#311 Diabetes Pro Tip: Long-Term Health

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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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
Hello, everyone, welcome to Episode 311 of the Juicebox Podcast. Today's episode is a pro tip. So you know what that means. It's not just me today and a guest, it's me and Jenny Smith. Today Jenny and I are going to talk about long term health as it relates to type one diabetes. This one's a little less pro tip and a little more conversational. The information rises to the level of pro tip. But the style of conversation is more like Jenny and I got together as friends and I said, Hey, tell me your thoughts about this. And then we chatted about it a little more laid back a little more conversational. But the information is definitely something you want to have in your tool belt. And that's why this episode is part of the diabetes pro tip series that begins back on episode 210. This episode of The Juicebox Podcast is sponsored proudly by dexcom, makers of the G six continuous glucose monitor. And of course, on the pod, the tubeless insulin pump that my daughter has been using for 1112 years, a long time. It's been an honor every day for that time, must be good. I'll never forget the day I was sitting in a hotel lobby when a person asked me what's next for your podcast? What are you going to do to innovate and keep it moving. And I said, I'm gonna do a pro tip series, I think I have all these ideas, and how to bring them all together and really talk through them with somebody equally knowledgeable, but who will come from a different perspective. And I had that person in mind already. That person was Jennifer Smith. Because Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator, a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. Plus, she's had Type One Diabetes for over three decades. And bonus, I like Jenny. I like the way she talks about type one. It just, there's a goodness about her. She seemed like the right person. And she certainly has been. It's been over a year since the first pro tip episode came out at Episode 210. And today is the 17th. In the series, I believe you got to go check them out. They're all listed as diabetes pro tip is a colon and then the titles afterwards. One last thing you know what it is? Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical, or otherwise, please always consult a physician before making any changes to your health care plan or becoming bold with insulin.

Jennifer Smith, CDE 2:47
What are we doing today?

Scott Benner 2:48
We are going to do a pro tip episode that you suggested and prevention of long term complications you said and you said What does optimizing glucose long term do for keeping things healthy? So I feel like what you meant by that is below less variability not low but in you know, lower than what a lot of people go for less variability, lower standard deviation, how is that going to help you throughout a lifetime? And so I feel like between that, and some other safety ideas that I'd like to bring into the conversation. I think we're gonna have a good a good talk here. So I guess first, why don't we talk about a little bit through time, right? Where does everybody and by everybody, I mean, doctors, where do they get the information that they put on their patients? You know, I'd like to see you have an A one C of x. Does that come from the American Diabetes Association? Do they set the tone who sets the tone for what we should be shooting for? Because somebody does it?

Jennifer Smith, CDE 3:51
As far as targets? You mean? Yeah. Yeah. So I mean, well, targets calm. It's funny. I just had a conversation with somebody who listened to the podcast, and I had a first visit with her just before this. And she asked the same exact thing. She's like, I'm getting all of these different targets from different people. And she's like, I don't even know what to believe anymore for a target. She's like, I know where I feel good. I know where I kind of want to be, but what am i aiming for? And I said, Well, there are a couple so the American Diabetes Association aims for your post meal target under 180. Okay, it comes from the American Diabetes Association, through research and gathering of all of this information and, you know, whatnot and looking at complications down the road. cumulatively. They aim for what less than 180. Now, the American Association of clinical endocrinologists recommends less than one six.

Scott Benner 4:48
So less than 160

Jennifer Smith, CDE 4:50
less than 160. Okay, so there are two high in the ranks of diabetes management. Yep. That are different. Already, right. And then we bring into the mix. Well, what are recommendations even further than that, like pregnancy? pregnancy recommendations, you know, are for the most part under 120, fasting under 100.

And post meal no higher than 140.

Scott Benner 5:20
So M is what I'm hearing good good for the shift. Oh, fusion.

Jennifer Smith, CDE 5:24
Yeah, confusion entirely. And then I had a woman in a couple of years ago postpartum, I had her visit with her. And she's like, so I was aiming for all of these targets in pregnancy to keep my baby growing healthy, and myself. And she's like, and then my doctor tells me to loosen up my target in my palm, and tells me I don't have to be so you know, quote, unquote, tightly managed, and she's like, sick, I want to ask your opinion, Jenny's? Like, why wouldn't I want to stay this tightly controlled if it was good for me and pregnancy? And these are targets that people without diabetes? maintain? Because their body does what it's supposed to do? Like, why wouldn't I want to maintain this? Whether I'm pregnant or

Scott Benner 6:03
not? Yeah, yeah. So here's right here. Exactly. And here's what it's making me feel like, so much like, with everything about diabetes, when you try to give someone like this just, I don't know, this is how things are right? Like it 181 6120 whatever anybody ends up saying, that's not personal. And and personal, between should be consideration should be you, your intent, your involvement, your intellect, your understanding, then it should be, am I injecting? Am I using a long acting insulin that's been I was made 20 years ago, or my using one of them that's, you know, been made more recently that people find more stable a lot of the times, am I using a pump? Do I have a glucose monitor? Is that you know, is it a Libra? Or is it a dexcom? Is that the G six? Or is it the G four like, it would seem to me that all of those variables would would make it more or less likely for me to be able to maintain targets that are lower or higher? Right? And so then you get the doctor, like what you just said about the pregnant person? I feel like that doctor was like, Look, you must have had to have killed yourself to keep your blood sugar that low. Right? Like, obviously, it ate up nine, you know, nine months of your life, you did nothing but keep your blood sugar in check, have to pay and watch television, that must have been your whole line months, right? Like, like, you're talking to a guy in 1920. It's like, you know, you didn't even have time to make me my pot roast. Like, like, like that, like Reagan old time idea, right?

Jennifer Smith, CDE 7:41
And now you come into the office and You look like you've got baby spitting your ear, you look like you haven't slept or combed your hair. So let's loot some things. Sure. Right.

Scott Benner 7:50
Right. I think that what would make your day easier is if you were less healthy. But it's not it becomes about and I get that right? Like, I think that out away from the ideas that we talked about on the podcast. Maybe that's real. Do you know what I mean? But when you start telling people, we, when I started asking people, you've been at this for a while now six months, eight months? Is it that hard? They say no. Like most of the people, I don't want to say most of them everyone I've ever spoken to who's picked up the ideas of the podcast, put them in practice, and gotten to the point where it's just second nature. They don't think about diabetes, very much these these targets are meaningless because you get to a spot you stay at that spot. If you leave that spot, you know how to get back to that spot? Right? That seems like it to me, honestly.

Jennifer Smith, CDE 8:40
Right. And from the standpoint of, you know, prevention, I mean, that's the that's one of the biggest things that brought out beyond Well, here's your insulin, here's how to inject it. And oh, by the way, insulin can cause your blood sugar to go too low. complications are always within the first like, new onset diagnosis, discussion. Always something about complication, right. Always, like you have to control things. I love that word control because like, like a moving target and control.

Scott Benner 9:11
Not only that, by the way, it gives you the impression that you're going to be out of control and it's your job to control the chaos.

Jennifer Smith, CDE 9:17
Correct. Right. Exactly. It's like your job to hurt all of the million cats in your yard with no fences. Yeah, right.

Scott Benner 9:23
What if I just didn't let the cats in? How would that be?

Unknown Speaker 9:26
How would that

Jennifer Smith, CDE 9:28
play? Yes, exactly. So you know, the prevention of complications that I mean, there's no, there's no set solution, really, on how to 100% prevent complications. In research. We've seen people with many years of diabetes, some of them poorly, you know, managed, some of them tightly managed, and complications can start for people at different points of time. And that makes it seem like well, gosh, I'm just gonna throw my hands up in the air if I can't 100% prevent anything. But what we do along the way makes you feel good. on a day to day basis with tighter containment of things overall, yes, we are likely 99% likely avoiding the complications down the road, right at 1% that something could happen. Sure, it could be there. But I don't think there are many things in this world that are 100%.

Scott Benner 10:29
Right? perfection. And so to your point, it's, it's presented incorrectly to people. It is like right away, like, you know, it's not your goal not to die. Right. It's your goal to live really well. until you die. Right. Right. And and if you can extend those years, wonderful. But you know, it's just and you just said to about how people feel? I've been talking about that a lot lately. I don't know why people don't think about that. Like just how they feel every day. Like, you know, are they tired? Are they sluggish? All the stuff that we've spoken about over and over again? Why is that not important to them? And I don't think it's not, I think they find it to be something they can't impact, which isn't true. It just isn't like there are times there are times genuine, I'm afraid people will realize that when I keep saying over and over again, it's about timing and amount and common sense. They're gonna go, Hmm, I don't think I need to listen to that podcast. That guy might be right about that. Like, why don't I just tie my insulin better? And when I see something happening, go, Hmm, that makes sense. I should do this now. Yeah. Right. Because, I mean, honestly, there's no pot, if you guys all figure it out, the podcast is over. Basically, I, you know, obviously there'll always be newly diagnosed people who are going to get this terrible information and start down the wrong path. I just I want I want people to think more about how they feel. And I spoke about this in my talk this weekend. And I've said it here before, too, but you have to, you have to believe that if your blood sugar is constantly high, you're altered. You just are like there is a person

Jennifer Smith, CDE 12:09
without short term and long term.

Scott Benner 12:11
Yeah, there's a person you would be intellectually articulately that you don't get to be when your blood sugar's high, or crazy low or bouncing around, right? Because your brains always just, it's, it's, it's just, it's not where it needs to be.

Jennifer Smith, CDE 12:27
I don't know. And within that, even within that day to day feeling, are those behind the scenes. Unfortunate what's happening in the body that you aren't feeling? Like, we know how high blood sugars make us feel. And if you're paying attention, you know, the containment of them, you get out of that you can think better, you can act better you can do the things you enjoy doing. But behind the scenes, internally, what's happening with better management is you're not causing damage to cells. You know, I mean, especially heart disease, I mean, heart disease is a huge component that we have to take into consideration. But it's not like it has to be there in your brain every single day. If you are managing the blood sugars, you're also managing a healthy heart. You're also managing healthy kidneys, healthy nerve cells, healthy eyes, you're managing those internal pieces that until they are damaged enough and give you indication that there's a problem. you're managing that along the way so that you don't get to the end of the road and have heart disease or kidney problems or whatnot, right? Yes.

Scott Benner 13:37
Oh, and where do you stand? Have you ever heard me explain how I think of it with the sandblasting? Have I ever said that? Because here's the place to say if I've ever said it to you, okay, so the way I think about high blood pressure, high blood sugars, and back when my kid was little, and I was looking for motivation, like seriously, like, what, what's gonna get me up at two o'clock in the morning to correct a 150 blood sugar. But when my doctor is telling me That's okay, like, what's the motivation. And whether I'm right or wrong, technically, in my mind, it feels like this. My body is built to withstand a certain amount of certain content of sugar, glucose in my bloodstream. And when there's more there, on a cellular level, glucose is still sharp, right? It's like, it's like if you take a sugar and you spill it on the table, you look at it, its course and you know, it's sharp, and even on a molecular level, like smaller, smaller, it's still sharp. So when you pack too much of it into your veins and your arteries that run through your heart and your eyes and your legs and your fingertips and everything else that's sharp. This is scratching at the inside of that soft tissue and those veins and those arteries, and one day, it'll wear through a little hole. And if it were through a hole in your heart, you have a heart attack. If it wears through a hole in your eye, you have vision trouble if it starts wearing through in your feet, you might not be able to feel your feet and honestly And again, so all of the diabetes complications that are on a list somewhere in your doctor's office to scare the hell out of you. What it really means is, if your blood sugar is too high, you know, what inside of your body, is it going to rub through first and create a breach? And you know, and will that breach, you know, and that breach will hurt. You might, you know, we talked recently about my friend Mike who passed away, he was on dialysis. So the first thing that it rubbed through worse his kidneys. And then as he was on dialysis, the second thing it rubbed through was his heart. And then he had a heart attack and he died. And that's it. And he'll he'll his death certificate says he died from complications of type one diabetes, though. That's it,

Jennifer Smith, CDE 15:43
right? And that's a great, it's a very layman's way to understand it. Because I think that the textbook explanation is, it's too clinical, it's to medical. And I think that's why, for the most part, people are aware of complications. But when you explain it, such as that damage piece, and I used to explain it in the class, the type two classes that I used to teach is that my sugars, cause damage to the inside of your vessels cause damage to the outsides of the nerves and everything and almost like eat it away. So like a sandblast. Yes, it's like cutting and cutting and cutting and calling causing small abrasions, right, scratches, scrapes, that the body actually tries in your body is a it's a, it's a self healing.

Like organism, right, which

Scott Benner 16:36
is why it doesn't happen to you right away it wrapped fixing little making little patches, it's like your road crew in town filling potholes, when you think you just repave the whole road, they're like, nope, best we can do is pop in a little patch in this hole.

Jennifer Smith, CDE 16:49
And it's more inflammation, I mean, long term, those little holes are really from inflammation in the lining, and along with cells and whatnot. And over time, I mean, if that inflammation causes a tear, the body tries to patch the tear. Well, if more and more tears happen, and more and more patches get placed into the vessels, you know, and I know visually, this isn't a podcast, people can see. But as you can see, my hands get closer and closer together to indicate the constriction and the narrowing of vessels. So then we have heart disease and potential for stroke and problems with blood flow, getting to the kidneys to do what they're supposed to do, and circulation to your fingers and your toes and never anything see. And Jenny, the way I think of it is I was just there one day in my house trying to talk myself into not giving up before I understood what was going on, right? So what do I need to do to not give up and this is how I put it, it's really no different than a football coach who just has a player has three brain cells in his head, and he goes, look, see this line right here. Don't let that ball go past that line. And that really is how I dumped it down for myself. I was like, I can't let that ball go past that line. Like I have to try to figure out how to stop that.

Scott Benner 18:05
And I think everything that everyone's listened to since then, is born from that idea. Like, how do I stop this from happening? Right. And I've had that moment where I realized I may not be stopping it from happening to like, maybe my kid genetically is just the one who can't withstand having type one diabetes. I don't know, you know what I mean, but she certainly has a better chance, the way the way she lives right now than she would if I just listened to, you know, just keep her under 200. You know, don't let her spike over 180 or 160, or whatever, after a meal if you right, you know if you can. To me that was just that just made sense. In the moment when I was scared and alone, and it didn't know what I was doing. I just thought like, I need a I need a I need a goal. You know, right? Why? blood sugar? Oh, sorry. Sorry. Go ahead. No, good blood sugar is gonna say blood sugar is a big piece of it. But you know, the other components to those complications, too, are the other factors that also contribute to blood sugar management, right? So the kind of nutrition you take in that interior sedentary versus more active lifestyle, all of those are also huge benefit for long term health, outside of just rolling or managing your blood sugar. And all of those things become exponentially more important. When you have type one diabetes, they're important to a person who doesn't have it. It becomes even more important when you do like sometimes you just feel like, you know, like how many, how many gunfighters are gonna be on the other side before I just I don't have time to get to the mall, you know, you'd be like, I'm gonna get overwhelmed because there's just so much over there. So you have to give yourself a chance. You know, and aside from the idea that exercise helps you keep lower blood sugars like that aside, exercise does all the other things that exercise you know, it's funny, it's worth mention Hear that I realized the other day that some people refer to me behind my back is like, somebody who pushes carbs on people. And I thought, That's odd. I've never considered that before. Excuse me, but I guess more low carb people kind of can feel that way a little bit. But I listened to it. And I thought it through and I don't feel like I do that. I feel like this podcast teaches, talks about preaches maybe how to use your insulin, like how insulin works. And I say all the time, once you know how your insulin works, I don't care what you you know, you do whatever you want. But I think you need to know whether you're low carb, or whether you're a person who's like, wow, I think I could eat that whole box of hohos. Like, like whether whoever you are in that scenario, you know, one side or the other. If you understand how to use the insulin, you can accomplish it. I'm not saying because I know how to bolster Chinese food. You should do it every day,

Jennifer Smith, CDE 20:54
every day. Every day. I know how to Bolus the chocolate chip muffin and the chocolate milk and the Hershey syrup on top doesn't mean it should comprise every meal. Because is that better than an apple with peanut butter? Right? And nutrition wise? Probably not. But

Scott Benner 21:11
is there a danger I found myself wondering of people focusing on themselves so much as diabetes that they forget to think of themselves as person. Like, you know what I mean, like Does, does a piece of this a big cupcake not seem unhealthy anymore, because you know how to stop a spike from happening when you eat it. And that's important to remember that it's still it's still a cupcake. It's still something that's, you know, a once in a while thing, not an everyday thing, because I can Bolus for it. And I think that's so I think Jenny's point is important too, is that there's just a lot more that impacts your health than just your blood sugar. And we sometimes we talk too much, not too much. But we're so focused on trying to understand it because there's so many components that people don't understand that you stop thinking about like, Hey, you know, what else is easy to Bolus for broccoli.

Jennifer Smith, CDE 22:05
It's learning to manage the insulin around what you eat, you decide what you're going to eat, and you figure out how to manage it, like not encouraging people to eat a high carb diet.

Scott Benner 22:17
Not at all. I don't see it that way at all. I see it as understanding insulin. It's it's just how it is I I was speaking somewhere recently, and I looked down and saw a person in the crowd who this has happened to me about three times since I've been doing public speaking around diabetes. But I've looked down to see what I would call like an old school person in the diabetes community. And when I'm talking I can see on their face, they're just there somewhere between angry and horrified that I that I would even deign to talk about insulin, and how to use it. You know, like, you can't tell people. When I'm on when I'm up on stage, I tell people, no different than, you know what I say here, right? I'm like Basil's first beat, we have to have your bazel, right, because we can't just start Pre-Bolus saying and doing other stuff. Because if your Basal is wrong, it could end up being dangerous. So first, we get your Basal right. Now after that, step two, you have to Pre-Bolus your meals. And that's usually when I look down and see like somewhere like a 60 year old mom whose kids had diabetes for 30 years. Like, you know, like their arms are moving around and like, Oh, you can't say that to people, you're gonna kill them. You know what I'm like. And so I'm like, you're thinking about this in a different way. Before that, you're not considering the technology, you're not considering that these are not the same last lambs that you talked to 30 years ago, right? Like these people are here to find this out. They want to know this.

Jennifer Smith, CDE 23:52
And long ago to bring in long ago, timing was an insulin issue. Long ago, I've had diabetes 31 and a half years, okay, I started on our insulin, and the cloudy, but most people started on something called nphr. And I was on L, which was Lily's brand. Okay. Um, I did no carb counting. I use the exchange diet. I took exactly this amount of searches and fruit portion and vegetable and protein and fat at every meal and my mom or dad gave me my insulin mixed in a syringe at breakfast and at dinnertime and I eat it strategic times in exactly the same amount of food there was no other than measuring the food for the right portion. There was no carb counting, there was no insulin based on carb. It was you take your insulin and from the dosing standpoint, my insulin regular insulin you know, it's slow. I mean, we call it short acting balls forever. I mean, it may man would dose me 45 minutes an hour before I even started to eat in order to curb that post meal,

Scott Benner 25:06
right? Yeah. And so everything you just said, is about using the right amount at the right time. Yeah, it's timing. It's all timing. Like I, again, I that I figured it out. I mean, we should all be able to figure it. Really I know myself, trust me, it's there's not a lot like I'm not, you know, I'm not over here. Figuring out the Pythagorean theory after or a theorem, whatever it's called. I see. I don't know, after I get off the podcast. Yeah, I just don't think i think there's so much fear in now that we forget later. And, you know, what we're talking about right now is long term health. And so let me jump to I can't quote it, I don't have it in front of me. I don't know where it came from. But I think everyone's fairly aware of this article that came out in the last six months that tried to say that lower a one C's aren't necessarily an indicator of health. And that, did you see that one they started talking about, like, you can have an A one see it like this here? It'll be fine. It tried to give the impression to me, that the way I saw it was someone trying to say, Look, I know a lot of you are using this technology to do better, but you really shouldn't do that. Like it's not necessary. And I thought, Well, how do you know? You don't mean like, like, I thought the same thing? I thought when I saw vaping The first time I was like, I have no interest in that. But if I did, I wouldn't do it. Because I don't want to be the one to find out 10 years from now what happens? Because no one knows, you know, right? So is there any in your mind, if you're safely at, if you're in the fives, and you're a one, say and look, you know what I'm going to do here, I'm going to actually pull up an email. To make my point, hold on one second, it's going to take me a second to find it. I apologize for that. But I got this email this morning from a person I know who listens a lot. And when she emailed I thought, wow, this is gonna work right into what Jenny and I are talking about. It's crazy. And it's from Laura. And this note from Laura mimics many, many, many, many notes that I get. Scott, I achieved a 5.4 a one C, first time I've ever been under 6.4. But my doctor freaked out at the number of lows. And she's asking, what's an acceptable amount of time under 70? Like, how many times can I dip under 70? And you know, and so I there's First of all, it's it's a two step thing, right? Everybody who goes to any kind of a doctor who's more like the lady in the crowd, who's thrown her arms around yelling, don't talk about it like this. When they get their blood sugar down, and they find a way to keep it stable, and it starts impacting their variability and it starts impacting their agency, the doctors flip out, they make this assumption that they have all these crazy lows and it's throwing them off. So I know what I'm okay with. But what Where do you stand in your personal life? I guess like how often do you find yourself under 70 DFA.

