Scott Benner 11/19/18 Scott Benner 11/19/18

#195 T1D Ryan has a DIYK9

Ryan has a do-it-yourself T1D service dog….

As Ryan fights to be a police officer with T1D his journey leads him to train his own diabetes service dog.

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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
Friends, Welcome to Episode 195 of the Juicebox Podcast. I just want to take a brief moment before we start and talk about Thanksgiving. This episode's going up just a few days before the holiday in 2018. And I'm seeing a disturbing amount of blogs and podcasts and people talking about, oh, it's diabetes, Thanksgiving, you can't win, just do your best. You know, don't worry about it if your blood sugar's high all day. I don't think any of that's necessary. And I simply don't like it. So if you have 15 minutes, when you're done listening to this, go back to Episode 139. It's a quick sit down that I did last year that just talked about how I was going to handle Thanksgiving, give it a try. Don't just accept that's just diabetes. Okay, so as the fourth year, that's correct, as the fourth season of the Juicebox Podcast comes to a close here through November and December, and we reached 200 episodes. I want to take a minute to remind you and me to be perfectly honest, that we couldn't have gotten here without the sponsors. That dex comment on the pot have been with me forever. And I want to thank them for that. I also want to thank them for re upping for 2019 Yes, very excited. And there's some more advertisers that are going to come on in 2019. I also don't want to forget the time that dancing for diabetes has been spending with us. Now dancing for diabetes has had their big show, but they are still going strong doing great work for kids with type one in the Florida area and beyond. Please take a minute, at the end of this episode to listen to a package piece. The dancing for diabetes made that I'm gonna I'm gonna put for you at the end. So you can listen I watched the video you'll hear the audio. It made me cry. But none of this good stuff happens if you don't click on the link, right. So if you're looking for an insulin pump, you want to go to my on the pod.com Ford slash juice box. You want to CGM you want to see what your blood sugar's doing. I know you do dexcom.com forward slash juice box and of course, dancing for diabetes.com that's dancing the number for diabetes.com. Listen closely because this is gonna blow your mind. Brian has type one diabetes for a long time. He wanted to be a police officer, he became a police officer. He had trouble with that because of his diabetes, he had to move on. He's trying to be a police officer again another part of the country. While he was there, nobody decided to do train his own diabetes alert dog. And more. I mean as if you'd need more, but there is more. A chock full episode. Please remember, while you're listening that nothing you'll hear on the Juicebox Podcast should ever ever, ever be considered advice, medical or otherwise, always consult a physician before being bold with insulin. And Happy Thanksgiving.

Ryan 2:59
My name is Ryan. I've been type one diabetic for about 16 years. And I always wanted to train my service dog. So I did a couple of classes and I read a book. And I got after it. That's crazy.

Scott Benner 3:13
So how old are you now?

Ryan 3:16
3116 Oh

Scott Benner 3:18
geez. This is like one of those like, even things let's do 1515 years about right look at me.

Your story is interesting. I think in the dog is a really interesting and I definitely want to get to it but there's you have a bigger picture so so diagnosed around. Alright, diagnosed around 15 years old. Was there any diabetes in your family or anything? Any autoimmune that makes this like not that surprising? Or were you guys surprised?

Ryan 3:51
absolutely shocked. no family history at all.

Scott Benner 3:55
Okay. Pretty standard presentation. You're paying a lot. Your parents are like, Hey, what's wrong and we went to the hospital or was it? Do you have a crazy story?

Ryan 4:06
Exactly. Nope. You nailed it.

Scott Benner 4:08
The easy one. Yeah. Ryan, you're paying a lot. Let's go to the doctor.

Ryan 4:16
And he smell really bad to

Unknown Speaker 4:19
what a bonus.

Unknown Speaker 4:21
Where were you live? Like,

Scott Benner 4:22
what part of the country were you living in when you were when you were diagnosed?

Ryan 4:27
I was in Northern California. Okay.

Scott Benner 4:30
So you became you go to college?

Ryan 4:33
Yes, sir.

Scott Benner 4:34
Okay, and so after college, you became a police officer?

Unknown Speaker 4:37
Yes, sir. Okay. All right. And

Scott Benner 4:39
was that like, kind of like a lifelong goal? Was that something you always thought about doing or did you fall into it?

Ryan 4:45
No, you know, at 18 years old, I thought, I didn't want that job. And then as I got a little older, I had some friends that were cops talked me into going for it and I actually went back to school and that's what I ended up doing. Going back to school to do and I got in a little bit later, but I was in my later 20s.

Scott Benner 5:04
Okay, and so you became a police officer with diet and there was no problem having diabetes becoming a police officer. I know some people talk about that sometime they always say there's some things you can't do. But I know there's a state trooper local to me that has type one and and so that was never an issue like guns. Did you go the academy? Or did you take classes specific to being a police officer in college?

Ryan 5:26
I did take specific academic courses related to police work. And then you I've had to go through their academy just further requirements. And you also have to do it to be licensed or to be valid through the state. Right, right.

Scott Benner 5:42
So how long are you still a police officer now?

Ryan 5:47
Currently, I work in the private sector. I'm waiting for some paperwork to go through. And I'll probably be working out here in Tennessee fairly soon.

Scott Benner 5:55
Okay, so but so that's what we're getting to really as you move from California to Tennessee, was the move anything to do with the trouble you had at work?

Ryan 6:05
Ah, a little bit. You know, the agency I work for, I guess it should have been a red flag when they said, the doctor called me and said, Hey, I want to hold you back three months when I was going through medical review. And it's required that every goes for medical review, and I totally get it. You know, we want people that have good agencies. And obviously, you don't want somebody passing out on a call for service when there's a dangerous person. And they said, Well, we want to hold you back for three months and monitor your glucose levels. And I you know, I told him, I said, Look, you know, my onesies are good. I don't have the perfect number every day every time like most type ones, but I haven't had any issues. And they were like, Whoa, you know, it was like, what are your episodes you talk about? You go to the endocrinologist? Maybe you feel like the endocrinologist is like, the humor blog. Is that for type twos? Is that oral?

Scott Benner 7:01
You're like I'm talking to somebody doesn't know what they're talking. And so they So basically, they wanted to get a baseline for you to figure out what you were doing. They wanted to track your blood sugar's but he didn't want you to walk into a room, pull out a gun, yell, freeze, and then fall over. And that's what they were. That's what they were worried about. Like, Hey, I'm dizzy. Would you hold this gun for a second while I pull out a glucose? Right? Can we ask pause this crime for a second?

Ryan 7:23
Yeah, can you do me a big favorite? Don't run my blood sugar. panelo If you could just listen to me, that'd be great. It's one of those days, man.

Scott Benner 7:30
It'd be wonderful though, if that turned out to be if there was just like, Ah, this poor guy. Yeah, let me just get the handcuffs on.

Ryan 7:36
Yeah. In the back of the car for you. But

Scott Benner 7:40
so Okay, so there's an understandable like, you know, there's like, maybe they don't have a ton of, you know, experience with type one or maybe they do and this is just how they do it. But they put you through this review. Did you make it out of the review at some point or how did that go?

Ryan 7:54
I did. The doctor called me back and he was like, Wow, I've never seen anybody with such great numbers. And I'm like, come on. I I'm not the perfect diabetic but I have good a one sees you know, between a six five give or take, you know, um, your average daily injection. You know, it was like, it's like, oh, no, you're fine. We're not gonna hold you back for three months we'll skip you through

Scott Benner 8:19
Okay, and so you so how long would you be on police officer it's a it's something you work towards all going really well. And then it doesn't go well how long until it doesn't go well.

Unknown Speaker 8:30
I want people to know that diabetes doesn't define you. I want people to be inspired. And if they even have type one that they're not alone and that we can do anything we put our hearts to

Scott Benner 8:48
dancing for diabetes wants you to know that you're not alone. If you're looking for inspiration, could it dancing for diabetes.com

Ryan 8:58
I felt a little uncomfortable in the first first day of the academy that the guy he came up who had us do the physical portion of it and he was like you know the guy who trains us in our defensive tactics and they run and have a few push ups all kinds of fun stuff.

Scott Benner 9:15
Make sure you can catch the guy who runs away although Ryan if you just drive after him with your car and just kind of give him a drink with the door I think that works in the movies that probably works in real life too so but but so you're going through your physical fitness right on the first day you don't you're not this guy's picture of what physical fitness is. Is that about what happened?

Ryan 9:35
No, I was actually runner up for like the athletic award but he was like you know I want you to keep your glucometer up here in the front of the class so I know where it is at all times. And I said you know sir, I I really appreciate your concern but I really prefer to keep it on me in on my at all times. And I have my glucose levels and if you ever need it if I'm ever in capacity, which knock on wood has never happened in my right pocket and that that just didn't build Well,

Scott Benner 10:00
so that's interesting. So you're, you're a standout in the class, you know, athletically. And and yet he, he needed that meter with him for whatever reason in his mind. And so did you keep the meter with him? Do you think that was the first time you were like, Where did he win? Where did that meter end up standing up in front of the class? You made it through the class, okay? Or did you not even get through the class because of this person?

Ryan 10:25
No, I was doing okay. In the class. You know, it was just I just told them, you know, look at Tom's I just gotta do my thing will take me 10 seconds or less. And he had gone through a very traumatic incident off duty. And he had, he came back to the Academy, he was gone for a couple of weeks for everything had to get cleared administratively. And I went to I started checking my blood sugar. Right, when when we were done with the physical portion, I would check because I noticed I'm starting to have a pattern of blows on the schedule, and just learning the routine of the Academy. And long story short, he yelled at me for checking my blood sugar in front the whole class, so it just wasn't. I thought it was rather frivolous.

Scott Benner 11:07
Yeah. And so does that. Is it something? How did you handle that? I guess it's my question next, when that happens, where do you go from there?

Ryan 11:15
I was really upset. And I was ready to take off my belt and yell at them and say, Hey, this is how you want to do it. I was I was really upset. I mean, I walked off and, and he walked over and later apologized. And he actually, after that, he was actually a great guy. He, you know, later on, he just said, Well, you know, I'm sorry, I thought I was looking out for your best interest. And that that wasn't the worst part. It was more actually, after I graduated, he go through what's called a field training officer, you have basically it would be like, you're the senior guy running the podcast. So you tell me all your tricks and how you do it. And and this is what you got to do your paperwork, this, this, this and they evaluate you. And this guy, you know, he he wrote me up for checking my blood sugar in the car, and he actually talking about it. And I like looking at the administration, like, isn't this liability on your part?

Scott Benner 12:09
Should he not be admitting to us?

Ryan 12:12
Yeah, and then, and then one night, I went to check my blood sugar in the report writing room, which is a sterile environment. I mean, it's safe. It's inside the station, right? And I'll just type it up my report. So I stopped real quick. And there's hand sanitizer there. And I poke my finger real quick. And it just goes, you know, can you not do that here. And I'm thinking to myself, you know, if I, if I go into that wall, as I walk into the bathroom, you're going to be out of a job. And, you know, I don't want to mask the law enforcement community they've got, they've got a hard job. But

Scott Benner 12:43
did you think it was a personal thing for him? Like, do you think the blood threw him off? Or do you think like, was he making a business decision when he said, I don't want to check in your blood sugar here? Do you think it just made him uncomfortable? Could you did you get a feeling?

Ryan 12:55
I I don't know. I mean, he wanted to scream and yell that everything.

Scott Benner 13:03
This guy was looking to yell, and there you are with your blood sugar. And he and you are an easy target. What was he yelling at other people as well? Just over different things?

Ryan 13:12
Yeah, I mean, he, it was an interesting person. So

Scott Benner 13:16
okay, so so so you're but you're working? I mean, you're on the street, right? And but you get written up for checking your blood sugar, which is crazy. And is there a point then when you think like, maybe I have, like a union representative here? Or like, I don't see I? Because I think I don't think there's a wrong answer to how you handle things. I just think it's in a real world situation. It's interesting. It's like, when do I rock this boat? Like, do I just sit back and let this guy have his way and try to keep the peace on my end? Or because you know what I mean, because once you once you push back in a real way, you're involved in a different situation, then it's not your fault when that happens, but it still needs to be considered when you make the decision.

Ryan 13:57
That's how it works. You're correct. They have a very strong union there. And I wasn't off probation. I was still in training, once you're out of the academy and the union, basically what that informally translates to that, unless something really, really big happens, they don't really care. I told the supervisor, and then I told another supervisor, and they just looked at me and kind of brushed it off. They didn't really acknowledge it, they didn't document it. So I I resigned as a result of it. I just said, you know, this job is not worth my life. It's not worth my kidneys. It's not worth my neuropathy. Or you know, I don't want to develop

Scott Benner 14:33
Yeah, you think we were you actually said the pressure it stopped you from testing when you wanted to and you realized it was gonna that was what it was going to be and you didn't want to be involved. Now that did that sucks because that's a lot of effort. Right? Like you went to school. You put in that effort. You went to the Academy, you put in that effort, like how much time did you have into getting to that spot? Do

Ryan 14:53
you think? Oh, yours? Yeah.

Scott Benner 14:58
I don't know what to say other than that. It really sucks I'm sorry. But now you think you're you're back at it. You think you're in a new you're in a new place in the in the in the country and you're you're looking for a job in law enforcement again, you think you're close to one?

Ryan 15:11
Yeah, yo, it was really interesting. I can't say too much because I'm here in Nashville, Tennessee, and what am I sure fate would have it? What am I good friends I end up meeting out here is actually works for Nashville Metro completely unrelated, just coincidental. And, you know, he kind of talked me into applying, I told him very openly about my experience. And he was like, Well, here's the thing in Tennessee, if you do that, here, you're going to get fired. Because if that would have happened to you here, that person would have been fired both of them. And if you would have gone and formally told the supervisor, and I openly talked about backgrounds, because before you get into any capacity of law enforcement, they do a very thorough background check. I mean, they come to your house, and they have a 50 page packet. And they openly, I openly wrote about my experience, and I felt like if it was going to negatively reflect me, then I don't want to be here. You know, like, I'm more than happy to be here. I want to work just as hard as athletically. I mean, I'm not a gazelle. I'm not gonna make the Olympics anytime soon. But I was, I was runner up for some of it. I just, I'm not a fast runner. That's worked against me. But everything else I was pretty good at. And I ultimately talked about it. And I was like, Look, I was a great wrestler in high school, I was looking at code for sight. I still do a lot of martial arts. It doesn't restrict me athletically, it doesn't restrict my strength. It's been Olympians, as you've interviewed. And they, they didn't care. They were like, Okay, well, we think you'll have a different experience here.

Scott Benner 16:43
Excellent. Oh, that's great. And I agree with what you said, too, because I often think that like, if you just, you have to put it out there however it is. Because if someone doesn't like it, like you said, I'm used the words I would have used like, I don't want to if you don't like this, I don't want to be here. You know, like, it's why would I go through this again? And you know, torture myself again? Let's find out on day one, if you're the kind of person who's not going to want me around, and let me get out of this, you know, before I even get in and waste all that time. I think that's really smart. I really do. And look how well it worked out for you. You found people who said Now don't worry about that. You're good. That's that's really actually you're in the process. Now there. Yes, sir. Yeah. Good for you. That's so how long is the distance in between time? So how long ago? Did you leave the other department?

Ryan 17:28
About two and a half years ago?

Scott Benner 17:31
Okay. And so did you consider not doing it in between that? And like, was it something you kind of gave up on until you met this person to talk to you into turn?

Ryan 17:39
Yeah, you're pretty much right on that.

Scott Benner 17:43
Well, it's a shame. I mean, it's it's, it's it sucks that you know, it sounds like you were you would have been one of the you know, one of the leaders in that situation and then be this guy sees your blood sugar meter and that it just sucks. You know, like it really it really does. I'm so happy that you feel like you've found a place that's not going to be like that did that experience at that first apartment did that change anything about how you felt about your diabetes or how you treated it and like the you find yourself being less public about it or anything like that. Let me read you an email I just received. Hi, Scott, thank you for your podcasts for helping us to be bold with insulin. Our daughter was diagnosed in January of 2014 when she was four years old. And we've been taking pretty good care of her with a one sees that of range between the mid sixes and the mid sevens. Yesterday at her quarterly endo visit, we got an A one C of 5.5. We credit a lot of that to your podcast, but also to Dexcom. And on the pod. Your podcast gave us the confidence to use these tools the way they were meant to be used. Now when I get this email, I am incredibly inspired to think that people are out there using the Omni pod the way it's supposed to be used. Temp Basal extended bonuses, no tubing, not tethered anything feeling the freedom, living life. And getting results like the ones you heard about here in this email is so easy to try it for yourself. Because Omnipod offers a free, no obligation demo, all you have to do is go to my omnipod.com forward slash juice box or click on the links in the show notes or Juicebox podcast.com. Fill in the tiniest bit of information about yourself. It is really just your name and your address. And on the pod will send directly to your door. A pump, you take the pot and you place it on your body and you wear it for days. So that you can see just how wonderful it is. Once you've decided it is wonderful to just keep going with the process. And the next thing you know, you're writing me an email about your a one C and how it's 5.5. Of course your results may vary but the demo is 100% free and there's no obligation so give it a try that experience If that first apartment, did that change anything about how you felt about your diabetes? Or how you treated it and like the Jew, find yourself being less public about it or anything like that?

Ryan 20:09
No, I just kind of figured, you know, that guy's gonna end up getting what he deserves. When he asked to go to a court of law, he's gonna have to answer to something. Because those people never last throughout the law enforcement community. You know, I mean, you might get away with it once or twice, but eventually, you're going to start stacking up complaints. And the laundry list is going to build and you're going to get reviewed one day, something's going to come up, and they're going to look at Oh, wow, hey, Scott has about five complaints. And Ryan over here has about 35. And they've been working in the same district, same time. Maybe we need to look at Ryan. But

Scott Benner 20:47
it also didn't change you personally. Like really, you didn't find yourself being more private about it or anything like that?

Ryan 20:53
No, why do you go get a service dog. I mean, I graduate canine I ended up in this job I'm working now I'm basically working in Tennessee, they have a very big, it's not security, you're actually considered private duty law enforcement, but they have a very big industry out here for it. And I ended up getting by sheer coincidence paired up with some hands and some retired canine handlers that I could kind of pick their brains about, you know, guys that were trying to scent detection for, for all kinds of stuff, you know, drug bombs. And it's the same theory, you know, essentially, our blood sugar goes to the second it goes higher low, there's a sense that you're just applying that training in a different context.

Scott Benner 21:36
And so so you see, you think to yourself, again, because you said your injections, right, you still you still do injections. And do you have a glucose monitor?

Ryan 21:44
a yes or no CGM and daily injections.

Scott Benner 21:47
Okay, so you're, you're, you're pretty old school. And, but but you, you decide you want to try to get a service dog, you found out they were incredibly expensive, I guess.

Ryan 21:58
20 to 40,000.

Scott Benner 22:00
That seems like overcharging. If it costs more than your car, you're in trouble. I think. I don't care what it does. By the way.

Unknown Speaker 22:09
a college education

Scott Benner 22:11
found me a flying dog. I wouldn't pay 40,000 dogs, because dogs just gonna fly away anyway. So. But so Okay, so you look into it really expensive. And there are this is very important for people. No, there are plenty of people who will try to take advantage of you and overcharge you for a service dog. If you do the process of picking the a reputable place is is very, very important. Or you could end up with you know, you your blood sugar goes low the dog pees on the carpet and and you're out 40 grand. And you know, it's but you figured out how to train it yourself. So this is this is incredible. So, so first of all, what made you think you could do it? What was it having the conversations with the guys you were paired with? Who had done in the past?

Ryan 22:58
Yeah, you know, so, a while back when I was actually working in law enforcement, I had a dog for a car. And I hear this, you know, the suspects in the back of our my car, meaning you know, the cars clear. And the dog I hear my hand like, No, no, no. And I hear that dog's paws kind of like, you know, like, like, if it was scratch, we got a door, the dog with the steering wheel. And I worked with another canine handler that was leaving the department and he gave up his dog he surrendered his dog and I'm like, and that's your dog like they make movies about this. You'll give up your dog.

