Scott Benner 6/14/19 Scott Benner 6/14/19

#234 Dexcom CEO Kevin Sayer Returns

It's a type 1 diabetes info-arama!!!

Kevin Sayer talks Dexcom G6 upgrades , G7, manufacturing, availability and much more.

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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 0:01
Hello friends and welcome. Hello friends and welcome to Episode 234 of the Juicebox Podcast. Those of you who listen every week are going to be like, wait, what's happening? There's another episode out, but I already got an episode this week. Oh my gosh, what have I done to deserve this? The answer to that question is simple. you've subscribed to the Juicebox Podcast. Today's episode is sponsored by Omni pod Dexcom and dancing for diabetes, you can go to dancing the number four diabetes.com dexcom.com forward slash juice box or my omnipod.com forward slash juice box to find out more. I can't really tease who's on the show because you guys see it in your podcast app. So not gonna bother doing all that. But I'm very excited today to have Kevin Sayer back on the show CEO of Dexcom. He's going to be talking about everything that's going on. Little bit about the future. A little bit about g six upgrades that are coming in to find out what happened at Costco, talking about their manufacturing, their phone service, and so much more. I want to say two things. First, of course, nothing you hear on the Juicebox Podcast should be considered advice, metal or otherwise, always consult a physician before becoming bold with insulin, or making any changes to your medical plan. And the second thing I want to tell you is thank you to everybody who follows me on social media who sent in their questions. The ones that trend towards Kevin's expertise were given to Kevin. And I've set up another interview to get Jake leech back on the program to ask the other stuff. So if you don't hear your question today, I'm telling you, you're going to hear it very soon in an upcoming episode.

Kevin Sayer, Dexcom CEO 1:46
Hi, Scott, how are you

Scott Benner 1:47
very well. Thank you How you been?

Unknown Speaker 1:50
busy.

Scott Benner 1:52
That's a good I was gonna say that's excellent.

I have a couple of questions for you from my audience. But I really want to hear what's going on. I think I know one of the things you're going to say. And it was overwhelmingly one of the questions that people asked so your timing on on this is a big deal. So I guess Let me ask you about Apple Watch first.

Kevin Sayer, Dexcom CEO 2:19
Okay, and and I will, I will say this here, your audience and your listeners to everybody. We are working on that frantically. What we are planning on doing with our apple watch release is that requires a different firmware and all the transmitters. And a different interface with Bluetooth then is in the current transmitters that are out in the field. Over the course of time after we get the software revision that supports direct to Apple Watch. All then files approved by the FDA. As we get through all the transmitters that are out there, we will then release this. This is not something quite honestly Scott, we're going to turn on overnight. Because then the switchboard would break. And everybody say I have it This isn't working and why Yeah, and the reason isn't working because you don't have the right hardware. So as we cycled through our transmitter cycles, one day, you're all gonna wake up and direct to Apple Watch is going to be there. I personally am using the direct to Apple Watch app, trying it out the engineers Let me try everything out before everybody else and I gotta say it's, it's really nice. What I like best about it was like one night, I put my phone away and use the direct to Apple Watch as my nighttime thing. And I you know, I don't have lows or highs but at night, I just woke up and took a look and fun and that is good. And then ultimately, if you have the cell plan on the Apple Watch, I believe and I'm speaking a little bit out of turn, I'm not sure how the first release works. But over time, theoretically you the Apple Watch can go to share as well. So I I think direct Apple Watches is something that our patients really want and and detect, you know, the programming is about there. We just have to cycle through some hardware and do this guy's manner. Well, I think that

Scott Benner 4:18
I think that there's a there's always the the desire to just get people excited about something like, Hey, we have this great thing coming. You guys have been looking at it for a while you know how exciting it is. And you tease it because you're like, Look, it's coming but then if you don't hit that date, it just it's I don't know, it seems it's something Yeah, yeah, it's it's thanks for that happens.

Kevin Sayer, Dexcom CEO 4:40
I understand but you also understand because you read the blogs and sometimes our phones go wacko and then oftentimes through no fault of our own and I don't want to deliver customer service experience with respect to the Apple Watch Apple Watch. Direct launch, that becomes a negative because I'm trying, we're trying to swap out every transmitter in the United States. It don't we don't want to go through that we don't want to put our patients through that. It will happen, it will happen in organized.

Scott Benner 5:15
Listen, it would be amazing. If you just got it into everyone's hands, they didn't realize they had it. Then one day, you just make one grand announcement say, hey, by the way, that transmitter you're using right now works with your Apple Watch. And that's kind of what we're, that's what we're shooting. That's excellent. Elizabeth forest was diagnosed with Type One Diabetes at the age of 10. As a dance student, Elizabeth decided to start a nonprofit organization. So this was not something that she had thought about doing before. But of course, either was having type one diabetes. After her diagnosis, she was driven by determination to not let diabetes negatively impact her life. And so what started as a community fundraiser organized by a middle school students, is today a full scale theatrical production. And that is really just the beginning of what dancing for diabetes does. To find out what else Elizabeth has born into the world, go to dancing for diabetes.com. That's dancing number four diabetes.com. To what is it you've been talking about recently,

Kevin Sayer, Dexcom CEO 6:18
we have a lot going on, you know, an ADA leaving ADA, the first thing that struck me while I was there was this Prop, the response I got from physicians and patients on the gen six system. We've always had great technology. But the response when I would ask people tell me about your Gen six experience was literally more emotional than anyone I've ever had. With our other product launches, this product has hit the right spot with ease of use, and with the no calibrations. And with the features that we've put in. It really is a great product. I recently, we recently had a 360 Management Review here. And one of the things they said to me, is you're really good at praising people for a short time, and then you turn around and say, Okay, let's go. And what Ada showed me is, I really respect the effort that our engineering team has put into this one, we will never not improve the product we have added in the field. So we are looking at the software features to add revisions to our apps and things that we can do to make it more reliable in the field. Or even looking at you know, things like new tape, is there a tape that would be more sticky to eliminate some of the sensors that fall off. Rather than, you know, I'm sure people will still use the overtake as well. And we're looking at all sorts of G six revisions of that nature over the next 18 months 1824 months to get g six exactly where it needs to be. The other thing that's very exciting for us and one of our corporate goals, is to double the capacity for the number of G six sensors that we can make if we double that capacity and can make it available to more patients. And more accessible, I think that serves the community very well. Two other exciting things. For me, you know, the announcements at Ada around artificial pancreas work. Next con was pretty much in the middle of all of them. And it certainly was tandems data or IQ systems system and the data obviously presented by by our type zero people who who wrote that algorithm and the influent data with with their horizon system. And then the loop announcements where we're looking at open architecture and open world whereby even possibly a Medtronic pump patient but in an authorized manner to run an algorithm with a dexcom sensor on their pump. Yeah, that's staggering. We've come a long way as a company and and where we used to just be this tiny little group, we're kind of at the center of everything. And the last piece is we're very excited about in addition to J six, our future product pipeline, I can't push our G seven technology I can't push the guy's fast enough on that either it is it is going to be as big a step forward as G six was over g five. From the experience particularly the ease of use and the physical components with just one piece. Throw away transmitters smaller and assertion system. One button push, fewer steps and G six longer were period I had it really addresses A lot of things people would like to see us address. With g six, we've addressed a lot of things with G six, but we'll address more there. It is a, it is a time of continual innovation for us. And as BGM gets more and more accepted, we've made the goal publicly in our investor presentations, we want to replace finger sticks. Yeah, I don't know if I really believe that in 2012 and 2013, and 14, you believe it now? Oh, yeah, I believe that there will come a day when CGM will be so accessible. And the experiences can be defined in so many different ways that anybody dealing with their diabetes can have a great experience with the CGM product that will give them more information that they can get from any anything else, and they can do it on a cost effective manner.

Scott Benner 10:48
I have a question about that. So how do you get the product that you have now into a form factor that allows it to be as accessible as a blood glucose meter to everybody like financially,

Kevin Sayer, Dexcom CEO 11:00
you know, it is not the form or even the cost of manufacturing the product. As far as getting it there is access through the payer community, we have an entire team whose sole goal in life is to make access to Dexcom products, easier for our patients. And we believe the easiest way to get our product over time is going to be through the traditional channels where our patients get everything else. And right now that's through the pharmacy, or through a pharmacy benefit with their insurance carrier in the form factor, there are some some form factor considerations, but they're, they're very high level, I mean, just like boxes, and having transmitters, receivers, and sensors and that type of thing with our G seven system, it will be much easier, but we're trying to lay the groundwork and do that now with G six, we have coverage as a pharmacy benefit and more than half of the insurance carriers. But it's not overly well known because they cover it in the DMV, DMV world the same way they've covered in the past. If we can make it easier for our patients to get this we know over time, with increased assets, access, we get more patients, and pricing will move down. As you get more and more people on the system, we're prepared for that. Where it gets very expensive for us is even through the reorder process. Every time we answer that phone, and then we call the doctor and then we call the insurance company and then we call you back. And there's all these steps, it takes like two days, it takes almost less time to buy a house. And we need to eliminate that and and so we need to increase access and get our patients there. And you'll see aggressive steps by us to do that. Over the next several months as part of that

Scott Benner 12:51
by partnering with people like sort of in the same way that you've you've got these relationships now with insulin and tide pool and all that stuff is it isn't to get those those like what happened to Costco I guess I have to ask you but like is that the idea Costco, Walgreens, CVS that Costco the

Kevin Sayer, Dexcom CEO 13:08
great Costco is a great thing. And I'll tell you exactly what happened at Costco. And it's an unintended consequence. We said Costco club, whereby patients could go in and buy sensors. And as we set that up, we did a structure with our wholesaler and all the people involved to make the transmitter extremely low cost. Other patients could pay cash for the sensors. And quite honestly, we ate the cost of the transmitter. So that was a good project Scott. When the patient community found out they could get transmitters cheaply at Costco, and they went there paid cash for their transmitters, but did not buy the sensors there. And so we're losing money hand over fist for something we did to be nice. Yep. And so we've restructured that and and and that will come in a different way in the future. And again, the law of unintended consequences, we did something nice and and it ended up getting a lot of people into Costco. A lot of people are interested in our product in Costco, and not in a manner that we'd hope.

Scott Benner 14:19
So you're gonna have some safeguards in place and reintroduce it in a way that you will 100% need to be a cash payer and you will need to be or through pharmacy contract again,

Kevin Sayer, Dexcom CEO 14:33
is our patients check. If they check with their pharmacist, the pharmacist can find out whether or not they're covered in the pharmacy benefit or contact their Dexcom person. Our patients could probably switch over to the drugstore if they want to now who have not and and not just the drugstore, not just Walgreens but several of the others as well. We're working through that whole time. developing relationships with the Costco as Walmart, CVS Rite Aid, Walgreens, we've announced digital and digital content sharing programs with Walgreens where we're going to work with them to provide a better experience for our patients in the Walgreens environment, to whereby walk Walgreens Dexcom becomes part of the Walgreens infrastructure for our patients and, and there can be data sharing if, obviously, if the patient chooses subject to the same privacy requirements we've had in the past. But you know what we'd like to see Sunday, that is on the G search app, when you run out of sensors, you have to Walgreens or, or whatever button and say, I want to pick up some more and you go pick him up, and you're done. And I believe we can do that, it's going to take some time. But those are the types of investments we need to make, make this more accessible for our patients and make it your farm to get

Scott Benner 15:59
it absolutely does need to be I just while you were looking, I just took a look. And this is just a one day, just one day, it's the last 24 hours. But in the last 24 hours, my daughter's estimated a one C is 4.7. Her standard deviation is 29 are average blood sugar's 88.

Kevin Sayer, Dexcom CEO 16:15
He's better than me.

Scott Benner 16:16
Well, I tell you all the time I tell people all the time, the way we get to those numbers, doesn't really exist without Dexcom. Like I can't make the decisions that I make without, without the information that comes back from the sensor. It's just that simple, really. And it's heartbreaking that everybody can't have it. Who wants it? You know,

Kevin Sayer, Dexcom CEO 16:35
I don't know how a person would do this, I have a complaint. I really don't know how a person would do this other than eat the same thing every day, at the same time, and literally make your life the most regimented thing in the world. I have tremendous empathy for our patients. I really do. I think we we've made this easier in many respects. There are other ways we can make it easier. In the future, you saw the interconnected announcements I went over earlier, and these automated insulin delivery systems will help a number of patients there will still be patients who don't want an insulin delivery device attached to their body, we believe with the things coming with integrated pens, from independent companies and also directly from the insulin manufacturers that we can develop decision support infrastructure, to replicate some of the things you do on a daily basis. You know, I asked the patient recently, tell me, tell me what you want. And it was a mom and she said, a newly diagnosed sentence. She said, I am so tired of making these decisions for my boy. And she should I don't even know if I'm also the time because just learning. This is exhausting. And it was a young woman, a young mother that I know from a long time ago. She's about the same age as my children and listening to that and just created a tremendous amount of empathy. We have technology to do that but we need to get that out in an organized and thoughtful manner to our patients. Now for sure.

Scott Benner 18:21
Let me ask you a couple quick questions g six for Medicare is that close by any chance?

Kevin Sayer, Dexcom CEO 18:26
More than likely fourth quarter we plan on doing it this year the G six for Medicare has been in a tough one for me personally. We've not had capacities like g six product the entire all the user base around the world and to six global launch manage that rather than then launch into Medicare and then tell everybody you get to wait even longer for product and upset all our customers we've had to do what we've done. We'll get this product to Medicare before the end of the year and I think that patient base will be absolutely thrilled with it.

Scott Benner 19:06
Hey listen I don't know if you've ever seen it or heard tell of it but I got to walk through insolence new manufacturing facility a Massachusetts I have to it is spectacular. No kidding. It's it's an incredible. I tell people all the time like that's a company really putting their money where their mouth is like look, we're gonna build our manufacturing right here at home. And it's it's state of the art in a way that it's hard to put into words. I'm actually trying to interview the gentleman who oversaw its its design and construction because it's just you

Kevin Sayer, Dexcom CEO 19:35
know what, I have such admiration for what they've done. We are doing similar things in our Arizona factory. We will have a number of G six automated lines up and running. In Arizona literally Where were the robots put the sensors together? Yeah. And we believe the quality from the robotic lines will be extremely good. We are Balancing the number of automated g six lines we put up in place as we develop manufacturing processes for the G seven. One of our big dilemmas, Scott is a perfect example, the insertion device for G six and every part in that is different than what everything was for the previous 12 years. Every piece, and when we go to the g7 system, we've not saved much from G six, we're going through what one refer to as the cost of innovation again, and are you willing to bet on that and make those type of capital investments? And we are cuz this is what we do. But it is it is interesting to sit and strategically figure out how much to spend where and how and that's why I really love the way in Flint made their decision right out there factory it is. It's awesome. And and we will be replicating that in Arizona will always will we our hope is to manufacture 75 to 80% of our product there over the next five years and then the other 25% here in San Diego, and then decide when and if we build yet another manufacturing plant and what the capacity for that would have to be is

Scott Benner 21:21
quality manufacturing the key to stable sensors like ones that last the 10 days they need to last or what like what do you know what I'm saying?

Kevin Sayer, Dexcom CEO 21:31
Oh, no, I absolutely know what you're saying. I think there are a number of variables in their quality of manufacturing is very helpful. But by and large, the quality of our manufacturing is pretty good. There are a couple other things that drive to the early sensor show off one of them is the CGM standards, we we have an obligation to perform at an accuracy level with the G six product that is higher than anything we've ever had. And by the way, we allow for no calibrations. And there are times in our software where we detect the data would not be adequate, or the ice jam standards that are applicable for us and the design of this product. So quite candidly, we shut it off and haven't stopped working when in reality, our users with our previous systems would have relied on that data and they would have been fine. Because of the accuracy bar that we're performing to now we have some sensors that shut off the things we do to fix that with with G six, are we looking at the algorithm, because we've always been able to launch an algorithm with every generation of products that we've launched while we improve performance, we look at a new sensor membrane materials that might be more stable and in reality that those will probably come in G seven, we probably would not roll them into g six. And we look at you know the mainly the algorithm and we contemplate different manufacturing techniques that we can do within the range that we've submitted to the FDA. But I think the most reliability change in the short term we can get is is our algorithm updates and with 188 points coming in per patient per day, be our servers we have a lot of things we can simulate algorithm development can move very quickly here and our guys have some really good good ideas and so we'll we'll work on that all throughout the lifetime of the G six.

Scott Benner 23:35
So you think it's time to try out and on the pod? You can request a free experience kit today a pod experience kit by going to my Omni pod.com forward slash juice box. Here's the important part tubeless insulin pump, no tubing, not connected to anything small. wearable doesn't get in the way can sleep with it can bathe with it can swim with it. Hmm. How exciting is this? I mean it's hard to get really super jacked up about an insulin pump I guess but you should because Omni pod is that next level is what you're looking for. My daughter Arden has been wearing it on the pod since she was four years old, is about to turn 15 every day from four to now. wearing it on the pod is absolutely a staple in her life. Giving yourself in some with a push of a button is amazing. Not being attached to a tube is free. Miami pod.com forward slash juicebox You don't even have to take my word for it. Get a free pod experience kit sent to your home. Try it on for yourself. See what you think. I'm now going to sing an impromptu love songs on the pod. Oh Nearpod we love you so much. It happens smooth. Your insulin is cool. The way you make me

Unknown Speaker 25:01
feel

Scott Benner 25:04
doesn't I'm but I'm not a songwriter at all. But that just became painfully obvious to admit. You know what you're lucky here though, because on the pod makes insulin pumps way better than I sing my ami pod comm forward slash juice box with links in your show notes or Juicebox podcast.com. Do you share that data with anyone or is that used just internally like your you this tide pool, for instance, have access to it,

Kevin Sayer, Dexcom CEO 25:33
I pull absolutely a patient if a patient goes to type one says I want my dexcom data. And they they there's a security protocol they go through with us. And then that patient's data would be available in title, we have created an API infrastructure to allow patients if they want their data on other apps, to grab their data. Now, we do make it retrospective a three hour delay. But no, we we make data available to a number of partners, we make data available retrospectively to Apple healthkit for patients who want to access their data that way. So we do make that data available for patients, we do not make the entire servers or the data available to the open world. We have a developer portal index column for the API's that contains the identified patient data that if somebody wanted to go in and develop an app around m data, we have a data lake of sample data that they could go work with and develop something with, without a whole lot of difficulty.

Scott Benner 26:42
Listen, I'm gonna just tell you this. So I don't forget. But overall, with the really hundreds of messages I got, there were just so many people who just want to say thank you and show their gratitude. So I will

Kevin Sayer, Dexcom CEO 26:53
give you an extra five minutes to play. So got a 1030 you're very

Unknown Speaker 26:57
nice. Okay, so

Scott Benner 26:58
I'm looking at my list, I'm trying to side with it. This one's a little bit of a, I don't This isn't a humble brag, but the podcast is spreading in such a way that I received the same message from Canada, Australia, Hong Kong and hungry, they all would like you to throw your weight around a little bit and get them to JSX as fast as you can. hungry, especially who said they're still using the G for

Kevin Sayer, Dexcom CEO 27:20
hungry is is not been a large market. For us, we have some plans to get to these other markets. It has a large extent been the same issue that has delayed the launch with Medicare, we have not had the capacity to go all these places, as we build out our factory and build out our manufacturing lines, we will we will launch in an organized manner in these places. And again, I spend time with our Australian distributor did a meeting I had dinner with him I heard loud and clear. And in Europe in some of the smaller geographies, we're developing some innovative plans, possibly into some other distribution strategies to get there because we may not have found the right distribution partner. So hungry in some other markets. Hold on, we'll we'll get there.

Scott Benner 28:09
Okay, so in the same vein of, of you flexing your muscles, I have a question I hear over and over again, from people about the stress around getting their supplies in time the idea that insurance won't let me reorder till something happens. And if I experience a transmitter that doesn't last as a, you know, six days as long as it should, or, or that it's expected to, that people have an incredible amount of stress around that is there a way to change what the norm is around letting people reorder so that they don't experience gaps because, you know, Dexcom becomes such an just an integral part of their life. And then all of a sudden, it's gone for a couple of days. And some people are just panicked by it. And

Kevin Sayer, Dexcom CEO 28:53
this is the bane of my existence. In all honesty. I would love to make this easier. I want to go on record, we've created some of these problems this year. Again, with the supply constraints we have been experiencing, we've had to delay shipments for patients from time to time. And sometimes it's it's a one day delay, sometimes it's a three day delay. Sometimes it's been longer. And so when a patient orders and then we create a delay, that's very problematic. The other thing that happens and a lot of this, this behavior is dictated by the terms we have with the insurance companies that you can only order in some specific timeframe and they do make it difficult. I would love to make it easier. We're exploring a number of business models. I'll give you two examples that I bounced off people at ADA. The Medicare business model is our Medicare patients pay a monthly fee and they get what they need. And the way Medicare is actually designed and there's 25 they get strips and sensors every month. They get what they need every month, right? They get transmitters when they need them and Medicare pays the same fee every month, and the patient pays their copay, a subscription model for our patients, I would love that. And the other thing is, again, getting using them to the drugstore, getting them easier for patients to get where this gets tricky. And so our counter was something back to you is is the warranty. Index, counter warranty policy is a gold standard of our company, we replace most everything anybody calls about. At some point in time, we've got to figure out a way to better interact with with the patient community. And I guess that that's more accountability for Dexcom and more accountability for our patients. So let me throw a theoretical out there. If we have a 15 day set, and last for 12, and it falls off and I and I send you a new one, we've now lost 13 days of patient revenue, because we were good. So the cost of that isn't just the cost of the sensor. There's a cost to us, economically. And, and I know our patients bear such a burden, that it's only fair today. But as this becomes more accessible as costs come down, as we become more accountable, I think we need business models where we're all more accountable and where Dexcom has to be more accountable, as our products have to be more reliable. And we think we've done well would you fix that I set the bar very high for those guys. And and in. And so I think this whole business model is to make it easier for patients has to be it has to change. And it's an effort between Dexcom the payers and, and making that structure that was easier. I totally empathize. In fact, one of your peers said to me, I hope you don't read all the blogs. And I said, Tell me why. He said because you might take personally people's frustration with the supplies. And he said Please don't. The reason they're frustrated is they really depend on this device. And when they don't have it. It really ruins your day. And it ruins your week. And and it's very uncomfortable. And you know what? That's a perspective we have to take. We need to make sure patients have it. And and and we're looking at a number of ways to do that. I haven't found the perfect answer yet. But but we're trying.

Scott Benner 32:39
I think that's a that needs to be the message. I think for some people who have the frustrations is that it's I hope they don't imagine you guys all sitting around going I

Kevin Sayer, Dexcom CEO 32:51
really think that I go home at night saying I was able to mess with these people. They didn't get their product today, right? I mean, no, that is the last thing that we want to happen.

