever you got over that period and activated proportionally just to what you needed to maintain a you know, a center point it's a 95 or 100 didn't Yeah, that would be far superior than then to do a mechanical device so so I'm going to speculate beyond what your question said and say yeah, I would go with the with the smart insulin because the the the artificial pancreas is a constantly evolving and constantly changing technology. Plus it has its its highs, it's high maintenance, you know, you have to Have this thing you've seen the pictures of the you probably talk to some of the people who have worn them. You have to be, you have to be strapped to the device. And it's exciting. And I'm all for it. I think everything's progress is great. But we all have to live our daily lives. And we have to make decisions and choices. And we all know how hard it is just to maintain an insulin pump. Sometimes that's an artificial pancreas and, and then maintain our cell phone coverage, as well as having the machine tying into the computer all the time to decide how much to give us. So I understand what that helps a lot of people who may just struggle overall with their diabetes. If I were offered the opportunity to have artificial pancreas right now, I'll be honest with you, I'm doing fine. My agency at 5.3 5.4. And the impairment I feel of being in charge of my diabetes, I'm not willing to give that up. I like the dominance I have over my diabetes or after after decades of feeling subservient to it. Now, I feel that it works for me that I own it. And and I don't want to actually I don't want to give that up. He's on an honest answer. Even if I were to wear the artificial pancreas, I might do it just to say I did it. But honestly, I get more gratification out of doing what I'm doing right now, which is you know, I glanced at Meyer Spencer, I'm 94 I've only drifted down a couple points. And that's just within the variance of the machine to begin with. And I'm straight lining. And that's how much effort it took me to do what I'm doing just like what you're probably glancing at Arden's readings, as we're talking right now. And making decisions. I mean, it doesn't keep you and me from doing this. And you might even tell your listeners just heard the fact that you're doing a podcast with somebody else at the same time you're managing your child's diabetes at the same time as the person you're talking to who's managing their diabetes, and nobody's skipped a beat?
Scott Benner 56:36
No, I've I've told my daughter to give herself insulin once while we've been talking. And we've adjusted her basil rate. Oh, yeah, yeah, yeah, it just and, and that is what? Yeah. So I think what what your messages is and what my noise has been I it's interesting, we're finding each other is that you just really do have to empower yourself to do that. Because when you just talk now about like, not even wanting to give back the control that you found. I don't think that, that, that dominance over diabetes is the way you put it, like, I don't think that's far off for people, as long as they know, the path to take to get to it. But if you're, if you're being given nine different things, you know, from a doctor, and from friends, and from the internet, that all sort of conflict with each other, that can get really frustrating really quickly. And oh, yeah, you can throw your hands up in the air. So I am, you know, so I'll tell you what, why don't we run a giveaway for your book, and we'll give somebody your book, and at least help one person? Or like, I'll do it on the blog. And we'll give somebody the opportunity to see the book. And, and do you see, and you see people? This is kind of my my, I guess my last question I want to ask you is that um, how do you because you are seeing patients? How do you get this across in the 20 minutes that you have?
Dr. Stephen Ponder 57:54
Well, I most of the patients I see now are well logged into my online sides. The power was done by Stephen ponder, and sugar surfing. On Facebook, I post on a regular basis information out there by my staff, or people that would be one of my nurses was my former patient. He's a male nurse who's a CD and type one himself. And he walks the walk, talks to talk. The other one is a young man who's not young, he's 40 this week, that he's a ex military. And he's in a nursing he worked for me in my private practice where I came back where I'm at right now. But I surround myself with people who share the way I do things. So they're teaching the way that I teach. And that's how I've done it. I've able to I've been fortunate over the years have people that I trained to look at things the way I do, and the 20 minutes, on my first visits, I have more than 20 minutes, I'll take an hour, hour and a half, I'll schedule more frequent visits for follow up as necessary. I have the online presence. I wrote the book. And I'll tell you what, God, this is the frustrating thing about the book in some ways. Many of my patients would benefit from the book and and they're always looking for more information. I said, Well, I wrote a book and someone will say, well, we have the book, but we haven't opened it yet. Well, what's holding you back. Other people have totally tabbed it up from one end to the other and highlighted. So that's the range you get. And and I have to say I have to admit a little bit of frustration with this because I tell them I had took nine months to write the book. You know, I agree with everything in there is a lot I won't say everything will benefit you benefit you bit of there's a lot of stuff that will and a lot of people have become posted online from around the world. Something you said earlier how much of a difference it made for their diabetes. So what's holding you back? It's right there. It's a resource. It begs the question is we have all this knowledge out there but what good is it if nobody ever picks it up and looks at it and reads it out? I can I can coach them. If I had the opportunity to coach people. This model. I think it would be exciting to actually if there were if we had health coaches that are diabetes life coaches that had were armed with this technology that like Kevin, I have really been talking about over the years was to develop a shirtless earnings, sugar surfing certification. So we could blog basis stuff and get this out to more people than just people who read the book and who are self starters that way, but actually have a coaching mechanism for that. That's, that's a long term vision for we're sugar serving yonago as a certified other people just like I'm a certified diabetes educator, but find some way to, and they're certified pump trainers, but there could also be a sugar certified sugar surfer, we would give them a certification. So that's a dream. That's that's still a ways off. But right now, we're just pleased that that the message is resonating. And people like yourself, have already embraced the message in your own way and have been using it. And it's hopefully you've you found it, validating what you've already been doing, and empowers you even more, and the other people who may be listening to this, I'm really excited about the opportunity to give a book away to someone who would benefit from it, and we'll be happy to ship it to them. So just let me know when when that when you find that that special family or person?