Jennifer Smith, CDE 28:19
So personal versus professional, I kinda, I really aim for the same thing, quite honestly, overall, and this is where I think that that data is very helpful from a CGM standpoint. Because especially and I speak for clarity. The other reports are the other CGM do give you something similar as far as data. But from a clarity standpoint, clarity always gives you that overview gives you your glucose management indicator, their quote unquote a one see right from CGM, not from your blood glucose, right? It gives you your average glucose, it gives you your standard deviation, and also gives you this little like chart that shows you time in range, right? And it is based on what you have your time in range numbers set for 70 to 180 60 to 140 90 to 200. So you have to adjust those parameters, but clarity has it set 70 to 180, for the most part, right? We aim for the lows specific to be less than 5% of the time. So from all of the gathered data, whether it's two months or two weeks, or one week or whatever you're looking at that percentage of time, we're aiming for less than 5% to the low and low being less than 70

Scott Benner 29:43
less than 70.

Jennifer Smith, CDE 29:44
That's that's the goal is to be low less than 70 or less than 70 less than 5% of the time. So from the standpoint of overall a one see though, you know if if a clinician is coming in saying hey, you know why? That's way too low. And they're looking at data, which proves that, well, gosh, you're hanging out in the 50s. consistently. And that's why you're achieving a five point for sure. And if you're low, let's say 12% of the time, okay, there's some work to do to bring that back up into range. So that that 5.4 is actually better for lack of a better word. better, right? It's, it's more real 5.4 in a target range, that's healthy, safe. And good for you overall. Yeah, you're

Scott Benner 30:33
reaching that number with quality decisions, not with not with, you know, being low. Correct. And that's

Jennifer Smith, CDE 30:40
coming out and saying 5.4% is it Oh, my goodness, that them that's way too low and not even looking at what other stuff 5.4 the person could have very low standard deviation, maybe their variability is 20. And they're ranging somewhere between 70 and like, 120 pretty consistent or 70 and 100. Great, fabulous. You're, you're knocking it out, have at it, and you what you're doing.

Scott Benner 31:09
So when I gave the explanation of a Pre-Bolus this week, this weekend, I used something that had happened an hour before because my wife was at home with Arden and I said actually my wife did a great job this morning with breakfast. About an hour ago Arden's blood sugar was 70 and it was time for lunch. Now Arden's at school, and I think 70 is a great blood sugar right before a meal. Arden's blood sugar was able to stay at that level for a number of reasons. But those reasons are evident to us as they play out, because we can see her blood sugar in real time with the dexcom g six continuous glucose monitor. Not only can ardency her blood sugar right there on her iPhone, but I can see it here at home on my phone as well. Because of that knowledge and seeing the stability that had existed within Arden's blood sugar for the hours prior to lunch, we were able to make a good Pre-Bolus and give her a nice launch into her meal time. Now that hour later, Arden's blood sugar is 132. The data that comes back from the Dexcom g six continuous glucose monitor is life altering with Type One Diabetes, but being able to see it remotely, that takes life altering to another level. So if you'd like to know what your blood sugar is, the speed and direction it's moving, and find those things out without a finger stick. The dexcom g six is something you should check out. I have a link you can use dexcom.com forward slash juice box. There are links also right here in your podcast player notes at Juicebox podcast.com. But I think you should check out the Dexcom Arden's results are hers and yours may vary. But I'm telling you right now Dexcom is a game changer. Now moving from continuous glucose monitoring to insulin pumping. I'd like to talk about the Omni pod until you first I have just as much affinity and love for the Omni pod as I do for next time. Arden has been wearing the Omni pod tubeless insulin pumps and she was four years old, she'll be turning 16 in just a couple of months. The Omni pod brings so much freedom along with the ability to pump your insulin right no injections all day long. No slow acting insulin and fast acting insulin let the army pod take care of your background basal insulin for you. It does that put your insulin pump you get your basal insulin from the pump. And when it's time to Bolus for a meal or to crack the high, same insulin, same pump, no tubing, right so not an infusion site on your body somewhere that's attached to this plastic tubing that runs through your clothing out to a controller that has to clip to your belt. You know whether you're an adult or a little kid, you're not looking to have something clipped to you. Here's what you can do. Go to my on the pod.com Ford slash juice box there, you can ask on the pod to send you an absolutely free, no obligation demo of the new pod. It'll come directly to your house. You can try it on and see what you think for yourself. You can see the difference between wearing a shirt and not having tubing running down your sleeve. Every time I've worn a demo pod. What I thought first was it's amazing how quickly I forget that it's there. This is super important. This is something you have to do every day. You don't want it to be constantly bugging you. Check it out my Omni pod.com forward slash juice box with the links in your show notes. Were the ones you'll find at Juicebox podcast.com. And absolutely free no obligation demo can be in your mailbox before you know it.

Actually, my wife did a great job this morning. With breakfast. She made a Pre-Bolus at like 83 right and it was a big kind of bread First, and Arden drifted down drifted down and she actually hit like 63 for like a split second and came back up. So imagine this 63 probably happened 30 minutes after my wife pushed the button, right? And probably 10 minutes after she had already started eating. So if you want to say she missed, I guess you can, but it's funny. Had she been at 68 everyone would have been like, That's amazing. But 63 is a number that somehow gotten to somebody said, so I'm like, so she hits 63 one revolution of the CGM and right back again, and I said, if she didn't have a CGM, you never even would have known that that happened, right? She's She's wasn't dizzy. Nothing happened like that. I can see it cuz I'm looking at it that this same person in the crowd, this person who's you know, you know, from a property from a different era with diabetes, you know, fell just shy of, you know, back of the hand on the forehead. Oh, Scarlet, what happened? I've got the vapors, you know, I mean, like, that kind of thing. And I was just like, I looked over second, I was like, You got us. I was thinking to myself, like, just stop, like, don't like, look at the rest of these people. These people are in Thrall. They're excited. These are people who a half an hour after they put their insulin in, or running around with their blood sugar's 250. And are you really telling me that that's what you want to say is okay for them. Because when I speak to them privately, when they come up to me, as I'm trying to walk around you guys, we're all delightful. But people would come up and be like, hey, look, this is my, you know, my 23 year old son's CGM, kids like 400 and 300 all the time. Like you tell me, it's not worth trying to do better for this kid. And so I think sometimes, both in the community, in people's minds, in doctors minds, in some older doctors minds, there's just more of that idea. And we talked about all the time, like, it's better not to like, like, I don't want you to have a seizure. Like that's it, like when I say don't die advice, like, that's what they're trying to say that I don't want you to have a seizure. I don't want anyone to have a seizure, either. But I don't want your blood sugar to be 300 all day. You know, it just it's, it's not okay. Because we say these nice things out loud, and other people who are maybe well meaning but don't have good information. They're like, Oh, you know, I want you to be safe, blah, blah, blah. But those people you're talking to online, or whatever your whatever that person's ability to get to people is, you don't get to see those people 20 years later, you don't know what's happening to them. And so I'd rather take a bet on what I'm saying being good for them 20 years later, than what I hear some of those other people saying, I think that if you're going to if you're going to roll the dice one way, you ought to roll the dice and try to be healthy, not hope, hope that your body's the one impenetrable thing that diabetes can't find its way through? Yeah, you know,

Jennifer Smith, CDE 37:47
right. Right. Well, and there's also the safety of bringing those high numbers down to, right. I mean, it's like, you don't want to end up going from an average of 280, which means you're drifting well above 300, and not quite into the low to hundreds to average a to 80, right? Yes, you're not gonna say, Okay, today, we're at, you know, an average of 280. And tomorrow, you're gonna be averaging 100,

Scott Benner 38:11
right, that goes on?

Jennifer Smith, CDE 38:13
Well, that would be a pie in the sky one, it's, it's not actually healthy, drops that fast, drop that fast. I mean, you will have efficient changes in your body. And you know, I remember when I came home from the hospital for two to three weeks after I was released from the hospital. And I think I started with an A one C in the 12, when I was first diagnosed, and my blood sugar was coming down and coming down. My vision changed so much, that my mom had to read me my homework in order for me to answer and she had to write things down. Because my vision was so blurred, I couldn't actually see well enough to read what I needed to get my homework done. Right. So and that was gradually. So again, you can imagine bringing a really high blood sugar down that's been consistently stable high. Yeah, it will be problematic.

Scott Benner 39:11
What I said to this group of people was luck. Like, don't go home, I'll shot out of a cannon, you know, and be like, I usually give a unit for this, but now I'm gonna do five I'm like, No, no, a unit in half, maybe, you know, and I was like, the next time go, ha, that could have been more I said, you know, over days, bring it down over weeks, bring it down, not like don't go home and just be like that. Because that's probably not going to go so well. You know. And, and again, bazel first, and it's funny, no matter how many times I say it, and how many times I preach how important it is. The look on people's faces. When you say to them, I need you to get your basal insulin right is like up then I give up. Like it's quick. It's they're so quick to be like, that's not possible. I can't do that. And I'm like, No, of course she can. And that's why I've got it down to like, they're like, well, how and I was like, Look, there's a great app. pisode on it that you could go listen to them like, but if you're looking for how I think of it, I think of it like volume, like I turn it up until it's too loud, and then I start bringing it back down. So you turn it up a little, not loud enough, turn it up a little not loud enough. And what I mean by that is turn it up a little, my blood sugar is not sitting stable, where I want it to, you know, blah, blah, blah, and then all of a sudden, you get to a spot and you go, alright, that looks like it. Or maybe it's Oh, I went a little too far. I'll turn it back down a little bit. I'm like, but don't you know, one woman's like, by basals? point nine. You know, should but my blood sugar's are 250. Should I try one? And I'm like, I mean, okay, and I'm like, but an hour later when that doesn't work. But could you push it up a little more for me? Like, I was like thinking about what you're saying? You your blood, your bazel is holding you at 250. But, you know, point nine, like, but you want it to come down 150 points, but you only want to move it up. point one. I was like, that doesn't make sense, right? Like, don't you feel like it might need more than that. She's like, yeah, I guess you're right. But that but that's a doctor that scared her not to touch her basal insulin. And so she's, it's just it's, I don't know, I'm a little heartbroken. Like, it's a little it's, it's very exciting and uplifting to talk to people and see them have some ideas they're going to take and at the same time, when they come up to you, and they show you how bad things are. You know, after the fifth, sixth 10th one, you start feeling like oh, gosh, like I'm never gonna reach enough people to make a difference in the world like it starts feeling

Jennifer Smith, CDE 41:28
might even like from the adjustment standpoint, sometimes comes from the people who had diabetes, a long enough time to have actually had a long enough experience with bazel injected insulin, and how long it did a week to really see the difference in an adjustment up and or down in the actual dose and the imprecision in which that basal insulin works on a 24 hour scale. Right. And I noticed immense different, going from lantis to using an insulin pump. Right, an immense difference. It was

Scott Benner 42:10
amazing. Is that where that kind of that that adage is like making adjustments here bazel wait three days and see what happens is that what that's from,

Jennifer Smith, CDE 42:19
for the most part because the well, you know, the basal insulin clears technically within like a 20 to 24 hour time period, right from let's say, for the example of Atlantis is supposed to work 24 hours, most people somewhere between like 20 to 24 hours. And so you adjust, you need kind of at least a 48 hour period, at least after that adjustment of incremental change by let's say two units, to see if that was enough to now hold things level and steady. And then it also depends on where you taking your basal insulin in the morning, or were you taking it in the evening, you know, the evening time was a little bit easier to see. Because you could notice an overnight with only true basal insulin there. No boluses no food, no activity component, you're sleeping on that right? And then through the course of the rest of the next day. How did things look in between meals or after the meal bolus was gone? Did you kind of get into the next meal on a nice stable level? Were you where you want it to be? Were you still too high? Or are you drifting way too low? And then we adjust again, you know, so I that it is probably where that like, adjust wait three days to see if the adjustment held things where you wanted them and then adjust again. It's kind of where that would have started. I like Spock because

Scott Benner 43:39
someone from the crowd asked me, How long is it going to take me to get my bazel? Right. And I was like, well, I said if I think if you listen to that episode, and you really understand it. So maybe a few days, you know, she says how long would it take you? And I was like What time is it now? She goes it's like It's one o'clock. I'm like I could have it done by dinner, you know, like so. And then we would adjust off the the rest of the clock moving forward, like but there's a there's somewhere there's a good number. And it's funny because I just I realized, um, I could just keep looking at the CGM and the side I said, Now, if you didn't have a CGM, it take me a couple days to write, right? Because now we're kind of blind. And we're testing and seeing things and, you know, making sense and seeing if we can see repeating that and stuff like that. It was like but, but looking at it. That's like, That's cheating, almost like that. That's pretty easy. But I also infer things from pitches and lines and and there's no and then people all the time, like can you do an episode about how you see that? I don't even know how to talk about it. Like I wish I did like I just look and I'm like, okay, that's not enough insulin. That's too much. This is here. You know what I mean? Like, it's just, I don't know what pops into my head, but I don't know. I really don't know how to quantify it. If I'm being right. Come on. I'm not joking.

Jennifer Smith, CDE 44:55
Well, you've you've looked at things enough and you understand, you understand insulin. Action, I think better because of the way that you've looked at things and the way that you've taught about things. But sometimes it is hard to just nail it down and explain, hey, if this is happening here, this is why and this is how we would adjust for. And that's kind of, that's kind of what we do. Get people's graphs and information and their insulin here. And like bazel testing for a pump, especially, you know, we'll do a bazel test within a time segment, I get the data The next day, I look at it, adjust here, test again tonight. They do great, that looks awesome, we're perfect. We've got it like checked off, move on to the next. So it shouldn't be like six days in a row that you have to test that to make sure that each single one of them exactly was nailed. Because we adjusted it four days ago, nope. If you adjusted, it looks beautiful with the adjustment. Great, we're moving on. We got it. I've learned

Scott Benner 45:53
from talking to people face to face to that. The stuff they want to tell you that they think is going to help you help them is never the stuff I need to know. Do you know what I mean by that? They start giving me like and it's it's not I don't even mean to be funny about it. Like, they're they've been paying close attention. And they're like, okay, like, here's a piece you absolutely have to understand. I'm like, I don't care about that doesn't matter. You know, like, like, I'm like, how much do they weigh? How old are they? What kind of insulin are you using? What's your basal rate right now? You know, where do you sit steady, when you don't have insulin, you blah, blah, blah. And then from there, I'm just like, okay, turn this up, turn that down, make this this. And then let's wait and see what happens. But it's interesting, because the information they've been given so far has led them to ask almost all the wrong questions. Right? That's the part that I find fascinating, right, is that somebody has been directing them along the way. And now I talked to them. And then I talked to them again, two weeks later. And now they want to make a small adjustment. And they're asking the right questions. It's very interesting. Like, it's just where you, it's who talks to you first. Like it really is, it's like, whoever talks to you first, you win, or you lose, like right then and there. You don't even realize it when it's happening. There's somebody being diagnosed right now, in the world, who's talking to an endo, who understands, and they're going to go on one beautiful path, they'll never find this podcast, because they don't need it. And then there's somebody else being diagnosed right now who's being told all that stuff that we, you know, have to debunk, and then reteach. It's just, it's bizarre. I mean, you don't like, get cancer and get two wildly different ideas like this one, cancer, doctors say to you, hey, listen, we're gonna try a little radiation. And then if that doesn't work, we'll try to cut it out. Is there another doctor that says you should go home, blow up balloons and eat birthday cake, and I'll fix the whole thing? Because it feels like it's that far apart. You know, like, one ideas, right? And one ideas? I mean, I'm sure there's variations in between?

Jennifer Smith, CDE 47:54
Well, I think the extremes truly are the people who still to this day, for whatever reason, will go into their clinical diabetes team, and they get the hand me your pump. It's like handing over like, you know, your foot. I think I said that before. And so it did nothing. And you're like, Hey, thank you. Your pump is like, like your butt. Like, no, not really my foot, just a body part over, they like, take it away from you. You're like, oh, my goodness, you've taken like my body part from me, you know, and then they bring it back to you. If they've dumped this data in, they look at the data. They don't ask you anything. The doctor might actually sit there and actually might push your buttons on your pump. Yeah, physically make all the adjustments for you. And your left, then handed back reconnected with your pump. The doctors like, Oh, we adjusted some of the bezels or we did this and this because I thought I saw this happening here. what's lacking there the education do? You adjust? What were the explanations that person could go home and say, Okay, I understood the doctor adjusted here because he was seeing this. I'm going to Now watch this. I'm gonna see did it help? Does it make it better? Did it make it worse? Do I need to readjust this? How should I readjusted? that's missing chunk. Yeah. And, you know, I think that that ease of not educating people nor even letting them push their own pump buttons to make the changes or add in Hey, b d is in a row this past week. I was at gramma Joe's eating like sloppy joes and birthday cake, and is please don't pay attention to that data. It's not my true trend, but the doctor is basing adjustments off of it.

Scott Benner 49:45
It messing up everything else that may have been working better than that. I brought a poor kid up on stage from the college diabetes network this past weekend. And I just we stood arm's length apart. We put our palms together you know standing side to side I said, you know, I'm going to be insulin, and he's going to be body function and carbs. And I was like right now, he and I are pushing, you know, an equal amount into each other. And we could stand here forever like this. I was like, but as soon as I don't push quite as hard, and he started, like overpowering me, I was like now the carbs and the body function or winning, which means my blood sugar is going up. And it should I push too hard. I start driving that down and your blood sugar gets too low. But as long as we stay balanced, and we're pushing equally on each other, this could go on like this forever. While I'm saying it, audibly I can hear people going, Oh, like out in the audience like, Oh, wow. Okay. And I just as I was saying it, I thought a doctor couldn't think of that. Like, like, you know what I mean? Like, cuz dumb me figured it out. And and, you know, put it into words, like, like, that was it and just them watching that. And it's something I'd done before with my own hands like palm the palm. I've explained, I've gotten people on the phone, and I've made them put their palms together and like, and, like done it. And I just think like, it's, it's just, it was so simple. You could see like nodding going on. And people were like, Oh, Okay, I get it, I found a million ways to talk about it. Since then I talked about like, bringing in more blockers to like, you know, stop by Blitz, like in football, like, I've talked about it a million different ways. And every time you kind of paint a picture around it, you get somebody else to understand it. I just don't know. It just doesn't make sense to me. So these doctors are telling you, I want you to be healthy forever. But then they kind of some of them don't tell you how. And so. So optimizing your glucose, right for long term is going to keep you as healthy as hopefully possible. Right?

Unknown Speaker 51:41
Yes, absolutely.

Scott Benner 51:42
What about gaps of fall off? Right? I don't like the word burnout so much. But what if they just stopped paying attention for a week that turns into a month, it turns into six months, is that if I if I come back from it, now, I'm not trying to give people like, like, I feel like I'm saying, you know, you can go off and, you know, go off and do heroin for six months and come back, and it's not gonna hurt you, right? Like, not me. But I'm saying like, if you have one of those moments that a slip up or your life gets, you know, busy, and all of a sudden you start leaving your blood sugar at 140 instead of 120 or 180, instead of 150. Is there any way to quantify what that means to you long term? Or there isn't really right?

Jennifer Smith, CDE 52:27
It really isn't? Because again, there's nobody has kind of quantified exactly what amount of mismanagement equates to this amount of complication down the road? Yeah, if you don't do this for three years, you will have this amount of heart damage 10 years from now, right? There's no, you can't quantify it. But I think you can also not bank

control that was optimal, yes.

Or the next month and saying, okay, I was really, really awesome for six months. And now I'm going to go on like an eidl convention, blow out in Italy, and just that care or pay attention, detrimental stuff could be happening. I don't know what's happening in your body, but you don't either. It's not great for you. But it's, you know, but you, you're not, you can't bank on the six months previous being like a code over for smoothing that out and being like, Okay, this whole month of like, mismanagement doesn't really count because I was so good before

Scott Benner 53:35
it's like sleep, you could get great rest six days in a row, and then stay up 24 hours, you're still going to be exhausted, you can't run, you can't bank sleep, you can't bank health, you can't like that. That kind of stuff is really super important to understand. But you know, it's funny because at the same time when I'm teaching people how to get going, like with a one season I started trying to impress upon them that overnight is easier than you think you know, and like once your Basil's right, you're not bolusing too much or too little, you're not going to get these wild swings. Now you've got this third of the day, you know, and it's like so if you see a 160 in the middle of the week, in the middle of the day, you can feel a little better about it because you had like, you know, your 85 or eight hours last night, right? It doesn't make whatever impact the 180 spike has. And like you said, I don't know what it does or isn't is or isn't doing your body. But if it is doing something being at all night long, doesn't stop that. But you know, like being safe right now doesn't mean that if I burn my finger five minutes from now it you know, it doesn't make it go away. It's still happening. I think that's really that's good information. So what are we in your own personal life? Is that how you think about it? Like just I'm gonna do my best and hope this works out?

