#327 Dr. DeSalvo has T1D

Dan DeSalvo, M.D. is a Pediatric Diabetes Endocrinologist

Dan DeSalvo, M.D. is a Pediatric Diabetes Endocrinologist at Baylor College of Medicine and a person living with type 1 diabetes. Dan shares his story and talks about how the Dexcom G6 is being used in hospitals for Covid-19 patients. 

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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 friends welcome to Episode 327 of the Juicebox Podcast. Today's show is with Dr. Daniel disalvo. Now, Dr. disalvo is a pediatric diabetes endocrinologist at Baylor College of Medicine and Texas Children's Hospital. He also has type one diabetes himself. Now, you know me, Dan came on the show to talk about how decks coms were being used in hospitals during the current coronavirus. But then I started talking to him. And I think we got to that part eventually, just I enjoyed Dan's conversation. So we didn't, you know, I don't make a bullet list and be like, talk about this, then this then this. I don't know how to do that. If you want that, go to another podcast, which I'm betting will be boring. Anyway, this one is interesting and fun. And you'll still learn about how Dexcom is used during the current Corona crisis in hospitals. So you know, all the information gets out. But you're not put to sleep by a boring host and stagnant questions that have been written down on a piece of paper. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter by touched by type one Dexcom and Omni pod. Now you can go to Contour Next one.com right now to find out if you're eligible for an absolutely free meter. Why would you want to do that? Well, one reason is, it's absolutely the most reliable and accurate meter that I've used in well over a decade. So that's a pretty good reason to check into it. I'm also going to ask you to check out touched by type one.org. In these trying times, organizations that are doing good work for people, they need your help. So check out touch by type one.org. And of course, you can get a free no obligation demo of the Omni pod tubeless insulin pump at my Omni pod.com forward slash juice box. And to check out the people who put these continuous glucose monitors in the hands of the people helping those who are suffering from COVID-19. Check out dexcom.com forward slash juice box.

Podcast something here. But first, let me remind you that nothing you'll hear today 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. I'm going to read to you now from Dan's professional statement. It says Dr. disalvo joined the faculty in pediatric diabetes and endocrinology at Baylor College of Medicine Texas Children's Hospital in July of 2015. Previously, he was a postdoctoral fellow at Stanford University, where he was an active researcher in diabetes device technology, including closed loop artificial pancreas systems. His overarching goal is to provide compassionate and comprehensive treatment to children entrusted to his care, and to advance the field through clinical research. It says some more here, but what I'm going to tell you is as a serious guy who knows how to have a good time while he's given an interview. And now, Dr. disalvo.

Dan DeSalvo, M.D 3:35
My name is Dan DeSalvo. I'm a pediatric endocrinologist at Texas Children's Hospital and I'm on faculty at Baylor College of Medicine. And I have been pediatric endocrinologist for I guess about seven years now. And my inspiration started when I was 19 years old as a sophomore at Baylor University in Waco, Texas. When I was diagnosed with Type One Diabetes, it was through that personal journey, and his desire to help others that I sort of had this epiphany about halfway through my sophomore year, where I realized I wanted to become a doctor for kids with diabetes, not realizing the journey that would lie ahead. I switched over to pre med and never look back. And here we are 20 years later after my diabetes diagnosis. And now I have the incredible joy and privilege of being a pediatric endocrinologist where I can walk with and Shepherd families on a diabetes journey. And I feel like I learned as much from them as they probably do for me. And you know, I'm really glad to talk to you Scott because a lot of my patients actually listen to your podcasts, read your blogs, and I've really found a lot of inspiration, hope, practical kind of tips and tricks, and also community so thank you for the work that you're doing.

Scott Benner 4:49
diagnosed in college. What were you thinking of majoring in before you made the switch?

Dan DeSalvo, M.D 4:56
So I was actually a political science major and I was thinking that I Maybe he wanted to go to law school, didn't know exactly what I wanted to do. And really, it was through my my diabetes diagnosis that sort of led to this, as I called it an epiphany. My best friend, or one of my best friends growing up was Eric paslay, who I think has been on your show before. So Eric paslay is a country music singer now. But growing up, he was just a good friend of mine who had type one diabetes. And so I learned a little bit about diabetes from Eric, and, but really had no idea that that would be what I would want to do with my own life until my my personal diagnosis, it's kind of a funny side story is that I had, I had for a moment, I thought maybe I wanted to go into medicine. And when I was a senior in high school, there was an internship where I spent about a week in a pediatricians office. And at the end of the week, I decided, you know what, medicine is just not for me. But, but I'm happy to say that, you know, through my personal journey, I've decided to go on this path. And I cannot be more grateful for the opportunities that has provided me in terms of being able to edify my own knowledge, but mostly just be able to, through my clinical practice, pass it on to others, and also, as a clinical researcher, helped to really advance the field of diabetes.

Scott Benner 6:16
Before I asked my my big question, was type one. A surprise? Like, were there people in your family who had it? Or did it come out of nowhere?

Dan DeSalvo, M.D 6:27
Scott, it was a total surprise. I, you know, I was that kid who never miss a day of school, always won the awards for for attendance, no family history of type one that we're aware of, in my family, some type two. But no family should type one. And yeah, I bet the summer after my freshman year of college, I went on a medical mission trip to Africa actually was just a mission trip, not a medical mission trip on a mission trip to Africa. And on the tail end of that got really sick. And when I came back was just continuing to lose weight, had to excessive thirst and urination, this similar story to so many have the diagnosis of diabetes, but was kind of in denial. And finally, it was my roommate, who was a really light sleeper, who every time I woke up was waking up. And finally I said, Dan, I don't know what's going on. But you've got to go find out what's going on, you know, what's wrong with you. So I went to the Student Health Center at Baylor was diagnosed with diabetes, and spend a couple of days kind of learning how to manage diabetes had a sister who was in college, about two hours up the road in Dallas, who actually came down to Baylor where I was, and such an amazing advocate would actually come to my classes with me, because she was so worried about me, you know, having a low blood sugar, this was all brand new for us, and would help me kind of talk to my professors about this in diagnosis and what to expect. So having advocates like my sister, Sarah was was really impactful. And it wasn't long before I became my own self advocate and develop my own knowledge base. But, you know, to answer your question, this was totally out of the blue. And while initially shocking, really led to, you know, learning so much building community with other people at Kent on campus who had diabetes, and ultimately leading to this sort of career calling for me

Scott Benner 8:20
so what would you How would you describe your, your goals for patients? I mean, we talk all the time here it's interesting the threw me off a little bit by saying that you knew the podcast but you know, we talk all the time here about giving people great tools, good information, so that they can make better decisions so they don't get caught sort of in the backsliding vortex that is being confused by diabetes. And and I hear back from a lot of clinicians who are like keep talking about this please this is how we do it. You know, we share the podcasts with people but I hear back from far more people who have successes after listening go back to their doctors and then are honestly yelled at like scolded in the office, even when they show data, even when they pull out a Dexcom graph and say look, no I don't have meaningful lows. You know, I've only been under 65 2% of the time you know in this 90 day period I'm getting this a one c you know legitimately the doctors you know what I always surmise is either they don't understand or they're just scared and they've never seen anybody with a good a one c before someone make a change that quickly and and that does happen people will listen and in the span of one a one c measurement sometimes dropped their their number a point or some people too, and it scares Is that what it's happening to them? Can you can you kind of put yourself in their shoes if you see somebody with an eight nine who all of a sudden has a six nine, and they tell you I heard this on a podcast. What would that sound like to you as a doctor if somebody came in and said that

Dan DeSalvo, M.D 9:59
Yeah. So a couple of things on that, Scott, first of all, you asked about sort of my my personal mission for caring for patients. And it's really, to help empower them to live well and die with their diabetes, to really take ownership of it. And I'm not only looking for improved clinical outcomes, but also less burden of diabetes. And I think part of that is, is being really tight in the community, and having a sense of purpose. And I think that's where the diabetes online community, your blog, your podcast, has really helped inspire them. I also think it's those nuggets of truth in terms of being able to have the self initiation to manage diabetes, having the confidence and the skill set that comes with time. And I think hearing other stories, what you've done with art in with so many of the parents who brought on what so many of the young adults, living with diabetes, their stories, I think, is really helping helping to empower others. You know, I think my sense, as a, you said, at the, at the onset and a younger physician, it all kind of takes the the what how I view this, for maybe some of my really amazing experience overheard colleagues, I think were from where they stand is that the diabetes control and complication trial was published in 1992. And at that time, you know, which really was in many ways, now, the Stone Age is a diabetes, having a lower a one C was associated with a higher risk of having a severe hypoglycemic event. having a seizure or loss of consciousness passing out, right to be clear with the tools that technologies that we have now, that is no longer the case. In fact, if you look at the T Wendy exchange data, which is sort of a cross sectional look at a one sees and the US, having a lower a one C is not associated with a higher hypoglycemic risk. In fact, those with the highest day onesies have a higher risk for having severe hypo, probably, because in many ways, they're managing their diabetes in the dark, maybe they have a lot of struggles with, you know, maybe their adherence and sort of where they are in their diabetes journey, it could be from a tough place, maybe it's the social determinants of health that don't allow them to have access to technologies that others may have. But you know, what I've heard on your podcast, but I've certainly experienced in my, in my clinical practice, is that so many families who have a one sees that are dropping, dropping, at the same time having less hyperglycemia on their CGM, that's sort of the holy grail diabetes, right, there's, I think, three things. One, a lower average glucose associated with the low re one C, two more time and range, the percent of I use in the 70 to 180 range, or 70, to 140. And then three less hypoglycemia, percentage values below 70, or below 54. And that can be achieved that can be done with a dynamic approach today to diabetes, with the technologies and skill sets and the self initiation. So in my personal practice, you know, my goal is really to help help to lift up and inspire my patients and their families. And really, to be sort of, in many ways, a coach and a guide, my hope is, is that they'll reach the point where they're just as self empowered and self initiated, as you and Arden are. And I do see that with so many of my patients, and it is a journey, everybody's on a different pace of that journey. And for some, they require a little bit more guidance and coaching. But they do often reach that sort of Zen state and diabetes, where they've got it, and they've got the confidence to do it. And they reach a place where it's less burdensome. And it's just so amazing to see the kids living well and thriving as students, as athletes as musicians. without diabetes getting in the way,

Scott Benner 13:42
I honestly the feet, you know, I've been doing this now for quite some time. And what I'm seeing coming back from people is that it doesn't really matter, your level of education or social status, or any of the ways we you know, quote, unquote, measure people, everyone can figure this out. And it's not as difficult as we make it seem, or you know, as others sometimes make it seem I'm not saying that taking care of diabetes is simple. I'm just saying that there's some basic kind of tenants, if you follow them, through experience trues are you know, on earth, and all the sudden you see them, and then it doesn't matter the situation I always kind of chuckle sometimes when people are like, Hey, what are you talking about on the podcast? Would that work during a soccer game too, and I was like, it works doing everything. It's it's the idea of putting insulin where it's needed. It really is all it's about I joke all the time. If you all figure it out, I'm not gonna have a podcast anymore. It's timing and amount, put the right amount of insulin at the right place. That's it. It doesn't mean there's not much more that there's other variables. Of course, that can impact those things. But you start to experience those variables and then before you know it, when something goes wrong, you just know what to do. I don't know another way to put it like when something happens with Arden's blood Sugar, I don't stop, put my hands on my hips and start thinking, Oh, okay, well, you know, I guess so she was outside, actually, I just, I can look at that graph on that Dexcom screen, I think for a brief second about what's going on, and I know what to do next. And that just comes with repetition, you just have to get your 10,000 hours. And once you have them, it's I hate saying this, but it's kind of easy, at some point and easy, not that it's not impactful and horrible. And you know, all the other things that diabetes is, it's just your time involved in it becomes so much lesser that it's sort of just a throwaway to me like it. We don't really talk about diabetes around here that often. You know, it's just something happens. We adjust, we keep moving, we don't look back. I don't know why that can't be. Well, I'm gonna I'm gonna rephrase, I believe that can be taught to anyone. But I think it's the same thing. I think the reason the podcast works is because of the repetition, the conversations around the ideas, because it's not something you can just sit and tell somebody, you know, one time how to do and write them down a rule, which is, you know, everybody wants, you know, tell me when tell me how much that's that's not how this works. So given that, I believe you believe you believe in that, too. My thought on this end always is if I can do it here, right? Like if you've ever you've never heard me speak live somewhere. But I guarantee you, I can talk for an hour an hour and 30 minutes, and a large percentage of the people in that room will leave and their agencies will go down by a point a month. So what if I can do that? Because Doctor, Doctor it Can I call you doctor Damn. Doctor Dan, I'm almost a more like an idiot. I know college barely got through high school. Okay. If I can do this, why can those even those silver hair doctors? Why can't they like were anybody like, why is every wire? Why are there a mass of people just going with you didn't die today? And that's a good day. Like, why is that the? Why is that the bar we're trying to get over?

Dan DeSalvo, M.D 17:04
Yeah, so. So you know, one is, is I think I think you're exactly right that your life experiences and sort of learning from cause and effect is something that can really help to inform the next way you do it right. So using CGM is what I call it heuristic learning tool, meaning something where you can sort of learn from cause and effect. Yeah, so with the breakfasts that you eat, or the activity that you that you do, or the you know, your favorite meal at your favorite restaurant, once, you know God willing, we can all go back to doing that, again, you know, really paying attention to it. And and the approach that you took with your insulin, the timing, how is delivered, you know, the adjustments you make with your temp basals are the carbs that you take, before exercise, make taking mental notes of that, and the next time trying to do it just a little bit better, and eventually reach that sweet spot where you can do it really well. You know, one of the joys I have is to be able to sort of watch families as they progress through this process. And you probably remember it well from monogamous first is when she was a little one and how daunting that was and how you wonder how you can ever do this. And then you start to gain a little bit more knowledge and a little bit more skill. And you eventually reached that, that that sweet spot where you realize I've got this, and I can do this, and I can really become an expert, I think with physicians, I you know, I think there, there are so many also who are nimble, and who do change and who were here during dcct, way back in the early 90s. Were before and who really had advanced, so to where, you know, we are now with leveraging technologies and taking an emic approach to diabetes. I think the nature of medicine, though is is that there are others who may be a little bit less resistant to change. They're still practicing the way that they were trained. And I think the other thing is, is as providers, we can all have the humility to sort of learn from our patients as well, you know, maybe there's a new tip or trick that they've learned. And if we kind of step back, and learn from that, it might be something that we can help to impart to another family as well, in the case of diabetes, and so i think that i think that's just a matter of being, you know, willing to sort of change to have an open mind to really advance one's knowledge and to be able to take the learnings from others. And you know, if it makes sense to help to realize that everyone is different, to be able to help to take those special tips or tricks or pearls so that others can can use those to improve their diabetes improve their quality of life as well.

Scott Benner 19:41
Yeah, well, I I just listened. I I agree with what you're saying. I I would like to put myself out of business here right Joe quit, you know, after I put my kids through college, but I would like to put myself out of business. I would like it that one day. This is how doctors across the globe talk to people about diabetes and I've had private comment sessions with some who will say, Well, you know, there's some people who don't get it. And I'm just thinking, I always think, no, you just, there's a way to explain it to them. You know, I, I fall back to a conversation I had a long time ago on the phone with someone, someone online connected me with this young mother, and she was struggling helping her daughter. And I got on the phone with her. And I was like, Oh, I can help her. And I started talking. And it became kind of evident to me that I was speaking with someone who had to drop out of high school to have a baby. And that maybe wasn't on track to go to college to begin with. If that, that, you know, I'm trying to be kind. And, and she just wasn't the she wasn't the brightest person I'd ever spoken to in my life. And I was explaining Pre-Bolus thing to her, the way I explained it to everybody forever, and she just wasn't grasping it. And in that moment, I had this horrible kind of dire feeling like, I have to get off the phone, I can't help her, I'm going to put her in a situation where she's going to hurt this kid, and you know, blah, blah, blah. And then I stopped and I thought, how am I gonna do that? How am I gonna just tell her Oh, well, good health isn't for your daughter, and and get off the phone. And so in that moment, I made up a story about a tug of war. And I put insulin on one side of the rope and carbs and body function on the other. And I started telling a story about this tug of war. And now I sometimes get notes from people who say, Hey, I was in an office the other day, and my doctor explained Pre-Bolus thing to me. And I said, Do you listen to the Juicebox Podcast? And the doctors said, Yes. And I thought, that's just such a wonderful thing. But it's because I didn't listen, I'm not trying to give myself credit, I'm trying to say that you can't give up on people that everybody has the ability to understand this, this is, it's not that difficult to understand. You just have to find the words that they need. And I think that, you know, Jenny and I were talking the other day on the podcast, and I said that sometimes, you know, it's not that we're bad students, sometimes you're not a good teacher. And and you know, that, that should be it, and I get the rest of it, man, like, I get the office hours, and you got to get people in, you got to get them out. And there's this minimum amount of time. Like, I can't imagine that that seems like a heart to me. But I don't think this is, um, I don't think this is how we're going to end up helping people with diabetes, I, you know, 15 minutes at a time every three months, I think the conversations where it happens. And and, and I think they can get it. I think everybody can get it at some point. I just I'm very excited by the idea that you heard about the podcast, and that you've apparently listened to it. That's really cool. I appreciate that. It's made it out like that to people. It's a very, it's very encouraging. When someone sends a note and says, Hey, I went in with my agency, I showed my doctor my graph, he looked at the graph and said, quietly, they always whisper for some reason you listen to the Juicebox Podcast, it looks like you do buy your graph. Like that's weird, man. You know, they mean like I, it throws me It gives me chills, you know. But anyway, I just think that people like you being out there, I find it very encouraging. I really think this concept of talking to people, like they can understand should just be commonplace.

Dan DeSalvo, M.D 23:18
Anyway, I agree. Yeah, no, I agree with that. I mean, I one of my favorite parts about my job is I get to interact with such an amazingly diverse group of people from so many different backgrounds, cultural backgrounds, races, ethnic backgrounds, education, socio economic status. And I think you're right, and I think everybody can get it, I think it might take a different approach, and really meeting people where they are. But if we take the time, the effort, the energy to do that, then then we can get there. I mean, everyone, you know, all these parents, they love their kids, they want their kids to be healthy and safe and to thrive. And if we take the time as a team to teach them how to do that, it's helpful, I think, something that you hit the nail on the head with is, is that it can all happen in the walls of a hospital. So finding community, and whether that's online or with with a podcast, or, you know, we have a lot of different community groups at our hospital to get families together, I think there can be shared learning there that can really help with others so that, again, we can transport this knowledge and we're not just keeping it with one family, but we can really share it, among others. I think it's also helpful for the for the providers, so the diabetes care team, and it can be there as well. Because again, we learned so many tips and tricks around diabetes management around how to use which adhesive to keep the CGM on or, or the pods or you know, how they you know, whether it's Pre-Bolus seeing or managing diabetes and exercise. And we all have a lot of learning there. And again, that knowledge can be transported to the masses

Scott Benner 24:51
being agile like that is so it's incredibly important. It's just like you said if forever allowed to travel again, I'm supposed to head out west to talk to a group of doctors About how I talk to people about diabetes. And that's, that's a cool thing, because they're those are a group of people who are going to leave their ego behind, get in a room, and, you know, stupid maze gonna walk in and say, Look, here's what I've learned about how people hear this. And that's, that's very, very exciting to me. Because, you know, listen, I have friends who are doctors, and one of them told me once he put an age on it, and he said, I'll never go to a doctor over that age. He's like, because they just stop learning. And, you know, now all the sudden you're being, you know, you're being treated 25 years ago, and that's, you know, not valuable for people. And I'm like, Wow, so everything we you know, but are plenty of doctors who are older that keep up to and that's just,

Dan DeSalvo, M.D 25:48
I don't know, man. Absolutely. Yes. In fact that a lot of my mentors so people like Bruce Buckingham at Stanford, who I trained under, people like Laurie lafell, at Joslin build terrible in at Yale, who have been doing this for a long time are not only incredible mentors, but they are, you know, at the cutting edge of diabetes. And there's so many who, you know, might be might have started this journey a little bit before me, but are way advanced in their knowledge and constantly have that agility to change and are really at the cutting edge of this. And so yes, I mean, that I wanted to specifically call out a few of those who've had such an impact for me and my training and mentoring me my career. But there are so many people like that who are out there,

Scott Benner 26:34
it can't get lost if we're talking about the problem where you know, but it can't be lost in the conversation. There are plenty of people who stay behind didn't mean they learn this thing, and then they don't run forward and keep it for themselves. They stay behind to share it with somebody else. And that's how the idea. Yeah, you know,

Dan DeSalvo, M.D 26:51
yeah, and I think that that gets back to being one's advocate, as a patient as a parent, where if you have an interaction with the diabetes provider, where you don't feel like you're learning where you don't like they're supporting the, what you're doing and managing diabetes, when you know, it's working. There are others out there too. And I don't think it's always an age thing. I think it's partly just an openness, and being really adept at taking cutting edge approach to diabetes care, a dynamic approach with Pre-Bolus. Seeing and, you know, dosing based on trend arrows and leveraging technologies like CGM and closed loop systems, you know, that that's what you want to learn from, that's you want to be in your corner, so to speak. And so if you don't feel like you're getting that, then you know, there are others out there, hopefully, depending on where you live, who can can who can be of more support to you.