Scott Benner 33:02
I think that's even a good look at what you were talking about, about the frustration because of how much you count on how much you love it. So I think Dexcom doesn't really need an official add in this episode, because we've just heard from Kevin, and we're about to hear more about how fantastic the product is. And I can tell you this, my daughter has been working at Dexcom. It seems like forever. It's been so long, I don't remember a life without it. And everything you hear us talk about on this podcast stems from the data that comes back from the Dexcom. If you're not using Dexcom now, and you don't think you want it or you don't think that it's for you, I would implore you to take a shot. Because it is life altering. It will change the way you live, love laugh, run, jump sleep, everything gets better when you can see the data that comes back from the Dexcom g7 not having to wonder what your blood sugar is doing and actually being able to see it is transformative. I can't stress it enough. dexcom.com forward slash juice box. There's also links in your show notes and at Juicebox podcast.com. If you're not a believer, take a leap. I think you'll be happy that you did. And if you're sitting on the fence, get off the fence, you're gonna hurt your butt.

I have a question for you. So you moved your your phone, your your CSRS in the Philippines. Is that right?

Kevin Sayer, Dexcom CEO 34:39
Yeah. And our tech support function and I'm happy to address that too.

Scott Benner 34:44
I just want to know what the what the process is like because it's not a that's not a turnkey operation. I would imagine imagine you have to get it there and there are bugs to

Kevin Sayer, Dexcom CEO 34:51
work. It has not been a turnkey operation. And in fact, we kept all those who wanted to stay with Dexcom who had those jobs domestically. We've kept for a significant amount of time. And we literally had double the people that we had, it has not been turnkey at all, we've done this in as much of an organized manner as we can. Over time, the way this will work, our inside sales will be over overseas, we will have some high level support people here in the States. And the same with tech support, the first level tech support will be in our Philippines call center with the specialists who when you get down to my reading appears to be three tenths of a point off at 515. Every day, could you help me, that person is going to be here, that person's not going to be over in the Philippines, we've got very good results on the tech support side, we are still working through the bugs on the inside sales side. And and it just, it takes some time, as we looked at how to do this, we could not add enough people in San Diego and Arizona to meet the demand that we see coming with our patients. We couldn't add enough buildings in San Diego and Arizona in an organized manner. There are 1.2 million people in the Philippines that work for us based call centers, much of the healthcare emphasis is healthcare degrees there and let me turn that off. And so over time, this will be a good thing for our for our patients that some may experience some bugs, this this will become better. Yeah,

Scott Benner 36:37
it's funny because I, I see people say oh, my sensor didn't last as long as it should, I should tell you, that never happens to us. And in and maybe it does once or twice a year. And I don't recognize it. But it happens so infrequently. I just think of it as not happening. And it's your experience is personal. You know, a lot of times, even with customer service, like you don't listen, I have a tendency when I get on the phone with customer service to talk too much. And I realized one day that when I take a person who's trying to follow their job, and I start, you know, interacting with them about the Superbowl or something like that, they're not focused then and I, one day, my wife said to me, she's like, stop talking to them so they can do their job. And I was like, Whoa, that makes a lot of sense. So you don't know. I'm not saying if you've had a bad experience with any customer service, it's your fault. I'm just saying that you're everyone's different. And you know, everybody has good days and bad days, you know, and the person you get on the phone might not have a great moment. But you guys are looking for a way to put that together. And so that it works well as often as it can for people and continues to get better. Yeah. That's, I'm done with that. So let me ask you one question, because I know we're too far out from g7, for me to say to you, when is that happening? But, Mike, my question would be on bigger, bigger ideas like size, where time and cost? When will you be able to start talking about that publicly? Not when is it going to be in my hands, but when are you going to get to a settled point where that's a shareable concept.

Kevin Sayer, Dexcom CEO 38:07
Next year, we've shown pictures of size, I can tell you it's significantly smaller, but the pictures don't show the whole thing is much thinner. It's not the size of an m&m, as we were shooting for in the beginning, but it is it is it is smaller than than anything else on the marketplace. And anything else we've done, and it's very, very thin. We'll get into where length and everything. As time goes on, we have to run the trial. To do that right now. What we are doing is we're doing a lot of feasibility work on G seven, we've done a lot of the hard part. Verily, Google's diabetes are and healthcare division really was instrumental in developing the electronics in that system, and it has completely new electronics. And we've worked very hard on the mechanical aspects of the system and designing the insertion device to work differently to be smaller, as we did listen to what everybody said about g six, and we're trying to use less materials. And what we're working on now is what that product is going to look like and we have to optimize it for a longer wear and make sure we meet the accuracy standards that have been established by the FDA. So we're looking at things like algorithms and membrane changes, manufacturing process, alternate manufacturing processes, fine tuning the things that Dexcom is really good at. So we can get gone with this trial next year as the trials begin to happen. More minion to happen. Word lakes innovation community. We've done some focus groups. And all I can tell you every focus group when we get the g7 out, they just say yeah, that's it. That's that's all we want. It's a I think it's just going to be wonderful product offering but what I learned VA is supposed to fix. It's a big step up from what we've had before it has been

Scott Benner 40:05
for us. Yeah, absolutely. Listen, I think that in the next year to two years, we'll look back on how diabetes was done prior. And just think, Oh, my God, that's, you know,

Kevin Sayer, Dexcom CEO 40:19
never never again get a look. It'll look medieval and and when we say that 80% of intensive insulin users will be on some form of sensor. I absolutely believe that. Now, I, I think they have to be, because I just think they do so much better. And I think the cost of all this will come down. That's excellent overtime.

Scott Benner 40:41
Kevin, I can't thank you enough for coming on and doing this. We were supposed to do this while you were at ADA. But I had a personal thing where I had to move and I apologize for that. Yeah, and I have a ton of questions here that aren't specific to you. So I have sent an email just so everybody knows who sent in their questions. And we're gonna get Jake Leach back on real soon to talk about the

Kevin Sayer, Dexcom CEO 41:00
you can get Jake back on He's great. Excellent. There's nobody and and CGM science in the world. They have the perspective Jake does because he oversees everything.

Scott Benner 41:13
He's, he's been fantastic every time he's been on. And he's, he's very open as the way you are. And let me ask you this last question. And I'll let you go. Is that, uh, am I just getting lucky speaking with you and Jake, or is that, uh, is that the way the company works at the like, from the top down?

Kevin Sayer, Dexcom CEO 41:31
That is the culture that I hope to drive. There are times when when we are probably more close than we should be. Or maybe sometimes I'm more open than I should be been Dexcom has been built on those types of relationships. And and I learned that way back in my mini med days, got the more we inaccurate people and the more open we are, the more success we will have. There's some things we can't share. But figuring out where those fences are, and then walking around them. It is easy.

Scott Benner 42:03
Yeah, I believe that and I see it too. I ask questions of sometimes people in other companies. And you can hear the pause. And that pause says is the guy who I report to are going to be mad if I say this? And I never I never hear that pause when I'm speaking with you. Of course, you're not reporting to anybody but Jake. And and it's just refreshing Yankees had afraid of what I would say to him, either.

Kevin Sayer, Dexcom CEO 42:27
He he really understands what we do. And he and I speak so frequently. We're always on the same page. And speed is a pleasure to work with. I

Scott Benner 42:36
agree. I and I hope maybe one day I can venture out to Arizona and see how you guys are doing that out there too. That would be really,

Kevin Sayer, Dexcom CEO 42:42
it was a few months. But yeah, come first here. We'll

Scott Benner 42:45
show you I'd be beautiful. All right, Kevin, thanks so much for taking the time. I hope you have a great weekend. All right, bye bye. Take care. Huge thanks to Omni pod dancing for diabetes and Dexcom for sponsoring the Juicebox Podcast always. And to Kevin, of course for coming on and sharing what's going on with the dexcom g six g seven and everything else that he shared with us today. I hope you agree. Because I certainly do. Kevin is a he's an open guy. And he talks about some things that I don't think are completely comfortable for a CEO to talk about. And he does that with grace. And I just appreciate him coming on and being that open. We're getting ready guys. Pretty soon we're going to be talking about it. 1,000,000th episode celebration this summer, I am putting together a gift bag like you've never seen. Let me tell you what I've got so far in there. Even though we haven't even announced even though I haven't announced anything about it yet. Just let me let me tell you a little bit here. Let me just throw something out here. Let me get my list up on the pod and Dexcom swag dancing for diabetes swag. Ooh, bunch of stuff from stay put medical, and you're gonna get a myabetic bag. The winner is going to get a myabetic bag for free. That's nice. How about a 30 minute conversation with Jenny Smith, the CD you all love from our diabetes pro tip episodes. That's just the beginning. I am still getting more one winner is going to get everything on the complete list and explanation of how we're going to celebrate the million downloads of the Juicebox Podcast coming soon. I just thought I would tease you a little bit with some stuff. And that nice, that's a good list common there. I'm gonna get more on here for you though.

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Scott Benner 6/10/19 Scott Benner 6/10/19

#233 A Rose by Any Other Name

Call Erin Rose E.R.

E.R. is a mom who came on the podcast to share her life with type 1 diabetes. We talk glucagon, diet and more.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello and welcome to Episode 233 of the Juicebox Podcast. In today's episode, I'm going to be speaking with Erin. Erin is the mother of a child with Type One Diabetes. And we're going to go over a bunch of stuff. Today we're going to talk a little bit about how Aaron's daughter eats, we're going to get into using glucagon for emergencies. And for non-emergencies talk a little bit about DK. This episode really flew right by I just got done editing it and I love that I hope you do too. Today's episode is sponsored by Omni pod Dexcom and dancing for diabetes, you can go to my Omni pod comm forward slash juice box dancing the number for diabetes.com or dexcom.com forward slash juice box to find out more. There are also links in your show notes in the Juicebox podcast.com.

longtime listeners know that it goes without saying that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to always consult a physician before making any changes to your medical plan. Becoming bold with insulin, or I don't know, you know, anything really just talk to a doctor first. This is just a podcast.

Erin Rose 1:23
Hi, my name is Erin Rose, you can call me ER. And my daughter eila is the type one diabetic. He's six years old. And I have been listening to the podcast for a couple of years now. And my daughter has had diabetes for four years. And that's what brings me here.

Scott Benner 1:41
Well, thank you not cool about the diabetes, but it was cool that you listen for. So I'm gonna call you er, and that will. I'm basically training my brain right now just so you know.

Unknown Speaker 1:53
And you come out with something else. That's okay, too.

Scott Benner 1:56
We're the only two people here. So you'll probably respond as I will to almost any noise. Okay, so let's talk for a little bit I let was how old when she was diagnosed.

You, too. Oh, jeez. That's how old Arden was. That's that's not a great time. Not that there's a perfect time. But you know,

Erin Rose 2:22
so it presents its own unique challenges. But like you've said many times, she doesn't really know a life without it. So in that respect, it is easier. I guess if you can call it easier, it just makes it easier to adapt, I suppose.

Scott Benner 2:35
Yeah. But well, there's less to remember and less to lose, right. And then when she gets older, she'll start seeing and I'm sure she already has, she'll start seeing the inherent differences between her and people who don't have diabetes. But at least she's who she is. At that point. You don't I mean, like, it's not like she's got to be apologetic for it. Or I've been corresponding with somebody recently whose 11 year old was just diagnosed, and they're having a really terrible time with it. Really, really just on every level, the child just can't adapt. And so now that that that kids stuck seeing a therapist, which was the right decision, I'm just saying, you know, in his 11 year old life without the diabetes, he probably wouldn't be at a therapist. And and you know, everything's changed for him. And I told the parents, I'm like, you will find your way through this. And it's going to be okay, but even for them, now, they have all this stress and anxiety and things to worry about in costs that they didn't have before. So I agree with you, I don't want to I don't want anybody to get diabetes. But if there's a perfect time, it's either when you're when you're like a Zen master or when you're too young to remember a life without it. So,

Unknown Speaker 3:45
yeah, yeah,

Scott Benner 3:46
yeah. And so how am I, you know, at diagnosis for it four years ago at age two, four years ago, 2014. So in the hospital, I like to ask, you say what did they indicate to you you should be doing for management as far as technology goes at the hospital?

Erin Rose 4:01
Oh, my gosh. Well, I mean, I look at it now. And it's a train wreck. And I think about how far we've come and you know, how much we know. So we were admitted in a typical way, the symptoms of deca, etc. You know, it was new to us. We we were clueless, obviously, at that point. And when we were told, okay, she has diabetes, we want you to use MDI, for at least six months, which in hindsight, I think is ridiculous, because at that point, her insulin knees were so small that a pump would have made much more sense, which I know you've alluded to and talks about in the past on your podcast, and with the Dexcom. They mentioned it in passing but said don't worry about it. For now. Just figure out how to use insulin, how to check her blood sugar and get yourself home. They are they offered us to stay several days we stayed I think one night we were like this is her life. We need to figure this out. We're just going to figure it out on the Fly and, and obviously made some mistakes along the way. I learned by doing especially with a two year old that can't really express herself very well. So and then about a month and a half in when we had been been connected and met some other families, I insisted on getting the decks calm and I said I can't imagine a life without it, I need it. Oh, and we were able to get that tool pretty quickly. And then about six or seven months into it, we got her on the Omni pod and since then she's been on the Dexcom and Omni pod and now she's on the e6 and Omni pod.

Scott Benner 5:33
How did how did you know to ask for a CGM?

Erin Rose 5:38
So I had helpfully been connected with some families through the jdrf when I was first diagnosed, and some families had shown me all their cool tech and I was like, what's that? And what's that? And you know, why am I doing this and and I saw the benefits of having it and then I did research and realize I need this in my daughter's life in our lives. And once we got it, you know, it was the light bulb went off and we were like, why did we not have this from the beginning? I truly believe that children in particular should be given it as it is a mandate before leaving the hospital.

Scott Benner 6:16
Um, you know, so it's funny so I come down on like most things I must be a moderate I come down on I come down on like, I understand both sides of the argument. So I get let you find out what it's about make a decision about you one I get the idea of this technology is is so kind of mind bendingly life changing that it should be like you should come through the door, like, you know, like a spaceship movie. And somebody's like, you have diabetes slap, here's this thing slap. Here's this thing. Go. Yeah, you know. And I see I see the value on both sides of the argument. I lean towards the way you're leaning. I think that I think that if you can see the speed and direction of your blood sugar, then that's something you should know about. And I think that if you put it on somebody on day one and told them, Look, this is just part of this now, then maybe fewer people would feel oddly about wearing something like that. Maybe they would just think like this is something I need now. You know, and it really is. Night and day. And I hate to I hate to say it because there's plenty of people who can't afford it. And it is it's if you don't have you know the insurance that covers it. You CGM is expensive. And at the same time, just today, and I know I say this so much that people think I'm lying. But I swear to God just the day an hour ago. Literally an hour ago, I picked Arden up at school. She got a half day today, an hour before that. She was 135 diagonal up her blood sugar just sort of jumped all the sudden, I knew she was going to be home in an hour I made an aggressive aggressive bolus for the 135 stop the deadness tracks. By the time she got home, she was 86. Now at six, I see a little diagonal down I knew she's gonna want to eat when she gets home. She says you know I'm hungry. Does it matter if I have something you know supercar B or not, I'm like, it doesn't matter because we're in a good spot here. As she's saying that arrow turns down. I was like, Hey, you have an arrow down. I'm like, go do whatever you want. Boom, she gets a bowl of cereal. And Arden has a giant bowl of Apple Jacks, which by the way, I did not count carbs for I just Bolus the amount I thought it was right. And her blood sugar right now, two hours after the 135 adjustment, a half an hour since the bowl of Apple Jacks is 94 and stable. Now if anyone thinks they could accomplish that without seeing their blood sugar, I mean, your that would be amazing. But I couldn't have done it. I couldn't do it before. So

Erin Rose 8:51
yeah, I mean, getting getting into this session about having access to tecton. That's a whole nother issue, which obviously is it's a big one. And it's a heated one. And I you know, and I wish there were a way to make it more accessible for everyone, because it really is a life saving tool, and a tool that makes your life so much more functional and easier to just get on with your life basically.

Scott Benner 9:13
Yeah, absolutely. Well, and that's such a good point, right? Because in the old model, the idea is go live for six months, some doctor's offices, say a year, you know, go live with this. But that's the other part that I didn't get to and is that while you're, you know, quote unquote, living with diabetes and quote unquote, figuring it out, you're experiencing significant psychological stress. And that's the part that nobody talks about. They always talk about the diabetes like it's this. I don't know, like this structural thing in front of you that you can touch. They don't talk about the rest of it when you walk when your kids blood sugar is 300 or when your blood sugar's 300. And then it's 60. And then it's 50. And you're scared of an email now from someone who's frightened out of their mind because their blood sugar is falling and they don't know why. How is that a valuable lesson to learn? Like, okay, one day, I can figure that out, I don't need to live like that for six months to know that I don't want that. I don't I don't get it and to affordability. You know, access is getting better. I just put up a show yesterday, the other day with Costco, who's trying to make Dexcom less expensive for people who are underinsured or uninsured. And I think but I think that until Dexcom, makes that next leap in their technology where they can shrink the form size of the CGM, I'm assuming bringing their cost down. I think we're stuck at this plateau financially. But I think when that next leap happens, and I obviously don't know anything, but if you put me in charge of a business like that, I would say to myself, look, I can sell these things, you know, you know, and you can sell a cheeseburger for $100 and sell three of them make $300. So you can sell them for $3 and sell 1000 of them, you know, and make a lot more money. So I'm hoping that that's what happens. And I have my fingers crossed for that. When you go to dancing for diabetes.com, now that's dancing, the number for diabetes.com, click on the Contact tab and scroll to the bottom, you can sign up for their mailing list. In the end, really, I just would like you to get connected with them somehow. Maybe it's through their mailing list, their Instagram account on Facebook, really doesn't matter to me, whatever is most comfortable for you, you know, wherever you spend your time. But I would love it if you found out more about dancing for diabetes. And those are just a couple of the ways that you can dancing the number for diabetes.com connect with them today.

So you're out of the hospital and you're on your way it sounds like you dove right in like you told them Look, let me out of the hospital. We want to get to this, what did you find in the early days.

Erin Rose 11:54
I mean, in the early days, obviously eila was honeymooning and we really didn't understand how insulin worked or the timing delivery, the the insulin needs the ratios and also the the types of foods to eat or maybe avoid or plan a little better. So in any given day, you know, we kept her log, we used to keep a manual log because this is where we have the Dexcom and the Omni pod. So for those first few months, we actually had a notebook that I was going to throw away my husband was like, You can't throw that away. That's like a time relic a time piece. I was gonna want to look at that when she gets older and laugh because we would say, you know, 5am 400, you know, 9am 60 and and this is just learning, you know, learning the ropes that we did that evened out pretty quickly. I mean, within the first year or a month, he went down significantly and then after the first year we've been there, she's had an excellent I went see like below 6.5 since then, so it's you know, we learn the ropes. But the first few months is in particular, we you know, the morning we were in the hospital, they gave her she woke up with a blood sugar of 350 and DK a and the hospital offered her for breakfast, banana Cheerios, and orange juice. And this is before I knew anything, and I'm like, okay, honey, here's your breakfast, just here's the insulin for it, you know? And I think about it now and I'm like, how is that even possible? That seems negligent? You know, it seems like, why was there not even a conversation at that point. But that that's another that's another topic for discussion. But I just it does shock me how you go into the hospital, and that you're not really prepared for the obvious thing. I think I think at least in my circumstance, I learned by doing basically.

Scott Benner 13:43
Well, and I listen, I think that's got to be the case. Right? Like so it's nice to say, I wish that someone would have told me and obviously someone should have said, you know, hey, I listen, sweetie special day, we're having bacon and ham for breakfast today or, you know, like, like something like that and then and pulled you aside and said, Look, her blood sugar's really high right now. You know, blah, blah, blah. So let's just do this. But when you stop and think about it, the person that brings the food isn't even the doctor, right? It's just it's that service that they have,

Erin Rose 14:20
Oh, I know, epic, but it should be the doctor's orders, right? It could be the doctors and nurses on a systemic level talking about nutrition and the importance of food and nutrition and you know when to eat certain things. And if this is the case, and maybe don't eat those things, because you're just going to exacerbate the situation.

Scott Benner 14:37
And so if we had a doctor sitting here right now, I'm guessing that they would say, look, you were in the hospital for a day. This was all just happening. We're still trying to get the kids blood sugar to come down. The last thing we're worried about is a piece of toast and some Cheerios. You know, we're not we don't want to skip they would have a reason behind it. And it wouldn't be that crazy when they said it to you. But I think the problem is and maybe the thing they don't see what They say that is that now you, as a person who have no idea what you're doing and don't know anything about diabetes think well, her blood sugar was really high, but they still Feder like this. So it it starts to reinforce the wrong things early on. And I always just uses a basic example, like insulin like Arden uses a pitcher, which we love. But in the hospital, we were given Nova law. And so in my mind in my like, addled crazed, like oh my God, my kid has diabetes mine when someone handed me an overlock, I thought, well, this is insulin, because the hospital gave it to me. And so then for years when no vlog didn't work well for her, I never thought twice about that. until another person who had been at this a little longer than me came around and said, Have you ever considered trying other insolence? And I was like, Oh, no, can I do that? You know, and so yeah, it's funny, what imprints on you early on is what I'm saying. So you could have if you leave there, if you're a different person, you leave there and you don't go out into the world and look into these things. You could have just left thinking, alright, high blood sugar, low blood sugar, doesn't matter, insulin eat, go, you know, it's just it's, I don't think that's I think that's the part that doctors don't pay much attention to is like, what's what's happening in my brain, like, what's deep seating in my brain right now, we're in my stress or my anxiety that they're not going to see when I leave, and it's gonna fight with me every day while I'm trying to deal with diabetes. So you got out of there quickly, you found friends, you looked into, you know, gadgets? And how long before you were in a place where you felt comfortable?

Erin Rose 16:36
I would want to say about a year. I mean, Well, it depends on what you mean, by comfortable by comfortable, I think, you know, her agency is really well managed, we're not seeing these crazy spikes and drops. So I mean, I felt within a couple of months, I had an understanding of what insulin is, and you know, the need to treat a low or treat a high, but it did take about a year to really fully understand her body and her body's needs. And by that point, you know, you've experienced a cold a stomach bug, whatever the case may be, and how to make adjustments. And when dealing with certain foods, you know, not all carbs are created equally. learning that as well.

Scott Benner 17:15
Yeah. And so when you say you had to learn about how the insulin worked, I mean, I think that's the focus of this podcast. If, as a matter of fact, if somebody said to me, what's your podcast about? I would say, it's about understanding how insulin works, that would be my first sentence. And did you learn that because of the dex calm, or did you find that out from other places?

