Scott Benner 6/17/19 Scott Benner 6/17/19

#235 Tommy

A type 1 diabetes conversation in transit…

Tommy and Scott chat while Tommy drives home from his endocrinologist appointment. Type 1 diabetes meta.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello and welcome to Episode 235 of the Juicebox Podcast. Today's episode is sponsored by Omni pod dancing for diabetes and Dexcom. You can go to my Omni pod comm forward slash juicebox dancing the number four diabetes.com or dexcom.com forward slash shoes box to find out more. There are also links in your show notes, and at Juicebox podcast.com.

In this episode of the Juicebox Podcast, I'll be speaking with Tommy, Tommy's had Type One Diabetes for a year, maybe a little longer. And I got to record this with him while he was on his way home from his endocrinologist appointment with his mom. Tommy is 11 years old. And I think you're going to be pretty amazed when you listen to this conversation. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise and always consult a physician before making any changes to your medical plan. or becoming bold with insulin.

Tommy 1:36
We're driving right now.

Scott Benner 1:38
Oh, you're in the car. Okay, I didn't realize that. Okay.

Tommy 1:51
My name is Tommy and I've, I've been diagnosed for a year and a half right now. And I've, um, I've stayed steady and strong. I recently very recently just got an A one fee of about 6.0 6.0 M. And I feel pretty confident with that. But it wasn't as good as my last day once the my last day once he was 5.7.

Scott Benner 2:19
How is your variability though? Are you You know, sometimes a lower a one c isn't better if your blood sugar's bouncing up and down. So are you how are you doing with staying stable?

Tommy 2:29
I'm staying stable. Um, but in the mornings in the mornings, I kind of spike up a little bit because I'm I eat cereal, but we figured out a way to kind of make that work. That's excellent. Cute. Would you like to hear that?

Scott Benner 2:43
Hold on a second. Let me let I see. You're excited. Tommy. I like that. Hold on a second. Let me ask you a couple questions. Okay, so you said you were diagnosed about a year ago? But you're 11 years old?

Tommy 2:52
Yes. All 11 right now about to turn. Well, in April.

Scott Benner 2:59
No kidding. All right. Well, happy birthday a little early. Okay, so let's think anybody else in your family have type one diabetes?

Tommy 3:07
Um, oh, no one actually had type one diabetes in my family. And we don't know how I got it. But I think we might run a test.

Scott Benner 3:17
or other people thinking of like doing testing on them? Is it gonna do trial net? Maybe?

Tommy 3:25
Um, I, we might try, but I don't think

Scott Benner 3:30
it's that big. I was just wondering, so Okay, so nobody else had type one. You're the first one in the family to to get it before gotcha. Okay. And you say that now I got an email from you. Let me see if I can find it. And you said that your mom listens to the podcast, and then tells you things that she's heard for you to try? Or do you listen as well. Um,

Tommy 3:51
I listened sometimes. But my mom really listened to the most. Gotcha. And

Scott Benner 3:55
how does that go? When she comes to you and says, Hey, I have this new thing I want you to try. Do you? Do you want to try?

Tommy 4:02
So, um, we listened to one and it was it was you talking to another boy. And he said that you ate cereal and other things by waking up covering then going in the shower. And that really helped him with his insulin. So we tried that. And, um, and we couldn't really tell the difference, but it worked just a little bit. But it was true. And we really liked it. So we wanted to give it a try. Gotcha.

Scott Benner 4:34
Yeah, I mean, I think things work differently for everybody, you know, so something that worked for him might not work for you. And you know, Vice vice versa. So that's no big deal. So you said you're eating cereal now and you're keeping your spikes down and you wanted to tell me about how that's happening. So tell me a little bit about Yeah.

Tommy 4:51
So um, I wake up and I give myself some I give myself insulin like so my ratios are One to 30. And so I give myself three units, which is 90 carbs. And my base is also very high. And if if I was pretty high overnight, I might hop in the shower. But then after that I could change and change, and get my shoes and socks on, get ready for the day or school or school, whatever I'm about to do. Um, and then after that I eat and, and then we go to school, but I eat, eat and sometimes I go up a little, but then it works. It works. It goes, it goes up to like maybe one one, like top 180. But it it's, it's the best system that we've tried so far. And it's pretty, it helps us a lot.

Scott Benner 5:51
It's excellent. So tell me something when you put that those three units in? How long between when you put the three units in, and when you start eating the cereal is it it would take like,

Tommy 6:02
maybe 15 minutes. But right now I feel my body. It feels like it's kind of it's, it's getting faster, like I'm

Scott Benner 6:15
thinking is starting to work more quickly than it has in the past.

Tommy 6:19
Uh, yeah.

Scott Benner 6:21
Yeah. Is that so let me ask you this. How long have you been using insulin pump?

Unknown Speaker 6:28
How long?

Scott Benner 6:29
Yeah, no insulin pump.

Tommy 6:32
Oh, um, for about? Maybe like, a year.

Scott Benner 6:35
Okay, so pretty much the whole time. You've had diabetes. You've had a pump?

Tommy 6:39
Um, yeah, pretty. Pretty much the whole time. Okay, we haven't really changed or anything like that.

Scott Benner 6:45
Gotcha. Okay, are you getting? Are you getting out the car going somewhere else now?

Tommy 6:50
No, I'm low right now. So I'm trying to find a new job. Take

Scott Benner 6:52
your time. What's your blood sugar?

Unknown Speaker 6:54
I'm like 71.

Scott Benner 6:56
Okay, and When's the last time you had insulin?

Unknown Speaker 6:59
I gave myself insulin because I was going a little high. So are you?