Scott Benner 27:47
I just want to be a cheerleader for organizations who are out in front and thinking in a modern way. And for the rest of them who through fear or whatever. The reason is that they keep good information from people, you know, Shame on them. You know, I just I don't have any time for it. Okay, yeah, we had you on for a reason. It wasn't this, although I'm really enjoying this. I wanted to talk to you a little bit. If you have type one diabetes, you need a blood glucose meter. Even if you're using the Dexcom, g six, or another CGM, you still need a reliable and accurate meter. It's easy to transport and use. And that meter for me, is the Contour Next One blood glucose meter. Now there are links right here today in your show notes, right in the podcast player, where you can go to Juicebox podcast.com, to find them. But what I'd like you to do is to go to Contour Next one.com and check out the meter. I mean, I know it's a blood glucose mate, and you're thinking what could it possibly do? Scott, you put a test trip in it, you poke your finger. I mean, they all do that. Yeah, they all do it, but some of them do it better. So right out of the gate, the Contour Next One, accuracy is insane. Top of the level, right at the top, right there, right at the pinnacle of the mountain. If you picture a mountain and up the side of the mountain, there's different blood glucose meters, in order of how great they are. Contour. Next One, right at the peak. I think you understand it's good because of my amazing description. Now, test trips offer a second chance, which means if you hit the blood and don't get it right, you can go back in, try again without ruining a test trip. It's got a great light that works at night. It's small and easy to hold on to without being so small or slippery. You don't mean that you can't handle it. I just love it. Absolutely 100% the best meter I've ever used. Contour Next one.com Check out the link at the top of the page. You might be eligible for a free meter. When you're done there, please check out touched by type one org wonderful people doing amazing work for people living with Type One Diabetes, they need to now more than ever touched by type one.org. And of course, if you'd like to check out the Dexcom g six dexcom.com forward slash juice box, and to get a free no obligation demo of the Omni pod tubeless insulin pump, go to my omnipod.com forward slash juicebox. All these links are in the show notes of your podcast player. We're at Juicebox podcast.com.

You know, I was talking to Dexcom. And they were discussing with me a little bit about how the sensors are being used during the current coronavirus crisis. And I found that idea in chanting and I wanted to know a little more about it, and they said you were the one I should talk to. So can you tell me how cgms are helping during this time?

Dan DeSalvo, M.D 30:56
Absolutely. So you know, I think the main reason why CGM why the FDA is allowing CGM to be used during this unprecedented time with the public health crisis of COVID-19 is that it came out of the need to really preserve personal protective equipment or PP, and also to reduce the frequency of staff exposure with COVID-19 positive patients. So you can imagine without CGM, if someone with diabetes who also is connecting positives, you have to have pretty frequent blood glucose checks. And every time there's a bug, because check, the staff is having to dawn TP to wear peepee to walk into the room to check a glucose, that's another that staff exposure to the person with with COVID-19. And, and furthermore, you know, of course, with with blood glucose, it's just snapshots in time of what the blood sugar is doing as well. As opposed to CGM, which really is the full, comprehensive picture also with the trends and the alerts. And so in step CGM, with this ability to have this cloud based technology, where if the person with diabetes, who asked COVID-19 is using CGM, with the Dexcom g six system, the transmitter can transmit up to 20 feet. But also, if it's on a cell phone, which Dexcom is supplying Android phones, for the user to have the patient who's hospitalized via x com share a follow feature. Those CGM data can be tracked remotely by the healthcare team so that the nurse who's no longer at the bedside, can receive an alert for low or high glucose on her phone or her hospital issued device to that that the doctors, the medical assistants, whomever are part of that care team can receive those timely alerts. And also, depending on hospital protocols, you could use CGM, in some cases to supplement or even in place of a normally scheduled blood sugar depending on where that that level is. So again, you're reducing the need for PPV, reducing the staff exposure to patients. But you also have this this real time CGM, which can aid in glucose management medical decision making. So that's where it came was really out of the need to limit PE and staff exposure with patients. But I think that there will be a lot of lessons learned on how CGM as a tool can really help with keeping one safe and healthy during hospitalization. For someone with diabetes,

Scott Benner 33:34
that's a second thing. I thought when you were saying this, the first thing is I wondered what the process was like. And, you know, I guess the the FDA had to say yes to this in a quick fashion. I guess that that is interesting. But I'll I'll bug Kevin about that when I get him on. But the idea that all of a sudden, nurses and doctors are going to get to see this technology that they maybe don't know about. And I know it's easy to think of course they do. They're doctors, they live in hospitals, you know, this is this is their life. But Arden had a cyst removed, you know, just a little cyst. This is a short surgery she had to have a number of months ago, and you know, had all the conversations in the world with the surgeon. This is what Arden wears. we'd like it to stay on her while she's in there doctor was like, Oh, yeah, sure, sure. I got yesterday. That's no problem. I get to the hospital on the day of the nurse comes in the room to prepper the prep nurses like oh, yeah, that's no problem. If the doctor said it was okay, it's fine. Well, then the nurse, the next nurse comes in the one who's going to be in the procedure. And I start you know, now at this point, I've set it to the doctor, I've set it to the prep nurse, everyone's Yes, me to death for a month about this. So I'm now I'm just talking to the third nurse and I say, Hey, you know, this is great that you guys are doing the shoes. Oh, that's not hospital protocol. We can't do that. Just like that. I was like, Wait, what? No, no, I've been talking to the doctor and I started explaining it to her, showing it to her and she's like, Yeah, it's great, but we can't use that. a nother nurse walks in the room. And I just I wish you could have seen me down I pivoted right from the one nurse to the other Other ones, like the first one wasn't there anymore. I was like, Hi. And I started explaining again thinking like, let me take another stab at making this clear to somebody. Well, that nurse says, Oh, my friend has type one diabetes. That's cool. Let me see. Oh, she has this too. Oh, yeah, yeah, we'll use this. I'll keep her phone with me. Just like that. The tiniest bit of understanding, when I made that conversation go from, oh, no, there's a hospital policy. We can't do that to no problem. Give me your daughter's phone, I'll take him to the operating room with me. And that's the understanding that this kind of technology needs throughout the medical community, because a podcast shouldn't be one of the main ways that people find out about Dexcom. Like, why that hell does that have to be the case? Do you know what I mean? Like, and by the way, don't don't get me wrong, Dan, I need my ads. Okay. But, but I, but what I'm saying here is, what I'm saying is, is that this should be something people just think of not something that they're scared of, or say I don't know about this. So this is a great, it's a great opportunity for them to see it live fire, and really help spread the word to other people with type one. Because until it's thought of like that, you're still going to run into situations where insurance companies say stupid things like you're a one sees too low for CGM, as if those two things in any way have anything to do with each other. You're going to get me upset, Dan, I want people to have Dexcom. So so that that is that is very cool. So what you're saying to me is now we're keeping we're saving equipment or saving exposure, and probably giving people I would think greater care than they were going to receive. The other way. I've seen friends in the hospital with type one it it doesn't normally go very smoothly. Well, have you ever been in the hospital and been hospitalized with your diabetes and have the experience of having to manage like that?

Dan DeSalvo, M.D 36:48
No, but you know, there was Adam brown from diatribe wrote a really, really interesting piece on this his experience in the hospital, somewhat diabetes, I've seen and you know, you're right, it's it can it can be there can be some challenges there. You know, that's one of the things that Dexcom is doing here is since Dexcom has or CGM has not been approved by the FDA for in hospital use previously only for in home use. There may be less knowledge or experience with it. So they're really doing a nice job of of providing training to those healthcare teams who will be deploying it. The other thing that hospitals are doing is looking to who are the experts, for example, diabetes educators, or maybe the the diabetologists, or their teams to help train the trainer so to speak, to help to teach and empower the the hospital staff to use these systems and also how to sort of set up and operationalize what that remote monitoring would be like. And then also, it requires a little bit of a new protocol. Right. So since in many cases, this will be the first time that CGM is being used by those care teams. What do you use for your low and high alerts? And what do you use for low and high alerts in a hospital setting may look a little bit different than it would be at home. For example, a hospital might decide that they would use a low alert of maybe 90 or 100, so that they can intervene in a little bit more timely manner, or a high alert of something more like 200 or 250. There have been some studies that have looked at sort of health outcomes as it relates to blood sugars. And actually in a hospital or especially an ICU setting, having a blood sugar that's more in the 100 to 100 to 100 range is associated with improved clinical outcomes, as opposed to running really tight like you might, when you're otherwise health and safety, health and safety in your own home. And so developing the systems and protocols is something that a soldier having to do. We've been talking for a while just as a industry about how we really need disruption in health care, right, so that we can do things a little bit more and a little bit more efficient. And I think technology forward way. And while COVID-19 has been such just a terrible tragedy for our country, the countless laws lives, lives loss, the impact it's had on our economy, how it's impacted almost every one of us personally in some way or someone we love has been so horrible. You know, one of the one of the silver linings, I think that may emerge is that we will see things like the plane these technologies and a a smarter, safer, more efficient way and move to telehealth where we can you know, instead of having families being disrupted from their their normal, you know, job or education having to do with traffic be able to do things by telephone, and diabetes, where we have cloud based CGM technology, where families can in some cases, download their pumps from home or at least provide a log of what their doses have been, actually lends itself nicely. So my hope is is that many of these lessons learned from this really horrible crisis can be used going forward too. deliver healthcare deliver medicine in a much smarter and better way for patients.

Scott Benner 40:06
It is normally in emergency times that medicine leaps forward, it's, you know, it's hard to think about, but wartime brings all kinds of revolution to medicine, because you put doctors in a situation that isn't perfect. You give them, you know, you give them less tools than they might normally have in a hospital. And all of a sudden, they've got to be MacGyver, and they figure something out. And some of that stuff ends up, you know, becoming commonplace in in practice. And I'm just, I'm excited about this, I'm, I'm imagining a nurse, getting an alarm on a CGM at 100, like you're saying, and intervening, and then watching the blood sugar bounce back up, and having that thought, like, wow, maybe I didn't need as much glucose drip as I thought I did here. And maybe next time, that'll stop them from driving some poor patients blood sugar to 250. Because, you know, because of fear, maybe you'll it'll teach the the fine tuning ideas around diabetes to them, you know, and, and then who knows where that goes from there? Like, where do they take that information? And where does it spread to next? This is the stuff to me, that's macro very, very exciting for people with diabetes. If you have no idea what's going to happen to that, that nurse in that, you know, made up situation, goes home becomes a, you know, the parent of a kid, but Type One Diabetes five years from now. And then that kid becomes a doctor like you 20 years from now, and blah, blah, blah, and where do we end up because of this? You know, I, I just I can tell you that where I am now, in my understanding of Type One Diabetes was held back by the direction I was getting from my daughter's doctor, I was seeing things. And I was having thoughts and desires about changing practice. But everything I heard on the doctor's office side, was telling me I was wrong. And I had to break out of that feeling that Oh, no, I am doing it. Right. This is just what diabetes is. I don't know man, like I'm very excited for people to not live the way some people do now in the way my daughter did for a number of years when she was first diagnosed, I just don't think there's a need for it. And I think that anything that moves us towards that is exciting. And this is particularly interesting and how it came about. Do you happen to have any numbers on how many people are actually wearing it? Who were infected with? COVID-19? Do you know?

Dan DeSalvo, M.D 42:30
I do not know how many it is. And I can tell you I've been hearing from a lot.

Dan just disappeared.

Hello, this is Dan. I'm back. Yeah, what happened? I'm wondering as zoom kicked us out, I don't know.

Scott Benner 42:44
I sang while I was waiting for you to come back, which I'll take out. Because I can't say

Dan DeSalvo, M.D 42:48
you were slacking picked up with your last question, which was in regards to how many people are using it right now? And I don't know the answer to that I can tell you from speaking with my colleagues, from all across the country, we're all eager to use this in our hospitals just because of the reasons we mentioned, in terms of being able to preserve PP to reduce staff exposure, but also to have that helpful tool for aiding diabetes management. You know, to your earlier point, one of the things that is helpful with CGM, in addition to having the comprehensive glucose stream to having the the alerts, it's having the arrows also, and in many cases, this will be the first time that some of the hospital staff will see that. So you know, I always describe glucose as being like a vector or an arrow has both a current level, but also direction. Yeah, glucose that's 150. And headed down is different from a glucose that's 150 and double arrow up change by more than three milligrams per deciliter per minute. And so to be able to kind of, you know, and in the case of daily management, you know, and leveraging those trend arrows for daily diabetes decisions is so important. And I think that that can play an important role in a hospital setting as well with managing insulin doses, or insulin drips, or IV fluids and dextrose, concentrations, and so on. So it's another one of the things I think will be born from this. This use of real time CGM during the covid 19 pandemic.

Scott Benner 44:17
That's a great point I talked about stopping the arrows I consider not just the, you know, the direction and the speed, I call it the momentum, like you have to stop the momentum of the blood sugar. And you know, you know, talking to people about I don't know about a Pre-Bolus idea. I'm like, you know, you you count your carbs, your blood sugar's 90, you put your insulin in, but you don't Pre-Bolus now all the sudden the food starts impacting your blood sugar before the insulin has a chance to before you know it, your blood sugar is 180. It's 190. It's 200. It has momentum, you only have enough insulin in there to cover the carbs if you're if you're lucky. And you know, the glycemic load of this food actually matches up with your carb ratio that's set up Right. And so now, you're staring and watching this, this number go up and up and up, you don't realize you need the insulin for the carbs you need to be, you need the insulin to stop the momentum, and you need the insulin to bring the number back, you know, you're sitting on one third of the insulin now that you need, you know, one third of the picture. And, you know, most people stare at it and stare at it, they think, Oh, I counted the carbs, right, like they're back at that point. That's not, that's not even a tiny bit of the picture. It's, I couldn't do what I do for my daughter, and what she does for herself, and what the people listening to the podcast end up doing for themselves. Without the data that comes back from the Dexcom. Like, it's just it's no bowl, you know, like I, I, there's a lot of people I could have, as advertisers on the show, there's a reason I chose the ones that are here. I was wondering about your management, do you have like, like, what are your goals day to day for yourself?

Dan DeSalvo, M.D 45:55
Yeah, you know, I think for for me, it's, you know, I live a pretty busy active life, professionally, but also as a father of two young kids. And so, certainly, for me, being able to watch my glucose and trend arrows closely is important. And, you know, I aim for pretty tight control. And so I have pretty tight thresholds on my low and high, you know, that works for me, it may not work for some of my patients, depending on where they are, and their diabetes journey. And so, you know, I pay, I pay pretty, really close attention to the trend arrows and a lot of what you're talking about in terms of, you know, stopping the glucose in its tracks, looking at the momentum of whether it ties or lows with insulin or carbohydrate, respectively. And really trying to sort of guide the glucose and, and sort of hone in on on that, that maintaining the time and range, and you guys seem strange that the range of, you know, for me, I'm aiming for 70 to 140, typically. And I also, you know, I do a bit of, you know, nutritional approach diabetes, for me as an adult works, you know, it's not, it's not necessarily advocate for my patients, but I tend not to eat breakfast on weekdays. And so I need to sort of ride my basal rate, usually, and within range glucose in the morning. And then for lunch, I usually fairly low ish carb lunch and get most of my carbs at dinner. And so I don't have to worry about blusher quite as much during the day. And then in the evening time is where I tend to have my largest meal. It's also when I exercise and so that can present some challenges with management. And so just like, the patients I care for, I'm always learning in my own diabetes on how to how to best manage it.

Scott Benner 47:39
Have you ever taken information from a patient and applied it to your own life?

Dan DeSalvo, M.D 47:44
Oh, yeah, I mean, absolutely. I mean, they're their little tips and tricks that I pick up from them that I might use my own. You know, I'll give you an example. Sort of a concrete example is with the adhesive that I use for my Dexcom you know, I run cycle and swim, I lead a pretty active life. And I have two kids who like to wrestle with me. So, you know, for a while I was having some challenges and keeping an eye out for 10 days. And, you know, some patch, this was a while ago, but some patches adhesive that's available on Amazon and other places. And it's also hypo hypoallergenic. And so that was something I was able to use to really buttress down the CGM, the sensor transmitter to prevent it from coming off. And, you know, I've really not had any trouble keeping it on for 10 days. And I usually wait until it starts to maybe on the edges start to come up just a little bit, and then apply the adhesive. Okay. And with that, it's really works well. And so that's something also for my patients who, you know, they may be athletes, or, you know, Texas, it gets really hot in the summer, people do a lot of swimming, using these sort of things can be really helpful. So that's just one of many examples I can I, you know, I can share, you know, that I've learned from from patients,

Scott Benner 49:01
I just thought you have a even interesting, you know, opportunity for yourself. Do you think that having Type One Diabetes is a benefit for you in what you do? Or does it give you an advantage? I mean, if I'm looking for an endo what I I want them to have diabetes.

Dan DeSalvo, M.D 49:22
You know, I think I think anyone can do this. And I think I think it really takes having a passion, but also having the kindness and just the the willingness to go the extra mile in terms of having the knowledge and skill set and diabetes management. I don't think you have to have diabetes to do that. I do think that living with diabetes does give you a way to really connect in a really powerful and impactful way with patients and families. And so I i do some time and I do oftentimes share that I have diabetes and and i don't really talk about how I manage my own diabetes as much But I do try to convey a message that, again, you can live well and die with your diabetes, you can become absolutely anything. You can become a professional athlete, a movie star, you can become a US Supreme Court Justice, a lawyer, a doctor, really whatever it is that you're passionate about, you know, I used to say there's only two things you can't do. One is become a commercial airline pilot. And the other is join the military. Well, the FAA has now a law now allows with a doctor's letter, the potential for someone to become a commercial airline pilot with diabetes. That was a huge win.

Yeah. And yet with Yeah, go ahead.

Scott Benner 50:39
I'm sorry to mean to cut you off. I had Owen Lieberman on the other week, and he was talking about this. And now I'm starting to see people holding their letters from the FAA. All of a sudden, in the last couple of days on social media. So it's happening, people are getting their their pilot's license back, and sometimes for the first time who have type one,

Unknown Speaker 50:57
it's super amazing.