Unknown Speaker 23:36
That's like a

Scott Benner 23:38
that's like a Disney movie moves to a farm with that dog I think and

Ryan 23:44
yeah, we can write a story yourself that we could we could really make this big. And I anyways, I ended up getting paired up with the guy at a job site and we had some time to kill and we were waiting. We were just talking and and he goes yeah, I'm a retired canine handler out of Indiana. I moved here you know after I retired blah, blah, blah, blah, blah. And I said Oh, really? I said hey, you know i ironically enough, I didn't even pick them out. It was my significant other Gina. She was like, oh, when we moved to Tennessee, it's very pet friendly. And I said, You know, I want to rescue a dog from the pound. And that's where I found Baylor. And Baylor was about six years old. We adopted him and he was a mess and he had been returned to the pound. I didn't know too much of the circumstances. They later on told me once I brought him in with a service vest and showed him all the videos, everything I did. And the lady told me because I promised her she cried when I adopted them and I promised her I would take them back there. And I would take great care of them. And she she told me a little bit about his background. They just said he wasn't a good dog. He was surrendered with his brother and they said he was really destructive. And one of the things people don't understand about working dogs is you have to have a dog that has prey drive or high energy because if they are not, they're not going to work.

Scott Benner 25:04
My dogs are laying around right now in two different piles. So I don't think I could get them to do anything to be perfectly honest, coming. If I don't want to say that loud because it'll end up with me, but I don't even know that walking across the room would motivate them. If there's food over here, and they'd be like, it'll be there later, won't it? So but so what kind of dog is a is is beller.

Ryan 25:26
He is a lab. And I think he's a pit mix because he's got a big broad chest, but he's got the stocky legs and the long lab nose and body. So you didn't just adopt a dog you adopted a hard lock dog

Scott Benner 25:39
like this dog had been given away by somebody picked up by somebody else in that person to come back and be like, Hey, I chose the wrong dog. Please take this one back again. And so he was kind of a two time loser by the time you got him. And and you really changed his life and yours I imagine. So what's the first step is the first step just getting him to be like a better pet like a more compliant animal? I guess is the beginning part of it. You can't you'll do you just dive right in with the blood sugar stuff.

Ryan 26:07
No. So that what the canine handler suggested I did because I'd taken a class for a diabetic alert service dog. And this class was actually intended for people that were interested in this charity, but we were moving from California. So we weren't going to be eligible, which I found out, of course, at the end of the class. And I'd read a book and I found online some more information on how to make samples and everything. And this guy's goes, Hey, so this is what he was the retired canine handler at Indiana that I got paired up with and I told him all about them because to start breaking them in off leash I go the dogs mess. I can't even walk them. I remember one night, I was walking and he's pulling, pulling, pulling and somehow he ended up into a car. I'm like, ah, Baylor you were wearing me out, but I mean, he was like a parked car. Who does that?

Scott Benner 26:58
Yeah. Was there ever a moment that beginning where you thought this is why this dog has been returned to them?

Ryan 27:05
You know, I guess you're gonna try him. That's what she said to me. She goes, she's Are you sure? And I said, Hey, you know, the dogs aren't perfect. I've seen them work in action. I've seen them do some amazing things and they're never gonna be so anyways, he he said, Hey, get a prawn collar and start breaking them. And he gave us some tips. He said, start breaking them in off the leash. And as soon as I started breaking them off the leash, took about three days. And he really started to excel. And then more obedience commands because you have to remember I had to think to myself like I've taken a 95 pound dog out in public. I have to be in control the stock or who knows. You know what can happen?

Scott Benner 27:47
You're well intentions turned into a lawsuit and the dogs hanging off someone's leg and you're like, yo, whose dog is that and you walk away? That's how I would handle it by the way. Oh my god, someone's dogs gone crazy. Call the goodbye.

Unknown Speaker 28:02
I don't know how that tag got on. That's not mine. So

Scott Benner 28:04
you don't call my house? No, but I mean, listen, it's very obviously very responsible and obvious. Like you can't you can't go out in the world. That's a big animal. And like you said, like if he if he decides to do something, you don't want him to do it, that's not a good situation. So you get him. Your his obedience training came along pretty quickly for you.

Ryan 28:22
Once I started breaking them in off leash it, it started to click, and I told them when I had intentions of doing, but I was struggling with it. And he goes, Well, this is gonna sound cheesy, but once you start to break them in, and you guys do more obedience training, you guys are gonna bond a lot more. And once you get them broken and more to the service, animal training, if it's a good fit, you guys will really take off. And one of the things I've noticed with all the handlers I've worked with, and the guys, you know, talking to them experience and watching the one to do work well in public, with their animals. regardless what it is, is the ones that do well have a good relationship. It's that simple. If

Scott Benner 29:02
that makes sense. It really does. Listen how much Let's beat let's so people don't get too excited. While they're listening be like I'm gonna do this too. I'm going to teach my, my laptop lot whatever those dogs are called to find out my blood sugar. So how much actual time and effort Do you think you put into like, if you had to break it down into months and hours? How much effort did it take to train Baylor to be a diabetes service dog for you?

Ryan 29:27
I would say approximately six to eight months, approximately and I was putting in I tried to keep the training sessions around 30 minutes, sometimes an hour. You know, it just kind of depended on his attention span or I try to break it down to where I'd be doing 25 minutes and then i'd i'd if he just wasn't wasn't having a good day, which is going to happen. Then I would stop and I would say all right, let's look Do this later. Yeah. I was. Kosh, I didn't think the hours but now.

Scott Benner 30:06
Yeah, it's a daily and it's not something you do on Monday and then forget about till next week like it's a it's a real constant. It's it's, you know, it's a real constant responsibility, I guess once you decide to do it. So what happened? So, are you just still amazed? Like, I would still look down once a while and be like, Oh my god, I trade this dog to do this thing that I would be amazed by that personally, but like, how does it work for you in your day to day life? How does he help you?

Ryan 30:36
Well, I don't take him everywhere with me. But he helps me tremendously. You know, down the road, I would like to switch to Dexcom and CGM and all that Omni pod. But I mean, there's been times you know, when you're having those bad days, and you're chasing that high, and then you're chasing that low. And what I didn't know at the time, and I thought he wasn't performing correctly. At first, I wanted him to notify me I set my numbers at 80 and 180. But what I didn't realize is that they can read ahead of our glucometers and our CGM. And so example, you check Arden's blood sugar, and let's say you didn't have the dexcom, the great technology that they they produce, let's say, and you check it, and she's at 85, you're like, oh, you're going to bed your blood sugar is at 85. This is perfect. And she's like, but that I feel kind of funny. And I feel like I'm going Oh, no, no, no, no, just ignore it, you're fine. And sure enough, 20 minutes later, she's at 40. And they can detect that. When I've had the this doesn't happen all the time. This has happened a couple of times off top my head. But Baylor has caught me when I've been at 120. And then I didn't believe it. At first I thought he wasn't working. And then I checked my blood sugar 20 minutes later, and I'd be down, going 85. And I'm like, yep, you're going low. Your blood sugar's rapidly dropping, you know, or couldn't believe it.

Scott Benner 32:03
He has a predictive low alerts, which is something they just added to the new Dexcom g sex.

Unknown Speaker 32:09
Oh, wow.

Scott Benner 32:10
Yeah. When it tells you like 10 minutes before, you're going to get low that you're going to get low. But that's amazing that Baylor does it. So that's a it's fascinating, actually, what do you think he senses? Is he actually because your blood sugar is legitimately 120? And you know, in that moment, let's say I guess there's there's something about your physiology that gives off that it's happening, but hasn't happened yet? Or is that is that?

Ryan 32:36
Is it a sense? So yeah, all I know is in the class, what they told us was the second your blood sugar goes low, or the second your blood sugar goes high, you instantly produce some sort of scent, and our range of smell, cannot smell that the dogs can smell approximately, I can't remember the one guy heard the seals. He was he was he worked with dogs in the seal program. And I can remember he said 30 times better 300 times better, but the point is way better than us their range of smell. So it has something to do with that. I don't know all the science. I just know how to make the samples. And that's that's what I'm looking for.

Scott Benner 33:20
It's amazing. And so how do you do that? How do you make the samples like to train him with? Okay, I don't know if I can do this in two minutes. But the other day, and you can see this as a blog post on my website. I'll put a link to that. But the other day Arden and I went to lunch for art and had chicken and waffles. So using the data that we get back from Arden's Dexcom g six continuous glucose monitor we were able to go into I'm going to look here, I want to make sure I get this right. We were able to go into the restaurant with a blood sugar around 120 and 1234 hours later, Arden's blood sugar was still right at 120. She had waffles, it was a weird meal, waffles, potato chips with cheese, real syrup. And we never ever once counted a carb. How do I do that? Super simple Pre-Bolus. Watch the Dexcom for responses stayed fluid gave more insulin when needed. It's all spelled out in the blog post. It's really easy to understand there that's at ardens de.com. It's actually you know, ardens.com forward slash blog forward slash waffle, but I'll put links in the show notes here. That's not the point though. The point is, if I tried to Bolus for a waffle with real syrup, after an appetizer of potato chips with cheese, I gotta tell you, I would have botched that without Dexcom. I totally would have watched it without on the pod because we did Bolus and Temp Basal and things like that. But this ad is about Dexcom go to dexcom.com forward slash juice box. To learn more, or go check out the blog post and scroll to the bottom, you can click on a link for Dexcom there. If you go to that blog post and see Arden's graph from those waffles and don't think I want one of those, I'd be really surprised.

Ryan 35:11
So you need to have a clear mouth. And when I say clear mouth, I mean, you can't have soda coffee on your bras, obviously, no alcohol for about 30 minutes beforehand, and you pick your numbers. So mine was 80 and 180. And then when you make that you buy sterile gauze pads, and you place them in your mouth, they'll come in your saliva, and you'll probably have to drink some water because you'll be like, cotton mouth dies. And you throw them in the freezer. And then I've purchased sterile six ounce bottles similar to like a small travel carry on like for the airport size shampoo bottles, but they were sterile. And I made three samples, meaning I made a Hi, hello. And I made a fake one. Because when I was training him, I didn't want him to just pay me for treats. So that's, that's how I did that. That's crazy.

Scott Benner 36:06
And so you make these ahead of time. And then how do you sue you just I so what's next I take the sample and what do I do with it to train him?

Ryan 36:17
So I just went with high and my theory was I don't know if this is accurate. And I'm sure there are better people in the world that know I have more information on this. And a lot of first responders I talked to paramedics and cops and aunties and say when a blood sugar goes high, when they have a diabetic they can always smell it on them, which is not always true. I've never been able to smell it but other people have. So I figured obviously if we can smell it, the dog can smell it plus some it'll be so i when i first

Scott Benner 36:45
okay. And so you just wouldn't you just like give him the sample. And I don't know like like, what's next? Like, like I get if you wanted to sit down and you get him to sit, you go, Okay, you've sat, that's great. Here's a treat. Boom, but you want him to bark or come for you or something when he smells the smell? Is

Ryan 37:04
that the idea? So I trained him to pommy and the theory was that way if I'm in public, he's not distracting or if I read to take them into a business like setting or a play or I don't know the movie knows.

Scott Benner 37:17
Yeah. And so so she you're in bed tonight, and your blood sugar goes over one at the dog wakes you up.

Ryan 37:25
That is the one thing I could never get him to do. He there's been a couple of times he's barked at me in the middle of the night. It's very rare. Okay, but they do tell you that with concealing yourself in your covers. And also, he's always been a heavy sleeper. I mean, if someone breaks into this house, I wouldn't be surprised. We just sleeps it off. And that's just always how he's been. And I adopted him. It's six. He's now I think he's Seven, eight, I don't know right around there. But he's always been a sound sleeper. And he's a little bit older dog What? Looking back on it, I would have actually woken up in the middle of the night and woke him up. And once I got up dialed in with the training with the piping and the sign the samples, I would have actually done that.

Scott Benner 38:07
Yeah, I say Well, listen. I mean, it's, there's a lot to think about, I guess. And so when you're low, do you know you're low? Like what number do you feel your lows at?

Ryan 38:18
Most the time? You know, everyone smile, catch them real early. I know. I'm starting to feel a little funny. Like this morning. I work nights last night. So I woke up right before talking to you. And I kind of felt a little funny. Baylor's got to go the bathroom. So he's distracted by that goes, the bathroom comes in the house pause me and I'm kind of thinking to myself, I better go check. And I check in on my 85 that's like, Okay, I know, based on my training based on my experience, you know, it's like you it's hard and you're like up, our blood sugar always likes to drop at this time, right? And now I just kind of have a poor man's Dexcom.

Scott Benner 38:57
it's it's a it's fun, how you how you learn, though, like really like it after having experiences over and over again, you really do get to that. I always think of it this way. You know, I see people talk about you know, Dexcom has a warmup period, right? You put it on, you wait two hours before you can start using it. And I always hear people like, Oh, this is the worst these two hours. I don't feel that way anymore. Because I have a reasonable expectation that I understand what's going on. And with a couple of finger sticks. I can I can still actually maintain the same. You know, sort of like the same basic rhythm that I had with a CGM. I can have without not you know, could I do it all day like that I could, but then I'd be testing again, like a lunatic and thinking about it all the time. But I do think you learn from your experiences. And I think that I think that makes total sense. So you're falling, you feel it, but if you don't feel it, he comes and he has she ever come to you and you've been so low that you kind of can't care that he's with you and pawing at you or does it does Yeah.

Ryan 39:56
That's interesting. So one time right after a We we just bought a house and we were in the process of moving and it was the first time we bought a house, you know, and I and you know, you know, stressful it is, you know, underwriting insurance, all that fun adult stuff. Not.

Scott Benner 40:13
Hey, listen, I just got my taxes today I know what I owe, so I'm not doing great with being an adult today either.

Ryan 40:23
And, anyways, Geno's working nights at the time. And there's nobody else home and I got off the couch. And I felt a little funny. And I didn't think much of it because I was focused on unpacking, and I got to work tomorrow, all these things. And as I walk away, Baylor pause me in the back of my calf. And I thought, honestly, he kind of fell or it was a fluke, or I didn't want to believe them, because I was trying to get my other stuff I need to get done. And then I walked into the kitchen, he follows me into the kitchen. And he starts staring at me first making eye contact. And then he kind of starts walking towards me. And then he doesn't quarter me like when I say that people think he's growing and he's trying to know, he then gets a little bit more aggressive and comes up and starts cutting me off. And then he paused me again when I stopped. And that's why I said, Okay, you need to check her blood sugar, because he's getting awfully aggressive about it, meaning he's not, he's not getting aggressive in the sense that he's not growing. He's not darling. He's making eye contact with me. He's giving me all these signs, right. And sure enough, I'm glad he was there. Because I was, I think I was at 40 year are not a good number of 40 or 60.

Scott Benner 41:33
Right? And it's so the lower you got the more aggressively he he's trying to get your attention. It's so it's like cutting you off like you're trying to walk? And he's like, No, you can't walk away. We haven't done the thing with a blood sugar yet. So when does he start? So your blood sugar's low? When you test? Does? Does he? I don't know. What's the next like? Does he see you test them? leave you alone after that? Or does he kind of stay with you and keep reminding you about the low blood sugar until it's back up again?

Ryan 42:00
No, typically, he'll leave me alone. And the one thing I've noticed about dogs, especially working with them, and I trained a couple dogs after this not for for diabetic alert, but they're very receptive to our patterns. So you grab your keys, this AWS thinks, oh, they're gonna take me out, they're leaving, maybe I can count them and to get me a no walk. You grab their leash, they know they're going to go somewhere. And I've noticed that with Baylor that after he sees me grab my black glucometer pouch. He seems to leave me alone holes sometimes still come up and pop me a little bit. But for the most

Scott Benner 42:35
part expects that's what he's trying to accomplish to get you to pick up that pouch.

Ryan 42:39
Yeah. And I didn't teach him that. That was just kind of what came with the territory. Once we started working together more. It's interesting.

Scott Benner 42:47
After all, the work and everything and you have Is it a benefit? Is he a real benefit in your life? Or have you ever looked back and thought, Wow, that was more work than it's been worth? Or I you know, I'm interested to know like, how valuable Do you find having a dog?

Ryan 43:02
Yeah, My only regret is that I didn't do it sooner.

Scott Benner 43:07
It's a big so it's a big even that can you imagine a day where you have a glucose monitor and you think I don't need the dog anymore? Or do you have or do you think you don't have a glucose monitor because you have the dog?

Ryan 43:18
I don't have a glucose monitor because I like to do a lot of the mix Martin a lot of the martial arts so Jiu Jitsu, and I've worried it will get torn off during like live sparring and stuff like that. And I'm also going to wait to see my insurance where that goes. But I have heard that when people switch to things like what you're talking about CGM index coms, that people that have had dogs in the past and have that they stopped going alone, they stopped going high and the dog stops working.

Scott Benner 43:50
Oh, the Dexcom breaks the dog. That's interesting. Like because it takes away because once you so now it's in that's an interesting idea. So once you don't have the highs and lows and the variability anymore, because the technology helps you get past that. Then the dogs like forgets all about it, because it's not happening as much. That's interesting.

Ryan 44:08
Well, they say that, but I worked with a guy too, that said he had to get a sock recertified. It was a drug dog. And he was like, Hey, you know, I hadn't had a bus. I'll keep it PG because I know his family. I haven't had a bust of this type of stuff in a long time. And I'm really nervous about my dog getting certification certified because they have to get certified for a certain accuracy. Okay. And sure enough, the dog walks in the room and nailed it right away. Okay. I don't know what they say. Yeah,

Scott Benner 44:39
it's still it's still an interesting concept that the idea that you could kind of you know, if you don't use it, you lose it kind of concept with anything really. I guess you don't you know, if you don't do it enough, it goes away a little bit.

Unknown Speaker 44:50
My name is Elizabeth, and at 10 years old, I was diagnosed with Type One Diabetes. Shortly after inspired by my middle school dance class. I came up with the idea to host a show to raise funds and spread awareness about diabetes and dancing for diabetes started and has grown ever since.

Scott Benner 45:11
You are only about 10 minutes away from hearing that entire recording. I'm telling you it is spectacular. Dancing for diabetes, calm dancing, the number for diabetes.com

Ryan 45:22
you're married or you're you guys are just together you're married. We're trying to get together that we're gonna wait probably tell after a while after I get through all this fun Academy stuff and the schedule pulls down and I can get time off

Scott Benner 45:38
but you own a house you live together you live together for a while I was wondering like how involved is issue with your with your care? Like, is that something you share with another adult? Or is it something keep yourself? No, Gina

Ryan 45:51
would definitely tell me at times if he she sees something like hey, I think you need to go check. But other than that, I mean, I try to do everything myself and it was Baylor I specifically wanted to train Baylor because who they dog typically trains with is who they're gonna bond with. So I told her I was like, No, no, no, no, I don't want to do anything. I mean, she'll take them for walks here and there, it will take them out to go to the bathroom. But beyond that, I mean, I was the one who really wanted them. So yeah,

Scott Benner 46:18
I was just trying to decide how my wife would feel if we had to take my daughter's insulin pump for a walk if he sort of like your diabetes tack, right? Like I like what would I do if I had to, like clean up and feed it like this? Does having a service dog preclude him from being a pet? Or do you if you get both of those worlds?

Ryan 46:42
You do get both those worlds? Um, you know, so so here's the thing with burning dog behavior. When dogs aren't working, they're at home. And that's when they get to be a dog. That's when they get to. He's he's actually good friends with their cat, Rainey. And they're their buds. They play tag outside. And at certain times. Yeah, he's an absolute pet. I mean, he's, if he jumps on the bed, and he's laying there, and you're watching TV. Yeah, he's a pad. He's laying next to your petting home. He's happy. But the thing is, when he's laying on that bed next to you, the chances of that dog working is minimal to none, because they work for your affection and your attention.