Scott Benner 7:03
Are you 71? And like, is your blood sugar falling right now? Is it stable?

Unknown Speaker 7:08
So I just want to give myself just a little bit.

Scott Benner 7:11
How do you feel at 70?

Tommy 7:14
I feel a little weird. A little hot, like getting hot. But I don't feel I don't feel really weird. But when it gets really low, I feel it.

Scott Benner 7:23
Yeah, no kidding. So now will you drink the whole juice box? Or just half of it? or What will you try here? Oh, yeah. So what's your goal to get your blood sugar back to where?

Tommy 7:35
Maybe like, one to five?

Unknown Speaker 7:37
Cool.

Scott Benner 7:40
Take your time Drink up. But what flavor is the juice?

Tommy 7:43
Oh, I'm cooler. But cherries. My favorite

Scott Benner 7:51
artist has one that she doesn't like. But I switch it back and forth just so she doesn't get sick of the one she does like and sleeping if she's if she has to drink it while she's sleeping. She makes a face even in our sleep. For the for the flavor. She doesn't like as much.

Tommy 8:05
Or sometimes my mom wakes me up to um, so maybe give myself a Duke juice all like, I'll talk I'll be like

Scott Benner 8:16
Alright, so you take the juice box to Rm while she's sleeping and touch the straw to her lip. And she knows it's there. And then she just opens her mouth and drinks. She never wakes up.

Unknown Speaker 8:27
My mom tells me

Scott Benner 8:31
Are you ready to keep going or do you want to take a minute?

Tommy 8:33
Oh, yeah, no, we can go right now. I already had

Scott Benner 8:36
no clue. So why are you in the car? Where are you going are coming from?

Tommy 8:40
So I just came from the Indra and an endocrinologist. Sorry, I can't say it.

Scott Benner 8:48
I'll say it with you. Ready? It's endo. chromo chronologist. See you got it. All right. Okay, so you went in the to do your this is your like quarterly checkup? Like you're like every few months?

Tommy 8:59
Yeah, we're gonna get blood drawn. But um, we had we had it.

Scott Benner 9:05
Listen to you. We're probably thrilled about that. Right?

Unknown Speaker 9:07
cancer so happy.

Scott Benner 9:10
Nobody wants to give blood for any reason. I hear you. So what did you find out at the at the appointment?

Tommy 9:18
Um, we found out we found an agency. We just, we we got stuff rescheduled. Um, and prescriptions?

Scott Benner 9:31
Yeah, new prescriptions. Yeah, you went to visit the prescription and a once a lady. Yeah, I

Tommy 9:35
think I think we're gonna get touch a new touch on the pilot touchscreen.

Unknown Speaker 9:41
Are you gonna get the dash?

Unknown Speaker 9:42
Yeah, I'm really happy about that. That's

Scott Benner 9:44
so cool. I used one a couple weeks ago and they're really neat. All right, yeah, you're gonna like it I have to wait just like everybody else. I have to wait to my insurances. More book cover, but that's really cool. You're gonna like it. It's it's a it's a different experience and using that other one. So Okay, so you got a six a one C, which is probably thrilling. I would be amazingly happy to see

Unknown Speaker 10:06
a six my mom, my mom, my mom kind of likes it. Oh, yeah.

Scott Benner 10:11
What do you want it to be lower war. Okay, all right. Oh, but you know, there's not a real big difference between like five, seven and six. Right? Well, I think that whether you're 576, you know, or in any tight kind of space like that, you have to realize that it's not about the number as much as it is about knowing that what you're doing is working. So the idea is that you're following and you know, the steps you're taking are keeping your blood sugar in a place where your a one c stays under six, and you're not going over 180 very frequently. Do you get low very often, like under 60?

Tommy 10:48
I'm not not that frequently, but this morning, I was pretty low. I like had two arrows going down. And I got in the O Ws, but um, we got back up. The funny thing was, is that I put the milk in the pantry.

Scott Benner 11:04
so low that you tried to put the milk in the refrigerator and you just put it the pantry instead. Do you remember what being that low felt? Like?

Tommy 11:11
Um, I know it feels. I mean, I I, um, I was all I feel. Um, I feel like shaky and a little like, lightheaded. Confusion, of course. Yeah. And I'm just like, you, you just kind of just like, you don't really know where you are. I mean, you feel like your head's in a different position in like a different place. But you you just can't really tell it's it's really hard to tell like, people ask me Hey, what is low feel like? I tell them. I tell them, I tell them that. It's not the best feeling and you can't you can't control you can't really control yourself. But you, you feel you feel you feel you feel normal, but like you feel like you're in a different you feel like you're in a different universe. Like you feel like you're floating in space. I felt like your organs and organisms are in different places of your body.

Scott Benner 12:18
I understand. I mean, I don't understand this never happened to me. But I understand your your explanation. That's a pretty clear explanation. So you don't get low like that very often. What do you think happened this morning? That got you low like that?

Tommy 12:29
Yeah, we I waited a lot.

Scott Benner 12:33
She you waited too long on your Pre-Bolus. And then the cereal couldn't catch up with the insulin. Gotcha. How long did you end up waiting? That was too long.