Scott Benner 51:00
And, I mean, honestly, that's in no small part to Dexcom as well. I mean, that that's a that's a an ability for someone who doesn't understand diabetes, to be given a visual way to understand it, and then be able to make that leap like, Oh, you know, we just, you know, the government just thought people randomly get low. And that's what we were talking about earlier, doctors 20 years ago, we're telling you keep everyone see higher, you know, keep your blood sugar higher. You don't want to randomly get low. And now there's, there's real concrete ways to stop that. Listen, last night. Last night at 1130 Arden's blood sugar started to trend down. And I couldn't figure out why. So we're talking and I was like, hey, it's holding, but it's like it's at 70. And I'm like, if you look at the line, I don't think it's going to, I don't think it's going to hold up for us. So we started taking bazel away to see if we could get it to rise and it wouldn't rise. So we're talking, I'm trying to find out what's going on, she see she pulls out her period tracker, and there are days prior to her period where her blood sugar, just that she just doesn't require that much insulin. And so this is where we're at, right? So from 1130, last night, no light or three in the morning, I kept Arden's blood sugar up using the dexcom. And without it, I can't tell you how low I think she would have gotten because I was able to, with confidence, take away the basal insulin in a way that held her up in the 60s, which is, by the way, the best we could do for a couple of hours, even with food intervention and everything else. I'm just trying to imagine if we were blind there, I would just see a low number I would treat her and then that, you know, I think oh, it's gonna come back up again. But for for four hours last night Arden's blood sugar just didn't want to come up. And I had the comfort of knowing that that was true and being able to manage her through it. And, you know, eventually, obviously, it started to move again. And then we were able to re add the insulin and bolus with confidence. After four and a half hours of not eating any insulin, I was able to look at a trend and say, whatever that was, is over now. And you need your insulin again. And so because we were able to bolster confidence, she didn't get high, you know, all the sudden when her body had different needs. And she had a, you know, a reasonable period of time where she didn't have very much basal insulin. It's just It's magical man. Like, it just is, you know, so?

Dan DeSalvo, M.D 53:25
I don't know I love Yeah, I think it's essential. I mean, yeah, for people who have busy professional lives, no matter what it is having that real time data on your phone or on your wrist. And I only know where you are, but where you're headed, so that you can actually, you know, as Wayne Gretzky said, it's not enough to know where the puck is, you got to know where it's headed. And really think 123 steps ahead. I think that that is absolutely essential for being able to do all the things we do to have that that information that helpful data, you know,

Scott Benner 53:55
the genesis of that story was Wayne Gretzky.

Dan DeSalvo, M.D 53:59
His father was something he was his dad, right? I don't remember the exact details.

Scott Benner 54:03
His dad was teach him to play. And he always seemed like he was behind the game. And he told his son, you got to skate where you got to skate where the puck is going, not where it is.

Dan DeSalvo, M.D 54:12
And it's just an analogy.

Yep. So So, you know, perfect for diabetes management, right?

Scott Benner 54:21
I tell people all the time, the insulin you're using right now is for later, it's never it's never for now, nothing you're doing with your diabetes. In this moment is for right now. It's always for later and more importantly, and it's a weird distinction that might seem like it's not a distinction, but it is if you really think about it, it's not so much the insulin you're using now is for later it's the insulin you used in the past is for now, and I know that seems like the same thing. But if you really kind of like really go into a Wavy Gravy plays and think about it for a minute then it's um, it's different. It's, it's more about it's about controlling the energy of the inside the power of insulin that's coming at you. It's about it's about being in It's, I know, I don't know, maybe you'll have to wrap your head around it. And other people will too when they're listening, but it's not so much about now for later, it's about before for now. And if you can wrap your head around them, this is kind of easy, you know? Anyway, Oh, dude, I'm really thrilled you did this, I didn't expect to have such a great conversation with you. I thought we were going to just be like, Hey, COVID-19 Dexcom That's cool. And then you'd be gone. But uh, but this turned into an excellent episode. And I'm really excited that we did this. I might have to ask you to come back on again sometime, and maybe talk more about your personal story, if that's something you might be interested in?

Dan DeSalvo, M.D 55:37
Absolutely, I'd be more than happy to. And Scott, thanks again for the work that you're doing to advance the cause that people living on thriving with diabetes for the community built and for getting this message out there. You know, again, it's it's so I think important for using real time CGM in this area of COVID-19. And I think that there will be many lessons learned from this, both in the hospital setting as well as with telehealth that will be propelled forward as we one day reenter normal life. It's hard to imagine that right now but we'll all be there and so my thoughts and prayers for everybody out there and hope you and your family stay safe well, and I'm adding sane to that list because it can be mind numbing sometimes to be stuck at home, but you know, my my best wishes for for all your listeners as well.

Scott Benner 56:23
I really appreciate that. Then, you know, we last weekend ended up I staked my entire family and we played poker. I played poker to get my own money, just to just to try to pass the time. I said to my kids, I'm like, Here's 25 for you. 25 I gave my wife $25 I took $25 like Alright, this pots worth 100 bucks. We played for seven and a half hours.

Unknown Speaker 56:45
No one wanted to give the money away.

Dan DeSalvo, M.D 56:48
Yes, we need distractions these days. Absolutely. I saw

Scott Benner 56:52
a woman online say that she spent four hours yesterday watching a truck get towed out of some mud. She said it's the most exciting thing that's happened to her. So Alright, man, wash your hands stay safe as well. I really appreciate this. Huge thanks to Dr. Sabo for coming on the podcast and sharing his story and telling us more about how the Dexcom g six is being used in hospitals to aid with the Coronavirus fight. Huge thanks also to the Contour Next One blood glucose meter for sponsoring this episode. Don't forget also, sponsors like touched by type one.org Dexcom and Omni pod. They make the podcast possible. So check them out, use the links support the show. I'm still here. I'm so bored. I don't know what to do. I mean, once I finish this, I'm just gonna go downstairs and like clean something or make something or put something away. All my options. Here's my here's my day. I sleep and then I wake up and take a shower and work on the podcast. cook something clean something. cook something clean something. Take out the recycling. cook something clean something. Watch Ozark and go to bed. That's it. It's the whole thing. It's my life. It's your life. It's our lives, but not for much longer. Hang in there people. Stay strong. Wash your hands. Cover your cough. You know what I'm saying? Don't be disgusting. Say

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#326 Medtronic 670G Insulin Pump

Jenny Smith RD, LD, CDE & T1D talks about her time using the Medtronic 670G

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

+ 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 everyone and welcome to Episode 326 of the Juicebox Podcast. Today's show is sponsored by the Omni pod tubeless insulin pump, and the Dexcom g six continuous glucose monitor, you can check out dexcom@dexcom.com forward slash juice box and find out everything you want to know about the Omni pod, including how to get a free no obligation demo of the pump sent directly to your home at my Omni pod.com forward slash juice box.

You know the podcast is about a lot of different things surrounding type one diabetes. And very often we talk about management. When we do we kind of speak about it on a macro and a micro level right? You know, the idea of using a Temp Basal increase or decrease for instance, that works with every insulin pump. But when you hear me speak specifically about a pump, most of the time, you'll hear me talk about Omni pod, because that's what my daughter has been using for 14 years. Same with CGM, my daughter's had an Dexcom. Since I don't even remember what the first one was called, but a really long time. So when I talk about CGM, you might hear me talk about it macro how to use the data to make good decisions or micro how Dexcom works. But we've never been able to talk about the Medtronic 670 g in a micro way, because I've never used it. So what I did was, I brought Jenny Smith on, because Jenny's worn the 670 G and she trains people on how to use it. So this is Jenny's experience. 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 are becoming bold with insulin. Of course, you know Jenny Smith from the diabetes pro tip episodes here on the Juicebox Podcast or defining diabetes episodes. We do ask Scott and Jenny together as a matter of fact, this Thursday, there'll be a live ask Scott and Jenny on my Facebook page, that's going to be Thursday the 23rd. He says because he's not 100% sure what today's date is, I'll look for you hold on Thursday, the 23rd at 3pm. Eastern Time on the bold with insulin Facebook page, Jenny and I will be doing a live hour of ask Scott and Jenny. Jenny is a certified diabetes educator. She's had Type One Diabetes for well over 30 years, she works at integrated diabetes. And Jenny is adept at walking people through using different pumps and cgms. And enough of you have asked about 670 G. And I thought well, let me get Jenny on. And we'll find out what her experience was, while she was wearing it. I would like to talk about and do an overview of how it works and how to use it. And what's good about it. What's bad about it about the Medtronic 670 g Ah, so this is not meant to, but start off like this. I think we all know that Jenny doesn't love the 670 G. Like she doesn't hate it. But when you talk about it, there's not loving your voice is what I'm saying. And and but there are plenty of people using it. And they should know how to use it as best as possible. And that's sort of what my goal is for this. I started off by familiarizing myself with the system a little bit online. And I was surprised to see immediately it's going to sound like I'm I'm not a fan. But I don't mean this in any judgmental way other than, you know, ardent users. And on the pod, I open up a little plastic thing. There's a pod inside of it. And that's the entirety of what we use, right. So I'm looking at this and there's a pump itself. There's a reservoir, glucose monitor and infusion set inserting device, there's an infusion set, and I was like, wow, that seems like a lot of stuff. But I get it like you know, it's it's a different situation, a different setup and everything. So anyway, so those are the pieces. There's the pump, the reservoir, the CGM, which is a proprietary Medtronic CGM. Correct?

Jennifer Smith, CDE 4:24
Yep. Got Now today's it's called the guardian. It used to be if you're still using it, you could potentially maybe still have the enlight and the old old one, I think it was called the soft sensor. Okay. So they've had quite a number of up updates. Um, yes. So current is guardian. That is,

Scott Benner 4:46
that is the exact lack of love I was talking about. So then there's the infusion set for people who aren't pumping or using an omni pod is a it's an adhesive thing with a plastic thing on top that Yep, you know, it's like a port. I guess the goes to a piece of tubing, the tubing goes to the insulin pump and you can disconnect that. That set right like to take it you have

Jennifer Smith, CDE 5:07
to take a shower to get in the pool to do all of those things. There's also a little piece that whether most people use it or not, there is a little extra piece that you pop into the infusion site, once you disconnect from the tubing that's supposed to and you you pop it, it's almost like a cap. Yeah, it's you're supposed to technically put it in, in order to prevent extra things from you know, getting in there.

Scott Benner 5:33
So when I disconnect that cap, I'm supposed to cap this like,

Jennifer Smith, CDE 5:36
okay, yes, you're supposed to cap it. Yes.

Scott Benner 5:39
So those are the pieces. And then there's the I'm sorry, the insertion. So it's sort of it to me, it looks like it's maybe palm size, sort of like a cup, I guess you set it on your skin and press on it or squeeze a button or something. Yeah,

Jennifer Smith, CDE 5:51
that would be for one of their one of their infusion sets. In all the pump. companies that have tube pumps have different types of sets dependent on you know, your body type. And what works well for you the one that you're talking about, it usually works with their, it's called the Quick Set, you kind of it comes with this little like, almost looks like a little pod, sort of like a like an alien UFO, almost as what I call, okay, and you open it up and you pull, there's like a little like a lever inside that you sort of pull back and you caulk it essentially. And then when you squeeze the buttons on the side, it pops the infusion set or the in the Yeah, the infusion set underneath your skin. There are other ones like the silhouette, which is more, it's an angle that's not 90 degrees, like the Quick Set. The Neo is another one, that's a 90 degree that they have. And the silhouette is an angled one that does come with an inserter I would say a good a good 75% of people, though, who are using the silhouette are self inserting, they're just pushing that infusion set underneath their skin. They're not actually using the insertion device. I myself when I when I was using Medtronic, I had tried using the silhouette and I wasn't using the inserter I was just doing it myself.

Scott Benner 7:14
So you just Fried my brain a little bit as a person who's never used the tube pump. So you're telling me at some point, there was an infusion set, and it still exists now that I press into my body, like metal with the covering canula on it. Yeah. And that's how it's meant to be used.

Jennifer Smith, CDE 7:33
It is so in two ways that that set in and of itself is it comes with an inserter the inserter. In fact, I think as a visual for people who can't see us talking, the insertion device looks much like the old g five inserter for the sensor. That's what it looks like. It's like it's almost like a thick pen. The infusion set goes into the end of it right. And then the button on the end, you press and it pushes the infusion set under your skin. The big thing with it is that you really it's meant to go in at a certain angle under the skin. And you know, with that device, it's like a very fine rocking of your own hand to keep it at a 45 degree angle. Okay, so you could technically insert it too shallow. Or you could insert it too deep. Not the way that the infusion set is technically supposed to be inserted. I myself found that the inserter did not work well for me. Okay, so I, even my husband, he was like, What are you doing? Now? I'm like, I'm putting my infusion set in. He's like, that's a really big needle. Thank you very much. I'm quite aware of that. So yes, it's a selfie. And it does. I mean, for people who are using it, they get used to it. I can say it's not my favorite thing to do. And of all the set. My favorite set of all, even compared to Omni pod, which you don't get a choice in a sec, right is just what it is. It's built in. I've never had any problems with Omni pod set, thankfully. But my favorite for any tube pump is the one that's called it's a steel canula so it's almost like a thumbtack that sits under the

Scott Benner 9:25
skin. Okay. And you Why do you like it? I like

Jennifer Smith, CDE 9:28
it because it goes in at a 90 degree angle. I had so many problems with kinked bent, problematic tubes that were the typical like Teflon type of canula under the skin. I never I've never in my almost 15 years of using Omni pod now, I have had maybe two kinked sites, maybe two with the two pumps, however, I have had my supply of way more than I've ever wanted. So the nice thing about the steel canula for Medtronic, it's called the shorty for if you're a tandem user, it would be called the true steel. So they both make a completely steel canula pops under the skin like a thumbtack popping into a cork board. There is no hassle to using it, it stays in place. No kinking at all. There's a lot less site irritation for many people with it. There are a lot less site infections with using it. Um, so yeah,

Scott Benner 10:40
I can say that. I know Arden has had one. One Candela problem in the entire time she's used on the pot and I was doing the math on it the other day. She started when she was four, she's gonna be 16 so Wow, it's been wearing

Jennifer Smith, CDE 10:54
almost as long as me

Scott Benner 10:56
Yeah. Arden's been wearing an army pod for 12 years every day. You know? And so we and we've had one and when I look back on it, it happened like it was a pump we put on like at a pool side. And I remember it all being a little like, like I want to get back in the pool. Like you know, like it wasn't

Jennifer Smith, CDE 11:14
like Quick, quick, quick, quick.

Scott Benner 11:16
wasn't, it wasn't it wasn't being done maybe exactly right. But you know, it was obvious the CGM made it obvious that it wasn't working. So right. Actually, it was funny. The CGM made it obvious it wasn't working after we got our away from the pool. It actually turned out that, you know, I think her exercise had kept her blood sugar down for the for the couple of hours away from the pool, then all of a sudden, you could tell, hey, this thing's not working. Right. So anyway, okay. Now, that seems like a lot to me. I'm not here. I'm not here to critique the, I really want everyone to understand it. It's tough, because there's the side of me that feels like um, I don't know, I A lot of what you just said, I think, Wow, a lot of that doesn't seem necessary, but okay,

Jennifer Smith, CDE 12:02
you know, well, and I can say to from, from just giving credit as well, of all the pumps on the system on the, you know, on the market today of which there are only three brands that are out there right now FDA approved, with Abi mipad is the easiest by far. So if you're going to rate them in ease of like, filling using even a canula and a reservoir, Omni pod is the easiest. Medtronic honestly is the second easiest, okay? As cumbersome as it looked to you having never really done it yourself or needing to, it's actually the second second easiest tandems is it's a weird system. I mean, and I say that from the standpoint, it just has a lot more steps in the filling of the reservoir, the filling of the tubing, and every it just takes longer. Yeah. So, um, there's some credit to Medtronic there.

Scott Benner 12:57
Hey, Medtronic, you're not as bad as the tandem when it comes to use. Congratulations. Put that on a box,

Jennifer Smith, CDE 13:03
reservoir and filling.

Scott Benner 13:06
Excuse me, specifically reservoir and filling use that. Wouldn't that be a tagline? Medtronic, we're not as bad as control IQ for filling the reservoir. This is getting out of hand already. I'm sorry, Medtronic. users don't leave. We're gonna get to the good stuff.

Unknown Speaker 13:20
Yeah, yeah.

Scott Benner 13:21
I do. I would, I would be remiss to say that, to not say that I could change it on the pod in about 45 seconds. Like it really doesn't take any time at all. I am. Jenny has a pump changing story that she won't let she won't tell on the podcast. But apparently, you can do it almost anywhere. She's like, I shouldn't tell people that I've done that. I'm like, Okay, well, sorry. You keep that private then. Anyway, Alright, so what the goal of this system and this was, and I I do say this all the time. This was the first like, closed loop system out the door, right? Like, this is the first one that got, you know, FDA approved. Yep. And, and on the market. So points for being first because, you know, just like in the military, or firefighting or anywhere else, stuff first guy through the door doesn't usually end up so good. So. So the point here is, is that, you know, this was early on, how long has this thing been available now?

Jennifer Smith, CDE 14:25
Oh, gosh, um, I even I'd have to check online exactly when

Scott Benner 14:30
it's gonna be a number of years now. Right?

Jennifer Smith, CDE 14:33
Correct. It has been a number of years, I would have to look exactly, but I feel like, gosh, it's got to be at least three. At least two, if not three years, because I'm trying to remember when I did my 670 training, and I feel like it was very soon after my three year old was born. Okay. So that would be about at least three years, I would say,

Scott Benner 15:03
Okay, let's call it. So first things. First. It's a it's a system that's making decisions about insulin on and off, right? does it increase? bazel? It does, it does. Okay. So

Jennifer Smith, CDE 15:15
from Yeah, from that like, kind of like hybrid closed loop system? Yes, it does that, as your glucose changes, it will temporarily increase or do these incremental adjustments up in insulin delivery, as your blood sugar changes and drops, it also does an incremental adjustment down. It also will temporarily suspend based on, you know, where glucose is going to get to it will do a suspend for you. It does not, it does not do, like an automatic Bolus, Bolus Bolus kind of thing. Um, it's it's bolusing. structure is truly around food.

Scott Benner 16:03
Okay. And that's still on you to tell it how much you're eating and all that stuff.

Jennifer Smith, CDE 16:10
It is in fact, that's the only, that's the only setting in the two modes of use of the 670. Pump, which you can use in manual mode, which is just like your normal conventional pump, use all the features all the settings everything you have set work as they normally would, you're the controller in auto mode, when you slip that on, then the only setting that is used for true calculation or exact calculation from a math standpoint, that the user can figure out his carbs, their carb, the insulin ratio stays true to what is set in the pump. So if you have set a one to 14 ratio, the pump is going to use that along with the glucose value to suggest a bolus for that food.

Scott Benner 17:04
Okay, can you adjust the bolus? Can you say, Oh, I would like this to be No you can't. Okay. So in a situation where, you know, you know, like, say the glycemic load of food is going to hit you heavier than the carb count. What do you do then?

Jennifer Smith, CDE 17:21
So that's the there are no longer temporary Basil's there is no longer in extended bolus. And on Medtronic pump, their extended bolus is referred to as either a square wave or a dual wave, right. None of those features are now available once you are in auto mode. So you're right. The hard thing is that for a meal, such as and we've talked about it so many times, but like pizza, right, right. I mean, a lot of people are not going to get the hefty management in the afternoon. And in the aftermath, for fat that they've been used to getting, when they're using maybe an extended bolus for fat or a temporary bazel to offset the later impact of fat, that feature isn't there. As an option with the auto mode, now, as glucose does start to change, you will get those microscopic adjustments in insulin dosing off to accommodate for the change that is happening. But it's not going to be like your very robust, temporary bazel of 60 plus percent above your normal in order to

Scott Benner 18:38
take care of experimental and smaller,

Jennifer Smith, CDE 18:40
correct and correction boluses it's another place to kind of bring in correction boluses are there they're very difficult to navigate within auto mode, okay? Because the system is it's more conservative, right? its target that it's aiming for is 120. And it doesn't really start to adjust or aggressively navigate blood sugars until you're higher,

Scott Benner 19:07
what is higher mean?

Jennifer Smith, CDE 19:09
Right, like the 161 80 range

Scott Benner 19:12
that it starts to crank on the bass or

Jennifer Smith, CDE 19:14
and then it starts to crank based on the trend and you know, it is referring to the trend and glucose that's happening, right. But overall, you're not getting an aggressive enough nature to assist so you know, many people are many people are learning when to potentially shift out of auto mode when to potentially shift back into manual mode or a you know, back into auto mode. So there are some tricks and or tips to using the system to your advantage

Scott Benner 19:51
right I think we'll be talking about that. So I just I I'm trying to understand just one more thing. So yeah, take some when I put a bunch of insulin in For something, right? I don't know how it's going to know. Is there a way to tell it? Hey, this is pizza, it's not really going to hit me for an hour. You can't You can't tell it timelines of food or absorption rates or anything like that. Okay, so this thing throws in, I say I'm gonna eat two slices of pizza. I tell it, it's 60 carbs. It throws all the insulin in, does it then work with the bolus? Meaning does it take the bazel away to let the bolus work? Or is this the basal still stay? in play?