Scott Benner 47:24
Oh, I see. So if he feels connected to you at the moment, he might be less apt to to do the work that you've trained him to, though?

Unknown Speaker 47:31
Correct? As about,

Unknown Speaker 47:33
okay. Yeah, and

Ryan 47:35
one of the first things that organization does is like, let's say you and Arden want a dog, you guys go through the paperwork. You guys are okay, you're selected. They take you out to the beach with a lot of dogs and they see which one you bond with. And it works the same way in police. Military, typically, they don't just take a dog and say, Hey, this dog shores god, this is gonna be your dog. They pair it up with your personality, what they think and how you communicate and how this dog is and their their profile, what they think is going to be a best fit.

Scott Benner 48:06
I say, I say, Well, that makes sense. I mean, it's like a dating situation. You can't just go he had just point from across the room be like you you'll work because it doesn't work that way. You gotta find you gotta find a bond, you gotta find common ground, you know, something to start with. Right? Some some something to something to build on. Not just, you look good demeanor. I like what color that dog is. I guess I'm wondering about like, with just managing with shots and everything. Because essentially, because you talk about, would you like a pump and you would like, you know, maybe a glucose monitor and a pump, but at the same time, you don't have them. You do have some lows. So what do you think, is the biggest? I don't know, what's the biggest impediment when you're doing injections? Like what do you find to be the thing you wish you could make? Go away?

Ryan 48:58
Oh, last, you know, versus in a pub. As you know, you can adjust your needs, and everybody's needs are going to be different. So that's, that's a great thing versus lantis. You know, you're either slave to if it's like you have seasonal allergies, and it shoots sky high on you. You're kind of stuck with that, that goes versus if you're going low all the time, then you're slave to eating every two hours or every 45 minutes or who knows, you know?

Scott Benner 49:26
Yeah. And so so you think the basal insulin is the is the thing you would like to have more control over the most. So what is what's the thing about injections that you like the most? Like what do you think you'd miss if you went to a pump?

Ryan 49:40
I would just be worried about it getting ripped off and either the line of duty or during grappling practice. I did have about 10 years ago, I had a mini med pump. Okay, and I was so lean. The problem was I had to do the the child inserts and they were amazing. They were the ones. And if I didn't use those, they would kink. And then of course, when I went to practice those hurt really bad, especially in any sort of aggressive sparring, it was really difficult.

Scott Benner 50:14
Why would say that things have changed pretty significantly since then I get your concern, I really do, I think that you would easily be able to, I mean, if you chosen on the pocket, you mentioned it before, if you chose that, I think you'd easily be able to put it somewhere where that wouldn't be an issue. I know some kids that play like football with them. And they'll like, there's like this band, and it's called a band, but there's a rap you put around it on your arm, for instance, that keeps it from shaking and pulling off when you get tackled. When my daughter knows, she's gonna go play softball, sometime, she keeps it more on her stomach. So that it, you know, like, it's just, it's not a place where people grab it grab at you were touching or something like that. I think it would be something that you would find that you'd look back one day and think, oh, that wasn't really a big deal. And I and I only bring that up not to sell you in some pump. But because I think you fall into a really interesting category. You've had diabetes for 15 years. You had an experience a while ago with a technology. It's a lot different now. And and you're and you're it's working for you what you're doing is working for you. And you're comfortable. I just I always get concerned, I always try to stay cognizant of the idea of I don't want to look back one day and think, what did everybody move forward? And I didn't notice, like, do you know what I mean? Like it's washed, you still know what it's all about. But I saw it with a friend once who, you know, did his injections, injections injections. And then a couple years ago, finally even just got away from the old insulin, it was at novalogic couldn't figure it out that know what they were doing. It was a real like, you know, a real hardship for him. And but I think had he moved along, like, I would not switch for the sake of switching. Like if a new pump came out tomorrow, I wouldn't just be like, oh, give me that one. Cuz it's new. But I mean, you know, I think Omnipod and Dexcom know this very well about how I feel if somebody comes out with something, it's that much better than what they're doing, I would have to look at it. Because I would want to, I would want to stay current. And hopefully these companies that I like, so much stay current on their own and staying with them is staying current. But I I don't want to get into a situation where I'm like, I'm the old timey like diabetes person who's like, I have this and people are like, yeah, we don't do that anymore. So I just I wouldn't want you to get caught in that space. Like that mindset of like, this is good enough, because some of the new stuff is, is a lot better, in my opinion. You know?

Ryan 52:41
Yeah, I do you want to check it out? I'm gonna wait to see if I get hired on here. And then of course, that's one of the things I thought about becoming a police officers, you know, working for the government, you're not really good medical? Yeah. So that's what I think I'm gonna kind of wait and see what's up for the Academy, because your life changes a lot after that. But I'm going to try to go in and check that out. There's, ironically enough, I met a really nice young family and they had, I think he's about one or two. And he's just been newly diagnosed type one, not in the family at all. And they're going to go Omni pod dex calm, and I turned him on to your show, too. I said, Hey, thank you. Listen to the show. It's got a lot of great information. I mean, I don't even have an omni pod or and I've learned great stuff about it stuff. I didn't know. So.

Scott Benner 53:27
Well. That's excellent. Thank you, you know, you're pleased. You're it's very much My pleasure. So that's interesting. So even though you're not using the technology that we use the stuff we still talk about still valuable for you.

Ryan 53:39
Absolutely. I mean, I love learning about new technology. I just can't figure out Skype to save my life. But we got it. I went to five in the morning. All right. Can we give me some slack?

Scott Benner 53:49
I actually think you're doing great. I actually think you've got that good. Like I'm tired energy going right now, which is it's just you you're trying to stay awake. But but so do you have something something pops into your head, like something we talked about here that you were actually able to take into your own life? It's not technology related, like like, kind of maybe one of the tenants of the ideas that you use with just injections?

Ryan 54:11
Yeah, no, totally. You know, I don't know why I never put this together. So when I was on the insulin pump, they always talk about pre bazel or right Pre-Bolus Thank you. Yep. And I'm like, Oh, man. Oh, my blood sugar's high. Again. I took a bunch of insulin and then it never my numbers never come out right when I eat carbohydrates, then my blood sugar's high. Oh, yeah, maybe I should apply that technique to this tale.

Scott Benner 54:37
It's, it's hilarious because it's just, it's it doesn't have anything to do with a pump, like it's called Pre-Bolus thing, but you could pre inject just as much, you know, and in the end, it's just it's just that concept, right? Like if the insulin doesn't start working right away, you need to give it a chance to to sync up with the carbs are done. I just had a I would say a pretty serious conversation yesterday for the first time, like, I am very much just sort of like, she picks things up as we go as we go. And I don't sit down and, you know, I don't give her like, now here's your diabetes lesson. You know, I, we, I've never done that with her. But yesterday, it just became clear to me that I needed her to kind of move along with me a little bit. And so I sat her down, and I gave her a bigger overview than she had had in the past, I guess. So she's, you know, closer to 14 and 13. And she came down the other day. And I've been taking care of her blood sugar as, as I wouldn't, she came down for breakfast, she was hungry, she said to my wife, you know, I need to eat. And my wife hasn't had not been involved with the blood sugar at all. And my wife took the words I need to eat as I'm low. And my daughter just meant I'm really hungry. And so and so my wife, sort of like I shouldn't panic, but she very quickly made her food that was, you know, higher in carbs situation, and not anything different than what we normally would have eaten. But she didn't Pre-Bolus or because she thought she was low. And it just all kind of happened really quickly. And so, I came back into the room, and I was like, Hey, what's going on? She's like, she's gonna eat this. And I was like, okay, and I started to pick up the thing to give her insulin and the food was ready already. And then her blood sugar shot up, and we spent a couple of hours getting it back down again, it was not easy. You know, it was one of those crappy rollercoaster situations. And so later in the day, I sat with Arden and I said, Look, you have to understand that just because me, you know, you just because someone says it's okay, here's the food. You I said, you still know, right? And I was like, you know, and she's like, yeah, I said, you have to Pre-Bolus for that food. It's never gonna work out if you don't. And she's like, right. And I said, what you needed to stick up for yourself a little bit there, even though it's Mom, you had to you needed to tell her Hey, wait, I don't think I can just start eating this right now without this insulin. And, and I showed her some of the reasons why. And she was really receptive and an understanding of it. I didn't overwhelm her with it. I didn't scare with it. But I did. I gave her more information, more real information about diabetes than she had had in the past. And I'm glad I did, because I saw her handle it maturely. And, you know, it, it sunk in a little bit. So I think every once in a while I'm like, I might do that I might, you know, just let her have it. Slowly, slowly. But every once in a while when I see something like this, I think I might have to step in and do a, like a 15 minute like, you know, masterclass on it, like, just here, here's the important things you need to know. I think it's really cool that any of that's helping you or anybody else, but, um, but it's great that you can apply that stuff with injection. So

Ryan 57:49
Well, yeah. And I mean, I just how much you're helping how much this show is helping this family? I mean, I can't imagine having basically an infant, and not knowing anything about the disease, not having a background in it, you know, and they're, they're doing great. And it's, I don't know why we're stuck in the stagnate of, well, you got to be diabetic for a year to get a pump. I mean, that's the that's the dumbest thing ever. You know, there's, I want to see the support that says, you know, you shouldn't have a CGM, I think they should. If your insurance and you can afford it, I think it should be a policy, you've leave it to CGM. And if you choose not to use it, that's fine. But we're gonna write you the prescriptions. And we want you to know that this monitors it. And this this this? I don't, I don't know why. And that's what they're kind of. I they didn't allude to anything negative, but that's what they're dealing with right now. They're like, Oh, we're gonna like Why? Why are we paying on a daily injections? You know, this is an infant stage. You can't talk, huh? No, I

Scott Benner 58:43
listen. It's just an old time idea that people hang on to like, you have to have this for a year. And then you can have this in the end. It's a pump, it's a needle, why does it matter how the insulin gets into you? It really, really doesn't, by the way, what's the difference of how it happens? I like that, like, once you figure out how to drive it like this, then we'll give you breaks. Well, you know, one of the breaks would be nice to have on day one, if you don't mind. Right? It's so if I can, if I can throw this rock out the window on this chain and bring the car to a stop without hitting anything, then you're really going to appreciate how great I understand how this car works. And I just, it's a simple idea. It's 2018 this stuff exists. If your insurance covers it, and like you said, If you want it, then it should be available to shut the fight for it. You shouldn't have to go home and have some terrible experience and some struggle because somebody's giving you this arbitrary number, you have to wait. And by the way, I tell people all the time, if anyone's listening, you don't have to abide by that I can count on my hand for people in the last couple of weeks that I've spoken to who all ran into the same thing. And I gave them all the same advice. And I can say that this was advice I said, just go back and tell the doctor I don't. It's nice. I thank you for your concern. But now write the prescription for the insulin pump and they always do No one fights you like it's just it goes to show you how little the statement Oh, you have to wait a year. You have to wait a year. No I don't. Okay, here you go. Well, why if it was so important how come I got the script from you by saying, you know by fighting with you for five seconds, you know what I mean? Like it's it just it just shows itself for how how random the idea that you have to wait a certain amount of time this

Ryan 1:00:23
right i mean when we get our license they don't sit there and say drive for a year get in an accident wear your seatbelt. You know, I mean, I I honestly do think CGM, you know, obviously in the artificial pancreas and in all those things are the technology is only working to improve us improve our quality of life, lessen your chance of neuropathy. I mean, my last day once he was a six, three, that's excellent. And I'm lucky that I had that. But there's going to come a day where I'm going to have a really, really stressful I'm going to have some stressful months ahead of me. And you know, why not take the advantage? Fine? No, why not?

Scott Benner 1:01:00
It Listen, I don't you'd want to give yourself every opportunity, I would think and then from there, you'll decide how valuable it is or isn't free. Listen, maybe you'll get a pump and just say you know what I was okay, with insulin injections. I should I'm going to go back to it. You very well may do that. But you should at least try to know. You know what I mean? Like you can't just assume that it's going to be one way because it really you're just using your imagination to think up reasons not to do it. Seriously. I mean, I completely I'm not I'm not totally not coming down. I think you can tell that from our conversation. But I think some of the reasons you are worried about a pumper just you making up reasons why, why it's not going to work out because there are plenty of people who do martial arts with an insulin pump. get anything like so, it'll work out for it's just something new for you. When you see it, you'll you'll you'll decide, but I think you'll have a good experience.

Ryan 1:01:54
So yeah, that gives me an excuse to buy an iPhone, and I watch. Hey,

Scott Benner 1:01:58
you know what? More fun, more fun stuff. I wrote off on our taxes this year, our cell phone bills and the purchases of iPhones for medical devices,

Ryan 1:02:09
right.

Scott Benner 1:02:11
I mean, it didn't stop me from owing money, but it helped a little bit. Yeah, yeah. So right now, we're breaking up on an hour. I just want to ask you, is there anything we didn't talk about that you wanted to say that that I maybe didn't hit for you?

Ryan 1:02:26
Know, thank you for doing the show. It's easy to follow. And I mean, it's it's a it's an honest, the thing I love is that it's honest, candid information. And it's basically kind of like what I did with Baylor. Look, this is what I did. It worked for me. Yeah, it helps you take it and if it doesn't find something else,

Scott Benner 1:02:48
right on Yeah, don't get stolen. If this isn't working for you. Don't stick with me go somewhere and figure out something that does work. That's it's amazing advice. I appreciate that. I really do. I'm so I'm super psyched that you found the podcast and he came on and told your story about training your own diabetes alert dog now I've got like a DIY DIY pancreas, Episode, artificial pancreas episode now even DIY training dog. I never thought that would happen. It's really as Dude, it's commendable about the effort and the focus you had for it. So good for you. Are you giving me ask you? Are you that way in other parts of your life? Or did just having this dog mean that much to you were able to put the time into it.

Ryan 1:03:27
Know what I like when I want something? I'm like, it's gonna happen. Okay.

Scott Benner 1:03:32
Gotcha. Gotcha. This is a big, it's a big undertaking. There's I mean, just to decide to train a dog like that is, especially when you especially when you live with a woman who eventually would look at you and go, Oh, we have this big lump in the corner. Now that does not check your blood sugar. And it's just eating a bunch of food and crapping all over the house. You said this was gonna be a diabetes alert dog. And it seems like it's a pillow in the corner. That's excellent, man. Good for you. I want to tell you. I hope you have a lot of success with the new job endeavor. I hope you get on the force in Tennessee. And and I hope you can fall back asleep after doing this because I know you're probably tired.

Ryan 1:04:13
look great. Well, hey, Scott, thank you so much. I mean, you know your podcast, just like that new family. You know, when when I was first diabetic, there was no, there was no check your podcast and let's share information. There was no, hey, this worked for me, Hey, you know what, I switched to this and this, I have this problem. I didn't know there's a two hour warmup period. And that's great, because now I go in with these realistic expectations.

Scott Benner 1:04:35
Yeah, right. I think a lot of what you see people complain about online, whether it's about technology or just, you know, anything really things you do Pre-Bolus, anything like that, as they get this, like you said there's a preconceived idea that this is going to work like this and when it doesn't, instead of just seeing it still for the real benefit that it is they see it as like some sort of failure. And so I think you're right having all the information you can have is is does always work. Thanks so much to Ryan for coming on the show and sharing his life with type one his DIY dog and everything else. Thank you of course to Dexcom and Omni pod, you can check them out@dexcom.com forward slash juice box, and my omnipod.com forward slash juicebox. Don't forget about that blog post I told you about where you can see Arden's graph from the waffles. And you can see how we bolused where we boast. I want to wish you all a Happy, Happy Thanksgiving, and remind you to hang out for one more second to hear this from dancing for diabetes. You can find out more at dancing for diabetes.com. My name

Unknown Speaker 1:05:43
is Elizabeth and at 10 years old, I was diagnosed with Type One Diabetes. Shortly after inspired by my middle school dance class, I came up with the idea to host a show to raise funds and spread awareness about diabetes. And dancing for diabetes started and has grown ever since. Raise your hand if you have type one diabetes. We operate a variety of programs year round through dancing for diabetes, but my absolute favorite is our kids and teens dance program. All the kids and teens have type one diabetes, it's free. It's open to everyone in Central Florida. And it's a lot of fun to see these kids and teens get together and they get to build these support networks and become free with their diabetes. Everyone in the room gets it. And I think that's really empowering for the kids and the teens in the room to be in an environment where they can still be a kid, but also be cared for and take care of their Type One Diabetes at the same time. What comes to your mind when I asked you to describe what type one diabetes makes you feel like not what it is. But what are words to describe diabetes.

Unknown Speaker 1:06:55
I don't like diabetes. Because a girl at my school, she made fun of me and mckaela because we were diabetic. It's been embarrassing. It's really hard to get to and like every day, but I battled through it because it's for myself. That's the only way I'd be here. And I don't like diabetes, but it does make me stronger. It kind of makes me feel

Unknown Speaker 1:07:23
what scares you about diabetes, low blood sugar, scary, some lows, they just come right away. But I've had lows where I could be low for over an hour. And like notice, and you keep treating it and like there. There's been times where like I'm 16 in the next 15 minutes when it should be like in the 142. And it's like it's scary. For me it was like feeling in my legs and everything like you're losing consciousness. That's a lot of times when it feels like for me, you're either like really tired, really hungry, like you're just like really drained and you can't like really put to anything. Ultimately, what's the worst case scenario a low blood sugar. I think that being diagnosed with Type One Diabetes forces kids to grow up a lot faster than their peers. So I think that this dance program allows the kids and teens an opportunity to be a kid but at the same time, see others that are there similar age and see how they're managing their type one diabetes, how they're making their decisions on their own. So I think that while the dance program offers the kids the opportunity to to be kids in that class, they also get the opportunity to learn from others that are in their exact same situation how many times you'd be around this thing people with type one diabetes these peoples

Unknown Speaker 1:08:39
and these peoples

Unknown Speaker 1:08:42
here and one other fish

Unknown Speaker 1:08:45
are only here. Yeah, those of you that said when you you are hanging out with others who have type one diabetes, where did you meet those friends? Hear? Hear hear? What has been your favorite part about dancing for diabetes? I think like meeting new friends like others that has the same disease and learning more fully finally feeling comfortable in a room and like later in the year like when people get closer we're like, oh, are you okay? Like I heard your ducks calm or like, Are you okay, I heard you from go off like I'm kind of cool and rolling in like, be uncomfortable about the show is incredibly entertaining and inspiring. But the best part is when the kids and teens walk out on stage and get to perform what they've been working so hard for, and remind us why we're all here and why we're working so hard year round, to ensure that they have better lives and one day don't have type one diabetes. What do you want people to learn the night of dancing for diabetes, but

Unknown Speaker 1:09:48
know that diabetes doesn't stop you from doing anything to know that we're not alone and

Unknown Speaker 1:09:53
we're strong.

Unknown Speaker 1:10:00
Be yourself and maintain diabetes and diabetes control my life.

Unknown Speaker 1:10:09
My hope for all the kids and teens in our dance program is that their Type One Diabetes will never get in their way it will never stop them from achieving any goals or dreams that they have, and that they will feel empowered by their Type One Diabetes to do more to do better, and to do well for everyone including themselves.

Unknown Speaker 1:10:31
On the night of the show, I want people to know that diabetes doesn't define you. I want people to be inspired. And if they even have type one, that they're not alone and that we can do anything. We put our hearts to

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Scott Benner 11/13/18 Scott Benner 11/13/18

#194 Dexcom Returns

Jake Leach is back...

Dexcom's SVP of R&D is here to talk about your favorite CGM!

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends welcome to Episode 194 of the Juicebox Podcast. Today we're sponsored by Dexcom. On the pod and dancing for diabetes, there are links in your show notes, but you can always go to my omnipod.com Ford slash juicebox dancing the number four diabetes.com or dexcom.com, forward slash juicebox.