Scott Benner 1:01:01
Yeah, I will see what I'm hearing from you is I'm hearing I mean, obviously, as a physician there, there are better ways for you to make money than to give people hour long, you know, appointments end to end, take your knowledge and put it online where I'm assuming people are getting it for free at your website and thinking what is your website address?
Dr. Stephen Ponder 1:01:20
It's sugar surfing.com.
Scott Benner 1:01:22
And so and so this is obviously a passion for you. And it comes through when you're talking about it, it absolutely does. And I can absolutely talk to I wrote a book myself. And it's not easy to sell a book, even if they're not expensive, even if they are you know, even if there's 1000 reviews that are like, Look, I swear you'll like this book if you read it. And, and it's a book so hard thing to, to, to get into people's hands and to get them to open. And so I feel for you with that, especially because I I'm hearing that you feel like you put the secret to their health in this book. And please open it and look, you know, so I definitely get that I really do and I feel for you. But like you said, we'll get we'll do a giveaway, and we'll get one out there. And maybe that person can can benefit and tell somebody else. And that's how they have the message of Oh,
Dr. Stephen Ponder 1:02:13
that'd be wonderful. That'd be wonderful. I appreciate that. Absolutely.
Scott Benner 1:02:16
I it's my pleasure. Like I said, I, you are one of those people who I saw online for the last year or so. And because we were in a really good place with our day to day management, I don't think I ever really chase you down or tried to figure out what you were doing. I saw when the book came out. I was like, Oh, that's nice. Somebody wrote a book, but I never really looked into it that far. And as soon as the podcast kind of took off, and the popularity rose around, and I just started hearing from people right away, like you have to tell people about Steven, so I was just thrilled to do it. So thank you for taking the hour to do this. I know you're actually in your office at work right now. So thank you for taking the time.
Dr. Stephen Ponder 1:02:53
Well, thank you for the invitation, Scott, it's an honor to be on your podcast. And it's an equal honor to be able to share ideas with you and hear where are you going and that your daughter and how well things are going there. So I know you're very proud of her. And I'm sure she's extremely proud of you as the rest of your family session this week of Thanksgiving. You're kind saving. I've
Scott Benner 1:03:12
been married a long time. I don't know if my wife even likes me anymore.
Unknown Speaker 1:03:17
Okay, well, on that note,
Scott Benner 1:03:20
not just kidding, I appreciate you saying that I really do. And it is such a family thing, like even as the one real interesting thing that we see is that, you know, my wife works full time. And I've been a stay at home dad for like 16 years. So once I figure out how to do something, and it's new, it's difficult to just to like give that to my wife in a way that she can just automatically start doing it. Like I can even see her I'm like, Look, you need to start using more insulin when you're by yourself with Arden. And she's like, based on what and I'm like, based on trust me, you know, like, because and that's hard, because that's not a real instruction to give to somebody. It's more difficult between spouses, I think sometimes than it is between the doctor and the patient to to kind of give that information back and forth. Because, you know, there's, there's something she's been doing for a long time with our networks. And I'm seeing through time, you know, slowly, incrementally that it's changing. And then one day I just I stand up, you know, and make this pronouncement like, by the way, this is what needs to happen now, but she didn't have the benefit of taking that walk with me.