Jennifer Smith, CDE 54:51
I do because like, you know, I

I try really hard not to like I go to all my checkups, right? I mean, I Get like, my heart checked, I make sure that I go to the podiatrist, I make sure that I get my feet checked, I've never had any problems, thank goodness. But I still go for all my checkups. I go on, I see my ophthalmologist to make sure they check all the vessels and you know, do the test for the puff of the air in the eyeball, right? is like

Scott Benner 55:23
an idiot when it hits your

Jennifer Smith, CDE 55:26
anticipation of that puff of a puff of air is worse than the actual puff is. But you know, I do all of those things, because I know that they are a check in the long term. And you know, what, if something does come up, then the checking is also prevention for furthering problem, then maybe you say it, check on something and up now something is happening. Okay? One, I might beat myself up a little bit of I could have done this better, I could have done that. But that doesn't help that's asked, you can't go back and fix it, what you can do is continue to go forward and say, Okay, I can try to do better here. Or maybe I need to add this or now I just need to see the doctor every three months instead of every six months or once a year, or they've got this treatment that could help me and it could make it better. And if I continue to do what I need to do, then I can prevent further complications down the road. So

Scott Benner 56:26
yeah, I also want to say that, I think I've never met anybody so far, I should say, that has told me, I decided I don't care, I'm going to run full force straight ahead, I'm not going to pay that much attention to my diabetes. And however long I make it, it's how long I make it. Whenever one of those people runs into a complication, they have always said the same thing to me, I wish I wouldn't have done this, like you don't mean like, I wish I would have bla bla bla or tried something else. Or it wasn't my fault. Even I didn't know. But I wish I would have kept searching. And and I think that that's the truth like it, whether you make it, you know, till you're 40, when all of a sudden, you're finding out at UT dialysis, or you make it to 70. And you're like I made it to 70. And then all of a sudden you're having a heart attack, a 70 year old type one is having a heart attack doesn't go at least I made it this far, you start thinking oh, I would like to stay alive a little longer. You know, like I get it, I don't think many people get to the point of no return whatever it is, and go, you know, I did my best. And I'm happy with this. I think I think that people such really do feel like that, like, Oh, I wish I would have whatever that means, you know, whatever they wish they would have done. I mean, if you're a person who can make it the whole way and just be like, you know, 35 years old, jumping your car over a canyon and realizing you're not making it the other end to go, Oh, well, I did my best. Like, you guys, like that's a special like, that's a special gear you have. But what I'm saying is that caring now will keep you from that feeling of I don't know what that feeling would be what how to describe it. When people talk about their they are disappointed in themselves. And then they can't shake that feeling for the rest of their life. Right? Like every day, they wake up with a problem. And they have this feeling like, oh, maybe I could have done something about this. And then you have to live with the problem and the guilt. And it's hard, you know, so I say all the time. I think with what we talked about on the podcast, diabetes becomes pretty. You know, I don't like to say easy, but I think it becomes like second nature thing for you. I would rather put that effort into understanding Pre-Bolus or, you know, something like that, then I would spending six, eight hours a day fighting with high blood sugars that cause a low that have me eating, that make my life feel like turmoil that I'm not living, I'm just existing through rock. So that's how I feel

Jennifer Smith, CDE 58:56
having and that I agree. And it's kind of the way that I feel about my own management is I do the things that I do every day to make it less of a visible upfront in my face, to let it be more of a Yes, I have to manage it. I still have to look at my blood sugar, I still have to take my insulin, I still have to count my carbs and Bolus the right way and whatnot. But those are like more second nature things that I just do now. And until I have like a bad site or something that I really have to completely put my focus into and you know, take care of

Scott Benner 59:37
the normal things that I do every day are just part of my day. Exactly. And those bad sight moments, because I recognize what you're saying is how Arden's life is and mine with helping are is that most of the time we are just sort of cruising along. And when something really goes funky, and you're all the sudden you have to stop thinking about life and you're now you're focused on this diabetes thing in my heart. I know that some People live like that all day long every day. Right? And that's just because that's an explanation to me like your bad sites a great explanation because you're but all that means is you're not getting insulin the way you need to. Mm hmm. And if if your bagels off if you're not Pre-Bolus if you're not doing all those things in every moment, you're not getting insulin the way you should. And, and so your life's always gonna be, you know, I like that.

Jennifer Smith, CDE 1:00:22
And in the instance, then of

blood sugar's being all over, you never really know unless the pump tells you if you are on a pump, that you have an occlusion and that there is a real problem. You never really know. If there's a problem you should be addressing. Yeah, I mean, I know when I know even ahead of clusion alert coming, that something's not right. Yeah, I can tell. Yep. Um, because things are contained. And if I see something odd happening, and I know that nobody is like, injected me with like the sugar to

Scott Benner 1:01:03
go,

Jennifer Smith, CDE 1:01:04
right, then clearly, I'm not getting in. For

Scott Benner 1:01:08
whatever reason, I don't know, change it out. I don't care what I'm going to address it, I'm going to take care of it. I'll just change my pot out and move on. Let's see you and Arden have a scenario, a life where your expectation is a lower, more stable number that reacts the way you expect it to. We said this the other day, when we were talking like I, I talked about how I think of the site as doing what I expect it to do. So the minute I don't see it, doing what I expect, or I see a blood sugar, that's all the sudden 150 my my I start thinking like, I can look back if I didn't mess this up somewhere. This is this is I'm not getting enough insulin. So I don't mess with that either. Like there's a moment. Like I think some people end up looking at a bad site for days. And then and then they they'll change their property. Oh, it turned out to be the pump 48 hours later. Right? Yeah, I'm not into that. You know what, the second or third time I bolus and what I want to happen doesn't happen. And I'm getting out of it. Yeah, I actually had

Jennifer Smith, CDE 1:02:08
it this morning. I mean, I wasn't, I wasn't actually supposed to change. My pod out until this evening is when it was supposed to expire. And I woke up this morning. Not at my normal like, he ish blood sugar. I was like 130 something I was like, kind of odd, right? And like, that's not where I should be. And I could see all this, like, positive temping that been kind of happening. And so I look at my site. And it's bloody in the window, or my pod site, right? And I'm like, had I not checked, I just gone I've got about three, though I'm higher than I normally am this morning. And I'll just correct some insulin, I'll eat for my or I'll take for my breakfast. And hope all goes well. Well, I just I know that that's not the norm for me. So what did I do? I changed out my pod. And that's it.

Scott Benner 1:02:58
Yeah. Because you're you would have been fighting with that all day.

Jennifer Smith, CDE 1:03:01
Otherwise, right? Oh, correct. In my post breakfast would have been for it. I'm sure. I'm sure. I bet she gets

Scott Benner 1:03:06
to 20. That in that situation? Right. Right.

Jennifer Smith, CDE 1:03:09
Yeah. Right. At least. Exactly.

Scott Benner 1:03:12
So, Jenny, if you and I were one person, we'd be a super diabetes brain.

Jennifer Smith, CDE 1:03:17
Oh, my goodness.

Scott Benner 1:03:22
place? Oh, my gosh, all right. I know you got to get going. I'm not sure if we talked about what we said we were going to talk about, but I found this to be a really great conversation about, about long term health and, and ideas of how to get to it and why it's important. So thank you very much.

Jennifer Smith, CDE 1:03:37
Yeah, absolutely. It was, it was good. I think sometimes, you know, the stuff about complications and whatnot gets, it gets to clinical. And I think people just need a return to all that. That's why I'm aiming for just keeping things tighter, or why I'm keeping things more in this range, or whatever. I mean, they know that the complications are out there. But this is the reason I'm doing that

Scott Benner 1:04:04
instead of talking about a thing that seems like it's so far away or so impossible, that there's no real reason to try to plan for it not to happen. Because it's so far I will always use this example. My father smoked cigarettes all day long, two and three packs of cigarettes a day and not like not some like Marlboro light thing like Chesterfield kings, no filter, you know what I mean? Like it was left over on the floor of the place that they just roll up and sold the people you know, and in his 30s in his 40s, in his 50s, smoke, smoke, smoke, smoke so 60s, he'd come back from doctor's appointments doctor says, I can't even tell you're a smoker and he would wear that with a badge of honor right up until smoking killed him. right up until he had COPD, and then and then he died. So you know, can only you can only you You only stay ahead of a charging bowl for so long right and right you don't want to be you just you don't want to give yourself

Jennifer Smith, CDE 1:05:07
up off the path and be like, let it run by. run by.

Scott Benner 1:05:12
My dogs are barking like crazy. I think someone's breaking into the house. I might be killed soon we'll find out. For me, Kelly, probably Yeah. Oh my god finally dating. Oh, I hope not. All right, I will talk to you soon.

Jennifer Smith, CDE 1:05:29
Okay, awesome. Bye. Bye.

Scott Benner 1:05:33
I bet you didn't know that you can hire Jenny. She works at integrated diabetes, just go to integrated diabetes comm or there's a link right there in your show notes that you can email Jenny directly. Jenny is not a sponsor of the show. She's a friend of the show. But that doesn't change the fact that she's got a mortgage to pay. huge thank you to Dexcom and Omni pod for sponsoring this and so many other episodes of the Juicebox Podcast, my Omni pod.com forward slash juice box go there today. Get the demo pod get a pod experience kit sent to you and get your Dexcom g six continuous glucose monitor right now stop waiting dexcom.com forward slash juice box. This episode is the 17th of the diabetes pro tip series. It began back on February 25 2019. With an episode called newly diagnosed you're starting over and there was 211 to 12. That's all about MDI and all about insulin to 17 to 18 and to 19 Pre-Bolus in Temp Basal and insulin pumping to 24 to 25 and 26. mastering a CGM bumping and nudging and the perfect Bolus, Episode 231 about the variables that come with Type One Diabetes, Episode 237 setting basal insulin 256 exercise in Episode 263. We talked about how fat and protein impact your blood sugar's and they do. Episode 287 illness, injury and having a surgery with type one diabetes in Episode 301, glucagon and low blood sugar emergencies and Episode 307 emergency room protocols different than illness injury and surgery. This is what happens when you're thrust into an emergency room. Not something you were planning for. And of course today's episode 311 diabetes pro tip long term health. Thank you so much for listening to the podcast. Please leave a rating and review in Apple podcasts if you're enjoying the show. But moreover, if you like what you've heard, find someone else who could use it the only way a podcast grows by word of mouth. So I appreciate it when you tell somebody else about the show.

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#310 She Is Having a Baby! Third Trimester

Part Three of a Four Part Series

Samantha is 24 years old, newly diagnosed with type 1 and pregnant. I'll be talking with Samantha after each trimester and after the baby arrives.

+ Click for EPISODE TRANSCRIPT

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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 episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. It's the best blood glucose meter My daughter has ever used. And when I say best, I mean, it's the most accurate one that we've ever used. It's the handiest blood glucose meter that we've ever used. It's got the greatest test trips that even allow a second chance sampling, and it has an app to help you make sense of all the data. All of you may not have a continuous glucose monitor, but you are testing and that data is important. Let Contour Next One help you with their app. Check them out Contour Next one.com, where you can click on the links in the show notes. Were the ones you'll find for this episode. At Juicebox podcast.com. After you get yourself a new meter, you're going to want to head over to touched by type one.org. Touched by type ones mission is to elevate awareness of Type One Diabetes to raise funds to find a cure and to inspire those with diabetes to thrive. I'll tell you more about the Contour Next One blood glucose meter and touched by type one a little later in the show Samantha's back. Samantha is really pregnant at this point. This is her third time on the show. She came on after her first trimester after her second trimester. And now as she's getting ready to deliver, find out how the pregnancy has been going. It turns out Samantha has one big fear. You'll find out what that is. programming note for those of you who listen with your children. We're going to speak about parent Neil massage at some point. We're going to read the steps for it. So it's clinical. But you know, we use all the words. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan. or becoming bold with insulin. Hey, if you haven't heard it, Samantha's first two episodes. The first one is she is having a baby. first trimester. That's Episode 259. second trimester is at 285. And this of course, is Episode 310. of the Juicebox Podcast. Thank you for listening. Hey, I just got back from Atlanta. Thanks to everyone who came out. I love seeing that big full room. You guys were terrific.

Samantha 2:32
Morning.

Scott Benner 2:34
Hey, how are you?

Samantha 2:35
I'm good. How are you? I'm

yeah, I'm alright. Yeah.

Scott Benner 2:42
I perhaps overcommitted a little bit on the public speaking but I'm

Samantha 2:45
really tired.

Scott Benner 2:48
I got sick on the last flight. Oh, no. And I um, I had this situation where I was in Dallas. And it was a it was a quick turnaround on a long flight. And so I left my house at 9am Saturday morning, and returned home at 1am. Sunday night. So Monday morning. Yeah. And then I had to get up in the morning and go to like a long dentist appointment at 10am. And while I was sitting in the dentist's chair, I thought, My throat feels weird. Oh, gosh, I remembering the coughing kid on the plane. And I was like, huh, yeah, so I was like, I'll be okay. Because Sam, here's the thing you don't know about me. I don't get sick.

Samantha 3:36
My dad says that too, until he gets sick. No,

Scott Benner 3:39
no, it really like I will get sick. You know, don't get me wrong. Like it'll be 10 o'clock at night. And I'll be like, wow, I have a fever. I don't feel well. And I'll go to bed and wake up in the morning. I'm like, Oh, don't miss over like that quickly. So you know, I'm like, Okay, my throats a little scratchy. This won't get me the next day and the next day. And then like, the third day afterwards, I raised my voice. And then I lost my voice. Oh, and I was like, seven days away from sorry, the music's playing. I was like seven days away from having to go to Atlanta, which is now I leave for Atlanta in like three days. And I couldn't speak it.

Samantha 4:20
Oh, gosh. Well, you sound like you don't sound like Yeah.

Scott Benner 4:24
My body wasn't putting up with that. Yeah,

Unknown Speaker 4:27
I'm by job to do.

Scott Benner 4:29
My jeans are a mess otherwise, but I don't get sick for very long. But I was in a bit of a panic. Because I felt Yeah, I thought oh my gosh, this whole Atlanta thing is it's built around my being there. Like there's four. There's four sessions that I'm in. There's not that many sessions. Yes, I was. Yeah. Oh my gosh, I'm in trouble. So I was real quiet for a couple of days. I didn't talk much. My wife was like, This is amazing. Alright. But he's funny, you know? Anyway, you're super preggers now. How's it going?

Samantha 5:01
I am I'm, I'm good. I it's three weeks from today that he will be here if he doesn't decide to come earlier.

Scott Benner 5:10
So are you being induced?

Samantha 5:11
Yeah, they're inducing me on the 17th of March. Wow,

Scott Benner 5:15
is that a day isn't the 17th of March something?

Samantha 5:18
Yeah, but it's also the only day my doctor is working the entire day. So I have to St. Patrick's Day, but

Scott Benner 5:27
I was just thinking all the Catholics listening are like, yes, idiot. It's Saturday. That numbers ringing true in my head for some reason. Um, are you excited to have the baby on St. Patrick's Day if it happens? Or do you just don't care, it's just the day they had.

Samantha 5:41
Um, I mean, I'd rather not be on a holiday but. But as long as I mean, it's fine. I because it was really important that my doctor was the one that was there to be the one to deliver. And so like, they're having me come in right after midnight, on the 17th. And then, because she's like on call, and then she's gonna be in the office all day on the 17th. So that was the best chance to make sure she was there.

Scott Benner 6:13
Here's my thoughts. My brother was born a few days before Christmas. And he got screwed over every year because my parents would just go Christmas shopping. And they? No, no, they would just go to his Christmas pile and pull out like two or three things and a birthday present. So the kid was getting less stuff. He was totally getting hosed. And now I'm thinking, What if your child your son grows up to be a bit of a drinker? I don't think I don't think we want his birthday on St. Patrick's Day.

Samantha 6:39
Everyone says that he'll like it when he's older. Yeah.

Scott Benner 6:42
How much? And how much were you like it? Yeah.

Samantha 6:46
So it's fine. It's

Scott Benner 6:48
so I'm super interested in how, because I realized when we started doing this, like, the first time we spoke, it was gonna be you know, there was a lot there, like you were getting, you're getting over a personal tragedy. You were pregnant again. You know, it was a lot of excitement. And like, and, you know, little consternation, maybe a little wary. And then the second one's always like, that's the cruise control part of the pregnancy, usually like that three to six month range, but I'm gonna curse and then bleep it out. It's real in the last three months, right? Yeah, what's going on?

Samantha 7:21
I mean, huge. That's definitely. And people keep saying how big I am. And I'm tired all the time. It's really hard to sleep, because especially in the last couple weeks, when he is like, big enough, in my stomach, where he's like running out of room. At night, he likes to stretch. So it's like his butt is pushing on one part of my stomach and his feet are pushing on the other part of my stomach. So it's very hard to sleep because his feet are on my right side. I usually try to sleep on my right side. But then it's like, he's poking me. And then I try to turn over. And he doesn't like that. Because like his whole body shifts, and it's a lot.

Scott Benner 8:13
It's hard to sleep with other people, whether they're outside of you, or inside of you, apparently,

Samantha 8:17
yeah.

Scott Benner 8:18
Are you able to move him? Or do you have to move yourself? Have you figured anything out? Or is there it's just kind of fruitless?

Samantha 8:25
At night, I think I'm just too tired to deal with it. During the day, if he's doing the same thing. I will like push on him until he moves. Gotcha. And

Scott Benner 8:35
go ahead. I'm sorry, I just I started to talk in my brain was like, You have nothing to say. So.

Samantha 8:41
Yeah, my husband gets worried when I push on my stomach a lot. But I mean, he's fine. Because sometimes you like you can't feel him at all. Like right now. He's not awake. So I can't feel him at all. But like, in a couple hours is when he usually wakes up. And he'll be like, poking insides and my stomach will look deformed because he's poking at two different sides of it.

Scott Benner 9:06
How do you find the commentary? Because I was thinking about it from my perspective. Sometimes you see a pregnant woman who's clearly like towards the end and yeah, it's nice like it's like oh my god you're so big kind of means like the baby's coming or you know, like something like that but that's if you hear at once what happens when every person who passes you is like oh my god, like a big year. Like, how does it end up feeling?

Samantha 9:29
I don't mind much the only thing that runs through my mind is like he has to get out of me. So Stop saying that. I'm like, so big, because that means he's so big.

Unknown Speaker 9:40
The exits not so big. Yeah.

Samantha 9:43
Like I'd rather him be like, Oh, yeah, you look like a normal size. So yeah, he'll be normal, but he's already he was measuring like, perfect normal size. Up until like two weeks ago. We had our final ultrasound where they measure him. And his, his. His like body is measuring a little bit bigger. So

Scott Benner 10:09
have you ever been behind a tractor trailer on the highway and you're coming up on an overpass? You think oh my god, it's not gonna make it's not gonna mean that it goes right under it. It's not a problem.

Samantha 10:17
Yeah, that's what everyone keeps telling me. He told me not to worry, but

Scott Benner 10:21
oh no, I would worry about it. I'm just saying that you won't see that you won't be behind the tractor trailer on the 17th. But your husband's gonna have that feeling he's gonna be like, this isn't gonna work. There's no look the baby came out that's really feel like it actually tell him unless he's got a strong feeling about it. He should really probably stamp on your half of the of the game. It's just,

Samantha 10:45
it's easier. Yeah, I don't know what he plans to do. Actually, we haven't talked about that. I always just assumed he was going to be next to me because I'll need him to be there for me. But I don't know. I wonder

Scott Benner 10:56
how that always goes. Because I felt like I was well, with my first son, with my first son, like, I have 17 sons with my first my son when my son was born, my wife was in labor for quite a time. And at one point, I was trying to do all the things that I thought I was supposed to doing, like comforting stuff. And it's she's like, why don't you go get something which I look back on now. And I feel like she was like, What if he just got out of here for a little while? realizing right? So back then I was younger, and a Dorito was nothing. So I had a sandwich and a couple Doritos or something come back up. She goes into labor later and I have diritto breath. My wife will retell this story with the same anger that she had. On the day of my son's birth. She'll tell that story right now. It just I must. I was like, it's gonna be okay. And she was like, Oh, my God, like, get back if he's going to screw something up. Or perhaps he won't. Excuse me. I'm excited to find out what happens like? Or if you get irritated with even the support at some point, if you find it necessary. Like it's a really interesting what happens in the moment? Are you thinking about epidural or what are you planning for? touched by type one has programs and services for those living with a daily reality of type one diabetes, they offer a supportive community with many interactive programs, and creative resources designed to empower one to thrive with type one. program programs like their annual conference, their awareness campaign bowl for a cure their dance program, dancing for diabetes, the big show every year. And they even have something they call a DI box that they send out to newly diagnosed people. That conference, by the way, touched by type one. It's on May 30. in Orlando, Florida, and I'm pretty certain I'm going to be speaking at it. I hope to see you there. Check that out. And everything else they do at touched by type one.org.

Samantha 12:55
As soon as they can give it to me or as soon as it starts hurting my eye yesterday, I was talking with the nurse. And she was saying like, if you don't feel anything and you're fine with the pain, then you can always put it off. And I was like No, I want it written on something that you give me the epidural right away. Like I don't want to feel.

Scott Benner 13:14
I don't know if you understand how pain relief works. But once you feel the pain, it's too late.

Samantha 13:19
Yeah. And I was like, I don't want to feel any pain. So I want it right away and keep it coming. It's 2020 lady.

Scott Benner 13:28
Yeah. No reason for mama to be like, Oh my gosh, why someone stabbing me?

Samantha 13:33
Yeah,

Scott Benner 13:34
I hear you. Oh my gosh, well, I'm okay. So so the people talking to you really just makes you think about the delivery more than anything. Like you're not like, don't feel like a body image problem. When they're saying like, you're pregnant, you're supposed to look like that.

Samantha 13:48
Well, I have a double chin now, which I'm not used to. And that's the only thing that I have an issue with. That's fair. But other I mean, other than that, that's a small thing. It's not like I dwell on it all the time. It's just like, it's there. And I know, I know, it's there.

Scott Benner 14:05
Not that I'm pregnant. But I have a double chin. And I daydream about having it altered. Oh, yeah, monthly, monthly. I look in the mirror. And I think How hard would it really be to make a small incision here, just whatever this is here. Just take it out and pull the skin the tiniest bit. I owe that to myself. afford it? But yeah, I feel like I'd be happier.

Samantha 14:26
Is that strange? No, no, I mean, I think I think it's something that everybody goes through your normal.