Jennifer Smith, CDE 20:34
kind of depends on what the shift in glucose? Is situation? What's happening? Yeah,

Scott Benner 20:40
so we could so it could take away the bazel. If it thinks you're gonna get low, and then let the bolus try to work. But then that doesn't feel

Jennifer Smith, CDE 20:49
right. Yeah. And yeah, and it does it along with, as I said before, the only true setting that's sort of carried over from your normal setting mode is the insulin to carb ratio, and then it also utilizes the active insulin time that you have set as well. Okay, so that's a piece of, you know, how long should this insulin really be working? If you've got it set for two hours? Well, then the pump is going to think that two hours from now you're clear of any active bolus insulin. So it may allow you to take some correction within the automatic mode. But yeah, it doesn't use your current basal rates, it doesn't use your current sensitivity or correction factor. Again, it targets a blood sugar of 120.

Scott Benner 21:37
So you just said if the action time is short enough, then you know, say two hours than two hours later, you'd be eligible to make a correction bolus,

Jennifer Smith, CDE 21:46
then potentially depending and it'll only suggest correction boluses if your blood sugar is above 150.

Scott Benner 21:53
Okay, so I can't decide. I'm 130. I want this to stop, I'm gonna give myself some it's, I have to be over 150 40 even allow that. Yes, but I could go out of auto mode, and then do whatever I want, then it's just it's all

Jennifer Smith, CDE 22:10
good, then it's just an insulin pump like you're normally using. Yes.

Scott Benner 22:14
But I just thought the problem with that is that it's been making decisions about insulin based on what it thinks is going to happen. And then I come in and make different changes. How do I get back into auto mode without a problem? I don't know about you. But here we are five weeks into our social isolation. I don't think I've been out of my house more than a few times, except the wander around in my yard. And it's starting to get a little weird. It's starting to be difficult to care about things. I don't know how I mean that exactly. Let me let me think it through for a second. I didn't comb my hair yesterday. And I didn't care. And I went outside and my neighbor saw me and my hair was sticking in 16 different directions. I just thought, whatever. I'm worried though, that that attitude is gonna bleed into other parts of my life. And I'm worried that it might for you as well. For instance, were you just about to find out more about ways that make yourself healthier right before all this happened. And now you just feel like you're on pause, just waiting for the world to pick back up again. Well, I know that's true for some things, but it's not for everything. For example, right now, with very little effort, you could get on the pod to send you a no obligation free demo of the on the pod right to your house. It's amazing Miami pod.com forward slash juice box. You go there you fill out your information, and a box will arrive at your home with your Omni pod. Now you'll probably like you know, it'll be on the front step and you'll be shooting it with Lysol and stuff like that. But after you do that, inside, you're going to find an omni pod. And it's all for you to wear to try to test to shower when you can find out how the Omni pod looks on you while you don't comb your hair. For a while you're sitting in a chair, staring off into space. Once you understand how that's gonna work, you'll be ready to wear your Omni pod as you launch yourself back into the world with your new insulin pump, ready to make these kinds of adjustments that you hear us talking about all the time on the podcast. Temp Basal increases, decreases. Extended boluses not having to disconnect your pump for a shower, being able to set up bazel programs which sounds really difficult but isn't but just think of it this way. If you're on MDI and you get low overnight, but not during the day and you think I don't know if I take away my insulin, my basal insulin, so I don't get low overnight. I'll get high during the day but on the on the pod you don't have to worry about that. You could set up one bazel program for the daytime and One for the night time. on time, you need more insulin. And one time you need less. You can keep that pump on while you're showering, swimming, walking around in your backyard, trying to remember what it was like to go to the movies. And then, you know, once everything's back to normal, all the other things that your life is Miami pod.com, forward slash juicebox, get a demo pod sent to you today, you're not doing anything else anyway, please don't put your health on pause. Now, when you get done with that, here's the next step dexcom.com. forward slash juice box. Find out today, why I love the dexcom g six continuous glucose monitor. So very, very much. The information that comes back from the dexcom is not just to keep you safe, it's to keep you healthy, it's to keep you ahead of the curve, that is your blood sugar, you can stop the blood sugar curve a lot easier than you can flatten other curves. By just Pre-Bolus Singh a little bit more understanding where you need more or less insulin, or how some meals impact you differently than others. You can get all of that, and so much more@dexcom.com forward slash juice box. Examples are from my daughter's life with Type One Diabetes, your results may vary links available at Juicebox podcast.com. And right there in the player of your podcast that their show notes look around, you can just touch on it, boom, you'll be right there. At the link you want. It's magical. How do I get back into auto mode without a problem?

Jennifer Smith, CDE 26:35
Yeah, it's a and that is the that is the difference. Sometimes it is just a button push right, it's a turn the auto mode back on. So it seems as though it would be an easy like fix. But when you go back into auto mode, it's then looking at the sensor data for like an accuracy. And then it's evaluating. And it may require some additional information it may ask you to calibrate, it may ask you to add a glucose, which isn't really a calibration, all it's doing is requiring a glucose value to be added. Which kind of goes into a lot of the alarms and things that people get annoyed with within the system. Because it just needs to see that glucose value and reevaluate where things are at this point. So you may get going back into auto mode, some of those some of those alerts and alarms, before it starts doing things. And then they're also limit, you know, to how much in auto mode, the basal insulin will be allowed to increase. And it does, it's interesting, because it does vary sort of person to person. Um, it's about from what we can kind of tell it's about like, two to two and a half times your average izle rate, excuse me, is what it'll allow, as far as an increase in the bazel adjustment that it's giving. And again, remembering that any temporary bazel increase isn't really like a bolus to correct. So if you're seeing a trend that's going up, and you're waiting for the system to kind of kick in, that temporary adjustment is also going to take time to start affecting that blood sugar. So it's like, it doesn't really adjust quick enough. And it's only a portion of how much you would put in if you were making a bolus in that situation. Right. So not only is it a fraction of what you need, but it's going in is bazel. And probably taking up to an hour for to actually be an impact potentially impactful. Exactly. And you're

Scott Benner 29:00
130 is gonna make it 200 by the time it's there. And it's not going to be enough by the time it's there to begin with. Right. Okay.

Jennifer Smith, CDE 29:07
And then and then on the opposite end to you know, if you're looking at like lower blood sugars. And this is true, even in conventional pumps, if you're low, now you need to treat the low, right, you don't expect that a temporary bazel adjustment or even one that's being augmented by an automatic system like this. If you're low, you have to fix it, you can't expect that a temporary adjustment down is going to offset where you are now my blood sugar's 50, it's 50 a bazel off isn't going to turn a 50 into 100 and any kind of reasonable amount of time right now if I ever if I ever right.

Scott Benner 29:41
So when I correct that 50 do I tell it that I did that? Do I tell it carbs? Because I find that to be an interesting problem because they're such quick acting carbs. You know that, you know, within reason if you're if you're you know if you're if you're reasonably good at correcting You're gonna take in enough fast acting carbs to get your 50 back to 80 or 90 or 100. Hopefully, you don't want any insulin for that, because it's that little, that little bumps not going to send you to the moon. So you don't want all of a sudden, I've just taken in 10 carbs, because will it then when you get to 90 start bazeley at the carbs. You're I mean,

Jennifer Smith, CDE 30:23
it's basically not based on any of the carb information it's giving you in fact, if you entered carbs, if it didn't, if it didn't think that you needed a bolus based on where you are, it would offer a bolus, but it's only really, it's not intuitively looking at that carb stamp and saying now I need to change the dosing because there are carbs in the picture. It's only looking at the change in glucose. So if

Scott Benner 30:47
that if that fast acting carbs did cause a rise, then it would start affecting it but not based on the carbs, it would be based on the the sensor data

Jennifer Smith, CDE 30:56
based on the sensor data. And again, based on where does the glucose start to be adjusted by the auto mode system, it has to be a certain height in order for it, or a certain like trajectory towards a high number, that it would start to offset things.

Scott Benner 31:13
What is that number? Where does it start to? Correct? You know,

Jennifer Smith, CDE 31:17
I'm trying to remember whether it's, um, I haven't used the system like personally in a while. And I have to think and I'd have to look that up, actually, and see if I can find that because I can't remember the exact number that it starts to correct. Like, at or above. I do know that you know, if for corrections, as we were kind of just chatting about to some, some users might already be thinking, well, gosh, I just I just enter some extra carbs when I'm high even though I'm not going to eat them. And so it generates the Bolus for me.

Scott Benner 31:54
Okay, so they're

Jennifer Smith, CDE 31:55
doing and a lot of people are calling that like, like ghost carbs, carbs that you aren't eating, but you're just putting them in because, hey, I know if I enter 20 grams of carb, I can get that one unit Bolus that I really need because my blood sugar is higher than it want it to be. But the system isn't offering anything outside of this. So I'm going to enter it in the problem is that it can offset data analysis then. Right. So when a practitioner or a caregiver or somebody is looking at data using it can get very confusing with where to make adjustments. So you know, if you if you did use that strategy, the one thing that we would really recommend doing is making a note in whatever your logging system is. tide pools a nice place to make notes like that, because they pop up right on that daily trend, to be able to say, Hey, I see a 10 gram entry here with a bolus. Yeah, that was a ghost carbs. I've got some people just enter ghost carbs. As a take note, you know. But again, it's it's also kind of, in practice, it's kind of discouraged, even though people do do it very often, well,

Scott Benner 33:10
is it a problem in inside of the system? Because you've now told us that carbs exist that don't exist? So what happens an hour from now if you've right? If you do, yeah, or you vote, right. But you know, your your examples better if I do want to eat, it believes there's carbs in there, and now it's going to change the Bolus somehow, either more or less, or

Jennifer Smith, CDE 33:32
because it'll be insulin on board for a purpose. Right? Right. So it will have effect on you know, auto mode for hours after putting in that corrective ghost carb entry to generate it and it is accumulating, then, you know, if you do that at three o'clock in the morning, you're not going to eat until nine o'clock in the morning. That's not really going to have any major impact overall, other than just hopefully navigating you down safely. If you're trying to stop a rise an hour before

Scott Benner 33:59
dinner, then right? It's gonna get messy

Jennifer Smith, CDE 34:02
and everything gets messed up. Yes. Mm hmm. I mean, and this all kind of goes back to the beginning of what we always educate is get your settings right also, right, before you go into auto mode. Okay, make sure things are good. And it's really I think, in in the the hybrid closed system, that the 670 is, this is even more important. Mainly because before you switch on auto mode, and all the system is gathering like insulin dosing data in the days before you switch on auto mode. So it essentially we'll update its algorithm of insulin use at midnight every night based on your amount of insulin you've used over the years. about the past week, okay, so we've found that it's best. And I'm not quite I don't remember exactly what Medtronic says, I think that they're saying two or three days, we've found that it's most advantageous for people to be in manual mode of normal insulin dosing with well set settings for about a week, before turning auto mode on.

Scott Benner 35:25
You're not gonna buy this thing, slap it on and be like, fix me, right?

Jennifer Smith, CDE 35:28
No, no, it's not. And that's where it is very different comparative to tandems control IQ. Okay, control IQ, you put your settings in all of your settings, work in control IQ mode, you can slap it on out of the box, put in all your settings, turn control IQ, and you're off

Scott Benner 35:45
and running just starts working. Okay. Not so with 676 70 G's actually trying to learn is that it fair statement are now

Jennifer Smith, CDE 35:55
in a very, in a very beginning sort of rudimentary way.

Scott Benner 36:01
Yeah, so it's just collecting data, like you used 50 units on Tuesday, 45 on Wednesday, but all of a sudden to end it. Somehow that's helping it make decisions.

Jennifer Smith, CDE 36:11
Correct. Now, there are there are also some drawbacks to that. Right.

Scott Benner 36:16
I see them as you're talking, but go ahead.

Jennifer Smith, CDE 36:19
Yeah, and and you probably do, I mean, you're intuitive about all of this, because of the years of experience that you have in managing with Arden. But you can see where this leads to, especially from a female point. Right? If you are in that time, potentially, before your cycle start, where you have these high insulin needs. And everything needs to be ramped up. Then what happens when your cycle starts and all of your insulin needs plummet to sometimes for women 10% less than what their standard profile is running for a day or two of their of their first two days? And this thing's made a decision based on when you've been resistant for a whole week? Correct? Right? For people who've been using steroids because they're sick, or people who've had like, an unbelievable amount of stress for the past three days because their father passed away or whatever, well, that could be two things being in auto mode, more aggressive really

Scott Benner 37:19
is so the thing that that is pretty common. Within You know, how people talk about diabetes that I completely discount, I don't pay attention to it, and I don't believe in it. 100% or even maybe 10%. But the idea that, you know, three days makes a trend. I'm like, okay, it makes a trend, it doesn't mean it's gonna keep happening. For all the reasons you just said, like, okay, I finally figured out I need my base, it'll be point five an hour. And then I get that set up and something changes. There's too many variables to say that any one trend is an indicator of the month. Do you mean? Like it just that doesn't make any sense? Male or female? I don't like buying into that at all. What if I just, what if one week I decide, I don't know, man eat more vegetables than red meat? Or then you know what I mean? And then the next week, it's different? I don't know, right? Like, there's just too many, there's too many things, I work a little harder at work this week than I did last week, I get a little more sleep a little less sleep. If you're looking for that, if you're trying to find a repeatable pattern in that. I don't imagine that exists. And if it does, it's well beyond what an insulin pump or me can figure out, you know, so I'm just more well, even

Jennifer Smith, CDE 38:35
for the people who have done the testing. And let's say they'd have for the most part figured out like, I always need about this much more for this time period, or this much less or whatever. Well, for the again, of the woman who sort of figured out her monthly, like cycle changes and how much more she needs and what bazel profile to set on and whatever. Well, what if you start training for a marathon? Or you've decided to now you know, go swimming for an hour every morning? Yeah, that is going to create a difference in need into this next month. And so it probably will look like, well, gosh, everything's different again. Well, you brought a variable into the picture that wasn't there when you were doing the testing to begin with,

Scott Benner 39:17
right? You can't turn to your pump and say, Hey, pump, listen, just you and me this week, I got a report, do it work, a lot of pressure here, my bonuses riding on this, I'm probably gonna be a little jacked up just so you know, 20 more percent. You know, I think I'm gonna have some stress, high blood sugar, there's that doesn't exist. So you need to be able to be flexible. For those things. I don't know, it, just it. I've just never been a fan of the idea that, you know, three days is a rule. It's a rule for those three days. It's not, you know, and so and so, if that's the case, what people always end up doing is spending three days trying to figure out what's going there. Stare at high blood sugars or stare at low blood sugar trying to find out if it's gonna be Um, uh, you know, it's gonna become a thing that they can count on. I'm always just like, I think you should deal with diabetes in the moment. And then whatever happens is now gone. And I don't I mean, don't get me wrong if Arden's needed less insulin on Saturday, and it looks like that's how it's gonna be on Sunday. I remember that. That's part of being flexible, right? Yeah, but I don't but but if I wake up on Sunday, and all of a sudden she needs more insulin. I don't say to myself, well, that's not true. Because yesterday, she didn't need a lot. So we're just gonna watch your blood sugar be 300 all day today? Like, I don't, that's not it. Like, I think diabetes is a in the moment situation. But, but okay. So I've got my, let me ask you this. I say this all the time. And maybe maybe it's not true for this one. And maybe it is I'm going to get your opinion. I think that for most people living with Type One Diabetes, these systems, you know, the 670 g that's available now. And obviously, it's been out for a couple of years, the the tandem system and the, you know, the forthcoming horizon from ami pod, which we should be seeing pretty soon from hope. Well, as long as the code that Coronavirus doesn't keep their own things. So, so those things exist. And for most people living with Type One Diabetes sorted up to like 1.8 million people now and like that habit, for most people, slapping the systems on is probably a huge improvement for them, don't you think?

Jennifer Smith, CDE 41:26
Yes, in fact, we've had quite a number of, I wouldn't say quite a number. But a good enough number of people that we work with who the 670 has smooth things out considerably. It has, you know, they were they were up down roller coasting consistently day to day high to low, high to low, no assistive management to help with that variance in their blood sugar. And overall, while there's weather still probably averaging a blood sugar of 140 to 150, the system has smoothed out the variants, and it's kept them more stable. That's a beautiful thing. Yeah, and, and for most people that that's the case, they're happy with it, getting them to a target of 140, it targets 120. But for the most part, they talk to most people, they're really achieving an average somewhere between 130 to probably 160, give or take, um, but again, stability there. That's a huge piece, right? So

Scott Benner 42:29
if you've gained stability, and you're an average of 160, instead of 220. It's an incredible improvement for you in the moment and probably for your entire life as well.

Jennifer Smith, CDE 42:39
And a lot of people still even in auto mode, they're still reaping the benefit of these, these hybrid kinds of systems, especially in the overnight. Most people without food in the picture, a system like this is a huge advantage for the overnight,

Scott Benner 42:56
get some sleep and you don't get lowest. You're not you don't get those crazy highs overnight is right. What about, I feel like we were missed if we don't mention the Guardian sensor? So yeah, obviously, we're I, my daughter uses the Dexcom g six, they're sponsors of the show. You use the Dexcom? Yep. The the, you know, the scuttlebutt for me from what I see on the street from the kids, is that people don't think the guardians as accurate as the dexcom. Is that Is that a fair statement from what you've seen? Or how do you even I

Jennifer Smith, CDE 43:32
think that's a very fair statement. It is, I mean, even from my personal sensor use of two of their sensors I tried the enlight years ago, I all when I was training, you know, on their pump to begin with. And then when I trialed and the 670 with their guardian, I would say that it's definite, it was an improvement from what I had had with the enlight it was it was definite improvement, but it was still not for me, anywhere near the accuracy or the consistency in accuracy that I get with my dexcom. In fact, when I was using the 670, I wore my Dexcom at the same time, okay, to compare, I mean, when you're wearing like, several things, and who cares about another site, right, like, I'm just gonna be the ultimate like robot person. Right. Right. Right, exactly. So, you know, and I, I mean, I follow there are certain you know, things to definitely make sure that you're getting the sensor to work as well as possible to begin with, from the Guardian standpoint, because it is, I would say the best word for it. It's finicky, comparative to Dexcom. And I personally tried all those tips, tricks, things that could possibly be done, and it never really worked well for me, and I think that that's the biggest hang up then that I had with it in automotive. It is that it drove me crazy with all of the requests for additional glucose entries and calibrations. It wasn't accurate. And thus, in any of these hybrid systems, if you have a sensor that is not accurate, the adjustments in something like auto mode or in control icube closed mode, you're you're not going to get accurate adjustment because your sensors not accurate to begin with

Scott Benner 45:29
when you say it asks for calibrate, so it knows well enough that it's not okay, but it doesn't know where okay is, is that.

Jennifer Smith, CDE 45:37
So for the most part our our go to recommendations for getting your sensor to work as well as possible. We recommend calibrating that sensor. And it does require calibration on like g six for Dexcom. The Guardian does require calibrations. But we recommend calibrating about three to four times a day, at more regular times of day. But the biggest thing is really to ideally do it when your glucose is more stable. In order to avoid what we know, in all of the sensing systems, there is lag time, based on if something is trending down or trending up right now. There's lag that's happening, your finger stick is often either lower, or it could be higher based on what's happening trend wise. So the goal is to try to calibrate when you've got a horizontal kind of angled trend happening. Also, the accuracy of the glucometer that you're using to calibrate with is a big deal too. Yeah, that's a huge deal. I mean, if you're using some off the market, like, well, not off the market, but like random, generic brand. Don't take out, right? Hey, that's easy. It just just don't, don't I and I know that some people it, it's based on what their insurance is able to cover, right? Right, or what they can afford, I get that. But then also understand that your calibration of these systems may actually mess up the natural sensing of what it sees as being

Scott Benner 47:20
you're wearing, you're wearing a state of the art glucose sensing system and calibrating it with something you got out of a bubblegum machine, it's not going to go well, because then you just confuse the sensor by by telling it, you know, let's say the sensor thinks you're 110 you're really 120 and your meters like no, no, we're at, and you put that information in that the sensor is going to go there, and it's not going to know what to do. And it's gonna confess it, you know, and you have to be careful.