On today's show, we welcome Jake Leach back. That's right, the Dexcom, Senior VP of research and development is back on the show to tell us about new developments with Dexcom. And answer a ton of questions that were submitted by you the listeners through Facebook and Instagram. Jake was very generous with his time today. So let's not waste any more of your time getting to the show. I'm not even going to give you the tease about what's on this episode. It's all of your questions, and everything Jake was allowed to talk about. Alright, before we get to it, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, and to always consult a physician before making changes to your health care

Unknown Speaker 1:08
plan. Hello is Jake, Jake and Scott? Hey, Scott. You know, we're

Scott Benner 1:32
recording right away. So I,

Unknown Speaker 1:33
you know,

Scott Benner 1:34
besides having you on last time, you said hey, I'm gonna have stuff to talk about after I go to Germany, which I thought was great. I actually reached out into the, into the, into the world and got a few questions for you that I'm going to rapid fire through at the end if we have time, which I think we will. Awesome. Okay, so the last time you were on, I can't believe I'm saying this. I kind of forget why you came on. I think we were talking about g sex. That's right. And it arriving right. And sort of at the end of the episode I said, Is there you know anything else you can tell me about stuff? That's common? And you said after October? So it's after October?

Jake Leach 2:11
Tell me all Yeah. I'd love to tell you every I'd love to tell you everything. But I've got the we got a number of exciting things that are now becoming public that we can I can talk about and obviously have a lot of exciting stuff in the pipeline that will also be coming out but influence influence partnerships as some of our new newest announcements so we can spend some time talking about how we're integrating g six with a number of influence and delivery partners.

Scott Benner 2:40
Okay, well, I'm thrilled because this is, you know, the first time that I genuinely have no idea what we're going to talk about. So I'm excited to find out along with everybody else. I don't even know where to start. Go ahead. What's the most exciting thing it's about that?

Jake Leach 2:55
Well, one of the one of the things that we that Novo Nordisk announced that the E ASD was that we've partnered together Dexcom and Novo Nordisk have partnered to develop diabetes technology, specifically around connected insulin pens. Also, some folks call them smart pens. But what it basically is, is it's a number of insulin pens that they are, have had in development, and are planning to launch as early as next year. And what they are is their pens to keep track of insulin doses, and then communicate via a couple different technologies, some, some are NFC, and some can be Bluetooth, communicate those readings to your phone. And so you're moving forward, the Dexcom app will be able to record insulin doses for those on MDI therapy, the influence and injections can be loaded into the phone. And then you can imagine all of the exciting algorithms and decision support technology that can be developed once you have a good valid insulin data, communicate to the app. That's the whole point is that we want it to be done passively. So that the users aren't typing in or trying to track themselves or their insulin doses. It's all about the pen. They know the technology doing that for them. Okay.

Scott Benner 4:26
Yeah, because I think that's a speed bump for people really, when you have to log things. It seems good in theory, right? Until you're, you know, injecting, you know, I don't know, on a park bench, and you're think I'm not gonna put this in my app. now. I'll do it later. And you'd ever remember that kind of thing. So these pens are just going to speak to an app or they're going to speak to the Dexcom that

Jake Leach 4:49
they'll speak to the Dexcom app. There's also other partners that novo announced that they are partners like gluco that will also be able to access the data. So There's a quite a bit of work going on, on developing the kind of architecture and how the apps coexist and how the data flows. But it's exciting that we have another originally we had Lily on the pen side, we still do. And now we have the next large insulin manufacturer kind of coming on board and connecting with Dexcom. So, we're pretty excited about that. Partnerships been, we've been working on it for a while. And so it was just recently announced last month. So we're gonna, you know, head down and develop some exciting products for both the US and outside the US.

Scott Benner 5:38
I have to ask, even though you won't be able to tell me but is there a timeline for it?

Jake Leach 5:42
Well, what what Nobu announced is that it's been public is that they're expecting to launch some of these pins in early 2019. In in key key markets, so they have a number of markets inside and outside the US. So the plans will continue to firm up, but they're planning to get the technology out soon. In 2019, which obviously means it's been in development for a while. You know,

Scott Benner 6:09
it's kind of incredible, as you're saying this, it strikes me that in the world I grew up in and I'm, you know, I'm getting towards 50 now, but in the world I grew up in there be I don't want to call them monopolies. But you if you made an if you made an agreement with a pen company, it would be with that pen company, and that would be kind of your power base, like your power would be in exclusivity. But now the power is in choice. It really is. It's a paradigm shift. Really, it's it's interesting that you're working with Lilly working with novo they all have these smart pens, and you're happy to do business with with any of them that are that are doing good work. It's it's really, do you know what I mean, how that's sort of uncommon for somebody my age, at least to look back on the way the world used to work.

Jake Leach 6:55
It is, it is a, you know, kind of the always been a key focus of Dexcom. To be, you know, we're very open, we really feel that partners can really amplify the value of our CGM, as well as our CGM can amplify the value of their systems. And so early on, we made the decision to non exclusively partner. Our first two insulin partnerships were with animals and intellect, you know, many years ago is when we first started those relationships and said, you know, what, we're, we're not going to be exclusive, or we're going to work with all the different options, because you said it's got it's all about choice. And some patients choose to use an insulin pump. For continuous infusion, others, find the pens, kind of their therapy of choice. So it really, our goal is to kind of cover as many options as we can with or different partnerships, both on the pen and the insulin pump side.

Scott Benner 7:53
I think it speaks to the quality of Dexcom, too, that the pump companies and the pen companies then are willing to do don't mean like, it's to be able to say, hey, it's on the pod with Dexcom, or it's, you know, tandem with Dexcom. Like, that's kind of that's interesting, I think, I think that shows that you guys are our leaders in the in the space for sure. Okay, cool. So, smart pens coming, that that are gonna make decisions. And basically, you're going to what you're going to start getting not only decision based data back, but sort of that it'll also log so that you kind of have the, I guess the information that a pump would give you to insulin on board time left, and that sort of idea is all going to be there. We interrupt your regularly scheduled podcast to remind you to go to dancing for diabetes.com. That's dancing, the number four diabetes.com.

Jake Leach 8:45
That's right. That's right. It'll be a lot of info on board. And then you can start algorithms that give guidance on around insulin dosing. We'll start with insulin visualization. So making sure that the insulin is captured, particularly in our retrospective views. So you can imagine for the healthcare provider, when you go into the clinic, you know, up into this point, the information from a MDI user is fairly challenging because they're giving their doses as they need whether you know, eating their meals, but you're not really getting an electronic copy of that. So this one, the idea is healthcare providers not going to get high quality data from the insulin pens visualized in clarity. So there's a lot of opportunity and visualization of insulin data in follow. That's another feature that we're looking at, because Wouldn't it be great to be able to see influence, delivery as well as glucose and excursion within the follow up, both for our pump and pen partners, we think that would be a really good feature for follow that we've actually already enabled it in the cloud in the back end, and so we just have to do the visualization. When we have to have the connection to the partner data, and then we do the visualizations both in clarity and in follow, and in the G six app. So a lot of a lot of work been going on behind the scenes there and now are excited to start getting ready to bring some of it to the market. And to

Scott Benner 10:18
extrapolate even further into the future. Even though it wouldn't be exactly the same. You could have that app prompt you when to, to Bolus. So it would almost be like as close as you could get to a closed loop system. But with MDI, is that reason? That's right,

Jake Leach 10:34
that's exactly how you got to Scott. And we can even we can detect missed meal, Miss boluses. I mean, imagine, you start to see a glucose excursion with no insulin delivery, you can actually prompt the user to say, Hey, did you remember to take that take that bolus, so there's quite, there's quite a bit of advice, guidance help that a system can provide, I think the key has always been got to be easy to use. And it's got to not cause you got to get a lot of benefit from it, you know, in order to be able to, you know, in order to use the devices. So these things have to be really simple. So,

Scott Benner 11:11
can I asked you to pretend with me for a second say I'm using this system in the future. And I'm injecting, and I'm and it tells and I forget to tell it, hey, I'm having a large meal. And it it can see my blood sugar starts going up. So it says to me, Hey, did you remember the Bolus? And I think, Oh, I didn't. And then can it? Can I tell it? Well, that's the meal I ate around this time. Could it make an insulin decision, not just based on the carbs, but on what it's seeing with my blood sugar as well?

Jake Leach 11:42
Absolutely, absolutely. I think the, you know, Bolus calculator. There's lots of them in existence today. But what what doesn't exist is a is a bolus calculator that not only takes a glucose level into account, but also takes change in direction. You know, there's a number of protocols with a number of, you know, guidances out there about how to dose insulin based on you know, glucose change and to train the arrows on your on your CGM. But if you can imagine that you would be fairly simple to take that and generate an algorithm that just prompts the user with, here's a glucose change, here's how much your blood sugar is, here's how much if it's correction dose here, so much insulins on board. And then you could basically enter carbohydrates, there's a lot of exciting work going on in terms of out to help folks estimate carbohydrates and a lot of thought on pattern recognition there. I mean, if you think about it, people don't eat. Most people don't eat, you know, dramatically different meals every day. to kind of have handled the added quite a few patterns, right? So you could start to understand for a certain person, what are the different meal sizes look like? So it may not have to be am dialing in exact number of carbs. It could be more like I'm having my typical breakfast.

Scott Benner 13:03
See, you're gonna put my podcast out of business, Jake, because I talked I talked about obviously Pre-Bolus thing is just monumentally important. But if you miss on Pre-Bolus, or Pre-Bolus in time, or Pre-Bolus just isn't possible. Then I talked about over bolusing. So Bolus for the carbs, then Bolus for the spike that's going to come because you didn't Pre-Bolus and Bolus for the momentum that the food causes. And it's a guessing game right when you're doing it without an algorithm. All this talk about algorithms and the future is making me excited. It also makes me incredibly happy that Arden is an omni pod user already. Because once all of this comes together, not only is Arden going to have all of the goodness that comes from this Dexcom stuff, but she's going to have the only tubeless insulin pump to make it all happen. But even before all that integration is finalized, I believe that Arden is incredibly lucky to be using a tubeless insulin pump that allows her the freedom to live the way she wants without being connected to a device and a bunch of tubing. The best part about the Omni pod really is it small form factor that it's self contained that holds your insulin, and that when you need to talk to it. It's not connected to something that you have to keep clipped to you. There's this little device off to the side, you push a couple buttons on it, tell it you want insulin, and then there's a wireless transmission that happens between that device and the pod in the bowl is just happened. Actually a little later in this episode, you're going to hear Jake talk about something about Omni pod that's going to make you incredibly excited. I don't want to spill the beans yet, but trust me when you hear it. It's gonna make a giggle.

Unknown Speaker 14:34
Like a little gleeful he like that.

Scott Benner 14:36
That's not playful. I can't do it anyway, it'll be delay. In the meantime, if you're not already using the Omni pod Today's the day to start and it's super simple. All you need to do is go to my omnipod.com forward slash juicebox. There you can try a free no obligation demo the pod they'll actually send you one out that you can wear and try for yourself. You can absolutely not be free. You cannot beat no obligate Just go on Miami pod.com Ford slash juice box, fill in the tiniest bit of information, get the demo, see what you think and get ready for the future, you want to be ready when the future gets here, you don't want to be standing around like oh, and the futures here, I didn't know.

Jake Leach 15:17
What's next, what we've got just a quick, kind of to touch on on the insulin pump side. We one thing I think we mentioned last time, when you and I spoke was that Dexcom had recently acquired type zero technologies, which is a group in Charlottesville, Virginia to spin out of the University of Virginia. They've licensed technology from the university and have a close working relationship with the technologist at the university. And what they've developed is both closed loop algorithms for insulin pump delivery, which is what's that technology thing implemented the next generation of the tandem pump, it's called control IQ. And so tandems that clearly clearly come through study. So there's that technology on the insulin pump side that we plan to make available to, to our pump partners, and continue to evolve that technology working closely with tandem on a next generation have even passed what they're having clinical studies now. And so we have that technology. But that group also as part of our approach to the decision support algorithms that united talked about. So that group was doing it was actually even conducting studies on MDI, in a, they called it the control, or the in control advisor is actually an app that gave advice about their diabetes, in terms of insulin and how much to take. And so was actually recording a lot of information during a study. So that study is still ongoing. And we're learning quite a bit about how to implement a good decision support system from that study. And we're just basically taking a team from type zero and combining it with some of our internal efforts, you know, to really supercharge this focus on decision support. But what guidance we can help give patients now that we've got, you know, accurate CGM, reliable CGM ratings along with insulin data. So we've got to kind of both sides covered. On our pump side, we've got tandem spoke about, we've got insolate. And with their horizon system, which is they've been continuing providing updates on the progress. They're, they're planning to enter clinical studies soon with that. One of the interesting things that they recently announced that if you heard this with it, they are now partnered with Samsung to bring to market the ability to dose your influence. So from hydro boluses, or make pump adjustments from your own cell phone. So it would be an insolent app on your phone that allows you to provide dosing guidance, which is really exciting because we for a long time at Dexcom, we've always taught that cell phone is a great interface for many, not for everybody. But for many patients. That's a very convenient option. And with the insulin system, we always had this extra PDM. Yeah, to carry the programmer. And now, for those who want to use their phone, they can use that connection on their phone. So that that was an exciting announcement that came out at the Samsung developer conference last week. But both insulin index contenders.

Scott Benner 18:32
I haven't dug into that as far as I have, but just the just the overarching announcement in seven days, became the second most popular blog post on my blog this year.

Jake Leach 18:45
And Oh, nice. I'm so excited. Yeah, I'm

Scott Benner 18:47
assuming you know what the most popular one was. But yeah, it's you guys. You guys are the I think that on the pod index commerce are the two most kind of compelling technologies in diabetes, but But anyway, that's, it's amazing. It's incredible. Can I ask you a sort of related question? Do you guys do you guys see pumps with closed loop systems? Do you see glucagon ever being necessary in the closed loop? Where do you think the algorithm will make the glucagon not necessary? Would you not care?

Jake Leach 19:17
You know, it's a it's a great question. It's got because we haven't, we're partnered with beta bionics, which is a you know, founded by Ed Damiano. And his approach has always been to use glucagon. You know, by hormonal, we got insulin and glucagon. And he's, you know, he's produced some really exciting results with that system, in both adults and in pediatrics, you know, in different environments. And I think what from for me, one of the things I always struggled with early on with it with the concept of glucagon in the closed loop was that there just wasn't nobody had pumps stable glucagon. Yeah. So He had to, he had to mix it, you know, and a lot of stuff that Ed was doing was he, every day, you had to either mix a new version of the glucagon and then put it into the reservoir or the pump. So I always thought, Boy, that's a real hassle. I don't know if the benefits are worth doing that. But he can he believe in the technology. And so he's been working with a couple of different manufacturers on, you know, making pump stable glucagon available, you know, so he's made a lot of targets there, I think there's still more road to go. But I think it's much more of a possibility now that you're getting glucagon that can remain stable in a pump for multiple days. So it's interesting to see, I think there's, you know, there's, there's, it's more of a system with the two drugs in it more complex, but, you know, potentially could get better outcomes from it. So the answer really is, I don't know, I think we're, we're partnered with some folks that are working on single hormone and with add on is dual hormone. And we'll see, you know, I think what's gonna end up happening is the usability of the product. And the clinical outcomes are kind of the two keys, ease to the product, as well as cost, you know, what, how are these markets going to evolve over time, my expectation across all the markets is we're going to continue to improve the technologies reduce the cost of them.

Scott Benner 21:19
So that'll be another important aspect of the technology. There's a small company in Chicago that's getting ready to put their their stable glucagon, I think into FDA. into the process.

Unknown Speaker 21:30
Yeah. Okay.

Scott Benner 21:32
Well, yeah, I just was wondering, like, because it makes sense that if you had if you if you could bump both ways, not just make, you know, kind of your future decisions based on on algorithm data that I get, I assumed it would be easier, but you make a point about cost, and something's going to come up later while we're talking. But okay, that's, that's absolutely terrific. I'm at a loss. I don't know what they ask you about next.

Jake Leach 21:56
Well, give me some more updates. So we've, we started last month, we started launching g six outside the US. So we started with the murky markets outside the US, Germany, Switzerland, UK, and we're going to continue to roll it out over the coming months. But our plan is to roll it out as fast as possible. We already overall there's more cheese users on G six than there are on G five. So we've been very quickly upgrading all the patients that g six got and balancing our ability to manufacture the product that we you know, we've been continually increasing the scale of our manufacturing operation on G six. And we've had some We've had a few struggle jiki broke up. You are completely gone. I can't hear.

Unknown Speaker 22:50
Did I lose you?

Unknown Speaker 22:54
I definitely lost you. Oh, a second. Everybody.

Scott Benner 22:57
On Jake on a cell phone today?

Jake Leach 22:58
We don't usually do that. Sorry about that. I guess we got cut off. Don't

Scott Benner 23:11
worry about you were set. I think you were getting ready to tell me you were talking about supply chain, I think.

Jake Leach 23:17
Okay, yeah. So we are, yeah, we're ramping g six as fast as possible. And we are, you know, excited about what we're seeing in the market. There's more users on G six that are on G five now. And we will you know, our plan is to get as many people on G six as possible. We recently got approval for Medicare with G six. So we're planning to launch that as soon as we have capacity to do that. So yeah, for us all things, g six, we're working on enhancements to that platform, and also working on our next generation platform, the g7.

Scott Benner 23:55
Okay, so let me ask you a question about supply chain because I reached out into the community. And there was a couple of things that I got asked about multiple multiple times. One of them was that. So it's interesting that some people experience it. Forget what the issue is, sometimes issues are experienced by some people and not by others, which must be a phenomenon makes you mental. But because like for instance, I have Arden's had the G six since the limited market release, so we have to be up on six months now, right, if not longer, and we have not had one failed sensor, every one of those made it 10 days. But then you'll hear somebody say I can't get any of my sensors to last more than seven days or six, you know, like that kind of thing. And the same goes with supply. I hear people say all the time that customer service is slower now that they've grown, which we've seen in the past, Kevin's been on the past and talked about that, like we grew really big. We're trying to catch up with customer service, we'll get there and that there's a problem with supplies. But as an example in my life, when by the way I want everyone to understand that when I call Dexcom it's not like a like a different phone rings too. So I call the same customer service people you do my account doesn't say the guy from the podcast. And I said, Hey, you know what I mean, it's time for me to order sensors. And I waited for I was on hold and had the whole, the whole call was done in less than 10 minutes and stuff arrived Three days later. Why is it different for some people than others?

Jake Leach 25:18
It's a great, great question, the dog project comes into play. So when it comes to just product performance, one of the things we're very proud of is that as we've continued to scale g six, we've been able to keep the product quality high. And so what I would say is what from from the data that I've looked at G six, often new users to the system, whether they're particularly if they're new to CGM, or even if they're just new to the G six system, because it is different. Sometimes it takes a little while to figure out some of the tricks to make and stuff, you know, and sensors last stay on all of those, all of those things. So what we've seen is new users continue to get better experiences with the product in terms of sensor lasting, Bluetooth connectivity, all of those things, once they learn some of the tricks to getting a feel for the for the system to work. And we we've uh, we're one of the things we're focused on is how do we continue to make it so that you don't have to know the cycle your Bluetooth on and off to fix your connection, or, you know, make sure you really clean the scan and don't use, you know, like, some sort of lotion on before you put your sensors on, and how you treat the adhesive and all those things, right. But all the things you've learned over years of using a CGM product. So, but you know, some some patients, but, you know, not all sensors last, they do, they can stop before 10 days. And so we, you know, we want those people to call in, we want to be able to replace their sensors. So I think, you know, different experiences, there are lots of different experiences out there. But from everything I've seen, the quality of the product is still still very high, even though, you know, we're continuing to scale manufacturing. on the supply side, it's a very, it's a very complex story, because different people based on their insurance and how they get the product or middle determine, and of what looks to happen, I'll give you an example. Some patients get the product directly from us. Some patients get them through a distributor, the distributors make very large orders from us. And then they take those orders, and they provide them to the patient. And so depending on which distributor you have, how they do their orders, and when you know, we do run into some sort of supply issue can dictate who could run into an issue and who doesn't. Our goal is to make sure that nobody runs into a backorder situation, whether it's a direct customer or through a distributor, or through the pharmacy, because more and more patients are starting to get the product in the pharmacy.