Tommy 12:43
I ended up I think I might have ended up like 30 minutes, something like

Scott Benner 12:47
that. That's a long time because there's that moment, Tommy where it starts to fall, like and you have to realize that that that CGM is not showing you exactly what's happening in the moments a little behind, right. So when you start feeling it when you start seeing that like drifting down and even if you don't get a diagonal arrow down, even if the numbers moving down, then you're insulins active and it's working. And that's probably a pretty safe place to start eating that. Wow. Well now you know, right 30 minutes is cool. Okay, well, you won't make that mistake again. What kind of cereal by the way? Oh,

Tommy 13:26
my brother likes lucky charms. Um, I kind of like rice krispies, but I'm pretty sure if it was curious

Scott Benner 13:34
Cheerios that see then those those hit you hard right? They if you don't do all right, they'll really send your blood sugar up. Let me tell you about cereal for a second time. Nowadays, it's not like it was when I was a young man your age. They used to have real sugar in it like it was just like, you know, it wasn't like all chemically and weird. stuff was so sugary. My Favorites included back then. Apple junks. Froot Loops. Right. Have you ever had a fruit loop? Oh yeah, they don't taste anything. Now like they used to end my absolute favorite fruity pebbles.

Tommy 14:06
Oh, 30 cable is amazing.

Scott Benner 14:09
I'm gonna tell you if I can put you in a time machine. take you back. 20 years. Wait a minute, let me do the math again. That would make me 27 I don't mean 20 Oh my god. Tommy I think what I mean is if I could put you in a time machine and take you back 40 years. Oh my god. I'm so old Tommy. Your Fruity Pebbles would have been a different experience. They were just magical. Magical. I'm telling you. Okay, so now they're just not the same foods different now. GMOs. We're killing the farmers. That's all Tommy let's get past that. Now. What what are you using for a pump?

Unknown Speaker 14:42
I'm using for my pump?

Scott Benner 14:44
Yeah. Which which pump? Yeah.

Tommy 14:46
Oh, I have the Omni pod the M

Unknown Speaker 14:50
I'm confused. No,

Scott Benner 14:51
no, don't be confused. You're confused because you're lower because of my question wasn't ordered. Well,

Unknown Speaker 14:56
I think your question was,

Scott Benner 14:58
I think so to me, because I I already knew you had an omni pod because you said you were thinking of getting a dash. Oh, yeah, so my question should have been what made you pick the on the pod when you chose?

Tommy 15:09
Oh, I didn't like giving myself shots that often. I didn't like I'm just like, I just kind of like I cannot like giving much like, I saw that the Omni pod would just like give you insulin, which was like, Wow, that's cool. So it's just like a shot and then you're ready for three days. But um, instead of shot shot, shot shot shot shot shot shot over constantly. Um, I like I just thought it just seemed weird to me. So I wanted to try it out for you.

Scott Benner 15:43
And did you get to CGM at a similar time? Dexcom?

Tommy 15:46
Um, yes, I think I got it maybe before the pump. No, I got I got the I got the CGM before before the pump.

Scott Benner 15:59
Okay. And so did you have the G six always? Or do you have the G five? g five.

Tommy 16:05
And now I have the G six.

Scott Benner 16:06
Nice. Do you like it?

Unknown Speaker 16:07
Yeah, it's amazing.

Scott Benner 16:09
I think so. Alright, let's think about this. 11 years old puts you in? Let me do the math real quick. Are you in? seventh grade?

Tommy 16:19
Um, I got held back. So right now I'm in fifth grade. So I would be a sixth. So

Scott Benner 16:23
I should have guessed sixth, but you're in fifth. Okay, so you're in fifth grade? How do you find school and diabetes theater? Like how do you manage to go to the nurse's office to do stuff with your mom? Like how do you handle it?

Unknown Speaker 16:38
My name is Elizabeth. And at 10 years old, I was diagnosed with Type One Diabetes. Shortly after inspired by my middle school dance class, I came up with the idea to host a show to raise funds and spread awareness about diabetes. And dancing for diabetes started and has grown ever since.

Scott Benner 16:57
When you're done here today, please visit dancing for diabetes.com that's dancing the number for diabetes.com.

Unknown Speaker 17:05
My hope for all the kids and teens in our dance program is that their Type One Diabetes will never get in their way, it will never stop them from achieving any goals or dreams that they have. And that they will feel empowered by their Type One Diabetes to do more to do better. And to do well for everyone, including themselves.

Tommy 17:27
On the night of the show, I want people to know that diabetes doesn't define you.

Unknown Speaker 17:35
I want people to be inspired. And if they even have type one, that they're not alone, and that we can do anything we put our hearts to.

Scott Benner 17:56
Like how do you manage to go to the nurse's office to do stuff with your mom? Like how do you handle it?

Unknown Speaker 18:01
At my school, I'm

Tommy 18:03
surprised where we live, we live way out in the country. So we live pretty far out and I go to a private school. Like there's no nurse's office. So when I get low, I would tell my teacher and have a juice box. But if I get like really low, I'd tell my T shirt I'd sit down or something like that. But there's no nurse's office. So that means like I can't I just do it on my own. I don't have pretty I mean, except for my teacher. She's just there to make sure I don't pass out and start having seizures. You have a phone? Yes, yes, sir. I

Scott Benner 18:33
do have a phone. Do you ever communicate with your mom during these times?

Tommy 18:37
Yeah. So it's, it seems weird to take out your phone during class and just start texting your mom. So I got a we got recently just got an Apple Watch. So um, I would just go on my Apple Watch and text my mom. I'm like, Hey, I'm low. Um, I took a juice box and blah, blah, blah. So she didn't get scared or nervous. Cool.

Scott Benner 19:00
That's really good. Yeah. And by the way, I mean, I know you don't want to take your phone out in class a lot. And you probably you know, you shouldn't always have it out. But if you need it for your diabetes stuff, don't feel worried about that. That's just that's what it's for. You know, so now listen, you said you live out in the country? How far out in the country? Like if you needed an ambulance with a cow come get you or would it be a car? How would it be like where are you?