Unknown Speaker 17:35
A combination Yeah, dex, calm and

Erin Rose 17:39
trial and error. Being that, you know, if she's having resistance to insulin, you need a lot more or if he's really active, and it's cold, she's sensitive, you know, a little things like that. Or, if you're going to be eating a pizza, or a bagel Pre-Bolus, extend the bolus, increase your basal rate, you know, all these things that, for me, it was foreign language, to be honest, because when we first got the pump, I didn't even know what a bazel was, you know, first, you know, and it intimidated me. And you know, you've rather the thing, you know, that the thing you don't so first getting on the pump, it was a big adjustment. And then then that's why I'd say she got the pump about six, seven months in, and then it took another six, seven months for me to really understand what the pump is and how it works. And I think you were talking about how, you know, it's like this really powerful rocket launcher or whatever. I think one of your podcasts you were alluding to that back then, that of just using it to do darts or whatever. Yeah, I

Scott Benner 18:35
tell people all the time when I'm speaking to Omnipod privately, and I just did it yesterday, actually. And I said, I always say I'm like you hand people a rocket launcher, and you tell them to kill flies with it. Like it's it. It does so much more than this. It's so much more powerful than this. How can you tell them it's a fly spotter. And an insulin pump is not is not just, it's not just a way to avoid getting injections. It's so much, much more than that. And it's a disservice to pumping to, you know, to think of it that way. Now in pump companies defense, not just on the power, but all of them. They are not doctors, and they're not allowed to give you medical advice. And as soon as they start telling you about like they can tell you look, you can set an extended bolus on this pump, they're allowed to say that their documentation the minute they start telling you when to or why to, that's medical advice, and they can't do that. Right. And so they're stuck, right? They're the company that sells you the pump. And the doctor is supposed to be the person who tells you now let me amend that the doctors the person we expect to tell us how to when to use the insulin how to use it. But if we really stepped back and it's interesting, er, we're gonna go in a direction you didn't expect but kind of behind the scenes. I spend a lot of time pressing the medical community To be more upfront with people early on, and I keep thinking the same thing, I just just occurred to me as we're talking like, it's their job, it's their job, but it's probably not their job. The ER Doc's job is to take your kid with the incredibly high blood sugar, bring her blood sugar back down, safely give you the tools you need, and tell you to go visit an endocrinologist. Like, that's really their job. Right?

Unknown Speaker 20:22
That's it. That's all they do.

Scott Benner 20:23
Now, the question is, when we get to the endocrinologist, why did they then treat us? Like, we can't handle any information?

Erin Rose 20:32
I would have to agree to that I and I, I'm going to just step in for a second. I think this is one of my biggest problems with endocrinologist, you know, we being told what to do what not to do, it took us a while to get on a good rapport and find someone we really like and, and who understands us and who, who gives us the freedom without making us feel guilty. Basically, you know, I wasn't taught how to bazel or even really change your basal rates or, you know, extend the Bolus, these sort of things. I learned this all by doing it by reading blogs, and by listening to your podcast, and you know, just doing my own research and learning as I go. And I agree with you like, Why is this not taught, this should be something, you know, when you get the palm. This is what your endocrinologist should be teaching you what to do.

Scott Benner 21:21
And so the common wisdom is, I can't tell people the first time I meet them, or the first couple times I meet them this incredibly confusing stuff. Because what if they don't follow it? What if they take these ideas home with them and do it wrong. And so I'm gonna go back to something I've said before, because the conversations really leading in that way, in, in society, we look at a classroom with 20 kids in it right, and say, three of the kids are brilliant, and three of them are really challenged, and the rest of the middle, these other 14 kids, they're pretty average kids. We don't teach to the average kids. We don't teach to the brilliant kids, we teach to the three kids who are having trouble, like the idea is, it's a compassionate thing. I don't want to leave those three behind. But what that does is it drags the other 17 down to the least common denominator of the conversation, which is now unfair to them. So the idea is when I don't know which one of you are the three bright kids in the class, I don't know which one of you the three challenged kids in class, I don't know which one of you the 14, you know, average kids in the class. How do I, how do I teach you something like where do I start? And so I think sometimes what they're saying is, look, I need time to figure out if you're able to follow what I need to tell you. And so you're interesting, because you fall right into there's there's pretty much two segments, there's the kind of people who get doctor's advice and follow it blindly to the point where they literally have pains in their stomach, because they see things go wrong in their, you know, with their kids, or whether their blood sugar, and they can't bring themselves to disobey what the doctor said. And there are people like you who were like, well, I gotta go figure this out right now. Because this doesn't seem right. That's a personality situation. And so and so I think that's what it is. But so, you know, that's the question is, how do you, it really is on you to look at the doctor early on and say, Look, I understand you don't know me, but give it all to me right now? And how would you even know that that's something you need to do? So in a perfect situation? Yeah. Yeah, it is.

Erin Rose 23:23
And it's all hindsight, I think, you know, you look at and the doctors are only doing their best and what they can do within their limitations. And with liability, like you said, so I get it, I do get it. Um,

Scott Benner 23:34
but but now personally for you how incredibly frustrating was it?

Erin Rose 23:38
It was, it was very frustrating. And you know, it, we kept lowering eyelids, I went See, and her doctors kept saying, Oh, it's getting below 6.5. Like, I don't like that. And I'm like, Well, if you look at her data, she's, you know, she's in her target, like between 75 and 150, like 80 to 90% of the time, I really don't understand what the problem is, you know, we're not achieving this by having her hang out at 50 all the time. And, and, most recently, once he went down to 5.8, and her endocrinologist who now is an actual type on herself, he's like, you have a once you've someone who's almost not a diabetic for six year old, that's amazing. And it just made me feel so much better to realize, like, I am actually doing really well, like I'm doing this. And I'm not, you know, and not at the detriment of her suffering and being low all the time. Like, there's someone here who gets it. And that's why, you know, and it took a long time to find that.

Scott Benner 24:31
And I think from my perspective, that's just exciting because what it means to me is that if the, my assertion is that if you give people good information up front, those 17 kids in the class will do good things with it. The other three are going to need more direction, but that's how you find out who they are in the scenario by giving them the information and seeing them get a 70 on the test, right like so. identify them early, instead of just almost being inspired. to them and teaching down to what you think their level is figure out what their level is, and then help them get beyond it. Like, it's such a simple concept, but we we always do it. We always do it wrong. Like as a society, we always just err on the side of caution. It's always like, well, we don't want to leave anybody behind. Well, I don't want to leave anybody behind either. But let's find out where we're all starting. So we know what to say to those people. Because those three people need different direction than these 14 and those three, and etc. And so I just, I'm excited that you got good feedback from your doctor, because far too many people will contact me and tell me the opposite. They press they get pressed just like you described the beginning. But then it goes on. And sometimes they buckle to it. Sometimes they don't have the nerve to say to the doctor, look, we're getting this five, eight, she doesn't have any crazy lows. We're in range. You know, this is doable. Yeah, that's terrible, too.

Erin Rose 25:52
That is, yeah. And I'm just I'm really glad we're in a place we are at. And I found, you know, the person we have. She's great.

Scott Benner 25:58
Well, that's and you know, it's funny, it's a little bit of dumb luck, right? Like, it's just it's your personality lent itself for you to be an advocate for yourself. And for your daughter. It's really cool. I mean, it's, it's, it's, it's absolutely, it's, it's the goal, it's the hope for everybody. How would you like to make diabetes treatment decisions with zero finger sticks? Well, you can with the Dexcom g six, continuous glucose monitor. And I'd like to tell you more about it right now, if you'd like to listen. What's that? You're gonna listen? That's excellent. Thank you. dexcom.com Ford slash juice box. Here's what's gonna happen. I'm going to do it with you right now. Ford slash juice box. There we go. Oh, it's a pretty little web page that pops up. And all you do is click on the green button that says get started with Dexcom. There's information in pictures, but the green button get started. Here's what it asks me. Personal Information name, email address, phone number, address, patient's birth date? And they can answer Oh, here they go. They ask you a little information about like, what kind of diabetes? Yeah, visit type one or type two? Do you have gestational? Are you currently using insulin injections pills, given insulin pump, managing with diet and exercise, this is for everybody. And then you just tell them about your insurance. I've private insurance, public insurance. And then you submit? Then they get back to you. And you get started. I mean, really, I don't know how much easier it can be. I guess somebody could come to your house. And I click the buttons for you. But I mean, honestly, this is something you can do. And I really think you should do it right now. I want you to imagine a world where you can see the speed and direction that your blood sugar is moving in so that you can make treatment decisions that will move things in the direction that you want, instead of in the direction that diabetes seems to be dictating to you go to dexcom.com forward slash juice box, click on that green button, fill in your information. It's a whole new world when you do now you are achieving the ANC and the levels with the kind of a modified paleo diet. Are you still doing that? Or how do you how do you eat?

Erin Rose 28:10
No, I mean, yes. And I would say I I, I alluded to it in one of my emails. I honestly I can't remember this my vote. Yes. So we do fairly low glycemic, low carbohydrate on during the week. Having said that, if she comes home and says I want popcorn, or let's make brownies, I'm like, okay, we can do that, you know, we'll make it work, we find a way I generally try and do low glycemic and paleo. But there are occasions where she's out with friends and there's pizza, and there's this and she wants to have it, she's going to have it, you know, we just make accommodations, I just know that it's, it makes it a lot easier, and she's more responsive to insulin, you know, the less carbs she has, so I wouldn't say it's completely restrictive. And then on the weekends, we eat whatever she wants, and she eats whatever she wants. So if she wants a bagel, if she wants to go for pizza, if she wants the ice cream, we just you know we do it, we don't even think about it. We just I try and and I look at it more from a health perspective rather than diabetes. And I always tell her that as well. And it because it's me too I eat that way as well. It's not and I don't have type one, you know, it's we try and fuel our bodies with nutrient dense food which is vegetables, whole grains, fruits, lean proteins, you know, lots of water and hydration and lots of activity just to maintain a happy healthy diet and to grow to be big and strong and healthy. And you know, it's not about diabetes, but eating a starchy carb diet is not good for anyone and I'm always you know, reinforcing that point with her and and I think if she gets it because she I think she does get it and you know we watch our twos and things like that so she can understand you know, and read books as well at her level about nutrition and health and she says she understands that it's not mommy saying no carbs, carbs are bad. That's I don't believe that at all. I think that we make the smart choices to eat the right types of carbs that will make us feel good. We call it go food versus Whoa, food. So go food is something that makes you want to go and give you energy and run and play and the World Food is the you know, the sugary, starchy things that maybe you don't feel so good are few weeds.

Scott Benner 30:16
That's so that's excellent. And for a number of reasons. But let me let me say this. I think that when you do a podcast, you say things, trying to give people hope. That's what I do here. Right? Like, if I tell you Arden eight Apple Jacks and her blood sugar, I got her blood sugar to stay at 94. That's not to tell you that our needs Apple Jacks every day. Because there's a box of Apple Jacks in our house, it's probably been here for so long, I'm pretty sure she probably just had stale cereal, you're like they don't mean like it's I use those as examples. Because you know, it's an example of what you can accomplish with the insulin. It's not an example that you should eat Apple Jacks every day. And I kind of think that most people who hear that understand that it's common sense. But there are some people who are so kind of fervently against carbs, that when they hear that they'll you know, contact me privately. I've been attacked openly online a number of times. It's like you're you're telling people to eat a hot a high carb diet. I'm like, I didn't say that. I never said that. Arden had a turkey stuffed pepper for dinner the other night. You know what I mean? Like the night before that was she had chicken that was lightly breaded with broccoli and a tiny bit of rice. It was you know, like that we eat like, like, you know, human beings. And then periodically there's cereal or bagels or stuff like that, or pancakes and that's the stuff when you can understand how to use insulin for those things. Well, then the stuff pepper with you know, is

Unknown Speaker 31:46
right, it's walking apart. Yeah.

Scott Benner 31:48
Yeah. And so, having you say that, to me, makes me think we need to stop labeling how everyone eats. I'm high carb, I'm low carb. I'm you know, I eat moderately, we do a little paleo. We all people are saying in all those regards, there's like, Look, I I'm just trying not to eat pojos all the time.

Erin Rose 32:10
Just trying to be healthy, right? I mean, and, and also you put it in perspective, I was only six weighs less than 50 pounds. So for her 15 carbs of breakfast 30 carbs at lunch and like maybe 30 to 40 dinner is a lot that's me but that but like a normal amount like a healthy growing girl, you know, eating the right sort of carbs. Like we make these choices. We're going to eat keyone vegetables and you know, like you're saying turkey or whatever. We're not going to have box mac and cheese every night. You know? Right? Right?

Scott Benner 32:36
We're very simply years ago, I realized my my son was going to be a chicken person, like the kid was just gonna eat chicken constantly. And when I first had him, I was young. And we were thought to give him a chicken nugget. I went to the grocery store. When the freezer section I bought a bag of chicken nuggets. Now this is an indication that I grew up broke and not well, like the like my family wasn't thinking about health. It took me a few months. And I thought I can't do this. Like why am I don't know what's in those frozen bag of chicken nuggets. So now I go out I buy chicken breast I cut it up into smaller pieces. And I take the time to bread it and cook it in oven. The first number of times I did that my son was like this is not chicken like he fought against. I'm like you better just shut up and eat it. And so he ate it. And it he got accustomed to it.

Erin Rose 33:24
Yeah. Hey, you raise your kid, they develop a taste for real food for real vegetables for different textures.

Unknown Speaker 33:32
And I go ahead I'm sorry.

Erin Rose 33:34
No, I was just, I never catered to the whole, you know, kiddie food. I always was like, you get what you get. You don't get upset, like this is what we're having for dinner. And you know, if you're hungry enough, you'll eat it.

Unknown Speaker 33:46
from the northeast?

Unknown Speaker 33:48
Yes.

Scott Benner 33:52
I agree. And so and I agree, moreover, that the problem, or one of the pitfalls, I shouldn't say the problem, but one of the pitfalls of social media and as interacting with each other and kind of like these, you know, like car accident ways where we don't see each other coming, then all of a sudden we're together in this idea. And then it's over real quick. And we all try to make our point is that we oversimplify conversations. So if you were to tell me that you were not letting your child have any carbs at all, I might say to you as an overarching way to make my point, gosh, what are you going to do when they get to college the first time they want pizza, and they don't know how to Bolus for it. And the problem is that severely oversimplifies my position. Right? Like, I don't care if your kid eats low carb, I don't care if your family's low carb, I think that's there's a perfectly reasonable and healthy way to do that. Just like I think there's a perfectly reasonable healthy way to be a vegan, you know, there's ways to accomplish it. I'm just saying understand the insulin first because you don't know what tomorrow is gonna bring or what five years from now it's gonna bring and when that when it comes. We all need to understand how to do it or you know, All this good work you put into your kids health for the first 10 years is going to go out the window the first time they you know, sit down in the cafeteria college and can't manage themselves. Let's surf the internet together one last time, my a pod.com forward slash juice box Juicebox. Podcast? Well, well, what do we have here, it seems I've missed typed the word juice box. So when you misspelled juice box, you get a picture of a lovely man fishing in a river. Looks like he's wearing on a pod. But when you type it correctly, there we go. When you type in my on the pod.com, forward slash juicebox correctly into your web browser, you're taken immediately to a page that allows you to request a free experience kit, a pack a pod experience kit, you can see it right here on the page, they're gonna send you a little quickstart guide, a non working demo pod that you can actually wear and try for yourself. Yes, sir, a tiny bit of information, name, address, email, phone number, what type of the diabetes you have, you just have to say here that you're over 18 or the parent or guardian and that's that request your experience credit, big red button, git push it. Let's pretend now that you've pushed the red button in your pod experience kit has arrived at your home, you or your child is wearing it now and you're realizing Hmm, I don't even notice I have the song. And then you think to yourself, while wearing this, that would be better than shooting needles into me all day long. I can just push a button and send in the insulin and there's no tubing, I'm not attached to anything. Just little thing I'm wearing and that's it. And then a light bulb goes off in your head. It's as if the angels saying ah like that, except musically. And then you'll realize Scott was right. I should get in on the Miami pod.com Ford slash juice box. Listen, if you get an omni pod, you'll never have to hear me singing again. So I mean, it's a win win. Really? Okay, so er, in your email, you also said you thought it would be really interesting to talk about glucagon. And I do too.

Unknown Speaker 37:07
Hey, guys, great. Have

Scott Benner 37:08
you had any situations where you've needed to use glucagon?

Unknown Speaker 37:13
Yes. So

Erin Rose 37:16
that was the reason why I suggested it. I know it can be scary and overwhelming. And I thought it would be helpful to walk people through it. Because for a lot of people, it's just this red box, it sort of just sits there. And you're told maybe once what to do with it. And then when the time actually comes, you might not be sure or overwhelmed or you know, there might be a lot of there's usually a lot going on at that point in time. That brings you to the point of actually necessitating glucagon. So we've had to use it twice. I can walk you through the two times. And then there was a you know, I just wanted to really talk about what it is how it works, that sort of thing. Absolutely. So these were emergency situations.

Scott Benner 37:58
Yes. Not not like hey, my kids, blood sugar's 50. And a won't come up. I'm going to give them a little bumper glucagon. Like you were thinking this was a seizure or a potential one,

Erin Rose 38:07
almost the first time I Ella that was my daughter, she was three. She had been at a birthday party got Bolus for cake and pizza and all the usual things and candy. And then started, came home and started projectile vomiting. So she had gotten some sort of stomach bug, you know, with his guests. And he wouldn't keep juice down. We tried, we wait to give her water gave her juice. And then if she's you know, she just kept vomiting. And we knew at that point, the monitor was saying low. After finger it just had low so and she was about to go out, you know, she was eyes rolling over that sort of thing. She had just, you know, basically thrown out the entire contents of her her poor little tummy. And so we worked out the glucagon, we administered it. And then we took her to the emergency room and got her zofran which is a caveat I do well, I just was on my mind, I want to recommend everyone should have a prescription for zofran in their house, and anti nausea tablets. So if you encounter a similar stomach bug situation, it can help you prevent flows like this. You can take it and then you can stomach swallowing juice. Okay, you don't that's just a caveat. I didn't want to forget that point. So I want to I want to recommend that to everyone. So we don't go anywhere. Now when we travel we always have to glucagon and zofran. So that was the first occurrence. And then more recently in December actually this just a couple months ago now. I mean, by the time you air it, it might be later but for me in real time was about a month ago eila was fighting a virus so she had just had really stubborn blood sugars and we're not talking seriously high, you know, 180 200 just it wasn't budging for several hours. So we change the pump, and whenever she's high for more than two hours out of practice. I like to give her a shot just to make sure he doesn't stay high for more than two hours. It's just something I like to do. So if she's above 180, for more than two hours, I usually give her a shot anyway as a matter of practice, just to get her down. So we gave her the correction, and we waited an hour and 45 minutes, it's still not budging. And at this point, we're then about to eat pasta for dinner. And we had been traveling, so she was tired, sick, you know, all of these compounded elements, right? That make you resistant to insulin. And so I Pre-Bolus in aggressive corrections, and the end for the pasta. And then she decided I'm not eating the pasta. And at this point, she now had like five units of insulin on board. And for her size, that's a lot, you know, her correction ratio is there. Relative to give you some relative ideas, one unit corrects roughly 70 points and a dinner is one to 20. So five minutes is a lot, you know, we were rushing her blood sugar, we were bolusing for like 50 carbs, a piece of pasta as I wanted. And then side is she eating so I immediately gave her a candy cane suspended insulin and gave her 20 carbs of juice. But at that point, I feel like all the insulin just was a perfect storm came crashing down and I no amount of juice was gonna, you know, stop the drop effectively. So I she had had over 30 carbs, I thought I would cover it enough with the you know, fast acting juice and the candy cane. And he was lying down, she was disengaged. She couldn't she wanted to read and she couldn't. And my husband, like, she's low get the glucagon now and I ran over and just you know, at that point, she could hardly walk her eyes were all gloss over. And she you know, she was about to go. So we had to then give it to her then. So that was the second time. And I yes, those are the two incidents, that we needed to administer it.

Scott Benner 41:57
Right? How did you find the process? Like? So it has to be? You know, I hope everyone's looked at their glucagon. So they understand how to use it. And a great, you know, a definite pro tip would be once they expire. You use them? You know, open them up. Yeah, sounds

Erin Rose 42:11
Actually, yeah, that was something I was gonna say, well, you have the expired ones practice with them, right,

Scott Benner 42:16
you know, and once you're practiced enough given to the school nurses, so they can practice with them too, and proxies at school, because they because it's powder in this in this, you know, in this class tube, then you get the needle, the needle has to the needle has liquid and already the liquid has to go into the powder, you have to mix it up, then pull it back into the needle. You know, it's there's a lot of that a lot of steps.

Erin Rose 42:36
And it's an it's a high stress situation, usually you don't come to use it. And most I mean, unless you're mini dosing, which is another topic I actually wanted to allude to, but if you're many dozing, because you're you know, just not feeling well. It's slightly less stressful situation. But in these, you know, emergency situations, you know, you you have to act quickly, because you don't have minutes to waste basically,

Scott Benner 42:57
do you know that? Maybe I'm just saying something but further that you know, but so when you inject this glucagon into you, there's I think, an idea that the liquid in this powder is what's going to bring your blood sugar back up. But what it actually does is it forces your

Unknown Speaker 43:14
Yeah, right.

Erin Rose 43:16
Yeah, so I was going to explain to that, and that's right, what it does is, the liquid does not bring your blood sugar up, it triggers your liver to release glucose face effectively. And then that will is what brings your blood sugar up. But what happens is it triggers your liver to release pretty much all the glucose reserves you have in your body. So what happens then, as a result, your blood sugar spikes pretty high, obviously. But it's a superficial high and there's a few caveats. So what happens is yes, firstly, it triggers your blood sugar to go very high. But in doing so it releases all the glucose reserves you have in your body. So what that means is for the next several hours, and it could even take a few days for your body to build up their glucose reserves again. So that means you'll be more sensitive to both insulin and sugar effectively. So you have to err on the side of caution and bolus. very conservatively feel like this is not the time to be bold with insulin effectively, if you find yourself in a position where you've had to utilize glucagon, you almost want to do you know, bolus half the carbs and then maybe see where they are within a half an hour, see what their arrows are doing and then make a decision based on that you want to be very conservative, because they have no glucose reserves left in their body at that point in time. And also, after you administer glucagon, it will obviously spike your blood sugar but it will come down as well. So you don't want to treat that blood sugar. So it will it can make you book blood sugar up to 303 50 even for a few hours. But if you watch it, it will go down. So you know you give it like three, four hours. Maybe in the end, I think I remember her and her chronologist eat, maybe you know, you would want to talk to a doctor about this, if you find yourself in a position where you need to use it, you call your endocrinologist obviously. But they had said to us wait at least three hours. And don't correct unless she's above 350 for more than three hours. So because because there's no glucose reserves left in her bloodstream. So, so we had waited three, and I'm like, and she had gone for, like, free ad to like 300. And I was like, You know what, I'm just gonna watch this, and obviously stayed up all night because I was nervous. And then she slowly crept down, and then by four hours later, she was 200 trending down. So I obviously didn't correct anything. And at some point, even in the night, she got low and needed juice. And this was like, eight hours after administering glucagon. So she obviously you just have to ride the wave basically,

Scott Benner 45:49
because, because what you're saying is to be 100% transparent is if you use glucagon. And your liver expels all the glucose that has saved, you can't use the glucagon again, eight hours later, because there's no there's no store of glucose in your liver at that point.