Scott Benner 27:58
So jump in for a second. Yeah, so a distributor, a distributor can throw out like they can make a decision to throttle their shipments. But that doesn't mean that. So I think what people imagine is that there's a big Dexcom warehouse somewhere and it's empty, and there's no stuff in it. And I believe that by No, I read through this stuff, and I think oh my gosh, thank God, I don't have like a market research shop. Because as I'm reading through people's questions, you can sort of see where sometimes this they don't realize that the questions very specific to them. Or that just because they went online and saw 20 people say the same thing. That doesn't mean anything because I don't think you guys do you guys release your actual amount of users. Would you? You don't say that. Do you publicly? No, no, I

Jake Leach 28:42
don't I don't I don't believe in anything, but it's the same

Scott Benner 28:44
but but if I said that I saw 100 people saying the same thing. That would be a tiny percentage of the overall users. It absolutely and imperceivable amount almost. And so and so that's sort of the internet playing tricks on you once in a while and when it's happening to you it's as real as it could be. You don't I mean like like you said something just a second ago was amazing. But you know, you put on the new g six right? You stick it on your break off the little tab you push the button and it's on. But how many people then go back and push down on the adhesive when they're finished? I do that and they never fall off of Arden. You don't I mean, like as Arden's been moving towards her first shower, she'll come to me and say, hey, let's cover this next calm before I jump in the shower, like little stuff that that takes you from thinking, Oh, this thing doesn't work to me just understanding like, Oh, this is exactly how this works. There's this thing that is incredibly specific. It's this device that's incredibly specific. It's static, trying to be put on what I'm guessing is hundreds of thousands of different people with different skin types, different hand lotions different bla bla bla bla bla. And it's interesting because it's easy to feel like it's you and it must be this horrible problem. But I will say that we've been using on the pod forever like it got it's gotta be it's 10 years. In the first week I had on the pot, three of them must have, I took them off. And I thought, Oh my God, this thing stinks. It doesn't work. And then I realized, like two months into it, that each one of those was me. Like, I just, I didn't do something that I now know how to do. And it's just very interesting, because when you're caught in that moment is super simple to feel like, this is a huge world issue. And it has to be happening everywhere. So my point is, is I believe that when somebody says, You know, I reached out to edgepark, and edgepark said, that there's a supply issue, they are apt to then blame Dexcom, not edgepark. But is that the case? Or how does it actually and I didn't mean to use edgepark as an example, but like a distributor can throttle their own stuff? That's a supply issue. That doesn't necessarily mean you don't have it? Is that what I'm, is that right?

Jake Leach 30:44
Yeah, generally what, if a distributor is struggling to meet an order, it's generally because their shipment from Dexcom, either they didn't order enough, or we weren't able to send enough, you know, to meet their forwarder. And then we're going to send a bunch more, but because one distributor is running into an issue doesn't mean the other distributors have that same issue. And doesn't mean that Dexcom direct customers or pharmacy customers will have it's one of those, you just kind of if you're tight on supply, somebody somewhere is going to get hit by that. And then our goal is to prioritize anybody who doesn't have sensors, we got to get, you know, get them sensors as fast as possible. So it's one of those things it's not, it's kind of it can move around, based on you know, what timing, but we are continuing to ramp and we're gonna, you know, our expectation is, we'll have plenty, plenty of capacity. We're almost there now. And so we, but we got to grow, you know, demand is definitely outpacing what we thought, we just the awareness around Dexcom CGM g six, it's, we knew it was going to be high, but it's a little higher than we planned. So yeah, we, we, you know, in hindsight, for our next launch, we'll plan or plan for even more demand than we think just just to be safe.

Scott Benner 32:05
I can I can I can we extrapolate that that same statement and sentiment applies to customer service that you're you're adding to that now?

Jake Leach 32:13
Oh, absolutely. Yeah, absolutely. We're, yeah, we're continuing to add more and more folks across our different call centers, depending on what technical support or customer support for orders. Patient Care, for those that need extra extra help. So we've definitely got all all those head counts are increasing so that we can make sure we can answer get to those phones. We we keep tight metrics on all the our ability to you know, how quickly can we answer phones? How long are folks on weight, and every time I see a long wait time, I feel feel awful. It's like, Hey, we got to get you know, this person needs help. Let's get somebody on it. So we're doing everything we can to bring on more folks.

Scott Benner 32:54
It's very cool. It's so funny how cyclical this whole thing is, like, I had this conversation with Kevin two years ago. Like, like, it's the same conversation like I'm going to ask you in a little bit like to explain like how Bluetooth works again, because the people who heard that explanation, some of them are off in their lives now. And now there are new people coming on, they need these same explanations. But first, do you have any other because? Any other announcements that we haven't touched on yet?

Jake Leach 33:20
No, I think I think, Scott, I think we've hit it all.

Scott Benner 33:22
Okay, so now we're gonna know we're gonna play fast money here. All right, we're gonna we're gonna whip through and see how quickly Jay can talk.

Jake Leach 33:30
I love it.

Scott Benner 33:31
Alright, so I have some now questions and some asks. Great, yeah. So I think some of them we've hit already, there are people who think the sensor failure rate is greater with G six and G five. Does any of the data support that statement?

Jake Leach 33:47
It does not. But what I will say is that the adhesive on G six, although it's a different shape, and a little more actual piece of material on V 6000. v five is the same past material. So if you are struggling, it is answer. The stands for seven is going to be more challenging for 10 days. So I think that in that aspect. Let's see in terms of our kind of rates, the replacement and rates of relapse, we're seeing good performance. But people do have issues and you know, within the product doesn't always last a full 10 days. So we are continuing to improve it. We do have a new patch material that will be coming out soon, which is very similar, same materials, but a little bit more advanced design on the patch side. So we're excited to see how that does in the market.

Scott Benner 34:45
Some of that somebody did. Is it possible that the Dexcom rep would have handed me some of that at the jdrf event in Ohio last week. He said out

Jake Leach 34:51
that. I don't know. I don't know. I know. I know. We're close on it. So I don't know. I know we haven't cut over full production to it. Okay. But you may have gotten some early access to it. But yeah, it's a little, little state here. And from our clinical studies, we've run with it. We've seen, you know, really good performance, folks that we're having issues with, with the older patch sticking this one, let's fix the vignette stuff better for them and their sensors. So that's Yeah, so we're not seeing sensor g six different but you know, 10 days is longer. So, you know, the poles can have issues. Okay.

Scott Benner 35:30
Okay. Let's see, did that. And that leads me to the next question. A bunch of people asked me, is the adhesive any different than prior?

Jake Leach 35:39
No, no, it is not not, not on the first year at present g six out there today. But there is a new new version coming, that's going to be at least from our clinical studies, you should be sticking around to stay on longer timeline for the new season. It's going to I don't know the exact time, but it'll definitely be out. Within, if not this year, next year.

Scott Benner 36:01
This is here, this one was huge. Is my Apple Watch ever gonna be able to act as you know, as my receiver without a phone nearby?

Jake Leach 36:13
Yes, the answer is yes. The timing is still you know, we're still working through all the challenges of the complexity of the Bluetooth under the hood. So you know, we've been working on the Apple Watch project since before Apple announced it, not this summer, but the past one. And what we found through working with Apple and working with the products is that the original user experience from some of the initial implementation from Apple, it wouldn't have been what we wanted, it would have been too complex and kind of frustrating for most people. So Apple's made a lot of enhancements on the way that the watch Bluetooth functions. And so a lot of it is very beneficial to the CGM communicating directly to the watch without a phone or receiver model. And so we're deep in development on net. And we're working on out the chain, the Bluetooth protocols within the transmitter. It can't support a direct to watch connection. But we will get there. Apple is committed to it, we're committed to it, we're going to make it happen. It's just taking longer than we want and longer than we hoped. But it's a very active project. And we don't have any timing on it. But it's it's as soon as possible the new operating system from The watch has allowed us to make a lot of progress on this development. We were a little bit stalled for a bit because there there's some challenges with how the system would pair to the transmitter. And so, but we've overcome most of that there's still a few things we got to fix, or figure out how to solve.

Scott Benner 37:54
So is it a hardware issue? or salt? Like what if I have an older watchmate? My might I just not be involved in this when it finally comes to fruition? Or was it more about the operating system? If you're listening to Jake right now and thinking How is it possible? I don't have a Dexcom it's time to get moving dexcom.com forward slash juice box. There's also links in your show notes. That's where you go. That's where you get this whole process started.

Unknown Speaker 38:21
Come on. Think

Scott Benner 38:22
about it. Listen to what he's saying. No finger sticks, integration, decision making. Everything is coming like a freight train. The future is bearing down on you like a bear in the woods and you're holding the big honeypot. Here comes your go.

Unknown Speaker 38:39
Hey,

Scott Benner 38:39
it's the future coming.

Unknown Speaker 38:41
Boo.

Scott Benner 38:41
I'm almost here. Here it Here it is. It's sneaking up behind it. It's not even that it's kind of like a big heavy footsteps. And it's like it's not even sneaking. Really it's right here. It's coming. Like I don't know what comes fast. Think of something that comes fast. Rain on a summer day. Yeah, like you know, you're walking around. It's nice to have that Awesome,

Unknown Speaker 39:00
cool beard. I'm

Scott Benner 39:01
sorry. That's how fast Dexcom is coming. And the stuff they have right now is spectacular. But the future is so bright. You're gonna have to wear shades to understand what I'm saying. Do you understand what I'm saying? dexcom.com forward slash juice box. Don't even let me spend time talking about sharing follow. Don't let me spend time talking about no finger sticks. That's all there. You understand that already? The last thing to do is to get it. I don't know. I just listened to music. Listen, didn't didn't didn't go get a dex coming. This is over cuz Scott was telling me about it. It sounds really cool. Yeah, that's it. dexcom.com forward slash juicebox. It's like you're the predator. And Arnold Schwarzenegger. Isn't that movie? What's it called predator and he goes, he goes he says that a predator kill Do it. Do it. Now I'm here. Do it. Just do it. dexcom.com for slash juicebox

Jake Leach 39:53
it's mostly about the operating system. I believe the very first the series one watch does not work as well. doesn't have the hardware, but the other series watches do work. And so if you don't have to have in the latest series for, for this feature to work, it's the way that we're we see it right now you can still have some of the older versions, you just need the latest operating system for the lock, which may almost everybody upgrades right away in the same vein,

Scott Benner 40:18
do you want to do this with Fitbit ever?

Jake Leach 40:23
So we, we do and we are working with Fitbit. And we actually recently got a few approvals for some products that are for really outside the title one intensive influence space, they're more protect to one of the integrations there is with a Fitbit. It's not direct to watch, though it's through the phones, though. So the Fitbit technologies though, they'll need to make some changes to the hardware and software on the Fitbit before we could enable a direct connection. But we are working with them on site, we call it secondary display. But it's the concept of have the convenience of the readings on your wrist. But you do still have you're still tethered to your phone, but the circuit still connects to the phone. So but we are working on that. And we did get approval recently for a product in the tattoo space that utilize that. And so we're looking at how do we take that and apply it to our D six product. Okay. Okay. Let's see.

Scott Benner 41:30
Oh, here's an easy one Android, any updates to the Android app? Will there ever be a widget or notification that includes the number?

Jake Leach 41:40
Yes, yes, yes, yes. We're working on that. I'm assuming when they say that the there's the the we call widgets on the iPhone. There is a display of on when you swipe, you can see the number on Android, they may be talking about follow. I don't believe we have that functionality on the Android follow. But yeah, our we're working on all of enhancements to follow as well as G six, as well as supporting more phones on Android. And so I mean, we we continually have done a number of point releases, you know, fixing bugs improving performance on both the iOS and Android apps over the past. Since we've launched the SEC, let me

Scott Benner 42:22
let me pop in with this just real quick. It's nothing I think you probably have to answer but people want you to know that the Google pixels aren't allowing follow to override default sounds or alerts with the latest release.

Jake Leach 42:34
Okay, that's good. That's good feedback. I hadn't I hadn't heard that yet. So we'll, we'll jump. I'll jump right on it.

Scott Benner 42:40
We can we can beta test you right now. And so to the beat information right now. So you did mention g six for Medicare that happened is that going to happen?

Jake Leach 42:50
Yeah, yeah. Yeah, we're going to Yeah, we're gonna we're going to launch that as soon as we have enough supply.

Scott Benner 42:57
Great. Oh, so that's another thing that's this year. We're not this year, but in the next handful of maybe a quarter to two quarters situation.

Jake Leach 43:05
Yeah, absolutely. Yeah. I think I think Kevin may have given given some more particular guidance on our last earnings call. But just you know, it was from last week. But yeah, we're definitely, you know, full force on getting getting ready to launch that.

Scott Benner 43:17
Is there a time in the future, we can expect a, like a generational leap with the follow up, like rise and fall alerts like that are, you know, for rapid rise and fall like no data alerts, like being able to use landscape? Those sorts of things?

Jake Leach 43:32
Yes, yes. There's a there's an entire revamp of follow in progress right now. Okay.

Scott Benner 43:39
I see, you're not gonna tell me when,

Unknown Speaker 43:41
in that same.

Scott Benner 43:42
In that same vein, a couple of people wanted to know that the watch app looks a little old. So fair, I

Jake Leach 43:48
passed. I agree. I agree. I agree. We, it's one of those. You know, for a long time, we were so focused on G six, and all our resources were on G six. And so we were just making the system compatible to make it work now, we need to continue to enhance the platform. And I completely agree there's a facelift is needed.

Scott Benner 44:10
Me banks have a couple more incentives. A couple of bigger questions.

Unknown Speaker 44:13
Let's see.

Scott Benner 44:16
Here's a small one. I guess the app update that happened recently, when you add an event, the highlighted.is gone that seemed very important to somebody, and I think they would like it back.

Unknown Speaker 44:27
So I know you will

Unknown Speaker 44:28
take a look.

Scott Benner 44:29
When will we be able to see a number on my watch complication? So not just the Dexcom icon, but as a follower, when can I look down on that complication and see a number without having to open it up?

Jake Leach 44:42
So that's, that's a very good question. And that's just one of those features that it's on our way called the backlog. We have a long list of features that we continually work to prioritize implementation, but that is something we do want to it's on our list to implement. So it will happen likely with a with a new release of five Have a will usually what we do is we will release features, you know, kind of one at a time, you know, or a few groups together. One of the exciting things is the new 510 k status of the texts come to the class to a little bit faster our ability to get releases out. So now that we have that, from the FDA, we're looking at how do we take advantage of it, and it's likely going to be a number of releases, with new features being able to get in more frequently than you've seen in the past, due to the faster approval times,

Scott Benner 45:38
I wanted to mention that I got a new Apple Watch. And there's the new face that, you know, is the one that I want to use, except the complications are sort of like a slightly different shape on some of the watch faces, and it doesn't allow for third party complications in some of them. Is that something you're aware of? And is that being blocked by Apple? Or? Or is your complication just not designed to fit in it?

Jake Leach 46:00
No, it's it's a certain certain complications work in those spaces, and other ones don't enter the apple really controls. That's, that's one of the unique things they control that watch face. And I think that is, you know, that they're all there's quite a if you get into the details, there's quite a few rules around the complications and how often you can update them. Most of it is driven by battery consumption on the watch, right? The more your activity you're doing, the more you're updating the complications, the number of complications, all those things have an impact on the battery life of the launch. And so they've got some tight restrictions that they've worked to loosen as a, you know, I get feedback from users and developers, they get feedback and they make changes, but they tightly control it so that you get a repeatable experience on the watch battery life.

Scott Benner 46:49
Okay. Yeah, that sounds like something they don't they don't want to make a claim about the watch battery life and then have your complication, drag that down. And then that's not something they can answer to. It's sort of like the trend, it's sort of like your problem with Bluetooth. Like it's trying to involve somebody else? And how do you address something with a different company? Hey, a lot of people a lot, a lot of people want to know, when there, you'll be able to increase the number of followers. Is that something that's being thought about? Because apparently, there's a lot of I have to drop somebody and then re add people and do a lot of this stuff. with smaller kids, it seems to be more prevalent there with their parents is that on the horizon by any chance?

Jake Leach 47:27
It is, it is it's one of the key features of our next generation follow is to be able to follow more, have more followers. And so it's all empty, able to follow more people. So both of those are on our list, because we recognize when we originally developed it five was like kind of a number that we optimized around. But there's no technical reason why we can't do more, it was just kind of that's where we landed in the original share. And so it's high time we we updated.

Scott Benner 47:58
Somebody wanted me to ask you if you can make it possible to log in the follow app and have that link to the main account.

Jake Leach 48:05
So Oh, that's a good, that's interesting, sort of had the follower. Enter events,

Scott Benner 48:11
right. And their events to meld seamlessly with what's being entered on the other on the on the person with diabetes phone two.

Jake Leach 48:20
So yeah, that's good. That's good. Good to be back. Okay.

Scott Benner 48:23
g six for iPad coming.

Jake Leach 48:27
But I do not be lose that.

Scott Benner 48:29
I don't know. I don't use my iPad for Dexcom stuff.

Jake Leach 48:32
So I was gonna Yeah, the Yeah, the iPad support. For the G six is no, is not on the roadmap right now, most, most of our experiences with the iPad, was that, you know, the use case, there weren't very many people using it and the amount of work for us to support it was quite, quite substantial. Because every time a new version comes out, we every time there's a new version of iOS or the phones, we actually have to do a tremendous amount of testing on the inside. Nobody sees that. But that's how we ensure everything works properly. And so the itI was just not not supported. For that reason, if if we didn't have to test it as rigorously, it could be But at this point, right now, that's where we're at. We do a lot of testing for each, each model of phones, whether it's iOS or Android. So

Unknown Speaker 49:22
let's see.

Scott Benner 49:24
Is there in in Actually, I'm gonna ask that one. One last one. Let me jump to that. Sorry about that. Alert sounds being more user definable. We talk about this a lot. I remember the last time I spoke to you, I talked about a person who was telling me that children like boys of a certain age can only hear certain pitches and like that voices work better. And so people really do overwhelmingly want more options because I think they get alarm fatigue, but someone made a specific asked me the specific question that I like so not only do they want more sound But they want to know if they can define if you guys can define better the alerts. So the example that was given to me was basically this. Say My target is 110. But my blood sugar's 120. And but the dex knows, I'm going to be, say 105, in in five minutes or something like that, Is it really necessary for me to be alerted that I'm 120? If I'm going to be 105, and stable five minutes from now? And are smart alerts like that possible? And so there are two different questions in there a Will we be able to make user defined sounds? If we can't, is that the FDA? Or is it? Is it just a limitation of the software? Something you guys haven't implemented? And can you make it so that it's smart enough not to alert us when it doesn't need to, even though the number might indicate that it should, dancing for diabetes just had their huge blowout show, it just happened. If you missed it, it's not too late to find out more about it, check them out on Facebook, Instagram, and dancing for diabetes.com. That's dancing, the number four diabetes.com?