Tommy 19:21
Um, so we recently just moved, we lived we lived like on a farm kind of we live we lived on 30 acres and then like 100 acres was private land. So I just ride my dirt bike, like the round. So we had chickens and stuff like that. Um, and then now we now we move to a place it's like 15 acres in like 158 acres private land. Um, so it's not a lot of land but it's like they live like so if you pull up a map of Charl South Carolina, Charleston You would see Charleston, and then you'd see James Island. And then there's this tiny island across, it's called the wall and blah, blah, blah is a hard word to say. But it sounds like it sounds like a watermelon. Um, so we live kind of far out on watermark. And so, um, we like, it would be a 30 minute drive or a 25 minute drive to school. Um, and then to the nearest hospital, it'd be maybe an hour.

Scott Benner 20:32
Okay. How do you spell the island's name?

Tommy 20:37
Who AWA de ma LAW.

Scott Benner 20:44
I found it. I'm looking on a map right now. Because I want to see what you're talking about. Yeah.

Tommy 20:50
That's cool. Yeah, so it's, it's just this tiny island.

Scott Benner 20:55
It would take me 11 hours and 15 minutes to drive to

Unknown Speaker 21:00
just LA.

Scott Benner 21:01
And so you're really close to the water to do you go to the beach a lot.

Tommy 21:05
Yeah, well, there's not really a beach. But um, we live on the water. So um, we live in a place that

Scott Benner 21:14
like, like, it's an inlet, like, like, what are the leads to the ocean?

Tommy 21:18
Yeah, so we had our front yard and then there's just big draw. There's kind of not a big drop, but like, maybe a five, five foot drop on down to the water. And then there's just trees hanging over the water, which is pretty cool.

Scott Benner 21:33
There's a lot of green around where you just told me. That's really cool. That's cool. So you today. So I have to ask you something, Tommy. Because this sounds crazy. And you don't have to tell me if you don't want to. But you're 11 years old. And you sound incredibly smart. And you're doing such a good job with your with your diabetes and talking to me that I can't imagine that you got held back in school. Did you? Oh,

Tommy 21:59
sorry. Um, I, I have dyslexia I have um, so I just don't have it. So dyslexia is like something with Word. So I um, so say you guys hear we're like people without diabetes. I mean, not hold on to the word.

Scott Benner 22:20
Don't worry. That was good.

Tommy 22:21
dyslexia. I'm there. So you'd, you'd be like, Oh, my teacher just taught me how to spell. Cow. I'd be like, okay, EAWCBO W.

Scott Benner 22:38
I gotcha. So it just so you just need to you just need to like a little more time. Like you didn't get held back like you couldn't. You couldn't add or subtract or figure out who Magellan was you were just you need a little more time to do what you needed to do. That's understandable, man. It really isn't. How are things going with that?

Tommy 22:57
Oh, it's honestly really difficult. It's not really difficult, but it's like difficult because I sometimes I forget how to spell. I'm, like, where or when I yeah, when I took someone I always say, I'm like, I'm, like, been bn? I don't spell b e and

Scott Benner 23:19
gotcha. Listen, I'm 47. And I'm misspell about 20 words like that all the time. So I won't even embarrass myself with the amount of words I can't spell. I think you're doing great. Can I ask you a question? And if it's a weird question, and you don't like it, you don't have to answer it. Okay. But if I if you were walking out on that beach, right, you follow the water down to the ocean, you went to the beach, you found a bottle on the beach, you rub it in a genie popped out of it. And he said, Tommy, I can take away your diabetes or your dyslexia. Which one would you pick?

Unknown Speaker 23:54
I'd pick my diabetes.

Scott Benner 23:55
Okay. Can you tell me why?

Tommy 23:58
Um, diabetes is a whole nother thing from dyslexia. Diabetes, you have a risk of like dying. dyslexia, it's just like, I mean, it's like, you can't spell a word. No biggie. But like,

Scott Benner 24:13
I hear what you're saying. He'd like to be alive and not be able to spell BB for being dead and be able to smell I got I think that's a quality answer. Very nice. I just was very interested in in what you might find. That's that's really cool. All right. So seriously, you're so you're on your way back from the endocrinologist right now recording a podcast about having diabetes. Yep. Just making a day of it, aren't you?

Unknown Speaker 24:39
Yeah, I got to skip school. So I'm happy.

Scott Benner 24:41
Hey, I'm with you. I won't even share with you how many days my senior year of high school I missed because it's embarrassing. And I think people would stop listening to the podcast if they knew. But I like having a day off to how's the weather there. I'm just gonna open up ardens Dexcom. Follow up here to see what our blood Pull up the six hour view last six hours. Arden's blood sugar is 93 right now it's stable. She got home a little early from school today. It's the end of the year they have half days, but she's still been studying for tests and doing homework, around four o'clock or blood sugar tried to get over 120 and we pushed it back down. And just prior to dinner at 6pm was 85. Now Arden's blood sugar is not been over 120 or under about 90 in the two hours since dinner, what do we have for dinner tonight, turkey breast, carrots, broccoli, mashed potatoes. Somewhere this afternoon, Arden had some snacks. I honestly don't remember what they were. But the information coming back from the Dexcom allowed us to make timely Pre-Bolus 's and adjustments to our dis blood sugar when necessary. So that heading into mealtimes, her blood sugar was where we expect it to be. And it made it easy to give her insulin for those meals. Now as the evening progresses, her blood sugar settling in nicely and getting ready for bed. Now with the dexcom g six, if her blood sugar tries to you know, get away from us here as bedtime comes, we'll be able to make some nice adjustments to get her back into range for needing food or something like that. Let's say she's drifting down a little bit, you know, we might trim back or basal insulin a little bit and get it to come back up again. I don't like Arden to have to eat things that she doesn't want to just because your blood sugar is going well. And with Dexcom, we can make decisions that'll stop that from happening, you can use the Dexcom link at Juicebox podcast.com. Or, of course right there in your podcast player, where you can just go to dexcom.com forward slash juice box, no matter how you get there, get there. These are our results. And yours may vary. But I believe that this six hour window is reflective of something that everyone can achieve. Especially when you have the dexcom g six continuous glucose monitor.