Scott Benner 14:33
I avoid taking photos sometimes because of it, which I don't have any other feeling about having myself photographed. Except for that.

Samantha 14:40
Yeah. See, that's when I noticed that the most in photos. And I'm like, Oh, wait, no more photo. me.

Scott Benner 14:48
Sure. Everyone's like this. I look in the mirror and I think I'm having I'm having a good day. And then I'll let someone take a picture. I look at the picture. I'm like, how is the person in the picture now? in the mirror like that's not I mean, and not that. It's like It's so far off.

Samantha 15:02
One of these things is lying. I don't know which one it is

Scott Benner 15:05
hundred percent. And I think it's I think it's anytime I look and think I don't look so bad today. Yeah, the light must be right or something. Oh my god. Okay, so we've got it, we've got a delivery date, but you're hoping that maybe he comes sooner.

Samantha 15:19
Um, I kind of well, not too much sooner. Because I mean, I'm working up until like, the 17th is a Tuesday, and I'm working until that Friday before

Scott Benner 15:30
so interesting. So it's a little bit of a money thing to like you. You need him to stay in.

Samantha 15:34
It's, um, it's a money thing. And it's like I otherwise I'd be sitting at home and what am I going to do at home? kind of thing.

Scott Benner 15:42
You're about to find out because you're having a baby.

Samantha 15:45
Yeah. And then the baby will be here. And I'll have things to do. But

Scott Benner 15:49
you certainly will. Oh, my gosh, I there was like a three year span where we'd watch the Academy Awards and just think I heard about this movie. Yeah. Yeah. I so okay. So you don't like staying a little bit hoping maybe? Do you prefer natural over being induced?

Samantha 16:12
No, I don't care. It doesn't. Yeah, as long as I don't, I don't want a C section. I really hope it doesn't turn into me having to get a C section just because I don't want my stomach to get cut open and have to deal with the longer recovery. But other than that, then, yeah, induced or natural whatever. Whatever happens.

Scott Benner 16:34
My son came out two weeks late.

Samantha 16:37
Yeah, usually what the first he they at least stay in their full term. So I'm thinking that he'll probably make it unless something happens where they're gonna like where they decide he needs to come early. Yeah,

Scott Benner 16:49
Arda needed a parachute on her on her due date. Like she was just like, coming out. Yes, we were we were our Kelly was going to be induced on Arden's due date. And the night before we're like packing up and getting ready. It's like 1230 and she's like, I think my water just broke. Oh, so we just made it that long, though. Should we made it to the hospital and Arden came out? A few five, six hours later, we actually were just at lunch the other day, where am I was chest I was chastised again by my wife for not knowing the times my kids are born. Oh, gosh. So my son's born in the early evening and Arden's born in the early morning, but I mean, the exact number. You would think I was really taken, taken to the woodshed at this restaurant for not knowing and then I start then I start guessing I'm like, I don't know. 716 then my brain doesn't remember. So they'll ask me 20 minutes later, and I'm like, I don't know.

Unknown Speaker 17:45
Doesn't matter now.

Scott Benner 17:46
They're here. I'm taking a great jet. Look at how good she's doing.

Samantha 17:50
Like me, like if it really matters what time they're born, then we're only selling they're celebrating their birthday at that time. For a minute.

Scott Benner 17:58
I'll say this yesterday was my son's birthday. Yeah, I turned 20. And it was the first day his first birthday. We weren't with him on his birthday. Oh, more impactful than I thought it was going to be. Yeah, but we saw him the day before. He played baseball the day before we went to see him but it just kind of didn't feel the same, like not being there for some reason. So anyway, all that sadness, you have to look forward to

Samantha 18:22
awesome, yay.

Scott Benner 18:25
Turns out when you love somebody, it hurts almost as much as it is. It feels good. All right, so how how's your diabetes been? How's that been going?

Samantha 18:37
Right now, in the last couple of weeks, it's been a lot nicer to me than it has before I went through like maybe a month plan where I wanted to scream because my my insulin resistance kicked in. I was hoping that it wasn't I thought I was gonna get like, it's gonna be a miracle. And I wasn't going to deal with that. Because everyone had said that it kicked in earlier for them. And it wasn't happening for me. So I was like, maybe I skipped that part. But I didn't. I hit that and I was needing a lot more insulin and I was changing my Omni pod, like every day and a half. Because I was going through so much insulin. And I mean, I probably could have eaten less carbee things and made it last longer. But I didn't really change the way I was eating. So I was going through my Omni pods. Like every day

Scott Benner 19:29
we had that chin defeat.

Samantha 19:31
Yeah, exactly.

There now so you guys will take care of it.

Scott Benner 19:38
What are you gonna do? What are you gonna do give birth of that chin and then ignore it. That's not okay. I'd have to call Beifuss on you for that.

Samantha 19:48
So that was really I felt like I was changing it like every second which was crazy. And then like once that's I think the most frustrating part is that it doesn't like change, like, your settings don't change, and then they're good. It's like my settings were changing every day to something different than the day before. So it was really hard to like, like, I would figure it out. And then the next day, it would just be completely different. And then I'd have to figure it out again. And that that's the most frustrating part to me.

Scott Benner 20:23
So that's probably off the F Jenny at some point. But that's probably hormones, because you're describing Yeah, you're describing like, like doing like, like, I don't know, like a period situation or something like that, where like, one day, it's, it's going this way. And then you know, a couple hours later, like, Oh, I got it, and then all of a sudden, it heads in a completely different direction. And it's really tiring to keep up with,

Samantha 20:44
it is tiring, and it's totally the pregnancy hormones it has, like it probably has to do with something like he's growing or something, I don't know. But definitely, it's happening. And that was the most frustrating part. Not that I was using so much insulin just that like, I like it when, like if it changed at one day, and it was like that for even like, even the next day, I would have been happy. But it was changing every single day, every hour, like the morning of Wednesday was going to be different than the morning of Thursday. And it's just really exhausting.

Scott Benner 21:20
I feel that. So you're using 200 units of insulin about in 36 hours for that amount of carbs. How much insulin Do you think you should have been using? In that 36 hour time period?

Samantha 21:32
will usually my pod while I'll be able to make the the for what? Three days?

Scott Benner 21:41
Yeah, doubling your insulin? Almost?

Samantha 21:43
Yeah. And like, right, my carb ratio is already pretty like I've ever since I was diagnosed, my carb ratio has been kind of crazy. So I use a lot of insulin in general. So when I hit when I need more insulin, it's just like,

Scott Benner 22:01
a ton more. Did you say you did it? Or did was it hard to do sometimes, like what is your current ratio? Now? 12124

Samantha 22:06
is my current ratio when like pre pregnancy

Scott Benner 22:12
artists is aggressive at like one, one to like seven and a half or something like that.

Samantha 22:16
Yeah, I've always been one to four. It's never it wasn't. It's not like a pregnancy thing. It's like since I've been diagnosed, it's been wonderful. And it works for me. So obviously, it's right. It's just when I'm needing more insulin on some days, it's like, my half I, I use a lot of insulin.

Scott Benner 22:37
Is it Mom? I'm thinking for you. But is it scary to use that much?

Samantha 22:42
It was in the beginning. I especially during the pregnancy, I've gotten a lot more used to using more. And I don't. So I break up the Bolus in the pod just because I worry about like, I have problems with the pod leaking. Sometimes if I do too big of a bolus, and I don't know if it's because of where I have it on me, or it's probably something that I'm doing wrong. So I'll break it up. And that kind of fools my mind also into thinking that I'm not taking so much.

Scott Benner 23:16
Because you're looking at like 445 carbs. You're looking at like 11 units or more. Yeah, one for four. So you mean you could have had a 45 carb meal and been doing 25 units like Yeah,

Samantha 23:28
yeah.

Scott Benner 23:30
Jesus, that must have been that does. There are people right now have kids that are just like, Wait, what?

Samantha 23:36
Yeah, cuz Yeah, it's crazy. And that's why I always find it so interesting to hear other people's carb ratios and settings because mine are so aggressive that it's just like, it's so interesting.

Scott Benner 23:50
Arden's I would say that, to get 11 units into Arden would be for something pretty carb tastic in the 80. To 90, maybe it might be the 70 to 80 carb ratio. Oh, yeah. And, and that's, you know, she does not very frequently eat more than 6070 carbs at a setting. Unless, unless it ends up being something like crazy, like a waffle and it has, you know, syrup. Yeah. But but every now and so what I wanted to kind of talk to you about a little bit is that from all of the other people I've spoken to adult women who have had babies, as hard as this part is right here. As far as your management goes, the real time to be vigilant. And for somebody looking in from the outside to like maybe be a little more concerned is going to be the after part.

Samantha 24:43
Yeah. And that's and that's what my the nurse was talking to me about yesterday to she was just because everyone says like, she was saying that my my needs are going to go back to pre pregnancy pretty quick after he's out of me. Which right now in the last two weeks, I have been doing my pre pregnancy settings. So I haven't needed as much insulin as the month before, like previous, which has been nice because everything's been more steady. And I've been able to keep things in my range easier. But I hear breastfeeding drops you fast.

Scott Benner 25:22
Okay? I didn't, that's interesting that I didn't, that I didn't hear what I was thinking about more is you're going to be tired. And the baby is going to suddenly seem more important than anything else. And that there's a concern, people stop paying close enough attention to their blood sugars and stuff like that.

Samantha 25:41
Yeah. And I met, the nurse was telling me because she knows me, because she is a nurse that went through our previous pregnancy. And then I see her all the time now. So she knows that I'm a little bit crazy with my management. And so she was telling me like that I need to kind of relax a little bit, because she's worried about, I think she's more worried. I had a whole kind of argument with her, like a month ago, because she thought my agency was too low. And I was trying to explain to her that I didn't go low. So it's okay, that my agency was on the lower side, because I wasn't having any hypose. And she was very adamant that that like that it was just too low, because I think she's used to dealing with different kinds of people. And so I think she's just worried about me going low and being with a baby, and not fixing it, and then something bad happening, which I understand. But

Scott Benner 26:45
so I have to say something from a more theoretical standpoint, let's keep in mind a I don't have type one diabetes. MB, I'm not a lady. C, I could not give birth but D I did take care of two newborn children. Like my, you know, joking, joking, and no joking aside, like, somewhere in the mix in the middle of my wife's job is to go to work, make babies and hand me the babies. You don't I mean, so it's not that she's not involved. But, you know, the overnight stuff, you know, that kind of stuff is I know what it's like to raise a newborn is what I'm saying. Yeah. And so from everything I've seen doing this podcast and everything I've heard from hearing from people who've do well or struggle vice versa. I sort of think that in the in the vein of bumping and nudging, the bigger concern would be letting it get away from you. Yeah, right. Because like management, obviously takes a little focus. Mm hmm. But not managing takes way more time. It's going to make your blood sugar higher a person like us not going to feel well with their blood sugar higher. Yeah, that's gonna just create different problems. Like I don't understand the idea of trading a possible problem for definite problems.

Samantha 27:59
Yeah, and that's what my husband said yesterday, when I was telling her telling, sorry, telling him what she said when she was a hurt, because then you wouldn't have this baby inside of you, but go ahead. Yeah, because I told him, I told him like, she was like, telling me if I go over 200 then it's okay. Like, we'll correct and, and they'll come down. Oh, I'm sorry. I lost I lost the earphone. And that my husband, my husband's reaction was, well, if you go anywhere near 200 you're gonna feel like, like, you're not gonna Yeah, you're gonna feel terrible. So that's not gonna help you any. So we'll see. It's gonna be an adjustment. And I'll probably

I'll probably mess up somewhere along the way.

Scott Benner 28:44
But all I'm saying is that it's not that you're gonna mess up it's that you're adding a layer of responsibility concern and like love and affection that you at this moment and I don't mean this pejoratively. But I also try not to use too many big words that I know while I'm doing the podcast, but I don't mean I don't mean this poorly. But people are like, is this guy smarter than he says he is maybe me. Okay, and, but the concept here would be you don't know what it's like to have a baby. I know you, won't you do you right now. You know what it's like to be pregnant. That kid's gonna come out. It's gonna hit you so deep in your heart. It's going to change everything you care about in a split second. Yeah, you're going to value your own health less. Yeah, soon as it feels like valuing his health comes first. I sat in a doctor's office yesterday, because my back has been a bit of an issue and I have plantar fasciitis in one of my feet, right? And so it sucks because my ankle gets stiff. I can't run when I can't run. I can't work out when I can't work out my back gets that from you know this cycle. So I go to a place where they offer physical therapy and chiropractic stuff. Like this whole kind of like Wellness Center, and I'm in there going, like, just let me go to the chiropractor guy. And they're like, no, if you do two weeks of physical therapy to like, we'll get you back to where you need to be, and you keep going. And I'm like, I don't have time for that. And the guy's like, What do you mean, I'm like, I just, I don't have time. And he's a younger guy. You know, he's a married man, but he doesn't have kids. And I'm explaining to him like, you mean, you don't understand. Like, I have a job like this. This podcast is a job, it takes up a lot of time. It doesn't make a ton of money, but it makes enough money to help me send my son to college. And this is how much college costs every weekend. And this is what my mortgages, my bills, and you know, and I have to support my wife who's making the lion's share of the money that's taking care of all these things. And I have a daughter who has type one diabetes, she has hypothyroidism, she's been struggling with muscle stiffness and other problems. She just had a surgery to have this thing taken out. I'm like, you don't get it, man. I'm like, I'm not a person. Yeah, I'm a facilitator. And then at the end, if there's anything left, that's when I'm a person. And the guy's like, that's wrong. And I was like, No, I know. And I completely agreed with you on that, right? Until I had a kid. And, and so like, you know, theoretically, for all single people listening, you're right, I need to value myself and make more time and all that stuff. But when you're in the fight, you know, when people are shooting, that's not how it goes anymore. So I just want to caution you against that, because you have a different layer with diabetes.

Samantha 31:27
Yeah, I feel like

Scott Benner 31:28
if Arjun was about to have a baby, this is what I'd be saying to her, that I you should learn from me, and value yourself enough that you can find strike a better balance than what our monkey minds do once we have kids. Which is just like, like, Oh, I'm gonna just die sooner as long as he's okay. Doesn't matter.

Samantha 31:49
I know. And that's probably something I'll struggle with. Because I already see myself like when we babysit my, my nephew more than my niece, because my niece is older, but my nephew was four, like, I, I noticed that when I'm taking care of him, I kind of don't, because I'm caught, like the person that constantly checks my decks calm. And every five minutes, I know what my blood sugar is. Because I like, if it changed, for whatever reason, I need to know so I can stay on top of it. Because that's just who I am. Probably not the most healthy, but

Scott Benner 32:24
you're probably insane. But, um, yeah.

Samantha 32:26
And but I, but I understand that I'm insane. So it's okay. But when I'm watching him, I don't really pay attention to it as much, and then my alarm will go off. And I'm like, Okay, I need to do something

Scott Benner 32:42
where your alarm set.

Samantha 32:44
Right now I have my alarm set at 80 and 120. So it's, it's the alarm when I have time to do things. But also, if I'm at and running around with a four year old, then I couldn't be 60 in the next five minutes. Right? Right. So it's something that I'm going to have to figure out,

Scott Benner 33:05
yeah, it's gonna be different, right? You're, you're gonna have to, you've now known what it's like to be, have type one, and not be apparent. And now you're gonna find out what it's like to have type one and be a parent. And maybe, you know, maybe stability at a slightly higher number than you're accustomed to, maybe will be the way to get through the first number of months. And I'm not also saying, like, for the rest of your life, because that's the other thing is that if you think your diabetes has changed a lot over the last number of months, day to day, like, Wait, do you see what happens? Like, you know, there's a stretch of time, where the baby is just like, you know, a drinking pooping mission with that. But once that stops, it's just like, I don't know, it just feels like you're on a roller coaster constantly going down a hill, and then one day it flattens out, and they leave for college. You know, so the rest of it is going to change frequently. And yeah, and it's going to happen so quickly, you're not going to notice it happening sometimes. So, you know, if you can't be fluid and be a parent, you're going to be in trouble. Yeah, of course. Yeah. So I I'm saying I think your management, like if you chose a slightly higher number to stay stable at and that benefited you not saying that even that's your answer. But if that's what you choose, it's not going to need to stay like that for long

Samantha 34:22
before. Yeah,

Scott Benner 34:23
life's gonna shift and you could probably shift along with it.

Samantha 34:26
Yeah, which is I'm sure. I mean, I'm thinking that because I've heard that your hormones are still wacky and will mess with your settings and your insulin needs. Like in the entire time you're breastfeeding up to just and then after you're done breastfeeding because your body still needs to adjust to being normal again. So I assume it's gonna be crazy for a while. A wild ride to say the very least, and I'll just have to do my best.

Scott Benner 34:57
And they remind us again with the with the Little Man is going to be called when he gets a name. Harrison. That's 100%. Correct? Yeah. After Harrison Ford in case any of you missed? Mm hmm. And by the way, if you missed the second episode, what are you doing the Sam's given her time Sam's came on? Right when you found out you're pregnant. Mm hmm. And then at the end of the trimesters, and now we're right, ready for the birth, you're going to come on once more. When I after the baby. And here's what I expect the last episode of viewers to go like Sam ready, I just, I don't know, I just say, Please, help me we eat the cat. We didn't mean to. We didn't even have a cat before the baby. We got a cat. I don't know where it came. A toxic shock. So we eat the cat and I don't know what to do. We're thinking of having another baby. Yeah, watch all this stupid stuff that happens to you now. Really, really excellent. Listen, having children, to me is is one of those things that you could put me on a deus and say, Scott, I want you to spend the next hour arguing against having children. And I could do it fervently and mean every word I'm saying and then move me to the other side of the stage and say, Scott, I don't want you to argue for having children. And I could rebut everything I was saying and I'd be right on both sides of the stage. So good luck.

Samantha 36:26
Yay.

Scott Benner 36:27
Really start looking back at what kind of a child you are. And your husband was because trust me there in is gonna lie. what's about to happen to you

Samantha 36:35
somewhere? Well, from all the stories, my husband was a little perfect Angel. So

Scott Benner 36:41
did his did his mom tell those stories? Yeah, you need someone else to tell those stories?

Samantha 36:46
Well, I believe it. He's very good now. So yeah, this whole thing it continues on through the generations.

Scott Benner 36:53
So if you told stories about your husband, they'd all be like, super positive about what a great guy is?

Samantha 36:57
Well, yeah, mostly, he's a great guy.

Scott Benner 37:01
Maybe you're gonna get lucky here. Some people's kids are nice. But

Samantha 37:06
I mean, I'm sure I'll think my kid is wonderful. So Oh, isn't that old? Man.

Scott Benner 37:12
I don't know if you'll think that or not like. So I'm wondering now, I'm super intrigued now to all the mothers that are listening. Like, I wish I could hear all their thoughts at the same time, because right now they're like, you know, the first one's nice, but the second one's kind of the very first thing you're going to notice when you go to Contour Next one.com is a yellow button at the top that says get a free Contour Next One meter, just give it a little click. When you do that, you're one step closer to the most accurate, Handy blood glucose meter, my daughter has ever had. To get started today with the Contour Next One smart meter and their contour diabetes app, you're going to discover that smart blood glucose testing with the Contour Next One meter. And the contour diabetes app is just what you've been looking for. get to that link, scroll down, fill out a little bit of information, find out if you're eligible for that free meter. And get started today. If you don't want to do that, you can just ask your endocrinologist at your next appointment say, Hey, come on. I've been using this meter right here forever. I think things been on the market for you know, a million years. I don't know how accurate This is. Is this the latest greatest technology and blood glucose metering? I don't believe so. But I'm hearing that the Contour Next One might be worth a looky loo. Your endocrinologist will probably say, I don't know why you're saying looky loo, it's not 1924 then they'll write you a prescription and get the thing yourself. That's it, get some test trips, a new meter, you're on your way. whole new life with accurate tests. Don't forget to be hit that blood drop once and you don't get a you know the beep with the Contour. Next One, you can go back in and go again without affecting the accuracy. So you don't have to waste that test trip if you don't get it right the first time. It's got a great little light for doing it in the dark. And this little neat system with like colors and arrows that shows you if your blood sugars in the range that you've preset, you got to check it out. Contour Next one.com I'm super intrigued now to all the mothers that are listening. Like I wish I could hear all their thoughts at the same time because right now they're like, you know, the first one's nice, but the second one's kind of then like it just it really does. It's interesting, like my wife and I were talking last night my son had a uh, his very first start at college. And they his team was getting like, they they were really putting it like getting it put to them. They had maybe two hits the whole game, but my son was putting the ball in play like hitting the ball hard. He just kept hitting it at people and even just hitting the ball seemed like an accomplishment in that moment but it was certainly not the excite exciting debut. I think he was hoping for in his second season you know, like nobody plays in there. freshman season if you get on the field in the first game in the sophomore year, that's pretty exciting for you. Yeah. And and so there's a doubleheader. And after the first game, he comes over, we brought some food for him. And he comes over. And as he's walking towards us, my wife and I, like, how's this gonna go? Like, is he happy that he's like, like, that he reached this goal, is he going to be upset at how the last, you know, hour and a half didn't go is probably the way he diagrammed in his head, like, where's this going to be? And we knew for certain that the year before he would have walked up to us, and been disappointed and probably aggravated to some degree. But instead, a completely different person walked up to us. And we had to admit, when he walked away that as good of a kid as he was prior, he had been short a lot in the last year, in some ways that we had not seen because he's been away at school, sometimes. His reactions were just measured and thoughtful. And we were like, Oh, my gosh, and he walks away. My wife's like, wow, that one really worked out. And sitting right there, and she's like, yo, you're doing fine, too, just like, we only time will tell with you. We're just like, he's starting to look like he's not gonna ever rob a bank. Like, maybe we can sit back a little bit pretty good about what's happened here, you know. But, you know, but last night, going to bed, I still felt like, I can't believe we didn't, you know, we didn't see him on his birthday, more than just like a FaceTime, you know, for a few minutes. And yeah, a couple of text messages. So I definitely don't want to be trite. But I have not found any better way to say it really does go fast. You know, just to try to enjoy it. And if you can, big picture once in a while, it helps on the really slow days that are mind numbing. There are going to be a lot of days, where you just start questioning your existence like why am I here? Even one of my kids no bigger doesn't look any different than yesterday.