Jake Leach 51:04
Two great questions. So the on the on the user defined sound is not it's just something that we haven't implemented. But we have talked about it quite a bit, because we do get the requests. And so I don't see any reason. Regulatory wise, as long as you know, we have a default sound. And then the if the user chooses to select a different sound, that they should be able to do that. So I think that's a good enhancement for the app as we move forward. And then on the smart alerts, yeah, we have a lot of discussion about this internally, we kind of we basically did implement the urgent low soon alert, which is kind of the concept of a of a smart alert, where the goal is to give the user more time have an alert sooner in time than they normally would get. If they're going to be urgently low in the next 20 minutes to 30 minutes. So I think there's a lot of opportunities for smart alerts I, I know I've heard many times about, you know, someone has a particular meal, and they know their glucose is going to be high. And they don't want to continually be alerted. They want to be able to say, Okay, I get it, I eat some cake and my glucose can be high, don't keep reminding me ideas. Remind me and, you know, way out in the future if something hasn't been corrected, but I think that it could a great idea about that concept of if you're about you're going above on 20, but we know are going to be 105. Particularly if we've got insulin information and kind of some patterns, I think there's a lot opportunity for making alerts and alarms more convenient. I think we've had threshold alerts for a long time, we're starting to introduce some predictive nature. And I think convenience is a big aspect. For us. For the alerts, it's always about, we got to make sure that our instructions about how they work are very clear. And that's where the FAA comes in. They we do you know, the way that you validate as you do a lot of human factors, testing with actual users to ensure they understand how the alert works, because the last thing you'd want is to implement an alert where the users, some users may understand it, but others may not understand exactly how it works and have a different view of the wrong interpretation. So that's where, you know, gotta be obvious. Yeah. Which is, sometimes I've always been surprised at how hard sometimes it is to make things obvious, because everyone has, you know, different assumptions. And they approach things differently. And so that's a that's an exciting part of developing user interfaces is, you know, how can you take lots of different people and have them all have the same assumptions about something? So Jeff, it's good, good to be back.

Scott Benner 53:48
Okay. Have you ever used Photoshop Elements? There's, I have not personally 13 minutes. So there's, it's an interesting in it in that you can choose to use elements as a beginner as a, as an intermediate, or as an expert. And as you click on tabs at the top of it, it changes what the app does. It's pretty, it's fascinating. I know, it's not something you could ever do. But it's it made me think of it while you were ready. We're talking about that. So in the in the end, what you guys make has to work for everybody. And just because some of us might be more expert users than the other doesn't mean we can leave a new person behind and then not understand their their alarms and other things I got. Okay, a couple quick I have kept you way longer. Are we okay? Yeah, we're talking. Let's see. Apple CarPlay Does that ever do you think that'll ever happen?

Jake Leach 54:36
It could we've we've prototyped with it actually, even a couple of years ago, when it first came out. We had we had CarPlay stereos there enabled stereos on engineers desks and we were playing with it. We, you know, haven't I don't think we kind of figured out how you would how we bring it to market yet. But I think it's an exciting option. So it's definitely something we've looked at and we're looking at

Scott Benner 54:59
web Access to follow. That's something simple like is a maybe like a little widget or something on my screen, something where I could see somebody's blood sugar without having to open up a phone or something like that. I know there are third, there's a third party option, which to be perfectly honest, I'm looking at right now my screen, it works great. So if you can, apparently they want your version of it. Oh, here's a small one. When I clear my alerts on my, my watch, can they Please clear my alerts on my phone too? So I don't have to clear them twice. Is that a limitation of iOS? Or do you

Jake Leach 55:32
just have to tell you it's not? It's not? No, it's it will it was a limitation of some of the earlier designs and also a little bit of the kind of regulatory approach, one of one of the unique aspects of is, if you can clear alerts on your watch. It's, it's not, it's no longer considered a secondary display, it's more of it's in control now as the system. So the regulatory kind of approval cycle for that in the past was different. Now that we're at the 510 K, we can fix that. And so it's in, it's on one of our higher items on the backlog of features to implement. So we do recognize that it would be much more convenient to be able to acknowledge it on your watch and not have to go back to your phone. So we will fix that. And it's not a limitation of the device. Okay,

Scott Benner 56:20
so two more questions, slightly bigger ideas, and then I'm going to ask you about pipelining. And then I'm gonna let you out. So one person asked, Are you guys happy with your mark value? Or is it something you're always working on?

Jake Leach 56:36
I would say we're happy with it. But we're also always working on improving it. The, you know, the sensors work, they're very reliable. But as everyone's experienced, at times, it can be inaccurate. And so I, there's always places for us to look. And so the team that's continually at Dexcom worked on, improving performance is going to continue to do that. So we're, we're really, my main focus is now not on, you know, the average metric, but it's, you know, the Amir de metric, I'm way more focused on anything, that's more than 20% off of a blood reference. It's kind of the outside of 2020, those, those metrics that we capture 30% off or 40% off, we have a very small number of readings that are in those areas. But those are the ones we're focused on. Because you know, we've hopped on system be as reliable as possible. So we'll never rest we're gonna keep keep where the performance later we intend to stay there. Excellent.

Scott Benner 57:39
Is there any, you know, I feel like people talk about waste, like recyclable waste with G six more than they did with G five. And I, it's funny, because when I hold the G five insert, I hold the G six inserter. They don't feel like one doesn't feel much heavier than the other, which in my mind means it's not that much more material one way or the other. But I think it just looks bigger. And so it bothers people more not that it shouldn't. But do you guys ever talk about recycling programs now? Or is that not we do, we,

Jake Leach 58:09
we talk we talk about recycling programs, we also talk about, you know, kind of next generation or next generation platform, you know, kind of making the applicator device even even smaller, with even less, less plastic involved. And I think the complexity of it is you're getting the sensor under the skin isn't as simple. There's a lot of important aspects to it isn't just like slipping into the scan. There's how the needle inserts the speed, the size before so all those things. And so the G sex was our first automated applicator with all that technology built in. And we do talk about recycling programs with it. But recycling medical waste is a bit challenging

Scott Benner 58:51
in the construction. Right, it has to be pulled and taken.

Jake Leach 58:53
Yeah. You know, and it's one of those things, there's a lot of cost involved in that for for you know, depending on who's paying for it and so just it wasn't we are we are very aware of it. And we think what g six you you do have less applicators per year they do a G five to the longer center life. And but yeah, we're aware of it and we want to continue to, you know, make the products you know, as environmentally friendly as possible. But the reality is, you know that it does take technology to get that sensor under the skin. Yeah. Hey,

Scott Benner 59:27
if someone sees a blood sugar, it's just off their testing and the CGM is not it's not saying anything close to what their their phone says even if she says you want them to calibrate then or no What are they supposed to be doing that?

Jake Leach 59:41
No, usually, most particularly, I mean with G six, my recommendation is if you take a finger stick and it doesn't match your readings, or if you're you know if if you're reading on the phone just seems way off, you know on your display it the CGM reading isn't what you expect. Take a finger stick, double check. I mean, don't don't ignore your symptoms or what you think things should work and trust it. Take a finger stick. And look. I think what I the way that I recommend folks use it is not to calibrate right away, because often, the errant signals in CGM resolve themselves. And so if you see like a persistent error, or a persistent difference between the finger stick and the CGM, then you don't think it's resolving then calibrate. But you know, give it some time. If you you know, if it's, you know, see Jim's not reading accurately don't don't immediately jump in calibrating, because what we've seen actually is that if you calibrate a CGM during a signal error, you can actually cause more damage than help. And so you want to kind of let it let it go for a little bit and then only really entered calibrations. If you're not seeing the sensor signal, go back to what you expect. Gotcha.

Scott Benner 1:01:00
Okay. There was a there's a lot of questions, and I don't think you're you because because your your r&d, but if you could pass on to anybody, you know, obviously always cost access. You know, people want to know if there's a coupon day stuff like that, you know, but it's, you know, I got a specific note from someone who listens in South Africa, and they're like, it's here, and it's available, but I can't afford it. And is there? Is there is Dexcom, helping to make that more affordable. Like, are they working with the entities that could help that be more affordable?

Unknown Speaker 1:01:31
You know, it's

Scott Benner 1:01:32
just, it is, is CGM, just something that's not affordable for everybody? Or is it something that we hope that one day it will be and behind the scenes you guys are working towards that we maybe just don't see that day to day?

Jake Leach 1:01:46
I think the the answer The answer to the axes of definitely, yes, we're working behind the scenes on a lot of things. Medicare was a big push for us, we have a number of folks internationally that are working across the different markets and the dynamics in those in those places. And I say, and so access is going to continue to get better as it has over the years, you know, more states are starting to cover Medicaid of different states are now covering, I think, with the movement of Medicare. So I think in the US reimbursement is it's always slow. But you know, access we've been we've got, you know, vast majority of folks with private plans or even public now, plans are covered into some capacity. And I think as we continue to improve the technology cost, you know, ultimately, the costs will come down as the technologies as we come out with, you know, future generations. Yeah. And so I think CGM is going to get to the point where it can replace finger sticks as the I think it already has in many places. But I think across the world, there's still some work to do to get CGM access better. I think a lot of it has to do with, you know, the, the amount of product in the country, the volume, the distribution, all of those, those aspects. So I just see CGM in the future being the lower lower cost over. But I think it takes time because we have to develop the systems that those have the level of performance that users need, as well as the cost. And in those, those are in a lot of the technology are competing requirements. And so there is a way to balance them. And we are continuing to make progress on both performance and cost.

Scott Benner 1:03:33
Let me ask you this. And I'm just gonna come right out and tell you like, if you can't say or you're uncomfortable, I get it. But there is a less expensive CGM available. Did they do in your opinion isn't? Is it not the same quality?

Jake Leach 1:03:48
Is it not something? Definitely, it's definitely not the same performance. I think, if anybody looks at the performance numbers, or even just talks to folks who have experience with the competitive product, I think it's they'll, they'll know that the system is not as reliable in the hypoglycemic ranges that it doesn't have today doesn't have, you know, kind of any kind of alerts or alarms that could signal us. So what you know, give me an example of what we've seen in Europe, is that the health care systems are willing to pay more for the Dexcom product because of the feature set, the alerts, the alarms, the performance, we even have some areas, health payers that call out the share feature is an important aspect of the system. And they're willing to reimburse it for a higher rate because of that. Yeah. So I think it's well recognized. I think patients recognize it as well as payers and physicians, they recognize that there's a pretty significant difference between the two products. But you know, the way I would look at a competition is good. I'd rather have a competitor than No, no competitors. So I think I think it makes us all better. And we all strive and push each other each other, so I like industries that have competition. And I like the fact that we do have some competition in a glucose monitoring space.

Scott Benner 1:05:08
Jake, I've sat in a car that you can buy for $10,000. I've sat in a car you can buy for 5470 and 120. I can't afford $120,000 car. But when I'm sitting in it, I get the idea of why it costs $220,000. And so I think there are levels of, there are levels of what you need to expect out of things. And it's easy to say, you know, I don't know. I mean, there's some Mercedes over there, I can't afford. But, you know, why can't it be as cheap as this Honda? And I think there's a reason you know what I mean, and I just didn't know what you would think of it. And it's a tough question for me, because, I mean, we're, you know, we've been with you guys for a really long time, I believe what you're saying, but I didn't want to, you know, I didn't know how comfortable you are talking about. So I appreciate that very much. I guess the last real question I have is then, is gees, you mentioned g seven. So g sevens next, but is G seven the last of that. That kind of, I don't know, I don't know, features like, like, form factor? Are we going to move to something smaller after that? Is that the goal? Or or could there be a g8? while you're still working on something else? I guess merrilees Next, right.

Jake Leach 1:06:20
Yeah, yeah, very rarely is next. We're working very closely with them on this next next generation platform. And yeah, there's, there will be G, G, H, and G nines and G 10. And then we're going to continue to innovate in all the areas we want to which is, you know, cost, convenience, performance and outcomes is a new one, right? I mean, trying to, you know, we've for a long time, we've provided reliable glucose readings. But now it's all about what do you do with that information? How do you get a better outcome for, for the user? With with no advice, connections that are excellent partners. So there's still a tremendous amount of opportunity to, you know, continue to evolve the system. And so yeah, there will be there's multiple platforms GG seven, as well, and development, which is how many, you know, in product development General, but also medical devices that where you have to run clinical studies, yet you you work on them for many years, before they become public.

Scott Benner 1:07:22
Yeah, there, hey, listen, there's a this is a little aside. But I hear anxiety from people a lot, because now used to be able to get a transmitter ahead. Like you used to know, if the transmitter when the transfer you had was done, the next one was sitting with you. But the insurance company's mind, I have pretty spectacular insurance. And I'm in that situation to where Arden sensors just arrived the other day, but I was not allowed to order another transmitter yet. And I don't I know, that's a very back room kind of thing. But if it could be impressed upon the the providers that there is a lot of just quality of life comfort, where it's not in the back of your head, oh my gosh, what do I do if this should happen? I mean, there's a lot of value in that for people. So I don't know if there's a way to pass that around and make any impact with anybody. But I know what it impacts a lot of people. So I just thought I thought that was worth mentioning here at the end.

Jake Leach 1:08:17
I can't, that's a great point. We, we recognize that. And we we will make sure that the the folks continue to communicate that but we we fully appreciate the amount of anxiety that can happen, you know, when managing diabetes and found the fact that, you know, if you can't, and if you don't have extra supplies, you don't have that transmitter. It's not a good, it's not a good feeling.

Scott Benner 1:08:42
Yeah, and I'm not looking for enough to, you know, stock up 10, you know, 10 people with diabetes for a year, I just want, I just want one, just enough to think that if something were to happen to this one, you know, that was outside of the parameters of expectation that I wouldn't then have to wait, I know, it seems kind of crazy, maybe to think but for some people having to wait two days is a long time, you know, having to wait, you know, and then some people fall into that. Well, my, you know, my distributor is two weeks out and above. And it's just it's a strange space for people to be in. So I appreciate you saying that. Jake, you stayed on way longer than we were supposed to. And I'm assuming I'm gonna get yelled out about that later.

Unknown Speaker 1:09:18
But I really appreciate

Scott Benner 1:09:18
that this was really fantastic. And you went through every one of these questions. So kudos to you for hanging on like this. And I really appreciate Hope you're nowhere near those fires out there.

Jake Leach 1:09:31
Now we're lucky. We're lucky in San Diego where we don't we're not near the fires, although Yeah, feel feel for everybody affected and really appreciate the time, Scott wonderful discussion. And yeah, don't worry, no one. No one's going to yell at you. This is great. I'm already married.

Scott Benner 1:09:48
I don't need to be yelled at by other people. Okay. appreciate that very much. Yeah, I really do. I you know, whenever you have stuff to talk about like this, I love having you on. So thank you very, very much.

Jake Leach 1:10:01
Okay, I look forward to the next day. Our next chat. Take care. Have a good day. Thanks, guys.

Scott Benner 1:10:09
Thanks so much to Jake leech for coming on the show. Thank you to Omni pod dancing for diabetes and Dexcom for sponsoring, please go to my Omni pod.com forward slash juicebox. good at dancing the number for diabetes.com or go to dexcom.com forward slash juice box. Of course you don't have to remember any of those because we go into the podcast app. There's links right there. There's also links at Juicebox podcast.com. If you enjoyed the episode, and you're looking for a way to share the podcast, go to Juicebox podcast.com. Go to the page specific to this episode, copy the link and take it out and share it in the world. I don't know where Facebook, Instagram wherever you talk to people. That would be wonderful if you could do that.

Let me end by saying thank you for all the new ratings and reviews on iTunes for everyone who shares the podcast and all the wonderful emails that I've been receiving. You all are far too kind.

Jake Leach 1:11:00
I'll be back next week.

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Scott Benner 11/6/18 Scott Benner 11/6/18

#193 LIVE from JDRF South West Ohio Type One Nation Summit

Recording in front of a live audience…

Scott interviews a fighter pilot and then talks type 1 diabetes management strategies with a huge crowd. Audio is different than you are accustom to..

Guilt/Shame Infographic

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello, and welcome to Episode 193 of the Juicebox Podcast. This is a bonus episode. So if you haven't looked back in your player for Episode 192, it's there too. It's called bolusing, cursing and tacos. What you're about to hear was recorded live at the Southwest Ohio chapter of the jdrf. There I spoke at their type one nation summit, to a room full of people, I'm telling you, they're high to open 500 people in that room, it was absolutely exhilarating. I can't wait to do more live events like that. You don't get the greatest audio from it. But you do get an amazing experience. So I want to thank the Southwest Ohio chapter for having me out. guys ran probably the most well attended best organized event I've ever been to. And being there made me want to do it more.

Unknown Speaker 0:57
This session will be recorded, and you can listen to it online on the Juicebox Podcast. Alright, now's the time you've been waiting for it is our live Juicebox Podcast. So I'm gonna turn it over to none other than Mr. Scott.

Scott Benner 1:19
Oh, my gosh. Thank you so much for coming out for supporting the jdrf. And for being even remotely interested in some of the things I'm going to talk about. My daughter was diagnosed when she was two years old. She's 14 Today, after a number of years of struggling with her a Wednesday being in the eights and you know, eventually got an insulin pump, got into the sevens, got a dexcom got down a little farther. And then we got stuck. And then one day my nurse practitioner told us something that really just changed everything for me. I asked her What's the hardest part for you your job and she said, it's to stop people from being afraid of insulin. If I could make people not be afraid of their insulin, they would have better outcomes. I took that very seriously. I thought about it for a long time. I wrote about it forever and ever online. And then one day I started a podcast now the jdrf would like me to tell you does anybody here listen to the show? Thank you. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before being bold with insulin or making any changes to your health care plan. We're going to interview mark in just a second. And we're going to trans kind of translate from Mark into some slideshow stuff. But just very quickly. That's my daughter Artie on the right when she was four when her when she was probably nine. Now she has last summer. She's 14 right now, Arden has no diet restrictions, or a one C and I only tell you this to you for the purposes of what we're doing here today has been between five, two and six, two for the last five years. Arden eats everything you can imagine. pancakes, waffles, Chinese food all times the day and night. And we manage to get that a one see through understanding how insulin works. So I'm going to invite Mark Lily up. We're going to talk for a little bit about his story. And then I'm going to tell you a little more about how we handle it as much sugar. So I'd like to give a big round of applause to mark. You want to say? Yeah, I think so sitting I'll look less short if Mark sits next to me. More hair. So the podcast is conversations with people just like you. As a matter of fact, has anyone in the room ever been on the podcast? Cool to work? Can you introduce yourself to everybody? Hi, everybody. My

Mark 3:41
name is Mark Luli. I'm a type one diabetic. I was diagnosed March 7 2005. And I'm also the father of a type one diabetic. My son Charlie sitting over here was diagnosed two years ago. Okay, so how old are you when you're diagnosed as 29 years old?

Scott Benner 3:55

That has been incredibly shocking. Yeah, so

Mark 3:58
at the time, I was a fighter pilot in the Navy. I had been a pilot for about eight years came back from my second deployment to Afghanistan and Iraq. And my wife and I were getting ready to move to France for three years, I was going to do an exchange tour with the French Naval Air Force. So we are living in beautiful Monterey, California taking French classes for six months, five days a week, not a bad time to spend your your days. And so a couple things were happening and ended up going into the hospital. And after a week in the hospital. I found out that I was a type one diabetic and that I would never fly again and I'd had to leave the Navy. So it was it was devastating. So you may not know that

Scott Benner 4:36
mark lost his pilot's license for certain crafts right. Like there's some stuff you can still do.

Mark 4:41
Yeah, as well. You can be you can you can get your private pilot's license and be a type one diabetic and Scott has interviewed a pilot and a previous podcast. You cannot be a commercial pilot and you certainly cannot be a military pilot with Type One Diabetes. Okay, so

Scott Benner 4:56
there are people in the world working towards changing that. And I actually interviewed a gentleman a few weeks ago, who's one of them. And I don't know if you know, but very recently, the laws have been overturned about CDL license. So used to not be able to have one of those with type one, but now you can. So people are always doing good work trying to move things like that forward. But I want to ask mark, so you're diagnosed as an adult? I can't imagine you thought you were getting diabetes. Did you have any of this in your background, your history

Mark 5:21
now, no family history at all. In fact, the only I guess the only history we had is my father in law as a PhD. And he worked on diabetes related medicines for years and years and years. And, but but no family history of type one diabetes, and so we lot of medical background of my family. And so you know, as those who have type one, diabetes, you know, the symptoms, I had the classic symptoms, I was urinating a lot, especially at night, there were times where I was getting getting confused, and I couldn't really explain it in my vision went from 2010 to 2070. And so, you know, we had some conversations, my wife and I, and we talked to my parents and her parents. And so we remember someone one of them saying, you know, that sounds just like diabetes, but you know, we just assumed type two diabetes, and I did not fit the profile of type two diabetes at all. So it really was a shock. Okay,

Scott Benner 6:15
so and no other endo issues like celiac or hypothyroid. Nothing at all. So So Mark was blindsided, much like most of you, I imagined were. What did they give you in the hospital? Start your management with? Did you leave with pens with needles? Did anybody talk about an insulin pump? How did that go?