Tommy 27:02
Oh, it's actually really rainy today. But normally, it's always sunny. Like I, um, my, my great. My grandparents live in Minnesota. So it's like, it's like, um, it's rainy and sunny. But in the summertime, it's, it's pretty pretty. I really like it because of all the lakes. Um, I kind of like the cold, which is weird, say, um, but um, I just like how it snows there. And I'd like to move to Minnesota, honestly. But here, it's just like really, really a hot every single day. Like, even in the winter, like, the coldest it gets is like 40.

Scott Benner 27:45
I would like like, do the bugs bother you after a while the bugs would bother

Tommy 27:50
a living here for almost 12 years. It's like, not you like the bugs don't really bother you. Gotcha. Here you stood. But if you come here, like straightaway, yeah, you'd hate the bugs. It gets like I'm a big animal person. So I wouldn't kill a bug single bug.

Scott Benner 28:10
You sound like my wife describing being married to me. She's got used to it after a while so it doesn't bother as much anymore. I understand what you're saying. I'm looking right now. There are a lot of people listening to this podcast in Minnesota. And I know a few of them. So if you want to move live. No, no, no, no, no. We're recording it. Not as many listeners in South Carolina as Minnesota. So if you move there, you'll find more podcasts friends, I think. Yeah, yeah. But do you think so? Hey, are you said your grandparents so if your grandparents are in a Minnesota and you're in South Carolina, who moved Where did you guys move?

Tommy 28:46
So, um, this is gonna sound really boring. But my family my whole family. Like is really interesting. So my, my debt like, way back. I'm from my dad's parents. Um, I forgot his name, but it's like Thomas or some. He came from Czech Republic, okay. To hear. And he he I'm pretty sure he can't he got from. He came from Maryland. And then he moved up to Minnesota. And he started this thing called the tracks loose. And the tracks lawyers is a huge hunting company. Huge hunting company. I love hunting, but my dad asked me to go hunting. I wouldn't. I'd say it right away. So so then from there, I'm one of the girls married a guy and his name was Taka. And that's my last name. So that then that was my great grandma. Great Great Grandma. Great, grandma. I mean, well, they came from my dad that I'm what my dad My great grandfather, great grandfather, great grandfather, all those other things. And then my parents ended up moving there. And they came up with a banking company and a bunch of other companies. Um, and so then my grandfather, his name is Thomas taco, like my name. Um, and he, he is an investor. And he invest because other things like thing companies like a real estate investor, yeah. And then he passed that on to my dad, which my dad is now a real estate investor. And he invests in houses, like companies and buildings and stuff like that. That's pretty cool, Tom. So

Scott Benner 30:45
this was gonna be boring. But then you said it was gonna be interesting. I think you were right. When you said it was interesting. So your family immigrated up north, from the Czech from the Czech Republic, I guess is the right way to say. All right.

Unknown Speaker 30:57
Well, you know,

Scott Benner 30:57
did you hear like at the end of last year, we had an episode with a Lenin. She's from the Czech Republic.

Unknown Speaker 31:04
Oh, cool. Yeah, she

Scott Benner 31:05
was on she has type 120. So, so you're okay, so your Do you guys move down there? I get this. Let me ask some other more like child friendly questions. What's the last movie you saw? What movie? Are you excited to say?

Tommy 31:19
Ah, last movie I saw was maybe the Spider Man movie.

Unknown Speaker 31:25
Spider verse. Wow,

Tommy 31:27
that's really changed it up.

Scott Benner 31:30
Tommy, I love that movie. You and I now have something we can definitely talk about here. Hold on a second. So they, so they kind of followed the, like different. My comic book thing. So my son didn't like some of the things that I thought were really great. So really weird. And you found it strange.

Tommy 31:49
Yeah, they had Spider Man having electrical shooting webs and also invisible powers, which the original spider man just had a just had, like, able to shoot webs. And that's that, like, I was totally fine with that. But a spider that can shoot electrical webs and going visible.

Unknown Speaker 32:10
But why was too much

Unknown Speaker 32:11
for that?

Unknown Speaker 32:13
Yeah,

Scott Benner 32:13
yeah. How about when they like? Did you notice the colors in the movie sometimes separated from each other? Do you know why they did that?

Tommy 32:21
No, I don't really Did you notice? Oh, yeah. Okay, but I didn't really

Scott Benner 32:27
do you want to know, I'll tell you why. Yeah, I want to know. So back when they used to make comic books a long time ago, the printing presses weren't really as good as they are. Now the idea of printing wasn't good. So sometimes you know how they print. Like, they lay colors overtop of colors, how our printing press works till you get to the color at once. So sometimes you write to like old inkjet printers still do that. Like they lay down the yellow and the black and like all these colors, and then you're like, well, it's purple. So what would happen was while they were doing that printing process on the comic books, the books would move. So you'd see like, the bands of other colors, like bleeding out from the actual color. So they so they reproduce that in the movie on purpose to give it like a comic book feeling sometimes. Oh, cool. And then need there's Yeah, there's a lot of cool stuff in that in that movie, actually.

Tommy 33:16
Right now I'm taking a huge animation class. Um, and well, not right now. I just finished it. And I I became white. I was I was pretty good in it. And my teacher, like, I was not not to like brag or anything, but I was like a straight A student in that class.