Erin Rose 46:05
And that's, and that's also why you want to eat and drink much as you can stomach basically. So without really reading for it, to be honest, like you don't even want it like you want to have some juice and some slow release carbs, assuming you're not having stomach bugs until at least you're eating food, and you can rebuild glucose reserves as quickly as possible. So it recommends I think you eat at least 15 to 20 carbs after you've had to administer glucagon. So you can build up your glucose reserves. So we ended up at that over the course of that night. She I think she needed like three juice boxes, or something. But she just kept dipping down. And even though we had a lower bazel, you know, we didn't want to have no bazel. So we had to just keep giving her juice throughout the night. And then yeah, and you're super sensitive for the next sort of few days. So you just need to play it safe. You might spike more than you usually do after you eat a meal. But you have to know that this is you know, like a sick day policy. It's not a normal, you know, scenario, you don't treat insulin the same way when you're coming, recovering from the use of glucagon effectively,

Scott Benner 47:06
yeah, now, so you handled it much better than I did Arden many years ago. And she was really little once right after she was diagnosed when she was two years old. And maybe a year or so after that. I saw twice. I gave her insulin that was too much. And she had a seizure. So that was like, you know, gone like just glassy eyed grunting you know, you just scared out of her mind, you couldn't really touch her because everything frightened her. Right, and we've got her out of both of those with glucose gel in her cheeks. Now, that was lucky, because the first time I just I opened up that glucagon. And I realized I didn't even know how to do it. Because that because the doctor says to you, Hey, this is the glucagon it's for emergencies. If they have a seizure, and then the next thing they say is don't worry, you'll never need it.

Unknown Speaker 47:55
Yeah, they do. They say that. Why did they say? Well, because they well, and here's what I share. Yeah, right. That's

Scott Benner 48:00
the psychology behind it. They don't want to send you like you've just been diagnosed. They don't want to be like, hey, look, this is for when you inevitably have a seizure. What they should say is, this is for if you have a seizure, the likelihood of it is really incredibly low, but it could happen. So pay attention while I show you how to use this because as soon as my like, as soon as my brain hurt, it's never gonna happen. I was like, I have enough other stuff to think about. I didn't pay how to reconstitute the, the glue gun, I was completely lost. When I opened it up. I felt like an idiot.

Erin Rose 48:30
So yeah. So you do you do need in practice, like you said, practice with the expired ones. And also it's good for 24 hours. Once you mix up that magical cocktail. You can keep it in your refrigerator, if you need it. Like let's say you're dealing with a stomach bug or the flu or something like that in your mini dosing. You can keep it for 24 hours. And, and to the point of mini dosing. I

Scott Benner 48:54
don't know. I've never done it, so go ahead and tell me about it.

Erin Rose 48:58
So mini dosing is effectively using glucagon to help with like you were saying earlier with like stubborn lows in the 50s. But there's still cognisant aware talking, it's just not coming up. So you effectively make the mixture you you know, you prepare the glucagon as you would regularly but then you use a regular syringe. And this is just good practice, by the way, because the glucagon syringe has been known to break I read about this in certain scenarios. So I always backup regular insulin syringes and Islas diabetes kit. If God forbid, the glucagon syringe, decides that today's the day she needs it and then the syringe is not working. So I, as a caveat, always extra syringes with her. And you use a regular insulin syringe and you dose based on roughly the age so no, baby two two would be like two units, two units using an insulin syringe of glucagon and then you Add a unit for every year on top of that until you get to I think about 15. And then it's about 15 units. So for example, Islas, fix it two units plus an additional six units for each year that makes eight units of glucagon. And what that would do is it will bring your blood sugar up, but it won't completely deplete all of your glucose reserves because it's a smaller amount. And, and it won't make you spike so hard. So I not and I would obviously like you said, you know, you would want to talk to a doctor, you wouldn't want to do this without the advisement of your medical professional. But the the availability is there, the option is there and it works well. If you've had a stomach bug, or you're really sick, and you just can't stomach the idea of more food or juice or whatever.

Scott Benner 50:45
Yeah. Oh, listen, this episode is getting an extra deep voice this episode of The Juicebox Podcast is, you know, not advice. situation. So I because we are talking a lot about stuff that happened to you. It happened to me that are this really specific?

Erin Rose 50:58
Oh, definitely. And yeah, and it, it's very much specific. And it Yeah, absolutely is not advice in any way, shape, or form. And

Unknown Speaker 51:07
it's just what happened to you. Yeah.

Erin Rose 51:10
Just experiences of it. You learn from it, obviously, you know, I think now I look back on it now. And I say, oh, wow, I wish I knew about mini dosing, because when I had her stomach bug, I would have done that and would have prevented going to 20 and almost having a seizure, you know. And now I know about that hindsight is a wonderful thing. We don't, then

Scott Benner 51:29
we don't and so we don't travel with glucagon all the time. But I wouldn't I don't even take insulin or pumps if we don't, unless we're going more than about a half an hour away from our house. So it just if I do, and that's totally fine. People should do whatever they're comfortable with. I'm just saying we don't. But there are times still when I leave and I'm like, I take the glucagon like jam in my pocket before we leave or something like that. But Arden doesn't like have one on her I guess. And you know, you can make the argument that that's bad practice, and maybe it is. But I think that as you live with diabetes longer and longer, you get to the point where you just like, I mean, there's like, what am I gonna do? Like, I'm gonna walk around with a pharmacy with me for the rest of my life. And and if you're in a stable enough situation, you know, now you're just hoping against hope that one of those unforeseen things doesn't happen. But Artem was that I'm in physical therapy for her shoulder last week. And while we were there, her pump just expired. And I was like, how did we like, like we just had gotten past all of us. So we finished up a whole bunch of was like 112. And we finished up probably 20 more minutes of what she was doing a 20 minute drive home by the time we got home or blood sugar was 185. And it was it was rising, you know, just from not having insulin for 40 minutes. And I bring that up because because you you also alluded in your email about discussing ketones and DK, which is also something I've never really talked about on the podcast before. So as a person who doesn't in any way regularly check for ketones unless I know unless she's sick. When do you check for them? And how do you do it? I use a blood meter. How do you do it?

Erin Rose 53:14
To me too, and that's something I wish the hospital told me about sooner because for the first year, I had piano stick

Unknown Speaker 53:21
your fingers so yeah, yeah, pretty much. Um,

Erin Rose 53:27
so yeah, we use the ketone meter. And I like you usually only check if she's sick, or if she's had a fever. But having maybe like she woke up with a fever, or if she's had high blood sugar for more than two hours, which, you know, fortunately, you know, we've got pretty good control, we rarely see her above 200. And if we do, it's almost never above 250 for more than two hours. Like, that's pretty unprecedented. Unless there's some weird scenario, you know, which is, but it's not the norm. But if that does happen, ever reason her pump fails. And then you know, she eats a slice of pizza. And then the next thing I know, she's 300 You know, it happens for whatever reason, those are the scenarios so above, above sort of 220 for more than two hours. Just I think it's good practice check. When she's sick. I checked twice a day. I mean, call me a bit OCD, but idk does scare me and I know it could go from bad to worse at the drop of a hat. So I I act aggressively with it. And yeah, and I think that it just high blood sugar not feeling well fever. You know, the usual scenario is I don't carry the ketone meter around with the I travel with it. You know, whenever we're away for more than a day.

Scott Benner 54:39
We travel with it. We travel with it, but we don't it's not with us. Like you know,

Erin Rose 54:44
yeah, I don't Yeah, it's not like in her day to day she her little you know, diabetes bag or whatever with her, her stuff. It's at home, I know where it is. And you know, and if and when she's sick. I do check twice a day after she's breakfast because you do get elevated status. Raising ketones in the morning. So you usually want to wait at least until after you've bolus for breakfast and had some water and you're hydrated. So like maybe an hour after breakfast, and then any.

Scott Benner 55:10
I'm sorry, I was gonna say I think it's important to say that to know, if you have ketones when your blood sugar is elevated, it becomes important for another reason not just to avoid decay, but because those ketones require insulin to clear, right. So if you have a 200, blood sugar that's been 200 for like, like, are insane for four hours, and you now have ketones present, you know, maybe 1.5, ketones, whatever insulin, you think you need to move your blood sugar down. You also need an amount on top of that to clear ketones.

Erin Rose 55:42
Yeah, yeah. And lots of water. Basic. Right. Right.

Scott Benner 55:45
And so you are gonna have to but and that's a scary proposition. I remember Arden had the flu early on, and she had ketones. And the doctor told me and I didn't know what I was doing. I called the doctor, she's like, you need a unit, give her a unit for those ketones. And back then she was like, seven, you know? And I was like, wait, what she weighs like, you know, 45 pounds, and I was like, she was so little. And I was like you want me to give her She said she's got the flu. She can barely keep anything down. Really. I'm like, you need me to get your ex me to give her another unit of insulin. I was like, I think she's like you have to?

Erin Rose 56:13
Yeah, well, we do it like we try and I actually just got the flu on her birthday.

Scott Benner 56:18
Happy birthday.

Erin Rose 56:19
Yeah, happy birthday. She had 105 fever, and we were in the emergency room with ketones on temuera 13th.

Unknown Speaker 56:24
So that sucks.

Erin Rose 56:26
I did suck a little bit Poor thing. But she was so cute. She thanked all the nurses for taking care of her on her birthday.

Scott Benner 56:34
Did they say nor

Erin Rose 56:35
they didn't think that they did wish her happy birthday. But the point I was making was treating the ketone. So we like to use things like coconut water or Gatorade so at least it has carbs in it but it's also hydrating her so you have less of a worry of them, you know crashing down effectively.

Scott Benner 56:51
Yeah, carry it's what I used so I over Bolus than that. Except at the at the Gator

Erin Rose 56:56
Gator aid or a popsicle or coconut water some sort of like sugary liquid effectively, that will help hydrate them but also give you the sugar so then you're not going to crash. Yeah.

Scott Benner 57:06
And and you know true to form. But exactly what the doctor told me that gives that insulin cleared the ketones away. So

Erin Rose 57:13
that a few hours if you're aggressive with it, and you drink a lot of water, within like two to three hours, you should see a noticeable drop. Yeah. Yeah. And

Scott Benner 57:22
at some point, I mean, listen, also, it's uncommon for me to say your contact your doctor and make sure they understand what's going on. And don't you know, if you're not making headway at it for a while, then you might have to get to the hospital and and like you said, DK comes It's nothing to joke around with it will knock you over, it could kill you. And it could it could last you all day, at the very least.

Erin Rose 57:43
Right? So we I mean, we narrowly escaped that on her birthday, basically. So she had come home with what we thought was a cold and she got progressively worse over the weekend. And by Sunday on her birthday, a few weeks ago, she she didn't want to eat anything she want to drink these she want to open presence. And we had a thermometer that wasn't working. So we thought her fever was only slightly elevated but not crazy high. And then we my mom who was in town visiting for a birthday was like this kid is burning up. And so I checked again and it said 102 and I'm like it must be higher. And then we also talked for ketones at that point I had checked in the morning, but then by the afternoon they were I don't even remember to point something. So obviously I was like we're going to the emergency room. Now we're dropping everything because she could be going into DK within a matter of hours, basically.

Scott Benner 58:30
So I have to ask you, when your mom pointed it out, did you first worry about Iowa's health or did you think Oh great. My mom is here acting like she knows more.

Unknown Speaker 58:41
Maybe a little bit of both.

Scott Benner 58:44
How disappointing was it with your mom was right.

Erin Rose 58:47
I mean, I mean her credit obviously was right. And I knew I needed to take her in because she wasn't drinking and she ketos you know so we didn't really have a choice at that point. I and fortunately you know they hooked her up to IV fluids and gave her a lot of Tylenol and then within a few hours actually she rallied and was able to go home we the doctors were all like I think it's okay i said i think it's a and then somehow she that was her birthday present she it wasn't DGA basically.

Scott Benner 59:16
Yeah, it's funny, Arden's been in the hospital after her diagnosis only twice or only once about diabetes and it was after she had the first seizure when she was like two two and a half years old. You know, we had called a part of the panic we were yelling at my son called 911 for us and so once the you know once the the rescue squad in the cops got there, they were like, Look, take her to the hospital. The second time we needed the glucose gel to stop what was clearly a seizure. We got it stopped and got her stable and put her back to bed. And you know, that was it. Because you know, once you get to the hospital and you're okay the hospital sort of like so you're okay. And I'm like, yeah, and they're like, Oh,

Erin Rose 59:54
yeah, yeah, sure. The second time we use glucagon, we obviously call her endocrinologist to let them know Keep them in the loop. But they were like, don't need to go to the hospital, you've done that. Like, yeah,

Unknown Speaker 1:00:05
yeah, I know,

Erin Rose 1:00:06
I know what to do, you know, and we were out of town visiting my, at my parents house actually. And, and I felt comfortable, you know, I knew there was an ER nearby, I knew what to do. And I would just stay up checking her and make sure you know, we had the tools and the resources and the experience. But in the case of the flu, it's different and ketones, you know, you don't want to mess around. So if you have ketones, and if after a few hours, they're not responding, don't, don't, don't delay, please don't hesitate. It's not, you know, it's not the same and you need the you need the help of a medical professional, you need probably IV fluid, you know, a lot more than what you can do at home, basically, to manage it. So that and that was the case with Iowa, like we if we had not gone it probably would have taken too much for her. And then it had and the reason able to go home after a few hours was because we went in and we responded and did what we did. So that's that's the takeaway from that scenario.

Scott Benner 1:01:02
I mean, listen, in dire health situations Better safe than sorry, is, is absolutely the, the word of the day like yeah, you don't you don't want to, you don't want to be lying on your floor dying with an insurance card in your pocket. That's for sure. Like, oh, I could have gone to the hospital. But instead, I thought I'll be okay. And now look at me, like, you know, I mean, like, don't let things get so bad that, right, you know, it sucks that you have to go to the hospital if it comes up, but it's certainly better than the alternative. And at the same time, don't be a person who's running to the hospital constantly yelling, my blood sugar was 150 for two hours.

Erin Rose 1:01:36
I know of course, no no exercise with caution use common sense that sort of thing. But aka is it's a serious matter. And, and don't you know, you don't take it lightly, basically. So if you present those symptoms of being sick and having ketones, and it's not going away, within a few hours, despite all your best efforts, now is the time to go you know, the sooner you go in, the sooner you get out. Basically, I would just separate caveat that also reminded me Tylenol does impair the readings on the Dexcom. So they say that it doesn't I know that they say that was a G six, but that's

Unknown Speaker 1:02:13
false. Okay, so

Scott Benner 1:02:15
I don't have that problem. So you're saying that you're using Tylenol and you're seeing dexcom readings that aren't?

Erin Rose 1:02:22
Yes, it went on the fritz basically. And we only ever utilize it when she has a really high fever. We try and use children's Advil, that reason, pediatric Advil, so it doesn't interfere with their interstitial readings, or that they gather that the dexcom gathers but for some reason. And they said that I and when I spoke with the rep, you know, as I call them from the hospital and explain the scenario when we were there when I had the flu, and they said, Oh, it can still happen. It shouldn't but it can and it was happening, you know, it was okay. And they they obviously replaced the sensor and they said, if you do need to use it, you know, if your fever for the next few days, we recommend just not wearing Dexcom for the next few days. Because it's gonna cause another one to fail, basically.

Scott Benner 1:03:05
Okay, so somewhere between the dehydration and the hot and the high fever and the Tylenol.

Unknown Speaker 1:03:11
So every day

Erin Rose 1:03:14
was obviously having either high fever was severely dehydrated, and then and we, yes,

Scott Benner 1:03:21
no, I mean, listen, in the end, here's what you're saying. In a medical situation like that when things are not normal, like you know, the way you expect day to day, your precautions, you have type one diabetes, your precautions go up, you have to be a little more. You know, vigilant. vigilant is the is the right word, you start you test your blood sugar a little more, don't. Don't just assume that, you know, I mean, listen, I tell people all the time, like I love Dexcom it is absolutely at the core of everything that I do with my daughter. But if her blood sugar is at three for six hours, and the line never moves, I don't think I'm doing a great job. I think I should check that thing. No, now sometimes your blood sugar's at three. But it's just you can't get so complacent that you just saved yourself. This stuff's gonna take care of it. I don't have to think about it.

Erin Rose 1:04:09
You're right, especially when you're sick. Because there are so many things you're running resistant to insulin, you're dehydrated. And there's all the other things and the Dexcom struggles to keep up with what's happening and the rapid rise the rapid drop all that thing. Yep. So with with illness, I you know, I'm I would say we check our finger every few hours, like at least four or five times a day, just you know, just to make sure we're you know, we're where we think we are basically and that's when normally it's like twice a day. If I remember

Scott Benner 1:04:35
this technology is far and away the best ever been on the planet for somebody living with type one diabetes, and at the same time, it's not your 3020 you know, like these this complex sounds a great example they've been at this a decade. You know what I mean? When you look back 50 years from now, the G six will be considered like the infancy of that technology. So it works as well as it works and you know, every time somebody like you has an issue like that They learn a little more about it too. And I'm glad you called them. And I'm glad I'm glad when anybody does, because they need to hear about stuff like that so they can make improvements and make it more efficacious for everybody. You know, as we move forward, I think it's, listen, I think you did the right thing. And I think that I think bringing it up is the right thing to let people know like, if the things acting wonky, it's acting wonky. Like don't just sit back and say, well, they said it was gonna work. Like, that's weird, right?

Unknown Speaker 1:05:29
But people

Scott Benner 1:05:30
do that, by the way, which is why I bring it up. They always bemoaning things like, well, it said it was gonna do that. I'm like, well, it didn't.

Unknown Speaker 1:05:37
So yeah.

Scott Benner 1:05:38
You just gonna sit there and pout like, like getting the game, you know

Unknown Speaker 1:05:41
something about it?

Scott Benner 1:05:44
So are we are over an hour? Oh, wow, this is usually you are such a good talker. This was so easy for me. Thank you. I, I this is usually the point where I asked you if there's anything we didn't talk about that you wish we would have? No,

Erin Rose 1:06:00
I think Thank you. Again, I really appreciate the opportunity. I think it's been helpful. I tried to get through, you know, all the things I could think about, you know, that I thought might be helpful to somebody else. You know, I'm not an expert. I'm not a clinical specialist. But I have some experience and I think I do a pretty good job. So maybe, just like when I listened to everybody else speaking I'm they might hopefully learn something, too. So that's what I hope is that people benefit from this,

Scott Benner 1:06:26
I guarantee they're going to and I and I absolutely appreciate that you came on. But the core of what the podcast is, is people's experiences. So having people on who have different experiences than mine is how we get the conversations to go where they go. Absolutely fantastic episode. I really appreciate it. Thank you so much for coming on. Ladies and gentlemen, I'm being serious about this big round of applause for er who came through today with the good information sharing about our life, but type one diabetes in a way that will help you. You know who else we're gonna clap for me, I was fantastic. me. I'm just kidding. Dexcom on the bottom dancing for diabetes, we're looking for dancing the number four diabetes.com you're gonna check them out, you're going to connect with them. You're gonna go to my omnipod.com forward slash juice box and get a free demo, insulin pump today, right the pod experience kit, you know you want it. And for those of you who want to Dexcom, the G six continuous glucose monitor, today is the day to get started. There is no day other than today. Unlike today better than today. dexcom.com forward slash juice box, you're going to get the Dexcom g sex and get to see what your blood sugar's doing, how fast it's doing it. So you can make the great decisions that keep you where you want to be. Two weeks from now, Jenny Smith will be back and Jenny and I will talk all about getting your baselines on set the first time just setting your bazel I received a number of notes from people requesting that episode. And so I bring it to you, as you request that. Also, the show is now available on the radio.com app if that's something you're using you like the podcast is there too. I mean, it's honestly pretty much everywhere. It'll be on Pandora soon. yet. Let me roll through it real quickly where you can listen to Juicebox Podcast through Amazon Alexa on your Android app. You can listen to on Google Play Music, I Heart Radio, right at Juicebox podcast.com. On the radio.com app, through radio, public Spotify, tune in radio, and even on YouTube. Of course the shows available on all your Apple devices. You can just say to Syria and listen to Juicebox Podcast or look in the podcast app that's available on your iPhone, iPad and coming to your Mac very soon.

Do you ever do that when you're a kid just like trying to put an orgy handle like it's not breathing and then just the bag?

Way Out of breath. Okay, see you later.

Unknown Speaker 1:09:23
Jeez.

Scott Benner 1:09:28
Are you still here? Do you want more? Okay, I'll go one more time.

I forget too much air

If you're still listening, I want you to seriously like think just stop going to a dark room, close your eyes for a second, sit down and say to yourself, what am I doing with my life? I, I stayed on a podcast two minutes after it was over and listen to a guy basically just make weird noises with the back of his throat. And I am, I think I need help just reach out to a friend or a family member and tell them I don't know when to shut off my podcasts. And I need your help, please just I mean, maybe someone will help you. Maybe they won't. Maybe they'll look at you strangely and think you're an adult, and you just can't. You can't just give up. Like he can't just say, obviously, the guy is now just talking to see if he'll hold on. And why. Like, why would you do that? Like, why wouldn't you say to yourself, the podcast is clearly over. You know, I'm hoping you'll you'll find someone like that in your life and, and that person will help you. Or that maybe this has helped you. Maybe you're just embarrassed at this point. Just enough to say to yourself, you know what, it's right next time the music plays and he tells me who the you know, the ads were from again, and what's coming next week. I'm just gonna stop after that. I don't know what you're gonna know. Honestly, I'm not judging you do whatever you want. But I'm just saying I mean, I mean, if I'm you by now I would have stopped.

Okay, seriously, if you have not shut it off by now, I want you to see a psychiatrist. At least a psychology I mean, whoever your insurance will cover really don't go into a ton of debt. You know, I mean, copay $20 a week, you go and you tell them a little bit about you. You know, when I was growing up, my parents weren't great. And we moved around a lot or whatever your story is. And you know, then the psychiatrists or the therapist or whoever you can find me but go to somebody reputable. It's not just like some like, you know, like, bored housewife with like a degree like you don't want that you want to you want a physician, you know somebody a doctor, I'm thinking and you sit down you say I you know, I don't know what's up. Like this podcast, they told me all this great stuff about diabetes. And then honestly, the guy went on for like, four minutes afterwards, and I never shut it off. I could not stop myself. I don't know what they'll do. I hope they don't medicate you. I don't think you're in the medication for this. But I think maybe they'll just teach you some coping techniques or some breathing exercise or something you might want to do to just you know, help center yourself.

Unknown Speaker 1:12:24
Anyway, that's it.

Scott Benner 1:12:26
You know, the best part of all this is that a minute after I stopped the podcast, you're gonna think it's still happening.