Jennifer Smith, CDE 47:48
The thing with Medtronic, it does come with a monitor that connects with the pump, which is nice, it's the best one that's on the market, it's the Contour Next One, if you get it with the pump, use it, because that is the best rated as far as accuracy on the market. And that goes for anybody that's out there.

Scott Benner 48:06
If you want to know why the Contour Next One is sponsoring the show. Now it's because Arden's experience with the Contour, Next One meter has been head and shoulders better than any other meter she's ever used. As far as consistency, ease of use, portability, and end how closely it agrees with the G six is fascinating. I don't know if that speaks well, for the G six or for the meter or for both, maybe honestly, but it's I've never seen so much consistency between technology before. And you know,

Jennifer Smith, CDE 48:40
according to I mean, one of the last conferences I went to, when I was able to fly and actually be within six feet of somebody else. I stopped at the actual the the Roche were accucheck their guide or guide me is also one of the highest rated accuracy on the market. So if you can't for some reason, insurance coverage wise, use the contour that accucheck guide or guide me it is also not very good. Yeah. So but that that goes along with sensor, any sensor that you're calibrating, but definitely one that could have some finicky component to it for The Guardian, try to make sure that your glucometer is a good one. So and then, of course, you know, any sensor, it's the insertion of it. Are you putting it in the right way? are you cleaning your sight? Are you making sure that you're the transmitter for The Guardian needs to be charged? And so unlike Dexcom, which you just slap it on, and it continues to work every time you put it with a new sensor until it's dead at 90 days. The transmitter for The Guardian has to be charged that's just confused me

Scott Benner 49:49
can I try? I can't charge it while it's on my body right Oh no. Then how does so I have to pop it out and charge it. How often do I have to do that?

Jennifer Smith, CDE 49:57
Oh, the charging Another one that I'd have to look back and see exactly, it doesn't take long to charge it. Okay, but I know that it's at least it's at least every five to seven days. But don't, don't you know, directly me on that. But yeah, it is it requires charging and there's like a little, you know, that comes with the system, there's a little charging like, port that you pop it into, and it charges and then it's ready. And then, but if you're, if your transmitter isn't well charged, or it's kind of at the end, you know, don't put on a brand new sensor, and then you're gonna have to pop it out and it just weirds up the system.

Scott Benner 50:37
We're selling the hell out of this thing, aren't we? So? Geez. Alright. So being serious, like, that seems like more work. I so I have to take so every

Jennifer Smith, CDE 50:50
number of days, if you do want a positive, good, it lasts longer than your transmitters. Okay, that's a huge positive. So right in

Scott Benner 50:59
place the actual devices frequently,

Jennifer Smith, CDE 51:02
you don't have to write this set at the transmitter is there you've got it until it's no longer working for you. And that's a nice thing.

Scott Benner 51:10
It's a great point. I only ever have our experiences, I've I've never experienced a gap where we didn't have Dexcom supplies. But I you know that very well, maybe because I'm on top of ordering them or because my insurance doesn't argue about I don't know why there's probably a number of different reasons. But okay, so there's there's the good and bad, so you have to recharge it, but it lasts longer,

Jennifer Smith, CDE 51:32
it lasts longer, it does require some taping, oh, it

Scott Benner 51:37
tries to fall off does it?

Jennifer Smith, CDE 51:39
Well. And all I think all the sensors on the market, depending on body type and what the moisture level and you know, everything in your skin is everybody's a little bit different. I mean, I occasionally in the summertime need to, you know, need to tape down or put up a thing around my decks calm as well. But the Medtronic sensor specifically has to be taped down. It's not a, I could choose to do it. It's kind of a funny, I wish we had like visual. But once the transmitter is popped into this little sensor piece, the transmitter bounces. Like it's like if you imagine a beaver with its tail. The tail is the transmitter

Scott Benner 52:23
Jenny, Jenny is making a hand motion that's making me feel like Has anyone anyone ever been driving in like snow, and you're the back of your car gets like a little light and starts bouncing around. And you know, so she's she's basically saying that, uh, that the back of her tail, the back of the transmitter is bouncing?

Jennifer Smith, CDE 52:43
Yes, if you don't take it. And obviously, you don't want it bouncing because it could easily come disconnected. It's pulling out the adhesive and it's pulling it the sensor wire and all the other stuff. And then that decreases accuracy. So Medtronic supplies you with all of the adhesive tape that you do need to tape it down and keep it in place, they give you directions to tape it the right way and pop it in and everything. So again, it's not extra stuff that you have to remember, it comes with your supplies, but it's an extra piece of use that isn't there for the other sensors.

Scott Benner 53:14
I'm holding in my laughter because I'm trying not to be a hater on this situation here. But my brain is going maybe don't design it to do that. And then or when you design it, you go, Hey, this thing's bouncing around, like who's the person that was like, we'll give them tape? Not maybe we should redesign it.

Jennifer Smith, CDE 53:31
Right, right. Well, the question in my mind, honestly, always comes and this is not specific to Medtronic, but it's any product that comes out on the market. People with diabetes, get it? And they're like, why did they do this? Why is it designed Like this? Like, did they not ask people with diabetes, how their life would work if we did this weird part to it? Right? Yeah. So I I just, I don't know, I'm always like, well, I guess somebody thought it was a good. Yeah.

Scott Benner 54:05
Well, some engineer maybe who doesn't have to wear it, right? Thought about the usability of it, and it works like it works. And that this shape, we can make it rechargeable. And you know, all that I listen, I'm imagining it wasn't by mistake. I don't think they were just like, I don't care, you know, but there's sounds like there were trade offs made. And you know, as we're having this conversation to, I don't know what the date is for g7. But g7 is going to become disposable, right? Like you're not

Jennifer Smith, CDE 54:32
I that's what I've heard as well,

Scott Benner 54:34
yeah, that you're not going to have that transmitter with the battery, you're gonna put it on and when it's over, the whole thing's gonna go in the garbage and you're going to start over again. And it's, it's gonna have enough battery life in it for the life of the sensor. Right. And that's it. So, yeah, I mean, things are moving forward quickly. I think I think from a personal perspective, as I watch Medtronic and their pumps, it feels to me like they're Like they're making a five pound bag of cereal, you know what I mean? Like, it's mass market. Like, like, like

Jennifer Smith, CDE 55:09
the ones that cost like $2 on the very bottom bed, and you're like, well, that's the best deal.

Scott Benner 55:13
But she gets so much of it, right? Like, I feel like they're just, I feel like they're the, they've put themselves in a position where they're giving pumps to more people than the other two companies, right. And so what they're saying is quantity over quality, like, that's how it feels to me, like, we're going to serve these pumps to as many people as we can, it will work for most of them, and it won't work for some of them. And that's just the price of doing business. I don't know I could be wrong. It's just how it feels from the outside. Because of all the things that I mean, listen, Jenny's just been sharing her experience wearing the device, and she's not, you know, and she hears people talk about it as well, and she's doing her job. But there's a lot here that seems fixable. Except it doesn't change ever, it's just sort of like they won't change this thing till they change the system, they're not going to come back and make an adjustment to it or anything like that. They are making them they're pumping them out, no pun intended. And this is what they are until they're done. We're just going to give people tape and then we'll fix it next time, I guess. Right.

Jennifer Smith, CDE 56:13
And we do. And there are I mean, speaking to that, specifically, from what we know, clinically, and the bit that's been shared, they are already on it, as your as a company there, there are products that should be coming out in the future, when I don't have any idea or not privy to that information. But there are, there will be a new sensor that will be more accurate, more user friendly, from what I remember and understand it will not have that beaver tail transmitter kind of piece to it. It will be much simplified. And their next iteration of this hybrid closed loop system that they have, will be more finely tuned with a lot of these pieces that are they're kind of a pain to have to deal with. Right. So they are working on it, as are all the companies out there, right? They're continuing to build and, you know, yeah, make changes and listen. And

Scott Benner 57:18
I meant what I said, when we started out that I think it's, it's not a great position to be in to be first. You don't I mean, because you probably had to do a lot of things to get through the FDA. And that's been softened for the pod and tandem now you know that that stuff is that past been cleared out a little bit for them. So there's a lot of good, you know, somebody's going first is and to be honest, if it was going to be anybody, it makes sense that it was Medtronic honestly because they're well,

Jennifer Smith, CDE 57:44
they're the oldest on the market. Honestly, of all of the pump systems. They are the oldest that is still around. I mean, all the rest are pretty much gone. Right? There are lots of people who love their, their combo pumps and their animists and things so

Scott Benner 58:03
they're all gone. They're all gone. Was it cosmo? What was that one that people? Cosmo's no pump, right. Yeah,

Jennifer Smith, CDE 58:09
yeah. In fact, another Scott Scott Johnson, who has his own little like diabetes blog, and he works with the my sugar group now. Um, he was like, he Bade his Cosmo and

Scott Benner 58:24
as long as he should

Jennifer Smith, CDE 58:25
hoarded supplies in order to keep it going, as long as he could, he could, he probably I don't know what he's using anymore. But he probably go back to because he really loved

Scott Benner 58:34
his cosmos. That's a nice person I've met. Awesome. So what's the overview here of this, if you have the system, and it's not working the way you want it to? You're going to have to go out of auto mode sometimes to address some meals, but not all, or you're going to have to understand that your blood sugars are going to be higher than maybe you want and just let it be.

Jennifer Smith, CDE 58:59
You have some kind of standards of when to go out of auto mode. Honestly, you know, the the initial question you asked a while ago about, well, what if I'm eating this really slow digesting or really high fat meal or, you know, my normal peek is going to be way out here and whatever. And you were used to using a square wave or a dual wave Bolus before you know what it might be best to temporarily switch back to manual mode, use what you knew work from the get go. And then when it's done, switch back to your Mac to your auto mode. I mean, that's, that's really one of one of the settings of switching out of auto mode. Another one might be honestly sick days, high stress, those kinds of things or even like I said, high fat meals etc. Where you really, let's say you always know that when you've got this really nasty, like cold that you use 25% more insulin, you've got a temporary, you've even maybe got a profile set for sick days. Right? You know what, don't hesitate to switch out and go back and use that because you knew it worked.

Scott Benner 1:00:11
Does that system allow for me to set? Could I set up multiple? Like profiles? No, but so I can't have a pizza profile on a regular profile. But see, that was because that would fix it. If I if I suddenly made the sensitivity, and the you know, the insulin on board times differently and changed, like my carpet is

Jennifer Smith, CDE 1:00:29
remember why it's gathering data over the past several days of insulin sensitivity, I keep changing it

Scott Benner 1:00:36
around because it will. Correct. Okay.

Jennifer Smith, CDE 1:00:40
Yeah. But that's a that's a great question. Again, you know, days, I even think of days, like, my brother in law works for Disney. And so we've gone down there more times than I can count. And we've enjoyed the parks and whatnot. And I know that a full day of getting up. This was pre kids, my husband and I were just enjoying the parks as adults like running around like crazy kids trying to get to everything, right. I had to use not only a temporary bazel all day long, but also overnight to avoid running too low. Well, you know, what auto mode would would not benefit me in that scenario. Because I would just be running too low, it would be consistently trying to probably suspend me not just temporarily decrease things. And that is also a limiting factor to the system that is different than the coming hybrid systems that are going to be on the market or are already, there's only a certain timeframe that it will high temp, your bazel for or Low Temp or suspend for before the system kicks you out of manual mode and say, Hey, this is all on you now, okay, you're and it will alert you. It's not like it's all of a sudden gone. And you're waking up at three o'clock in the morning. Great, I would have loved to know that you kicked me out. There's an audit, there's an alert that tells you you are out of auto mode you are back in manual mode. And it's because either you've reached the max amount of insulin delivery in a time period that's divined or you've been suspended or decreased bazel for a certain amount of time as well.

Scott Benner 1:02:23
Interesting.

Jennifer Smith, CDE 1:02:24
So in a day, like I was describing, yeah, that's to switch out of auto mode, go to your Temp Basal that worked. Mine was always setting a Temp Basal decrease of 15% for the whole day that we were the year and into the overnight. That worked beautifully.

Scott Benner 1:02:39
That's it's a great advice. And it also feels like it's, it's a little sad, because you're telling me that this pump that I'm I'm thinking what's gonna stop me from getting high, it's gonna stop me from getting too low, it's gonna be great. It's gonna take my mind off of blood sugars, blah, blah, unless I go to Disney and run around all day, and then it's back on me. Or I have pizza. Or you know,

Jennifer Smith, CDE 1:03:04
and remember, if you are going to Disney today, and the last four days, you were in some type of horrible business meetings that had you all jacked up and insulin needed, it's gonna crush you insulin. sensitivity is Yeah, exactly. You can't whisper and be like, Hey, 670 on vacation. Now I got

Scott Benner 1:03:22
a Fast Pass today. So keep up, right? So keep up with Oh, it's gonna thank No, for the last three days, you've needed more insulin?

Jennifer Smith, CDE 1:03:29
Correct?

Scott Benner 1:03:30
Exactly. So you go from I've needed more situation to I need less situation and it can't, it can't

Jennifer Smith, CDE 1:03:35
adjust it. It can't adjust again, fast enough is kind of the issue, right? And then I guess one of the last ones truly, which we've all experienced on every single pump is an infusion site problem, or a site failure or something, you know, and if you're in that high blood sugar, and you know it's a sight problem, and you go ahead and you change it, it really is best to switch back to manual mode, change out your set your tubing, maybe even your insulin, give a bolus we usually recommend via injection instead of through the new pump site. And then once your blood sugar is back in range, switch back to auto mode, right?

Scott Benner 1:04:15
Okay, I am at pump changes. I do something very similar pump changes. Like I don't rely on the new site right away like I tried to. And I also do not stare at bad sites like when sites no don't. When you know, you know how I say when when when an insulin pump site stops doing what I expect it to do. I do not stare at it for 10 hours wondering if it's gonna get better again, you know, right to bosses. It doesn't do what I want it by time. Yeah, right. Yeah. And it doesn't have it's not like you know, doesn't happen constantly. I'm just saying when it happens. I don't look at a pump and think oh, I have three more hours left on this one. I can't wait. That's an that's a rookie move. Right? Like that idea of like, oh, there's three more hours. Here, I don't want to waste those three hours, there's five more units here, I don't want to waste those five years, I mean, money aside, I understand insolence expensive, you're gonna have diabetes, for abs, you know, I mean, so like it just trying to cheat two hours here and three hours here and four hours here, you might think oh, I'm, you know, I'm saving myself an insulin pump set or something like that every month, what you're doing is you're costing yourself three and then two, and then four, and then six. And before you know it 20 and 25 hours and 30 hours a month of high blood sugars, by trying to sneak an extra two hours out of your pump. You know, I think, I think you have to, if you can afford to, you have to think about it the other way or supplement with injections, if that's crass, not working?

Jennifer Smith, CDE 1:05:40
Correct, or something like you know, a frezza, or something that works very rapidly, and you know, that it's going to work and it's going to get things down, or, you know, whatever, I don't get

Scott Benner 1:05:48
a 180 going, Oh, it's only for eight more hours until the right, come on. You know, don't do that. Just

Jennifer Smith, CDE 1:05:54
don't do it to yourself. Yes, yeah, yeah, exactly. Health is what your

Scott Benner 1:05:59
health is, first health is the goal.

Jennifer Smith, CDE 1:06:01
And I think you're talking to you know, you're kind of like hiding from a situation that you can, you can visibly see, it's there, and you're like, we're just gonna like, it's gonna fix it, kind of like even you know, going along with like the auto mode, we really try to recommend not hiding things from auto mode, too. Right. And one big one that is often forgotten, especially if you've gotten into this routine before having auto mode. And if you were an omni pod user switching to this system, you wouldn't even really think about because you've never disconnected. But when you disconnect from the pump, in auto mode, suspend your pump, so the system knows that you are not receiving insulin, okay? Because if it thinks you're receiving auto mode based adjustments of insulin counts, when you're really not getting them pumped into your body. It may, it will then continue once you do plug back in, it'll continue to think that there's insulin there that wasn't

Scott Benner 1:07:07
okay. So you have to tell it up if you just connect to bathe or something like that.

Jennifer Smith, CDE 1:07:11
You suspend your suspend

Scott Benner 1:07:12
the pump so that it realizes nothing's happening, correct. Okay. Yep. And I'm assuming that's an easy thing to forget to do. But do people forget,

Jennifer Smith, CDE 1:07:21
I would say it's an easy thing to forget to do. I, you know, some people, especially in conventional mode, coming from conventional mode into using an automated mode like this system has, because I'd say probably 50%, at least of people who disconnect from their pump, because their system isn't connecting with a CGM to do anything with that insulin. They're just disconnecting, letting it pump. They reconnect when they're done with their shower done with their swim or whatever. Maybe they're maybe the really meticulous people are remembering to suspend their pump and then remembering to resume their pump. Once you reconnect.

Scott Benner 1:08:03
I used to be surprised by the number of people who would tell me I took my pump off to get a shower and three hours later remembered where I forgot. Yeah, yeah. And I guess and like I said, buy used to be surprised. They used to be surprised because Arden uses a pump you don't disconnect from I never considered it. But you know, after you think about it for a while it's reasonable. You can be rushing around or right doing whatever it's you know, I don't know. To me, it's a selling. Yeah, no, I hear you. Okay. Well, alright, I don't know what we've Do you think we've done anything valuable here, like if a 670 g person heard this, but they'd be like, I've heard something that might help me.

Jennifer Smith, CDE 1:08:38
I think if you're a person currently using it, there are some there are some tips if you didn't know about them already, to maybe put into action to make it work a bit better for you, especially if you're somebody who is using auto mode, pretty much 9095 maybe 100% of the time and you feel like there is something to tweak but you're not quite sure where to start maybe some of these tips. While we spoke about some of the drawbacks, I think the tips that are in here for people who are using it could be an advantage if they're already not trying them. Um, you know, I think another another big one that often times again, with these hybrid types of systems is often a forgotten piece of teaching someone when they start on it is how to treat lows.

Scott Benner 1:09:30
So you're not over treating your lows,

Jennifer Smith, CDE 1:09:32
correct. The age old 15 grams every 15 minutes kind of thing. A lot of people are still following that and on a conventional pump, especially if your settings aren't really dialed in very well. Maybe it does work quite well for you. Maybe you even need to use 20 grams are 25 grams because you're really not sure how much insulin is there and that's always seems to be brings me up and I don't get low again. So I keep using this well, you can guarantee that on any of These hybrid system systems that are augmenting the insulin delivery, right, you have to remember that in auto mode, if your blood blood sugar is decreasing, the system is has already seen that. And if it's decreasing, and you're going to get below a certain value, or to a certain value, depending on the rate of trend, the system is either temporarily decreasing, or it may already be suspending.

Scott Benner 1:10:32
So it's already created a void of basal insulin correct with the food in. And once you stop the drop, there's nothing else there to help with the food.

Jennifer Smith, CDE 1:10:41
Correct. Because that bazel deficit, remember how long into the future that can make a change? So think about under treating your lowest?

Scott Benner 1:10:52
No,

Jennifer Smith, CDE 1:10:52
I think easiest way to say it,

Scott Benner 1:10:54
I think those are the little pieces that that get lost, especially in a low situation, because there's a panic, I got a really lovely note from a person today, just this morning, who said how much the podcast has helped them just with that idea, you know, they used to get low, and then eat a bunch of food. And then just let whatever is going to be be after that instead of recognizing some of this food was for the low. And some of it was because I'm ravenously hungry, because I'm low and I'm scared and all these reasons that this food needs insulin, you know, some of this food needs insulin, right. And the person said that just that idea from the podcast has really changed their, like their days, you know what I mean? Like they're not spiking and dropping and spiking and dropping all the time. And that's the stuff nobody talks about. And it's tough. And not to put that on a pump company, either.