Scott Benner 33:34
And what kind of anime or do you Is that something you might be interested in doing when you get older?

Unknown Speaker 33:38
Yeah, maybe?

Scott Benner 33:39
How do you Are you good? Can you draw or like, my Arden likes design clothes, but she can't draw.

Tommy 33:46
So there is there's, um, there's traditional animation, which is like the flip books and stuff like that. And then there's computer animation, which is like the ones that they're doing right now. Um, with, um, like, with, like, on computers, like explains itself. And then there's, um, claymation, which I study down a lot. And you make you make these fingers of the clay and you take a picture, then you move them then you take a picture. So long process, but when it ends up when it ends up, it looks really cool. And then you can also add green screens and music and stuff like that to the videos, which was really interesting to me.

Scott Benner 34:28
Okay, so do you. What do you have a favorite claymation movie?

Tommy 34:35
Chicken one is claymation which is pretty good. It's one of the most recent. Um, I bet I bet your kids I've seen that.

Scott Benner 34:46
Trust me, so if I

Tommy 34:50
Yeah, um, but there's not claymation I don't know it's, I wouldn't like to say it's fine, but there's just not a lot happening. anymore, but the most popular one is computer animation, obviously.

Scott Benner 35:04
Yeah, well, there's a company that's still making movies like the ones you're talking about. Maybe you've seen some of them. So have you seen kubu and the Two Strings?

Tommy 35:14
Yeah, that one's really good. That's

Scott Benner 35:17
right. I really enjoyed that one. Mm hmm. And but else that comes about paranorman.

Tommy 35:23
I've never known and also, um, this is Halloween. Like I for Halloween is one.

Scott Benner 35:30
Are you talking about?

Unknown Speaker 35:32
Yeah. Christmas. Yeah,

Scott Benner 35:34
that one is great. I just want I just saw the Nightmare Before Christmas back at the holidays. In a theater, and instead of the music to the, to the dialogue from the movie came from the projector. But all of the music was done by a live orchestra.

Tommy 35:54
Yeah, I heard that. And then, yeah, that's, that's what they used to do. In the olden days. They used to, um, it was always it was always a they'd make their claim nations and then they'd do a live orchestra and add it to the background of the movie.

Scott Benner 36:12
And live like so it was really cool. So there's a new one coming out soon. But paranorman is Kelly's favorite my wife loves loves paranorman. From that, that production company, what is it called La? I'm trying to think of the name of the production company. I'll think of it in a second. But they have just, they they really it's Laika like la ik A. So they have a new they have a new movie coming out soon. With Hugh Jackman. called missing link. But my wife loves paranorman and Coraline. JVC Coraline. Oh,

Tommy 36:50
yeah, Coraline, I was just about to say that

Scott Benner 36:52
right in that cool now you know which one I I saw in the theater, but didn't like but I want to go back and try it again. Because I'm not sure if I was in a bad mood that day. But have you seen the boxtrolls?

Tommy 37:01
Oh, yeah, that one that one. Did you like it was a good movie, but it was just like, it was weird to come up with that theme of them making little kids that have boxtrolls and stuff like that.

Scott Benner 37:15
Yeah, I wasn't sure where I stood on that one. I'm gonna watch it one more time to know. But I'm gonna tell you right now that I think that spider man into the spider verse is one of the best movies I saw last year. Yeah, that's what I was really good. So I've already seen it a couple of times. Like I watch it up in the corner of my computer when I'm editing the podcast and stuff like that. So I really do. Okay, so we've covered movies. That's pretty cool. And you you like animation? Are you thinking about doing this? I mean, I know you're young. It's weird to ask you when you're 11 what you want to do when you grow up? But is that something you really think about?

Tommy 37:46
Oh, maybe? Oh, by now, I don't really know. You can

Scott Benner 37:51
always invest in real estate sounds like that. Working out for Paul. Is that, I think? Um, yeah,

Unknown Speaker 37:57
I think it's

Scott Benner 38:00
Let's pay in the bills, though. Right? You've got like shoes and a car and stuff. So it must be working out pretty well. You fix up? Yeah, yeah. Who? So? I guess your dad does that. But who has more involvement with your diabetes with you? Is

Tommy 38:14
it your mom? It's my mom. Definitely my mom.

Scott Benner 38:18
How does that work out? Like, how many times in a day? Do you actually go up to her and say, Hey, I need help with this?

Tommy 38:27
Most likely, probably once but I don't really I always her, it's always her. Tommy, do you have this? Oh, okay, Tommy, you okay?

Scott Benner 38:40
Miami pod.com, forward slash juicebox. That's where you're gonna go to find out about the insulin pump that Arden has been wearing for over a decade, the Omni pod. When you get to the link, you're gonna ask for a pod experience kit, you're gonna get a pack, you fill out a little bit of information, they're gonna send you an absolutely free demonstration pod that you can wear at home. And really, that's the best way you're going to be able to tell what you think of the Omni pod, you're gonna be able to see it. Hold it your hands, and where you'll be able to put it on your child. Take a moment to step back and say you know what? This isn't bad. I was scared to put something on the maybe with you know, tubes and all this stuff attached to them, but the only pods not like that. It's tubeless it's worth the try. Take a look. Miami pod.com forward slash juicebox. I cannot. I just can't I don't know how to say it enough. The Omni pod is a staple in our life every day for over a decade Arden's been wearing it on the pod. This pump offers freedom in so many different ways. The freedom to adjust your basal rates up and down to extend out your boluses to bathe without disconnecting. These things are possibly something that if you don't have the Omni pod You can't imagine, but they're wonderful. They're life changing. They allow a adjustments that just make all the difference. And if you're skeptical because you're thinking, yeah, I mean, Scott, you're being paid to say this. Okay, fair enough. But you can still get the demo for free and decide for yourself. Miami pod.com forward slash juicebox. Give it a try today. There is nothing to lose. There's 100% no obligation.