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Scott Benner 6/3/19 Scott Benner 6/3/19

#232 A Journey of a Thousand Miles

Amy comes full circle……

Insulet’s Community Manager Amy Drauschke is not just an employee, she’s also the mom of a pre-teen Podder! Amy and Scott chat about being bold with insulin, not being a diabetes defense attorney, and creating great content that helps people manage their type 1 diabetes.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
I just finished recording the opening for the show and it was perfect, but was it perfect? It didn't flow exactly the way I wanted it to. So I'm just gonna blow through it right now. top of my head ready? Welcome bold people to Episode 232 of the Juicebox Podcast. Today's episode is sponsored by Omni pod Dexcom and dancing for diabetes. You can go to Miami pod comm forward slash juicebox dancing the number four diabetes.com dexcom.com forward slash juice box or if you want to see them all in one place Juicebox podcast.com. That was good.

On today's episode of the podcast, we're going to be speaking with Amy. Now Amy is the mother of a preteen named miles who has type one diabetes, but she's also the Community Manager for Omni pod. Amy reached out and she wanted to interview me for the Omni pod blog. And I being incredibly lazy, and not having the time to write out my answer. So why don't you just come on the podcast instead? So I tricked her. Because I could have written out the answers. I just I really didn't want to. Anyway, Amy and I had a really wonderful conversation. And we covered so much about her son miles and type one diabetes, that I've named this episode, a journey of 1000 miles. While you're listening to Amy and I please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult your physician before making any changes to your medical plan. We're becoming bold with insulin.

Amy Drauschke 1:44
My name is Amy Drauschke, and I'm a two MD mom of an 11 year old boy, his name is miles and I live in New Hampshire. I also work in diabetes, and the consumer content and Community Manager at insulet Corporation.

Scott Benner 1:58
Amy, I know you because you work at insulin. Is that correct?

Unknown Speaker 2:02
Yeah, that's how we got connected. Exactly. And

Scott Benner 2:04
so tell me what you do there.

Amy Drauschke 2:07
So I work on the marketing team. But I'm the content and community manager which means that I deal with a lot of digital content, which is we have a blog, we have social media channels. I get involved in some website, any type of communication that's online. My primary role is to be that connection to the diabetes community and to the potter community, which we call our Omni pod customers Potter's it's sort of a dual role of community manager and writer slash editor of, of online content.

Scott Benner 2:40
I understand. That's excellent. And you guys have been branching out in that space a lot in the last year and a half, I would say like you have an Instagram now that just didn't have before that's doing well. And you guys put Instagrams up for like different parts of the country like, excuse me different parts of the planet, like different countries and everything. And so you guys are kind of, you're moving in that direction more. So how long have you been at insulin?

Amy Drauschke 3:04
I've been in slept for two years, I started out primarily focused on the blog, Potter talk is our blog, which I'm hoping everybody will check out and then I'm going to share our interview on there. But the blog is, it was just basically supposed to be stories about people with diabetes, not always necessary people, not necessarily people who use Omni pod, but just inspiring stories as well as helpful information about living with diabetes. And I started out as that being my primary focus, and I was really part time, but then about six months later evolved into a bigger role with the social media channels. And I also attend conferences and get involved in some of the local, you know, jdrf events and ADA and things like that. So I'm sort of a connection to the patient community, both in person and online.

Scott Benner 3:58
The first time I ever took money from Omnipod was to write on their blog. Actually, was it actually now I take it for the podcast, but it was really valuable because they gave me a lot of freedom when I was doing it.

Unknown Speaker 4:11
Oh, yeah. So

Scott Benner 4:13
when I first started, cobbling together the thoughts that we now discuss on the podcast, one of the big ones everyone knows is just the idea of not being afraid of insolent not being afraid, in general. And I resigned my contract, which sounds so fancy, trust me was not a lot of money. And I resigned my contract with the pod one year and I and they were like, Well, what do you want to write about this year? I said, I'm gonna write a six part series about fear. And there was dead silence. I'm like, wait, what are you doing? That's like, trust me, it's gonna be fantastic. And I said, it's, yeah, and it's not just content for you. I'm gonna run it on my blog, too. And they're like, wait, we're gonna pay you to write for our blog, but you're gonna use it on your blog. I was like, Yes, those are the terms of my of my new contract. And they were really cool about it and did it and it just helped me It helped me formulate a lot of the thoughts that I share now. So

Amy Drauschke 5:02
Oh, that's a no When was that? Do you never remember

Scott Benner 5:05
years ago? I don't know it. I mean, honestly, had to have been four or five years ago. It was a long time ago.

Amy Drauschke 5:13
Yeah. Because there's been a lot of change and a lot of, you know, different focuses. And, you know, I'm constantly trying to get my head around what we want to put on there. So that's really interesting. I'm gonna have to have to see if I can go check it.

Scott Benner 5:24
Check it out. Find out the history. Amy's like, that's interesting. If you tried that nowadays, we wouldn't let you do that. Well, anyway, so you've been interesting. You know, you're on the show today for a couple of reasons. You're on the show, because you're the mother of a child with type one you said Myles is 11. How old? Was he? When he's diagnosed? He was six. First grade five years ago.

Amy Drauschke 5:48
Yeah. So five and a half years ago, it was the fall of 2013.

Scott Benner 5:51
When he was in first grade, yeah. Okay. So you have that you've got that part of your life. And you work for Omnipod. So you're going to actually, during this conversation, kind of slip in a couple of questions for me. I'm going to expels which now I just have two people just tuned up I go Scott's going to talk a lot in this. And but um, but you're gonna interview me a little bit here and there as we go. And maybe put that up. I guess it's going on for Father's Day on your blog. Is that right?

Amy Drauschke 6:18
Yeah. So um, I really have always wanted to. It's funny, a year ago, I think I had you down as somebody I wanted to interview and put on the blog. And for some reason that time got away from me, and it didn't happen in time. But I I'm really hoping to share your story and how, you know, being a diabetes dad has morphed into this amazing role that you have in the community. And obviously, we have a partnership with Omnipod, and that you're an Omnipod customer. So that's, you know, I think it's a perfect story to tell. And I'd love to be able to take this interview and share it on our social channels as well as the blog.

Scott Benner 6:51
I'm not just the spokesperson, I you

Amy Drauschke 6:54
and I'm the thing I you know, I'm in that same boat. So I was my funniest Omni pod before I ever went to work for insolate. So it's a great, I feel like it's something really cool that you and I have in common.

Scott Benner 7:05
It's excellent. So and you have a third thing that that we're going to kind of dive into today, which is interesting is that you and I spoke privately, I'm going to say a month or so ago. And I did I did one of those, like, information dumps about my diabetes management ideas into your brain, which I know is overloading and we probably did it for like 45 minutes or an hour on the fun. So we're gonna get to find out how that's all struck you and how its hazard has not helped you in your life.

Unknown Speaker 7:33
Oh, wait,

Scott Benner 7:34
let's let's start with a little simplicity right. Myles is diagnosed in kindergarten, how did he present?

Amy Drauschke 7:43
It was actually first grade. It was the very beginning of the school year. So he in my in our town where where he lives. We don't have full day kindergarten. So the first time you go to school for the whole day is first grade. And so this was September, October time, he had just started school going all day. And you know, he was showing signs of fatigue he was wetting the bed, all of a sudden, that was the biggest sign. And he had never, you know, I have two other kids who were in pull ups for years. He was my one kid who never had trouble with nighttime bedwetting or needed pull ups or anything. He just immediately was toilet trained when he was little. And that was it. So when that was happening, all of a sudden, I was like, That's weird. All of a sudden, at six years old. He's He's wetting the bed. But I had, of course, you know, I feel like a lot of parents, you chalk it up to something else, they find another reason why it's not a big deal. And so in my head, I was like, well, he's just started first grade, he's going to school all day, he's exhausted and his body is just not waking him up. So that's how I talked myself out of being worried about it.

Scott Benner 8:48
How long were you able to talk yourself out of it?

Amy Drauschke 8:51
I feel like it was probably maybe two or three weeks. It didn't go on too long. Thank goodness, we did catch it early. But it was really more of a convenience thing I had he had a well, well child checkup, normally scheduled annual checkup with his doctor. And you know, they always say Do you have any questions and the time his dad was the one who took him to the appointment? And I said, Do you think you could just ask him about the bedwetting and see what he thinks? Yeah, what

Scott Benner 9:19
we're where we could get a reasonably priced mattress was like six of them.

Amy Drauschke 9:24
Exactly. Um, but at the end of employment, I said, How did it go? and his dad said, Oh, fine, everything's fine. And so did you. Did you ask him about the wedding? And he said, You know what, I didn't want to embarrass him. But didn't. And I was like, Ah, so that was a Friday.

Scott Benner 9:40
Good luck, because now I'm gonna embarrass you can we step in this room privately?

Amy Drauschke 9:45
So, um, I don't know why that was just an that was his decision. But on. just coincidentally on Monday, that was a Friday and on Monday, I had my own appointment and we go to a family practice. So I was back in the same doctor's office for my own. appointment. And I just kind of mentioned it to my nurses that, you know, I, my son was here Friday, and we didn't we had one more question that we didn't get answered, can I just leave a note for for Dr. Ariane and see what he thinks. And so I wrote my note, and I had my appointment, and she came back in the room after my appointment and said,

Scott Benner 10:17
Amy, you should check out dancing for diabetes.com it's dancing the number four diabetes.com Oh, and they have really great social media on Facebook and Instagram. That's really what she said. I saw.

Amy Drauschke 10:31
She came back in the room after my appointment and said he read your note about the bedwetting he has a couple more questions. And it was questions around, you know, is he excessively thirsty? Is he hungry? Is he tired? And I was like, Oh, he is pretty sick. And he's busy. And he's tight. You know, he's gone to first grade all of a sudden, and he's running around. And so all the questions they asked me I had reasons why it was not a big deal. But he knew immediately like that was something he wanted to check was his blood sugar. So, you know, I think it was a very quick couple of appointments that day later that day, and as well as maybe the next day, where they just wanted to check his his urine and his blood for glucose levels. And like I said it was it wasn't totally out of control. I think he was maybe in the 400. But he was like, yeah, I'm pretty sure this is this is what it is.

Scott Benner 11:19
And that was it. So I'm really, really grateful that I had that appointment myself and I and I followed up because if not, we probably would have waited a few more weeks and not really thought much of it. Gotcha. So so the bedwetting and the other thing is just the tired and lethargic stuff. That was just that was it. You never got to any of the kind of worse stuff which Yeah, did he honeymoon at all? Or were you was it pretty much I need insulin right away? and it stayed like that?

Amy Drauschke 11:45
Um, yeah, I mean, when people say honeymoon, I think of that as and I'm in my experience honeymoon was he didn't need a lot of insulin, but he definitely needed it. And we definitely had to start doing injections right away and checking blood sugar right away. So yeah, he definitely honeymoon, probably six or eight months. And then it just, you know, he needed more after that.

Scott Benner 12:03
Were there ever moments when he flatly did not need insulin at all?

Amy Drauschke 12:08
Not really. No. And I mean, we were so new to it all. It was kind of a roller coaster. Okay,

Unknown Speaker 12:14
yeah.

Unknown Speaker 12:16
It really shakes you up

Amy Drauschke 12:18
any other endocrine problems in your family line that you know of? He had some relatives on his dad's side that had celiac and lupus. Actually celiac and his preterm on his dad's dad's side, and then his dad's mom's side, someone had lupus. So I feel like autoimmune diseases sometimes come together. But nobody would die. No one with Type One Diabetes. Gotcha. Okay, well, you know,

Scott Benner 12:44
how did it start for you? You said you've been using on the pod prior to working for them? Did you go right to a pump? Or did you start with injections? Or what was the process of getting to where you are now?

Amy Drauschke 12:53
It's funny, because you know, when you are in that doctor's office, and they start talking to you about all this stuff, and you have absolutely no familiarity with it. You know, I remember in the endo office, when he was a, you know, in the hospital, when he was first diagnosed, they said, you know, we typically wait six months to get people on a pump, but we could probably advance that up to a little bit and get you started sooner. And I didn't even know what an insulin pump was, you know, it was like, Could somebody back up? Someone back up and tell me what that means. But yeah, so lo and behold, we did get started with a different a tube pump an animist pump at the time, probably, it was probably closer to a year, almost a year later, I think it just took time to, to get trained up on everything, and then to choose the one we wanted. And we changed clinics in that time, too. So

Scott Benner 13:45
a lot of different a lot of different reasons. Yeah. So

Amy Drauschke 13:47
I think we were just getting comfortable with everything. And then we went to the pump in September that following year, and so he started on the animals. He was so he was seven, he's birthdays in August. So he was just a little bit after seven and definitely made life easier. We picked that one because it had the remote, and you could Bolus like across the room or not have to find it on his belt. And I liked that. Of course Omnipod had that same ability. But for some reason, we didn't think that he'd like to have it stuck on his on his skin. And at the time, we didn't have a dexcom yet. So I think it was that idea of like, I don't know if he's really going to wear something on a skin. So we'll try this one first.

Scott Benner 14:29
And you have a dexcom now,

Unknown Speaker 14:30
yeah,

Scott Benner 14:31
using the G six.

Unknown Speaker 14:32
Yes, yeah.

Scott Benner 14:33
You said you were interested in interviewing me, but that's kind of professionally But personally, were you aware of the podcast and did you listen to it or no,

Amy Drauschke 14:41
not at first. So I actually before I worked for insolate. I worked for two nd exchange in Boston, which is a type one diabetes nonprofit research organization. And I had a similar role there. I was the content and Community Manager for their online patient community which was called glue.org and so it was there that I think I started to be more connected and aware of all of these different resources and blogs. And, and I think I had definitely heard about Juicebox Podcast through that. But I don't think we ever worked together. I don't think, you know, there was never an opportunity to have content connection. But I just remember hearing Juicebox Podcast and seeing your little logo with the, with the picture of art and on the jukebox, but I wasn't really into podcasts. In general, we actually had our own at at TNT exchange called diabetes speaks.

Scott Benner 15:35
I crushed it, I crushed them all.

Amy Drauschke 15:38
I had a colleague who was I'm just kidding, I had a colleague who was working on that. And he was so passionate about podcasting. And I was kind of like, I don't really understand, like, when would I listen to this? And what? And why would I listen to this?

Scott Benner 15:51
I understand I I really do. I am. I don't I did not know that they had a podcast. I really was just joking. I didn't I didn't want I did not find out they had a podcast and set out to destroy

Amy Drauschke 16:03
that a couple of seasons. And then it just didn't get you know, the funding that we needed to keep it going.

Scott Benner 16:09
Yeah, I understand. Okay, but so you want to listeners Well, here's what we're getting at. But and so when you and I spoke a month or so ago? How would you? How would you characterize how you were doing with miles, like as far as his blood sugar's go? And as a one season and your goals? Were you reaching them? Were you struggling? Did you realize like, Where were you at?

Amy Drauschke 16:30
When we first spoke recently? Yeah, I think all along, we've been kind of on this roller coaster up and down, up and down, up and down. You know, you have good, better periods of time. And then you have others that are harder to manage. But I think when we when I, when we spoke, I was very skeptical because I had started listening to the podcast. And I just couldn't get my head around what you were saying versus what his doctors were saying and telling us to do what is every three month appointments. And I'm a rule follower. I'm very, you know, a type like, I'm not going to, I'm going to do exactly what somebody tells me to do. And for some reason, I started listening and feeling like maybe I should give this a try if all of these other people are trying it. I know he's not a doctor. I know he's not my doctor. But he can't argue with the numbers. So maybe I should listen to what he has to say.

Scott Benner 17:25
Was that difficult for you to kind of set aside a part of your brain that tells you I've already got a doctor, they're telling me something, even though it's not going anywhere near what I expect or what I wonder what I need? Yeah, yeah. How did you do that? Did you just yeah, I

Amy Drauschke 17:38
think that was exactly it as I was kind of like, okay, so we go to these appointments, and they tell us not to correct within three hours. And I don't really understand how they can say that, and then look at his numbers. And, you know, is a one C has always been, I'd say, between seven and a half and eight and a half. I don't think it's ever gotten below, maybe a couple of seven and a half, like once for like three months. And that was it. And so I started to think like, that's all fine that they're telling us to do this, but they're not really helping us to get this number down. And they're not saying it's bad. And I guess it's you know, it's this scale, you know, it's not as bad as it could be or as high as it could be. But I would like it to be lower. And if I'm hearing that you are having all the success and other families are having, you know, much lower a win season much less of a burden of diabetes taking over there every moment, then maybe I should put aside the Yeah, at the end of directions and take a look at this.

Scott Benner 18:35
Well, let's just say that we would never ask you to put aside your endos directions.

Amy Drauschke 18:39
Right? Exactly. Right. Right. But maybe incorporate it, maybe just incorporate some other insights. Yeah,

Scott Benner 18:46
gotcha. But that's really, I mean, it's honest of you, I appreciate it. And it's valuable for people to know because I'm sure that it's off putting to be on social media somewhere on Instagram On Facebook, and everybody's like, you know, somebody comes on and says, I can't get this this down, or this won't work for me. And then some people come and go, you should listen to Juicebox Podcast, you should try this go to this episode. Try that. Then you get there. And I'm saying things you've never heard anybody say before. And and you're just like, wait, what that's completely different. And somehow in the spot where you ended up being where you were like, Look, I've seen this eight and a half a one see enough. Now I'm done with this. Let me try figure something else out. And some people aren't in that spot yet. I listen, one of my best emails is from someone who's like, I started listening to the podcast, and I hated you and everything you were saying. And then six months later, I picked it back up again. And I was like, let me try this. And now here's my a one c 6.8. Yay. And and I was like, great. That's wonderful. I'm glad that it like struck you at some point, you know. So for the people listening who have heard the pro tip series so far. Basically what happened to Amy is that in less than an hour on the telephone, I condensed that 10 that that now I guess nine part series, it's up to now. And I jammed it into Amy's head. And when it was over, she sounded dizzy even when she wasn't speaking.

Amy Drauschke 20:14
Well, to be fair, I, I had listened to the pro tip series as well.

Scott Benner 20:20
But yeah, love to hear like all jam like that, or was it clarifying in ways? Or did it just make more questions?

Amy Drauschke 20:26
No, it wasn't too bad. I mean, I took notes and I think it's funny we we work with Kate Hall, the amazing track long jumper I don't know if you if you know about her, but she held the high school record for a long jump. And she's also an omni pod where Omni Potter,

Scott Benner 20:43
I feel like she might be set up to be on the show. I'm not sure.

Amy Drauschke 20:47
Oh, yeah, she's just really great. And she had given a talk at the jdrf summit in Boston this past winter, about sports and managing type one. And what she's, there's something she said that always struck me is that with her diabetes, and with her long jump, you know, her track, and now she's a professional track athlete is that she wanted to you know, she takes goals, and she just picked one thing that she could be doing better. So you had given me a lot of things to think about. But she said, You know, there's always going to be a million different things, you could do better, but just pick one thing at a time. And she started doing that with her training. And and also she thought, you know, she said, that's a really good way to look at diabetes. So you would give me, you know, ways to use bazel ways to, you know, the bump in nudge corrections and things like that. And I was just kind of like, Okay, I've got all this information. But even if I just do one of these things, that's gonna be better than than none of these things. So that's kind of how I took it in.

Scott Benner 21:47
That's excellent. That's, that's I think that's smart. You want to hear something funny? It is may right now, right? In 2019. Is that correct? Yes. Yeah. recording with Kate Hall on December 3 2019. And she'll Oh, wow. She probably won't go up until like, I don't know, maybe four months after that. So I'm set up the

Unknown Speaker 22:08
lady. Yeah.

Scott Benner 22:10
I need to push her off a little bit. My kit, my scout my calendars. pretty sad. So

Unknown Speaker 22:14
so I have to say,

Amy Drauschke 22:16
I also like her because she's from Maine. And so she's from New England, Northern New England here where I'm from. So we have a lot of time I

Scott Benner 22:24
can stay alive in that. In those temperatures is tough, except for. I love that at one point where you're like, I just thought my son was overwhelmed by like, starting like full day, like first grade. I was like, oh, gosh, I was like me didn't think the kid was tough for a minute. She was like, I can't hack it. He's very sleepy after first grade. Right? Okay, so you see, you've done that. Now you chose something and you're like, Well, let me start with this idea. What did you pick to start with? Before I start the army pod, do you wanna hear something hilarious? The Kate hall that I'm scheduled to record with? Is not the Kate hall that Amy was talking about? I know, right? Oh, Mind blown. The Kate Hall I'm recording with is a famous soap opera writer. But that's for later, for now. Um, the pod baby, the only two bliss insulin pump in the world and you want one. You know how I know because my daughter Arden has been using one for over 11 years. And it is fantabulous. You do not have to take my word for it. And that's the really kind of amazing part about the pod. All you have to do is go to Miami pod.com forward slash juice box and request a pod experience kit. That's right, a peck ami pod would like to give you a pack, they'd like to send it to your house for free. So that you could try a pod on yourself and wear it and say to yourself, hmm, that Scott guy on the podcast said I'd put the pod on then I wouldn't notice it after a little while. And that happened. And look how small it is. And it just holds the insulin and no tubing and inserts itself. That part you can't figure out what the demo of course because it's not really good to insert it's a demo. But the best part is this after you've decided that you love the Omni pod it is completely simple just to get back in touch with on plenty. Let's keep going. Maybe I want to be a potter, my omnipod.com forward slash juice box, get a pod experience get today, wear it or let your child wear. See what they think. Get started at your own pace. Get it today, summer's here you want to swim without having to disconnect from your insulin. You guys we talked about all the time you want your basal insulin working for you. You don't want to disconnect again in the shower, go swimming, my omnipod.com forward slash juicebox with the links in your show notes or Juicebox podcast.com

Amy Drauschke 24:41
those biggest things in my head without even looking back at my notes. We've definitely been doing the hat like I think when you said if you see the arrow going up even if the algorithm and the pump or whatever says don't correct, you know, because you've got too much insulin on board just to a half a unit just to slow the arrow down. I've definitely been doing that. A lot. lot like just do a half a unit or a point to five units just a tiny amount. And that's, that's been helpful. I mean, sometimes it's not enough, but at least you feel like it's something you can do to take action and you can see if it makes a difference before you then make your next decision or while you're waiting for that, you know, okay, I really shouldn't do much I should wait it out a little bit. Yeah,

Unknown Speaker 25:22
I people are starting. That's something

Scott Benner 25:25
that and that's working. So you're you're stopping the arrow, or I think Jenny called it to Jenny called arrow tax at some point while we were talking like there's an arrow tax, somebody said an arrow tax on and I don't know, it's popping up on social media now, like something that that stuck in people's heads.

Amy Drauschke 25:40
But the other. Yeah, the other thing is, we struggle with Pre-Bolus, saying, I know that you're supposed to and I know how much of a difference that makes, and I understand the science behind the speed at which insulin works versus your food, hitting your bloodstream. But he Oh, he's very, in the moment, you know, doesn't have a lot of patience. So when you said there was a bit about, like, add to that amount, you know, add to your Bolus to cover that spike that will come because you didn't Pre-Bolus that made a lot of sense to me. And we've been doing that as well.