Samantha 41:59
All he's doing is sitting there crying.

Scott Benner 42:01
If he was an egg, at least I could just turn a lamp on him and go out. But you know, it's illegal to leave them by themselves. In the 50s, you could put a kid in a crib and go outside. No one cared. Nowadays that'll get you locked right up. So I just I'm so what do you expect? You have expectations now? Are you clear minded about what you think is about to happen?

Samantha 42:30
Uh, like when he actually here for I think

Scott Benner 42:34
it's gonna be like to be a mom. Like, I want to match this up against what he's

Samantha 42:38
saying? Um,

I don't know. I guess I don't really have. I'm just more worried about him like getting out. Get like escaping getting getting out of me, like no sleep

Scott Benner 42:57
and have that kid wander off someday?

Samantha 42:59
No, I'm like, I haven't got farther than that. I'm like, I worry. I worry that he's not going to be able to fit into his clothes, because he's going to be I think I'm making him a lot bigger in my head than he's going to be at least I hope so.

Scott Benner 43:13
Did they give you an estimate of how big they think he's gonna be?

Samantha 43:15
Well, last, and was that it was either two weeks ago or it was last Monday. Whenever the holiday was. It was last Monday. He was measuring at six pounds 10 ounces, which is bigger, or than he should have been measuring. For my comfort.

Scott Benner 43:38
zone. Okay, so. So how tall are you? I'm five nine. I see you're taller person. Yeah. How are your hips? Are they narrow?

Samantha 43:47
I see my my ob told me that I'm tall and I have wide hips. So I should be okay. But that doesn't assure me any.

Scott Benner 43:56
Absolutely shouldn't listen. But my wife is five nine. And my son was 711 when he was born 710 maybe. So is your kid gonna pack on another pound in the next three weeks?

Samantha 44:08
Oh, that's what I'm worried about. If he's if he's not if he's eight is like the maximum okay with but I'm worried he's gonna be over.

Scott Benner 44:17
Did you let me do some math here? three more weeks. Baba. I bet she's seven, four maybe? Yeah, it'd be like that. Yeah. We'll see. I mean, I have Keep in mind, no medical training whatsoever. Go with it. But I'm just trying to make you feel better. I don't think I don't think that's not doable.

Samantha 44:40
Of course, it's not doable. But

Scott Benner 44:44
can I ask a delicate question, and there's gonna be a lot of bleeps in this. So feel free to answer but prior to this. It wasn't like super tiny or something, was it? Yeah.

Samantha 44:55
No, but I have to push and pull baby out of me. Basically.

Scott Benner 44:59
comes out on its own. It really your body just rejects it at the end. It's just like, Yeah, get out.

Samantha 45:05
And I'm afraid of like the leg ripping. Oh, you might be worried about that. Yeah, I'm worried about I think I'm more worried because I'm hoping I'm not going to feel anything during the delivery. I think I'm more worried about how much pain I'm going to be in afterwards.

Scott Benner 45:24
Yeah, I listen, if you have a nice natural birth, that should be you should have too much trouble. Are you doing any prep stuff? Let's talk like adults for a second. any of that, like oil massaging around your exit?

Samantha 45:37
Are you know, I've never heard of that.

Scott Benner 45:40
A whole bunch trying to keep things like loose. No, here's

Samantha 45:43
everything is uncomfortable. Listen, you want your cake and

Unknown Speaker 45:47
eat it too. Like

Scott Benner 45:50
have to have some uncomfortable sex with your husband to get this together? I think or by the way, you don't actually have to do it with him. You know what I'm saying? But if he's become a problem, but But no, I mean, are those things wives tales?

Samantha 46:06
I will I've never heard that that help. I've never heard the oil thing ever, ever. And then I've never heard I've heard that. Having sex couldn't do like couldn't make you have the baby. But I haven't heard that it loosens you up to get ready for the baby to come out. Hold on.

Scott Benner 46:27
I've googled. Okay, there are six things you can do now for a better delivery on your labor day. Find the right caregiver when this isn't eat well, okay. This is

Unknown Speaker 46:38
we're talking about how do we take breathe

Scott Benner 46:43
and make it more accepting of what's about to happen. Right? This is not let me be. Let me be more clear about my googling make childbirth

Unknown Speaker 46:55
easier.

Scott Benner 46:57
On my vagina. There we go. vaginal stretching, how to stretch your vagina before giving birth? You got to Google more

Samantha 47:06
like cables or whatever they're called. Is that isn't it? Oh, oh. Learn To Play shouldn't do that.

Scott Benner 47:16
Lengthen pelvic muscles and soft tissue practice getting into labor positions, practice relaxation techniques, prevent or treat urinary incontinence. Oh my god. You're not incontinent, or you

Samantha 47:25
know?

Scott Benner 47:26
Yeah. How's your back pain? Anything?

Samantha 47:29
Yeah.

Scott Benner 47:31
The sex hurt or did you just give up on trying? Don't say your husband's lovely. Let's not say that he hasn't gotten laid in six months. Okay. for him. Oh, here's my thing. perinatal massage perineal. Massage lengthens and softens the tissue of the peronism. You can start this at 35 weeks, how far you and 36 weeks. Thank God I'm here. This massage technique for 10 minutes once a day, take a warm bath or hold a warm compress on the its premium right? I thought yeah, premium per diem? I don't know I don't have one. Or do I? Just the taint? What are we talking about here for 10 minutes to help you relax. I'm gonna send you this link. Sit or lean back in a comfortable position. Put a water soluble lubricant on your thumb. And apparently, um, place your thumbs one to one and a half inches inside your vagina. Press downward toward the rectum and to the sides until you feel a slight burning, stinging or tingling sensation. Hold the pressure for two minutes until the area becomes numb. Oh, this sounds fun. pretty painful. Breathe deeply. Listen,

Samantha 48:42
I want to put myself in more pain that I'm just gonna still feel pain later on. This baby's

Scott Benner 48:47
gonna fire out if you just loosen these muscles up deeply and concentrate on relaxing the muscles as you continue to press down with your thumb slowly and gently massage back and forth over the sides of your vagina. If you would have done this, you wouldn't have gotten it would have been like, you know what Never mind. And massage thing was enough. Thanks. Relax, repeat this process once after you give birth, you may experience new physical problems that prevent you from fully enjoying life with Wait. Hold on a second. skip that.

Samantha 49:16
Don't send me this link.

Scott Benner 49:19
But just talks about getting your body back into shape afterwards that did a physical therapist might help but this massage thing I'm telling you this is all you have. You gotta gotta like you know, when you get like a new baseball

Samantha 49:33
well, then my husband will be good at it. I'll have him do it.

Scott Benner 49:36
Tell him to get some oil out and beat that thing into shape. So you can play with it on the 17th I think that's worth talking about.

Unknown Speaker 49:43
Oh my god, I'm so happy. I don't have

Unknown Speaker 49:47
realized that as I was reading.

Samantha 49:48
I keep telling myself that people have like another child after the first so it can't be that bad. Because why would they do it again. I

Scott Benner 49:57
think some women are trying to keep wealthy husbands I think that's

Samantha 50:04
because women that are having babies because they want, because

Scott Benner 50:07
they love their babies. Oh, I do. I mean, I think it probably just feeds that dopamine part of your brain,

Samantha 50:14
right? If it was so terrible, then there would just be only children everywhere. Yeah, right is what I keep telling myself hundred percent

Scott Benner 50:24
and don't listen, we're joking around a lot here. Of course people have babies all the time and it goes all the time. But yeah, I listen, I think if you don't need what is that word when there's when they when they cut to make the space?

Samantha 50:42
Oh, I don't know what you're talking about. I don't know what the

Scott Benner 50:45
word is such a silly word to I'll think of it in a second. It starts with the P. program note, I realized it was a PC Atomy as soon as I said starts with the P but then when I remembered what it was it felt mean to say in front of Samantha, I'll figure it out. That doesn't happen. And if you don't prove yourself when you're pushing, I think you're doing really well.

Samantha 51:04
Yeah, I'm fine with that. That's not gonna matter to me.

Scott Benner 51:07
I like your line. You're like, Listen, if someone's got to clean that up. that's their problem, not mine. I'm paying to get in.

Samantha 51:15
Yeah, I'm paying plenty they can clean up my poop.

Unknown Speaker 51:25
Yeah, exactly. All right, Jesus. I think

Unknown Speaker 51:35
we'll end on

Scott Benner 51:36
early today, but I feel like we've covered a lot. I didn't realize we'd be reading about the massage technique. I just came up like, because I remember hearing it somewhere. I don't know if my wife did it or not. I don't think she did. If she did, she was like, I don't need him for this. But I mean, I just it makes sense, right? Like, if you were gonna go for a run, you'd stretch your legs.

Samantha 51:56
Right? I mean, yeah, I logical.

Scott Benner 52:00
I will tell you this. I don't think that your concerns are unfounded, or unreasonable. My daughter is 15. She has like, zero. You know, besides thinking some boys are cute and something like that. She's not thinking about having a baby. But anytime the subject comes up, she immediately says, I'm adopting kids, because I don't want anything to have to come out of my vagina. Like, you might change your mind. She goes, I really don't think I'm going to just like okay, yeah, so um, yeah, that's it, you're gonna be great.

Samantha 52:35
Yeah, I can do it.

Scott Benner 52:37
Hey, listen, you're gonna do it.

Samantha 52:40
I have to do it. Now. It's way too late.

Scott Benner 52:43
backing out now would be unprecedented in the history of the world. I think you're having a baby. Let's talk a little bit before we go about. I mean, I feel like I don't feel like we can Jinx the last three weeks of your pregnancy? Do you spend much time thinking about your first pregnancy? Um, or does it just make you feel like I'm

Samantha 53:05
me? Um,

I don't think I spend time thinking, well, it's, it's a little bit. This is like I was pregnant in January, February, March, April, May last time. So it's kind of that time zone. And it's getting to April's when my diagnosis anniversary is. So it kind of brings up the thoughts. But I don't think we're really thinking about the actual pregnancy rather than just like her. The fact that like, we were supposed to have another baby before this. And she's not here. And like, like, we just kind of think, I don't know, it's hard. It's hard to not like, compare that technically, this could have been like our second child, you know?

Scott Benner 54:01
Yeah, no, I think I mean, I don't understand from Kant, you know, from context. I obviously, it hasn't happened to us, but I feel like I understand what you're saying. Like, even though your daughter was never born. It doesn't feel like she didn't exist.

Samantha 54:16
Yeah, yeah. She she's still very much like a person to us. And we say that she's up watching over us and like, she'll be watching over Harrison, and she's very, she's very much a part of our family, even though she never like took a breath.

Scott Benner 54:36
Does she have a name in your mind?

Samantha 54:38
Yeah, her name was gonna be Elena.

And then I mean, we even have, like, I don't know if I had said it in the first episode, but the doctors made her footprints for us. So we have her footprints, like framed in our bedroom, and we have her ashes. So like, she Is the person to us?

Scott Benner 55:02
No, I agree with you. I, I don't think that's Um, I don't think that's something anybody could argue with, you know, just the idea that that you were going to have a baby. And just because she didn't make it all the way to the world doesn't make any of that less. Anything, you know?

Unknown Speaker 55:17
Wow.

Scott Benner 55:18
You guys are doing great. You really are you you've rebounded from, you know, a tragedy and turned it right around. It must have been incredibly scary to try to have a baby again. And then to have diabetes on top of all that is a stressful a lot. Yeah, but you're doing it.

Samantha 55:36
Yeah. Yeah, that is, I am doing

Scott Benner 55:41
the truth. Right. Like, yeah, you hear people say things like, you know, just try it. You'll say, you know, that kind of stuff like anything's accomplishable. And I have found that my life just,

Samantha 55:52
yeah, completely doable. I want people to know that just because you have Type One Diabetes doesn't mean you can't get pregnant. I've had people tell me that their doctors have told them because you have type one, like that sole reason alone, you cannot get pregnant. And I think that's terrible have a doctor to even say, because if my doctors had said that to me, then we wouldn't be here. And both my doctors were very supportive. And they told me as long as I manage it, too.

The point like where I need to do management.

pregnancy is completely doable without complications.

Scott Benner 56:40
Yeah, I no lie. I get a lot of emails from people who say that though, they can now have kids because they listen to the podcast, they got their agency down and their blood sugar's are more stable and stuff like that. But almost every one of their notes includes some statement about they didn't think they could ever have a baby or or a doctor told them they couldn't. Listen, I don't know when this will come out in the timeline. But since I pretty comfortable yours will be out soon. I've been helping my daughter's friend, Jani. So Arda met a girl online years ago, and they've been friends, you know, for a while. They've never met in person. But Jani and Arden are the same age and Johnny's had diabetes for six years. And so there was times where Arden would come to me and say, I think Jani needs help. Like her blood sugars are high a lot and Arden was concerned for but it didn't feel like anybody's business. Do you know what I mean? Yeah, so one time I just said to her, like, Look, if you want to, because they were comparing their blood sugars. And so you know, I said, if you want to tell her, I can help her just, you know, have her ask, but I wasn't going to push it on her. I wanted somebody to ask me. I don't know why that seemed to make a difference to me. But eventually, it came up and we start talking about it right before Christmas. And about four weeks ago, she and I spoke for the first time and I've been recording with her like 10 or 15 minutes at a time a couple of times. Oh, yeah. So she went yesterday. Yesterday. Yeah, she went to her. She got her a one c done yesterday. Now this is not a full a one c after she and I've spoken it's four weeks after she and I spoke and her a one c went down two points. Oh wow. From the last time and so to tell somebody you know your you know your blood sugar's don't support having a baby. That might be true in the moment. But yeah, the rest of the statement, you know, like, here's what we could do to get your blood sugar into a place where you could have a baby, and by the way, enjoy your life more and be healthier.

Samantha 58:38
I think that's the most important thing from like, hopefully people are getting from listening to at least at the very least, like my episodes, like it's completely doable without any complications. And to have I mean, despite having to deal with the diabetes to have a completely normal pregnancy.

Scott Benner 58:58
I'm super excited for you. This is really great. I feel like I'm having a baby a little bit.

Samantha 59:03
I'll send you a big shirt in three weeks.

Yeah, hundred percent. That's what my endo, I'm not going to see my endo again until the end of April. He said that I just need to make sure I text him a picture of a baby.

Scott Benner 59:16
That's so nice. It's cool to have so many different people like thinking of you and supporting you and everything that must be helpful as well.

Samantha 59:22
Yes, definitely. Yeah.

Scott Benner 59:24
The only difference between you having this baby and me being involved is that on the 18th, I'm not going to be tired.

Samantha 59:31
Well, hopefully, the 18th all already have the child by them.

Scott Benner 59:34
Well, let me give your husband a tiny bit of advice here. That night you have the baby and they get you up to move around the room and there's not a lot of space so he sits down on your bed for a little while. Don't fall asleep. Oh, yeah. Because I might have done that after hours after hours. Like I got in the bed notice like, and she's the other day she's like, I can't believe you fell asleep again. 15 years ago. And I said I was tired. I just had a baby. And I said, Kelly, I know I've said this a million times, right? But just because you're tired doesn't mean I'm not

Samantha 1:00:16
feeling so you understand we were talking heard your struggle doesn't

Unknown Speaker 1:00:19
negate mine.

Scott Benner 1:00:23
I don't think she accepted that, by the way as a viable excuse. But anyway, I was sleepy. And it turns out, I used to have really low iron, so this isn't my fault at all. Oh, there you go. Hey, I'm good. I've valuable medical reasoning. I can get a doctor's note for that. I should. Each time I go in for an iron infusion. I'm gonna get the doctor to write a note. Back on the date Arden was born excusing me for fall asleep.

Samantha 1:00:48
It's gonna matter much but

Scott Benner 1:00:52
trying to when we're in a point system here. We've been married a long time. I'm way behind. Okay. All right. So, I hope the I hope everything goes great. I'm sure that baby's gonna be fine. There's no gonna be any problems. Fingers crossed. Yeah, yeah. Hundred percent. I am sending you this stuff for the massage. I'll take. I'm sending out I'll send you the text. So okay. And if you do it, you have to tell me.

Samantha 1:01:18
Yeah, it'll be it hurt a lot. And it's still frickin hurt when I gave birth.

Unknown Speaker 1:01:24
All right, that seems fair.

Scott Benner 1:01:27
Alright, happy birthday. I will talk to you soon.

Samantha 1:01:30
Okay, thank you. Bye.

Scott Benner 1:01:34
A huge thank you to Samantha for coming on again to describe her journey through pregnancy. She's going to be back one more time. A few months after she has Harrison to tell us what it's like to be a new parent with Type One Diabetes. huge thank you to the Contour Next One blood glucose meter, please go to Contour Next one.com to find out more. And of course, touched by type one. When you go to touched by type one.org, you're going to see an organization helping children and people living with Type One Diabetes, you're going to find an organization that's helping to raise money for a cure, and so much more touched by type one.org. Give them a look. Once again, I want to thank the Georgia chapter of the jdrf for having me down to Atlanta this past weekend. I had a terrific time. I met a ton of wonderful people. Want to wish you all success if you're listening for the first time here. Hello. Coming over the next couple of episodes. a two part conversation about looping coming soon. Maybe it'll be Friday. Maybe it'll be next week. I haven't decided yet, but I'm getting close to deciding. Anyway, it's gonna be really soon. Dan, don't

do you think I have a future in this ASMR thing? I could just make like relaxing sounds into a microphone. That would be so much easier than interviewing people. I don't even know how to begin to do that. What would I do? What I was I don't think I can whisper Oh, you're listening to the Juicebox Podcast. Today, I definitely can't whisper it makes me like shorter breath whispering I need to like fill my lungs and go you don't mean like that? Yeah, I don't know. I couldn't do that. Alright, I fallen down a rabbit hole here. A s m R stands for Autonomous Sensory Meridian Response. The Autonomous Sensory Meridian Response sometimes auto Sensory Meridian Response is a tingling sensation. That typically be excuse me that typically begins on the scalp and moves down the back of the neck and upper spine. A pleasant form of para thesis paraesthesia paraesthesia. I think it has been compared with auditory tactile synesthesia, and may overlap with Phrygian well, hell now I don't know what Phrygian means. Give me a second Phrygian is that a made up word? A sudden strong feeling of excitement or fear a thrill that just comes from like what what's an example of ASMR then? Alright, people give me a second set of video here. Listening to a video from Mashable. Get to it, man. What does it mean? Common triggers. Here we go. whispering crisp sounds like tapping and crinkling Hold on.

Wait, you have to roleplay and pretend you're doing it like I'm not doing that. Just like a whole business. Not everybody gets the sensations from the trigger sounds, the video says, well, it's definitely not doing anything for me. So I thought I could make a little extra money on the side here.

By the way, if you're still listening, examine your life. I don't even mean because the SMR I just mean like, I mean, the the part about the diabetes has been over for a while now. Alright, let's keep going.

Here's an idea. We try this.

Now it's not working. It's not as easy as it looks.

Okay, I'm done.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

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#309 Omnipod and Dexcom Updates

With the CCOs of both companies

Omnipod CCO Bret Christensen and Dexcom CCO Rick Doubleday are both on this jam-packed type 1 diabetes technology episode. Let's talk about automated insulin delivery!

+ Click for EPISODE TRANSCRIPT

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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
Hello, everybody, welcome to Episode 309 of the Juicebox Podcast. Today's episode is a little different than usual. It's two different interviews. The first interview is with Dexcom, Executive Vice President and Chief Commercial Officer, Rick Doubleday. Rick and I are going to be talking about things that are going on at Dexcom. And interoperability interruptible, inter Robin to interoperate. Oh, it's a word that you're probably hearing a lot around diabetes lately, but maybe aren't 100% sure how to say? Let's sound it out together in turn app for a bill, ed d. Hmm, that wasn't helpful either. Hold on one second. Okay, hold on, I'm gonna play it through my headphones into the microphone. Let's see if this works.

Unknown Speaker 0:51
interoperability

Scott Benner 0:54
the ability of a computer system or software to exchange and make use of information. So why do we care about that around diabetes, because the information coming from the dexcom continuous glucose monitor is going to help pump companies to build their own algorithms, right, like closed loop systems that will make insulin decisions for you. So we're going to talk about that from Dexcom perspective. And then go right into a conversation with Brett Christianson, the chief Commercial Officer of insulin. Insulin, of course, is the company that makes the Omni pod and the forthcoming horizon automatic its own delivery system, which is going to be the Dexcom g six, or the Dexcom g seven when it comes out. And the pods algorithm and their pump making insulin decisions for you. This is all very exciting. Here's the one thing you need to know. Rick and I are gonna go first, then it's going to be Brett and I. Brett was calling from Spain. So he's on a cell phone. There's a bit of a gap, right? Like I'd be like, hey, Brett, you're Brett, right? And then he'd say, pause. Yes, I'm Brett. There's a little pause. It's also a little cell phone Ian noisy. It's not perfect. I don't love that. It's not perfect, but the information is great. So I hope you can hope you can just you know, listen a little extra hard, you'll be alright, you can figure it out. It might not surprise you to know that this episode of The Juicebox Podcast is sponsored by Omni pod Dexcom and touched by type one.org. So you can go to dexcom.com forward slash juice box to find out more about the Dexcom g six continuous glucose monitor. You can go to my omnipod.com forward slash juice box to get a free no obligation demo of the Omni pod sent to you right now.