Tommy 40:25
It's always her. Tommy, do you have this? Oh, okay, Tommy, you okay?

Scott Benner 40:30
She's worried about you. And Sheila, it said, you said earlier, right? It's something you probably should worry about a little bit. So that's nice. Listen, trust me on this topic. You would rather have your mom be involved with this, then not be involved with it. So you do tell her sometimes like, Hey, I don't want I got it here. I'm okay. Or, oh,

Tommy 40:51
I usually I don't, I don't really want to say that. Because I'm, I know that if I if I say that I might hurt her feelings or something like that. But I always need your help. There's nothing I can do without her help. So she's always out. She's always looking up to me. And it will she's not looking up to me. But I'm always looking up to her. And she's always very helpful and kind of got my diabetes. And she doesn't give me any things that stressed me out. Which is, that's what I love about her.

Scott Benner 41:19
Yeah, that's beautiful, man. That's exactly what she should be doing. She's letting you figure it out and helping you when you need help. I think that's really cool. It really is. And she gives you a lot of trust, which I bet is nice. Right?

Unknown Speaker 41:32
She does. Good for you.

Scott Benner 41:34
That's very cool. I, I can't tell you that I hear stories about other people. And some of their stories aren't as good as yours. So there's plenty of people listening who are older now. And they'll think by wish my mom was more involved when I was younger, or gave me space when I needed space and everything. And I think it's really amazing that you're so involved in it. Can I ask you Do you ever get sad about having diabetes?

Tommy 41:58
Sometimes I there's always ups and downs to having diabetes, there's always something that will pull you down, there's always something that will just let you up a little bit. There's always someone out there that will be like, Hey, you got this. You You can get through this. But diabetes can be tough for some people and diabetes can just die. I mean, the thing I try to do is just I you have to always remember about diabetes, because it's life or death situation. But diabetes, I just if I could I just feel like, hey, just leave me alone just by. But right now, right now there is some there's some things that I don't like about diabetes, which is like, you have to give yourself shots you have to worry about. It's just sometimes it's not the best but diabetes. Diabetes,

Scott Benner 42:55
yeah. Push that. I hear what you're saying. So it kind of is what it is. There's not a lot you can do about it. Sometimes stuff happens, they, you know, kind of lifts you up. And sometimes there's stuff that knocks you down, but you know, you can do it. You just sort of keep going right? Yeah, that's excellent. Man. That really is that is an absolutely great attitude to have, because it isn't going to be wonderful every day. And there are going to be days that are harder than others. But that's your situation and you need to make the best of it. Because it's not going to change right? Like it's not like you can't wish it away right there is no real Genie on the beach. It's going to come by and ask if you want to get rid of it. You know, so you just you just do the best you can it sounds like you're doing really fantastic I mean I'm completely impressed with your a one season your variability it's it's stunning. I mean, you're 11 you've only had it for a year you're really doing a great job What if I'm, if I asked you to give other people advice about how to keep their blood sugar's you know, where they want them to be. What do you think the the most? The most best? I almost said, say, Tommy, I'm trying. What do you think the best advice would be?

Tommy 44:02
So I hear what you're saying. But first of all, I I I always I always, always, always. I'm trying to get the word out there and I'm trying I'm trying so hard to um, help people with newly diagnosed diabetes, just like just giving them advice and stuff like that. So this is a perfect question asked me Okay. Um, like, like, so if you newly just got diagnosed with diabetes, there's, there's no, there's no wrong answer to diabetes. Like, if diabetes. If, if you think diabetes, the worst thing that could ever happen to you. It's, it's really not theirs. Diabetes is just another one of those things that it's just like, it's bad. It's not that bad, but you can push through it and you can always stay active with your diabetes and give yourself Give yourself the ups and downs. Like what I said, like what I said, like, you can always you can always just be the happiest about diabetes, but then there's some times that you can be diabetes, the worst, I hate diabetes, nothing else is gonna happen better to me. But you know what? That could be true. And but then the other thing you just said, diabetes, the best could be true too. There's no wrong answer to diabetes.

Scott Benner 45:29
So what's one good thing that's happened to you because of it,

Tommy 45:33
I mean, a lot you get, you get a lot of attention, you get a lot of attention. And then you also some things like you get, like, right now I'm skipping school because I kid to do diabetes. And then you get juice boxes, like sugar when you're low, like. And then I recently decided my diversity, um, diversity is your, like, when you got when you just got born, like, it's like a happy birthday, but for diabetes. Um, and then. So like, I recently just had it and it's like a second birthday. So you get two birthdays in one year. Congratulations.

Scott Benner 46:16
So Tommy, you're telling me that I get if I have diabetes, the way I can be thinking about it is I get an extra birthday every year, I get to skip days of work or school to go to the doctor. Right? People like around me and care. I can tell people care for me. And I see the love that other people have for me that I might not get to see in other situations. And I get snacks. Yeah, yeah, you've made it sound pretty good. You really have and, and tell people that it's not as bad as it seems. And you know, you just have to, you just have to keep going. I hear that. Okay, well, so where do you try to help people you said, it's important for you to try to help people in that you're trying really hard. What do you do that?