Scott Benner 26:12
So you've been over bolusing the meal to make up for the lack of a Pre-Bolus. And that's working. Yeah, that's

Amy Drauschke 26:18
working pretty well. Yeah. I mean, it's, it was a little tough, when it's a meal, that's, you know, you also are extending and you're figuring all that stuff out. But I had a pretty good sense of extending Pre-Bolus before so this piece was kind of like, a like, light bulb over my head when you said that, like, Oh, that makes total sense. And it makes me feel like it's not always an immediate failure when you can't Pre-Bolus

I was gonna say, it's so hard to figure out bazel so that, you know, I feel like it's constantly like, you've no idea what bazel is the right amount. And that and I remember you said that, too, was like, well, none of this matters if you don't have your basals. Right. And I just feel like that's a constant struggle is increasing and decreasing and changing bagels. And then you're like, Oh, no, I did it too much. He was low all day. And it's hard.

Scott Benner 27:07
Yeah. If you're not thinking about basal insulin, in the, in the, in the framework of timing and amount, just like I'll tell you like when I say everything's timing and amount, I mean, the Bolus and the Basal, like, it's always the right amount of insulin at the right time. And that could mean, it could mean a lot of different things. I saw a person online today, who showed a graph of like their kids blood sugar, who had gotten high during an activity. And I said, That's bazel. And they're like, No, no, the basal is right, because a couple hours later, it went right back. And I'm like, Yeah, but the basal wasn't right during the activity. Right, just because at the at three, three o'clock in the afternoon, the day before the kids blood sugar was stable. You added something else till you added? Right? another variable, right? That hit him with some adrenaline probably and pop them up. And but it's funny when you say there's not enough bazel there, the default in their head was no, no, that's always That's right. I know. That's right. And so they skip over the actual answer, and then start searching for something else that must happen. And the things they come up with are always amazing. It's like, no, it's more bazel. And they're like, No, no, here's what it is. He bumped his knee on a thing. And I'm like, I don't know what you're talking about more bazel. And it is, it's just great. It's great to hear you say that you're that you're figuring out. So it's only been like a month or so. But do you have the clarity app? I was gonna ask you. Like, um,

Amy Drauschke 28:27
I probably I probably do, but I haven't set it up. I should look and see if I have it while we're talking. But I used to use gluco. And this is probably I just have we switched to dash. And I haven't figured out how to hook up dash to glucose. So I just feel like I'm a little bit in this place where of all the times I should be looking at it very carefully. I'm in this transition.

Scott Benner 28:51
I'm dying to know what the estimate of your a one C is for the last like 30 days.

Amy Drauschke 28:54
Well, yeah. So that being said, I have the sugar mate app. And that's what we use. And that has, we've been keeping our eye on that. And actually, that is something we can talk about this more to but like behaviourally, that's something that motivates miles is to keep his eye on that. And so if I look at the 30 day estimated through sugar mate, it's like 6.9. And what was it? What was it at your last but I believe it was, I want to say 8.20?

Unknown Speaker 29:21
Well, that's Yeah, significant reactions. Yeah, that's really exciting. It really is exciting. I

Amy Drauschke 29:30
mean, and that's a that's an estimate. And it's, you know, you never know if it's accurate, but it's definitely gone down a lot. It wasn't 8.4.

Scott Benner 29:38
So yay. Imagine if a month later, you're like it hasn't moved at all. This is just the god the podcast guy. And now I get to talk to him. I pretend I care, but my agency hasn't moved at all, but 6.948 and a half

Unknown Speaker 29:50
is nuts. Like try now on 30 days.

Scott Benner 29:53
I'm gonna go try to imagine where you're gonna be in 60 days.

Amy Drauschke 29:56
I know. It's exciting. And I guess one thing I'd say is like, I Right now I'm literally looking at it. And he's 360. And he's at school and we struggle a lot when he's out of sight because he, you know, he's definitely in that like, preteen mode of like, I'm gonna ignore my diabetes and his, but his school nurse is not always able to be on top of it. So I kind of have to look at it, like we do the best we can with doing these techniques when we can, but it's not all the time. And it's, you know, it's definitely not perfect, but it's enough that it's making a difference. It's making it Oh, can

Scott Benner 30:30
I ask you a question? And please don't feel judged. Just for the conversation. Can you not text them right now and be like yo Bolus?

Amy Drauschke 30:40
I could. So it's funny, he, he got a text. We have like a group text between his school nurse and his dad night. And the school nurse had texted him and, you know, texted all of us, but said, you know, milestone needs to correct and this was at 937. And there's no response. So it's a little hard. I never know whether I should jump in and also ask or, you know, call her and say So did he he's also had lunch since then. So we're still, you know, we struggle a lot with like, how to manage him in middle school when he is on his own. And the school nurses not right there with him all the time. And I'm not right there with him. But yeah, I probably could. Yesterday we had a day where the three of us has stepped out his dad and me all texted him to ask if he had corrected and I found that out last night and felt terrible, you know, so

Scott Benner 31:27
I would send is using an iPhone. Yes. Yeah, I send what I do is if I don't get a response in a timely fashion, and it's important I send the Find your iPhone tone, which is a deafening and incredibly embarrassing tone that the phone makes and that

Unknown Speaker 31:41
really fine

Scott Benner 31:42
then Arden texts me right back after that happens. So I'm I'm less concerned with her. What's the word I'm looking for? Happiness. No, no, that's not the social calm, like, like I don't I listen. It's not every day. It's not even every week. And it's not every time like don't get me wrong if Arden's blood sugar was 120. And I'm like, hey, let's, you know, bolus point four here. And I don't hear back from her. I'm not gonna bother her. Like, that's that silly. But, but if she was climbing or rising, or if it was an hour before lunch, and she was 200, and I thought we have to get this down before we Pre-Bolus for the food, and she wasn't answering me, then I would, I would. And I don't By the way, you sort of said it a second ago, and I want to reiterate, miles isn't doing anything wrong. He's 11 Arden's for, like, you know, I'm happy. My daughter's not running around constantly thinking, I have diabetes, I should be doing something. I don't want her thinking like that. I don't want to, like, invalid. But but she has to know, I think that there are times when I don't really care. You know, like, she told me one time she's like, you have to she's like, Don't text me right now I'm taking a test. And I actually texted her back. And I said, knowing math won't help if your blood sugar's over 200 all day. And so I don't care about your math quiz. I care about your blood sugar. And then I care about your math quiz. There's a pecking order health is first, the rest of it comes later.

Unknown Speaker 33:04
And I think that's a dad thing.

Amy Drauschke 33:07
I think that's a perfect segue into our conversation about parenting, because I feel like I get accused all the time. By my husband of you know, you're too soft on him, you're too worried about how he feels about it all in his, you know, emotional state, you know, he's lying to you, or he's ignoring you or whatever. And he's like, you've got to punish him for that, or you've got to get him to understand and I'm like, oh, but I feel bad. It's not as salty as diabetes.

Scott Benner 33:32
Just be a little jerk about something else. If he didn't have diabetes, probably. I've told my wife throughout the years, you're not his defense attorney. That's what I tell my wife about my son. I've never, I've never once seen her defend my daughter, the way she defends my son. First is interesting. Oh, my God, are you kidding? The minute the boy was born, right? He came out, the doctor grabbed him, I cut the cord. And then it was like an alarm went off in the room. I said, What's that bell and Kelly goes, Oh, you're not my boyfriend anymore. Now that kid is. And so you know, you're just here. You're just here now to make me and my new boyfriend happy and comfortable in any way you possibly can. And so we'll tell you what to do. You'll do it and then quietly sit in the corner and wait for a new task to come. And it does happen to mom sometimes. And I do think especially with boys, and I don't know why I don't understand the psychology behind it. But my children are aware that if if they were to ignore me on that level, diabetes and diabetes, I would show up in their school I'd be like hi and I'd bring like I have to just go talk to my kid for a second and then once you pull them up here and they pull them up I'd walk assign ago have been texting you have an answer, man, it's gonna be a problem if you don't do it, and then that would be it. Yeah, that's it. You're, you're from New England. Take them out in the cold without his clothes, making friends for 15 minutes, break down with diapers, find out, bring them back in and be like, do you want that to happen again? Of course you don't because your toes are blue. Now miles, let's say so what do you got? What are you going to Do so if people tell you about it, and you kind of seem to see it, what stops you from doing? I think that's the real, like joking aside, that's the real question, like, what stops you from being like, hey, you're 360 I don't care if you've been talking to the nurse, this isn't Okay.

Amy Drauschke 35:15
Um, I mean, I get to the point where I'm like, Listen, like you, this is unacceptable. There's certain times a day when you have to pay attention to your diabetes. I know this isn't your choice to have this condition in your life. And it wasn't mine either. But we've got to, there's certain times a day when you've just got to do what you got to do. And it's, it's not negotiable. That being said, if you do that, then I won't be texting you. And I won't the bothering you, because we'll be keeping it in check. But it does, it gets to the point where it has to be like, a really kind of high day, like really high, you know, and I'm like, okay, it's not just a little high, it's really high, and it's not good. So here's my suggestion, maybe,

Scott Benner 35:53
maybe You scared the life out of him in a different part of his life, not the diabetes part. Like for instance, have you ever taken every piece of anything that brings any joy to your child out of the room and locked it into a closet for a month? Have you ever done that? Because it's exhilarating, when you take the television down, and they're looking at you like, Oh, my God, my TV? And like, Oh, yeah, everything's gone. Yeah, you just have to assert yourself.

Amy Drauschke 36:19
It's funny. That's what it basically came down to. Recently, we had one of those days, and I and he had a baseball game that night, and baseball means everything to him. And I said, you know, what, not only can I sit here and tell you that you're not gonna play well, and you're gonna let your shame down. But like, I might just not let you play. If this happens again, that day, you know, on this, you know, you can't be at school all day and be off the charts and ignoring your diabetes, and then come home and expect to go to baseball, like it's just not. And I think that scared a little bit, you know. And I think that, that we have to find that thing that he cares about, but he could lose, and it's hard, because I again, I go back to the emotional part, like, I don't know, if psychologists would agree, like, you shouldn't punish your child for anything related to diabetes, you know, you should incentivize them and reward them, but don't punish them. It's like, it's like anything with parenting, diabetes or not, you know, it's there's just different techniques, and some people feel strongly about about different ones. So I definitely struggle with that. And I definitely have, you know, I have a, my, my ex husband and my husband both involved, and we probably all have different opinions about that. Which makes, which makes it interesting. So

Scott Benner 37:27
so let me say, I've joked around a lot here, but let me be serious for a second. So. And I was serious about some of it. I you know, I think that there's, I agree with you, I don't punish Arden related to diabetes, right, I speak to her clearly about it, I make sure she understands the pros and the cons and what could go right and what could go wrong, and why some things are important, why they're not in other aspects of her life, though. She knows, and I'll just bleep this out later. She knows I'm not. So there's an invitation, that that knowledge translates to other things. And you don't have to say it. Yeah, that's good point. And so I'm gonna give you the benefit of my, of an experience. So most people may or may not know, listen to this, but I have been a stay at home father, since my son was born and my son, tomorrow, I'm going to go pick my son up from his last day of his freshman year of college. So that's how long I've been a stay at home dad, right. And in that time, in that time, I've learned a ton about what women bring to parenting that men don't in instinctively bring to parenting. And I've tried my hardest to incorporate some of those ideas into myself. And I've done that because I thought my children deserved it. You know, we had this role reversal. And I realized my wife would have done things said things felt things that I'm not experiencing. And so I need to understand what those things are. Because my children are at the moment being robbed of a maternal influence in their day to day life while my wife's at work. So I'm a bit of a blend and now of, you know, a traditional mom and a traditional Dad, I think, yeah, but the one thing, the one thing that I've noticed over and over again, that I am grateful for, for being a stay at home father, is that in those moments, I am not conflicted by any of the things that you brought up. Like it's not fair to them. Or they didn't ask for this, like those feelings. They never popped into my head. Like, not once, I would never in that moment. I have a simple packing list. I've prioritized it in my head health comes before everything else. And so I'm a guy. I'm like, a, like a rock with a pulse. Right? I'm not I don't think that Yeah, I just I just I set out on my course I follow my list and I go, okay, health is first. I don't care if you're taking a quiz. We're going to Bolus now. You know, I don't care if you're talking to your friends. That's meaningless to me. You know, I know we've texted more today than we do normally, and it's annoying and trust me, I'm annoyed too, but let's just do it. We have to do and move on. And that has served me well, in the bigger picture, because my kids and I do have a relationship where we can be at, you know, for the lack of a better term parenting odds in one moment, and then it shifts right back again, like, no, there's no hard feelings. People don't, aren't mad for hours at a time after I've had to assert myself as a parent. It's, it's expected. Next comes taught me how to expect something. You want to know what it is rock solid data about my daughter's blood sugar, the direction it's moving, and the speed it's getting there? Is she 102? and headed up, headed down or staying stable? That's the incredibly important information. Forget that she's 102. I don't know if she's one of the two or 80 or 130. I mean, I do but you know what I mean, it's more important to know how fast she's moving, and where she's going. It's incredibly interesting to see, I ate dinner at 6pm. And my blood sugar just never moved, right until 640. And then, oh, it started to go up. That kind of information makes me think, hmm, is there a way I can change my Pre-Bolus or an extended boluses are a way to put my son in a different spot to help that rise? To not happen? How about three hours after I eat, it's my blood sugar going down. Maybe my insulins gotten unbalanced, right? Maybe the food's gone now. But the insulin remains behind. I wonder if I would have slipped my Pre-Bolus forward five more minutes or done a different? I don't know amount of insulin would that low have never come. It's interesting information to have. That's how you think about your diabetes. at another level. You want to be a ninja with diabetes, you need the information you need to know when to react. Right. I'm not Yoda. I can't close my eyes and see stuff coming at me. I need to know what's happening. So I can react so that I can get out of the way or get in the way.

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Amy Drauschke 43:00
I definitely had some some new ideas, though about like, well, maybe I should do this differently. Or maybe I should do maybe I should show up at the school. I'm lucky enough that I get to work from home a lot. And I literally the other day had this thought that if no one else, if he's not going to pay attention to this and his school nurse can't or isn't. I'm going to just bring my laptop and sit at the middle school all day one day and do my work from there and check in with him when I need them like that would maybe that would turn him around quick to have mom in the hallway with her left.

Scott Benner 43:27
Not just the helicopter mom, but an attack helicopter

Amy Drauschke 43:29
mom, like I mean, literally, there's Wi Fi there, right? Like what else do you

Scott Benner 43:34
see, I've told this story in the past. I haven't told him in a while. But when I think of that, I'm obviously nowhere near the parent. My father was in the 70s. Right, like in the 70s in like outside in Northeast Philadelphia. I don't think he once thought about anything about what I cared about or was concerned with, right. But I've told the story before that I got sick one time. And the doctor gave us pills and we got the pills home and they were huge. I mean, like really big, not just because they were monstrous. And I took it out. That's like I can't take this somebody that's like, Oh, don't do that. Just take the pill. And you know, and so I put it in my mouth. And I was like, I can't do this. And he said something like, those are expensive. And if you spit that out and he didn't even like get the finishes thought and I thought okay, I really have to smallest so I went to try small and I couldn't. And the next thing you know, a man who could have just broke me in half if he wanted to was about six inches from my nose and he was like, swallow the pill right now. And you know what I did? Amy I swallowed the pill. And it's better than the perceived beating I was about to take. And I don't think he really was going to do that. But I mean, he pressured he pressured me to swallow that pill and I did it. And I'm not a serial killer now. I don't have any weird sexual fetishes that I'm not

Unknown Speaker 44:52
no no.

Scott Benner 44:52
I'm not broken in any meaningful way. Yeah, so lean on that kid a little bit. That's that's my

Amy Drauschke 44:58
I know. Yeah. And I definitely think I was talking about this. At work yesterday, we had a retreat, and we were all socializing, and somebody was talking about chores and allowance and that kind of thing. And one of the people in the conversation that doesn't have kids, she was she's younger than us. And she was like, but I don't understand. When I was growing up. I just had my chores, and I had to do them. And that was it. There was like, it was just this expectation. I don't understand what you guys are talking about struggling to get your kid to do what you want them to do. And we were like, it's just a generational thing. Like kids just, they don't have that same fear of their parents for that same.

Scott Benner 45:33
My kids are still afraid.

Unknown Speaker 45:37
Maybe it's because we're too soft on them. So

Unknown Speaker 45:39
it's the it's the it's the winters and it's an ongoing battle.

Amy Drauschke 45:42
And I have to say, when I when I listened when I used to listen to you before I started these techniques, that's, that was always kind of something I've skeptical of as I was like, he must be bothering her all day long on her phone, and she must hate it. And I don't know if I could do that.

Scott Benner 45:58
It's 11 o'clock here. She left the house at seven. I haven't spoken to her today at all. So that's awesome. Yeah. And she will talk while we're be she will text while we're talking about her about her lunch about our lunch bolus. But that's it. It'll go back and forth real quickly anyway. And I get to imagine if you start listening to this podcast on the day where I'm joking around about, like, you know, pressuring children to swallow pills they can't swallow or stuff like that. If that was your first episode, you'd be like, Oh, my God, but I don't know. I should call I should call somebody. Well, this guy said in his pockets, but it's, you know, it's an it's an idea. It's an overarching kind of like feeling in your life. Like, I don't, I didn't grow up feeling like I could assert myself too much with my parents. I could tell them what I thought. And when they told me they didn't care, I was pretty much done. You know, I didn't get to. I didn't get to appeal to a higher court. I couldn't turn to my mother or father, depending on who I was talking to. There was just that was it and they were nice. They were blue collar people and they did not have time for my BS. So yeah, it was this is how it is and and do it. And so the other day, I took on a big project at my house, I regraded a portion of my lawn. And I had to rent like a small machine to move a significant amount of topsoil around and when it was over. And Arden came home from school, she's like, can I help? And I was like, Yeah, sure. Get a broom. And we're gonna hose off the driveway, you can broom the mud into the grass as I'm doing it. Right? Yeah. And she comes out and she's like, Alright, and for some reason she was into helping, I didn't know why. So I just let her help. And she says, I should get paid for this. And I said, you know, no, something I agree with you. I said, I will give you 10 American dollars for this work today. And she said this is that's not enough money. And I said, That's all I'm offering. And and then she was like, okay, since she starts doing shoes, my sneakers are getting muddy. If they get dirty, I'm gonna need new sneakers. I said, Well, you better hope you can buy them for $10 because that's gonna make on this job. And so she kind of like laughed, and I was like, Don't laugh. I'm not kidding. And and, and she just had these sneakers only cost $20 I'm always thinking about saving your money. And I said, Okay, I said, Well, if they get ruined, I will buy you a new pair of sneakers up to $20. She's like, Oh my god, I'm gonna get a new pair of sneakers and $10 Oh, no, you can get the new or you can get the $10 you can't get both. Right, right. And, and she looked at me like maybe I was crazy. And then I was like, do you want to try to drive the the little loader that I ran into like the bobcat? And she's like, really? I'm like, yeah, sure, try it. So I let her drive that around in the driveway. And, you know, taught her how to drive it. And it took her a couple minutes to figure it out. And then she was like toying around with it. We got everything cleaned up. She put it back. And I said, was it fun driving the thing? And she said, Yeah, I said, I want to charge you 10 bucks for driving that. But I won't because I love you. And I think you did a good job working here. So then we get in the house, my wife because you're gonna pay her I'm like, No, let her come to me. And she's like, well, I don't like I'm not giving her the money. So she asked me for it. I was like, we don't pay for 90 days here. That's our, that's how we handle it here. I send my invoices out for the podcast ads, I don't get my money back the same day. I was like letter, letter done letter done me a little bit later coming after like, but seriously, like, give her some responsibility and then a little bit. So we were joking around. But I think that's just the general vibe here is that we're in charge. They can have their opinions, we totally let them you know, we're not like my dad. You know, my wife's parents were they're allowed to voice their opinions. They're allowed to argue with us, they're allowed to show us why they think we're wrong. And in the end, if we say no, that's kind of where it ends.

Amy Drauschke 49:31
But i well i think that's I was gonna say I think is related to diabetes. When I when I when my son was first diagnosed I very quickly got into this business as a you know, as a professional, and I found myself connected and getting to know adults with diabetes who were diagnosed as kids. And I had this constant you know, information about what that was like and them saying what it was like when their child when their parent wouldn't let them go on the on the overnight school trip and what it was like when they had to eat the same amount of goldfish every day for snack and and so I think I just early on got that like sympathy bug where I was hearing from these adults about how hard it was to have parents all over them about their diabetes. And so I'm not I don't do as well with the like, it's, I'm in charge, It's for your own good. You can have an opinion, but it's really, you know, I'm not interested. So it's just tough for me, I think and I think in this community, that's something that's so different is the people who have diabetes versus the parents who are managing it for a child who has it. It's such a different experience. And you can never know what it's like to be on a on the other side. And I, you know, I've had brainstorms and wishes around, like, how could we connect more people like so that that experience that I had with my co workers? Like, how could we get the general community to have that, like, have a relationship with somebody else who could give them that insight in case it would be helpful, I don't know if it would be helpful for adults who have diabetes to hear from a parent, but I think definitely parents could bet could benefit. You know, maybe even you I don't know, from talking with an adult who was diagnosed at six and hearing all those stories, so it's like, it kind of sucks when your parents texting you or it kind of sucks when you can't do things that you want to do? I don't know. I'm just Well, let me tell you, I'm thinking out loud.

Scott Benner 51:17
Let me tell you my experience from from recording the podcast. So there are 230 episodes up. And I've recorded 40 more, and I will do hundreds more in the coming years, I imagine. And if you have had that experience, and I've heard I've heard from those adults, and I've heard what you got, which was it stunk being like somebody up my butt all the time, and blah, blah, blah. And I've also heard from people who are on donor lists waiting for kidneys telling me they wish their parents would have been more Yeah. And so and, and everywhere in between, like, those are two, two sides of the of the, you know, of the rainbow. and everywhere in between my parents helped a little, they helped a lot. Sometimes they didn't know, but they wanted to be valuable. What I got mostly from most of them was that it was comforting to know that they cared. That was that's that's most people's takeaways, whether they were harsh and didn't know what they were talking about. Or at least I knew they were interested. The people whose whose parents just don't talk to them at all about it in one way or the other. They seem devastated. Just leave it to them. Right.