Unknown Speaker 1:11:40
No, no.

Scott Benner 1:11:41
I don't know if people understand like the pump companies, through FDA regulations can't tell you how to manage your diabetes, they can tell you what the pump does, and how to technically make the settings like how to use it. They can't tell you when to use it. They're not allowed. You know, I mean, and that's supposed to be for your doctor, but then your doctor is busy telling you, you know, just keep eating 15 carbs and 15 carbs and fat and carbs. And then you know, see what happens afterwards.

Jennifer Smith, CDE 1:12:07
And along with that, you know, we bring into the picture technology, right? Our technology today using CGM, you have to remember that CGM is leg, especially in times of lower blood sugars or in times of rapidly changing blood sugar values. So if you've treated your low, especially on an automated system like this, if you've treated it, you've you've got to wait, yeah, unless you're willing to do a finger stick and a finger stick to see that things have now up they've stabilized up I'm rising, my blood sugar's coming up. But look at that my sensors still reading at 52. But my finger stick is at three, stop eating your 15 grams every 15 minutes,

Scott Benner 1:12:47
you have to stop caring about this. It's an interesting situation, you've corrected the low. And now you're going to wait for your body to respond, your body begins to respond with a blood sugar that's rising. The sensor doesn't figure it out quickly enough. So you're still looking at the 52 going, I probably need more food. If you fingerstick you might be 65. Right? If you wait 10 minutes, you might be 74. And the CGM might believe you're 74 too. But it's that panic time right in there. Yeah. And I I'm a fan of testing. I like testing in that spot.

Jennifer Smith, CDE 1:13:18
I do too. You know, I do too. In fact, when I you know, in a conventional pump sense, I usually enter the carbs into my PDM. Because when I do that for a low blood sugar, if I enter too many grams of carb, the PDM will tell me I need to Bolus and if I have a certain amount of carbs and it's recommending a 0.0 Bolus, I know that it's at least offsetting enough to bring me up. And potentially if I've got insulin on board, it'll allow me to actually then take in enough carbs to compensate for insulin on board. And the low blood sugar without recommending a bolus, yeah, if you enter it, and you're like, I'm gonna eat 49 grams of carbs to treat this low and your pump is like okay, well you need 2.2 units of insulin. I guarantee you probably need that 2.2 units of insulin even though your blood sugar is sitting too low. I will tell a story sometimes when I'm speaking publicly about the time it It struck me like when I finally figured it out and Arden had a bad low. It came out of nowhere in the middle of the night. And you know, everything you described like she's falling

Scott Benner 1:14:34
so fast that the CGM this is years ago. She was falling so fast. That CGM didn't pick it up right away. It was also I think, two generations of Dexcom ago, it was probably the g4 right, and so she's falling fast. And I catch it. I test she's really low. She's like 36 she takes in 65 carbs, right and the 36 I finger stick it holds wait five minutes the longest five minutes your life you stick again. She's still 36 Okay, she's not falling. You know, you're like, Alright, wait again you wait again you wait again fingerstick 42 going up. All right, the CGM still just yelling low, low, low. Yeah. Because it's just waiting. Yeah, it was. It's a little behind now, right? So I'm like, okay, 36 went to 36 went to 42. I'll wait. And I wait. And then I saw 54. And it was that time it was this one time that I was like, god damn, you know what I'm gonna do. I was like, I'm gonna Bolus. It was like, so she had like 65 carbs. And I think

Jennifer Smith, CDE 1:15:42
you were like 65 carbs was a lot of carbs.

Scott Benner 1:15:46
But the leap is, first of all, you have that adrenaline. You just saw 36 blood sugar. The CGM is yelling low at you. All this is happening. But she's clearly coming up. I didn't Bolus Roth 65 cars. But if I remember correctly, I think I did 40 of them. And I stopped her blood sugar like 170 because trust me, 20 minutes later, her blood sugar started shooting up, right. And even that gives you this anxiety because the CGM is catching up, you know, it's telling you low now she's 54. Now the sudden she's probably 65. Now all of a sudden it goes ooh, 40. And then it shows you arrow straight up and the arrows panicky, you're like, Ah, you know, but because I was testing, I knew what was happening. I was like, Alright, forget this first second, I'm gonna stop paying attention to the glucose monitor for a second. And I'm going to go back to knowing what I know is going to happen. She's got food. She's clearly not low anymore. She's moving up. This is no different than a bad Pre-Bolus at a meal. Like it's almost like I Pre-Bolus too long. Like, right, that's all that's happening now. So like, what do I do next? And what I did next was insulin. And I'll tell you, if you've ever seen me speak, speak live like sometimes like I do. I go out into my my hallway afterwards that I leave Arden's room, and I'm like, hey, my arms over my head. I'm like, Oh, I killed this. Oh, my God, I did such a good job on this. And then I go to bed. And that was it. But yeah, you can't if you over treat Lowe's, especially in these auto system, this one specifically, you're just gonna bounce forever, they get it, then it's, then you're not letting the system do what it's there to do for you either. Right, you know, all right. Well, I truly believe that, you know, Medtronic next system will be an improvement over this one. I 100%. Want to give them credit for doing it first, because I think it's a I don't think that I don't think they had a chance for an outcome any different than the one they got being first and probably I'm guessing, dealing with the restrictions from the FDA that they put on a first, you know, hybrid system. So

Jennifer Smith, CDE 1:17:48
absolutely, I'm quite sure that the that the restrictions and the parameters they had to stay within were outrageous to actually get a system on the market. That could actually, I mean, the first step really was allowing CGM to replace fingerstick. Yeah, it was 100%. And once that was approved, and they were like, okay, now that that's approved, now, we can actually have a system that doses insulin based on CGM values. And that was the huge first step. So I mean, they put a lot into place I, you know, I would not like,

Scott Benner 1:18:26
we all need to appreciate that we all need to appreciate the speed in which things are moving through the FDA now that they did not used to. And I mentioned this to somebody personally, last night, if you go back a couple of years, and the CEO, Shea see from from Omni pod is on the podcast, I'm asking her about like, hey, am I ever gonna be able to control my daughter's pump from a phone? And her answer a couple years ago was like, I mean, we would love that. But I don't know how we're getting that through the FDA. And now the horizon is going to come out and it's going to be controlled through your phone. And it's a couple of years later. And so for new people who are used to like Dexcom, being like, here's the G four, here's the G five, here's the G six, the G seven is coming. That's not how diabetes has worked. Historically, getting new technology to market, so things moving so much more quickly than it used to. It's really yeah, you know,

Jennifer Smith, CDE 1:19:16
and it's making a big difference for people. I mean, really even considering just the 670 system, and some of the pivotal trials and the things that Medtronic came out with even years ago. I mean, they really proved that people who used it with a lot of the strategies of applied management to using it mean they can achieve an A one C, kind of shortly under a 7% sort of in like the 6.8 6.9% range. I mean, a good percentage of time in range. I mean, if you were falling short of that 40% 50% if you're using the system well and auto mode, most often you can get 70 75% in range, with that range being like you know that 70 to sort of 180 ish kind of plays such a

Scott Benner 1:20:01
big but yeah, for a lot of people

Jennifer Smith, CDE 1:20:03
for that that's huge for many people. So you

Scott Benner 1:20:07
have to remember where you're coming from when you listen like when you say, an eight, one c like in the low sevens. It My mind is like, Oh, that's a point and a half higher than I want it to be. But that's for me, a person who's got to see in a one see who's nine is like, wow, just saved my life.

Jennifer Smith, CDE 1:20:23
I'll take it. Yeah,

Scott Benner 1:20:24
yeah. No, 100% No, I, I believe I really do. Like I like to tease Medtronic. Mostly, I like to tease them in case they're listening. Because I am not a fan of what you do in Washington, around insurance and the way you throw your weight around and limit other pumps. So it for that, and I'll bleep this later. I think you're a bunch of it. But you know, for the rest of it. We're just here talking. I agree. Yeah, that's all let's Scott Johnson have his goddamn Cosmo pump. It wouldn't have been that bad. Damn, it. wouldn't know he wasn't taking that much money out of your pocket. Medtronic, he could have let it be. Alright.

Unknown Speaker 1:21:01
Right. You can

Jennifer Smith, CDE 1:21:02
all these other products off the market right here.

Scott Benner 1:21:04
Okay. Huge thanks to my sponsors, Dexcom and Omni pod. You know, we never mentioned it. But the opinions expressed on this podcast are not those the advertisers probably should say that once in a while to take that thought a step further. I'm an idiot. I don't really know anything. So, you know, grain of salt, though. And I'm sure there's a ton of wonderful people at Medtronic. To find out more about the dexcom g six continuous glucose monitor, go to dexcom.com forward slash juicebox. Please use my link, click on it. You know, you can do it right there and your podcast player right now. And to get a free, no obligation demo of the AMI pod sent directly to you my Omni pod.com forward slash juice box. Don't forget Thursday the 23rd of April 2020 at 3pm on the bold with insulin Facebook page. Alive Scott and Jenny. Jenny and I are gonna answer your questions right there on the Facebook machine. And later, you'll hear it on the podcast. It's actually at bold with insulin on Facebook. So I don't know how you do that Facebook calm. There's some slashes in there but you'll find it. What else? I don't know. I hope you guys are being safe and find the things to pass your time and all that stuff. I am recording this right now in a pair of shorts and it's too cold to be in shorts, but doesn't matter because I'm not going anywhere. So at least I'm wearing the shorts

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#325 Glucose Gang Mike

Mike is an adult living with type 1 diabetes

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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 0:02
Oh my gosh, I'm so tired. Okay, I don't know how I'm tired. haven't left the house in a month. Hold on me. Draw up energy for this. Hello and Hello everyone. Welcome to Episode 325 of the Juicebox Podcast. Today's guest is Mike. I met Mike on Instagram he has type one diabetes and an interesting story. That's what got him on the show. And while you're listening to Mike remember that his story is brought to you by advertisers like Dexcom on the pod the Contour Next One blood glucose meter and touched by type one. Find out more about the dexcom g six continuous glucose monitor@dexcom.com Ford slash juice box Get yourself a free no obligation demo of the Omni pod tubeless insulin pump at my Omni pod.com forward slash juicebox dig into what the Contour Next One blood glucose meter is and see if you're eligible for a free meter at Contour Next one.com. And of course, my absolute favorite diabetes organization touched by type one is their name plus.org touched by type one.org. I want to thank everyone for continuing to listen to the show during the coronavirus lockdown. The numbers for this show the downloads that is have not changed since the Coronavirus has a has come about. But I've heard from some other people who have other podcasts that their shows are struggling. This means the world to me. Thank you very much. All right. So music and then like

I honestly didn't know where this conversation was going to go when we began having it but Mike and I had a lot in common. Like as an adult living with Type One Diabetes. He has specific experience growing up in a culture with diabetes. He's a young man who enjoys some similar music to me. I like his outlook on life and what he's trying to accomplish. All that turned into a lovely hour. While you're listening to that hour, 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 healthcare plan. or becoming bold with and so on. In this little bit of time I have here I'd like to remind you that while you're locked up at home, don't think of it as being locked up. Think of it as safe at home. But anyway, while you're locked up at home, it's a perfect time to work on your blood sugars. Go back and listen to the pro tip episodes again, they begin at Episode 210 to take you all of a day and a half maybe to listen and put the ideas into action. So if your blood sugars have been getting out of whack it might be time to you know tighten them back down again.

Mike 3:15
This is Michael. Um, some of you guys know me on Instagram as glucose gang, Mike, I'm a What am I a? Well, since I'm not a father, let me say I'm a son, brother.

uncle's

somewhat of a parent, not in the biological sense. And, you know, in regards to this podcast, I am a type one diabetic that has had this disease for 20 years.

Unknown Speaker 3:47
How old are you?

Mike 3:49
I'm 27

Scott Benner 3:51
seven years old. That seems to be a popular diagnosed number four people I'm talking to this week. I I kid you not you're the third person who said to me, I was diagnosed when I was seven. Maybe it's a maybe it's a good year for diabetes, like you know when they talk about wine. But who knows? Seven years old 20 years ago. You're 27 now

Unknown Speaker 4:12
go to college.

Mike 4:15
Yeah, so I graduated from the University of Michigan in 2017. And I moved from Michigan to North Carolina and that is currently where I reside.

Unknown Speaker 4:27
Did you Where were you born?

Mike 4:31
I was born and raised in a place called Ypsilanti, Michigan. But I went to my family's from Ypsilanti Michigan. So I have I know people throughout Ann Arbor as well as and Ypsilanti is spelled funny so people have a hard time pronouncing it. It's y p si. La en ti

Scott Benner 4:58
you just said it so naturally How did How do people mispronounce it?

Mike 5:03
Yes, the link, or

they emphasize the the Yep.

Scott Benner 5:11
I think you might have just named this episode of the podcast, the EPS mic, but we'll see where the rest of it goes. So are you so born and raised? Go to school there? What? What took you in North Carolina?

Mike 5:23
I have family down here. So I have two sisters that stay down here. And I wanted to get out of Michigan. The joke in Michigan is always the running joke, when you're a teenager is always like, Oh, I, you know, when I turned 18, I'm testing the first plane out of here, and I'm moving and this and that. And, you know, it. That was ideally my plan, but I didn't want to leave Michigan without something tangible. So I decided to get my degree first. And then I went ahead and left.

Scott Benner 5:57
Excellent. So, um, it makes a lot of sense to me. Did you say did you It's interesting, when you moved after college? Did you like have a job set up? Or did you just think I'm gonna go to North Carolina and reset my life here with this, you know, degree in this new person that I am?

Mike 6:14
No, I, I didn't have any job offers. At the time, I was just kind of, you know, jumping out of the plane with no parachute, so to speak. And I went ahead and I did it. And, you know, I don't regret it. Um, things kind of fell into place, thankfully for me. But when I first got here, it was kind of hard. I didn't have a car didn't have a job. So I had like, a bike and I wouldn't bike around Durham. And, you know, eventually I got a job. And with me getting a job, I got a car. So that was great. And

things just kind of fell into place. Excellent. Oh,

Scott Benner 6:54
how did you work out medical support, you know, health insurance, getting insulin and supplies, stuff like that between school and, and getting your luck getting your first job?

Mike 7:09
Well,

I had an idea I had a, I didn't know what was going to happen. So like a lot of people. I have tried to stock up on supplies before I went ahead and graduated and, you know, made the move down to North Carolina. But like a lot of people that I'm sure you've spoken to at times, I did have to ration my insulin, just to make sure that, you know, I had enough if necessary

Scott Benner 7:41
to get to get and so it's because I guess when you're in college, I mean, I guess depending on your situation, if you're, you know, if your parents have health insurance, you can stay on their health insurance while you're in college. But the minute you're, you know, whatever they whatever the phrasing is for, you know, what happens when you graduate legally to you just gone that, like they can't cover you anymore, stuffs expensive. So you just sort of like, turned into a little bit of a hoarder held onto as much as you could, and then went and tried your thing. And then it was, I guess, a race to get a job before he ran out of insulin.

Unknown Speaker 8:16
And the worst game show ever Mike, by the way. Hey, man.

Mike 8:23
You know, sometimes you got to do what you got to do. I don't even think my parents knew that. But now, you know, once they listen to this, they'll know. Yeah,

Unknown Speaker 8:32
yeah. Would you say that? Um, how often

Scott Benner 8:36
did you think about that while you were trying to get going? And like, was it on your mind constantly? Or did you every once in a while, open up the refrigerator and look at that insulin and think, Wow, maybe I'm gonna have to take a job I don't want soon or, like, how did that impact your life?

Mike 8:52
It was definitely stressful for someone like me, where I'm constantly on the go, I'm constantly somebody who is has to, like I can't sit in the house and just relax. Oh, with activity comes corrections and blood sugar drops, and you know, all of those different things that affect your diabetes. So for me, there definitely was a bit of a rush. And in addition to all of that, I also just, you know, I liked the idea of working. So there was a bit of a rush to go ahead and find a job but thankfully, one came through. I think I got hired maybe a month after I moved down here and then moved down here, August 2017. And then I got a job and September, I want to say the end of September so it worked out. It's amazing. Yeah.

Scott Benner 9:50
Hey, I've one last question about this. When you talk about like when you hear people say I have to ration my insulin because I don't have enough. What's that look like? Like nuts and bolts Do you do Just aim for a higher blood sugar. So you use less insulin? Or do you

Unknown Speaker 10:05
skip

Scott Benner 10:07
meals? Do you eat low carb or no carb when you don't want to? Like how does that kind of take shape?

Mike 10:16
So for me, especially when I was younger, I had to develop and not develop, but I discovered different ways to somewhat maintain and also obviously brought my blood sugar. And if you want to raise it to see a bunch of sugar, right, so that was not a problem. But for me, it was more so like you said, eating healthy. So eating less carbs, maybe like salad instead of bread. And included things like cardio, are you a really, really helped my agency. And also men just from my personal 20 years of experience. If I constantly drink water, and I don't eat anything crazy, then my blood sugar relatively stays the same. I don't know what it is. I don't know if it's just exclusive to my body and my hormones work but I'm just constantly drinking water. Like I said, I was drinking I'm drinking a Fiji water throughout the day. That's like my thing. And that really helps to maintain and regulate my blood sugar's

Scott Benner 11:21
it's simple. It's interesting that you said that because I had a, I sat down with a like a 20 year old guy last night. And he was looking to understand what we talked about on the podcast. And I know him personally. And so we went to dinner and sat in a restaurant like he sort of got the talk that I do in public, but he got it in a restaurant. And I at some point asked him. So you got this 190 blood sugar, what do you usually do? And he's a person just managing with a meter and pens, you know? And he said I'd probably drink some water. And I said you would you correct it with insulin. And that was a completely foreign idea to him, because he's had diabetes for about seven years. And no one's ever talked to him about correcting a blood sugar. He's been told, you know, to count his carbs, give himself insulin, wait three hours. And you know, by the time that happens, you're hungry again anyway, and you start the process all over again. But he had never considered the idea of pushing that number down with insulin. But immediately he said, I would drink water. And you know, and then if it doesn't move, probably work out. And I thought, huh, that's a I mean, I know it works. But I've never heard anybody say that as like their go to idea. And then Just now you said the same thing. So kind of took me by surprise for a second. Alright, so seven years old. Mike, when you're diagnosed then do you have any real recollection of that's a long time ago.

Mike 12:47
Oh my gosh, God, are you are you calling your old?

Scott Benner 12:51
No, I'm just saying 20 years is a long time ago. You're By the way, I'm going to turn. What is today's date is today like the length of the 10th. In two days, I turned 48. So I have 20 years on your 20 years. So I'm not calling you old. But but I'm just saying the 20 years is a long time ago because if you ask me something that happened to me when I'm 28 I'm pretty sure I don't remember. And and I was an adult then. So I'm wondering, just do you have recollection of being seven and being diagnosed? And what that was like, if you do?

Mike 13:24
I have? Um, yeah, that to answer your question. I have a brief like glimpses and flashes of I remember. It's a funny story. And I'm going to break it down for you. So I was on a cruise ship with my family. And there is including my parents, for brothers and sisters. So there's seven of us right on this cruise ship. And we're all having a good time. Everybody's you know, celebrating, I think it was my brother, older brothers 15th birthday. And now we're just having a good time, and I ate something at dinner. And I just had to use the bathroom. And I use the bathroom. And then I felt like I had used the bathroom again. So I use the bathroom again. And I did it. I felt the sensation again. I'm constantly using the bathroom. And I'm really I just remember being very, very thirsty and asking my mom for a lot of water and it never quenching my thirst. And my mom before the end of the trip, she was like I think something's wrong. We need to take it to the doctor. And so I remember because my brother ironically, my brother's birthday just passed. His birthday was in July 7. No. Um, so yeah, so we got on the cruise. So I want to say I was After we got off the cruise, I want to say I went to the doctor in August. That's when they diagnosed me. And they were like, his diabetes. And my mom was like, totally blown away. And my dad, they were both just like, how is that possible? Like, he's seven years old. He's healthy. He's not, you know, obese or overweight. And by my endo at the time was like, you know, there's different types of diabetes. And he has what's known as Juvenile Diabetes is what they called it back then. Yeah, type one is what they call it now. And,

Scott Benner 15:38
well, I'm happy to hear, but like, I'm happy to hear that you went to a doctor off the boat, because in my mind, you were like, seeing that Love Boat doctor in those shorts, shorts with a glasses on and I thought, what could he possibly know about type one? The other thought I had when he said you were on a cruise was? Were you just cruising around like Michigan? Or did you fly somewhere and then go, coach,

Unknown Speaker 15:57
I'm assuming it was an ocean cruise?