Tommy 46:55
I recently just started a social media page on Instagram. And I'm almost 200 followers in like, less than a week, which is amazing. I didn't, I didn't realize that I get this much. Um, and so I reached out to people with type one diabetes, saying, I haven't actually right here. So I say, um, I said, Hey, I'm a diabetic with the dream, blah, blah, barely pull it over here. I say, um, hey, so I'm a diabetic with a dream. And I, I dream, that one day, one day, diabetes will be no more. So I, I reach out to people saying, saying I asked them for a photo with their, and also with their glucose monitor and pumps, and stuff like that. And then what's what's you're able to see? And like, when did you get diagnosed? How long have you had diabetes for and then if you hear, I'll tell you what my Instagram pages, it's p, e, one D, all lowercase underscore power. Um, right now we're in at 797 followers, and I post things. My most recent post is of this boy of this boy named Dalton. And he is he's age seven. He was diagnosed of at 20 months old on on, on the 20 22nd of April. It will be six years now. And he he has a pump in GMC. I mean to CGM and he's been very confident with this type one diabetes. So I make people without Type One Diabetes more, like have more aware awareness what type one diabetes is. So um, so we can get the word out there that type B Type One Diabetes isn't just a disease. It's like a cool thing that other people have that. That's amazing. And you should you should like you should tell people about it. Tommy I'm

Scott Benner 49:05
looking at your page now. So you so I see what you're doing. You're having you're having other people with type one kind of share their pictures on your page and you're telling their story and everything and just trying to raise awareness for all these people. Is this you in the picture? At the waterfall?

Tommy 49:22
up the waterfall? Yes. That is me like a year ago?

Scott Benner 49:25
Yeah, go see. Yeah, I gotcha. All right. So listen, I want everyone listening who's on Instagram. Please go check out Tommy on Instagram. He's T one D underscore power. And give him a give him a follow. Say hello. All

Tommy 49:39
right. 98 followers right now. So

Scott Benner 49:40
good for you, man. That's really cool. I gotta tell you that stuff takes a long time to build up if you do it the right way. And it means more. If you if you do it the right way you don't like just try to get like clicks and likes out of you know, anything you can but but you're really trying to do something thing and I think that will, that will end up working out for you it really well. And I'm going to I'll share your, I'll share your stuff on my, on mine as well. I'm not the greatest at social media, I'm a little better at this podcast and I am a social media,

Unknown Speaker 50:13
now you're doing great.

Scott Benner 50:19
I have no idea why it's coming through my phone. And in my headphones, that sucks. I appreciate that. I, I appreciate that very much. I'm trying really hard to do just like what you're talking about. Like, I feel like I've found some ideas that would help people keep their blood sugar in the range that they're hoping for, give them some freedom that they might feel like they don't have, and I'm doing my best to spread the word about it. So I really appreciate what you're doing. I know how hard it is.

Tommy 50:48
Yeah. And I I really appreciate what you're doing to on with the, with the podcast and social media. It's just it. It's from my hopes up, like 100% like I feel great with diabetes a lot because because of what you did, and I really appreciate how how you've handled like with your podcasts and social media.

Scott Benner 51:13
Thank you. That is really kind of you. I think that's a it was very sweet of you to say thank you so much. I I am hoping that it continues to grow. It really is. And, and I'm hoping to reach more and more people. And you know, I say sometimes I get nice notes from people about how well they're doing. And they'll tell me that, you know, it has something to do with the podcast. And I just think that's amazing. I wish I could reach more people. And I just keep trying. So I can tell you that this past month, just ended. March just ended. It was the most downloaded month in the history of the podcast, just like the month before and the month before the month before. I think I'm up to like 18 months in a row where each month does better than the last one. And this in March, I had, I think 71% more downloads than I had in December and the ones I had in December. We're pretty amazing. So it's it's really going well. Yeah, I bet your your Instagram page will take off like that as well.

Unknown Speaker 52:15
Yeah, absolutely, man.

Scott Benner 52:16
All right, Tommy, I'm gonna let you go because you've got to get the rest of your day going here. He took off this whole day you need to do something cool. Please thank your mom for letting you Come on. And I will I will let you know as soon as this is gonna be on the podcast. Okay.

Tommy 52:32
Okay, you can you can either DM me or

Scott Benner 52:36
Thank you or not? I will I absolutely well might it might take it might take a couple months, but I absolutely will have it on Okay. Okay. All right. Keep in touch Tommy. All right.

Unknown Speaker 52:45
Okay, bye bye.

Unknown Speaker 52:50
What a nice kid.

Scott Benner 52:53
That's a first for us Tommy having a conversation while riding in the car coming home from his endo appointment. It's about the most diabetes meta thing you could imagine right? On a diabetes podcast on your way home from your endo. Thank you so much Tommy for being interested in being on the podcast and to his family for allowing him to come on please don't forget to check out his Instagram. Thank you also have Dexcom on the pod and dancing for diabetes, you're good at dancing the number four diabetes.com my omnipod.com forward slash juice box or dexcom.com forward slash juice box. If you can't remember any of that. Those links are actually in your show notes right there in your podcast player or at Juicebox podcast.com. Keep your eyes open later this week, we're going to start a little bonus episode. We'll just be a few minutes long. It'll be Jenny Smith and I defining simple diabetes terms. You'd be surprised how many times I get notes from people who asked me What does Basal mean? What's an extended bolus. I don't understand what ketones are. Somewhere here I have a absolutely delightful note from someone who said I was doing MDI for six months before I knew it was called MDI. So some diabetes definitions coming your way. You'll see them start appearing your podcast feed this Friday, and they should go on every Friday, you know, till I run out of definitions. If you have a definition suggestion, send it to me. Anyway. You can I don't care, Facebook, Instagram messaging, email, through the blog, whatever you want to do. If you have a phrase or word or diabetes idea that you'd like to find, send it in Jenny and I'll see what we can do.

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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.

+ Click for EPISODE TRANSCRIPT

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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