Unknown Speaker 52:18
Yeah. And so I can see that. So I,

Scott Benner 52:20
I take your point, 100%. But I would want to I would want to add to it. I wonder how those people who you spoke to back then would have felt if their parents were more involved and had valuable information for them. Right. So that's the goal of this pod. And that's what you

Unknown Speaker 52:37
Yeah, yeah. And

Amy Drauschke 52:38
we've come so far, you know, now versus them. So I Oh, you know, of course, there's that, you know, I'm talking to a 35 year old talking about her experience in the 80s is obviously going to be very different. Yes,

Scott Benner 52:47
when she was taking regular an MPH, and her meter was the size of a break. And it didn't leave her house,

Amy Drauschke 52:53
right. And she had to eat the same food every day. And there was no wiggle room,

Scott Benner 52:57
right. And that, and that's what was in her parent's head, which was, you know, either they were doing carb exchange, right where it was like, You have to eat this certain amount of carbs. And so some so so imagine some doctor who had a 1980s idea of type one diabetes, I mean, imagine that versus the idea you hear now. And still you talk to doctors, like God, these people understand this at all. So, so so they had that 1980 idea of it. And they're like, Look, at this time you put in this amount of insulin, and you make sure to eat this many carbs and do it. Because if you don't balance out, yes, if you do this exactly like this, everything will be okay. And if you don't, you're gonna, you know, someone's gonna have to cut your foot off one day, or whatever, like scary thing. They told Gary Yeah, right. And now that parent every time they have that meal that's in their head three, three times, at least a day, for years and years and years. So it probably gets boiled down to, hey, eat that right now. Or make sure that's 25 carbs, or that kind of thing. Where I would say to them, Listen, you know, are you going to snack on that, that's fine. Start with three units, and we'll readdress it if you snack longer than you think you're going to. And that's a freedom Arden loves because the other day, excuse me the other day, I had to go to the dentist in the afternoon. And she I'm leaving, and I was in a rush. And I'm like, I gotta go. And she's like, I'm really hungry. I want to have some of these like little Ritz crackers or something like that. I was like, all right, do me a favor, because I'm leading count them out. So we know how much we're doing. And she was like, I don't want them then. Like if I didn't count these crackers, I don't want to eat them. And so that shows you how much the freedom of snacking means to her. Like Like she you know, we have set up this world where you know, she can have a little bit of insulin snack and then add more if she needs more insulin later. When I said to her account, these all make sure you eat these and put in the sense on she's like, I don't want to do this. Now. You might think Oh, that's interesting. I wonder what Scott did next. What I did was I said just count the crackers out. Put the insulin in, I gotta go. I'm late for the dentist. Okay, I'm not interested in your conversation here about your thoughts about these crackers. You're hungry, I see that you're hungry. This is not the time to take some sort of a stand. We'll deal with this later. And you know what she did? She counted the crackers. She gave herself the insulin, everything was fine. So

Amy Drauschke 55:18
that's a good, that actually leads me to a question. So Arden was diagnosed when she was a baby. Right are two very young

Scott Benner 55:27
just a couple of weeks after her second birthday. Yeah.

Amy Drauschke 55:29
Yeah. So my question to you is, you know, my my thought is the other day I was trying to get miles to understand this is that he came into this world, right when Dexcom was coming out, it will not coming out. But like the g4, I think was the first one we had Omnipod was available, he has all of these tools. And we're fortunate enough to have access to them. And he doesn't realize how flexible life is for these tools.

Unknown Speaker 55:59
He looks at it

Amy Drauschke 56:00
as like, I don't want to put my ducks on center on. I don't want to Bolus like, it's all a burden to him. But when I think about someone like Arden, you know, you must have really experienced it. You know, before we had such flexibility, maybe not as much as like my my friend who's 35. You know, she didn't have any flexibility. But the fact that all of these devices and tools that that we are fortunate enough to have access to make our lives easier. I wish I could get him to understand like, this is not that bad. Like if this had been 10 years ago, it would have been totally different. So I was just wondering if you you know, if it was when she was obviously as a toddler, that must have been difficult for different reasons, but just the devices alone make it easier.

Scott Benner 56:42
I think it's an ongoing conversation. And it's one we've had over and over again, you know, in different strengths based on how old she was and how mature she was. So the other day this came up, and I said, Arden, we really need to add a fifth and sixth location for your on the pod because Arden is left over naval right of her naval sort of up and down and thighs, right. But I really want her to periodically put them on the back of her arms. Is it FDA approved for the back of your arms? Yeah, so

Amy Drauschke 57:12
actually, I will say as the marketing person. Everybody always shows pictures of the arms. And I'm always trying to remind people you don't have to just use your arms. There's other places so that's awesome to hear she she's not an arm of a lot of people, you know, love the armors or think that's the only place

Scott Benner 57:29
so she hates the idea of it being on her arm now. Now here's why she hates it. She said Okay, so we're good now so I'm quitting my my messaging app. So she she hates the idea of her arm based on an experience she had when she was like six where she worked on her arm had to go to softball One day, she threw it and all she crawling arm, you could feel it moving around. And that sticks with it all this time.

Amy Drauschke 57:50
So I said, well, miles won't won't wear it on a stone at all, during baseball season.

Scott Benner 57:55
Yeah, exactly. But she somehow had it as has an aversion to it now, but I'm like, Look, we have to start using your arms more frequently. And she kind of like pushed back. And I told her look, if we ruin your sites, on your stomach and on your legs, or they're done, you're done. If you want to go back to injections that fine, but I'm thinking for what we do, you're going to get about 15 of them a day, and you're gonna have to, you know, is that what you want to do? If that's what you want to do? I don't care. I was like, but, but just understand that, you know, some of the food decisions you make aren't gonna work out as well anymore. And, you know, and you're gonna get injections a lot more. So do you want that? If you do, I'll do that for you. Yeah, she's like, no. And I said, Okay, well, then we're gonna try your arm, just get over. Like, it's not it's not the worst thing in the world. And, and we've had versions of that conversation, you know, a few times a year for years.

Amy Drauschke 58:48
And what I say to like, when when he doesn't want to say, miles is the thing about the sensor assertion, you know, even with the JSX, he still winces and says, it hurts. And so he procrastinates or he says, Can I have a break? And I and I have that same like, well, it's your choice, it's your body. However, if you don't worry, CGM, we're gonna be checking your blood sugar with your finger every hour, or every half hour or whatever. And I'm like, I don't think you want to do that, do you? But if you do, then yes, but if not, let's just put the sensor on. And usually He's like, all right.

Scott Benner 59:22
Of course, the truth is if we get into a time machine and go ahead, you know, 50 years, and the G six is the size of a hair and it's a little tiny pill and you have to swallow and they're gonna complain about that. Like well, because it sucks because because Amy everything anything excuse me anything you have to do beyond what normal situations ask of people is extra an extra an extra things but it doesn't have to be a fight your entire life. Like at some point, you just have to say like this is this is my life, like this is this is gonna go and I'm I'm going to just accept that move on. Listen, my son is finishing up a college, I told you and we were facetiming with him last night. He's got like one paper left. And it's in. It's in a class, he doesn't particularly enjoy that I don't think he's as strong as mine doesn't sort of work in that way. It's a philosophy class. And I got to write this paper. And you know, we were talking to him a little bit, he was bouncing some ideas off. And right before he went, I said, Hey, I need to tell you something real quick before you go. And I said, I'm at the moment, you're thinking about this paper as something that you have to do to get a grade. I like you've decided it's work. And I was like, I really think that this next 10 hours with this paper would go a lot easier if you just tried to do your best. Like if you read this stuff, and instead of thing, I have to read this, just think like, let me try to learn this. Because it's all just your perspective, one way or the other, you're going to read all this material, you're going to write all the things you're going to write, and you're going to hand it in, this is not going to change. But it's it's you that you could change, you could change your attitude about this situation. And if you did, that, this could end up being a pleasant thing. And not only that, but the outcome is going to be better. I said, I promise you if you stop thinking about this as a chore, and start thinking about it as something that you're going to do and try to do your best and try to enjoy. It will you'll feel better when it's over. And I watched a real look on his face of like, Alright, that that makes sense. And he said, I'll try and I was like, Okay, I'm like, just chill out, man. Like, just read that. Read the thing and write what you think. And yeah, it'll be it'll be better. I promise. I think this is all the same thing.

Amy Drauschke 1:01:38
There was a we have on the on the blog, a series with Sean Busby from writing on insulin, he had done some video interviews with people. And they were all you know, a lot of them were folks that are in his writing on insulin organization. And one of them was this, this kid, I can't remember his name, I want to say his name may have been Dan. But he his story of when he was first diagnosed, as he said, I think he was maybe a teenager. So he was a little bit more, you know, cognitively mature. But he said there was a sign in his kitchen that his mom had on the on the wall, and it said, whatever you are be a good one. And when he read that, he said, Well, if this is what I've got to deal with, at least I'm going to, I'm going to do the best that I can and be a good teacher, I'm going to be a good diabetic, which I know diabetic is not a label that people always like to use, but he said it himself. And I think about a lot. And I think that's similar to what you're saying is like if your hand you dealt this hand, you might as well play, play it the best you can.

Unknown Speaker 1:02:36
You know, it's funny, man, I

Amy Drauschke 1:02:37
think that's a good thing to remember.

Scott Benner 1:02:38
I think that's it's perfect. It's not just about diabetes, or parenting. It's about life like you just yeah, you know, I mean, your situation is your situation, complaining about it or feeling bad about it. I mean, if you're chemically Listen, if you have a chemical imbalance, and you can't stop yourself from feeling depressed about something, that's one idea, but for the rest of you, just stop dwelling about like your perspective, like I tell people all the time, like you can't be dramatic about diabetes and be successful with diabetes. Like if you're always running around yelling, oh, can you believe this happened? Can you believe that the pot, you know, my infusion bag fell out. It's so irritating, or, you know, the next time needed to be reset for two hours? I can't believe it. Or, you know, this stuff always happens at the worst time. Like there's a good time for your, for your sensor to need to be replaced, like what's the

Unknown Speaker 1:03:27
right, exactly. It's so bad

Scott Benner 1:03:29
when you want to be dramatic about things, then it's always a problem. Or you could just accept it, this is it and do it. And that's just that's how I do it. And but again, I'm a boy. So I mean that like detrimentally about women, I just mean that I lack I lack the ability to think about

Unknown Speaker 1:03:49
just like

Scott Benner 1:03:51
it's that old thing. Like, you know, a kid gets hurt on a on a sports field and all the moms jump up and the dads don't even notice it happens there.

Unknown Speaker 1:03:57
I said

Scott Benner 1:03:58
to my wife, like he could really be hurt. And I said, Well, if he's dead, there's nothing we can do about it. Like, like, but if he's not dead,

Unknown Speaker 1:04:07
these are nothing great. Well,

Scott Benner 1:04:09
well, beyond that, though. If he's not then these couple of minutes will read Don't rush out to him like his nursemaid are gonna build character. So he's either dead, he's not dead. And if he's not dead, then let's do something positive for him. And if he is dead, we can be sad in a minute. Like, like, like, you don't need to just sit here it's worth sitting here for a second just let him live in it for a minute. And I don't know it just seems like common sense to me.

Amy Drauschke 1:04:36
I think that's that's a good It's also a good segue to um, you know what I wanted what the one question I had for you for just our conversation is I feel like what you're doing on the blog and what are you know on the podcast and what I'm trying to do on our content and in I also do freelance writing articles for other diabetes sites. is like not always trying to be Susie sunshine, but to show That positive aspect and to show that, like, he can struggle with certain topics and certain things, but here's the tools that can, that can help and can make it better. And, and I think that that's an important thing for, you know, I don't know how involved everybody with diabetes gets with being connected to the community, but I think if you do have that connection, and you can read and hear about other people's experiences, you know, that's, that's impactful. And I'm really grateful to you for this podcast, because you know, as I'm driving to Acton, Massachusetts, 90 minutes each way, when I do go to the office, you know, I have something to listen to, that helps me at the end of the day with my own management of this, and however you absorb those experiences and that information, you know, I do think that can change people's perspectives. Otherwise, when you're alone, and you feel like no one understands and nobody else gets it, you can wallow and you can be very negative. So I'm particularly proud of, you know, both of us for being in this community, and in this world of giving people some information that hopefully helps, even if it helps one person, you know, it's the one more than zero.

Scott Benner 1:06:04
Yeah, I appreciate that. And I appreciate that, that you're trying to do, you're doing the same thing. I'll tell you that my perspective on it is, is pretty simple. So there are a when you say, the diabetes community, I hope I hope that you and everybody else knows who's listening that right now. I just said those words, and close to 10,000. people heard it, okay. And, and to the main thing to them, they don't care about the diabetes community, they care about connections, they don't care that there's this thing in place, like Like, for instance, I like that when I go to my faucet, water comes out of it. But I don't care about I don't care about the water company in my local municipality, right? I don't I know it's there. And I know there are wonderful people, they're doing good work, and that's why I get the water, but I really don't care about it, I care that I have the benefit of it. But that's the as much as I think about it. Most people don't think about the diabetes community, the way people who create content, think about it. So what what you all might not know when you're listening is that there are people writing blogs and, and doing other things. I know those people, most of them, and they know me. And sometimes we have private conversations, I had a really wonderful private conversation with Mike Hoskins from diabetes mine the other day where we talked about how to help people, right, like, like, hey, and so there's more going into it than you might think sometimes. And, and if you're lucky, you're talking or listening or reading someone who really cares about you, I genuinely do. And there's no way for you to know that except to listen and decide for yourself. There are also people in this world, there are also people in this community, just trying to make money off of you and your diabetes. And you have to figure out who those people are as well. And I can't, I can't tell you, but you need to figure that out, too. What I can tell you, what I can tell you is this. Some people are trying to give you the benefit of their experience in a way that will make your life healthier, lighter, happier, more full of joy, more free time for yourself and your family. And there are some people who are trying to keep you scared, and anxious and worried. Because that brings you back to click and read and come somewhere. I've always said, I hope you listen this podcast forever. I hope I make it entertaining enough that you can keep listening to it. But if there's a moment where you get your like, my a one C is six and a half. I never think about diabetes, and I don't really need this podcast anymore. Nothing would make me happier. Yeah, seriously, and don't feel bad about leaving, because 17 more people are coming right behind you people get diagnosed all the time. And yeah, but but the point is, is that I am not going to do something for clickbait, I am never going to try to make a person feel scared or angry or anxious, or put a worrisome thought in their head. I'm also not going to treat them like a baby. I'm not going to hide things from them, I'm not going to tell them what they want to hear. I'm also i'm not i'm not that person who's like I speak the truth. You know, those people sometimes those people are mean you got to speak the truth when the truth is eligible to be accepted by somebody. Right, right. Like you don't run up to somebody on fire and start telling them about how if they would have been more careful with matches have happened, right? Those people need water thrown on them. So some of you some of you listening need the water thrown on you and some of you need the safety talk about the matches. And I'm trying to put this podcast together in a way where it is entertaining, light hearted. And yet all of those things are happening for you. And it's my goal that they happen to you for you in a way that you almost don't know what's happening. And so, to kind of bring it full circle, I mean, that's how I parent like I I don't, I don't grab my kids and sit them down and go here's the lesson for today. I try to involve them. conversation, let them see things that move them in the direction that I'm hoping to direct them. I told somebody recently, I may have said it here, I don't remember anymore. Somebody asked me like, What's your job as a parent? Like, how do you say it? And I said, Well, I think of my job as a parent as having to say the same thing 1000 times, but not be irritated by having to say it 1000 times and trying to find 500 different ways to say it, and trying to build it into conversations about other things, and other people in other situations. I'd like to think that my son thinks about how to treat his sister through a conversation we've had about politics, or that he's considered about how to vote in an election based on a conversation we've had about how to treat a sister. You know what I mean? Like, I think I think it all builds together. I think that when you preach it, people, it doesn't work. But I also think there are moments when you need to be told, shut up and swallow the pill. Right. And so that's what I'm trying to do here. And I don't know if I'm doing it or not, but that's my goal.

Amy Drauschke 1:10:58
Well, you know, I, I will be honest, and say, My first reaction to to your podcast was, like, this guy's got it all figured out. And he's bragging and telling everybody that he's got it all figured out in the end. And then I started really listening and realizing, wait, you weren't just about that, you were saying, I've got this figured out, and I want to help other people figure it out. And I needed to be open to the fact that like, you know, maybe I needed to listen and do some things differently. And I think that that's my initial defensive, you know, I am the kind of person who, when my son was first diagnosed, they said, go to this parent support group at the hospital. And I went, and there was a bunch of moms in the room all talking about what they do and how they do it. And I left thinking like, Well, I'm not doing with those things, what those moms and dads are doing. So I must be a total failure at this diabetes thing. And I never went back. And so it's a weird, like, reaction I have to hearing other people's ways is that you can take the information and then decide for you whether it's helpful or not. But you don't have to feel like you're always comparing yourself to them. And I think that's something over the last five and a half years, but I've evolved into thinking about is like, it's not there's no one way, there's different ways, and there's different things you can try and tweak and no one's perfect, and no one's got it all figured out. But some people, you know, really might be able to help you with with some little tip or some little piece of information. And so I'm always listening to as well as writing and, and putting content out. And you're right, like there are people that are newly diagnosed every day, and they know nothing. And so I might feel like I said the same thing a million times through my writing or through the blog or through social media. But then it's like, no, somebody may have just joined for the first time. And I think, as I write for tea, when everyday magic, I don't know if you know that site, it's specifically for parents. And they asked me to write a lot about the diagnosis experience. And a couple times I wrote, you know, they'd give me a topic, and it had to do with something around diagnosis. And then I turned it in. And I see I there was one article, I forget what the topic was, but at the end, they said, Can you end it with something that gives people you know, some hope and some feeling like it's gonna be okay. And I was like, I guess like, I don't think I felt that way at the time of the story that you're asking me to write, but I can spin it that way. And it's like, that's what people do need at that time. So, you know, it's all just, it's so interesting. And it's so much, there's so much going into it. You

Scott Benner 1:13:25
just gave me so many different thoughts. So first of all, the first thing I thought was, there is an incredibly popular diabetes blog that only talks about bad things. It seems like no matter what you do, it's something scary or something that went wrong or here. Yeah. And then, but don't worry, I'm persevering. And I'm like, Okay, great. Like I get that's a good message, right? Sometimes things go wrong, and I'm persevering. But at some point, the person writing that blog realized this sells. Yeah, so everything you do is Oh my god, can you believe this happened? But I'm not giving up? And I'm like, Okay, yeah, great. And people don't not need to hear that. But that could be every once a month, it doesn't need to be every day or every time. Yeah, that's right. Yeah,

Amy Drauschke 1:14:12
I read blogs like that, too. And I've been turned off because I'm like, I don't need to read about the terrible bad negative stuff all the time. Like I get it that have bad stuff happens to us, too. But maybe it's that I'm too much of the glass is half full, I don't know. But But you're right, like those people get. There are people that are making a lot of money in this business by speaking at conferences, and being on every keynote, you know, every agenda of every conference and every patient event because of that.

Scott Benner 1:14:36
For those of you who reach out to me and say, I really want you to come to like my jdrf type one nation event. And I don't end up at the ones all of them. You should know that the ones I end up that are run by progressive thinking people because when I get on a phone with them privately, I'm not like Oh, I'm so thrilled that you want me to come talk. First of all, I'm irritated. Because I live in the northeast. I've got to go I got to go to a horrible airport. And then I've got to park my car. somewhere that when I walk away from it, I think that's probably not gonna be there. When I get back and I get to fly somewhere I'm missing time with my family. I don't want no to this place, right? It's not something. I'm always amazed like, Oh my god, I got here people like, I got to go to Ohio tonight, nothing against Ohio. But it's an airport with and I go to a hotel, it's not a big deal, right? I love meeting the people and exciting people, but everything else about it is a horror, okay. Except for that. And so I tell them if I'm going to come, I'm going to explain to people how to use their insulin, I am not there to tell them a sad story. I'm not there to tell them a sad story that turns into a happy story. I'm not there to shake. I'm not a cheerleader. And I'm not an I'm not gonna whip them into supporting your you know, your cause I know you're trying to raise money. But if you let me come and discuss with them how insulin works so that they can have success sooner, and get rid of anxiety and stress and fear, then I will tell them how great you are. Yeah, and and some people say, well, we're not comfortable with that. And I don't get to go to those places. But you're not if I'm speaking where you are, you should know I'm saying exactly what I wanted to say when I got there. Because if I wasn't I wouldn't have gone. Yeah. And and there are too many people who get stuck in the situation. You just got in like you wrote something you felt and someone's like, can you happy it up at the end, they're like, you know, by the way, I've written for them a couple of times, but I don't like the way they pay. It's a very irritating to get your money. And so when I got to the point where I thought I would rather not do this and get paid for this blog, I was like, Well, I'm never doing this again. And so I stopped but but point point is you need you need to follow people who have your best interest at heart. And, and my mind for me, it's simple. I spent two years thinking I was killing my daughter every five seconds, and crying in the shower, and just mortified about what our life was. And then I started finding little pieces that made sense. And slowly. And I've said it before because of writing on the blog, I got to sit down and thoughtfully go through like this seems important. I'll write about this, this seems important. I'll write about that. Yeah, one day, I was able to step back and go, Wow, I put these things together. I kind of have a system here. And and then I just couldn't get past it didn't matter like you eight and a half, eight, one c couldn't I was stuck like that wouldn't work, realized, Oh, my fear of insulin got passed it wrote about it. And then boom, it all started like downhill. I was like I just started finding it and honing it and fine tuning and seeing the bigger picture and writing about it and sharing it. And if that sounds egotistical, try to understand that I'm trying to make this fun before if this you do this podcast was medicine. And I was so careful about every word, I said, you wouldn't have had that initial thought. But then again, you wouldn't have kept listening. Because there have been a lot of diabetes podcasts that have come and gone. And you have to ask yourself, why did they stop? or Why do people listen to this one in such greater multipliers than the others. And the reason is, is because because they found a way to make it fun at the same time. And the downside of that is is periodically I say stuff that's stupid, or that's overblown or sarcastic. And sometimes you don't hear the sarcasm when you're in a situation where you're like, buddy, I'm I'm here for life and death. You got to tell me how to get my kids a one c down right now. And now you're making funny, like, like, and that strikes people wrong sometimes. I'm thrilled that you came back. I really am. Like, because I'm sure well, no,

Amy Drauschke 1:18:44
I definitely. And I wasn't saying like when we do content it on the blog at Omni pod is what I find through you know, analytics is that I also send out the email newsletter. So if anyone's not a customer, and you're opted into email, you get like a monthly newsletter with all kinds of links to blogs and information. And definitely, it's the helpful resources and the helpful tips and information that people click on the most like, they don't need to read a sad story or hear a sad story. I feel like that's the stuff that's more for the general public's awareness of how serious Type One Diabetes is. But that's not the the diabetes community and that's not really going to help somebody in their everyday if you really do have to give them information that will help them and so I think that's definitely what you're like I said, I know it's not you know, you're kind of Rogue and you're This is what works for you and you're sharing the information but you're not a you're not a doctor and you're not a CDE but at the same time, so much of this disease is managed on an everyday basis by people who don't have degrees and you do kind of have to lean on your your peers to figure this stuff out on a daily basis. So isn't it I've learned that through listening to you and you know, I thank you for that. It's been really helpful and we'll see in a couple months which is I very much appreciate that and

Scott Benner 1:19:57
I'm in and I'm I'm compelled to say Isn't it? Isn't it fascinating that that the word you considered was rogue? Like if something in a roadway and all I all we're talking about here is using the right amount of insulin at the right time? Like, how is that rogue?

Unknown Speaker 1:20:15
I know

Scott Benner 1:20:16
how well that's different from what people are taught, but it is.