Unknown Speaker 16:01
Absolutely.

Scott Benner 16:03
It's like, you know, those super famous Michigan cruise lines. And I realized you can fly somewhere and get on a cruise, it just struck me when you decided I had a picture of you on a cruise boat as a child, like rolling around the lake michigan over and over again. But um, so it's interesting, because it just kind of hit you that your brother's birthday is this month. So this is July, is probably the anniversary of when you figured it out in August is, I guess the anniversary of when someone told you, you know, for sure that you had

Mike 16:36
my diversity is they like to stay on Instagram, I don't know the actual date. I'd have to ask my parents that I don't know if they even remember. But I know that it was like, fall, because we were getting ready to go back to school and the leaves were changing and different things. I also remember them telling me, you know what I mean? Like, I remember going to like the unit U of M hospital. And then you know, hospitalizing me Of course, and, you know, telling me what the disease was and different things. And I feel like it was the maybe the second or the third day. And they came into my bedroom. Because you know, they check your blood sugar, like every two or three hours when you're recently diagnosed. And they came into my room. And the nurses like, Okay, it's time to take your shot. I remember just being like, no, like, no. And she was like, Michael, come on, like we have to be this is you know what I mean, we have to get and I was like no. And I remember very vividly, I remember this crystal clear, like, biting the nurse and the doctors had to run like come in like something out of a movie almost where you're like, you see this little seven year old kid who doesn't want to accept the fact that he has a chronic illness? I'm stressed out because I'm like, I don't want to you know what I mean? Like, all over the

Unknown Speaker 18:03
place, I

Mike 18:05
would say

Scott Benner 18:06
that's in your blood sugars are all over the place to like there's a lot impacting your, your behavior, besides just the fact that you're seven scared out of your mind some ladies trying to jab you with a needle. And you know, you're I mean, it, I can't wrap my head around it completely, because our aim was to. So we didn't really have to explain that much to her. You know what I mean? Like we did, obviously, we talked her through what was happening, but she didn't cognitively think to herself, oh, I have diabetes now. And you know, like, it just, it's different when they're when you're younger, but when you're younger, but at an age where you can understand some but not all of it. It just has to be. I mean, it has to be the most frightening thing that's ever happened to you. I would imagine.

Mike 18:48
You know, no doubt. Yeah, no doubt.

Scott Benner 18:51
Listen, I watched one time, like my son was, I don't know, eight, nine years old, getting a flu shot. And luckily, out of the corner of my eye, I saw what was going on. And this is not like a violent kid. Like I had to reach up and grab his hand. Because when the nurse came at him, he was gonna defend himself. It was it was really just a like a gut. Like reaction to him. He's like, if you could have tried to stab me with that. I'm gonna try to stop you. And so just you know, I'm with you, man. I would have I would have I would have maybe thrown some hands to the lady

Mike 19:26
to let her know

Unknown Speaker 19:28
exactly what

Scott Benner 19:32
you go find another mark because Mike's not getting Java whatever that

Unknown Speaker 19:37
Yeah, I don't know what your sick game is honey. But

Unknown Speaker 19:41
anyway,

Scott Benner 19:42
so but but I mean, 20 years ago, you must have done injections for a long time, right?

Mike 19:48
Oh, man, that was like yeah, so like, I'm gonna like a dinosaur at this point when it comes to like, how to give insulin and get insulin. So yeah, we were doing like you said this. I Remember this syringes with the orange needle caps and the vials and shaking up the vials. And you have to draw up the insulin with the syringe and the syringe has the tick marks on it.

That was the era when I was diagnosed. Yeah.

You know what I mean? I remember the big machines. And when you check their blood sugar

you have like the big machines and you have to

put the blood onto the

I'm drawing a blank. I had to check my blood sugar and like a huge, not a huge machine but a relatively large machine

Scott Benner 20:40
and needed a lot of a needle a lot of your blood to Yeah, it wasn't

Mike 20:45
now It wasn't like now where you know what I mean? You don't some some people don't have to check their blood sugar because they have the CGM. Right. But like, I don't have one yet. All right. So right now. Yeah, I mean, the amount of blood is like significantly smaller, less painful. Yeah,

Scott Benner 21:03
yeah, the leaps in technology are stunning. And especially with, you know, with what we're talking about here, the amount of blood size that you need to fill that test trip has gone from, you know, a gallon basically to like, basically, you know, there's some the one my daughter's use, now she's in the Contour Next One, and you barely even like, bump the thing into the blood. And it's like I'm working. And and even if you if you don't get enough, it doesn't ruin the test strip, you just touch it again and get a little more whereas there's some if you put blood on, but it didn't was enough to read like that would ruin the strip, there. And in the meter you're talking about. My friend Mike had one when we were 16 is a long time ago. And it looked like it was like literally the size of a brick. And you know, like you couldn't travel with it. You couldn't take it anywhere. It just sat in your house. And that's when you tested your blood sugar. If you were near it, and you thought to do it. It's just a different world. Yeah, you know, and when you're seven, when somebody is like, Look, we got to open a vein,

Unknown Speaker 22:06
you know, so that we could begin to get enough blood out of here.

Scott Benner 22:10
It's got to be incredibly off putting I know that Arden just got her a one seat done by fingerstick the other day, and you know, that needs a large sample. And she was put off by that she's like well afterward she's a cleanse a lot of blood that woman talk. And just it's her her perspectives different now.

Mike 22:27
Absolutely. And even like, oh, to touch back on that too. So even like being seven and like, Can you imagine having like as a child having died, so like I used to I used to carry my like, insulin is not my insulin, but like my needle, my syringes. My little pricker things I used to carry all of those and in a like, like a little pencil box. You remember the plastic careful boxes like with the green, the different colored tops? I do. I use it. So you know that was? That was like,

Unknown Speaker 23:03
that's a slick. Look, Mike, I'd like to see a photo of you carrying around your pencil box.

Scott Benner 23:13
Yeah, it might be your version of Napoleon Dynamite right there. Because that's really that assuming that how the ladies like that, by the way. We're

Mike 23:23
on. I was like I was totally shy. When I first got diagnosed. Like I remember. My teacher I remember my teacher saying was how we check my blood sugar. At one point, I told her like, I want to go in the hallway and check my blood sugar. Because I just didn't want everybody to know. And I also didn't want to feel alienated from my classmates, you know what I mean? And even though because kids won't say anything, you know what I mean? If you're, they'll just stare at you.

Scott Benner 23:53
While we judge you. Yeah, and then form a cabal form a cabal later where they hate you.

Mike 23:59
badly and then later on, it's like, they'll ask you, but for me, I didn't want any type of extra attention on me. So I had to take extra steps. Like I said, checking my blood sugar in the hallway.

Scott Benner 24:13
Usually just trying to blend when you're a kid, you know, you really are just trying to be wallpaper, you know, you're just like, don't let me be too different. And even think about Think of all the crazy things that you will avoid when you're a child. My wife is tall. She loves being tall. But when she was in middle school, she said being a tall girl was a problem. Because you were taller than boys and so boys didn't talk to you. And you know, like, and so she's growing up not liking that she's tall, which is something that's amazing for her. You know, like, just somebody too athletic, not athletic enough to rnc. Not artsy like you don't mean like you never you're just trying to be vanilla, right? You're just like, like, no one looks at me right? And and and you know what to Mike and I don't know how to I never know how to say something like this to a person I've never met before. Because in my personal life, this wouldn't be a big deal. I don't think it's a big deal here. And I feel like you're gonna handle this well. So I've now built it up so much that when I say it, people are gonna be like, that was not a big deal. Why did Scott do that? But you're African American, right? So is your, your beard? Right? And that's what I would have said, If I didn't, I would have been like, Mike, your black guy, aren't you? And, and so and so it did that community have different opinions about diabetes. And because I see it and hear about it a lot, like sometimes you get more, I don't know, like Southern roots. And then diabetes is thought of in a different way. And I hear a lot, I don't know if you heard it. But I interviewed Anthony Anderson, you know, a number of months ago now. And he was talking about his father having diabetes, he was talking about him having type two back then. But that his father, it just resolved themselves to the fact that basically, he had the sugar, and his life was going to be shorter. And that was all he could do about it like that he couldn't really do anything about it. And I see that from different cultures running this podcast over and over again, there are some places in the country, or ethnic backgrounds or something, they all treated like a little differently, some people stigmatize it, some people embrace it, it's really, it's I was wondering if you if you had anything like that just, you know, coming from a black community.

Alright, a little treat, I'm going to do all of the ads without stopping. And as you heard at the beginning of the show, I'm tired. So this is going to go. I mean, you got to guess not well, the Dexcom g six continuous glucose monitor is one of my favorite pieces of diabetes technology. And I can say in all honesty, that without it, the success that we have with my daughter Arden's blood sugars, and her a one season variability and our stability, I don't think it would be possible. I can say that with comfort because prior to the Dexcom CGM, we were not accomplishing the things that were complex now. seem you just have like a little flub there. I kind of swallowed a word. It's okay. I'm gonna keep going. So here's what you need to do. You go to dexcom.com forward slash juice box and get started today with the G six continuous glucose monitor. Why? You're gonna ask me why it's fine. I'll tell you, because you'll be able to see loved ones blood sugars remotely on an Android or iPhone, right? I see their blood sugar going up. Is it going down? How fast is it moving? What's the number? It's because the Dexcom is FDA approved for zero fingerstick treatment. That's not bad, right? And what else Dexcom Dexcom Dexcom. Ooh, I personally we work on Pre-Bolus thing and Temp Basal going and stopping high blood sugars and cutting off lows and all kinds of cool stuff with the data that comes back from Dexcom. Now, when we do stuff with artists insulin, like I'm just talking about that happens through Arden's Omni pod tubeless insulin pump. Now the coolest thing about on the pod is that they'll give you a free no obligation demo. Okay, you understand I'm saying you go to my omnipod.com Ford slash juice box, fill in a tiny bit of information about yourself. And on the pod, we'll send you out a pump to try on and where nonfunctioning so you can't, you know, hurt yourself with it. But you can figure out what it's like to live with the Omni pod. So just imagine yourself sitting on the sofa, staring at a wall, sitting in the kitchen, staring at a wall sitting in your bedroom staring at a wall, and you'll get to see what it's like to wear the AMI pod while you're staring at that wall. Right COVID-19 gottschee in the house, good time to work on your blood sugars, great time to work on your diabetes technology with x comment on the pod. Now, once in a while, you're going to need to test your blood sugar with a meter. And for those of you who don't have the dexcom this is happening all day long. Why not get great information back like the information that comes from the Contour Next One blood glucose meter. It is the most accurate and easy to use meter that my daughter has ever had. And she's had a number of them over the years. At Contour Next one.com. You can learn more about the meter about the app that you can use with it if you'd like. And you can find out if you're eligible for a free no obligation. Game Damn that was on the pod, you'll find out Contour Next one.com you'll find out if you're eligible for a free meter. You can actually fill in some information to find out. I told you I'm not editing and I'm not stopping. Here we go. They used to be dancing for diabetes, but now they're touched by type one, same organization. They just want you to understand they're not just about dancing. They realized maybe people think we're just about dancing, but they're not. They do so much more and you can find out about what they're doing. Find out about that isn't right. And you can find out more about what they're doing at touched by type one.com no.org touched by type one.org. I'm almost out of music, I'm freaking out. My omnipod.com forward slash juice box dexcom.com forward slash juicebox. Contour Next one.com touched by type one.org. Please, during these tough times, support the sponsors of the show, let them know you're coming from here, use my links. We got to make it through this Corona thing together people. And I mean, you know, health wise, obviously, but I'm talking about gotta keep the podcast strong. Because once we all go back to work, and you jump in your cars, again, walking around the grocery store popping out to your to your podcast, this podcast needs to still be you know what I mean? viable. So, hit up the sponsors. I'm out of breath is terrible. I don't usually do them like that, like I do one and then I'll stop and think about it for a second. I'm like, you don't want to say that on the panel. Boom, I do that. And sometimes, anyway, I'm tired.

Unknown Speaker 31:06
Oh, wait.

Scott Benner 31:09
It's not the end of the show. It's the end of the ads. Here comes Mike. He's gonna answer a question that I just asked a moment ago, I'll even re ask it just so you know where we're at. If you had anything like that, just, you know, coming from a black community.

Mike 31:26
Oh my god, totally. Um, so

where do I start with this? Um,

yeah, man. I mean, essentially, to answer your question, it is hard pacifically having diabetes and being black because so much of the word what a lot of people would call like Southern food or soul food. I'm not the healthiest for you. You know what I mean? And so if you're Thanksgiving, and you know, your nine year old kid, and even today, even today, and your mom cooks candy, yams, collard greens, you know, Turkey, which is protein, which is fine. Cranberry Sauce for the the, you know, mashed potatoes are not the master for the stuffing, mac and cheese. I mean, all of that is very, very, it definitely plays a role in your diabetes. You know what I mean? Depending on your nationality, it's it was very hard. Growing up, as well as you know what I mean, just measuring how much insulin to take and what to eat, what not to eat. On average, a friend also who I went to college with, I won't say his name. But he actually told me that he had type one diabetes. And the reason why he told me was because he saw me in class taking my inhalable insulin one day, and he told me as I knew that, Hey, I got it too. And I was like, Oh, cool. I was like, so, you know, what's your a CT test? And he was like, No, he's like, I don't he was just like, essentially, like, you know, it is what it is. And I don't have I'm not gonna, you know, check my blood sugar and this and that. So, that was disheartening. And to touch on your other point. It's, it is, it's hard. You know what I mean, because a lot of people do feel hopeless. Like you stated, like, a lot of people do feel that, you know, this is what it is, this is my life, and I have to take pills, or I have to take shots, and I'm gonna die at 50. And I've accepted that. I'm just one of those people who, you know, unfortunately, for fortunately, for my diabetes, I'm a fighter. Yeah, you're not going out.

Scott Benner 33:57
All right. So,

Mike 33:59
no, no, and I've always been like that. So I just, I, you know, once I accepted that, I had it. I buckled in, you know what I mean? And I, I made adjustments to my life, and I'm still constantly trying to improve, I'm still trying to better myself and, and speak to different people and get their advice. And you know what I mean, just, but I couldn't, I can't go out. I can't just let diabetes take me over. Yeah.

Scott Benner 34:32
Give me Give me a second on that. Because it's just it's, it's sad when you hear somebody say like, this is my lot in life. And that's the end of it. And I think sometimes that becomes generational, right? Like some things. You don't learn from your parents as much as your parents got a little bit from their parents who got a little bit from their parents, that eventually just becomes a feeling. And it's sort of like anything else. Like you can get generational wealth, you can have generational poverty, you could have a generational malaise about taking care of your, you know, your health. There's, there's, like these ideas that build over time, I'll tell you what I see recently is there's a spike in type two diabetes in the Indian population. And, but their diets are so carby with, you know, rice and things like that. And when I when I speak to people from that culture privately, it's funny how they say, Look, I know this isn't good for me, but, and then this is the sentence that throws me off. This is how we eat. Like, it's a rule. You don't even mean like, Hey, I'm Indian, I have to eat like this. And, you know, our food is like this. And I said to a friend, I was like, you know, there's other food, right? Like, you could just you don't have to do that. You don't have to soak big beans and brown

Unknown Speaker 35:52
sugar and honey, before you eat them. You might be could just eat the beans, Mike, you know what I mean? Like,

Scott Benner 35:57
and so I get that generationally, it builds, and people start thinking of like, it's not Christmas Without this, or it's not my birthday without that, but man, you know, you don't get Christmas in your birthday if you're not alive. So,

Mike 36:10
you know, and, and, absolutely, and not even to throw anybody else under the bus. But to touch on that, too. So like, it sometimes, you know, even your family members will be like, Oh, come on, you can have some of this cake, or, you know what I mean? Or Yeah, you know, you know where that comes from insulin and

Scott Benner 36:28
right. But you know where that comes from? Mike, it's, they feel bad for you. And then then they skip over this is my opinion. But I think when someone says, Come on, you can do it. What they mean is, we're all eating cake, and you're making me uncomfortable, and I feel bad that you can't have some. So why don't we all just ignore for a second that your situation, and you eat the cake, so that we can all feel like this is normal and happy. And I don't mean to say that if you have type one, you can't have cake. I'm not saying that. I'm saying that. You know, listen, if it's a cake soaked in, you know, look or certain this so can that you just look at it and go, you know what, I'm just gonna stick with what I got here. Because this is just, I don't know how to Bolus for this, you know, then then I get that if you don't want to eat it, but I really do think that's what happens is that when you break from the norm in a group, you become the problem, even though that's not true. You don't I mean? Like, it's, it turns into a pack mentality. Like there's more people there who think you should eat the cake than think you shouldn't. And so suddenly, you're wrong for not eating it. And that's a weird, you know, human nature thing. But it could pressure a person into doing something they don't want to do. And you just sound like you're the one who goes, you know, No, thank you. And I don't mind being a little different. How did you go from the kid who wanted to take his pencil box in the hall to somebody who didn't mind? If people saw?

Mike 37:53
Um, it got easier the older I got, I'll say that you know what I mean? Because as you elevate, as far as schooling goes, and different things, like once I got to college, it was just kind of like, I see these people every now and then I don't see them all the time. If they have questions they can ask me. Um, I also think that having a community that embrace diabetes, specifically, I'm referring to the Instagram community, have hashtag T one D or type one diabetes, that where, you know, they wouldn't post inspirational stuff and really rally behind people who are going through the same thing that you are, it really encourages you and motivates you to, you know, what I mean? put the word out, I do you

Scott Benner 38:39
know, I I see it constantly, the power of sameness, I guess, or community, you know, whatever you want to call it, just looking up and seeing somebody who's got your struggle. It's huge. You know, like, it really is impactful. I always think of this podcast, sort of first and foremost about like management. But I, I get so many notes from people who are like, yeah, I managed fine. And what you do is cool when I incorporate some of it, but for me, I listen to this podcast I hear Mike on there Mike's The only person with Type One Diabetes I've ever heard speak out loud. That isn't me. And and it. It's interesting how it can be so many different things for so many different people. Like I feel like it's one thing somebody sees it another way somebody else sees another way. Instagrams the same way, like you don't know you put a picture up because you have in the back of your head, this is going to impact somebody like this. You have no idea how it's really going to help them. It's um, it's really fantastic, actually.

Mike 39:37
Right, and then that's something that we need to highlight as well, too. I feel like because oftentimes, and I'm not condoning this either. Social media is looked at as a negative thing, which at times it can be but again, in my mind is a tool. So you can use it to you know what I mean? Most pictures of you doing stuff and and you putting people down or sharing terrible news about different events going on in the world. Or you can use it to inspire, you can use it to motivate you can use it to, you know what I mean? touch someone who you might not have been able to previously, just based on geographic location. Yeah,

Scott Benner 40:19
no, no, I'm 100%. And listen, there's always going to be, you know, it's easy to say there's always going to be people who are negative, and there's always going to be people that are positive, but I've seen somebody who's negative be a positive person, I've seen a positive person be a negative person, I think people are just a different spots in their life, they use the relief that they have, I usually think of people who are, you know, kind of being kind of shipped online as just there's somebody having a bad day, you know what I mean? Now, I gotta bleep it back, because I can't curse. And and like I, you know, I don't think this is a person and don't get me wrong. I've seen people who just appear to be a, you know, a tornado of unpleasantness and hate, and then everything but, but but it's, it's not everybody. And to your point about it being a tool, like, Look, if I build a house with a hammer, that's amazing. If I go next door and kill my neighbor with it, hammers not so great anymore. And so you can do, you can decide you can pick that hammer up and do what you want to do with it, you can use your Instagram for, you know, for good, or you can use it to try to make people feel bad. I think sometimes when people try to make people feel bad, they're really just trying to make themselves feel better. And I mean, I've been in, I've been in the space a really long time. And I've had people come at me, oddly, you know, there's there, there are groups of people who don't like that I talked about just, you know, listen, just use the amount of insulin you need. You know, and so those people, every once in a while flare up, and they're like, You're killing people by telling them they can eat whatever they want. I'm like, I said, I didn't tell

Unknown Speaker 41:46
anybody to eat anything. I just told him

Scott Benner 41:48
understand how to use your insulin, like, I don't care what you do with that knowledge once you have it. But I think you should understand how insulin works. And what I have found in those scenarios is these people aren't like, I've heard people talk about them, or call them angry, and you know, like mob mentality and stuff like that. And I'm like, No, you don't understand what they're really doing. They got to a spot in their life with diabetes, where they were just, they couldn't find something that worked. And they finally did, they found this thing that worked for them. And you have to understand that what they believe in their heart they're doing right now is saving you and other people, they think they're saying, look, this works. My agency is amazing. Now I don't have spikes like this, etc, etc. You should pay attention to this. Moreover, this guy over here was talking about Be bold with insulin, he's

Unknown Speaker 42:37
killing you.