Bret Christensen 2:41
And

Scott Benner 2:42
touched by type one, of course, is dancing for diabetes. They've just changed their name, expanded themselves a bit. They're doing all the great stuff they were doing before plus a lot more touched by type one.org. I'm going to get started with Rick from Dexcom right now. But first, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. or becoming bold with insulin. Here comes Rick. Rick Scott. Hey, how are you? Can you hear me? Okay?

Rick Doubleday 3:21
I'm good. How are you?

Scott Benner 3:23
Good. Thanks.

Rick Doubleday 3:25
Hey, yeah, Scott, can I ask you a quick question hundred

Unknown Speaker 3:28
percent.

Unknown Speaker 3:30
Did you?

Rick Doubleday 3:32
Did you send a story? A letter to Dexcom once upon a time right after Arden was diagnosed about what a difference seven plus had made and include her picture.

Scott Benner 3:44
Maybe? I'm not certain

Rick Doubleday 3:46
I am. I am 99% sure that you did. Because I used Arden's picture in a sale to our national sales team. It was one of the first patient stories I had. I had received I started here in 2009. Right, No, I know.

And,

and it was such an amazing story.

Scott Benner 4:10
I'm thrilled. I have to dig through my emails and find out. You know, that sounds possible, you know, prior to I don't know how to say this, I guess but prior to companies understanding the impact, I guess that users had on stuff and it probably wasn't you didn't understand it, probably you're just a tiny company with, you know, right. Not that much ability to delve into stuff like that. I I pretty immediately realized how valuable the data was. And we struggled greatly. I tell people this on the podcast all the time, but we struggled greatly with my daughters, they wouldn't see her stability, you know, shooting highs and crashing lows. For a number of yep for a number a number of years honestly. And then a woman My name Lorraine, who was probably another person who was kind of out in front of being vocal about diabetes at a time when not a lot of people were online. She just asked me if I, you know, had ever tried this Dexcom thing. And I said, my nurse practitioner just mentioned it to us. So it's funny when I tell the story, I tell it through my nurse practitioner, but the nurse practitioner brought it up. We were thinking about it. Lorraine brought it up, where I asked out loud, and she's the one that comforted me and said, that's a good idea. And now I'm talking to you now Arden has been eating lunch for the last half an hour blood sugar 77 like, you know, that's awesome. Yeah. Very onesies cemented in the fives. She does not have frequent or, or dangerous lows. A spike to us is 150. You know, the data is it's insane. It's It's just what it does. Yeah, I really appreciate it. I can't believe you've been there that long either.

Rick Doubleday 6:02
Right? Yeah. It'll be 11 years in June, right? Oh, that's been a lot of change.

Scott Benner 6:09
Yeah. Well, I bet Actually, I'm sorry. Just Just to let you know, I started recording before we talk. That's all okay. Is that all right?

Bret Christensen 6:17
Absolutely. Cool.

Excellent.

Rick Doubleday 6:20
How old is our now.

Scott Benner 6:22
So she's 15 at the moment, and she'll be 16. In July, she was diagnosed when she was two, it was literally a couple of weeks after her second birthday. So in August of 20, of 2006.

Rick Doubleday 6:37
Wow, that's really making me feel

Scott Benner 6:43
dexcom helps you not to, to feel quite as old when you're thinking it through the timeline of the technology. Because you guys have just leapt forward so many times, in a way that was prior unheard of in the diabetes space. You know, I don't think people will ever appreciate that. At some point. The Dexcom receiver did not have the ability to share blood sugars to the internet. So you guys built this little cradle so that at least overnight? Yeah, you could slide out your receiver into the cradle. And the cradle would you know, help people see blood sugar, so at least your kid was down the hall in another room in your bed, you could have these numbers. And I can't imagine how much effort went into making those cradles and putting them into the world? And I don't think it was, was it not even a month before the receiver that had Cher built into it was okayed by the FDA.

Rick Doubleday 7:36
It was a little longer than a month. But yes, we had a warehouse with a quite a few of the share cradle sitting in them after we launched the receiver.

Scott Benner 7:48
I joked with Kevin one time that I imagine that those cradles are business card holders on everyone's desks now.

Rick Doubleday 7:55
That's right. We often thought about maybe that would be a good use. It's funny that you say that Scott, I still I still have you know, those rubber bands that people wear around their wrist. Mine is share direct that was the codename internally for the receiver that allowed people to share their data off the phone. And I keep it there because I thought I believe it was such an immense step forward. And it was driven based upon feedback from customers what they were looking for. And this was, you know, our attempt to provide even greater a greater experience for for the users.

Scott Benner 8:37
Yeah, I found the most impressive part of that story business wise to me was, you know, I don't know what they all cost you to make them and develop them. But as soon as there was a better option, you guys have ended it walked away like he didn't foist it on us. Like, alright, well use these up, we already paid for them, you know, you were just like, okay, we we move faster than we thought we were going to with the FDA. So let's get to the better thing. And

Rick Doubleday 9:01
yeah, no, that is, that is absolutely the dexcom way, you know, it's consistent with our sensor technology, as we look at, you know, what it takes us to stand up all the manufacturing capability for G six, we're gonna have to do the same amount of work, because g seven is different. And we're gonna have to go through all of that, but it's the right thing to do.

For the users, it just is,

Scott Benner 9:29
is that what's going to, I mean, I think of you guys, as the leader in this space based on just the quality of the of the data that the product brings us back and the consistency, the consistency that it provides. And honestly, if I'm if I'm being 100% honest, just feedback that I see online. That is, I think, significantly better for Dexcom products, and it ends up being for the Libra stuff. But as Libra moves forward, and I'm assuming they're gonna change Trying to make their stuff better? How does Dexcom stay in that spot that they're in? Like, how do you hold the lead? I guess?

Rick Doubleday 10:07
Yeah, I think it's a I think it's a great question. I think it's, it's everything, Scott from how do we continue to make the technology better. So faster, warm up times longer length of time, of usage, robust, you know, 288 results, for the entire length of the sensor, all of those things we know are extremely important to the user. But it's also going to be a customer experience play. And, you know, similar to what we did with with share, follow, we understood that that was a really important feature, then we continue to add to that we went from five followers to 10 followers, we've totally re skinned it. We're actually in the process right now, of implementing the ability to message in the follow app, we had the Thanksgiving outage, which we were absolutely not happy about. And we knew we needed to find ways to be able to better communicate when situations happen. So that will be coming soon. The ability to actually communicate and let people know what's going on. So it's it's technical innovation, its scale, how do we make the tech services or customer support? process better? How do we provide a greater customer experience, we think that that's really going to be a differentiator, as we look to the future.

Scott Benner 11:40
So a couple of things. I'll start with easier one first, last night, I got a call from Dexcom. Because we've placed an order for new sensors. It's the beginning of this of the year. So you know, there's a check that has to be done. They got to go back to my insurance company and make sure everything's copacetic before they send this stuff out, happens every year, completely. So the phone call is it's pre emptive. It's, it's it's not I had to call in wonder someone called and said, Hey, you know, it's time to order. Do you want to do this? And I'm like, yeah, and then they said, Okay, so a couple days later, this other guy calls back ends up being last night. And we're talking and he says, we have to do a insurance verification. And they say, verification, he used the word that made it seem scary. Maybe it was verification, like you like, you know, we have to we have to do an insurance investigation investigation. He said, he said insurance investigation. And I'm assuming that's what he's been told to say and everything. And at the end of the call, I just said to him, Hey, real quick. I said, there's a better word, that investigation, and he said, What's that? And I said, it made me feel like, scared for a second. And I said, I don't know another way to put it. I'm like, but find another word. And and he's like, thank you. And I could hear him like, he's like, I'll make sure I say that to somebody. He's typing and everything. And I'm like, he's gonna tell somebody that, you know. And I really felt good about I think I forgot my wife came up with the right word. But But she, because I don't know, it was a weird thing. But I know the process. So when he said insurance investigation, I was just like, Oh, I know what's gonna happen. But it made me think about, what about somebody who this is their first time reordering? You know? Right? And maybe they'd be like, oh, what do you mean, an investigation is that, you know, we done something wrong like that. And it's just, it's a little thing. But it was met with, you know, it was met with comfort the guy, he thanked me a couple times, we started to have more human conversation, if that makes sense. Like, if we, you know, he might not off this script a little bit. And I thought, this is where things get worked out, like in these little moments, you know?

Rick Doubleday 13:45
No, and I think that's, I think that's a great point. And we do we really do listen to customers, and there was a, I still, I will still get emails, calls from customers good and bad when they have an experience. And I think the beauty of it is Scott, we I learned from each and every one of them. And we do try to implement those kinds of changes.

Scott Benner 14:11
Yeah, I mean, honestly, the, you know, you got to take your own advice, right. Like the, the data that comes back from the CGM is how I continue to make better and better decisions, how all these people do who have it. I mean, it'd be silly for you to ignore the data coming back as valuable. Right there a little. You know, that would just be ironic. When we were talking, we were talking about bettering the g7. You know, for the, you know, working on that. And first of all, it made me think somewhere at Dexcom. There's little wristbands that keep everybody motivated about g seven with some kind of code name on it. I'm wondering what that code name is. But, but the other thing I was thinking is, it is and Kevin's mentioned to me a couple of times, but its price point, the next hill to climb. Like like and just the disposable nature of the g7 does it begin to address that?

Rick Doubleday 15:04
I think that there is price point is absolutely a hill for us to climb, we know that we have to continue to make this technology less expensive to be able to make it affordable for a broader audience. And we are absolutely focused on that Scott, everything from working with the payers, moving the benefit from a DMV to pharmacy to ease the access. g seven, you know, will not be more expensive than g six, and we're continuing to focus on how we can make it less expensive. But there are there are so many other factors that g seven brings to bear just from, you know, I'll start with a simplicity from a simplicity standpoint, the fact that it is a fully integrated transmitter and center. So there's nothing snapping and snapping out, you just insert the entire unit. A faster warmup time, we're targeting 15 days. So there's just so many different features that we're looking to add at the same time understanding we have to continue to be focused on how do we take costs out of the system, right,

Scott Benner 16:23
those features you're talking about? Are they mostly? Do they mostly happen on the algorithm side? Like I'm assuming you make you know, maybe you're doing maybe you don't I make changes to like the sensor wire itself and and the physical technology, but is it more in the in the algorithm in in the way the information is being interpreted?

Rick Doubleday 16:46
Well, that's part of it. algorithm is absolutely part of the change. But again, we were talking about how Dexcom is willing to go out and make changes across the board. That's what we did with GE six, it was a you know, a new wire new membrane, and we're going to do the exact same thing with G seven as well. That's cool.

Scott Benner 17:09
That's excellent. I mean, I just got please.

Rick Doubleday 17:13
No, I was gonna say and I wanted to go back, you were talking about people wearing little rubber bands to keep themselves motivated around g seven, right. The beauty of that is we don't need the little wristband everybody in around this place is so excited to get g7 to market. You know, it's funny, you mentioned Kevin a few times and he gets absolutely giddy when he talks about g7.

It's, it is truly going to be

an amazing product g six is amazing. g seven is just another step forward for Dexcom.

Scott Benner 17:53
I'm, I'm super excited, is there timelines yet or not yet.

Rick Doubleday 17:58
We're still taught, we are still targeting 2021.

So, you know, we have to be, we have to be I know you and I talked to earlier, Scott about, you know, my time here from 2009 to two now. And you know, one of the big differences are installed base has, has truly grown. And we really have to be cognizant now of ensuring that we've got the right amount of product on the shelves and all of that before we go into a full blown launch, so that we don't get ourselves sideways, and delay launches and things like that. So you know, we are going to be very, very focused on making sure that this launch is our best ever.

Scott Benner 18:45
I think that under promise over deliver is definitely the way to think about stuff like this. You just, you know, there's no winning, if you say if you say April, and it's May, if you're you failed, if you say March and it's February, you're a genius, you know, so, yeah, it just it makes sense. Okay.

Rick Doubleday 19:03
Spoken like a true commercial person.

Scott Benner 19:06
I just you have to, you just have to, you know, you're gonna eventually take this amazing thing and lay it on people. There's no reason for them to start with it feeling like some sort of a letdown when it's clearly not that and that last piece, you know, is, is FDA so you don't ever know exactly the length of, of, you know, time. That's that effort it's going to take? Yep, yeah, that's it's really cool. So the reason I asked you to come on tonight, although all this has been really interesting is that I'm really interested in some of the agreements you just signed. And talking about, you know, closed loop systems or algorithm based pumping, I guess whatever you want to call it. I have I firmly believe that, that this is the way forward for a great number of people. I think that you take any algorithm based system And put it on somebody who's struggling, and they're going to suddenly be doing significantly better. And I think that ends up being, you know, kind of, sadly, the larger part of the community, like the podcast is great, but it talks to people a lot of times who are super motivated to do something. And you know, if you're talking to people who have, you know, who have an eight, they want it to be a seven, they have a seven, they want to be a six, but we don't often get to talk to people who have a 12 a one C and don't know what to do. And so I just think that this is going to be such a health game changer for such a large segment of people. And you're not. And by that I mean, Dexcom Dexcom is not limiting who in the pump community can use the technologies nears like Intel. So what have you done recently with? I guess, tandem and and their control like you? That's, that's on the market now. And then horizon from insolate, from Omni pod is coming. I mean, they're saying this year, right. So I guess talk a little bit about those agreements. First, when you sign like, like a commercial agreement with the pod, you did it for just the G six or the g7, the g7.

Rick Doubleday 21:15
No. So as we as we write these, what we call commercial agreements, typically starts with a development agreement, Scott. So we sit down and lay out kind of the rules of engagement as it relates to how we're going to develop products together. And it's really about who owns what in that development process. And the same thing with the commercial agreements. So as we write these commercial agreements, it is about how we now go about commercializing the commercializing these products. So you know, let's take the insulin agreement for a second. It will be an insolent launch, we are we're there to support where we can. We will, you know, work through various things from there may be co promotions there, there will be tools to jointly make the announcements. And that's what the commercial agreement is really about. I think what I'm most excited about about these agreements is we're actually getting the products to market that, as you talked about, products that change people's lives are truly becoming real. And the tandem control IQ was the first product, I can tell you that there are a number of people that work here at Dexcom that that use that product, one that I work closely with just talks about what a game changer, it has been loved bazel iq absolutely loved it. But now is seeing the impact on his nighttime highs that he'd never seen before. So these products are just like you say they're they're allowing people to get the benefits with with maybe a little less work. And that's what it's all about, how do we make this this disease easier for people to manage? We have always, we've always approached it, you know, we started at Dexcom with this philosophy of partnering with everyone because we're about providing choice. And, you know, we'll continue to look at that and for the right partners that have the ability to commercialize a product the right way we you know, we're always open to that as a potential opportunity.

Scott Benner 23:44
And that road goes both ways too. So like when weleda Yeah, when on the pod also does something similar with I think they're doing something with Libra but not for this current generation like they're doing I think they signed up with them too for like the Libra to moving forward. And and that to me, again, you know, I didn't just have you on here to butter your ass a little bit, but I'm imagining you could stop them from doing that if you wanted to. I'm imagine you could get in a room, close the door and go listen on the pod only works with Dexcom. That's what we want. And and they might be in the position where they have to go, okay, make dinner me like, I don't know, the inner workings of it. But I'm just saying that it's all working this harmoniously through these different, you know, user bases and products. It's it's very encouraging, because things just didn't go like that, you know? Right.

Rick Doubleday 24:41
Yeah. And I think it would be.

I would tell you, I think it would be disingenuous for us to go and do that. I think that you know, whether we could or we couldn't Scott and it wouldn't be the right approach. We went into this with a strategy of offering choice and in at the core We believe that the user should have choice and where where the rubber meets the road is, it's our job to make sure that we have the best product today where the, you know, I would challenge where the only real time continuous glucose monitor out there, Libra is in the market. But we're the one that provides a result every five minutes that allows patients to see their number, their trend era, you know, all agree. Yeah. And it's, it's our job to make sure that we continue to have the best product. And like I said earlier, also the customer experience is going to play such an important role. So customers will have choice, it's our job to make sure that we give them the best choice.

Scott Benner 25:43
Oh, you're doing it for my money. I'll tell you that much. And I wonder if I can ask a couple of different questions. So how do you handle when you're taking this? This thing, right? It's metal, and it's plastic, and you know, and you're fashioning it into this amazing device. And then you're putting it on a human being right. So now you're not just bolting it to a board or hanging it from a wall? You're, you're putting it into somebody whose body chemistry is different? Who is there? hydrations different? There's so many things individually about us that are different. How, how is that? Fine? tuneable? Like for somebody like my daughter who has nothing but success with Dexcom? And then you'll talk to somebody else who's like, you know, I get my period and it goes wonky. Now, it's not that it's it seems that simple from the outset. But how do you actually talk to that person and get them through understanding things like being hydrated so that the interstitial fluid moves around properly? And like, like all that stuff that we just, do you know what I mean? Like, is there a way forward for that? That kind of thing? customer education, or I was wondering what you guys do around that, or what you're thinking about for the future?

Rick Doubleday 26:57
Yeah, no, I think that's one of the things that

one of the things I think Dexcom does extremely well, Scott is, when you look at a lot of companies, you know, you find that the organization is pretty siloed. So r&d would sit off by itself, and they would, you know, create the next latest, greatest thing, marketing is out worried about promotion. And then you've got tech services, you know, our customer support that's in another silo, and they're sitting back and just answering the phone. We're a really integrated organization. So you know, first and foremost, when we are when we're creating new algorithms and new technology, we do a lot of small trials to really get good data to understand how the algorithms performing how the sensor is performing. And we have to do that before we ever take it to the FDA. Right. But it it doesn't stop there once the product launches. And we have the ability to see the data. Our r&d, and marketing and customer support centers are really tied together, they look at the complaints that are coming in. And they work together to figure out what is the right educational components to be able to provide to that user on the phone so that they have a great experience there was there was an example. Not long ago, where I had, I had gotten an email about somebody having an issue with a sensor, and was able to connect them back through to our customer support team. And they were able to walk this person through and it's so funny that you said it. It was really a hydration issue they were they were not hydrating as well as they could so talked about drinking more water. And that really seemed to make a difference for this individual.

Scott Benner 28:58
It's the little stuff you don't think of we we talk on the podcast a lot, because the person came on in and made this analogy one day, and he was an attorney from Canada. And so he said that there are some people who see a man put a pencil in his back pocket and then rob a bank and come to the conclusion that pencils cause bank robbery. And, and and, and you know, you put your CGM on your drinking, you know, a 10th the amount of water a human being needs in a day you don't get a reading back from the century like this CGM doesn't work. Well, right. You know, the CGM is reading fluid in your body and there's no fluid in your body. It's kind of a separate thing. Right? And but that's not your brain wouldn't jump to that being the user. It's always the pencil, you know, right. It's just It's very, it's very interesting. I've had some close contact with a friend of my daughter who has type one recently. And she would make these kinds of statements like oh, that's what my Dexcom does. And I was like, yeah, that's not really what's happening. Let me try to Like help you out here and we got our blood sugar down and stable and got her hydrated, and she's in a better, healthier situation. And now all of a sudden, her CGM reports back much more consistently than it had when her blood sugar was frequently over 400. And, you know, and her body was just going a different way. Now, you know, it's, it's, I guess it's interesting, really, you guys sort of started as a safety company right? In the beginning, you were just trying to make alarms so that people don't get too high or too low. And then, as the equipment the algorithm gets better, you become a decision making company, like, like the help of actually like when insulin goes in, so that now in this timeframe, it's more important than ever, because now these, the horizon algorithm is gonna be is gonna look at information from the Dexcom and say you need insulin or don't need insulin based on this number. I guess that ratchets the game up to a different level. Hmm.

Rick Doubleday 30:53
Yeah, I would agree. I think that

you know, we started out, and I spent, I spent 10 years at lifescan. Before Well, I spent 10 years at lifescan. And then three years at Animas before coming to Dexcom. So I, you know, I spent time in the self monitoring blood glucose face with one touch. And I think the thing for me, and really, one of the things that brought me to Dexcom was the differentiator that this technology provided, you know, you know, this better than I do, Scott, that a blood glucose result, a single point in time does not tell you the information that you need, and Dexcom with a real time continuous glucose monitor. Not only do I see the result, but I see the speed and direction. And I always believe that that was a differentiator, differentiator from a safety standpoint. But exactly what you're saying a differentiator as it relates to, you know, how much and when do I put insulin into my body? When do I not? And I'll take it the next the, you know, the next step, I truly believe that this technology has so much runway in front of it as it relates to individuals not taking insulin, because where else are you going to get a behavior mod tool that truly tells you the impact of the meds that you're taking, that you know, the therapy that you're on the impact of exercise, the impact of the food that you that you eat, I think all of those factors, there's just such a runway for this technology in the future. It's really exciting.