Mark 6:33
Yeah, so it was interesting, because I was not in the military hospital, I was in a civilian hospital and Monterey and endocrinologist actually thought I was a type two diabetic. So he sent me home with I think it was glipizide, which is a type two diabetes medication, and just said, you know, take this for a week and see if that has any impact on your blood sugar's and of course, it didn't have any impact whatsoever. So after about a week of doing that, we went back in and then they obviously discovered that I was not a type two diabetic, I was type one. And so I left this facility at that point with, you know, pen, pen, needles and those type of things, relatively basic instructions. And we're kind of left to our own devices. And it was frightening, it was absolutely frightening.

Scott Benner 7:15
So there was no, this is how insulin works, or this is what you should always count your carbs, inject this insulin, wait three hours test, that that was pretty much it. I

Mark 7:26
characterize it, as they gave us a bunch of pamphlets, they fed us a whole lot of information that we just could not necessarily ingest. We were not in the right mental state to be able to do so. And I felt like we were dealing with people that were not used to type one diabetes whatsoever.

Scott Benner 7:42
So here's what I think. I think that doctors know you're overwhelmed when you're first diagnosed, and they give you what I call, don't die advice. It's just enough advice that you won't die. You know, you can't hurt yourself too much with the insulin, it's not about keeping your blood sugar and level, they don't tell you how things work. It's probably fair, right? you're overwhelmed, you're probably confused. The lots going on. The problem is that in subsequent visits, it doesn't get ratcheted down at all places. Some some Enders do an amazing job. But more often than not, you get what you got, which is go figure it out for yourself, do your best, and how did you do in the beginning.

Mark 8:18
So it was rough, because it wasn't just, you know, trying to understand diabetes and deal with the physical aspects of it. It was I you know, for me, personally, I had to deal with with the mental part of it, not just diabetes, but the fact that, you know, being a fighter pilot is all I'd wanted to do in my life. I mean, since I was a little kid, I'd always known and always wanted to do that. And suddenly, without any warning that was taken away from me, and there was nothing I can do about it. And that was, you know, for several months after that it was it was devastating. I mean, I wasn't a, what I would consider fairly severe state of depression, and and really didn't know what to do. But at the same time, I had to learn how to take care of myself. And you know, I'm blessed with a wonderful wife and an incredibly supportive family, who's who's, you know, able to do that with me. So I knew I wasn't alone. And without them, there's just no, there's just no way I'd be here.

Scott Benner 9:13
And so I think what Mark is characterizing here is that he was afraid just like he probably should have been, and he needs some sort of support. So what I'm going to tell you is that no matter where you get your support from I'm sorry, I didn't mean to ignore you over here. No matter where you get your support from, it has to come from somewhere, you have to have some sense of community. There are people who live in the middle of nowhere who listen to the podcast, and they think of the people that they listen to every week as their their community. It could be a friend and neighbor. It could be someone here for the jdrf. But I really want to implore you, it is very important to be connected to someone else and to not feel alone. But that's not the entirety of what you need. But it's a really good start. The next thing you need is the fear aspect. It has to go away at some point. So I'm going to ask Mark about something because I think Mark probably has an experience overcoming fear like no other. I don't know about the rest of you, but this man can get into a machine and make it fly off the ground. To me, that sounds incredibly frightening. I would never do that. I think he's probably crazy. But that's fine. Okay, but I want to know about that I want to know about when you're faced with incredible fear, what are the steps you take to get past it?

Mark 10:20
You know, I don't know if I've got a recipe a few that I can share. But what you know, what I do remember is I've never flown before. So I graduated college and became an officer A few days later and went down to Pensacola for flight school. And I remember, you know, I take my lunches by the runway, and I would sit and watch these pilots learning how to fly and they would start the engine and you know, off they went. And I just, I just thought, like, you know, how the heck do they know how to do this, it seemed, it seems so impossible, and so daunting. And then I started going through some of the academics of how to fly. And then I started learning some of the basics of flying and doing my first flight. And then I realized, like anything else, you gain confidence through experience. And so I learned how to fly a turboprop aircraft. And then I went to do initial jet training. And I thought the same thing again, Oh, my gosh, how did these guys and gals do that. And then again, I just started, you know, some of the basics and you improve and you improve. And then you get to a point where you feel like you're very confident, you know, you really understand how to operate in an ambiguous environment, and you actually look forward to taking some additional steps. So I felt like that when it came to diabetes, eventually, when I was diagnosed, that it was so incredibly daunting, and how am I going to have to incorporate this into my life, but just like, you know, I reverted back to when I was in flight school. It's not something I knew initially. But as I learned more, I gained confidence. And I just felt like that's what what was the secret for me to control my a one C's to make sure there are less volatile, and to make sure that I could incorporate Type One Diabetes into my life without having it ruin my life, if that makes sense.

Scott Benner 11:59
And I'm going to be here today, and we're going to talk a little bit about how to translate those ideas to type one. Because it is very true. This is all about experiences that you have to have over and over again until you don't have to think about them anymore. And then it's hard to imagine for some of you maybe but it comes it really does. I sit before you. I tell you I was standing in my shower crying most days when my daughter was diagnosed at two I didn't know what she was doing. I couldn't figure out what was happening 12 years ago, no Dexcom she had a little tiny meter and some needles. And that was the whole thing. She weighed 18 pounds when she was diagnosed. And I spent most of my time in that unsure place. It took me a long time to realize that all the things that I would have back then characterized as mistakes or problems ended up being the learning experiences that I needed to make better decisions moving forward. But one thing you have to do for yourself is lose that verbiage that says, I messed up that this was a mistake. It's not it's always just data for next time. It's just incredibly important. So Mark, how many years after you were diagnosed? Was Charlie diagnosed.

Mark 13:07
So Charlie, who's somewhere around here, he should be sitting here but he's a rascal. So I apologize if he's underneath your table right now. He was diagnosed in December of 2016. So my family and I was living in Singapore. And we woke up one morning and he had he had went to bed, which is extremely unusual. And so later in that day, we were getting ready to fly to Cambodia. So we're going to take a four day vacation with our with our kids to Phnom Penh. And so I actually my wife and I decided to test him using my glucometer and and then I saw the number we knew right away he was in the four hundreds we knew right then and there that he was a type one diabetic. And I tell you that when I was diagnosed, when I was a pilot, that was the second most devastating moment in my life, that you know that the most devastating moment is when Charlie was diagnosed because it's, it was one thing for me as an adult, you know, I'd achieved my dream and it was difficult to transition. But I was able to do that. It's a whole other ballgame. a whole other ballgame when your child is diagnosed with this disease. So, you know, even though Heather and I were very experienced with Type One Diabetes, there was a lot of learning that we had to do. You know, with a child now who has it, which is a far different experience than than when I was diagnosed. So we actually it's a little bit of a funny story, but we ended up going to the endocrinologist. And you know, he's we told him we were leaving for Cambodia later this afternoon, you know, what should we do? He said, Listen, I would never, I would never do this with another family. But you know, Heather, you're a nurse, Mark, you've had Type One Diabetes for years. You guys really understand this. So let me go ahead and give you some of the basic equipment. You guys go to Cambodia and have yourself a great time and that's exactly what we did. And we're thankful for it and we're lucky or fortunate. Maybe not I wouldn't recommend that to most people today. to Cambodia, you know, the same day that your child is diagnosed. But but it's also that's how we've chosen to incorporate type type one diabetes in our life. We don't let it control us, we're very much in the driver's seat. And that would be one piece of advice I would I would give folks in the room here today, I would

Scott Benner 15:17
have to add to that as maybe delicate as Arden looks in her picture, I'm not sure that little kid was two wins away from going to a Little League World Series last year. So she plays softball in incredible heat 100 degrees 345 times a day, starting at six in the morning and not ending sometimes till seven. She does that without crazy lows. And I really do think that marks words should echo in your mind that there's nothing you can't do. It's tough sometimes. Let's make fun of Mark from it's tough sometimes, where a handsome man here who can find the place it's in front of you and tells you this is all doable, right? I even think Whoa, I can't fly a plane, this guy must be smarter than me somehow, right? But the truth is around diabetes, it doesn't matter. That's why they brought me here. I can do it, you can all do it. Right? I'm telling you, there's nothing special about me. I'm not good at math. I wasn't a very good student. All I know is how to use insulin. And I'm kind of good at explaining it to other people too. So we're gonna get to that part. But I really want you to believe moving forward, that when you have the right tools, and the right understanding the sky is absolutely the limit is 100%. is I want to ask you, do you guys use pumps or kind of technology? do you use?

Mark 16:30
Yeah, we do. We use insulin pumps? Both Cheryl and I had the same pump.

Scott Benner 16:33
Okay. And are you using the glucose monitor? We do? Yeah, we

Mark 16:36
use the Medtronic 670 G. So the closed loop system,

Scott Benner 16:39
okay, and my daughter uses a Dexcom g six, I'm going to tell you that the data that comes back from the glucose monitors, makes what I'm going to talk about later, a lot easier. It's not not doable without the technology, it just takes longer without it because you're a little more blind than you would be with it. Can you tell me a little bit about your management style? Do you I know already. But Mark, you don't shoot for the same a one ci shoot for Right. Yeah. And

Mark 17:03
I think it's Listen, I think the important point is, listen, there's a range of a one sees that are acceptable. And I think what you what each person needs to do, which each family needs to do is decide what is what is good for you. How do you want to manage this, you can be all over this 24 seven, actually, for those of you who are in the previous sessions here, yeah, I sat through the one Chris, who's the power lifter of Chris really manages this very strong. But even you know, he said, You know, he fluctuates between about six, five, and maybe a little over seven. That's exactly where I tried to be that works for me. It allows me to do the things that I want to do in life without making it so overburdened some and and having to think about it so much. The beauty of the technology out here, whether it's Medtronic or Dexcom, or anything else, you want the technology to do the work for you. So it doesn't manage your life, right, you're managing your own life. And that's what Charlie and I had done that that was the reason that we put him on the pump that he's on, so that he can see me go through all the same motions and you know, insertions and sensors and all that kind of stuff. In quite honestly, some there's times when we share some of the same pump supplies, which is as a

Scott Benner 18:15
giant company, it's fine, hopefully, but,

Mark 18:19
but it just, it makes it much easier. And then and then Heather and I are both very, very comfortable with managing with the pump that I have, which makes it that much more comfortable managing the same pump that he has, and I want you to be sure,

Scott Benner 18:31
please hear me when I say this, he don't imagine my daughter's blood sugar is at 8524 hours a day, it is not her blood sugar spikes a couple of times a day 151 80 we get it back pretty quickly. And we keep her at a lower number. You know, I don't worry about being low, I don't start thinking about low till 70. But that's that it's not a perfect system, I don't want you to think that her blood sugar just goes like this. And it's magic. It's not showing something, we'll miss a little bit on the inside on both, and we readdress and I'll talk about it later. And maybe you guys can incorporate a little bit into your life. But I want to thank you very much for doing this. Thank you very much.

Do you guys accept blood sugars that are higher than you want? Because you're afraid of lows? That happened? Anybody I understand that completely. And you probably should be a little concerned. Diabetes is not easy and insulin is to be respected, but it is not to be feared. The problem is, is that when you err on the side of caution, you're always going to be a little higher than you want to be. And then you sort of get used to it right? Like you know a lot of people get told at the doctor's office that you're fine anywhere between 80 and 200. They tell you that a lot when you're diagnosed. The problem is that makes 200 seen in range when they while that's double what somebody in the audience who doesn't have diabetes, this. The problem is when you get to 200 then you start thinking about 220s Okay, it's so close to 200 And you sort of talk yourself into it eventually. The key to this is understanding how the insole works in your body. It is the entirety of it. If you leave here not remembering anything, remember this, you have to Pre-Bolus your food. And the entirety of managing Type One Diabetes is timing and amount, it has the right amount of insulin given at the right time. All of the other variables don't matter as much as timing and amount. We're going to talk about it try to make sense of it. These are not mine, I stole them offline. The one on the left is with a post from a mother who said I can't figure out diabetes, no matter what I do, this is what happens. And that's just diabetes. She said, I'll never forget that. She said that, that's just ID. So what I did was I eliminated carbs out of my kids diet. Now look how good they do. And I thought, well, that doesn't sound like a lot of fun not eating carbs, because carbs are fun. As you can see, I've had a car before. And there are a lot of fun. That's just diabetes, I am here to tell you. That's not just diabetes, when she says that when anyone says that, what they mean is I don't really know how the insulin works. And I'm doing my best. And I'm trying, but I just can't get it right. And I need to cut myself a break. So I'm going to put it on somebody else or something else, I'm going to put it on diabetes, it's just incredibly important to know that if your blood sugar goes up out of nowhere, it is not the magic diabetes failure that came along and tapped you on the head. So I'm going to tell you a story about m&ms. And I'm going to hope that by the end of this, I'm going to be your MLM story. A very long time ago, my daughter and I were in her endocrinologist appointment. And the as was before glucose monitors, right as Dexcom was getting started. And she said, Are you guys gonna get a dexcom? And I said, I don't know what that is. And she said, Well, there's a 17 year old boy in the practice, he got one because he wants to eat m&ms without his blood sugar going all over the place, tells me that what happens is the boy goes out, he buys these little packs of m&ms the ones you get at the register by the cashier, and he buys a bunch of them. And the first day he goes home, he gives himself his insulin like he always does. He eats the m&ms and he watches what his blood sugar does, it went up. So the next day, he gave himself more insulin, and it went up less. And the next day he gave himself more insulin, it went up less, but then it got low. So the next day, he gave himself the insulin sooner but a little less, and it went up less and it didn't get low. And he kept doing that for a week. Until one day he put the insulin at m&ms and his blood sugar just stayed like this. And when she told me that, I thought, well, that means it's possible. If he can do it with m&ms, you can do it with anything. I'm going to figure out how to do it with everything. So you have to stay off the diabetes roller coaster, you can't be chasing your blood sugar around. That sounds easy for me to say. But it's true that begins with Pre-Bolus in your incent those of you who are injecting Pre-Bolus things just the word people with pumps used to indicate they've given themselves their insulin before they start eating. Does anyone here understand that? When you put the insulin in your body, it doesn't immediately start bringing your blood sugar down? You do. But do you know how long it takes you individually for it to work? Is it five minutes? 10 minutes? 15 minutes? 20 minutes? How long do you think it takes to work? 30 minutes, does anybody else know anybody have a number they think how long an hour is kid takes Thank you an hour, it's different for everybody. First thing you need to do not be afraid. Second thing you need to do. Remember, it's about timing and amount. And once you know those things in your head, you're gonna go home and figure out how long it takes for your insulin to start working. I can't tell you how long it's gonna be. But get yourself in a position where you haven't had insulin for a few hours, you haven't had food for a few hours and your blood sugar's pretty stable, you know, under 200. And give yourself an amount of insulin you think will bring you down to 100. And then if you have a glucose monitor, wait for the arrow to turn down. And if you don't test yourself every 10 minutes or so and see when do I start dropping and that's probably pretty close to your Pre-Bolus time. Because what you want to accomplish everybody the tug of war, right? the option of tug of war is one side pulls the other side pulls somebody wins diabetes tug of war, you want no one to win, you want the flag to stay in the middle, never go to one side never go to the other. You can't accomplish that. If you put your insulin in and then eat, you give the carbs a head start. By the time they're moving, they have so much momentum, you can't overcome them. Even if that amount of insulin you chose was exactly right. It's still not going to work because the carbs have a head start. So what you need is for them to get in a battle. That just doesn't move. And here's how I think of it in my mind. I'm sorry about the mic. So the mic is here and it's the insulin I put the insulin and it starts working. It goes along the timeline. Then we put the carbs in the insulins already pulling down. Then the food tries to pull up. This is where they get caught in the battle. They're pulling and pulling and neither side can win. And at the end they both get tired and you're back where you started. The problem that you have if you're spiking is you put your insulin in too late, the food got a head start, you jumped way up. Now the foods being digested by your body, eventually the food leaves your system, or what's still left in your body when the food's gone, the insulin that you put in too late, and then you get incredibly low. If you put your insulin in too soon, you get low First, if you had the nerve to wait at a blood sugar of 65, eventually that food would catch and bring you back up again. I do my best for my daughter's blood sugar to be falling, when she starts to eat, you will all figure out what's best for you. I'm not telling you that what I do is exactly right. But I try for that battle between insulin and food to happen as low of a blood sugar as I think is safe. Because if you don't, you're just not going to win that fight. Okay, I can tell you this for sure. If your blood sugar is high, you have missed time to miscalculated your insulin and if your blood sugar is low, you have Miss timed or miscalculated your insulin. There are other reasons. But this is the this is the key. It's absolutely the key. And it's simple effects. I want to tell you about Rosa who's not here, Rosa put a post on online the other day, and that was her 22 year old daughters in XCOM graph it went from 60 to 400 like this, like a smile and a pumpkin. And I reached out to her and I said I think if you call me I can fix this at a half an hour of talking. So a stranger called my house her and her daughter on a conference call. We talked about the things you and I are going to talk about here today. And 23 hours later, she sent me a grant for her daughter hadn't been below 85 or over 120. And today she sent me another graph with her daughter ate a bagel and didn't go over 140 or below 100. So this is not rocket science. I know it feels like it is because you get the information in such little pieces you get a little bit when you're first diagnosed, and it feels like someone just hit you in the head with a shovel. It's hard to think. And then you think you remember some of it, and you go to the next part. And then someone tells you something else. And somebody online will tell you Oh, you need more Temp Basal. And have you tried an extended bowls. And none of this stuff makes sense. And the truth is, the further you get away from starting with this concept, the more those things are just going to end up confusing you and making things more difficult. The reason I bring that up is because a lot of people spend a lot of time wondering what's going on. My blood sugar is going up. I wonder what happened. I'll wait an hour. One more hour, three hours. Wow, it's not coming down. I should do something about it. Bring you that sugar down, your blood sugar goes up, bring it down, your blood sugar goes down, bring it up, do not wait around wondering because Sure. Maybe you're sick. Or maybe you are dehydrated. But it doesn't matter. What matters is your blood sugar's high, do something about it. Because you're going to have, you're going to have experiences. And it's crazy as it sounds, these experiences start building on each other. And eventually it just makes sense. The other day, my daughter's endocrinologist asked me what my daughter's insulin to carb ratio was. And I said I have no idea. I haven't looked at that in years. We don't even count carbs. I just look at the plate. And I think that's seven units. That's 10 units. It's 10. It's six, it's probably a 10 minute Bolus will do 70% of it now and the rest over an hour. I haven't thought about counting carbs in so long. And it's such a great thing to get away from cuz it's thanks to count carbs. It's no fun at all. There's no fun planning to eat. That's one of the worst things about diabetes is having to think about it and count your food and am I gonna eat all this? Am I hungry? It doesn't matter. I look at the plate. We put in the insulin if we're wrong, we we address it. That's it. Anybody in a fistfight? Anybody would have a good fist fight you.

So sorry, he's so little, I thought it would be an adult. Okay, here's the thing you want to hit first, you do not want to get punched in the face and then have to fight because you're dizzy. You don't know what happened. When you go first, when you act, that you know what happens next came from what you did. So it's sort of a mathematical formula that I've made up, it doesn't have numbers in it. I did this. This happened. I wanted this to happen. So next time, I will do a little more insulin, a little less insulin a little sooner, a little later. Because then you can't really say I bolused and I got low. There's cause and effect that you can actually trust. Woman the other day was telling me my daughter gets low whenever she works out. I said, Well, that's crazy. My daughter exercises like crazy shots. I get love from exercise. She does. She starts to work out and she gets slow. So we start talking about it. And what ends up happening is she has this theory about eating before she works out and when I looked at it, I just know you're She's mistiming her boss for the food, her blood sugar shooting up, she's working out, then the blood sugar is getting hit by the insulin, it's Miss time that she gets low. And in her mind, it was because of the workout. I want you to be able to say I did this, and this happened, because that's the only way to make an adjustment and move forward. It's incredibly important. Don't react act, okay? For pumpers. If you're bossing too often, your basal rates too low. That's it. Kids are gonna grow quickly. Okay. You're not gonna notice that happening because they're your kids. For instance, I lost some weight to come here today. But nobody in my house noticed. That's fine. So my daughter comes home from school in the beginning of the year last year and tells me that a math teacher sucks and can't teach. And she's an algebra. And at the end of the year, my daughter understands algebra just great. And I said, Well, there must have been some magical day during the year where your math teacher got good at it, right? And they taught us the magical thing that taught you that Audrey said no, I don't know what happened. I just know it now wasn't heard about that. I was like, Okay.