Scott Benner 42:38
You don't mean like, it's it's their opinion. And don't get me if they find my podcast before they find that they might be a person who's like a, just eat whatever you want. If you use the right amount of insulin, you don't know, they found something that saved them. And they feel they, you know, everybody who's listening right now knows what I'm trying to say that I can't get the words out on it's like, you feel like you have the ability to save someone. And it feels important to do you know, so I don't even take those people as angry. I honestly take them as passionate. And they get to the point where they're like, Look, you're not listening to me, you have to listen to me, this is really important for you. So I don't know, but I hear you. I wish I'd like to see a little more flowers and sunshine like myself, you know, I think there's I think there's a way to, to put your message out there in a positive way. And I love anybody who does it? Is that what you try to do with your Instagram?

Mike 43:33
Absolutely. And I'm glad that you you know what I mean? You said all that. Um, so as far as me like diabetes, I looked at my diabetes. And I really thought to myself, like a lot of times people hear this word, and they say it's a negative thing, there's a negative spin on it, you know what I mean? And that's, you know, a lot of my life is kind of based around turning negatives into positives. So even amongst, with, you know, being black, a certain degree, certain things have a negative connotation around being black, but my whole thing is trying to change that and spin it, which is why I started glucose gain. Which is, which is honestly, it's a, it's a brand. It's a brand that I started. It's something that I've been trying to do for I had that concept for like a year, two years, and I've just never really did anything with it. But it's a brand and, you know, obviously it's raising awareness about type one diabetes, but I just reach to the back of what I have here on the card. So for me, it's just about redefining what is negative and creating something positive. And I put like we are, you know, fighting against the odds, even when they're not in our favor. And that can be for anything. Obviously this is specifically directed to related to diabetes and type one. Because we are against the odds and you know, people Oh, my limb fell off, or I have numbness in my toes and we are fighting against the odds, but we're not giving up. And that's really what glucose gangs and for. Um, and so, you know, I think that staying motivated and doing different things. Um, speaking of tools, let me ask you, have you heard of a book called bright spots in landmine?

Scott Benner 45:32
Oh, Adam Brown? Yeah, yeah. And when I had him spin on a couple of times on the podcast,

Mike 45:39
oh, my God, God, if you talk to them next time, if you can, please just thank him for me because I read this book. And you know what I mean, it really did make a difference. There's some of the techniques, you know what I mean, the chia seed pudding, and you know what I mean, exercising and bolusing. I mean, this guy's great. Adam is really a good guy. I also have, like, because I feel like diabetes affects my psyche. Sometimes. Yeah, I also have a friend who got me what's known as like an awesome journal. And essentially, it's just a book where, no, it's blank. And you write why you're awesome. is whenever you feel like it, whenever if you feel down, if you feel like you're having, you're gonna start a great day, if you this whenever, if you're feeling like, you need to get something off of your chest is awesome journal has really helped me as well, like, psychologically with the diabetes and this encouraging myself and really trying to, you know, get into the right mind frame, because oftentimes with diabetes that affects not only our body, but like, also our psyche.

Scott Benner 46:57
I think a lot. Yeah, I think it does a lot. I see your, so that book is like, is like your own hype, man. It's just you can you can hype yourself in that book, just be like, just see, ya know, I mean, there's so much science behind that idea of just saying something positive, moving in a positive direction, believing in something even when it doesn't seem like it's true. You know, there's all different ways of saying it, I think. I think a says fake it till you make it, right. You know, just,

Unknown Speaker 47:31
you know, you, you pull out a book

Scott Benner 47:33
and be like, Mike, here are the things that are great about you, like, let me just remind myself all the things that I am or that I, that I've done the things that I dream about, or I want to be, and you know, it's pretty much the equivalent of your guy standing in the corner, grabbing you by the shoulders and yelling, get in there and kill him, you can do it, you know, you're just, I always, I always say that football must be the easiest like sport to like, coach, because really, in the end, after you've gone over the X's and O's, your job is just to whip everyone into a murderous rage and send them out on tour. Right? And so and so that they can, you know, fling their bodies into things that if they were thinking about it, they'd go, you know, I don't really want to do that, because I think I'm gonna hurt my head. But you know, you can you can jack people up to a spot where they believe in themselves, and then they actually can perform at a level that might not be, you know, what their norm is. And so, when you're doing that, what leads you to that journal, because I think you're, you know, you and anyone else living with type one are uniquely qualified to answer the question like, what? And so my real specific question is, day after day, living with type one, making your boluses you know, trying to keep your blood sugar in a spot thinking about your foods. Worrying about is my you know, is my is my second Uncle, you know, pissed at me for not eating this cake, all that stuff going on? How does it start to impact you as the day's build on each other? Like, how do you get to the point where you're like, I need this journal right now. Kind of a deep question. I'm sorry to throw it on you but but I'm looking for like, you don't mean like, How does it feel? Like is it is does it feel like you're carrying a box and someone puts another box on top of it? And that just keeps happening to the point where you think I can't hold all this? Or does it hit you in a wash? Do you feel like you're doing great, and then all of a sudden you don't like you? Can you put into words, I guess?

Mike 49:25
I would say Yeah, um, it's similar to what you said. It's like, you know, it comes in waves. You know what I mean? Sometimes in life, you'll be doing great. Everything will be fine. It's, you know, birds and pain and and, you know, family's good, everything is great. And then the next minute, you know what I mean? Oh, something happened that works. Oh, my girlfriend broke up with me. Oh, my blood sugar is out of whack now because my hormones are mad. It comes in waves, right. And it's just Is the book really the awesome journal really is a reminder to, you know what I mean? Keep going this to, you know, lock in and understand that these things happen. And even good times will pass and then there'll be bad, but then also be good again. Yeah, you know what I mean? one of my heroes, one of the people that I look up to the not the most, but one of the top three people that I look up to is a guy named nipsey hussle. He recently passed, I'm sure you heard back in March, the end of March. And his thing was, one of his models was just like, you know, again, life is, is it's a marathon, you know what I mean? So you're, there's gonna be some bumps, there's gonna be some bruises, there's gonna be some slip and falls, there's going to be ankle pain, there's, but there's also going to be victory, there's also going to be, you know, winning and being surrounded by your family, there's, there's life comes, this is how life is. And,

Scott Benner 51:11
but I'm just gonna say nothing lasts forever, just get you know, it's, it's, um, I don't know why some people learn it in a way that they're able to endure the bad times and get back to the good times, I don't know, if you have to be brought up in it to know it. Or, if you had to have a good role model that had it happen. I grew up completely broke, like we didn't have, you know, two sets. And I can't, I just saw my mom just never gave up like it no matter how bad anything looked, I never saw her give up. And, and when she got overwhelmed, she'd cry. And then she'd do it again. You don't mean like that. That was my, that's what I got to see. And when I became an adult, and I got into the world, and started, you know, working and having money, and then not having it and getting a bill you didn't think you could pay and things like that. I eventually said to myself, you know, you have these worries. And then inevitably, you always find a way out of them. Like always. So why, why when it's happening, see it is this horrible thing like this is going to kill me like why would I expect this thing's going to kill me? It hasn't killed me the last 50 times. You don't you mean? Like, at what point do I say to myself, this is the part where it's hard. I need to do this, this and this to get back to the part where it's not. And, and so I just sort of adopted that idea like that, you know, I know this is gonna work out because traditionally, and historically, it works out. So I'm going to stop worrying about it. Now, that might not be easy for everybody. Some people have, you know, real, like anxiety and depression issues that would would maybe stop them from being able to make that leap. But for everyone else, you're like, Man, you wake up every day, stop acting like it's not gonna happen, you know what I mean? Like it is the sun's gonna come up all the all the isms that you've ever heard in your life are true. And, you know, instead of wallowing in something that feels terrible, just look forward to the part where it'll be over. And you can, you can move on. It just makes sense to me. I love that you said that.

Unknown Speaker 53:21
And, and to your By the way, your your question, I actually do know, nipsey

Scott Benner 53:26
My son has a wide range of music interest. And he particularly enjoys rap music on the way to and from his baseball games. So I now have a wide exposure to music I probably would not have heard at age 48, to be perfectly honest with you. And I really do like some of it. I actually, I have to tell you, my kid was off at college, you know, and I missed him, you know, in his first semester, and I'm out in the car by myself. And I put some Meek Mill on so I could feel like he was there.

Unknown Speaker 54:03
I'm telling you, I'm telling you.

Unknown Speaker 54:09
I really

Scott Benner 54:09
wish Yeah, I really wish it was like warm outside the windows would have down in the people could have looked over to me and went look at that old white guy listening to me.

Mike 54:21
But it gives you that feeling, you know, I mean, it gives you that motivation that

Scott Benner 54:25
felt like he was there. Like it really did. It felt like we were driving to a baseball game and it made me feel better than I'd see him again soon. You know? I didn't think I'd Uh, I don't know, man. Like if you looked at my Apple Music, you'd be like this an eclectic mishmash.

Unknown Speaker 54:46
Oh, my God.

Scott Benner 54:48
Yeah, so, but But isn't it funny to not to get too far off the path but to talk about community that my son's best friend is black. And that's where it's at. Some of this music was introduced to him. And so if my son doesn't meet this boy, and they don't become great friends, he doesn't you know, he doesn't see this music. It doesn't expand what he thinks of as music. He probably gets, you know, stuck in whatever his friends are listening to. Doesn't get outside of it. When he gets outside of it. I listened to it. I get outside of it. I mean, don't get me wrong. There are some lyrics still, Mike that stopped me in my tracks.

Unknown Speaker 55:27
But I'm getting

Scott Benner 55:28
better at it. I sometimes this will make you laugh. I'll be like, hey, just now when he said that thing about this the G six What is that? Exactly. And my kid hates it. When I break down rap lyrics. He's like, stop it. You're ruining it. I was like, I know, I'm just scrolling with it.

Mike 55:44
I just wouldn't figure it out.

Scott Benner 55:45
Yeah, just real quick, when he talks about his woman's woman's like, exactly what is he trying to get at? My kid looks at me like do not ruin this for me, man. Do not make me think about what that guy is saying. I was like I hear. So I'm screwing with him a little bit. But but anyway. But yeah, I mean, he brought something into my life I didn't know about. And I think that on Instagram, with this podcast, any other number of ways where people are trying to reach out beyond where they are to people who they may never meet in real life and say, Look, I know you're, you know, I know your baked beans have brown sugar on them, come on over here where they don't, you know, like, check this out. Like, I know that you're scared of this and you don't like you know, inject them public. But I think you should I think you should, because maybe one day, you'll meet a guy at college? Who goes hell, yo, you have diabetes. Me too. And then you can ask him how you're handling yourself. And maybe you put it into his head like, man, I should be paying closer attention to this, you know, like, there's, we're always touching people like that if we let ourselves. But you know, if you don't let yourself reach to people, then then you're just in your little bubble. You're not helping them. And and conversely, they can't help you.

Mike 57:01
And that's the thing, man, we're all conduit, you know what I mean? And we're all, you know, not to get spiritual and all that stuff. But we're all energy. And we're all you know, having a human experience. So why not encourage somebody or help somebody? Or even just put something in somebody here? Never know how it can affect them? Or what it can do? You really

Scott Benner 57:25
don't you? Listen, I I can't tell you. Most of the feedback I get about the podcast is overwhelmingly positive, which I really appreciate. But sometimes people find the podcast at bad moments, and it strikes them really wrong. And then a couple of them are, you know, prone to sending an email. It's like, I listen to your stupid podcast, and I've had diabetes forever. And that's not how it works. And you know, this is not right, and blah, blah, blah, and, and then six months later, you get another note from they're like, well, I listened again. And I did try that Pre-Bolus thing. And that really did work. And my agency did come down, you know, and then this is it goes on and on and on. And then three months later, the next note is like I love the podcast so much. Oh my god. Okay, I see we're on a little journey together here. And you know, and but but if you don't, so Mike, I guess my point is, is that you can't always expect a big smiling, thank you back from somebody, when you reach out. Sometimes you just have to be able to say to yourself, you know what I said didn't reach that person this time. Maybe it will one day, maybe it won't. I've done what I can do, and feel good about that and move on. And, you know, to bring it kind of back around to what I said earlier. I'm sure when low carb diet people are attacking me, they feel the same way. It hurts, by the way if you're listening, guys, but I can take it and you know, like, like, but but I'm just trying to do what you're trying to do. You know what I mean? Like I found something that works. And I'm just trying to share it with people what they do with it after that. I don't, I'm not in control of you know, but at least it's there. And I mean, you said it a second ago like like, I'm the least like religious person you'll ever meet. But I don't even know if I think about spirituality, to be honest with you, but I am driven every day. By what I've seen this podcast do. And I, I try really hard every day to move it to someone else. Whether it's by recording one, editing, one, putting it up having a private conversation with somebody, I can't even show if I tell people I talk to people privately and all that does is make more people come. I'm telling you, I'm gonna have to get one of those like deli tickets where you pick a number, you know, I mean, like pretty soon. I'm not gonna be able to live my life. There's times like I'm in bed. My wife's like, what are you doing? Like this woman just got a question about premium justice. She's like, it's midnight. I'm like, I mean, she seems upset. You know? It's, um, it's hard to stop doing like once you've had a good impact on somebody, it's difficult to just flip the switch and not not do it again. You know what I mean? So Mike, are you trying to move? So when you when you say your Tell me your hashtag again? And

Mike 1:00:09
so you can find me on Instagram at fucose? Do you see oh s? Dang ba n g, Mike. And then I'm on Facebook too, but I'm more so on Instagram. But you can, if anybody has any diabetes related questions or anything, anything really, man, I'm on Instagram a whole lot. I'm trying to get glucose gang as a brand up and off the ground. So Scott, my friend, I will send you a T shirt, you will definitely be in the next round and also send one for your daughter as well. I just need your guys's sizes. You guys can join the gang. And

yeah, that's where you can find me cool.

Scott Benner 1:00:56
I hope people reach out and you know, you can broaden what you're doing and and reach more people with, you know, you being positive and sharing your story. It's all just incredibly important. And not enough people stick with it. By the way. I'm talking to everybody out there who has this, like everybody comes out of the chute. They're like, I've got an Instagram, I'm doing this. I'm like, yeah, go get them. And then you know, when they don't talk to a million people in the first month, like, What a waste of time? I'm like, No, it's not you like, you know, you really, you know, for everyone out there who thinks that they have something to offer someone else, please know that in 2007. My blog reached 110 clicks a month. That was 110 clicks a month. I guarantee you that while Mike and I were talking here 1000 people downloaded the podcast. It just it's, you know what I mean? Like, you know, and, and so it doesn't all happen at once. You know, you have to like you have to have something real to say you have to stick with it, you have to say it when you think no one's listening, because they're listening, they're just not getting back to you. And and you have to believe in it. And if one day you say to yourself, wow, this really didn't work right on, like, there's no shame in walking away from it. But if you see it building, even if it's building slower than you want it to, if it means something to you stick with it, because one day, it could be the one day, it could be the most popular diabetes podcast online, getting their name in. And I didn't intend that when I started. So you never know where things go. So I want to just encourage everybody, if you're if you're in Mike's mine, you know, mindset of helping people. Keep going, be positive, keep going. Don't give up. I will say this too. At the end. Mike, there's recently was an article recently where a writer said something kind of terrible about testing in public. And so by the time people hear this, it will happen months and months and months ago. In the old school sort of diabetes community that would have been met with a lot of positive explanation, Hey, no, this is why you're, you know, off on this, let me explain this to you and explain that to you. In 2019, this person got kind of jumped a little bit, like, you know, internet jobs. And I have to admit, like I heard a like, kind of an odd, you know, diabetes blogger say, I'm disappointed that this is how the community responded to this. This isn't how we used to do this. And I have to admit, I agree a little bit like there's, I get that it's upsetting. But just lashing out at people is not the way like you, you know, it's easy to say you should educate, you know, and and that'll elevate and I think that's right. And I get that sometimes it's angering, but trust me, I've seen this for, you know, I'm coming up on a decade and a half here with this. Yelling back at somebody, it's not going to do anything. Like it just it falls on deaf ears. So if you just keep putting good information out there, hopefully more and more people will pick it up and less people say something stupid.

Mike 1:03:59
And I think too, I mean, it's, you know, how many times have you heard this? It's not what you say? It's how you say it. I'm a huge believer, I definitely believe that. So you know what I mean? They could have said what they said it's just maybe they could have cried they should have crafted it a different way. And you know, again, on the on anybody to judge anybody, I'm sure I've said some off the wall things some people before but putting that out there

Scott Benner 1:04:29
now pay for if you have another minute, it's so funny you said that because because just last night my son was with me when I was talking to somebody about diabetes, somebody who's got no idea about the things we talked about on this podcast, who's just living meter and you know, and meter and pen. And so we sat and explained all this stuff. And we were driving home and my son said, How do you do resist the urge not to say to him, like just get the glucose monitor. And like, like, you don't I mean, he's like, he's like, you know, yeah, right. And I was like, well I said that people don't hear that like, well, like, you know, like, and nobody needs me telling them what to do. Like, my best bet here is to give them an honest assessment of what I think the technology does. And they're going to need to decide like, he can't just thrust things on people, but my kids 19. He's like, just tell him to do it. And I'm like, yeah, it doesn't work like that, you know? And I said, I know what makes sense. Right? Like, like, we have all this data over all these years. We know what it does. You know, we're sitting there with, you know, a couple of days removed from my daughter's last day one. See, that was like five and a half. And I can tell and I can tell you, it's, it's, it's because of

Unknown Speaker 1:05:37
the data,

Scott Benner 1:05:38
right? Yeah. So you're very nice, thank you. But it's because of the data. It's like, I can make good decisions based on the data. And this person that we're talking to, doesn't have that data back. And, and therefore it's difficult for them, they could afford it, they have insurance, they wouldn't mind wearing it. And they're just understandably averse to just trying something new. And, and I think that's, you know, it's a good lesson for everybody out there who's trying to help somebody else is that all you can really do is be you know, you put up an example, and hopefully somebody will say it, it's no different than parenting or anything else in life. You can't, you know, you can't make people do things they're not ready for you can't make people do things they don't understand or they're scared of the best you can do is help them be comfortable, show them why it's important. And hopefully they'll come to it, you know, and if they don't, you did your best, that's all. So I love what you're doing, Mike, I really appreciate that you're out there. Thank you.

Mike 1:06:36
Thank you. Thank you for the opportunity, and a pleasure.

Scott Benner 1:06:42
Don't forget to check out Mike on Instagram at glucose gang Mike. Thank you so much to Dexcom on the pod touched by type one, and the Contour Next One blood glucose meter for sponsoring this episode of the Juicebox Podcast. I hope you guys are all doing well. getting along as best you can with your family as you're living so close in quarters. I'm going to try to take a nap. But first dexcom.com forward slash juice box my Omni pod.com forward slash juice box Contour Next one.com and touched by type one.org. Check them out if you get a chance

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