Scott Benner 32:37
No, I agree. I was actually just talking the other day with some I was getting physical therapy on my ankle. And the guy that was helping me was talking about how in his culture, there's a lot of type two diabetes all of a sudden, and he's talking about the things they eat being, you know, much heavier, more carbs, things like that. And how his mother is beginning to wear a glucose monitor. She's self funding at Dexcom. Because her husband got type two diabetes, and she's trying to figure out what foods are impacting her or trying to keep it from happening to her. It's really a forward thinking idea from a person. But yeah, that all exists. It really super does. So what is what's happening right now around Dexcom? Like, what mode? Are you guys in? I mean, I know you're supporting g six and that stuff, but is there like, what's your day like there? Are you trying to get stuff to Canada? Are you trying to spread out into Europe? Like, like, all this happened at once? And how much of that stuff do you have your finger on?

Rick Doubleday 33:44
So my day, let's call it hyper. Dr. Scott.

Yeah, I, so my accountability is global. So yes, all of the things that you just described, we, we've recently, let's, let's take a step back, let's start with the US for a second, we're getting ready to launch in probably the beginning of q2 quarter to our Dexcom Pro system. So this G six, so this will be a professional device that physicians will use. And they'll use it for type one type twos, and it's also the first CGM indicated for people outside of diabetes. And they'll use that within the Office. It's both blinded, meaning you can just use it if you're a physician, just as a tracker patient brings it back. I download the data into clarity, our software program, and I can make adjustments to therapy. It can also run in an unblinded mode real time, you know, similar to what Arden uses and a little bit more scaled back, but then that patient can interact with their diabetes and understand what's going on during that period. So we're really excited about bringing that to market outside the US. We've recently launched g six and the business is going extremely well. We are in GC, we're in, you know, g six, and a number of countries outside, we just recently got approval for GE six in Japan and Korea, and Australia. So the Asia Pac business is growing. So we're really excited about not just what's happening in the US where we're having, you know, tremendous growth is, is more and more people have access to this technology. But we're also excited about being able to offer it outside the US and we're in 40 plus countries now outside the US.

Scott Benner 35:45
Well, Joe, let me tell you that the podcast is in every country except for nine at this point. Most of them are right through the center of Africa, where the North Korea, there's only a couple of places people don't listen. And so I get emails that always start, Scott. Hi, I live in Saudi Arabia. I live in New Zealand, Scott, I'm in Australia, Scott, I'm in South Korea, and I want and it's either a Dexcom, or an Omnipod is the next thing they say how do I do that? And I I always giggle like when I read it. I'm like, I can't believe they've they think I know, but I'm like, okay, so. So I always get to my contact person. I'm like, Can I just forward you this email? And, and I know nothing's you know, listen, if you don't sell it there, you don't sell it there. But it's always my goal to make sure not that you don't know, but that you really, you really are aware that there are people, you know, all over the world looking for this stuff. It's so exciting that it's spreading like this.

Rick Doubleday 36:43
I agree. Yeah. No, it is it is really exciting.

Scott Benner 36:46
Well, so your day is long and tiring. And and do you? Here's a fair question. How many days and how many days end with you feeling like good day? mood for the most days go that way? Or? Like, like, what's that feel? Like? I guess I'm trying to bring people a little bit into, you know, like, it's easy for us to look from the outside and just say this thing I bought doesn't do what I want it to do. Nobody cares. Yeah, you know what I mean? Like, like, but there's a real person on the other side of the of the wall. And and they're, they're banging their head on that wall trying to get you that thing? You know, so it does most days it do most days at Dexcom feel positive, like like you're going in the right direction?

Rick Doubleday 37:29
Yeah, I it's a great question.

Yes, the short answer is yes, Scott, I think we're absolutely going in the right direction. I think that one of the things so I'm going to I'm going to take you back if you'll give me just a moment here. I'm going to take you back to I was actually at Animas at the time. And I had just started at animus. And my boss at the time says, Hey, I need you to go to a conference. I was first week on the job. I was leading the marketing team. He said, I need you to go to a conference. He said, okay, where am I going? Said conferences, children with diabetes in Orlando, Florida. My response was You do realize it's July, right? And he was like I do and you're going, so I'm like, Okay. And I went and I walked in, and I was handed my animus badge and I was walking down the hallway. And this woman who I had never met before, remember, I'm three days on the job at Animas, turns around, sees my badge and comes running to me, throws her arms around me and starts crying, sobbing saying you don't know what a difference you've made in my child's my child in my life. And Scott at at lifescan. It was a great company. And we did provide a tool. But I never understood the impact that the things that we made had on people's lives. And it was at that moment that I decided that you know what, as long as diabetes would have me, I was going to be focused on diabetes and not leave it. Then I got introduced to Dexcom. My last job was strategic partnerships and my personal relationship alliance with dexcom. And that's where I got to learn the technology, the leadership. And what Dexcom brought was this whole focus on the patient and the end user, which was absolutely what I believed in. And it was, and then with the technology, it was absolutely what I believed was the game. game changing technology second, only to answer One. So for me, it was an easy choice to join Dexcom that hasn't left here. So I know it's a really long winded answer to, yes, most days that I end up and they're long days, but they're really good days, because we're headed in the right direction. I take every one of those, you know, where we have fallen down and not provided what we needed to do. It hurts. But I know that we're working to make sure that that experience in the future is the best possible. And that's what keeps me motivated and brings me in here each and every morning. So long answer, hopefully, it was, you know, what you were looking for. But yes, I think I think we're absolutely headed in the right direction. The technology that Dexcom offers, in my mind is second to no one with our real time glucose monitor. It's what we are focused on. And we're focused on the technology and the patient experience. So I couldn't be happier about you know, the direction we're going

Scott Benner 41:03
well, I hope you get to say stay around the space for a really long time. So you can see it bear out in decades, because I interviewed a woman this morning, who's you know, toddler was diagnosed it baby even under two years old. And she found the podcast on day one, which led her right to index calm. And if you could see this kids graphs, this mother figured out the stuff I'm talking about on here, so quickly and so thoroughly. And so like, as I was speaking to her, I had troubled not wondering like, how much better this child's life's going to be over decades that might reach beyond my lifetime, even. And right and, and it's just really encouraging. I just, you know, Rick, you don't know me prior to this podcast, and diabetes and everything, but I sort of was not a Chicken Soup for the Soul person when this all started, you know what I mean? And now, I don't know if I am that. But I definitely have a really strong feeling for helping other people that maybe didn't exist in me before. And to hear somebody say something that that could to an outsider feel small, like, I'm able to concentrate while I'm doing my homework now. Or, you know, I thought I thought I was crazy, because my blood sugar would jump around. And my doctor would always say, you know, you're doing fine, but it didn't feel fine. Those little things. You know, the to a casual observer wouldn't seem like a big deal to me. They fill my heart up, like a woman once said to me, and there's a little bit of a curse in here, but not much. And it just I think it really shows the the intensity of it, she said that she thought her daughter was. And when she found the podcast and stabilized her blood sugar, and got her on the tools that we talked about here, she realized her daughter was a really lovely person whose blood sugar was bouncing all over the place. And I just thought when she said that, imagine if they would have spent their whole life thinking that about each other. And just right, what a sad shame that would be it just goes so far beyond just diabetes. I think sometimes.

Rick Doubleday 43:08
No, I agree. And I think and and the fact you're right, what their whole life could have been. But I think what's so exciting about that, that comment, Scott is what their what their life will look like, in the future. Because they the flip side, they could have been stuck in that mode for a really long time.

Scott Benner 43:24
Oh, no, I, I always come back to a single mom that I spoke to once in her late 30s, who had had diabetes since her teens, and was genuinely living with a 12 a one c forever. And then she said, you know, we spoke privately once and the next day she her blood sugar was between like 80 and 120. And she had a dexcom she had the tool, she just didn't know how to use it. And it just, there was this moment where she was grateful. But then for a minute, she got upset. And she said How come nobody ever told me this? You know, like, like, why is that not the standard of explanation and care in the space and and so the part that fills me with hope is that one day, I just hope that one day people are diagnosed, and they're told, hey, this glucose monitor exists, this is how an insulin pump works. Here's how insulin works now you can you can build off of that but at least you have those building blocks right there to start with instead of the fear and anxiety and you know, the your blood sugar starts jumping all over the place and you know, you lose you lose your personality. And before you know it you think it's it's it's hopeless. It's just a very slippery fast slope. You can fall down that hill and and never climb back up again. But it's just not necessary. So I hope one day that it just, I hope one day somebody that you know, the king of diabetes calls me and says Hey, everybody knows you can you can stop now. And you know and i i don't know what i would make a podcast about then.

Rick Doubleday 44:58
Yeah. I would be right. I, and I've said this before that, you know, nothing, nothing would make me happier Scott than a cure for diabetes. I'll happily go out of a job if we if we can solve this. I think in the meantime, you know, your comment about looking to the future, and being in this space for time to come. I can't wait for that teenager, adult that I meet in the future, that when I talk about doing finger sticks, has no idea what I'm talking about. Because they've been using a dexcom, continuous glucose monitor not having to do finger sticks. And it's ancient technology, like the rotary phone that I grew up with. That that's, that's, you know, the next thing I'm looking forward to

Scott Benner 46:01
when it just feels like you just said to them, Hey, did you you know, do you know, people used to have to boil their urine test their blood sugar, you know, like, like that guy stuff. You just just gone down? Hey, listen, what I'm going to do is I'm going to keep my Contour Next One ad off of this episode. I've I've done yet.

Rick Doubleday 46:22
I'm looking to the future. Don't

Scott Benner 46:23
Don't worry, essentially, it's gonna be a while from now. But no, no, but I, but I, Seriously though, I'm, I feel very lucky. You know, I started a podcast hoping to help people, the first month, it had a few hundred downloads. This month, it'll have no downloads. And, and I was very lucky that it was successful enough that I could pick and choose the ads I took, because I couldn't, I just don't know how I would get on this microphone, and talk about stuff that I don't believe in that I don't see doing. You know, the things that they're doing run by the kinds of people who I get to meet, you know, like you. And Joking aside that Contour. Next One is the best damn blood sugar meter I've ever used. And so that's, that's why they're the ones on this podcast, getting to talk about their meters, because trust me, they all wanted to be on the podcast, those are the ones I chose. And index comment on the potter right there with that, I just, it's just it's next level stuff. And the people, whether their voices being recorded or not, give me a good feeling. You guys, you know that that's how I feel when I walk away from a conversation with someone like you. I think I really believe you. I believe that if somebody tomorrow walked into your office and said, Hey, Rick, I got the you know, I got the cure to diabetes here. You know, you know what you want to put it in this in this drawer so we can keep this Dexcom thing going? I think you would say, you know what, we're all gonna have to find another job. Because, yep, you've met these people. And you know, what it what the disease does to them. So, yeah, that's excellent. I really appreciate you coming on. I realize we never set it in time. So as we're talking, I'm like, is he like, I gotta go or. But I really, I really do. I really do appreciate you coming and doing this. Is there anything? I know you probably did you just get back from Spain.

Rick Doubleday 48:20
I was not in Spain. I had team members there. I did just get back from your tie in about awareness, and which is still such an opportunity for us. So I appreciate what you do Scott, and helping drive that awareness. But I was had a chance yesterday to meet Sugar Ray Leonard. And he actually has a foundation, the Sugar Ray Leonard foundation. And he had his father who just recently passed away lifted the 94 had type two diabetes. So he has a real passion created this foundation that is connected with Children's Hospital of Los Angeles, and is about promoting awareness around diabetes. And the I think the thing that was so cool that he said was, you know, this is a guy that fought Marvin Hagler Duran, Tommy hearns. And he said, and he was sincere. He said, my toughest, the toughest battle I'm going to fight is fighting this diabetes thing. Because we've just got to find a way to make a difference. So I, I'm, I'm telling you that because I appreciate what you do as well to drive the awareness to let people know that there are solutions out there like Dexcom CGM, like insolate and that others are taking up that cause as well.

Scott Benner 49:57
So I appreciate what you do. Listen, it's Just a reflection of what I see working in my life with my daughter, and honestly is like I, it's you because you work it, you know what I mean? Like if it was somebody else, it'd be somebody else. But but you guys are the ones doing it right. So it's easy to talk about, I really appreciate it. Great. If I could say goodbye for a second, and would you hold on for just one second,

Bret Christensen 50:19
I would.

Scott Benner 50:22
We don't really need much in the way of ads for this episode. Let's just go over it one more time. If you'd like to get started with the dexcom, g six continuous glucose monitor, it would help me if you went to dexcom.com Ford slash juice box to find out more about the dexcom g six continuous glucose monitor, you want to know about the speed and direction that your blood sugar is going, you want to be ready for these great automatic insulin delivery systems that are here and on the way you just want to be healthier. You'd like for diabetes to be a smaller part of your life, these tools are going to help that dexcom.com Ford slash juicebox, there's going to be links in your show notes of your podcast player. And at Juicebox podcast.com. type it into your browser. But if you can, you know, hit my link, that'd be terrific. I don't get paid by the link, I don't want you to think that that's not how this works. It just lets the sponsors know that you're coming through the show. Also the Omni pod tubeless insulin pump, don't wait. Right? Don't get it into your head, like I'll wait for her eyes and just get the on the pod down Get going, you're going to be an absolute rock star stud with it by the time horizon gets here, and you'll make an easy transition to horizon, it's not going to be a problem. And by the way, if you don't want an automated system, you don't have to on the pod. They want what you want. In just a moment you're going to hear from Brett, and he's going to tell you that what Omni pod wants for you to have more than anything is choice. You'll see what I mean in a second. The great thing about on the pod of course is that they'll offer you a free no obligation demo of the on the pod right now, you don't have to buy it, you're not locked into anything. You just go to my Omni pod.com forward slash juice box, you fill in a little bit of information and they'll send a pump right to your house. It's non functioning, don't worry, can't hurt yourself with it. Give yourself insulin or anything like that. But what you can do is where you can live in it and see how you'll enjoy it. One of my favorite things about wearing the demo pod is that you just forget it's there after a little while. Touched by type ones mission is to elevate awareness of type one diabetes, raise funds to find a cure and inspire those with diabetes to thrive. They are my absolute favorite type one diabetes, charity. They're small, but they're powerful. And they're growing constantly check them out, just go to touch by type one.org. They're not looking for anything else from you. They just want you to know they're there. So you can see what they're doing. Touched by type one.org. And now, let's go to Brett Christiansen from the bot.

How are you?

Bret Christensen 53:29
Good. How you doing? Good. Where are you at?

Madrid Spain?

Scott Benner 53:37
Oh, okay. All right. How long you're there for?

Bret Christensen 53:42
all week. So I mean Friday morning. Nice. Thank you always. Great show.

Scott Benner 53:47
You're in Madrid. I'm in New Jersey, yes. Using a cell phone, which we don't usually do. But it's a big exciting kind of time. So we're making an exception.

Unknown Speaker 54:00
All right, so

Unknown Speaker 54:02
So, so you guys had a pretty big

Scott Benner 54:06
announcement the other day, I think it's sort of to me felt like a cementing of something we knew was coming as far as Dexcom. But the libri thing was a curveball for me. Can you tell me about that a little bit?

Bret Christensen 54:21
Yeah, I mean, I know that it should have been a curveball, because you know, the strategy all along right with interoperability is that you allow patients choice. And so we've been working for a long time with x calm. And as you know, we're launched on the pod horizon limited Dexcom g six. We announced last week that we're going to work together to quickly add g seven, which we know is important to our users. And then the abbot announcement was again, consistent with interoperability because, you know, what we do is we want to provide the best content delivery system out there. And so we're in the business of selling pods and pods marking pods. And so we want to allow patients, our users, sensors. And so if for whatever reason they want to use a Dexcom versus Abbott sensor, we see a product where you turn on your, your TPM, or you access the app from your smartphone. And there's a drop down box that says select your sensor, you're able to say that stop g six Dexcom g seven. That liberates you. That's the vision that we provide that choice to our users.

Scott Benner 55:34
And, and that Libra is not the current one that's available, though. There's one that's coming. That's the one that's going to work with.

Bret Christensen 55:42
Yeah, so the Libra shoe. That's right. It's the one that's coming. And and, you know, the real rationale for that is in Abbott said this bill working with the FDA to get ai CGM certification for Libra to as you know that that designates that CGM is an AI CGM. We've already been designated as an ace top. And then with horizon will be pivotal. But right now, we we intend to make the horizon algorithm the AI controller. So those are the three components necessary for an AI system. And what it actually does is it's a quicker to market pathway. So it's not a PMA product, it's not really going to add 10 kids, it's a it's a validation that the two companies should do together to make sure that that's actually works. odd. And with the rise in algorithm, it's a real short to market timeline.

Scott Benner 56:37
Not to jump around. But does that mean that tide pool also has to begin over? If they want to support the librato?

Bret Christensen 56:49
No, no, because, you know, the tide pool application is, is already being developed with the parks and effects job. And so that will just continue. So they, I guess, if they wanted to add lubri, to to that application, they could do so. But that system is being built with those three components in mind. And so then that comes g six is already an IC GM that they're working on is becoming the AI controller. And so they're working on that designation with the FDA, then they'd be able to pair that with Omni pod, the pump, those three components should be able to work together that system. I understand.

Scott Benner 57:29
Yeah, I didn't ask my question correctly. That's what I was asking. So Perfect. Thank you for clearing that up. So is it fair to say that? Is it fair to say that when horizon launches, Dexcom will probably be before Libra to where do you think Libra can catch up and get their designation in time for your launch?

Bret Christensen 57:50
No, I know, we're pretty tough. So when when we launched because we're again, we're in the trial now with Dexcom and Dexcom, kusik. So what we anticipate is that launch, which we've set it up for the second half of this calendar year, the system will be in the beginning, we will have full control on certain Android smartphones, there will be just the Dexcom gs six initially, and on the on the horizon algorithm. So that will be the component and that will be the system on day one. And then we'll look to add g7 and Libra to future developments. But there's still technical work that we have to do, even though the FDA does the clinical pathway to get there. Gotcha. And

Scott Benner 58:30
so, horizon. So I think this is a when I'm listening to people talk and ask their questions. And even just for the last two hours, I asked people, you know, that are following the podcast just on Facebook, like what would you be wondering? their questions, mimic them? I know a lot. But there were some interesting things I saw pop up where they just don't understand. So, you know, a lot of people said, Look, I can't get I can't seem to get a dash PDM. Is that going to stop me from getting horizon? Which led me to believe that they don't understand that horizon is going to be phone control, right? You're not going to need a PDM with horizon? Is that correct?

Bret Christensen 59:08
It's correct. But one clarification is that we will still distribute a PDF to every user. So even a user that says, Look, I want to I want to start off on horizon, using my own smartphone will still ship them a PDF, just as a backup device for that company we told the FDA to do. Yeah, so they'll have that right. So you don't need your need from control. For horizon, it will come Wikipedia, but anyone that chooses to just have the app on their phone, it can effectively eliminate one component of the system. So that's the beauty of phone controls. And you can do that. But but those that don't have an Android device don't want the app to want phone control, the ability to have a rising PDF,

Scott Benner 59:49
so horizon won't run off of iPhone.

Bret Christensen 59:55
Not initially. So again, that's the partnership with tide pool, but the one One of the real benefits that we get there, that's probably a shortage pack way to have Omni pod control through the iOS Apple system, because the tide pool application is built on exclusively iPhone. So it's probably the shortest path with Apple. But we have said that we are going to be working on an iOS version of horizon,

Scott Benner 1:00:21
I say, How are the trials going? Are they steaming along like you hoped? Are you learning anything from them?

Bret Christensen 1:00:31
Yet you also were blinded to the data. So we did a pre pivotal that started in December until almost the first of the year for a real small number of patients that we can have visibility to, will look to probably shoulder data potentially at ABA. But you have to be here on out we're really blinded to the data. So we'll get feedback from our investigators to fix even problems or issues that and then we see enrollment, but that's about it. So I will say this a Roman has been very strong. And if you talk to Dr. Lai, our medical director, she'll tell you that many investigators said they had people will fly from Texas to the Pacific Northwest to be in the trial. There was that much demand, so we won't have any problem during the enrollment for the trial. We know that much. But we don't see that the comfortable results and print the results until that Yeah. Okay.

Scott Benner 1:01:19
And so that you won't you don't get to see those results until the FDA comes back with a report for you about how they found the trial to be.

Bret Christensen 1:01:28
Yes, that's right. What we'll see it once it's complete in the data block and the results are in that's when we see it. We do get, you know, anecdotal stories I will have investigators will tell us how horizon has changed where their patients lives, there's, there's a story about a young patient that you know, had problems really wetting the bed, because the lot of rains, you know, the just that they couldn't keep the right, the right level. And that went away with almost immediately with the horizon. So there's some really cool patient stories, how it's changed people live, parents that are sleeping with their kids, a lot of that. But again, we don't see any time and range or you need to know clinical results. Until the completion of the trial. Do you do you see horizon as being for people who are really struggling? Only? Or do you? Or will it be able to be used by I don't know what to call it like a super user, somebody who's got a six and a half a one C and just really wants it to be a five and a half? Do you think that it has applications for for both kinds of people? Yeah, I do. I actually, I think it's for everybody. And and you'll see that is really stilted. So it's flexible enough that you could still be a super user. And really fine tune your time and arrange your will have set points from 110 to 150. But just the way it works is about you know, the beauty of CGM is it gives users really powerful information they can act on to try to get a real tight timing range. But they're not acting on that in a way that horizon writings getting a value from CGM from Dexcom every five minutes. And then it's making an interim dosing decision every five minutes or every five minutes that you've assumed a unique dose of insulin that's driving them to a target. That's just something that I could give it a power user on dash saves a hard time driving to that road. So I think it's for everybody, the ease of use and simplicity, it's gonna be great for somebody that hasn't wanted to adopt pod therapy. But I think it's flexible enough that a power user can get even better results on arrival.