Amy Drauschke 1:20:20
That's the rule follower part of me that had a hard time with that at first, because I was like, what I don't understand what how this can be right? Because this is not what I'm hearing in other areas. You know, and I don't know if it's, I don't know, I don't know if it's the system or if it's the education or if it's keeping up with the times and you know, the technology is advancing faster than the the medicine medical community, I'm not sure. But it's, you know, I do have the Dexcom I have all these tools that you have, why not? Why not use them in a different way?

Scott Benner 1:20:50
I appreciate that. And and, you know, when you hear me say or when anyone hears me say like, I'll say like, Oh, my daughter, say once has been between five, two and six, two for over five years solid, no, no food restrictions.

Unknown Speaker 1:21:01
Yeah.

Scott Benner 1:21:03
Imagine if I didn't say that. Imagine, imagine if I said, Hey, I have this way of thinking about insulin that's completely different than what your doctors told you. I won't tell you my results with it. Right?

Amy Drauschke 1:21:14
Or when you say no dietary restrictions, like I would assume if you didn't say that, I would say Oh, they must be you know, on a keto diet, because there's plenty of people that are out there pushing that agenda. You know, it must be that she never eats carbs,

Scott Benner 1:21:25
right example in that. And that is I hear that from people all the time. I saw you online, and I thought, Oh, yeah, sure. This guy's done eating carbs. And then realize you weren't, I was like, Oh, let me find out more. And so it's important for me to say this is the a one c range, there's no diet restrictions. And Arden doesn't have protracted or frequent lows. Like that's, that's the important part. Yeah, having to say it over and over again, in different ways, is where sometimes you might hear me and I might just say, I might say it like it's a throwaway or like I'm bragging, or you might hear it that way. And not what I'll tell you mostly is that when people are struggling, when they hear about people being successful, it turns them off immediately.

Amy Drauschke 1:22:06
Exactly. That's how I definitely agree. That's how my reaction was that I was feeling frustrated in my own kind of failure. And I was didn't want to hear about someone else's success.

Scott Benner 1:22:15
And so what I was gonna say to you, but luckily, you said it anyway, as if I may, you weren't mad at me. You were mad at yourself.

Unknown Speaker 1:22:22
projecting, I was projecting.

Scott Benner 1:22:24
So if I have to be that for some people, I'm okay with that. Did you know to me, like I don't mind. Like I didn't get to actually feel the moment when you were in your house going, this guy's a jerk. I'm not listening to this. And so I didn't, you know, and so but but if I have to be that for some people, that's fine with me, if you want but what I want you to think of what I what I hope people think and I try to repeat enough without making it, you know, too repetitive is that when you hear about somebody doing, let's just say better than you were their diabetes, you should see that as hopeful not as something to be angry about. Like if if I can do it, you can do it.

Amy Drauschke 1:23:01
Exactly. And I think that's what you do. Like when you when you tell me like what she hasn't her lunch. I can't tell you how helpful that is. Because I'm like, Oh, I can't get you know, my kid isn't gonna sit there and eat cauliflower crust and protein shakes. I've tried it all I've tried all of the like less carbs, higher protein and he is who he is. He's I look at it. Like he's the total carb King and the fact that you don't have any diet restrictions and you list off all the things kids love to eat in her lunch, and it's still okay, that gives me a lot of hope. And let me just say this Amy, if you do want cauliflower crust pizza, you go to a real good foods calm, that's

Scott Benner 1:23:37
real good foods calm and use the offer code juice box, you'll save 20% of your entire order. And there's free shipping

Unknown Speaker 1:23:44
on cauliflower crust pizza. I just wish he did. So I will definitely I'm both

Scott Benner 1:23:50
joking and trying to keep my advertisers happy at the same time. And so I appreciate that. Because I hear that from so many people that just and by the way that was by mistake. That's a function of laziness. I the first time I did ardens Bolus while I was recording the podcast, I was just like, I'm just gonna leave that in because I don't feel like editing it out. And then as I went back and did the Edit, I thought oh, this is kind of interesting. I'll leave it in. But I wasn't a mastermind. I didn't say to myself Oh, people are gonna love to hear this but it is one of the most like commented upon things in private messages. I love hearing you do Arden's Bolus.

Amy Drauschke 1:24:31
Well, I remember when you you did it on the interview with Brett Christian Christiansen from Omni pod and I remember he was asking you about it. He was like now what are you doing right now? are you texting her? Are you looking at it on a

Scott Benner 1:24:42
screen? You know, and I thought that was really great. It's a different way of doing things that listen, we're all in the same situation. We all get diagnosed by a doctor who tells us to count our carbs. Push the button, eat the food, push the plunger down, eat the food. wait three hours test. Correct. Do it again. Keep doing that till you drop that, like that's pretty much what they tell you. And then and then if you're a one sees nine, they'll say, Well, what are you doing wrong and you're like doing wrong. I did exactly what you told me to do. You know, like, how what's your diet like and then then you start feeling bad. I spoke to a young girl last night through a messaging. And she was thanking me for the podcast, she said, she felt like a quote, bad diabetic. Because she's a she's not a, she's a bigger girl. She She described herself as a bigger girl. And she said, because of her diet, she needed more insulin. But when she dialed up the insulin, if she got too, too much, she felt bad about it. So she was eating the food, but not correcting with the insulin, because the amount of insulin made her feel bad about her weight. And so now, not only was she eating poorly, but she wasn't using enough insulin and causing yourself a different problem. She said, she found the podcast threw away that idea, or a one sees already coming down. She's got her blood sugar, so she's starting to exercise think differently about her diet and everything. And that's from someone speaking to her honestly about this, instead of trying to make her feel good about it, or tell her it's okay or don't worry. And by the way, don't worry. But don't do the same thing over and over again, that's causing a bad outcome. And then not worry about it. That's, that's called ignoring it. And I don't worry, Arden's blood sugar's gotten upside down a couple of times this week. I didn't spend all day upset at myself. I was like, Alright, I did this. And that happened the next time. Let me do this. And let's see what happens. It took me a couple days. And now I figured out I mean, how long has it been since we Bolus now a long time, it's maybe 25 minutes, 35 minutes, and she bolused she'd been eating for a while. Her blood sugar 71 still. So this insulin is now it's now active, we have a perfect balance between that insulin and her food. And so we're gonna ride this I bet you for the whole afternoon. She's gonna come home from school two hours from now. Two and a half hours from now. And I don't think I don't think your blood sugar's ever getting over 80. Yeah, it'll probably be right around 80. That's amazing. Right in there. Yeah. With a big, biggest bagel.

Amy Drauschke 1:27:17
I still struggle with though like, does he need more than a different carb ratio at lunch than he does at dinner? And is this you know, are the bases, I just feel like his days are so unpredictable. But it is. It's all. It's just so hard to think of all the variables and all the things. So I understand that today is not going going so well so far. But we'll get a handle on it. He did, he did text me back and say I can't, you know, I have seven and a half units on board. So we're going a little bit of a waiting pattern right now. But I think that's the hardest part for me is being being in this in this role and talking about diabetes all day long at work and managing it at home. And like when he's not with me and I can't do anything about it in the moment. It's so hard to not be able to just fix it is really hard.

Scott Benner 1:27:59
And you're in a different situation to because you've just obviously you're remarried and you have a you know, you have an ex husband who's obviously involved with miles and and so there's now three or three people trying to make a decision. And I think there's a story about like too many cooks and wives how the cake doesn't work out. But you know, like, yeah, you're in a different situation. And so you do your best with that. Can we before I let you go, can we talk nuts and bolts about this high blood sugar right now for a second? But miles has had I'm sure. Yeah. Okay, so. So you said he was I mean, you I think you said 360 earlier, and that was probably 45 minutes ago. Is he still there?

Unknown Speaker 1:28:37
Um,

Amy Drauschke 1:28:38
yeah. So I'm looking at it right now. It's updating. He's at 375. straight across. And he said he had seven and a half units on board around when he at 1109. So it's been

Unknown Speaker 1:28:53
40 minutes since then.

Amy Drauschke 1:28:56
What's your ex only I did, I asked him to increase bazel 75% for the next two hours around 10. So he he has a hard his mornings are tough because he goes to middle school, he has breakfast before he leaves the house around 630. Then they have snack at nine o'clock. And then they have lunch at 1045. So he has like three meals or three opportunities to eat in a very short period of time. And it always messes us up.

Scott Benner 1:29:22
So me you you just thought about those food options. There's opportunities completely backwards from how I would have thought about them. So because he's leaving the house at 630, but he's going to get food again. What time at nine. Yeah, that that's an opportunity for you to be super aggressive with the breakfast because he's gonna have food to catch it if you go wrong. And then again, and then again, you can stay foot on the pedal at the snack because lunches come in an hour and a half later. Like you have so many opportunities to address insulin. So instead of thinking about how the insulin affects his blood sugar or how the insulin affects the carbs, flip it around and think about how you can affect the insulin with the carbs. Like so instead of the insulin pulling his blood sugar down, how could you be as aggressive as possible with the insulin with the safety net of more carbs coming in two hours? And again, an hour and a half?

Unknown Speaker 1:30:16
Yeah, that's true. So

Scott Benner 1:30:17
you could so if you have a heavy enough, I know it's tough in the morning, and you're talking about he, it's tough for him to Pre-Bolus the morning, it's tough for anybody to Pre-Bolus at 630 in the morning, like, let's be honest, right. But if you if you're super aggressive with his 630, and just spread the insulin out a little bit, you know, maybe a broken like an extended bolus or something like that. And then so really keep your foot on the neck of the blood sugar, like don't let it up. And then that insulin is going to come together in three hours, two and a half hours, you're going to have food, though. So say, say he's at two and a half hours later, who cares? He's about to have a snack. And so now you can. And now when you bolus that snack without much of a Pre-Bolus, it probably doesn't matter because you still have active insulin going from the, from the breakfast to some degree. So do you see what I'm saying? like yeah, always he's kind of right, he's always eating ahead of when a low is gonna come.

Amy Drauschke 1:31:19
Right? And so you don't have to worry as much. So you would just do more insulin? Like, would you double his breakfast and spread it out over the 90 minutes until he has snack and then do the same thing at snacks?

Scott Benner 1:31:29
First of all, the answer is almost always more insulin.

Unknown Speaker 1:31:32
Right?

Scott Benner 1:31:34
What I mean, I don't know, like the exact like thought of it. But if you can tell me like so how many carbs does he have in the morning at? And what time does he eat them?

Amy Drauschke 1:31:43
So this morning, he had 20. And we Pre-Bolus, probably 15 minutes. And he was at. I'm looking at it right now he was at, like 140 when he woke up, okay. And so he had his for even with a Pre-Bolus and 20 of 20 carbs, he went up to about 200 by 730. So an hour later, then it dropped pretty dramatically, but not not well not dramatically dropped from 200 to 150. Again,

Unknown Speaker 1:32:21
by eight o'clock,

Amy Drauschke 1:32:22
but then he went up again, you know, he started rising pretty dramatically, even without more food. And then by nine o'clock when he had his other snack, he was 260. And this is the part where I cannot wait for Omnipod for the for the apps to come out because I can't see a fee. I can't confirm he actually bowls for his nine o'clock snack because that's been a struggle sometimes with him is that he just doesn't. But without knowing whether he had insulin or not. He's you know, he's almost at 400 by 1130. And he does eat lunch at 1040. So and he gets a Pre-Bolus of 30 minutes before lunch. But when he's already 300 going into that Pre-Bolus it's like, you know, he just keeps he's just gone up, up, up, up up all morning. So okay,

Scott Benner 1:33:07
so what I would say is you said at one point in that breakfast, you said he went down, but how far did he go down?

Amy Drauschke 1:33:14
Um, so an hour after he had the breakfast, he went from 200 to 150. Oh, so but he's standing right back up again.

Scott Benner 1:33:24
So a little bit of it is changing how you think about it. 150 isn't down. So high, right? 150s 70 points higher than 80.

Amy Drauschke 1:33:33
Right? It just what I meant is he's been on this upward track all day. But there was one instance where he blipped down a little bit, but then kept going up.

Scott Benner 1:33:40
So that's that, that that dropped down to 115. At some point that insulin peaked, and it overwhelmed the food for a second. But after the peak was gone, the food was still there, and brought him back up again. So you needed more insulin, spread out a little more over like maybe 90 minutes. Okay, and so if he ends up at 260 later, I mean, how much insulin did you use for the 20? carbs?

Unknown Speaker 1:34:08
Do you remember, um,

Amy Drauschke 1:34:09
I think he's at like an eight to one ratio. So pi two and a half years.

Scott Benner 1:34:13
So I would suggest to you to ignore whatever his ratio is. And just think about it in terms of how much insulin Do I need. So what really would have worked here, so it doesn't matter if you use it, you know, it doesn't matter. Say you use two and a half units. And let's say that that snack didn't exist at nine o'clock. And so at 930 He's 260. How much would it have taken to correct it to 60 back to 100.

Unknown Speaker 1:34:39
And

Unknown Speaker 1:34:43
what was that 160? You know,

Scott Benner 1:34:45
so you're doing the math.

Unknown Speaker 1:34:48
three units about how many

Scott Benner 1:34:50
how much do you think it would take forget what the math says? I think about 260 back to 100. If I just said you right now you can't there's No Bolus calculator. You're on your own Amy, how much insulin is gonna give you? 100 right now?

Unknown Speaker 1:35:06
Probably for you. Okay, so

Scott Benner 1:35:08
probably that meal that you gave him with, like two and a half units was probably more like five and a half units. Okay. Right. And so you could have taken this five units and spread them out, you could have put, I don't know, it sounds like he didn't go up for the first hour. So maybe you could have put like 30 or 40% in at the beginning and the balance over an hour. And that would have stretched it out, you know, then you would have had some peaking. You know, in that hour range, you would have had some peaking in an hour and a half range, there would have been some in the beginning more over time, like I don't know the exact answer. But what I'm saying to you is, is you have to figure out how much insulin and where it needs to be on the timeline of that food.

Amy Drauschke 1:35:50
Do you typically extend very frequently, like because when I when I learned about extended Bolus Originally, it was always like I only used it for the heavy fat, long, long digestion foods. But what I think I'm hearing you say is that you can use an extended bolus only over 30 minutes or 60 minutes and have help but give more insulin as a total bola right.

Scott Benner 1:36:13
Yeah, so like in some people, like people on injections, I'll tell you sometimes I inject some now and some and a half an hour, sort of the same idea, you know, 35% 40% up front, the rest over an hour. The fourth the first 40% goes in when you push the button and then incrementally this other 60% is being jammed in over the hour, over a half an hour. You know, I know that most people think of extended bonuses is how to spread insulin out over four hours for pizza, right like that. But you can manipulate the insulin with the extended boss you can manipulate it with Temp Basal. You could if you were scared that five and a half units was too much. What's his basal rate? If he told me how much he weighs? I might be able to guess it. How much does he weigh?

Unknown Speaker 1:36:52
You know what I was below it, but I don't know how much. I was one in 10. So is his basal rate like 1.1? Like point nine? Yeah, it's probably a little low too, by the way.

Unknown Speaker 1:37:01
Really? Okay.

Scott Benner 1:37:02
Right. So so you know if so you could have doubled as bazel to make a unit. And when done four and a half Annabelle, so say four and a half and a bolus and a double bazel for an hour. And that way, if that's too much insulin at any point, you can just cancel the Temp Basal. Yeah, and like and get some of it back again, it's all about manipulating the insulin to be where you want it to be.

Amy Drauschke 1:37:22
It's funny, because when you said that about the 50%, up front, and over an hour, that's what we did yesterday. And it's what my husband did, I wasn't home. And he texted me later. And he's like, I figured it out. This is what we need to do for when he has those french toast, things. He has this french toast sticks with like

Scott Benner 1:37:39
disgust or maybe poison. I know what you mean,

Amy Drauschke 1:37:42
pancake wrapped around a sausage. He's like it's 50% up front over an hour. And he's looking at work. And I was like, great.

Scott Benner 1:37:50
Later, no, two or three hours later.

Amy Drauschke 1:37:52
No, yesterday, he had a great day. Oh, okay, interesting.

Scott Benner 1:37:55
Just think about it that way about how to put the insulin where where it's needed stop. So stop thinking about what the pump says. Because all the pump says is the arbitrary numbers that your doctor put into the pump. Right when the doctor did that they weren't thinking that you were gonna find a way to wrap a sausage in a pancake. They were just they're just like that. But I do think again, like I said before, it all comes back to it. You got to figure out if it's Basil's right first. And because if he's point nine, and he should be 1.2. So that's every hour, he's not getting a third of a unit of insulin that he needs. Right. And then that happens all morning long, like while he's sleeping, he gets up and then you give him two and a half units for something that, by the way, probably was more like five units, and one of the units is only going to replace the bazel over the next hour. Yeah, so you're right. There's no deficient in. You have a deficit of insulin at that point.

Unknown Speaker 1:38:50
Yeah, that's it. No, I

Amy Drauschke 1:38:52
mean, that's, that's really good. I've been trying to figure out the bezels for, you know, days. And then it's, of course, the like, do you give it three days and wait and see? Or do you play attack it every day? That's what

Scott Benner 1:39:03
people say, I'm more of a three hour kind of girl. Like I put it in? And if it's not working more, it's much less? Because Yeah, you have access to the Dexcom right away. So like, use a pretend Do you have time we were going on forever? Do you have to go?

Unknown Speaker 1:39:20
Um, well, I

Scott Benner 1:39:22
think I have a little bit more time. So. So think about this about adjusting bezels. Right. Say your base will set it at a unit say it's set at five units. I don't care where it's at. And your if your blood sugar is not resting at 90 without food or insulin, then your basal is not high enough. And so, right you know, well. Okay, Scott, well, my basal is resting at one my blood sugar rests at 180 how much more I don't know how much more but definitely more. So say you're at one and you're you rest at 180 I would push it 20 or 30% and see what happens. It's not like it's not like you're gonna put your bazel up 30% for an hour and he's gonna be dead 90 minutes from now. Like you You're just gonna see his blood sugar coming down. And so maybe it only comes down to, I don't know, 150 and then it sits at 150, well then try a little more. And just keep trying a little more until you get where you want to be. And now you're down to where you want to be. And maybe you'll end up getting too low. So bump it back the other way a little bit. Just, you know, yeah, mess with it until it's making sense. And now when you're close, you know, it doesn't have to be perfect. But when you're close, now you can start making adjustments.

Amy Drauschke 1:40:30
I think the hard thing is like, it's that resting with no foods, like he just so rare that there's no food in a system and no exercise and no anything in it. I mean, so I look at nighttime a lot as like, like, last night, he,

Unknown Speaker 1:40:45
you know, he

Amy Drauschke 1:40:46
slowly rose up after being like, 100, he ended up at like, 180. And so I'm like, okay, so clearly the bazel I always think of nighttime is like, it's definitely bazel because nothing else is happening. But it is. And then I wonder if like, is the base of the same across all 24 hours? Oh,

Scott Benner 1:41:01
it's not the same over every hour. Yeah,

Amy Drauschke 1:41:04
it's so that's really hard to figure out is like, Well, does he need more in the morning? I left sir.

Scott Benner 1:41:08
But but that but here's why. It's here's why it's not. Because more. Because if you're not if you're not 90 more, if you're 180. Overnight, more, if you're 180 overnight. You're right. There's less happening overnight, although there's still body functions and growth and stuff. But you're right, more happens during the day. His eyes are open, he sees things. They make him anxious. They make him excited. They make him angry, he eats food. So if you didn't if you needed more overnight, you probably definitely need more during the day. Right, right. And then yeah, so just more, so I get him down. You know, I'd get him down from this high get him home from school. And I do a Temp Basal increase of, I don't know, 20 or 3020 20% 30% for four hours and see what happens.

Unknown Speaker 1:41:54
And you because what you're gonna when he comes down? You mean once he's back?

Scott Benner 1:41:58
Yeah, right now I'd have his bazel double till I could get him back.

Unknown Speaker 1:42:01
Yeah, right.

Scott Benner 1:42:02
Because you're fighting with a high blood sugar and food that wasn't counted wasn't covered correctly with insulin right now. And when you look at that insulin on board, when you have a 270 blood sugar, and your was a 270 was at three, seven, I forget now. It's 37. So you're looking at 370 blood sugar, and you're like, I have seven units on board. I'm going to tell you, if that was me, I wouldn't consider those in those units at all. Because if they were doing something, they would have done it. Yeah. You know what I mean? So I think it's more

Unknown Speaker 1:42:32
to do add a couple more units, like, keep bumping it. I mean, in addition to the bazel It's tough. School,

Scott Benner 1:42:39
right? But I mean, I would I would Bolus, get it down and catch it with juice later if I had to. But But sitting and staring at it's not going to help you like and the other thing is to your insulin action time, is where that insulin onboard number comes from. So do you. Do you know what the insulin action time is set for?

Amy Drauschke 1:42:59
I do I believe it's two and a half hours. That's where I like to keep it. Okay. Hold on. So I think originally when we got the dash, it was defaulted to three hours. And I changed it right.

Scott Benner 1:43:13
So the point is, is that you if you tell it two and a half hours, three hours, four hours, whatever you tell it that's affecting what it's telling you the insulin on board is and you're saying, Oh, that's definitely in there that amount? Well, if you went into his pump right now and changes insulin, it was action time lower, higher, it would all of a sudden tell you he has less insulin on board. Because it does the calculations is Oh, we must have used it up because she told me it was only going to take two hours for it to use up or write you know, you know, she told me for

Amy Drauschke 1:43:40
me, I know what that right amount is?

Scott Benner 1:43:42
Because if it was the same for everybody, no, but if it was right as blood sugar wouldn't be 370. So so you'll figure out what his insulin action time is, by when you one day get his blood sugar to not go up while he's eating. And at this point in the recording, I suffered a massive computer failure. So this is the end had been some time it's almost two hours long. Last thing I was gonna say was that when she gets the insulin right, she'll one day get his blood sugar to not go up while he's eating and not to get low later. All right, people if you made it this far hour and 45 minutes of this show, you're a huge fan of the Juicebox Podcast and for that I am eternally grateful. Thank you so much for listening. Thank you to Omni pod Dexcom and dancing for diabetes for sponsoring the show you guys rock go to my omnipod.com forward slash juice box to get started today you get a free no obligation demo of the Omni pod to try for yourself and@dexcom.com forward slash juice box you can find out how to get started with the Dexcom g six continuous glucose monitor. And let's be honest, if you're listening to this podcast and you don't have a Dexcom I mean let's go right here we go get on it. All right, the music's gonna stop in a second, you're gonna go to dancing for diabetes.com that's dancing the number four diabetes.com. And you're gonna like them on Facebook and Instagram. I mean, you know, please saw all of your new reviews and ratings on iTunes recently. Thank you very much. And I would like you to know that this show is now available on radio.com. They have their own app radio.com. If you're using the radio.com app, and you'll want to listen to the podcast there, you absolutely can. But if what you're doing is working, don't feel any pressure to switch. I'll be back next week. Thanks for listening.

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