Dr. Stephen Ponder 1:04:26
Well, yeah, you're, it's well, it's you're trying to transfer a skill. And you know, if you can, like these four sided for you, if you can throw a baseball, that doesn't mean you can just transfer that act to her. She has to learn that through her own journey. And the same thing applies here. And that's what I think a lot of people misunderstand. They don't see diabetes care as a skill. They just see it as a series of actions, and that somehow they'll all fall into place if I just follow the recipe. Well, there are lots of examples out there just following the recipe doesn't result in what you and the outcome you desire. You have to have a certain skill and experience and you obviously have That and it's something you can't just easily transfer, you can try to walk people through it, but you really can't transfer that that is unique to you, Scott. And it's frustrating because I know right
Scott Benner 1:05:09
now, if you brought a person into my house right now, and they had a glucose monitor on them, and just turn their care over to me, I think I could do within a day or so to their graph what I do to my daughters, but at the same time, you know, I think even if someone was watching and happen, they wouldn't leave with the information that would be necessary to to duplicate that.
Dr. Stephen Ponder 1:05:31
It is I don't get you in the lead. In fact, I think that's exactly true. I think that, you know, I actually make a similar comment to new onset families that, you know, they're, they're in the hospital for a while, and I say, you know, honestly, the, the kid is not in the ICU anymore, I'd say their, their blood sugar is being managed on the floor. So I could take your son or daughter home right now and take care of him, because I know what I'm doing. And in the next several days, we have to find a way to get at least a minimum level of training, so you can at least go home relatively safely. And then we still get calls of course, because they don't know how to deal with the situations that come up, they can give the shots a check the blood sugars and so on. But they don't know how to manage the problems that occur the unexpected things. And that's a skill that takes time and, and you have attained attain that level of, of excellence, that proficiency is needed beyond proficiency. And I had no doubt that I could give you any of my patients and, and within a day or so you could get them in line, you know, with with the information you have and the experience you have. That's what I'm getting at is you would be one of our prototype traverser for certainly certified sugar surfers and trying to you know, motivate and educate people, you know, just fight we have to find a mechanism to make that happen someday.
Scott Benner 1:06:41
Yeah. Well, I wish you luck with it, because that that sounds like a very worthwhile journey. So all right. I've held you longer than an hour. I apologize. But But thank you very, very much, Steven, for coming on.
Dr. Stephen Ponder 1:06:51
Thank you so much, guy, you have a great day and a great holiday. Okay,
Scott Benner 1:06:54
you too. Happy Thanksgiving.
Unknown Speaker 1:06:55
God bless. Bye, bye. Hey, you've
Scott Benner 1:06:58
just heard Steven talk all about his theories about managing type one diabetes and his book sugar surfing. If you want to purchase that book, it is available on Amazon and there's a link in the show notes to it. But if you want to take a shot at winning a copy, Stephen is going to give one away through my blog. Let's say what's today, today's the second of February. Let's say we're gonna let the giveaway run till the 12th Lincoln's birthday and honor president link will let it run to the 12th in case you're listening to this after February 12, then there is no giveaway just go ahead and buy the book. So go to Arden's de.com. And they'll be something right on the front page where you'll see a copy you'll see Stephens book and and a little link that says click to to enter to win the giveaway or something like that. I haven't really worked out obviously all the verbiage details, but trust me, you'll see it when you get to ardens de.com. Also, if you go to Juicebox podcast.com, there'll be a blog post there about Steven and in there, there'll be a place to also enter Stephen is going to give away two copies. Now one copy is a paperback and that's going to be available for us residents only because of shipping costs, but the other copy will be an E book. And that's going to only be available to people who live outside of the US to try to make things fair and give everybody a chance. So two copies, one paperback, one ebook, the paperback for us residents, the E book for people who live outside of the US get over there Arden stay calm and take a shout out. There's plenty of different ways to enter. Also, while we're thanking people insolate the makers of the Omni pod the world's only tubeless insulin pump. Thank you very much for sponsoring the show. Don't forget to go right into the show notes and click that link. Get yourself a free demo pod support the Juicebox Podcast something else must be important to say Follow me on like the internet. You'll find it at Arden stay at Juicebox Podcast. If you're enjoying the podcast, please take a moment to go into iTunes and leave a rating and a positive review. It really does help the podcast get found by other people. Remember nothing you hear on the Juicebox Podcast is advice medical or otherwise there'll be a new show next week. See you then.