She's really something. And, and so I think that that really is the key about how we learn. Things happen slowly, you don't see them happening. kids grow and you don't see it happening. You gain 10 pounds, you don't see it happening. If your bolusing alive. Your base is too low. You need more insulin, what do we say before it's either not enough insulin, or it's Miss time. If your basis to our it's not enough insulin, and it's Miss time to cross the entire day. It's all about timing and amount. If you are injecting and you're using a slow acting insulin, how long did they tell you to start acting until last year body? Would you inject that once a day, last 24 hours? That's not true. Okay, so what you want to do is split in half. If you're having trouble at the end of your day, and your blood sugar's getting high and you and jack, your Basal instance, probably running out or becoming less effective. If you split the dose and do it every 12 hours. Again, I'm not a doctor, you'll find the balance. But if you do your slow acting insulin every 12 hours, you might have a little better luck. That's an MDI tip for me to you. Okay, all carbs are not created equal. Eating a slice of pizza is different than having a salad with some coupons in it. It is because heavier, more dense carbs sit in your system longer and they are broken down slower. When you eat pizza and your blood sugar gets high Three hours later, that was not the diabetes fairy. That's when your body started breaking down the pizza and it started going to your blood. So you might have to say, all right, well, I start eating pizza hits me a little bit, but I don't get high for two hours later, what do I do? What you do is you figure out how to time the insulin against the carbs. I can't tell you what that is. But I can tell you that if you try you'll figure it out. Some people use extended boluses I'm going to explain to you right now my daughter has Chinese food. I don't know how much she's gonna eat. It's general chicken, white rice, vegetables, is she gonna have three pieces of jello is chicken How much? I couldn't tell you. What I know is that most times, my daughter needs 12 units of insulin to eat Chinese food. That's what I know. So when I start, we Pre-Bolus I get her blood sugar running down. And I get that 12 units in I don't know how much she's going to eat. So I Pre-Bolus eight of those units, and I tell the other four units to go in over the next hour. That way, I've got a shot to bail on it if I want to right. Maybe she starts eating and she goes on to stinks. My daughter does the most disgusting thing when she's eating. She says she has a limit. She doesn't know it till there's food in the mouth. So she goes, nope, that was it. And then she takes a napkin. It's horrible, takes it out of her mouth and decrees that lunch is over. If that happens, and I gave her 12 units, and she's only eaten three quarters of what I imagined she was going to eat. I can't sell her extended Bolus. Well, I use a combination of a Temp Basal re I'll double her basal rate for a couple of hours. This is important. We do this thing with pumps. It's weird. Everyday at two o'clock, my basal rates 1.4. It's 5.6. That's so stupid. Why would your body need the same amount of insulin just because it's two o'clock, it doesn't make any sense. You have to stay fluid. If you're having more carb, heavy things, you might need more basal insulin, you might need a 30% increase for hours, it might be a 50% increase for hours, I don't know, figure it out. Don't wait around and say that's just diabetes, or I can't eat Chinese food. Don't do that.

This is very important. You have to trust yourself and the diabetes experiences you've had before you have to trust your gut. You have to have to have to you can't say but the doctor told me this. So I'm going to keep doing it. If I taught you how to drive, and I said that you only put 20 pounds per square inch on the brake. And you somehow could measure that and you're driving along coming towards a train you put your 20 pounds on in the car keeps going it keeps going and keeps going. You go oh the guy who taught me how to drive said this is going to be okay. And drive into the truth. You know, you press on the brake harder. The doctors have done their best to explain to you the basics and it's up to you to keep going to understand when you do that this gets incredibly easy. And I don't say that lightly. But I don't think of how. But today I do. But I don't think about diabetes for more than about 10 minutes a day. My daughter and I speak about it through text messages. Mostly, it does not encompass a bunch of my time. I don't stare at her glucose monitor. We are not crazy about it. All it is, but I just said she's a freshman, right. So I started figuring this stuff out when, maybe second grade. So the last time I bought it was to the school nurse was the last day of second grade, she has not been to the school nurse since then, we do everything through text messages. I watch her blood sugar, she watches her blood sugar. And we talk together usually for a couple seconds, hey, do a half a unit, do Temp Basal offer a half hour drink a half of a juice, that kind of stuff. Her range on her Dexcom is between 70 and 130. And we most of the time stay in that range. It's because highs cause lows. When your blood sugar's high, you use too much insulin, eventually it makes you low. If you never get high, you don't get low. So if I give her that insulin for the Chinese food, and she hits 130, and starts going like this, we bump it back down again, we stopped the arrows, that's what we call it, I'm like stop that arrow, it might be a unit, it might be a half a unit, it might be a Temp Basal, we stopped the hour and bring it back. And then for another driving analogy, because they're so exciting when you're driving, and you know, they're young people in here, you guys are going to get taught how to drive at some point, you're going to drift a little to one side and the person sitting next, you're gonna have a stroke. And you're going to overcompensate and end up 20 feet this way, it is gonna happen, it happens to everybody. But once you become a seasoned driver, you realize that when you see that line coming, your hands move almost an imperceivable amount to get you back to where you want to be. And when you do that, you don't overcorrect. And if you keep yourself in a situation with your blood sugar for small corrections do the job, then you don't see a bunch of over corrections, you don't end up high, you don't end up well most of the time. But if you end up high, do something about it, get it back down, you might have to crush that high with insulin and be prepared to catch it with a fast acting carb later, that might be what you have to do. But that's better than being high for four hours. So it's all just learning how to manipulate the insulin, you're going to have these experiences over and over again, at some point, if you want to be able to look at a plate and go, that's 15 units, you have to trust what you've learned in the past. You have to trust yourself. I talked to a lot of people privately and at the end of every conversation, but I end up telling those people, you have to trust your gut. Go with what you think I know, we're taught and listen to cops and doctors and teachers without question. And please, if it's a cop, put your hands up, especially nowadays, hands up. Okay, but but the rest of the guys, you can say why you can wonder a little bit. Again, take care of it first. Don't wonder why I saw Johnny sniffling this morning. That must be it. Who cares? blood sugar's high, get it down, maybe he's dehydrated, don't care, get it down. Doesn't matter to me think about it later later to learn these things right now get your blood sugar down.

And if you have glucose monitors, there's there's a study that's proven that the lower you raise your high threshold the lawyer wants to obey. And it really is what I just talked about, it's about reacting soon enough that it doesn't get out of hand. So if you have a glucose monitor, don't think of the beeping as annoying. Get it down, bring it down to 150. And try when it gets to 150 bring it back a little bit. It's incredibly important. Like if you don't have a glucose monitor, these things are still valuable. Don't think this is a sales pitch that you have to go get a glucose monitor, it makes it easier, I'm not gonna lie to you. But it's still doable. There are plenty of people who do it, you can do it without a pump. But you're going to inject more, here's what a pump brings you the injections don't have if you have a pump, you can manipulate your basal insulin, which is incredibly helpful. And you don't have to inject other than that MDI is the same thing. But being able to see 60 blood sugar, that kind of comes up and sits at 70 and 75. And you haven't had insulin for all that food for a while you really don't want to eat, you know, you can just shut your basal insulin off for a half hour and a lot of times that fixes it. That is a valuable tool for pumping. But it's not that none of this can't be done. With injections, it's just going to take more injections. If you're not bothered by injecting more frequently, don't worry about it. But you have to be ready to be able to say this meal takes 10 units. Oh gosh, my insulin is going up. I need two more. You got to be willing to inject again 20 minutes later, half an hour later, something like that. I know people tell you not to stack insulin. But if you have a glucose monitor, you're just addressing something went wrong. You're not you're not stacking insulin. Okay parents incredibly important.

exhaustion comes, you don't notice it happening. When it gets there, you don't know you're lost in it. It is detrimental to everything in your life. Please, if you're in a two parent household, make sure someone else understands, do not be afraid if you're the primary caregiver to look at the other one and say, hey, it's Friday, and I'm going to bed and good luck. Because if you don't do that, you're gonna go a little crazy. And you can argue about a lot of things that later you'll look back on, and they're pretty stupid. So please be very aware of that the exhaustion just overwhelms. Thanks. It's absolutely crazy. Okay, this is important, and it's not anti doctor. So don't throw me in jdrf present. But sometimes people say no, because they don't know. It's hard to say, I don't know, my children asked me things all the time that I tell them no to it is because I don't know the answer to their questions. My daughter was once in a pump class, like, I'm sure many of you have been, we're gonna pick a pump, and they're all laid out like Christmas gifts everywhere. And I said to my wife back in the corner of this room, literally on a dusty table, there was a box that looked like someone threw it there. This is a long time ago. And it wasn't I walked over and looked at it was an omni pod. And I said to the nurse, I'm like, why is this one not out with the rest of it? She said, You don't want that. And I was like, Are you sure? And she said, Hey, you don't want that your daughter's too lean. I was like, okay, the candle goes on the angle. She said, I forget, she gave me 17 reasons why I wanted one of those other pumps. But I found a pod look like the way to go. So I get it. Two years later, leaving an appointment, she pulled me aside and apologized. And she said, We told you not to get beyond the pod because we didn't have any experience with it. We didn't think we could support you. That's what she said. Now we're giving it to all the kids blah, blah, blah, and whatever. But they told me no, in that moment, because they didn't know how to support me. So if you walk in there and say I want to get a pump or I want to get a glucose mount and they say no, you have to have diabetes for a year before you do that. Say Why? I want to try a difference on Neto stick with that one. Why? Because I think what you're gonna find next is there's no answer. You should advocate for yourselves. You should do what you think is right. These are not magical people. You live with diabetes, you know what you want? It is incredibly important to advocate for yourself. Good. Sorry. Okay. This is a blown up view of a breakfast. So it's gonna look crazier than it is. But I want you to believe me when I tell you that this encompasses a bout five minutes of my overall thought over an hour. This is from a couple of years ago. So at this point, her high was still set at 160. Now you would it would be down here. And this low is actually at 80. Right now now we're at 70. Would it be a little lower. So my daughter is having a sleepover with a bunch of friends. She gets low in the middle of the night I get up and I just shut off her bazel and that's what it did. So I didn't give any juice. I didn't do anything else. I shut her base off for a little while her blood sugar came back up. Now the girls were sleeping in, as you can see here, because they were up late last night, but I knew because of her friend Shay who the night before said Can we hear french toast in the morning? And I was like Sure, sure that'll be great. And chocolate milk. Why don't we just put piles of sugar on it and one goes, like powdered sugar. I was like, Okay, yeah, that's what we had bananas, grapes, chocolate milk, powdered sugar, a French toast, everything. While my daughter was sleeping, I started bumping her blood sugar. I got it to come down. She woke up in here somewhere. I started cooking here, we put in the unit, we started to get a down arrow. Then the food came in. So we put in more insulin, got it to come down more. Now she starts adding powdered sugar, which I thought she wasn't going to do so we upped her basal rate.

It seems like it's a lot, but I'm gonna tell you me and then she says Can I have more french toast? And I was like, Yeah, let's go for it. So we put in more insulin. There it is at noon 97 with a finger stick, not just the CGM. All I did is balanced the insulin with the food. It's all dead. There's nothing else to it. I promise you. It's hard to kind of understand in a half an hour. But I'm proud of the podcast because this was a little stilted with Mark here because I've never done this live before. Although it was fun. But what'll happen is someone will come on like Ryan, and we'll talk and things will come out. Kaylee Oh yeah. She comes on and she talks and things come out. It's not planned. If I told you that I didn't even plan on what I was gonna say to you here today. Please take that as the truth. I think that these natural conversations are important. I think that during every hour podcast, we come up with a couple of things that you'll come away with and think wow, that really relates to me. Much like the algebraic it takes time to get. You're not gonna leave here today like Superman and make all these fixes. But if you leave here today, knowing that it's about the timing and the amount, and that you have to Pre-Bolus a meal or it's not going to go your way and then think about the rest of this. I promise you, this stuff happens. It is incredibly simple. blown up. Here, it looks like an hour's worth of thinking. But I guarantee you that what happened was I was cooking. And I said, Okay, Pre-Bolus this and do a Temp Basal. Here comes the food put on the other four units. Nowadays, she's bigger I would that would probably be a Pre-Bolus of five units and five more units later. And I was stretching it out to try to cover the bread. And I was stretching it out because the chocolate was like chocolate milk. She never drink chocolate. But there's another little girl talking about chocolate milk. And so but when my daughter looked at me, I was like, yeah, drink the chocolate milk. Here we go. I never ever, ever counted a carb. They're never going to ask if you guys have any questions, I'm happy to answer. And if not, I'll keep going. But just real quickly. The podcast is 100% free. It's available for iPhone or Android iPhone has a native app called podcasts that you can just use Android Spotify, you have to find an Android app. It's also Juicebox Podcast comm if you listen, that'd be great if you don't sweat, but I appreciate you letting me speak. Does anyone have any questions at all? I'm happy to answer anything that anybody might be able to tie.

You would have to ready? Yeah, that's not gonna work. But you have to figure it out for yourself. So only I know I said a lot. And I'm from the east coast. So I was talking really quick. But I said in the beginning, you're gonna have to go home and figure out what that is get a blood sugar stable somewhere where there's no insulin, no food, put in a big bolus and see how long it takes to move. And then from there, it's, I try it's the m&m story, then I put it in here. It didn't work tomorrow, I'll try it a little sooner. Tomorrow, I'll try a little later tomorrow, try a little more a little less. Yet there is one thing you can do to make it easier on yourself, which is make similar meals over a weekend. Similar breakfast, lunch and dinner, take out the variable so there's less to think about. And then just keep keep swinging at it. Try it one lunch, and then the next day go Okay, got a little higher than I thought try it again. The next day, the next lunch. Somebody else? Hi.

So I handle my daughter and I handle her diabetes. And my wife by my wife's done a great job today while I'm at home, we do it the way the same way I think about parenting, which is I have never, I don't think there's a light switch fixed to diabetes stuff. I don't think there's something you say or do or read that just makes it all makes sense. And I don't expect my kids to figure life out in one day. So she and I do it together. We talk out loud about it while we're doing it most days. Plus, most of it's done through text messages. So she gets to see it happen. And what I see is that slowly over time, you know, I'll I'll say hey, how much do you think that is? And she'll guess about what I was thinking. So my goal is just for her to learn it at her own pace. There's a podcast early on in the show called texting diabetes, texting is the absolute most important tool in type one. Besides the pumps in the CGM, as far as I'm concerned, because it limits the amount of time you're talking. I'll tell you right now that when she was much younger, back in second grade, I was downstairs very loosely on my sofa, and her cgmp. And she needed a half unit of insulin. And I didn't want to get up and she was upstairs for some friends playing. So I texted her bolus, a half a unit and she said okay, I was like, Oh my god, that was easy. And then I started I started worrying, like, What if she didn't do it? Right, I found a reason to look. And I was like, Oh, she doesn't have the internet. It's great. Then it hit me about 20 minutes later, the only difference between me being in the room with her and not being in the room with her it was my fear. If I let that fear go, it didn't matter where she was in the world. She could be across the street, the house or at school, and it hit me like a ton of bricks, I can never go to the nurse again. And that's what we did. You have to wait till they're at enough of an age where they you can be confident that they're gonna do what you ask. But it's it's that I think it's just time. I think that if anybody thinks that there's a light switch health issue, I think that is a very kind of American feeling like I want to take a pill and make it go away. And I don't want to think about it again. You are going to have to put some effort into diabetes. That's for sure. Anyone else? I'm sorry. So I'll get you next. Hi. Not at all.

Unknown Speaker 49:20
No, I don't know.

Scott Benner 49:24
I look at the food. I think it looks like five minutes. It's experience. It happens for everybody. If anybody who's had diabetes for a long time. Do you count carbs? Now? You're talking about a little kid. Okay. What's your name, sweetheart? Because Hannah eat one slice of pizza on one Saturday and the next Saturday eat the whole pizza. No. So you know about what she's going to eat right? So give her the insulin. If she goes up and you say you give her five units of insulin. It goes up and you give her two more she's little it's probably not five but say that happens then that next time You eat that food. Seven, start with seven, because last time it took five. And to start with seven, you are mostly not using enough insulin if your blood sugar is high. And I want to say this, and I'm sorry, if I missed out on saying earlier, you have to have to have to have to understand that you need to stop erring on the side of caution. You would much rather much rather have a couple of lows a month than 28 highs. So you have to kind of come out and really try. So if it's You have to trust that what you know is going to happen is going to happen. You can't say Oh, last time my blood sugar went up when I did this, but maybe it won't this time. Everyone has done that, right? Like I should put mine somewhere. No, maybe I won't need it. You always need it. Always. You always need it, you are very frequently not using enough insulin. And you don't do that because you're scared of Lowe's. And I get that. But after that we'll take seven units over and over again. Stop starting with five, like stop, just trust yourself. It's a huge leap. I swear just so experience and repetition with meals plus kids eat about the same amount every time they eat. So in the end, you start looking it's about the same over and over again. So I'm sorry. Wow, that's amazing. You had the same question. Does anyone else have the same question? Did you really? You just screwed me Okay, that's fine. Hi, good.

Yeah, exactly the same way. That said, I don't do anything differently. I just stay fluid. She needs carbs. She gets carbs, she needs insulin, she gets insulin. The thing you don't talk about a lot with activity is is that adrenaline can drive up your blood sugar. So I'll tell you a story that people seem to really find useful. My daughter was about eight years old. She was in some recreational Basketball League that happened on Sunday. So it was one of them where you came in, and you were like in sweat pants and looked a rack and everybody else did too. We all ignored What a mess we were, you know, and I bear into this blood sugar of 100. She'd go out and play basketball and a bunch of it would go to 250 happened every Sunday. So one day I just thought I can't keep letting this happen. How do I Bolus for adrenaline right? And I realized one day I'm like, I'm gonna stop thinking about the juice box like medicine and I'll start thinking about it like food, like, what would I do? If I wanted her to drink that without our blood sugar going up, I figured out how much insulin that would take. So one day, I got into the chair blood sugar's 100. And I bought a unit a half of insulin, etc. to play basketball. And the adrenaline hitter and that fight happened and nothing moved. And had it not happen. Because here's the interesting thing about adrenaline when they play teams that weren't any good. And she didn't think she could lose her adrenaline never went up. It was only when she felt like competitive that went up. So I thought if this is a bad team, I'll have a drink the juice, right. And that day, they weren't a bad team. And I didn't do it. But that one thing I've shared with people over and over again, I get so much correspondence back. When you're looking for a way to be bold the first time, try thinking about it that you're just Pre-Bolus in the juice box. And then I bet you'll find out you don't need the juice box. And that's how you're going to learn you're not using enough insulin before we go. Because I promised I would do this and I see Melissa standing here. It's his birthday. And I thought it would be great to embarrass her and say happy birthday to her.

So just not the whole song but 123 Happy birthday. Would you mind 123 Happy birthday. Sorry. So was I

Unknown Speaker 53:53
thank you, Scott. Thank you again to Scott a couple of announcements before we head out.

Scott Benner 54:04
Thank you so much for listening. We'll be back next week with another show. If you're interested in having me out to your event or creating an event of your own where we just get together and talk about being bold with insulin and other management ideas contact me through Juicebox podcast.com

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