Scott Benner 1:03:34
Are the are targets definable by the user? Or is it locked in it at at some target blood sugar

Bret Christensen 1:03:44
defined by the user. And so you can set different targets for different situations. But, you know, we wanted the flexibility with the lowest one. So that's the bottom set point. And if I want to do so, in increments of 10, so 141 5130 and 2110, those are the set points that are user defined. And then there's a you know, a feature like hyper protect, where, let's say you have a child that's going to sleep over or you're going to be exercising in some extreme way, you can set it too high for protect mode, which really kind of ignores that setpoint and lets you run at a higher rate for a longer period of time. And so this is something that we think is gonna be really valuable as well for this in situations. Okay,

Scott Benner 1:04:27
so I don't know if this is your space are not like I think I'm asking one of the right people. But, you know, dash came out in, I think in the within the last year and some people are able to grab it and some people are seem to be having trouble getting covered for it. And what I'm seeing is that that's causing people concern that they're not going to be able to get horizon moving forward. Is there a way to talk about the first I guess what what people should be doing if they want bash and if that has any impact on horizon

Bret Christensen 1:05:00
Yeah, let's back up as far as I can. So, you know, one thing we did with that, we really wanted to start over with, with the way that omsa reimburse the way patients pay for pumps and the way, they're restricted to migrate from one technology to the next. And so, you know, this, but the pump market historically has been a decision that it should make, there's a large upfront fee. For the pair case, of course, and other than patients pay for course, now, because of that large upfront fee, the pair had locked a patient in for four years to that piece of technology. That's troublesome. And it's actually it's not, it's it actually is a counter incentive to innovating and innovating quickly. And so a manufacturer like us actually has an incentive to only release a product every four years, because we have a large install base that can only adopt that new technology once every four years. And so if we hadn't done that, in which imagine patients actually digit cash, so we've spent over a year now, putting patients on dash from our legacy Omni pod product, those patients in the old model would be locked into a four year warranty carrier would not have access to horizon for the work through that four year period. So that that went away with that, because we did that, you have to renegotiate contracts in pairs. And so there are some users that have not been able to get gas because their pair will not pay for it in that manner. But the one existence that we made when we watch dashes, and we want to charge these large upfront fees, we also want to lock patients into a four year period. So the good news for those patients who's literally got gas yesterday, or still haven't got it, it has no bearing on their ability to get horizon because the baby launch horizon, the only thing that matters was real their pay or pay for it. And so it doesn't matter if they've had dash haven't had dash, none of that matters because it adopt that new technology, because you're not locked in to that four year period. And we're not going to build a pair for the largest selfie, that she's not paying up front. That's the good news. But that's been a shift, and it's taken us some time to build that access. Today, we've got over 50% of covered lives that have access to this new model. So we're not charging that fee. But if you're part of the the, you know, the 40 or 50%, that doesn't, we may have a problem getting on DAC so far. But that's getting better every day. But you know, the way I always talk about this, Scott is it's like cell phones were 20 years ago, you know what I had the key to Brian, they owned by phone number, they locked me into a three year contract, and I wasn't able to switch regardless of how poor my service was. And that's the pub market today, the the durable medical equipment, so we decided go away from that. So it'll be easy for patients to get on product that it's easy for them to get off, will not do a good job. That's the model that we see patients that choice, this choice of DVDs.

Scott Benner 1:07:50
So if I'm gonna make a hypothetical here, if I'm a person who can't get dash at, you know, for whatever reason about my insurance horizon comes out, can I just get horizon and use it with my phone? Or do I have to be able to receive the dash because the FDA thing like I'm saying, are the people who are are somehow blocked right now from dash? Will they also be blocked from horizon for that reason? Or do you think you'll have that straight by the end?

Bret Christensen 1:08:20
Just depends. But look, we're we're making progress on that every day. But what's likely is that their dash coverage will be pretty closely mirrored by the horizon coverage, because we all have the same payer, right? So pick pick a large commercial payer, and let's say they are paying for gas today, they're likely to pay for horizon when it comes out, right away, right, reimburse that, if they're not, for whatever reason, if it's a holding on to this four year locking period, and this larger, upfront fee, and we haven't been able to convince them that this new model is better for patients and frankly, better prepares. Because we assume that risks, we're not charging them for four years of therapy of swans, and they don't have to hope that patients use that product. So we haven't been able to do that yet. We need to do that between now and arising. Because it'll be the same model for a rising and so it again, it's a good thing, because horizon will be we're gonna be given a software company, right. And so as we innovate through software into applications, patients should always be able to adopt that newest version of horizon without having an upfront period, this four year locking period, but we just got to establish that access for them.

Scott Benner 1:09:24
So you're making an improvement a shift into the type of business you're doing, because of the improvement in the technology. But the insurance companies are stuck in, in the model they're in so you, is it a is a Yes. Is it a Is it an explanation thing? Do they not understand or they just resistant? Like, like, I'm assuming every day is frustrating when you're trying to make this work. But is there a path to it eventually do you think?

Bret Christensen 1:09:54
Well, yeah, and I. So let me let me say one thing, so you know, what I started with in 2003. years ago, we had been on the market for 15 years, and we were the worst reimbursed influence on the marketplace at that point in time. And so it took us forever to get to really good access with our legacy Omni pod today, you know, after just after less than a year of launching bash, we have better access to the ad, when I started with and slept with, after 15 years of work, it's actually happening very quickly, believe it or not, and most of the large parents have adopted it. But there's thousands of pairs, there's a lot of small plans, every state's got their own Medicaid. And so it's just a lot of work. And the story, we have to tell, thankfully, is a useful model that takes four pumps in the way that I described, locks up free Wi Fi for your locking period. So I feel like scratching the value of this new system, that value really is that we're owning the rest, because they only get outcomes, which they want. Because they get health outcomes. And they don't, it doesn't cost them very much if the user actually uses on the pod every day. And so they don't, because we didn't do the job of the product, then they stopped paying for it, then, you know, with the historical models, they pay for the front that hopefully, usually you got, you know, every patient from an average migrate between health plans every two and a half years. So why appear would want to pay for four years of therapy for anything knowing that on average, that that patient is going to stay with their health plan for two and a half years just doesn't make sense. So once we tell that story, it resonates with payers and the adoption actually very quick. We just have to, we just have to deal with it, we were the first to market and we were the first insulin pump on the marketplace. This is how reimbursement would have been set up. Here's what if it all paid for what the patient's using it for the benefits I'm getting, but they stopped using it, I want to stop paying for it, nobody would pay for four years of allergy medicine right up front, you know, you get that prescription filled every month, and that's okay, I just want to do. So they're they're migrating actions pretty rapidly. It's improving every day, it's just you have to tell the story and reach all those health plans.

Scott Benner 1:12:02
You know, it's funny, and I'm not known for being great at being like, office, correct, my wife always tells me if you had an office job, you would just get fired in a week. But so I'm gonna say this because I have, I have like historical, you know, time with on the pot, I've been working with them in one way or another for a really long time. And so I've had access in and had impactful conversations with people throughout the years. And what I can say is that, from my perspective, around five years ago, the leadership of Omni pod changed significantly. And I mean, through the actual people sitting in the positions, but also with the idea of what the company was for, like there was a time prior to JC that I thought this company might sell or even go out of business at some point, like I used to support on the pod because I loved it. And I wanted it to exist for my daughter. And I always felt like I always just felt like that leadership prior wasn't doing what I would hope they would do as a customer. And it is completely 180 degrees from that now. And it's, it's interesting. Because I have that perspective, I see how far it's come, how fast it's come and how the focus has become something that I'm excited by. But that's not exactly something you can communicate to people as they're coming in. And they're seeing, you know, tandem, put their pump out and it looks suddenly like their head when you don't know the whole story. It's it's an interesting, I don't know if you want to talk about that. But that's my perspective of it.

Bret Christensen 1:13:38
Well, I'll tell you the good thing about being able to state that we have the right to the entire management team, and that's just the executive level, but you're hard pressed to find anybody in it for the schedule longer than five years. The good thing about that is that, you know, we were in such a state at that time, you know, just how we marketed the product, how we sold the product, the quality of the product, the the amount that we were spending on r&d, or how little we were spending, frankly, on r&d. You know, when the new management team came in, it was pretty easy to take some risks because we had to, we had to do things dramatically different. And so we've done some things and the question I get asked so often is how are you willing to make these bold decisions and take these types of risks because frankly, some of them could not have worked out and ended up in a worse situation. But you know, we made the decision to move a large portion of our manufacturing from China to the US. That's a big decision which stood over $300 million automating the manufacturing lines and why as important you know, last year we made over 30 million parts until the quality has to be really really good on those that we have the opportunity to provide a bad patient experience bad news experience every three days. You know where you get a lemon when you buy a car once in a while. You don't buy a car every three days. We're effectively delivering a new pump to a patient every three days has to be done. Quality. So we put significant investment in that, we decided to disrupt the way the products paid for and to go to the pharmacy pays to go model that where patients don't pay for this large amount upfront, they're not locked into a piece of technology for four years, that's a long time, imagine not being able to upgrade your iPhone software for four years. It's silly, and it's not the way that it should be done. So that was a bold move. You know, we took our, our business back from our European distributor. So we went direct in a really short amount of time in Europe, which enabled us to expand beyond the small amount of European countries that we're in today to expand globally, there's just there's been a lot of things we've done in the finals, we took this was a good product, you know, an omni pod, and we're manufacturing with PDM is controllers with our own proprietary software. And we realize that there are companies out there that make pretty good handhelds called Apple and Samsung and these type of companies we moved on, we pocket this mobile platform, which took a lot of time, it was really risky, very expensive. But it's set us up now. And I appreciate that it's really all that work, it's just kind of coming to a close. Now, we haven't seen the result from a lot of it, but it's going to enable us to move really quickly in the future. And to innovate very quickly. And you know, the reason why I think users and patients only have adopted, you know, insulin pumps 35% of the time, which is probably the penetration rate of all type one patients in the US, that's a that's a visible penetration rate and usage rate, considering the insulin pumps have been around for 30 years, but the technology has not been good enough. And so if you're willing to give yourself four or five shots a day, that tells me that we just just have to do a better

Scott Benner 1:16:46
I am, I couldn't be more excited about where this all is. It's it's just it's tough for the, for the casual observer to understand the big picture of it, it's you know, and when you tell them, they just want nobody wants to hear it, you know what I mean? Like, everybody just wants it now, and, and they don't know, they don't know what had to happen. It's not like it's not like, it's not like you guys made a bad decision. Like you're making these, you're making these amazing moves. I saw the manufacturing floor. You know, I don't know if I ever shared this on here. But I came up and spoke to employees last year. And I was able to I was just there to tell them what Omni pod meant to my family. But I got a tour of the manufacturing and it is incredible. It's just it's people would not believe how on the pods are made. It's it's stunning. You guys are set up for you know, I was talking to the gentleman that set the floor up who I always think I want to interview because he seems so damn interesting. And, and, and he was explaining how you know how this setup allows changes to be made without like, huge tear downs from the manufacturing. And I was just like this is this is like state of the art. And you move that into the country. And and you haven't right there. It's right there. So I don't know, it just makes sense to me. I'm jacked up. I'm excited. So I hope

Bret Christensen 1:18:04
I'm excited to you know,

I get I get that it feels like we're not doing enough. I'm not doing it quickly enough. And I frankly I was there too. When I started with inside, why don't we just put an app on the phone that controls on Wi Fi, that's easy enough to do, right? Every 14 year old kid in America has got a video game on the phone that they built in their garage, that seems like it should be something pretty easy to do. But it's incredibly complex process and then never would really, you know, developing software that's going to deliver micro doses of insulin have to be incredibly accurate because insulin is a fantastic life saving drug that can be deadly if you don't do it. So it just there's a lot of scrutiny here and technology, not real quickly. I will say this, how can we estimate credit because the other we've always had the idea to put an app on a phone and control on the pond, but nobody ever thought that the FDA would get there would be comfortable with that. So you know, we've worked with them very closely to get there. I think once we get through these pivotal roles, and if we can get horizon approved on the marketplace, it's going to solve so many of the things that people are asking us for the number one request we get from a patient that still using multiple injections and they want an app on their phone. And if they could get an app on their phone, they put it on the playground and give it a shot. We can get to that. We're gonna we're gonna have a tremendous uptick of legalization because we know it's going to be a tremendous experience. You

Scott Benner 1:19:31
know, I can't tell you how many years ago it was where JC was telling me the very same thing. She's like, Listen, we want to put it on the phone. You know, we have to prove it out to the FDA, but it always felt like yes, we wanted to do it, but we don't I mean, it seems unlikely they're gonna say yes to this and that. That was a handful of years ago, but in FDA terms, it's quick, you know, and it's a big leap for them and you can see why. Especially how you described earlier like just how pumps have been forever. You know, to go from That sort of stagnant system to Hey here, it's gonna be on your cell phone is a is a major jump. Let me ask you a couple of quick hit quick heading questions here and see if you, um, if you have answers, I know you're saying the last half of the year, and you're a publicly traded company, you can't just give me a day. But do you think you're gonna hit in 2020?

Bret Christensen 1:20:23
Yeah, absolutely, we wouldn't be saying it, you know. So again, you know, we'll finish enrollment into the middle of trial, probably end of May, the latest will submit to the FDA, a little bit by 30 to 90 days, and then and then, you know, it's just a matter of doing some sort of relief at the end of the year. And so yes, I do think we'll hit it. And, you know, then 2021 will be all about getting as many people on really the best product on the market, which will be horizon. So we'll make sure that we're ready to do the, I'm glad that we've got the time. Because your point earlier, we've got, we've got market access to build further, even though we've made tremendous gains there, we've got supply to build, we've got marketing materials, we've got to make sure you have product support worked out, because now you know, we're talking about patients calling us and saying something's wrong with my system. And we got to quickly assess it to, you know, the way Dexcom is communicating with Omni pod is is the army product is the next commerce with something in between, and we just have to, you have to serve those goods. And so we're adding some complexity here on our ends, so that life is simpler for the user. And so we just got to figure all that out. But I'm excited for it could be one sided.

Scott Benner 1:21:37
I have a follow up for that. But first, it does Canada and Europe happening concurrently? Or will that take longer?

Bret Christensen 1:21:46
Not concurrently in the US will be first. And really just the it's the regulatory pathway for each individual country? And then you know, languages units of measure, but will they'll be fast followers, both of them? But but also the first,

Scott Benner 1:22:02
can I press you and ask you do you think 2021 for Canada and Europe?

Bret Christensen 1:22:10
You can trust me, I think. But you don't have to answer.

I just don't know if I can. I guess I don't I don't think we've hit that timeline out there. But I think I think they'll be fast followers.

Scott Benner 1:22:24
So you just mentioned something that I was going to bring up. So I've seen an algorithm work. And I've been in this space where I've tried to understand it. And what you just said about support is, it can't be stated strongly enough. So we we already live in a space where you know, and I see it more from the podcast than maybe most people do. But we already live in a space where most endocrinologist struggle to help people who are pumping or using MDI, to have the outcomes that they're looking for. And when you're using an algorithm, there are settings to consider. And if you don't have those settings, right, the algorithm, you know, you can't you can't tell a robot that there's a wall, eight feet in front of it, but the walls really four feet in front of it and expect it not to walk into the wall. And so the settings, you know, the parameters you put on it are incredibly important. But moreover, the way the algorithm thinks is unlike how most people are accustomed to thinking about diabetes, so the support is it's paramount. And I think that it's even more so maybe not just for people's success. But because I truly believe that algorithm based insulin pumping is what people should be doing moving forward and what they will do and what will be the best for them as far as their outcomes and their health and their stability and the amount of time they have to put into diabetes. But what I've seen is, is that when they try it, and it doesn't do what they expect it to do, and like it or not, their expectation is set it and forget it, which it's never going to be that right now. If you aren't able to shepherd them through the process, I'm so fearful that this really amazing advancement will will scare people away. And have you guys thought about it in that in those terms. I'm wondering

Bret Christensen 1:24:27
yes or no.

You're right about your stat. If something's not working in in, you know, one of the biggest challenges we might have is patient perception in their automated insulin delivery or artificial pancreas or how it's described to them. And we might think that they don't have to do much in one day. That might be possible. Because what we have done with the algorithms we have booted simpler, we're starting to make it make it so it's the parameters are set just right to the algorithm can compensate a little But for that, and so the algorithm gets better. And each one, you know, becomes faster actually, we'll be able to get better and better at that. And the goal will be one day to eliminate parameters, right. So that, you know, the reason why physicians have these complicated data management systems, and they're all budgeted out there, and they probably have all of them in their office, because they're looking at these reports, they're trying to achieve CGM values and influence those seasons. And then they're trying to fine tune these parameters. That's a real hard thing to do. And it's something that an algorithm should be better at doing in the future. But we're not quite there yet. We haven't eliminated all the knobs and the parameters that need to be set. So we do need to make sure that you train with just diligence and training, you know, this is going to be an incredibly simple system to use. And we'll move on to dash for existing users of Omni pod, have you provided online training, some patients do the content on training, because it's so intuitive, but they've been on pump therapy, so they know how important it is to know about your meals. important is to set the right base level, they know all these things. But if the pump gets easier and easier to use, we need to make sure that we're with justice, diligence and training. So we plan on doing that with horizon review. We do live training with our users and follow up in seven days, we call them 30 days, we bought the 90 days, just to make sure that they're just as guilty, because if they're not, and they look at this as an opportunity to do a lot less, they're not going to get the results that they should be getting improved results from arise. And so I'm excited about the future one day that I think I think we will get to the point where we can eliminate a lot of defenders because the algorithms that go in technological perspective, we're not there today. And so we just got to be very good at training and make sure that we take very seriously that the user has to do it, even though that's a lot easier with horizon.

Scott Benner 1:26:50
Isn't it interesting how you're on the cutting edge of something. And in its infancy at the same time, it's when you're making a leap like this, right? It's such a it's a weird headspace to be in because you're like, this is better than it's ever been. But with the way technology grows and leaps, two years from now, you'll look back at the first algorithm be like, Ah, you know, like, it's just, it's fascinating how quickly things move. And by the way, that's exciting. Yeah, because in diabetes, there were no leaps, just just five or six, maybe seven years ago, it was I say it all the time, you get excited if somebody made a new meter? And you say, is it more accurate? And they're like, no, but it's got a, it's got a color screen, you know, like that, and that excitement. So

Bret Christensen 1:27:40
it's just there's no other time, like, you know, what, what's interesting is, you know, expectations will just keep getting higher with our users. And that's okay, we're gonna live with that, right? You know, we would actually, it was a big leap from our legacy Omni pod to dash, we just, we, we launched the view app, right, where a parent can see what's going on with Omni pod for the child to the distance, you know, you should send your child to people, but you get to see what's going on within put on board and without me but but when that doesn't work exactly the way it's supposed to work, that people are upset, right, regardless of the fact that that didn't even exist a year ago, right. So so that's the way it will be is technology gets better expectations will just get higher and higher. That's great, though, because, you know, our mission is to improve the lives of patients with diabetes. And we will do that through technology use that looks like patients will be that that continues to get better over time. And well,

Scott Benner 1:28:32
yeah, I believe it will. I mean, I've I've got a long enough lines now that I've seen it in the past. And for everybody who's newer diagnosed or, you know, prone to be a little impatient, I guess sometimes. And for really good reasons. I'm just telling you, like, just hang on, like, I think ami pods moving in the right direction. And they have been for a really long time. This is just like another example of that. So I let me ask you, do you have to once your trials done, do you have to restart for a kid's trial? Or is that being done concurrently, so will pedes be available at launch?

Bret Christensen 1:29:10
So the trials going down to the age of six, so that should be available at launch, and then we will need to do more clinical work to lower the age glowsticks so could a you know Omni pod is cradle to grave. It's there's there's no limit on the age range. And we're the leader in pediatrics. So we also you know, there's an ad system has gone down to six today. And so we've, we were really, you know, emphasizing that to at least get to six in this clinical trial, but we're going to quickly get below six. We've got some data for patients down to the age of two, so we're going to have to get there. But yeah, at launch dance, your question would have been down to the age of six.

Scott Benner 1:29:54
Huge thanks to Rick and Brett for coming on the show. Rick Of course from Dexcom Brett from Omni pod. Another thank you to touched by type one.org for their support of the Juicebox Podcast and for what they're doing for people living with Type One Diabetes. You can check out the Dexcom G six@dexcom.com Ford slash juice box, learn everything you need to know. And get yourself a free no obligation demo of the Omni pod app my omnipod.com forward slash juice box. And of course, and of course touched by type one.org. Head over, see what they're up to. Now I'm gonna put this online, go to sleep, wake up, fly to Atlanta, and tell a roomful of people about being bold with insulin. You know who's gonna be there with me, Jenny Smith. Today's Jenny's birthday. I'm gonna see Jenny The day after her birthday. That's when I'm gonna meet her for the first time in person. Isn't that crazy? If I don't look too horrible. I'll take a picture and send it to you. But if I take that picture, and I think

Bret Christensen 1:30:59
No,

Scott Benner 1:31:01
no, then you're not gonna see Jenny on the day after her birthday. Hope you guys enjoy this. coming next week, part three of she's having a baby. Sam is about ready to burst and I just talked to her the other day. Things have gotten more difficult as the pregnancy has gone on. She's doing well. She's gonna come on and tell you all about it. I just remembered she likes being called Samantha but I don't feel like going back and editing it. So Samantha and good bye.

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